Introduction Scheduling and distribution of medical care capacities approved by a healthcare organization, management of the key processes of patient selection and hospitalization with the use of digital technology are the most important organizational tools for successful implementation of state assignments.

Purpose To develop an organizational model of medical care capacities, management of the processes of patient selection and hospitalization at a specialized federal center with the use of digital technology.

Materials and methods Analysis of the plans of rendering specialized medical care in 72,547 cases, including high-tech medical care, for 10-year period (years 2013-2022) in the fields of “traumatology and orthopedics” and “neurosurgery” by means of healthcare information system and digital patients’ registries was conducted by the continuous method.

Results Rates and types of patients’ nonappearance for hospitalization were identified: the rate of informed nonappearance was 37.9 ± 0.4 (per 100 planned patients), the rate of uninformed nonappearance was 18.4 ± 0.4 (per 100 patients who referred to admission), the rate of repeated nonappearance was 1.6 ± 0.1, and the rate of patients’ unplanned referral (arrival) was 6.0 ± 0.1. The rate of hospitalization rejection for a 10-year period (2013-2022) was 6.4 ± 0.1 (per 100 patients who sought medical care). For a 3-year period (2020-2022), the rate of non-confirmed surgical indications was 6.9 ± 0.1 (per 100 patients). Comparative analysis of 5-year periods (2013-2017 and 2018-2022) identified a 1.4-fold increase in an average 5-year rate of hospitalization refusal (t = 13.6, P < 0.0001). For a 5-year period (2018-2022), the rate of hospitalization of patients aged 75 and older was 5.3 ± 0.1, of patients with co-morbidity (diabetes mellitus) 11.8 ± 0.2 per 100 treated patients. Multi-purpose calculation method for prediction of patients’ hospitalization was offered.

Discussion Based on the specified rate of patients’ nonappearance for hospitalization it would be advisable to provide a number of patients that would be over the plan in order to achieve necessary hospitalization numbers. An operating reserve in the digital patients’ registry would solve an issue of hospitalization plan execution and to substitute the patients who were not able to appear. Conclusion Our study has identified regularities of implementation of planned hospitalization of patients to traumatology/orthopedics and neurosurgery units in the conditions of a federal center.

Background Open reduction and internal fixation (ORIF) remain the standard method of treating acetabular fractures. Many authors report poor results in quadrilateral plate fractures of the acetabulum with the use of ORIF. The objective was to evaluate outcomes of quadrilateral plate fractures of the acetabulum.

Material and methods Surgical outcomes of 55 patients with quadrilateral plate fractures of the acetabulum were retrospectively reviewed between 2009 and 2019. Early postoperative results were followed up in 55 patients. Surgical treatment was provided for 32 (58.2 %) control patients with acetabular fractures and 23 patients (41.8 %) with quadrilateral plate fractures of the acetabulum in the main group. Long-term results were explored in 45 patients aged 18 to 60 years with acetabular fractures (control group, n = 24) and in combination with quadrilateral plate involvement (main group, n = 21).

Results Surgical interventions were performed by one team consisting of the same specialists. Surgical outcomes in oth clinical groups were evaluated according to 11 criteria.

Discussion The results of surgical treatment of acetabular fractures and quadrilateral plate involvement were associated with the negative impact of quadrilateral plate involvement on the duration and volume of blood loss, intraoperative and late complications and dynamics in the development of post-traumatic hip arthrosis. The results obtained were comparable with the data of the itation sources.

Conclusion A comparative analysis of the outcomes suggested a negative impact of quadrilateral plate involvement on the results of surgical treatment and an objective necessity to rank quadrilateral plate fractures of the acetabulum as a risk factor for adverse outcomes with ORIF.

Introduction The current status of small joint arthroplasty, the metacarpophalangeal joint replacement, in particular, dictates the need for development and research of new implant designs and materials for their manufacture. The vector of development of anatomically adapted implants has become established, and full preclinical study is required to obtain the best functional results from the use of new medical devices.

The objective was to analyze digital models of critical conditions of metacarpophalangeal joint replacement using mechanical and clinical data.

Material and methods A two-component all-ceramic, anatomically adapted endoprosthesis of the metacarpophalangeal joint was developed between 2017 and 2021. A digital model of the metacarpophalangeal joint endoprosthesis was constructed using 3D modeling technology. Critical conditions of the digital model imitating the main stereotypes of movements were explored with the finite element method; objective technical results obtained and interpreted in a clinical language.

Results Loads over 20 kg should be avoided with movements up to 60° in the early postoperative period. The load must not exceed 10 kg for motion ranging between 60° and 90°. The endoprosthesis allowed for a functional range of motion of 30-60° after MCP joint replacement without significant risks of complications. Discussion The study has demonstrated the importance of objectifying clinical results to minimize the risk of complications in a clinical scenario.

Conclusion The technology based on a digital model of the metacarpophalangeal joint constructed to calculate critical conditions using the Ansys software facilitated prediction of most common complications of MCP arthroplasty and preceded further multicentric clinical trials.

Introduction The widespread application of large joint arthroplasty is accompanied by an increase in the complications associated with periprosthetic infection. Currently, treating patients with infectious complications in the area of large joint arthroplasty remains a relevant issue.

Purpose To determine the prognostic value of leukocyte indices in patients with revision hip arthroplasty.

Materials and methods The study involved 88 patients with revision hip arthroplasty hospitalized at the Ilizarov National Medical Research Centre for Traumatology and Orthopedics. The patients were divided into two groups: group 1 (n = 77) were patients without periprosthetic infection (mean age 60.1 ± 1.5 years) and group 2 (n = 11) were patients with periprosthetic infection (age 55, 2 ± 4.7 years). An analysis of the preoperative results of determining the number of leukocytes and leukocyte formula was carried out with the calculation of the leukocyte index of intoxication and the resistance index of the organism. The reliability of differences in indicators in groups was determined. According to the odds ratio, the probability of developing an infectious process was estimated.

Results The level of leukocytes in the blood serum and the leukocyte index of intoxication of patients of groups 1 and 2 had no significant differences. In patients with an infectious process, their level was higher by 19.7 %, however, not going beyond the normal range. Differences in the index of intoxication in patients of groups 1 and 2 were not noted. In the 2nd group of patients, the resistance index of the organism significantly exceeded that of the 1st group, remaining within the normal range in both groups. When calculating the prognosis for the development of infectious complications, the value of the odds ratio for the resistance index of the organism is exactly an order of magnitude higher than this indicator for leukocytes and the leukocyte index of intoxication.

Conclusion The prognosis of the clinical situation in revision hip arthroplasty should consider not only local changes and the general condition of the patient, but also an assessment of laboratory parameters, in particular, the resistance index of the body.

Introduction A poorly balanced, unstable, or stiff joint is a major cause of residual pain, dissatisfaction, and revision after total knee replacement (TKA), but the definition of a well-balanced joint remains debatable.

The aim of the study was to explore the influence of the knee space and the extension-flexion gap being accurately restored in primary TKA on the knee function and the quality of life of the patient.

Material and methods A prospective, single-center, randomized, controlled study was performed for 41 patients with grade 3-4 knee osteoarthritis. (K-L): the first group (n = 21) underwent primary TKA with the method proposed for precise realignment of the extension-flexion gap, the second group (n = 20) underwent standard arthroplasty. The patients had CT scans of the knee performed preoperatively and postoperatively, and VAS scale pain, knee joint scales: OKS, FJS-12, KSS (pain and function), SF-36 (parameters: PF, RP, BP, GH, VI, SF, RE, MH) were used at 3, 6 and 12 months.

Results Comparison of the standing height of the joint space preoperatively and postoperatively showed a high statistical significance measuring about 20.7 % in frontal plane (group 1: 2.06 ± 2.368, group 2: 2.629 ± 2.455, р < 0.001), 28.2 % in the sagittal projection (group 1: 2.657 ± 2.143, group 2: 3.7 ± 1.717, р < 0.001), i.e., the method proposed allowed for more accurate positioning of the extension gap by 20.7 %, the flexion gap by 28.2 % and more accurate positioning of the knee space level. Preoperative and postoperative VAS, OKS, FJS-12 and SF-36 scores showed significant positive dynamics in both groups with no statistically significant difference between the groups. A statistically significant difference was seen in the functional KSS score in the groups measuring 90.6 ± 3.5 in group 1 _{12 months after surgery} and 85.6 ± 4.2 (p < 0.001) in group 2 _{12 months after surgery}.

Conclusion The study demonstrated the simple and effective technique proposed for positioning the flexion and extension gap of the knee joint in primary TKA and facilitated more accurate positioning of the implant and improved knee function at standard testing 12 months after surgery.

Surgical methods for treatment of spinal muscular atrophy (SMA) in children are aimed at improving their positioning and maintaining the ability of verticalization. Assessment of neurological, somatic and motor status of patients, individual selection of drugs for anesthesia and sedation at the stage of planning surgical interventions allow the anesthesiologist/resuscitator to avoid perioperative adverse events.

Purpose To compare the course of the perioperative period in children with SMA who received pathogenetic therapy with nusinersen with the control group during orthopedic correction of acquired skeletal deformities.

Materials and methods The retrospective analysis for the period from 2019 to 2021 included 23 children. Depending on the ongoing pathogenetic therapy, children with SMA were divided into 2 groups. The main group (SMA+N) included 9 children who received nusinersen; the control group (CG) included 14 children without antisense oligonucleotide therapy. Co-morbidities, hemodynamic parameters, blood loss, need for analgesics and complications were studied.

Results Insignificant differences between the groups were recorded based on the Hammersmith Extended Scale (HFMSE). At the same time, similar comorbid pathology, the severity of respiratory failure, and the absence of differences in the frequency of the NIV application indicated that the groups were comparable. This is probably due to the late start of SMA treatment, degenerative changes in motor neurons, and fatty degeneration of muscle tissue.

Conclusion Intake of nusinersen in patients with SMA type II-III and a long period of illness, severe neurological and respiratory disorders do not lead to a significant regression of symptoms in the perioperative period. The therapy with antisense oligonucleotides in severe muscle hypotonia does not exclude the risk of adverse events in the perioperative period in children with SMA type II-III during orthopedic correction of skeletal deformities.

Background Periprosthetic infection develops in 0.5 to 5.0 % of cases after knee replacement, which is a social and economic problem. The most common causes of periprosthetic infection are methicillin-resistant staphylococcus aureus (MRSA) (36 %), gram-negative bacteria, and microbial associations.

The study was aimed at improving the results of the sanitizing stage of revision arthroplasty in patients with periprosthetic infection of the knee joint by a developed long-acting antimicrobial composition and improving the designs of articulating spacers of the knee joint.

Materials and Methods The treatment results of 121 patients with knee joint periprosthetic infection were analyzed. Nine patients had an early periprosthetic infection and 112 had a late one. Patients in satisfactory condition with stable implant components who had early periprosthetic infection underwent surgical treatment of the purulent focuses, replacement of a polyethylene tibial insert, thorough surgical wound washing using pulse lavage, drainage, and VAC-therapy. Patients with late periprosthetic infection were divided into 3 groups on the basis of the spacer used. An articulating spacer based on the developed antimicrobial composition of prolonged action (RU 191236 patent) was used in 59 patients of the first group. Preformed spacers were implanted in 29 patients of the second group, and 18 patients of the third group got a block-shaped spacer.

Results An antibacterial anti-adhesive non-toxic composition with a prolonged action based on bone cement with gentamicin and such antiseptics as poviargol, dioxydine, and high-molecular polyvinylpyrrolidone has been developed. All the patients underwent the sanitizing stage of revision arthroplasty, implant removal, and spacer installation. Periprosthetic infection recurrence developed in 3 patients of the first group, 9 patients of the second group and 7 patients of the third one. The average time from the sanitizing stage to the second final stage of revision was 3-6 (4.8 ± 1.9) months.

Discussion According to scientific data, the impregnation of new antibiotics into bone cement with gentamicin does not improve the antimicrobial effect of a spacer, especially in case of antibiotic-resistant strains. Block-shaped and preformed spacers lead to infection recurrence and complications. Antiseptic impregnation with different mechanisms of action is able to affect antibiotic-resistant bacteria, and the polymer is able to prolong the effect.

Conclusion The use of articulating spacers for the knee joint, which include an antimicrobial composition, allows preserving the function of the joint and reducing the number of infectious complications, which facilitates the final stage of revision arthroplasty.

Introduction Diagnostic algorithms are used for detection of periprosthetic joint infection (PJI) including sampling for histological evaluation (HE). The purpose was to assess the diagnostic significance of emergency HE of fresh-frozen intraoperative biomaterial as part of preoperative PJI screening of patients undergoing revision total knee arthroplasty (RTKA).

Material and methods The prospective study included 83 patients who were admitted to two trauma and orthopaedic centers for RTKA. The European Bone and Joint Infection Society 2021 (EBJIS21) algorithm was used to detect PJI of the knee joint. The diagnostic value of screening PJI with/without regard to the results of an emergency HE was compared with the results of a microbiological study (MBI) of all types of biomaterials obtained from each patient. Subanalysis was additionally performed in patients with aseptic instability and antimicrobial spacer.

Results Pathomorphological examination of freshly frozen and paraffin-embedded tissues showed the difference of 7.2 %, which did not significantly affect the interpretation of the results (p > 0.05). Diagnostically significant pathogens were identified in 83.3 % of cases with PJI confirmed by emergency HE (p < 0.001). A positive emergency HE result increased the chances of isolating diagnostically significant organisms by 34 times (95 % confidence interval (CI): 4.721 – 244.859) as compared with negative HE cases. The proportion of detected cases with emergency HE included in the screening increased from 2.4 to 8.4 %. The inclusion of emergency HE in the screening improved the diagnostic value both in the general cohort of patients and in the subanalysis of comparison groups due to a two-fold increase in sensitivity.

Conclusion Relevance of the emergency HE results and the PJI criteria should be considered as a significant prognostic factor for an infectious process, however, this technique should be used only in a complex algorithm for PJI detection. Poor outcomes in 18.2 % of cases of probable PJI necessitated a change in the approach to managing this cohort of patients.

Introduction A brief review of modeling purulent septic inflammation in rats, including with the help of an active bacterial agent, and methods for diagnosing inflammation are given.

The aim of the study was to demonstrate the results of the development of an effective experimental model of purulent septic inflammation of the tibia in rats using minimally invasive methods for diagnosing infection in vivo.

Materials and methods Various models of purulent septic inflammation were studied in four groups of small laboratory animals, when using the inoculation of Staphylococcus aureus. Methods for assessing purulent-septic inflammation that are not destructible by the object have been worked out: microbiological, tomographic, morphological.

Results The results of the study indicate the possibility of creating experimental purulent-septic inflammation in rats by 14-60 days using S. aureus inoculation, which is a severe, rapidly progressive purulent infection that leads to extensive destruction of the bone with the formation of sequesters.

Discussion To guarantee the formation of a purulent-inflammatory process of bone tissue in a shorter period of observation, a quantitatively controlled invasion of an active bacterial agent is necessary. A sclerosing agent and formation of a fistulous tract are not essential in creating inflammation.

Conclusion The results of the development of experimental models for the creation of purulent-septic inflammation using minimally invasive in vivo diagnostic methods are demonstrated, which will allow an adequate assessment of the degree of infection before treatment.

Introduction Surgical treatment of knee osteoarthritis is a controversial issue. Knee replacement is the treatment of choice in the orthopedic practice for patients with severe knee osteoarthritis. However, total knee arthroplasty (TKA) has not only beneficial results and implant survivorship is limited in time. In recent years, the number of publications devoted to the limitation of indications for TKA in patients with osteoarthritis has been increased. The use of drilled tunneling in its modern modifications enables to delay or, in some cases, avoid knee joint arthroplasty.

Purpose To substantiate the safety, low invasiveness and effectiveness of the tunneling method as a minimally invasive organ-preserving treatment for knee joint osteoarthritis.

Materials and methods The electronic Pub-Med/MEDLINE and eLibrary databases were searched for works published for the last 30 years. The search was carried out with keywords and phrases: knee joint osteoarthritis, articular cartilage, bone drilling, arthroscopy of the knee joint.

Results The effectiveness of tunneling is based on the concept of simultaneous revascularization, drainage and decompression of the subchondral sections of the knee joint and the medullary cavity of the tubular bones. Up to 96 % of patients report a positive effect of tunneling immediately after surgery. Intraosseous pressure decreases for up to 2 years in 88 % of patients.

Discussion The tunneling method in the treatment of knee osteoarthritis helps to reduce pain in the projection of the femur and tibia, including night pain, improves the functional parameters of the joint, inhibits the progress of cartilage destruction, improves the quality of life of patients and reduces the need for replacement of the affected joint. In addition, tunneling does not require serious economic costs. Due to the fact that this method is a minimally invasive surgical intervention, the risk of infection is noticeably lower than with TKA.

Conclusion Thus, the tunneling of the articular ends is a simple, safe, low invasive and effective method of treating knee joint osteoarthritis.

Introduction Post-traumatic hemarthrosis is identified as intra-articular hemorrhage accompanied by five classic signs of inflammation: hyperemia, hyperthermia, edema, pain and changes in the joint function.

The objective of the study was to establish whether inflammation should be underestimated in post-traumatic hemarthrosis based on the analysis of the world scientific literature of recent years.

Material and methods Internet search platform Web of Science (Clarivate Analytics, USA): databases Web of Science Core Collection (subscription access), Publons (open access), Medline (open access) were used to review scientific articles. Papers from the Scopus Elsevier database (Netherlands) were explored. The search depth was 15 years. Topics that did not receive coverage in the literature of this period were studied until the 1960s in some cases. More than 200 sources were identified on the subject. The literature published in the current year was analyzed covering 15.0 % of the materials, brought out in the last 5 years including the current year covering 56.3 %, in the last 10 years including the current year covering 73.8 %, in the last 15 years including the current year covering 81.3 %.

Results and discussion The severity of injury and the accompanying inflammatory factors would characterize a rapid resolution or a more severe course of post-traumatic hemarthrosis during treatment. The combination of several variants of inflammation can lead to the development of complications including osteoarthritis in cases that show mechanisms of chronic systemic inflammation of low intensity being manifested at the time of injury; ankylosis of the joint resulting from chronic systemic inflammation of low intensity involving degenerative processes. Synovitis, as a complication of post-traumatic hemarthrosis, should be differentiated with signs of low-grade inflammation, chronic course of classical inflammation and presystemic inflammation (purulent arthritis) in view of the inflammation theory.

Conclusion The analysis of modern literature has shown the complexity and versatility of aspects of inflammation in posttraumatic hemarthrosis. The lack of emphasis on the assessment of the inflammatory response in rehabilitation of patients with post-traumatic hemarthrosis can result in complications causing preconditions for the development of osteoarthritis, ankylosis, synovitis.