Introduction

Fractures of the distal metaepipheseal fractures of the radius (DMER) have a leading place in the overall structure of upper limb injuries. DMER fractures are frequently associated with soft- tissue injuries of the wrist joint, and namely, the triangular fibrocartilage complex (TFCC). The additional use of arthroscopy of the wrist joint in the treatment of patients with a DMER fractiures reduces the duration of recovery of patients and improves the result of their treatment.

The aim of the study was to determine the effect of arthroscopic surgical treatment of TFCC injuries during bone osteosynthesis for DMER fractures on the functions of the upper extremities (extension/flexion of the hand, hand grip strength, pronation/supination of the forearm, DASH index).

Materials and methods

The study included 68 patients with DMER fractures, who were divided into 2 groups, depending on the treatment of the fracture. After reduction and osteosynthesis, all patients underwent arthroscopy of the wrist joint. If TFCC injury was detected, either a debridement or a TFCC suture was performed.

Results

TFCC injury was detected in 61.7 % (n = 42). Debridement was performed in 42.9 % (n = 18); suture using the inside-out technique was performed in 47.6 % (n = 20); one patient underwent reinsertion. After 6 months, the function of flexion and
extension of the hand was significantly worse in patients with combined TFCC and DMER injuries, but after 12 months, the indicators were similar. The strength of the hand grip and the rotational function of the forearm did not differ between the subgroups. The subjective assessment of DASH after 6 months was worse in the group with TFCC injury, but after 12 months the results were similar.

Conclusion

Surgical treatment of TFCС injury in intraarticular fractures of the distal radius contributes to the restoration of the upper limb function to a premorbid level 12 months after surgical treatment.

Introduction In Perthes disease of stage 1 to 2, intraosseous pressure (IOP) of the tissue fluid in the head of the femur due to disorders of the venous outflow increases, the microvasculature is compressed and pulse blood supply is limited. To eliminate secondary circulatory insufficiency, the proximal femur and the supra-acetabular region of the ilium were perforated with wires, and differences in the pulse wave of blood filling in the femoral head associated with the order of perforation of the articular ends of the bones were revealed. Purpose To determine the dependence of the pulse wave of blood filling in the femoral head on the sequence of drilling of the supra-acetabular region of the ilium and the proximal femur in patients with Perthes disease. Material and methods A pulse wave of blood filling in the intraosseous tissues was recorded in 47 patients, aged 6-9 years, using rheovasography. In 6 patients, the supra-acetabular region of the ilium was perforated, then the proximal femur; in 41 patients the sequence was vice versa. Results In the hip joint, perforation of the articular end of one bone leads to post-traumatic angiospasm in the articular ends of both bones, and pulse blood supply decreases. However, by the initial perforation of the proximal end of the femur, the pulse blood supply to the tissues of the femoral head increases, and subsequent drilling of the supra-acetabular region of the ilium contributes to its additional increase. Taking into account the initially increased IOP in the femoral head, it was concluded that perforation leads to decompression of its microcirculatory bed, and pulse blood filling increases, and post-traumatic angiospasm does not develop. Conclusion In Perthes disease, the femoral head should be drilled first to decompress its microvasculature, then the supra-acetabular region of the ilium to redistribute blood circulation and further increase blood flow to the femoral head.

The aim of the study was to evaluate the effectiveness of treatment of gonalgia, pain syndrome associated with knee osteoarthritis, using radiofrequency neuroablation (RFNA) of nerves. Materials and methods The data of 92 patients (92 joints) who underwent outpatient treatment at the State Institution "Institute of Traumatology and Orthopedics of the National Academy Medical Sciences of Ukraine" from 2017 to 2019 were analyzed. The patients' condition was assessed before the RFNA procedure, after 2 weeks, and then 1, 3, 6 and 12 months after the procedure. Results According to the results of the VAS before treatment, it was 9.10 ± 0.04 cm. Thus, one month after RFNA in the group of patients, there was a significant decrease in pain syndrome according to the VAS within 3.96 ± 0.28 cm (p ≤ 0.05). After 3 months a stable positive result was retained in the group at the level of 4.33 ± 0.29 cm; after 6 months – 4.46 ± 0.32 cm; after 12 months – 5.01 ± 0.34 cm (p ≤ 0.05). After RFNA treatment, an improvement in the functional capabilities of the damaged joints was observed according to the WOMAC questionnaire (change by more than 15 points), namely, after 2 weeks the indicator was 52.60 ± 1.60 points, after 1 month – 48.80 ± 2.01 points, after 3 months – 51.29 ± 1.99 points, after 6 months – 54.18 ± 2.32 points, after 1 year – 55.48 ± 2.60 points. Discussion The results of our study complement the results of randomized controlled trials by Choi, Taverner, Alcidi, Takahashi et al which state that RFNA is an effective method of treating pain in patients with gonarthrosis in both short-term (2-4 weeks) and long-term follow-up (more than 3 months). Conclusions Radiofrequency neuroablation of the articular branches of the knee nerves is an effective and safe method for treating pain in gonalgia, but it is not universal and does not prevent the disease.

The aim of this prospective study of a continuous cohort was to investigate anatomical and functional disorders, as well as their combination with manifestations of pathological changes in the articular cartilage of the knee joint in patients with cerebral palsy and a gait pattern classified as crouch gait. Materials and methods The study cohort consisted of 24 patients (20 men and 4 women) with cerebral palsy who had completed natural long bone growth (ages 16 to 42 years). Clinical, X-ray data, results of magnetic resonance imaging, computer analysis of gait, as well as visual assessment of articular cartilage according to Outerbridge were studied in two groups of patients: with natural development of crouch gait (group 1) and with iatrogenic crouch gait (group 2). Results According to the KSS questionnaire, in group 1, four patients (28.6 %) had a satisfactory function of the knee joint, and 10 patients (71.4 %) had poor function. Pain in the knee joint was reported by 12 patients (85.7 %). In the second group, two patients (20 %) had a satisfactory function, and the remaining eight (80 %) a poor one; pain syndrome was reported in 8 cases (80 %). Local articular cartilage defects were found in 6 out of 14 examined patients (42.9 %) in group 1 and in 6 out of 10 examined patients (60 %) in group 2. More pronounced efforts and high energy intensity of walking were found in patients with iatrogenic crouch gait: a more significant moment of force acting on flexion in the knee joint at initial contact, as well as a more pronounced pelvic tilt, combined with significant energy requirements to overcome the maximum flexion and extension moments in the hip joints. For the group of iatrogenic crouch gait, additional factors were found that predispose to pain and arthrosis of the knee joint: stiff knee gait (“frozen knee”), the shift of the generated energy towards the knee and hip joints. Conclusions The crouch gait pattern is heterogeneous in terms of the mechanisms, radiological features of foot deformities, and parameters of computer analysis of gait. An increase in power generation at the level of the hip joints is a common phenomenon in crouch gait, but with the natural development of this gait pattern, a large degree of power generation is also preserved at the level of the ankle joint, while in iatrogenic crouch gait, a decrease in the power generation of the ankle joint and, as a result, the developed increased power at the level of the knee joint contributes to the progression of arthritic degenerative changes. Damage to the articular surfaces of the knee joint is a manifestation of early arthritic changes and requires correction along with the standard elements of surgical intervention in the crouch gait pattern.

Introduction Digital technologies used for lower limb amputation patients wearing prostheses are mostly experimental due to the complexity involved in model development of the stump socket. The objective was to develop a technique for additive manufacturing of lower limb prosthetic sockets to minimize negative results using a three-dimensional model of a prosthetic socket and considering anatomy and functionality of the stump. Methods The review included 20 lower limb amputees who were assigned to 3 groups depending on the method of stump scanning. Results The results of prosthetics were evaluated with the stump scanned naked (n = 9), covered with a silicone cloth (n=6) and with the use of embedded components (n = 5). The results of clinical and instrumental examination showed the advantage of the scanning method offered. The symmetry index for the time of foot roll-over was 0.55 ± 0.14 in the first group, 0.63 ± 0.07 in the second group, and 0.85 ± 0.04 in the third group. Discussion The best results of prosthetics in third group were associated with the most favorable load distribution in the receiving cavity of the prosthetic socket due to embedded components. In these cases, processing the digital model was simplified with no need to unload bone prominences. With scanning of a naked stump, processing a digital model was complicated and required professional skills. This solution had the potential to prevent any sort of direct physical contact to avoid inadequate modeling of the computer model of the prosthetic socket. The use of a silicone liner allowed reducing the pressure on the bone prominences. With a sharply skeletonized stump, the elastic properties of the liner were not enough and could cause injury to the tissues. Conclusions The findings suggested that improved quality of prosthetics was dependent on the technique used to scan the stump. The use of pre-installed embedded components allowed for effective load distribution in the prosthetic socket and created favorable conditions for prosthetic use.

Introduction One of the most prevalent ailments for which people seek treatment at a foot and ankle surgery facility is heel discomfort. Plantar fasciitis (PF) is one of the most common causes of adult heel pain and accounts for 11 to 15 % of all foot illnesses requiring medical care. The major symptom is pain and soreness at the heel where the plantar fascia is attached while starting weight- bearing after lengthy periods of rest. Rest, non-steroidal anti-inflammatory drugs (NSAIDs), stretching of the plantar fascia, physical therapy, foot cushioning, and orthotic devices, which may be utilized to meet the patient's demands, are some of the current conservative therapies for PF(planter fasciitis). In intractable instances of plantar fasciitis, where conservative therapy have failed to provide relief, steroid injections into the plantar fascia are often employed. Other treatment options for PF, including extracorporeal shockwave therapy (ESWT) are advised if patients do not react to conservative therapies. Patients and methods This study included 50 patients with chronic PF who had failed to react to conservative treatments such as physical therapy, NSAIDs, stretching exercises, and heel cushions for at least 6 months, and who did not have flatfeet or gastrocnemius contracture met the inclusion criteria. Patients were randomly divided into 2 groups: 25 patients received radial extracorporeal shockwave therapy (ESWT) once a week for six weeks (Group I); 25 patients got a single local corticosteroid injection at the plantar fascia's origin (40 mg / 2 ml of methylprednisolone together with 1 ml of local anesthesia, once) (Group II). Assessment of heel pain was done at the start of the trial and before each session using VAS score which was the primary outcome measure at 1, 3 and 6 months. Results A total of 50 individuals with persistent planter fasciitis (PF) were included in this investigation. Their age varied from 25 to 45 years old. Females made up 70 % of the sample, while males made up 30 %. Group I: 25 patients with PF who got extracorporeal shockwave treatment for 6 weeks at a time (once a week). There were 17 females (68 %) and 8 males (32 %), in the age ranging from 28 to 44 (mean SD 18.2).Group II: consisted of 25 individuals with PF who were given a local corticosteroid injection. There were 18 females (86.7 percent) and 7 males (13.3 percent) with ages ranging from 25 to 45 years (mean SD 21.9). Group I included 20 patients (80 %) and group II had 22 patients (88 %) who had pain in one foot, whereas 5 (20 %) patients and 3 (12 %) patients had pain in both feet, with no statistically significant difference. There was no significant difference between the groups in terms of the VAS score at the start of the trial (p = 0.26), the mean VAS scores were 6.4 and 6.2 in groups I and II, respectively. At one month, the mean VAS scores were 1.6 and 1.2 in group I and II, respectively. At 3 months, the mean VAS score were 2.2 and 1.7, at 6 months 5.1 and 2.3 for groups I and II, respectively. Conclusion ESWT and local corticosteroid injection therapies are safe and effective but local corticosteroid injection is more effective than ESWT in the treatment of chronic plantar fasciitis.

Introduction The use of minimally invasive techniques is of utmost importance to future developments of foot and ankle surgery requiring largescale clinical randomized studies. This retrospective study is based on a comparison of the classical open and minimally invasive techniques. Material and methods The review included 65 hammertoe surgical cases (76 feet) treated with minimally invasive approach and postoperative strapping and taping techniques (group A, n = 39) and with open procedure using transarticular wire fixation (group B, n = 37) . Open surgical procedures were performed for the first metatarsal at the same time for all patients. The mean follow-up period was 15.3 ± 2.8 months. The mean age of patients was 62.8 ± 10.2 years. Results The follow-up protocol included a survey, physical examination, assessment of pain, function and treatment satisfaction (AOFAS, VAS FA, PGIC) and radiographic estimation of fusion. A floating toe was a common complication. Discussion Minimally invasive technique was demonstrated to be a less safe approach (risks associated with burr manipulations and surgeon skills) and more effective (minor and moderate pain in the postoperative period, lower risk of infection, attainment of personal anatomicity and early loading without internal fixation, extended indications with no need for use of surgical tourniquet) demonstrating adequate radiographic and clinical results and high patient satisfaction. The technique promotes patient's comfort and willingness to cooperate due to the lack of internal fixation and has a high intraoperative radiation load compared to other methods. Conclusion Minimally invasive technique has demonstrated good results and can be advocated for extensive orthopaedic practice with its ow n niche of application.

Diabetic neuroosteoarthropathy complicated by osteomyelitis is one of the severe conditions of the ankle joint in patients with diabetes. The role of the synovium in the pathogenesis of this disease remains poorly understood. Purpose To identify structural changes in the synovium of the Charcot ankle depending on the inflammatory phase of chronic osteomyelitis. Material and methods The synovium and osteochondral fragments of the ankle were studied in 33 patients. Paraffin sections stained according to the three-color Masson method, hematoxylin and eosin, and semi-thin sections stained with methylene blue and basic fuchsin were studied using an AxioScope. A1 microscope with an AxioCam digital camera (Carl Zeiss MicroImaging GmbH, Germany) and Zenblue software (Carl Zeiss MicroImaging GmbH, Germany). The phase of the inflammatory process of chronic osteomyelitis was assessed according to the HOES of Tiemann et al (2014) and synovitis according to Krenn et al (2006). Results Full-thickness articular cartilage defects, synovial pannus, foci of osteonecrosis in the subchondral zone, bone microsequesters, osteoclastic resorption of the subchondral bone plate, replacement of bone marrow structures with granulation tissue, the severity which depended on the inflammatory stage of chronic osteomyelitis, were recorded in the process of studying osteochondral fragments. In 82 % of patients, the inflammatory phase of chronic osteomyelitis was characterized as active and subacute. In all the cases, hyperplasia, hypervascularization and hyperemia of the synovium with the presence of bone and cartilage fragments were observed, as well as inflammatory infiltrate, synovial pannus invading the articular cartilage. The vessels featured a pronounced narrowing of the lumens or their complete closure. The severity of synovitis correlated positively with the inflammatory phase of chronic osteomyelitis; Spearman's correlation coefficient of 0.76 indicated high relationship. Conclusions In diabetic osteoarthropathy of the ankle joint complicated by chronic osteomyelitis, the irreversible structural changes revealed in the synovium contribute to the formation of synovial pannus and the progression of destruction of the articular cartilage and subchondral bone. The severity of synovitis positively correlates with the inflammatory phase of chronic osteomyelitis.

Introduction One of the complications of diabetes mellitus is Charcot's osteoarthropathy, associated with the development of angio-neuropathic and metabolic disorders in the foot and loss of limb weight-bearing. Its association with purulent infection not only worsens the quality of life of patients, but also poses a threat to life. The literature reports very conflicting information about the choice of reconstruction technologies and methods of foot fixation. The lack of unified approaches and generally recognized protocols indicates the dissatisfaction of orthopedists with the results achieved and the imperfection of the technologies used. The aim of the work is to evaluate the effectiveness of the combined use of the Masquelet technology and Ilizarov transosseous osteosynthesis in Charcot osteoarthropathy in conditions of purulent infection. Material and methods The authors present an original approach to foot reconstruction in 8 patients, based on the combined use of the Masquelet technology and Ilizarov transosseous osteosynthesis. The follow-up period ranged from 1 to 11 months from the date of the primary operation. Results In all patients treated by this technique, the limb support was restored. Nonunion, loss of correction, and late infection complications were not detected. Discussion The combined use of transosseous osteosynthesis allows discrete correction of multicomponent foot deformities without creating additional angiotrophic disorders, and the use of Masquelet bone grafting to sanitize pathologically altered tissues with the formation of an induced membrane that produces growth factors and has antimicrobial activity. Choosing the tactics of treatment for preservation of the foot as an organ in patients with severe condition of the feet with Charcot osteoarthropathy, the method of two-stage surgical treatment is justified and provides length compensation of the segments, limb support even in cases where, at first glance, amputation has relative indications. Conclusion Differentiated application of the Ilizarov and Masquelet technologies is effective and justified in conditions of Charcot's arthropathy.

Introduction Pyomyositis denotes primary pyogenic infection of skeletal muscle. It is predominantly a disease of tropical countries. It usually involves the largest muscle groups around the pelvic girdle and lower extremities. Primary reasons for delay in diagnosis are its low incidence and vague presentation [7]. This delay can result in complications such as extension into and destruction of an adjacent joint, sepsis and, even death. Our study is aimed to highlight the extent and sequence of treatment protocol required for good management of these patients. Methods We retrospectively analyzed our experience with a series of 14 pediatric patients with primary pyomyositis who were treated and followed up. There were five girls and nine boys. All 14 patients underwent plain radiographs, USG and MRI of the affected area followed by surgical drainage and a course of antibiotics. Patients were followed up with weekly CRP. Results Six out of 14 (42.9 %) patients had a history of mild trauma. Ileopsoas muscle was involved in 4 patients, 3 cases in which the gluteals or quadriceps were involved, 2 cases with obturator muscle involvement and 2 cases in which adductors were the infection site. All 14 patients were treated surgically. Conclusion Our study shows that early diagnosis, complete drainage of the purulent material and the use of appropriate antibiotic therapy are the key determinants of successful treatment that lead to complete resolution in the majority of cases.

Introduction Treatment of chronic non-healing wounds in the presence of deep post-traumatic soft tissue defects is a challenge for trauma reconstruction. The objective of the study was to improve healthcare quality for patients with chronic soft tissue defects of the limb. The goals included evaluation of the effectiveness of reconstruction of defects of the lower limb using local transposition perforant flaps, and rationale for a preferred choice for the keystone perforator flap. Material and methods The review included 48 patients with post-traumatic and osteomyelitic soft tissue defects of lower limbs. Patients were divided into 2 groups. Patients of the study group were treated with regional perforator fasciocutaneous flaps combined with osteonecrectomy that could be also performed later (n = 22). In the comparison group (n = 26), post-traumatic and osteomyelitic defects were treated with conventional methods of local wound treatment, staged osteonecrectomies followed by autodermoplasty. Results The use of the transposition loco-regional perforator flaps resulted in the incidence of secondary necrosis reduced by 33.7% and the two-fold reduction in the average number of staged operations. One-stage reconstruction was performed in 72.7 % patients of the study group. The length of inpatient treatment decreased by an average of 30 bed days. Discussion The reduced length of treatment in the study group could be caused by the absence or a significantly reduced stage of local wound treatment; there were fewer complications in the form of secondary necrosis of deep-lying tissues that would require additional treatment stages. Conclusions Reconstruction of osteomyelitic defects with the transposition of loco-regional perforant flaps allowed lower complication rate and improved functional outcomes for patients with posttraumatic and osteomyelitic defects of soft tissues of lower limbs.

Introduction Amyoplasia is the most common type of arthrogryposis multiplex congenita. Some patients may lack active elbow flexion due to aplasia of the forearm flexor muscles. The objective was to identify the optimal age for pectoralis major muscle transfer to improve elbow flexion in children with amyoplasia and estimate outcomes of the procedure depending on the level of spinal cord injury. Material and methods Restoration of active elbow flexion was performed for 34 children with amyoplasia (39 upper limbs) between 2011 and 2020 using partial monopolar pectoralis major muscle transfer. The age of patients ranged between 1.5 and 15.5 years (6.24 ± 4.24 years). The patients were divided into 3 groups depending on the level of spinal cord injury: C6–C7 (n = 4; 11.8 %), C5–C7 (n = 24; 70.6 %), C5–Th1 (n = 6; 17.6 %). The outcomes were estimated at 6 to 99 months (44.53 ± 31.72 months). The patients underwent preoperative and postoperative clinical and neurological examination. The results were statistically analyzed. Results Active elbow flexion improved by 56.8 degrees (p < 0.0001), forearm flexor muscles strengthened by 2.0 points (p < 0.0001) and extension deficit improved by 14.5 degrees (p < 0.0001) were postoperatively statistically significant. Results were rated as good in 15 (38.5 %); as fair, in 8 (20.5 %) and poor in 16 (41 %) cases. Greater differences were found between the group of patients with the level of C6-C7 spinal cord injury in relation to the group of patients with the level of C5-Th1 (p < 0.05). There were no statistically significant differences between patients with C6–C7 and C5–C7 lesion levels (p > 0.05). Children of different age groups showed no differences in the results of treatment (p > 0.05). Conclusion Pectoralis major muscle could be used for active elbow flexion restoration in patients with amyoplasia. The best results were observed in patients with C6–C7, C5–C7 segmental lesions of the spinal cord. There was no correlation between age of patient at the time of surgery and the effectiveness of operation.

Relevance There are data in the literature describing the trajectory of displaced center of rotation of the knee joint. However, data on the exact location of instantaneous centers of rotation at various angles of the knee flexion are not available. Objective To identify the localization of instantaneous centers of rotation at various angles of the knee flexion and present the results in the form of a template. Material and methods The bench testing was performed using a specially developed device that provides fixation of the anatomic cadaver preparation of the lower extremity. The device made it possible to identify the zero instantaneous center of rotation using a radiographic positive marker. Control radiographs were performed to determine the "movement" of instantaneous centers of rotation at every 10° of flexion to reach an angle of 120°. The exact location of instantaneous centers of rotation at different knee flexion angles were obtained with a graphical editor and tibia internal rotation identified during the knee flexion. Results The identified instantaneous centers of rotation were applied to the contour of the distal femur to form the template and allow scaling. Conclusions The template developed could be useful for computer hexapod assisted orthopaedic surgery in the treatment of knee stiffness, for mechanotherapy and joint replacement.

Introduction The investigation of the trabecular bone strength in the acetabular area and its dependence on age and gender may provide a theoretical basis for the development of implants for bone replacement. The purpose of this study was to determine the mechanical characteristics of the bone tissue in the supra-acetabular region in patients of different age groups. Materials and methods The cadaveric material of 60 patients was studied and included 20 young patients (age range, 18 to 44), 20 middle-aged patients (age range 45 to 59) and 20 elderly patients (age range, 60 to 74). Fragments of bone tissue 3 × 3 × 1.5 cm in size were removed from the supra-acetabular region using an osteotome. Cylindrical specimens, 6 mm in diameter and 9 mm high, were produced from these fragments using a crown cutter. All samples were subjected to uniaxial compression at a loading rate of 1 mm/min. Results Comparison of male patients for each of the mechanical parameters did not reveal age differences (p > 0.05). In women of different age groups, the magnitude of elastic deformation was significantly different both by multiple analysis and in pairwise comparison of groups (p < 0.05). There was also no statistically significant difference in the maximum stress and modulus of elasticity in women (p > 0.05). Discussion The data obtained on the mechanical behavior of the trabecular bone and the values of the strength parameters are explained by the spatial arrangement of the fibers of structural proteins, the cross-linking profile of collagen, the degree of matrix mineralization, the structure of hydroxyapatite, and the amount of bound water. Conclusion In male patients, mechanical characteristics of the bone tissue in the supra-acetabular region do not change significantly with age. In women, the value of elastic deformation increases significantly with age. The maximum tensile strength and modulus of elasticity in women of different ages did not show any changes.

Bone xenomatrix is an available material for plasty due to its availability and possible significant modification. The purpose was comparative evaluation of the efficacy and safety of xenogenic bone graft material impregnated with antibiotics, vancomycin or meropenem, in an experiment on a model of long bone defect healing in rabbits. Methods The study was performed on 28 male rabbits aged from 8 months to 1.2 years. All animals were modeled with a cavity defect of the right and left distal femoral metaphysis measuring 4 × 4 × 6 mm. Bone matrix blocks of the same size were implanted into the defect cavity. Animals of group 1 (n = 8, control) were implanted with a free “clean” bone block. Animals of group 2 (n = 10) with a bone block saturated with vancomycin. Animals of group 3 (n = 10) with a bone block impregnated with meropenem. To assess the effectiveness and safety of the material, clinical, radiological, pathomorphological, histological, and laboratory methods were used. Results X-ray signs of substitution of the studied materials in the defect in animals of group 1 were noted by 182 days, in group 2 – by 84 days, in group 3 – about 182 days. In each group, there was a complication, arthrosis of the knee joint (one animal in each group). According to the histological study, it was found that in groups 2 and 3, a complete elimination of xenomaterial in the middle part of the defect and its replacement with trabecular bone was noted by 182 days after implantation. The severity of irritating action of the materials in the animals of groups 2 and 3 did not exceed the control value. The laboratory blood tests in the animals of groups 2 and 3 also did not reveal significant differences with group 1. Conclusion The developed osteoplastic materials based on bovine bone xenomatrix, impregnated with vancomycin or meropenem, have acceptable safety and efficacy characteristics.

Introduction Osteoid osteoma (OO) is a rare bone pathology of the hand. OO localization and pain syndrome associated with it may present a challenging diagnosing problem as its symptoms are nonspecific and the X-ray pattern is unclear. Our research is aimed at presenting the findings of the clinical and instrumental examination, and the outcome of successive surgical management of a patient with OO of the capitate. Material and methods We examined a 46-year-old male patient to verify the diagnosis of OO; he had the ultrasonic examination of his hand soft tissues and joints, biplane radiography of the wrist joint, computed tomography (СТ), and magnetic resonance imaging (MRI) of his left hand. A 0.6-cm defect of the capitate bone along with its increased bone density was visible in the X-rays of the patient’s left hand. In CT and MRI images, a 0.65 × 0.65 cm and up to 0.45-cm deep marginal bone defect on the capitate dorsum was identified. A 0.55 × 0.45 cm loose bone fragment was also found at that level. The examination was followed up by surgical management that involved marginal excision and extraction of the nidus of the left capitate bone. Results The patient reported the absence of pain in his hand and the increase in the range of motion in his wrist joint right after the surgery. The check-up X-ray images after three months revealed the signs of bone remodeling in the area of surgical intervention. The capitate defect was not found. Discussion OO in the hand may resemble a grainy remodeling of the osseous structure. A comprehensive examination that includes CT and MRI is crucial for revealing this rare OO localization. Conclusion The atypical localization and the patient’s age unusual for the liaison challenge the diagnosis and provide for the wrong choice of the treatment strategy.

Giant cell tumor of the tendon sheaths and palmar fascial fibromatosis are both fibrohistiocytic diseases. There is no information about their combination in the available literature. Aim To analyze the histological characteristics of a giant cell tumor of the tendon sheath associated with palmar fascial fibromatosis. Materials and methods Case history and pathomorphological examination of the surgical material of patient M with recurrent palmar fascial fibromatosis and Dupuytren's contracture of the 5th ray of the right hand in grade 3 and a neoplasm of the 2nd finger of the right hand Results A neoplasm with a thin fibrous capsule, permeated with blood vessels, many of them had abnormally thickened fibrous walls and completely obliterated lumens. The cellular composition of the tumor is mixed: fibroblast-like cells, small histiocytes, siderophages, osteoclast-like giant multinucleated cells, xanthoma and plasma cells. The frequency of mitoses is less than one per 10 fields of view, apoptotic bodies from zero to several per field of view. In the composition of fibromatous cords in the projection of the V beam, giant multinucleated cells (possibly cells of foreign bodies) were found. Conclusion For the first time, a clinical case of a giant cell tumor of the tendon sheaths, which developed against the background of a long-term recurrent palmar fascial fibromatosis, is presented. Taking into account the pathomorphological characteristics of the surgical material, the risk of its recurrence and malignancy in patient M. is low. However, the unpredictability of the histogenesis of this tumor known from the literature is an indication for active clinical observation.

Introduction The list of pathological conditions that need surgical correction of bone length is very long. In the literature on the topic under discussion, it is reported that the best results are obtained by lengthening according to the Ilizarov method. But many surgeons are not satisfied with the long duration of external fixation, which requires a large number of adjustments and patient compliance. The aim of this work is a analysis of the modern technologies for limb lengthening that actually shorten the time of osteosynthesis using the apparatus for external fixation. Materials and methods Literary sources have been analyzed since the first publication on limb lengthening according to Ilizarov in 1963. The search was carried out in the databases of the RSCI, NCBI Pubmed, Medline. The developments of the employees of the Ilizarov Center are presented. Results An analysis of the literature showed that the fixation units of the apparatus, units for providing movement for distraction, compression and correction of angles have been improved. The invasiveness of the surgical intervention is minimized. Best results can be obtained using automatic lengthening. The Ilizarov Center has developed and experimentally proven methods for reducing the period of distraction and the period of fixation with the apparatus. We combined three factors: an increased round-the-clock distraction rate (2 or 3 mm) with a motorized distractor adjusted to the Ilizarov frame and fixation reinforcement along with regeneration stimulation with HA-coated intramedullary wires in our experimental and clinical trials. This technology has easily conquered a number of clinical practices in Russia, France and Serbia. Conclusion Experimental and clinical substantiation of a two- or three-fold increase in the rate of automated distraction in the conditions of intramedullary reinforcement with a bioactive implant can drastically reduce not only the time of the distraction period, but also the duration of the fixation period with the Ilizarov apparatus.

Introduction Bone morphogenetic proteins (BMPs) are members of a large family of growth factors known as the transforming growth factor-β (TGF-β) superfamily. BMPs are known for their ability to induce bone formation and successfully used in orthopaedic and neurosurgical applications. Various proteins, such as BMP-2, 4, 7, have been reported to have osteoinductive abilities. Recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human bone morphogenetic protein-7 (rhBMP-7) are widely used for surgical correction of bone defects and spinal fusions. In addition to the effect on bone formation, BMPs also play a role in cell lineage determination, differentiation, proliferation and apoptosis, and BMP receptors are present in many cell types including tumor cells. A large number of studies in vitro and in vivo have examined the role of BMPs as stimulating oncogenesis and metastasis. Therefore, there are some concerns about the use of rhBMPs in clinical practice. Objective In the present study, we aimed to investigate the causal relationship between the use of rhBMPs and oncogenesis by presenting the results of some preclinical and clinical studies. Material and methods For a comprehensive search, we used the following databases: PubMed, Embase, the Cochrane Database and Google Scholar to identifying studies that described a causal relationship between therapeutic use of rhBMPs and oncogenesis. Results The paper represents the findings on the role and identification of molecular mechanisms of BMP involvement in oncogenesis. In addition to that, the studies reporting a risk of oncological diseases with the use of rhBMPs in both preclinical and clinical studies were also analyzed. Conclusion There is a need for further clinical trials in a wide population over a longer timeframe.

Introduction Diseases and injuries that affect the small joints of the hand, the metacarpophalangeal, in particular, lead to a limitated hand function and a reduced quality of life. The high functional demands of the hand impose strict restoration requirements and the development of the new and improvement of the existing surgical treatments of hand joints remains a serious challenge for the medical community. Arthroplasty of the metacarpophalangeal joint is widely used and can help restore function to hand. Despite the long history of arthroplasty procedures there is controversy concerning functional results. Objective Review foreign and Russian literature on metacarpophalangeal joint replacement and analyze the current state of the problem. Material and methods Foreign and Russian scientific publications on the treatment of metacarpophalangeal diseases and injuries were reviewed. Online searching for the articles published in Russian and English in the last five years was performed with the help of GoogleScholar, PubMed, eLIBRARY, PubMedCentral using the keywords "arthroplasty of the metacarpophalangeal joint", "osteoarthritis of the metacarpophalangeal joint", "finger joint replacement". Results and discussion Today, a wide range of total hip prosthesis designs, differing in geometric configurations and features is available with the current trend towards adaptation of the soft tissues to the structural modifications. Major indications for the use of different types of arthroplasty have been identified. Specific design features of implants can show higher failure rates and postoperative complications. Conclusion Arthroplasty is the best surgical treatment option for diseases and injuries of the metacarpophalangeal joint and improved construction solutions and materials for metacarpophalangeal arthroplasty are essential for better outcomes.

The objective of the review was to systematize information on potentially modifiable risk factors for infectious complications following total hip and knee arthroplasty and the possibilities to control them. Material and methods For a comprehensive search, PubMed, eLIBRARY, Scopus, Dimensions were used. The search depth was 30 years. Results The review reports potentially modifiable risk factors and the possibility to control them in the perioperative period. Patients undergoing total joint replacements often suffer comorbid conditions that must be addressed preoperatively and postoperatively. Comorbidities can be associated with such joint pathologies as oligo-, polyosteoarthrosis, arthroplasty of other joints, septic arthritis or with a history of periprosthetic joint infection. Somatic disorders can be associated with abnormal laboratory findings. All these risk factors cannot be eliminated completely and are detrimental for hip and knee arthroplasty. Discussion The current level of information on the risks of infectious complications following total hip and knee arthroplasty may be insufficient to reduce the spread of an infectious agent. There is controversy regarding some predictors of surgical site infection and periprosthetic joint infection. There may be equivocal cause-effect relationships between the patient's potentially unfavorable features and the adverse outcome, which requires further in-depth study of this problem.