Vol 29, No 2 (2023)


30 years of the journal "Traumatology and Orthopedics of Russia"

Tikhilov R.M.
Traumatology and Orthopedics of Russia. 2023;29(2):5-6
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Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification

Bazarov A.Y., Sergeev K.S., Tsvetkova A.K.


Background. Treatment of vertebral osteomyelitis (VO) is accompanied by a number of organizational and tactical problems related to the multidisciplinary nature of the disease. Therefore, the use of classifications determining treatment tactics is necessary. The evaluation of treatment outcomes and efficacy should be conducted in accordance with the classification type of the lesion and decisions made based on the tactical algorithm.

Aim of the study to identify the dependence of long-tenn treatment outcomes of vertebral osteomyelitis on the type of lesion according to the modified Russian version of the E. Pola classification and the methods of treatment used.

Methods. The study analyzed the treatment results of 266 patients with vertebral osteomyelitis from 2006 to 2019. Type A lesions accounted for 24.1% (n = 64), type B — 47.0% (n = 125), type C — 26.3% (n = 70), and lesions of vertebral processes — 2.6% (n = 7). Neurological disorders were detected in 53 observations (type C). Conservative treatment, debridement, and reconstructive surgeries were perfonned. The evaluation of results was carried out a year or more after discharge.

Results. The maximum effectiveness of conservative treatment was noted in uncomplicated courses and minor bone destruction. Conservative treatment of type A lesions led to recovery in 97.4% of cases compared to reconstructive operations (p = 0.002) and recurrences (p = 0.034). Mortality was higher after reconstructive interventions (p = 0.001). The highest number of fatal outcomes after debridement of the focus was observed in type B lesions — 15.8% (p = 0.022). Analysis of type C lesions did not reveal significant differences between the methods of treatment used. The maximum number of unsatisfactory results was registered in patients with sepsis: mortality was 17.4%, and in its absence — 4.9% (p = 0.039), recurrences — 21.7% versus 7.8% (p = 0.043), recovery — 56.6% versus 83.5% (p = 0.004), respectively. There were no significant differences in the assessments according to the ODI, NDI, SF-36 scales in the long tenn. The overall survival rate was 84.4%, and the long-tenn one was 90.4%, which increased with conservative treatment compared to reconstructive interventions (p = 0.045).

Conclusion. Conservative treatment and extra-focal fixation of the spine showed maximum effectiveness in low-destructive and uncomplicated lesions (type A). Reconstructive interventions lead to an increase in the number of recurrences and fatal outcomes. Debridement of the focus in septic course of type В lesions leads to an increase in hospital mortality. There were no statistically significant differences between the results of different treatment methods for type C lesions.

Traumatology and Orthopedics of Russia. 2023;29(2):7-17
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Anterior Dynamic Versus Posterior Transpedicular Spinal Fusion for Lenke Type 5 Idiopathic Scoliosis: A Comparison of Long-term Results

Pereverzev V.S., Kolesov S.V., Kazmin A.I., Morozova N.S., Shvets V.V.


Background. Despite the active implementation of dynamic correction in case of idiopathic scoliosis, there are no comparative studies of results of posterior and anterior dynamic correction in patients with completed and near-completed growth.

Aim of the study to compare clinical and radiological results of anterior dynamic correction and conventional posterior transpedicular correction of Lenke type 5 scoliotic defonnities in patients with completed or near-completed growth.

Methods. Eighty-six patients with Lenke type 5 scoliotic deformities were enrolled in the study. The first group (54 patients) underwent deformity correction via posterior approach using a rigid transpedicular system; the second group (32 patients) — using dynamic correction system. Mean patients’ age was 22.6±12.8 and 27.3±10.9 years, respectively. We studied radiological data before surgery, immediately after surgery, and 2 or more years after surgery. Blood loss volume, duration of hospital stay, and duration of narcotic analgesics intake in the early postoperative period were analyzed. Functional results were assessed using SRS-22 questionnaire.

Results. Preoperative Cobb angle in the first group was 65.5°, and 27.5° at the long-term follow-up. Junctional kyphosis of T10-L2 before surgery was 21.0° and 13.2° at the long-term follow-up. Preoperative Cobb angle of the initial curve in the second group was 52.5° and 24.5° at the long-term follow-up. Junctional kyphosis of T10-L2 before surgery was 19.5°, and 19.0° at the long-term follow-up. Nash and Moe apical vertebral rotation in the first group before surgery was 1.62 and 0.17 at the last follow-up; in the second group, it was 1.80 and 0.81, respectively. Mean number of fixed levels was 6.4±1.0 in the first group and 5.6±1.5 in the second group. Mobility of the thoracolumbar/lumbai curve was higher in the second group, 28.2±9.1°, compared with 36.0 ± 7.2° in the first group. Preoperatively, lumbar lordosis in the second group was 42.5°, in the long-tenn period — 43.5°, and in the first group — 43.4° and 44.3°, respectively.

Conclusion. Both posterior rigid and anterior dynamic correction in case of Lenke type 5 idiopathic scoliosis can provide satisfactory radiological results with initially similar thoracolumbar deformities in patients with completed or nearcompleted growth. However, dynamic approach can reduce blood loss, duration of hospital stay, duration of narcotic analgesics intake after surgery, and improve quality of life in the long-term period.

Traumatology and Orthopedics of Russia. 2023;29(2):18-28
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Prevalence of Osteoporosis and Its Correlation With Common Secondary Risk Factors in Population from Rural Areas of South India

Ram P., Narayan P., Janardha P., Chintapalli S.


Background. Osteoporosis is a common metabolic disorder characterised by decreased bone mass and weakened micro-architecture of bone tissue. After 50 years of age, one in three women and one in five men experience osteoporotic fractures. This is projected to cause a yearly loss of 5.8 million healthy life years to disability. The number of patients who attend the outpatient clinic and emergency department of Sanjay Gandhi Institute of Trauma and Orthopaedics with fragility fractures has been increasing, hence to know the prevalence of osteoporosis in the general population who were asymptomatic, we decided to conduct a study in the rural areas of south India.

Aims: 1) to estimate the prevalence of osteoporosis among the population above 50 years in rural areas of south India; 2) to determine the correlation between common secondary risk factors for osteoporosis like tobacco consumption, alcohol, diabetes, and hypertension.

Results. The prevalence of osteoporosis in the rural population was more in females at 42.2%, whereas the males had a prevalence of 32.5%. Among the population with habits of tobacco consumption and alcohol consumption, the prevalence was 78% and 30.6% respectively. 20.2% of non-smokers and 39.7% of non-alcoholics were osteoporotic. Among the population with comorbidities, 53.6% of diabetes and 55.4% of hypertensives were osteoporotic. 33.7% of non-diabetics were osteoporotic, and 29.5% of hypertensives were osteoporotic. The correlation between osteoporosis and the individual risk factors ranged between weak negative to moderately positive (r = -0.2 to 0.5). The correlation between the combination of all the four risk factors and osteoporosis is weakly positive (r = 0.339), which is highly significant (p<0.001).

Conclusion. Overall, the findings of this study suggest that addictive habits such as tobacco and alcohol consumption may have a significant impact on bone health, with a higher prevalence of osteopenia and osteoporosis observed in individuals with these habits. Comorbidities such as diabetes and hypertension were also found to be associated with a higher prevalence of osteoporosis. These findings emphasize the importance of early detection and prevention of addictive habits and comorbidities to reduce the risk of osteopenia and osteoporosis. Furthermore, the study highlights the need for further research to fully understand the complex relationships between sociodemographic factors, addictive habits, comorbidities, and bone health.

Traumatology and Orthopedics of Russia. 2023;29(2):29-37
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Fixation Techniques for Intraarticular Proximal Humeral Fractures

Afanasiev Y.A.


Background. The most severe type of injuries of the proximal epiphysis of the humerus are intraarticular fractures. One of the main complication is the development of avascular osteonecrosis, which is caused by the peculiarities of blood supply of the humeral head and its compromised vascularization as a result of trauma. Current osteosynthesis techniques for intraarticular fractures of the proximal humerus (PH) do not reduce the risk of avascular osteonecrosis of the humeral head (AONHH) and do not reduce the risk of nonunion. To prevent ischemic changes in the humeral head, osteosynthesis with reparative osteogenesis stimulation is recommended.

Aim of the study — to specify indications for various fixation techniques of intraarticular fractures of the proximal humerus.

Methods. The study enrolled 48 patients with AO/ASIF type 11C1 and 11C2 intraarticular PH fractures requiring surgical treatment. All patients were allocated into 2 groups. Retrospective (control) group included 25 patients who were treated using locking plate osteosynthesis or intramedullary locking osteosynthesis with proximal humeral nails. Prospective (main) group included 23 patients who were additionally treated with a vascularized musculoskeletal graft from the coracoid process of the scapula transplanted to the fracture area.

Results. Functional treatment results of patients who underwent surgery using vascularized musculoskeletal grafts from the coracoid processes of the scapula (71.50% were excellent and 14.3% were good) were better than those of the control group (35.28% were excellent and 17.64% were good). Consolidation of the fracture in the control group occurred in 92% of cases (23 patients); the remaining 8% (2) of patients had pseudoarthrosis of the anatomical or surgical neck of the humerus developed within 6 months after the surgery. In the main group, the fractures consolidated in all patients.

Conclusion. Fractures with no damage to the bicipital groove should be considered an indication for performing plate osteosynthesis without vascularized musculoskeletal grafting. Locking osteosynthesis in case of intraarticular PH fractures makes it much more difficult to reduce the humeral head and the tubercular area. Locking osteosynthesis decreases the rigidity of fixation of fragments, which may contribute to their secondary displacement.

Traumatology and Orthopedics of Russia. 2023;29(2):38-45
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Efficacy of Novel Oral Non-Steroid Anti-Inflammatory Drugs for Pain Management After Total Knee Arthroplasty

Saraev A.V., Kornilov N.N.


Background. Total knee arthroplasty (TKA) typically associated with moderate to severe post-operative pain that resolves quite slowly. Therefore, injectable forms of non-steroid anti-inflammatory drugs became the key element of multi-modal analgesia in early post-operative period.

Aim of the study — to evaluate the effectiveness and safety of ketorolac vs. ketoprofen for relief of postoperative pain in patients after TKA.

Methods. 100 end-stage osteoarthritic patients (mean age 66,6 years, 80 women and 20 men) that consecutively admitted for primary uncomplicated TKA were randomized in two groups. Ketorol Express (10 mg oral, 4 times per day) used for post-op pain management in the first (49 patients) while Ketonal (100 mg oral, twice a day) — in the second (51 patients). The outcomes assessed by numeral rating scale (NRS), visual analog scale (VAS), pain diaries, comorbidities, peri-operative characteristics, knee function (Oxford Knee Score — 12), adverse effects, drug tolerance and usability, overall satisfaction of treatment. Both groups had no significant gender, age, clinical, radiological, functional or intra-operative differences.

Results. The NRS and VAS ratings showed the similar tendency in both groups: the next day after surgery the pain increased up to moderate, followed by 2 times reduction at day four. There were no differences in average, minimal and maximal pain both in rest and movement as well as amount of daily moderate to severe pain and speed of analgesic effect after oral drug intake. The similar number of patients needed additional analgesics in both groups: on average 3,57 and 4,41 injections correspondently. However, in ketorolac group at day 3 & 4 the percentage of such patients was significantly lower: by 30% at day 3 (p<0,05) and 50% at day 4 (p<0,05). Reported side effects were comparable in both groups but the high level of overall satisfaction was two times more in the patients who took ketorolac.

Conclusion. Oral administration both of ketorolac and ketoprofen proved to be highly effective for pain management after TKA with appropriate tolerance therefore could be used instead of injections since early post-op period.

Traumatology and Orthopedics of Russia. 2023;29(2):46-56
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Evaluation of Biocompatibility of New Osteoplastic Xenomaterials Containing Zoledronic Acid and Strontium Ranelate

Stogov M.V., Dyuryagina O.V., Silant'eva T.A., Shipitsyna I.V., Kireeva E.A., Stepanov M.A.


Background. The problem of improving the functional characteristics of implanted devices and materials used in traumatology and orthopedics is a topical issue.

Aim of the study — to study biocompatibility of bovine bone matrix xenomaterials modified by zoledronic acid and strontium ranelate when implanted into the bone defect cavity.

Methods. The study was performed on 24 male rabbits of the Soviet Chinchilla breed. Test blocks of bone matrix were implanted into the cavity of bone defects of the femur. Group 1 animals (n = 8, control group) were implanted with bone xenogenic material (Bio-Ost osteoplastic matrix). Group 2 animals (n = 8) were implanted with bone xenogenic material impregnated with zoledronic acid. Group 3 animals (n = 8) were implanted with bone xenogeneic material impregnated with strontium ranelate. Supercritical fluid extraction technology was used to purify the material and impregnate it with zoledronic acid and strontium ranelate. Radiological, pathomorphological, histological and laboratory (hematology and blood biochemistry) diagnostic methods were used to assess biocompatibility. Follow-up period was 182 days after implantation.

Results. It was found out that on the 182nd day after implantation the median area of the newly-formed bone tissue in the defect modeling area in Group 1 was 79%, in Group 2 — 0%, in Group 3 — 67%. In Group 2 the maximum area by this period was filled with connective tissue — 77%. Median relative area of implanted material fragments in Group 1 was 4%, in Group 2 — 23%, in Group 3 — 15%. No infection or material rejection was observed in animals of all groups. There were no signs of intoxication or prolonged systemic inflammatory reaction. Laboratory parameters did not change significantly over time. One animal in each group experienced one-time increase in C-reactive protein level against the background of leukocytosis. Two animals in Group 1 had a slight migration of implanted material under the skin, one animal developed arthritis of the knee joint.

Conclusion. Osteoplastic materials based on bovine bone xenomatrix and filled with zoledronic acid and strontium ranelate have acceptable values of biocompatibility including their safety profile.

Traumatology and Orthopedics of Russia. 2023;29(2):57-73
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Analysis of regional features of the tibial plateau fractures in the Rostov region

Golube G.S., Andrienko S.G., Khadi R.A.


Background. The prevalence of tibial plateau fractures reaches 51.7 per 100,000 population per year, accounting for approximately 1% of all fractures, and is associated with the development of post-traumatic knee osteoarthritis in 25-45% of cases.

The aim of this study was to investigate the regional features, including frequency, structure, and outcomes, of S82.1 fractures.

Methods. An anonymized sample was obtained from the region’s database, covering the period from 2017 to 2021, using the ICD-10 codes S82.1, Z47.0, M17.2, and M17.3. Data Science principles and software were applied for analysis.

Results. A total of 14,705 records were obtained. The average prevalence of tibial plateau fractures in the region was 24 per 100,000 population per year. The frequency of fractures was highest among the working-age population, with a male-to-female ratio of 1.02:1.00. There was a shift in the age group of knee osteoarthritis occurrence to individuals over 60 years old. Since 2018, a decrease in the number of fractures has been observed among elderly individuals. Out of the total sample, 1,017 patients were hospitalized, and 1,752 operations were performed. Open injuries accounted for 1.9% of cases, and the complication rate was 5.3%. Moderate correlations were found between open fractures, complicated course, and inpatient treatment costs (0.42>r>0.3). The probability of developing knee osteoarthritis within a five-year period was 0.0161. The average age of men with knee osteoarthritis was 51±7 years, while for women, it was 60±7 years. The younger age of osteoarthritis onset in men may be associated with a higher prevalence of severe fractures. The average cost of inpatient treatment increased from 26,533 rubles in 2017 to 34,682 rubles in 2021, significantly exceeding the cost of outpatient treatment.

Conclusion. Tibial plateau fractures (S82.1) predominantly occur among economically active men. The decrease in the proportion of elderly individuals with fractures in the years 2019-2021 may be explained by a decrease in the elderly population in the region and the impact of pandemic-related restrictions. The compulsory health insurance system incurs the highest costs during inpatient care. It is advisable to include classification features of fractures according to the OA/OTA system in databases to facilitate more accurate planning and differentiation of treatment expenses.

Traumatology and Orthopedics of Russia. 2023;29(2):74-87
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The Effect of Nationwide Lockdown in India on the Epidemiology of Injuries During the First Wave of COVID-19

Zacharia B., Udupa H.H., Chandran R., Prakas A.


Background. The pattern of hospital admissions and medical care changed during the COVID pandemic.

The aim of the study — to describe the nature of patients attending the orthopedic emergency department of a level 1 trauma center in terms of number and proportion based on demographic characteristics and the nature of the injury before the lockdown, during the lockdown, and during the unlocking period of the nationwide lockdown for controlling the COVID-19 pandemic in India.

Methods. We conducted a longitudinal study from 01.01.2020 to 31.12.2020. Patients attending the orthopedic emergency were grouped based on cause, type, and site of injury. The median number observed each day with IQR. The distribution of the same was compared between the prelockdown with lockdown period and the lockdown period with a phased unlocking period.

Results. A total of 10513 patients were included. There was a statistically significant reduction in the proportion of patients needing inpatient care between the prelockdown phase and lockdown phase (p = 0.008). However, this was not seen between lockdown and postlockdown periods (p = 0.47). The proportion of road traffic accidents dropped from 26% to 15% during this time (p<0.001). The proportion of contusions was reduced and that of soft tissue injuries increased (p<0.001). The proportion of lower limb injuries decreased from the prelockdown phase to the lockdown phase, and that of spinal injury patients increased (p = 0.007). The proportion of patients with contusions increased and soft tissue injuries decreased during this period (p<0.001). Lower limb injuries and road traffic accidents increased, and spinal injuries were reduced (p<0.001).

Conclusion. The lockdown for controlling the spread of the pandemic affected the demographic and epidemiological aspects of injuries attending the orthopedic emergency department of a level 1 trauma center in a developing country. There was a decrease in the proportion of females and children attending the ED during the lockdown. The number of road traffic accedents s decreased during the lockdown. The number of patients with contusions attending the trauma center during the lockdown decreased, but there was an increase in the number of patients with spine injuries. We suggest that improvement in triage facilities, wider use of telemedicine, and increasing the stock of PPEs are essential for tackling such situations in the future.

Traumatology and Orthopedics of Russia. 2023;29(2):88-98
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Case Reports

Tenosynovitis of the Flexor Digitorum and Flexor Carpi Caused by Mycobacterium Tuberculosis: Case Report and Review

Abdiba N.V., Rodomanova L.A., Zolotukhina I.Y.


Background. Mycobacterial tenosynovitis of the hand and forearm is an extremely rare form of extrapulmonary tuberculosis, which can lead to permanent disability of patients.

Case presentation. We present a rare clinical case of generalized tenosynovitis of the tendons of all hand and finger flexors of the right upper extremity caused by Mycobacterium tuberculosis (MBT). Patient complained of a lump on the palmar surface of the right hand with periodic spontaneous discharge in the form of rice grains. MRI revealed a peritendinal synovial cystic mass on the volar surface of the hand and wrist joint with the presence of multiple chondromal bodies, tendinitis and tenosynovitis of the flexor of IV and V fingers. Removal of the neoplasm, pathological tissues, and total synovectomy were performed. Intraoperative material was tested using PCR. DNA of Mycobacterium tuberculosis complex was detected.

Conclusion. Presented case report demonstrates the importance of preoperative MRI examination in tenosynovitis of unknown etiology and the necessity of histological and bacteriological examination of intraoperative material. Transportation of obtained tissues for examination should be performed without the use of formalin in order to exclude false negative results. One should be vigilant against nonspecific infections, including Mycobacterium tuberculosis, when treating patients with immunocompromising diseases. The presence of limb neuropathy, instrumental signs of the second or the third stage of tuberculous tenosynovitis according to Kanavel classification are indications for surgical treatment.

Traumatology and Orthopedics of Russia. 2023;29(2):99-109
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Progressive Calcification of Supraspinatus Tendon in Patients With Calcific Tendinitis: Two Case Reports

Ryazantsev M.S., Olchev A.A., Logvinov A.N., Frolov A.V., Andreev P.S., Korolev A.V.


Background. Calcific tendinitis (CT) is a common disease characterized by the presence of calcific deposits in the tendons of the rotator cuff. CT has a wave-like course, and the formed calcification tends to be resorbed. The lysis of the calcium deposits is characterized by a strong pain syndrome, and the site of the calcification is replaced by collagen.

The aim — to demonstrate clinical observations in which the deposited calcification in the rotator cuff did not resorb but increased over time.

Cases presentation. We report on two rare clinical cases of an increase in calcification of the rotator cuff in patients aged 51 and 50 years old. Calcific tendinitis occurred with periods of remission and exacerbation. During exacerbations, conservative treatment was carried out, including courses of massage, physiotherapy, and pain relief therapy. In one case, a single injection of a hormonal drug was performed. Control X-rays and MRI during one of the exacerbations showed an increase in the size of the calcifications. Due to the lack of effect from conservative treatment and the detected increase in calcifications, a decision was made to perform surgical treatment. Arthroscopic removal of calcifications with re-fixation of the supraspinatus tendon and elimination of internal damage was performed on both patients. Good results were noted on the follow-up examination according to the ASES orthopedic score, as well as clinical examination data.

Conclusion. The presented case reports illustrate the possible increase in calcification, unlike the standard course of the disease, in which the calcification is resorbed. Further study of this pathology is necessary to establish the causes and mechanisms of calcification increase over time and its dependence on the phase of the disease.

Traumatology and Orthopedics of Russia. 2023;29(2):110-117
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Migration of a Kirschner Wire Into the Urinary Bladder: A Case Report

Farion A.O., Paskov R.V., Dushin D.V., Bazarov A.Y., Prokopev A.N.


Background. Migration of Kirschner wires is a dangerous complication of osteosynthesis, especially when they displace into adjacent anatomical areas. Preventive measures do not eliminate the possibility of this complication.

Aim of the study to draw physicians’ attention to the possibility of asymptomatic migration of a Kirschner wire into the bladder after osteosynthesis of a femoral neck fracture with a bundle of wires

Case presentation. We present a case report of a 70-year-old patient with asymptomatic migration of Kirschner wires into the bladder and hip joint cavity, which occurred 5 years after the primary surgery for the fracture of the left femoral neck. To manage the complication, a combination of endoscopic removal of the foreign body from the bladder and open removal from the hip joint followed by total hip replacement were used simultaneously. The surgical intervention was performed without any complications. The patient began rehabilitation the next day after the surgery.

Conclusion. Osteosynthesis should be supplemented with preventive measures against the fracture of fixator and its migration. The patient must be dynamically followed up during the treatment period with all necessary monitoring methods (X-ray, CT scan, ultrasound, etc.). In case of wire fracture and/or migration, it must be removed immediately. Once the fracture has healed or the period of fixation of the dislocation is over, the wires should also be removed. Preventive measures can avoid the migration of Kirschner wires and related complications.

Traumatology and Orthopedics of Russia. 2023;29(2):118-125
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Editorial Comment on the Article by A.O. Farion et al. “Migration of a Kirschner Wire Into the Urinary Bladder: A Case Report”

Belenkiy I.G.


The article “Migration of a Kirschner Wire into the Bladder: Case Report” describes a rather rare but serious complication after osteosynthesis of a medial femoral neck fracture performed with wires, that is a fatigue fracture of a Kirschner wire with migration of its proximal fragment into the bladder. It is stated in the commentary that such complications do occur and the results of their successful treatment have been published in the modern scientific literature. The author of the commentary draws attention to the tactical and organizational aspects of treating patients with femoral neck fractures related to this case. It is pointed out that there are standard replicable osteosynthesis techniques for fractures of a number of localizations that provide good clinical results. Proximal femur is one of these localizations, and the methods of surgical treatment of its fractures are described in details in current clinical guidelines. Possible reasons for the long-term persistence of pseudarthrosis of the femoral neck are also analyzed. Conclusions: when choosing a method of surgical treatment, it is necessary to follow the approved clinical guidelines to reduce the risks of nonunion of femoral neck fractures. Hip arthroplasty should be performed without delay in cases of fracture nonunion after osteosynthesis.

Traumatology and Orthopedics of Russia. 2023;29(2):126-130
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Current Concepts in Diagnostics and Treatment of Patellar Instability: Review

Khominets V.V., Konokotin D.A., Rikun O.V., Fedotov A.O., Grankin A.S., Vorobiev A.S.


Background. Patellar instability is one of the most common pathologies of the musculoskeletal system, predominantly observed in physically active young individuals. It ranks third in the structure of knee joint injuries after anterior cruciate ligament and meniscal injuries.

The aim of this review — to present modern perspectives on the diagnosis, principles, and surgical treatment techniques for patients with patellar instability based on an analysis of the literature.

Methods. Publications were searched in the PubMed/MedLine and eLIBRARY databases. A total of 112 foreign articles published between 1984 and 2023 and 12 domestic publications from 2011 to 2022 were found. During the analysis, 68 articles were selected, which had full texts or abstracts containing sufficient information on diagnostic methods, commonly used standard and modified surgical correction methods for patellar instability, and treatment protocols considering patient age structure, instability characteristics, and functional demands.

Results. A qualitatively new stage in the reconstructive and restorative surgery of patellar instability is the in-depth examination of patients to determine the extent of damage to the medial retinaculum and the presence of dysplastic changes in anatomical structures that provide normal biomechanics of the knee extensor apparatus. A strictly individual approach to the selection of surgical treatment methods considering risk factors contributing to the development of chronic patellar instability becomes of particular importance.

Conclusion. Precise restoration of the medial patellofemoral ligament, supplemented by the correction of identified dysplastic changes in anatomical formations of the knee joint area, allows for better functional outcomes in patients with acute and chronic patellar instability.

Traumatology and Orthopedics of Russia. 2023;29(2):130-143
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Anatomical and Biomechanical Features of the Lateral Compartment of the Knee and Associated Technical Aspects of Unicompartmental Knee Arthroplasty: Lecture

Chugaev D.V., Kravtsov E.D., Kornilov N.N., Kulyaba T.A.


The frequency of lateral unicompartmental knee arthroplasty is estimated at 1% of the total volume of knee arthroplasties, according to contemporary literature. Recent studies analyzing this type of surgical intervention indicate that when performed with proper indications and technical accuracy, it is equally effective and safe as total knee arthroplasty. Potential advantages of partial knee replacement include reduced invasiveness compared to total knee arthroplasty, lower perioperative blood loss, faster patient rehabilitation, and preservation of native joint proprioception. However, it is important to consider that successful implementation of lateral unicompartmental knee arthroplasty requires not only appropriate patient selection but also technical proficiency, advanced operating room equipment, and precise surgical techniques performed by experienced surgeons. Failure to meet these conditions can negate the potential benefits and may lead to early revision surgery. It is evident that unicompartmental knee arthroplasty is not simply a half-operation of total joint replacement, and the lateral compartment’s partial arthroplasty only shares general similarities with the more popular and established medial unicompartmental knee arthroplasty. The differences lie primarily in the complex anatomy and biomechanics of the lateral compartment, which present a challenging task even with the use of modern anatomically designed implants. The development of robotic surgery and personalized joint implants may help overcome these challenges more effectively. However, in our current routine practice, we rely on conventional instruments and strive to optimize our techniques. The authors of this article aim to provide an overview of the contemporary understanding of the anatomy and biomechanics of the lateral compartment of the knee and the specific technical aspects related to partial lateral arthroplasty using a fixed tibial platform implant.

Traumatology and Orthopedics of Russia. 2023;29(2):144-158
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