Background Unstable pelvis injuries are one of the most difficult and severe trauma of musculoskeletal system that needs emergency measures. Aim of the study is the optimization of treatment tactics in unstable pelvis fractures in polytrauma patients. Маterial and methods This is a prospective study of treatment results of 96 polytrauma patients with unstable pelvic fractures type C. Unilateral injuries of the posterior pelvic ring were 85.42 % (n = 82), bilateral injuries were 14.58 % (n = 14) of cases. Diagnostic complex included physical examination, laboratory tests, X-rays and CT. Examination was carried out simultaneously with anti-shock measures and intensive care. Primary basic stabilization of the pelvis with an external device and fixation of the posterior ring were performed. Results and discussions Three patients died (3.13 %), the remaining 93 (96.87 %) patients completed treatment with good outcomes. The biomechanics of pelvic injuries shows us the necessity of external fixation. Unstable pelvis injuries in polytrauma patients with hemodynamic instability should be temporary stabilized to decrease the intrapelvic volume. Conclusions Primary stabilization of the pelvic ring is an effective therapeutic tactic that leads to a significant reduction in the severity of patients’ condition, prevention of post-traumatic complications and early functional recovery of the damaged organs.

Introduction To investigate clinical, laboratory findings and identify pre-operative variables associated with increased waiting time to surgery (WTS) and length of hospital stay (LOS) among hip fracture patients. Material and methods This prospective study is conducted between April 2020 and April 2021. Patients’ information was collected from medical records and subjected to analysis using a univariate and multivariate model. Results The study included 118 patients in a mean age of 79.5 years, and the majority were female (68.6 %). Overall, 66.9 % of the patients had at least one comorbidity. Almost all (95.8 %) patients had fractures due to a low-impact fall and an intertrochanteric fracture was the predominant type (61.9 %). The most abnormal laboratory findings at admission were elevated C-reactive protein (CRP) levels (94.9 %) followed by decreased mineral density (85.1 %), anaemia (81.4 %), electrolyte abnormalities (69.4 %) and hypoalbuminemia (66.1 %). The mean of WTS among 115 patients undergoing surgical treatment was 52.1 ± 47 hours and no patient-related factors had a significant influence on WTS. The mean hospital LOS was 15.9 ± 4.7 days. Marked elevation of CRP level (OR = 3.317, p = 0.042), type of surgery (OR = 4.413, p = 0.005) and WTS (OR = 4.602, p = 0.001) were independent predictors of prolonged LOS. Conclusion Most patients with hip fractures are elderly and suffer from many comorbidities and laboratory abnormalities. No
patient-related factors are predictors of WTS but the elevation of CRP, type of surgery and time of waiting to surgery influence the LOS.

lining of one or more freely moving joints, as well as persistent inflammation, are the causes of osteoarthritis. Current medication focuses on alleviating symptoms rather than curing the condition. Methods This review article was completed by searching for information with the keywords “Fibroblast Growth Factor Receptor-1”, “Extracellular Vesicle”, and “Osteoarthritis” in various journals in several search engines. Out of 102 publications found, 95 were suitable to be studied. Results The upregulated amount of fibroblast growth factor receptors (FGFR1) signaling suggesting the progression of degenerative cartilage that commonly seen in osteoarthritis (OA) patients. Several studies showed that the involvement of extracellular vesicles (EV) derived from MSCs could enhance cartilage repair and protect the cartilage from degradation. EVs have the potential to deliver effects to specific cell types through ligand-receptor interactions and several pathway mechanisms related with the FGFR1. EVs and FGFR1 have been postulated in recent years as possible therapeutic targets in human articular cartilage. Conclusions The protective benefits on both chondrocytes and synoviocytes in OA patients can be achieved by administering the MSC-EVs that may also stimulate chondrocyte proliferation and migration. EVs have a promising potential to become a novel therapy for treating patients with OA. However, further research is needed to discover possible application of this therapy.

incidence, character and type of uncomplicated fractures of the vertebrae of the cervical spine in children and adolescents. Materials and methods Out of 1000 children who had uncomplicated vertebral fractures, 27 (2.7 %) people were diagnosed with fractures at the cervical level. There were more boys among the injured – 77.77 % of the injured. 29.63 % of the patients were under the age of 12, and 70.37 % of – aged 12–17. Traditional methods for emergency traumatology were used for clinical diagnostics. Results In 17 (62.96 %) of the patients only the cervical vertebrae were compressed, in 10 (37.04 %) patients – both the thoracic vertebrae and the cervical vertebrae. Among the cervical vertebrae, compression of C7 vertebral body was most often observed – in 30.64 % of cases, less often – the body of C3 – in 4.08 % of cases. The main mechanism of injury was falling on head from a height of 2 m and more – 25.98 % of cases. Analysis of the character of  C2 fractures showed that four patients had fractures of the odontoid process (three patients – type I, one – type III), one patient – fractures of the arches of this vertebra corresponding to type I. Fractures of subaxial location mainly corresponded to group "A" (subgroup I (36 compressed vertebrae), subgroup II (6 injured vertebrae)). In 2 cases, vertebral fractures were referred to group "B" (subgroup I). In 25 (92.59 %) clinical cases conservative treatment was used, in 2 (7.41 %) – there were indications for surgical treatment. The average duration of in-patient treatment for fractures of the cervical vertebrae was 9.4 days. Evaluation of long-term treatment results showed "good" results in 83.33 % of cases, satisfactory – in 16.67 % of clinical observations. Discussion The results that we have received are mainly comparable with the literature data on the main aspects of cervical trauma in children. At the same time, it is necessary to mention some differences. For example, many authors report that younger children most often get fractures of the C2 vertebra. According to our data, the average age of patients with these fractures was 14.8 years.

spine, and also to study their correlation with pain and the life quality of patients. Materials and methods Using X-ray analysis of growth profile spondylograms of 103 patients we studied the effect of segmental post-traumatic deformity (SD) and anatomic shape of the spine (Roussouly type) on regional (TK, LL), pelvic (SS, PT) and global (SVA) parameters of sagittal balance. In addition, the analysis of dependence of pain (VAS) and the life quality of patients (ODI, SF-36) on the above parameters was done. Results SD of the thoracic spine (Th1–Th10) increased TK, which led to hyperextension of LL and a decrease in SS. These compensatory mechanisms were reflected in significant correlations SD-TK, TK-LL, TK-SS, and LL‑SS. In the thoracolumbar spine (Th11–L2) SD at the level of Th11 and Th12 increased TK (SD-TK r = 0.553), and at the level of L1 and L2 they caused reactive hypokyphosis (SD-TK r = –0.687). A compensatory increase in LL was typical for injuries of Th11–Th12 (TK-LL r = 0.831) and L1 (TK-LL r = –0.629). Deformities at the L2 level led to hypolordosis (SD-LL r = –0.710), the magnitude of which, in turn, significantly influenced the TK, SS, and PT (LL-TK r = 0.690; LL-SS r = 0.832; SS-PT r = 0.597). The effectiveness of sagittal alignment in thoracic and thoracolumbar SD was confirmed by normal SVA values, as well as their lack of correlation with TK, LL and SS. In the lumbar spine (L3–L5), SD in 75 % of cases led to a critical decrease in LL and sagittal imbalance, which was reflected in significant correlations SD-LL, SD-PT, and SD-SVA. Compensatory correction of regional (TK, LL) and pelvic sagittal parameters (SS, PT) depended on the anatomical features of the spine (PI, Roussouly type) at all levels of the spinal column. However, a significant effect of PI on global sagittal alignment was noted only in lumbar SD (SVA-PI r = –0.617). Correlation of sagittal modifiers with pain intensity and quality of life was also typical only for patients with SD of the lumbar spine (PT-VAS r = 0.777; PT-ODI r = 0.752; PT-SF36 (PH) r = 0.651; SVA-VAS r = 0.775; SVA-ODI r = 0.762; SVA-SF36 (PH) r = 0.703). Conclusion Sagittal balance in fixed thoracic and thoracolumbar kyphosis is satisfactorily supported by changes in the curvature of adjacent parts of the spine, in contrast to lumbar deformities, in which in 75 % of cases, decompensation of the spine profile alignment occurs.

the spine and the spinal cord have been developed and a variety of surgical options offered, none of the existing classifications can be used to identify appropriate treatment guidelines and surgical practices. Design Expert consensus level. Evidence level: 5 (UK Oxford, version 2011). Objective of the study was to offer an algorithm of surgical treatment strategy for patients with congenital malformations of the spine based on identification of a leading syndrome. Material and methods The algorithm was developed through the clinical experience and consensus opinion of the authors based on the management and follow-up of 284 patients with different patterns of congenital spinal deformity treated between 2008 and 2018. Results The algorithm offered to identify an appropriate treatment strategy for congenital anomalies of the spine included a stepwise protocol for sequential assessment of the criteria selected and considered as components of the leading syndrome of multiplanar deformity allowing well-argued surgical options and succession of treatment stages. Sequential evaluation is essential for patients with multilevel congenital anomalies and several main arcs. The algorithm is presented as a checklist with a table and comments to the main syndromes and decision-making process. Conclusion The algorithm offered is a stepwise checklist providing a step-by-step process for making decisions on the approach and practice for treating congenital  nomalies of the spinal column. It is designed to consider main pathological syndromes being typical of congenital pathology and reduce tactical and methodological flaws. The algorithm is of purely advisory nature. The consensus opinion of experienced surgeons has been shown to be essential for timely management facilitating appropriate treatment strategy for the rare and diverse nosological group.

Degeneration of the multifidus muscle of the back after stabilizing operations on the lumbar spine and its impact on rehabilitation measures remains understudied. There are isolated data in publications on the partial effectiveness of minimally invasive surgery, but the problem has not been completely solved, there is no data on the effect of physical therapy and physiotherapy methods on the progress of degeneration of the multifidus muscle of the back. Purpose To study the effect of electroneuromyostimulation and physical therapy in the postoperative period in decompression-stabilizing operations on the progress of adipose degeneration of the multifidus muscle of the back. Materials and methods The parameters of the multifidus muscle of the back were analyzed and determined in 3 groups of patients who underwent operations with stabilizing systems in the lumbar spine: in group I (n = 56), it was recommended to limit physical activity for 2 months after surgery and wear a semi-rigid corset; in group II (n = 41), early rehabilitation was initiated in the form of physical therapy with the continuation of the recommended exercises after discharge, in group III (n = 43), patients after discharge were recommended to limit physical activity, but with the use of electroneuromyostimulation on the paravertebral muscles 2 times a day lasting 15–30 minutes. All patients underwent clinical examination, MRI, MSCT to assess the condition of the multifidus muscle. Results In group II, there was a decrease in the rate of adipose degeneration of the multifidus muscle, but with increase in pain and decrease in life quality compared to group I. Patients of group III had the lowest rate of increase in adipose degeneration with less pain and a higher level of life quality compared to groups II and I. Conclusions A combination of early postoperative stimulation for two months with a subsequent transition to physical therapy is optimal; otherwise exceeding the functional threshold may cause disruption of adaptation systems.

The main purpose of spinal fixation is to provide conditions for vertebral fusion at the level of injury. Bone fusion is associated with many factors including stability of injured segment, restoration of the anterior support column, condition of the bone tissue and other aspects. The timing of bone formation can be affected by soft tissue inflammation at the site of the rods of the external fixation system. Peri-implant infection is reported to occur in 0.7-20 % of cases with external transpedicular fixation. The timing of the complication and the dependence of the frequency of the occurrence on the patient's treatment strategy are debatable. Another topical issue is the study of the consequences of peri-implant infection with the need to establish the validity of the assumption about the effect of peri-implant infection on the rate of bone formation using a clinical model. This would allow the findings to be used for new methods of treatment considering the risk of possible complications, giving preference to low-traumatic semi-closed methods of spine fixation. Nevertheless, external transpedicular fixation is practical for open spinal injury or significant vertebral displacement with the need of significant reduction efforts to be applied. The purpose was to explore the effect of soft tissue inflammation on the timing of bone formation with spinal fusion surgery using different surgical methods of treatment of uncomplicated spinal fractures. Material and methods The review included 111 patients with uncomplicated fractures of the lower thoracic and lumbar spine. Based on a retrospective analysis the participants were assigned to three groups depending on the presence/absence of peri-implant infection and the timing of the occurrence: 81 patients experienced no complications, 16 had serous-purulent inflammation of soft tissues at the site of the rods of the external fixation device that developed on average after 20 days with 14 patients seen with pin tract infection after 2 months of anterior fusion surgery and failed bone formation. Results Peri-implant infection rate was found to be higher with external fixation (14.4 %) than that with anterior fusion surgery (12.6 %). The complication rate was 1.85 times less with one-stage surgical treatment as compared to two-stage treatment. Peri-implant infection developed later (after 21‑63 days) with one-stage treatment as compared with two-stage procedure (after 12-24 days). Infection associated with the external fixation led to increase in timing of bone formation by 6-7 %, by 2-4 weeks on average. Bone formation failed in 35 % of cases (p < 0.0002) due to peri-implant inflammation caused by Staphylococcus aureus, as the common pathogen and the bacteria detected resulted in ineffective antibacterial therapy. Immunological parameters (IgM and haptoglobin) were quantified to assess the risk of peri-implant infection. Discussion Peri-implant infection rate associated with external transpedicular fixation was shown to be comparable with the previously obtained data. Sharply defined notions were reported earlier to differentiate between infectious peri-implant osteolysis and mechanical loosening. We compared the data on the duration of bone formation and the timing of peri-implant infection and developed a model that with high sensitivity (73 %) and specificity (100 %) allowed description of cases with impaired osteogenesis. Changes in some immunological parameters (immunoglobulins, acute-phase proteins) were shown to affect both bone formation and stability of bone fixation

to determine the incidence of sepsis in patients with non-specific osteomyelitis of the spine (NOS) and tuberculous spondylitis (TS), and compare the main risk factors contributing to the occurrence. Material and methods Treatment was produced for 82 patients with verified sepsis that accounted for 8.6 % of all patients operated for infectious spondylitis (IS). Patients were diagnosed with NOS (n = 48, Group 1) and TS (n = 34, Group 2). Microflora in the blood was detected in half (n = 39, 47.5 %) of the patients with procalcitonin test performed in all cases. Results IS patients were diagnosed with chronic pulmonary diseases (45/58.0 %), renal diseases (32/39.0%), chronic stomach and duodenal diseases (23/28.0 %), viral hepatitis (18/21.9 %), cardiovascular diseases (23/28.0 %), diabetes mellitus (12/14.6 %), etc. Factors contributing to the development of sepsis in TS patients were chronic pulmonary diseases (p = 0.024, χ2 = 7.132), liver cirrhosis (p = 0.036, χ2 = 6.458) and HIV (p = 0.035, χ2 = 6.158). Discussion Risk factors for septic conditions in IS patients included age over 70 years, severe neurological deficit, hypoalbuminemia, cachexia (BMI < 17 kg/m2), obesity (BMI > 35 kg/m2), HIV and severe comorbidities (ASA 3 or ASA 4). The favorable outcome of the disease occurred due to early detection of sepsis based on SOFA score and timely initiated pathogenetic treatment.

Introduction Spinal tuberculosis is an extra-pulmonary tuberculosis infection caused by Mycobacterium tuberculosis (MTB) which affects the vertebrae. Culture test is the «gold standard» diagnostic method, but it takes a long time. PCR is a method of a shorter time than the culture test, so it can be an alternative diagnostic method for MTB. Materials and Methods This study is a cross-sectional study. The data were analyzed with diagnostic tests on patients with suspected spinal tuberculosis who performed surgery in Hasan Sadikin Hospital in Bandung. Clinical examinations and diagnostic examinations were done in 40 patients and surgery was performed to obtain samples from the spinal cord and the infected tissue. GeneXpert, PCR targeting IS6110 and culture tests were performed. The research was conducted at the Department of Orthopaedics and Traumatology and the Clinical Pathology Laboratory of FK UNPAD/RSHS from September 2019 to September 2020. Results GeneXpert assay compared with culture tests as the standard diagnostic method showed sensitivity of 96.67 %; specificity of 90.00 %; positive predictive value 96.67 %; and a negative predictive value of 90.00 %, with an accuracy of 95.00 %. The PCR targeting IS6110 against culture showed that the sensitivity of MTB bacterial infection was 93.33 %, the specificity was 80.00 %, the positive predictive value was 93.33 %, the negative predictive value was 80.00 %, and the accuracy was 90.00 %. Conclusion This study concluded that the GeneXpert MTB/RIF RT-PCR assay has a high sensitivity, specificity, and accuracy compared to PCR targeting IS6110 in examining tissue samples in patients with spinal TB.

Study design Retrospective analysis of a single-center cohort of patients with pyogenic vertebral osteomyelitis. The purpose of the study was to review risk factors for perioperative complications and recurrences in patients diagnosed with hematogenous pyogenic vertebral osteomyelitis. Material and methods 141 inpatient records of hematogenous pyogenic vertebral osteomyelitis were reviewed at the Regional Clinical Hospital No. 2, Tyumen. Patients who developed complications, neurological deficits and recurrences were assigned to A group (n = 66), and those who did not included in B group (n = 75). Results Perioperative complications, recurrences, risk factors and neurological disorders that could develop with different treatment methods were explored. There was a greater risk of recurrences and a lower rate of neurological complications seen in chronic cases and drug addicts. There was a lower risk of intra- and postoperative complications seen in thoracic spine involvement, a greater risk of neurological deficit with involved cervical spine and a lower risk in the lumbar spine involvement. There was a lower risk of neurological disorders in type A and type B disorders, and a greater risk in type C disorders as categorized by E. Pola. There were no differences in recurrence rates among different types of involvement. HIV did not increase the risk of complications and relapses. Surgical site infection developed in 8.1 % cases of transpedicular fixation and in 6.9 % following ventral interventions. No correlation was observed between the recurrence and complication rate and the surgical methods used. Overall, recovery or stable remission was achieved in 88.6 % of cases after treatment of relapses. Conclusion Recurrences and complications were primarily caused by delayed diagnosis, co-morbidities and neurological deficits. No correlation was observed between the recurrence and complication rate and the surgical methods used. There was a greater risk of recurrences and a lower rate of neurological complications seen in chronic cases and drug addicts. Neurological disorders are common for cervical spine disorders. The risk of complications was dependent on the type of involvement as categorized by E. Pola. There was a lower risk of neurological disorders in type A and B disorders and a statistically greater risk in type C disorders.

Background Idiopathic scoliosis in children can cause noticeable changes in the musculoskeletal system including the feet and the relationship between spinal deformity and impaired biomechanics of the feet is important to learn in the case. The purpose was to explore plantographic characteristics of feet in children with severe idiopathic scoliosis before and after surgical correction of the curve using transpedicular spinal systems. Material and methods Foot support indices were measured in 18 children aged 14-17 years with grades III and IV idiopathic scoliosis Lenke types I, III, V and VI. The results were compared with plantographic findings of 18 healthy children. Results The medial index m was within normal limits with a double-support load in patients with idiopathic scoliosis before spinal surgery. The rest of the indices were significantly reduced irrespective of the extent of the foot load. Double-support load tests showed a pathologically strong correlation between the medial and median support indices m ~ s. The spring function of the foot arches was intact. The frontal balance of the spine correlated with the foot support indices. Patients developed no foot rigidity at 9–10 days of surgery and showed an increased asymmetry in the arches of the contralateral feet and an abnormal increase in the relationship between the foot support indices m, s and t with no correlation between the frontal balance of the spine and the plantographic characteristics. Conclusion Children with severe idiopathic scoliosis were shown to develop impaired biomechanics of the feet with decreased contact area between the feet and the support surface, and a pathological increase in the functional relationship of the arches. Impaired biomechanics of the feet appeared to aggravate at a short term following correction of spinal deformity.

Introduction Analysis of psycho-emotional aspects in children suffering from spinal deformities demonstrates a high level of dysfunctionality in mechanisms of personal and intra-family adjustment. There is a paucity of publications on the problem. Objectives included multidimensional psychometric assessment of parents' attitude toward children with spinal deformities and the correlation with psychological characteristics of patients. Material and methods Results of a survey performed for 45 patients who underwent operative treatment for spinal deformities of different etiology and their parents were reviewed. The patients' age ranged from 7 months to 17 years inclusive. Validated questionnaires used as survey tools included the "DOBR" questionnaire, FACES-3, SDQ and DERS. Patients were assigned to two age-related groups, Juniors aged from 7 months to 6 years inclusive and Seniors aged from 7 to 17 years inclusive. An intergroup and correlation analyses were performed in the study groups. Results Multidimensional analysis showed that parents of children with spinal deformities tend to downgrade the severity of the child's condition neglecting postoperative prescription standards that was more common for Seniors (p = 0.001). Parents look toward the maximum intra-family cohesion but do not have the necessary knowledge to achieve it. Emotional problems and social adjustment difficulties are more common for Seniors (p = 0.031). Conclusion Lack of adequate parental knowledge about the child's disease is the key factor behind the imbalance in intra-family functioning. Therapeutic intervention and parent management training can facilitate to psycho-emotional well-being in the family and postoperative improvements for maladapting children with spinal deformities.

Relevance Application of 3D printing using the method of selective laser fusion for production of intervertebral cages is a topical trend of the spinal surgery. Purpose Assessment of the efficiency and safety of original interbody fusion implant application made of titanium alloy according to 3D printing technology with selective laser fusion. Materials and methods The original flattened bean-shaped cages, with an integral side part and an internal configuration in the shape of three-dimensional 1.5 × 1.8 mm porous lattice were tested . The products were made of Ti6Al4V powder using 3D printing technology with selective laser fusion. Post-processing of the products surface included abrasive blast cleaning using the SLA method and sterilization with ethylene oxide. Experiments on modeling interbody fusion with replacement of intervertebral discs with cages at levels L4 – L5 and L5 – L6 were performed in 8 mongrels. Additional primary stabilization of the lumbar spine was produced with an external fixator within 30 days after implantation. The total follow-up period lasted 180 days. Radiography, scanning electron microscopy, roentgenospectral and biochemical analysis methods were applied. Results X-ray examination demonstrated the contact between the frontal surfaces of the cages and the bone tissue of the vertebral bodies and the development of fusion in all experimental animals. Biochemical analysis did not reveal the signs of intoxication, indicating the danger of the products application. The microrelief of the implants was characterized by microroughness ranged from 1to 50 μm. In the surface layer of products, in addition to the elements of titanium, aluminum and vanadium, the carbon, oxygen, silicon, trace amounts of other organic and inorganic elements were found. Newly formed bone trabeculae were macroscopically and submicroscopically visualized in the sawcuts of bone blocks in the porous lattice of the internal part of the implants. Conclusions Experimental testing of porous implants made of titanium alloy using selective laser fusion has shown their effectiveness in obtaining interbody fusion and acceptable safety.

Objective was to investigate an effect of anti-adhesion hyaluronic-containing resorbable gel on the course of traumatic spinal cord disease caused by a simulated contusion spinal cord injury (SCI) in rats. Material and methods A moderate spinal cord injury was simulated at the Th9 level of 40 female Wistar rats that were randomly divided into 2 groups. Group I received hyaluronic-containing absorbable antiadhesion gel Antiadgezin® that was intraoperatively applied to the dura mater of experimental rats; Group II of control rats received no gel. The BBB locomotor rating scale was used to evaluate the extent of recovered pelvic limb function. The animals were sacrificed on days 5, 15, 30, 60 and 90. Paraffin and epoxy semi-thin 1 μm sections were used for morphological examination of the spinal cord using light microscopy. Results The gel used for contusion SCI in rats caused neither significant changes during postoperative period nor local infectious and inflammatory complications, and showed no negative impact on functional results. Morphological examination revealed pathomorphological changes that were identical for both groups and characteristic of contusion SCI showing softening, necrosis of the nervous tissue, tissue and cell detritus of gray and white matter, small cysts in the early stages of the experiment; progression of syringomyelia and formation of large cysts primarily seen in the gray matter and the onset of regenerative processes in the white matter at 60 and 90 days of the experiment. Conclusion The absence of a negative effect of the anti-adhesion hyaluronic-containing resorbable gel on the functional results, and morphological characteristics of the spinal cord offer the opportunity of the further experimental use as a carrier of substance composition initiating beneficial metabolic and neuroprotective action for transdural delivery in simulated SCI.

Purpose To perform the comparative assessment of the mechanical strength of models of semitendinosus and peroneus longus tendon grafts prepared using the GraftLink technique. Materials and methods Tendon material was collected on the base of the Irkutsk Regional Bureau of Forensic Medicine. The main stage of the mechanical strength study of graft models was carried out at the National Research Irkutsk State Technical University, the Department of Strength of Materials, using universal tension testing desk-standing machine Shimadzu AGS-10kNXD. The mechanical strength of graft models of tendon of the semitendinosus and peroneal longus muscles, prepared by a known method (GraftLink technique) was defined. Statistical data processing was carried out using the statistical software Statistica for Windows 10.0 (StatSoft Inc., USA; license holder is the Irkutsk Scientific Center of Surgery and Traumatology). We used a nonparametric method for defining the statistical significance of differences, i.e. the Mann-Whitney test. Differences in the compared groups were considered statistically significant in p < 0.01. Results The mechanical strength of the graft harvested from the semitendinosus muscle tendon according to the known technique averaged out at 351.8 ± 133.0 N, and the mechanical strength of the graft from the half of the peroneus longus tendon, prepared in a known manner, averaged out at 632.4 ± 193.7 N. Statistically significant differences were revealed (p <0.01). Discussion Our study is the only one that shows the results of studying the mechanical strength of allografts prepared by two different techniques. In addition, we identified two phases of the graft rupture, when the free end of the graft being the weakest site of the graft ruptures during the first phase Conclusion The rupture of the graft from the half tendon of the peroneus longus muscle, prepared using the GraftLink technique, occurred at a force of 632.4 ± 193.7 N, which is 1.8 times more than the graft from the semitendinosus muscle prepared using the GraftLink technique.

Objective was to obtain preliminary data on the knee osteoarthritis risk following canine tibial prosthetics using one-stage osseointegration, external fixation and compression loading. Material and methods The study was carried out on 5 intact (control group) and 3 experimental (experimental group) animals aged 1.8 ± 0.5 years with a body weight of 19 ± 1.2 kg. Osteotomy was performed at the boundary of the upper and middle third of tibia and a PressFit type construct implanted. A special device was used for bone fixation and compression loading of FN = 20 N. Paraffin sections of the articular cartilage and the underlying subchondral bone were used for histomorphometric examination. Results The zonal structure of the articular cartilage and cytoarchitectonics were shown to be maintained in all experimental animals with insignificant destructive changes in the form of impaired homogeneity of the intercellular substance in the upper third of the surface zone. There was a two-fold decrease in the thickness of the calcified cartilage and a 1.9‑fold decrease in the thickness of the subchondral bone. The volumetric density of trabeculae in the subchondral bone decreased to 22.31 ± 5.41 % in experimental animals and to 46.94 ± 1.94 % in controls. Complete absence of calcified cartilage and the subchondral bone were observed in one case with vessels and bone marrow pannus invading the noncalcified cartilage. Conclusion Structural changes in the contact zone of the articular cartilage and the subchondral bone seen in the knee following experimental canine tibial prosthetics indicated the risk of developing knee osteoarthritis.

Introduction The prevalence of osteoporosis is predicted to increase among individuals over 50 years of age. Research was initiated to evaluate the effectiveness of the clinical use of asynchronous quantitative computed tomography (QCT) facilitating the diagnosis of the condition. Objective Review the results of asynchronous QCT introduced in an outpatient clinic in Moscow, with reference to the risk factors included in the FRAX tool. Material and methods Bone mineral density (BMD) was measured in patients referred for QCT by specialized clinicians employed at the same medical institution. The QCT scanning included two areas: the lumbar spine and the proximal femur and was produced with the Toshiba Aquilion 64 CT Scanner, and BMD measured using QCT PRO. A sampling analysis of the 10-year probability of a major osteop orotic fracture was produced using the FRAX tool with the exclusion criteria of anti-osteoporotic treatment, unreliable data in the questionnaire, artifacts in the images of the proximal femur. Based on the results, patients were assigned to groups by indications for initiating treatment in accordance with the FRAX strategies, FRAX corrected for BMD of the femoral neck, QCT, FRAX in conjunction with QCT. Results Within a year of the study, QCT scans were performed for 710 women with the mean age (MA) of 67.3 (9.3) years. Based on CT findings of three sites of interest patients were diagnosed with osteoporosis (n = 418, 59 %), osteopenia (n = 252, 35 %), and 40 (6 %) showed normal manifestations. The FRAX-based 10-year probability of major osteoporotic fractures was used selectively for 111 patients with a high risk detected in 15.2 %, and BMD of the femoral neck adjusted in 14.3 %. QCT findings revealed a high risk of fractures in 46.4 % of the surveyed patients who could receive treatment. The use of QCT in addition to FRAX allowed optimal identification of patients who had antiresorptive treatment indicated in 30.4 %. Conclusion QCT findings detected osteoporosis in 59 % of patients, while the FRAX-based estimates of 10-year fracture probabilities indicated to the need for initiation of treatment in 15.2 % only. Using the FRAX tool and QCT findings together allowed optimization in the proportion of patients who required anti-osteoporotic treatment up to 30.4 %. The results of the study can be used in the development of a clinical decision support system for management of patients with suspected osteoporosis.

Introduction A case of a successful surgical treatment of a neglected injury of the upper arm muscles and rotator cuff in a working-age man with a history of an episode of thromboembolism of small branches of the pulmonary artery is presented. The aim of this study was to demonstrate one of the approaches to surgical treatment of this pathology that resulted in the improvement of upper limb function and the quality of life of the patient. Material and methods A comprehensive study of the patient's outpatient and inpatient records, results of clinical, instrumental and laboratory methods, the types of intervention and rehabilitation along with medical prevention of thrombosis are described in detail. Results Eight months after the surgery, there was an improvement in the function of the right shoulder joint. The range of active motion significantly increased; the DASH score decreased from 136 to 52 points; pain decreased from 46 to 31 points according to VAS; the level of self-service significantly improved. Discussion Сombined techniques of preserved muscle transposition to replace the lost function of the damaged ones was a condition and a guarantee of the achieving significant progress in the anatomical and functional status of the patient. Nevertheless, a further search for more rational technologies for restorative reconstruction in the disorders under consideration seems appropriate. Conclusion A correctly chosen and based on clinical and instrumental data transposition of the tendons of the active muscles of the shoulder joint area to replace the lost shoulder antagonists provides improvement of the upper arm function and patients’ quality of life while the justified tactics of thromboprophylaxis allows control of hemostasis and absence of vascular failures.

Introduction Artificial intelligence (AI) includes software systems combined with applied methods and algorithms which main feature is the ability to solve intellectual problems. One of the most popular trend of AI application is the prognosis of various situations, evaluation of any digital information with an attempt to give a conclusion and analysis of different data with a search for hidden patterns. Study design Systematic review. Purpose To assess current possibilities of artificial intelligence (AI) for predicting unfavorable conditions in spine surgery that require medical care, and future development prospects in this area. Materials and methods Until June 2020 we performed a search using the Protocol (PRISMA) "Preferred Reporting Parameters for Systematic Reviews and Meta-analyzes" and keywords for articles in Medline, Scopus and eLIBRARY intended to summarize the available data on algorithms for predicting any pathological conditions in spine surgery that require medical intervention using artificial intelligence technologies. Results 20 publications were selected for systematic review, which presented data on the application of artificial intelligence, machine learning and neural networks to predict any condition in spine surgery. According to the review, the data obtained indicate that AI can be successfully used to optimize prognosis in various diseases of the spine. Therefore, the application of AI in the clinical practice of the spine surgeons can improve treatment results. Conclusion The promotion of artificial intelligence application in medicine is inevitable. Currently AI shows good results in the area of making clinical decisions by the surgeons and the ability to predict treatment results depending on certain factors. It is imperative that spinal surgeons should realize the potential of these new technologies. Nevertheless, some factors that determine the clinical application of artificial intelligence, i.e. the ability to consider the context of a patient's history, are difficult to calculate mathematically and, so far, are difficult for an algorithmic approach. Eventually, the doctors will continue to play a vital role in patients’ treatment, and artificial intelligence will not depreciate their clinical skills, but make them even more important.

Introduction Aggressive vertebral hemangiomas occur in 10–11.5 % of the working-age population that determines social significance of the disease. Percutaneous vertebroplasty technique is normally used for the treatment of aggressive spinal hemangiomas. Cement leakage is the most common complication during vertebroplasty (40–87. 5 %). Balloon kyphoplasty is associated with a low incidence of cement leakage. Objective We aimed to analyze literature and summarize information on balloon kyphoplasty used to treat aggressive spinal hemangiomas. Material and methods The original literature search was conducted on key resources including PubMed and GoogleScholar. Literature searches included both Russian and English studies based on keywords. Results and discussion The article presents the main results of balloon kyphoplasty used as a standalone procedure and in combination with other methods of surgical treatment of aggressive spinal hemangiomas. The use of balloon kyphoplasty was shown to reduce the risk of extraspinal cement leakage. However, this aspect is represented by a small number of scientific publications in the current medical literature that emphasizes the relevance of the topic raised. Conclusion Despite the variety of available treatment options, the optimal management strategy remains controversial for aggressive forms of vertebral hemangiomas. There are no well-defined criteria and indications reported recently to be included into a well-structured algorithm for of balloon kyphoplasty in the treatment of aggressive spinal hemangiomas, and therefore the debatable questions need further investigation.

Radiography of the spine makes it possible to assess disorders in the global sagittal balance of the spine only in statics. Therefore, the assessment of the dynamic sagittal balance according to the data of three-dimensional (3D) gait analysis including the balance of the trunk in general (in the sagittal and frontal planes) and the lumbosacral area, in particular, and determination of the compensatory mechanisms employed by the patient while walking due to the body segments and limbs, is getting more topical. Foreign publications on these topics in the last decade in the search resources of PubMed, e-Library, Cochrane Library and Scholar Google are not numerous, and there are no domestic ones at all, that, in turn, requires an independent detailed study. Purpose Primary analysis of the literature with the identification of methods and criteria for assessing the dynamic balance of the body. Materials and Methods In preparation of the review, the search and information resources of PubMed, eLibrary, Cochrane Library and Scholar Google were used. In the resources of the scientific e-Llibrary, there are no publications on the sagittal dynamic balance, that, in turn, requires an independent detailed analysis. Results and Discussion The postural model that considers the trajectory of movement of the center of mass (CoP) below foot was used to assess the dynamic sagittal balance. It is possible to evaluate the compensatory mechanisms for maintenance of dynamic sagittal balance basing only on the data of three-dimensional (3D) analysis of gait motions. Compensated / decompensated condition of the dynamic balance was defined according to the data of the ground reaction in 3 planes, the motions of the chest with regards to the pelvis, and according to the evaluation of the frontal vertical alignment (CVA-G) and sagittal vertical alignment (SVA-G). Conclusion The standard medical block for 3D gait analysis allows to perform quantitative estimation of compensatory mechanisms for sagittal imbalance, such as in-phase / antiphase coordination pattern of the trunk with regards to the pelvis; the compensated / decompensated condition of the dynamic balance according to the Ground Reaction data in three planes; and compensatory mechanisms, manifested in the parameters of the kinetics and kinematics of the lower limb joints. Assessment of dynamic sagittal balance is carried out in laboratories, where there is a software with an additional calculation option. Two main directions were proposed for its formation, taking into account either the maximum approximation to the X-ray criterion, or to the anatomical position of the center of mass.