It is able to completely preserve the anatomical structures (skin, fascia, muscles, clavicle, arteries, veins, nerves) and minimize damage to the structures of the brachial plexus, since neurolysis is carried out along the trunks and bundles of the plexus through a low-invasive transaxillary approach. However, the effectiveness of this type of operation has not been studied previously. The aim of the study To evaluate the effectiveness of brachial plexus neurolysis under video endoscopic assistance in the treatment of brachioplexopathies in adults Materials and methods The study involved patients hospitalized in the Tyumen Federal Center for the period from 2017 to 2022 with a diagnosis of brachial plexus palsy, who, for medical reasons, underwent neurolysis of the brachial plexus under video endoscopic assistance. The number of patients gave informed concent was 25 subjects. The results of treatment were assessed with score systems and questionnaires; neurological examination was performed and muscle strength was assessed according to the British scale (M5-M0), the type of sensory disorders and their degree on a scale from 0 to 10, where 10 is the complete preservation of sensitivity, and 0 is its complete absence and were confirmed by the data of functional diagnostics (stimulation ENMG) 3, 6 and 12 months after the operation. Statistical data processing was carried out using the Microsoft Excel (Microsoft Office 365) and Stattech 2.0 software package. For quantitative traits, the arithmetic mean (M) and standard error of the mean (SEM) were calculated. To assess the statistical significance of the results obtained, the parametric t-Student's test was used. Differences were considered significant at p < 0.05. Results The mean age of the patients was 48 ± 15 years, gender ratio (m/f) was 18/7, the affected side (right/left) ratio was 12/13. A positive result was achieved in 75 % of cases (n = 19), the absence of positive dynamics was noted in 25 % of cases (n = 6); there were no cases of poor results. When comparing the indicators in groups with a positive result and its absence, it was revealed that the degree of limb dysfunction and the degree of paresis affect the treatment outcome (p < 0.05). In all patients with a positive result, a positive trend was observed starting from 5.89 ± 0.93 (range 1-15) weeks after surgery. Conclusion The proposed method of neurolysis of the brachial plexus is an effective method for the treatment of patients with brachial plexus palsy of various etiologies. The main factor influencing the outcome of reatment is limb dysfunction, the severity of which is inversely proportional to the function recovery in the postoperative period. Based on the results obtained, neurolysis was not effective in paresis of the affected muscles scoring 0-1 points. If there is no positive effect from the intervention within 3 months after its implementation, further waiting tactics is not advisable. Other treatment options should be considered.

Introduction Diagnosis and treatment of children with multiple injuries of the bones that form the elbow joint is a relevant problem in pediatric traumatology. Due to the high variability of the cases encountered, it is necessary to differentiate the volume, timing and sequence of surgical interventions, as well as the duration of fixation of the injured limb with immobilizing means. The aim of the work was to study the dependence of long-term anatomical and functional treatment results in children with multiple fractures around the elbow joint on the type of injury. Materials and methods The medical records of 82 pediatric patients with multiple injuries of the bones forming the elbow joint were studied. The patients involed in the study were divided into two groups. Group 1 were patients with multiple fractures of the bones that make up the elbow joint (35 children), and group 2 were patients with intra-articular fractures of the distal end of the humerus and fracture-dislocations of the forearm bones in the elbow joint (47 children). The results were evaluated using the DASH questionnaire and the Broberg-Morrey rating scale. Results In the first group of patients with multiple fractures of the bones that make up the elbow joint, the anatomical and functional results of treatment were significantly better, and the process of restoring the function of the elbow joint was shorter. The treatment results of patients in the second group largely depended on the severity of the injuries. The use of the Ilizarov method with rational arrangements of the apparatus enables to preserve the function of the elbow joint in the course of transosseous osteosynthesis. In hybrid fixation (the use of pins and apparatus or plaster immobilization and apparatus), patients frequently developed immobilization contracture of the elbow joint and the anatomical and functional results turned out to be worse, since the fixed elbow joint needed long-term rehabilitation. Discussion Multiple injuries of the bones of the elbow joint are highly variable. The treatment of patients with multiple injuries of the elbow joint remains a difficult clinical task, partly because there is no differentiated approach to rehabilitation measures depending on the nature of the injury, and, accordingly, a rational approach to the treatment of this group of patients has not been developed. Due to the fact that most dislocations are usually associated with fractures, accurate diagnosis of the severity of injuries and rational surgical intervention in terms of timing and volume are necessary to achieve good anatomical and functional results. Conclusion Accurate and timely diagnosis of skeletal injuries of the elbow joint and rational determination of treatment tactics are of great importance in pediatric emergency traumatology. They determine the anatomical and functional outcomes of rehabilitation.

Introduction The low detection rate of osteoporosis and the lack of treatment in the elderly can contribute to a higher rate of low-energy fractures, poor results of surgical treatment and mortality. The purpose of the work was to evaluate the frequency of detection and treatment of osteoporosis before the fracture and during specialized trauma and orthopaedic care provided for a low-energy fracture of the proximal femur in the elderly. Material and methods A retrospective analysis of 209 medical histories of individuals aged 60 years and older who received treatment for a low-energy fracture of the proximal femur in 2 randomly selected trauma departments and a telephone survey of the patients performed at 3-8 months were produced. Availability of the diagnosed osteoporosis and the treatment before and during fracture repair were identified. Results The diagnosed osteoporosis was established in 5.2 % prior to fracture occurrence and in 16.7 % after the fracture occurrence. In both cases, the condition was treated with colcalciferol, calcium and pathogenetic therapy used in some cases. Discussion Diagnosis and treatment of osteoporosis in the elderly remained low before a lowenergy fracture of the proximal femur and during trauma and orthopaedic treatment. Conclusion The initiation and treatment of osteoporosis during the trauma and orthopaedic management of a low-energy fracture should be considered as a component of the high-quality specialized care.

Introduction The aim of the study was to analyze the functional results of surgical treatment in patients with unstable ankle fractures with the Ilizarov method (controlled retrospective cohort monocenter non-randomized study; Level of evidence II). Materials and methods Fifty-three patients, 15 males and 38 females, in the mean age of 48 years, with ankle fractures met the inclusion criteria. The patients were divided into three groups according to the principle of dominant lesion location and according to the number of damaged bone structures. The patients underwent surgical interventions comprising closed reduction and external fixation with the Ilizarov apparatus bridging the ankle and subtalar joints. The study period was 34.6 months after surgery. Functional outcomes were evaluated based on the data of the AOFAS questionnaire. Results The average AOFAS score for Weber type A fractures was 95.25 ± 6.84 (SD), 93.77 ± 6.85 (SD) for type B, and 93.57 ± 4.03 (SD) for type C. In the patients with isolated fractures of the lateral malleolus it was 93.44 ± 8.38 (SD), in bimalleolar fractures – 94.09 ± 6.41 (SD), and in trimalleolar fractures – 93.71 ± 6.39 (SD). There were no significant differences between the groups of patients with different (Weber) types of ankle fractures. There was tendency to worse outcomes in patients whose surgical treatment was carried out 7 days or more after the injury. Conclusion Ankle osteosynthesis with the Ilizarov apparatus in unstable ankle fractures demonstrates excellent mid-term (range, 2 to 4 years) functional outcomes. The number of damaged bone structures of the ankle joint and the location of the dominant injury are not predictors of an unfavorable outcome in unstable ankle fractures in case of definitive fixation with the Ilizarov apparatus. There is a tendency to worse functional outcomes in delayed surgical treatment if the time from injury to surgery is more than seven days.

The objective was to retrospectively review the relationship between the parameters and the position of intracanal bone fragments in comminuted fractures of LI vertebra and the effect on neurological status and restoration of the anterior wall of the spinal canal using a transpedicular reduction device. Material and methods Spiral computed tomography (CT) scans and case histories of 45 patients with spinal cord injury at the level of L1 vertebra were reviewed. The study included patients with comminuted fractures including intracanal bone fragments from the posterior portion part of L1 vertebra. Bone fragments were relocated from the spinal canal to varying degrees in patients who underwent procedure using the posterior access and transpedicular reduction system. Two groups of patients were identified with regard to displacement: the bone could be shifted by 50 % and over in the first group (n = 25) and less than 50 % in the second group (n = 20). Results Preoperative time was shorter in the first group: 6.7 ± 3 versus 15.5 ± 5.6 days in the second group. The bone width was statistically smaller in the first group with 18.2 ± 2.3 mm versus 22.3 ± 2.6 mm in the second group. Deficient lumen and deficient area of the spinal canal were significantly greater in the first group. Discussion Prediction of the effective ligamentotaxis is essential for optimal surgical strategy. Bone parameters and position, performance of distraction and correction of angulation of injured vertebral segment play a role in the effectiveness of indirect reduction of bone fragments protruding into the spinal canal. Conclusion Deficient lumen and deficient area of the spinal canal, the length and width of the intracanal bone fragment were not associated with neurological disorders ASIA C, D and E types in case of comminuted fractures of LI vertebra. The effectiveness of closed decompression of the spinal cord in spinal cord injury at L1 level was dependent on the width of intracanal bone fragments and the preoperative time.

There is a paucity of Russian medical literature reporting lumbosacral transitional vertebrae in children and adolescents. Many important aspects of the condition including two nosologies of sacralization of the L5 vertebrae and lumbalization of the S1 vertebrae have been under-explored. The objective was to establish overall frequency and frequency of certain types of lumbosacral transitional vertebrae in children and adolescents who sustained a lumbar injury and to investigate clinical manifestations of the pathology. Material and methods A comprehensive examination of 312children aged 7 to 18 years who suffered a lumbar injury was performed. Lumbosacral transitional vertebrae was radiologically diagnosed in 19 (6.09 %) subjects. Grading system of A.E. Castellvi et al. (1984) was used to classify the pathology. Results From 19 patients with lumbosacral transitional vertebrae, sacralization of the L5 vertebrae was detected in 16 (84.21 %) individuals. Lumbalization of the S1 vertebrae was diagnosed in 3 (15.79 %) children. Type II (n = 13) and subtype "b" (n = 10) were most common. No types III and IV of the disease were seen. No clinical symptoms indicating the likelihood of having lumbosacral transitional vertebrae were observed in the patients prior to the lumbar injury. Conclusion The frequency of occurrence of lumbosacral transitional vertebrae and its structure were reviewed in children and adolescents. The patients demonstrated no clinical manifestations of the condition before the children sustained lumbar injuries. Various aspects of transitional lumbar vertebrae in children and adolescents
require further study.

Introduction Multifactoriality in the etiology of idiopathic scoliosis (IS) requires an integrated approach to diagnosis, while the regular examination of patients is limited to radiography, computed tomography without a detailed analysis of the data obtained on the state of the musculoskeletal system. The problem of complex diagnosis of IS is practically not covered by the literature including the syndromic approach to the rationale for the method of treatment and rehabilitation. Purpose of the study To define the concept of "syndromocomplex" of idiopathic scoliosis based on the study of the state of the spine, muscles, proximal femur, bone mineral density (BMD), mineral metabolism and bone metabolism using current diagnostic methods. Materials and methods The state of the spine (300 patients), proximal femur (57 patients), paravertebral (40 patients) and gluteal muscles (60 patients of the main group and 40 of the control group) were studied using the method of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), densitometry – BMD (40 patients of the main and 40 of control one), mineral metabolism and bone metabolism were studied by biochemical methods in 55 patients with IS. Results and discussion The study of patients with idiopathic scoliosis at different ages and with different grades of deformities in various parts of the musculoskeletal system revealed pronounced disorders in the shape of the vertebrae, including an increase in the frontal diameter, wedge shape with a significant difference in density along the convex and concave sides, structural changes in the vertebrae, manifested in a decrease in density, the presence of rarefaction zones, areas of maximum density at the top of the deformity, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, a decrease in BMD, a decrease in the density of the femoral head, impaired mineral metabolism and bone metabolism. Conclusion Severe disorders in the shape, X-ray morphological changes in the vertebrae, malnutrition and fatty degeneration of the paravertebral and gluteal muscles, concomitant changes in BMD, hip joint, mineral metabolism and bone metabolism, are included in the concept of "syndromocomplex” of idiopathic scoliosis, underlie the tactical concept for diagnosis, treatment and further rehabilitation measures for patients with severe forms of scoliosis.

Introduction Bone metabolic markers informatively reflect the complex balance of bone formation/resorption and are widely used in clinical practice. Genetic predisposition also plays a significant role in the etiopathogenesis of aseptic necrosis of the femoral head (ANFH). We aimed to establish probable associations between a number of biochemical parameters of bone tissue metabolism with clinical ones (sex, age, body mass index (BMI)), disease stage, T and Z criteria) with regard to the leading polymorphisms of the vitamin D3 receptor gene (VDR) in patients with ANFH. Materials and Methods Based on clinical and biochemical examination of 273 patients with ANFH, factor analysis was performed. Results Clinical parameters (age, BMI) correlated most with biochemical parameters. Age showed most association with β-CrossLaps, DPD, osteocalcin, and osteoprotegerin; BMI, in turn, was associated with 1.25(OH)2D, 25(OH)D, Ca, and DPID. Carriers of G/G genotype A-3731G were found to have more than a three-fold increased risk of ANFH compared to healthy controls; carriers of G allele had a 2.5‑fold increased risk. Carriage A/A genotype +283 A > G increases the risk of developing ANFH by 2.4 times. Carriage of the A allele of the same locus is associated with a 1.5-fold increased risk of ANFH. Discussion We determined a reliable association of age with β-CrossLaps, DPD, osteocalcin, osteoprotegerin, and BMI with 1.25(OH)2D, 25(OH)D, Ca, and DPD in patients with ANFH, suggesting significant prospects for using these biochemical parameters to monitor changes in bone tissue remodeling. An increased risk of ANFH was established in the presence of the G/G genotype and the G allele of the A-3731G (Cdx2) locus, the A/A genotype of the +283 A > G (BsmI) locus in the VDR gene. Conclusion Associations of BMI with 1.25(OH)2D, 25(OH)D, Ca, DPD characterize the relationship between resorption and osteogenesis processes and somatic parameters of the examined patients with ANFH. The genotypic variants G/G rs11568820 and A/A rs1544410 in the VDR gene are associated with an increased risk of AFHD.

The objective was to explore the dynamics and duration of antibiotic elution in samples based on polymer hydrogel and PMMA. Material and methods The samples impregnated with vancomycin, rifampicin and cefazolin at various concentrations were placed in phosphate-buffered saline and incubated at 37 °C. The medium was completely replaced at 1, 3, 7, 14, 21 and 28 days. Spectrophotometry was used to measure concentration of drugs in solution and the release profiles. The median and 95 % CI were employed to statistically describe data obtained from 5 parallel studies. Results Concentrations of the antibiotics eluted from the polymer hydrogel were 7 times greater than those released from PMMA on day 1; 15 times greater on days 2 and 3; 6.6 times greater on day 7 and 3 times or more in the following days of observation. The rate of antibiotic release from hydrogel volumes also differed markedly. Discussion The drug release was more than 70% of the total amount for all hydrogel samples in contrast to PMMA with elution not exceeding 10 %. Despite the fact that a burst release was observed with 80 % of the antibiotic released in the first 5 days as seen in the case of bone cement, the concentration of the drug eluted from hydrogels was several times higher and exceeded the MIC throughout the observation period. The release of the antimicrobial agent from hydrogels was caused by diffusion of the particles from the entire volume of the matrix demonstrating an important advantage over PMMA with the potential being limited by surface depletion. Conclusion At this point, we have shown the possibility of creating potential depot systems based on unsaturated PVA derivatives with controlled release of antibiotics and characteristics being superior to PMMA.

Features of structural changes in the joint components (synovial membrane, articular cartilage, subchondral bone) under the conditions of adjacent limb segment osteomyelitis are poorly understood and require thorough histological studies. Purpose Сomparative assessment of the structural reorganization of the main components of the distal articular end of the femur in experimental modeling of osteomyelitis. Material and methods Objects: distal metaphyses of the femur of intact rats (n = 5) and experimental ones (n = 16) in the conditions of modeled osteomyelitis of the femur. The culture of S. aureus was injected into the medullary canal in the experimental animals (n = 8) while saline was injected in the control group (n = 8). The animals were taken out of the experiment on the 21st day. Methods: histological, morphometric, and statistical methods were used. Results In the control group, the articular cartilage, subchondral bone plate, and subchondral zone retained their normal structure. Synovitis was not revealed. The values of the morphometric parameters were comparable with the intact norm. In the experimental group, bone microsequesters, osteoclastic resorption of the subchondral bone plate, inflammatory infiltration with the content of plasma cells and neutrophils were detected in the subchondral zone. Histological changes in the articular cartilage according to the classification of the International Society OARSI (2006) corresponded to grades 1 to 3 and were accompanied by synovitis. There was a significant (р < 0.05) decrease in the thickness of non-calcified cartilage, a significant twofold decrease in the thickness of the subchondral bone plate, while the values of the thickness of the calcified cartilage exceeded those in the control group and the intact norm. Conclusion Under the conditions of an experimental model of chronic osteomyelitis of the femur, the revealed structural changes in the subchondral zone contribute to the progression of the destruction of the subchondral bone plate, articular cartilage and synovitis. This model of chronic osteomyelitis can be used to experimentally study various therapeutic strategies aimed at modifying subchondral bone remodeling and relieving synovitis.

Introduction The complex treatment of osteoarticular tuberculosis is based on combination of anti-tuberculosis therapy, complete (radical) removal of involved bone and restoration of the supporting and motor function of the affected musculoskeletal segment. Inhibited activity of osteoclasts involved in osteoresorption as one of the mechanisms of reparative osteoregeneration can be involved in regulation of bone formation after radical reconstructive surgery. The objective was to explore CT signs of osteoregeneration due to multimodal treatment of experimental tuberculous osteitis with use of bisphosphonates as targeted inhibitors of osteoclasts. Material and methods An experimental study was carried out on 21 mature male Chinchilla rabbits. The first stage included bone tuberculosis simulated in the medial condyle of the right femur using invasive local infection with M. tuberculosis strains H37Rv, a virulent reference laboratory strain. Pathological focus was resected and bone graft used at the second stage. Animals receiving antituberculosis therapy (ATT), ATT and bisphosphonates (BP) and BP only were divided into three groups at the third stage. Animals were sacrificed at 3 and 6 months of surgical treatment at the fourth stage. Autopsy implantation zone, bone of the contralateral condyle and intact femur were quantitatively and qualitatively assessed using micro-CT imaging. Results Positive dynamics in bone restoration was seen in the groups. ATT group showed complete lysis of the implant with bone cavities identified and no bone restoration in half of the cases seen at 6 months. Rabbits treated with BP demonstrated absence of complete lysis of the implant and CT signs of ingrowth of bone trabeculae. CT signs of maximum osteoregeneration were noted in the group of isolated BP therapy. Discussion The use of bisphosphonates can prevent lysis of grafts preserving the osteoconductive properties and facilitating formation of new bone. Conclusion Targeted osteoclast inhibitors can be safety and efficaciously used in the complex treatment of focal infectious skeletal lesions and be recommended as a potential component of pathogenetic therapy in the postoperative treatment of infectious (tuberculous) skeletal lesions.

Osteoporotic vertebral compression fractures (OVCF) are common fragility fractures of the spine that can lead to the functional failure and neurological deficit in 15-35 % of cases. There is no clear understanding of preferred surgical techniques to be used for treatment of patients with complicated thoracic and lumbar OVCF. The objective was to analyze reasons of failed ventral intervention in a patient with old Th12 injury affected by osteoporosis and demonstrate a short- and long-term outcome of repeated surgery. Material and methods A 63-year-old patient underwent stabilization of the thoracolumbar spine using a combined polysegmental (screws/hooks) dorsal system with screws augmented with bone cement. Results Physical examination and radiography at 12 months showed no loss of correction or signs of structural instability. Bone-metal fusion was observed at the level of the mesh endofixator (Th11-L1). VAS scored 0-1 (standing = lying), the Oswestry Disability Index was 12 %. Discussion The poor outcome of ventral intervention was caused by inadequate instrumentation of the transitional thoracolumbar spine in osteoporotic patient leading to L1 destruction and gradual kyphotization of the stabilized spine. The satisfactory short- and long-term outcomes of the revision dorsal intervention indicated the effective surgical strategy in the case. Conclusion With the results of the case reported, the reliability of anterior fixation is to be considered in osteoporotic patients to determine the feasibility of extended ventral systems in elderly patients. Dorsal stabilization and spinal fusion without preliminary abdominal revision are practical with unstable anterior fixation being not accompanied by significant secondary spinal deformity.

Introduction Chronic osteomyelitis is a common disease, but malignancy is its rare and late complication. The aim is to present a clinical case of malignant transformation 34 years after the diagnosis of chronic osteomyelitis of the hip. Materials and methods The medical case history was studied and pathomorphological examination of the surgical material of patient D. with chronic osteomyelitis of the femur was conducted. Results Patient D., after a comminuted fracture of the left femur as a result of an accident, at the age of 25 years, developed chronic osteomyelitis, the surgical interventions did not lead to a long-term remission of the process. The course of the disease was complicated by malignancy and pathological fracture. The treatment ended with the amputation of the limb. The pathohistological examination revealed structural changes in bone tissue: necrosis, bone marrow fibrosis, bone microsequestration, inflammatory infiltrate with a high content of neutrophils that corresponded to the morphological signs of chronic osteomyelitis in the acute stage. Signs of pseudocarcinomatous hyperplasia, mass appearance of "horny pearls", invasion of the squamous epithelium of the bone tissue, squamous epithelial cells seemed to be highly differentiated. Discussion The pathomorphological picture of the surgical material was characterized as pseudocarcinomatous hyperplasia, the prolonged existence of which could cause the occurrence of squamous cell carcinoma of the femur. It is not clinically and histologically possible to establish when the reactive proliferation of the epidermis acquires fundamentally different biological properties of a malignant tumor. It is a serious problem in the timely diagnosis. Conclusion A thorough pathoanatomical assessment of the material from the affected areas (ulcers, fistulous tracts, bone marrow space) is necessary for the early detection of malignant neoplasms that may occur in osteomyelitis. The presence of long-term dynamics of pseudocarcinomatous hyperplasia requires vigilance in relation to the process of malignancy.

Introduction Ehlers-Danlos Syndrome (EDS) is a group of hereditary pathological conditions caused by various defects in collagen metabolism. EDS can be accompanied by progressive spinal deformities that may require surgical correction. No review papers reporting the results of the interventions were found in the literature. The objective was to present and analyze the results of surgical correction of severe progressive spinal deformities in EDS patients. Material and methods The review is based on 11 papers published between 1990 and 2014. They report the results of the treatment of 56 patients with half describing individual observations and half reporting clinical cohorts of 7 to 9 cases. Results and discussion The results of conservative treatment indicate its low efficiency. Scoliosis ranged between 45° and 143° with low preoperative mobility (20-40 %) at baseline and corresponded to the average surgical correction (30 to 55 %) and insignificant postoperative loss of correction. The average blood loss measured 540 to 1800 ml. A total of 36 complications were noted in 56 patients, with most severe of them being neurological (three cases of paraplegia, without recovery in one of them) and vascular (damage to segmental vessels and major vascular trunks) events developing from ventral access. Conclusion Surgical correction of spinal deformities due to EDS is challenging and requires an individual approach in each specific case. Modern technology makes it possible to obtain very good results in the correction of spinal deformities in EDS. There is a paucity of published observations and new studies are needed.

Introduction Tuberculous spondylitis is the most common extrapulmonary tuberculosis. The thoracolumbar lesion due to tuberculous spondylitis is one of the most difficult locations for surgical treatment. Analysis of the recent literature shows a limited amount of data on the results of various current surgical reconstruction techniques. Purpose To review the literature on surgical treatment of thoracolumbar tuberculous spondylitis published during the last five years and judge upon an optimal method. Materials and methods A systematic literature review was performed of the sources from eLibrary, PubMed, Cochrane Library databases. Inclusion criteria: etiologically verified tuberculous spondylitis of thoracolumbar location, follow-up ≥ 1 year, patients older than 18 years. Twenty-one studies that summarize 1,209 cases were selected. Patients were divided into three groups depending on the method of spinal reconstruction (group 1 – ventral approach, group 2 – combined approach, group 3 – dorsal approach). Surgical indicators, correction of kyphotic deformity and its dynamics in the long-term period, rates of complications and the length of hospital stay were analyzed. Results and discussion Blood loss and duration of the intervention were significantly lower in the reconstruction of the thoracolumbar spine from the dorsal approach (599.6 ± 195.1 ml and 196.3 ± 35.6 min). Correction of kyphotic deformity from posterior and combined approaches was higher than in the reconstruction from the ventral approach (64 and 69 %, respectively). At the same time, an inverse proportional dependence of the degree of correction loss in the long-term period was revealed, which was higher with anterior fusion (7.3° ± 1.7° according to Cobb). The duration of hospital stay was shorter in patients with reconstructions from the dorsal approach (13.7 ± 8.2 days). The rate of complications in group 3 was significantly lower (p < 0.0001), while the assessment of their structure indicates prevalence of neurological deficits in dorsal reconstructions, while in ventral and combined reconstructions, infectious complications, pneumothorax, and chronic pain syndrome in the area of autologous costal graft harvesting. Conclusion The optimal method of surgical treatment of thoracolumbar tuberculous spondylitis is a three-column reconstruction from the dorsal approach. The advantages of the method are a decrease in the rate of postoperative complications, a reduction in the duration of inpatient treatment, surgical blood loss and duration of surgical intervention.

The objective was to analyze experimental animal models of osteonecrosis (ON) using the femoral head, show advantages and disadvantages, capacity to translate the findings for adult and pediatric orthopaedics, potential model modifications for orthopaedic and rheumatology research. Material and methods The original literature search was conducted on key resources including PubMed, Web of Science, Cochrane Library, E-library, and the Springer databank. Literature searches included Russian, English, and Italian studies. The research covered studies of 1980 to 2021 and included important landmarks of laboratory experiments with animal models. Results and discussion Although there was no ON model with ideal conditions found for it, the choice of a model could be based on the researcher’s goal reproducing ON as a type of “osteochondropathy” to explore the results applicable to pediatric orthopaedics or classical ON in adults. Animals with long-term open growth plates, intensive blood circulation in the bone and rapid regeneration being characteristic of juvenile models of rats, rabbits and pigs could be appropriate for the experiment. Dogs, sheep, pigs and emus, in particular, were practical for reproducing ON in adults. Non-traumatic models of ON in adults were reversible and consistent with early stages of the condition. Conclusion The need for ON simulation increased due to progressing orthobiological techniques (PRP‑therapy, BMCs technologies, etc.) in the treatment of ON. Application of orthobiological treatment resulted in heterogeneous, scattered outcomes being statistically unreliable and necessitating the search for optimal animal models and assessment of treatment methods for ON in modern orthopaedics.