ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS

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ISSN / EISSN : 0030-5987 / 2518-1882
Current Publisher: Orthopaedica, Traumatology, and Prosthetics (10.15674)
Total articles ≅ 1,093
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Sergij Bezruchenko, Olexij Dolhopolov, Igor Lazarev, Olexij Chkalov, Maryna Yarova
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 19-28; doi: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; doi: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.
Maksym Golovakha, Serhiy Maslennikov
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 11-18; doi: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; doi: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
Oleg Vyrva
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 114-116; doi: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
Vadym Sulyma, Roman Bihun
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 89-92; doi: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.
Sanjar Kochkartaev, Shahaidar Shatursunov, Elena Danilova, Natalija Osinskaya
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 29-35; doi: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.
Traumatology And Prosthetics" Staff Of "orthopaedics
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 108-109; doi: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.
Sergiy Khmyzov, Anton Gritsenko, Mykhaylo Karpinsky, Olena Karpinska, Igor Subbota
ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS pp 5-10; doi: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; doi: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.
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