卷 28, 编号 2 (2022)

Background. In case if it is impossible to eliminate the knee contracture by soft tissue release, external fixation is additionally used. Most often, the Ilizarov apparatus with a uniaxial hinge is used for this purpose. Orthopedic hexapods, unlike the Ilizarov frame, are able to reproduce the kinematics of movements in the knee joint.

Aim of the study — to evaluate the effectiveness of orthopedic hexapod for the treatment of patients with knee extension contractures in comparison with the Ilizarov apparatus.

Methods. We analyzed 64 cases of combined treatment of extension knee contractures, which were divided into two groups. In the 1^st group (31 patients) in addition to the soft tissue release, the orthopedic hexapod Ortho-SUV Frame (OSF) was used. In the 2^nd group (33 patients) the Ilizarov apparatus with an uniaxial hinge was used. In a comparative analysis between groups, the number of flexion-extension cycles, the time required to complete them, and the time needed for complete knee range of motion (ROM) restoration were evaluated. Functional results were assessed using specialized scales-questionnaires KSS, Lysholm, LEFS in 2 days, 6 and 12 mon. after frame dismantling.

Results. Comparing the total external fixation period, as well as the time needed for ROM restoration, no significant difference between groups was found (р>0.05). When using the orthopedic hexapod, in comparison with the Ilizarov apparatus, fewer flexion-extension cycles were required. When assessing the amplitude of movements in 12 mon. in the first group, excellent results were found in 27 patients and good results in 4. In the second group, in all 33 patients good ROM was evaluated. On average, the ROM in the 1^st group was 20º more than in the 2^nd group. The knee function in 12 mon. was 16 points higher on the KSS in the 1^st group, 5 points higher on the Lysholm scale, and 15 points higher on the LEFS scale than in the 2^nd group. When analyzing the frequency of complications, no significant differences were found (р>0.05).

Conclusions. The results obtained indicate the effectiveness of the orthopedic hexapod in the treatment of patients with knee extension contractures.

Background. Hip dysplasia, characterized by pronounced anatomical changes, continues to be one of the leading positions in the structure of all congenital malformations of the musculoskeletal system. Late diagnosis or ineffective conservative treatment leads to the need for surgical correction of congenital deformities of the proximal femur and acetabulum. The choice of the method of operational reconstruction of the latter remains a subject of discussion over the past decades.

Aim of the study — a comparative X-ray analysis of surgical treatment outcomes of children with hip dysplasia type IHDI III-IV after Salter and Pemberton pelvic osteotomies.

Methods. The study included 80 patients (80 hip joints) aged 2 to 4 years (3.1 ± 0.45) with hip dysplasia of the III-IV degree according to the IHDI. Patients were divided into two groups: group I consisted of 40 patients who underwent modified Salter osteotomy, group II — 40 patients who underwent Pemberton pericapsular acetabuloplasty. Radiometry of the following parameters was performed: acetabular index (AI), Wiberg angle, neck-shaft angle, anteversion angle of the proximal femur, degree of bone coverage, the depth of the acetabulum (AD) and pelvic height (PH)

Results. The values of AI and Wiberg angle in patients in I group indicate that a greater correction was achieved (p<0.05) in contrast to patients who underwent Pemberton pericapsular acetabuloplasty. At the same time, the values of AD and PH in I group patients had pronounced differences (p<0.05) from those in II group patients, whose values were close to similar indicators in the contralateral hip joint.

Conslusions. In the treatment of children with hip dysplasia IHDI III-IV degree performing a modified Salter osteotomy leads to a significant decrease in the values of AI and an increase in the values of the Wiberg angle, which corresponds to hypercorrection of the position of the acetabulum, does not affect the AD and contributes to the elongation of the hemipelvis by an average of 13.8 mm. Pemberton acetabuloplasty allows to achieve values of AI and Wiberg angle close to the age-related indicators of the norm, leads to an increase AD, approaching the contralateral joint in its value and does not significantly affect the PH.

Background. Infection of percutaneous implants in patients with limb amputation is the most common complication.

This study aimed to evaluate the microbiological contamination of the implantation zone depending on the implant mechanical compression under the conditions of the additional external fixation.

Methods. The study was performed on 36 male rabbits. The tibia of all the rabbits was sawn at the border of the upper and middle parts. The medullary canal was reamed and a percutaneous implant was placed in the tibial stump. The segment and the implant were fixed with an Ilizarov apparatus. An additional compression device was installed in 30 animals. We used 5 compression modes, accordingly, 6 experimental groups were formed, 6 animals in each: group 1 — without compression, group 2 — compression on the implant with force of 0.053 N/mm², group 3 — compression on the implant with force of 0.105 N/mm², group 4 — compression on the implant with force of 0.158 N/mm², group 5 — compression on the implant with force of 0.211 N/mm², group 6 — compression on the implant with force of 0.263 N/mm². The restraint was removed 6 weeks after implantation for a total follow-up of 26 weeks. The microflora of the place where the implant enters the skin (the implant / skin interface) was investigated, the level of blood leukocytes and the level of C-reactive protein in blood serum were determined.

Results. On days 9-10 after implantation, significant differences in the microbial landscape were found at the site of the exit of the metal implant in animals of different groups. The largest number of strains was found in animals of groups 1, 5 and 6, the smallest in groups 2 and 3. The most frequently detected strains: S. saprophyticus and Enterococcus spp. It was found that the greatest statistically significant increase in the level of CRP in the blood serum was observed in animals of group 6. The level of leukocytes in animals of all groups did not change statistically significantly relative to preoperative values. Animals with better osseointegration (groups 2 and 3 — no cases of implant loss) showed a minimal number of growing strains.

Conclusions. The microbiological profile of the implantation zone of percutaneous implants changes depending on the amount of mechanical compression. The optimal mode is 0.053-0.105 N/mm².

Background. Urgent osteosynthesis requires number of organizational, material, technical and staff resources.

Aim of the study — to determine advantages and disadvantages of existing strategies for osteosynthesis basing on literature data and comparative analysis of organization of osteosynthesis on the first day after injury and at a later time.

Methods. Data were collected through review of medical records from first half of 2021 calendar year and consist of the patients have been treated by different types of osteosynthesis on the first day after admission to the hospital and later. Average length of hospital stay (LOS) for surgical procedures and duration of the operative time were compared.

Results. In total 266 osteosynthesis of the extremities immediately after admission to the hospital were performed in the first half of 2021 in 260 patients. The most frequently performed ankle fractures fixation (20.7%) and clavicle fractures surgical repairment (13.9%). Cases of early infections complications and no revision surgeries required due to unstable fixation after urgent osteosynthesis were excluded. In the same period 659 delayed osteosynthesis were performed. Mean value of inpatient day in patients, who underwent urgent surgery, was 8.40±16.67 days, while patients, who underwent delayed surgery, spent significantly greater (p<0.05) amount of time in the hospital — 12.98±6.28 days in average.

Discussion. Three strategies of osteosynthesis exist: urgent surgeries, delayed surgeries in daytime in operating rooms for planned surgeries and combination of these approaches. Urgent osteosynthesis surgeries do not lead to infectious complications or unstable fixation, what makes them viable option while choosing treatment tactics in case of some injuries. Precise determination of patient groups according to fracture pattern and its localization, that can be operated on in urgent manner, is necessary. Moreover, introduction of urgent osteosynthesis requires serious organizational measures. It is also necessary to perform economical assessment of described approach. Only after solving these questions, it will be possible to make final conclusions about optimal strategy for performing osteosynthesis.

The commentary discusses the advantages and disadvantages of the model proposed by the authors of the article for performing osteosynthesis for urgent indications within 24 hours after the patient’s admission to the hospital, and also focuses on the need for comprehensive assessment of treatment outcomes and financial costs of the healthcare system. The determination of indications for emergency osteosynthesis and the identification of patients groups depending on the pattern and localization of the fracture are also important issues in justifying the shortening of the time before surgery. It is necessary to justify the priority localization of fractures for urgent fixation based on the analysis of the authors’ own experience and literature data. Changes in the system of emergency trauma care will require a revision of the standards of staffing and financing in the system of compulsory medical insurance. Therefore, the commentary emphasizes the expediency of a preliminary assessment of the new model effectiveness in some medical institutions by comparing it with the traditional system.

Background. Heterotopic ossification (HO) is the formation of mature bone in soft tissues. HO in the hip area can be a consequence of both injury to the nervous system and local trauma. After total hip arthroplasty HO develops in 30% of cases.

The aim of the study is to demonstrate a rare clinical case of a recurrence of HO in patient after a primary total hip arthroplasty, accompanied by ankylosing.

Case presentation. A 32-year-old patient was admitted to the clinic for revision hip arthroplasty with a diagnosis «long-standing dislocation of the right hip joint endoprosthesis head, heterotopic ossification» 3 years after dislocation. During the surgery, there were difficulties with the sciatic nerve dissection, as well as the structures of the endoprosthesis. We removed all the ossifications that obstructed the dislocation of the endoprosthesis. The patient had sciatic nerve neuropathy on the right lower limb with lesions of the fibular and tibial nerves on the background of edema. The patient was discharged on the 21st day. The presented clinical case is interesting because the patient’s relapse could be caused by a combination of various risk factors. Taking into account the fact that the injury was received as a result of an accident and the patient had a fracture of the bones of the contralateral shin, it could be the effect of a local hip injury that aggravated the process.

Conclusions. This clinical observation highlights the importance of preventing possible complications after surgery and maintaining feedback with patients, especially those belonging to the high-risk group. It is likely that with adequate prevention of the HO formation and timely reduction of dislocation, the problems described in the article after primary total hip arthroplasty could have been avoided.

One of the significant problems of surgical treatment of Dupuytren’s contracture is skin deficiency after subtotal aponeurectomy. There are many options for skin grafting after subtotal aponeurectomy. However, there is no consensus on surgical approach to an altered palmar aponeurosis and on the choice of method for replacing soft tissue defects, taking into account the severity of the disease and the number of rays involved in the pathological process. The aim of the study was a comparative analysis of skin plasty methods after subtotal aponeurectomy in patients with Dupuytren’s contracture stages III-IV. The review analyzes various treatment tactics, including preliminary distraction elimination of contracture in the external fixation devices followed by aponeurectomy, as well as various methods of skin plasty methods formed after excision of altered areas of palmar aponeurosis and elimination of contracture. In the early stages of the disease, Z- and V-Y plasty are sufficient. In patients with severe degree of the disease, more complex techniques have to be used due to large skin defects that cannot be covered with local tissues. Each of the proposed methods of surgical treatment has its advantages and disadvantages. An analysis of the literature has shown that the most common method of soft tissue plasty after aponeurectomy is Z-plasty. However, as the severity of the disease increases, its effectiveness decreases. To date, there is no consensus regarding surgical approach to an altered palmar aponeurosis and the choice of technique for soft tissue plasty in the Dupuytren’s contracture stages III–IV.

Background. World literature data indicate the involvement of Vater-Pacinian corpuscles in the pathogenesis of palmar fascial fibromatosis, but the information about their pathomorphological changes and histomorphometric characteristics is contradictory.

Purpose — a comparative analysis of qualitative and quantitative changes in Vater-Pacinian corpuscles in patients with Dupuytren’s contracture of varying degrees.

Methods. The analysis of case histories and material resected during operations from 100 patients with Dupuytren’s contracture, was made. The patients were divided into two groups: group 1 — those with degree I-II contracture (n = 31), group 2 — those with degree III-IV (n = 69). Histomorphometry of 122 Vater-Pacinian corpuscles, in which the cut plane passed through the central nucleus, was performed in paraffin and semi-thin sections of the patients’ surgical material.

Results. At the time of the disease onset, the difference in age medians in the groups was not statistically significant. The age median at the time of surgery (group 1 — 56.0 years; group 2 — 61.0 years, p = 0.001) and the median of the disease duration (group 1 — 5.0 years; group 2 — 9.0 years, р = 0.006) were higher in group 2, the variability in the disease duration was comparable. As it has been established, Vater-Pacinian corpuscles undergo successive reactive-destructive changes in the form of death of the central axon, stratification of the capsule, inflammation, fibrosis, deformation and destruction. The number of corpuscles is greater (р = 0.040) in group 1 — 1 (0; 3) than in group 2 — 0 (0; 6). In group 2, the corpuscles have larger diameters (group 1 — 0.85 mm; group 2 — 0.96 mm, p = 0.072), more layers of the outer capsule (group 1 –17; group 2 — 20, p = 0.032).

Conclusions. In patients with Dupuytren’s contracture, along with compensatory and adaptive changes in Vater-Pacinian corpuscles (hyperplasia and hypertrophy), their irreversible destructive changes develop, which, when the disease progresses to grade 3-4, lead to a loss in the number of bodies.

The article “Modern method of biomechanical estimation of the rational lower extremities prosthetic sockets production” published in “Traumatology and Orthopedics of Russia” (2007, N 3) by M.G. Gusev, A.S. Malykhin, K.K. Shcherbina is a duplicate of the article “Modern method of biomechanical estimation of the rational lower extremities prosthetic sockets production” published in the “Bulletin of Mechnikov Saint Petersburg State Medical Academy”. 2007;(3):186–189. That was the reason for retraction.

Revealed April 20, 2022 by the Editorial Board.

The article “Immunologic criteria of prediction of bone delayed union” published in “Traumatology and Orthopedics of Russia” (2009, N 2) by O.V. Berdyugina, K.A. Berdyugin is a duplicate of the article “Immunological monitoring of slow down ostheogenesis” published in “Medical Immunology”. 2009;(3-4):371-378. That was the reason for retraction.

Revealed April 20, 2022 by the Editorial Board.

The article “Patellar resurfacing of total knee arthroplasty: Analytical review” published in “Traumatology and Orthopedics of Russia” (2014, N 3) by G.M. Kavalersky, A.P. Sereda, A.V. Lychagin, S.M. Smetanin is a duplicate of the article “Patellar resurfacing of total knee arthroplasty” by A.P. Sereda, A.S. Sagradyan, A.V. Lychagin published in “The Department of Traumatology and Orthopedics”. 2014;(3):18–28. That was the reason for retraction.

Revealed April 20, 2022 by the Editorial Board.