Introduction

Distal humerus fractures are relatively rare and being intra-articular are difficult to manage. As the number of elderly people grows steadily and also with increasing use of motor vehicles in the developing countries, it can be said that the frequency of intraarticular fractures of the distal humerus will increase similar to the fractures of the distal end of the radius, hip, and spine. There are several treatment plans for managing intraarticular fractures of the distal humerus depending on fracture anatomy. We conducted this study to assess which approach is superior, closed percutaneous reduction with K-wires or ORIF.

Methods

A total of 30 patients who satisfied the inclusion criteria were included, out of which 16 patients underwent ORIF and 14 patients underwent closed reduction and percutaneous pinning (СRPP). Patients included were between 21–50 years of age with intraarticular nonpathological closed distal humerus fractures without preoperative neurovascular deficit and presented less than 10 days between the fracture event and treatment.

Results

In our study, mean age of patients undergoing CRPP was 28.1 years while the mean age of patients undergoing ORIF was 30.1 years. This study showed that distal humerus fractures are more common in younger age groups. In our study, mean arc of motion at 6 months postoperatively in patients which underwent CRPP was 106.07 degrees while the mean arc of motion in patients which underwent ORIF was 80.94 degrees. In patients who underwent ORIF, only 6.2 % (1/16) had excellent outcome, 56.3 % (9/16) patients had good outcomes, 31.3 % (5/16) patients had fair outcomes, and 6.2 % (1/16) had poor outcome. It was found that out of a total of 14 patients which underwent CRPP, only 7.1 % (1/14) had cutaneous impingement. Fracture union occurred in 100 % of patients except 3 patients in ORIF group; however, they had partial union up till 6 months of follow-up.

Conclusion

Our study concludes that even displaced intra-articular fractures of the distal humerus can be satisfactorily treated with closed reductions and percutaneous pinning.

Background

Volar locking plate (VLP) has gained the most popularity in the treatment of distal radius fractures due to its superior biomechanical property. In contrast, external fixation (EF) is not so extensively used.

The aim of this study was to find what procedure is better in the management and achieves favorable outcomes in patients with comminuted distal radial fractures.

Patient and methods

This study included 30 patients with distal radial fractures AO types A3, C2, C3 in which 15 ubjects were managed with open reduction and internal fixation by volar plate, and another 15 were managed with external fixation augmented by K-wires. The minimum duration of follow-up in our study was six months.

Results

Patients treated with external fixation augmented by K-wires had grip strength range 15-27, patients treated with volar plating had grip strength range 8-27. There was no significant statistical difference between 2 groups regarding extension. In Group A Mann-Whitney test revealed that Gartland-Werely score had negative correlation with affected hand. In Group B the correlation was positive with AO/OTA classification only and negative with affected hand and ulnar styloid fracture but also not statistically significant between Quick-DASH score with affected hand, AO/OTA classification and ulnar styloid fracture.

Conclusion

Both volar plating and external fixation augmented by K-wires are treatment choices for distal radius fractures. Whereas external fixation maintains a significant role in the treatment of distal radius fractures, ORIF with locked volar plating has changed the way many surgeons treat certain types of distal radius fractures.

Introduction

Among the ranges of electromagnetic waves used in clinical practice, electromagnetic waves of the terahertz range (EMWTHR) have promising applications. The experimental and clinical studies show that they are able to provide correction of the main pathophysiological disorders of a living organism such as hypoxia, hypercoagulation, and immunodeficiency.

Purpose

To study the effectiveness and safety of terahertz electromagnetic waves in the complex treatment of patients with the consequences of fractures of the humeral condyle.

Methods

Clinical, radiological, physiological and laboratory studies were conducted in 30 patients with consequences of fractures of the humeral condyle (post-traumatic deformities, osteoarthritis of the elbow joint). Surgical treatment of patients with consequences of injuries of the elbow joint was classical and consisted of corrective osteotomies and osteosynthesis with the Ilizarov apparatus of the humerus and forearm. The main group consisted of 15 patients who underwent 10 sessions of EMWTHR exposure to the osteotomy zone, and 15 patients did not undergo physiotherapy.

Results

It was found that in patients of the main group, the average values of the intensity of pain and the deficit in the range of motion were significantly lower than the findings of the comparison group in the short term after treatment. The use of EMWTHR therapy led to differences in metabolic processes in the compared groups. There were no significant changes in radiological, physiological and laboratory parameters, as well as clinical signs that could be attributed to adverse events or complications associated with the use of EMWTHR.

Conclusion

The results of the comparative study allow us to recommend the EMWTHR therapy in the system of complex treatment of patients with the consequences of fractures of the humeral condyle and can be used as a means for local stimulation of
reparative processes in target patients.

Introduction

Nonunion or delayed union is a known postoperative complication in long bone fractures. Substance abuse may impair bone healing. In this paper, we investigated the effect of narcotics on healing time in femoral shaft transverse fractures and the effect of substance abuse and smoking on postoperative healing time.

Material and methods

This cohort study was conducted at the Orthopedic Clinic of Poursina Hospital, Rasht from 2017–2019. Patients with transverse fractures of the femoral shaft who underwent intramedullary rod insertion were followed for 6 months. Bone healing time based on substance abuse and smoking status was evaluated.

Results

There was a significant association between various groups (categorized based on cigarette smoking and using drugs) in terms of bone healing status (P = 0.006). There was a statistically significant difference in healing status among the control group, smoker group, and addict and smoker group (P = 0.034 and P = 0.004, respectively). However, there was no statistically significant difference in healing status between control and addicts group (P = 0.517).

Conclusions

Treatment efficiency and performance in addicted and smoker patients are more unfavorable and hence which, in turn, requires more follow-up periods; therapies such as bone grafting and other methods are more frequently considered in addicted and smoker patients in case of lack of healing reaction. Therefore, prevention plans in high-risk groups can play a significant role in primary identification, treatment, and reducing the complications of fractures.

Introduction

Functional recovery of the finger flexor tendon after surgical treatment is a problem due to formation of unavoidable blocking adhesions. For prevention of the adhesions, the mechanical separation of the sliding surfaces of the tendon and the wall of the fibro-osseous canal with a polymer tube was proposed. However, despite good clinical results, it is not possible to morphologically confirm the healing of the suture zone after such an intervention.

Objective

To present an experimental model and technique of surgical intervention on the calcaneal tendon of laboratory animals for isolation and blocking with a polymeric tube, longitudinally cut, for obtaining and studying the regenerate in the suture site

Materials and methods

In an experiment under inhalation anesthesia with Isoflurane on both hind paws of 10 laboratory Wistar rats, the tendon suture was simulated with blocking and isolation of the tendon suture (n = 14) and the control operation without isolation (n = 6). The tendons were excised three weeks post-surgery, and the appearance and histological picture of the regenerates in the suture zone were examined.

Results

The surgery model with isolation of the suture site on the calcaneal tendons of rats reproduces well and adequately simulates the operation on the human hand tendons. The morphology of the obtained regenerates demonstrates the restoration of continuity with the formation of tendon-like tissue at the junction. In the experiment, subtotal isolation did not lead to tendon necrosis, but slowed down the healing of the suture zone. The tube prevented the formation of adhesions and maintained tendon nutrition through the fissure space.

Conclusion

Modeling of the operation of tendon suture on the rat calcaneal tendon with its isolation provides material for demonstration the primary tendon regeneration in vivo. Regeneration of the suture site during subtotal isolation slows down and occurs due to the cells of the tendon itself.

Introduction

The risk of the femoral neck fracture nonunion is 48 % with avascular necrosis of the femoral head being reported in 42 % of cases. There are many classifications of acute intra-articular fractures of the proximal femur and there are no grading systems for femoral neck nonunions that would allow prediction of outcomes of total hip arthroplasty (THA).

The objective was to evaluate mid-term results of THA in patients with femoral neck nonunion and develop a new classification of nonunions.

Material and methods

A prospective cohort single-center comparative study included 78 elderly patients with atrophic femoral neck nonunions treated with primary THA. The mean follow-up period was 24.2 months. Three prospective groups were identified. Separation criteria included shortening of the lower limb and femoral offset, changes in the Barnett-Nordin index, the Hounsfield bone density index, the presence of metal constructs and bone defects. Groups A and B were divided into 2 subgroups depending on the presence/absence of fixation metal constructs for a femoral neck fracture. Group C was divided into 2 subgroups: type C1, acetabular defect and type C2, proximal femur defect.

Results

Mean operating time was 81.1 minutes in group A, 102.9 minutes in group B and 145.2 minutes in group C. The minimum blood loss was recorded in group A measuring on average 429.25 mL in both subgroups. The maximum blood loss was seen in patients of groups B and C measuring 606.62 mL and 631.5 mL. Overall revision rate was 7.7 %.

Conclusion

A classification for femoral neck nonunions was developed suggesting grading patients into 3 types: type A, type B and type C which were further divided into 2 subtypes. The grading system was based on lower limb shortening and femoral offset, severity of osteoporosis, presence of metal constructs and acetabulum or proximal femur bone defect which prognostically affected the outcome of THA.

Introduction

Surgical options used to treat recurrent patellar dislocations (RPD) in different countries include release of the lateral tendon retinaculum, tibia medialization, fixation of an autologous graft to the hip, transplantation of the ipsilateral gracilis tendon and medial patellofemoral ligament reconstruction. The methods may not completely eliminate the dislocation to ensure patellar stability and we undertook to develop a new surgical technique.

The objective was to identify advantages and disadvantages of the new methodology for the treatment of RPD through comparative analysis.

Material and methods

28 patients with RPD of varying degrees treated in the Department of Sports Trauma, State Institution "RSNPMCTO" the Ministry of Health of the Republic of Uzbekistan between 2015 and 2018 were reviewed. Dislocations were graded as average (grade 2; n = 3, 10.7 %) and grade 3 (n = 25; 89.3 %). Five (17.8%) of 28 patients had impaired m. vastus medialis and 23 (82.2 %) were diagnosed with impairment and defect of the retinaculum patella mediale. The patients underwent physical, laboratory, radiological and instrumentation (ultrasound, magnetic resonance imaging, diagnostic arthroscopy) examinations.

Results

Arthroscopic procedure of the knee joint with autoplasty patellar stabilization using the m. gracilis tendon and a biodegradable screw resulted in good outcomes (n = 27; 96.4 %) and a fair result in a patient (3.6 %) with grade 3 RPD due to synovitis, bursitis and pain in the knee joint; no poor results reported.

Conclusion

The patients could completely regain the limb functions through arthroscopic procedure of the knee joint with autoplasty patellar stabilization using the m. gracilis tendon and a biodegradable screw, optimization of surgical treatment strategy with regard to severity of displacement and injury to the soft tissues at the medial aspect of the patella. 

Introduction

Complicated multiplanar static forefoot deformities can occur at any age ranging 72 % to 80 % in older patients significantly reducing the quality of life. The results of treatment of flexible mallet toe deformity of "smaller" toes cannot be considered satisfactory with floating toe syndrome reported in 20–54 % of cases.

The objective of the study was to evaluate the effectiveness of the original technology offered for the treatment of complicated multiplanar static forefoot deformities which differs from traditional methods by the way the plantar plate of "smaller" toes is restored.

Material and methods

The study included 43 patients who were divided into two groups depending on the type of reconstruction performed. Long-term outcomes were evaluated at 12 months of surgery using AOFAS questionnaire, radiology, VAS and the Hamilton-Thompson metatarsophalangeal “drawer test”.

Results

Conventional surgical technology applied for patients of group A and group B allowed reduction of the M1-M2 angle by 7.2 ± 1.1 degrees and visual elimination of the the second mallet toe deformity in all cases. There was no floating toe noted among patients of group B, and the deformity was defected in 5 (27.8 %) patients of group A; contracture of the second metatarsophalangeal joint diagnosed in 1 (4.0 %) patient of group B and in 8 (44.4 %) cases of group A.

Conclusion

The flexible mallet toe deformity of the second toe treated with the technique we developed allowed us to avoid the development of floating toe syndrome, contracture of the second metatarsophalangeal joint and improve the quality of life by 28.7 ± 2.4 AOFAS score.

Introduction

This study is a comparative assessment of early and long-term results of two different methods of surgical treatment of hallux extensus.

Materials and methods

The results of surgical treatment of 22 patients with Hallux extensus at the orthopedic department of the Moscow Yudin City Hospital from 2017 to 2019 were studied. The patients were divided into 2 groups depending on the tactics of surgical treatment. The main goal of this study is a comparative assessment of the functional results of two surgical techniques. The first group of patients, which included 11 subjects, underwent needle percutaneous tenotomy of the extensor tendon of the big toe, the second group, which also consisted of 11 people, underwent tenodesis of the tendon-muscular part of the short flexor of the big toe according to the proposed by us technique.

Results

The study results are based on the assessment of subjective patient satisfaction and radiography images, as well as on the ACFAS score. In the group of patients who underwent percutaneous tenotomy of the extensor tendon of the big toe, there was a recurrence of deformity in 4 patients (36 %) and insufficient correction of the deformity in 2 patients (18 %). In the group of patients who underwent tenodesis of the tendon-muscle part of the short flexor of the big toe, 100 % showed good functional results, pain relief and esthetic effect. Good treatment results were observed in 73.3 % of the patients.

Conclusions

Analysis of the clinical results of surgical treatment showed a high efficacy of tenodesis of the tendon-muscle part of the short flexor of the big toe in comparison with percutaneous tenotomy of the extensor tendon of the big toe. Positive results were achieved in 100 % of cases. No recurrence of deformity was observed. The patients did not complain of pain, and there were no problems with footwear in the postoperative period.

Introduction

Congenital clubfoot is the most common congenital malformation of the foot in children. Despite the relatively low birth rate clubfoot shows no tendency to decrease in the population. On the contrary, there is an increased number of foot pathologies associated with central nervous system anomalies and other pathological syndromes. Atypical clubfoot according to Ponseti's classification requires early recognition and continues to challenge the skills of the pediatric orthopedic surgeon.

The objective was to draw the attention of pediatric orthopedists on the problem of atypical clubfoot. The goals were to discuss common errors in the treatment of atypical clubfoot and assess a recurrence rate that would require a re-operation.

Material and methods

A total of 135 children (184 feet) with atypical clubfoot which amounted to 12.1 % of the total clubfoot cases were treated in hospitals of the city of Yaroslavl between May 2006 and December 2019. The review included 106 children (147 feet) with atypical clubfoot who could benefit from Ponseti treatment. The mean long-term followup period was 7.2 years.

Results

Relapses requiring re-operation occurred in 51 children (83 feet) that amounted to 48.1 % of the total atypical clubfoot cases treated in Yaroslavl. Discussion Appropriate bracing is an important component of the Ponseti technique of atypical
clubfoot correction in everyday practice of the pediatric orthopedist. Untimely detection of atypical clubfoot and non-compliance with bracing protocol in typical clubfoot can result in an iatrogenic atypical clubfoot with likelihood of major reconstructions and poor prognosis.

Conclusion

The Ponseti method in Russia is the "gold standard" for the treatment of clubfoot. 

Background

Conventional radiography, magnetic resonance imaging, nuclear medicine scintigraphy are the imaging techniques currently in use for the evaluation of diabetic neuroosteoarthropathy (DN) with computed tomography being not commonly employed even for cases complicated by chronic osteomyelitis.

The objective was to explore MSCT-semiotics of anatomical and radiomorphological changes in foot bones in patients with DN complicated by chronic osteomyelitis (CO) to determine most common manifestations of CO in diabetic foot.

Material and methods

Single-centre retrospective study. A series of cases. Preoperative radiological findings, MSCT (multislice computed tomography) were examined in 14 patients with DN complicated by chronic osteomyelitis. Results The patients showed impaired structure of the cancellous bone of various severity depending on the nature and localization of foot bone destruction. Overall bone density was higher in cancellous bone of the distal tibia, talus, calcaneus with the local density ranging within significant limits and was maximum at some points of the subchondral tibia and talus and minimum in the intertrabecular areas of the calcaneus and the distal tibia. MSCT scans showed medial calcinosis of the arteries in 5 (35.7 %) from 14 patients.

Conclusion

MSCT as one of the most objective method for the qualitative and quantitative assessment of the bone is practical for identifying anatomical and topographic relationships of the foot bones and the ankle joint to facilitate reconstructions in three planes and VRT, which is important for assessing the foot in patients with DN complicated by chronic osteomyelitis. The technique allows measurement of the foot bone density in Hounsfield units determining the severity of osteoporosis, the extent of architectonics impairment to facilitate preoperative planning.

Introduction

Optimization of the conditions of distraction osteogenesis using the method of G.A. Ilizarov remains an important challenge to ensure a reduction in the number of complications and an increase in the effectiveness of this technology.

The aim of the study was to study the changes in the antioxidant/prooxidant balance in patients with acquired shortening of the lower leg bones at the stages of the Ilizarov lengthening procedure.

Methods

The antioxidant/prooxidant status was studied in 12 patients with shortening of one of the lower legs resulting from hematogenous osteomyelitis (group 1) and in 13 patients with post-traumatic shortening of one of the lower legs (group 2). The level of peroxidation products, the activity of superoxide dismutase and vitamins E and A in the blood of these patients were assessed in the dynamics of monofocal bone lengthening using the Ilizarov method. Results It was found that in patients with acquired shortening of the shin bones, regardless of the shortening etiology, during surgical lengthening, an increase in the level of peroxidation products in the blood was observed with a decrease in the level of vitamin E and an increase in superoxide dismutase activity.

Discussion

The data obtained, together with the current findings from fundamental research, allow us to note that the use of antioxidants (AOs) in patients undergoing segment length correction using the Ilizarov technology is possible from two positions. 1. The positive effect of AOs in terms of stimulation of distraction osteogenesis has been proven. 2. AOs have a systemic effect in the regulation of the recovery processes in the paraosseous tissues of the limb segment under lengthening.

Conclusion

Peroxidation is activated in the course of surgical lengthening of the lower leg bones in patients with acquired shortenings, regardless of the shortening etiology. The use of antioxidants in such patients can specifically inhibit peroxidation,
thereby reducing the risk of provoking bone formation disorders.

Background

Percutaneous minimally invasive surgery (MIS) has been increasingly implemented to treat thoracolumbar (TL) fracture against a conventional open pedicle screw fixation (OPSF) with desirable radiological and clinical outcomes. Studies in the Indian context are required to determine the efficiency of MIS over OPSF.

Objective

To compare restoration and maintenance of vertebral body height (VBH) following MIS versus OPSF.

Methods

A prospective comparative study was conducted in a tertiary care hospital. Patients (n= 36) aged 18–65 years (males = 23, females = 13) with traumatic TL fractures were identified. Eighteen of them underwent OPSF and other eighteen underwent MIS. The radiological outcomes like anterior and posterior vertebral body height percentage (AVBH % and PVBH %) restoration and maintenance were evaluated. Quantitative variables were analyzed and described using mean ± standard deviation and qualitative variables were presented using frequency and percentage. Student t-test was used to analyse continuous data and Chi-square/Fisher Exact test was used to analyse categorical data.

Results

The mean age of the patients was 38.8 years. The majority of fractures were seen in the T12-LI segment (52.7 %). The AVBH % restoration and maintenance in OPSF was significantly higher compared to that of MIS at immediate post-operative (IPO) period (p = 0.01), 6 weeks (p = 0.02) and 12 weeks (p = 0.006) post-surgery. Long segment stabilization provided statistically significant AVBH and PVBH values for OPSF compared to MIS (p < 0.05). The presence or absence of pedicle screw at fractured vertebral level did not restore AVBH and PVBH to a statistically significant level in both the groups (p > 0.05). Superficial surgical site infection (SSSI) was seen in both the groups without any statistical significance between them (p > 0.05).

Conclusion

OPSF is superior over MIS in the restoration of AVBH. Restoration of PVBH was also better with OPSF although not statistically significant. OPSF with longer segment fixation had better restoration of both AVBH and PVBH. The presence or absence of pedicle screw at fractured vertebral level did not seem to have any significance in both the groups. However, the MIS approach can be a reasonable alternative to open surgery with potential advantages like better clinical and functional outcome. A selected population of patients treated with MIS will show better surgical outcomes.

Introduction

The more accurate is the measurement of the parameters for correcting the deformity of damaged spinal segments the more accurate will be the restoration of the sagittal profile and original anatomy of the spine.

Purpose

Substantiation of calculated indicators for deformity correction in one or two damaged spinal motion segments in the thoracic and lumbar spine according to spiral computed tomography.

Material and methods

The material for the study was the results of spiral computed tomography (SCT) of an anatomically unchanged thoracic and lumbar spine in 25 patients (12 women and 13 men aged 18 to 60 years). The study model consisted of three vertebral bodies and four adjacent discs from T4 to L4. Anterior and posterior dimensions of the vertebral bodies, intervertebral discs, and segmental deformity angle α (formed by the lower endplate of the overlying vertebra and the upper endplate of the underlying vertebra) were measured using RadiAnt computer software in the midsagittal projection. Damage to the body of the middle vertebra with adjacent discs was modeled, the dimensions of which were calculated from the adjacent vertebral bodies and adjacent discs. Statistical processing of the material was carried out using the computer software SPSS Statistics.

Results

The measurement error of the anterior interbody spaces was 1.4 ± 0.4 mm, the posterior interbody spaces were 1.3 ± 0.5 mm, the error in calculating the segmental deformation angle α was 2.5 ± 0.6 degrees, what indicates the high accuracy of the proposed method. Discussion The use of absolute deformity values as a standard for surgical intervention in the treatment of vertebral fractures is complicated by varieties of normal anatomy.

Conclusion

The proposed calculations for the restoration of the anterior and posterior interbody distances, as well as the angle of segmental deformity α after a spinal cord injury of the thoracic and lumbar spine provide an approach to the target individualized anatomical dimensions.

Introduction

Dissatisfaction with conservative treatments of various types of dorsopathies results in increased number of surgical interventions to eliminate the accompanying clinical manifestations. Patients' psychosocial characteristics are likely to impact treatment satisfaction, and personality traits as cognitive status, depression, anxiety and coping strategies of the patient have a role.

The objective of the study was to assess the impact of the coping strategies of a patient on surgical treatment outcomes in older patients with dorsopathy.

Material and methods

The study included 149 patients with dorsopathy aged 60 years and over. The patients were divided into 2 groups. The first group (n = 54) consisted of patients with central stenosis of the spinal canal (M48.0) who underwent minimally invasive surgeries without stabilization. The second group included 95 patients with degenerative spondylolisthesis and unstable VMS (M43.1, M53.2). A variety of decompression and stabilization surgical technologies were employed for the patients.

Results

The majority of patients in the first group ( n = 46, 85 %) obtained satisfactory surgical outcome. Eight patient (15 %) had poor outcome. An inverse, moderate, statistically significant correlation was revealed between maladaptive coping strategies identified with Ways of Coping Questionnaire (distancing, avoidance), Stress Coping Questionnaire (behavioral avoidance of a problem), the Coping Strategy Indicator (avoidance) and surgical outcome. Surgical outcome was rated as satisfactory in 79 (83.2 %) cases and poor in 16 (16.8 %) patients of the second group (n = 95). Patients of the second group showed a greater number of coping strategies having a statistically significant correlation with treatment outcome. Patients with adaptive strategies resulting from decompression and stabilization operations had a more favorable outcome. Maladaptive coping strategies such as confrontation, avoidance and behavioral avoidance of the problem had a negative impact on treatment outcome.

Discussion

A comprehensive analysis of the questionnaire data showed that the more aggressive the intervention was with the use of fixation constructs, the greater the impact of the patient's coping strategies on the outcome of treatment observed. This relationship was not found in decompression cases with maladaptive strategies being most significant.

Conclusion

We can conclude about the predictive value of coping strategies based on the impact of the severity of adaptive and maladaptive coping strategies on the outcome and satisfaction with the surgical treatment of dorsopathies in older patients. This factor is essential for the preoperative stage to facilitate personalized treatment options for the complex group of patients.

Purpose

To determine the normative values of the kinetic parameters of gait in healthy children in different speed ranges of movement.

Materials and methods

Locomotor profile assessment by video gait analysis (CGA) was performed on an outpatient basis in 27 children (54 limbs), aged 10–13 years. The following variables were used and processed: peak negative hip, knee and ankle power (W/kg) (relaxation); peak positive power of the hip, knee and ankle (support push) joints (W/kg) (generation); the total positive and total negative power was calculated(for the hip, knee and ankle joints); total peak power; net peak power values and overall mechanical efficiency. Kinetics indicators were generalized according to the ranges of ranking of the absolute walking speed (km/h), taking into account the weight of patients. Quantitative characteristics are presented in the table as a median, percentile range of distribution of values (25÷75 %) and the number of observations (n) equal to the number of limbs.

Results

The normative kinetic parameters of gait are presented at a speed of movement in the range from 1.1 to 5.0 km/h in healthy children aged 10–13 years. A strong correlation was found between the values of the power of the reference shock during the formation of the reciprocal inhibition reflex of the shin sprain and the speed parameters of movement (r = -0.925, n = 142 and p < 0.001). To change the speed of movement, the motor locomotor stereotype was changed with the redistribution of the load from one joint muscle to another. If the share of the contribution of the power of the muscles of the hip joint increased, on average, by 10.8 %, and of the knee joint – by 15.3 %, then the share of the contribution of the ankle joint decreased by 16.8 %.

Discussion

In locomotor stereotypes in the examined children, a significant positive correlation was found between walking speed and the total (r = 0.907, n = 104) and useful peak power (r = 0.475, n = 104) of the joint muscles, while the maximum median values of the useful total peak the power of all joint muscles was recorded at a speed of movement in the range from 3.1 to 4.0 km/h.

Relevance

Traumatic spinal cord injury is a complex, urgent and multidisciplinary problem with a high percentage of disability and subsequent social exclusion. Treatment of neuroorthopedic pathologies is often associated with the need to use technical means of rehabilitation. The objective was to develop a successful orthosis for a patient with severe spinal cord injury.

Material and methods

The article describes a clinical case of a 16-year-old female patient with the outcome of a severe concomitant injury: lower paraplegia, sensory disturbances in the lower extremities and pelvic organ function. MRI of the spinal cord revealed cystic-glial changes and atrophy of the spinal cord at the Th10-12 level.

Results and discussion

With clinical signs of paraplegia and a complete spinal cord injury according to the instrumentation findings, the patient had poor prognosis for the recovery of motor functions in the lower limbs. One of the main tasks of medical rehabilitation of patients with spinal cord injury is the activation of movements and restoration of locomotion. The Hip-Knee-Ankle-Foot Orthosis (HKAFO) manufactured at the Center was intended for unloading, replacement and fixation. The device was light and strong due to greater use of carbon layers, equipped with functional hinges to prevent development of contractures, had a high corset for external stabilization of the body and double knee splint for safe standing.

Conclusion

For the paraplegic patient, the opportunity to stand and walk with the support using successful orthosis was important from both physical and psychosocial perspectives and allowed correction of contractures in the catamnesis.

Introduction

The paper deals with the main aspects of osteochondropathy of the heads of the II–V (small) metatarsal bones. The relevance of the problem of treating patients with Freiberg-Kohler disease can be explained by high incidence and poor results of traditional methods of its management.

Objective

The aim of this work was an attempt to generalize the available data and improve the understanding of approaches to the treatment of osteochondropathy of the heads of the II–V metatarsals.

Materials and methods

The publications obtained in various information systems (PubMed, eLibrary.ru, Google Scholar) were reviewed. Results Issues of history, etiology, pathogenesis, systematization and diagnosis of this disease were highlighted. The analysis of existing methods of treatment was carried out. Their advantages and disadvantages were assessed.

Conclusion

Despite more than a century of studies on Freiberg-Kohler disease, the available literature is scarce. Most works are case reports or series of cases describing small samples. This fact significantly reduces the scientific value. Thus, improving the methods of diagnosis and treatment of patients with this disease based on the foundations of evidence-based medicine is a task of current traumatology and orthopedics.

Introduction

Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures around the knee. Despite good long-term outcomes in general, thousands of revisions after ACL reconstruction are performed annually in the world due to graft failures, repeated injuries, technical errors, disorders in ligamentization process or inadequate rehabilitation.

The aim of the study was to evaluate the current evidence and describe the relevant clinical features of planning and performing revision ACL reconstruction.

Materials and methods

A search was conducted for English- and Russian-language publications in the electronic databases PubMed and e-LIBRARY for the period from 2000 to 2020 using the keywords: anterior cruciate ligament, ACL, revision, re-reconstruction, re-rupture. Among 572 publications, 107 corresponded to the study topic. Based on the inclusion criteria (more than 50 reported cases; follow-up more than 2 years; homogeneous groups of patients; assessment with knee function scores; application of various imaging options), 31 articles were included in this review. There were no Russian studies that met the above-mentioned criteria.

Results and discussion

The analysis of the literature identified four clinically relevant features in the treatment of patients with failures of ACL reconstruction: criteria and principles for the implementation of a one- or two-stage approach; additional features of the revision ACL reconstruction; determination of the optimal graft type. Conclusion Most of the revision ACL reconstructions can be performed at one stage, combined with bone grafting if needed. For a successful treatment outcome, in some cases, correction of frontal and sagittal deformity of the lower limb, management of the injury to other knee joint stabilizers, to cartilage or menisci is required. Surgeons’ preferences in the choice of plastic material has shifted to autografts with bone blocks, or allografts, especially if reconstruction of several stabilizers is necessary.

The objective was to review the orthopaedic literature on treatments of diabetic foot disease.

Material and methods

PubMed, CyberLeninka, Google Scholar, Scopus, Medline, eLIBRARY were searched. Studies in English and in Russian that reported foot deformities in the pathogenesis of diabetic foot disease and orthopaedic correction methods in the complex treatment of this late complication of diabetes mellitus were included for review. All study designs were considered. The search was produced using the following terms: diabetes mellitus, foot deformities, diabetic foot syndrome, orthopaedic treatment, osteotomy, metatarsophalangeal arthroplasty, achilles tendon lengthening. Literature sources reporting methods of orthopaedic correction of foot deformities in isolation from the diabetic foot syndrome and literary sources reporting manifestations of the diabetic foot syndrome without description orthopedic methods of treatment (surgery for purulent complications, vascular surgery, hypoglycemic therapy) were excluded from the study.

Results

The literature review allowed us to evaluate the role of orthopaedic treatment of foot deformities in patients with diabetic foot syndrome to be addressed either conservatively or surgically. The effectiveness of conservative methods has long been reported in studies with higher degree of evidence. Surgical correction of DFS through orthopaedic interventions has not been covered in such detail. Conclusion The literature review focused on the topical issue at the junction of various medical specialties. The results of treatment reported by Russian and foreign authors were analyzed. "Blind spots" in the literature were explored, goals for subsequent research delineated.