Vol 21, No 2 (2015)

CLINICAL STUDIES

Comparative analysis of treatment technique in patients with distal radius fractures

Khominets V.V., Tkachenko M.V., Syrtsov V.V., Ivanov V.S.

Abstract

The purpose of the study was to compare long-term results of surgical treatment of patients with fractures of the distal the radius with use of external fixation and angle stable plates, to make reasonable selection of optimal method of surgery for fractures of this localization. Material and methods. Surgical treatment completed 81 patients (34 men and 47 women) with 81 fractures of the distal radius: 49 patients were operated using angle stable plates (group I), 32 - external fixation (group II). The results of the treatment was assessed using clinical, radiological indicators, DASH questionnaire. Results. One year after surgery in group I we received 81,6% excellent and 18.4% good treatment outcomes, in group II - 71,8% excellent, 15.6% good and 12.5% fair results. Conclusion. Extra-articular fractures of type A are applicable all kinds of operations. However, closed reduction and external fixation has a number of advantages over plate fixation. Type B fractures virtually eliminate the use of external fixation because of the difficulty to achieve precision (anatomic) reduction the fragments. Intra-articular comminuted fractures (type C) require precise reduction with the restoration of the integrity of the articular facet and stable fixation of the whole period of callus formation for early movement in the joint. The results of the study showed that the volar angle stable plates provide these conditions.
Traumatology and Orthopedics of Russia. 2015;21(2):5-15
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Correcting osteotomy for intra-articular malunion of the distal radius

Semenkin O.M., Izmalkov S.N., Golubtsov V.I.

Abstract

The purpose - to analyze the results of the surgical treatment of patients with intra-articular malunited fractures of the distal radius (DR). Material and methods. The operative treatment was performed in 12 patients (5 men and 7 women) with 12 malunited fractures of the DR. The average term from the injury to surgery was 19,67±7,13 weeks (from 5 to 92 weeks). We performed an intra-articular correcting osteotomy in 9 patients, combined intra-articular and extra-articular correcting osteotomy was used in three ones. The results of the treatment were assessed according to the DASH questionnaire, Cooney - Krimmer (1996) score, Martini (1999) score and the scheme offered by the authors. Results. In a year after the operation the rates of DASH questionnaire were 14,21±2,43 points averagely; 11 patients showed positive outcomes - 91,7% (Cooney - Krimmer score), 9 patients - 75% (Martini score) and 10 patients - 83,3% (scheme offered by the authors). Complications were observed in 3 patients. The fixators were removed from 3 patients. Conclusion. Corrective osteotomy in patients with symptomatic malunited intra-articular fractures of the distal radius is a safe and effective procedure that improves the structure and function of the wrist.
Traumatology and Orthopedics of Russia. 2015;21(2):16-23
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Diagnostic of patellar instability after total knee arthroplasty

Zhizhenkova T.V., Danilyak V.V., Kluchevsky V.V., Kluchevsky V.V.

Abstract

Objectives - to identify main reasons of patella instability after primary total knee arthroplasty, and to determine further treatment strategy of this complication. Material and methods. Since 2011 till 2014 1098 total knee arthroplasties have been performed in Yaroslavl Regional Hospital for Veterans of Wars. We observed 14 (1.3%) patients with postoperative patella instability The evaluation included clinical and radiographic methods. Rotational alignment of the femoral and tibial components was studied by computed tomography (CT) scanner. Conclusion. Position of the femoral components ranged from 2° excessive external to 8° excessive internal rotation. Position of the tibial components ranged from 0° to 6° excessive internal rotation. The summary endoprosthetic position ranged from 1 ° to 10° excessive internal rotation. We found direct correlation between summary implant internal rotation and the severity of postoperative complications in patellafemoral joint. Results. The main reason of the patella instability is implant summary internal malrotation. Extensive lateral release with patella resurfacing was sufficient for pain relief and tracking correction if the combined internal rotation did not exceed 6°. Large value of internal malrotation was the indication for revision surgery with selective approach.
Traumatology and Orthopedics of Russia. 2015;21(2):24-31
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Long-term results of «Universal» total knee endoprosthesis

Pilny J., Kubes J., Perina M., Basa V.

Abstract

The objective - to evaluate long-term results and survival rates of «Universal» condylar knee prosthesis. Material and methods. There were a total of 121 total knee joint replacements in the set with 107 patients aged 71.3 years on average (52-86 years). A total of 115 knees diagnosed with osteoarthritis of the 3-4th degree were indicated for the surgery, and there were 6 patients with the diagnosis of rheumatoid arthritis. Functional outcomes were evaluated using the Knee Society Score (KSS), Results. The assessment of the knee state on a scale KSS average clinical section KSS (knee score) was 48.2, and functional (function score) - 46,8 points. After surgery, the indices increased to 87.4 points and 85.8 points, respectively. One complication was described during the surgery, namely - the fracture of the medial tibia condyle (0.8%). In the early post-surgery period, peroneal nerve paresis was observed in two patients (1.6%). In the postoperative period, disorders of the wound healing were observed in 6 patients (4.9%), which were healed successfully in a conservative way. In the late post-surgery period, there were infectious complications in the knee joint in 4 knee joints (3.3%). Aseptic loosening was observed in 4 cases out of 117 endoprostheses (3.4%). It always concerned the loosening of tibial component. The loosening of the femoral component was not observed. In the period from the implantation until June 2014, which is 16-22 years after the implantation, there are 16 patients in total surviving, who had a total of 21 implanted endoprostheses. Among them there are no signs of a loosening only in 4 patients (19%); there was an apparent radiolucent line up until 2 mm with a sclerotic rim under the tibial component. All the patients were without clinical symptoms for the loosening. Six female patients (28.5%) state troubles in the area of the femoro-patellar joint, where there is a lateralization of the patella, apparent on the X-ray images. Two patients (1.6%) experienced a periprosthetic femur fracture during the period of observation. It was possible to resolve this state by the distal femoral nail osteosynthesis. Upon assessing the results via the Kaplan-Meier curve method, the survival index was 98.7% after 7 years, 94.3% - after 22 years and 91.8% - after 22 years. Conclusion. The result of this study had showed the reliability of «Universal» prosthesis which can be recommended for the treatment of patients with degenerative knee disea;

Traumatology and Orthopedics of Russia. 2015;21(2):32-38
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Giant nonossifying fibroma of the distal tibia in adolescents treated by curettage and intralesional cementation

Bishay Sherif N.G.

Abstract

Abstract Background. Fibrous cortical defects and nonossifying fibromas are the most common benign non-neoplastic bone lesions occurring in the metaphyses of long bones in children and adolescents. Giant nonossifying fibromas (NOF) are not asymptomatic but usually present with pain and/or pathological fractures due to increased stress. Materials and methods. 20 adolescent patients, 14 males and 6 females, with mean age 18 years and 6 months (range, from 16 to < 21 years); presented to the National Institute of Neuromotor system, Egypt, between September 2007 and September 2009, with giant nonossifying fibromas of the distal tibia. Diagnosis was made by clinical examination, plain radiographs, magnetic resonance imaging, and histopathological reports. Treatment was achieved by curettage without bone graft, but with intralesional filling with bone cement. Evaluation concerning pain, functional activity using MSTS scoring, pathological fracture, and local recurrence were done over a mean follow-up period of 6 years and 2 months (range, 5 to 7 years). Results. Pain and functional activity improved in the twenty patients with mean MSTS score of 29.2 (range, 25 to 30). There was no pathological fracture, no local recurrence, no change in the cement-bone interface, and no arthro- genic problems over the follow-up period. The p value was <0.05. Conclusion. Giant nonossifying fibromas can be treated simply and effectively by curettage and intralesional cementation with excellent functional results.

Traumatology and Orthopedics of Russia. 2015;21(2):39-47
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Postoperative delirium and myocardial infarction in elderly patients with hip fractures: the role of postoperative anemia

Kuz’Min V.V., Menshchikova O.A.

Abstract

Objective. To assess the impact of anemia on the incidence of myocardial infarction and delirium in the early postoperative period in patients with hip fractures who underwent total hip replacement. Materials and methods. A retrospective study of 303 patients with hip fractures who underwent total hip replacement was performed. Patients were divided into two groups according to the level of hemoglobin (Hb) on the 2nd postoperative day: Group 1 (n = 116) with Hb levels above 100 g/L and Group 2 (n = 187) with Hb levels below 100 g/L. Results and conclusion. Transfusion in Group 1 was performed more often intraoperatively or in the early postoperative hours (67 vs. 35 patients; p <0.001). Hb levels on the 2nd day were significantly higher in Group 1 (108 [104; 117] vs. 87 [80; 92] g/L; p <0.001). Moderate and severe anemia in the early postoperative period was noted in 53.5% and 4.3% of the patients of Group 2, respectively. The incidence of myocardial infarction and delirium was higher in Group 2 than in Group 1 (6.4% vs. 0%; p = 0,013 and 7.5% vs 0.8%; p = 0.021, respectively). The study has shown that moderate and severe anemia in the early postoperative period is associated with an increase in the incidence of myocardial infarction and delirium.

Traumatology and Orthopedics of Russia. 2015;21(2):48-55
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THEORETICAL AND EXPERIMENTAL STUDIES

Significance of medial patello-femoral ligament in support of patella stability: features of anatomy and biomechanics

Malanin D.A., Novikov D.A., Suchilin I.A., Cheresov L.L.

Abstract

The purpose of the study - anatomical and biomechanical substantiation of medial patellofemoral ligament (MPFL) reconstruction in cases of recurrent patella dislocation. Material and methods. Anatomical studies were performed in 27 fresh frozen cadaver knees. Biomechanical study was made using video capture system with 5 specimens of the knee. In the first stage we examined the lateral displacement of the patella when the knee was flexing, and in the second - isometric properties of the MPFL. Results. In all cases MPFL was found between the knee capsule and the superficial fascia. In 6 (22.2%) cases singlebundle structure was revealed, in 14 (51.8%) - two-bundle and in 2 (7.4%) - three-bundle structure. In 2 (7.4%) knee joints MPFL was presented in one thinned bundle, attached to the upper third of the patella. The degree of the MPFL isometry was indicated by changing in the distance between the optical markers located in the regions of attachment of MPFL ligament. For all of the knees this distance had reached 58.3±1.2 mm tibia in knee flexion at 20°; 57.8±,4 mm - when flexed by 30°; 56.9±1,3 mm - at 45°; 56.8±1,3 mm - at 60° of flexion and 53.0±0,7 mm - at 90°. Conclusion. There are several variants of MPFL anatomical structure, and in most cases it has two bundles oriented to the medial surface of the knee from posterior to anterior and from proximal to distal directions. MPFL has a streak of isometry, as a normal characteristic of each anatomical ligament and this isometry must be followed in MPFL reconstruction in case of recurrent patella dislocation.
Traumatology and Orthopedics of Russia. 2015;21(2):56-65
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Possible prevention ways of thromboembolic events in traumatology and orthopedics: experimental study

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

Abstract

Objective - to examine coagulative and lytic activity of blood and tissues out of a blood flow with the combined anticoagulation and antioxidant therapy in the early posttraumatic period at pelvic bone fracture. Material and methods. The study was based on estimation of coagulation activity of tissues (skeletal muscles, liver, kidneys, heart and lungs) and blood at pelvic trauma while receiving anticoagulation and antioxidant therapy. All studies were performed in accordance with the federal ethical and legal standarts of investigations in experimental animals and approved by the local ethics committee. Results. It was found that anticoagulation (fraxiparine) and antioxidant (mexidol) therapy at pelvic trauma reduce the disturbances in the hemostatic system in the early posttraumatic period. Correction of hemostatic disorders was observed not only not only in the blood (organismal level), but also in the liver, kidneys, heart, lungs (the organ level). The effect of combination therapy on skeletal muscles in the area of injury was especially important - isolated use of anticoagulation therapy did not give such significant effect. Conclusion. Thus we obtained that using anticoagulant and antioxidant therapy on pelvic trauma is pathogenetically substantiated. It affected not only the intrinsic but also on the extrinsic coagulation pathway, which significantly increased likelihood of hemostatic disorders in early posttraumatic period.
Traumatology and Orthopedics of Russia. 2015;21(2):66-73
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RESEARCH METHODS

The role of glenoid dysplasia in the pathogenesis of recurrent shoulder instability

Prokhorenko V.M., Filipenko P.V., Fomenko S.M., Plotnikova N.N.

Abstract

The purpose - to analyze computerized tomography data in patients with recurrent shoulder instability for signs of glenoid dysplasia. Methods. We studied the diagnostic data and the results of surgical treatment of 168 patients (137 men and 31 women) mostly of young age (under 30 years) who addressed to the clinic during the period from 2010 to 2014 with the symptoms of recurrent anterior shoulder instability. A risk group has been defined with alleged glenoid dysplasia in the amount of 27 patients who were studied by glenoid dimensions (height, width, area), glenoid version (anteversion, retroversion) and inclination angle of the glenoid. Results. In 22 cases, there has been a change in the normal anatomy of the glenoid as its excessive anteversion, increased angle of inclination, and decrease of its absolute area. Research has identified a pathogenic role of changes in the normal anatomy of the glenoid because recurrence of chronic instability in some cases after surgery, as well as in cases of nontraumatic instability in patients without anatomic lesions. Conclusions. Dysplastic changes of bony structures of the shoulder represent the risk factor for recurrent instability and can serve as one of the causes of recurrence after surgical treatment. When choosing a treatment strategy in patients of modern population is advisable to suggest the possible presence of dysplastic changes glenoid. In the event of recurrence after surgical treatment is shown holding computerized tomography to rule out dysplastic changes.
Traumatology and Orthopedics of Russia. 2015;21(2):74-82
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CASE REPORTS

Treatment of shin iatrogenic electric burn and its complications using the cross-leg flap (case report)

Bezoyan V.S., Filimonov K.A., Dorozhko Y.A., Kirillov V.I.

Abstract

The authors presented a case of iatrogenic electric burn of shin. The electric burn was very deep and extensive. The complications of burn included: wounds requiring debridement, extensive necrotic myositis, cellulitis and osteomyelitis. We made a debridement. After it, we used the cross-leg flap for recovering of tissue defect. The treatment led to a good result. Cross-leg flap offers the possibility of salvaging limbs that are otherwise nonreconstructable. It is an easy technique, not time consuming, suitable for junior plastic surgeon, and highly reliable tool for the reconstruction of difficult wounds of the lower limbs. It offers a large flap dimensions to cover most of the defects of the lower extremities especially whenever bone, tendons, and neurovascular bundles are exposed.

Traumatology and Orthopedics of Russia. 2015;21(2):83-89
pages 83-89 views

The first case of revealing of Klebsiella pneumoniae ST147, producing NDM-1 carbapenemase, in trauma and orthopedic hospital in Russia

Shabanova V.V., Krasnova M.V., Bozhkova S.A., Ageevets V.A., Lazareva I.V., Rukina A.N., Sidorenko S.V.

Abstract

Present report describes the first case of isolation of NDM-1 carbapenemase-producing K. pneumoniae in a patient with wound infection after open tibial fracture. Identical isolates were twice detected in various microbial associations: first time during therapy with ampicillin/sulbactam, second time after the relapse of wound infection during therapy with cephoperazone/sulbactam with vancomycin. The strain of K. pneumoniae was resistant to all beta-lactams, aminoglycosides and fluoroquinolones, but retained susceptibility to tigecycline and polymyxin B. The presence of blaNDM-1 was detected by PCR and Sanger sequencing. On the basis of multilocus sequence typing K. pneumoniae isolate was classified as sequence-type 147 (ST147). Eradication of the pathogen, successful osteosynthesis of tibial bones and skin-muscle flap plasty of the extensive wound were completed together with combined dioxydin and phosphomycin therapy. Due to the danger of the emergence of nosocomial infection sources and of the development of the potentially incurable nosocomial implant-associated infection, detection of NDM-1 carbapenemase-producing K. pneumoniae strain in a trauma and orthopedic in-patient clinic is alarming.
Traumatology and Orthopedics of Russia. 2015;21(2):90-98
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EXPERIENCE EXCHANGE

Analysis of the unicompartmental knee arthroplasty results

Firsov S.A., Gagarin V.V.

Abstract

In 2012-2014 total 67 unicompartmental arthroplasty surgeries with use of Oxford knee meniscal bearing were performed. The surgeries were performed by a single surgeon. Minimally invasive approach was used. All patients were evaluated clinically, radiographically and with Oxford Knee score scale, Knee Society score scale and functional scale. Obtained data was processed with nonparametric Mann-Whitney-Wilcoxon test. Results were processed using the statistical analysis application package SPSS, version 10.07. Analysis of of mid-term results showed that the average for Oxford Knee score increased from 16.4 (95% CI 9-23) to 41.3 (95% CI 29-47). Average for Knee Society score scale increased from 42.7 (95% CI 31-55) to 88.6 (95% CI 73-100). No occurrence of early postoperative complications have been reported. Statistically significant improvements of knee function in patients after unicompartmental arthroplasty have been observed. Unicompartmental arthroplasty currently can be considered as an advanced treatment option for medial knee joint pathology. Meniscal bearing cemented prostheses such as Oxford III are preferable.

Traumatology and Orthopedics of Russia. 2015;21(2):99-105
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REVIEW

Use of platelet-rich plasma for bioplastic processes stimulation after arthroscopic reconstruction of anterior cruciate ligament (review)

Rybin A.V., Kuznetsov I.A., Netylko G.I., Rumakin V.P., Rykov Y.A.

Abstract

Based on the analysis of the scientific publications, the authors analyzed the possibilities and effectiveness of platelet- rich plasma (PRP) application as a stimulator of engraftment and biological transformation of tendinous autografts and allografts after arthroscopic reconstruction of knee anterior cruciate ligament. The topic of impossibility of spontaneous recovery of torn anterior cruciate ligament of knee, and describe the staging of biological incorporation of tendinous transplant in a bone wall was discussed. The authors presented methods and techniques of accelerating engraftment of free tendinous graft into bone channels described in the literature and the difference of terms of remodeling the autografts and allografts. The effect of different techniques of sterilization and preservation of tendinous allografts on the change of their biological properties was disclosed.
Traumatology and Orthopedics of Russia. 2015;21(2):106-116
pages 106-116 views

Ruptures of the pectoralis major muscle and it’s tendon: review of the literature and our experience in the treatment

Kavalersky G.M., Sereda A.P., Nikiforov D.A., Koshelev I.M., Kapyshev S.V.

Abstract

Tendon ruptures of the pectoralis major muscle are considered a rare type of injury, but there is a tendency for a greater frequency of occurrence in such cases, which is associated with an increased interest in sport and fitness among the population. Despite the seeming simplicity of diagnosis, many complete ruptures remain unrecognized and many patients do not seek medical help or being treated for bruises, sprains and partial damage, although in fact there a complete ruptures of the pectoralis major muscle or it’s tendon. Currently there is no consensus on diagnostic tactics, surgical approach, the optimal method of fixation, indications for use of plastic material; disputable tactics of chronic ruptures and rehabilitation program in the treatment of tendon ruptures of the pectoralis major muscle.

Traumatology and Orthopedics of Russia. 2015;21(2):117-131
pages 117-131 views

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