Introduction Existing discrepancies in knee arthroplasty registries regarding the definition of indications for  revision TKA lead to confusion related to the identification of the leading pathology. Many works indicate not only one but several reasons for revision which makes comparison difficult. Therefore, the issue of  categorizing indications for revision TKA is a weak point of the available registries and of any large retrospective series.

Purpose To systematize the etiology of pathological conditions leading to revision knee arthroplasty.

Materials and methods The study included 361 revision knee arthroplasties. A comparative analysis of the etiology of complications of primary arthroplasty was carried out with data from national arthroplasty registries and clinical studies.

Results The main indications for revision knee arthroplasty were infection in 48.2 % of cases (174/361), aseptic implant instability (osteolysis) in 38.2 % (138/361), and instability of the ligamentous apparatus in 4.2 % (15/361). In 98 cases (27.1 %), only one type of complication was identified, and in 263 (85.2 %) more than one. Infection prevailed among early complications (126/234, 54 %) and aseptic loosening (osteolysis) (69/127, 54 %) predominated among late complications.

Discussion In our opinion, the indications for revision arthroplasty can be divided into three main etiological groups: periprosthetic infection (group I); conditions associated with a response to polyethylene wear products (osteolysis) (group 2); and biomechanical disorders, which include spatial malposition, incorrect implant sizes and all types of instability (group 3).

Conclusion Our systematization of revision arthroplasty causes can help in further research and will be useful in creating a national registry of arthroplasties in Russia.

Introduction Primary repair of the anterior cruciate ligament (ACL) torn from the femur and the synovial membrane being intact can be an indication for two competing methods including dynamic intraligamentary stabilization (DIS) as the saving method and resection of the stump and primary autoplasty as a more traumatic option.

The purpose was to evaluate the five-year results of DIS in comparison with early ACL reconstruction of the knee joint.

Material and methods A review and statistical analysis of outcomes of 72 patients with ACL injuries (47 males and 25 females) were performed. The patients aged between 18 and 45 years (30.9 ± 8.5), with the length of time from injury ranging from 3 to 21 days (10.6 ± 5.0) and the Tegner activity score of 5 (1–9; 5.8 ± 0.9) prior to injury. DIS was performed for the first group of patients (n = 39) who arthroscopically were diagnosed with  ACL torn off the femur with the synovial membrane preserved. Early ACL repair was performed for the controls (second group, n = 33).

Results VAS scored 1.4 ± 0.8 in group I and 1.9 ± 0.8 in group II at 6 months, p = 0.004. Patient satisfaction scored 8.0 ± 0.8 in group I and 7.4 ± 0.8 in group II at 12 months, p = 0.003. Tegner activity level scored 6.5 ± 0.9 in  group I and 6.3  ±  0.8 in group II at 12 months, p = 0.014. The Lysholm knee score measured 91.1 ± 2.2 in group I and 88.6 ± 3.5 in group II at 12 months, p = 0.001. Five-year dynamic observation showed relapses of anterior-medial instability of the knee joint in 10 patients (13.9 %), with 4 patients in group I (10.3 %) and 6 patients in group II (18.2 %).

Discussion Outcomes of proximal ACL tears with intact synovium can be as good as with ACL repair. Removal of the torn cruciate ligament with the synovium being intact and grafting may be an unnecessary and aggressive approach.

Conclusion Dynamic intraligamentous stabilization as compared to early ACL repair shows a faster recovery of physical activity at a short term and less relapses of knee joint instability at a long term.

Introduction The adequate, pathogenetically substantiated pain management is essential for treatment of  early stages of deforming osteoarthritis of the knee joint. There is a need to explore the effectiveness and mechanisms of modern methods of electrical therapy and their impact on the quality of life due to close cause-and-effect relationship between the pain, inflammatory and destructive components of osteoarthritis (OA) as one of the most common conditions.

The objective was to evaluate the effect of interstitial electrical stimulation (IES) as a monotherapy in  the  course of conservative treatment of early stages of gonarthrosis based on clinical and biochemical findings.

Materials and methods Radiographic findings, skin electrometry (objective parameters of pain intensity), limb weight-bearing capacity, biochemical parameters of connective tissue matrix degradation in blood serum and 24-hour urine samples, and treatment satisfaction were explored in 43 patients. Patients who received a course of IES were assigned to the treatment group (n = 22) and patients who received standard treatment without IES constituted the control group (n = 21).

Results Electrometric analysis showed a higher effectiveness of pain relief in the treatment group compared to the controls with asymmetry coefficient measuring 3.2 ± 0.31 versus 1.9 ± 0.4 at p > 0.05. The weight‑bearing scored 3.59 ± 0.34 versus 3.26 ± 0.2 at p > 0.05. The treatment group showed shorter treatment length with 13.21 ± 1.2 days versus 18.3 ± 1.2 days in the control group at p > 0.05 and a higher degree of satisfaction with outcomes scored 96.2 ± 2.59 in the treatment group versus 86.2 ± 3.17 in the control group. A statistically significant difference (p > 0.05) was established in the levels of free and total hydroxyproline characterizing the different intensity of collagen breakdown in the groups at the end of treatment.

Discussion The IES used as an analgesic and anti-inflammatory therapy was shown to be highly effective with changes in the hydroxyproline level in the media suggesting a chondroprotective effect. The analysis and  comparison of objective parameters demonstrated high effectiveness of IES in the treatment of early stages of gonarthrosis in middle-aged and elderly adults.

Conclusion The IES used for treatment of early stages of gonarthrosis helps pain reducing the intensity of collagen destruction and improving weight-bearing.

Introduction The number of surgical interventions on the cervical spine for stenosis has been constantly increasing. This fact proves that there is a need for careful preoperative preparation that would consider the complexity of the intervention and the age of the patients.

Purpose To substantiate the need to include the MSCT data processing algorithm of bone tissue density of vertebral bodies and arches to assess their quality for planning osteoplastic decompressive laminoplasty in patients with cervical spine stenosis due to degenerative changes.

Material and methods This single-center retrospective study investigated qualitative and quantitative characteristics of the spine with radiography and multislice computed tomography (MSCT) in 82 patients with degenerative diseases of the cervical spine and associated spinal canal stenosis (CSS).

Results and discussion The data obtained indicate a tendency for the total density of the cervical vertebrae to increase from C3 to C5 and to decrease caudally, with minimal density in C7 without signs of osteoporosis. A similar trend is characteristic of trabecular bone. The density of the osteon layer of the vertebral arch cortex differs significantly from the density of the outer and inner plates. The total density of the compact layer of the vertebral arch cortex exceeds 785.15 ± 38.4 HU.

Conclusion The data obtained justify the need to include the study of the density of vertebral bodies, vertebral arches, and its thickness in the MSCT data processing algorithm to develop a plan for surgical intervention in patients with cervical spine stenosis in order to obtain objective data on the quality of the bone.

Introduction The understanding of the biomechanics of movements in the spinopelvic segment plays an important role in the successful treatment of patients with hip-spine syndrome. Analysis of the biomechanical processes occurring in the biokinematic chain of the spine–pelvis–hip during the transition from standing position to sitting position allows us to conclude that the acetabular axis of rotation of the pelvis in space is not the only one. Classical methods for measuring PI, PT, overhang S1 are applicable for patients in a standing position and use the hip joint as a starting point, since it is the point of rotation of the pelvis in space in a standing position. Previously, using mathematical modeling, we described spatial changes in the pelvis during a given change in the body position and showed the presence of a second point of pelvis rotation in space, which appears in a sitting position. We assumed that in a sitting position, it is necessary to use other methods for calculating indicators of spinopelvic relationships for their determination.

Purpose of the study was to evaluate the parameters of patients’ sagittal balance using the proposed alternative method in standing and sitting positions.

Materials and methods Medical documentation and the results of X-ray examination of 20 patients with unilateral idiopathic coxarthrosis who underwent total hip replacement surgery were analyzed. The radiographic parameters were calculated: PI, PT, overhang S1 in standing and sitting positions, anterior inclination of the acetabular component; parameters PI ischial, PT ischial, deviation of the ischial tuberosities in standing and sitting positions were proposed and calculated.

Results The study shows that there is no statistical difference in the values of the angles PI standard for a standing position and PI ischial for a sitting position. It corresponds to objective data and is generally accepted. Examples of changes in radiographic parameters of the sacral slope and the deviation of the ischial tuberosities were shown reflecting the rotation of the pelvis in space through the second, ischial axis, that confirm the biaxial concept of pelvic rotation.

Discussion The calculations demonstrated the possibility of using alternative indicators of spinopelvic relationships (PT, distance of overhang of the sacrum (overhang S1), deviation of the ischial tuberosities). They enabled assessment of the spatial transformation of the pelvis and the ability to predict the spatial position of the acetabulum, which is an important factor for successful treatment of patients with combined pathology of the hip joint and spine.

Conclusion Our findings complement the biaxial concept of pelvic rotation. An alternative method for measuring sagittal balance parameters in a sitting position has been proposed. Further research is required to assess the practical significance of this method.

Introduction The study of the kinematic and kinetic parameters of gait in children with achondroplasia would allow a more detailed understanding of the features of their locomotion and determine the strategy of planned treatment.

Purpose To evaluate features of locomotor kinematics and kinetics in children with achondroplasia and compare with peers without orthopedic pathology.

Materials and methods The locomotor profile was assessed by video gait analysis. Kinematic data were recorded by Qualisys7+ optical cameras (8 cameras) with passive marker video capture technology synchronized with six dynamic platforms KISTLER (Switzerland). The analysis of kinematics and kinetics was carried out in the QTM (Qualisys) and Visual3D (C-Motion) programs with automated calculation of the values of indicators of the total peak power in the joints. Three groups were formed for gait analysis: 1) children 6–7  years old, achondroplasia (6 subjectsle, n = 12 limbs); 2) their peers, children without orthopedic pathology, 6–7 years old (8 subjects, n = 16 limbs); 3) children without orthopedic pathology 3–4 years old similar in height (8 subjects, n = 16 limbs).

Results In children with achondroplasia, statistically significant disorder in locomotor kinetics and kinematics were found. The former are associated with a longitudinal deficiency of limb segments and decreased walking speed. The latter are not associated with a longitudinal deficit, but manifested in all planes, namely: an increase in the maximum forward inclination of the pelvis, a flexion position in the hip and knee joints, and dorsal flexion of the ankle joint; increased maximum angle of hip abduction and varus deformity of the knee joint; increased rotational range of motion of the pelvis.

Discussion Since the characteristic features of the main gait profile begin to appear in children by the age of 4–5 years, and is associated with the formation of the activity of central and spinal generators that induce the self-organization of motor stereotypes, we believe that the deviations detected in the locomotor kinematics are secondary pathogenetic manifestations of the kinetics due to the longitudinal deficit in limb segments.

Conclusion Features of locomotor kinetics in children with achondroplasia are due to the longitudinal deficit of the limb length and are associated with low walking speed. Significant deviations of the locomotor kinematics were not associated with the longitudinal deficit of the segments, but were detected in all planes and are related to the entire biomechanical chain.

Introduction Self-administered questionnaire recommended by international orthopaedic community is a practical instrument for use in pathological conditions related to the foot and ankle.

The objective was to validate the Russian-language versions of the FADI and FAAM questionnaires to be filled out by orthopaedic patients with forefoot disorders before and after surgical treatment.

Material and methods The study included 100 adult patients with forefoot disorders to be surgically treated. The average age of the patients was 52 ± 12.1 years with 97 % being females and 26 % being athletes. The  patients completed the FADI and FAAM questionnaires preoperatively and at 2 months after surgery and they were requested to fill out the SF-36 questionnaire and the LEFS scale preoperatively.

Results The Cronbach's α value was 0.91 for activities of daily living and 0.94 for sports measured with both questionnaires. The reproducibility of the questionnaires was demonstrated by high ICC values (≥ 0.992) and no  changes (ES < 0.01) in stable patients. Satisfactory construct validity was confirmed by significant correlations in activities of daily living and sports activities; criterion validity was confirmed by the dorsiflexion angle in the MCP1 and the daily (p < 0.001) and sports activities (p < 0.05). Convergent validity of the FADI and FAAM was identified with correlations measured with SF-36 and LEFS. Patients with moderate/severe impairment in range of motion had worse functional status scored with the FADI and FAAM as compared with those who had no/mild impairment. A significant improvement was seen postoperatively in non-athletes (p < 0.001). Sports activity significantly improved postoperatively in athletes (p < 0.05).

Discussion A limitation of the study includes the sample consisting mostly of patients with one type of  orthopaedic pathology (valgus foot). Another limitation is that the majority of patients were females, and the patients were treated in the same health care facility. We can conclude that in the future it would be advisable to test the Russian versions of the FADI and FAAM questionnaires in patients with other foot pathologies and to conduct multicenter studies using these questionnaires.

Conclusion The FADI and FAAM scores measured in the Russian population showed greater sensitivity to changes in the foot/ankle joint in individuals who had indications for surgical treatment for a foot condition.

Introduction Challenges of treating the injuries of pubic symphysis in patients with combined pelvic injury require developing new techniques for stable minimally invasive osteosynthesis in the acute period of trauma.

Purpose of the work was to assess the application of low invasive fixation of the pubic symphysis with a system of transpedicular screws in the patients with combined unstable pelvic injuries in the acute period of the traumatic disease.

Materials and methods The results of treatment of 12 patients with polytrauma with unstable pelvic injury with rupture of the pubic symphysis who were treated at Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, in the period from 2017 to 2023, were analyzed. All the patients underwent final minimally invasive fixation of the pubic symphysis with a system of transpedicular screws in the early period of the traumatic disease.

Results The overall assessment of the results in 12 patients found no complications or technical errors during the installation of transpedicular screws. Control CT scans of the pelvis showed that osteosynthesis was stable in all patients, and the position of metal was correct in all. One patient from the study group died in the clinic from massive pulmonary embolism. The long-term results in 11 patients in the period from 6 months to 3 years after trauma were evaluated as excellent and good anatomical and functional results in 10 patients, one case had fair outcome.

Discussion The use of bone plates to fix ruptures of the symphysis pubis leads to disruption of its physiological mobility, and the patient’s activity in the postoperative period can cause an implant fracture. Original dynamic plates and wire cerclage help avoid this complication; however, all these techniques involve significant surgical trauma and blood loss, as well as the risk of postoperative wound suppuration. Minimally invasive methods of  fixation using cannulated screws, systems such as Endobutton, Tight Rope can reduce intraoperative trauma and the risk of complications (blood loss, suppuration); however, the procedure for their installation is quite complex and lengthy, and for greater stability, external fixation of the pelvic ring is often required. The  proposed minimally invasive fixation of the pubic symphysis with a system of transpedicular screws avoids a lot of shortcomings and is sufficiently stable.

Conclusion The method of minimally invasive fixation of the pubic symphysis with a system of transpedicular screws meets current requirements in the treatment of patients with polytrauma and unstable pelvic injury, and it may be successfully used in the acute period of trauma.

Background There is currently no pathogenetically based treatment for aseptic necrosis of the femoral head. One of the most promising areas of possible targeted therapy is the use of genetically engineered drugs, including monoclonal blockers of proinflammatory cytokines, aimed at inhibiting inflammation and indirectly reducing the activity of osteodestruction. The aim of the work is to evaluate the effectiveness of the use of the IL-6 monoclonal blocker in the course of aseptic necrosis of the femoral head in an experiment.

Purpose Evaluate the preliminary results of the use of the IL-6 monoclonal blocker in the course of aseptic necrosis of the femoral head in an experiment.

Materials and methods Surgical induction of aseptic necrosis of the femoral head was performed in 18 male Wistar rats. The animals were divided into two groups of 9 individuals each. The first group did not receive any treatment, the second received therapy with a monoclonal IL-6 receptor blocker, starting from the second week of the experiment, one injection once every two weeks. All animals were removed from the experiment at 4, 6 and 8 weeks after the induction of aseptic necrosis, 3 rats from each group at a time. Total RNA was isolated from the femoral head on the aseptic necrosis side and the conditionally healthy side as a control. The expression of genes of regulatory proteins of osteogenesis was studied by PCR. To study the features of osteodestructive processes, histological examination of femoral head preparations in all animals was conducted.

Results Histological preparations of femoral heads of the second group animals were characterized by less pronounced osteodestructive, chondrodestructive processes compared to the animals that did not receive therapy. The mRNA profile of the rats of the second group displayed an increase in the expression of genes encoding proteins involved in osteoreparation at all stages of the experiment. At the same time, the activity of genes encoding proteins of proinflammatory cytokines, regulatory molecules of osteoclastogenesis was reduced relative to the first group.

Discussion The data obtained indicate an important role of inflammation in the regulation of osteodestruction. Inhibition of the biological action of IL-6 contributed to inhibition of the expression of osteoclastogenesis genes, increased activity of bone metabolism genes, and caused a decrease in the intensity of osteodestruction and activation of osteoreparation. Conclusion Preliminary results of the use of a monoclonal blocker of the proinflammatory cytokine IL-6 indicate the inhibition of osteodestructive and strengthening of osteoreparative processes due to the correction of the expression of bone metabolism genes during the progression of aseptic necrosis of the femoral head in rats in an experimental model.

Introduction World literature data indicate the effectiveness of single intraoperative electrical stimulation (IES) of the proximal segment of the damaged nerve to stimulate its regeneration, but there is no data on its effect on the long-term results of autoplasty of resection defects.

The purpose of the work was to evaluate the long-term results of a single IES after autologous plastic surgery of the tibial portion of the sciatic nerve in rats.

Materials and methods Thirty rats after autologous repair of the resection defect of the tibial portion of the sciatic nerve were divided into series 1 (unstimulated control, n = 16) and series 2 (single IES for 40 minutes, n = 14). At 4 and 6 months after surgery, the static sciatic functional index (SFI) and morphometry of epoxy transverse semithin sections of the tibial nerve at the level of the middle third of the leg were assessed. For comparison with the normal values, the corresponding data from 7 intact rats were used.

Results The number of animals with excellent results of SFI restoration was 12.5 % in  series 1 and  50 % in  series  2 (p = 0.05). The numerical density of regenerated myelinated fibers (MF) exceeded the norm: in series 1 — by 63 % (p < 0.01) and 34 % (p < 0.01), in series 2 — by 58 % (p < 0.01) and 47 % (p < 0.01), respectively. In series 2, there were greater values in comparison with series 1: the median diameters of MFs were by 11.7 % and 15.7 %, the median diameters of their axons were by 5.4 % and 11.9 %, the median thickness of the myelin sheath was by 17.0 % and 24.1 %, respectively (p < 0.05 4 months and p < 0.01 6 months after surgery). Four months after surgery in series 1 and 2, the numerical densities of endoneurial vessels exceeded the intact control by 134 % (p < 0.05) and 156 % ( 0.05), their average diameters by 18 % and 16 % (p < 0.01) respectively, and lumen diameters increased only in series 2 by 8 % (p = 0.07). After 6 months of the experiment in series 1 and  2, the  numerical densities of microvessels decreased, but significantly exceeded the control by  66 % (p < 0.05) and 83 % (p < 0.05), the average diameters — by 14 % and 36 % (p < 0.05), lumen diameters — by 26 % (p < 0.05) and 50 % (p < 0.01), respectively.

Discussion The difference between stimulated and unstimulated animals in all MF size parameters 6 months after surgery was greater than after 4 months, indicating a persistent neuroregenerative effect.

Conclusions A significant increase in the diameters of regenerating nerve fibers in the tibial nerve, as well as the diameters of their axons and the thickness of the myelinated sheaths 4 and 6 months after autoplasty of the tibial portion of the sciatic nerve in the group of animals with a single 40-minute IES of the proximal portion of the sciatic nerve indicates the promoting effect of the applied additive effect on regenerative axono- and myelinogenesis. Increase in the lumens and improvement of blood flow of the endoneurial vessels of the tibial nerve in the series with IES ensured the stability of the neuroregenerative effect. The functional significance of the effects of a single IES is confirmed by a significantly higher percentage of animals with excellent results in restoring the static functional index.

Introduction The use of 3D printing technology in finger reconstruction improves accuracy of the procedure minimizing the donor defect and optimizing the appearance and function of the finger. The use of this technology in the finger reconstruction with an osteocutaneous radial forearm flap with axial blood supply and lengthening of the digital stumps and metacarpals remains poorly explored.

The objective of the study was to demonstrate new methods of preoperative planning for finger reconstruction and improve surgical outcomes.

Material and methods Outcomes of five patients treated with original methods based on 3D technology were retrospectively evaluated during preoperative planning, reconstruction of the thumb using an osteocutaneous radial forearm flap with axial blood supply, relocation of the stump of the third finger and lengthening of the stumps of the first and second metacarpals. The patients could achieve consolidation of interpositional bone allografts following lengthening of the finger stumps, stability of the bone base of the finger, organotypic restructuring of the marginal allograft during plastic surgery with an osteocutaneous radial forearm flap, and a functional position of the reconstructed thumb using the middle finger stump.

Results and discussion An individual device for planning finger reconstruction allows identification of the optimal size and position of the finger in three planes, which is essential for patients with severe hand deformities to avoid corrective procedures. An individual guide was used to osteotomize the radius to harvest a vascularized graft providing a cutout of a given size and shape and a cortical-cancellous allograft being identical in shape and size to replace the donor bone defect. The combined use of Masquelet technology and distraction of the finger stump or a metacarpal improved conditions for consolidation and restructuring of the interpositional allograft preventing fractures and infection.

Conclusion The use of 3D technology in finger reconstruction using an osteocutaneous radial forearm flap with axial blood supply and distraction of the finger stumps and metacarpals can improve surgical outcomes.

Introduction Acute hematogenous osteomyelitis can persist as chronic infection in pediatric patients due to delayed diagnosis and treatment. An extended bone defect of the limb caused by osteomyelitic destruction is a rare clinical scenario in pediatric surgery. Metaepiphyseal and articular involvement suggests specific and long-term treatment with a high risk of disability.

The objective was to report a clinical case of a teenager who suffered chronic hematogenous osteomyelitis of the tibial bones and raise awareness of primary diagnosis and treatment.

Material and methods A clinical case of a teenager treated for extensive destruction of the tibial bones caused by chronic hematogenous osteomyelitis is reported. Clinical and functional evaluation of the effectiveness was produced at the stages of treatment.

Results A positive functional result was achieved due to staged surgical treatment including radical debridement of the chronic infection nidus followed by total ankle arthroplasty.

Discussion Acute hematogenous osteomyelitis persisting as chronic infection could be caused either by a wait-and-see strategy when the patient first sought medical help or a long-term follow-up. There is no consensus on the use of reconstruction or replacement of large long bone defects extended to the joints caused by chronic infection. Staged treatment including total joint replacement with custom-made endoprosthesis can be one of the options.

Conclusion Staged surgical treatment including radical debridement followed by delayed total joint replacement with custom-made endoprosthesis provided satisfactory functionality for the limb without signs of infectious and inflammatory activity at a follow-up period of more than a year.

Introduction Surgical treatment of patients with avascular osteonecrosis of the talus and post-traumatic hindfoot deformity is associated with high morbidity, difficulty of early disease detection, the discrepancy between patient expectations and orthopaedic requirements for surgical outcomes due to traditional methods. The use of customized ankle joint replacement may be a potential solution to this problem.

The objective was to evaluate the results of treatment of a patient with avascular osteonecrosis of the talus, crusarthrosis and hindfoot deformity using an original replacement method for the ankle joint and the talus.

Material and methods A 30-year-old patient with post-traumatic avascular osteonecrosis of the talus, crusarthrosis, equinovarus and adducted foot underwent replacement of the ankle joint and talus using the  method developed by the authors. Radiographic and tomographic methods were used for diagnosis. The  VAS  scale, AOFAS, FFI, EFAS questionnaires and pedobarography were used to assess clinical and functional results.

Results The results of treatment evaluated at 12 months showed maintained foot deformity correction, stability of a tailored construct with no signs of loosening and osteolysis. The clinical and functional result showed a 81/2 VAS decrease in pain, functional status improved by 4.3 times with functional foot index (FFI) improved by 2.2 times according to the AOFAS scale at 12 months.

Discussion Orthopaedic surgeons are conducting research aimed at preserving ankle motion in the treatment of  avascular osteonecrosis of the talus. A serious problem is associated with concomitant deformities of the hindfoot and available implants fail to solve this problem.

Conclusion The surgical method offered for the patient provided good clinical and functional results with the hindfoot deformity corrected within one stage reducing the treatment time.

Introduction Treatment of unstable injuries of the pelvic bones is one of the unsolved problems in modern traumatology. The instability of the injuries is determined by the nature of the destruction of the posterior semi-ring of the pelvis. The most used technique for osteosynthesis of sacral fractures for unstable pelvic injuries is ileosacral screw fixation.

The purpose of the work was to demonstrate a clinical case of an iatrogenic complication: ileofemoral thrombosis caused by compression of the internal iliac vein due to malposition of the ileosacral screw.

Materials and methods Medical records of a 34-year-old patient injured in a traffic accident (front seat passenger) were studied, who was referred from a district hospital on the fourth day after the injury diagnosed with a fracture of the transverse process of L2 vertebra on the left, closed fracture of the pubic and ischial bones on the left, fracture of the lateral mass of the sacrum on the right. Alcohol intoxication. Traumatic shock stage 1. Treatment results were monitored throughout the inpatient and outpatient treatment periods. Long-term follow-up was 6 months.

Results Timely suspicion of the complication based on physical examination data with CT angiography that assisted to exclude internal bleeding and urgently carry out repeated surgical intervention to correct the  implant malposition, reosteosynthesis of S1 body without loss of reduction, to achieve regression of the clinical picture of ileofemoral thrombosis, and also to mobilize the patient in the shortest possible time. During inpatient treatment, regression of the symptoms of the complication was achieved, the patient was fully activated, and was discharged for outpatient follow-ups.

Discussion Variability in the anatomy of the sacrum and the characteristics of fractures hinder the navigation while inserting iliosacral screws, which in some cases result in malposition. Compression of the common iliac vein without damaging it causes difficulty in blood outflow and the development of a clinical picture of ileofemoral thrombosis in the early postoperative period.

Conclusion This clinical case shows that X-ray images in standard views are not a reliable method for diagnosing sacral injuries and are not sufficient for preoperative planning. The use of standard C-arm did not provide sufficient intraoperative visualization to correctly assess the position of the iliosacral screw, especially in cases with sacral dysmorphia. The 3D volumetric image reconstruction significantly influenced the correct perception of the anatomical structure of the bony structures of the pelvis. Malposition of the screw and its exit to the anterior surface of the sacrum caused disruption of the iliac vein outflow and development of thrombosis in the early postoperative period.

Introduction Adolescent Idiopathic Scoliosis (AIS) is a condition that affects an otherwise healthy child 10 years of age or older and is the high risk of severe deformity and surgery. Different brace applications include the Milwaukee Brace, Boston Scoliosis Brace, TLSO and others, and the success rates of orthoses vary. With little experience in the use of the Chêneau-type corset, the brace provides an effective means for the active correction of scoliotic spinal deformity.

The objective was to demonstrate an outcome with a 3D functional corrective German-designed corset used to treat a patient with AIS in the period from the onset of the curve to the onset of skeletal maturity.

Material and methods The medical history of patient S. including anamnestic, clinical and radiological findings recorded 2018 and 2023 when she used a 3D German-designed (3D GD) corset. The corset design was defined as 3CL/B2 according to the Lehnert – Schroth scoliotic classification as modified by Rigo.

Results The left-sided thoracolumbar curve of a 9-year-old patient with a Risser sign of 0 and a Cobb angle of 25° at baseline decreased to 12° at the age of 16 years (Risser sign — 5) due to bracing.

Discussion The AIS was diagnosed in the patient at the age of 5 years and bracing was initiated at the age of 9. The curve correction using 3D GD brace was based on the principles offered by Chêneau. The patient used the corset for 20 hours per day. The initial brace correction was 90 %. The curve decreased from Cobb angle 25° to 12° over a six-year period of brace treatment with no need for surgery. Three cases with identical outcomes were reported with the use of the Boston and Chêneau braces in AIS.

Conclusion The clinical case showed effective use of the 3D GD corset as a new exponent of corsets developed on the principles offered by Chêneau to prevent surgical treatment by the time of skeletal maturity.