Introduction Hallux rigidus (HR) is the second most common disease of the great toe affecting the first metatarso-phalangeal joint (MTPJ) and is characterized by a painful and stiff joint. Cheilectomy is considered the gold standard treatment for early stages of HR. The objective of the study was to evaluate the functional results of cheilectomy as a standalone procedure or in conjunction with great toe proximal phalangeal osteotomy (P1) and/or first metatarsal osteotomy (M1) performed for patients with grade-3 HR according to the Coughlin and Shurnas classification. Material and methods The study included retrospective review of 17 patients (20 feet) with grade 3 HR using the Coughlin and Shurnas Grading Scale who underwent operative treatment between September 2010 and January 2017. The patients' mean age was 52 years (range, 39 to 66 years). The median interval between surgery and the last follow-up was 5 years (interquartile range, 4.5 to 7.5 years). Outcome assessment relied on patient satisfaction, radiographic examination, visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) and the Foot and Ankle Ability Measure (FAAM) scores. Results AOFAS score was rated as excellent in 90 % of the cases (18/20) and good in 10 % (2/20) with neither fair nor poor results recorded. The median AOFAS score increased from preoperative 60.0 points to postoperative 97.0 points that was statistically significant (p less 0.05). Postoperative median FAAM Activities of Daily Living (ADL) and median subjective ADL was 100 %, median FAAM sport was 97 %, and median subjective sport was 90 %. Patient subjective assessment was scored as excellent in 60 % of cases (12/20), good in 40 % (8/20) with neither fair nor poor results recorded. The median VAS pain score decreased from 6 points at baseline to 1 point postsurgery (p less 0.05). Measurement of the first MTP dorsiflexion showed statistically significant increase in the median angle from 10° at baseline to 40° postsurgery (p less 0.05). Conclusion Cheilectomy as a standalone procedure or in conjunction with P1 osteotomy and/or M1 osteotomy has demonstrated 100% positive long-term outcomes for patients with Coughlin and Shurnas grade-3 HR. The procedure can be advocated as a predictable and excellent option for the cohort of patients. First MTPJ decompression is to be considered with P1 osteotomy and/or M1 osteotomy for grade-3 HR patients in preoperative planning to ensure normal forefoot anatomy and can be an option for some cases of Coughlin and Shurnas grade-3 HR.

Introduction For long, orthopedic approaches to the management of diabetic foot syndrome (DFS) remained underexplored in Russia. Deformities of the distal segments of lower extremities play a role in the pathogenesis of DFS. There are limitations and a paucity of research on classifications of DFS within the existing literature. Methods We reviewed 183 DFS patients aged 24 to 82 years treated for various foot deformities between 2015 to 2018. Results Analysis of clinical studies allowed us to systematize deformities of the distal segments of lower limbs in DFS patients. DFS related foot deformities were classified; clinical and radiological classification of foot deformities caused by Charcot neuro-osteoarthropathy (CN) developed and amendments to the generally accepted classifications of DFS with emphasis on the orthopedic management offered. Discussion Lack of a clear understanding of locomotor function disorders, staging of clinical, radiological and anatomical changes in the foot bones at different stages of the disease strongly influence on the potential for multidisciplinary collaborative practice (endocrinologists, surgeons and orthopedists) to ensure an optimal clinical outcome, and an orthopedist may even refuse to treat. The approaches we offered for classification of DFS and foot deformities are different from the known ones and are made from the perspective of the orthopedic and trauma surgeon whose service is rarely used for the treatment of DFS patients in Russia. Conclusion The orthopaedic classification of DFS offered can be helpful in determining the optimal surgical treatment, predicting the course of the pathological process and the functional outcome.

Purpose Analysis of the severity and staging of pathomorphological changes in the arteries of palmar aponeurosis in patients with Dupuytren's contracture of different age groups Materials and methods Analysis of case records of patients younger than 50 years old (n = 19, group 1), from 50 to 65 years old (n = 60, group 2) and over 65 years old (n = 32, group 3). Light microscopy of paraffin sections of palmar aponeurosis fragments resected in partial fasciectomy and histomorphometry of palmar aponeurosis arteries of three calibers: small (outer diameter less than 150 microns), medium (150–300 microns), large (more than 300 microns). Control samples – fragments of the aponeurosis of three patients younger than 50 years old with hand injuries. Results Groups 1–3 arecomparable in terms of fibromatosis duration, frequency of lesions in both hands, and the number of fingers with impaired function, but in group 3 the frequency of contractures in advanced stages and cardiovascular diseases was higher (p less 0.05). In arteries of small caliber, obliterating lesions and signs of expansive remodeling were also encountered; in arteries of medium caliber, expansive remodeling prevailed; in arteries of large caliber, constrictive remodeling was expressed. Discussion The types of remodeling identified were found in all age groups. Based on the results of the study and the data obtained earlier, 6 stages of pathomorphological changes in the vessels of the palmar aponeurosis were identified in Dupuytren's contracture. Conclusion Dupuytren's contracture refers to diseases mediated by vascular remodeling, affecting mainly the arterial bed, the severity and staging of which does not depend on the age of a patient

The objective of this study was to evaluate outcomes of single-event multilevel orthopaedic procedures including distal rectus femoris transfer (DRFT) performed for adolescents and adults with cerebral palsy (CP) and stiff knee gait (SKG) pattern. Material and methods Twenty patients (mean age, 17.1 ± 2.9 years) with SKG were included in the study. Among them, 16 were classified as GMFCS level II and 4 as GMFCS level III. All patients underwent singleevent multilevel orthopedic procedures including DRFT. Gait analysis was performed preoperatively and at a 1-to-2-year follow-up using Edinburgh Visual Gait Score and 3D analysis. The Gait Profile Score (GPS), peak knee flexion in swing phase, knee range of motion across the gait cycle and the maximum knee flexion angle recorded with the time of occurrence as a percentage of the gait cycle were measured in the patients. Results Comparison of pre- and postoperative measurements showed improvement in peak knee flexion in swing phase and the associated improvement in foot clearance. Improved knee terminal-swing position was found to improve initial foot contact with the supporting surface. Postoperative statistically significant increase in the knee range of motion across the gait cycle could be attributed to both increase in the knee flexion in swing phase and decrease in the knee flexion angle in stance due to correction of a pathological angle of dorsiflexion that necessitated correction of compensatory knee flexion to retain vertical position. Conclusion DRFT has been shown to be effective for correction of disturbed knee kinematics in patients with SKG pattern to allow increase in peak knee flexion in swing phase and overall knee range of motion across the gait cycle. The technique can be advocated as part of single-event multilevel orthopedic procedures to improve integral gait parameters. Excessive ankle dorsiflexion in stance phase resulting from previous triceps surae lengthening surgeries must be accurately addressed with DRFT procedure in order to prevent a greater increase in ankle dorsiflexion and iatrogenic crouch gait.

Aim Bleeding diseases are rarely studied as complications of an orthopedic surgical procedure with postsurgical bleeding. This study aims to present a retrospective cohort-study about the approach to bleeding disorders in an ordinary orthopedic clinic. Material and Methods 344 patients were recorded for our study group between November 2017 and September 2019. These patients were monitored for bleeding disorders, both primary or secondary. Results 27 (7.84 %) patients with bleeding diseases [1 (0.29 %) patient with VWD, 1 (0.29 %) patient with hemophilia, 1 (0.29 %) patient with ITP, 15 (4.36 %) patients with drug use, 5 (1.45 %) patients with vascular disorders, 4 (1.16 %) patients with herbal agent use] were detected in all traumatic cases which were admitted to our clinic in this time period . These patients were divided in 6 groups. Patient with VWD was Group 1, patient with hemophilia was Group 2, patient with ITP was Group 3, patients with drug use formed Group 4, patients with vascular disorders – Group 5, patients with herbal agent use – Group 6. Conclusion We advise to have a careful preoperative control for postsurgical bleeding risks according to three criteria: i) patient anamnesis should be studied carefully (diathesis/hemophilia searching), ii) platelet counts must be checked (twice is guaranteed), iii) coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT) and International Normalized Ratio (INR)] must be studied.

Introduction The quality of medical rehabilitation and habilitation of children with lower limb defects depends on early prosthetic and orthopedic care. Purpose Analysis of the provision of prosthetic and orthopedic care for children with orthopedic pathology of the lower extremities at the Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht. Methods The results of rehabilitation and habilitation of 261 children with orthopedic pathology of the lower extremities were studied. Methods of clinical examination, radiography, physiological and biomechanical study were applied. Statistical analysis was carried out. Results In 261 cases studied, the causes of defects were congenital anomalies (82 %) and amputation defects (18 %). Surgical preparation for prosthesis application was performed in 85 cases (33 %). More than half of the patients who sustained interventions had a defect at the hip level. The anatomical and functional features of stumps in children with abnormal development of the lower extremities were studied and the principles of prosthesis and orthosis application were developed. Discussion Delay in prosthesis application leads to negative effects on the child's body. The supply of children with technical means of rehabilitation is not regulated in due manner by the current legislation, which leads to the complexity of the purpose of the product and the delay in the timing of prosthesis and orthosis fitting. Early prosthetic and orthopedic care for children with orthopedic pathology of the lower limb is a prerequisite for normal development of their growing body. Due to subjectivity of child's assessment of the results of prosthetic fitting, there is high risk of secondary deformities of the child's musculoskeletal system; for children using limb prostheses and orthoses, it is necessary to use an objective instrumental assessment of the results of prosthesis application; dispensary observation; monitoring of motor loads and the technical condition of the prosthesis. Early prosthetic and orthopaedic assistance to children should be conducted not only according to the rules of registration of the individual program for rehabilitation and habilitation (IPRH), but also followed to disability with the aim of preventing the development of complications, injuries, diseases of the musculoskeletal system, and impairment of functional disorders.

Relevance It is known that the state of sagittal balance is strictly correlated with the quality of life of the patient. At the same time, reference values for correction of sagittal parameters of the spine are derived only from vertical radiographs. Current evidence shows that the use of only standardized sagittal parameters in the standing position for planning the volume of surgical reconstruction is erroneous. However, rare publications show the difference between the sagittal profile of the spine in the sitting and standing position related to age. There is no information on the profile in extended degenerative pathology of the spine. Aim of the study Comparative assessment of the variability of the parameters of the sagittal profile of patients with Hip-Spine syndrome in the standing and sitting positions and comparison with healthy subjects from the average population. Design A prospective case-control monocenter observational study with historical control. The study included 74 patients with "Hip-spine" syndrome at the age of 63 ± 9.9 (43 to 83) years at the time of examination. The recruitment period was 23 months. The main group was formed by 74 patients with Hip-Spine syndrome. The control group (58 subjects) was represented by healthy individuals from open sources on the average population. The criteria of the analysis were sagittal vertebral-pelvic parameters of the trunk - CL, TK, TLK, LL, PI, PT, SS, SVA. The calculation of sagittal parameters was performed with Surgimap Spine software. Results In all patients during the transition from standing to sitting, there was kyphotization of the thoracolumbar transition (mean TLK angle was 10.3° – 145 %), a decrease in lumbar lordosis (mean LL angle – 23° – 44.4 %) with pelvic retroversion (PT: 18.6° – 126.5 %, SS: 18.3° – 51.6 %) and an increase in forward SVA deviation (10.5 mm – 25.5 %). No significant changes in cervical lordosis and thoracic kyphosis were revealed. When comparing the average values of sagittal parameters of patients of the main and control groups, there were no significant differences. However, among all patients of the main group, there were 6 patients (8.1 %) in whom the difference in the parameters LL, SS, PT in the standing and sitting positions was less than 10°, which indicates a pronounced rigidity of the lumbosacral spine. Conclusion Postural sagittal vertebral-pelvic parameters of the trunk in the standing and sitting positions in patients with Hip-Spine syndrome differ significantly from each other. A key role in the changes is played by the position of the pelvis, which retains mobility, despite different severity of degenerative changes in the complex "hip joints-lumbosacral spine".

Introduction Osteoporosis is a disease causing high morbidity with increasing prevalence. It is one of chronic diseases caused by reduced bone mass thatsubsequently decreases bone strength and increases fracture risks. Pharmacologic treatments for osteoporosis include antiresorptive agent (bisphosphonate) and bone-forming agent (strontium ranelate), so further research is needed to compare these two medications. Objectives We aimed to histopathologically compare bone density in post-menopause white rats after being treated with strontium and ibandronate. Material and methods 45 ovariectomized female rats were divided into three groups. The subjects in the first group were only ovariectomized (control). The strontium group was given daily oral strontium at a dose of 625 mg/kg BW/day for 60 days. The ibandronate group was given one subcutaneous ibandronate injection at a dose of 1 μg/kg BW/day for 60 days. We measured osteoclasts, osteoblasts, trabecula area and cortical thickness. Results The animals in ibandronate and strontium groups showed a significant increase (p less 0.005) in osteoblasts and significant decrease in osteoclasts compared to the control group. The subjects in both groups had a significantly thicker cortex and a larger trabecula area than in the control group. The subjects in the strontium group had more osteoblasts and thicker cortex than in the ibandronate group. Conclusion Strontium had a double effect, increasing osteoblasts and inhibiting osteoclasts. On the other hand, ibandronate had only a strong antiresorptive effect, but a lower osteoblast effect. It could be inferred that strontium was more effective in increasing bone density as compared to ibandronate. © Bastian D., Martiana I.K., 2020

Objective Explore structural changes in the tibialis anterior muscle (TAM) and the peroneal nerve (PN) in repair of postresection tibial defect using the Ilizarov external fixation and a cement spacer. Material and methods A defect-nonunion was simulated in the proximal tibia of 10 mongrels using the Ilizarov external fixation followed by use of a cement spacer to fill the 2.5 cm defect-diastasis. The spacer was removed after 30 days and tibia distraction commenced with the rate of 1 mm performed 4 times/day following transverse osteotomy in the distal tibia to achieve docking of bone fragments. Animals were sacrificed after 60-day fixation (F60) and 30 days after frame removal (FR30). Histomorphometric parameters of the TAM and PN samples were examined. Results TAM appeared to be denervated with death or decreased size of myons and angular contours noted at F60 and FR30. Degenerated and intact muscle fibers (MF) were shown to increase by 32.5 % and by 1 %, respectively, at FR30. The peak of histogram distributing MF by diameters at F60 indicated to ischemic muscles, and a 2-fold decrease in muscle diameter and the histogram skewed to the left by 4 classes showed increase in muscle atrophy at FR30. Reactive destructive changes were noted in at least 5.4 % of myelinated nerve fibres of the PN at F60 and FR30. A 1.6-to-1.7 times decrease in larger and a 1.6-to-1.8 times increase in smaller fibers, the presence of regenerative clusters indicated to previous destruction of a large number of motor and sensory nerves. Changes in the population structure, destruction of myelinated fibers and loss of non-myelinated fibers were associated with obliteration of epineurial vessels and loss of endoneurial capillaries at F60. Conclusion Reactive destructive changes in the TAM and PN revealed in bone defects repaired with the Ilizarov external fixation and the Masquelet technique should be considered in planning of postoperative pharmacologic thearapy and rehabilitation.

Objective To study the effect of bone defect augmentation on the dynamics of bone remodeling markers. Material and methods The effect of resorbable xenoplastic material (RXM), synthetic beta-tricalcium phosphate (b-TCP), porous titanium implant (PTI) and nanostructured carbon implant (NCI) on the markers of bone remodeling (osteocalcin, OC; bone alkaline phosphatase, BALP; C-terminal telopeptide of type I collagen, CTX-1) and inflammation marker (C-reactive protein, CRP) was investigated using bone defect model in rabbits. 24 animals were divided into 4 groups (n = 6 in each group) according to the type of osteoplastic material. Control group (n = 6) was without augmentation. An impression fracture of the proximal tibia was modeled. Blood samples were taken on days 1, 3, 7, 14, 45, 90, 180 after surgery. Results CTX-1was not detected in the control, b-TCP, PTI, and RXM groups after 90 days, but in the NCI group CTX-1 remained elevated until the end of the study. OC in the control, b-TCP, PTI groups reached a maximum at 14-45 days. No significant increase in OC was found in the NCI group. The BALP in the control group peaked at 90 days. In the b-TCP and PTI groups the concentration of BALP increased more rapidly. The dynamics of CRP in the RXM, b-TCP and PTI groups was similar to the dynamics in the control group, in the NCI group an increased level of CRP remained until the end of the study. Conclusion When a bone defect was augmented with both resorbable b-TCP and nonresorbable PTI, high osteogenesis activity and low osteoresorption activity were detected. The use of xenoplastic material did not reveal any advantages in comparison with surgery performed without augmentation. An increase in osteoresorption and a low level of osteogenesis were found by using NCI.

Introduction Reduction of time to restore bone integrity remains one of the main problems in traumatology and orthopedics. To solve this problem, various kinds of components have been used, one of which are bisphosphonates. This article presents an experiment, the purpose of which was to study the effect of components based on etidronates of lanthanide or calcium on blood indicators by different ways of their introduction into the femoral fracture site in experimental animals. Materials and methods Studies were conducted on 75 male rats aged 5–6 months, weighing 300–350 g. A femoral fracture was modeled in all animals, and retrograde intramedullary osteosynthesis was performed. Animals were divided into 5 groups. Group 1 received no components; a component based on etidronates of lanthanide and calcium was introduced in group 2 through a catheter; group 3 had paraossal administration of etidronates of lanthanide and calcium; group 4 had paraossal introduction of a component based on etidronate calcium through a catheter; and group 5 had introduction of components based on etidronates and calcium. Animals received the investigated components twice in the fracture zone on days 3 and 5 after the operation, except the comparison group. Results In groups with a catheter, the most pronounced local inflammatory response was observed. Changes in hemoglobin concentration were observed in all groups, in the early (7 days) period. It was found that in rats which were injected with components containing lanthanides, the average content of hemoglobin, erythrocytes and leukocytes were identical to those of group 1. Conclusion The study revealed that the components, which include lanthanide ions do not cause negative changes in the rat blood according to hematological tests.

Introduction Hereditary multiple exostoses, according to different authors, account for 16.0 to 43.0 % of all the cases of tumors, tumor-like and dysplastic diseases of the pediatric skeleton. Deformations of the forearm develop in 30–80 % of patients with multiple exostoses. The purpose of our research was a comprehensive presentation of the deformities of the forearm in children that occur in multiple exostoses, assessment of the efficiency of various surgical treatments. Methods We carried out the analysis of scientific medical articles reflecting the options of surgical treatment of this pathology (PubMed database) published between 1984 and 2018. The retrospective analysis of Russian-speaking and English-speaking sources of literature shows that elimination of forearm deformities in hereditary multiple exostoses is performed only in the surgical way. Results Analysis of results of surgical treatment established that 649 interventions published in literature resulted in 5.5 % of excellent, 33.5 % good; 23 % fair and 38 % poor outcomes. The most perspective and widely applied technique is gradual lengthening of the radius as an independent method of treatment, and in combination with other options of surgical interventions. Discussion Deformity recurrence and exostosis in most cases occur in patients with unfinished bone growth. The authors find optimal perform resection of exostosis in combination with other methods of treatment. At present, the dependence of the choice of surgical option on the severity of anatomical changes has not been established. There are no accurate indications to the choice of a specific technique of surgical intervention based on the deformity revealed. Despite improvement of treatment methods, the rate of poor results remains high and reaches 38 %.

Introduction Total hip arthroplasty (THA) is one of the most successful orthopedic procedures performed today. Rates of THA have been steadily increasing over the past several decades with increasing number of patients who need proper effective rehabilitation therapy after orthopaedic surgery. Evaluation and introduction of new rehabilitation techniques is crucial for patients undergoing replacement of major joints. Objective Review the literature and our own findings with various rehabilitation programs used for THA patients to aid recovery following surgery at a short and long term. Material and methods The study included 57 THA patients referred to rehabilitation department of the Kurgan Ilizarov Center to help manage pain at different terms following surgery. The sample was divided into main (n = 29) and control (n = 28) groups. Post-isometric relaxation techniques were included in rehabilitation program of the main group. Clinical outcomes were evaluated with VAS, the Lequesne Index, McGill Pain Questionnaire, WOMAC, and Harris Hip Score. Results Outcome measures showed 1.5 times improvement in controls with high statistical significance (p > 0.01) and 3.3 times improvement in patients who received post-isometric relaxation therapy with greater significance level (p > 0.001). Conclusion The findings suggest that post-isometric relaxation techniques applied as a part of restorative treatment facilitate improved outcomes of rehabilitation. The optimal rehabilitation protocols have been shown to be largely unknown for THA patients.

Implant survival is a very important outcome measure of surgical treatment of patients with severe degenerative joint disease in the hip. The aim of this review is to summarize the present knowledge on the possibilities for earlier laboratory diagnosis of osteolysis and prognostic approaches to prevent aseptic loosening of prosthetic implants. Results Periprosthetic osteolysis is often seen as an early sign of an adverse event associated with the development of unstable total hip arthroplasty (THA). A lot of data support the concept of osteolysis as a condition caused by biomechanical stresses, surgery specific factors, preoperative decrease and postoperative loss of bone mineral density, vascular impairment and chronic inflammation. Hemostasiological, biochemical and immunological parameters of patients were explored before and after THA. Surgical intervention was treated as the cause of secondary immunodeficiency, and results of the recovery period evaluated with regard to the extent to which immunodeficiency appeared to be compensated. Dynamics in stress related bone remodeling around the implant was found to be be a marker for early detection of osteolysis and prediction of aseptic loosening of THA, as well as control over the "target" of drug exposure. Conclusion Literature review suggests that there is a common understanding of the pathogenesis of osteolysis and the development of aseptic loosening of THA, and there is scanty data on the laboratory markers for early diagnosis and prediction of the complication that would require further study.

Introduction There is evidence in the literature over the past 5 years that pelvic and acetabular fractures are increasing in prevalence with the rise of injuries sustained in road traffic accidents, the growing number and severity of trauma, significant complication rate and unsatisfactory outcomes due to untimely surgical treatment. Objective Review current trends in the selection of surgical approaches and fixation of the pelvis and acetabulum, the postoperative rehabilitation strategies and identify factors for poor outcomes of surgical treatment. Material and methods We performed searches using HAC peer-reviewed and SCOPUS indexed journals, EMBASE, MEDLINE, Сochrane library, еLibrary.ru, Wiley Online Library with search criteria of pelvic fractures, displaced acetabular fractures, open reduction of the pelvis and acetabulum, osteosynthesis, minimally invasive osteosynthesis and primary total hip arthroplasty, approaches and complications of acetabular fracture surgery. Results Indications to surgical treatment of patients with concomitant, multiple and isolated fractures of the pelvis and acetabulum were identified with the use of current strategy and principles of damage control surgery and damage control orthopaedics. Surgical approaches for two-column acetabular fractures have been shown to be extensile and traumatic. Discussion Most authors report use of the active surgical strategy for displaced fractures of the pelvis and acetabulum. Open reduction internal fixation is the standard of care for pelvic and acetabular fractures. Conclusion Postoperative complications and long term rehabilitation of patients with pelvic and acetabular fractures support further research and development of new more effective approaches to address the solution of the challenging issue.

Purpose To conduct a systematic review of literature on the results of simultaneous surgical interventions (SSI) in spinal surgery to determine their value in the treatment of degenerative diseases, traumatic injuries, destructive changes due to tuberculous spondylitis, correction of congenital anomalies and tumor lesions Material and methods A systematic search of literature in English and Russian published between January 1960 and December 2018 was conducted using the Medline, EMBASE, Cochrane Library and eLibrary databases. Results The systematic review included 20 studies on the use of simultaneous technology in the surgical treatment of degenerative diseases and injuries of the spine, tuberculous spondylitis, as well as rare combined pathologies. It has been established that SSIs used in combination with high-tech tools and minimally invasive surgical techniques are able to eliminate several diseases simultaneously, to preserve low invasiveness of the approach, to activate patients early and to reduce the number of complications. Conclusion There is a need to develop specialized criteria and an objective classification of SSI, as well as to study the effectiveness of various options for such interventions based on the parameters of the duration of surgery, volume of blood loss, duration of intraoperative exposure to radiation, duration of inpatient treatment and economic costs.

Aggressive vertebral hemangiomas represent 4 % of all hemangiomas. Percutaneous vertebroplasty is typically considered as the first-line treatment option for aggressive hemangioma. The lesions that involve the entire vertebral body, extend into the cortical bone constitute 44 % of all vertebral hemangiomas. Extra-vertebral cement migration is reported to occur in 40 to 87.5 % of the cases at percutaneous vertebroplasty being less with the use of balloon kyphoplasty. There is a paucity of literature examining surgical treatment of aggressive hemangiomas with balloon kyphoplasty. We report two cases of aggressive vertebral hemangiomas involving the entire vertebral bodies treated with balloon kyphoplasty. The treatment provided good outcomes with no complications observed postoperatively.

Introduction Osteolysis is a common problem in the long-term outcome after total hip arthroplasty, since the wear of a polyethylene liner is an inevitable process. However, its pace depends on many factors and not all of them have been proven. In particular, many studies do not find a connection between the wear rate of the liner and the position of the acetabular component. The purpose of this publication is to demonstrate the importance of correct acetabular component positioning. Methods A clinical case of bilateral total hip arthroplasty with follow-ups after 17 and 19 years is presented. The patient was operated being 31 and 33 years old, respectively, by one surgeon. The same type of the acetabular component was installed with the same type of polyethylene and friction pair diameter. It eliminates implant or surgical approach factors and patient characteristics. The position of the implant components is then remains the most important factor. For analysis, there were radiographs before the operation, at different times after it, CT data and intraoperative photos during the revision surgery. Results At the time of the last examination, there were minor manifestations of retroacetabular osteolysis that were better seen in CT and were more pronounced on the right. CT radiometry data on the angles of inclination of the acetabular components were 50.6° and 46.7° on the right and left, respectively, and the anversion was 40.3° and 25.4°. Revision of the right total hip arthroplasty was performed and it was found that the liner wear extended till the metal layer. Given good fixation of the cup, only the liner was exchanged and osteolytic cavities were filled with allogenic bone chips. Discussion The case can be considered a very good result of primary arthroplasty as revision surgery in this young patient was performed only after 17 years. However, in the contralateral joint the implant with the same pair of friction has survived for 19 years and at the moment it is early to decide on its revision. In our opinion, this case is an excellent illustration of the importance of the correct positioning of implant components.

Background Chronic Chopart dislocation is one of the causes of acquired painful flat foot, which is treated by midtarsal arthrodesis causing limitation of movement and smaller-sized foot. Gradual reduction based on the principles of аrthrodiastasis using the Ilizarov external fixator is used for treating chronic Chopart dislocation. The case and method Twenty-two year-old male presented with painful right flat foot fourteen months after a motor vehicle accident. Gradual reduction was used for the chronically dislocated Chopart’s joint by arthrodiastasis using the Ilizarov external fixator. Result The follow-up result after four years is presented. The longitudinal arch of the foot recovered and the foot is painless with full range of movements; the size of the foot is preserved. Conclusion Treatment of chronic Chopart dislocation by arthrodiastasis using the Ilizarov external fixator is a preferred method of treatment as the size of the foot will be preserved , movement of the joint will not be restricted, the joint will be painless. There is no need for thromboprophylaxis, no chance of compartment syndrome and less operation time in comparison to arthrodesis. 

Introduction The archives, which include 670 medical cases filed at the Leningrad Research Institute for Prosthetics (LNIIP) during the siege of the city, is unique for understanding the specific scope of medical work during the tragic time of the Great Patriotic war. The purpose of the study was to analyze the activities of the Leningrad Research Institute for Prosthetics in the besieged Leningrad during the Great Patriotic war. Methods The analysis of the LNIIP archives using the methods of content analysis, deduction, induction and synthesis was carried out. 670 cases related to the time of the Great Patriotic war were studied. Statistical data processing was performed. Results The LNIIP hospital worked as a front-line evacuation station from 01.09.1941 to 30.12.1942 and treated a total of 1,221 patients. 131 medical records of military officers and soldiers treated there during that period were found. The reason for hospitalization in 65 % of those patients was the consequences of shrapnel wounds, gunshot and mine explosion injuries were less frequent. In the period from 25.05.1943 to 19.06.1945, there were 539 medical records of civilians. In 51 % of the cases, the reason for hospitalization was shrapnel wounds, gunshot and mine explosion wounds and only 2 % were pre-war cases. Discussion The nature of injuries the civilian population of the besieged Leningrad did not differ from that of the front-line soldiers. The front passed right through the besieged city, and its inhabitants were soldiers of that front. 1428 medical interventions were performed including 31 % of operative plasty procedures (re-amputation, skin and bone grafting, amputation) and 32 % were surgical interventions. 356 individuals were provided with prostheses, 10 with orthopedic devices, and 48 with orthopedic shoes. Preparation for prosthetic fitting was complicated by avitaminosis, dystrophy, and scurvy. The work of LNIIP in the extreme conditions of the war and blockade is a vivid example of the contribution of medical workers to the victory of the whole country. The experience of organizing a medical hospital in special conditions has not lost its relevance today.