Purpose. To assess the effectiveness of minimally invasive technologies of osteosynthesis and electromagnetic waves of the terahertz range in patients with multiple and concomitant trauma.

Materials and methods. The process of rehabilitation was studied in 513 patients with polytrauma of varying severity which was more than 26 points on the ISS scale. The patients were diagnosed with 545 injuries of different organs and systems. All patients with severe concomitant and multiple trauma were divided into 3 groups: Group I of controls, treated in1995–2001, consisted of 269 patients whose treatment was conservative and aggressive (surgical, with the use of plating or intramedullary osteosynthesis); Group II was the experimental study group consisting of subgroup A of 202 patients treated in 2002–2009 in whom “damage control” concept was applied and subgroup B of 42 patients treated in 2010–2017 using the damage control tactics and new minimally invasive methods of treatment and devices (non-invasive lung ventilation in intensive care for fat embolism; rational osteosynthesis in closed chest trauma; minimally invasive guided method of transosseous osteosynthesis, including the use of fixators with hydroxyapatite coating; rational surgical approach to pelvic bones; universal guide for reaming the medullary canal) and exposure to electromagnetic waves of the terahertz range (EMWTHR)of the xiphoid process of the sternum to stimulate the immune system.

Results. It was revealed that the use of minimally invasive, low-traumatic methods of treating bone fractures in severe polytrauma and methods stimulating the immune system and tissue regeneration (subgroup II B) contributed to an improvement of anatomical and functional results of treatment by 1.3 times compared with the control group. The quality of life of patients in this group, in comparison with the control group, was 1.6 times higher for injuries of the upper limb and 1.9 times higher for injuries of the lower limb. An integral analysis of the effectiveness of the treatment revealed a reliable increase in the effectiveness to a satisfactory level.

Conclusion. The use of EMWTHR in the complex treatment of such patients is a promising method for stimulating hematological and immunological processes. The first results described in the literature are optimistic.

Introduction. One of the most common injuries in children is clavicle fractures. They account for up to 14 % of all pediatric bone injuries.

Aim. Comparative evaluation of the effectiveness of surgical and conservative methods of treating closed clavicle fractures in children.

Materials and methods. Between 2011 and 2018, 1,800 children with clavicle fractures referred to the traumatology and orthopedic department at the Children's Clinical Hospital No. 9 in Yekaterinburg.Most of them were treated conservatively, and 94 (5.2 %) children were hospitalized for surgical treatment. Depending on age and type of displacement, children received different conservative treatments, such as Deso dressing in children under two years old, figure-eight-bandage in children over two years of age. Surgical treatment was open reduction of fragments and fixation with either a Kirschner wire or a titanium elastic nail (TEN); titanium plates were used in several cases. For a comparative assessment of the results of the treatment methods for clavicle fractures, two groups of patients were formed.

Results. Shortening of consolidated clavicle was not observed in children of the main group treated surgically. In several cases, the elongation of the clavicle was revealed by no more than 1 cm. Patients in the comparison group showed shortening of the broken clavicle in three cases, no more than 1.3 cm.

Conclusion. After surgical treatment, the length of the shoulder girdle was fully restored; insignificant shortening after conservative treatment did not cause functional disorders.

Objective. Improve the effectiveness of pediatric treatment of chronic radial head dislocations (CRHD).

Material and methods. The review included 100 pediatric patients aged 2–18 years treated for CRHD between 2005 and 2019. Patients underwent physical examination, radiological (conventional radiography, US, MRI, MSCT) evaluation and statistical analysis was performed. Patients were divided into two groups. A major group consisted of 33 (33%) patients who were treated with new bone and plasty procedures including open reduction of the radial head (ORRH), plasty of the annular ligament with m. anconeus flap and fixation with the plaster cast; osteotomy of the proximal ulna and ulnar realignment with the Ilizarov external fixation. Outcomes were retrospectively compared with 67 (67.0 %) control patients treated with different classical techniques including ORRH, radial head fixation with wires, polyethyleneterephthalate band or the remnants of the annular ligament, with/without ulnar osteotomy. Anatomical and functional results of treatment were evaluated at a short (up to one year) and long term (over one year) after frame removal using modified Mattis-Lyuboshitz-Shwarzberg grading scale.

Results. Comparative analysis of outcomes of surgical management at a short- and long term in both groups showed that the percentage of good results was 1.5 times higher in the major group. A table of differentiated indications to pediatric treatment of CRHD was devised based on the findings.

Conclusion. Biomechanical articular parameters appear to deteriorate over time following radial head dislocation and can result in radial head deformity, malaligned and shortened ulna. Pediatric treatment is supposed to be differentiated depending on time of injury, patient's age, anatomical and radiological manifestations of the joint. Operative pediatric treatment of CRHD involving bone and plasty procedures can provide good internal fixation preventing recurrence.

Introduction. Although surgical treatment of carpal tunnel syndrome (CTS) is known to be highly effective outcomes may not be equally satisfactory for the patients due to severity of clinical presentation and objectifying assessment of the condition.

Purpose. Provide clinical evaluation of outcomes of surgical treatment of CTS using questionnaires and electroneuromyography (ENMG) findings depending on baseline severity of the condition.

Material and methods. The review included 161 patients who underwent 189 operations of open decompression of the median nerve using mini-access. The patients were assigned to three groups with mild (Group I), moderate (Group II) and severe (Group III) CTS. Evaluations were produced at 6 weeks, 3, 6 and 12 months following the surgery.

Results. The majority of patients showed positive dynamics, and delayed recovery of the wrist function was noted in Group III at a 12-month follow-up. Patients of Group III exhibited spasmodic improvement of the wrist function at 6-week-to-3-month follow-up.

Conclusion. Open decompression of the median nerve performed for patients with CTS using mini-approach facilitated substantial clinical and functional improvement in most cases. However, the most favorable results could be provided for mild and moderate CTS.

Objective. Search for the relationship between innate immunity and bone and cartilage metabolism in patients with developmental dislocation of the hip (DDH).

Material and methods The study included 27 patients with DDH who underwent reduction of the hip at pediatric orthopaedic department of the Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation. The patients aged 15.0 ± 1.7 months. The study enrolled the babies diagnosed with grades III, IV, V unilateral or bilateral DDH as classified by M.V. Volkov, 1978. Patients with hip dysplasia (grade I DDH) or congenital hip subluxation (grade II DDH) were excluded from the study. The control group consisted of 15 patients without musculoskeletal pathology. The mean patients' age was 24.0 ± 1.8 months. Peripheral blood monocytes, toll-like receptor (TLR2, TLR4, TLR5) expression, serum concentrations of fibroblast growth factors (FGF), vascular endothelial growth factor (VEGF), serum magnesium, type I, II collagen and aggrecan were measured in patients of major and control groups.

Results. DDH patients showed statistically significant differences in all the parameters measured except for the type 2 collagen with decrease in peripheral blood monocyte and increase in TLR2 and TLR5 expression, slight increase in the serum magnesium with decreased concentration of aggrecan and increased FGF level. There was a two-fold decrease in VEGF level and a two-fold increase in type I collagen concentration. There were moderate significant correlations for monocyte matches TLR2 and TLR2 – TLR5 in major group. Three main factors detected with factor analysis included (1) monocytes, TLR2 and TLR5 as most meaningful, (2) FGF and type 2 collagen and (3) aggrecan.

Conclusion. The findings suggested that specific factors of innate immunity can be involved in the pathogenesis of DDH. Toll receptors regulate many metabolic pathways and connective tissue metabolism, More studies are needed to further explore this topic.

Introduction The systemic nature of the disease and the use of modern conservative therapy may cast doubt on the effectiveness and necessity of total hip arthroplasty (THA) in ankylosing spondylitis (AS). A comprehensive assessment of the functional state, quality of life (QOL) and subjective assessment of patients allows the most complete analysis of treatment results.

Objective. Comprehensive analysis of short-term results of quality of life, clinical and functional status and treatment satisfaction in patients with AS after THA.

Materials and methods. 17 patients with AS underwent primary THA (5 women, 12 men, average age 43.8 ± 3.1; from 33 to 52 years). Cases of complete bone ankylosis of the hip joint were excluded. An analysis of the functional state using Harris Hip Score and QOL (SF-36v2) was performed before surgery, 2 months, 6 months and 12 months after surgery. Patient treatment satisfaction analysis (VAS) was performed at the same follow-ups.

Results. A significant improvement in clinical and functional status (HHS) and QOL (SF-36v2) was obtained after 2, 6, 12 months compared with the preoperative level (p less 0.05). High levels of patient satisfaction with treatment outcomes were achieved. Para-articular ossification (3 patients, 18 %), a hematoma in the postoperative wound area (1 patient, 6 %), implant dislocation (1 patient, 6 %) were the main complications.

Conclusion. THA in patients with AS improves not only the functional state but also the QOL compared with the preoperative level.

Introduction. Non-traumatic avascular necrosis of the femoral head (ANFH) is a poly-etiologic and socially significant disease in the age of 20 to 50 years and is associated with disability. Research on the identification of necrosis causes/predictors is a relevant issue.

Purpose. To study the contribution of polymorphisms in the genes of coagulation factors F7 and F13 in the aetiology of non-traumatic avascular necrosis of the femoral head.

Methods. Polymorphisms of the genes of coagulation factors F7 and F13 were studied; comparative analysis of the frequency of important allelic variants of F7genes (Arg353Gln) and F13 (Val134Leu) in patients with a verified diagnosis of aseptic necrosis (study group) and in healthy patients (control group) was performed. The study group included 41 patients (all males) with aseptic necrosis of the femoral head of unknown etiology.

Results. The frequency of gene alleles in the F7 Arg353Gln in the study group were: GG in 30 out of 41 patients (73.2 %), GA in 11 out of 41 patients (26.8 %), and none of 41 patients had a polymorphic variant AA. The frequency of alleles of this type of gene in the control group was as follows: GG in 7 out of 320 subjects (2.2 %), GA in 66 out of 320 patients (20.6 %), AA in 247 out of 320 (77.2 %). Significant differences were identified in the frequencies of homozygous genotypes, AA (χ2 = 100.215, p less 0.001) and GG (χ2 = 205.770, p less 0.001) in the study and control groups respectively. As for the heterozygous GA genotype, the differences were not significant (χ2 = 0.834, p = 0.362). The GG genotype of the gene Val134Leu F13 WAS 2.8 times more frequent in patients of the study group, differences were statistically significant (26.8 % against 9.7 %, χ2 = 10.388; p = 0.002). The presence of the TT genotype of the gene Val134Leu F13 was almost five times more frequent (χ2 = 18.956, p less 0.001) in healthy individuals (control group). Differences in the frequency of allele T in homo/and heterozygous combinations (TT and GT) in the study and control groups was also significant (72.7 % vs 90.1 %, respectively, χ2 = 4.946, p = 0.027).

Discussion. Polymorphisms of coagulation factors genes F7 and F13 have a significant effect on the genesis of non-traumatic avascular necrosis of the femoral head. Risk factor of ANFH development is homozygous GG genotype in the gene Arg353Gln F7. Low probability of the disease is due to a protective role of AA genotype of the gene Arg353Gln F7 and TT genotype of the gene Val134Leu F13.

Purpose. Evaluate clinical effectiveness of anatomical reconstruction of the anterior cruciate ligament (ACL) and determine the perspectives for practical health care.

Material and methods. The review included 706 patients who underwent arthroscopic reconstruction of the ACL and graft interference screw fixation between 2010 and 2018. ACL reconstruction was performed using either anteromedial portal (n = 396, Group I) or an isometric transtibial tunnel technique (n = 310, Group II). Outcomes were evaluated clinically and radiographically using the 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Lysholm scoring scale. Clinical and economic outcome measures included surgical time, rehabilitation and disability periods and period of recovery for sports performance.

Results. The knee anterior drawer test was equally negative and showed no significant differences in the groups. The Lachman test and the pivot shift test showed better results in Group I (p less 0.001). Contractures, atrophic femoral muscles (p less 0.05), synovitis (p less 0.01), vertical position of the femoral graft channels and pathologically extended bone channels with wind-wiper effect (p less 0.001) were more common among patients of Group II. Although knee function returned to normal, as rated with the 2000 IKDC Subjective Knee Evaluation Form, in 91.3 % of cases pathological changes in the knee (C) and severely impaired function (D) were 2.5 and 5 times less common in group I than in Group II (p less 0.05). Pain, symptoms and sport scores were significantly higher on the KOSS scale for Group I (p less 0.05). Surgical time was longer in patients of Group I (p less 0.05) who had shorter rehabilitation period (p less 0.05).

Conclusion. Anatomical reconstruction of ACL using anteromedial portal was shown to be a more reliable technique as compared to transtibial approach to ensure overall knee stability arranging adequate bone channels. The technique is capable to protect the graft from injury, reduce the likelihood of pain, synovitis, contractures, muscle atrophy, providing shorter rehabilitation, disability period and recovery for sport performance.

Background. Gout, lasting 5 years or more, and high uncontrollable levels of uric acid in blood lead to the formation of tophi – gouty stones containing the UA crystals surrounded with connective tissue. As the result of tophi formation in the joint area patients felt extreme discomfort and quite often completely lose ability to work.

Objectives. To define indications for tophaceous gout surgery in the Chengdu Rheumatism Hospital, evaluate surgical results and complications, as well as the effectiveness of a new surgery equipment.

Materials and methods. The indications and results of tophaceous gout surgery were investigated in 63 male gout patients of Chengdu Rheumatism hospital in 2019-2020. A retrospective analysis was carried out on the basis of medical records for all patients who were prescribed with urate lowering therapy and underwent arthroscopic intervention or complex surgical intervention combining arthroscopic shaving with open tophectomy procedure.

Results. The most common lesion site was foot joints: toes (49.41 %), ankle (39.68 %) and knee (34.92 %), with restricted mobility in the mentioned joints. Among common complaints were inability to perform daily routines due to enlarged joints (inability to wear shoes), joints’ dysfunction and pain. Younger patients (aged 20–44) had significantly higher levels of uric acid in serum before treatment. In most cases, indications for surgery for this group of patients were pain and discomfort in joints, inability to perform daily work. After accessing pain levels, 38.46 % of younger patients reported pain leveled 6 or higher on VAS score, which was more often, compared to patients aged 45–55 (26.92 %) and older than 55 (10.0 %). After surgery and following urate lowering therapy all patients noted functional improvement and reduction of pain. Decrease in serum urate levels were reported in 96.83 % of patients.

Conclusion. The results of surgical treatment for functional impairment of the joint (inability to perform daily work due to restricted range of motions) and massive joint transformation (inability to wear shoes/clothes) in gout patients are positive, with all patients reporting functional improvement and reduction of pain, and the risk of complications is low. In addition to urate lowering therapy we cautiously recommend performing arthroscopic shaving even in younger gout patients consistent with aforementioned indications.

Introduction. Correction of the shape of the lower extremities for aesthetic purposes has specific features that are associated with the role of the patient in the treatment process and assessment of results. An important element is the relationship between the appearance of the limb and changes in the axes of the skeleton.

Aim of study. Assessment of many-years of experience in orthopedic correction of the shape of the lower extremities for aesthetic purposes, discussion of possibilities, analysis of problems and search for possible ways to prevent them.

Methods. The material of the study was 123 patients who underwent aesthetic surgical correction in the period from 2005 to 2020. Their results were followed in the period from 6 months to 11 years. In all cases, operations were performed simultaneously on both limbs. The total number of operations, thus, amounted to 246. The main indication for surgery was the so-called true O-shaped curvature (varus deformity) of the lower extremities. In all cases, the main elements of the operation were osteosynthesis with theIlizarov apparatus and osteotomy of the tibia. Wires and half-pins were used as transosseous elements. To assess the main reference lines and angles (RLA), X-ray examination of the lower extremities was performed with the capture of the hip and ankle joints.

Results and discussion. Corrective manipulations in the group of patients led to a change in the position of the main RLA. Before treatment, MAD value was 15 ± 7 mm, after correction MAD = -2 ± 4 mm, before surgery MPTA = 85 ± 40, after correction MPTA = 91 ± 20. Subjective satisfaction was reported in 114 (92.7 %) cases. Subjectively unsatisfactory results were recorded in 4 (3.3 %) cases; objectively unsatisfactory results were detected in 5 (4.1 %) cases.

Conclusions. Aesthetic surgery of the lower extremities is a part of orthopedic practice and has its specific features due to the goal of realizing the patient's wishes about changing the appearance of the lower extremities indirectly by performing operations on the skeleton. Corrective interventions should be considered as a preventive measure aimed at preventing the development of gonarthrosis in old age. The key to a good result is careful selection of candidates for surgery and their compliance, along with a thorough explanation of the principles and features of correction.

Introduction. Morphological, biochemical and histopathological characteristics of paraspinal muscles have been well described in patients with idiopathic scoliosis. However, there is a paucity of literature on morphological picture of paraspinal muscles in patients with severe idiopathic scoliosis.

Objective. To explore how the magnitude of thoracic spine deformity affects morphological characteristics of paraspinal muscles in patients with severe idiopathic scoliosis.

Material and methods. A total 21 patients with idiopathic scoliosis were reviewed. The patients were assigned to two groups depending on magnitude of preoperative thoracic spine deformity. A major group consisted of patients with scoliosis of ≥ 60º (n = 11) and control group included patients with a curve less 60º (n=10). Biopsy samples were taken from muscle fragments (multifidus muscle) at the apex of the curve (major arc) at the Th6-Th10 level on the convex side while approaching to the posterior spinal structures during surgical correction of kyphoscoliosis using light microscope. The specimens were examined histologically with light microscope.

Results. Patients with severe idiopathic scoliosis (≥ 60º) showed evident muscle fiber atrophy and dystrophy of different extent. There were nucleus free areas and homogenized muscle fragments observed with connective tissue layers being swollen and frayed with multiple fibroblasts seen in nearly all the samples. Arterial walls were normally fibrotized. Structural changes ranged from minimal with a curve of 60º to degrading muscles with the fibers replaced by fat and connective tissues with a curve angle of 145º.

Conclusion. Morphological characteristics of paraspinal muscles have been shown to be severely affected by the magnitude of thoracic spine deformity in patients with severe idiopathic scoliosis. The findings should be considered in surgical correction of kyphoscoliosis with special focus on postoperative vascular and neurotropic therapy to allow wound healing and lower complication rate.

The purpose of the study was to assess the reliability, accuracy and effectiveness of a mobile application SpinoMeter for measuring the sagittal balance of the spino-pelvic complex in comparison with the desktop preoperative planning system Surgimap.

Methods. SpinoMeter mobile application was developed in 2019 at the laboratory for Medical Decision Support Systems of Saratov State University. SpinoMeter is intended for measuring the actual and for calculating the optimal parameters of the sagittal balance of the spino-pelvic complex of a particular patient. Pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS) and pelvic tilt (PT) were measured with the help of Surgimap and SpinoMeter. Inter-observer reliability was assessed on X-rays in a standing position of 52 patients having consequences of injuries and pathology of the lumbar spine with imbalance syndrome. The research site was the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University. Measurements of the sagittal balance parameters were presented in tables and diagrams. For all data, the hypothesis of a normal distribution of the measurement results was tested using the Kolmogorov-Smirnov test. To test the hypothesis of homogeneity of the measurement results for normally distributed samples, the paired Student t-test was used. In the absence of a normal distribution, the Wilcoxon test was used for related samples.

Results. For PI, PT, SS and L1-S1 lordosis at a significance level of 5 %, the hypothesis of uniformity of measurements was confirmed. The average value of L4-S1 lordosis, measured by SpinoMeter, was shifted down relative to the measurements of this parameter by the Surgimap program. The shift did not exceed 0.7 %.

Conclusion. SpinoMeter mobile application is equivalent to the Surgimap system in terms of measuring the sagittal balance parameters based on radiographs in a standing position.

Introduction. Glucocorticosteroid injections have been widely used in clinical practice. Betamethasone is one of the agents of this group of drugs. Its efficacy and therapeutic effect with intra-articular administration are undeniable. There are special instructions on the dosage and frequency of use of the drug but unfortunately there are cases of its wrong administration. There is also an evidence of an adverse effect on cartilage both of the drug itself and its combination with local anesthetics.

Aim. Evaluation of the results of different weekly intra-articular protocols of betamethasone administration on histological preparations of rabbit knee joints.

Methods. Histological preparations of the right knee joints of three groups of rabbits were studied: after one, three, and six administrations of betamethason per week and the control intact left knee joints.

Results. Histological preparations of the control group and the group with a single weekly administration of the drug did not have any changes in the structure of diarthrosis. Dystrophic and necrotic changes affecting all morphological components were observed in the joints of animals that received intra-articular injections of betamethason three times a week (compared to a single injection, the area of dystrophy and necrosis of the cartilage was greater by 10.05 ± 0.75 % (p less 0.05), of subchondral bone by 8.11 ± 0.5 % (p less 0.001), and of synovium by 6.25 ± 0.32 % (p less 0.05). The group with six injections of the drug per week had the most pronounced changes. The area of necrotic changes of the cartilage was greater by 6.39 ± 0.75 % than in the group with three injections per week (p less 0.001), of subchondral bone by 11.18 ± 0.5 % (p less 0.001), of synovium by 6.12 ± 0.32 % (p less 0.001).

Discussion. Inflammatory cell infiltration of joint structures was absent in all cases. It indicates an aseptic nature of tissue necrosis. Evidence has been obtained between the increase in the frequency of intra-articular injections of betamethasone and the severity of dystrophic and necrotic changes in all morphological components of the joint.

Introduction. Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect. Neither internal fixation nor open reduction could be considered due to substantial bone loss and severely impaired circulation with a high risk of soft tissue necrosis and infection. We report staged management of forearm fracture using avascular autologous graft to repair the defect and maintain the forearm length.

Objective. Demonstrate the successful management of the double open comminuted fracture of forearm bones with extensive bony loss using Ilizarov external fixation, classical autologous grafting harvested from fibula and intramedullary (IM) nailing.

Results and discussion. The limb was temporarily fixed with Ilizarov frame in an extra-focal manner. An autogenous fibular graft of 11 cm was used to fill in the gap. Intramedullary nailing of the radius and ulna was produced and ulnar defect was repaired with autogenous fibular graft. IM nails were removed once the bones consolidated. The limb function was completely regained, anatomical length of the segment maintained and metal constructs removed.

Conclusion. Combination of different bone fixation modalities, classical autografting technique and intramedullary nailing provided complete recovery of the broken limb maintaining the function and bringing down the risk of complications to ensure a good clinical result.

We report a clinical case of a 27-year-old patient with posttraumatic painful ankle arthritis following sport injury treated with combined methods. The patient underwent ankle distraction arthroplasty with original Ilizarov apparatus and arthroscopic diagnosis and treatment of the ankle injury followed by the joint unloading and exercise therapy with frame on performed for 6 weeks at the Kurgan Ilizarov Center. The patient could improve pain relief and function at a long term following comprehensive treatment including surgical intervention, a course of physical procedures and exercise therapy. The combined technique can be used as an alternative treatment for patients with posttraumatic ankle arthritis.

Introduction. The problem of treating chronic unstable pelvic injuries is characterized by the complexity of delayed one-step or staged reduction, difficulties in choosing the technology and treatment options, complexity of selecting criteria for evaluating planning along with the effectiveness of treatment. The use of spinal systems to perform reduction manipulations and fixation of the pelvis is described in few clinical observations. Therefore, the assessment of the effectiveness of the sequential use of various fixation systems in one patient was regarded by the authors as a rare opportunity and determined the purpose of the study.

Purpose. Demonstration of the possibilities of various osteosynthesis methods and their combination in reconstructive surgery of the pelvis in a case of its severe chronic injury.

Materials and methods. We present a clinical case and a brief analysis of the literature. A case of a patient with post-traumatic pelvic deformity and imbalance syndrome as a leading component of pelvic ring deformity is presented by us. The effectiveness of reconstruction options, including those with the use of spinal systems, was analyzed. The treatment was assessed with radiological study methods (X-ray and CT) with balance evaluation on a digital platform and functional scores for the quality of life.

Results. Correction of frontal deformity of the pelvis was achieved with compensation for a relative shortening of the left lower extremity, restoration of the center of rotation of the hip joints, and relief of pain in the lumbar region. The functional state according to the Majeed score system and clear radiological signs of stabilization of the pelvic ring while maintaining the position of the acetabulum in the frontal plane prove the effectiveness of hybrid osteosynthesis with the use of spinal fixation systems.

Conclusion. The leading syndromic complexes are instability with clinical manifestations of non-union and pain along with an imbalance syndrome, manifested by a gross deformation of the pelvic ring. Syndromic evaluation determines the tactics of surgical treatment while a detailed planning of the sequence of intervention, choice of the level of osteotomy, combination of osteosynthesis options using spinal fixation systems provide the solution of reconstructive pelvic surgery tasks in one session.

Introduction. Distal femoral fractures are a challenging medical and social problem as they may occur at any age. All the available osteosynthesis types can be used to treat such injuries. However, despite the disadvantages, fixation with plates has been the most common and developed.

Aim of study was to analyze the world literature and summarize the information regarding the use of plate fixation in the treatment of distal femoral fractures, identifying unresolved issues and promising directions.

Materials and methods. The following sources were used for collecting the information: Pubmed and E-library databases, publications of Elsevier, Springer and other publishing companies, materials of the Russian National Library, AO Surgery Reference on line.

Results. A review of global literature demonstrated that a minimally invasive approach which allows for bone fragment blood flow and stable fixation with a locking compression plate (LCP) are the most important factors that can improve the quality of treatment with plating. Discussion Plate fixation is still the most preferred method in the treatment of distal femoral fractures. In most severe injuries, accompanied by the medial support loss (33–A3, 33–C2 and 33–C3 fracture types according to AO classification), the use of not only the lateral but also the medial plate to achieve stable osteosynthesis has been discussed.

Conclusion. Further advance of the technology for treating these injures may be associated with designing an “anatomical” medial plate and a method for its minimally invasive implantation. Development of a lateral plate which could provide the stability similar to bilateral osteosynthesis seems even more prospective. Undoubtedly, such a plate would be useful in limb reconstruction surgery as well, for changing the external fixation to internal one after deformity correction and limb lengthening.

Introduction. Osteoarthritis (OA) is a heterogenic group of disorders of different etiology with similar biological, morphological and clinical manifestations and outcomes. OA is now considered a disease of the whole joint, including alterations in the articular cartilage, subchondral bone, synovial membrane, ligaments, capsule and periarticular muscles. OA of the knee as the most commonly affected joint accounts for the great medical, medical, social and economic impact.

Material and methods. A literature review assessing Russian and foreign studies on molecular mechanisms of etiology and pathogenesis of knee OA identified a set of factors for which there was consistent evidence for their association with onset of knee OA. A search of studies published in Russian and in English for the last ten years was conducted using bibliographic databases, including PubMed, PubMedCentral, GoogleScholar, eLIBRARY. Search terms included 'knee osteoarthritis', 'etiology', 'pathogenesis', 'risk factors'.

Results. Review of the literature showed that patients with knee OA are characterized by changes in cartilage, subchondral bone, synovium, suggesting common mechanisms of joint degeneration during OA development. Osteoarthritis (OA) is multifactorial in origin and closely associated with a wide spectrum of local (previous injury, muscle weakness, knee malalignment, knee surgeries, abnormal mechanical loading, excessive high impact sports, occupational physical activities) and systemic risk factors (advanced age, female sex, height, greater body mass index and obesity, hormone status, family history, mineral bone density, vitamin D deficiency, ethnicity). The prevalence of the knee OA and patterns of joint involvement vary among different racial and ethnic groups.

Conclusion. The literature review allowed us to identify the molecular mechanisms of etiopathogenesis of knee OA and the major risk factors for the pathology.

Introduction. The leading method for treating patients with injuries of the anterior cruciate ligament is its reconstruction. Although this operation is a common procedure, the issues of rehabilitation have not been fully studied. The aim of study Collection and analysis of available published studies on current methods of rehabilitation treatment after arthroscopic reconstruction of the anterior cruciate ligament.

Materials and methods. We analyzed the publications that were devoted to current methods of rehabilitation treatment of patients after arthroscopic reconstruction of the anterior cruciate ligament. The materials were searched for in the PubMed and Web of Science databases using the keywords “anterior cruciate ligament reconstruction”, “anterior cruciate ligament rehabilitation”. Inclusion criteria were compliance with the general topic, relevance, introduction of new rehabilitation treatments. Studies published earlier than the last 10 years were excluded.

Results. The analysis found that the main rehabilitation treatments used in patients after reconstruction of the anterior cruciate ligament are of protective character (wearing a functional orthosis or other immobilizing appliance, dosed walking with crutches) and physical activity (complex of exercises, swimming). The most effective way to prevent contractures is early activation of the limb and the maintenance of muscle tone. In turn, the main task of immobilization is prevention or relief of pain. Our study proposes the authors’ methods of rehabilitation which can be used for restorative treatment and accelerate the process of ligament repair. The work includes rehabilitation procedures performed at home after reconstruction of the anterior cruciate ligament under the supervision of a rehabilitation instructor.

Discussion. Rehabilitation of patients after reconstruction of the anterior cruciate ligament is a necessary complement to surgical treatment. Fast recovery of patients and a full return to an active lifestyle depend on a proper rehabilitation program.

Introduction. Recently backward/retro walking has been increasingly used in medicine. Kinetic and kinematic analysis during backward walking showed advantages over traditional ambulation making it ideal for those who struggle with knee pain. Retro walking is well known for reducing the strain on the knees and it is one of the few natural ways to strengthen the quadriceps of the thigh. Walking backwards leads to a more significant load on the cardiovascular and respiratory systems. This load builds a more substantial increase in both the aerobic and anaerobic capabilities than just walking forward with similar parameters of physical activity.

Material and methods. A systematic search of studies published during the period up to February 2020 was conducted using bibliographic databases in English, including Medline, PubMed, Scopus, Web of Science and in Russian, including eLIBRARY, CyberLeninka to summarize the available information on the possibilities of retro walking in treatment and rehabilitation of patients with knee pathology. Search terms included 'backward/retro walking/running', 'knee joint'.

Results and discussion. Several studies have been performed to explore the effectiveness of backward walking for knee osteoarthritis. There is a strong evidence that backward walking can be a useful adjunct to conventional physiotherapy to improve pain, knee function and strength of the quadriceps muscles. There is a limited number of papers describing effects of backward walking for patellofemoral pain syndrome and anterior cruciate ligament injury.

Conclusions. Although there is little data overall reporting effects of backward walking, and more studies are needed to further explore this topic this version of walking has been shown to provide great beneficial effects in knee joint rehabilitation.