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Results in Journal ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS: 10,310

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Volodymyr Filipenko, Stanislav Bondarenko, Ahmed Badnaoui, Volodymyr Mezentsev, Valentyna Maltseva
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 87-95; https://doi.org/10.15674/0030-59872020487-95

Abstract:
Objective. Basing on the analysis of the scientific literature to study the prevalence of osteoporosis and osteopenia among patients with hip osteoarthritis undergoing THA and to establish the influence of osteoporosis/osteopenia on the choice of implants and on the restoration of the joint function after the surgery. Osteoporosis and osteopenia are manifested in 21–32 % patients undergoing hip arthroplasty. Low bone mass may be a cause of intraoperative (periprosthetic hip fractures) and postoperative complications. In patients with low bone mass bone remodeling with an increased resorption and inhibition of bone formation around hip components can lead to increasing of its micro-movements, the formation of fibrous tissues, and diminution of implants survivorship. In patients with normal bone mineral density (BMD) also the loss of bone tissue around the acetabular cup can occur; it can occur up to 20–60 % in the first three years post operation, which can lead to the cup instability. But the dynamics of changes in bone tissue around the acetabular component in patients with osteoporosis/osteopenia is nowadays poorly understood. We suppose that porous acetabular components have advantages in patients with low BMD. Due to the elastic modulus which is closely similar to cancellous bone, as well as the corresponding porosity, which facilitates osteointegration and gives a reliable secondary biological fixation of the acetabulum. Rehabilitation and restoration of kinematic and support function of the hip joint after arthroplasty is an important issue for patients with low BMD. Gait disturbance can persist 12 months after surgery. One of the reasons is the weakness of the muscles of the femur. Rehabilitation after total hip arthroplasty leads to faster recovery, but particularities of rehabilitation in patients with low bone mass are not fully studied.
Dmytro Prozorovskiy, Ruslan Buznytskiy
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 58-63; https://doi.org/10.15674/0030-59872020458-63

Abstract:
Transverse-spread deformity of the forefoot with hallux valgus is found in 75 % of women in the population. At the same time, structural and functional changes in the foot lead to redistribution of load during walking between the heads of the metatarsal bones and the occurrence of metatarsalgia. Objective. To conduct a comparative analysis of the results of surgical treatment of metatarsalgia in patients with transverse-spread deformity of the forefoot after performing corrective osteotomies Helal and Weil. Methods. The study is based on the surgical treatment of 42 (64 feet) patients with metatarsalgia due to transverse deformity of the forefoot. Patients were divided into two groups depending on the surgical method of eliminating metatarsalgia: in the first performed an osteotomy Helal (32 cases), in the se­cond — Weil (32). The mean follow-up of patients in the first group was 19.8 months, the second — 21.5 months. Results. According to the assessment of AOFAS scale, the result of treatment of metatarsalgia and transverse deformity of the forefoot in patients of the first group was 89.4 points, the second — 83.1 points. Regression of metatarsalgia in patients of the first group was recorded in 29 (90.6 %) cases, the second — in 26 (81.3 %) (criterion χ2 = 1.16; p = 0.28). Recurrences of metatarsalgia were observed in patients after the use of both Helal and Weil osteotomies and accounted for 6.3 and 9.4 % of cases, respectively. The occurrence of transfer metatarsalgia of the anterior foot was registered in 3.1 % of cases after Helal osteotomy, in 9.4 % — Weil osteotomy. Conclusions. Surgical treatment of metatarsalgia caused by transverse deformity of the forefoot with the use of corrective osteotomies Helal and Weil allowed to achieve positive results in 90.6 and 81.3 % of cases, respectively. These surgical techniques can be successfully used for the treatment of metatarsalgia of the forefoot with a violation of the metatarsal parabola.
Olena Vyrva
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 96-101; https://doi.org/10.15674/0030-59872020496-101

Abstract:
Osteoporosis is a systemic disease of the skeleton, characteri­zed by a decrease in bone mass and qualitative changes in bone structure, which lead to increased fragility and increased risk of fractures. Objective. To analyze the published information on the awareness of women in the United States, Europe and Ukraine about the risk of osteoporosis in the postmenopausal period. It is estimated that in general, about 50 % of postmenopausal women in most countries do not receive osteoporosis drug therapy and are unaware of the different treatment options for disease, 25 % associate it only with femur and spine fractures. Surveys have found that most respondents without a diagnosis of osteoporosis have had one or more risk factors for developing it, but osteoporosis is often not diagnosed until one or more fractures have occurred. That is why orthopedists-traumatologists, who most often face pathological fractures on the background of osteoporosis, have proposed special protocols for the timely diagnosis and treatment of fragile fractures. Treatment standards require women aged 65–85 who have suffered a fracture to be screened and receive osteotropic therapy for 6 months. However, the diagnosis and treatment of osteoporosis for 6 and 12 months after femoral neck fractures received only 17–23 % of respondents. Misconceptions about the causes and consequences of postmenopausal women fractures, combined with insufficient information from health professionals, point to the low level of attention of the population and the health care system in general to osteoporosis in all countries. The incidence of fractures in women was 3.1 higher than in men and progressively increased the age 50+. For high risk fractures women due to osteoporosis ensuring their osteoporosis awareness is a critical preventive point. This is essentialy can influence positive changes in the fight against osteoporosis around the world. Osteoporosis is a systemic disease of the skeleton, characteri­zed by a decrease in bone mass and qualitative changes in bone structure, which lead to increased fragility and increased risk of fractures. Objective. To analyze the published information on the awareness of women in the United States, Europe and Ukraine about the risk of osteoporosis in the postmenopausal period. It is estimated that in general, about 50 % of postmenopausal women in most countries do not receive osteoporosis drug therapy and are unaware of the different treatment options for disease, 25 % associate it only with femur and spine fractures. Surveys have found that most respondents without a diagnosis of osteoporosis have had one or more risk factors for developing it, but osteoporosis is often not diagnosed until one or more fractures have occurred. That is why orthopedists-traumatologists, who most often face pathological fractures on the background of osteoporosis, have proposed special protocols for the timely diagnosis and treatment of fragile fractures. Treatment standards require women aged 65–85 who have suffered a fracture to be screened and receive osteotropic therapy for 6 months. However, the diagnosis and treatment of osteoporosis for 6 and 12 months after femoral neck fractures received only 17–23 % of respondents. Misconceptions about the causes and consequences of postmenopausal women fractures, combined with insufficient information from health professionals, point to the low level of attention of the population and the health care system in general to osteoporosis in all countries. The incidence of fractures in women was 3.1 higher than in men and progressively increased the age 50+. For high risk fractures women due to osteoporosis ensuring their osteoporosis awareness is a critical preventive point. This is essentialy can influence positive changes in the fight against osteoporosis around the world.
Oleg Vyrva, Yanina Golovina, Roman Malyk, Mykhaylo Karpinsky, Olena Karpinska
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 18-24; https://doi.org/10.15674/0030-59872020418-24

Abstract:
Objective. To determine the most effective method of segmental bone allograft fixation during allograft — prosthesis composite based on searching the x-ray density of bone tissue at experimental animals. Methods. The work was performed on 28 laboratory white male rats (age 5 months, weight 350–400 g), which were divided into 2 groups, 14 animals in each group. All animals underwent allograft-prosthesis composite hip replacement: after transverse osteotomy of the femur in the 1st group of animals, after step cut osteotomy in the 2nd group. Animals were withdrawn from the experiment after 3 and 6 months after operation. The optical bone regenerate density in the contact of allograft and the recipient’s bone areas and the cortical layer of the recipient’s bone below the distal end of endoprosthesis were measured on Х-ray images. Results. Optical bone regenerate density after 3 and 6 months after operation had significant difference between recipient’s bone in both groups (p < 0.05). There was no statistically significant difference (р = 0.373) of recipient’s bone density depending on using different osteotomy types on the cutoff date of the study (6 months). But bone regenerate got more density after step-cut osteotomy ((216 ± 26) units) which was significantly (p = 0.001) compare to transverse osteotomy ((161 ± 19) units). Conclusions. The using of long bone allograft-prosthesis composite with implementation a step cut osteotomy contributes to the most rapid increase in bone regenerate density than transverse osteotomy. This is due to the achievement of better stability during fixation of the bone allograft and the bone of the recipient due to the step cut osteotomy, which contributes to fast regenerative process.
Оlexandr Kostrub, Nazar Vadzyuk, Viktor Kotyuk, Petro Didukh
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 80-86; https://doi.org/10.15674/0030-59872020480-86

Abstract:
Anterior knee joint pain is one of the common complaints, mainly in young people. Patellar instability is more likely to occur without a history of direct injury. Anatomical variants of the patellofemoral joint (PFJ) are of great importance in the development of arthritis, and could affect the appearance of complications after surgical treatment. The pathology of the patellofemoral joint continues to be a common and unsolved problem associated with the features of the anatomy and biomechanics of the knee joint. It has been found that the shape and ratio of the bones in patellofemoral joint have a crucial role in the development of patellar instability and arthrosis. Objective. To analyze the scientific database as for methods for determining the shape, the relationship of bones and patellofemoral joint dysplasia. Results. We studied the bone anatomy of the patellofemoral joint and current methods for determining the normal variants of the form of patella, dysplasia of the femoral facet and the rotational relationship of patella to the femur; or relationship of femoral facet to the tibial tuberosity. In clinical practice one needs to identify intercondylar angle, Laurin angle, the patellar slope, condylar dysplasia, the relationship of intercondylar notch to tibial tuberosity. Conclusions. The development of diagnostic methods such as MRI or CT provides expanded opportunities for identifying the features of patellofemoral joint. Increased latera­lization of tibial tuberosity, dysplasia of femoral condyles, and patellar shape play a critical role in the development of patellar instability or development of patellofemoral joint arthritis.
Olexii Popsuishapka, Valerii Lytvyshko, Olga Pidgaiska, Nataliya Ashukina, Kateryna Nesvit, Valentyna Maltseva
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 33-42; https://doi.org/10.15674/0030-59872020433-42

Abstract:
Objective. To study internal tensions in bone and soft tissues of shin at normal condition and at isolated tibia nonunion, the range of fragments displacement, callous structure and to sustain the conception of treatment. Methods. Due to finite element method we created three models: I — anatomic norm; II — transverse defect of 5 mm height on the middle-lower 1/3 border filled with collagen, III — as the second model with empty fibula defect of 10 mm height on the same level 2/3–1/3 border. In 45 patients with tibia shaft nonunion (term 4–18 months) we made resection of fibula fragment 10–15 mm on the same level of tibia nonunion with apparatus of external fixation. We studied the linear bone fragments displacement and callous structure. Results. At the axial loading in normal condition (I model) there was asymmetry of tensions in the lower part of shin bones on the lateral and medial sides. At the II model vertical tensions in the lower part of tibia decreased on the medial side up to 69 % and on the lateral side — up to 44 %, tensions increased in 5 times on the lateral side of fibula. The tangential stresses increased 3 times, their resulting force vector changed the outward direction and increased 7 times. In the III model tension distribution on the tibia surface became close to normal situation. In case of tibia nonunion there was fibrous-cartilages tissues, appeared because of transverse tensions. Patients walked with weight bearing from the first days after surgery, in 95.6 % bone fragments consolidation happened in 3.5–4 months. Conclusion. Excluding of fibula from bearing function due to its 10–15 mm resection on the level of nonunion will normalize the vector of loading in the tibia fragments and fibrous-cartilage regenerate and leads to it ossification.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 107-108; https://doi.org/10.15674/0030-598720204107-108

Abstract:
On November 14, 2020, Professor Dr. Friedrich Paul Magerl, a pioneer in spinal surgery and orthopedics, passed away.
Nataliya Prytula, Inga Fedotova, Iryna Korzh
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 64-71; https://doi.org/10.15674/0030-59872020464-71

Abstract:
Comorbidity is one of the leading problems in clinical practice. Interaction of diseases, involutive processes of natural aging and pathomorphosis of drugs significantly change clinical picture and course of the disease, the nature and severity of complications, limit or complicate the treatment and diagnostic process. Objective. To analyze current information on available recommendations for the treatment of comorbid diseases in patients with orthopedic pathology. Materials. An overview of the recommendations of the European Society of Cardiology, European Society of Hypertension, European Society for Vascular Surgery, Ukrainian Gastroenterological Association and American Diabetes Association for the period 2017–2019 is presented. Results. The first stage in the treatment of arterial hypertension is the lifestyle optimization, and the initial therapy of most patients with hypertension should be a combination of two drugs. Management of patients with lower extremity artery disease is associated with an increased risk of any cardiovascular events. Therefore, preventive measures are of particular importance. Gastropathies induced by non-steroidal anti-inflammatory drugs are widespread in orthopedic practice. In the prevention of their occurrence, a well-chosen gastroprotective therapy is important. Once the diagnosis of diabetes is made, lifestyle modification should be started immediately along with the start of pharmacotherapy. Metformin remains the first-line drug for treatment, drugs of other groups can be prescribed when there are contraindications to metformin. In the treatment of neuropathic pain in diabetes or pre-diabetes, only pharmacological treatment strategies are effective. Conclusions. In most cases, a number of comorbidities with timely diagnosis and compliance with the algorithms of medical care can be corrected and treated. Properly selected conservative therapy can reduce the risk of peri- and postoperative complications.
Maxim Golovakha, Serhiy Maslennikov, Rostislav Titarchuk, Vadim Kirichenko, Alexandra Gritsenko
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 49-57; https://doi.org/10.15674/0030-59872020449-57

Abstract:
Anterior cruciate ligament (ACL) repair remains one of the most common surgeries in orthopedics and traumatology. The evolution of the ACL repair technique continues, new fixators appear, and the position of the graft, its shape and size are modified. Semi-tendon and gracilis muscle (STG) grafts are the most common used due to low-trauma and technically simple method of obtaining. Its disadvantage is a long period of intratunnel incorporation, one of the ways of this acceleration is the implantation of a polypropylene mesh. In an experiment on rabbits, we proved its positive effect. Objective. To develop a method of improving the intratunnel incorporation of STG-graft at ACL repair of the knee joint using polypropylene mesh. Methods. Results of 75 patients were analyzed. The study group consisted of 35 patients who underwent surgery during 2018–2019 using polypropylene mesh, comparative group — 40 patients who had surgical treatment in 2017. Evaluated demographic data, pre-operation period, recovery functions, complications rate, data of KOOS and IKDC scales. Results. Non-specific data of the inflammatory process (CRP and ESR) did not change significantly in patients with inserted polypropylene mesh. They did not have more pronounced pain after surgery, there were less cases of reactive synovitis with significantly minimized the number of the knee joint punctures. Restorationof knee function was faster, and early weight bearing of the leg allowed up to 6 months. Better results by the KOOS and IKDC scales received after surgery. Conclusions. Implantation of polypropylene mesh around the intratunnel part of STG-graft at ACL repair surgery did not increase the complications rate and allowed to improve the dynamics of limb function recovery up to 6 months after surgery.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 105-106; https://doi.org/10.15674/0030-598720204105-106

Abstract:
On October 7, 2020, at the age of 100, life ceased to beat the heart of an outstanding scientist, a wonderful man, laureate of the State Prize of Ukraine, doctor of medicalSciences of Professor Bohdan Ilyich Simenach.
Volodymyr Filipenko, Petro Vorontsov, Husak Valeriia, Arutunan Zorik, Kateryna Samoylova, Oksana Slota, Volodymyr Mezentsev
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 5-11; https://doi.org/10.15674/0030-5987202045-11

Abstract:
Bone loss and significant acetabular defects remain one of the major problems in revision hip arthroplasty. A promising material for grafting of bone defects can be materials based on allogeneic bone after various types of processing, combining optimal properties for osteoregeneration. Objective. To analyze the results of acetabular reconstruction with bone implants «OMS-A» in the case of revision arthroplasty. Methods. The results of examination and treatment of 57 patients (33 women and 24 men) were analyzed. The patients’ age at the time of hospitalization ranged from 24 to 81 years. Patients were diagnosed on the basis of a combination of clinical ma­nifestations of the disease, laboratory data, radiography, computed tomography with 3D reconstruction. According to the classification of W. G. Paprosky, the largest group consisted of type I defects — 25 patients (44 %), II — 13 (23 %), III — 19 (33 %). For the reconstruction of the acetabulum, 21 patients (37%) we used fragmented cortical-cancellous pieces (CGP), 28 (49 %) — volumetric bone implants (OCI), 8 (14 %) — a combination of CGP and OCI. All patients underwent revision hip arthroplasty with an anterolateral approach according to Harding. The resulting acetabular defect was tightly filled with an allografts. Results. X-ray and G. A. Gie results were assessed as good in 36 patients (63 %), satisfactory — in 14 (25 %). The manifestations of infection associated with the use of bone implants «OMS-A» have not been determined. The necessity for repeated surgery in order to restore the acetabulum occurred in 7 patients (12 %). Conclusions. Тhe clinical efficiency of bone implants «OMS-A» for the reconstruction of the acetabulum according to the classification of W. G. Paprosky was: with type I defect — 92 %; with type I and type defect — 92.3 %; with type II and type defect — 78.9 %.
Mykola Korzh, Vasyl Makarov, Mykola Shidlovsky, Vladlen Yermakov, Yurii Nikitin, Olga Pidgaiska, Оleksiy Tankut, Mykhaylo Karpinsky, Olena Karpinska, Olexandr Zakhovayko, et al.
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 12-17; https://doi.org/10.15674/0030-59872020412-17

Abstract:
Тhree-dimensional printing of porous titanium implants is a promi­sing area of additive production in orthopedic surgery. The question remains relevant mechanical strength and durability of such device. Objective. Determine in the experiment the strength of the stem, the neck of the stem and the cups of hip endoprosthes made by 3D-printing from titanium alloy, and compare with a similar rate of serial implants. Methods. The strength of the stem and cups of hip endoprostheses made by 3D-printing on an Arcam printer from titanium alloy TI6AL4V was studied. Serials hip implants made form titanium alloy. There were 3 samples of hip endoprostheses for each test. Stems of endoprostheses were exa­mined on the TIRATEST-2300 machine under the conditions of loading on a three-point bend, the necks of stems were exami­ned under the influence of combined load on the bend with a shift, the cups were examined on compression. Results. Tensile strength in the case of three-point bending of the stems of implants made by mechanical processing and 3D printing did not have any differences significantly (p = 0.146) and was (1480.62 ± 62.50) MPa and (1396.88 ± 50.90) MPa, respectively. The necks of stems of serial endoprostheses and made by 3D-printing had a comparable limit of strength — (408.61 ± 1.25) MPa and (403.49 ± 8.99) MPa, respectively (p = 0.384). Under the conditions of compression tests of cups of endoprostheses all the samples withstood a load of 98.0 kN without any signs of destruction. Conclusions. The va­lues of the tensile strength of the components of serial implants and those made by 3D-printing did not differ statistically significantly. Thus, 3D-porous structures have significant potential for creation of elements of hip endoprostheses.
Volodymyr Radchenko, Andriy Popov, Dmytro Petrenko, Marina Nessonova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 25-32; https://doi.org/10.15674/0030-59872020425-32

Abstract:
The main goal of the primary and metastatic spinal tumors treatment are local control, preservation of weight bearing and protective function of the spine with improvement patients quality of life. Objective. To develop mathematical algorithm for selection of surgical treatment volume in spinal tumor cases. Methods. Spinal instability neoplastic score supplemented with additional signs such as ASIA scale, tumor type, epidural spinal cord compression scale by Bilsky, local kyphosis, adjacent vertebras lesions was used for the model developing. Point system that takes 9 signs has been tested in 237 metastatic spinal tumor patients. Cluster analysis for the decision tree development was applied. Results. It has been confirmed the hypothesis about decreasing surgical volume with higher SINS score. But, it was not defined which boundary indicator to define specific volume of the surgery is precise. Two patients clusters were defined, that have differences in the surgical volume, degree of tumor lesion, epidural compression and local kyphosis, neurological symptoms. Cluster I included 115 patients with higher score (severe condition, higher volume of the surgical intervention) in comparison with 122 patients from the cluster II. Decision tree for the surgical volume selection in spinal tumor patients has been developed. Conclusions. The most important signes that affect the choice of the surgical volume selection are: neurological symptoms, type of vertebra lesion, spinal stenosis and type of the surgery (radical vs palliative). Application of the deve­loped decision tree in the clinical practise gives the opportunity to select appropriate volume of the surgical intervention in spinal tumor patient with the high significance level that provides satisfactory treatment outcome.
Inga Fedotova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 109-111; https://doi.org/10.15674/0030-598720204109-111

Abstract:
The article summarizes the results of the 18th International Symposium "Minimally Invasive and Instrumental Spine Surgery", held on the basis of the Institute of Spine and Joint Pathology. prof. MI Sytenko NAMS of Ukraine "under the auspices of ISMISS with the assistance of NASS and SICOT December 5, 2020.
Sergey Tymochenko, Igor Gajovich, Sаmir Аbbasov, Аndrij Lysak
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 43-48; https://doi.org/10.15674/0030-59872020443-48

Abstract:
Method of concentrated bone marrow aspirate (BMAC) injection into aseptic bone necrosis of different localizations are described in the literature, however, without demonstrating structural and functional results for Kienbeck’s disease. Objective. To establish functional and radiological changes at injection of concentrated bone marrow aspirate into lunate bone in combination with scaphoid-trapezoid-trapezius joint temporary fixation in patients with idiopathic lunate bone necrosis. Methods. The procedure was performed in 11 patients. Age 18–46 years (28,9 ± 9,5) 6 women, 5 males. Kienbeck's disease stage II — 4 patients, IIIa — in 2, IIIb in 5 patients. Bone marrow aspirate concentration from the ili­ac bone was obtained using Arthrex-Angel technique, injection of 2–3 ml of the concentrate with intraosseous needle under X-ray control into the focus of aseptic necrosis of the lunate bone, STT-fixation of the wrist joint in the position of rotational correction of the scaphoid. Immobilization followed for 2 months, than remo­val of the K-wires and rehabilitation. X-ray, CT control and DASH testing before the procedure and in a year. Results. Five patients (45 %) had a distinct positive clinical and radiological dynamics, definite positive changes on CT (pathological fracture consolidation, lunate bone remodeling), as well as DASH scale improvement, maintenance of wrist joint radiometric parameters and an increase in strength and range of motions in the wrist. Four patients had no significant dynamics, and in two patients there was a distinct decline in function, advance lunate bone destruction, and an increased wrist joint instability. Conclusions. The technique requires advance revision of the conditions under which it demonstrates its effectiveness. Today it can be recommended in addition to other surgical procedures (shortening of the radius, STT arthrodesis), which have more predicted effectiveness.
Inna Golubeva, Olena Shevchenko, Volodymyr Tankut, Olexii Dynnik
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 102-104; https://doi.org/10.15674/0030-598720204102-104

Abstract:
The article is dedicated to the 135th anniversary of the birth of prof. MI Sitenko. November 2020 marked the 135th anniversary of the birth of the outstanding orthopedic traumatologist and health care organizer, corresponding member of the Academy of Sciences of the Ukrainian SSR, Professor Mykhailo Ivanovych Sytenko. The merits of Professor MI Sytenko are difficult to overestimate. His name is associated with the formation and development of orthopedics, traumatology, prosthetics and rehabilitation care in our country. With his assistance, a wide state network of institutions was created, which provided the population with highly qualified orthopedic-traumatological and prosthetic-orthopedic care, and carried out rehabilitation measures.
Kostiantyn Romanenko, Yaroslav Doluda, Dmytro Prozorovskiy, Vasyl Pariy
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 72-79; https://doi.org/10.15674/0030-59872020472-79

Abstract:
The treatment of patients with long bones fractures, despite the development and improvement of treatment methods and fixing devices in certain cases can lead to unwanted results such as a formation of posttraumatic deformity — malunion. Objrctive. To provide modern approach regarding clinical significance and necessity of correction of secondary changes in moving segment that appeared as a result of formation of lower extremity malu­nion. Methods. The results of treatment of 196 patients were analyzed (89 men, 107 women; age from 19 to 76 years). All the patients had the malunion of the long bones of lower extremities and have been treated from 2004 to 2019 years. Analysis of special literature and own experience was performed to identify the effects of malunions. Results. It was shown that formed malunion lead to tangible shortening of injured extremity, joints overloading and muscle function violation. Malunions are compensated by the means of changing in movement arch and gait pattern. While it is noted that unphysiological load on joints, that predispose the development of degenerative changes, and muscle fatigue and pain are the results of muscle work to support inadequate position of the joints. Malunions on the level of femur and tibia became clinically significant on condition of severe restriction of extremi­ty function, thus its restoration is the goal of treatment. Diffe­rent cases of malunion development were considered: varus, valgus, antecurvatio, recurvatio, translation, torsion malalignment. Clinical examples are given. Conclusions. Clinical significance of different malunions depend upon their localization, presence and severity of secondary changes, status of injured extremity and physical condition of the patient, his or her individual demands. Secondary changes can play the role of compensation and spread on injured extremity, sacro-iliac joints, lumbar spine, contralate­ral extremity. The assessment of secondary changes of musculoskeletal system is mandatory for the patients with malunions during the planning of treatments measures. The indication for surgical correction should be defined with taking into considera­tion possible development of malunion complications in future.
Olena Baburkina, Oleg Ovchynnikov, Inna Shestakova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 80-88; https://doi.org/10.15674/0030-59872020380-88

Abstract:
Objective: to clarify the status of Ukrainian traumatology and ortopedics as a science by analyzing the quantity and the topic of Ukrainian publications in foreign scientific journals taking into account citation. Methods: publications were analyzed (January 1999 – March 2020) of native orthopedists-traumatologists in electronic scientometric Scopus database and in all journals headings «Orthopedics and Sports Medicine» from the rating Scimago Journal & Country Rank (SJ&CR). Search completed from the first issue of each journal. Results: studies of Ukrainian scientists in the speciality of «Orthopedics and traumatology» were published in 10 of 270 scientific journals (SJ & CR): quartile Q1 — 4, Q2 — 5, Q3 — 1. Topic of publications: 36.3 % in traumatology, 27.2 % — vertebrology and arthroplasty, 9.1 % — epidemiology. In the database Scopus data found 23 doctors of science in «Traumatology and Orthopedics», who had 2 or more publications (authors with a Hirsch index of 0 were not taken into account). Ukrainian institutions were distributed as follows by their number: SI «IPHS named after prof. M. I. Sitenko NAMS» — 7 scientists, GA «ITO NAMN» — 4, National Medical Academy of Postgraduate Education named after P. L. Shupik — 2, State Institution «Institute of Gerontology named after D. F. Chebotareva NAMS Ukraine» — 2, the rest — one at a time. Conclusions: there were only 11 publications of Ukrainian scientists in «Orthopedics and Traumatology» journals at the SJ & CR website for the period 1999–2019. In the NDB Scopus, much more works are published, but not all of them are cited, which reflects the authors Hirsch index. Preparing an article for publication,it should be take into consideration that the most cited publications were, where the authors present guidelines, the results of multicenter studies, clinical trials, the study of new materials for use n orthopedics and traumatology. Also, the citation of works increases if they are published in the journals with quartiles Q1 and Q2.
Volodymyr Tankut, Kostiantyn Berenov, Olga Berenova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 61-66; https://doi.org/10.15674/0030-59872020361-66

Abstract:
The course of pregnancy is often complicated by pelvic spine pain (PSP), which leads to household and occupational disability, negatively affects the condition of the fetus and the unborn child. Objective: to analyze the main factors in the development of PSP in pregnant women, to improve the methods of diagnosis and treatment. Methods: the protocols of clinical, biomechanical and ultrasound examinations of 175 women of reproductive age (18–45 years old) with PSP were studied. The following structural sources of pain were identified: facet joints, sacroiliac joints, and hip joints, intervertebral discs, pubic joints, and myofascial structures. Each type of pain was classified according to the nature of the pain syndrome. Results: mapsschemes of sources and variants of pain syndromes localization were proposed. There were 4 main factors in the development of lumbar pain syndrome (instability (40.8 %), facet joints pain, diskalgia (5.1 %), functional blockade of the lumbar vertebral motor segments (26.3 %)), 5 — pelvic (instability joints (39.5 %), arthralgia (23 %), functional blockade (40.8 %), syndromes of the sacroiliac joints (80 %) and symphysitis (48.7 %)). Basic treatment programs for pregnant women with PSP have been developed, the use of which led to a decrease in pain intensity during pregnancy by an average of 75 %. Some of the positive results of rehabilitation increased from (70.11 ± 16.42) % in the first trimester to (75.80 ± 18.43) % in the third. The rehabilitation index was (81.49 ± 19.26) %. Conclusions: PSP in pregnant women differs from pain at degenerative spine diseases and pelvic. The proposed working charts-schemes of different types of sources and variants of localization of pain syndromes significantly improved the diagnosis of these pathological conditions, which helped to determine the treatment method. The effectiveness and expediency of using the developed program for the treatment of pregnant women with PSP in medical practice has been confirmed.
Volodymyr Filipenko
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 99-105; https://doi.org/10.15674/0030-59872020399-105

Abstract:
Evidence-based medicine plays a leading role in modern clinical practice. The most well-known scales for evaluating the quality of evidence and recommendations based on them are OCEBM (Oxford Centre for Evidence-based Medicine), GRADE (Grading of Recommendations Assessment, Development and Evaluation), NICE (National Institute for Health and Care excellence). Objective: to acquaint readers with modern clinical guidelines for conservative treatment of osteoarthritis (OA), developed on the basis of the principles of evidence-based medicine. GRADE scale is widely used. The greatest authority among professionals have community leaders: ACR (American College of Rheumatologists), EULAR (European Antirheumatic League), OARSI (International Society of Osteoarthritis Researchers), AAOS (American Academy of Orthopedic Surgeons), ESCEO (European Society for Clinical and Economic Studies aspects of osteoporosis, osteoarthritis and musculoskeletal diseases). Their differences are due, in particular, to the use of different scales for assessing the levels of evidence and strength recommendations and relating to the use of SYSADOA (symptomatic slow-acting drugs for the treatment of OA), intra-articular injections of various drugs (corticosteroids, PRP, hyaluronic acid, etc.). The article presents strictly and conditionally recommended methods of conservative treatment of osteoarthritis of the hand, knee and hip joints. Conclusions: modern clinical guidelines are based on objective scales for evaluating evidence and recommendations, respectively, the probability of systematic errors is reduced. Therefore, prescribing according to them OA treatment regimes, we are sure that we choose the most effective among all available approaches.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS; https://doi.org/10.15674/0030-598720203111

Abstract:
The article is dedicated to the memory of Professor The article is dedicated to the memory of Professor Shimon Vasyl Mykhailovych.
Sergiy Khmyzov, Anton Gritsenko, Mykhaylo Karpinsky, Olena Karpinska, Igor Subbota
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 5-10; https://doi.org/10.15674/0030-5987202035-10

Abstract:
Achondroplasia is a genetically caused disease, which is accompanied mainly by a violation of the growth of the skeleton and limbs in length. Most authors came to the conclusion that it is advisable to carry out the elongation simultaneously on the symmetrical segments, and begin with the legs. At the same time, the authors note a significant number of complications, among which the most severe are the appearance of secondary deformations of the segment during distraction. Objective: to determine the stabilizing capabilities of external fixators (EF) with their various configurations in the experiment on physical models. Methods: an experimental study was carried out on physical models of plastic tibia that was cut in the upper third of the diaphysis. In the experimental group, EF were fixed on the model according to the author’s scheme with a V-shaped arrangement of rods in the proximal tibia (3 models). As a comparison group, we used models with EF, which were fixed according to the «classical» scheme with the location of all the rods in one plane (3 models). All models were tested under axial compressive loads. Bending loads were performed in two planes: parallel and perpendicular to the support beam of the EF. Results: at compression loads of up to 50 N, the displacement of the proximal fragments of the tibia does not have statistically significant differences (p = 0.066). At loads of 100 N or more, the EFs, which were fixed according to the V-shaped scheme, provided smaller displacements of the proximal fragment of the tibia in the diastasis zone compare to EFs with an in-line layout of the rods. At loads of 50 and 150 N, the in-line arrangement of the EF provides a statistically significantly less (at the level of p = 0.001 and 0.019, respectively) displacement of the proximal tibia fragment in the area of EF application of the load than the EF according to the V-shaped pattern. At loads of 100 and 200 N, there is no statistically significant difference between the displacements of the fragments in the both models. (р > 0.2). Under bending loads in the plane perpendicular to the supporting beam of the EF, devices with a V-shaped arrangement provide more stable fixation of the proximal fragment of the tibia than comparative model. Conclusions: the V-shaped arrangement of the EF allows statistically significantly stabilize fixation of fragments of the tibia than the EF with the in-line layout of the rods in almost all the studied loading methods.
Ievgen Matelenok
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 54-60; https://doi.org/10.15674/0030-59872020354-60

Abstract:
Dislocations that remain unreduced for 3 weeks or more, are called the chronic elbow dislocation. Today they are found quite rarely. Objective: to study the probable causes of long standing forearm dislocations, to analyze medical tactics and results of treatment. Methods: we used the data of clinical observations of 5 patients (2 men, 3 women), mean age (38 ± 8) years with long standing forearm dislocations. All patients had surgical treatment. Results: the cause of the long standing dislocations occurrence, in 2 cases there was a violation of medical recommendations by patients, in 3 — insufficient medical control, absence of control radiography after immobilization, lack of timely correction of the patient's management, erroneous the choice of conservative treatment tactics in the presence of indications for surgery. Features of treatment tactics depending on the characteristics of dislocations were analyzed. Comparative data of the joints function are given: the amplitude of flexion/extension movements before the surgery was 25° ± 6°, after — 108° ± 5°; assessment of the limb function according to Mayo Elbow Performance Index before the surgery was equal to (23 ± 5) points, in the follow-up period (17 ± 2) months) — (81 ± 7) points (p < 0.001). Conclusions: in the case of long standing posterior dislocations, open reduction of the forearm can be performed from the lateral approach with restoration of injuried ligaments, in the case of posterior-lateral — it is advisable to use posterior approach, which allows for more complete arthrolysis, tissue mobilization, restoration of ligaments, as well as perform neurolysis, transposition of the ulnar nerve. In case of short terms of long standing forearm dislocation it is possible to manage a temporary fixation of the joint with one or two wires, passed through the joint and external fixation with a plaster cast for a period of 15 up to 30 days with subsequent mobilization without the use of external fixation devices.
Sergij Bezruchenko, Olexij Dolhopolov, Igor Lazarev, Olexij Chkalov, Maryna Yarova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 19-28; https://doi.org/10.15674/0030-59872020319-28

Abstract:
The injury of acromioclavicular joint is one of the causes limitation function of the shoulder joint. Choice of fixation methods of acromioclavicular joint dislocation is actual topic to research. Objective: to study by a biomechanical experiment and to substantiate influence of different fixation methods of acromioclavicular joint dislocation on range of motion of acromioclavicular and sternoclavicular joints during the upper extremity elevation. Methods: 6 prototypes of a natural skeleton 3D technology from ADS plastic were used. The capsuloligamentous components, dynamic and static stabilizations of acromioclavicular and sternoclavicular joint were modeled from artificial materials. Each model of acromioclavicular dislocation was fixed by 6 different fixations methods: «intact joint», «fixation by Weber», «Bosworth screw», «Hook-plate», «DogBone», «External fixation». During the experimental study, the range of motions was fixed in acromioclavicular and sternoclavicular joints in 90 and 180 degrees of arm elevation, each experiment was repeated 5 times. Results: range of motion in acromioclavicular and sternoclavicular joints in position of 90 degree of arm elevation, with fixation of acromioclavicular joint dislocation by Hook-plate and system of 2 mini plates and suture material (DogBone), in position of 180 degree of arm elevation with fixation of «DogBone» was physiological. Other methods of fixation — «Bosworth screw», «Weber fixation», «External fixation», «Hook plate» limited the range of motion in the acromioclavicular joint and increase motion in the sternoclavicular joint at maximal arm elevation. Conclusions: fixation of acromioclavicular joint dislocation by 2 mini plates and suture material (DogBone) gives physiological range of motion in acromioclavicular and sternoclavicular joints during arm elevation.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS; https://doi.org/10.15674/0030-598720203110

Abstract:
The article is dedicated to the memory of the outstanding scientist, doctor, honored worker of Kazakhstan, head of the Research Institute of Traumatology and Orthopedics of the Ministry of Health of the Republic of Kazakhstan, doctor of medical sciences, professor of academician of NAS RK Batpenov Nurlan Dzhumagulovich.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 108-109; https://doi.org/10.15674/0030-598720203108-109

Abstract:
The article is dedicated to the memory of the famous scientist, doctor, public figure, academician of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Anatolij Oleksandrovych Lobenko.
Maksym Golovakha, Serhiy Maslennikov
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 11-18; https://doi.org/10.15674/0030-59872020311-18

Abstract:
The problem of anterior cruciate ligament (ACL) reconstruction of the knee joint remains relevant, despite of significant number of designed surgical techniques for its reconstruction. Repeated ruptures of the restored ACL are recorded in 3–15 % of cases. Objective: to determine the morphological features of the knee joint tissues rearrangement in rabbits after implantation of a polypropylene mesh (PM) into the capsule defect. Methods: the study was performed on 50 rabbits weighing (694 ± 27) g. A capsule defect was formed on the right knee joint between the patellar ligament and the medial collateral ligament. In the experimental group (25 rabbits), the defect was repaired using PM, in the control group (25) — the edges of the defect were tightened and sutured with vicryl. A modified Vanderbilt University scale was used to assess the scarring process. Morphological analysis was performed. Results: no significant clinical differences in the state of the operated knee joint in the postoperative period were found between the groups. In the control group, from the 7th day after the surgery, the formation of dense connective tissue (scar) was observed. In animals of the experimental group, against the background of the formation of connective tissue around the PM, a significant thickening of the capsule and ligaments was observed at the points of contact with it. In 21 days after PM implantation, 51–75 % of its area showed ingrowth of connective tissue, after 45 — 75–100 %. After 2 months after the surgery, the relative area of dense connective tissue in the experiment was (68.12 ± 2.74) % versus (51.68 ± 4.22) % in the control.Conclusions: implantation of PM into the area of the knee joint capsule defect of rabbits between the patellar ligament and the medial collateral led to the formation of a larger volume of dense connective tissue at the final follow-up period (2 months). Ingrowth of connective tissue between cells and fibers of PM promotes the formation of a tight connection with the surrounding tissues, thereby strengthening area of traumatic injury.
Oleg Vyrva, Yanina Golovina, Roman Malyk, Iryna Bets
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 93-98; https://doi.org/10.15674/0030-59872020393-98

Abstract:
Replacement of large bones and soft tissues defects formed after radical removal of the tumor remains a topical issue in oncological orthopedics. Today the combined methods of large segmental defects replacing of bones and joints are distraction osteogenesis with bone autograft and APC (allograft prosthesis composite). The combination of techniques allows us to minimize the disadvantages and to use the advantages of each method. Many methods of primary soft tissue grafting are used to replace soft tissue defects depending on localization and spread of the tumor process. The problem of soft tissue reconstruction and restoration the function of joints and limbs is relevant. Objective: to present a clinical case of malignant tumor treatment of the distal tibia part with an integrated approach to the restoration of bone defects and soft tissues. Methods: a clinical case of undifferentiated pleomorphic sarcoma of the distal tibia T2N0M0, stage II, clinical group II was described. The patient underwent replacement of the postresection defect of the distal tibia with an osteoarticular allograft and fascia-cutanoeus flap grafting in order to replace soft tissue defect in the lower third of the leg. Results: using osteoarticular allograft replacing technique reduced the risk of complications as opposed using bone allograft or prosthetic replacement separately. The application of massive complex soft tissue graft made it possible to obtain a positive surgical outcome of treatment in patients with malignant tumors of long bones. Conclusions: an integrated approach to the replacement of post-resection defects in long bones and soft tissues helps to preserve the patient's limb in case of malignant bone tumor. Key
Sanjar Kochkartaev, Shahaidar Shatursunov, Elena Danilova, Natalija Osinskaya
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 29-35; https://doi.org/10.15674/0030-59872020329-35

Abstract:
Studies of the mechanisms of lumbar spine disease are relevant, as the choice of adequate treatment requires in-depth knowledge of the its etiopathogenesis changes in the spine tissues. The macro- and microelement content of intervertebral disc herniation (IDH) are least studied. Objective: to assess changes in the element composition of intervertebral disc herniation at conditions of degree of degeneration. Methods: using instrumental neutron activation analysis (INAA) we studied biomaterial obtained during microdiscectomy at LIII–LIV, LIV–LV, LV–SI spine levels. Group A — 8 fragments of hernias from patients aged 24–36 years with structural changes of intervertebral discs, group B — 7 fragments from patients at the age of 37–44 years with total degeneration of the spinal motor segments, group B — 7 samples from patients aged 45–60 years with degenerative deformities of the spine. INAA allowed to outline the content of 22 essential trace elements. The maximum error of the activation method for determining the elements did not exceed 12 %. Results: it was found a gradual change in the content of certain essential elements depending on the stage of the destructive process in intervertebral discs tissues. In particular, changes in sodium, potassium, chlorine leads to contravention of acid-base balance in the tissues, reducing the iron content by 1.44 times — to reduce the flow of oxygen to the intervertebral disc. At the same time, the reduction of calcium levels at the beginning of the degenerative process by 2 times, and then its increase by 1.6 times indicates on calcification of the intervertebral soft tissues. Conclusions: microelement correlations in intervertebral discs tissues are established and the course of the degenerative process can be used to predict the patient’s condition and the choice of adequate treatment.
Vadym Sulyma, Roman Bihun
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 89-92; https://doi.org/10.15674/0030-59872020389-92

Abstract:
Obtaining of surgical skills in «Ideal Conditions» with simulation training can improve the results in practice both for beginners and experienced specialists. There are various methodological approaches to the gradual mastery of a certain skill. Methodology of Peyton provides four steps: demonstration, deconstruction, comprehension, performance. Objective: to determine the effectiveness of obtaining a simulation osteosynthesis skills by orthopedic physicians during training with Peyton method. Methods: we made a four-step Peyton’s simulated practical training of osteosynthesis with stable-functional extra-bone fixators LCP on dummies with isolated fragments of a complex intra-articular fracture. Physicians (35) were divided into two groups according to their experience. The initial level of theoretical knowledge was determined by standard tests. The effectiveness of mastering a skill was assessed by the developed six-point scale. Results: the initial level of theoretical knowledge averaged 27 % for cadet physicians and 13 % for residents. When teaching practical skills, the assimilation of material among traumatologists on step I is estimated at (23.3 ± 7.2) %, step II — (29.5 ± 5.5) %, III — (42.3 ± 8.6) %, IV — (46.2 ± 5.4) %. The indices of residents almost at the first and second steps were (25.3 ± 6.7) % and (35.5 ± 9.5) %, respectively. At the end of step ІІІ (comprehension), an improvement in the assimilation of the material was observed among residents — (51.1 ± 8.1) %, and among experienced physicians — (57.7 ± 6.3) % at step IV. Conclusions: Peyton’s four-step approach showed significant advantages in teaching of practical instrumental skills of complex osteosynthesis. The most significant to assimilate the material, step III should be considered — comprehension. Despite the advantages of Peyton method in teaching of practical skills, new methods of assimilation and modification of existing ones should be done.
Oleg Vyrva
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 114-116; https://doi.org/10.15674/0030-598720203114-116

Abstract:
August 20-22, 2020 the World Congress "Osteoporosis, Osteoarthritis and Diseases of the Musculoskeletal System" was held in Barcelona
Mykola Korzh, Vasyl Makarov, Alexander Sabsay, Оleksiy Tankut, Olga Pidgayska
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 44-53; https://doi.org/10.15674/0030-59872020344-53

Abstract:
Objective: a retrospective study of anatomical and functional results of open reduction and plate osteosynthesis in patients older than 50 years with of the proximal humerus fractures type AO/OTA 11-B, 11-C and osteoporosis, who were treated with plate PHILOS taking into account the surgical treatment of adverse results with reverse total shoulder arthroplasty (RTSA). Methods: we analyzed case histories of 58 patients (age older 50 years) with osteoporosis and three- and four-fragment fractures of the proximal umerus according to the Neer classification (type AO/OTA 11-B, 11-C). In group I — 20 patients (age from 50 to 76 years, 8 men and 12 women) — we made open reduction, ORIF with plate PHILOS; II — 38 patients (aged 54 to 78 years, all women) — had surgeries ORIF with PHILOS plate and 3D polylactide implants. Results: according to the Constant Murley Shoulder Score system in 11 (55 %) patients of group I excellent and good results were obtained, in 5 (25 %) — satisfactory, in 4 cases (20%) are unsatisfactory. At the last cases we made RTSA in terms from 6 to 12 months after the primary surgery, one of them had revision RTSA due to fracture of the humeral shaft and instability of the stem implant. According to the Constant Murley Shoulder Score system, the average score after 12 months in group I was 78, in II — 87. No signs of avascular necrosis of the humeral head were observed. Conclusions: the use of PHILOS plates with additional reinforcement with 3D polylactide implants allowed us to obtain positive results in 34 (89.5 %) patients after 6–12 months after the surgery with a lower complications rate compare to known techniques. If ORIF method gives an unfavorable result then RTSA gives the possibility to achieve positive results within 3 years after the surgery.
Liudmyla Klymchuk, Oksana Haiko, Roman Luchko, Yulianna Halii, Tymochenko Sergey
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 36-43; https://doi.org/10.15674/0030-59872020336-43

Abstract:
Median nerve (MN) compression neuropathy (CN) at the carpal tunnel (CT) level goes up to 90 % of all tunnel neuropathies. Instrumental methods of examination that are used to diagnose this pathology are electromyography (EMG) and ultrasound (US). Objective: to systematize diagnostic possibilities and to determine the value of US for the patients with carpal tunnel syndrome (CTS). Methods: 99 patients (160 MN) of the main group with CTS (38 — unilateral, 61 — bilateral) clinical signs were analyzed. Control group included 35 patients (70 MN) without symptoms of CTS. Patients were examined clinically and with US on «Esaote MyLab 20 Plus» and PHILIPS HD 11 XE with a 5–12 MHz multi-frequency sensor. Cross-sectional nerve area (CSNA), flattening coefficient (FC), nerve deformation index (NDI), thickness of transverse carpal ligament, its shape, contours, nerve structure, median nerve and carpal ligament echogenicity were studied. EMG was performed in 64 (64.7 %) patients. Thresholds of sonographic parameters for the diagnosis of CTS were determined with ROC analysis with sensitivity and specificity calculation. Results: main qualitative ultrasound parameters of CTS were: change of nerve shape and decreased echogenicity with loss of structural pattern. CSNA in main group was (14.1 ± 4.59) mm², and control — (8.32 ± 1.92) mm², FC — 3.02 ± 0.63 and 2.48 ± 0.60, NDI — 1.21 ± 0.09 and 1.03 ± 0.06, respectively. Optimal threshold level for CSNA was value ˃ 10 mm², FC — ˃ 2.73; NDI — ≤ 1.09 (sensitivity 84.3; 68.0; 81.7 %, respectively). Total frequency of concomitant pathology in main group was 54 (33.8 %) cases, in control group — 13 (18.6 %) (p < 0.02). Conclusions: ultrasound is objective and valuable method to diagnose MN compression neuropathy at the CT level and allow to assess the adjacent structures.
Anatolii Diedkov, Bogdan Maksymenko, Sergii Boychuk Boychuk, Viktor Kostiuk, Maria Kukuskina
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 72-79; https://doi.org/10.15674/0030-59872020372-79

Abstract:
The standard treatment option for Giant cell tumor (GCT) is surgery. The radical resection followed by reconstruction is associated with definite clinical problem: high rate of complications, reducing of limb function. Tumor excohleation allows to preserve the joint, but has a high rate of local recurrence. Objective: in retrospective study to analyze the advantages and disadvantages of intralesions and wide radical resection based on results of treatment in patients with Giant cell tumor. Methods: we performed a retrospective analysis of treatment results of 142 patients with long bones Giant cell tumor in the period from 1977 to 2012 years. Tumor excohleation (intralesional resection, IR) with grafting the defect with bone or biodegradable materials was performed in 70 cases, wide resections (WR) with defect reconstructions — in 72 patients. Results: in the group of patients who underwent IR the local relapses were revealed in 35.7 % of cases, which is seven times higher than in WR group. Functional result according to MSTS scale in patients after IR was 92.5 %, after WR — 78.8 % (p = 0.02). Such clinical factors as IR, localization of tumor in the distal radius, age under 25 years is strongly associated with appearence of local recurrence. For patients after IR PFS was 71.0 %, after WR — 95.8 % (p = 0.001). Conclusions: the optimal surgical method in patients with Giant cell tumor of long bones is IR due to good functional results. However, local relapse rate in this group remains high — 35.7 % versus 4.5 % in group after WR (p < 0.05). One of the way of its reducing is application of new therapeutic agents e. g. denosumab, the effectiveness of which can be assessed in prospective trials.
Sergiy Khmyzov, Olena Baburkina
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 112-113; https://doi.org/10.15674/0030-598720203112-113

Abstract:
The authors give their assessment and briefly reveal the content of the monograph by V. Orlyansky and M. Golovakha "Osteotomy in the knee joint"
Dmytro Prozorovskiy, Ruslan Buznytskyi Buznytskyi
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 67-71; https://doi.org/10.15674/0030-59872020367-71

Abstract:
Treatment of metatarsalgia in patients with hallux valgus deformity is one of orthopedic problem. It is known about a significant role in the relationship of the length of the metatarsal feet bones and biomechanical metatarsalgia. A number of surgeries have been proposed, including Helal osteotomy, which consists mainly in the posterior displacement of the metatarsal head and it shows good results. Objective: to study the results of surgical treatment of metatarsalgia caused by biomechanical disorders in patients with hallux valgus deformity with corrective Helal osteotomy. Methods: the study is based on the surgical treatment of 114 (179 feet) patients with hallux valgus deformity. Among them, metatarsalgia was found in 32 (17.9 %) of cases. For its treatment corrective osteotomy of the metatarsal bones was used according to the Helal method with screw fixation. Results: according to the ACFAS scale, the average score improved by 32.5 (from 63.1 points before operations to 95.6 points in followup potsurgery period). In 26 (81.3 %) cases with metatarsalgia the regression of symptoms was determined. Conclusions: in our study the frequency of metatarsalgia caused by biomechanical disorders was 17.9 %. In patients with metatarsalgia in 40.6 % of cases metatarsal parabola had small anatomical shape. Surgical treatment of metatarsalgia caused by biomechanical disorders with Helal osteotomy patients allowed us to get positive results in 81.3 % of cases. Helal osteotomy with screw fixation of metatarsal fragments can be an option for the treatment of metatarsalgia.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 106-107; https://doi.org/10.15674/0030-598720203106-107

Abstract:
The article is dedicated to the famous scientist, head of the Department of Orthopedics and Traumatology of the National Medical University named after A. A. Bogomolets, Professor, Doctor of Medical Sciences Alexander Anatolyevich Buryanov, who celebrated his 60th birthday on July 19, 2020.
Mykola Ankin, Taras Petryk, Viktoriia Ladyka
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 16-23; https://doi.org/10.15674/0030-59872020216-23

Abstract:
The treatment of pelvic bones injuries is one of the most difficult problems in traumatology. Objective: to analyze the results of surgical treatment of patients with pelvic fractures of the «open book» type and to determine the most effective methods of its stabilization. Methods: a retrospective analysis of the results of treatment of 61 patients with «open book» type pelvic fractures (age from 16 to 64 years) in two groups was carried out. Patients of the first group (24 patients, 39.3 %) were made osteosynthesis the anterior part of the pelvic bones only with an external fixation device — 20 and with a plate — 4. In the second group (37 patients, 60.7 %), anterior and posterior osteosynthesis was made. To assess fractures, the Tile classification with the additions of AO was used. X-rays and CT of the pelvic bones was used in all cases. Fractures of type B1.1 were detected in 32 (52.5 %) cases, B1.2 — 29 (47.5 %). Surgery was planned according to the developed local protocol. The results were analyzed according to the system of functional assessment S. A. Majed. The follow-up period was from 6 to 12 months after the surgery. Results: early complications were found in 4 (6.5 %) patients: infection — 3, secondary displacement of bone fragments — 1. There was no significant difference between the groups in terms of treatment outcomes. Conclusions: in case of pelvic injury as an «open book», accurate diagnosis of injuries with assessment of sacroiliac connection using x-ray of the pelvis in three planes and CT are important. In case of injuries of type B1 and differences in the pubic joint up to 2.5 cm, conservative treatment is recommended, more than 2.5 cm — internal fixation of the anterior section by one or two plates, and in the case of suspected injury of sacroiliac joint, additional fixation of the sacroiliac joint with ileosacral screws.
Maxim Golovakha, Bohdan Kuznietsov
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 48-54; https://doi.org/10.15674/0030-59872020248-54

Abstract:
Latarjet procedure is one of the relevant techniques for the anterior and antero-inferior type of recurrent instability at the shoulder joint with a defect of the articular surface of the glenoid. A deeper study requires arthroscopic modification of this operation to assess its clinical effectiveness. Objective: to conduct a comparative analysis of open and arthroscopic Latarjet procedure, to evaluate intraoperative and postoperative complications and side effects of this surgical technique. Methods: a prospective randomized study was conducted, which included 30 patients: after open Latarjet procedure — 16 (53.3 %), arthroscopic — 14 (46.7 %). The results were evaluated at 3 and 6 weeks, 3–4 and 6–9 months after the operation using x-ray methods, computed tomography, Walch-Duplay and Rowe scales, and intraoperative and postoperative complications were also analyzed. In the case of arthroscopic technique, an increase in the volume of external rotation during the adduction and abduction of the shoulder, an open technique — a decrease (p = 0.01). A decrease of the volume during internal rotation (spinous process) was revealed with the use of both techniques, but with better results after arthroscopic (p = 0.02). Conclusions: when using arthroscopic and open methods of Latarjet procedure, a statistically confirmed equal improvement in results is observed with recurrent instability of the shoulder joint. The results indicate the clinically significant advantages of restoring the function of the shoulder joint, especially external rotation when using the arthroscopic technique of Latarjet procedure in comparison with the open technique.
Volodymyr Filipenko, Svetlana Zolotareva
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 110-113; https://doi.org/10.15674/0030-598720202110-113

Abstract:
Conference of KRВUPO «Ukrainian Association of Orthopedic Traumatologists» dedicated to 75th anniversary of birthday of professor Goridova Lidija Dmitrievna
Margarita Khokhol, Oleksandr Buryanov
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 106-109; https://doi.org/10.15674/0030-598720202106-109

Abstract:
Review of monograph of Korzh M. O., prof., MD; and Dynnik O. A., PhD «The sources of Institute named in honor of professor M. I. Sytenko»
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS; https://doi.org/10.15674/0030-598720202102

Abstract:
May 27, 2020 marks the 90th anniversary of the birth of an orthopedist-traumatologist, Doctor of Medical Sciences, Professor Vitalij Mykolaiovych Levenets.
Sergei Kirilenko, Vladimir Rozhin, Eldar Nadyrov, Vladimir Nikolaev, Andrei Mazurenko, Artem Dobysh
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 75-79; https://doi.org/10.15674/0030-59872020275-79

Abstract:
Application of grafts for bone grafting is essential for spine surgery, traumatology and orthopedics, oncology, maxillofacial surgery. However, there is no ideal graft that would have all the necessary properties (osteogenic, osteoconductive, osteoinductive) and it would not have significant disadvantages. At spinal surgery, high-speed bone milling machines are used during decompression. In the case of bone tissue resection an equivalent amount of bone chips appears which is routinely aspirated and disposed of together with blood and destroyed tissues. At the same time at bone grafting there is a shortage of local graft material. Objective: to acquaint readers with the possibility of obtaining bone grafts with the help of the developed device as a high-speed bone surgical reamer during spinal fusion. Methods: a device for filtering bone chips is created, consisting of a flask and a filter element inside it, connected in parallel to the aspiration system. The device allows preserving a sufficient amount of bone-grafting material, which consists of bone tissue elements, fibrin clot, bone marrow cells, platelets, mesenchymal stromal cells and others. Results: a clinical example of its application at transforaminal interbody fusion at the level of the lumbar segment LIV–LV is presented. The device differs favorably from the known ease of assembly, reusability (possibility of repeated sterilization) and placement on the operating table. Conclusions: the application of a bone filter is appropriate in the case of spine decompression of a high-speed bone reamer, when the stage of surgery is bone grafting. Do not use the device in case of spine tumors, spondylitis, spondylodiscitis.
Vadym Chornyi, Natalia Polishchuk, Dmytro Kyryk
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 68-74; https://doi.org/10.15674/0030-59872020268-74

Abstract:
Infection complication as a result of metal alloys usage in surgery is a challenging problem in medical practice. The main infectious agents are staphylococci and enterococci, which have numerous pathogenic factors, including the ability to form biofilms on the implant surface. Objective: to study the antibacterial effect of magnesium alloy ML-10 as for antibiotic resistant strains of staphylococci and enterococci in order to substantiate the feasibility of its application in the surgical practice for implants facilitating the prevention of nosocomial infections. Methods: ML-10 magnesium alloy extract was used, as well as antibiotic resistant clinical strains of staphylococci and enterococci obtained from the wounds of patients with infection complications. During 120 hours’ incubation of the extract with bacteria, its antimicrobial activity was studied. Results: it was found that antibiotic resistant clinical strains of staphylococci and enterococci are sensitive to the products of the magnesium alloy ML- 10 biodegradation. In the process of the alloy biodegradation the formation of corrosion products occurred, which caused an increase pH of the medium from 7.2 up to 9.3. There was a significant decrease in the extract of the genera Staphylococcus and Enterococcus with an incubation time of 120 hours of thermostating. A decrease in the growth of the number of colonies on Mueller-Hinton agar was recorded after daily seeding from the extract. Conclusions: products of magnesium alloy ML- 10 biodegradation have antimicrobial effect on antibiotic resistant clinical strains of genera Staphylococcus and Enterococcus, which renders feasible the use of this metal for implants that facilitate the prevention of nosocomial infections.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 99-101; https://doi.org/10.15674/0030-59872020299-101

Abstract:
May 26, 2020 marks the 70th anniversary of the birth and 47 years of medical, scientific, pedagogical and social activities of the Academician of the National Academy of Medical Sciences of Ukraine, Honored Worker of Science and Technology of Ukraine, laureate of the State Prize of Ukraine, Head of the Department of Traumatology and Orthopedics of the Dnipropetrovsk Medical Academy, Doctor of medical sciences, professor Loskutov Aleksandr Yevgenievich.
Stanislav Bondarenko, Frieda Leontyeva, Dmytro Morozenko
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 61-67; https://doi.org/10.15674/0030-59872020261-67

Abstract:
Introduction: application of hyaluronic acid gel for intraarticular administration is actual topic of modern orthopaedic concerning to its therapeutical efficacy. Objective: to assess the influence of different concentrations of proFLEX® INTRA on the synovial fluid and biochemical blood markers in patients with the 2nd knee osteoarthritis stage in the different age groups. Materials and methods: 30 patients with Kellgren–Lawrence stage II knee osteoarthritis were examined. The first group consisted of 15 patients aged 40–50 years, in the second group the average age of patients was 50–70 years. Each group was divided into 3 subgroups (a, b, c) of 5 patients. In each group the first subgroup of patients received intra-articular 1 injection of proFLEX® INTRA 10 mg/ml 2.0 ml, І-b, ІІ-b — 12 mg/ml 2.5 ml, І-с, ІІ-с — 20 mg/ml 3.0 ml. Results: an inflammatory-dystrophic process in the knee joint of patients was found in both groups, which was more expressed in elderly patients. The dynamics of blood markers in patients of the 1st and 2nd groups after the treatment showed a decreasing the level of inflammatory and dystrophic processes in the knee joints. In the 1st group 1 month after intra-articular injection, the content of glycoproteins and chondroitin sulfates (CS) decreased, did not reach the normative values. In subgroup II-c the level of glycoproteins and CS decreased, the concentration of interleukin-6 (IL-6) remained elevated comparing to subgroups II-a and II-b. Conclusions: it was found that patients with stage II knee osteoarthritis had increased CS and lower levels of hyaluronic acid in their synovial fluid. Markers of inflammation (glycoproteins and IL-6) and destruction markers (CS) in the blood serum changed unidirectionally and indicated a decreasing in the activity of inflammatory process after the injection of hyaluronic acid gel, which was clinically confirmed 1 month after intra-articular injection. In this case, the results after the reexamination of blood biomarkers of patients aged 40–50 years indicated a higher efficiency of hyaluronic acid gel injection with a concentration of 10 and 12 mg/ml, aged 50–70 years — a concentration of 20 mg/ml was confirmed by a decrease in the level of glycoproteins, CS and IL-6 in the blood of patients.
Volodymyr Filipenko, Stanislav Bondarenko, Sergey Denisenko, Ahmed Badnaoui
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 55-60; https://doi.org/10.15674/0030-59872020255-60

Abstract:
Total hip arthroplasty (THA) at acetabulum defects is an actual problem of modern orthopaedics, as it is associated with multiple complications. Objective: to evaluate the results of porous titanium cups application in patients with acetabulum defects of various etiologies. Material and methods: there were 83 patients (98 hip joints) in the period from 2016 to 2019 with acetabulum walls defects who underwent cementless THA with the use of porous titanium acetabular cups with «pressfit» fixation with Trabecular Titanium Metal (pores sized from 600 to 800 microns, porosity 80 %, elastic modulus 12.9 GPa, friction coefficient 1.08). The average age of the patients was 55.7 years (34 to 80 years); 28 men and 55 women. The average body mass index was 28.6. The assessment of acetabulum defects was carried out according to D’Antonio classification. In all cases, lateral approach to the hip joint was used, acetabular components were implanted in the anatomical position with the restoration of hip rotation center. In 9 cases the reconstruction of acetabulum defects was performed with structural autografts, in 87 — spongy autografts, in 2 — a combination of these two grafting methods. Results: the average follow-up for patients was 23 months. The functional state of the hip joint according to Harris Hip Score increased from an average of 37 to 89 points. During the post-operative follow-up, radiological signs of the components’ instability were not detected. All patients showed a complete incorporation of autografts after surgery. Conclusion. The use of porous titanium acetabular cups «press-fit» fixation in THA of patients with defects of acetabulum walls gives the possibility to obtain positive clinical outcome of surgical treatment in the early post-operation period.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS; https://doi.org/10.15674/0030-598720202103

Abstract:
May 11, 2020 marked the 60th anniversary of the birth of Doctor of Medical Sciences, Head of the Department of Scientific and Medical Information of the State Institution «Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine» to Baburkina Olena Pavlivna.
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