Objective To review long-term outcomes of surgical treatment of patients with acetabular fractures using an original outcome assessment questionnaire. Material and methods The study included 79 patients with acetabular fractures. The patients' age ranged from 16 to 67 years. Long-term follow-ups were evaluated with an original questionnaire measuring pain intensity, timings of primary surgery, reoperations including total hip replacement, technical details, accuracy of bone reduction/residual displacement and extent of restricted working capacity. Results Good and satisfactory long-term outcomes of acetabular fractures repaired with a primary surgery performed 22.7 ± 5.7 days of injury were observed in 43 (54.4 %) patients with complete bone reduction or 1–2 mm of residual displacement. Severe posttraumatic coxarthrosis, complications (avascular necrosis of the femoral head) or incomplete bone reduction with residual displacement of 2 mm to 2 cm detected in 36 (45.6 %) patients were rated as a poor outcome and required total hip replacement. Conclusion An active surgical approach to acetabular fractures employing open reduction and arthroplasties has shown to provide a good rehabilitation effect even for neglected cases with adequate restitution of the hip joint congruence ensured.

Introduction Traditional lateral plate osteosynthesis for distal femoral fractures does not provide sufficient stabilization in comminuted fractures due to a lack of medial support. Materials and methods Study on 16 lower limbs of 9 cadavers was conducted. We performed osteosynthesis of distal femur with precontoured medial plate implantation using a minimally invasive surgical technique. Then, the soft tissues were dissected to explore an exact location of the medial plate and the distances between plate and crucial anatomic structures of the distal femur. Fifteen patients underwent surgical treatment of distal femoral fractures with a loss of medial stability (AO/OTA classification 33-A3, 33-C2, 33-C3 fracture types) using the method of low invasive double-plating. Follow-up examinations were performed after 6 to 12 months. Results were evaluated using KSS and Lysholm scales. Results Cadaver study showed safety and feasibility of described minimally invasive osteosynthesis of distal femoral fractures method. We did not encounter specific complications associated with medial plate implantation during surgery. All fractures healed 12 months after surgery. The functional outcomes were good and excellent in more than 70 % of cases according to KSS and Lysholm scales. Discussion Fracture management in the segments with eccentric axial load is still problematic. The double-plating technique is a promising method which can be used by trauma surgeons in distal femoral fractures without medial stability. However, further clinical research to prove safety and feasibility of this method of distal femoral fracture fixation in comparison with alternate ostheosynthesis techniques is needed to determine more specific indications for its application.

Background Minimally invasive plate osteosynthesis (MIPO) corresponds to the modern principles of "biological" fixation as it implies closed reduction and plate insertion causing minimal iatrogenic trauma. However, the lack of direct visualization increases the risk of damage to important anatomical structures. Purpose To develop recommendations in the use of MIPO for diaphyseal fractures of the humerus from anterolateral approaches to prevent possible complications and improve the results. Methods 16 shoulders of fresh cadavers were included in the study. In all cases, MIPO was performed with a straight plate (10–12 holes) and screws (2 proximal and 2 distal) using two anteriolateral approaches. Complete revision of the shoulder area was carried out in order to determine the accuracy of plate location and the relationship between the implant, neurovascular structures and bone landmarks. Results No damage or compression of the neurovascular and tendomuscular humerus structures was revealed. The average distance from the acromion to n. axillaris was 5.8 ± 0.66 mm (range from 4.9 to 6.9 mm). The average distance from the lateral epicondyle of the humerus to n. musculocutaneus was 56.5 ± 4.66 mm (from 49 to 63 mm). We observed the difference in location at the extreme pronation (5.1 ± 0.33 mm, from 4.5 to 5.7 mm) and supination positions of the forearm (5.8 ± 0.6 mm, from 5.1 to 6.1 mm) measuring the distance between the edge of the plate and n. radialis. The average distance between the distal medial edge of the plate and a. brachialis, n. medianus was 17.1 ± 2.7 mm (from 13 to 21 mm). Conclusions Based on the obtained data, we offer MIPO recommendations for anterolateral accesses in diaphyseal fractures of the humerus. Compliance with the proposed recommendations will reduce the risk of iatrogenic damage and improve the results of humeral fractures treatment.

Introduction The patellofemoral joint is a complex structure. Dysplasia of the trochlea and the adjacent portions of the lower limb has been shown to predispose pediatric patients to severe recurrent patellar dislocation. The comprehensive diagnostic workup has important implications for determining treatment of a complex multicomponent deformity of the patellofemoral joint in severe recurrent patellar dislocation. The objective of the study was to develop a preoperative diagnostic protocol for optimal surgical treatment of pediatric patients with severe recurrent patellar dislocation to enable complication rate reduction. Material and methods Between 2015 and 2017 54 patients diagnosed with patellar dislocation were treated at the Samara State Medical University hospital. Severe patellar dislocation according to the Volkov classification was identified in 37 patients. Patients were evaluated according to the algorithm described in the article and treated appropriately based on the findings. Results Multiplanar pathological changes were detected in the patellofemoral joint of all participants. The patients underwent supracondylar derotational varus osteotomy of the femur combined with a tibial tubercle medialization osteotomy to address multiplanar deformity. No complications were seen in 32 patients at a long term and re-dislocation occurred in one case. Four patients developed a contracture of the knee joint due to inadequate postoperative rehabilitation. Conclusion The thorough diagnostic workup is crucial for identifying treatment strategy of a recurrent patellar dislocation due to a complex structure of the patellofemoral joint and a multicomponent deformity at the anatomical site to avoid postoperative complications.

The aim of this study was to evaluate the results of multilevel interventions in patients with spastic diplegia and crouch gait. Materials and methods The study cohort consisted of 39 patients (10 females, 29 males). The average age of the patients was 16.3 ± 4.29 years (range, 7 to 26 years). In 19 cases, the GMFCS level was III, in 16 cases it corresponded to level II and in 4 cases to level I. The gait study data were analyzed in two groups of patients. In group 1, patients did not have any previous orthopedic interventions, and the crouch gait pattern was considered to have developed naturally (15 patients). In group 2, patients underwent previous operations on the tendon-muscular apparatus (in other medical institutions) such as fibromyotomy (16 patients) or open lengthening of the Achilles tendon (8 patients). The crouch gait pattern in group 2 was considered iatrogenic. Gait analysis using the Edinburgh Scale and 3D analysis was performed before surgery, and at one to 2 years after the interventions. Results Upon comparing the pre- and postoperative indicators of the Edinburgh scale, there was an improvement in the indicators of movements in the ankle joint both in the supporting and in the non-supporting phases of the stride cycle for both groups: a decrease in the maximum dorsal flexion of the foot under load, an improvement in the maximum extension in the knee joint during the support phase, practically complete elimination of the pathological orientation of the foot relative to the motion vector, as well as improvement of the position in the knee joint immediately before the initial contact with the supporting surface. Computer gait analysis showed that multilevel surgical interventions improved the parameters of the knee flexion angle at the time of initial contact, increased the amplitude of knee joint extension in the support phase of the stride, normalized the orientation of the foot relative to the motion vector, reduced or completely corrected the pathological values of the dorsal flexion of the foot in the support phase of the stride and reduced the energetic intensity of movements. There was no significant increase in the indicators reflecting the strength characteristics of the plantar flexors, which reflects a pronounced suppression of the function of these muscles in the development of crouch gait. GPS changed from 17.1 ± 3.01 to 13.4 ± 3.19 for natural crouch gait and from 15.9 ± 6.16 to 14.8 ± 4.6 for iatrogenic one. Conclusion The crouch gait pattern is not homogeneous, both in terms of natural and iatrogenic development, and in terms of orthopedic disorders. The iatrogenic pattern develops with excessive surgical weakening of the plantar flexors of the foot, even if there is no pathological rotation of the lower limb segments in younger patients and with lower GMFCS levels. The planning of multilevel surgical treatment is based on 3D gait analysis and should be aimed at eliminating orthopedic components of the pathology that determine the crouch gait pattern. Surgical treatment enables to improve the kinetics and kinematics in the knee joint and the kinematic indicators of the ankle joint and, in general, increase the gait profile indicator.

Children with cerebral palsy (CP) typically suffer from epileptic seizures as a co-occurring condition to be addressed with antiepileptic drugs (AED) on a long-term basis. The incidence of coagulation disorders related to AED in children with CP is evaluated to range from nearly 4% to 20.7%. Surgery at the hip in CP children requires prolonged epidural analgesia that can be associated with serious adverse events such as epidural hematoma. The evidence for the use of continuous peripheral nerve blockade in children with CP, however, is limited. Purpose To evaluate the effect of AED on hemostasis and safe use of regional anaesthesia techniques at hip surgery in children with CP and concomitant epilepsy. Material and methods A prospective randomized study included 45 children with CP who underwent surgical treatment for spastic hip displacement. According to a type of anesthesia used and a co-occurring condition diagnosed, patients were allocated into 3 groups of 15 participants each: PEA group (control), children with no history of epilepsy receiving prolonged epidural analgesia (PEA); PEA-E group, children with epilepsy receiving AED and PEA; CFSB-E group, children with epilepsy receiving AED and a continuous femoral plus single-shot sciatic nerve block. Hemodynamic and laboratory findings, a need for blood components and complications were evaluated. Results A preoperative fibrinogen level was significantly higher in controls (PEA group), whereas PEA-E and CFSB-E patients showed reduced levels of circulating fibrinogen, prolonged aPTT and decreased coagulation index with negative values measured during major surgical phase. Conclusion Although basic anticonvulsant therapy with use of AED in children with cerebral palsy has been found to be associated with tendency to hypocoagulation evaluated with laboratory tests, neither clinically significant coagulopathy nor a greater risk of hemorrhagic complications have been identified with use of regional anaesthesia at hip joint operations.

Congenital hip dislocation in adults (Crowe type IV) is an indication for hip replacement. Shortening subtrochanteric osteotomy of the femur reduces the risk of vascular and neurological complications and corrects the antetorsion of the proximal femur. Purpose To demonstrate our experience with the use of the method of shortening osteotomy of the femur in hip joint replacement for congenital hip dislocation with an assessment of postoperative complications. Materials and methods 64 hip arthroplasties were performed using corrective osteotomy. The follow-up period was from 6 months to 8 years. We evaluated pain and functional status according to VAS and Harris Hip Score. Results Pain according to VAS in the hip was 3.4 ± 1.1 and 2.1 ± 2.2 in the lumbar spine. HHS was 55.6 ± 17.2 points. Pain relief in the lumbar spine might be associated with changes in the lateral radiographs of the lumbar spine.In the postoperative period, pelvic anteversion returned to normal, as did the other angles of the lumbar-pelvic balance. Conclusions Hip joint arthroplasty for Crowe type IV hip dysplasia is an operation of high complexity and is associated with a high risk of complications (19.7 %).

Relevance Knee joint replacement is the main method of surgical treatment in patients with oncological lesions of the distal femur and proximal tibia. The article presents the results of the use of this technique in Herzen Moscow Research Institute for Oncology. Purpose To evaluate the results of arthroplasty in patients with tumour lesions of the distal femur and proximal tibia. Materials and methods Between 2011 and 2019, primary knee replacement due to oncology was performed in 106 patients. Distal femoral resection was performed in 70 (66%), proximal tibia resection in 36 (34%) patients. Primary bone tumors were detected in 70 (66%) patients. Metastases of various solid tumors were observed in 36 (34%) patients. Results In the group of patients with primary malignant bone tumours (49 patients), 36 (73.5%) patients survived without signs of tumour progression, 3 (6%) were alive with disease manifestations, 10 (20.5%) patients died from progression. Relapse was diagnosed in 6 (12%), metastatic lung damage in 13 (26%). All patients with a giant cell tumour survived without signs of disease progression. In the group of patients with metastatic lesions (36 patients), 25 patients (69%) died from disease progression. The average value of the functional result on the MSTS scale was 78% for all endoprostheses. The incidence of postoperative complications was 30%, among which the prevailing was infection (9.5%). Conclusion The main adverse event in arthroplasty of large joints in oncologic patients remains the frequency of postoperative complications, which can develop in 20 to 30% of the patients. Further research on the possibility of using various designs and types of implants is necessary in order to reduce the incidence of postoperative complications and improve long-term functional outcomes in such patients.

Objective Review outcomes of arthroscopic management of femoroacetabular impingement (FAI) at two years. Material and methods This is a retrospective,uncontrollable, unicenter level IV evidence study (case series) that included 29 patients (19 females and 10 males) with clinical and radiological signs of FAI treated arthroscopically. Exclusion criteria included Kellgren-Lawrence grade 3 osteoarthritis, avascular necrosis of the femoral head and Wiberg’s center edge angle less 20° and more 40°. All patients underwent a preoperative complete set of radiographic views including the plain, 45° and 90° Dunn's views to identify impingement mechanisms and quantify alpha and Wiberg's angles. The Kellgren-Lawrence scale was used to grade hip osteoarthritis. The Outerbridge classification system was intraoperatively applied for grading cartilage lesions. The Hip Disability and Osteoarthritis Outcome Score (HOOS) was used to evaluate physical function of the hip and the International Hip Outcome Tool (iHOT-12) and the Oxford Hip Score were employed to measure health-related quality of life. The mean follow-up period was 29.3 ± 3.1 months. Results Combined hip impingement was observed in 82.8 % of the cases, 10.3 % had Pincer and 6.9 % Cam types. The mean alpha and Wiberg's angles measured preoperatively 67.7 ± 12.1º and 31.8 ± 8.3º, respectively. Patients reported improved pain and function of the hip at a 3-month follow-up. Patient reported outcome measures rated 65.8 % results as excellent, 6.8 % good, 13.7 % fair and 13.7 % as poor at 12- and 24-month follow-ups. The mean alpha angle measured postoperatively 48.7 ± 3.9º. Patients with poor outcomes underwent consersion to total hip replacement within a year following arthroscopic procedure. No complications were recorded in the patients. Overall two-year survival was 86.3 %. Conclusion Hip arthroscopy now has an established place in the treatment of FAI. Poor outcomes seen in 13.7 % of the cases were associated with acetabular cartilage lesions undetected preoperatively and seen as intraoperative arthroscopic findings.

Introduction Transfemoral socket designs commonly used with ischial tuberosity as the key weight-bearing part or accomodating the ischial tuberosity show some inefficiencies. The most recent advancement in socket design has provided transfemoral amputees with new options, however, it is not well known in Russia. Objective To explore theoretical and practical aspects of fabricating the Marlo anatomical socket (MAS) for transfemoral amputations and evaluate its application in clinical settings in Russia. Material and methods The new ischial containment socket design was shown to have advantages over conventional transfemoral sockets using comparative ichnographic studies. Results The MAS socket demonstrated improved cosmesis and appearance for the patient, increased sitting comfort, greater range of motion for the prosthetic limb and enhanced stability. Conclusion The technology requires no additional equipment and special fixturing. The new socket design can be successfully used by prosthetists in Russia to allow above knee amputees benefit from properly fitting socket.

Introduction Preoperative assessment of the acetabular bone defect location and size is an important stage in the preparation for revision hip arthroplasty. It is generally recognized that radiographs are not sensitive enough to assess peri-implant osteolysis, and therefore difficulties arise in determining the true dimensions of acetabular defects and in choosing the optimal surgical tactics. Purpose To determine the effect of three-dimensional visualization of the pelvic bones in patients with significant acetabular defects on the evaluation of the defect and the choice of surgical tactics at the stage of planning operations. Materials and methods For our study, a questionnaire was compiled, in which the surgeon’s experience in performing revision interventions in the hip joint was evaluated and it was proposed to consistently evaluate 20 clinical cases based on radiographs, and then on three-dimensional reconstruction. Each clinical case was asked to be evaluated for defect type according to the Paprosky classification, and also to choose one of the proposed options of surgical techniques. Results After comparing the data obtained by viewing the radiographs with the data obtained after evaluating the three-dimensional reconstruction of the defect, the Kappa consistency coefficient for the type of defect according to the Paprosky classification was 0.10 (95 % confidence interval 0.05–0.26), and for the choice of surgical tactics was equal to 0.08 (95 % confidence interval 0.01–0.15). It indicates that surgeons changed their minds in a significant number of cases. Conclusion The results of the study show the need for additional studies, in particular three-dimensional visualization, as part of the preoperative planning of revision arthroplasty, especially in cases of complex acetabular defects.

Introduction The changes that occur in the femoral head in Legg-Calvet-Perthes disease and aseptic necrosis in the early stages have been described sufficiently. The aim of the work was to study the condition of the hip joint in patients with Legg-Calve-Perthes disease and aseptic necrosis of the femoral head with magnetic resonance imaging (MRI) in the terminal stages of the disease and by formation of a symptomatic complex of deforming arthrosis. Materials and methods A retrospective single-centre MRI study (case series) included 15 patients with aseptic necrosis of the femoral head and Legg-Calve-Perthes disease. Results Among the studied group of patients, patients with stages III-IV of the disease prevailed. Five patients in the third - fourth stage of the disease had complete horizontalization of the cartilaginous labrum as a result of the outward displacement of the head. In seven patients, horizontalization was less pronounced, and the angle of the cartilaginous labrum ranged from 5 to 10°. The study of the cartilaginous acetabular index showed that in 9 out of 13 patients its value was less than 75–77 %. In stages III–IV, changes in the shape of the head and its lateralization is more pronounced. Discussion The complex of pathological changes in the hip joint in Legg-Calvet-Perthes disease and aseptic necrosis of the femoral head, especially in children, is most fully revealed with MRI, allowing to assess the state of the femoral head, acetabulum, all soft tissue and cartilaginous formations of the joint. One of the most important indicators is the lateralization of the cartilaginous labrum which reflects the severity of the mechanical stress in it resulting in displacement of the femoral head.

Introduction The diagnosis of spinal statics disorders requires a study conducted both with and without axial load. Standard multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are limited to the examination of the patient in the supine position. Axial loading techniques have expanded the indications for the use of high-tech methods of radiological diagnosis in assessing the statics of the lumbar spine. Methods 124 patients underwent conventional radiographic examination of the lumbar spine in the frontal and lateral projections in a standing position and an MRI study before and during axial load. Radiography with functional tests was used for cases with displaced vertebras. The Pearson correlation coefficient was used to compare the data; the significance of the methods was evaluated using calculations of diagnostic performance indicators. Results An increase of the angle of lordosis was noted in tests with axial load (r = 0.93). Indicators of scoliotic deformity obtained with MRI with axial load corresponded to X-ray data (r = 0.89). The diagnostic efficiency of MRI with a dosed axial load was the following: Se = 91.7 %, Sp = 89.2 %, Ac = 90.6 %; the results of MRI in the upright position were slightly lower: Se = 89.2 %, Sp = 73.9 %, Ac = 83.3%. Spondylolisthesis was found in 11 patients. The instability data obtained by comparing MR studies before and during the axial load with radiography with functional tests revealed their almost complete correspondence (r = 0.88). Discussion Axial-loaded MRI can provide additional information on statics, which is necessary to assess the nature of pathological changes. MR techniques based on low-field tomographic systems are limited in the diagnosis of extended deformations. MRI with axial load is a method of choice, especially when dynamic monitoring is necessary, due to the absence of ionizing radiation. Axial loading of the spine in MSCT study seems promising.

The aim of this study was to assess the information value of the content of C-reactive protein (CRP) for predicting disorders of distraction osteogenesis. Materials and methods A retrospective analysis of the results of surgical lengthening of the bones of the lower extremities due to short stature was performed in 39 patients. There were two groups of patients. Thirteen patients (main group) had cystic cavities formed in the area of distraction regenerate by the end of the surgical lengthening. The formation of distraction regenerate ran without complications in 26 patients (comparison group). Results Before treatment, all patients in both groups had CRP levels not exceeding 6 mg/l. On the 10th day after the onset of distraction, 15 patients of the comparison group had the CRP level equal to 6 mg/l or higher than (57.7% of all patients in this group). In the main group, the CRP level was equal or higher than 6 mg/l only in 3 patients (23.1 % of all patients in the main group). The significance level of the differences was 0.041. Discussion A retrospective analysis of clinical data revealed that the CRP level at the beginning of the distraction stage in the range of up to 6 mg/l was associated with an increased likelihood of developing cystic cavities in the regenerate by the end of the lengthening stage. This test is acceptable for use in clinical practice. Conclusion Preservation of the level of CRP in the blood serum, not exceeding 6 mg /l within 10 days after the onset of distraction, is a prognostic sign indicating a high probability of disorders in the formation of distraction regenerate in the patients undergoing surgical lengthening of the lower limb bones with the Ilizarov method.

Introduction Analysis of the literature and our own data confirm that changes in bone structure in chronic osteomyelitis vary in extension and severity, the boundaries of which are very difficult to determine. Purpose To analyze the extension of the lesion and the depth of bone structure destruction with the method of MSCT in various types of osteomyelitis and variants of its location. Materials and methods The study is retrospective and single-center. The method of polypositional radiography and multislice computed tomography (MSCT) was used to study the features of the X-ray morphology of the femur and tibia with a quantitative assessment of the density of various bone areas in 235 patients with chronic osteomyelitis. Results Chronic osteomyelitis was mostly located in the diaphysis of the femur (33) and tibia (52). Osteomyelitis in all cases was post-traumatic or post-surgical. Fourteen patients had pseudarthrosis or bone defect as a result of a long duration of the disease. Analysis of MSCT data showed that anatomical changes in the femur and tibia in chronic osteomyelitis were individual in all patients. Radiographic morphological manifestations consisted of general symptoms (osteoporosis, osteosclerosis, disorders in architectonics). However, the severity, extension and nature of the structural changes were extremely diverse. The change in bone density featured large deviations. Conclusion The data obtained indicate that the “imaging reality” in the diagnosis of chronic osteomyelitis is computed tomography as it enables to determine the extension and nature of bone changes, to detail various changes in anatomy and architectonics, indicating the “multifaceted character” of chronic osteomyelitis.

Defects of the cartilage surface are a frequent joint damage in orthopaedic practice. First of all, they arise as a result of high-energy trauma or a consequence of chronic systemic diseases. In both cases, incongruence of the articular surfaces leads to the development of osteoarthritis. Joint resistance to residual incongruence depends on the depth and area of the damage, as well as on the thickness of the articular cartilage. The restoration of cartilage defects in the knee joint remains one of the urgent problems of modern orthopedics and traumatology. Purpose Search for new methods for filling extensive defects of the articular cartilage of joint surfaces with the possibility of restoring a typical joint structure Materials and methods Using clinical, microanatomical, and histological methods, a study was conducted to investigate the possibility of filling the defect of the joint surface of the femoral condyles of adult mongrel dogs (n = 3) with a thin elastic polycaprolactone woven by electrospinning, the threads of which are coated with hydroxyapatite nanoparticles, in combination with the introduction of an enriched platelet blood autoplasma into the defect. Results After 60 days of the experiment, restoration of the congruence of the articular surface along with mosaic-like replacement of the implanted material in the region of the cartilaginous layer with portions of hyaline-like cartilage and in the subchondral bone zone with a new cancellous bone tissue was noted. In the defect of the articular surface of the control animals, which was not filled with a bioactive implant, vascularized loose fibrous connective tissue was formed after 60 days of the experiment. Conclusion The results obtained may be promising in terms of the possibility of prolonging the functional ability of joints in patients with articular cartilage defects; after further longer experimental and clinical observations) may offer a new universal method for filling articular defects of various etiologies to restore their biomechanics and typical strudcture.

Objective To explore histomorphological characteristics of articular cartilage of the knee and ankle joints in repair of postresection tibial defects using the Ilizarov method and cement spacer. Material and methods A defect-nonunion was simulated in the proximal tibia of 10 mongrel dogs using the Ilizarov external fixation followed by application of cement spacer to repair a defect-diastasis of at least 15 % of the original bone length. The spacer was removed after 30 days and tibial distraction commenced at a rate of 1 mm four times at the site of transverse osteotomy in the distal tibia for bone docking. Histomorphological evaluation of articular cartilage of the trochlea of the talus and femoral condyles was produced at 60-day fixation (F60) and 30 days following frame removal (FR30). Results The structure of articular cartilage of the trochlea of the talus was intact at F60 and FR30, and morphometric parameters were comparable with those in controls at the end of experiment. Pannus was detected on the articular surface of the femoral condyles in 60 % of observations, and subchondral bone structure appeared to be impaired with marrow pannus penetrating deep into the cartilage. Intact zonal structure of the cartilage with no pannus, persisted integrity of the basophilic line, thin subchondral bone were observed in 40 % of observations. Compared to controls, greater number of empty lacunes and cartilage thinning were recorded at FR30. Conclusion The Ilizarov external fixation and cement spacer used to repair simulated postresection tibial defect was shown to be a cartilage-sparing procedure for the ankle joint with a higher risk of irreversible destructive changes in articular cartilage of the knee joint.

Introduction Eleven million burn injuries have been recorded in the world annually, and 180 thousand of them result in death. Burns are the fourth leading cause of trauma. Mortality in adult patients with burns in the Russian Federation is 4.8 % and 5.3 % in the Ural Federal District. Materials and methods A retrospective analysis of statistical data on the provision of specialized inpatient medical care to patients with thermal trauma in the regions of the Ural Federal District for five years has been undertaken. Results In most regions of the Ural Federal District, there are no transfer protocols for patients with burn injuries. The load on the existing capacity of hospital beds in the regions is uneven. Most of the thermal trauma patients in specialized departments are treated conservatively. Not a single "burns" department of the Ural Federal District has a certified plastic surgeon. Conclusion The following organizational measures are a need: introduction of a unified approach to statistical reports, deployment of surgical beds at departments for burn injury management to provide specialized medical care to patients with various wound defects, referral transfer of patients with the consequences of thermal injury to a specialized federal institution and creation of a unified register of burn patients.

The literature was reviewed for reports on the pathogenesis, diagnosis and treatment of injuries to the posterior cruciate ligament (PCL). PCL is the largest intra-articular ligament in the knee joint and has good tensile mechanical properties. Optimal diagnosis and appropriate treatment strategies for PCL injury are discussed. Nonoperative treatment of isolated PCL injuries is associated with a significant risk of degeneration of the knee structures and impaired function. A comprehensive line of PCL reconstruction options are offered for the surgical approach to PCL reconstruction to restore functional joint stability in the knee.Literature data on protective effect of glucosamine, chondroitin sulfate in the prevention of secondary knee osteoarthritis caused by PCL ruptures were reviewed.

The article presents an overview of foreign publications on surgical treatment of hallux rigidus with comparison among different available surgical approaches, good evidence to support most effective modalities and perspective surgical treatment options for the condition.

The literature review focuses on artificial intervertebral fusion. An increasing number of instrumented spinal procedures are performed each year with improved diagnostic and treatment strategies, advanced surgical technologies and optimal anesthetic techniques. One of the most common complications of spinal fusion is nonunion with the high reported incidence. Factors affecting fusion rates in lumbar spine surgery are described. Data from articles and textbooks of the last two decades have been used to reflect the current understanding of the research problem including reports in the earlier literature when appropriate.

Digital tomosynthesis is a radiological method having an intermediate position between x-ray and computed tomography (CT). Benefits with the imaging technology include improved image quality, post-processing (reconstructed to 1 mm thick slices), minimal tissue overlap in the projection image and a lower X-ray dose as compared to CT. Tomosynthesis is most commonly used in breast, chest (pulmonary tuberculosis), musculoskeletal and intraoral screening examinations. There is disagreement among professionals on feasibility and clinical effectiveness of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases. Our goal was to summarize evidence relating to efficacy and feasibility of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases. Russian and foreign literature was reviewed based on methodological principles of the PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions. The review included 34 articles in English and in Russian (referenced 16 to 49) describing an original study with focus on phantom, diagnostic, clinical studies. We considered articles which investigated use of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases including rheumatoid arthritis affecting the hands and feet, specific and nonspecific spine lesions and injuries, nonspecific lesions and injuries to the joints; subtle fractures and dislocations. With the advantages of tomosynthesis in clinical practice, the imaging modality can be recommended for the diagnosis of the above conditions.

Analytical review of scientific theses defended in 2019
with the dissertation board D 999.063.03 at the Russian Ilizarov Scientific Center for Restorative
Traumatology and Orthopaedics of the Ministry of Health of Russia,
FSBEI of higher education “South Ural State Medical University" of the Ministry of Health of Russia
and FSBEI of higher education "Tyumen State Medical University" of the Ministry of Health of Russia

Introduction Modern technologies for treating patients with fractures of the humerus using metal structures (various options for free and non-free bone autoplasty, dynamic plates DCP, LCP, intramedullary locked osteosynthesis, external fixation devices) do not always guarantee restoration of the integrity of the segment. Patient's fibula as an autologous osteoplastic material assists in achieving adequate contact of the ends of the fragments, prevents secondary displacement, and creates conditions for bone formation. Material and methods We retrospectively evaluated the results of restorative treatment in four patients of the same sex, with the same etiology of pseudoarthrosis, and failure of previous operations in whom a free fibular autograft was used for humerus reconstruction at one medical institution. A new method of humerus reconstruction in hypotrophic pseudoarthrosis patented in the Russian Federation is described in detail. Results and discussion Capabilities of any dynamic internal system are limited in time and effects. The external fixation device allows for controlled fixation of the fragments of the humerus and maintains it in the required mode until the consolidation of the fragments. The fibular graft, implanted into the bone marrow cavity in the area of the junction of fragments, plays the role of an interface and additionally reinforces the humerus, preventing secondary displacement that may be caused by compression forces created with the fixator. The autogenous osteoplastic substance formed in interfragmental gap and along the periphery is a substrate for local osteoplastic intervention that stimulates osteogenesis. Conclusion A free bone autograft shaped as a cylindrical fibular fragment s implanted into the zone of active angio- and osteogenesis. The coaptation zone of fragments of the humerus is reinforced with an implant intraosseously along its length to eliminate the risk of secondary displacement of the fragments by creating compression with an external fixator. The use of an external fixation device provides contact in the area of the bone wound and maintains compression between the ends of the humerus fragments until bony fusion.