Introduction Open tibial fractures are generally managed by wound debridement and temporary stabilisation with AO external fixators followed by delayed internal fixation provided the soft tissue cover is adequate and there is no infection. This study aims at analysing the factors influencing the outcome of treatment of open tibial fractures using external fixation with Ilizarov ring fixators as definitive method.

Materials and methods Twenty eight patients of both sexes aged more than 18 years who presented with  open tibial fractures were included as our study subjects. The open fractures were classified according to  Gustilo‑Anderson classification of open fractures. Skeletal stabilisation was done either with Ilizarov ring fixators primarily or with AO external fixators in whom within 5 days since the injury the Ilizarov ring fixators were applied after thorough debridement of wounds. Patients were followed up first 4 weeks after the definitive procedure, then after 6 weeks, 3 months, 6 months and 1 year. The results were analysed using Tuckers criteria.

Results We achieved union in 25 patients without infection. Three patients were lost for follow-up. In  majority of  patients (48 %) union occurred in 24 weeks. In 10 patients we had pin site infections. The  functional outcome was studied using Tucker’s Criteria according to which 5 patients (20 %) had excellent outcomes, 9 patients (33 %) had good outcomes, 8 patients (29 %) had fair outcomes and 3 (16 %) had poor outcomes.

Discussion Limitation of the present study is the absence of a comparison group, though it was possible because of the nature of the injuries that these patients had while arriving at the trauma care facility. Another limitation is the follow-up period. We followed the patients for one year but if we followed the patents for longer periods we could have assessed the long-term prognosis.

Conclusion The definitive treatment of open tibial fractures especially Type 3B fractures with the Ilizarov Ring Fixator system is found be optimal and cost-effective.

Introduction Pelvic fractures in children are rare but extremely severe injuries associated with a significant threat to life. The search for new rational tactics of their surgical treatment based on a combination of various minimally invasive osteosynthesis techniques and instruments for its implementation remains relevant.

The aim of the work was to evaluate the results of staged treatment and a combination of minimally invasive osteosynthesis techniques at different periods of traumatic disease in children with combined and multiple pelvic injuries.

Materials and methods An analysis of 48 cases of treating pelvic ring fractures in children who sustained combined and multiple injuries within the period of 2000 to 2023 was carried out. The study group included 23  children treated at the pediatric polytrauma center of the Amur Regional Children's Clinical Hospital, in whom the author's methods and instruments were used for anti-shock and final osteosynthesis of the pelvic ring. The comparison group included 25 patients treated at the Republican Scientific Center for Emergency Medical Care (Tashkent). The comparison group was divided into three subgroups based on the treatment method: conservative treatment, osteosynthesis with pins, osteosynthesis with an external fixation device (EFD). Pelvic fractures were classified according to AO/ASIF; the severity of polytrauma was assessed according to the ISS scale. Anatomical and functional treatment results were evaluated using the methods of I.L. Shlykov and S.A. Majeed.

Results In patients of the main study group, residual displacement was observed by 57.6 % less frequently than  in  the  subgroup with conservative treatment, by 32.6 % than in the subgroup with wire osteosynthesis and  by  15.9 % than in the subgroup with osteosynthesis with an external fixation device (EFD). The  functional  treatment result of patients in the main study group was significantly better than in the subgroups of conservative treatment and wire osteosynthesis of the comparison group, with no significant difference when compared with the subgroup of EFD osteosynthesis.

Discussion Staged combined treatment using developed techniques and metal structures for osteosynthesis allows better reduction and stabilization of pelvic ring fractures and achieves good functional results. Not all problems of pelvic surgery can be solved with EFD; a number of injuries require the use of internal osteosynthesis for more accurate reduction. Disintegrating pelvic injuries accompanied by complete bilateral instability should be operated using temporary transpedicular fixation, since there is no alternative to this method.

Conclusion The combination of external fixation with internal osteosynthesis provides accurate reduction and reliable stabilization of pelvic ring fragments. Staged specialized care including internal bleeding arrest and  fixation with an anti-shock device at the first stage and final stabilization of pelvic ring fragments at the second stage is the most rational tactical approach to polytrauma in children. External fixation can be used not only as a reliable and simple anti-shock fixation, but also as a method of final osteosynthesis.

Introduction Limb amputation impacts physical activity and quality of life. Complications of limb amputation and prosthesis are essential for individuals who are losing limbs from vascular diseases and in military casualties.

The objective was to identify contraindications to prosthesis based on clinical and statistical stump characteristics.

Material and methods Medical records of 253 lower limb amputees aged 18 to 85 years including 15 individuals with bilateral amputations and 238 with unilateral amputations caused by mine blast injuries, vascular diseases and infections, peacetime injuries, congenital anomalies, osteomyelitis, osteosarcoma. Assessment of the amputee was produced by multidisciplinary teams at the prosthetic orthopedic company, military hospitals, medical and preventive healthcare institutions in 2023. The patients' stumps were examined radiologically and with ultrasound. A total 228 prostheses were manufactured including 120 for tibia and 108 femur amputees. Stabilometric platform and a rehabilitation complex were used for suitable alignment of lower limb prostheses.

Results The stump defects that complicated prosthesis included osteophytes, the fibula cut located distally to the tibia cut, the bone cut protruding to under the skin or a scar, foreign bodies of soft tissues, stiff scars, high location of truncated muscles. Prosthesis was complicated in 59 cases (23.3 %), of which 33 patients (56 %) had absolute contraindications.

Discussion The findings indicated the importance of timely assessment and preparation of stumps for effective prosthesis. Modern technologies and rehabilitation methods help improve quality of life of amputees. Pain and psychological difficulties were the main problems associated with primary permanent prosthesis. The multidisciplinary approach appeared to be practical for successful prosthesis and rehabilitation of patients. Limb amputation caused by combat injuries and other reasons is associated with physical challenges affecting the patient's quality of life.

Conclusion A failure to maintain proper prosthetic socket fit is an absolute contraindication to prosthesis preventing the patient from prosthetic use after amputation. Inadequately cut tibia, club-shaped or excessively conical stump, a stump being too short or too long, osteomyelitis, impaired wound healing or ulcer, ligature fistulas are relative contraindications.

Introduction Trapeziometacarpal osteoarthritis is a very common condition that leads to progressive loss of  functionality of the first finger that can be surgically treated with arthrodesis of the saddle joint and suspension arthroplasty of the first metacarpal bone. There is a controversy over the surgical technique to choose without consensus in the literature.

The objective was to compare surgical outcomes of patients with trapeziometacarpal osteoarthritis treated with arthrodesis and suspension arthroplasty of the saddle joint.

Material and methods The use of both surgical options resulted in significantly reduced pain measured with  the  VAS (p < 0.001) and improved upper limb function evaluated with the Quick DASH scale. The  treatments differed in the median duration of plaster immobilization. The duration of postoperative immobilization in arthrodesis patients was statistically higher (p = 0.004) than that in suspension arthroplasty group. No statistically significant differences were found between the two groups of heavy and light manual laborers (Pearson coefficient = 0.311).

Discussion The findings of the series indicated parameters being different from those published in  the  literature. The dependence between functional results and the type of working activity of patients treated with both surgical methods was not confirmed. The choice between trapezio-metacarpal arthrodesis and  suspension arthroplasty of the first metacarpal bone based on the criterion of severity of work was not always correct. Increased periods of plaster immobilization in the saddle arthrodesis group are reported in the literature and associated with complications of the treatment option.

Conclusion No significant differences were found between the outcomes of saddle arthrodesis and suspension arthroplasty of the first metacarpal bone.

Introduction Total spondylectomy for spinal tumors provides optimal local control and is associated with a high risk of implant instability.

The objective was to determine risk factors for implant instability after spondylectomy in patients with neoplastic lesions of the spine.

Material and methods A retrospective cohort study included patients with spinal tumors treated with tumor resection between 2007 and 2023. Inclusion criteria were spondylectomy and vertebral body replacement, thoracic or lumbar spine localization, follow-up period ≥ 12 months. LASSO regression and Random Forest methods and multivariate analysis were used to identify instability predictors.

Results Implant instability was observed in 16 patients (18.4 %). Risk factors included the use of bone cement instead of allograft (OR = 0.125, p = 0.014), contact surface mismatch > 10° (OR = 0.214, p = 0.026), prosthesis subsidence > 2 mm at 3 months (OR = 4.497, p = 0.023).

Discussion The risk factors identified had a great clinical role for the prevention of implant instability. The use of bone graft instead of cement, precise matching of contact surfaces and control of early prosthetic subsidence can significantly reduce the risk of metal construct failure. Careful preoperative planning and regular postoperative monitoring are essential for the outcome.

Conclusion Three independent risk factors for implant instability after spondylectomy identified in patients with  spinal tumor lesions included the use of bone cement instead of allograft, a discrepancy between the contact prosthetic surfaces of more than 10°, and an implant subsidence of more than 2 mm after 3 months. These factors are important for planning of the surgical intervention and postoperative monitoring to prevent metal construct instability.

Introduction The study of the functional characteristics of the unaffected side of the musculoskeletal system in patients with spastic hemiparesis contributes to the development of various aspects of medical rehabilitation.

Objective To determine the features of compensatory and adaptive behavior of the limb not involved in the pathogenesis in children with hemiplegia during walking and their dependence on age and previous surgical interventions on the triceps surae.

Materials and methods Locomotor characteristics of 78 children under 16 years of age with spastic hemiplegia  and  motor disorders corresponding to levels I–II GMFCS (Gross Motor Function Classification System) were compared with 77 healthy peers. Based on age and the triceps surae lengthening surgery, all  children were divided into 6 groups. Kinematic data were recorded using Qualisys 7+ optical cameras and KISTLER dynamometric platforms. The video material was analyzed using QTM and Visual3D programs, and statistical data processing was performed using Microsoft EXСEL-2013 and AtteStat 12.0.5.

Results In the unaffected limb of children with spastic hemiplegia, a flexion position in the limb joints was observed, while the kinematics of its ankle joint did not differ significantly compared to healthy peers. Moreover,  movements in the joints of the unaffected limb in children with hemiplegia were performed at  greater  energy consumption, especially in the knee and hip joints, while the power characteristics in the ankle joints were statistically lower than in healthy peers.

Discussion Significant increase, in comparison with the norm, and redistribution of power locomotor characteristics, as well as an increase in the GPS indicator of the total joint kinematic variability of the limb not involved in the pathogenesis indicate exclusively the compensatory nature of its behavior. Compensatory behavior is also shown by increased flexion angles in the joints and the sagittal tilt of  the  pelvis, which  posturally  eliminate the difference in leg length. Rotational positions of the pelvis and the femur, apparently, also serve to maintain the orientation of the foot.

Conclusion Compensatory behavior of the unaffected limb in children with hemiplegia during walking is  manifested in kinetic and kinematic activity. Power locomotor characteristics are significantly redistributed compared to the normal values. Power indicators in the knee and hip joints increase, but power characteristics in the ankle significantly decrease. According to the GPS index, the total joint kinematic variability significantly increases, and the joint flexion angles and sagittal pelvic tilt increase to compensate for the difference in leg height. The procedure of early surgical lengthening of the triceps surae did not have a significant effect on the motor characteristics of the uninvolved limb.

Introduction Infectious spondylodiscitis is rising in incidence and and is often a late diagnosis and identification of the causative agent.

The objective was to evaluate the treatment outcomes of patients with infectious spondylodiscitis depending on the positive/negative results of intraoperative microbiological culture.

Material and methods Treatment outcomes of 52 patients with infectious spondylodiscitis were retrospectively analyzed with no culture growth in the biological samples (group I, n = 22) and with identified pathogen (group II, n = 30). The diagnosis was verified using MRI imaging, intraoperative microbiological culture test, the  clinical picture and blood inflammation markers (ESR and CRP). Poor outcomes were associated with death and/or recurrent spondylodiscitis.

Results Positive culture growth was detected in 57.7 % with staphylococci predominated in 57.2 % and  Staphylococcus aureus detected in 42.9 %. Patients of group I were twice as likely to take antibiotics at the preadmission stage (p = 0.0049), had a 20 % longer delay in diagnosis (p = 0.7286), and had lower CRP and ESR levels than those in Group II (p > 0.05). Adverse events included one fatal case in each of the groups; recurrent infections occurred in 13.3 % of cases of group II (p = 0.3814) with three quarters of cases caused by Pseudomonas aeruginosa.

Discussion Poor prognostic factors in infectious spondylodiscitis include negative microbiological results, neurological impairment and concomitant endocarditis (p ≤ 0.05). S. aureus associated spondylodiscitis is accompanied by increased mortality and morbidity. Patients with spondylodiscitis with a negative microbiological test result compared with patients with a culture-positive infection, had a better treatment outcome with minimum recurrent rate (p > 0.05).

Conclusion Spondylodiscites with a negative microbiological result compared with a culture-positive infection had a better treatment outcome with a minimum of relapses (p > 0.05).

Introduction World literature indicates the relevance of predicting the outcomes of Dupuytren's contracture (DC) treatment, including those based on laboratory methods. There are no comparative studies of the results of surgical DC treatment based on preoperative peripheral blood counts in the available literature. The purpose of the work was to identify possible differences in preoperative leukocyte counts in DC with  different outcomes of surgical treatment one year after surgery and to evaluate their prognostic significance.

Materials and methods The analysis of medical records of 52 DC patients operated on in the Hand Surgery Clinic of the Ilizarov Center in 2021–2022 was conducted. The results were assessed using the Khan scale, as well as by calculating the contracture reduction index (CRI). The subgroup included 111 patients with fair and poor results, the remaining 41 were included in subgroup 2 with good and excellent results.

Results According to the CRI values, the subgroups were in non-overlapping ranges. The percentage of eosinophils and basophils (B + E) in subgroup 1 was higher than in subgroup 2 (p < 0.05). ROC analysis of the "CRI — (B + E)" model revealed an area under the curve of more than 0.7 at p < 0.01, specificity of 100 %, sensitivity of less than 60 %. In patients with (B + E) < 1.2 %, the rate of excellent and good results one year after surgery was 95.23 %, with (B + E) ≥ 1.2 % 70.00 % (p < 0.05).

Discussion The role of eosinophils and basophils in the development of fascial fibromatosis is unknown, but it has been established that interleukins IL-4 and IL-13 secreted by mast cells, basophils and eosinophils directly contribute to the activation of myofibroblasts and the development of fibrosis.

Conclusion In (B + E) < 1.2 %, a favorable outcome is predicted for both open and minimally invasive surgeries; at (B + E) ≥ 1.2 % there is a high probability of progressive postoperative fibrosis, which justifies the choice of radical open interventions (hypodermectomy or dermofasciectomy) and the use of antifibrotic therapy in the postoperative period.

Introduction The study of procalcitonin (PCT) levels simultaneously with blood cultures for sterility is an important addition to the diagnostic algorithm for chronic osteomyelitis detection.

Purpose of work is to study the relationship of serum PCT with the microflora isolated from blood, wounds and fistulas in patients with chronic osteomyelitis.

Materials and methods A retrospective analysis of wound microflora, blood cultures for sterility, and procalcitonin test results was performed.

Results Gram-positive microorganisms prevailed in the microbial tests from wounds, fistulas and blood in patients with PCT less than 0.5 ng/ml and from 0.5 to 2.0 ng/ml. In patients with PCT levels from 2.0– 10.0 and  above10 ng/ml, both gram-positive and gram-negative bacteria were isolated. Among positive blood cultures, S. epidermidis strains were the most frequently isolated, followed by S. aureus, K. pneumoniae, S. agalactae, and S. hominis isolates. PCT in the blood of seven patients was higher than 10 ng/ml; and six patients had it from 2.0–10.0 ng/ml. Two subjects had a low PCT level, but an infectious agent was detected in their blood.

Discussion In patients with PCT lower than 0.5 ng/ml, gram-positive microorganisms are most often found in the microflora of wounds and fistulas. The proportion of patients with PCT values ≥ 2 ng/ml and gram‑negative bacteria in the focus was higher compared to patients with gram-positive microflora. Nevertheless, the detected high correlation relationship between the microbiocenosis of patients' wounds and procalcitonin values confirms the leading role of gram-positive bacteria in the development of osteomyelitis.

Conclusion In positive blood cultures, the serum PCT level was usually higher than 2.0 ng/ml. The presence of  gram-negative bacteria in the blood, as well as in the wound, was accompanied by PCT values higher than 10 ng/ml.

Introduction Replacement of bone defects is an important issue of modern traumatology and orthopedics. With increasing technological advances there is a spectrum of bone-substituting materials, and the choice of the effective option is essential for biomedical research.

The objective was to determine the effect of the three-dimensional structure and pore size of tricalcium phosphate based bone substitute materials on osteoconduction using a critical diaphyseal defect of the rat femur.

Material and methods A monocortical 7 mm defect was simulated in the middle third of the rodent femoral shaft under anaesthesia and filled with blocks of one of four tricalcium phosphate based materials differing in the number, size and direction of pores. Eight rats from each group were sacrificed at 3 and 6 months, and the newly formed bone was histologically examined and the results compared using statistical methods.

Results The bone tissue was shown to grow into the defect area through the pores of the material in all the groups at 3 and 6 months, The newly formed bone measured (11 ± 4) % and (31 ± 6) % of the defect area in  the  Cylinders group, (14 ± 5) % and (29 ± 4) % in the Gyroid group; (39 ± 5) % and (41 ± 7) % in the Gyroid-150 μm group and (17 ± 7) % and (27 ± 8) % in the Gyroid-50 μm group, respectively. The area of newly formed bone was statistically greater in the Gyroid-150 µm group compared to that in the other groups (p < 0.05, Kruskal – Wallis test).

Discussion The effect of the type of architecture of the bone substitute material, the pore size and their relationships are reported in many studies with larger diameter pores (more than 600 μm) improving osteoconduction, and the upper limit of porosity being limited by a decrease in the mechanical properties of the block. The advantages of the Gyroid structure over other types of architectures are described in theoretical and applied research. Structures with pores of different sizes were examined in few studies, and our findings demonstrated the feasibility of using the complex structures and the role in replacing bone tissue.

Conclusion The three-dimensional structure of bone substitute materials based on tricalcium phosphate was shown to have an effect on osteoconductive properties, with an additional pore mode with a diameter of 150 μm added to the Gyroid structure leading to significantly greater experimental bone tissue ingrowth in the sample.

Introduction Impaired reparative regeneration in patients with fractures is the most common complication; immunogenetic mechanisms play a leading role in its pathogenesis. Many researchers are engaged in the search for an "ideal" diagnostic marker. For this purpose, neural networks have been increasingly used, which allow not only to predict various pathological conditions but also to determine reliable options for prevention and treatment.

The purpose of the study was to evaluate the effectiveness of predicting impaired consolidation of long-bone fractures of the extremities using the neural network data analysis.

Material and methods We examined 108 young patients (WHO classification) with fractures of lower limb long bones. The clinical comparison group consisted of 62 patients without complications at the age of 34.5 [18; 44] years. The study group included 46 patients of similar age (36 [18; 44]) years and gender with delayed consolidation. The control group included 92 practically healthy individuals. Exclusion criteria from the study were any concomitant disease, other location and nature of injuries, alcoholism, as well as inaccurate reduction of bone fragments, and repeated operations. Patients who received antiresorption therapy and calcium supplements in the prehospital stage were also excluded. Laboratory (genetic) studies included determination of carriage of polymorphic molecules — TNFRSF11B-1181(G>C), IL6-174(C>G), TGFβ1-25(Arg>Pro), EGFR-2073(A>T) and VDR(BsmI283G>A). Amplification was carried out using primer sets Litekh-SNP (Russia). The risk of developing delayed consolidation was assessed using SPSS Statistics Version 25.0 (Neural Networks module). The predictive performance of the neural network was assessed using ROC analysis.

Results For determining the importance of the independent variable, the following gradation was noted: TGFβ1-25(Arg>Pro) gene polymorphism — 100 %; gene polymorphism TNFRSF11B-1181(G>C) — 97.1 %, gene polymorphism VDR-BsmI283(G>A) — 34.7 %; IL6-174(C>G) gene polymorphism — 31.5 %; polymorphism of the EGFR-2073(A>T) gene — 15.3 %. The percentage of incorrect predictions was 8.3 %. Area under the curve of ROC analysis (AUC) = 0.91[0.85–0.98], p < 0.001. The specificity of the resulting model is 0.95 %, sensitivity is 0.87 %, accuracy is 91.7 %.

Conclusion The use of the neural network for predicting delayed consolidation of fractures using data on the carriage of certain gene polymorphisms has a sufficient degree of accuracy (91.7 %), which indicates that the introduction of the neural network analysis into practical medicine is promising.

Introduction Thymidine phosphorylase (TP) is known to be correlated with the pathogenesis of solid tumors. IL-6 is overexpressed in osteosarcoma, and data exist showing that high concentrations of IL-6 are linked to a poor prognosis.

The aim of this study is to investigate the diagnostic role of thymidine phosphorylase and IL-6 in the pathogenesis and progression in patients with osteosarcoma.

Materials and methods Thirty patients diagnosed with osteosarcoma (with age ranging between 15–44 years) were included in the current study. Those patients were distributed as 6, 15, 5 and 4 subjects for stages AI, BI, II and III respectively.

Results Statistical analysis pointed out that IL-6 tends to be increased patients in stage III (3.89 ± 0.34 ng/ml) compared to stage AI, BI and II: 1.48 ± 0.22 ng/ml, 1.55 ± 0.24 ng/ml and 2.45 ± 0.45 ng/ml respectively. Regarding thymidine phosphorylase, the current study also found that it tends be increased patients in stage III 8.3 ± 0.33 ng/ml comparing to stage  AI, BI and II: 7.2 ± 0.92 ng/ml, 6.82 ± 1.14 ng/ml and  7.8 ± 0.22 ng/ml, respectively. The area under the curve (AUC) for thymidine phosphorylase was 0.87, with high significant difference p < 0.001, at a cut-off point 2.44, while the sensitivity and specificity ratios were 0.85, and 0.71 respectively. Regarding IL-6, the area under the curve (AUC) was 0.75, with significant difference p < 0.038, at  a  cut-off point 6.32, while the sensitivity and specificity ratios were 0.81, and 0.69 respectively. These biomarkers can also be used in the diagnosis and progression of osteosarcoma.

Discussion High levels of TP are expressions of tumor aggressiveness and poor prognostic factors. Some separate studies focus on TP expression at different osteosarcoma stages but their numbers are few, arguing that there is a gap in the current available literature. TP more recently has attracted significant attention for its involvement in cancer biology, especially with regard to its influence on disease pathogenesis and prognosis, according to available studies, TP plays a major part in the development of most malignant diseases, and particularly bone-related malignancies. It has been observed that TP promotes angiogenesis, is expressed in tumor-associated macrophages within the tumor stroma. TP expression has been studied in different types of cancer as a predictive body. New prognostic models for patients with bone cancer can be developed based on literature data.

Conclusion It is suggested that thymidine phosphate activity and IL-6 have a significant high diagnostic power in the diagnosis and progression of osteosarcoma.

Introduction Intertrochanteric fractures account for almost half of all hip fractures, with a mortality rate of 15 to 20 % within one year following fracture, primarily in elderly patients aged 65 years old and older. The purpose of this study is to compare the operative time, intraoperative blood loss, intraoperative blood transfusion, hospitalization time, weight-bearing time, Harris Hip Score at 1, 3, 6, 12 months follow-up, and  complications after proximal femoral nail antirotation versus bipolar hemiarthroplasty for intertrochanteric fracture in elderly patients based on the published literature of their comparison.

Methods We conducted a comprehensive search in the electronic databases such as PubMed, Scopus, and  Google  Scholar. Original articles up to November 2024 were screened, focusing on retrospective or prospective cohort studies.

Results and Discussion The initial search yielded 702 studies. Six cohort studies with a total of  495  participants  were assessed. The Proximal Femoral Nail Antirotation (PFNA) showed statistically significant shorter operative time (p = 0.006), lower intraoperative blood loss (p < 0.0001) compared with  bipolar hemiarthroplasty. Bipolar Hemiarthroplastty had statistically significant better Harris Hip Score at 1 and 3 month follow-up post-operatively (p < 0.00001), (p = 0.001). It provides early weight-bearing (p = 0.003) and helps mobilize post-operative patients. Blood transfusion, hospitalization time, Harris Hip Score after 6- month follow-up, and complications had balanced results between two apporaches.

Conclusion PFNA and bipolar Hemiarthroplasty have comparable results in intertrochateric fractures in the elderly. PFNA has the advantages of shorter operative time, and lower intraoperative blood loss. Bipolar hemiarthroplasty has the advantages of better Harris Hip Score at 1 and 3 month follow-up and earlier weight-bearing.

Level of Evidence: I.