Introduction The rates of hand injuries in the structure of total of injuries range from 30 to 50 % in recent decades. The improvement of approaches to the choice of optimal options for treatment of injuries of the distal phalanges of fingers that ensure the preservation of anatomical integrity and function of fingers remains relevant.

The purpose of the work was a comparative analysis of the clinical efficacy of various methods for surgical treatment of trauma to the distal phalanx of fingers.

Methods Forty-seven patients (18 men and 29 women, mean age 34.2 ± 13.3 years) with injuries to the distal phalanges of the fingers were examined and treated. The patients were divided into 2 groups. Group 1 (comparison) was 25 patients. Conventional approaches to the formation of finger stumps were used by shortening the bone part of the phalanx, forming two opposite flaps and applying several interrupted sutures; group 2 (main group) were 22 patients treated according to the surgical tactics developed by us. The proposed tactics of reconstructive plasty of the defects in the nail phalanges of three joint fingers involves the formation of a stump of the nail phalanx with a visual effect of elongation of the phalanx due to local or cross-plasty with dermo-fascial flaps. Comparison of treatment results in the groups of patients was performed 1, 3, 6, 12 months after reconstruction operations.

Results It was established that the use of the developed surgical treatment of the injury to the distal phalanx of the fingers results in less severity (compared to the use of standard methods) of pain on days 10-21 after surgery (by 44.8-54.3 %), lower levels of the Quick DASH indicators after 3-12 months, decrease in Vancouver scoring of skin scar severity changes after 6-12 months, higher patient satisfaction with the functional result of treatment. Based on the results obtained, a diagnostic and treatment algorithm for providing medical care to hand injuries has been proposed.

Discussion The results of the study indicate the effectiveness of the developed method of plastic surgery of fingertip defects of nail phalanges in the three joint fingers by moving the palmar-lateral and dorsal-lateral blood-supplied flaps from the fingers of the same name and neighboring fingers without shortening the bone stumps of the nail phalanges while achieving an esthetic result by visual lengthening of the fingertip phalanx. Based on the results obtained, a diagnostic and treatment algorithm for providing medical care to patients with finger injuries has been proposed.

Conclusion The proven method improves the results of reconstructive surgical interventions in the treatment of fingertip defects the of tnail phalanx in three joint fingers.

Introduction More than 80% of injuries to the acetabulum involve its posterior parts or injuries associated with their destruction. Most poor outcomes of surgical treatment of acetabular fractures manifest themselves in the first 24 months. Surgeons consider accurate anatomical reduction of fragments to be the main predictor of good results. A number of researchers showed good results of its surgical treatment, including those with inaccurate reduction. Poor results also occur in patients with no risk factors and ideal reduction. Thus, inaccurate reduction does not always lead to poor results; the reasons for positive results have not been discussed.

Purpose To evaluate the effect of maintaining hip joint isometry in surgical approach on the outcome of reconstructive operations in the treatment of traumatic destruction of the posterior parts of the acetabulum.

Materials and methods From 2005 to 2021, surgeons from the Moscow Regional Research and Clinical Institute performed 120 reconstructive operations on 120 patients with fractures of the posterior structures of the acetabulum. Of these, 84 patients followed the recommended monitoring regimen, completed the Harris Questionnaire, and had radiographs taken within the specified time frame. From the 84 patients, two groups of 42 patients each were formed that differed in the method of treating the external rotators.

Results During two years of follow-up after reconstructive surgery on the acetabulum, clinical indications for hip replacement were identified or hip replacement was performed in 5 patients in the first group and in 25 patients in the second (11.9 and 59.5%, respectively).

Discussion Accurate reduction of fragments is considered to be the main condition for good results after reconstructive operations for fractures of the posterior part of the acetabulum.Maintaining the isometry in the joint, namely, cutting off and then reinserting external rotators while preserving the attachment sites and length of the muscles, can have a significant impact on the outcome of reconstructive operations for traumatic injuries of the posterior parts of the acetabulum due to maintaining isometry of the hip joint. It seems that the preservation of force vectors centering the femoral head in the acetabulum causes the growth of ossification that forms secondary congruence.

Conclusions Maintaining hip joint isometry in surgical treatment of fractures of the posterior acetabulum by changing the method of treating the external rotators provides significantly better clinical outcomes.

Introduction Currently,there is no consensus regarding optimal treatment options of Achilles tendon rupture. The purpose of this study was to evaluate long term results of Achilles tendon repair using different surgical techniques, assess complication rate and subjective satisfaction

Methods The study included patients treated for Achilles tendon rupture using minimally invasive and open surgical repair. Complications including re-rupture, infection, deep vein thrombosis and neuropraxia were identified. In order to evaluate the factors influencing the risk of postoperative complications, logistic regression analysis was performed. The Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Score (AOFAS) evaluated subjective outcomes.

Results 130 patients with Achilles tendon tear were enrolled (123 primary and 7 revision cases). In primary repairs percutaneous technique was used in 60 % of cases (74/123), mini open technique – in 16 % (19/123), and open technique – in 24 % (30/123). Re-rupture occurred in 2.4 % of patients treated with minimally invasive techniques. There were no repeated ruptures following open repairs. Predominant number of infections was registered after open repairs and made 10 %, while minimally invasive techniques had 3.2 % of infections. Logistic regression analyses showed that steroid injection, open repair, application of tapes and autografts increased the risk of infectious complications. There were no significant differences in ATRS and AOFAS scores between different primary Achilles tendon repair techniques (p > 0.05).

Discussion Results, obtained in the current study, are consistent with previously published data.

Conclusions Open Achilles tendon repair showed a higher rate of infections, and lower rate of re-ruptures. The anamnesis of steroid injection, open repair, application of tapes and autografts increases the risk of infectious complications.

Background Fibular hemimelia (FH) is a congenital disease manifested by valgus deformity and instability of the knee joint, shortening and deformity of the tibia, hypoplasia and deformities of the foot and ankle.

The aim of this paper was to determine the efficacy of the strategy of separate reconstruction of the foot along with correction of tibia deformity, and then tibial lengthening in patients with FH of types 3 and 4 according to Paley.

Methods This retrospective study is based on an analysis of the treatment of 12 children with severe FH. The patients, aged no older than 24 months, were treated for foot reconstruction along with correction of tibial deformity followed by a separate stage of tibial lengthening. Tibial lengthening was performed in the age 4.6 ± 1.2 years. The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire.

Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. The results of lengthening were classified by Lascombes as IA in 7 cases, IB in four cases, 2B in one case.

Discussion In severe FH, the question of reconstruction or early amputation remains open. There are two opinions on the staging of reconstructive orthopedic surgery and tibial lengthening in young children with severe FH.

Conclusion The strategy of reconstruction of the foot and ankle joint at an early age (16-24 months) in children with severe FH followed by lengthening of the lower leg (at the age of 4-6 years) proved to be effective and can be used when it is chosen by the patient's parents. In 3C type cases, the use of external fixation to correct the deformity and simultaneously lengthen the tibia at the first stage is an alternative reasonable strategy option.

Introduction Elbow trauma is common accounting for 40-50 % of all musculoskeletal injuries in children. From them, lateral condyle fractures are the second most common fractures in the pediatric elbow with complications ranging from 3.3 to 54.8 %.

The objective was to determine the effectiveness of nonunion of the lateral humeral condyle (LHC) treated with bone grafts harvested from the patient's fibular shaft and the Ilizarov apparatus.

Material and methods We report surgical treatment of bone defect repaired with bone graft and the Ilizarov apparatus in 57 children with nonunion of the LHC. Maintained articulation between the non-united bone and the radial head, magnitude and direction of displacement, visible resorption of the epimetaphysis, bone deficiency, malaligned upper limb, late ulnar neuritis were the parameters used for outcome assessment. Depending on the type of surgical treatment the patients were divided into 3 groups: Group 1 (n = 13) included patients who underwent open osteosynthesis and bone fixation using 2-3 Kirschner wires; Group 2 (n = 30) consisted of patients who underwent surgery to repair the bone defect between the humerus metaphysis and an non-united fragment of the LHC fixed with wires and immobilized with a cast; Group 3 (n = 12) included patients who were treated with bone graft followed by fixation of the bone and the graft using Ilizarov wires and frame. Two patients underwent supracondylar osteotomy.

Results The outcomes were evaluated based on criteria to include non-union consolidation, joint function, limb alignment and condition of the growth plate. Long-term results were explored in 49 (85.9 %) patients out of 57 over a period of 6 months to 10 years. The results were rates as good in 39 (79.6 %) patients, as fair in 9 (18.36 %) and poor in one (2.04 %) case.

Discussion Various types of operations are reported for non-united fractures and non-unions of the cervical spine to include surgeries from open osteosynthesis to complicated reconstructions.

Conclusion Surgeries aimed at repair of bone defects using fibular autograft facilitated consolidation of non-unions and engraftments.

Introduction Among the generally accepted theories of the etiology and pathogenesis of palmar fascial fibromatosis, the role of infectious factors has not been considered; however, there are references to fungal skin lesions in patients with advanced contractures and several studies that identified fungal infection in surgical material from such patients.

The purpose of the work was to assess the pathogenetic and clinical significance of fungal infection of the palmar fascia in Dupuytren's contracture.

Materials and methods We studied 41 medical records of patients operated on for Dupuytren's contracture in stages II-IV. The surgical material was examined at the light-optical level (hematoxylin-eosin and methenamine-silver PASM stains) and with scanning electron microscopy.

Results Fungal infection of the palmar aponeurosis was detected in 20 out of 41 patients; various types of tissue reaction to the introduction of fungi into the palmar aponeurosis and the blood vessels perforating it were found. Groups of patients without signs of fungal invasion (n = 21) and with signs of fungal infection of the palmar aponeurosis (n = 20) were comparable in clinical and demographic characteristics, but significantly differed in the rate of early relapses, 0 versus 25 % in the group with fungal infection (p = 0.02).

Discussion The immunogenetic characteristics of patients with palmar fascial fibromatosis and characteristic skin lesions create general and local conditions for the introduction of fungal flora.

Conclusion Histological detection of pseudohyphae of the genus Candida in the palmar aponeurosis and the lumens of blood vessels in patients with Dupuytren's contracture verifies invasive candidiasis; the relationship between fungal infection of the aponeurosis and an increased rate of early relapses of contracture has been statistically proven. To increase the duration of the relapse-free period and potentially the life expectancy of patients, consultations with infectious disease mycologists and correction of modifiable risk factors for candidiasis are necessary.

Background Bone age is essential for pediatric patients with active growth zones and anteromedial instability to facilitate optimal treatment strategy and minimize postoperative complications. However, many people are unaware of various tools for determining bone age, including classical methods and modern machine learning techniques.

The objective was to show and compare different methods for calculating bone age and determining surgical strategy for patients with anteromedial instability of the knee joint.

Material and methods All-Inside anterior cruciate ligament reconstruction was performed for 20 patients. Wrist radiographs were performed for bone age assessment using the "point scoring system" of Tanner and Whitehouse and the "atlas matching" method of Greulich and Pyle. Machine learning programs were used in addition to standard bone age assessments.

Results The findings showed an average difference of 21 months (80 %) in a group of 20 individuals with bone age ahead of the passport age and an average difference of 18 months (20 %) in patients with retarded bone age.

Discussion The findings showed the difference between chronological and bone age and could be encountered in scientific articles on endocrinology and pediatrics. No scientific studies on the use of the methods could be found in the specialty “trauma and orthopaedics”.

Conclusion Bone age assessment, prediction of children's target height are essential for surgical treatment of patients with open growth plates.

Introduction To date, a wide variety of synthetic materials, including metals, polymers and ceramics, have been proposed and used as a substitute for bone grafts in the field of traumatology/orthopedics, neurosurgery and oral and maxillofacial surgery (OMFS). However, the most studied materials are calcium phosphate ceramics (CPC), in particular hydroxyapatite and tricalcium phosphate, as well as their mixtures, called byphasic calcium phosphates. This interest stems from the fact that the main component of bone is the apatite mineral calcium phosphate. Hydroxyapatite and tricalcium phosphate are among the most commonly used and effective synthetic substitutes for bone grafts. They have not only osteoconductive properties, but also osteoinductive. These properties, combined with cell-mediated resorption, ensure complete regeneration of bone defects. This study will analyze existing clinical trials, registered on the clinicaltirals.gov website, on the use of hydroxyapatite and tricalcium phosphate in the field of traumatology and orthopedics, neurosurgery and OMFS.

Aim To identify the potential for clinical use, as well as possible side effects, of CPC as a replacement for bone grafts.

Materials and methods The search strategy was to use material from the clinicaltrials.gov website, which focused on key terms such as hydroxyapatite, tricalcium phosphate, hydroxyapatite and tricalcium phosphate, traumatology and orthopedics, maxillofacial surgery, dentistry, neurosurgery, bone, и diseases of the musculoskeletal system.

Results and discussion As of November 2022, there were approximately 85 clinical trials with hydroxyapatite application, approximately 49 clinical trials with tricalcium phosphate, and approximately 16 clinical trials with the hydroxyapatite/tricalcium phosphate combination. Most of the studies were Phase 1-2, Phase 2, or Phase 4. Most focused on tibial trauma therapy, osteoporosis/osteopenia, alveolar bone resorption, and spinal surgery. It was found that full results were published only in 3, 7 and 2 clinical trials on the use of hydroxyapatite, tricalcium phosphate and their combination, respectfully. All clinical trials had similar preparation methods and all of those clinical trials produced positive results without serious side effects.

Conclusion There is a wide potential for clinical use of CPC as synthetic bone graft substitutes without reports of serious side effects. Many preclinical and clinical studies are currently underway on the use of hydroxyapatite and tricalcium phosphate, and their future results will further explore their clinical potential.

Introduction Non-surgical treatment of osteoarthritis is aimed at managing joint degeneration and inflammation to prolong the life of the original joint and delay total joint replacement. The objective was to pathomorphologically substantiate preclinical effectiveness of PRP in OA using comparative analysis of depleted plasma and serum.

Material and methods The experiment was performed in 120 Wistar rats, divided into 4 groups. Osteoarthritis was simulated using an original method. Knee joint injection given to the animals after skin dissection under inhalation anesthesia and visual control two weeks later contained 0.05 ml PRP in group 1, 0.05 ml plasma in groups 2 and 0.05 ml blood serum in groups 3. The same volume of physiological saline solution was used for the injections produced for control animals. Injections were administered three times at 2-week intervals. Animals were sacrificed in groups of 10 at 2 weeks of each injection.

Results The median MANKIN value scored 2.0 (1.0; 2.0) in group 1, 6.0 (5.0; 7.0) in group 2 and 7.0 (6.0; 7.0) in group 3 at 6 weeks. The median MANKIN value scored 7.5 (7.0, 8.0) in the control group. Statistically significant differences were determined between the groups at p < 0.001.

Discussion Literature data on preclinical evaluation of the effectiveness of PRP therapy in biological models of OA are controversial. An original, low-traumatic functional method was used for simulating knee OA to reproduce major pathogenetic mechanisms in rats.

Conclusion The findings suggested a pronounced therapeutic effect with improved morphofunctional features of the hyaline cartilage and MANKIN score of 2 at 6 days of intra-articular administration of modified PRP as compared with plasma and serum.

Introduction Many different suture configurations and pathomorphology of tendon repair have been described for tendon repair over the past 20 years. However, the biomechanical properties of suture material at primary flexor tendon repair have not been sufficiently explored. A cyclic loading test is performed to evaluate the performance of the different sutures under repeated loading conditions simulating dynamic conditions in postoperative rehabilitation procedures.

The objective was to compare the strength of suture materials under cyclic loading on a biological model of a tendon.

Material and methods Eighty porcine digital flexor tendons were examined in a pilot study. The sutured tendons were tested with a universal testing machine. Tendon repair was produced using polypropylene in group I, braided polyamide suture in group II, complex polytetrafluoroethylene thread in group III and a thread of superelastic titanium nickelide in group IV. The standard Chang protocol was used for cyclic loading.

Results The percentage of intact sutures was 25 % in group I and in group II, 80 % in group III and 85 % in group IV after completing the entire load cycle. A pairwise comparison showed suture disruption being more common for group I and group II as compared to group III and group IV. Irreversible gap was more common for group 1 as compared to group IV. Neither knot ruptures nor tissue cutting were seen in the groups.

Discussion The topic of biomechanical properties of suture material remains poorly understood. Although static load testing is commonly used in current experimental studies and cyclic testing is suitable for simulating postoperative conditions. The search continues for the “ideal” suture material for flexor tendon repair to prevent tears and retain tensile properties until the repair reaches strength.

Conclusion The threads of polytetrafluoroethylene and nickelide-titanium showed the best biomechanical properties for tendon repair in the form of linear strength, good elasticity and low plasticity of the suture material. There were no significant differences between polypropylene and braided polyamide threads.

Introduction Thermal injury to the palmar surface of the hand is usually complicated by flexion desmogenic contracture of the finger joints. This condition is more complicated with significant wound areas and depths of soft tissue destruction. Conventional surgical methods and soft tissue reconstructions may fail to provide full restoration of the hand function.

The objective was to present the optimal treatment strategy for patients with scar flexion contractures of the fingers after thermal injury to the palmar surface of both hands using a pediatric case report.

Material and methods A child aged 2 years and 4 months underwent surgical treatment to include excision of scars, skin grafting of both hands with a vascularized fasciocutaneous flap raised with the radial artery.

Result The patient could regain all types of hand grip on both sides 12 years after surgical treatment. Both hands were aesthetically acceptable.

Discussion Treatment of patients with thermal injury and substantial soft tissue damage is a complex disease process. Conservative treatment and surgical procedures using non-vascularized skin flaps are normally used for the condition. These approaches are associated with cicatricial and arthrogenic flexion contracture of the finger joints. The radical treatment includes thorough wound debridement and early flap coverage and wound closure using a flap with an axial-pattern blood supply, free flaps and reverse-flow flaps. The surgical approach helps to avoid flexion contracture of the fingers initiating early restoration of professional, social stereotypes and stereotypes in everyday life.

Conclusion The clinical observation has shown the possibility of one-stage organ-preserving surgical treatment using flaps with an axial blood supply.

Background Ceramic materials are currently in wide demand in various fields of medicine. Zirconium ceramics demonstrate exceptional mechanical properties and biocompatibility and do not cause cytotoxic effects or allergic reactions in surrounding tissues.

The objective was to present an analysis of current literature data on the use of zirconium ceramics as a bone replacement material in traumatology and orthopaedics.

Materials and methods The search for publications was conducted using the databases of Scopus, PubMed and the electronic scientific library eLIBRARY in the Russian and English languages using the keywords: bioceramics, bone, bone defect, zirconate, zirconium ceramics, bone tissue engineering, implant, scaffold, augment, biointegration, bioactivity. Depth of search for scientific papers was from 2000 to 2023.

Results and discussion Zirconium dioxide is the main ceramic bioinert material. The study presents the characteristics of ZrO₂ as a bone replacement material and its comparison with titanium implants. Data are presented on various strategies for improving zirconium bioceramics: improving the surface of the material by physical and chemical methods, obtaining volumetric porosity, including using additive technologies, creating composite materials, and developing bioactive coatings. New methods of creating zirconium ceramics compatible with living tissues containing bioactive ions that promote both osseointegration and bone tissue regeneration have been actively studied.

Conclusions Zirconium dioxide ceramics appear to be a promising alternative to titanium implants in terms of mechanical strength, biological functionality, chemical stability, osseointegration, and antibacterial properties. Future experimental and clinical studies will further improve zirconium ceramics.

Introduction Bone defect management is a critical stage of treatment and rehabilitation that still remains a challenging problem for traumatologists and orthopaedists. The need for tissue engineering techniques is due to limited abilities of the human body to correct bone tissue autoregeneration, especially in comorbid and elderly patients with osteoporosis. Bone autografts is a gold standard in those cases but is associated with certain restrictions. Regenerative medicine and stem cell biology development opened up capabilities to employ new methods for enhancement of bone tissue repair. A special interest of researchers is focused on mesenchymal stem cells and extracellular vesicles for bone tissue regeneration optimization.

Purpose of this review was to show mesenchymal stem cells and exosomes effeciency in bone defect treatment.

Materials and methods Open electronic databases of scientific literature, PubMed and e-Library, were used. The literature data search was carried out using the keywords: regenerative medicine, bone defects, exosomes, mesenchymal stem cells.

Results and discussion The review presents current ideas about mesenchymal stem cells, their microenvironment and exosomes influence on bone tissue repair. Clinical need in effective bone regeneration is still high. Mesenchymal stem cells and acellular regenerative treatments have shown good results in bone defects repair and are perspective directions. Productive use of mesenchymal stem cells and exosomes in bone defects treatment requires further study of their mechanisms of action, the regenerative techniques efficacy and safety evaluation in preclinical and clinical studies.

Conclusion The use of mesenchymal stem cells and cell-free regenerative approaches has demonstrated good results in the restoration of bone tissue defects and is a promising direction.

Introduction Despite the large number of articles on complications associated with surgical lengthening, information about such a complication of transosseous distraction osteosynthesis as failed bone regenerate (called hypoplastic in foreign literature) is extremely rare. There are no methods for predicting the restructuring of the regenerate and clinical recommendations for the management of patients at various stages of reconstruction of the distraction regenerate. This entails a long period of immobilization and severe complications.

The objective of the work was to define the notion of inadequate (“ischemic”/hypoplastic) bone regeneration and the problem of its formation as a complication during surgical limb lengthening

Material and methods The PubMed database and the eLIBRARY scientific electronic library were used to select sources for a systematic literature review. The sources published between 1997 and 2020 were selected

Results and discussion Ineffective distraction bone regenerate is a complication of surgical segment lengthening with the shape and/or structure of the newly formed bone preventing functional load on the segment. There is a general tendency with bone elongations being greater than 15-20 % to significantly reduce biomechanical properties of the distractional regenerate bone. Patients' age at surgical lengthening is not reported as a risk factor for distraction regenerate fractures and a history of adverse events and complications is regarded as an additional risk factor. Inadequate (unstable) distraction regenerate bone includes morphotypes III-V and structural types 1, 5, 7 as classified by Ru Li. There are no clinical guidelines for operational strategy. Failed distraction bone regeneration as a complication of distraction osteosynthesis was reported by different authors between 1997 and 2020. There are conflicting statistically unreliable data regarding a risk for regenerate bone to develop into a less stable type. The surgical options presented have no statistical significance (occasional case reports) and do not describe all possible clinical scenarios.

Conclusion The problem of failed distraction regeneration and impaired organotypic restructuring remains one of the most important problems in limb lengthening. Inadequate formation and restructuring of newly formed bone can be caused by many factors including anatomical, physiological and technological aspects that would require further comprehensive study.

Introduction The optimal surgical approach for malleolar fractures and distal tibiofibular syndesmotic (DTFS) disruption remains controversial. There is no uniform treatment protocol for this type of injury.

The objective was to review modern surgical treatments of the pathology and determine the optimal option.

Material and methods Articles of French, English, Uzbek, Kazakh, German, Danish, Japanese and Chinese authors were retrospectively reviewed. An internet search of MedLine; PubMed; Scopus; Web of Science, CINAHL, the Cochrane Central Register of Controlled Trials databases was performed.

Results Comparative studies of dynamic fixation and static fixation of the DTFS showed advantages of the dynamic methods enabling precise, anatomical syndesmotic fixation and faster healing. Dynamic fixation methods would require no implant removal, while syndesmotic screw woul be taken off to reduce compression in the ankle joint and minimize a risk of malreduction facilitating mobility of the ankle joint. Dynamic methods are associated with greater stability and less complication rate. However, static methods have the advantages of being more accessible and less expensive, which can be an important factor choosing a treatment method. Static methods are a wide application and can be used in a wide range of clinical cases. Long-term results show no statistically significant differences between dynamic fixation and static fixation.

Discussion Literature review indicates the dynamic method with suture-button, a combined method and titanium cable isotonic annular fixation system as the preferred technique for surgical stabilization of distal syndesmosis associated with ankle fractures with a lower risk of postoperative complications and the possibility of short-term rehabilitation.

Conclusion The choice between dynamic and static methods of distal syndesmosis fixation depends on many factors, including the complexity of the injury, the availability and cost of implants and the experience of the surgeon.

Introduction A coronavirus, SARS-CoV-2, called COVID-19 by the WHO has caused a pandemic of respiratory illness killed more than 6 million people. The severe infection has a significant negative impact on the entire musculoskeletal system.

The objective was to summarize literature data on the mechanisms of the condition and identify musculoskeletal symptoms of COVID-19.

Material and methods An internet search of PubMed, MedLine and eLIBRARY library databases using the search terms: COVID-19, aseptic osteonecrosis, post-COVID-19 syndrome, arthropathy, musculoskeletal system, spondylitis, osteoporosis was performed.

Results and discussion Musculoskeletal symptoms of COVID-19 are reported in 31-59% of cases. Mechanisms of musculoskeletal involvement of coronavirus infection include cytotoxic effect of the virus on osteogenesis cells, vascular inflammation and coagulopathy, “cytokine storm”, side effects of drug therapy and hypoxia. According to an etiological factor, musculoskeletal manifestations of SARS-CoV-2 include autoimmune (reactive arthritis, sacroiliitis, ankylosing spondylitis, axial spondyloarthritis, psoriatic arthritis) conditions caused by impaired circulation of bone tissue (aseptic osteonecrosis), infectious (septic arthritis, spondylitis, spondylodiscitis) and metabolic (osteopenia, osteoporosis) conditions.

Conclusion It has been established that COVID-19 infection has a negative impact on the musculoskeletal, endocrine and immune systems increasing the risk of degenerative diseases of the musculoskeletal system and infectious complications in orthopaedic patients early post surgery.