Background One of the most common reasons of patients’ visits with complaints in the area of the elbow joint is epicondylitis of the elbow joint. Surgical treatment is recommended if conservative treatment fails after 6-12 months. Arthroscopy of the elbow joint is one of the current surgical methods of minimally invasive interventions on the elbow joint. Purpose To conduct a comparative assessment of the effectiveness of treating epicondylitis of the elbow joint using modified arthroscopic and open techniques Methods A prospective cohort-controlled study was performed on 120 patients. The patients were divided into two groups: group 1 – patients operated on by the open method (control), group 2 – patients operated on by the arthroscopic method. Additionally, depending on the nosology, the patients were divided into four subgroups. Functional results were assessed using VAS, DASH, MEPS; additionally, dynamometry was performed before surgery, and 1, 3 and 12 months after surgery. Results There is a significant improvement in the function of the elbow joint one month after surgical treatment, mainly in III and IV subgroups according to the MEPS scale, p = 0.0001. According to the VAS scale, a pronounced and persistent decrease in pain in the long-term period compared with the preoperative period was revealed in patients of the arthroscopic subgroup p = 0.0001. According to the DASH questionnaire, the functional results in patients of arthroscopic group in the postoperative period significantly exceeded over the open method p < 0.001. Discussion The use of the open surgical method provides good or excellent functional outcomes of treatment in 75-85 %. However, it has a number of disadvantages, including infectious complications and the inability of the surgeon to identify and completely remove the pathological altered tissues. The arthroscopic technique allows leveling these shortcomings and obtaining up to 95‑100 % excellent functional results. Conclusion Based on the data obtained in this study, the reatment of patients with epicondylitis of the distal humerus according to the developed arthroscopic technique significantly improves the functional state of patients, which, in turn, improves their quality of life.

The objective was to evaluate the efficacy and safety of closed transosseous osteosynthesis in the treatment of patients with diabetic Charcot neuroosteoarthropathy at the acute radiographically positive stage (Eichenholtz 1-2) with hindfoot and midfoot deformity and immobilization using Total Contact Cast. Material and methods Eight patients of the treatment group underwent closed deformity correction and Ilizarov external fixation. The frame was removed with radiographic signs of consolidation and conservative methods of fixation and off-loading employed. The control group consisted of 11 patients who received outpatient conservative treatment with Total Contact Cast combined with crutches. Results The treatment length of surgical patients prior to the use of orthopaedic shoes was shorter than that of patients treated conservatively. Foot ulcers seen in the conservative group during the observation period were not detected in the surgical cases and were associated with the lack of deformity correction. Discussion The advantage of operative reconstruction includes more stable foot and lower risk of ulcers. Reduced rehabilitation period improves the patient's quality of life. Complications that developed in the treatment group were resolved and had no effect on the outcome. Conclusion Closed deformity correction using transosseous osteosynthesis can be an option for patients with diabetic Charcot neuroosteoarthropathy at the acute radiographically positive stage as compared to the conservative treatment.

Introduction Self-reporting of well-being by patients with disorders of the musculoskeletal system is of value and might be considered in decision making. The international orthopedic community recommends to use the questionnaires FADI, FAAM and SEFAS for assessing the function of the foot and ankle in different conditions, including changes after surgical treatment. The aim of the study was linguistic validation and cross cultural adaptation of the Russian versions of FADI, FAAM and SEFAS measures, including their testing in the population of patients with different foot and ankle disorders. Methods In accordance with current international recommendations, the linguistic and cultural adaptation of FADI, FAAM and SEFAS questionnaires included the procedure of their forward and back translations, testing of the Russian versions via patients’ interviews, expert evaluation of Russian versions by specialists and decentering. Results Test versions of FADI, FAAM and SEFAS questionnaires in Russian were created. The tools were tested in the group of 40 patients with different foot and/or ankle joint disorders, including 10 athletes. The majority of items and questions of the tools were clear, comfortable and easily understood by patients. Based on the results of interviewing, an acceptable indicator of external validity of the Russian versions of the three questionnaires was established; according to the results of a survey by specialists (n = 14), their content validity was confirmed. Due to the fact that some questions of the questionnaires were difficult to understand for > 15% of patients, at the decentering stage, clarifying statements were made to the wording of two questions of the FADI and FAAM questionnaires and one question of the SEFAS questionnaire, what enabled to maximally adapt the new language versions of the questionnaires to the ethno-linguistic features of the Russian language patient population. Discussion Due to the fact that some items of the questionnaires caused misunderstanding and were difficult to understand, clarifications were made to the wording of these items. The final versions of the FADI, FAAM and SEFAZ questionnaires were approved by the Expert Council in accordance with the results of decentering and on the basis of available recommendations. In general, good substantive validity of all three Russian versions of the questionnaires, FADI, FAAM and SEFAS, has been demonstrated. Conclusion The final Russian versions of the FADI, FAAM and SEFAS questionnaires were developed through linguistic validation and cross-cultural adaptation that are equivalent to their original versions and correspond to the ethno-linguistic features of the population. Their use in research and clinical practice is possible after assessment of psychometric properties of these tools.

Introduction World literature data indicate the involvement of mast cells in the pathogenesis of Dupuytren's disease. There is no information on the content of mast cells in the pathologically altered palmar fascia of patients depending on the severity of the contracture. Purpose To study changes in the number, location and degranulation activity of mast cells in the palmar aponeurosis with Dupuytren's contracture of varying severity. Material and methods Histopathological study of surgical material from 52 patients (49 men and 3 women) with Dupuytren's contracture (age range 35-78 years, mean age 59.12 ± 1.25 years) using histomorphometry of epoxy semi-thin sections stained with methylene blue – the main fuchsin. Patients were divided into two groups: group 1 with 1‑2 (n = 16) and group 2 with 3-4 (n = 36) grades of the contracture. Results In group 2, the location of mast cells among contractilely altered collagen fibers of dense connective tissue was recorded more often than in group 1. In group 2, compared with group 1, the following significantly increased: the median number density of mast cells – by 33.79 % (p = 0.0508), the median area of mast cells – by 48.40 % (p = 0.0008) and the index mast cell degranulation – by 94.68 % (p = 0.00000001). Discussion Along with a change in the typical location of mast cells, objective evidence of an increase in their number, activation and degranulation in patients with severe contractures was obtained. Conclusion The obtained results indicate the role of mast cells in the progression of Dupuytren's contracture and expand the understanding of potential therapeutic targets.

Introduction Currently, orthopedic hexapods have been effectively used for long bone, foot and large joint deformity correction in both adults and children. Previous studies demonstrated the superiority of the reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) in comparison with other designs of external fixation devices. However, the reduction capabilities of the minimized version of this hexapod (minimized Ortho-SUV Frame, OSFm) have not been studied yet. Purpose To identify the reduction capabilities of OSFm compared to OSF. Materials and methods The bench test was performed using plastic models of the tibia osteotomized at the middle third of the shaft. One-ring modules were used to fix each of the bone fragments. In the first series of the experiment, the reduction capabilities of OSFm with a standard strut size and in the second series OSF with a short strut size were studied. In each series of experiments, three groups were studied depending on the method of fixing the struts to the rings: directly to the ring, using straight plates, and using Z-shaped plates. Reduction capabilities were assessed by the maximum displacement of the distal bone fragment relative to the proximal one in distraction, translation, angulation, and rotation. Results The magnitude of the maximum distraction of OSF and OSFm with fixation of the struts directly to the rings and with the use of straight plates is the same (p > 0.05). With Z-plates, OSFm outperforms OSF by 27.3 %. OSFm surpasses OSF by 2.8-29.3 % in terms of the planar-parallel movement. OSFm surpasses OSF by 29.6-55.4% in terms of angular movement capabilities. The study of rotational movement found that OSFm exceeds the capabilities of OSF by 20.3-41.3%. Conclusion The findings obtained indicate that OSFm, in comparison with OSF, has better deformity correction capabilities.

IIntroduction Sciatic nerve neuropathy is common pathology. Development of endoscopic method of decompression and neurolysis is extremely prospective. Objective Analyze the results of endoscopic decompression of sciatic nerve at a 1-year follow-up. Material and methods 15 patients (11 females – 79 %, 4 males – 21 %) were included into the study and were treated in the period from 2018 to 2022. Endoscopic sciatic nerve neurolysis and decompression were performed. Mean age of the patients was 47 ± 16 years. The severity of pain according to VAS was 8 ± 1. Motor dysfunction according to the BMRC scale was 2.6 ± 1.7 points. Degree of sensitive dysfunction according to Seddon scale was 2.9 ± 0.9 points. Functional activity of the lower limb according to LEFS scale was 49 ± 7 points. Results The severity of pain one year after surgery according to VAS scale decreased to 2.8 ± 2.6 cm. Degree of motor dysfunction according to BMRC scale became 4.4 ± 0.8 points. Degree of sensitive dysfunction according to Seddon scale became 3.7 ± 0.4 points. Functional activity of the lower limb according to LEFS scale increased to 68 ± 8.7 points. Efficacy of surgery in our study was 80 % (12 patients), there was one complication after surgery (6.7 %). Discussion Our study obtained clinical results that are comparable with the data of domestic and world literature. Conclusion Endoscopic decompression of sciatic nerve is an effective and low-traumatic method with a low rate of complications, which allows for pain relief, promotes restoration of function of the sciatic nerve and lower extremity.

Introduction Stenosis of the cervical spine can lead to serious complications resulting from spinal cord dysfunction. There are different methods of posterior decompression of the spinal canal. The method of choice for surgical treatment of cervical stenosis is laminoplasty. Purpose Analysis of long-term (from 2 to 5 years) results of clinical outcomes after bilateral decompression laminoplasty and simultaneous foraminotomy Materials and methods Study design: case series (27 patients); a single center retro/prospective study. Patients who were treated at the Federal Center for Neurosurgery in Tyumen were examined. In the pre- and postoperative periods, the clinical condition of patients was assessed using questionnaires and scales JOA, VAS, Nurick. The stenosis severity was objectively assessed using a standard closed polygon measuring instrument. The cross-sectional area of the dural sac and the average linear dimensions were measured according to neuroimaging data. Results In the late postoperative period, patients had positive dynamics in pain relief, improvement in motor functions, and partial recovery of sensory disorders. There was a slight increase in the average cross-sectional area of the dural sac measured at the follow-up. Discussion The method of bilateral osteoplastic laminoplasty is one of the surgical treatment options and allows full visualizing of the neurovascular structures, as well as safe performance of hemostasis and foraminotomy at the levels of interest. Conclusion Thus, the effectiveness of this technique was shown by this study.

Introduction Improving the results of treatment and rehabilitation is essential for polytrauma patients. The aim of the study was to prove the effectiveness of terahertz electromagnetic waves (TEW) in polytrauma patients early after traumatic event to improve immune parameters. Material and methods The study included 20 polytrauma patients who were divided into two groups. Patients of the treatment group (n = 10) received TEW early after traumatic event in addition to standard treatment using the damage control approach. Control patients (n = 10) received no TEW therapy in the complex of therapeutic measures. Immunological studies were performed during treatment. The effectiveness of rehabilitation was assessed at a long term using an evaluation scale. Results The mean rehabilitation score was significantly higher in the treatment group compared to the controls. The treatment group showed significantly higher production of TNFα and IL-2, spontaneous production of IFNγ by lymphocytes, phagocyte activity (NBT-test) and absorption activity of monocytes after the use of TEW in comparison with controls. An increased level of IgG and IgM was also noted in patients of the treatment group. Discussion The findings showed that the use of TEW in polytrauma patients early after traumatic event resulted in the increase in cytotoxic activity of lymphocytes and phagocytic cells. The immunostimulating effect of TEW was also achieved through boosting humoral immunity. Conclusion The TEW used early after traumatic event in polytrauma patients resulted in strengthening of the immune system which contributed to more effective rehabilitation.

Introduction Idiopathic scoliosis is associated with severe spinal deformity, and prediction of scoliosis progression is important in the early stages for prevention and treatment. The objective was to identify the relationship between the serotonin blood level in children and adolescents aged 4 to 15 years and progressing scoliosis grades I-II over a five-year period. Material and methods Eighty-six children and adolescents with impaired posture and scoliosis were assigned to 3 groups according to clinical and radiological data and the serotonin level, the course of scoliosis, and the parameters were measured during 5 years. Results A significant increase in the medians, interquartile intervals of serotonin levels and the curve angle was observed in the group of progressive scoliosis with higher rates seen in girls. Significant differences in the serotonin serum level were observed in the groups. Correlation analysis showed a weak relationship between the serotonin level and the curve evaluated radiologically in patients with non‑progressive scoliosis with an increase in the relationship to moderate in the progression group at 5 years. The analysis of the diagnostic efficiency of the serotonin blood level in patients with different course of scoliosis revealed the good quality of the prognostic test. Discussion The serotonin serum level had a statistically significant relationship with the progression of the curve examined radiologically. Conclusion A laboratory marker indicating progression of the curvature in children and adolescents with idiopathic scoliosis was identified. The marker included an increased serotonin blood level of greater than 270 ng/ml. The marker appeared to be practical because it could 1) be measured in the blood of children and adolescents; 2) show the dynamics in the increased serotonin level correlating with radiographic findings of the spine; and 3) indicate to the neurohumoral state of a growing body with the pathology under study. The serotonin blood level can be a marker of progressive scoliosis. The findings have been protected by an invention patent.

Introduction Sagittal and coronal balance of the body cannot be evaluated with the modern programs for musculoskeletal assessment using 3D motion capture and additional software operations are required for the measurements. The objective was to review information capacity and comparability of the quantitative assessments of the dynamic axial balance of the body using radiography and 3D gait analysis. Material and methods Comparative analysis of the information capacity of sagittal and coronal balance using radiographs and 3D gait analysis was performed in adolescents without orthopedic pathology (n = 12); untreated patients with idiopathic scoliosis (n = 53); patients with degenerative disorders of the spine (n = 15). Results Axial balance identified with 3D gait analysis showed dynamic measurements and depended on the posture during recording. There were no significant differences in the balance measurements in the samples in comparison with radiological findings with the medians being almost identical. Correlations between the balances were statistically significant in patients with degenerative disorders of the spine without clinical manifestations and in patients with idiopathic scoliosis without pain, and were not significant in patients with clinical and antalgic manifestations of vertebral pathology. Discussion Absence of statistically significant differences and close central trends in the samples indicated the comparability of the measurements in general population due to sagittal and coronal balance measured in the same patients, at different time points, in different postures and by different methods. However, significant differences in variation and a statistically significant effect of antalgic manifestations on the strength of correlation suggested that the dynamic balance measured with 3D gait analysis were more sensitive and informative to pathogenetic symptoms. Conclusions Algorithms for measurements of the axial balance using 3D gait analysis were comparable with radiographic findings and were much more informative and sensitive to antalgic manifestations of spinal pathology.

Introduction Deforming osteoarthritis is the most common articular disease, with gonarthrosis accounting for a quarter of the patients aged 50 years and over. The disease is associated with impaired function, pain, disability, reduced quality of life and requires total joint replacement in severe cases. There is no clear understanding of the causes of the disease, however, the pathogenesis is well studied. Intra-articular injection of synovial fluid prostheses including hyaluronic acid is one of the approaches to restore the properties of synovial fluid. Stabilometry that is a rare use in orthopaedics, and no use in this aspect was added to the traditional treatment effectiveness assessment. The objective was to explore biomechanical changes in patients with Kellgren-Lawrence grade II-III gonarthrosis who underwent a series of three knee injections of synovial fluid prosthesis over a period of 6 months. Material and methods An open prospective non-comparative study was performed for 30 patients with unilateral gonarthrosis at a mean age of 60 (56; 63) years. The effect of intra-articular injections of a sterile mannitol heat-stabilized biopolymer synovial fluid prosthesis on the biomechanics was evaluated in two samples using WOMAC score (overall and ≥ 30). Biomechanics was assessed in the form of stabilometry. Standardized stabilography and questionnaires were used at 3 follow-up visits: at 0 month (before administration), at 3 and 6 months. Results General sample showed no cases of true drift of the stabilogram parameters, decreased area of the statokinesiogram, and the WOMAC ≥ 30 sample demonstrated an additional improvement in the speed parameters of vertical oscillation at 6 months, a decreased area of the statokinesiogram at 3 months and at 6 months, decreased energy costs at 6 months (p < 0.05). Discussion Positive changes in stabilometry indicated a decreased pain and fatigue reactions in a vertical static position in gonarthrosis during the treatment. Most effects were statistically significant in moderate and severe dysfunction and pain. Intra-articular injection of synovial fluid prosthesis objectively improved the physiometric parameters of the support reaction. Conclusion Three intra-articular injections of a synovial fluid prosthesis based on mannitol-stabilized hyaluronic acid used in gonarthrosis Kellgren-Lawrence grade II-III showed improved body posture parameters of maintaining upright posture and reduced energy consumption in moderate and severe knee pain according to dynamic stabilometry for at least 6 months.

Introduction Pediatric and adolescent patients with aneurysmal bone cyst of the spine are normally treated by orthopaedic, neuro surgeons and oncologists. There is no consensus on the strategy and volume of preoperative and surgical treatment of the condition. There is a higher risk of pathological fracture and secondary neurological complications, tumor recurrence if open surgery is not performed in time. A second surgical intervention can hardly be avoided in such cases. The objective was to report the result of surgical treatment of a patient with aneurysmal bone cyst of the spine. Material and methods Outcome of a patient with an aneurysmal bone cyst of the L3 vertebra is presented. The technique of using therapeutic punctures as a preoperative preparation to be followed by an open surgical treatment is described. Absence of complaints and tumor recurrence, stability of the metal construct and bone fusion were the evaluation criteria. Results The patient was followed for 17 months after open surgery and CT scans showed no recurrence and demonstrated bone fusion at a long term. Discussion Many aspects of the course of the disease are to be considered in the treatment of children and adolescents with aneurysmal bone cyst of the spine. In our opinion, the step in the treatment of aneurysmal bone cyst of the spine should be considered Puncture for therapeutic and diagnostic purposes is to be performed to reduce pathological process is reduced, and the procedure to be followed by surgical intervention to remove the tumor. The strategy of surgical treatment would rely on impaired supporting columns of the spine, the degree of neural structure compression and a secondary spinal deformity. The need and extent of metal fixation is to be evaluated, potential vertebral growth identified, expediency of bone grafting after tumor removal, radical excision of the pathological focus to be considered. Conclusion The clinical case showed an effective combination of surgical techniques in the treatment of an aneurysmal bone cyst of the spine. Preoperative therapeutic puncture of the cyst allowed for reduction of the pathological process (decreasing pressure inside the cyst, thickening the cortical layer of the cyst and delimiting the tumor from the surrounding tissues), decreased volume of surgical intervention and blood loss due to a decreased activity of the pathological process compared to cases of untimely performed open surgery. Metal fixation in combination with bone auto- and allograft was practical for bone fusion.

Introduction The paper discusses the main issues of treating patients with avascular osteonecrosis of the talus. The importance of the problem of treating patients with avascular osteonecrosis of the talus is explained by its high incidence, the difficulty of diagnosis in the early stages of the disease and poor treatment results with the use of traditional methods. Рurpose Based on the analysis of foreign and domestic literature, to determine the current state of the problem of surgical treatment of avascular osteonecrosis of the talus and to identify the range of possible surgical interventions in patients with the pathology under the study, to analyze in historical retrospect the arthroplasty of the talus bone due to its total involvement in the pathological process. Materials and methods The review analyzes the literature on this topic, in which 79 foreign studies, published in the period from 1911 to 2021, were selected along with 9 domestic publications for the period from 2011 to 2021. PubMed, MedLine and eLibrary Internet resources were used to search for publications. Results Based on the literature data, the issues of the history, etiology, pathogenesis, systematization and diagnosis of this disease are highlighted. The existing methods of treatment have been analyzed along with their advantages and shortcomings. Conclusion The analysis of current professional literature has demonstrated the preference of the method of talus bone arthroplasty in its total avascular osteonecrosis, in comparison with arthrodesis of the joints of the hind foot of various extent. Nowadays, the technology of arthroplasty of the talus bone is scientifically sound, biomechanically confirmed and effective for the treatment of patients with avascular osteonecrosis of the talus bone and its consequences, while the demand for this technology has been growing all over the world. There is a constant improvement of tools, technologies, methods and materials.