ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS

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ISSN / EISSN : 0030-5987 / 2518-1882
Total articles ≅ 10,296
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Inga Fedotova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 109-111; doi: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; doi: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; doi: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; doi: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.
Nataliya Prytula, Inga Fedotova, Iryna Korzh
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 64-71; doi: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; doi: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; doi: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; doi: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; doi: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; doi: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.
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