Introduction Due to the steady increase in the number of primary total hip arthroplasties, the problem of eliminating periprosthetic joint infection (PJI) has become pressing. The rise of antimicrobial-resistant PJI pathogens significantly complicates and prolongs treatment, contributing to the development of chronic infection, sometimes with latent clinical manifestations.

The aim of this study was to identify the microbial landscape characteristics in different types of hip joint PJI.

Materials and Methods Microbiological studies of 96 patients with hip joint PJI were analyzed: Group 1 (n = 16) with type I PJI; Group 2 (n = 80) with type II and type III PJI. Patients in Group 1 underwent the DAIR procedure and those in Group 2 underwent two-stage revision hip replacement.

Results A total of 103 microbial isolates were obtained from 96 patients: 16 (15.5 %) Gr(–) and 87 (84.5 %) Gr(+). Among Gr(+), MRSA, MRSE, and MRSH were detected in 18 isolates, and among Gr(–), ESBL+ was detected in 16 isolates. The predominant pathogens in the PJI structure were S. aureus (52.9 %), S. epidermidis (19.5 %), E. cloacae (37.5 %), P. aeruginosa (18.6 %), and E. coli (18.6 %). Associations were more common in type 1 PJI (25 %) than in chronic forms (18.4 %). Microbial associations were detected in 20 cases (19.4 %). Culture-negative infection (CNI) was detected in 16 patients (16.7 %) in both groups. Relapse of PJI in patients with microbial associations occurred in three cases (15 %). In CNI cases, recurrence developed in four cases (25 %).

Discussion The growth of Gr(–) flora in early PJI exceeded that in the chronic one: 31.3 % and 9.2 %, respectively. DAIR is ineffective in such conditions. S. aureus, as a causative agent of bone and joint infections, exists in a quasi-dormant state which contributes to chronicity.

Conclusion Gram-negative microorganisms and their associations dominate in the etiology of early PJI (type I), while gram-positive pathogens predominated in chronic types (types II and III). Culture-negative infection was a more common cause of early PJI than of chronic types (25.0 % and 16.1 %, respectively). No statistically significant differences were found between the groups in the detection of methicillin-resistant staphylococci or gram-negative bacteria ESBL+.

Introduction Inflammation at the wire tract sites in patients treated with transosseous osteosynthesis is one of the most common complications. Bone manifestations of inflammation are quite common in clinical practice, yet characteristic radiographic findings have not been well described.

The aim of this study was to identify the nature of radiographic bone changes in patients with pin tract osteomyelitis at various inflammatory sites.

Materials and Methods The study included 22 patients with chronic pin tract osteomyelitis (PTO) that developed following transosseous osteosynthesis with the Ilizarov fixator. To assess structural bone changes, multislice computed tomography (MSCT) was used, including analysis of axial sections and multiplanar reconstructions (MPR) in the sagittal and coronal planes of the femur and tibia. Bone density (Hounsfield units, HU) in the inflammation area was quantitatively assessed, and the morphology of the wire tract canals (width, wall contours, and the presence of sequesters) was analyzed to identify patterns relevant for treatment decisions.

Results The data obtained indicate the presence of specific radiographic manifestations of osteomyelitis, characteristic of chronic osteomyelitis of any origin, especially in the late stages of inflammation. The most prominent symptoms of osteomyelitis in the early stages include characteristic changes in the wire tract canals: widening and blurring of the contours, increased density, and the appearance of periostitis around the wire tract. Wire canals in the metaphyseal regions are characterized by increased wall density and low density of the canal contents. In the diaphysis, the wire canals have walls with irregular contours and no density differences from the cortical plate. Small sequesters featuring the density of 650–700 HU are often visualized within the canal. "Walled-in" sequesters are also characteristic of pin tract osteomyelitis in the diaphysis.

Discussion The literature has devoted considerable attention to soft tissue inflammation, its prevention, and treatment methods during transosseous osteosynthesis. However, the radiographic semiotics of pin tract osteomyelitis have been limited, primarily presenting clinical cases without detailed analysis of bone changes. Pin tract osteomyelitis is characterized by general manifestations of osteolysis and increased density of the wire canal contours. A distinctive feature of pin tract osteomyelitis in the diaphysis is the presence of "button-shaped" sequesters, confirmed by MSCT. Information on the location and nature of the changes allows clinicians to more effectively plan the extent of surgical intervention and select the optimal treatment strategy, taking into account the characteristics of the lesion and bone condition.

Conclusion Wire tract canals in the metaphyseal regions are characterized by increased wall density. In the diaphysis, the wire tracts are wider than in the metaphysis, with walls of irregular contours and no density differences with the cortical plate. Sequestra in the metaphysis have half the density of those in the diaphysis and vary in shape and size.

Introduction Epidemiological studies have shown a link between genetic factors and the development of purulent complications after treatment in traumatology and orthopedics. Studies on candidate genes help identify mutations associated with diseases, which is important for diagnosis and prevention. The polymorphisms of the IL-17A and PPARG genes are of particular interest. The G197A polymorphism in the IL-17A gene may increase the risk of autoimmune and infectious diseases. The C1431T polymorphism in the PPARG gene is often associated with metabolic disorders, including obesity and diabetes type 2. Both polymorphisms are significant for developing methods to predict and treat purulent complications, as their impact on patient health can be substantial.

Purpose To study the influence of IL-17A and PPARG gene polymorphisms on the course of purulent complications after treatment of patients with lower limb bone injuries.

Materials and methods Candidate genetic study: identification of the PPARG C1431T gene polymorphism and the IL-17A G197A gene polymorphism in the genome of 114 patients treated at Solovyev Hospital in Yaroslavl for purulent complications after treatment of lower limb injuries during various periods from 2018 to 2024.

Results Analysis showed that the baseline for the PPARG gene (rs3856806) is at the level of allele C (82 % and 89 %), predominantly in the C/C genotype (70 % and 80 %). For IL-17A (rs2275913), the baseline corresponds to allele G, with the A/A genotype occurring in 46 % and 42 % of groups. Hardy – Weinberg equilibrium was found for PPARG but not for IL-17A, indicating the influence of this polymorphism on complication recurrences. Associations were identified between SNPs and comorbidities such as diabetes and hypertension, confirming the relationship between gene polymorphisms and the risk of purulent complications.

Discussion The study revealed that the mutant T allele is associated with an increased risk of metabolic disorders and complications, as confirmed by both our own observations and data from other authors. In the non-recurrence group, C/C homozygotes were found in 70 % of cases, while in the recurrence group this number reached 80 %, which partially agrees with previous studies that noted the impact of this polymorphism on the metabolic profile.

Conclusion The study of PPARG and IL-17A polymorphisms highlighted the importance of considering mutations when predicting recurrence of infectious complications in patients with lower limb injuries. The study of PPARG and IL-17A polymorphisms can be used to build predictions about the progression of complications and their recurrences, taking into account covariates such as BMI, hypertension, coronary heart disease, and diabetes. A connection has been established between these gene mutations and the recurrence of complications in patients with lower limb injuries.

Introduction Acetylsalicylic acid (ASA) is one of the promising candidates for enhancing the action of antibacterial drugs.

Purpose To evaluate in vitro the effect of aspirin in combination with antibacterial drugs on the growth of microbial cultures of clinically significant bacterial strains in osteomyelitis.

Materials and methods The object of the study is clinically significant bacterial strains K. pneumoniae (n = 12), P. aeruginosa (n = 12), S. aureus (n = 12), S. epidermidis (n = 12), isolated from wounds of patients with chronic osteomyelitis. The experiment was divided into four series: control group; group of ASA administration; group of antibiotic administration; group of ASA + antibiotic administration. Antibacterial effect was assessed by the absence of a bacterial growth zone around the discs.

Results There was no growth of microorganisms on Petri dishes when ASA (0.05 %) was incubated with gram-negative bacteria (K. pneumoniae, P. aeruginosa). In the case of S. aureus bacteria, the number of CFU was reduced compared to the control group. There was no growth on plates with S. epidermidis. When polymyxin was incubated with P. aeruginosa, slight bacterial growth was recorded on Petri dishes, while only individual colonies were observed with K. pneumoniae. When incubated together with polymyxin and aspirin (0.03 %), there was no growth of microorganisms on plates with K. pneumoniae, while slight growth was noted on plates with P. aeruginosa. Gentamicin suppressed the growth of S. aureus bacteria (an insignificant number of bacteria was noted on the plates). ASA (0.03 %) enhanced the bactericidal properties of gentamicin (there was no bacterial growth on the plates).

Discussion The absence of growth on plates with S. epidermidis bacteria under the influence of ASA, even without antibiotics, suggests that one of the mechanisms of its action may be the suppression of adhesion and biofilm formation. The presence of a pronounced effect of ASA on gram-negative bacteria (K. pneumoniae, P. aeruginosa) may be associated with the effect on the outer membrane of microbial cells, while aspirin had a lesser effect on gram-positive bacteria (S. aureus) and only reduced metabolic activity.

Conclusion Our study demonstrated that acetylsalicylic acid exhibits synergism with a number of antibiotics in vitro and significantly enhances their bactericidal activity against clinical isolates associated with osteomyelitis.

Introduction Postural control (PC) is a predictor of gait recovery and can be performed in the early postoperative period following total hip arthroplasty (THA) for adequate appraisal of the treatment and recovery of orthopedic patients. The search for PC markers is practical for relevant evaluation of the effectiveness of motor rehabilitation following THA of one (contralateral) hip or both joints.

The objective was to establish specific features of PC assessing effectiveness of motor rehabilitation in patients with hip osteoarthritis after unilateral and bilateral THA.

Material and methods A total of 40 patients with grade III–IV hip osteoarthritis were examined as Group 1 (n = 21) with unilateral THA of the contralateral hip joint and Group 2 (n = 19) with bilateral THA. The PC was assessed using an inertial sensor placed at the L4–L5 projection to record angular and spectral parameters of postural fluctuations from the vertical in the coronal and sagittal axes. Examinations were performed on admission and upon discharge after a course of motor rehabilitation in the inpatient medical rehabilitation department.

Results Improvements in the PC during the inpatient rehabilitation were accompanied by greater deviations in the coronal plane and less deviations in the sagittal plane in the unilateral THA group suggesting frontal instability. There was no increase in frontal axis deviations with sagittal deviations being maintained in the bilateral THA group. Models for predicting the effectiveness of motor recovery were offered.

Discussion Objective indicators of the PC in patients with hip osteoarthritis treated with unilateral or bilateral THA, were obtained with inertial sensor technology and could be used to identify compensatory musculoskeletal mechanisms, determine markers of the effectiveness of rehabilitation and adjust recovery programs.

Conclusion Motor rehabilitation of THA patients suggests that bilateral arthroplasty destabilizes the biomechanics of the hip joint to a lesser extent, limiting excessive deviations in the frontal plane and slows down restoration of statokinetic stability due to proprioceptive insufficiency.

Introduction Bariatric surgery is the most effective treatment of morbid obesity, which is common in patients with hip osteoarthritis. However, the extent to which weight loss after bariatric surgery affects the outcomes and complication rates of total hip arthroplasty (THA) has not been adequately explored.

The aim of the study was to determine the impact of bariatric surgery on the results of THA and functional restoration of the lower limbs facilitating a lower risk of postoperative complications.

Material and methods A retrospective-prospective cohort, single-center, controlled study included patients with hip osteoarthritis grades 3–4 as described by I. Kellgren and I. Lawrence in 1957. Patients were referred for THA, had a history of morbid obesity (body mass index > 40 kg/m²) and underwent bariatric surgery. The parameters assessed included body mass index, pain, functional status of patients measured with the Harris hip score and complication rate.

Results The findings suggested a significant statistical difference (p < 0.001) in pain intensity on the first day after surgery measured in patients of the study group and the comparison group with (6.3 ± 2.3) and (7.4 ± 2.3) scores, respectively. The modified Harris Hip Score measured at 12 months of surgery reached the maximum with (90.2 ± 10.3) scores in the study group and (86.5 ± 11.6) scores in the comparison group, with a statistically significant difference in the measurements, p = 0.021. The Kaplan – Meier estimator showed a five-year survival rate of THA being 94.6 % (5.4 % complications) in the study group and 77.2 % (22.8 % complications) in the comparison group.

Conclusion The bariatric surgery used in patients with morbid obesity and grade 3–4 hip osteoarthritis prior to THA facilitated a statistically significant risk of postoperative complications reduced to 17.4 % and the five-year survival rate of THA increased to 94.6 %.

Introduction Revision foot surgery has increased in recent decades with the increasing surgical procedures. Nonunion is common after arthrodesis and osteotomies. From an economic perspective, revision surgery can be associated with greater length of disability imposing an additional financial burden on healthcare facilities. Impaired bone metabolism is one of the key factors leading to the risk of nonunion and a revision surgery.

The aim of the study was to determine the impact of metabolism bone abnormalities on the incidence of nonunion in revision foot and ankle surgery.

Material and methods A prospective study with retrospective control was conducted to compare two groups of patients aged 45 to 70 years who required revision foot surgery. The retrospective control group (n = 36) consisted of patients who had no bone metabolism assessment prior to revision foot surgery. The prospective group (n = 42) consisted of patients who underwent bone metabolism assessment preoperatively and subsequent correction if needed. Revision surgery was produced in the hindfoot and midfoot due to failed arthrodesis of the corresponding joints. AP and lateral weight-bearing radiographs of the foot, the Salzmann view and a CT scan of the feet were produced preoperatively.

Results The mean period from the initial consultation to surgical treatment was longer in the prospective group than in controls: (16.0 ± 4.0) weeks and (8.0 ± 1.7) weeks, respectively. There were no significant differences in the mean period of consolidation/ankylosis measuring (10.0 ± 2.2) weeks in controls and (8.0 ± 1.5) weeks in the prospective group. A statistically significant difference was found in the frequency of non-unions between the two groups showing 14 % (n = 5) in controls and 2.4 % (n = 1) in the prospective group.

Discussion The findings demonstrated clinical effectiveness of a comprehensive approach to revision foot surgery including optimization of biological factors for bone union. Protocol for preoperative assessment and correction of bone metabolism can significantly improve outcomes of revision procedures reducing the risk of recurrent nonunions and the need for revisions.

Conclusion The time from initial consultation to revision surgery was longer in the prospective group of patients with no statistically significant differences in the time to bone consolidation. The nonunion rate was higher in the control group with no diagnosis and correction of bone metabolism diagnostics performed, highlighting the importance in reducing the rate of revision foot and ankle surgeries.

Background Plantar fasciitis is one of the main causes of heel pain, which is one of the most prevalent complaints in foot and ankle clinics. Surgery may be necessary if conservative therapies have failed. The appropriate surgical technique has been debated, open plantar fasciotomy and percutaneous plantar fasciotomy are the two common surgical techniques.

The aim of the study is to compare the outcomes of open release versus percutaneous midsole release of the plantar fascia in this study to treat recalcitrant heel pain.

Methods A prospective study was conducted on 54 patients who had unresponsive plantar fasciitis following conservative treatment for at least six months. 20 patients in the 54 enrolled cases had open plantar fascia release, whereas the remaining 34 patients had percutaneous mid-sole plantar fascia release. All patients' surgical outcomes were evaluated using the Foot and Ankle Disability Index (FADI) both before and after the procedure and a follow-up period of one year was used to assess the functional results.

Results The percutaneous plantar fasciotomy group's mean foot and ankle disability index score improved statistically significantly from 39 ± 6 preoperatively to 101 ± 3 postoperatively, compared to 38 ± 5 preopera tively and 98 ± 2 postoperatively for the open plantar fasciotomy group at the final follow-up. Two patients in the percutaneous group experienced numbness at the site of surgery, compared to seven in the open group. By the time of the last follow-up, there had been no recurrence of pain.

Discussion We performed a percutaneous release of the mid-sole plantar fascia with a minimum incision and little dissection. We could thus access the plantar fascia effectively while preserving the surrounding tissues and maintaining optimal cosmetic results. Open plantar fascia release is the most conventional technique. However, disadvantages of the surgery include large wound, longer postoperative recovery time, and potential postoperative occurrence of complex regional pain syndrome.

Conclusion Both open and percutaneous plantar fascia releases resulted in a considerable improvement in the patients' limb function and pain symptoms. The long-term curative results of the two surgical treatments were identical. Due to fewer postoperative problems, percutaneous plantar fascia release is a superior procedure.

Introduction Surgical streategy for patients with grades 3–4 osteoarthritis (OA) of the first metatarsophalangeal (MPT) joint is generally accepted. There is a variety of conservative treatments including NSAIDs, orthopedic insoles, physical therapy and pharmacological blockade to be offered for patients having contraindications or unwilling to undergo surgery. However, the role of orthopedic footwear can be underestimated.

The aim of the study was to evaluate results of dynamic in-shoe pedobarography with standard shoes and rocker bottom shoes used by patients with grades 3–4 OA of first MPT joint.

Material and methods Plantar pressure was evaluated in 12 patients wearing standard shoes and rocker bottom shoes. Major biomechanical parameters were analyzed to evaluate the force, walking speed and distribution of plantar pressure.

Results The in-shoe dynamic pedobarography revealed a significant decrease in the values of peak (p = 0.011) and average (p = 0.019) pressure for the whole foot and the forefoot (p = 0.029) with use of rocker bottom shoes. A decreased length of the stance phase was noted (p = 0.027). No changes were found in walking speed (p = 0.604), duration of the swing phase (p = 0.495) and duration of the step cycle (p = 0.721).

Conclusion A significant decrease in plantar pressure and the force in the forefoot was observed in patients with first MPT joint OA using rocker bottom shoes compared to those using shoes with a standard sole, with no differences in time indicators and walking speed.

Introduction Calcaneal fractures account for approximately 2 % of all fractures and are common in younger population. Treatment of the patients can be challenging with involved articular and soft tissue component. Conventional methods can be ineffective for complex and rare type IV and type V Zwipp – Rammelt fractures necessitating development of new surgical approaches.

The objective was to explore short-term (10 months of observation) outcomes of patients with type IV Zwipp – Rammelt calcaneal fractures using a new technology. The technique suggested improved accuracy of remodeling osteotomy due to three-dimensional reconstruction of the broken foot during preoperative planning and creation of customized resection templates with additive technologies.

Material and methods A prospective, hypothesis-generating study was performed for 13 patients with type IV Zwipp – Rammelt calcaneal fractures. There were 6 males and 7 females with the mean age of 45.5 ± 13.02 years. The patients were treated with the new method which employed 3D reconstruction of the broken foot using MSCT images, fabrication of customized resection templates using FDM printing, their sterilization with ethylene oxide, precision osteotomy of the calcaneus through an L-shaped approach and subtalar arthrodesis. The results were assessed at 77 weeks using AOFAS, EFAS, FFI and VAS scales.

Results Functional parameters significantly improved at ten months with the EFAS increased by 2.5 times (to 34.0 scores, p = 0.0002), AOFAS improved by 1.6 times (to 80.0 scores, p = 0.0002), FFI increased by 1.57 times (to 38.0 scores, p = 0.0002). Pain improved with the VAS decreasing by half from 60 mm to 30 mm (p = 0.001).

Discussion The technique demonstrated several advantages with the possibility of multiplanar osteotomies, precise template fixation and control of resection parameters facilitating anatomical restoration.

Conclusion Short-term outcomes of patients with type IV Zwipp – Rammelt calcaneal fractures showed that custom-made resection templates were practical for accurate surgical technology, improved functional outcomes, pain relief using the effective technique.

Introduction The complexity of treating intra-articular fractures in children is due to the anatomical features of the joint, its biomechanics, and the tendency to develop post-traumatic arthritis. This necessitates a detailed study of the structural organization of all elements of the joint synovial environment.

The aim of this study was to evaluate, using an experimental model, the severity of structural changes in the synovial membrane of the carpal joint during osteosynthesis of intra-articular metaphyseal fractures with titanium screws.

Materials and Methods The study was performed on six outbred male lambs (46.1 ± 3.0 days old, weighing 15.7 ± 2.0 kg). An oblique intra-articular metaphyseal fracture of the radius on the right limb was modeled. Fracture fixation was performed with two cannulated cancellous bone screws made of Ti6AL4V titanium. The experimental periods were 120 (n = 3) and 365 (n = 3) days after surgery. Histomorphometric analysis of the synovial membrane was performed using an AxioScope.A1 microscope and Zenblue software (CarlZeissMicroImagingGmbH, Germany). The synovium of the contralateral joint served as a control.

Results In the control joint, fibroblast-like synoviocytes predominated in the synovial membrane lining layer; no signs of synovitis were detected. After 13.5 months, a decrease in lining layer thickness (p = 0.0326) and synoviocyte density (p = 0.0009) was noted. In the experimental joint, mild synovitis, hyperplasia of the lining layer, increased synoviocyte density and macrophage-like synoviocyte representation (more than 50 % per field of view), formation of synovial villi, and the presence of focal and diffuse lymphohistiocytic infiltrates were detected after 120 days. After 365 days, signs of synovitis were absent, fibroblast-like synoviocytes predominated in the lining layer; elevated synoviocyte density values persisted (p = 0.0141), and lining layer thickness values were comparable to the control (p = 0.1301).

Discussion Non-bioresorbable fixators used for osteosynthesis of intra-articular fractures can cause a number of complications, including infection, pain, and arthritis. It was established that macrophage and fibroblastic synoviocytes perform various pro- and anti-inflammatory functions and can both prevent inflammation by forming an anti-inflammatory barrier and contribute to the development of synovitis.

Conclusion Osteosynthesis of intra-articular metaepiphyseal fractures of the distal articular end of the radius in lambs using titanium screws provoke mild synovitis after 120 days of the experiment. This synovitis was characterized by thickening of the lining layer, an increase in the numerical density of synoviocytes and in macrophage synoviocytes, and the presence of a lymphohistiocytic infiltrate. By the end of the experiment, the synovial membrane inflammation revered, and histological signs of synovitis were absent.

Introduction The optimal surgical approach is essential for osteosynthesis of intra-articular fractures of the distal tibial metaphysis (pilon fractures). None of the existing approaches provides complete visualization of the articular surface, increasing the risk of complications and inadequate reduction.

The objective was to optimize the choice of surgical approach in preoperative planning of internal osteosynthesis of intra-articular fractures of the distal metaepiphysis of the tibia (pilon) based on 3D prototyping and standardized marking of the articular surface.

Material and methods An algorithm developed was based on a full-size 3D prototype and CT data. The articular surface of the tibia was divided into nine standard zones. The surgical approach was selected depending on the location of the key fragment (occupying > 2/3 of the zone) or the fracture line exit point. The method was used in 12 patients with AO/OTA 43-C pilon fractures. Surgical time, blood loss, the quality of postoperative fracture reduction categorized according to the Burwell-Charnley criteria, functional outcomes measured with AOFAS and VAS FA grading scales, and radiographic union determined with the mRUST scale were assessed at six months.

Results and discussion The mean operating time was (65.08 ± 7.03) min, blood loss was (119.3 ± 18.51) ml. The wounds healed by primary intention without infectious complications. The quality of reduction was anatomical in eight patients and acceptable in four patients. The mean AOFAS (78.67 ± 8.68) and VAS FA (41.08 ± 5.05) scores indicated good functional recovery. The mean mRUST score (13.5 ± 1.43) suggested complete consolidation. The method objectified the surgical approach avoiding subjectivity and allowed for personalized intervention by combining approaches for optimal visualization of all fragments, including hard-to-reach ones (e.g., Tillaux – Chaput fragment).

Conclusion The method integrating 3D planning and a standardized coordinate system improves reposition accuracy, reduces morbidity, and improves functional outcomes in patients with complex pilon fractures.

Introduction An Essex-Lopresti lesion is a fracture of the radial head and a rupture of the interosseous membrane of the forearm, resulting in disruption of the longitudinal relationship between the radius and ulna, leading to longitudinal radioulnar dissociation. Most Essex-Lopresti injuries are diagnosed late, and surgical treatment is challenging even for an experienced orthopaedic surgeon.

The objective was to demonstrate and analyze the results of multicomponent surgical treatment first applied for a patient with a chronic Essex-Lopresti injury.

Material and methods A 29-year-old patient was diagnosed with a chronic Essex-Lopresti injury first treated with multicomponent surgical treatment including replacement of the radial head, Adams – Berger ligament reconstruction for the distal radioulnar joint, ulnar corrective shortening osteotomy, interosseous membrane reconstruction using synthetic graft, lateral ulnar collateral ligament reconstruction with an autograft.

Results Pain improved and range of motion increased in adjacent joints at six months. A follow-up X-ray of the forearm showed a consolidating fracture of the ulna.

Discussion Multicomponent surgical treatment of chronic Essex-Lopresti injury ensures restoration of the anatomical relationships of the forearm bones and correction of associated ligamentous injuries improving clinical and functional outcomes even with delayed treatment. Early diagnosis and timely reconstruction of the forearm structures are essential for prevention of irreversible changes providing functionality of the upper limb.

Conclusion The study demonstrated the potential of a multi-component surgical approach as a single-stage treatment for patients with chronic Essex-Lopresti injury.

Introduction The use of combined techniques for long bone lengthening in patients with Ollier disease is of interest due to issues of both external fixation time reduction and improvement in the strength properties of the lengthened bone. The uniqueness of the presented clinical case is simultaneous femur and tibia lengthening over a titanium telescopic rod in the femur and tibia combined with external osteosynthesis and osteotomies.

The purpose of this study is to demonstrate the stages and results of polysegmental bone lengthening in a child with Ollier disease using a technique combining the Ilizarov fixator and a titanium telescopic rod.

Material and methods This clinical case is a five-year-old patient with Ollier disease without comorbidities, but with a significant discrepancy in the length of the lower limbs, impaired weight-bearing ability, and impaired gait biomechanics. Surgical treatment included multisegmental femur and tibia lengthening over a titanium telescopic rod inserted retrograde into the femur and antegrade into the tibia, simultaneous osteotomies and placement of a wire-and-halfpin external fixator.

Results Exceptional data were obtained confirming the possibility of the titanium telescopic rod extension during distraction by more than 20 % without locking or loss of fixation of the threaded parts in the epiphyses. The elongation amounted to 11.4 cm (femur: 5.8 cm; tibia: 5.6 cm). The overall external fixation index was 12.02 days/cm. At a 12-month follow-up after dismantling the Ilizarov apparatus, growth of the elongated bones and telescoping of the femoral rod continued.

Discussion This combined technique is consistent with the current concept of extended telescopic reinforcement in children with genetic diseases. The divergence of the titanium rod components both during the distraction period and during the first year after completion of limb lengthening demonstrates the feasibility of this combination and the reliability of using a telescopic titanium rod. This study demonstrates for the first time that rapid divergence does not predispose to locking of titanium rods and continues with growth.

Conclusion This case demonstrates the effectiveness of using a combination of telescopic intramedullary titanium rods and external fixation for simultaneous lengthening of two adjacent segments in a child with Ollier disease. The findings on further natural growth of the lengthened segments along with telescoping of the rod are unique.

Introduction The scientific literature database contains numerous studies comparing the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) preparations in knee osteoarthritis, but the results are contradictory due to methodological limitations and high heterogeneity of treatment protocols.

Purpose To compare the data from scientific studies on the effectiveness of using PRP and medium molecular weight HA preparations in the treatment of patients with knee osteoarthritis.

Materials and methods A search of randomized controlled trials was conducted in PubMed, Embase, and the Cochrane Library published in the period 2017–2024 using the following keywords: osteoarthritis, knee joint, intra-articular injections, platelet-rich plasma, hyaluronic acid, WOMAC, and meta-analysis. Studies that examined patients diagnosed with knee osteoarthritis of any severity who received intra-articular injections of PRP or HA and assessed pain using the WOMAC were reviewed. After rigorous selection, four studies with identical treatment protocols were included.

Results The meta-analysis included 4 studies involving 333 patients (164 in the PRP group and 169 in the HA group). The mean WOMAC pain score at 6 months after the start of treatment was 4.52 (SD = 1.59) in the PRP group and 4.95 (SD = 2.07) in the HA group. The effect size of Hedges' g was 0.26 (95 % CI: –0.61 to 1.14; p = 0.336). Egger's test did not reveal a statistically significant publication bias (p = 0.06).

Discussion Our study revealed no significant differences between the use of PRP and HA, which contradicts several previous meta-analyses. This may be due to the use of more stringent inclusion criteria in our analysis and the evaluation of HA preparations with only medium molecular weight.

Conclusion This meta-analysis was aimed to compare the effectiveness of using PRP and medium molecular weight HA in the treatment of patients with knee osteoarthritis and did not reveal statistically significant differences between the groups in severity of pain using the WOMAC system six months after the start of treatment, which indicates comparable effectiveness of these therapy methods.