Traumatology and Orthopedics of Russia

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ISSN / EISSN : 2311-2905 / 2542-0933
Total articles ≅ 572
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А. А. Белокобылов, N. D. Batpenov, S. S. Balgazarov, V. D. Serikbayev, A. A. Krikliviy, S. V. Plotnikov, , D. V. Rimashevskiy
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-175-182

Abstract:
Background. There are few cases of entire femur modular replacement with hip and knee joints in patients with periprosthetic joint infection (PJI) in literature. They report encouraging results in patients of elderly and senile age. We present case of a copper-coated femoral spacer implantation to 50-year-old patient with multiple PJI episodes and osteomyelitis of the entire femur. Clinical presentation. A 40-year-old male patient after resection of the proximal part of the right femur for fibrotic osteodysplasia underwent total hip arthroplasty with replacement of 15 cm of the femur. In December 2010 (20 months after implantation), instability of the femoral component developed, revision arthroplasty was performed with stem recementation. After 4 months, sinus tract formed in the area of the postoperative scar. After another 4 months, the head of the prosthesis was dislocated. In September 2011, the endoprosthesis components were removed and a unipolar cement spacer was implanted. The limb immobilized in a hip spica cast. Methicillin-sensitive S. epidermidis (MSSE) was detected in the preoperative joint aspiration puncture and periprosthetic tissues. After 3 months (December 2011), patient underwent revision total hip arthroplasty (25 cm defect was replaced). 5 years of PJI remission followed. In November 2016 after PJI recurrence the endoprosthesis was removed, and an articulating spacer was implanted. P. aeruginosa was detected in periprosthetic tissues. For the past 2.5 years there were periodically sinus tracts formations. In August of 2019 spacer’s migration resulted in an intercondylar fracture of the right femur. In September 2019, spacer was removed, and MSSE was detected in the surrounding tissues. An articulating cement spacer based on an oncological modular total femur coppercoated endoprosthesis was implanted. At each control examination during the year copper concentration in blood serum was determined, it did not exceed 900–1200 mcg/l. No local or systemic side effects were detected. The patient started working 3 months after surgery. After 6 months poor functioning sinus tract formed in the postoperative scar area in the lower third of the thigh. 1.5 years after the operation, the functional condition is satisfactory. Conclusion. The use of the copper-coated spacer based on modular total femur endoprosthesis with hip and knee joints in a patient with multiple PJI allowed to improve the function of the limb and reduce the severity of the infectious process. No local or systemic toxic effects of copper were detected.
, E. V. Preobrazhenskaia, N. S. Nikolaev
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-86-96

Abstract:
Background. Stimulation of osteogenesis (SO) by biophysical methods has been widely used in practice to accelerate healing or stimulate the healing of fractures with non-unions, since the middle of the XIX century. SO can be carried out by direct current electrostimulation, or indirectly by low-intensity pulsed ultrasound, capacitive electrical coupling stimulation, and pulsed electromagnetic field stimulation. SO simulates natural physiological processes: in the case of electrical stimulation, it changes the electromagnetic potential of damaged cell tissues in a manner similar to normal healing processes, or in the case of low-intensity pulsed ultrasound, it produces weak mechanical effects on the fracture area. SO increases the expression of factors and signaling pathways responsible for tissue regeneration and bone mineralization and ultimately accelerates bone union. The purpose of this review was to present the most up-to-date data from laboratory and clinical studies of the effectiveness of SO. Material and Methods. The results of laboratory studies and the final results of metaanalyses for each of the four SO methods published from 1959 to 2020 in the PubMed, EMBASE, and eLibrary databases are reviewed. Conclusion. The use of SO effectively stimulates the healing of fractures with the correct location of the sensors, compliance with the intensity and time of exposure, as well as the timing of use for certain types of fractures. In case of non-union or delayed union of fractures, spondylodesis, arthrodesis, preference should be given to non-invasive methods of SO. Invasive direct current stimulation can be useful for non-union of long bones, spondylodesis with the risk of developing pseudoarthrosis.
V. V. Khominets, R. V. Deev, A. L. Kudyashev, , D. A. Shakun, A. V. Komarov, I. Yu. Bozo, A. V. Schukin,
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-66-74

Abstract:
Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions. Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points. Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.
R. V. Gladkov, V. V. Khominets
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-106-120

Abstract:
The aim of the study — to evaluate clinical outcomes, complications, bone-block healing, positioning and subscapularis muscle insufficiency after modified mini-open arthroscopically assisted Bristow - Latarjet - Bankart procedure. Materials and Methods. The study included 133 patients who underwent modified mini-open arthroscopically assisted Bristow - Latarjet - Bankart procedure, assessed the functional outcome using the Rowe and Walch-Duplay scales, the range of motion and stability of the joint, and the function of the subscapularis muscle. All patients underwent CT, 82 patients were assessed for MR-signs of subscapularis muscle atrophy. Results. All patients were satisfied with the treatment results. The mean value on the Rowe scale increased from 35.7 [31,2; 41,0] to 91.3 [82,1; 96,8] (38 to 100 Me 90) (p<0.001) and on the Walch-Duplay scale from 41.5 [34,2; 44,5] to 88.9 [80,4; 97,2] (32 to 100, Me 88) (p<0.001). In 2 (1.5%) patients, shoulder dislocation recurred, in 9 (6.8%) patients, a positive test of premonition of dislocation or periodic feelings of instability were observed. There were no persistent contractures. In 6 (4.5%) cases, the graft was located medially and in 3 (2.3%) cases — laterally. The average α-angle was 14° [5°; 24°] (2° to 39°, Me 15). The proportion of the graft area lost due to resorbtion was 19% [9%; 30%] (from 6 to 58%, Me 20). Nonunion of the graft was observed in 4 (3.0%) patients, 2 (1.5%) of whom had a fracture and bone block migration. A significant (p = 0.021) decrease in the intensity of the MR-signal of the subscapularis muscle was observed, most pronounced in the lower portion. In 9 patients with a positive test of anticipation of dislocation or sensations of instability, the degree of bone block resorption (p = 0.038) and MR-signs of atrophy of the upper and lower portions of the subscapularis muscle were significantly higher (p = 0.031 and p<0.001), and the results of stress testing significantly worse (p<0.001) than in 122 patients without signs of instability. Conclusion. The results of this study show the efficacy of the modified arthroscopically-assisted Bristow - Latarjet - Bankart procedure in patients with large bone defects, when the soft tissue technique is not a reasonable option.
S. A. Rokhoev,
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-185-197

Abstract:
Relevance. Knee contractures have an impact on quality of life and are also a common cause of disability. The use of external fixation devices has a certain place in the treatment of this pathology. Purpose. Using the world literature, to identify the modern position, problems, and prospectives of external fixation in the treatment of knee flexion and extension contractures in adult patients. Methods. EMBASE, Medline, Google Scholar, PubMed, e-LIBRARY, and Cyber resources were used. The analysis included publications relative treatment of knee joint stiffness using external fixation in patients over 18 years old, regardless of gender. At analysis several criterial were used: frame ability to provide movements in the knee joint according with its natural kinematics (biomechanics), stable fixation of the femur and tibia, and possibility inserting wires and halfpins in projection of Reference Positions (RP). Results. The devices used in the treatment of knee joint contractures in adult patients were conditionally divided, depending on the type of hinge, into 4 groups: non-hinged, uniaxial, reproducing, and virtual. It has been established that only orthopedic hexapods, based on virtual hinge, can meet all of the criteria mentioned above. However the technology of any orthopedic hexapod hardware and software usage for the treatment of contractures of the knee joint, was not developed till now. Conclusion. The necessity of developing hex-based technology for treatment patients with knee joint contractures was justified by world literature review. Hexapod hardware must provide possibilities of any inclination angle of any ring, and struts fixation not only to base and mobile rings, but to stabilizing as well. Software should be equipped with multi-total residual option. Ortho-SUV Frame (OSF) meets these requirements.
E. A. Shchepkina, I. V. Lebedkov, Г. И. Нетылько, , L. O. Anisimova, V. V. Trushnikov, I. V. Sushkov
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-19-36

Abstract:
Background. The methods of “lengthening over the nail” (LON) and the sequential use of the external fixation and nailing in the option “lengthening and then the nail” (LATN) are characterized by ignoring non-observance of the formulated by G.A. Ilizarov is the most important condition for optimizing the osteogenesis process, namely, the preservation of medullary blood supply and osteogenic bone marrow tissue. At the same time, in clinical practice, there was no negative effect of the intramedullary nail on the formation of the regenerate. In experimental studies, the activation of periosteal bone formation during LON is noted. But the active periosteal bone formation detected in clinical practice with a sequential technique has not been confirmed by experimental studies. The aim of the study was to compare the organotypical rebuilding of the distraction regenerate during tibial lengthening in rabbits according to Ilizarov, over the intramedullary fixator and with the sequential use of the external fixation and nailing. Materials and Methods. The study was carried out on 54 mature rabbits of the Soviet Chinchilla breed, which were divided into 3 groups of 18 animals. In Gr-1 (control), the tibia was lengthened by 1 cm in a mini-Ilizarov apparatus at a rate of 1 mm per day for 4 sessions step. In Gr-2, the LATN technique was modeled. After the end of lengthening, an intramedullary fixator was implanted installed, the apparatus with the presence of wires only in the base supports was kept as an imitation of blocking the intramedullary fixator. In Gr-3, lengthening was performed over the intramedullary fixator; at the end of lengthening, the wires were left only in the base supports. The fixation period was is 30 days. The total duration of the experiment is 45 days. On the 10th, 15th, 20th, 30th, 45th day X-ray, CT and morphological studies were performed during the experiment. Results. In the experimental groups, a more pronounced periosteal bone formation in the area of regenerates was noted, while in Gr-3 (LON) cortical plates were formed mainly from the periosteal component, and in Gr-2 (LATN) wide cortical plates were formed from the intermediate and periosteal areas. In this group, the maximum densitometric density values are noted. Endosteal bone formation was preserved in all groups. Conclusion. The LON and LATN techniques, when compared with the classical Ilizarov lengthening, do not demonstrate any deficiency in the organotypical rebuilding of the bone tissue of the regenerates. All zones of bone formation are present, including endosteal, with intense periosteal bone formation. The most powerful bone structures are formed with the sequential use of the external fixation and nailing (LATN) in the form of the formation of wide cortical plates due to the intermediate and periosteal zones of the regenerate.
L. A. Cherdantseva, E. A. Anastasieva, , ,
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-53-65

Abstract:
The aim of the study was to evaluate in vitro the effect of native and deproteinized compact and spongy allogenic bone matrices on the characteristics of adipose mesenchymal stromal cells (ASC) in combined tissue engineering. Material and Methods. 24 samples of native and deproteinized compact and spongy bone were examined, which were exposed to mechanical treatment, modeling, followed by sterilization of the samples by ionizing radiation and bacteriological control of sterilization. Some of the samples underwent deproteinization. The characterized cultures of human ASC were used as test cultures to assess the interaction with the bone samples. The Cytation-5 fluorescent imager and Hoechst 3334 fluorochromes (BD Pharmingen™) and calcein (Calcein AM, BD Pharmingen™) were used to characterize the degree of adhesion, migration, and viability of ASC on bone matrix samples. Matrix cytotoxicity was evaluated by MTT assay on days 1 and 7 of extraction. Results. The bone matrix samples are characterized by the absence of cytotoxicity (rank 1). ASC demonstrated good adhesion and migration on any surface of the bone matrix and preservation of cell viability during 7 days of observation. Nuclei sizes of the cells adhered to the deproteinized bone matrix of the spongy structure increased by 25–30% compared to other samples. The cells on deproteinized bone matrix had greater size (the size of the cells from nuclei 8.8 to 11.5 μm, the average size of cells nuclei from an 86.3 μm to 129,0 μm, the average perimeter of the cells nuclei from 30.7 μm to 40.7 μm) than in the native bone matrix samples. Conclusion. The results of the study of various allogeneic bone matrices demonstrate that deep purification of the bone matrix determines the absence of cytotoxicity and the most favorable conditions for the adhesion, migration, proliferation and viability of ASC. Also makes it possible to use tissue engineering based on bone matrices of different structures. Deproteinized spongy bone matrices are best suited for this purpose.
N. A. Shchudlo, , M. M. Shchudlo, D. A. Ostanina
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-166-174

Abstract:
Background. The data available in the literature on the features of the clinical course and functional prognosis of Dupuytren`s disease in women is contradictory, there are no data on comparative pathomorphological studies of palmar fibromatosis in men and women. The aim of the study was to identify possible differences in the clinical and pathomorphological characteristics of Dupuytren`s disease in men and women. Materials and Methods. 228 cases of men and 39 women (6:1) who underwent fasciectomy in 2013–2019 period were analyzed. Histomorphometry of paraffin sections of the patient`s palmar fascia specimens of 24 men and 24 women was performed. Results. Men ranged in age from 26 to 83, the median age is 3 years more in women (p<0.001), but the median age of Dupuytren`s disease debut is 2 years less in women (p<0.001). The frequency of contractures of the 3rd–4th degree was 35.9% in the group of women and 65% in the group of men (p<0.001). In the group of women the frequency of both hands involvement is 15.2% higher, I–III fingers involvement is 8.7% higher, recurrent contracture is 11.1% higher (p<0.1). Histomorphometric analysis of the patient`s palmar fascia specimens showed that women compared to men had 10.23% less adipose tissue (p<0.001), 7.87% less dense connective tissue (p<0.05), but the proportion of hyperplastic connective tissue was 20.31% higher. Conclusion. Dupuytren`s disease is less common in women, than men. Women seek surgical treatment earlier than men. The tendency to functional limitations intensification and the risk of recurrence in women is associated with higher expression of hyperplastic changes in the fascial structures of the hand.
V. Yu. Murylev, N. E. Erokhin, P. M. Elizarov, G. A. Kukovenko, A. V. Muzychenkov, S. S. Alekseev, L. R. Ivanenko
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-153-165

Abstract:
Background. Among the methods of surgical treatment of early stages medial knee osteoarthritis in the partial knee replacement (PKR) becomes more and more relevant. The relevance and increasing number of PKR are confirmed by data from various national registers. The aim of the study was to research the early functional results of PKR and to analyze the complications at various stages of the postoperative period. Material and Methods. Study design: a single-center prospective study. The results of 90 operations of PKR in the period from March 2018 to April 2020 are presented. Assessment of knee function and quality of life of patients was performed according to three scalesquestionnaires: KOOS, WOMAC, SF-36, which were filled in preoperatively and then at 3, 6, 9, 12, 18 months. after surgery. Patients within the reporting period provided X-rays and filled in the scales at the face-to-face examination and at remote contact. Results. The most significant improvement of quality of life and median values of the functional results observed after 3 months, and after 18 months. After replacement the best median functional outcome scales KOOS, WOMAC, SF-36 — 79,4 (73,6–84,3); 27,1 (24,8–30,6); 89,1 (85,3–92,6) compared with the functional results obtained before surgery 32,3 (22,8–38,4); 73,6 (63,6–78,8); 35,2 (31,3–42,1); p = 0,027; p = 0.023; p = 0,028, respectively. A negative correlation was obtained between BMI and functional outcome (p = 0.027, R = -0.7). Conclusion. PKR allowed us to achieve an improvement in the quality of life and functional results already in the early postoperative period (from 3 to 18 months after the operation). The improvement of the operating technique, the analysis of errors and the regularity of the performed PKR will improve the results of PKR and minimize the number of complications.
A. A. Korytkin, Ya. S. Novikova, Yo. M. El Moudni, K. A. Kovaldov, S. A. Gerasimov, E. V. Gubina
Traumatology and Orthopedics of Russia, Volume 27; doi:10.21823/2311-2905-2021-27-1-131-142

Abstract:
Background. Pelvic osteotomies are widely used for treatment of young active patients with developmental dysplasia of the hip (DDH) Type I according to the Crowe or type A according to Hartofilakidis classifications and the absence of severe degenerative cartilage lesions. Nowadays, Ganz periacetabular osteotomy (PAO) is the most common choice of surgeons around the world in treatment of such patients. The aim of the study was to evaluate the radiological and functional results of Ganz periacetabular osteotomy in patients with DDH. Material and Methods. A single-center retrospective analysis of 49 Ganz PAO was performed in 43 patients aged 36±9 years. The radiological evaluation criteria were Wiberg (AW), Lequesne (AL), Tonnis (AT) angles, and joint medialization. The results of treatment were evaluated using the Harris scale, iHOT-12, and VAS before treatment and 1 year after, the presence of complications was also monitored. Results. The average follow-up period was 35±15 months (from 1.0 to 6.9 years). Radiological parameters improved after surgery compared to preoperative ones: AW +19.9° (17.1° vs. 37.0°), AT -11.5° (19.9° vs. 8.4°), AL +14.1° (25.1° vs. 39.2°), joint medialization -5.5 mm (14.3 mm vs. 8.8 mm) (p<0.001). Functional results and quality of life of patients also improved: the Harris scale +35.6 points (47 vs 83 points), iHOT-12 +40.9 points (44 vs 85 points), pain level -2.8 points (5 vs 2 points) (p<0.001). Various complications developed in 20 out of 49 cases (40.8%). Neurological complications were resolved conservatively (22.4%). A direct correlation was evaluated between the surgical treatment of DDH in childhood and the development of neurological complications after PAO (R = 0.76; p<0.001). In 9 cases out of 49 (18.4%), revision surgery was required: in 3 — total hip replacement, in 2 — reorientation of the acetabulum, in 4 — arthroscopic fixation of the anterior articular lip. In 93.9% of cases native hip joint surfaces were preserved. Conclusion. Ganz PAO has good reconstructive capabilities and sufficient efficiency. The operation allows to restore the coverage of the femoral head with the acetabulum, delays total hip replacement and provides improved functional results.
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