Background Trauma with associated damage to major arteries and veins typically occurs in adults; reports on such injuries in children are rare. In the organization of their treatment, difficulties are encountered such as formation of teams that must include angiosurgeons. The issues of restoring limb function after injuries with damage to muscle, nerve trunks or complete amputation of the limb remain relevant in children, despite their high abilities to recover. Each particular case in health care institutions has its own characteristics and difficulties for treatment, which was the reason for this communication. Purpose To share our clinical experience and details of providing urgent medical care to injured children with complete impairment of the main arteriovenous blood flow. Materials and methods Three cases with complete damage to major arteries and veins, including their defects, were studied. We describe the details of tactics and features of their surgical management. All patients underwent clinical and laboratory examination; emergency assistance was provided by orthopedic traumatologists and angiosurgeons. All patients were admitted in a state of hemorrhagic shock in stage 2 or 3. Surgical aid was provided in patients with a critical, almost terminal condition. Results On admission 40 minutes after the injury, one patient was diagnosed with a deep cut wound on the posterior surface of the right thigh with damage to the flexor muscles of the leg, femoral artery and vein with their defects up to 3 cm, and a cut wound on the right lower leg. Combined plasty of vascular defects with grafts from the great saphenous vein of the thigh and muscle suture were performed. An excellent result was noted after 3 months. In the second patient, there was an injury with glass in the area of the left axillary fossa with a transverse cut of all nerves, brachial artery and vein, tendons of the biceps and triceps muscles of the shoulder. An excellent result of primary reconstruction was diagnosed 1.5 years later. In the third case, the patient was admitted with a complete traumatic amputation of the right forearm in the lower third due to the use of a mechanical wood splitter; replantation began 5 hours after the cut off. Replantation was successful. It included 4 stages of treatment; the 2nd one was repeated revision and suture of the vessels 16 hours after the onset of thrombosis following the 1st operation. The next two stages included combined plastic surgery of muscles and tendons, first on the extensor and then of the flexor surface of the forearm. Movements appeared 6 months after the injury during the restoration of sensitivity. A completely satisfactory result of treatment was obtained; the patient began to use his hand in everyday life and to write after one year. Conclusion Damage to the main arteriovenous formations requires urgent surgical treatment, aimed at preserving the limb, restoring blood supply, nerve formations, and bone integrity. In complete amputation, restoration of  muscle-tendon formations may be postponed for subsequent stages. In primary care, one should consider the need for subsequent, sometimes long-term rehabilitation, the result of which directly depends on the restoration of neurotrophic and sensitive functions.

Introduction Surgical treatment of massive non-repaired injuries of the rotator cuff of the shoulder (RCS) is associated with many difficulties for orthopedic traumatologists. Standard refixation is ineffective in these patients and there no any generally accepted treatment strategies. Therefore, there is a need to look for alternative methods of reconstruction. The aim of the study was to develop a new technique for the reconstruction of irreparable ruptures of the RCS, comparing its clinical effectiveness with the technique of partial reconstruction. Materials and methods The study included 58 patients with massive irreparable injuries of the RCS, who underwent arthroscopic reconstruction of the RCS in the time period from 2017 to 2020 at the FSBI "FCTA" of the Ministry of Health of Russia (Cheboksary). Thirty patients of group I (control group) underwent partial reconstruction of the cuff, and 28 patients of group II had reconstruction according to the technique developed by us. The essence is additional plasty of the rotators using tendon autograft from the long fibular muscle and the proximal biceps. The average follow-up period was 30.7 ± 5.6 months. The results were evaluated using the VAS, ASES, UCLA, CSS scales, X-ray and MRI data. Results Good and excellent results according to the UCLA-ASES-CSS scales were achieved in 53.6 % in patients of group II versus 26.7 % in patients of group I (p = 0.036). In group I, VAS was 2.1 ± 1.8 and in group II – 1.0 ± 1.1 (p = 0.02). The average value of the acromiohumeral interval was 6.7 ± 2.7 mm after using the modified RCS reconstruction technique, versus 3.6 ± 2.1 mm in the control group of patients (p < 0.0001). According to MRI data, the rate of full-layer repeated ruptures of the RCS tendons after reconstruction using the modified technique was significantly lower, 17.9 % versus 56.7 % in the group of partial reconstruction technique (p = 0.002). Four patients from group I underwent revision surgery, and two of them required arthroplasty with a reversible endoprosthesis due to the progression of arthritic changes in the shoulder joint. Conclusion The developed technique for reconstruction of ”irreparable" massive injuries of the RCS allows restoring vertical balance in the shoulder joint, significantly improves clinical and functional indicators, reduces the number of repeated ruptures of the rotator tendons in comparison with the method of partial reconstruction.

Partial or full-thickness rotator cuff tear is one of the leading causes of pain and dysfunction in the shoulder joint. Despite the variety of existing surgical techniques, the incidence of re-ruptures after surgical treatment, according to MRI studies, varies from 20 % to 39 %. Purpose To evaluate and compare the clinical results of full-thickness rotator cuff tears surgical treatment using various methods of tendon fixation. Materials and methods A retrospective analysis of case histories, surgery protocols and interviews of patients who underwent surgical treatment for rotator cuff tears at the Krasnoyarsk Regional Clinical Hospital within a period of 6 years was carried out. The sample consisted of 120 patients. All patients were divided into three groups depending on the method of fixation: 1) SutureBridge technique using anchors, 2) classic double-row transosseous suture, 3) double-row transosseous suture using extracortical fixators (Endobutton, Fliptack). Results In the first group, excellent and good results were obtained in 72.86 % and poor results were observed in 18.57 %. In the second group, excellent and good results were obtained in 66.66 % of cases, unsatisfactory results in 18.18 %. In the third group, e xcellent and good results were obtained in 76.47 %, there were no poor outcomes. The best clinical results were obtained in the group of patients who underwent postoperative rehabilitation. Conclusion Anchor SutureBridge technique and classical transosseous suture technique demonstrate comparable long-term outcomes. The absence of poor outcomes in the group of extracortical fixators makes further study of this method promising and should be shown in a larger sample.

The aim of the study was to identify the features of total elbow arthroplasty in traumatic cases and their consequences in patients of different age groups and to conduct a comparative retrospective analysis of differentiated treatment tactics. Materials and Methods A retrospective analysis of the results of total elbow arthroplasty (TEА) in the period from 2009 to 2019 was carried out in 101 patients with injuries and severe consequences of elbow joint injuries, 56 (55.4 %) men and 45 (44.5 %) women among them in the average age of 48.5 ± 12.5 years. Three groups of patients were formed. Group I were 29 (28.7 %) subjects who underwent conservative treatment of fractures before TEА; the second group (II) of 52 (51.5 %) patients underwent TEА after ORIF, the third group of 20 (19.8) individuals (III) were patients who had primary TEА. We investigated pain (VAS), range of motion, tests with the DASH and MEPS scales, hand strength. Results One year later, there was a statistical difference in the results (p = 0.0213) between group III DASH = 7.3 ± 2.1) compared with groups I (DASH = 20.6 ± 3.3) and II (DASH = 18.4 ± 4.2); in group III, MEPS was excellent (90.7 ± 8.4), and in groups I (MEPS = 83.8 ± 7.4) and II (MEPS = 84.2 ± 5.6) good (p = 0. 0344). There were no differences in the dynamometry of hand strength and pain. Discussion Treatment of fractures of the elbow joint is a challenge that has several aspects. Conservative treatment results in high incidence of pronounced contractures, which affect the range of motion in the elbow joint after TEA; in severe damage to bone and cartilage, it is necessary to evaluate many factors in order to make the right choice between ORIF and primary TEА. New prosthetic technologies are needed to ensure good long-term functioning of the elbow prosthesis, especially in young patients. Conclusion To choose the treatment tactics in severe injuries of the elbow joint, it is necessary to consider not only the severity of the injury, but also the age of the patient and the quality of the bone, especially in elderly patients. Rejection to perform osteosynthesis in favor of primary total arthroplasty is aimed at maintaining the range of motion, improving the functional results and survival of the endoprosthesis.

Defects of the thumb negatively impact physical and mental health, lead to depression, inferiority complex and hopelessness in the future. The aim of the study was to explore long-term results of thumb reconstruction using autologous transplantation of the second toe with microvascular anastomoses. Material and methods Second toe transplantation for thumb reconstruction was performed for 54 patients. There were 48 male and 6 female patients aged from 12 to 55 years. When analyzing the long-term results of surgical treatment of patients. The anatomy and functionality of the repaired finger was evaluated at a long term measuring the range of motion in the joints, muscle strength of the hand and major types of hand grips. Results The autograft completely healed with opposition of the reconstructed thumb and the rest fingers restored in 51 patients. The autograft failed in three cases treated with less functional methods. Conclusion Microsurgical reconstruction technologies used for a lost thumb facilitated rapid recovery of the finger and significantly improved functions of the injured hand as an entity. Free second toe transplantation using microvascular anastomoses for the thumb reconstruction allowed the patient regain basic gripping functions and improve cosmesis of the injured hand.

Despite the apparent simplicity of diagnosis and treatment of injuries of the finger extensor tendons, the number of unsatisfactory outcomes reaches 10-15.7 %, and 61.2 % in combined injuries. The small volume of extensor excursions (a small lever to the joint), unlike the flexors, requires a special attitude to the surgical restoration of the extensors. The accuracy of extensor length recovery is an essential factor in successful treatment. Purpose of the study was to develop diagnostic and surgical algorithms for the treatment and rehabilitation of hammer-like deformity of the fingers. Material and methods The study included two groups of patients with dropped distal phalanx of the fingers. The control group consisted of patients (n = 149) with a separation of the extensor tendon from the tuberosity of the nail phalanx. The main group (n = 163) were patients with tendon rupture at the level of the joint space. Patients in both groups underwent radiographic and ultrasound examination. Evaluation of the results was carried out using the subjective DASH criterion and objective assessment according to J.P. Crawford. Results Most patients in the control group were diagnosed with a tendon separation from the tuberosity of the nail phalanx. These patients were treated with a diagnosis of damage to the extensor tendons of the fingers in the 1st zone. Thus, the treatment tactics did not correspond to the diagnosis and is the reason for the deficiency of extension of the distal phalanx of the fingers of the hand after conservative therapy. According to the evaluation criterion (J.P. Crawford), the distal phalanx was observed in the majority of patients (n = 132), and according to the subjective assessment of DASH, only 45 could not fully perform these tests. In the patients of the main group at the diagnostic (ultrasound) stage, the position in the joints of the fingers of the hand was revealed, where the diastasis approached maximally between the damaged ends of the extensor tendon of the fingers of the hand in the 1st zone. Assessment of treatment results in this group of patients according to J.P. Crawford received excellent and good results, and according to DASH, all patients were able to perform these actions. Conclusions For the diagnosis of drooping distal phalanges of the fingers, it is necessary to apply x-ray and ultrasound examinations. Patients with an extensor tendon separation from the tuberosity of the nail phalanges should undergo surgical treatment using the blocking suture method. After surgical treatment of patients with subcutaneous rupture of the extensor tendons of the fingers in the 1st zone, immobilize the hand in the physiological position.

Introduction Meniscus tear is one of the most common injuries of the knee joint. Medial meniscus tear accounts for 23–31 % of knee joint injuries. The main method of treatment is partial resection. As reported, 13.5 % of patients undergo arthroplasty within 15 years after meniscus resection, what is regarded as an unsatisfactory result. Purpose To evaluate and compare the long-term clinical, functional and radiological results of surgical treatment in patients with medial meniscus tear combined with varus deformity of the tibia and without it. Materials and methods From 2013 to 2020, medial meniscus tear was treated in 245 patients. The patients were divided into 4 groups. Group 1 included patients with a mechanical femorotibial angle (MFTА) from 0º to 3º who had arthroscopic meniscus resection (AMR). In the 2nd group, all patients also underwent AMR, but their MFTА was more than 3º. In group 3, patients with MFTА from 3º to 5º underwent simultaneous AMR and proximal fibular osteotomy (PFO) with the formation of a defect. Group 4 included patients with MFTА more than 5º, who underwent high tibial osteotomy (HTO) and AMR. Changes in the main lines and angles were assessed with telemetry radiography of the lower extremities. Functional results were evaluated before and after surgery using the Lysholm Knee Scoring Scale, 2000 IKDC, KOOS. Results Isolated meniscus resection in patients with MFTА more than 3º without axial correction leads to a gradual increase in the deformity by 1,070 ± 0.50º during the first year after surgery, and by 2.20 ± 0.70º to the fifth year. In groups 1, 3 and 4, there was no statistically significant increase in MFTА during the entire observation period. The clinical treatment results of patients of the four groups in the first three years after surgery did not differ statistically. However, within the period from 3 to 5 years, patients with MFTА greater than 3º who underwent only AMR had poorer clinical results than in the other groups (p < 0.001). Conclusions A personalized approach to the method of surgical treatment for medial meniscus tear based on the MFTА enables to correct the mechanical axis of the lower extremities and MFTА, and thus improve the long-term clinical, functional and radiological results of surgical treatment.

Introduction Growing knowledge and understanding of the biomechanics and kinematics of the knee are prompting the search for new surgical techniques and new ACL grafts. Purpose Evaluation of the medium-term results of primary arthroscopic reconstruction of the anterior cruciate ligament of the knee using peroneus longus tendon autograft and comparing the results with the control group of patients who underwent primary arthroscopic reconstruction of the anterior cruciate ligament using patellar tendon autograft with two bone blocks. Materials and methods 108 patients were operated on in 2017-2018. They were divided into two groups. 55 patients underwent reconstruction of ACL using peroneus longus ligament autograft – group 1 (study group). 53 patients underwent reconstruction of ACL using patella tendon autograft – group 2 (control group). Evaluation of the knee joint function was based on clinical examination, medical history, results of functional tests, MRI results, on the data of instrumental diagnostic methods (CT‑1000) after the surgical treatment, patient responses when filling out scales before surgery and two years after the surgery (Tegner Lysholm, IKDC). Additionally, the patients of the study group underwent a study on a plantograph before surgery and 24 months after it. Postoperative evaluation was also performed using the AOFAS scale. Results In group 1, the average score on the Tegner Lysholm scale before surgery was 69.2 ± 10.7 points, after surgery – 92.2 ± 10.4 points; on the IKDC scale before surgery – 68.2 ± 10.6 %, after surgery – 90.1 ± 9.5 %. KT-1000 – 3.7 ± 1.4 mm, AOSAF – 95.3 ± 7.5 %. An autograft rupture within 2 years after the surgery was detected in 4 out of 50 patients, which amounted to 8 %. Measurements on the PKS-01 plantograph 24 months after the operation did not reveal changes in the arch of the foot. In group 2, the average score on the Tegner Lysholm scale before surgery was 70.2 ± 11.6 points, after surgery it was 94.3 ± 8.7 points. The mean value on the IKDC scale before surgery was 68.6 ± 8.7 %, after surgery it was 91.5 ± 8.2 %. KT-1000 – 3.4 ± 1.2 mm. Autograft rupture within 2 years after the surgery was detected in 3 out of 50 patients, which amounted to 6 %. Conclusion The results of the operations performed in the two groups can be assessed as good, no statistically significant differences were found, which indicates that the peroneus longus tendon autograft is an alternative option for primary ACL repair.

Background Conservative treatment of pediatric patients with anteromedial instability after ACL rupture is a very topical subject and raises many debates in the scientific community. Results of this treatment are rather controversial both in patients with open physis and in adult patients who reached skeletal maturity. Influence of anteromedial instability on damaging such structures of the knee joint and meniscus and articular cartilage also generates interest. Purpose The purpose is to evaluate results of conservative treatment in young athletes using methods of clinical examination, questionnaires and MRI-diagnostics. Material and methods The study included 20 patients with anteromedial instability aged 13-20 years. Duration of observation was up to 2.7 years (33 months). The patients filled out KOOS-Child and Pedi-IKDC questionnaires. At least two MRI-examinations were done also. The patients were treated conservatively. Results and discussion MRI data indicated that 9 (45%) patients had osteochondral changes in condyles of the both bones. Thinning of the knee cartilage by ≥ 0.7 cm was observed in 14 patients. Eighteen patients has the clinically confirmed knee joint instability. Eight (40%) patients underwent operative treatment later. Conclusion Our study results allowed us to make a conclusion about poor results of the conservative treatment. Only 2 patients returned to previous activities and the knee instability was not observed clinically. The rest of the patients were not satisfied with the treatment results. MRI data and statistical analysis data indicated that the patients had signs of significant weight distribution disorders in the knee joint and also secondary damage of meniscus due to anteromedial instability.

Introduction Severe open injuries and wounds of the tibia refer to the topical problem of traumatology due to the difficulties in the functional restoration of the segment when there is a bone and soft tissues defect. Material and method The treatment of 11 patients with soft tissue and tibial defects was analyzed. At the time of reconstruction, the age of male patients ranged from 20 to 52 years (mean age 34.2 ± 3.2 years). Gunshot wounds of tibia occurred in 7 injured and tibial injury was observed in 4 cases. Segmental defects of the tibia ranged from 6 cm to 18 cm, mean 12.6 ± 4.4 cm, myocutaneous defects ranged from 20 cm2 to 112 cm2, mean 74.4 ± 22.4 cm2. Results In seven cases, the wounds healed by primary intention, the signs of infection and marginal necrosis of the soft tissue component of the flap were observed in 4 (36.4 %) cases and were addressed conservatively (dressings and debridement), but in one case, necrosis was excised (on day 21) and autodermoplasty was performed using split skin graft. We had no problems with the transport (distraction) of bone regenerates, since the rib cage of the flaps protected the soft tissues and the vascular pedicle of the flap, despite the early start of distraction (mean period 7.3 ± 2.1 days) and the length of treatment, when averaged, was 163.2 ± 8.7 days. Support function was restored in all patients and the functional results were satisfactory. Discussion The combination of Ilizarov distraction osteogenesisand soft tissue reconstruction using free vascularized flap grafting makes it possible to invalidate the short-comings of both, i.e. to lighten up the bone transfer, to avoid damage to the scarred skin of the anterio-medial surface of tibia and to preserve the axial circulation of the graft. The inclusion of a rib fragment provided the required conditions for application the Ilizarov distraction method. The rib, not being a supportive bone tissue, protected the soft tissue component of the flap and its vascular pedicle from deformity and participated in the formation of callus. Conclusions Plastic filling in the extensive tibial defects using free vascularized myocutaneous flap with rib fragments and Ilizarov distraction osteogenesis provides favorable conditions for acute surgical intervention allowing to save the limb, restore the support ability and return the patients to work.

An Achilles tendon injury is most common among subcutaneous tendon ruptures and accounts for 47 %. The purpose was to experimentally evaluate the effectiveness of new methods of the Achilles tendon reinforcement. Material and methods The experimental part of the work was performed in 3 stages using 60 biomannikins with intact Achilles tendon. A Krakow suture was used at stage 1 for a group of 20 tendons and a force that would result in rupture of the tendon was measured. Reinforcement was performed using the plantaris tendon (technical innovation offered at the Samara State Medical University) at the 2nd stage and the force required for the appearance of signs of rupture was subsequently measured. A portion of the peroneus longus tendon (RF patent No. 2616767) was used for reinforcement at the 3rd stage and the force measurement produced. Results The mean force required to rupture the Krakow suture applied to the tendon at the first stage was 11.5 kg., The force required to rupture the suture reinforced with the plantaris tendon at the second stage measured 33.4 kg. The force required to rupture the suture reinforced with a portion of the peroneus longus tendon at the third stage was 37.3 kg. Conclusion The new techniques offered to reinforce the Achilles tendon with the plantaris tendon and a portion of the peroneus longus tendon at the distal base facilitated increase in the strength of the injury site by 195.6 % and 214.4 %, respectively.

The complexity of the condition, lack of clear routes for patients with degloving injury of integumentary tissues, inadequate and untimely diagnosis, lack of clinical guidelines and a paucity of literature lead to a great number of failures and complications in treatment of the cohort of patients. The objective of the study was to analyze failures and complications encountered in treatment of patients with degloving injury of integumentary tissues, and identify ways for the prevention. Material and methods Medical records of 40 patients with degloving injury of integumentary tissues were retrospectively reviewed. The patients treated in trauma departments and the Burn Center in Chelyabinsk between 2008 and 2014 were divided into two groups according to the time of admission to the burn center. The first group of patients was hospitalized within 6 days of injury and over. The second group of patients was admitted to the combustiology department in the first 5 days of injury. Results Failures in diagnosis and treatment were mostly observed in patients who were admitted for treatment after 5 days of injury. Most common complications included necrosis of integumentary tissues, infected wounds, necrosis of skin autografts. Discussion Most of the complications seen in patients with extensive degloving injury of integumentary tissues resulted from organizational, diagnostic, therapeutic, strategical and technical failures, and several adverse events were associated with the severity and extent of the involved tissues. Conclusion A number of recommendations have been offered for prevention of failures and complications in treatment of the cohort of patients.

Introduction Treatment of a patient with an open comminuted humerus fracture and an extensive bone defect is challenging and associated with high risk of a poor outcome, infection resulting from skin and soft tissue injury and considerable bone transport. The objective of the study is to demonstrate the experience with an open comminuted humerus fracture and an extensive bone defect treated with staged use of transosseous fixation with rod-andwire device, autologous fibula graft and internal wiring. Material and methods We report a case of an open humerus fracture and an extensive bone defect treated with a bone replacement technique and followed up to 4 years. Results and discussion The limb was temporarily fixed with external fixation device extrafocally using wires and rods. A 24 cm autograft was harvested from the fibula. Osteosynthesis of the humerus and autografting were produced with the graft fixed using smooth wires and external fixation was provided using wires and rods. With consolidation of the humerus achieved, the external fixation device was dismantled and transosseous wires removed. Anatomical length of the segment was restored. Conclusion Combined techniques and technical means of external fixation, autologous graft, internal fixation with smooth wires facilitated complete restoration of the injured limb avoiding complications with a good clinical outcome.

with high risk of substantial long-term morbidity. Tissue defects resulting from staged debridement require skin grafting or vascularized island flap coverage. Hand therapy is an important part of the complex rehabilitation of such patients. The objective is to present complex surgical reconstruction of severe high-pressure injection injury of the hand aimed at preserving limb function. Material and methods Methods and results of surgical reconstruction of a patient with severe high-pressure injection injury of the hand treated at the Research Institute – S.V. Ochapovsky Regional Clinic Hospital No.1 in 2018–2019. Results Short-term result of surgical treatment demonstrated complete skin restoration and maximum possible preservation of underlying deep anatomical structures of the hand. Subsequent surgical interventions were aimed at restoring the hand function. Conclusion The restorative treatment of a high-pressure injection injury of the hand includes the earliest possible primary surgical treatment of the wound with wide revision, maximum removal of the injected substance and non-viable tissues and prevention of secondary injuries and infection in the wound. Nonfree vascularized flaps, full-thickness free grafts or split-skin autografts are used for skin reconstruction. Restoration of other functionally significant structures can be considered at a long term with wounds healed and autografts completely implanted. Hand therapy is integral to the comprehensive functional rehabilitation of the high-pressure injection injuries to the hand.

The objective was to explore possibilities with reconstruction of opposable digital stump of the hand transplanted with microvascular anastomoses in frostbite patients. Material and methods Medical histories and long-term results of treatment of two frostbite patients with finger stumps of both hands were reviewed. The triphalangeal finger and the thumb were reconstructed by transplanting the opposable finger stump together with the metacarpophalangeal joint using microvascular and microneural anastomoses. The stumps were mobilized and transplanted to the distal ulnar artery with the venous drainage performed using the dorsal saphenous vein of the hand. Long-term results were examined at 10 years and 2.5 years of surgery. Clinical, radiological, biomechanical and biophysical investigations were produced. Results The bilateral gripping function was restored in recipient stumps without functional damage to the donor stumps. Discriminatory sensitivity of reconstructed fingers was 6mm and 8 mm, the range of active motion in the transplanted joint was 55 and 66 degrees. Discussion Opposable digital stump transplantation with microvascular anastomoses has significant advantages over the classical surgery. The technique allows for one-stage restoration of a finger to have sufficient length, function, adequate blood supply and innervation due to a short digital stump being transplanted with the metacarpophalangeal joint. The advantage over a toe transplant consists of the use of digital structures of the hand that are identical in functionality and the anatomy reducing the need for secondary interventions.
Conclusion The method of management can be successfully applied for frostbite patients with hand stumps according to indications.

Introduction The tibial collateral ligament (TCL) is one of the major ligaments of the knee and designed to counteract valgus forces. Tibial collateral ligament injury can be treated conservatively with prolonged immobilization and limited weight-bearing on the injured limb. Clinical experience and a high complication rate after conservative treatment indicate the need for surgical intervention to restore the integrity of the TCL. The purpose is to demonstrate a successful management of a patient with ruptured TCL of the right knee joint and substantiate the priority of surgical treatment in the case. Material and methods A clinical case is reported and a brief literature analysis on the topic provided. The experience with open lavsanoplasty used for a patient with rupture of the TCL resulting from dislocated tibia is presented. The effectiveness of treatment was assessed radiologically and physically for the limb functionality and ROM in the knee joint. Results and discussion Open lavsanoplasty performed for the TCL injury resulted in complete restoration of the limb function and anatomical integrity of the ligament. The good result persisted after the removal of the metal construct. The method allowed us to avoid complications being typical for conservative treatment: medial instability of the knee joint and deforming arthritis, and showed the advantages over other surgical treatments used to regain the integrity of the TCL. Conclusion Open lavsanoplasty of the TCL used as the patented technique facilitated complete recovery the injured limb, the functionality, less risk of complications providing a good clinical result.

These include refracture, nonunion, delayed consolidation. The purpose is to explore modern methods of treatment of delayed fracture consolidation. Methods The literature search was produced via open access electronic databases of scientific literature PubMed and eLIBRARY. Search depth was 10 years. Results The article presents methods of medication and local therapy for delayed fracture consolidation. The effectiveness of the use of the ossein-hydroxyapatite complex and vitamin D is reported in patients with normalized healing time of a long bone fracture. The findings showed that bisphophonates, denosumab and strontium ranelate can reduce the risk of fractures with no adverse effect on bone healing. There is controversy on the effect of Teriparatide improving fracture healing. This review will envisage the current clinical trials on bone healing augmentation based on bone grafts, bone substitutes, synthetic growth factors, cell therapy and PRP therapy. Local use of bisphosphonates administered either alone or in combination with other agents is of great interest. Bisphosphonates (etidronate) locally applied in combination with lanthanide ions and calcium for animal fractures demonstrated a positive effect on the reparative process. Conclusion The applicability of medication and local therapy is very high in the treatment of patients with delayed fracture consolidation. Despite numerous studies many questions remain unresolved, and there is a need for the investigations. The local use of bisphosphonates was shown to be promising in the management of delayed fracture consolidation.

Introduction Heterotopic ossification (HO), also known as myositis ossification, paraosteoarthropathy, or heterotopic calcification, among others, is a common pathological condition that refers to ectopic bone formation in soft tissues. Although the molecular mechanism of HO is not fully understood, it is believed that signaling of bone morphogenetic proteins (BMPs) plays a key role in the overall process of HO. Today, recombinant human BMP-2 (rhBMP-2) and recombinant human BMP-7 (rhBMP-7) have been already actively used in clinical practice in the treatment of bone defects. However, despite the positive sides of using rhBMPs, there are a number of side effects, one of which is HO. Purpose In this study, we demonstrate cases of HO following the use of rhBMPs in both clinical and preclinical studies and make an attempt to explain the relationship between the signaling pathways of BMPs and the HO process, as well as the possibilities of preventing and treating the HO process. Materials and methods PubMed, Embase, the Cochrane Database, and Google Scholar were comprehensively searched for original articles, literature reviews, case reports, and meta-analyses demonstrating a causal relationship between therapeutic rhBMPs and HO as a complication. Results This review analyzes the potential for therapeutic use of rhBMPs in neurosurgery and traumatology and orthopedics, demonstrated by both clinical and preclinical studies. In particular, the studies confirm that ectopic bone formation is one of the side effects following administration of rhBMPs. Moreover, the molecular mechanisms of the HO process were highlighted, and the possibilities of modern methods of prevention and treatment of HO were discussed. Conclusion According to the FDA safety database for rhBMPs, the rates of adverse effects related to HO range from 1 % to 10 %. However, to date, the clinical use of rhBMPs is justified, especially when there are no alternative substitutes for bone grafting.

Background Management of patients with sequelae of intra-articular fractures of the distal tibia continues to be a substantial clinical challenge in orthopaedic trauma due to the high incidence, poor outcomes and high disability rate. The objective was to review Russian and international experience in repair of intra-articular ankle fractures and explore contemporary trends in treatment strategies. Material and methods The literature search was produced using medical electronic databases of eLibrary, PubMed, Medline, SpringerLink between 2000 and 2020 and keywords: cruzarthrosis, arthrodesis, total ankle arthroplasty, arthroscopy, distal tibia, ankle joint, joint replacement, intra-articular fractures of distal tibial. Results The article presents an insight into the problem of malunited and nonunited ankle fractures, ankle contractures and deformities, post-traumatic ankle arthritis. Major surgical techniques used to address sequelae of ankle fractures include correcting osteotomy, arthroscopy, distraction arthroplasty, arthrodesis, total ankle arthroplasty with the advantages and disadvantages with each of the practices. Discussion The surgical option would depend on the time of injury, condition of soft and bone tissue, malalignment and severity of ankle arthritis. Joint saving procedures of correcting osteotomy, arthroscopy or distraction arthroplasty can be applied at early stages of the disease, and arthrodesis or total ankle arthroplasty are secured for terminal stages of ankle arthritis. Benefits of total ankle arthroplasty include preservation and improvement of ankle mobility, a short inpatient period. Ankle fusion is associated with less complication rate and low costs. Conclusion There is an obvious need for a uniform treatment algorithm with specific indications and contraindications to each surgical option.

syndesmosis rupture are associated with worse outcomes. There is no diagnosis and treatment algorithm for such injuries to date. The objective was to summarize the data on diagnosis and treatment of syndesmotic injury alone and in combination with ankle fractures through world literature review. Material and methods A systematic literature search was undertaken using elibrary, PubMed, ResearchGate databases with articles dated 1990 and later. The search depth was 30 years. With preliminary information collected low-relevant articles were excluded. Meta-analysis studies, randomized controlled trials, systematic reviews, cadaveric biomechanical studies were reviewed. Results Screws and suture buttons can be used to fix DTFS, and Volkmann, Shaput and Wagstaff fractures being transosseous injuries to DTFS can be repaired with osteosynthesis. Imaging evaluation of reduction can be produced with radiography, MSCT, MRI and arthroscopy. Partial injuries to the DTFS, if timely detected, can be treated conservatively with transition to surgical stabilization if signs of instability persist. Discussion Conventional radiography has very low diagnostic value for DTFS injury. Bilateral MSCT is recommended for assessment of a syndesmotic injury and MRI of the ankle joint is practical for partial isolated injuries. Concomitant injuries of the fibular notch of the tibia are recommended to address first prior to transsyndesmotic fixation. Open reduction of displaced DTFS is accompanied by a lower risk of fibular malposition and malreduction. Suture buttons are practical for transsyndesmotic fixation. Removal of positional screws does not affect the functional result of treatment. More stable osteosynthesis would be needed for DTFS injury in neuropathy.

Introduction The foot bears the load of the entire body while walking and particularly the plantar part of it resists a tremendous weight-bearing. A peculiarity of the skin cover of the supporting zones is that the elastic fibers of the soft tissues of the plantar foot fix the skin to the deep fascia and the bone skeleton, resulting in minimizing of the supportive tissue mobility and increasing pressure stability without circulation disorder in areas of increased weight-bearing. Therefore, the requirements to the plastic properties of the selected material for the reconstruction of the soft tissues of the foot increase. Purpose is to review the various methods and techniques of surgical treatment for extensive soft tissue defects of the foot using flaps with an axial type of circulation. Material and methods The search of materials was performed from 2015 through 2020 in the following sources of information: eLibrary.ru; bibliographic bases (Scopus,; Web of Science); electronic library of dissertations of the Russian State Library (http://diss.rsl.ru) and sites of Dissertation Boards. The review of 72 publications of national and foreign authors related to this topic is presented. The depth of source selection was 16 years, starting from 2004. In the last 5 years, 45 studies data have been published. The literature related to surgical treatment of extensive defects in the foot soft tissues using complex flaps with an axial type of circulation supply was analyzed. Results Basing on the analysis of publications from various sources, the disadvantages and advantages of various methods and techniques of reconstructive plastic surgery are presented and various approaches and criteria for choosing the techniques of surgical soft tissues reconstruction are described. Conclusion In the treatment of patients with extensive soft tissue defects of the foot at the current stage of the reconstructive plastic surgery development, the doctrines based on microsurgical technologies of autografts of tissue complexes with an axial type of circulation became the most acceptable ways and techniques for lost skin restoration.