Introduction The majority of paediatric both bone forearm fractures are treated with manipulative reductions and casting; loss of reduction is one of the most commonly reported complications. We aimed to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures.

Materials and methods This prospective observational study was conducted at the Department of  Orthopedics, Kalpana Chawala Government Medical College in Karnal to assess the role of cast index and  3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures. In the present study, 55 patients 16 years old were included irrespective of sex with distal both bones forearm fractures, managed by closed reduction and casting were included.

Results Fracture reduction failure was observed in 32.7 % of the patients. Both three-point index and cast index were found to be significantly higher in patients with reduction failure. It was observed that at 2 weeks Area under curve (ROC Curve) for Cast index and Three point index was 0.72 and 0.85 respectively. At 4 weeks, Area under curve for Cast index and Three point index was 0.77 and 0.84 respectively and at 6 weeks 0.74 and 0.86 respectively. Thus, in the present study, CI and 3PI had similar predictability for fracture reduction failure.

Discussion There are a few limitations of our study: We could not observe the patients for a longer period of time to know re-modelling in the long term. We did not take in to consideration the severity of fracture, type of anesthesia used (conscious sedation versus General Anesthesia) and the fracture configuration while assessing the outcomes. We also did not collect information about anthropometric parameters like child weight and diameter of the forearm.

Conclusion The three-point index and cast index are clinically useful tools to assess the quality of cast molding following closed reduction of pediatric forearm fractures and to predict re-displacement in distal forearm fractures.

Introduction The largest number of factors contributing to the development of cerebral palsy (CP) relate to the pre- and intranatal periods. Premature birth and low birth weight are the most important predictors of cerebral palsy and are associated with persistent brain and motor disorders. Purpose To evaluate the main etiological factors of severe cerebral palsy and comorbid pathology in children with severe motor disorders.

Material and methods A retrospective observational study included 170 patients with severe forms of  cerebral palsy, divided into two groups (85 subjects each) depending on motor disorders: GMFCS IV, GMFCS V. Perinatal risk factors for severe cerebral palsy were assessed, correlations between perinatal risk factors for  expressed movement disorders and height/weight indicators, comorbid pathology in children at the time of admission to the trauma and orthopaedic hospital.

Results Prenatal risk factors were responsible for the development of cerebral palsy in children in 71 % of cases. In the GMFCS IV group, gestational age had an inverse correlation with preterm birth (R = –0.53; R2 = 28 %). In  the  GMFCS V group, disorders caused by a shorter gestational age were interrelated with  the  duration of the antenatal period (R = –0.79; R2 = 62 %), and also directly correlated with delivery by cesarean section (R = 0.58; R2 = 34 %). Among the comorbid pathologies, eye diseases and psychological development disorders were most often detected.

Discussion Low height/weight parameters of patients were due to comorbid pathology, rather than phenotypic constitutional features. Inverse correlation between the disorders caused by the gestational age, low birth weight and duration of pregnancy, risk of developing respiratory disorders, and a direct correlation with cesarean section seem logical. Severe conmobid diseases were more frequently diagnosed in patients with GMFCS V, indicating more extensive perinatal catastrophes in the central nervous system and the relationship between the developed pathology and severe motor disorders.

Conclusions The main risk factors for the development of cerebral palsy in patients with severe GMFCS IV–V motor impairments are associated with the pre- and intranatal periods. Comorbid pathology of patients with  severe forms of cerebral palsy is caused by severe brain damage and movement disorders that have developed against this background.

Introduction Avascular necrosis of the femoral head (ANFH) is a phenomenon vascular supply disruption lead to death of bone cells around the femoral head. The disease is a severe health issue all over the world. Within 2 years about 80 % to 85 % of symptomatic cases will result in collapse of the femoral head. Recovery of hip function after total hip arthroplasty (THA) may be influenced by many factors that vary among different racial/ethnic groups. Most findings in this field have been from Western developed nations, and not much information from developing Asian countries is available.

This study aimed to determine the six-month functional outcome and patient–related factors that predict functional recovery in patients with avascular necrosis of the femoral head (ANFH) undertaking total hip arthroplasty (THA).

Methods Between January 2022 and December 2023 there were 143 patients participating in this prospective study. Demographic, medical history and clinical findings were collected from their medical records. The six-month functional outcome was evaluated using the Harris hip score (HHS). The mean age of the participants was 55.90 ± 11.49 years, and the majority (86.7 %) were male. Most patients had excellent (43.4 %) or good outcome (51.7 %).

Discussion Our study had some limitations: the length of the follow-up after surgery is short (6 months), that hospital-related factors like the type and volume of the hospital have not been analyzed. Nonetheless, previous observations suggest that most of the improvement in physical function occurs during the first six months following surgery and remains the same for a long time. However, our sample has typical demographic and clinical characteristics of patients with THA for ANFH, suggesting that determinants of the 6-month functional outcome in the current study could apply to other patients undergoing this surgery.

Results The determinants of excellent outcome were a  higher preoperative HHS (odds ratio (OR): 4.369, 95 % confidence interval (CI) =1.854 – 10.299; p < 0.001) and absence of comorbidity (OR: 2.440, 95 % CI = 1.071 – 5.557, p = 0.034). No demographic (age, gender, body mass index), medical history (using of steroids, alcohol consumption or smoking), or any other clinical parameter (stage or side of the affected hip, time until surgery) had a significant influence on functional outcome.

Conclusion Earlier surgery during functional decline and better management of comorbidity may help improve THA outcomes for patients with avascular necrosis of the femoral head.

Introduction The "gold" standard for the treatment of late stages of coxarthrosis is total hip arthroplasty. Direct anterior approach (DAA) refers to minimally invasive surgical interventions in orthopaedics. Extended anesthetic measures in combination with low-traumatic surgical techniques may reduce postoperative pain and accelerate patient's recovery.

The purpose of the study was to compare the recovery times of patients after hip arthroplasty using DAA in  combination with PENG block, lateral cutaneous femoral nerve (LCFN) block and without extended anesthetic measures.

Materials and methods A prospective randomized comparative clinical study was performed, which involved 62  patients divided into two groups: the study one (n = 29) and the control one (n = 33). In  both groups, arthroplasty was performed using DAA. Patients of the study group underwent PENG block and  LCFN block. The patients in the control group did not receive extended anesthesia. The evaluation criteria were pain assessment using the visual analogue scale (VAS), administration of painkillers, patient’s mobility and the length of hospital stay.

Results The VAS score for pain in the study group were lower than in the control group after 6 hours — 3.7 (3.4; 4.1) and 4.3 (4.2; 4.8); 24 hours after surgery — 3.5 (3.3; 3.6) and 4.1 (3.9; 4.5) (p < 0.001). After 48 hours, the indices were comparable: 3.5 (3.1; 4.1) and 3.7 (3.6; 3.9) (p = 0.19). The rate of requests for pain relief in the first 24 hours was lower in the study group than in the control group: 2 (1; 2) and 3 (2; 3) cases (p = 0.003). The results of the manual muscle test after 6 hours and 24 hours were comparable (p > 0.05). The time interval between the end of the operation and the first walking on crutches was shorter in the study group — 3.1 hours (2.9; 3.4) and 3.98 hours (3.8; 4.2) (p < 0.001). The length of hospital stay was shorter in the study group: 1.5 (1.2; 2) and 2.5 (2; 3) days (p < 0.001).

Discussion Lower postoperative pain allows faster activation of patients, thus improving the results of the early rehabilitation period.

Conclusion The use of PENG block and LCFN block in arthroplasty with the use of DAA has clinical effectiveness in the first 24 hours, and helps to accelerate the postoperative recovery of patients.

Introduction The number of hip and knee replacement surgeries is increasing annually in Russia and worldwide. The majority of patients receiving joint arthroplasties are elderly women.

The objective was to assess the clinical, functional and neuropsychological status of patients undergoing total knee or hip replacement.

Material and methods The study included 448 patients admitted for elective surgery of total knee or hip replacement at the Department of Traumatology and Orthopedics of the Federal Center for High Medical Technologies (CHMT, Kaliningrad Region). Anthropometric parameters of the patients were measured, the medical history and concomitant diseases recorded. Common blood count and biochemistry test were evaluated preoperatively. Neuropsychological examination included assessment of cognitive and executive functions, levels of distress, depression, anxiety and somatization.

Results Almost all patients studied were found to have varying degrees of obesity. A typical combination of  concomitant pathology in volunteers was stage 2 hypertension, risk degree 2–3, and chronic gastritis in  remission. Half of the volunteers showed moderate and high levels of distress, depression, anxiety and somatization. A significant number of volunteers showed moderate to high levels of cognitive decline. Age- and sex-related blood counts were slightly different from the normal ranges for a CBC and biochemistry. Changes in leukocyte count were detected.

Discussion Leukocyte counts indicated the osteoarthritis induced inflammatory process in most patients. Mitochondrial dysfunction and aging of the immune system contributed to the “proinflammatory status.” The high rate of cognitive impairment in volunteers was associated with age and comorbidity, cardiovascular conditions, in particular. Distress and anxiety were associated with emotional reactions to surgery.

Conclusion The factors reported can affect the duration and course of rehabilitation. The “pro-inflammatory status” of patients can complicate the healing of a postoperative wound. Neuropsychological disorders noted during postoperative rehabilitation can have a significant impact on physical recovery, social and professional adaptation.

Introduction The study of the antibacterial effect of photodynamic therapy against the leading pathogens of chronic osteomyelitis is one of the promising directions today.

Purpose of the work was to evaluate the antibacterial effect against the strains of Staphylococcus aureus and Pseudomonas aeruginosa with the ALOD-01 laser system in the presence of photodithazine.

Materials and methods The object of the study was 24-hour archival cultures of gram-positive and  gram-negative microorganisms belonging to two taxa: Staphylococcus aureus (25923), Pseudomonas aeruginosa (27853). The  antibacterial effect after the exposure to laser radiation in the presence of photodithazine on the microbial cells of the studied cultures was assessed by the absence of microorganism growth in the area of the light beam.

Results Laser exposure in combination with photodithazine (concentration 0.5–1.0 mg/ml) on S. aureus for two minutes at 200–300 J achieved a bactericidal effect in the beam area. A bactericidal effect on the entire surface of the Petri dish was achieved with light exposure of 400 J for 5 minutes and a photodithazine concentration of 1.0 mg/ml. Laser exposure for 2 minutes in the presence of photodithazine at a concentration of 0.5 mg/ml and 1 mg/ml did not have an antibacterial effect on P. aeruginosa strains. Continuous growth of microorganisms was observed on the dish. Increasing the light dose and exposure time contributed to a decrease in the growth of microbial cells. A bactericidal effect was obtained only in the center of the dish in treating the bacterial suspension with photodithazine at a concentration of 5 mg/ml.

Discussion The effectiveness of PDT depends on the type of microorganisms, the anatomical location of  the  infection site, as well as the properties of the photosensitizer and the laser used. Depending on the structure of the cell wall, different susceptibility of bacteria to photodynamic effects is observed.

Conclusion S. aureus strains can be successfully photoinactivated using photodithazine. For P. aeruginosa strains, it was not possible to find a regime in which microbial cell growth was absent throughout the dish. The  photodynamic reaction occurs only when adequate doses of light energy act on the photosentisizer in the presence of oxygen in the medium, while the photodynamic damage is local and the bactericidal effect is limited by the zone of light exposure.

Introduction Increasing the integration of transcutaneous implants is an important goal for their application in clinical practice.

The purpose of the work was to evaluate the osseointegration of transcutaneous titanium implants with calcium-phosphate coating containing zinc ions.

Materials and methods The studies were performed on 12 male rabbits, who underwent implantation of an original implant into the tibial stump. After implantation, a compression device was installed on the bone, maintaining a load of 3.5 N for 5 weeks. Duration of observation was 26 weeks. The animals were divided into two groups: a control group (n = 6) with an implant without coating and an experimental group (n = 6) with a zinc-substituted calcium-phosphate coated implant.

Results The implant fell out in one case in animals from the control group; no cases of implant loss were noted in the experimental group. It was revealed that the weight concentration of Ca and P in all zones of the bone-implant block of the animals in the experimental group significantly exceeded similar indicators in  the  control group. In the control group, long-term persistence of high levels of C-reactive protein was noted, which was not observed in the experimental group.

Discussion This series of studies has shown that an implant with a zinc-modified calcium-phosphate coating exhibited a more effective integration, in contrast to an uncoated product. The absence of serious adverse reactions to the tested products indicates acceptable tolerability and safety of its use.

Conclusion The implants with a zinc-modified calcium-phosphate coating showed signs of more effective osseointegration compared to the product without additional coating.

Introduction Dynamization of the nail can be used to improve osteoreparation during intramedullary interlocking nailing (IIN). The procedure can be difficult to perform in some sub- and intertrochanteric femoral fractures due to anatomical and functional features.

The objective was to demonstrate a case of successful use of an original version of the lateral cortical notching (LCN) technique for dynamization of an intramedullary proximal nail in a patient with a nonunited subtrochanteric fracture.

Material and methods The treatment was performed for a 66-year-old patient with a non-united intertrochanteric fracture of the right femur complicated by the breakage of an intramedullary nail. The LCN technique was successfully used to dynamize the IM nail.

Results Radiological healing of the fracture and functional recovery of the patient were observed at a two-month follow-up. The absence of interfragmental compression in IIN could be caused by blocking of the sliding screw by the lateral cortical bone of the peripheral femur fragment. The complication could be prevented with LCN during primary osteosynthesis of the above fractures.

Discussion Based on scientific publications and our clinical experience, we assumed that LCN can be indicated for  failed healing of intertrochanteric AO/OTA 31A3.1–3 fractures, type 3 Boyd and Griffin trochanteric fractures and all types of subtrochanteric fractures as graded by Seinsheimer with a vector of interfragmental compression to be created along the femur axis during cephalomedullary osteosynthesis. The case report showed the mechanism of impaired consolidation in some intertrochanteric and subtrochanteric fractures of the femur.

Conclusion The case report demonstrateed the successful use of the original version of the lateral cortical notching (LCN) technique for dynamization of an intramedullary proximal nail.

Introduction Müller – Weiss syndrome is a rare condition that is characterized by avascular necrosis of  the  navicular bone leading to severe foot deformity, pain disturbing activities of daily living. There is no generally accepted treatment for avascular necrosis of the scaphoid, and the available treatments have disadvantages, which necessitates the need for new options.

The objective was to present short-term results of three patients with osteonecrosis of the scaphoid and local necrosis of the talar head treated with ceramic talar head prosthesis, plastic surgery, metal osteosynthesis of the scaphoid and related surgical techniques.

Material and methods Three patients diagnosed with Müller – Weiss syndrome were treated with ceramic talar head replacement, autologous bone grafting and metal osteosynthesis of the scaphoid bone with  accompanying surgical techniques. Severity of pain and the condition of patients were assessed with the VAS and AOFAS AH scores.

Results Short-term results showed consolidation at the site of metal osteosynthesis in all patients with  no  signs of  instability of the talus hemiprosthesis. VAS and AOFAS AH scores indicated decrease in the pain and improved condition of the patients.

Discussion Hemiarthroplasty of the talar head combined with plastic surgery and restoration of a congruent joint surface of the scaphoid, and associated surgical techniques may become an effective alternative to existing treatments for patients with Müller – Weiss syndrome, with further study.

Conclusion The short-term findings showed that hemiarthroplasty was practical for restoration of the talonavicular mobility maintaining stable fixation of the talus.

Introduction Due to the constant increase in the number of primary and revision hip arthroplasties, the incidence of complications has been also increasing. Periprosthetic joint infection (PJI) is the most common and dangerous complication in joint arthroplasty, including PJI with cavitary defects of the acetabulum (Paprosky type 2C).

The purpose of the work was to demonstrate successful results of managing acetabular defects in patients with periprosthetic infection at the stage of installing an articulating spacer.

Materials and methods The patients underwent surgical management of cavitary defects of the acetabulum with allobone plastic material at the stage of installation of an articulating spacer impregnated with antibacterial drugs. A clinical and functional assessment of the effectiveness of treatment of patients with PJI of the hip joint, who underwent bone grafting of acetabular defects at the first stage of two-stage revision arthroplasty, was carried out. Remission of the infectious process was assessed according to the ICM 2013 (International Consensus Meeting), and the function of the affected limb was assessed according to the HHS (Harris Hip Score).

Results At a 6-month follow-up after implantation, there were no clinical and laboratory manifestations of PJI and radiological signs of instability of the implant components. Bone grafting was evaluated to be satisfactory; the function of the affected joint restored to 80–90 to HHS points. Remission of the infectious process according to ICM was achieved.

Discussion Clinical cases studied demonstrate a positive result of treatin PJI with plastic surgery of cavitary defects of the acetabular bottom at the stage of articulating spacer installation. Filling acetabular defects at  the  sanitizing stage (implantation of a spacer) subsequently provides improvement of primary fixation and  osseointegration of the acetabular component when converting the spacer to a permanent implant. This is due to an increase in the contact area of the acetabular component with bone tissue (native bone and remodeled allobone material).

Conclusion The treatment of the first clinical case improved joint function from 24 to 85 HHS points, and in the second from 27 to 76 HHS points. The use of defect filling techniques enabled to stop the infection and improve functional results.

Background The incidence of injury worldwide remains high, with a global estimate of  6763  cases per  00,000  population (95 % confidence interval 6412–7147). Trauma to the limbs is a common injury to an individual anatomical area during multiple or combined trauma that accounts for 40 % to 85.2 % of cases. Assessment of the effectiveness of different fixation options and development of treatment algorithms are essential for patients with tibial fractures and multiple (combined) injuries.

The objective was to determine how often temporary tibia fixation is applied for patients with multiple and combined injuries.

Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), CyberLeninka between 2008 and 2023 using search words and phrases: tibial injuries, osteosynthesis of lower limbs, multiple injuries, combined injuries, temporary osteosynthesis of the tibial bones.

Results and discussion A differentiated approach to the repair of bone fractures resulting from multiple and combined injuries is mostly common with the choice of fixation technique depending on the severity of injury and the severity of the patient’s condition. The definitive internal bone fixation is normally used for  stable patients, “damage control” strategy is secured for borderline and severe cases using primary temporary external fixation followed by staged surgical intervention. There is no generally accepted strategy for the use of early mobilization of long bone fractures as a component of anti-shock measures in a polytrauma patient.

Conclusion Certain issues remain unresolved, including the use of osteosynthesis for tibial fractures in some cohorts of patients, the optimal time of transition to definitive internal fixation, the possibility of using extrafocal osteosynthesis as a definitive treatment, the optimal configuration and assemblies to be employed. The lack of high-quality randomized controlled trials in this field is an important limitation.

Introduction Triphalangeal joint flexion contracture of the fingers is a common and challeging posttraumatic hand condition. The goal of surgical treatment is to correct finger deformity and increase interphalangeal range of motion.

The objective was to systematize data on the causes of post-traumatic triphalangeal joint flexion contracture of the fingers and methods of surgical correction.

Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), ScienceDirect, Google Scholar, Ovid databases according to PRISMA recommendations. Literature searches included both Russian and English studies, with one or more cases of post-traumatic triphalangeal joint flexion contracture of the fingers with the deformity surgically corrected. Cases of non-traumatic flexion contractures were excluded. Etiological factors of flexion contractures, heterogeneity of definitions and methods for recording the range of motion in the joint, anatomical features, surgical correction of flexion contractures and postoperative complications were reviewed.

Results Common causes of flexion contractures included burns (32.3 %), dislocations and fracturedislocations of the finger joints (23.5 %). The median postoperative follow-up period was 13.5 months after surgical treatment. Surgical correction was produced with external fixation device (EFD) in 40 % of cases, open procedures performed in 50 % and a combined technique employed in one case (10 %). Based on calculations of the odds ratios of postoperative complications, a weak positive linear relationship was revealed between EFD and pain syndrome, and a weak negative linear relationship was observed between the open procedure and pain.

Discussion There is heterogeneity of approaches regarding methods for correcting flexion contractures, surgical approaches, techniques for mobilizing joints and releasing the anatomical structures of the finger with  open procedures, the distraction rate with EFD, methods for repair of soft tissue defects following the treatment of flexion contractures of interphalangeal joint of a finger.

Conclusion Open procedures are commonly used for precise elimination of all components of flexion contracture of the joint and repair of soft tissue defects of the finger. A weak positive linear relationship was revealed between EF and pain syndrome. There was no significant correlation between open techniques and complications. There were no correlations between the treatment method and the contracture type; there are no treatment regimens for patients with this pathology.

Introduction The proximal interphalangeal joint (PIP joint) plays an important role in ensuring optimal finger dexterity, grip strength and overall hand functionality. Arthroplasty is a promising direction in the surgical treatment of arthritis of the PIP joint of the hand, however, the inconsistency of the results encourages the  world scientific community to be restrained and further investigate the problems associated with PIP joint arthroplasty.

The purpose of the work was to identify the main problems of PIP joint arthroplasty based on the analysis of foreign and domestic medical literature.

Materials and methods In this literature review, an analysis of foreign and domestic scientific publications devoted to the treatment of diseases and injuries of PIP joint was carried out. The purpose of the study was to provide a brief historical background and identify the main problems of PIP joint arthroplasty based on the analysis of foreign and domestic medical literature.

Results and discussion The choice of the implant and the surgical aproach used are the two most frequently discussed issues in PIP joint arthroplasty; dorsal, palmar and lateral surgical approaches are described, each with its own advantages and disadvantages. Dorsal approaches are used most often because they are easier to perform; however, the fragile extensor apparatus is damaged with the subsequent development of extensor lag. A number of authors concluded that stiffness and extensor lag were the most common postoperative complications. Several combinations of materials are available: from classic chrome-cobalt/polyethylene to ceramic/ceramic and pyrocarbon/pyrocarbon. Most of them have not stood the test of time yet, and for most implants there is still a lack of real long-term monitoring series for survival of the design.

Conclusion The morphology of joints, small bone sizes, complex biomechanics and the load on the hand are a  special problem in PIP joint arthroplasty. It is still not possible to restore the full range of motion in this joint, despite the success of colleagues in arthroplasty of large joints.

Introduction The advancement of surgery is set against a backdrop of continuous development and surgical innovations have transformed the way clinical care is delivered. Revision surgery might be required to  address complications of primary arthroplasty. The first stage of revision arthroplasty would involve removal of  an  implant and placement of an antibiotic-impregnated cement spacer to maintain the joint space and stability, prevent soft tissue retraction, provide local antibiotic release and preserve bone tissue for revision implantation at the final stage of revision. Custom-made articulating spacers are a promising tool for optimizing the first stage of revision arthroplasty.

The objective was to summarize the current data and present comprehensive information about spacers used in two-stage revision arthroplasty including manufacturing techniques, physical and chemical properties, clinical applications, the possibility of customization within the first stage of revision arthroplasty, current and promising directions for research.

Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), the Cochraine Library (www.cochranelibrary.com) between 2018 and 2023 using search words and phrases: total arthroplasty, complications, revision arthroplasty, articulating spacer, periprosthetic joint infection, additive manufacturing, 3D printing.

Results A comparative analysis of factory supplied, home-made, dynamic and static spacer models showed that the choice of articulating spacers for revision arthroplasty of major joints is of great relevance. Advantages of factory-made spacers include standardized range of sizes, the reliability and availability for medical institutions. They are characterized by limited use in repair of severe bone defects.

Discussion Custom-made articulating spacers enable specific tailoring to accommodate individual defects. Despite high expectations from custom-made spacers, development of optimal technologies for rapid prototyping is essential. Investments in research and development in this area have the potential to create innovative solutions that can significantly improve the results of revision arthroplasty.

Conclusion The paper explores the importance of systemization of knowledge about spacers and the role of new research in improving the design and functionality. Progress in the field of materials science, additive technologies and a personalized approach to spacer manufacturing can expand possibilities of  revision arthroplasty and the effectiveness. Personalized approaches and improved methods of local drug delivery that provide controlled release of antibiotics can improve the results of treatment of periprosthetic joint infections.