Vol 20, No 4 (2014)

Original Study Articles

Hip arthroplasty in patients with complex femoral deformity after surgical treatment of dysplasia

Bliznyukov V.V., Tikhilov R.M., Shubnyakov I.I., Denisov A.O., Shilnikov V.A., Chernyi A.Z., Bilyk S.S.


Objective - based on the analysis of remote results of total hip arthroplasty in patients with complex deformities of the femur to compare the effectiveness of operations with standard cases and identify the factors that determine the surgery effectiveness. Material and methods. in Vreden clinic 73 patients with complex deformities of the femur underwent surgical treatment between 2001 and 2013 by various surgical interventions: arthroplasty without femoral osteotomy (23); arthroplasty accompanied by great trochanteric slide osteotomy or Paavilainen technigue (37), arthroplasty with femoral osteotomy below the lesser trochanter (13), including 4 - at the level of deformation, 4 - with double two-stage osteotomy and 5 - with one-stage double osteotomy. all patients were assessed with Harris scale before and after surgery. the results obtained in the course of the study data were processed using statistical methods, including correlation analysis using Pearson's coefficients and Gamma. Results. in assessing the long-term results the Harris hip score improved from a preoperative average of 40.2 (95% Ci 38.2 to 45.6) to 78.4 (95% Ci 76.7 to 83.5). the analysis of various factors influencing on operation efficiency showed that maximum results are achieved with good initial function and a small level of pain (Harris score of 40-45 points), residual femoral deformation should not exceed 5 degrees, the rotation center displacement - no more than 30 mm, the offset increasing - no more than 20 mm and of limb length increasing - no more than 25-30 mm. Conclusion. Hip arthroplasty in patients with coxarthrosis associated with complex femoral deformities is technically challenging, but the using the algorithm presented by authors allows achieve the best possible results.
Traumatology and Orthopedics of Russia. 2014;20(4):5-15
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Modern approaches to diagnostics of combined degenerative hip and spine pathology

Khominets V.V., Kudyashev A.L., Shapovalov V.M., Miroevsky F.V.


The results of standard radiographs of 90 patients with hip-spine syndrome associated with one unilateral or bilateral III stage hip osteoarthhrosis were analyzed with the aim to improve the diagnostics of pathological changes in the "hip joint-pelvis- spine" complex. 12 parameters of sagittal spinal-pelvic balance and 3 parameters of frontal one were studied and the degenerative changes in spinal motional segments were evaluated. The statistical processing of obtained data was made. It was stated that the most frequent variant of sagittal spinal-pelvic profile is hyperlordosic one, followed by formation of degenerative changes especially in dorsal regions of spine (р=0,076).The strategy of patient examination with hip-spine syndrome was established from clinical and radiographic positions.
Traumatology and Orthopedics of Russia. 2014;20(4):16-26
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Results of the proximal humerus endoprosthetic reconstruction after tumour resection

Mikailov I.M., Grigoriev P.V., Ptashnikov D.A., Maykov S.V.


The purpose of the study was to evaluate the results of surgical reconstructions of the proximal humerus after transarticular tumour resection, compare the functional results with the results of shoulder arthroplasty in patients with extensive damage of the proximal humerus of non-neoplastic origin. Material and methods. Between 2001 and 2013 38 proximal humeral reconstructions were performed in our clinic: using monopolar endoprostheses - 26 (68%) and modular systems with reversible head -12 (32%). The control group included 46 patients with extensive lesions of the proximal humerus of non-neoplastic origin, operated in our clinic in the period from 2006 to 2012. Term follow-up of patients ranged from 7 months to 9 years. Assessment of functional results was carried out in a period from six months to one year. Results. The seven-year survival according the Kaplan - Meier method for patients with primary malignant tumors of the proximal humerus (25 patients) was 77%. In the study group the average value of functional outcome MSTS score was 77.7%. Unipolar prosthesis showed a bad result, both in the control (61,3% MSTS, 60,7 Neer) and in the main (67,7% MSTS, 61,1 Neer) study groups. Conclusion. Currently the method of choice which doesn’t impair the oncologic component of treatment patients with shoulder neoplastic lesions is its replacement with modular reversible systems in combination with additional soft tissue fixation.
Traumatology and Orthopedics of Russia. 2014;20(4):27-35
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Comparative analysis of results of early and late microsurgical reconstructive operations in patients with extensive posttraumatic tissue defects of lower extremities

Rodomanova L.A., Kochish A.Y.


Comparative analysis of patient treatment results with extensive and deep posttraumatic defects of different segments of lower limbs has been done in this article. Early (n=71) and late (n=127) microsurgical reconstructive operations with using island flaps and free axial skin flaps have been performed to all these patients. According to authors, early microsurgical reconstructive operations have significant opportunities due to similar but later done operations. In particular, operative treatment makes necessary conditions for reliably more frequent using of less difficult operations with island flaps and creates statistically reliable reduce of additional operations demand. This treatment also provides the best long-term results and a more complete functional recovery of the damaged lower extremities in terms from two to six years.
Traumatology and Orthopedics of Russia. 2014;20(4):36-45
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Errors and complications in the surgical treatment of patients with distal radius fractures

Semenkin O.M., Izmalkov S.N.


The purpose - to analyze errors and complications in surgical treatment of patients with distal radius fractures and to determine methods of its prevention. Material and methods. 203 patients (62 male and 141 female ones) with 204 distal radius fractures were treated using plate osteosynthesis. 105 patients were operated ear-lier than 1 month after the injury (I group), 98 - in 1 month or later after the injury (II group). The results of the treatment were assessed with morphometric and clinical indi-cators, scheme offered by the authors and DASH questionnaire. Results. 88,68% of positive results in I group and 72,45% in II group were ob-served in a year after the operation. The frequency of complications on application of palmar surgical approach was 4,72% in I group and 17,35% (р=0,0001) in II group. The rate of hardware removal reduced to 6,6% in I group and to 11,22% - in II group of patients (р=0,245) that is in 3,3-4,75 times lower than the data given in the literature.
Traumatology and Orthopedics of Russia. 2014;20(4):47-56
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Rotational stability of different hip revision systems

Thomsen M., Jakubowitz E.


The authors present an experimental investigation that compares the primary rotational fixation of 4 revision stems. Methods: Each stem was implanted into 4 synthetic femora. Micromotion of stem and bone was measured at defined sites under torque application. Femoral neck osteotomy and AAOS type I and III defects were simulated by reproducible saw lines. Results: Up to a type I defect, all implants are capable of bridging the substance loss in a rotationally stable manner. The relative movements show a dependence both on the bone defect and on implant design. Even within the basic design types clear differences (p < 0.0001) are partially observable. Major differences were seen in type III defects. Whereas the conical stem designs had the ability to bridge the extensive defect the cylindric shapes showed no rotationally stability. Conclusion: As the major fixation area the femoral isthmus plays a decisive role for all tested stems. Due to enormous and partly selective load transmission of the conical stems the cylindrical designs is good for type I defects. In case of an extensive substance loss the decision should be a conical implant.
Traumatology and Orthopedics of Russia. 2014;20(4):57-61
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Changes in coagulation and lytic activity of the blood and tissues at the pelvic trauma during anticoagulant therapy

Vlasov A.P., Shevalayev G.A., Kremcheev R.R.


The purpose of our study was exploration of coagulation and lytic activity in blood and tissues during anticoagulation therapy in the early posttraumatic period in patients with pelvic bone fracture. The study was based on experiment researches using methods allowing to estimate coagulation activity in different tissues (skeletal muscles, liver, kidneys, heart, lungs) and blood at pelvic trauma during anticoagulation therapy. It was established that at pelvic trauma using anticoagulation therapy (fraxiparine) leads to hemostatic system modification in the early posttraumatic period. We observed fast decrease of a hypercoagulability in a blood plasma (organism level) and growth fibrinolytic activity. In liver, kidneys, heart and lungs tissues (organ level) we also registered correction the hemostatic disorders. However, the rate of these recovery processes in tissues is lower than in the blood. Especially low it was in skeletal muscles in the area of injury. Thus, it is proved that anticoagulant therapy at a pelvic trauma affects on the extrinsic coagulation pathway less than on the intrinsic coagulation pathway. The established regularity explains the risks of coagulation abnormalities in the early posttraumatic period during anticoagulation treatment.
Traumatology and Orthopedics of Russia. 2014;20(4):62-67
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Osteoporosis and osteomalacia - clinical and diagnostic problems

Avrunin A.S.


Aim: to define main clinical and diagnostical problems related to osteoporosis and osteomalacia. Literature data showed that not only osteoporosis but osteomalacia may be the reason for decreasing of mechanical properties of skeleton with risk of low-energy fractures. The solution of associated medical and social problems is difficult because DEXA does not allow to differentiate between osteoporosis and osteomalacia that leads to misdiagnosis and unnecessary prescription of antiosteoporotic drugs. This approach is pathogenetically unproved and even may be harmful for the patient. Osteoporosis and osteomalacia does not exclude each other so bone mass reducing in one cohort of patient may be due to osteoporosis, other - osteomalacia and some of them - combinations of both. Another point is that results of controlled clinical trials that evaluated efficacy of antiosteoporotic drugs without differentiative histology tests for osteoporosis and osteomalacia are of doubtful value. As the bone biopsy that is necessary for osteomalacia diagnosis is invasive procedure there is need in definition of clear criteria when it has to be done in patient with reduced bone mass.
Traumatology and Orthopedics of Russia. 2014;20(4):68-76
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Case Reports

Pain syndrome in patient after hip replacement with a dual-modular femoral component (case report)

Tikhilov R.M., Shubnyakov I.I., Kovalenko A.N., Tsybin A.V., Rumakin V.P.


Total hip replacements with dualmodular femoral components (stemneck interface) allow optimization of hip joint biomechanics via selective restoration of femoral anteversion, offset, and limb length theoretically improving muscle function and stability. Potential disadvantages are the additional stemneck interface and the possible generation of metal ions and debris by fretting and crevice corrosion. The authors reported a case of patient with dualmodular stem presenting with pain and decreased function. Earlyonset adverse inflammatory tissue reactions developed as a result of corrosion at the stemneck interface of a dualmodular implant, requiring subsequent revision of wellfixed components with an extended trochanteric osteotomy. Additional examinations excluded infection. We consider that patients with a modular stem and neck junction and presenting with pain should be suspected on corrosion at the stemneck interface and adverse inflammatory tissue reaction after infection exclusion.
Traumatology and Orthopedics of Russia. 2014;20(4):77-84
pages 77-84 views

Clinical cases of patients with arthroplasty and heightened blood concentration of metal ions

Thomsen M., Krenn V., Thomas P., Kretzer J.P.


We report on several clinical cases of different appearance and complications of patients after THR with metal-on-metal (MoM) couplings or a revision knee system. There may be skin irritation mainly due to chromium hypersensitivity or systemic effects and even cobalt intoxication can appear. We recommend clinical control to patients with MoM and a head size of 36 mm or larger or with knee revision systems. Patients who have problems such as pain or mal positioning should have measured the metall ion levels of cobalt. A serum cobalt level of >7 µg /L indicates possible periprosthetic metallosis and may cause trouble. A normal serum cobalt level is below 1 µg /L. We also need an MRI with Metal-Artifact-Reduced-Sequences or if not possible an ultrasound investigation to detect pseudotumors around the hip joint. For the clinical investigation you should look and ask for general hypersensitivity reaction (skin rash), cardiomyopathy, neurological changes including sensory changes, renal function impairment or thyroid dysfunction which may occur in cobalt intoxication. To optimize the diagnostic histological investigations using the Krenn classification are extremely helpful.

Traumatology and Orthopedics of Russia. 2014;20(4):85-89
pages 85-89 views


Treatment of local talus osteochondral defects using mosaic autogenous osteochondral plasty

Koryshkov N.A., Khapilin A.P., Khodzhiyev A.S., Voronkevich I.A., Ogarev E.V., Simonov A.B., Zaytsev O.V.


The authors presented the brief incidence analysis of talus osteochondral defect (local joint surface osteonecrosis of the anklebone), its etiology, pathogenesis, symptoms, modern diagnostic algorithm and described proposed surgical procedure. The operation consists of ankle joint arthrotomy, osteonecrotic tissue resection, harvesting of cylindrical mosaic osteochondral graft from low weightbared region of femoral knee joint surface and its implantation into resection cave of the anklebone. The indications to supramalleolar osteotomy for concomitant ankle frontal deformities are grounded. Rigid osteosynthesis and early movements in ankle joint are recommended. Eighteen patients with age from 20 to 58 years old were operated: 8 men and 10 women. In 13 cases (72.3%) the lesion was found in medial edge of talus trochlea, and 5 (27.7%) were lateral lesions. Treatment results of 18 patients evaluated according AOFAS score (H. Kitaoka) improved after operation from (38.2+3.3), to (88.9+3.6) when assessed one year after surgery. Two clinical case reports are presented.
Traumatology and Orthopedics of Russia. 2014;20(4):90-98
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Use of oral anticoagulants after intramedullary nailing of femur and tibial fractures in trauma department

Dulaev A.K., Tsed A.N., Dzhusoev I.G.


The authors evaluated of the effectiveness of new oral anticoagulants in patients with diaphyseal fractures of the femur and tibia.We analyzed the effectiveness of thromboprophylaxis in 85 patients with diaphyseal fractures of the femur and tibia in the early postoperative period. Patients were divided into 3 groups: group 1 - patients, who was taking enoxaparin, group 2 - dabigatran etexilate, group 3 - rivaroxaban. We evaluated the frequency of thromboembolic complications and bleeding for 4 weeks after intramedullary nailing of femur and tibia.The lowest frequency of postoperative bleeding was observed in patients treated with dabigatran etexilate. In addition, the minimum frequency of complications was observed among patients of the second group of the study (9.7% in the group receiving dabigatran etexilati compared with 27.8% for the combined group I and III).Statistically significant differences between groups of patients taking oral or parenteral anticoagulants was not obtained.

Traumatology and Orthopedics of Russia. 2014;20(4):99-103
pages 99-103 views


To the question of the immobilization after the reduction of primary traumatic shoulder dislocation (review)

Aslanov V.A., Matveev R.P.


The article presented the evolution of views on the conservative treatment of primary traumatic shoulder dislocation. The shortcomings of common method of conservative treatment for shoulder dislocation are listed, as well as the ways to eliminate them. The trends for further investigations for this problem are marked.The authors conclude that the standard treatment for primary traumatic shoulder dislocation is the immobilization of the damaged shoulder joint immediately after atraumatic traction reposition in the position of external rotation for a period of 3 to 7 weeks.

Traumatology and Orthopedics of Russia. 2014;20(4):104-109
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Primary traumatic anterior shoulder dislocation:conservative or early arthroscopic treatment (review)

Kuzmina V.I., Dokolin S.Y.


Primary traumatic shoulder dislocation occurs in 1.7% of the general population. There are conflicting opinions about the treatment methods this pathology in the literature. This review analyzed the current literature, which show a lower percentage of recurrent dislocation after early arthroscopic shoulder stabilization in younger patients (15 to 25 years.) The older patients with primary shoulder dislocation may be treated with closed reduction followed by immobilization by retaining bandage.

Traumatology and Orthopedics of Russia. 2014;20(4):110-114
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Periprosthetic infection diagnosis. Part 1: serology

Sereda A.P., Kavalersky G.M., Murylev V.Y., Rukin Y.A.


Periprosthetic joint infection continues to be a challenging problem. The demand for total joint arthroplasty is increasing, and the burden of such infections is increasing even more rapidly, and they pose a great problem due to economic reasons and poor outcomes. This review describes the current knowledge regarding diagnosis of periprosthetic joint infection with testing erythrocyte sedimentation rate, serum C-reactive protein, Interleukin-6 and some other novel approaches.
Traumatology and Orthopedics of Russia. 2014;20(4):115-126
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Topical issues of treatment of degenerate scoliosis at adults at the present stage (review)

Mikhaylov D.A., Ptashnikov D.A., Usikov V.D., Masevnin S.V., Hao M.


Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. Authors carry out the review of literature data, consider various approaches of surgical treatment depending on a stage of a disease and extent of deformation, including a decompression, instrumented posterior spinal fusion, an anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.
Traumatology and Orthopedics of Russia. 2014;20(4):127-134
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Letters to Editor

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