Introduction The use of high-precision, high-yield munitions in modern warfare has led to an increase in the number of wounded personnel with extensive defects of the tibial shaft. Effective methods for filling such defects are the methods of G.A. Ilizarov: bifocal or trifocal osteosynthesis with subsequent transport of fragments and (or) bone segments relative to each other (referred to as "bone transport method" in foreign literature), as well as acute, gradual, or combined shortening and subsequent lengthening.
Aim of the study: To compare the efficacy and safety of the bone transport (BT) method and the acute shortening with subsequent lengthening (ASL) method for filling (elimination) of gunshot defects of the tibial shaft.
Materials and methods The study included 60 male patients aged 18 to 59 years with gunshot defects of the tibial shaft ranging from 2 to 16 cm. They were divided into two groups comparable in main characteristics, depending on the treatment method applied. In the first group (30 subjects), the tibial defect was managed using the BT method, in the second group (n = 30) the ASL was applied.
Results In all patients of both groups, defects were eliminated, the length of the injured lower leg was restored, and the weight-bearing function of the limb was regained. According to the criteria of consolidation time at the docking site and maturation time of the regenerate, a statistically significant advantage of the ASL method was noted. The total treatment time and the external fixation index were greater in the BT group compared to ASL, but the differences were not statistically significant. The results on the ASAMI anatomical and functional scale were statistically significantly better in the ASL group. Substantial statistically significant differences between the groups were revealed in the number and types of minor and serious complications that developed during treatment. Non-union and invagination were observed only in the BT group. Differences regarding axis deviation of the segment and contracture of adjacent joints were not statistically significant.
Discussion The identified advantages of ASL are due to the absence of drawbacks that are characteristic of BT: prolonged absence of contact between bone fragments, technical difficulties and the long duration of moving a bone segment from one fragment to another and the necessity to achieve union simultaneously in two foci of bone damage (the defect zone and the regenerate zone).
Conclusion In the treatment of patients with gunshot defects of the tibial shaft, the use of BT and ASL methods ensured effectiveness with the possibility of achieving a positive result in up to 100 % of cases. The advantage of the ASL method in terms of safety indicators (type and number of complications) compared to BT was statistically significant.

Introduction Despite significant advances in the development of new fixation systems and improvements in surgical technologies, algorithms that guarantee anatomical reduction in proximal humerus fractures are lacking.
The aim of this study was to evaluate the clinical efficacy of using thread joysticks for fragment reduction and allogeneic bone grafting materials to repair bone defects in patients with proximal humerus fractures.
Material and methods A total of 219 patients with proximal humerus fractures were treated. The main group consisted of 123 patients and was treated according to the proposed by us osteosynthesis, while the comparison group included 96 patients was managed with traditional methods. Long-term outcomes were assessed at 1 to 4 years postoperatively using the Constant score, as well as two questionnaires: the Simple Shoulder Test (SST) and the Oxford Shoulder Score (OSS).
Results In the main group, the Constant score ranged from a maximum of 98 to a minimum of 6, with a mean of 69.8 and a median of 73. In the control group, the maximum score was 93, the minimum was 8, with a mean and  median of 54. Poor results were observed in 9 patients (7.3 %) in the main group. Of these, 4 (3.3 %) were due to infection, 3 (2.4 %) to implant migration, and 2 (1.6 %) to poor compliance with rehabilitation, leading to shoulder joint contracture. In the comparison group, 32 patients (33.3 %) had poor outcomes. Among them, 15 (15.6 %) had persistent limitations in abduction and internal rotation, 10 (10.4 %) exhibited implant migration, 5 (5.2 %) developed infection requiring reoperation, and 2 (2.1 %) experienced severe post‑traumatic arthritis and humeral head collapse.
Discussion The described technique has a number of advantages compared toexisting methods, which allows for  stable fixation in cases of 3- and 4-part fractures and avoids the need for shoulder joint replacement. It  features a clearly defined algorithm of procedures that simplifies the reduction and fixation of bone fragments, especially in defects of the proximal humerus.
Conclusion The application of this surgical technique reduced operative time and improved treatment outcomes in fractures of the proximal humerus.

Introduction Supracondylar humerus fractures are the most common elbow fractures in children, often resulting from falls on an outstretched hand. The standard treatment for displaced fractures involves closed reduction and percutaneous pinning. However, the optimal pin configuration — cross-pinning (medial‑lateral) versus parallel pinning (lateral-lateral) — remains a topic of debate due to concerns regarding stability and risk of iatrogenic ulnar nerve injury.
Aims This study aims to compare the clinical and radiological outcomes of cross-pinning versus parallel inning in the management of displaced supracondylar humerus fractures in children.
Methods A prospective observational study was conducted over 18 months at Kalpana Chawla Govt. Medical College, Karnal, Haryana. A total of 54 children aged 3–12 years with Gartland type III supracondylar humerus fractures were enrolled. Patients were divided into two groups based on the surgical technique: cross-pinning (n = 27) and parallel pinning (n = 27). Both groups were comparable in terms of demographics, mechanism of  injury, and pre-operative neurovascular status. Functional and radiographic outcomes were evaluated using Flynn’s criteria, Baumann’s angle, carrying angle, and range of motion at follow-up intervals (3, 6, 10, 14, and 24 weeks).
Results Mean Baumann’s angle, Carrying angle and range of motion showed no statistically significant differences between the two groups. At the final follow-up, 92.6 % of patients in the parallel pinning group had excellent outcomes per Flynn’s criteria, compared to 51.9 % in the cross-pinning group (p < 0.01). One patient in the cross-pinning group developed ulnar nerve neuropraxia, whereas no cases of nerve injury were reported in the parallel pinning group.
Conclusion Parallel pinning demonstrated superior radiological and functional outcomes, with a lower risk of ulnar nerve injury compared to cross pinning. These findings suggest that parallel pinning should be the preferred method for stabilizing displaced supracondylar humerus fractures in children.

Introduction Total ankle arthroplasty (TAA) can be associated with postoperative difficulties during the rehabilitation phase. A unified, tailored approach to rehabilitation and postoperative care is essential for the patients.
The objective was to evaluate clinical effectiveness of the algorithm developed for postoperative management of TAA patients to improve functional recovery, reduce postoperative complications for greater patient satisfaction.
Material and methods The study included 28 patients with impaired distal tibia and the ankle. The surgical treatment performed after a comprehensive examination included segmental resection of the distal tibia and ankle replacement of the original design. The implant had an articulating ankle joint and the distal tibia replacement. The algorithm developed for postoperative rehabilitation relied on a six-level approach borrowed from rehabilitation guidelines for total ankle arthroplasty devised at the Massachusetts General Hospital.
Results Postoperative management included multimodal analgesia with a regional component, multi‑level prophylaxis of infection, antithrombotic protection and staged immobilization with early controlled loading. Primary wound healing was observed in all patients. The mean postoperative swelling measured with  the  visual  swelling scale decreased from  (3.8 ± 0.6) to  (0.9 ± 0.4) scores after six weeks. Dorsiflexion measured (20 ± 3)°, plantar flexion was (36 ± 4)°, and 100 % of patients could regain a stable biphasic gait pattern at 16 weeks.
Discussion There are few detailed protocols for postoperative care and rehabilitation of TAA patients. The algorithm offered showed the effectiveness with the gait being almost normal with the range of motion and strength restored at four months. Patients reported high satisfaction measured with functional scales and subjective quality of life assessment.
Conclusion The step-by-step six-phase algorithm developed for postoperative management and rehabilitation of patients treated with segmental tibia resection and TAA facilitated a lower risk of postoperative complications, reduced function recovery time and high satisfaction ratings.

Introduction Foot drop syndrome due to peroneal nerve neuropathy significantly impairs limb support and  patient quality of life. The aim of this study was to evaluate the clinical effectiveness of the Bridle procedure compared to ankle arthrodesis and isolated tendon transfer.
Materials and methods A retrospective analysis of 27 patients was performed, divided into a main group (n = 14, Bridle technique) and a control group (n = 13, arthrodesis or tendon transfer). Functional outcomes were assessed using the AOFAS and VAS scales, along with rehabilitation duration, orthotic use, and complication rates. The mean follow-up period was 2.3 years.
Results The main group showed significantly better outcomes: AOFAS score improved from 38 to 82, VAS score decreased from 6.8 to 2.1, and the need for orthotic devices was reduced. In the control group, improvements were less pronounced (AOFAS: 37→65; VAS: 6.7→3.9). The complication rate was 14.3 % in the Bridle group versus 38.5 % in the control group.
Discussion The Bridle technique restores active dorsiflexion while preserving ankle mobility. Its functional and rehabilitation advantages make it preferable in cases of isolated peroneal nerve injury without severe deformities.
Conclusion The Bridle procedure is an effective joint-preserving surgical method for treating foot drop, providing superior clinical outcomes compared to alternative interventions.

Introduction Evans osteotomy remains one of the most common methods of surgical correction for mobile flat foot deformity by lengthening the lateral column. However, this technique is associated with damage to the articular facets (56–63 %), support of the talus (5–15 %), as well as the tendon of the flexor of the toes and the ibial nerve (11 %). The main causes of complications are insufficient visualization from the surgical approach and difficulties in accurately of the osteotomy level of the anterior process of the calcaneus. In this regard, despite the proven effectiveness of the Evans technique, further improvement of surgical techniques and the development of more accurate intraoperative control methods are required to minimize the risks.
The aim of the work is to analyze the results of surgical treatment of patients with flexible flatfoot by introducing an original method based on 3D modeling of the calcaneus and preoperative planning of the osteotomy level.
Materials and methods The study included 40 patients with mobile flat foot deformity, who were treated at the Novosibirsk Research Institute named after Y.L. Tsivyan. All participants underwent a comprehensive examination, which included a clinical examination, radiography of the feet with load (in direct and lateral projections), MSCT of the ankle joint and an assessment on the AOFAS scale. The patients were divided into two groups: the control group (n = 20), where standard Evans osteotomy was used, and the main group (n = 20) using the developed method. Postoperative follow-up was carried out for 12 months.
Results The study was dominated by patients with combined anterior and middle articular facets: 12 (60 %) cases in the main group and 13 (65 %) in the comparison group. It has been established that this type of structure of  the  subcutaneous joint is more often damaged by Evans osteotomy. In the comparison group, damage to the articular surfaces occurred in 9 (45 %) patients, while in the main group — only in 1 (5 %); p ≤ 0.05. Damage to the talus support was noted only in the comparison group — in 3 (15 %) cases out of 20. In both groups, there was a significant improvement in subjective assessment on the AOFAS scale and radiographic parameters one year after surgery.
Discussion The application of the developed method made it possible to significantly reduce the frequency of intraoperative injuries to the articular facets of the talus joint and the support of the talus bone. Stable radiological indicators of deformity correction were observed without cases of recurrence or loss of achieved correction during the 12-month follow-up period.
Conclusion The personalized surgical approach demonstrates significant benefits, including a reduction in  the  incidence of complications and recurrence of deformity, which contributes to improved clinical outcomes and improved quality of life for patients with squamous foot deformity.

Background Clubfoot, or congenital talipes equinovarus, is a congenital foot malformation and condition. Its early detection and identification can ensure the best possible long-term outcomes for the infant. Stress radiographs provide objective evidence of residual deformity, guiding further treatment.
Aim of the study was to compare radiographic findings of residual idiopathic clubfoot deformity in non-stress and stress positions to know the relationship of the angles difference and the type of treatment.
Material and Methods This study is a cross-sectional comparative study conducted at Al-Nasiriyah Teaching Hospital. Data was collected for the period from the 1st of March 2024 to the 1st of March 2025. The study includes 73.3 % males in a mean age of 1.7 years. Unilateral deformities among them were 80 %, equinus 85.2 % and adduction 66.7 %. 112 children with clubfoot deformities and 45 with idiopathic clubfoot cases (54 feet) which had residual deformity were included.
Results Stress radiographs revealed significant angular reductions in various deformities. Cutoffs of > 18° for the talo-first metatarsal angle in lateral view )adduction) and > 20° for the tibio-calcaneal angle (equinus), both with high sensitivity and specificity.
Discussion Clubfoot is more prevalent in male patients and often presents as a unilateral deformity. The most common residual deformities observed are equinus and adduction.
Conclusion Stress radiographs play a crucial role and show significant angular changes that help evaluate deformity flexibility and severity. Larger angle differences correlated with successful casting, while smaller differences predicted surgery.

Introduction Staphylococcus aureus is a leading pathogen causing osteoarticular infections. Panton – Valentine leukocidin (PVL) is considered one of the key of virulence factors with its role being poorly explored in orthopedic infections.
The objective was to evaluate the occurrence of the PVL gene in S. aureus strains, the effect on laboratory markers of inflammation and on the course of the infectious process in orthopedic patients.
Material and methods A retrospective analysis of 130 S. aureus strains isolated from 100 patients was performed. The presence of the lukS-PV and lukF-PV genes was determined using PCR. Laboratory parameters (CRP, ESR, leukocytes, neutrophils, and procalcitonin) and long-term treatment outcomes were assessed.
Results PVL was detected in 15 % of strains S. aureus. No statistically significant effect of PVL on the levels of routine inflammatory markers was found. A key finding was that the presence of the PVL gene was associated with an increased risk of adverse outcome.
Discussion The findings can be associated with debates on the clinical significance of PVL. Despite a significant impact on outcome The absence of significant differences in systemic inflammatory markers suggests that the negative effect of PVL is rather mediated by other mechanisms than by global inflammation activation measured by routine tests. These include direct cytotoxic tissue damage, impaired immune cell function, and the emergence of specific immunological processes. The association identified between PVL and the MRSA phenotype is consistent with the global epidemiological picture, where this toxin is a marker of hypervirulent community-acquired strains.
Conclusion The presence of PVL is a significant risk factor for a poor outcome of orthopedic infection suggesting the need for its detection for risk stratification and optimization of patient management strategy. Conclusion The presence of PVL is a significant risk factor for an unfavorable outcome of orthopedic infection, which indicates the need for its detection for risk stratification and optimization of patient management tactics.

Background Osteoarthritis is multifactorial joint disorder marked by the progressive breakdown of articular cartilage, alterations in the underlying subchondral bone, and chronic inflammation of the synovial membrane.
Objective To measure serum levels of bone biomarkers (osteocalcin and sclerostin) in osteoarthritis patients as compared to healthy controls and also to find out the link of these biomarkers with proinflammatory cytokines including IL-6, IL-17, IL-1β and TNF-α.
Materials and methods A case-control study was implemented on 65 osteoarthritis patients and 35 healthy controls participants. Blood samples were taken from participants after obtaining written informed consent. Serum levels of cytokines and bone markers were measured using ELISA. Pain disability and intensity were measured using the "Chronic Pain Grade questionnaire".
Results Compared to controls, patients with osteoarthritis had significantly higher levels of IL-1β, TNF-α, IL-6, and IL-17 (P < 0.0001 for all). Osteocalcin levels were dramatically lower in the osteoarthritis group than the controls (mean ± SD: 23.50 ± 19.30 ng/mL vs. controls 48.90 ± 5.20 ng/mL), while sclerostin levels were much higher (11.70 ± 1.10 ng/mL in osteoarthritis vs. 3.80 ± 0.90 ng/mL in controls, P < 0.0001). Osteocalcin showed a moderate positive correlation with IL-17, IL-6, and TNF-α; sclerostin showed a negative correlation with these cytokines.
Discussion A strong positive correlation exists between osteocalcin and proinflammatory interleukins. The  downregulation of sclerostin in OA also shares common pathways with proinflammatory cytokines that drive expression of osteocalcin. Inflammation results in osteocyte apoptosis or their dedifferentiation, and  this further lowers the population of sclerostin-secreting cells in the subchondral bone. This is how the reverse correlation is explained between sclerostin and proinflammatory cytokines in OA.
Conclusions Results show a robust inflammatory-bone axis in the pathogenesis of osteoarthritis. High proinflammatory cytokines might bring about osteocalcin expression and also inhibit sclerostin, leading to pathological subchondral bone alteration. These biomarkers reflect disease activity and therefore could be used for early detection as well as monitoring and phenotypic stratification of osteoarthritis.

Introduction The incidence of pathological fracture of the radius at the site of a marginal defect following graft harvesting reaches 31 %. A finite element computer simulation model allows for non-invasive determination and prediction of the stress and strain (SS) of the bone, the strength and susceptibility to fracture under various loads and strengthening methods.
The objective was to present the results of the finite element analysis on the influence of various marginal notch shapes, bone curvature and methods for increasing the strength on the SS of the radial shaft.
Material and methods Based on anatomical preparations of the human radius, solid-state linear-elastic modeling of the entire cortical diaphysis of the radius was performed including the shaft with rectangular and  triangular marginal notches, curvature in two planes using different reinforcing plates and fixation methods under non-destructive tensile, compressive, torsional and bending loads. The longitudinal stability of the bone was determined. ANSYS and NX Siemens software packages were used in the study.
Results A triangular cutout reduced bone stress by 21.4 % in tension and by 51.5 % in torsion as compared to a rectangular cutout increasing the longitudinal stability margin by 1.18 times. Bi-planar bone curvature increased stress and reduced the tensile load-bearing capacity by 2.89 times. A 2 mm thick semi-tubular plate, compared to a flat narrow plate of similar thickness and 10 mm width reduced the level of maximum stresses in the bone model by 1.2–1.5 times in tension and by 3.5–3.9 times in torsion for different cutouts. Measurements of longitudinal stability for a semitubular plate increased critical stresses by 1.3–1.5 times for different osteotomies as compared to a bone without a cutout and plate.
Discussion With all the loads, the strength conditions of the bone model with a cutout were provided when fixed with a plate at least 2 mm thick on four 2.0 mm bicortical screws inserted two distally and two proximally to the cutout.
Conclusion The findings demonstrated practical use of bone plates reducing SS of the radius with any cutout.

Introduction Injuries to the acromioclavicular joint (ACJ) can range from modest, transient pain to significant displacement, chronic pain, and shoulder biomechanical changes that result in long-term disability. We aimed to evaluate the functional outcome of anatomical reconstruction of the ACJ using fiber tape, as in type III–VI AC joint dislocations.
Materials and Methods In this study, 28 patients with AC joint dislocation (Rockwood type III–VI) were managed by surgical fixation using fiber tape from November 01, 2019, to October 31, 2024, at the tertiary care center. After providing written informed consent, the study enrolled patients who satisfied the inclusion criteria. The mean age of the participants was 36.50. Preoperative, three-month, and six-month UCLA shoulder scores were assessed.
Results The UCLA scores increased from 29.20 at three months to 35 at six months. Radiological evaluation at each visit suggested a 100.0 % success rate of this method. No participants had surgical site infection (SSI).
Discussion Several treatment options have been described for managing AC joint dislocations, including various implants and fixation methods, such as Bosworth screws, wires, locking plates, and hook plates. Unfortunately, these methods often lead to hardware-related complications, necessitating implant removal. The advantages of fiber-tape fixation technique include short surgery time, small incisions, fast recovery, cost-effectiveness, and ease of reproducibility.
Conclusions Open reduction internal fixation with a knot using fiber tape for type III–VI AC joint injuries is a viable surgical option. It has the advantages of being stable, single surgery, and excellent functional outcomes. However, extensive multicentric comparative studies are required to draw definitive conclusions.

Introduction The classic Ilizarov technology of transosseous distraction osteosynthesis provides rigid fixation, accurate bone control in frontal and sagittal planes addressing all types of deformities and the limb length. Long-term Ilizarov fixation can be associated with adverse events and distraction forces are to be monitored. A  new technology for limb lengthening using automated 24-hour control of distraction force facilitates optimal rate of deformity correction and can reduce Ilizarov fixation when combined with intramedullary titanium pins with a bioactive coating.
The objective was to demonstrate continuous distraction force control technology in the correction of varus deformity of the tibia and anatomical lengthening.
Material and methods Simultaneous tibial lengthening and correction of tibial deformity was produced with a new automated distractor (patent RU No. 2763644) measuring forces of the external fixation device every time with the gearbox switching on.
Results and discussion Continuous distraction force control was well illustrated in an Ilizarov patient treated with combined distraction osteosynthesis. The use of the device was associated with a shorter bone consolidation time (IO = 15 days/cm) after sequential distraction osteosynthesis with genu varum eliminated and the bone lengthened.
Conclusion Dynamic distraction force control with a new automated device allowed for monitoring the lengthening process, identifying potential complications, adjusting the distraction rate, reducing osteosynthesis time by two to four times.

Introduction The term "acetabular walls" is used to describe the survival rate of total hip replacements (THR) and classifications of THR surgeries. With the experience accumulated in THR surgery, there is no  information  on  establishing boundaries of the acetabular walls. ASPID is a classification system used to describe post‑traumatic acetabular deformities with no technique for establishing boundaries of acetabular walls.
The objective was to demonstrate and provide a theoretical substantiation for a method establishing the boundaries of the acetabular walls in primary THR.
Material and methods Pelvic computed tomography scans of five children aged 10–12 years and 30 pelvic preparations of adult bones without signs of acetabular dysplasia were used.
Results Extraacetabular fixed anatomical landmarks were identified in 3D models from CT scans of pediatric pelvic bones with the planes dividing acetabulum into conditional walls separated by cartilage. The pelvic bones of 30 adults were scanned, and similar reconstructions performed to delineate boundaries of the acetabular walls. The proportional ratios and areas of each acetabular wall were determined in the pediatric and adult groups, and the results compared. The absence of statistical differences in the proportions of the superior, posterior and medial walls of the pediatric and adult acetabulum suggested high reliability of the method.
Discussion There were insignificant statistical differences in the anterior acetabular wall fraction of children and  adults and could be associated with a small quantity of measurements. The absence of statistical differences in the proportions of the superior, posterior and medial walls of the pediatric and adult acetabulum suggested the reliability of the method. A larger number of measurements to be performed by several specialists, determination of the Cohen's Kappa coefficient and statistical analysis of the results are essential for the validity of the method.
Conclusion The method offered for establishing boundaries of the acetabular walls can be practical for scientific research, but cannot be used in routine practice due to its complexity and the need to use special software. The method can be recommended for describing post-traumatic deformities of the acetabular walls in cases where extraacetabular landmarks are not damaged or displaced.

Introduction The fight with nonspecific infection in immunodeficient HIV-infected patients is challenging. There are no standardized treatment protocols yet. The most effective treatment method of purulent coxitis remains two-stage total hip arthroplasty with the first stage of joint resection and implantation of an antibiotic‑loaded cement spacer, and the second stage of total hip replacement. One of the ways to reduce poor results and revision interventions is the development of new types of spacers for treatment of coxitis in patients with HIV infection.
The aim of the work is to demonstrate the effectiveness of a new method of surgical treatment of infectious coxitis in HIV-infected patients using an original design of an antibiotic-loaded articulating spacer in two  clinical cases.
Materials and methods The treatment results of two HIV-positive patients with infectious coxitis, in whom an original two-layer design of an antibiotic-loaded cement spacer based on the individual bacterial sensitivity was applied at the first stage of treatment, were retrospectively evaluated. To study the effectiveness of this method we used the results of the dynamics of pain evaluation according to Visual Analogue Scale (VAS), the  functional state of the affected joint using Harris Hip Score (HSS), Western Ontario and McMaster University osteoarthritis Index (WOMAC) scale and radiological data of patients in the early postoperative period and after 12-month follow-up.
Results Clinical cases demonstrate positive results of treatment of infectious coxitis associated with HIV infection. Application of the developed spacer design allowed eradication of bacterial infection. As a result of using of the new spacer model with an antimicrobial effect in the first clinical case it was possible to restore the joint function from 35 to 89 HHS points, from 79 to 14 WOMAC points, to reduce the pain syndrome from 7 to 1 VAS point; in the second patient from 32 to 91 HHS points, from 84 to 11 WOMAC points, to reduce the pain syndrome from 6 to 0 VAS points.
Discussion Based on scientific reports and our own clinical cases, we hypothesize that in HIV-associated purulent coxitis, one of the main reasons for poor results after two-stage arthroplasty is insufficient local concentration of antimicrobial agents, caused by the imperfect design of traditional cemented spacers. The  original spacer design allows for a higher concentration and may become an effective alternative to traditional treatment methods.
Conclusion Application of the developed technology of surgical treatment of infectious coxitis in  HIV‑positive  patients resulted in eradication of infection, reduction of pain syndrome, restoration of the hip joint functionality.

Introduction The clinical case demonstrated low prevalence and complexity of spinopelvic dissociation. Up‑to-date diagnostic and modern osteosynthesis techniques were used for unstable injuries of the pelvic ring and the sacrum.
The objective was to report a rare clinical case of spinopelvic dissociation in an adolescent with severe combined injury complicated by cauda equina that resulted in a positive treatment outcome.
Material and methods An adolescent patient with spinopelvic dissociation as part of a severe multi-trauma injury complicated by cauda equina was reported. Cauda equina root decompression surgery, triangular osteosynthesis and minimally invasive fixation of anterior pelvic ring fractures were performed after four days of injury because of unstable hemodynamics in the patient.
Results A positive treatment outcome was achieved in the form of life-saving, restored musculoskeletal function of the pelvis and lower limbs and complete regression of neurological dysfunction of the pelvic organs demonstrated by the Majeed pelvic score at six months and at one year of injury.
Discussion Spinopelvic dissociation as part of a severe combined injury was caused by a fall from a height in the case. A ISS score of over 25 points is classified as profound and very severe with a high risk of mortality and is often accompanied by traumatic shock. There is a high risk of neurological disorders and damage to other locations in spinopelvic dissociation. The patient suffered damage to the cauda equina roots and disturbed pelvic functions, adjacent pelvic fractures (fractures of the left acetabulum, right pubic and ischial bones), visceral injuries including contusion to the right lung and the brain. Triangular osteosynthesis is considered the method of choice for spinopelvic dissociation providing stable and biomechanically reasonable fixation system for the vertical, rotation and angulation loading on the pelvic ring. Although the risk of postoperative complications is very high and can reach 50 % with open techniques according to international literature the patient developed no postoperative complications. The treatment strategy was adequate for the teenager with spinopelvic dissociation and severe combined trauma and resulted in consolidated pelvic ring fractures and positive long-term functional outcome.
Conclusion Despite the complexity of the injury, high risk of postoperative complications and the lack of experienced specialists the teenager could survive, avoid postoperative complications and restore pelvic and lower limb function due to the coordinated work of a multidisciplinary team, timely diagnosis and modern osteosynthesis techniques used for unstable pelvic injuries.

Introduction One of the most challenges in spinal deformity surgery is screw placement, which utilizes various methods and options for radiographic guidance, particularly computed tomography-based navigation (CT navigation). Discussions about the advantages and disadvantages of the technologies used determined the relevance of this study.
The aim of this study was to evaluate the effectiveness of intraoperative CT navigation in the surgical treatment of patients with spinal deformities using systematic data from the scientific literature.
Materials and Methods A literature search for studies evaluating the parameters of surgical interventions using CT navigation in spinal deformity surgery was conducted in Pubmed, EMBASE, ELibrary, and Google. The article type was a systematic review and meta-analysis, with a search depth of 10 years. The study was conducted in accordance with the PRISMA international guidelines for systematic reviews and meta‑analyses. Levels of evidence and strength of recommendations were assessed using the ACCO protocol. A  total of 40 articles were found in the databases, with 11 more articles in their reference lists, 48 of which were full‑text articles. Eight studies met the inclusion criteria, and two more were added in the sample by agreement of the authors. The following parameters were determined for analysis: screw placement accuracy, malposition rate and complications, operative time, blood loss, reoperation rate, reference frame positioning, and radiation exposure.
Results and discussion The analysis revealed the advantages of using intraoperative CT navigation for screw placement. CT navigation improves screw placement accuracy, does not increase surgical time, and  does not  reduce the effectiveness of deformity correction. Surgery time, blood loss, and radiation exposure with  CT navigation are comparable to other methods. Positioning of one reference frame significantly reduces surgical time, does not affect screw placement accuracy, and does not require additional CT scanning, thereby reducing radiation exposure. To reduce radiation exposure, it is recommended to set a scanning mode with a reduced radiation dose.
Conclusion CT navigation offers advantages in terms of screw placement accuracy, lower malposition rates and associated complications, and reduced reoperation rates. The high safety profile of the navigation system is due not only to the increased accuracy of screw placement but also to lower complication rates.