Introduction The relevance of studying the treatment of proximal humeral fractures in children stems from the high incidence of fractures in this anatomical region and the absence of a standardized treatment approach. This highlights the need for further research to develop treatment protocols that account for the unique characteristics of the pediatric body and the specific features of these fracture types.

Objective of the study was to analyze and compare the outcomes of treating children with extra-articular proximal humeral fractures using double-nail versus single-nail modifications of intramedullary osteosynthesis with elastic nails.

Materials and Methods Patients were divided into two groups. The study group (n = 39) patients underwent surgical treatment with a single elastic rod while patients in the control group (n = 32) received treatment using a double-nail modification of osteosynthesis. Treatment efficacy was analyzed in both inpatient and outpatient settings with clinical, radiological, and sociological assessment methods.

Results Postoperative parameters (duration of pain syndrome, hospitalization period, return to school, and fracture consolidation time) were comparable in both groups, indicating similar efficacy of the treatment methods in these studied parameters. Statistically significant differences were observed only in operative time, directly linked to the specific surgical techniques employed in each group. The proposed method in the main study group allowed for faster surgery and did not significantly affect other key parameters of anatomical and functional recovery. Patients in both groups were satisfied with the treatment outcomes.

Discussion Unlike the conventional two-nail configuration, the single-rod approach significantly reduces operative time, thereby lowering the risks associated with anesthesia, and slightly reduces the duration of pain syndrome. The study had limitations, including a short follow-up period (no more than 12 months post-injury and 1 month post-implant removal) and a lack of differentiation between fracture configurations (metaphyseal vs. epiphyseal fractures).

Conclusion The single elastic nail osteosynthesis method provides functional recovery of the injured segment and restoration of the child’s overall activity comparable to the double-nail technique. Fracture consolidation occurs with correct fragment alignment within standard timeframes.

Introduction Currently, up to 30 % of cases after surgical treatment in distal humerus fractures result in permanent disability. It is important to improve the surgical techniques to ensure the restoration of the anatomical integrity of this department.

The aim of the work was to perform a comparative analysis of the results of surgical plasty with donor block and cubic cadaver allografts for bone defects of various locations in the distal humerus fractures based on an assessment of bone density and vascularization of the grafted area.

Materials and methods The study involved 56 patients with distal humerus fractures, divided into three groups based on the defect location and two subgroups depending on the method of surgical plastic surgery. A comparative analysis of treatment outcomes was conducted based on the values of the vascularization index of the defect zone obtained by ultrasound study, as well as the Hounsfield index values obtained by computed tomography of the damaged segment. The allograft area was assessed in three zones of interest, the central, marginal and native bone structures.

Results The use of a block allograft provided increase in the values of the Hounsfield index 3 months after surgery in the central graft zone with a defect in the medial column to a value of 190HU (p = 0.01),with a lateral defect to 185HU (p = 0.01), with a central defect to 170HU (p = 0.03); increased the values of the Hounsfield index in the marginal zone 3 months after surgery, the graft area with a medial defect was 210HU (p = 0.01), a lateral defect was 200 HU (p = 0.01), and a central defect was 185 HU (p = 0.02). It provided the increase in the values of the vascularization index of the graft zone with a defect in the medial column by 1.2 times (p = 0.01), in the lateral column by 1.15 times (p = 0.01), in the central zone by 1.18 times (p = 0.02).

Discussion The results of the study indicate that the use of a block allograft increases the density of bone tissue in the marginal and central zones of defect grafting area 3 months after surgery, more expressed if it is localized in the medial and lateral columns, and increases the intensity of blood flow in the defect grafting area 2 months after surgery.

Conclusion Comparison of the results of plastic surgery for post-traumatic bone defects in comminuted fractures of the distal humerus showed the advantage of using native block allograft in defects of the lateral and medial columns due to the optimization of osteointegration processes in the defect zone in the mediumterm postoperative period.

Introduction Goniometry is used to measure shoulder abduction range of motion aiding in diagnosis, rehabilitation planning and monitoring progress in rehabilitation evaluating a patient's shoulder function. Computer vision technology holds promising potential for the assessment of movement by unifying and objectifying goniometric studies of different somatometric parameters.

The objective was to validate a video-assisted computer vision goniometry of the motor function of shoulder abduction using the potential of neural networks.

Material and methods The study involved 33 volunteers, males and females aged 18 to 56 years, with the weight of 53 to 108 kg and the height of 155 to 195 cm. Measurements of related samples were compared to validate the author's method of goniometric examination of shoulder abduction. Classical goniometry was used for patients of group 1. Changes in the shoulder position were radiologically explored in group 2 and video-assisted goniometry computer vision was employed for examinations in group 3. The study was performed using hardware and software "Arthro-Pro" system. Statistical processing was produced using the Statgraphics software package.

Results The average difference in the abduction was insignificant in groups 1 and 2 measuring (0.62 ± 0.63)° from a minimum of 5.2° to a maximum of 1° with confidence interval of p = 0.95. The difference in the abduction angle ranged from -11.8° to 22.7° in groups 1 and 3 with the average difference of 6° and confidence interval of p = 0.95.

Discussion The minor difference in the abduction angles obtained with computer vision technologies and classical goniometry indicated the comparability of the two methods facilitating the possibility of introducing artificial intelligence for assessing musculoskeletal function in clinical practice.

Conclusion The video-assisted computer vision goniometry is practical for measurements of shoulder abduction in clinical practice.

Introduction Transosseous osteosynthesis has the advantages of controllability, mobility and minimal invasiveness and is commonly used by trauma and orthopaedic surgeons for elbow deformity correction. There is a paucity of publications reporting errors and complications with external fixation devices used to restore the biomechanical axis of the upper limb.

The objective was to identify errors and complications in patients with post-traumatic coronal deformities of the elbow joint treated with the Ilizarov apparatus and to determine a rational algorithm for the prevention.

Material and methods The study included 68 patients with elbow deformities in the frontal plane. The patients age ranged from 4 to 56 years. The surgeries were performed between 1990 and 2024. Patients were divided into 2 groups: control and treatment. The control group included 41 patients who underwent correction surgery up to 2018. The limb was realigned either acutely or gradually post op through Ilizarov distraction produced on the concave side of the deformity. In order to prevent errors and complications, since 2018, patients with the condition have been treated according to a protocol developed to contain the sequence of intraoperative and postoperative manipulations taking into account time factors. These patients were included in the treatment group (n = 27).

Results Complications were identified in the limb biomechanics (residual deformity, disturbed limb axis); in the joint (contractures); in the bone (comminuted osteotomy, presence of teeth); in the bone regeneration (ischemic regenerate); in the nerves (short-term and long-term neuropathies of the radial and ulnar nerves).

Discussion The number of complications in patients of the treatment group was seven times less compared to literature data, while the total number of complications after supracondylar osteotomy of the humerus and Ilizarov fixation was 1.6 times lower. Review of errors and complications in the treatment of patients with post-traumatic frontal deformities of the elbow joint using supracondylar osteotomy and the Ilizarov fixation facilitated development of a rational algorithm for the correction.

Conclusion The limb axis can be realigned and biomechanics of the elbow joint restored with corrective supracondylar osteotomy of the humerus and manipulations with the Ilizarov apparatus. The algorithm developed for treatment of patients with elbow deformities suggested a strict sequence of actions with time factors, reducing errors and complications in the form of failures in performing osteotomy, residual deformity, poor regeneration, contractures and neuropathies by 6.3 times.

Introduction The possibilities of medical visualization of changes in the articular cartilage and subchondral bone in wrist osteoarthritis are limited. There are few studies devoted to its histological manifestations.

The purpose f the work was to determine the relationships between histological features of wrist osteoarthritis and the duration and stage of SLAC / SNAC syndrome.

Material and methods The surgical material of 12 patients who underwent resection of the proximal row of wrist bones or removal of the scaphoid bone and intercarpal arthrodesis was studied. In nine patients, the duration of the disease was shorter than four years and in three it was from 10 to 22 years. Stage I SLAC / SNAC syndrome was detected in two patients, stage II — in six, stage III — in four. Cartilage changes were assessed using the international OARSI scale, the prevalence of subchondral bone necrosis was determined semi-quantitatively (from 0 to 3 points) in 3–10 fields of microscopic views of the from each patient.

Results The OARSI score varied from 1–2 to 5 points if the duration of the disease was shorter than four years and from 3–4 to 4–5 points if it continued from 10 to 22 years. The osteonecrosis score in the compared subgroups was 3 (2÷3)(0–3) and 3 (2÷3)(2–3), p = 0.11. In SLAC / SNAC stage I, the OARSI score variability ranges from 1–2 to 4, in stage II — from 2 to 4–5, in stage III — from 3–4 to 5. The osteonecrosis score in the compared subgroups was 2 (1÷2)(1–3), 3 (2÷3)(1–3), and 3 (2÷3)(0–3) (P^1-2 = 0.03; P^2-3 = 0.62; P^1-3 = 0.02).

Discussion The SLAC / SNAC syndrome can be of two types, progressive and stagnant. In the second type, the disease is asymptomatic for a long time. Regardless of the cause of SLAC / SNAC syndrome, all patients with wrist osteoarthritis experience irreversible osteonecrosis of the subchondral bone and bone marrow, which probably reflects the degree of acute or chronic damage to the vessels that feed the bone.

Conclusion With a general tendency for greater degenerative changes in the articular cartilage at a higher stage of SLAC / SNAC syndrome, their histological manifestations vary between individuals at each stage. Osteonecrosis of the subchondral bone is more common in SLAC / SNAC stages II–III than in stage I. 

Introduction Instability of the total hip arthroplasty is a common complication and an indication for revision arthroplasty. The implant instability is diagnosed as aseptic with no microbiological culture growth to be obtained through preoperative synovial aspiration. Etiological interpretation of intraoperative findings in cases of so-called "aseptic instability" is critical for determining subsequent treatment strategies.

The objective was to determine the role of microbiological methods in diagnosing periprosthetic joint infection (PJI) of the hip.

Material and methods A bacteriological analysis was produced for 173 patients with aseptic instability of total hip replacement. The patients aged 27 to 82 years. Based on laboratory, clinical and microbiological (MB) findings, the patients were divided into two groups. The first group consisted of 118 (68.2 %) patients who underwent one-stage revision and had a favorable postoperative prognosis. The second group consisted of 55 (31.8 %) patients with elevated hematological parameters, local signs of inflammation, positive MB findings and had unfavorable prognosis. These patients underwent two-stage revision arthroplasty. Biopsy samples were tested using polymerase chain reaction (PCR) in cases of minimal microbial load.

Results Positive MB results were registered in 5.1 % of patients in the first group and in 25.5 % of patients in the second group. Intraoperative biopsies revealed positive results in 20.3 % of the first group and 30.9 % of the second group. PCR identified PJI in 7.5 % of MB biopsies and in 19.6 % of aspirates.

Discussion The findings indicated low diagnostic value of microbiological cultures with PCR improving diagnostic accuracy by 7.5 %. Detection of low-virulence microorganisms including coagulase-negative staphylococci required specific evaluation criteria.

Conclusion Microbiological culturing demonstrated moderate sensitivity, in low-virulence infections, in particular, while PCR in low-virulence infections was essential in establishing the microbial etiology of PJI.

Introduction Distal tibia pilon fractures are complex injuries involving the tibial articular surface. Managing these fractures requires balancing stable fixation with soft tissue preservation. The Ilizarov technique offers a minimally invasive alternative to traditional open reduction and internal fixation (ORIF), allowing for gradual correction and early weight bearing.

This study aimed to evaluate functional and radiological outcomes in patients with distal tibia fractures managed by limited open reduction and Ilizarov fixation.

Materials and Methods The study was conducted in a tertiary care hospital's Department of Orthopaedics over two years. The inclusion criteria were patients aged >18 years with distal tibia fractures. Exclusion criteria included refracture, previous surgeries, and associated vascular injury. The study included 20 patients (18 males, 2 females) with a mean age of 39.2 ± 10.5 years. Most injuries (80 %) were due to road traffic accidents. Fracture patterns were classified according to the AO-OTA classification. The surgical procedure involved placing the patient supine under spinal anesthesia. Traction was applied, and fluoroscopy was used to assess reduction. A three-ring tibial Ilizarov frame was assembled and applied, with additional fixation for the calcaneum. The median time to full weight bearing was 26 days.

Results At frame removal, all cases had ankle stiffness, but two months post-removal, 85 % of cases had full ankle range of motion. The median time to frame removal was 17.5 weeks, and the median time to consolidation was 22 weeks. Patellar tendon bearing cast was applied for 3 weeks followed by a PTB brace with foot extension for the next 4 weeks.

Discussion The Ilizarov technique should be considered as a viable option, especially for complex fracture patterns or cases with compromised soft tissue envelopes not amenable to ORIF.

Conclusion The Ilizarov technique represents a valuable approach for managing distal tibia pilon fractures, demonstrating improved clinical outcomes and minimal complications.

Introduction Post-surgical dysphagia is one complication particularly common in early postoperative period after Anterior cervical spine surgery (ACSS). However, the pathophysiology of dysphagia after surgery has not been well understood.

This study aimed to analyse the frequency and risk factors for developing dysphagia following ACSS and find an effective program to prevent and treat.

Materials and methods A prospective observational study was conducted on 50 patients undergoing ACSS from April 2021 to Oct 2022 at the Department of Orthopedics, Guru Gobind Singh Medical College and Hospital, Punjab (India). Patients were in the age group of 27 to 60 years. The indications for cervical surgeries were traumatic, degenerative, infective and neoplastic involving C2 to C7 vertebra with signs of neural compression unresponsive to conservative treatment. Data on patient age, gender, duration of surgery, intraoperative blood loss, segment operated and the number of segments operated were collected. Follow up time was 24 weeks.

Results Incidence of dysphagia was 20 % (10/50) within first week which reduced to zero at completion of six months of follow-up. Dysphagia was present in 2 % (1/50) patients in age group 21–40 years and 18 % (9/50) patients in age group of 41–60 years. 14.6 % (6/41) males and 44 % (4/9) of females had dysphagia. Prevalence of dysphagia in patients with one affected segment was 9.5 % (4/42), two segments was 80 % (4/5) and three segments was 50 % (1/2). Mean duration of surgery in patients with post-operative dysphagia was 115 mins. Mean blood loss in patients with post-operative dysphagia was 171.40 mL Mean Et (endotracheal) tube cuff pressure in patients with post-operative dysphagia was 24.70 cm H₂O. Within the first week of surgery, there were 10 cases out of which one was mild, six were moderate and three were severe.

Conclusion Despite the fact that some inconsistency is there in the literature regarding risk factors it can be safely concluded from our study that incidence of post-operative dysphagia can be reduced by decreasing blood loss during surgery, reducing surgery time and optimizing Endotracheal tube cuff pressure during surgery. 

Introduction Extra-articular operations for correction of ischemic deformities of the femoral head are not effective enough. Currently, intra-articular correction methods are used, among which one of the most effective methods is considered to be reduction osteotomy of the femoral head.

Purpose The aim of the work is to evaluate the results of intra-articular and combined interventions in patients with ischemic deformity of the femoral head.

Materials and methods The study included patients with ischemic deformity of the head and proximal femur (n = 15), divided into two groups. In the first group (n = 7), the patients underwent reduction osteotomy of the head using only the Ganz technique. Patients of the second group (n = 8) additionally underwent surgery on one or both joint components: corrective intertrochanteric osteotomy of the femur, pelvic osteotomy, or combined intervention. The joint was fixed with the Ilizarov apparatus.

Results The average D'Aubigne-Postel score in the first group was (14.7 ± 0.3) points, in the second group — (15.0 ± 0.2) points. When analyzing the radiometric data after treatment, a reliable improvement in the parameters characterizing the sphericity and the degree of head centralization was recoreded in patients of both groups. Radiographic results of patients in the first group: good result — 3 joints (43 %), fair — 3 joints (43 %), poor — 1 joint (14 %); the second group: good result — 3 joints (38 %), fair — 4 joints (50 %), poor result — 1 joint (12 %).

Discussion Simultaneously with the reduction osteotomy of the head, it is allowed to perform additional surgical interventions aimed at eliminating instability of the hip joint. Conducting a reducing osteotomy of the head in the conditions of a functioning growth plate is considered debatable.

Conclusion Intra-articular interventions that change the shape and improve the congruence of articular surfaces may be an alternative to early arthroplasty in adolescents and young adults in certain clinical situations.

Introduction Titanium has been successfully employed as artificial implants in orthopedic surgery for decades. Surgical intervention, specifically the implantation of medical devices, carries a risk of implant-associated infection (IAI), the causative agents of which are staphylococci in more than half of the cases.

The objective was to evaluate the antibacterial, antibiofilm activity and cytocompatibility of a multicomponent coating with magnesium and silver oxides on the surface of 3D titanium samples.

Material and methods The MgO-AgO-MgO complex The MgO-AgO-MgO complex was applied to 3D samples of medical titanium. Elemental analysis was performed using a TM 4000 Plus scanning electron microscope. The samples were incubated with bacteria for 24 hours to identify antibacterial activity against S. aureus. S. aureus biofilms were formed by immersing the test samples in a nutrient medium with bacteria. After a 24-hour incubation, the samples were washed, placed in an ultrasonic washer, and then sonication fluid was seeded using the sector seeding method. The cytocompatibility of the coating was assessed on a culture of eukaryotic cells of the Vero line.

Results Elemental analysis and mapping confirmed the uniform distribution of oxides on the surface of 3D titanium samples. The coating was characterized by antibacterial activity against S. aureus for three days. The MgO-AgO-MgO complex effectively prevented S. aureus adhesion and microbial film formation, while the control samples showed biofilm formation by staphylococci. However, cytocompatibility analysis of the 3D samples showed no viable cells after 72 h of incubation in a medium with an extract from coated titanium samples.

Discussion Despite a decrease in antibacterial properties on day 4, the MgO-AgO-MgO complex prevented microbial adhesion to the surface of the samples which ensured protection of the implant from the formation of microbial biofilm. The cytotoxicity of the complex was caused by significant activation of lipid peroxidation reactions, which resulted in suppression of the viability of eukaryotic cells.

Conclusion The MgO-AgO-MgO coating prevents primary interaction between the pathogen and the abiotic surface, which is one of the main factors in preventing the development of IAI and the relapses after revision surgeries with implant replacement. However, the high level of cytotoxicity requires further modification of the coating application technique and its composition.

Introduction Ankle fractures are one of the common injuries treated by orthopaedic surgeons. The lack of a standard medical care can be associated with poor outcomes, high disability rates with conservative treatments. Reported outcomes following operative fixation vary widely in the literature and infectious complications can complicate the rehabilitation process.

The objective was to show a clinical possibility, safety and feasibility of a new method of fibula fixation in ankle fractures using necropsy material and to reduce negative consequences after surgical treatment.

Material and methods Major vessels and nerves were isolated in the lower third of tibia in 11 biomannequins, AO 44C1 and 44C2 fractures obtained mechanically and fibula fixed using the technique offered. Forces were applied to the injury site through mechanical stress tests.

Results The fixation method did not lead to a conflict between fixing screws and major vessels and nerves. No visible changes in the fibula position were noted in the biomannequins with the foot brought to extreme positions of plantar and dorsal flexion, with stress tests causing valgus and varus deformities.

Discussion As opposed to conventional surgical treatments of ankle fractures, no large incisions are required with the technique to place implants. There is no need to use plates, and the fracture can be fixed using the paired bone of the injured segment instead. Fixation screws can be inserted transcutaneously through soft tissue punctures. The new method is associated with less trauma, less quantity of metal needed and reduced probability of infectious complications. It can be used for AO 44C1 and 44C2 fractures in medical institutions with different availability of equipment.

Conclusions Ankle fractures can be repaired with the technique offered causing no damage to the major vessels and nerves at the surgical site. Stress tests showed stable fibula fixation achieved in all cases avoiding mobility at the fracture site. The new technique can facilitate normal reparative osteogenesis in clinical practice.

Introduction Failures in surgical rehabilitation of patients with humeral fractures result in the formation of a multicomponent complex of pathological symptoms, including nonunion or bone defect, changes in the shape and length of humeral fragments, development of persistent angiotrophic disorders of the upper limb and contractures of the shoulder and elbow joints. Despite the effectiveness of using metal implants, there are risks in surgical osteosynthesis in complex anatomical and functional lesions.

The purpose of the work was to demonstrate a new technology of bone plasty with free fragments of the fibula as a bone-plastic material for restoring the integrity of the humerus in bone nonunion and defects in the conditions of transosseous osteosynthesis and transosseous fixation of the grafts with wires.

Materials and methods A free autograft of the fibula shaped as a cylindrical fragment, which was resected proximally to the ankle joint level at 8.0-9.0-cm distance, was used as a bone plastic material. The fibula graft was fragmented intraoperatively. Fragments were implanted along the periphery of the humerus fragments overlapping of the pseudarthrosis site. Free autografts of the fibula were transosseously fixed with wires. A wire/half-pine Ilizarov apparatus with three external supports was placed to fix the segment.

Discussion The "gold standard" material for bone plasty is autogenous bone. If defects and pseudoarthroses of the humerus are located in the distal metaepiphysis, the application of the fibular cylinder-shaped fragment with intraosseous reinforcement of the humeral bone is technically difficult. Open co-aptation of the humeral fragments with adequate contact between them and application of the optimal autogenous bone-plastic material which overlaps the pseudarthrosis zone to increase the volume of bone mass ensure the restoration of bone regeneration in the pseudarthrosis zone. External fixation is optimal for fixation of bone fragments and grafts.

Conclusion The originality of the developed technology lies in the use of several free bone autografts from the fibula implanted along the periphery of the humeral fragments junction. The area of active osteogenesis is thus created due to the combined effect of open co-aptation of the ends of the humeral fragments with resection of the endplates and bone autogenous grafts that overlap the problematic area. Additional transosseous fixation of bone autografts with wires ensures the stability of free grafts. Controlled fixation of humeral fragments with compression and adequate contact of the fragments is achieved with the Ilizarov apparatus.

Introduction Unicompartmental knee arthroplasty (UKA) is an effective surgical procedure used in patients with gonarthrosis with a part of the knee being severely affected. Insufficient or excessive correction of the lower limb axis can cause a poor outcome of partial arthroplasty.

The objective was to evaluate ways that would help prevent insufficient or excessive correction of the lower limb axis with UKA and demonstrate techniques preventing and solving the surgical problem using a clinical example.

Material and methods A patient presented with valgus deformity at the knee level, knee pain and inability to walk without support was seen at the Vreden National Medical Research Centre for Traumatology and Orthopedics. The patient underwent UKA three years ago. The radiographs showed sparing resections of the femur and tibia, the working surface of the polyethylene liner/tibial implant component being 5 mm proximally to the articular surface of the lateral condyle of the tibia.

Results and discussion The limb axis was corrected by 6° during revision arthroplasty. The patient had no limping at one year and the result of the operation was rated as excellent measuring 45 OKS scores. The authors reviewed prerequisites of the complication in question and ways to prevent it. Iatrogenic causes primarily associated with surgical technique are reviewed.

Conclusion Inadequate mechanical alignment is characterized by a heterogeneous identity in UKA and can be caused by ineffective preoperative planning and specific anatomy of the patient, intraopereative technical failures.

Introduction High risk of infectious complications in gunshot wounds remains a pressing issue in military medicine. Analysis of the structure of sanitary losses shows that limb injuries account for 55 % to 81.4 %, with about 35 % of them accompanied by bone fractures. Performing operations for the final stabilization of these fractures under the conditions of primary microbial contamination is associated with a high risk of infectious complications. However, the use of antibacterial coatings on internal implants significantly reduces the risk of such complications.

The purpose of the work, based on the analysis of Russian and foreign literary sources, is to determine the effectiveness of using antibacterial coatings on titanium implants for gunshot fractures.

Materials and methods The search for scientific publications was carried out in the search engines eLibrary, PubMed and Connected Papers using the keywords: antibacterial coatings, gunshot fractures, implant-associated infection, internal osteosynthesis, infectious complications, antibacterial coating, gunshot fractures, infectious complications, peri-implant infection. The sources were selected based on the hypothesis of the possibility of using antibacterial coatings in clinical practice. The search depth was from 2009 to 2025.

Results and discussion The existing systems for delivering antibacterial drugs to the surgical intervention area demonstrate high clinical efficacy in the prevention of peri-implant infection. To date, the most studied agents for creating coatings are metal ions, polymers, as well as composites containing antibacterial / antiseptic drugs. The most effective are multifunctional and intelligent coatings that have a combined effect on microbial biofilms due to their pronounced anti-adhesive and biocidal properties. There is a shortage of research on the use of multifunctional coatings in traumatological and orthopedic practice. There are no publications in the world literature devoted to the use of antibacterial coatings in the treatment of gunshot fractures and their consequences.

Conclusion The use of polymer and multifunctional antibacterial coatings, hydrogels, as well as oxides of silver, iodine and zinc demonstrate high efficiency in the prevention of infectious complications after internal osteosynthesis, and, in our opinion, can be considered for use in clinical practice in the treatment of gunshot fractures of limb bones.

Introduction The optimal rotational alignment of the femoral component in a knee implant with navigation devices is important for total knee arthroplasty. Measured resection and gap technique are available intraoperative methods to determine the rotation of femur with navigation devices, but each of these methods has its advantages and disadvantages. These aspects have contributed to the development and clinical validation of navigation tools for large joint arthroplasty.

The objective of this study was to evaluate the efficacy of determining the rotational alignment of the femoral component in a knee implant with mechanical and robotic navigation devices as a basis for processing intraoperative decision making by surgeons.

Material and methods The planning, execution and reporting of this systematic review were conducted in accordance with the established Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Initially we identified 366 studies that corresponded to the main focus of this research, and 158 studies were selected for analysis after the duplicates had been excluded. Ultimately, only 11 studies fully met the selection criteria. The evaluation included the article data, the type of mechanical or robotic navigation device, the number of cases, the complication rate, and the specifics of the preoperative, intraoperative, and postoperative methods used for determining the rotation of the femoral component in a knee implant in the cohorts reviewed. A total of 1,198 total knee arthroplasties reported in those studies were analyzed.

Results and discussion It should be noted that in most of the scientific papers on the postoperative complications of surgeries that involved various navigation devices, the information about them was incomplete or the patients with complications were excluded from the study. In general, the incidence of complications averaged 2 %.

Conclusions When the navigation devices are used, the preoperative planning of the femoral component alignment frequently remains unperformed, and techniques and reference points used in surgeries are the same as in the traditional technique. The postoperative monitoring of rotational alignment of the knee implant is performed exclusively when complications are detected.