Traumatology and Orthopedics of Russia

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ISSN / EISSN : 2311-2905 / 2542-0933
Total articles ≅ 586
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V. A. Artyukh, , A. A. Boyarov, Ju. V. Muravyova, A. A. Kochish
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-9-22

Abstract:
Background. Chronic periprosthetic joint infection (PJI) remains the one among the most severe complications of total hip arthroplasty. Presence of sinus tract assosiated with polymicrobial infection development, complexity of bacteriological diagnostics and damage of soft tissues lead to constrictions of one-stage revision hip arthroplasty (RHA). The aim of this studywas to assess the influence of draining sinus tract on the outcomes of one-stage RHA in patients with chronic hip PJI. Materials and Methods.A prospective cohort comparative study included 78 patients who underwent one-stage RHA in 2017-2020. Two groups were formed: 48 (61.54%) patients without sinus tract (WST) and 30 (38.45%) patients with sinus tract (ST). Results. The presence of a sinus tract significantly increased the duration of a one-stage RHA in groups of ST and WST (230 and 197.5 min respectively, p = 0.02), as well as blood loss (850 ml and 700 ml, respectively, p = 0.046). Sinus tract was a reliable symptom of soft tissue local infectious inflammation (86.67%, p = 0.00031), fasciitis (36.67%, p = 0.012), purulent cavity (66.67%, p = 0.00027). The structure of the pathogens was comparable. Monobacterial infections predominated in the WST group (82.98%) and in the ST group (77.78%, p = 0.08). In most cases staphylococci were isolated. The median follow-up was 20 months for both groups. The PJI was healed in 93.0% (n = 28) patients in WST group and 82.2% (n = 43) in ST PJI (p>0.05). Postoperative evaluation in the WST and ST groups: HHS 92 and 90 points (p = 0.79), EQ-5D-5L – 0.82 and 0.78 points (p = 0.84) respectively. The proportion of patients who were indicated revision surgery with no PJI association in the ST group exceeded this indicator more than twice according to the WST group — 25 and 11.62%, respectively (p>0.05). Conclusion.As a result of the study, there was no statistically significant difference between the outcomes of one-stage RHA in patients with and without sinus tract. Factors such as the anamnesis morbi, the soft tissues condition at the surgical site and the pathogenic microflora characteristics should be taken into account in order to achieve favourable outcomes of surgical treatment.
P. A. Berezin, ,
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-156-169

Abstract:
Traumatic hip dislocations occupy the fourth place among dislocations of various localizations and, as a rule, are the result of exposure to a high-energy traumatic agent. Such injuries are more often observed in young and middle-aged males. The main cause of hip dislocations is road accidents. The femoral head is more often dislocated posteriorly, but anterior dislocations are not casuistic and account for approximately 10%. Hip dislocations are often combined with acetabular fractures, while their fairly clear clinical picture in the presence of fractures can be leveled. Traumatic hip dislocations require urgent diagnosis and treatment. After the clinical examination of the patient, an x-ray of the pelvis and hip joints are performed. Radiographic diagnosis of hip dislocation remains relevant, but modern imaging methods allows to study the hip joint in more detail and identify concomitant injuries. The main treatment for hip dislocation is closed reduction. Early dislocation reduction and the absence of damage to the structures forming the hip joint are important for the treatment results prognosis. The further patient management tactics after the dislocation reduction is determined by the results of stress tests and the CT data. When confirming the instability and associated injuries of the hip joint anatomical structures, surgical treatment is indicated. Among the complications of hip dislocation: sciatic nerve damage, post-traumatic coxarthrosis, the femoral head avascular necrosis, heterotopic ossification. Current literature data indicates the importance of early diagnosis of dislocation-associated injuries of the hip joint and periarticular tissues. Early and comprehensive repair of all existing injuries is crucial for favorable outcomes. A number of therapeutic and diagnostic methods, primarily arthroscopy, show optimistic results, but need further study.
A. S. Tryapichnikov, A. M. Ermakov, T. A. Silantieva, A. V. Burtsev
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-23-33

Abstract:
Background. Periprosthetic infection is a devastating complication that influences the duration of treatment and patients life quality. Debridement, Antibiotics and Implant Retention (DAIR) is considered as least invasive surgery patients with stable implant, except cases of chronical periprosthetic infection. The aim of this study was to evaluate efficiency of surgical debridement and implant retaining in control over infection in group patients with early postoperative and acute hematogenous periprosthetic infections. Materials and Methods.We performed retrospective monocentral cohort study of treatment early postoperative and acute hematogenous periprosthetic infections of hip in 26 patients. The group included cases with stable implants and period between manifestation of infection and DAIR no more than 4 weeks. We have classified infection as early postoperative in 22 patients (84,2%) and as acute hematogenous in 4 cases (15,8%). Results.At mean follow-up 42,8±2,3 mounts five patients underwent removal of implant due to reinfection. We performed successful twostage revision for four of them and had to perform resection arthroplasty in one case. Thus, DAIR protocol was successful in 80,8(%) cases. The mean Harris Hip Score significantly improved compared to preoperative values from 59,2±2,5 to 80,5±1,3 at the last follow-up (p = 0,0002, Z-3,7). Conclusions.The efficiency of DAIR according to our data was 80,8%. These results allow to consider DAIR as a method of treatment of patients with early postoperative and acute hematogenous periprosthetic infections. Exchange of modular components can decrease the reinfection rate.
M. R. Salikhov, D. A. Shulepov, O. V. Zlobin, N. N. Dmitrieva, А. И. Мидаев
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-44-53

Abstract:
Background. There is not enough research on the topic of arthroscopic treatment of medial epicondylitis. Topographic studies are needed to justify surgical approaches with minimal trauma to the medial collateral ligament and ulnar nerve. The aim of the study was to optimize the arthroscopic treatment of medial epicondylitis and evaluate its clinical effectiveness based on the results of the topographic and anatomical study. Materials and Methods. The material for the topographic and anatomical study was 12 «fresh» anatomical preparations of the human elbow joint, of which 6 were taken from female cadavers, and 6 — from men. The features of the structure and topography of the elbow medial collateral ligament were studied, and the safety and effectiveness of arthroscopic approaches to the elbow for the flexor carpi radialis release were determined. A prospective cohort comparative study was performed, which included 70 patients. Two comparative groups were formed. In the group I (35 patients) surgical treatment was carried out by the open method. The group II included 35 patients who underwent minimally invasive surgical treatment using arthroscopic technique. The results were evaluated by Mayo Elbow Perfomance Score (MEPS) and VAS before surgery and 1, 6, and 9 weeks after. Results. Functional results in 9 weeks: group I — 81.77 (95% CI 81.13; 82.41); group II — 92.66 (95% CI 91.61–93.70) points. The average score for VAS in the same period: group I — 34.30 (31.89–36.68) points; group II — 1.5 (0.46–2.45) points. Conclusion. The safe zone is located above the midline of the humeroulnaris joint by 2 (1.0–3.2) mm. The risk of the medial ulnar collateral ligament anterior bundle injury is minimal in this area. Treatment of patients with the medial epicondylitis according to the developed arthroscopic technique can significantly improve the patients functional state and quality of life.
Т. А. Силантьева, A. M. Ermakov, A. S. Tryapichnikov
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-84-98

Abstract:
Background.The effectiveness improvement and standardization of the methods of histological diagnosing periprosthetic infection (PPI) is an urgent task in the treatment of complications after large joint arthroplasty. Purpose of the study— Histopathological evaluation of the infection involvement of periprosthetic tissues at the stage of revision arthroplasty for deep infection of the hip using HOES scale and immunohistochemical analysis of CD15 expression. Materials and Methods.A single-center prospective study was performed on the clinical intraoperative material obtained at the stage of revision arthroplasty of the hip in 27 patients at the age of 65 (55÷69) years. The group of examination included patients with acute and chronic forms of deep periprosthetic infection. Light-optical microscopic investigation of the samples of periprosthetic connective-tissue membrane and bone tissue from the foci of infectious involvement was made on paraffin sections stained with hematoxylin and eosin; with the immunohistochemical reaction to determine the expression of CD15 neutrophil granulocyte markers. HOES Scale for pathohistological assessment was used in order to objectify osteomyelitis signs in periprosthetic bone tissue. Results. The signs of acute and chronic stages of periprosthetic osteomyelitis were observed in 9/16 patients with PPI chronic course within 1–30 months of postoperative period, from one to 18 months after manifestation of the symptoms. The signs of subsided osteomyelitis were determined in 12/27 patients with PPI of acute and chronic forms. Infected periprosthetic membranes were found in 19/27 clinical cases in the early and longterm time periods after arthroplasty surgery. A direct significant correlation was revealed between histopathological signs of infecting the periprosthetic bone and the connective-tissue periprosthetic membrane, especially strong one in patients with acute and chronic PPI osteomyelitis. Conclusion. The use of HOES Scale and the analysis of CD15 expression ensure the objectivity of PPI histological diagnosing. The results obtained indicate an increased risk of osteomyelitis development in patients with chronic periprosthetic infection after the hip arthroplasty.
S. S. Rodionova, Yu. V. Buklemishev, I. N. Karpov, O. B. Shugaeva, A. N. Torgashin
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-114-123

Abstract:
Background. The rarity of the disease and, in this regard, the lack of doctors awareness about the pathology, late diagnosis and severe complications of the musculoskeletal system emphasize the relevance of clinical case demonstrating. The uniqueness of the case lies in the fact that hypophosphatemia, noted 3 years after the disease debut, was not taken into account. Case description. A 45-year-old patient with complaints of muscle weakness, gait disorders, torso deformity and multiple vertebral body fractures that appeared against the background of any somatic diseases absence, a differential diagnosis of metastatic vertebral bodies lesions and secondary osteoporosis complicated by vertebral body fractures was carried out for four years in various hospitals, and was even treated with bisphosphonates. Against this background, the chest deformity increased, kyphosis and remodeling fractures of other bones appeared. The assessment of calcium and phosphorus homeostasis was first performed at the 4th year of the disease, but the detected hypophosphatemia was not regarded as a manifestation of hypophosphatemic osteomalacia. Conclusion. Among adult patients with multiple low-energy fractures, severe muscle weakness and bone pain that appeared against the background of complete health, to exclude hypophosphatemic osteomalacia induced by mesenchymal tumor, it is necessary to include the level of phosphorus in blood and daily urine assessment in the diagnostic algorithm.
A. A. Korytkin, S. A. Gerasimov, K. A. Kovaldov, A. A. Pronskikh, A. V. Novikov, E. A. Morozova
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-132-143

Abstract:
Introduction. Main objective of total hip replacement (THR) is fast recovery of hip joint function and patient’s return to daily routines. Use of minimally invasive approaches (MIA) may help achieving set objective. The purpose of the study was to analyze and compare MIA in THR. Materials and methods. Databases of PubMed, Scopus, Cochrane Systematic Reviews, Google Scholar and E-library were searched for the period since 2000 to 2020. 55 scientific articles were selected for the analysis. Publications contain results of studies of MIA, such as Direct Anterior Approach (DAA), Micro-Hip (MH), Röttinger (R), Mini-posterior (MP), Direct Superior Approach (DSA), SuperCap (SC), PATH (P), SuperPATH (SP). The initial data were combined and underwent statistical processing. Results. A comparative analysis of MIA couldn’t identify superiority of any approach. Blood loss, length of hospital stay, functional outcomes (Harris Hip Score) at 3 and 12 months didn’t differ between the groups. Significant differences were found in the operation time between DSA and SP. Acetabular inclination was different between some approaches. Cup inclination in R and DSA, cup anteversion in DAA, MH and SP slightly exceeded Lewinnek's «safe zone». Recurrent dislocation, periprosthetic fractures, damage to the lateral cutaneous nerve are the most frequent postoperative complications. Conclusion: THR can be done using a variety of surgical approaches. The choice of approach relies on surgeon’s experience and personal preferences. Minimally invasive approaches have the advantage of short-term recovery due to the preservation of soft tissues.
S. S. Asachuk, O. S. Yakovleva, A. F. Martsinkevich, Е. A. Karpenkа
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-65-74

Abstract:
Background.Osteoporosis is the fourth most common disease after cardiovascular diseases, cancer, and diabetes. All these diseases have common pathogenetic mechanisms associated with impaired cholesterol metabolism. In recent decades, the use of the key enzyme of cholesterol synthesis inhibitors — statins, which can stimulate osteogenesis, has become widespread. However, statins affect the production of the vitamin D active form by reducing the production of testosterone and thus reducing the activity of 1α-hydroxylase. The combined use of statins and α-calcidol (α-C) for the osteoporosis prevention seems promising. The aim of the study was to evaluate the effect of long-term atorvastatin (ATV) and α-C administration on morphometric growth parameters and bone vascularization in the experiment. Materials and Methods. The experiment was conducted for three months on 120 laboratory male rats, which were injected daily intragastrically with ATV and α-C. After 90 days of the experiment, the animals were decapitated under ether anesthesia. For the study, the right femur and jawbone were taken from the animals. The rat bone sections were impregnated with silver, decalcified, and the histosections were stained according to van Gieson. The distribution of the studied features was evaluated according to the Shapiro-Wilk test. The differences were considered statistically significant at p<0.05. Results.It was found that ATV, both separately and together with α-C, increased the size of the newly formed bone in the endoostal and periosteal zones of the femur by 64.8; 40.4 and 15.8; 29.1%, respectively. The combined use of ATV and α-C had a positive effect on the growth of blood vessels in the femur (+23.4%). ATV increased the size of the newly formed bone from the periodontal and vestibular surfaces of the lower jaw by 18.3 and 29.5%, respectively. α-C potentiated the effect of ATV on the size of the newly formed bone tissue in the periodontal and vestibular growth zones of the mandibular bone by 10.1 and 15.0%, respectively. As for the number of vessels in the jawbone tissue, thanks to ATV, it increased by 17.2%, α-C had no effect. Conclusion. ATV increases the thickness of the newly formed bone layer in the growth areas of the femur and jawbone and increases the number of vessels in the jawbone. α-calcidol increases the number of vessels in the bone tissue of the femur and potentiates the effect of ATV on the jawbone growth zones. The combined use of ATV and α-C shows that they positively complement each other.
, С. Хужамурот Угли Исоков, А. Хужумурат Кизи Исокова
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-75-80

Abstract:
Background. Achieving a durable connection between the lacerated tendon ends is difficult. The outcome of treatment depends on many factors. Several authors consider the properties of the surgical needle used for suturing the tendon to be important. The aim of the study— to compare the strength of the tendon suture applied with the conventional cutting edge and reverse cutting edge surgical needles in the experiment. Materials and Methods.We used porcine tendons for the experiment. The tendon fragments were divided into 2 groups of 20 tendons each. On all 40 tendons, the same type of “injury” of the tendon was simulated — using a scalpel. In the first group, the interrupted suture of the tendon was applied with a cutting edge surgical needle, in the second group — reverse cutting edge. Laboratory tests of the tendon sutures strength were performed on the improvised stand. Results.In the first (suture made with a cutting needle edge), diastasis of 2 mm was determined at an average load of 1219.5 g (m = ±76.56, where «m» is the representativeness error). Complete suture failure occurred at an average load of 1770.8 g (m = ±100.02). In this group, the thread rupture was not recorded. In the second group (a suture made with a reverse cutting edge needle), diastasis occurs with an average load of 1754.75 g (m = ±77.32). Complete suture failure occurred at an average load of 2571.25 (at m= ± 103.78). In three cases, the thread ruptured. In the second group (reverse cutting edge needle), the tendon suture strength was statistically significantly higher than in the first group. Conclusion. The tendon suture strength depends on the surgical needle properties. In tendons reconstruction the reverse cutting edge needle use is more preferable compared to the conventional cutting edge needle use.
, E. M. Gordina, M. A. Markov, A. V. Afanasyev, V. A. Artyukh, K. V. Malafeev,
Traumatology and Orthopedics of Russia, Volume 27; https://doi.org/10.21823/2311-2905-2021-27-2-54-64

Abstract:
Background.Local prevention of periprosthetic infection and treatment of infectious complications after various joints arthroplasties includes the use of polymethylmethacrylate-based spacers impregnated with antimicrobial agents. At the same time, the added components are able to change the bone cement characteristics and have variable antimicrobial effect duration. The aim of the studywas to evaluate the duration of antimicrobial activity and the effect on the MRSA ATCC 43300 biofilm formation on bone cement samples with gentamycin impregnated with vancomycin and/or highly dispersed silver. Materials and Methods.Samples were made from bone cement DePuy CMW 1 Gentamicin and mixed with vancomycin and/or highly dispersed silver. The elemental composition was studied by scanning electron microscopy and micro-x-ray spectral analysis. The study of the antimicrobial activity duration was performed by daily applying an incubation solution with samples to the bacterial lawn surface. The effect on biofilm formation was evaluated by immersing the test samples in LB-broth with MRSA. Results.The control samples did not have antimicrobial activity (AMA) against MRSA ATCC 43300. Test samples, additionally containing 10 wt.% of vancomycin was effective for 9 days. When adding highly dispersed silver, the lengthening of the samples activity time was recorded. So, when applying 2.5 wt.% of highly dispersed silver, the duration of AMA was 21 days, and when increased to 10 wt.% — 34 days. Energydispersion analysis of the sample surface with 10 wt.% of vancomycin and highly dispersed silver showed that the skeletal structure type contains matrix component based on barium sulfate with silver inclusions. During the study of the samples effect on a typical strain biofilm formation, no statistically significant differences were found between the optical density of gentian violet extracts in the negative control and in the medium with MRSA. Conclusion. The vancomycin with highly dispersed silver combination prolonged the antimicrobial activity of the samples against MRSA ATCC 43300 and effectively prevented the formation of microbial biofilms on its surface. Despite the fact that the conditions of the conducted experiment in vitro are not identical to the conditions of bone cement antimicrobial spacers clinical use, our results indicate the need to use spacers with a known duration of antimicrobial activity and to comply with the terms of temporary structures replacement.
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