Introduction. The problem of complications after surgical treatment of pertrochanteric fractures in elderly patients is relevant and far from a solution.

Materials and methods. The retrospective study was based on the analysis of the results of treatment of 129 patients with pertrochanteric femoral fractures (average age 76 years). All fractures in the early time from trauma were fixed with two types of cephalomedullary nails, either dynamic or static. All patients could not limit the load on the operated limb after surgery because of different reasons.

Results. The results of treatment were evaluated in 109 patients after one year. In dynamic cephalomedullary fixator group (59 patients), there were 7 orthopedic complications with a functional Harris scale result of 68 points (range, 26 to 94 points). In static cephalomedullary fixator group (50 patients), there were 14 orthopedic complications with a functional Harris score of 56.5 points (range, 15 to 92 points).

Discussion. Higher results of treatment in the group of dynamic fixator in the condition of full-weight bearing on the operated limb may be associated with the possibility of dynamization of the part of fixator in response to bone resorption in the contact area of bone fragments. The use of dynamic cephalomedullary fixators instead of static ones for treatment of pertrochanteric femoral fractures in elderly patients exercising full weight-bearing leads to a decrease in orthopedic complications (from 28 to 11.9 %) and improves the functional results of treatment.

Introduction. Analysis of publications on primary hip replacement shows lower survival rates in patients with acetabular injuries. With the lack of a unified system for assessing post-traumatic acetabular deformities, authors tend to use the available classifications of acute pelvic trauma (AO/ ASIF, Young & Burgess, Tile, etc.) and acetabular osteolysis (AAOS, DGOT, Gross and Saleh, Paprosky), which we think can be inappropriate with the classifying systems meant for different patterns of acetabular deficiency.

Material and methods. CT scans of 117 patients with posttraumatic acetabular deformities were reviewed prior to total hip replacement (THR) performed for posttraumatic grade III coxarthrosis. The displacement of acetabular walls was determined with the measurements tabulated and analyzed.

Results. An original "ASPID" classification of post-traumatic deformities based on the findings obtained was offered with use of three assessment criteria: localization of the deformity, extent of displacement and the integrity of the pelvic ring. The ASPID classification can be used for the localization of the deformity with anterior (A), superior (S), posterior (P) and inner acetabular walls (I) to be identified. Measurements of displacement ranging 0-5 mm suggests grade 0 displacement; 6-15 mm, grade 1 displacement and greater than 15 mm, grade 2 displacement. The integrity of the pelvic ring evaluated from the involvement side as D0 suggests maintained pelvic integrity and D1, broken pelvic integrity. An acetabular hardware would be marked with 'H'.

Conclusion. ASPID classification is easy to use and has shown to be practical for planning of primary THR after acetabular fracture.

Background. Patients with rheumatoid arthritis (RA) and baseline anemia may have an increased risk of complications after total hip replacement (THR). Inflammation in RA is the main factor manifesting anaemia, neutropenia, thrombocytosis and eosinophilia. The changes in blood components are important for the outcomes of major orthopaedic surgery.

The purpose was to identify hematological parameters in RA patients undergoing THR and assess the effect on intraoperative blood loss.

Material and methods. Outcomes of 44 THR patients treated for grade III degenerative coxarthrosis (n = 21, OA group) and RA coxarthrosis (n = 23, RA group) in Ekaterinburg regional hospital № 1 between 2018 and 2019 were reviewed. The patients' age ranged from 41 to 70 years. Clinical, radiological, laboratory examinations, computed tomography and statistical analysis were used for the study. Cell counting was produced with the Sysmex XT-4000i automated hematology system. Statistical analysis was performed using the tools of Statistica software. Nonparametric Mann-Whitney test was used to compare cell counts between the groups. The Spearman Rank correlation was used to analyse the correlation between the the cell counts in the groups. For calculations, a significance level of р < 0.05 was adopted.

Results. There were no significant differences in the preoperative white blood cell (WBC), neutrophil, lymphocyte, monocyte, eosinophil counts between RA and OA groups. The RA group showed an evident decrease in red blood cell (RBC) count and haemoglobin level as compared to OA group. The RA group demonstrated the higher platelet count with mean platelet volume (MPV) being significantly lower than that in the OA group. WBC count, neutrophils, in particular, was shown to increase with lymphocyte, RBC, platelet count and hemoglobin, plateletcrit levels decreased at 24 hours postoperatively. There were no significant differences in WBC and RBC counts in the groups postoperatively. The differences in the MPV were leveled up in the groups with the platelet count being higher in the RA group as compared to the OA group.

Conclusions. Hematological parameters of RA patients who had undergone specific preoperative preparation were not shown to be associated with greater blood loss during hip replacement surgery. The leukocyte count leveled up in the preoperative and early postoperative periods can be indicative of the absence of a significant effect of RA on the postoperative inflammation.

Introduction Isolated acetabular revision with the retention of a well-fixed and aligned femoral component is the priority treatment method in aseptic acetabular loosening.

The aim of the research was to predict the survival rate of a well-fixed and aligned femoral component retained during the
isolated acetabular revision surgery.

Material and methods We used the survival tables and the Kaplan-Meier method to create the survival curves. The object of the study was the database of 44 patients (45 interventions) who underwent isolated acetabular revision surgeries with their well-fixed and aligned femoral components that was retained. The average age of the patients was 59.5 [50; 69.5] years. The ratio of women to men was 25:19, respectively. The observation period was 1374 days. The creation of tables and graphs was carried out in Statistica 13.3 software package.

Results The survival rate of the retained well-fixed and aligned femoral component in isolated acetabular revision within the period up to 4 years was high and amounted to 0.9524 ± 0.03. The probability density and the hazard rates were 0.0017 and 0.00320, respectively.

Discussion The retention of a well-fixed and aligned stem in acetabular revision features high survival of the components as well as a low risk of endoprosthesis failure within 3 to 4 years. This fact confirms the need to maintain a stable and correctly oriented stem to reduce the surgical trauma, obtain good functional results and reduce rehabilitation terms.

Conclusion Isolated acetabular revision in isolated aseptic cup loosening is a priority method of surgical treatment with a low risk of complications in the postoperative period.

Abstract. Introduction The study deals with the approaches to the analysis of the dynamics in the course of a long-term postoperative period in patients
who underwent hip arthroplasty. Aim To feature the variants in the course of a long-term postoperative period in patients who underwent arthroplasty
of the hip joint. Materials and methods 806 patients (age range, 9 to 88 years) suffering from osteoarthritis underwent primary total hip arthroplasty
(THA). Statistical analysis was carried out using the R programming language, freely available at https://cran.r-project.org. The probability of maintaining
satisfactory quality of life (QoL) at a certain time of observation t (year of observation) was assessed with the Kaplan-Meier method. To compare the
likelihood of maintaining a satisfactory QoL level throughout the observation period in several groups (for example, patients of different sexes), the logrank
test was used. Results By year 6 of follow-up, the following tendency emerges regarding the age of the patients. The indicators are the best in young patients
(up to 44 years old), where the probability of maintaining a satisfactory QoL evaluation was 0.92 (0.84; 0.96). A somewhat lower values were observed in
the patients of the middle age group (from 45 to 64 years old) – 0.87 (0.78; 0.92). Excellent and good QoL was found in patients aged 65 and older, 0.83
(0.76; 0.88). Discussion Survival analysis methods have been used for the first time in traumatology and orthopedics. Previous researchers assessed the
long-term results of the quality of specialized traumatological and orthopedic care without considering censored observations. Thus, the coverage of the
investigated clinical observations averaged 80-85%. Information about 10-15% of cases was excluded from the studies. The proposed method of analysis
provides information about all patients. Conclusions Five years following THA, an excellent and good quality of life could be expected in 85 % of patients.
Satisfactory and poor levels are observed in 15 % of patients. At 5-year follow-up after THA, the quality of life is worse in older female groups with severe
concomitant pathology; however, there are no statistically significant differences. This is a tendency, and requires further study.

Abstract. Introduction Current operations of elbow arthroplasty are accompanied by an extremely high rate of complications in the early and long-term
periods. Therefore, along with the widespread growth of primary arthroplasty, there is a growing need for revision interventions. Purpose To study the age
groups of patients at the time of primary and revision arthroplasty, to investigate the reasons of the first and repeated revisions, the scope of interventions,
as well as the time since the previous AP. Materials and methods A retrospective analysis of 133 cases of elbow revision arthroplasty (111 patients)
treated from 2003 to 2019 was conducted. The rate of re-revisions was 16.5 %. The study investigated the age of patients, reasons for the first and repeated
revisions, the scope of interventions, as well as the time passed since the previous elbow arthroplasty. Results In the structure of primary and revision
arthroplasty, there was a significant dominance of patients aged 51 to 60 years (25.4 % and 33.3 %, respectively). However, the total rate of patients under
40 years old in the group of primary arthroplasty was 33.5 %, and in the revision group it was 34.2 %. The most frequent reason in the first and repeated
revisions was aseptic loosening: 47 % and 50 %, respectively, followed by PJI (23 % in both groups), dislocation (10 % and 18 %, respectively) and breaks
of the implant's components (8 % and 4 %). Other complications were less common (12 % and 5 %, respectively). Most of the revisions for PJI were
performed in the first year since the previous arthroplasty (56.7 %). In terms of aseptic instability, early and late periods were identified. The ratio of early
revisions to the total number of primary arthroplasty during the entire time of the surgical team's work decreased from 19.4 % to 3.5 %. Discussion The
observed number of young people in the age structure of primary and revision AP in the long term is likely to lead to an increase in the number of patients
with severe bone defects. The data of our study demonstrate a significant decrease in the number of revisions over the past 5 years performed for early
loosening, despite the general increase in the number of primary APs. Conclusion The study identified a considerable number of young patients, which
could potentially lead to an increase in the number of repeated revisions and related problems, including pronounced bone defects and recurrent infection.
All this actualizes the need to improve the technique of revision arthroplasty.
All this actualizes the need to improve the technique of revision arthroplasty.

Abstract. Introduction Re-infection rates remain high after revision for periprosthtic joint infection (PJI). We conducted a complex diagnostic study
of hip PJI and studied bone tissue involvement into the infectious process. Material and methods Twenty-nine patients treated for PJI were examined.
Ten patients had acute, seven had late and 12 hematogenous infection (Tsukayama, 1996). Clinical, laboratory, microbiological, radiographic and
histological methods were used for PJI detection. Results ESR exceeded the threshold in 16 and CRP in 23 cases. Pathogenic microorganisms were
confirmed in 23 cases. Radiographic manifestations of periprosthetic bone destruction were seen in 14 patients with late and hematogenous infection.
The histological study showed signs of osteomyelitis in 19 patients, including five cases with acute PJI. Histological study of periprosthetic and
pseudosynovial membranes revealed PJI in 20 patients. The histological and microbiological tests together confirmed PJI in 27 cases (92 %). ROC
analysis showed that the accuracy of CRP in the diagnosis of osteomyelitis exceeded that of ESR due to its higher sensitivity. Microbiological tests
showed satisfactory sensitivity but low specificity. The radiographic study had an extremely low sensitivity and low specificity. Histology of membranes
was quite sensitive and specific for the diagnosis of osteomyelitis but did not reach the level of bone histology. Conclusions Our complex diagnostic
study has enabled to accurately characterize the septic process in revision arthroplasty. The histological findings show that osteomyelitis of different
severity might develop in each PJI type. This fact may be a key factor for a surgeon in choosing a more reliable treatment option.

microorganisms. Purpose To evaluate the effectiveness of the first stage in two-stage revision arthroplasty for the treatment of deep periprosthetic
infection of the hip joint by improving the constructive and antibacterial features of spacers. Materials and methods The treatment results of 127 patients
with late deep periprosthetic hip joint infection who underwent two-stage revision arthroplasty in the period from 2015 to 2019 were analyzed. In the first
group, 42 patients were fitted with a two-component (total) spacer based on the developed antimicrobial composition of bone cement with gentamicin,
antiseptics and polymer (patent RU 191236). In the second group, a two-component spacer (patent RU 174697) based on conventional bone cement
with gentamicin was implanted in 43 patients; the third group of 42 patients had a preformed spacer. Results A bactericidal and antiadhesive, nontoxic
composition based on bone cement with gentamicin with antiseptics poviargol, dioxidine and high molecular weight polyvinylpyrrolidone with a
prolonged action for 348 days against gentamicin-resistant staphylococci has been developed. All patients underwent the first stage of hip arthroplasty
with removal of the implant and installation of a spacer. Recurrence of periprosthetic infection was observed in 1 (2.3 %) patient of the first group, in
5 (11.6 %) in the second and in 6 (14.2 %) patients of the third group. Non-infectious complications such as spacer dislocation and instability were
observed in 12 cases, one case (2.3 %) in the first, 2 (4.6 %) in the second and 9 (21.4 %) in the third group. The average time from the first stage of
treatment to the second stage of re-implantation was 7.5 months (range, 4–13 months). Discussion According to the literature, the introduction of new
antibiotics into the bone cement with gentamicin does not increase the antimicrobial action of the spacer, especially against antibiotic-resistant isolates,
and the use of a preformed spacer contributes to an increase in the number of non-infectious complications. Antiseptics with different mechanisms of
action are able to act on antibiotic-resistant bacteria, and the polymer can prolong this effect. Conclusions Creation of two-component spacers based on
bone cement with gentamicin using antiseptics with different mechanisms of action and polymer promotes long-term bactericidal action of the spacer,
which leads to effective sanation of the joint area, reducing non-infectious complications.

Abstract. Introduction Periprosthetic joint infections (PJI) are serious complications of total hip arthroplasty (THA) and affect the patient's life expectancy.
The aim of the study was to identify independent factors influencing the risk of death in patients with PJI after revision THA. Materials and methods The study
included 51 lethal outcomes in patients with chronic PJI of the hip. Results and discussion In our cohort of 434 patients, 13 (2.99 %) patients died within
the first year after surgery (p > 0.05), which is 2.2 times less than similar published data. The result of gender analysis showed no statistically significant
differences in the risk of death between men and women (OR1.05 CI 0.59–1.89, p = 0.87). It was found that in patients over 70 years old, the risk of death
was significantly higher (OR 2.05 CI 1.09–3.87, p = 0.031). Additional independent risk factors of death are diseases of the cardiovascular system. It was not
possible to find a statistically significant effect of the nature of infection on the risk of death: no growth (OR 2.23, CI 0.52–9.61), monomicrobial infection
(OR 1.98, CI 0.45–8, 73), polymicrobial infection (OR 3.2, CI 0.71–14.45, p > 0.05). Conclusion The mortality rate during the first year after revision THA
in patients with PJI was 2.99 %, which is lower than the results of other researchers. In the next 2–3 years, the rate of death increases 3.9 times. The main

independent risk factors are the age of patients and concomitant diseases of the cardiovascular system.

Abstract. Introduction The paper presents a comparative analysis of routine screening methods and the EBJIS 2021 algorithm in detection of latent
periprosthetic joint infection in patients admitted for revision knee arthroplasty due to aseptic loosening and after spacer implantation. Materials and
methods Group 1 included 49 patients who underwent revision knee arthroplasty due to aseptic loosening, group 2 were 47 patients with PJI after
spacer implantation. Results and discussion There were no significant differences between patient groups in terms of age, gender, and preoperative
ESR and CRP levels. In 62.2 % of all cases, the aspirate was inappropriate for cytological examination; this fact limited its diagnostic value. The most
frequently intraoperatively isolated pathogen in both groups was coagulase-negative staphylococci. However, in 70 % of cases these results were not
diagnostically significant, and infection was diagnosed only in 8.2 % of cases in group 1 and 12.8 % in group 2. Moreover, the chances of isolating the
pathogen from tissue biopsies were 5.6 times higher than from intraoperative aspirate (OR = 5.6, 95 % CI = 1.2-26.4). In case of negative preoperative
aspirate, in almost 25 % of cases, pathogens were isolated from intraoperative tissues, 40.9 % of them were diagnostically significant. The chances of
its detection increased 4.7 times in combined increase in ESR and CRP blood level (OR = 4.686, 95 % CI = 0.765-28.700). Using EBJIS 2021 criteria,
infection was confirmed in more than 10 % of cases in each group, and the diagnostic significance of the criteria exceeded the significance of using
routine screening methods. At a follow-up period of more than 2 years, the effectiveness of treatment was 95.3 %, while signs of infection were detected
in 4.7 % of cases, regardless of the group. Conclusion EBJIS 2021 criteria are characterized by high diagnostic sensitivity and specificity and enable to
identify periprosthetic joint infection in knee revision cases even in its latent form and to correct treatment tactics in patients without a history of PJI.

been a tendency for early discharge after arthroplasty for quite some time due to the increasing burden on health care systems that became possible due to the
implementation of accelerated rehabilitation protocols. This study is dedicated to the effect of discharge terms on the incidence of postoperative complications.
Material and methods A retrospective study of 1,837 patients who underwent primary/revision THA and TKA at our center in 2020 was carried out. The
impact of the pandemic was assessed by comparing the duration of hospitalization, the incidence of complications and functional status in patients operated
on before and after the introduction of epidemiological restrictions. Purpose of the study To assess the impact of the Covid-19 pandemic on the length of
patients’ hospital stay after knee and hip arthroplasty. Results The total duration of hospitalization after primary THA was reduced by 35 % (from 11.8 ± 3.3
to 7.7 ± 2.6 bed-days), and by 38 % (from 19.9 ± 7.5 to 12.8 ± 6.3 bed-days) after revision THA. The overall readmission rate (for surgical and nonsurgical
complications) after primary THA was 4.1 % before the pandemic and 4.3 % during the pandemic; for primary TKA it was 2.1 % and 5.1 %, respectively; for
revision THA – 13.9 % and 4.5 %, revision TKA – 4.4 % and 9.8 %, respectively. Comparative assessment for each diagnosis separately did not show significant
difference. Evaluation of the questionnaire survey using the Oxford hip/knee score also showed the absence of a statistically significant relationship between the
time of discharge and the functional state of the operated joint. The interviewing of patients regarding the infection with coronavirus yielded positive answers
in 22 % (n = 419). The onset of symptoms during hospitalization or within 14 days after discharge was noted by 4 % of respondents (n = 75). Conclusion The
incidence of complications and unfavorable outcomes did not depend on the length of hospital stay after THA and TKA.

Abstract. Introduction Post-traumatic elbow contracture is a severe disabling condition of childhood that interferes with both physical and psychic
aspects for the child. A high rate of poor results encourages surgeons seek for better surgical treatments. Current diagnostic modalities were practical to
get the clinical picture of the contracture mechanogenesis and determine the treatment strategy. The goal of the study was to review long-term results
of new surgical techniques developed for post-traumatic elbow contractures in children. Material and methods The inpatient records of 102 pediatric
patients with post-traumatic elbow contractures operated on with the technique offered were reviewed. All patients underwent conventional radiological,
ultrasound and MSCT examinations. Results Based on the pathobiomechanics of the injured elbow a mobilization technique was developed to ensure
complete bone realignment, relieve pain and allow early exercises for the joint. Postoperative lavage of the joint cavity, intra-articular administration
of corticosteroids and polyvalent enzymes in the early postoperative period facilitated improved long-term outcomes of elbow contractures. All
patients reported good results. Discussion Tenotomies of the lateral ligaments can be added to arthrotomy and reconstruction of articular surfaces
for temporary instability of the joint to restore movement in the elbow joint in severe cases. Post-traumatic elbow contractures are accompanied by
impaired biomechanics. MSCT and 3D reconstruction of bone structures is the gold standard in the diagnosis of post-traumatic elbow contractures.
Conclusion Bone impingements are to be addressed and an extended mobilization of the capsular ligamentous complex be provided for complete
movement recovery through partial elbow instability to be temporarily ensured. Prolonged lavage of the elbow joint can be used to prevent adhesions
and allow early elbow exercises and provide improved outcomes.

Abstract. Purpose To demonstrate the need for a multidisciplinary approach to the treatment of patients with deep periprosthetic joint infection (PJI) and
emphasize the importance of preoperative preparation and well-coordinated work of related specialists using a specific clinical instance. Case report Reported
is a successful experience of two-stage treatment of the patient with hip PJI complicated with urinary bladder defect. A 40-year old male patient diagnosed
with left-sided deep hip PJI Tsukayama type 3 was treated at department of infection surgery, Rostov Regional Clinical Hospital No. 2 in January 2019. Total
hip arthroplasty performed in 2008 was complicated by migration of acetabulum component. A retroperitoneal bladder defect (pressure ulcer) was detected
during the first stage of resection arthroplasty and placement of an antibacterial spacer. Urological procedure was performed in a delayed manner due to
technical difficulties of implant removal, prolonged and traumatic procedure, and high blood loss. With the patient's condition stabilized cystoscopy and
bilateral ultrasound guided percutaneous nephroureterostomy were performed. Prolonged antibacterial aetiotropic treatment was administered. The second
stage of surgical treatment included revision hip arthroplasty using a tailored acetabular component and a standard revision femoral component performed
at 6 months of debridement. Results Short- and long-term results were good with sustained remission achieved. Patient could walk unassisted using a cane
and had a satisfactory ROM in the left hip with HHS scored 76.255. Conclusion Multiple disciplinary teamwork is appropriate for treatment of deep PJI
with much coherence, coordinated efforts and expertise from diverse professionals.

Abstract. Introduction There are several options of fixation and plasty for tibial defects. Screw and cement augmentation of the tibia is an alternative to
conventional bone autograft and allograft. Although use of metal and cement augments provides reliable support for the tibial plateau and facilitates early
weight-bearing on the operated limb the technique fails to maintain enough bone stock for future revisions. The purpose was to present an option of cement
and metal augmentation of the tibial component in total knee arthroplasty (TKA). Material and methods The technique consists of cement and screw
augmentation using three screws placed vertically as a regular triangle and being perpendicular to the tibial plateau. We describe the technique and a clinical
instance of type 2A defect of the proximal tibia using the author's method. Outcome measures were goniometry and radiography. Results Goniometry
examination showed positive dynamics in the first week after surgery with flexion of 110.0 degrees, extension 175.0 degrees; at 12 months with flexion
of 90.0 degrees and extension of 180.0 degrees. Radiographic examination demonstrated no instability and micromobility of the cement mantle.
Discussion The author's technique of screw and cement augmentation of the tibial component was practical for type 2A defects of the proximal tibia with a
shortage of materials of bone autografts. This is a pilot study that requires further investigations.

Abstract. Introduction Treatment of patients with acute fractures of the patella is the task of the trauma and orthopedic service and should
provide restoration of the integrity of the bone tissue and the extensor apparatus of the knee joint for its early mobilization. There is an opinion
that conservative treatment cannot meet requirements of patients’ quality of life, and therefore, most traumatologists are inclined to surgically
treat patellar fractures. Purpose Based on the available literature data, to determine the most rational way to treat patients with patellar fractures
Materials and methods Available studies published in the last 10 years were analyzed. The databases NCBI Pubmed, Healio Orthopedics, Medline
were searched. Results Such osteosynthesis methods as patella suture, osteosynthesis with plates, special internal devices, external fixation devices,
Kirschner wires and wire cerclage, various screws were covered. The question of clinical application of patellectomy was touched upon; the contribution
of the Department of Traumatology, Orthopedics and Urgent Surgery of the Krasnov Samara State Medical University to the development of operative
techniques of osteosynthesis of the patella, the basic concepts of scientific research, and also the most optimal ways of treating patients with patellar
fractures were described. Conclusion The conservative method of treating patients with patellar fractures is most relevant if there are contraindications
to surgery. It inevitably leads to persistent arthrogenic contracture. The best functional results of treatment have been achieved with surgical treatment
due to the possibility of early mobilization of the knee joint. According to the data of available studies, plates and screws as well as osteosynthesis
with Kirschner wires and wiring cerclage show maximum stability. There is evidence of a direct correlation between the risk of developing infectious
complications and pain in the postoperative period and the number of elements of subcutaneous metal implants. Thus, the most optimal way to treat
closed fractures of the patella is osteosynthesis with the use of wires and wire cerclage according to the tension band principle.

Abstract. Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to
improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and
severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the
rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature
sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online
Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration
and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury
is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority
of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and
internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the
classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use
surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications
for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are
still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most
authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma
and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average
3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical
approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the
determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures
is the combined anterior and posterior approach.

Introduction Total hip replacement is the most effective technique for the consequences of acetabular fractures. The study includes the
literature review on the outcomes of total hip replacement (THR) in patients with post-traumatic coxarthrosis. Material and methods The search was
performed via databases of PUBMED, SCOPUS, Google Scholar, Cochrane library, E-library and publications using the keywords “acetabulum”,
“fracture”, “total hip arthroplasty” and “post-traumatic arthritis” published between 1995 and 2020. The exclusion criteria were a series of less than
10 patients, a follow-up period of less than 12 months. Abstracts of the meetings and review articles published either in Russian or in English were
included in the study. Patients' demographic data, surgical characteristics and outcomes were reviewed. Results Total 1,843 publications were reviewed
and the analysis included data from 20 studies with the total number of 1,184 cases reviewed. Surgical treatments of the patients were performed
between 1984 and 2018. The follow–up period averaged to 5.5 ± 1.19 years (range, 2 to 18 years). The mean age of the patients was 56.4 ± 12.7 years.
The mean interval from an injury to total hip arthroplasty was 8 ± 2.7 years. The mean Harris Hip Score was 39.4 ± 11 prior to surgery and 86.2 ± 22
postoperatively. The most common postoperative complications were heterotopic ossification (28.9 ± 10 %), aseptic loosening (8.15 ± 1.82 %) and
periprosthetic joint infection (7.89+1.86 %). Complications that required revision surgery were noted in 13.47 ± 2.91 % cases. Conclusion THR in
patients who sustained acetabular fractures is challenging, and bone grafts or acetabular augments would be needed to address an acetabular defect of
any localization.

Abstract Over the past decades, there has been a steady increase in the incidence of osteomyelitis. It is associated with an increased use of implants in
traumatology and orthopedics. The social aspects of osteomyelitis are, on the one hand, significant financial costs for the healthcare system, and on the
other hand, high recurrence and re-infection in the treatment of joint pathology associated with long-term loss of work ability and a high risk of patient’s
disability. Purpose To conduct a search and analysis of publications in Russian and English, devoted to the problem of osteomyelitis and periprosthetic
infection, on the basis of which to summarize the main current notions about the etiology, pathogenesis, diagnosis and treatment of osteomyelitis.
Materials and methods The search was carried out in the Pubmed and CyberLeninka databases of literature sources over the past 10 years. The data
were analyzed and compared with the materials from earlier publications. Only publications from peer-reviewed journals were considered for analysis.
Results and discussion Success in the treatment of peri-implant infection with prosthesis re-implantation and satisfactory joint function has been
achieved in only just more than a half of patients. Recent studies have significantly changed the understanding of the etiology and pathogenesis of
osteomyelitis. It has been proven that in osteomyelitis and implant-associated infection, four reservoirs of infection are formed in the patient's body:
abscesses in soft tissues and bone marrow canal, biofilms on the surface of implants and necrotic tissues, intracellular colonization with bacteria of the
macroorganism and lacunar-canalicular system. Understanding the mechanisms of osteomyelitis development and its course forces the specialists to
take a fresh look at the causes of failures in the fight against such a severe pathology and change approaches to its prevention, diagnosis and treatment.

Abstract. Introduction The number of total joint arthroplasties performed globally has increased over time, and the projected growth for total knee
arthroplasty (TKA) and total hip arthroplasty (THA) in 2030-2050 is associated with an increase in the number of surgical complications, such as
periprosthetic joint infection (PJI). Perioperative modifiable risk factors can be altered to help improve rates of the devastating scenario. The purpose
of the review was to systematize information on modifiable risk factors for PJI after THA and TKA and the ways to improve them. Material and
methods Scientific literature search was performed via web-based services of PubMed, eLibrary, Scopus, Dimensions. The search depth was 30 years.
Results Modifiable risk factors were shown to be associated with the patient's condition, medical history, current status, intraoperative and postoperative
surgical options. Well-established modifiable risk factors include tobacco use, alcohol consumption, excess body weight, obesity, malnutrition, duration
of surgery, postoperative wound hematoma. Discussion Timely diagnosed modifiable risk factors for PJI can be improved at the preparation stage,
perioperatively and postoperatively. The interaction of inpatient and outpatient hospital services in the perioperative period is essential for reducing the
risk of PJI after THA and TKA.

Abstract. Introduction Total ankle replacement is definitely a tough issue for both orthopedic surgeons treating patients with ankle pathology and
engineers who develop optimal implant constructs. Extreme short-time kinetic loads, complex motion biomechanics, anatomic features of the ankle
result in high demands for ankle joint implants. In general, there is a positive tendency in an annual increase of the number of total ankle replacements.
Alongside, a significant lagging in performing this procedure and the tendency for ankle arthrodesis has been observed in Russia. Aim To review the
literature data about development and current status of total ankle replacement. To evaluate the use of modern implants for distal tibia replacement.
Material and methods The given literature review includes analysis of foreign and domestic publications focused on issues of treatment of osteoarthritis
of the ankle joint and tumors of the distal tibia. The information was searched for using GoogleScholar, PubMed, eLIBRARY, PubMedCentral in the
Russian and English languages with the following keywords: total ankle replacement, ankle arthrodesis, ankle osteoarthritis, distal tibia replacement.
Discussion Currently, there are controversies in selection of biomaterials and constructive parameters for ankle implants. Separately, there is an
unsolved issue of selecting the optimal friction pair for bearing surfaces, as well as of operative technique features, such as implant fixation, surgical
approach, modeling and restoration of the capsular-ligamentous complex. Conclusion Total ankle replacement is an effective alternative procedure to
ankle arthrodesis and limb-sacrificing operations. To improve treatment results, optimal implant construction, fixation methods, selecting appropriate
friction pair and capsular-ligamentous complex restoration should be further investigated in complex studies.

Abstract. Introduction The disease that is manifested by primarily induced fibrotic changes in the gluteal muscles resulting in hip contractures and,
in particular, in extension-abduction contracture of the hip joints has been known in the English literature as the “gluteal muscle contracture” and
“gluteal fibrosis”. The world literature on the subject covers this pathology mostly in pediatric and adolescent patients, whereas this disease has not
been sufficiently discussed in the adult patients, even in foreign studies. Therefore, diagnostic methods, methods of examination and treatment of adult
patients have not been systematized and this nosology presents certain clinical and diagnostic difficulties for many domestic orthopedists. Materials
and methods We searched the PubMed and eLibrary systems for studies on the topic and used combinations of key words “gluteus muscle contracture”,
“gluteal fibrosis”, “gluteus maximus contracture”, “abduction contracture of the hip”, ”extension-abduction contracture of the hip”, “aplasia of gluteal
muscles” published from October 1974 to February 2020 and found a total of 106 results. The first publication coincides with the date of the initial
search period. The criteria for including studies in the analysis were a discussion of the issues of etiology and pathogenesis, epidemiology, diagnostic
criteria, clinical presentation, and approaches to the treatment of this pathology. We excluded articles related to the installation of gluteal implants and
other pathology of the gluteal region, so the number of articles decreased to 67, what means little investigation of this problem. Results Our analysis
showed that out of 67 articles, only 9 articles were related to issues of etiology and pathogenesis, five articles dealt with epidemiology, 15 dealt with
diagnostic criteria, treatment options were described in 12 articles, and the majority of publications focused on the results of surgical treatment of
clinical samples including 1-2 to 1280 cases. In the context of the 50-year-old depth of the literature search, the analysis indicates the fragmentation
of the material devoted to the gluteal muscle fibrosis published over this period of time, which requires the systematization and generalization of the
literature data accumulated to date. Conclusion Gluteal fibrosis is a rare independent disease, which is prevalent among certain ethnic groups. The
extension-abduction contracture of the hip joint develops due to gluteal fibrosis, the clinical picture of which has been very well documented and has
specific radiological signs. Surgical treatment methods vary, from open to endoscopic treatments and minimally invasive techniques. Since the main
group of patients described in the literature is children and adolescents and the surgical methods used are discussed for these age groups, treatment
methods and their efficacy for adult patients have been little reported. Therefore solution making is difficult for patients older than 18 years. It primarily
refers to providing specialized orthopedic care in places where ethnic groups with this pathology reside.