Calcific tendinitis of the rotator cuff is a common disorder and can be successfully treated with non-operative techniques in most cases, although surgical management should be considered in some patients for adequate calcium removal. No clear consensus exists regarding whether the involved tendinous portion to be repaired or not with suture following the deposit removal. The purpose of this study is to evaluate and compare results of re-fixation and debridement of the rotator cuff tendons after calcium removal. Material and methods The study is a retrospective analysis of case histories, operation protocols, magnetic resonance images and radiographs of the shoulder of 19 consecutive patients diagnosed with calcific tendinitis that was surgically treated at our clinic between 2013 and 2016. The median age of the patients was 52 years. All patients were divided into two groups depending on the surgical treatment performed. Calcium deposit was removed and the rotator cuff sutured in patients of the main group, and calcium was removed and the rotator cuff debrided in controls. Results Outcomes were rated as excellent with OSS in 58.3 %, as good in 33.3 % and satisfactory in 8.4 % of the patients in the main group. Controls showed 28.6 % of excellent outcomes and 71.4 % of good results. Excellent ASES shoulder scores were recorded in 91.6 % of the patients in the main group and 8.4 % had satisfactory results. Excellent results were achieved in 71.4 % of controls and 28.6 % had good results. No poor outcomes were observed in the patients. No statistically significant differences were found between the groups. All patients of the main group completely regained the function up to 100 % at a follow-up visit. However, the median time required to regain function by 50 % was 3 months (interquartile range 2:6) after surgery in patients of the main group and 1.5 months in controls. There was a correlation revealed between persistent history of calcific tendinitis and dimensions of the deposit according to the Bosworth classification. Conclusion A type of calcium deposit identified with radiological classifications was shown to have no impact on outcomes. Patients who underwent no repair of the rotator cuff achieved 50 % recovery of the shoulder function almost twice as quickly as those with repaired tendon. No statistically significant differences in outcomes were found between the groups but patients of the main group showed higher scores measured with patient-reported outcomes. More research needs to be carried out on a variety of techniques before definitive conclusions can be made on strategies of surgical treatment of calcific tendonitis.

Juvenile arthritis is a severe inflammatory disease of pediatric musculoskeletal system that leads to the development of contractures, early disability and loss of joint function. An isolated elbow injury in children with juvenile arthritis (JA) is a rare condition that is diagnosed at a late stage and has a poor prognosis. Early diagnosis using a variety of imaging modalities is vital for maintaining elbow function and decreasing disability rate in children. Objective To specify diagnostic methods and clinical and laboratory tests that allow visualization of JA-specific signs in pediatric elbow. Material and methods The retrospective study included 15 children who received treatment for chronic arthritis of the elbow joint. Clinical and instrumental findings, dynamics in articular syndrome and efficacy of antirheumatic therapy were evaluated. Results and discussion The study allowed us to reveal specific features of elbow injury in children with JA. 1. The onset associated with an injury to the upper limb and ‘mute’ laboratory tests were observed in more than 80 % of the cases. 2. Clinical examination of patients with JA showed absence of morning stiffness and evident pain, dry synovitis and joint contracture in most of the cases. 3. Radiological evaluation exhibited early erosion of the subchondral bone at the articular surface of olecranon. 4. There was a slight monotherapeutic effect on elbow joint synovitis noted with NSAID use. 5. Diagnosis of pediatric chronic arthritis of the elbow joint suggests a complex approach to evaluation of clinical and instrumental findings and their dynamics taking into consideration age related specific anatomy of the elbow that can facilitate detection of the underlying cause of chronic arthritis.

Introduction Improving the approaches to treating patients with hammer toe deformity is a relevant task. The problems of its management are a lack of uniform approaches to treatment, a significant number of complications and low patient satisfaction with the results of treatment. A frequent complication of its surgical treatment is a residual abduction deformity of the second toe. However, the available literature does not adequately cover the treatment of this pathology, and the methods of surgical correction have serious shortcomings. In this regard, the aim of the study was to evaluate the efficiency of the original method for correcting the abduction deformity of the second toe. The proposed approach is based on strengthening the medial capsulo-ligamentous structures of the metatarsophalangeal joint with the tendon of the brevis extensor digitorum muscle. Material and methods Treatment of 26 (100 %) patients operated for abduction deformity of the second toe at the Novosibirsk Research Institute of Traumatology and Orthopedics in 2016 and 2017 was analyzed. The index group included 15 (58 %) patients in whom the residual deformity was corrected according to the method proposed. In the comparison group of 11 (42 %) patients, the capsulotomy method of the second metatarsophalangeal joint with transarticular Kirschner wire fixation was used. The study utilised clinical, radiological, surgical, functional and statistical methods. Final treatment results were evaluated one year after the operations. Results The use of the traditional method of abduction deformity correction in the comparison group demonstrated its extremely low efficiency. On the other hand, in the index group there were 13 (86.6 %) good results, one (6.7 %) was fair and one (6.7 %) was poor. Discussion Many authors state the importance of restoring the capsulo-ligamentous complex of the metatarsophalangeal joint while correcting the toe deformity in the plantar plane. The method proposed by us enables to avoid residual deformities due to a number of technical merits with good clinical and functional results.

Introduction One of the most common causes of revision hip arthroplasty is aseptic instability of the primary implant. The acetabular component of the implant is less stable, even if fixed with bone cement. Two merits of cemented replacement are important for practical activity of an orthopaediс surgeon: its need for elderly patients and its low cost. In this regard, it is important to predict aseptic instability of the acetabular component and increase its survival by improving the methods of cemented fixation. Purpose To develop a method of predicting the probability of revision hip arthroplasty with replacement of the acetabular component. Materials and methods We studied 102 patients who underwent total cemented hip arthroplasty. Six clinical and radiological criteria were identified associated with revision after 10 years using a multifactorial pathometric analysis. Results A system was developed that allows integral calculation of the probability of revision hip arthroplasty with replacement of only the acetabulum component. The retrospective analysis confirmed the prognosis in 83.3 % of clinical cases. Conclusion The method proposed for prediction allows for a differentiated approach to cemented fixation of the acetabular component in primary arthroplasty, minimizing the probability of revision in 10 years.

Objective To explore the gluteal muscles in patients with avascular necrosis of the femoral head and Legg-Calve-Perthes disease using magnetic resonance imaging (MRI). Material and methods MRI was used to examine gluteal muscles in 20 patients with avascular necrosis of the femoral head and Legg-Calve-Perthes disease. There were 8 female and 12 male patients aged from 6 to 18 years. Results The extent of MRI changes detected in femoral abductors of patients with avascular necrosis of the femoral head and Legg-Calve-Perthes disease was dependent on the grade and onset of the disease and patient age. There were differences found in thickness, length and area of the m. gluteus maximus, m. gluteus medius and m. gluteus minimus in unilateral involvement. Maximum changes were revealed in children aged 14-17 years with grades 3 and 4 of the disease. There was a greater decrease in length of m. gluteus minimus as compared to that of m. gluteus medius. Conclusion The findings revealed anatomical (area, thickness, length) and radiomorphological changes in the gluteal muscles of patients with avascular necrosis of the femoral head and Legg-Calve-Perthes disease that were dependent on the grade and onset of the disease and patient age, and indicated to close relationship between anatomy and function of the joint and muscles.

Introduction The incidence of forearm deformities in children with multiple hereditary exostoses (MHE) ranges from 30 to 80 %. There are few studies of deformities of the forearm in MHE patients in the literature that describe not only the location of exostoses and position of the head of the radius but also the true variants of forearm deformities. The aim of the study was to investigate forearm bone deformities in patients with multiple hereditary exostoses. Materials and methods Radiographs of the bones of the forearm in 84 patients (151 limbs) diagnosed with multiple hereditary exostoses in the age of four to 17 years who were treated at our institute from 2004 to 2018 were retrospectively analysed. The study involved 47 boys and 37 girls; 67 patients (80 %) had bilateral lesions, and 17 patients (20 %) had lesions of only one upper limb. Patients were divided into four groups depending on the type according to the Jo and Jung’s classification. The deformities were evaluated based on radiological methods in accordance with the reference linesand angles for the forearm bones. Results The most common variants of forearm deformities were revealed: varus recurvatum at the border of the upper and middle third of the ulna (55 %), varus recurvatum at the border of the upper and middle third of the ulna associated with varus of the radius in the middle third (15 % of cases); as well as their combinations accompanied by dislocation or subluxation of the radial head (30 %). RAA (radial articular angle) and RB (radial bowing) did not have significant difference in various types of deformities of the forearm according to Jo and Jung’s classification. Conclusion The study of the variety of forearm deformities in children due to multiple hereditary exostoses will assist in a differentiated approach to the choice of surgical treatment methods depending on the type of deformity.

To interpret the clinical gait analysis (CGA), it is necessary to associate changes in gait with clinical impairment and differentiate the primary deviations in the gait stereotype from compensatory adaptive changes. Purpose To assess the pathological elements of the locomotor profile according to video gait analysis and clinical examination of patients; to compare the abnormalities identified in gait kinematics with the probable clinical causes of these abnormalities. Materials and methods Clinical examination and assessment of the locomotor profile with video gait analysis (CGA) were performed in 46 children (92 limbs) with bilateral spastic types of cerebral palsy (25 boys, 21 girls). We used 6 Qualisys Oqus cameras and one AMTI dynamometric platform (Advanced Mechanical Technology Inc., Watertown, MA, USA) with passive marker video capture technology. The IOR model was used for installing markers. The patterns of the locomotor profile adopted by the Delphic Convention were analyzed. The assessment of diagnostic coincidences or discrepancies was evaluated as percentage rates. Results The portion of the pathological elements of the locomotor profile identified according to the video gait analysis and clinical examination of patients is presented in the tables. The positive ratio of the pathological elements of the locomotor profile identified according to the video gait analysis and clinical examination of patients averaged 66.7 %. The lowest error rate: when assessing the limitation of the range of motion of the ankle joint and hip joint there were 82.6% and 81.8% of positive results, respectively. Discussion Clinical gait analysis (CGA) is crucial in controversial situations regarding detorsion osteotomies in multilevel operations. Conclusions Muscle retraction is the main (primary) clinical sign leading to positional kinematic deviations in joints and segments. The limitation of the range of motion in the knee and ankle joints due to muscle retraction results in secondary contractures of these joints.

Introduction Cerebral palsy is the most common cause of motor disorders that occurs in early childhood and is present throughout life. The incidence rate of the disease is 1/500 newborns. About 17 million people with cerebral palsy live in the world. According to domestic epidemiologists, the reported incidence of cerebral palsy in Russia is from 2.2 to 3.8 per 1,000 births. Spastic cerebral palsy types are 80% of all the cases. Purpose Analysis of changes in the kinematic parameters of gait after multilevel interventions in children with cerebral palsy with the initial true equinus gait and jump gait patterns. Material and methods This retrospective study included 64 children (26 girls, 38 boys) with cerebral palsy and spastic diplegia. The average age was 8.7 ± 2.41 years. All patients corresponded to levels I or II of impaired motor function (GMFCS: I/II = 14/50). Results All patients showed a significant improvement in the kinematic parameters of gait throughout the observation period. Deviation from the normal values decreased almost four times in the whole group of patients. Conclusion Multilevel single-event orthopedic interventions improve the kinematic and kinetic parameters of the gait of the entire biomechanical chain in the lower extremities. In addition to the local effects of surgical interventions (elimination of orthopedic disorders such as contractures and deformities of bones and joints of the lower extremities), there are long-term changes in the reduction of energyconsumptive compensatory movements.

Purpose To evaluate the changes in gait parameters in patients over 16 years old with cerebral palsy who underwent detorsion osteotomy in the lower extremities as part of multilevel interventions. Materials and methods This retrospective study evaluated functional treatment results of 32 adolescents and adult patients (average age, 23.4 ± 6.5 years). Included were patients with cerebral palsy, able to move independently and having clinically significant torsion deformities of the lower limb bones. Exclusion criteria were age younger than 16 years, as well as patients with stiff knee gait and crouch gait. All patients underwent multilevel single-event surgical interventions, including detorsion osteotomy. Gait analysis using the Edinburgh visual gait score was conducted before surgery, and 1.5–2 years after the interventions. Patients were divided into group 1 who had no previous surgical interventions, or had undergone the Strayer operation, and group 2 after surgical interventions such as lengthening of the Achilles tendon or fibromyotomy in the early age. Results Before the operation in group 1, the changes in the parameters corresponded to true equinus gait or jump gait in combination with internal rotation of the lower extremities. Correction of torsion deformities of the femurs improved the orientation of the knee joints. In the support phase, improvements were recorded for initial contact, heel lift, maximum dorsiflexion of the foot, rotation and obliquity of the pelvis. In the non-support phase of the cycle, clearance, maximum dorsiflexion of the foot, and peak flexion of the knee joint improved. Before the operation in group 2, the changes corresponded to true equinus gait in combination with the internal rotation of the knee joints in the support phase in five subjects. In the remaining patients, torsion was combined with the initial contact produced by the forefoot due to excessive bending of the knee joint at the terminal swing of the non- support phase, followed by late heel lift and insufficient knee joint straightening in the support phase. It can be explained by weakening of the triceps due to previous operations. Correction of the femur significantly improved the orientation of the knee joint. In the support phase of the cycle, improvements were in the initial contact, heel lift, maximum dorsiflexion of the foot, and pelvic rotation. Lengthening of the knee flexors enabled to improve the maximum extension of the knee joint in the support phase of the gait cycle in all patients. No improvement in trunk balance was found in either the first or second group in the long-term period. Differences were statistically significant by comparing the parameters between the groups before surgery according to the Mann-Whitney criterion showing better results in patients of group 1. The result in the long-term period did not show statistically significant differences. Conclusion Correction of torsion deformities of the lower extremities in adolescents and adult patients with cerebral palsy as part of multilevel single-event interventions results in improvement in many gait parameters and the overall total score. During the follow-up period of 1.5-2 years after surgery, there was no improvement in the parameters of the trunk balance by walking. Patients who underwent early surgical interventions in childhood had worse walking parameters before surgery than the patients not operated previously.

Introduction Carcinomatous degeneration is a severe complication of chronic osteomyelitis. The exact mechanism of the malignant transformation remains unknown. This degeneration most often results from squamous cell carcinoma arising in chronic osteomyelitis. Early diagnosis and appropriate treatment are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis. Definitive treatment of chronic osteomyelitis and antimicrobial therapy are thought to be effective in prevention of malignant changes. Objective To identify diagnostic criteria for neoplastic disease in chronic osteomyelitis. Methods We reviewed 7 (2.75 %) patients aged 39 to 65 years who were treated for relapse of bone infection at the Clinic of Osteology Infection between 2017 and 2018. The average duration of the disease was 36 ± 6.42 years. A comprehensive examination performed for the patients on admission included radiographs of the involved limb segment, microbiological analysis of wound discharge, complete blood count, serum biochemistry panels, Doppler ultrasonography of the lower limb arteries and an excisional biopsy. Results Squamous cell carcinoma was diagnosed in the feet of all patients. Discussion The examinations performed were useful for identifying several diagnostic criteria for neoplastic process associated with pseudocarcinomatous hyperplasia in chronic osteomyelitis.

Purpose To study structural reorganization of the cartilage tissue of the joints, depending on the location of osteomyelitis in the bones of the foot. Materials and methods Intraoperative material of 16 patients with chronic osteomyelitis in the foot bones was studied (10 males in the average age 45.3 (33 ÷ 56) years and six females in the average age of 40 (23 ÷ 53) years). The material was resected fragments of the osteo-cartilaginous complex: calcaneus, talus and adjacent joint tissue (subtalar and talo-navicular, phalangeal and metatarsal bones and metatarsophalangeal joint). The material was fixed in 10% formalin. Paraffin sections (5–7 μm thick) were stained with hematoxylin and eosin. Histological studies were performed using a stereo microscope “AxioScope. A1” with a digital camera “AxioCam” and software “Zenblue” (CarlZeiss MicroImaging GmbH, Germany). Results The subchondral bone plate and basophilic line remained continuous and the vessels did not penetrate into the cartilaginous tissue in chronic osteomyelitis of the calcaneus and talus, when the osteomyelitis foci were remote from the articular surface. If an osteomyelitic lesion was present in the subchondral zone, abnormalities in the articular cartilage were detected both from the side of the subchondral bone and on the articular surface; and vascular invasion was observed. In the deep zone of the cartilage, there were hypertrophic chondrocytes with signs of chondroptosis, what indicated a violation of the chondrohematic barrier. Disorders of the basophilic line and penetration of the bone marrow pannus were revealed. From the side of the articular surface, a synovial pannus was observed invading the cartilage matrix. In chronic osteomyelitis of the phalanges and metatarsal bones, regardless of the phase of the inflammatory process, in all observations, disorders in the structure of the subchondral bone plate and articular cartilage were detected; there was invasion of blood vessels from the subchondral zone and articular surface that might be explained by the small size of those bones. Conclusion The intensity of articular cartilage destruction in chronic osteomyelitis of the calcaneus and talus depended on the location of the osteomyelitis focus and the phase of the inflammatory process. In chronic osteomyelitis of the phalanges and metatarsal bones, regardless of the phase of the inflammatory process, there were disorders in the structure of the articular cartilage and vascular invasion. The findings on structural changes in the articular cartilage in chronic osteomyelitis of adjacent bones are helpful for defining the tactics of surgical treatment.

Introduction In the last decade, there has been an increase in the incidence rate of mycoses in patients after injuries and/or operations performed on limb segments and major joints. Mycoses are difficult to diagnose early because the mycotic flora may mimic the bacterial flora being present in the osteomyelitic nidus and primarily identified in the wound exudate. Objective To develop diagnostic criteria for osteomyelitis complicated with mycotic infection. Methods We performed a retrospective study of 28 patients (17 males and 11 females) aged 21 to 76 years (49 ± 16 years) who were treated for purulent inflammatory lesions of bones and/or joints at the clinic of osteology infection between 2000 and 2018. Results Mycotic infection was pathomorphologically detected in the osteomyelitis nidus of all patients. Patients were treated according to the established protocol including radical sequestrectomy, diagnostic biopsy and postoperative administration of antimicrobial and antifungal therapy. Discussion The study allowed identification of several diagnostic criteria for osteomyelitis complicated by mycotic infection. Pathomorphological examination of surgical specimen from purulent inflammatory nidus was shown to be the keystone in diagnosis of osteomyelitis complicated with mycoses.

Introduction The incidence of compression spine injuries account for 0.49 % to 0.9 % of total pediatric trauma victims. Spine fractures constitute 7.5 % to 14.6 % of all inpatient hospital admissions and require conservative treatment. The aim of the study is to analyze the system of outpatient rehabilitation of pediatric compression vertebral fractures at follow-up care provided in St. Petersburg. Material and methods Medical records of 1230 children and adolescents who sustained compression fractures of the vertebral bodies and were followed up by orthopaedic surgeons in St. Petersburg between 2011 and 2017 have been reviewed. Results and discussion Pediatric bone fractures constituted 24.8 % of total injuries registered in St. Petersburg in 2017. From pediatric vertebral body victims, 53 % were boys and 47 % were girls. Vertebral fractures were most common in children aged nine, ten and eleven years (range, 13% - 14 %). A system of consistent non-operative treatment performed for the patients at trauma departments of children's hospitals, through inpatient and outpatient services of rehabilitation and restorative treatments, follow-up care in the outpatient setting is presented. Conclusion The incidence of pediatric bone injury and vertebral body compression fractures is higher in St. Petersburg than the average incidence reported in the Russian Federation. Questions of overdiagnosis of vertebral body compression fractures in pediatric population are considered to be important and relevant. An overview of treatment options and strategies, utilization of braces, follow-up term required for children with compression vertebral body fractures suggests revised approaches to treatment methods, length of inpatient management and follow-up care.

Relevance Compensatory mechanisms of the lumbar spine-pelvis complex in concurrent degenerative changes remain a poorly understood problem. Numerous publications report data either from the point of view of spinal pathology or from the point of hip joint damage. Objective To evaluate changes in the parameters of the spine-pelvis sagittal balance in patients with the hip-spine syndrome. Materials and methods Two groups of patients with hip-spine syndrome were analysed: 1) "Hip-spine" group (n = 54) and 2) "Spine-hip" group (n = 66). All patients underwent radiographic examination. Radiographs of the spine with the capture of the head and hip joints in the anteroposterior and lateral projections in the standing position were taken. Results In the first group, the position of the pelvis was within normal anteversion or pelvic hyperanteversion. In the second group, pelvic retroversion was revealed; normal position of the pelvis (without its compensatory deviation) was present only in several cases. Discussion Regularities in the compensatory mechanisms in the hip-spine syndrome variants have been identified. However, cases with pelvic retroversion require further study and assessment of the balance after surgery. Conclusion Compensatory mechanisms in hip-spine syndrome depend on the dominance of the pathological process (joints or spine), which must be considered in evaluation of the parameters of the sagittal balance in these patients.

Design Presentation of clinical cases and literature analysis. Material and methods Clinical observation of patients with congenital cervical spine and shoulder girdle anomalies operated on with neuromonitoring was performed. Operative treatment of Sprengel’s deformity was produced with the use of neuroimaging. Results Surgical treatment resulted in good clinical outcomes without neurological adverse events and good aesthetic and radiological appearance at the descended scapula. Discussion Consideration for intraoperative neuromonitoring should be given to prevent neurological complications at lowering the elevated scapula. Conclusion Review of outcomes showed efficacious application of the most valid methods used to descend the scapula with neuromonitoring. This was supported by clinical and radiological findings of the extent of cranial transposition after appropriate correction and absence of neurological adverse events early postsurgery and at a long-term follow-up. No recurrence of scapular dislocation was observed at a long-term follow-up.

Introduction Long bone refractures can be a common injury among pediatric population. Approaches to rehabilitation of children with refractures are similar to those used for primary injuries. However, refracture healing and bone repair involve specific pathways that should be considered in rehabilitative approaches to restorative treatment. Objective To identify morphological specific features of simulated reparative processes in long bone refractures of growing animals (rats) at different stages of observation. Material and methods Two series of experiments were carried out on 36 laboratory animals (rats) to explore histological picture at the healing site of primary and repeat fractures at different stages of reparative process. Transverse fracture of the tibial shaft was simulated and fixed with external fixation device in the first series (n = 18). Tibial shaft was refractured and fixed again with external fixation device after 21 days of primary injury in the second series (n = 18). Results Delayed osteogenesis and greater period of organotypical regenerate restructuring were observed in animals with long bone refractures. Mechanism of slower osteogenesis was found to be associated with disturbed blood supply affecting cell differentiation at the refracture site. Conclusion Delayed bone repair and longer period of organotypical regenerate restructuring were specifically detected in growing animals with long bone refractures.

The search for new more effective techniques to repair bone fractures and defects is an urgent task of healthcare. Objective To explore the efficacy of a preparation containing etidronates of lanthanide and calcium ions in regenerative repair of bone defects. Material and methods The osteoblastic MC3T3-E1 and the osteoclastic RAW 264.7 cell lines were used in in vitro experiments at the first stage of the research. The agent was postoperatively injected in a bone defect of 36 rabbits on days 3 and 5 to assess the preparation’s effect on regenerative repair of small defects with diameter of 2.5 mm. Radiometric and reactive morphological characteristics of bone tissue were evaluated at the fracture site at the beginning, middle and end of experiment. Results The above preparation was found to enhance osteogenic differentiation and stimulate accumulation of intracellular calcium in MC3T3 E1 cells. However, the preparation was not shown to inhibit RANKL-induced osteoclast differentiation in vitro. Histological and computed tomography findings demonstrated statistically significant differences between control and experimental animals (p less 0.01) and indicated to the preparation’s effect of promoting regenerative repair of small bone defects. Conclusion The series was the first to show the effect of the preparation containing etidronates of lanthanide and calcium ions as stimulating osteoblast activity in vitro and promoting early regenerative repair of small bone defects.

Multifragmentary fractures of the distal humerus have traditionally presented a treatment challenge for the orthopaedic surgeon because of the growing incidence, severity of injury and compromised elbow joint function. This is a comprehensive review of the current literature that details treatment options of distal humerus fractures. Objective Our aim in this article is to provide the readers with a review of current approaches to the treatment of multifragmentary fractures of the distal humerus

Purpose A retrospective analysis of clinical efficacy and safety of using the external fixation apparatus of G.A. Ilizarov’s design. Materials and methods Analysis and evaluation of clinical data was performed using 107 literary sources. 4.200 clinical cases were studied to evaluate effectiveness, and 6.274 cases to assess safety. Results The analysis revealed a high clinical efficacy of using the Ilizarov apparatus for external fixation (various assemblies) in solving a wide range of practical problems in the field of traumatology and orthopedics. According to the results of the study, its high clinical treatment effectiveness was confirmed both on the use of the method in general (about 95 % of positive outcomes), and in specific nosological groups of patients (not lower than 90 % of positive outcomes). After having assessed the available data on the safety in the application of the Ilizarov apparatus for external fixation (various assemblies), we can conclude that the rates of adverse events, recorded in the literature analyzed, can be considered acceptable. Among all those events, the events classified as adverse effects of the product amounted to 17.03 % (5 ÷ 95 % CI: 16.11 ÷ 17.97 %).

Indications to primary and revision total elbow arthroplasty, clinical outcomes and implant survival rate depending on underlying pathology are discussed in the literature review. Total elbow arthroplasty (TEA) has become the method of choice for severely comminuted distal humerus fractures, posttraumatic conditions and inflammatory arthropathies. TEA can provide substantial improvement in elbow function and quality of life as seen from the review of the foreign and native Russian literature for the last 10 years. However, the complication rate that requires revision surgery remains rather high, and the reported 10-year survival of elbow implants (83–92 %) is lower than that in total hip and knee replacements. Purpose To identify major indications to primary and revision total elbow arthroplasty and explore mid- and long-term results of the procedures based on the review of the foreign and native Russian literature for the last 10 years.

The paper discusses the problem of chronic osteomyelitis from the positions that are either circumvented or not taken into account by practitioners. Microbiological, clinical, pharmacological, pathomorphological and pathophysiological aspects of the inflammatory process of bone tissue are presented. The review also outlines the immunological features of the chronic osteomyelitis course, as well as a contemporary view on this disease as an interdisciplinary problem.

Introduction The severity of intra-articular fractures of the distal tibia results from the morphological features of this segment, and therefore, bone injury is combined with trophic soft tissue disorders. Open reduction and internal fixation have a negative effect on reparative processes in the local morphological structures, and complications such as soft tissue necrosis, infection, infected and deforming osteoarthritis, or nonunion may develop. The aim was to show a clinical case of a stage-by-stage treatment of an intra-articular fracture of the distal tibia using minimally invasive methods, reduction with the Ilizarov apparatus and closed intramedullary osteosynthesis with a modified ChM nail. Results and discussion The Ilizarov apparatus was used for primary reduction and stabilization of the fracture that enabled to eliminate gross displacements and to align the axis of the segment. After the edema had ceased and soft tissue condition improved, closed intramedullary osteosynthesis was implemented with a modified ChM nail. Conclusion A staged approach to manage intra-articular fractures of the distal tibia enables to avoid additional soft tissue trauma and results in good clinical outcomes. The available metal intramedullary implants for intra-articular fractures are imperfect, but their modification may improve stability and decrease the risks of postoperative complications if the number of holes for locking is increased.

Objective To detect pathomorphological characteristics of the palmar aponeurosis in Dupuytren’s contracture in patients with liver disease. Material and methods The review included a medical record and histological findings of surgical specimen of a 60-year-old patient who underwent surgeries for Dupuytren’s contracture in 2016 and 2019 first on the right and then on the left side. Micropreparations of palmar aponeurosis stained with hematoxylin and eosin, Masson’s trichrome, using van Gieson and Hart methods were examined with light microscopy. Results Typical lamellar pattern in thickened pretendinous cord of the palmar aponeurosis was observed in surgical specimen of 2016 with flexion contracture at the metacarpophalangeal joints in IV-V digits of the right hand that developed 4 years after the first clinical signs of the palmar fascial fibromatosis. In 2019 the patient developed grade III–IV Dupuytren’s contracture at the metacarpophalangeal joints and the proximal interphalangeal joints in IV-V digits of the left hand. Active proliferative areas were observed in central parts of tendon resembling bands of digital fasciae with signs of fibrocartilaginous metaplasia and lipomatosis seen in the surgical specimen. Collagen fiber bundles were shown to intensively develop de novo at the periphery of the cords. Discussion Fibrocartilaginous metaplasia of dense Dupuytren’s connective tissue was described in single publications, and this is the first report on lipomatosis and collagen fiber bundles developed de novo. Conclusion Specific features of pathomorphology of fascial fibromatosis were likely to be associated with chronic hepatitis of unknown etiology.