Introduction

Shoulder dislocation is one of the most common shoulder injuries and occurs in all age groups. Methods for diagnosing and treatment of the middle and older age groups patients with acute injury currently remain open. Surgical treatment is usually applied only in cases of chronic instability. However, conservative treatment in cases with a missed rotator cuff tear leads to a dysfunction of the shoulder joint and can lead to the development of chronic pain and recurrent shoulder instability. Therefore, it is necessary to develop an algorithm for diagnosing the rotator cuff tear and to find the most optimal methods for its surgical correction.

The purpose of the study was to compare the results of conservative and surgical treatment in patients of the middle and older age groups after traumatic dislocation of the shoulder, accompanied by rotator cuff tear.

Materials and methods

The study is based on a prospective analysis of examination and treatment of 114 patients with shoulder dislocation aged 18 to 89 years. Among all patients with rotator cuff tear, 19 patients were selected for conservative treatment and 24 patients for surgical refixation of the rotator cuff tendons.

Results

The result of treatment was assessed 12 months after the surgical operation or the injury using ULCA shoulder score, DASH and ASES. It was found the scores of patients who underwent surgery for rotator cuff tear were significantly better than in the patients treated conservatively.

Conclusion

Therefore, all patients of middle and older age groups with dislocation of the shoulder should be examined for the presence of rotator cuff tear. In case the rotator cuff
is torn, surgical treatment is preferred over conservative treatment.

Introduction: Stabilization of chronic injuries of the pelvic ring with standard methods may result in plate breach, destabilization of the implant and the need for repeated operations. Therefore, it has become necessary to use special tactical approaches in surgical treatment of chronic injuries for fixing traumatic foci and searching for adapted implant designs for such cases. Thus, an original plate has been developed. Purpose To study the features of fixation of chronic injuries of the pelvic ring using an original plate in comparison with the standard approach. Materials and methods We conducted a retrospective analysis of the surgical treatment performed using the developed plate (Group 2) and a group of patients who underwent fixation of the anterior pelvic ring with two reconstruction plates (Group 1). Results In group 1, four patients (16.7 %) had failed osteosynthesis within two weeks to two months after the operation. In group 2, thirty patients underwent surgical treatment using the developed design, and destabilization of the metal construct was detected only in 2 patients (6.6 %). In one case, migration of plate screws was detected after 3 years during routine X-ray study while the patient was not bothered by pain and did not feel any instability. Discussion Analyzing the positive and negative aspects of the methods used, we made a choice in favor of internal plating. Due to cases of destabilization of fixation using one or two plates, an original metal structure was developed and applied to strengthen fixation. Conclusion Changing the standard approaches to the treatment of chronic injuries (after 3 weeks since injury) of the anterior pelvic ring enables to create conditions for stable fixation, using the original monolithic plate, despite the rigidity of the pelvic ring in chronic injuries.

Introduction

The problem of varus deformed knee joint osteoarthritis remains one of the actual topics of modern adult orthopedics. The use of many well-known methods of surgical interventions and arthroscopic technology are not rational in terms of restoring the biomechanical axis of the lower limb.

The purpose of the research Analysis of the results of arthroscopic debridement and the use of proximal fibular osteotomy (PFO) in the treatment of varus deformed knee osteoarthritis.

Materials and investigation methods

Our study included a survey of 152 patients with deforming osteoarthritis of I-II-III degree and varus deformity of the knee joint, dividing them into 2 groups: Group I (control) consisted of 131 patients who underwent debridement of the articular surface. Group II (main) consisted of 19 patients with debridement and PFO developed in our clinic. The analysis of the achieved results was assessed on the basis of indicators of the KSS scale.

Results

The results of the surgery in both groups were reviewed comparatively at 1 year after surgery by KSS scale data with results: < 60 points – unsatisfactory; 60-69 points – satisfactory; 70-79 points – good; 80-100 points – rated very good.

Conclusion

The use of the KSS scale to assess the long-term results of treatment of patients with deformed osteoarthritis of the knee joint is optimal. The combined use of arthroscopic debridement with PFO allowed to increase the proportion of good results to 89 % versus 69 % of patients using arthroscopic debridement without PFO, as well as reduce the proportion of unsatisfactory results to “zero” versus 9 % of patients using arthroscopic debridement.

Sciatic nerve (SN) injury associated with total hip arthroplasty (THA) is a challenging issue due to the high prevalence of the complications. However, there is no consensus about the injury mechanism, surgical treatments, indications and timing for the surgeries which necessitates the studies. The objective was To perform a comparative analysis of the dynamics in clinical, neurological and electrophysiological parameters in patients with sciatic nerve injuries associated with THA performing various surgical treatments. Material and methods The study included 61 patients who were hospitalized between 2005 and 2021. Patients were divided into two groups being homogeneous in terms of gender, age and severity of neurological deficit. Microsurgical neurolysis of the sciatic nerve trunk was performed in group I (n = 32) and was added by direct electrical stimulation of the sciatic nerve at the level of injury in group II (n = 29). Clinical, neurological status and electroneuromyography parameters of the patients were assessed preoperatively and at 6 months of surgery. Results All patients showed pain relief with VAS score decreasing from 6 (5.5; 8) to 4 (2; 6) in group I and to 3 (1; 5) in group II (p < 0.001). Functionality of the lower limb scored preoperatively 31 (24.5; 40.5) on the ODI scale in group I and 27 (21; 36) in group II. The patients showed positive dynamics postoperatively with improved lower limb function due to decreased neuropathic pain syndrome scoring 28 (20; 34.5) in group I and 16.5 (8.5; 21.75 ) in group II (p < 0.0001). Conclusions The findings suggested the advantages of the electrical stimulation method in combination with microsurgical neurolysis of the sciatic nerve over the use of microsurgical neurolysis alone with decreased intensity of the pain syndrome and functional insufficiency of the lower limb.

Introduction Osteotomy is an important part of orthopaedic interventions and can result in an injury to the periosteum reducing regenerative capabilities of the bone.

Material and methods A device for processing the femur was developed to allow osteotomy be produced from the medullary canal. An experimental study was conducted on femoral models in two comparison groups (20 models in each). Osteotomy of the femoral shaft was performed at a distance of 15 cm from the apex of the greater trochanter. Duration of bone intersection and magnitude of partial and complete defects of the simulated periosteum were evaluated.

Results The average duration of osteotomy was 482.8 ± 15.4 s in the main group and 181.3 ± 16.1 s in the control group. The average overall length of injury to the simulated periosteum to the entire depth was 1.4 ± 3.0 mm in the main group being significantly less in the control measuring 13.6 ± 3.8 mm (Mann-Whitney U-test = 7.0, p = 0.00). The average total length of partial injury to the periosteum (1.4±2.6 mm) was significantly less in the main group than in controls (21.8 ± 5.8 mm, Mann-Whitney U-test = 0.0, p = 0.00).

Discussion The surgical device offered, as opposed to existing devices, allowed bone intersection to be performed with high accuracy. The presence of endoscopic control of the osteotomy depth ensured preservation of the periosteum. The device could be used for several bone cuts using a single surgical approach. Conclusion The use of the device slightly increased duration of the osteotomy and facilitated minimally invasive intervention retaining periosteum at the osteotomy site and provided better conditions for bone regeneration.

Introduction Bone graft is the best option to repair postsurgical bone defects. The biomaterial is highly adaptive, structurally dynamic, metabolically active and characterized by high strength. Standard preparation of grafts for implantation includes cleaning followed by deep freezing and sterilization. However, methods used for processing bone material and reagents can change the biomechanical properties of the bone. The purpose was to explore the effect of chemical purification and subsequent lyophilization on the mechanical strength of bone grafts in comparison with native fresh frozen bone.

Material and methods Metaepiphyseal sections of a single level of one tibia of a single cattle were used to rule out the influence of the variable density of native bone obtained from different donors. The bone was cut into blocks with a hand saw. Three groups of samples formed depending on the processing method included freshly frozen native bone, bone purified by combined chemical and physical methods and bone purified by the same technique followed by lyophilization. Mechanical properties were measured by axial compression mode using a 1958U-10-1 strength machine. Statistical data analysis was performed using the Kolmogorov-Smirnov (K-S) test and the Lilliefors correction with statistical significance of differences assessed with one-way analysis of variance (One-Way ANOVA).

Results The cross-sectional area of hand-made blocks was comparable. No decrease in bone strength below the baseline was recorded regardless of the method of bone processing. Purified bone blocks demonstrated maximum strength characteristics prior to lyophilization. The sample strength decreased after lyophilization and was higher as compared to freshly frozen native bone. No statistically significant differences in the maximum force applied and the cross-sectional area were recorded between groups of samples. Modulus of elasticity and relative deformation had statistically significant differences in the groups (p < 0.05).

Conclusion Modern methods of bone processing were shown to maintain biomechanical properties of the bone and can be used in the form of bone blocks or chips and as a structural graft.

Introduction Annual microbiological monitoring of the leading causative agents of osteomyelitis and their antibiotic sensitivity is essential for identifying drugs that have lost the effectiveness. An increase in microbial associations requires different approaches to antibiotic therapy. Analysis of the composition of associations with a priority pathogen to be identified to avoid administration of ineffective drugs and optimize treatment. The purpose was to monitor qualitative and quantitative community composition of microorganisms isolated from the osteomyelitic focus in patients with chronic osteomyelitis over a three-year period.

Material and methods The object of the study were strains of gram-negative and gram-positive bacteria isolated during primary inoculation as part of associations of bacteria from wounds and fistulas of patients who were treated in the clinic of infection osteology at the Kurgan Ilizarov Centre between 2018 and 2020. Standard bacteriological methods were used to isolate pure cultures. Bacteria were identified using bacteriological analyzer.

Results and discussion Two-component microbial associations isolated in patients with chronic osteomyelitis included P. aeruginosa + S. aureus, Enterobacteriacae + S. aureus, S. aureus + CoNS. The strains of S. aureus and P. aeruginosa were most common pathogens identified in mixed cultures. Inoculations of S. aureus + Enterococcus sp. increased and P. aeruginosa + Enterococcus sp. associations showed a two-fold decrease in 2020 compared to 2018. Three- and four-component associations of bacteria increased with the spectrum of combinations being diverse among the isolated mix cultures over a three-year period. Bacteria of the Enterobacteriacae and S. aureus family were most common in three-component associations. Four-component associations were represented by mix cultures of gram-positive and gram-negative bacteria including NFGOB and S. aureus.

Conclusion An increased frequency of isolated microbial associations necessitates an annual analysis of changes in the qualitative and quantitative composition to identify the spectrum of the most common microflora of the osteomyelitic focus and correct antibiotic therapy.

Purpose To evaluate the results of a comparative analysis of the in vitro antimicrobial activity of polymer hydrogels and PMMA impregnated with antibiotics against test cultures of the leading pathogens of bone infection.

Materials and methods A comparative analysis of the antimicrobial activity of the polymer hydrogel and PMMA impregnated with antibiotics was carried out. The bactericidal efficacy and prolongation of action of the following microbe-antibiotic pairs were assessed: MSSA – gentamicin, MSSE – cefazolin, MRSA and MRSE – vancomycin, A. baumannii – tobramycin. The duration of the study is 7 days. Statistical comparison of groups was carried out using the Mann-Whitney and Wilcoxon tests; the median and 95 % CI were used to describe the data.

Results The obtained indicators of the zone of inhibition of the growth of microorganisms around the polymer hydrogel were several times higher than the results of PMMA (p < 0.05 for all periods). The antimicrobial activity of hydrogels in all cases lasted more than 7 days. Hydrogels impregnated with vancomycin showed the lowest rate of contraction of the inhibition zone. The best antimicrobial effect was demonstrated by the compared samples with cefazolin in relation to MSSE, the maximum index of the zone of suppression of which, on average, for the hydrogel was 29.3 mm, PMMA – 22.3 mm.

Discussion Samples from polymer hydrogel impregnated with antibiotics demonstrated prolonged pronounced effective antimicrobial activity against the leading pathogens of orthopedic infections in comparison with PMMA. The bactericidal efficacy of the polymer hydrogel significantly exceeded the activity of PMMA already from the first day of the study (p = 0.002). The action of the hydrogel throughout the study was uniform without abrupt changes or dips (p > 0.05), in contrast to bone cement, whose activity against all test cultures significantly decreased (p = 0.042) on the 2nd day of the study.

Conclusion Polymeric biodegradable hydrogels impregnated with antibiotics have a greater antimicrobial potential compared to PMMA. Uniform, slow and controlled release of the drug and effective inhibition of the growth of microorganisms, as well as prolonged action show that these properties may turn hydrogels into an effective depot system. 

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus.

Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022.

Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm.

Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature.

Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area.

Introduction Causes of aseptic loosening of THA components and improvement of the implants remain the subject of scientific discussions.

The objective was to perform comparative analysis of the results of biomechanical modeling of cementless total hip arthroplasty using implants with different stem neck-shaft angles as a prerequisite of aseptic loosening of the acetabular component.

Material and methods A biomechanical model of the pelvis and an implant with different stem neck-shaft angles was constructed based on computed tomography findings. Stresses and strains that the patient typically experienced under full weight-bearing on the operated lower limb were explored.

Results The use of a stem neck-shaft angle of 125° provided the most favorable localization of the contact patch at the border of the acetabular component – the pelvic bone and lower values of equivalent stresses and contact pressure in comparison with more "valgus" femoral components (135° and 145°).

Discussion The data obtained were fully consistent with the results of biomechanical studies by L. Quagliarella et al. (2006) who reported the substantial significance of the neck-shaft angle for on the parameters of contact pressure, since wear and debris-associated osteolysis decrease with a decreased neck-shaft angle. The use of stem neckshaft angles equal to 125° can be indicated for young patients with good bone quality and equal lower limb length. Unstable femoral cup can be caused by eccentric position of the contact spot at the border of the bone and the acetabular component and distribution of contact pressure and equivalent stresses inside the spot that are typical for artificial joints with stem neck-shaft angle of 145°.

Conclusion The findings suggested that the value of stem neck-shaft angle was likely be considered a prerequisite for aseptic loosening of the acetabular component.

Introduction Telescopic intramedullary osteosynthesis (TIO) is used in children with osteogenesis imperfecta and other diseases accompanied by frequent fractures and deformities of long bones due to pathological bone tissue featuring reduced strength properties.

Purpose In an animal experiment to study the growth characteristics of an intact tibia under conditions of intramedullary reinforcement with a telescopic rod.

Material and methods A non‑randomized controlled study was conducted on 4 animals (puppies, littermates) that underwent TIO of the right limb tibia with a telescopic titanium rod (outer diameter of 4.2 mm) at the age of 5 months. X-ray parameters (length of the tibia, angles of inclination of the articular surfaces, telescoping magnitude) were studied before surgery, on the day of rod placement, and after the end of spontaneous growth of the segment (7 months after surgery). The contralateral left tibia served as a control, and its X-ray parameters were studied at the same time-points.

Results Transphyseal reinforcement with a telescopic rod caused growth retardation with loss of length in only one case out of four (8 mm or 4.8 % of residual growth). In other cases, no difference in the length of the tibias of the right and left lower extremities was found. Eccentric insertion of the transphyseal rods into the posterior third of the distal epiphysis (due to the natural anatomy of the canine tibial shaft) formed an angular deformity during growth: a significant increase in the distal anterior and lateral tibial angles of the operated limb compared to the intact limb. The amount of divergenceof the parts of the rods was, on average, 11.3 mm. There were no cases of migration of intramedullary rods or loss of fixation of threaded sections in the epiphyses.

Conclusion Under experimental conditions, the slowing down of longitudinal bone growth is not a constantly observed effect. Titanium telescopic rods are not prone to blocking during the limb growth or to losing the position of the threaded parts in the epiphyses. The eccentric passage of the rods through the growth zones causes angular deformities in the course of growth of the segment.

Introduction Transformations of the nerves and muscles of the distal extremities after nerve injuries at the level of the proximal segments are critical for the restoration of functions, but have not been sufficiently studied in experimental biological models.

Purpose Histomorphometric evaluation of the tibial nerves and plantar interosseous muscles after internal neurolysis and autogenous plasty of the tibial portion of the sciatic nerve (SN) in rats.

Materials and methods The study was performed on 21 male Wistar rats, aged 8-10 months. Series 1 (internal SN neurolysis) – n = 6. Series 2 (autogenous SN neuroplasty) – n = 8. Control – 7 intact rats. The rats were euthanized 6 months after the operation. Light microscopy and histomorphometry of transverse semithin sections of the tibial nerve at the level of the middle third of the lower leg and paraffin sections of the plantar interosseous muscles of the foot were performed.

Results In series 1, endoneural vessels had increased diameters and wall thickness in the tibial nerve, but a smaller lumen compared to the norm; the dimensional characteristics of the myelinated fiber population were increased due to myelin decompactization and axonal edema; about 10 % of myelinated fibers were destructively changed. In series 2, the numerical density of the endoneural vessels of the tibial nerve was doubled in comparison with the intact one; the numerical and dimensional composition of the regenerated myelinated fibers indicated active but incomplete regeneration. The vascularization index of the plantar interosseous muscles in series 1 was close to normal, in series 2 it decreased twice, the median of muscle fiber diameters was reduced by 12.41 % (p = 0.000) and 20.96 % (p = 0.000), respectively. Muscle fibers with a diameter of more than 30 μm increased in series 2 compared to series 1.

Conclusion Internal neurolysis and interfascicular autoplasty of the sciatic nerve cause multidirectional changes in the endoneural vessels of the tibial nerve, which predetermine the multidirectional nature and severity of denervation and reinnervation changes in the nerves of the lower leg and small muscles of the foot.

Aim Study of mechanical and biological properties of five variants of alloys of the Ti-Nb-Ta system.

Materials and methods Five alloys were obtained from the system: Ti-(15-20)Nb-(5-10)Ta (at. %). Their mechanical tests were carried out by stretching on the INSTRON 3382 universal testing machine in accordance with GOST 1497-84. The biological properties of the resulting alloys were evaluated in in vivo experiments (implantation surgery) on white outbred male JCR mice. Histological study of the tissues of the limb with an implant, kidneys and liver was carried out at three time points: at 1, 4, 12 weeks after surgery, which corresponds to the early, middle and late phases after implantation.

Results The samples showed ductility from 11.5 % to 14.6 %, strength from 549 to 673 MPa and Young's modulus from 42 to 50 GPa. The yield strength also varied depending on the composition of the alloy within 188 – 572 MPa. The inflammatory reaction was the least pronounced in the groups with Ti-20Nb-5Ta and Ti-15Nb-10Ta alloys implanted.

Discussion Compared to the widely used TiAl6V4 alloy, the obtained alloys approximately correspond in terms of plasticity and have approximately 2 times lower Young's modulus, which should lead to better biomechanical compatibility between the implant and the surrounding biological tissues, preventing the effect of protection against stress and, accordingly, bone resorption. The relatively low tensile strength of the obtained alloys does not reduce the above-mentioned advantage over TiAl6V4, since this strength is quite sufficient for the proposed application. Histological study after 1, 4 and 12 weeks showed that the intensity of the local inflammatory reaction due to new alloys is higher than with the use of TiAl6V4, which requires further study and could be associated with a small sample size.

Conclusions The way to create titanium alloys with a low Young's modulus may solve the problem of biomechanical compatibility of the implant with the surrounding tissues. The obtained and described alloys of the Ti-Nb-Ta system showed the neceary mechanical and, according to the initial assessment, acceptable biological properties that require further broader research.

Introduction Combined injury, as a cause of death, occupies a central place in different age groups and is common for individuals ages 50 and younger. Most sacral fractures are traditionally repaired with screw or plate. However, the fixation can be unreliable in atypical anatomy of the upper sacral segment, U-shaped and H-shaped fractures, compression of nerve structures and failed fixation.

Material and methods Reported is a case of a 29-year-old patient who suffered a severe concomitant injury including comminuted fracture-dislocation of the sacrum complicated by caudopathy.

Results A good clinical and anatomical result was obtained. She developed a complete regression of neurological symptoms. The patient could ambulate without additional support. The function of the pelvic organs was restored.

Discussion For a comparison, two methods were presented: lumbopelvic fixation using two rods and a transverse buckle and triangular fixation with a rod and an additional iliosacral screw. Lumbopelvic fixation is a surgical procedure for unstable pelvic ring injuries that allows immediate weight-bearing. Biomechanical tests showed greater primary stability with triangular lumbopelvic fixation than iliosacral fixation with no stress to the injured area. Bilateral lumbopelvic fixation with a transverse buckle allowed secure fixation of the lumbopelvic junction for fracture healing, protection of the sacroiliac joints preventing the development of transitional kyphosis and maintaining the spine balance with careful surgical handling of the soft tissues.

Introduction Infection is a devastating complication of joint replacement surgery and is associated with significant medical costs of treatment and rehabilitation. This review is based on the analysis of modern domestic and foreign literature and demonstrates the problem of periprosthetic joint infection (PJI) in terms of etiology, pathogenesis, diagnosis and surgical treatment options for PJI, as well as economic costs in different countries. Currently, two-stage revision arthroplasty is the most used treatment method in the world. At the same time, the number of publications on the effectiveness of one-stage revision arthroplasty in PJI has been increasing every year.

Purpose Analysis of the clinical and economic efficiency of one- and two-stage revision arthroplasty interventions for suppression of the purulent inflammatory process and their medical costs.

Materials and methods The literature search was carried out in open electronic databases of scientific literature PubMed, eLIBRARY and Scopus. The search depth was 22 years. Sixteen articles were selected for economic analysis in which the expenditures on PJI management in developed and developing countries were reported. Also, there were 15 studies on evaluating the effectiveness of two-stage revisions and 26 articles on evaluating the effectiveness of one-stage revisions and 15 articles on analyzing the functional state of the affected limb according to the Harris Hip Score. The following inclusion criteria were used: systematic reviews, literature reviews, cohort studies on the topic of periprosthetic infection.

Results The rate of PJI arrest with one-stage method was 89.5 % (Me-88.6; Q1-86 Q3-94) and the average mortality was 2.23 ± 2.24 (Me-1.2 Q1-0.8 Q3 -2.7). The rate of PJI suppression by two-stage method averaged 91.4 % (Me-93;Q1-88.2 Q3-96) with an average mortality rate of 3.2 %. The functional HHS after onestage replacement averaged 81.8 points, and after two-stage revision arthroplasty it was 77.4 points. The economic cost of treating one patient with PJI, according to various authors, varies from 6,500 to 150,000 dollars.

Conclusions One-stage revision is cost-effective, has better functional parameters and lower mortality with comparable results in PJI arrest if strict adherence to indications is followed.

Introduction Osgood-Schlatter disease is manifested by pain, swelling and the appearance of a painful "bump" in the area of the tibial tuberosity. For 90 % of patients, conservative treatment is effective. It relieves painful symptoms but if they persist after the closure of the growth plate, surgical treatment is recommended. The study of literature reviews on invasive methods of treatment of the Osgood-Schlatter disease revealed only a few works on various methods of treatment with a description of clinical cases.

Purpose Review of current methods of invasive treatment of Osgood-Schlatter disease, comparison of their effectiveness from the point of current evidence-based requirements.

Materials and methods The electronic databases eLibrary, PubMed and Scopus were used for literature search.

Results This literature review presents a comparative analysis of the effectiveness of various surgical methods of treatment, namely, the use of surgical and puncture methods. The main advantages of the methods were discussed, as well as their disadvantages caused by postoperative complications or difficulties resulting from the techniques for their implementation. Conservative treatment, which is resorted to in the majority of cases, does not relieve pain in the knee joint, and discomfort at sport activities persists. Minimally invasive techniques, which were used by a number of authors whose works are described in this review, are at a low level in the hierarchy of evidence, because there no large comparative studies. Conclusions Due to the rarity of surgical treatment of this pathology, it makes sense to create a register of patients with Osgood-Schlatter disease for the purpose of a remote unified assessment of treatment results in order to identify the most appropriate method of surgical intervention.

Introduction Blount's disease is a severe pediatric pathology of the musculoskeletal system. The condition is characterized by impaired growth and development of the proximal medial tibia and epiphysis, leading to varus deformity of the knee joint. Blount's disease is not just a cosmetic defect, but a serious orthopaedic condition accompanied by a gait disorder in a child. Patients with Blount's disease need surgical correction followed by longterm rehabilitation and can develop recurrence. The etiology of Blount's disease is unknown. Varus deformity of the knee joint is diagnosed in children all over the world, but studies on this pathology are few. There is a paucity of publications in the modern Russian literature reporting the pathology.

The objective was review the literature on the classification, diagnosis, etiology and treatment of Blount's disease.

Material and methods Electronic databases of PubMed, Scopus, eLibrary were used to source literature on the topic.

Results Blount's disease has been shown to be characterized by disordered growth of the medial aspect of the proximal tibial physis and epiphysis that results in a three-dimensional deformity of the lower limb. In recent years, significant progress has been made in the diagnosis and surgical treatment of the cohort of patients. The etiology of Blount disease is unknown, and it is currently thought to result from a multifactorial combination of hereditary, humoral, biomechanical, and developmental factors.

Conclusion Genetic predisposition has been postulated in the development of Blount's disease in many studies. Multiple factors such as ethnicity, obesity and early walking age are thought to be the contributing elements to this disease. To understand the key factor of the disease, further study of the hereditary nature of this pathology is necessary.