Introduction The work analyzes the results of using elastic opposite-directional transphyseal reinforcement for treatment of severe orthopedic complications in patients with osteogenesis imperfecta as well as the ways and their effectiveness to overcome the shortcomings of this technique. Material and methods The series included 24 patients. Among them, four patients had osteogenesis imperfecta of Type III, 19 were of Type IV, and one patient had Type VIII. The patients’ mean age was 14.4±2.8 years (range: 2-46 years). A total of 52 reconstructive surgical interventions were performed. Elastic intramedullary reinforcement was used in 83 segments. The combined osteosynthesis technique (the Ilizarov fixator and/or subperiosteal reinforcement) was used in 27 cases. Results Correction of deformities was achieved in all the cases. Consolidation at the osteotomy level was obtained after 26.2±7.8 days on the average (from 3 to 12 weeks postoperatively). The period of follow-ups was from 6 months to 4 years. Twenty-four complications were observed in 8 patients (33.3 % of cases). Twenty three additional interventions due to the problems of correction were performed in 20 patients (unplanned surgeries were necessary in 83.3 % of cases). The ability to stand in the vertical position and bear weight on the lower limbs with the use of auxiliary supports or without them was achieved in 22 cases out of 24 (91.7 %). Patients’ ambulation ability was evaluated with the Gillette scale and improved in 21 cases out of 24 (87.5 %). In all the cases, patient’s care facilitated, self-service capabilities improved, and patients’ social activity increased. A more comfortable position for sitting was achieved in 22 patients. In 100 % of the cases, pain reduced or disappeared by doingexercises or during walking, including exercise therapy or hygiene procedures. Conclusion The technique of transphyseal reinforcement using elastic titanium nails is indicated for deformity correction in children with severe types of osteogenesis imperfecta. Lower limb deformity correction and increased bone strength contributed to patients’ motor activity and improved their quality of life. Complications were not rare after surgical treatment but their timely correction enabled to retain the achieved anatomical and functional results. The use of a minimum fixation, the Ilizarov apparatus following corrective osteotomies and intramedullary reinforcement, assisted in achieving patient’s early verticalization and full weight-bearing on the operated limb as well as helped avoid a number of complications. Osseointegration of intramedullary implants with bioactive coating prevented their migration in the long-term period. Telescopic constructs of such nails should not be used in children under the age of 10 in order to avoid their locking in the medullary canal due to osseointegration.

Introduction Severe congenital radial club hand is aesthetically unacceptable. This paper represents our experience in treating early and late diagnosed cases using gradual distraction by Ilizarov external fixator. Methods We treated 34 cases of congenital radial club hand with an age ranged from 1 to 15 years. There were 20 girls and eight bilateral cases. Three had been treated on both sides. So, we have treated 37 limbs. Nine cases had been operated before. Centralization alone was done in 12 cases and followed by lengthening in eight cases. Ulnar lengthening and gradual correction of wrist deformities were done for the rest of cases. The patients were followed clinically and radiographically with the following parameters: hand forearm angle, range of motion, daily functional activities, extent of lengthening achieved, and cosmetic improvement. Results The follow up ranged from 1 to 10 years. The magnitude of lengthening achieved ranged from 5 to 11 cm. The average healing index was 52.02 days/cm with cosmetic appearance satisfaction in all cases. Complications included; pin tract infection in 24 cases, flexion contractures of the elbow and fingers in 26 cases [which mostly disappeared during follow up], and spontaneous ulnocarpal fusion in 2 cases. Two cases suffered fracture in the regenerate zone. Conclusions The use of the Ilizarov method with gradual distraction of bone and soft tissues in treatment of radial club hand was effective in forearm lengthening with functional and cosmetic improvement.

Relevance The work deals with the challenging problems of improving the function and aesthetic appearance of the finger stumps using a surgical technology of osseointegration. Purpose To present preliminary results of osseointegration with the use of titanium implants and exoprostheses for finger stumps. Material and methods Osseointegration was performed in order to improve the function and aesthetic appearance of 17 phalangeal finger stumps in 8 patients at the age of 15 to 57 years who underwent treatment at the FSBI RISC for RTO of the RF ministry of health in 2014. Results Osseointegration that was assessed with clinical and radiographic methods, bench tests, and DASH scale resulted in positive short-term outcomes. Conclusion Osseointegrated finger prostheses for defects at the phalangeal level improve hand functions and appearance within a short period of time. The method of osseointegration is strategically important for management of large limb segment amputations and high levels of truncation. It is relevant to develop domestic implants that will optimize treatment terms, its results, and further prosthetic application.

Purpose To compare the incidence of hip implant loosening in cemented and uncemented fixation, to work out the recommendations for bone cement removal from the femoral canal and to evaluate the efficiency of using spacers and the proposed technique of filling the bone defect of the acetabular components. Materials and Methods The authors present the analysis of indications for performing revision hip arthroplasty and the relative frequency of performance after using the implants with uncemented and cemented fixation. Twenty eight (84.8%) out of 33 patients with implant instability had implants with cemented fixation. The authors focus on the need of sparing removal of the primary implant. A technique of bone cement removal from the femoral canal with the preservation of the proximal femur is proposed. The use of allogenic spongy bone grafts produced from the utilized femoral heads at the FSBI All-Russia Centre of Ophthalmic and Plastic Surgery of the RF Ministry of Health (Ufa) is offered for bone defect plasty Results Among 33 patients, good results were obtained in 23 patients (80-100 points according to W.H. Harris score) with the outcome of functional joints at follow-ups (range: 3 to 8 years), and fair outcomes in four (4) patients. The implant stem sinking developed in two patients within one year after surgery that required the replacement of the stem. The outcomes were good at follow-ups of five to seven years. Conclusion The presented technical solutions for performing revision hip arthroplasty can be used in orthopaedic practice.

A wire-and-half-pin device (WHPD) was offered for arthrodesis of the knee joint (AKJ). Objective Conduct mechanical tests of WHPD and a combined wire-and-half-pin device (CWHPD) to determine rigidity of osteosynthesis (RO) provided by the devices and make a comparative analysis. Material and methods To evaluate RO of WHPD and CWHPD comparative mechanical tests were carried out for the devices that are used for AKJ. WHPD was tested in two different assemblies. The tests were performed according to medical technological guidelines as outlined in “Technique for testing rigidity of transosseous osteosynthesis during preoperative planning” (Kornilov N.V. et al., 2005). Rigidity of the frames were tested longitudinally (distraction and compression) twice, total, 12 times; in frontal, sagittal and transverse planes twice for each of 3 constructs, total 18 times. Statistical analysis was produced with MedCalc software for Windows (version 12.7.8.0) using Mann-Whitney test (independent samples). Results Comparative analysis of the findings showed inconsiderable differences in RO between CWHPD and WHPD-II that we improved. Conclusion The findings allow for safe application of the device we improved for AKJ with no risk of losing RO.

Introduction
Hip dislocation is one of the most severe orthopedic complications among the problems in patients above 10 years of age with severe forms of cerebral palsy (CP), when reconstructive intervention is impossible. The purposes of palliative surgical orthopedic treatment in patients of this category consist in elimination or reduction of the pain syndrome, as well as elimination of the hip faulty position, possibility of limb free mobilization, improving the patient’s care conditions. Proximal femoral resection arthroplasty and valgus support osteotomy of the proximal femur combined with head resection are the main methods of palliative surgical treatment.
Purpose
To evaluate the encountered errors and complications, as well as to compare the authors’ own observations with the literature data.
Materials and Methods
The authors analyzed the complications encountered in the process of palliative surgical treatment (37 surgeries) of the hip dislocation in 22 patients which represented severe forms of motor disorders for spastic CP forms. Level V by GMFCS was observed in nine (9) cases, Level IV – in 13 cases. Proximal arthroplastic resection was performed in 11 cases (Group 1), proximal valgus support osteotomy – in 26 cases.
Results
The authors observed five (5) complications in Group 1 after 11 interventions (45.5%). Correction of the developed complications led to the full achievement of the desired result of treatment in five of six patients from this group (83.3%): disappearance or significant reduction of the pain syndrome, ease of hygiene, a comfortable sitting position. In Group 2 where the purpose of treatment aside from the pain syndrome elimination, the increase in the range of passive hip mobilization and achieving the proper postural management consisted in creating the conditions for passive verticalization with the lower limb support, seven (7) complications occurred after 26 interventions (26.9 %). The proper result of treatment was achieved in 24 of 26 hips after surgical correction of the complications (92,3%).
Conclusion
In most cases, surgical intervention is required in order to eliminate the complications after the palliative intervention, that allows, in general, achieving the desired result of treatment. When the severe pain syndrome develops due to mechanical conflict between the hip and pelvic bones through heterotopic ossifications and marked periosteal stratifications, the femoral arthroplastic resection after palliative interventions allows controlling the pain syndrome, restoring the hip passive mobility, providing postural management, but not to impart weight-bearing to the limb. It’s necessary to use only the plates with angular stability and without placing the screws in the direction of the acetabulum.

Purpose To study the characteristic features of femoral neck blood circulation in children with femoral head ischemic defects of traumatic and dysplastic genesis. Materials and methods The authors analyzed rheovasography results of 17 patients with the ischemic femoral head defects developed due to posttraumatic aseptic necrosis (Group 1, n=9) and Legg-Calve-Perthes disease (Group 2, n=8). The measurements were performed before surgery, after tunnel perforation of the neck, and after cell-and-tissue transplantation. Results More marked changes in the parameters of pulse blood filling were recorded in Group 2 and corresponded to the state of decompensation ischemia that might be associated with the disorders of venous blood outflow. Conclusion The results confirm the feasibility of re-interventions that stimulate hemodynamics and the use of a prolonged stimulation with wires in order to achieve the draining effect.

Introduction Septic coxitis is sustained in the early childhood and has a devastating effect on the musculoskeletal system. Systematization of the acquired defects and deformities is of great importance for treatment planning and outcome prediction. A radiographic classification based on the features of the deformities in the proximal femur and acetabulum as well as on their mutual orientation was proposed at the Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics. Purpose To study the reliability of the mentioned classification and to compare it with other classifications. Material and Methods Six orthopedic surgeons divided into two groups according to their specialization evaluated 23 X-rays of the hips using the classification systems of I.H. Choi, O.A. Sokolovsky, Е. Forlin, and RISC for RTO. Two orthopedic surgeons re-evaluated them two weeks later. Intra-rater and inter-rater agreement was determined using kappa value calculations. Results The number of inter-rater and intra-rater consensus depended on the specialization of experts, and it was higher in the first group. The highest proportion of the coincidences of three expert conclusions was observed when the classification systems of Forlin and RISC for RTO were used. The values of intra-rater and inter-rater reliability of the RISC for RTO classification were 0.542-0.641 and 0.436-0.738. Conclusion Taking into account a sufficient level of reliability, the RISC RTO classification can be used as a working system by planning surgical treatment and for prediction of its outcome in children with consequences of septic coxitis.

Because of extensive changes in social protection laws in the Russian Federation (RF), as well as ratification of the Convention on the Rights of Persons with Disabilities, the organization of rehabilitation for disabled persons with musculoskeletal disorders has especially become relevant. Aim To improve the organizational and legal mechanisms for implementing individual programs of rehabilitation or habilitation of disabled persons with musculoskeletal system diseases in RF. Materials and Methods The authors analyzed existing international and Russian literature. The study used analytical, legal, organizational, and methodological techniques aimed at perfecting the system for rehabilitation of disabled adults and children. Results In RF, the “disabled child” category was established for the first time for more than 70,000 children (70,600 in 2013 and 72,800 in 2014) according to governmental statistics of the Institutions of Medical and Social Examination, and more than 340,000 individual rehabilitation programs for disabled children were established, including for those recognized as disabled children for the first time and for those who were rerecognized as disabled children. The disability due to diseases of the musculoskeletal system and connective tissue was established for the first time in 3,500 children and is the fifth highest ranking primary disability in RF. Conclusion The introduction of fundamentally new federal schemes of implementing individual programs of rehabilitation or habilitation requires the authorities of RF to be experienced in the field of health promotion to create the organizational and legal mechanisms for implementing such programs. Thus, the features of regional rehabilitation infrastructure, medical care and monitoring should be considered.

Introduction Osteoporosis is one of the most common and important symptoms of tuberculous involvement along with the classic symptomology. Aim To evaluate bone tissue mineral density and microstructure in patients with tuberculous spondylitis. Materials and Methods The results of studying 75 patients with active tuberculous spondylitis admitted to the Department of Bone and Joint Tuberculosis of Republican Specialized Scientific and Practical Medical Center of Phthisiology and Pulmonology in 2015 formed the basis of the present work according to the intended purpose. Complex examination of the patients included their case history, clinical and laboratory data, and orthopedic status evaluation. Radilogical examination consisted of performing sagittal and frontal radiographic views, CT, and/or MRI of the involved segments. Both tomographic examinations (CT and MRI) were performed, if indicated, for differential diagnosis to identify the pathological process. Results Male patients of working age prevailed in the group of patients with normal bone mineral density. The number of patients with decreased bone mineral density was twice more as compared with those with normal bone mineral density. One-third of the patients were over 50 years of age. The value of bone tissue resorption exceeded the normal rate by two-fold. The values of bone tissue formation in middle-aged patients were increased irrespective of gender but remained within the limits of the two-fold increase. Conclusion Tuberculous spondylitis causes general changes in the bone metabolism values in 90 % of the patients. Intensive bone resorption takes place in tuberculous spondylitis that exceeds twice the rate of bone tissue formation.

Introduction The decrease in the external osteosynthesis index during limb lengthening is a relevant problem to solve by the current orthopaedics, especially in regard to children. Intramedullary rods in pediatric orthopaedics are contraindicated due to open growth plates. The use of intramedullary wires reduces the period with the fixator on the patient’s limb but the index of osteosynthesis remains rather high. Purpose To analyze the results of the combined use of the Ilizarov fixator and an internal plate of an original design for experimental tibial lengthening. Material and Methods Leg lengthening was performed in 6 experimental dogs using the Ilizarov fixator and plating. The procedure of segmental lengthening by 14-16 % from the initial length was performed in the manual mode with the rate of 1 mm per day produced with 4 steps. Results The planned amount of lengthening was achieved in all the animals. The use of plating enabled to remove the fixator on the day of distraction completion. The index of external osteosynthesis was 12.7±0.7 day/cm. The regenerated bone was of normoplastic type. It acquired a homogenous structure after 30 days of fixation in the majority of cases. As for the complications, the resorption round one of the screws that fixed the plate was observed along with soft tissue inflammation but it did not affect the experiment results. Conclusion The combined use of plating and the Ilizarov fixator decreased the external osteosynthesis index and prevented the complications related to regenerated bone fracture or deformity after the fixator removal.

Background Antegrade locked intramedually nailing (IMN) is considered to be a method of choice for repair of femoral shaft fractures. We studied the articular cartilage of the canine femoral condyles in the conditions of immediate and delayed antegrade IMN to reveal whether timing of operation results in any structural changes in the cartilage tissue. Material and methods Femoral shaft fractures were modelled in 12 adult mongrel dogs and fixed using antegrade IMN immediately after the injury in group 1 (n = 6) and four days after the injury in group 2 (n = 6). Five dogs were intact. Results In group 1, fractures united after 42 days but in group 2 the union was seen in the radiographs only by day 70. Unified bone marrow cavity and cortex were formed by day 70 in group 1 while in group 2 it was seen only by day 100. The histological study showed that the structure of the articular cartilage of the femoral condyles was not damaged in group 1 at all time points. The changes were the decrease in the cartilage thickness and in the volumetric density of condrocytes. In group 2, the cartilage of the femoral condyles featured defibration of the articular surface that was accompanied by breakage of the basophilic line integrity and penetration of vessels into the cartilage. Conclusion Delayed antegrade locked IMN provoked destructive changes in the articular cartilage of the femoral condyles and decreased chondrocyte proliferation. We suppose that delayed IMN of a femoral shaft fracture might cause initiation or deteriorate the existing knee osteoarthritis. Level of evidence: IV.

Relevance Chronic osteomyelitis makes about 10 to 25 % in the structure of locomotion system diseases. Moreover, osteomyelitis recurs in 20 to 30 % of the affected patients and results in secondary amputations and limb functional deficiency in 10.3 to 57 % of them. Management of secondary cavities and defects under such conditions is a challenge that does not have a uniform solution to date. Nano-composite carbon materials combine sufficient strength with possible biological integration and seem to be promising materials for filling bone defects of osteomyelitic origin. Purpose To study experimentally the results of using a nano-composite carbon-based material and compare it with allologous bone and porous ceramic implants for filling osteomyelitic long bone defects. Materials and method Experimental studies were performed on 20 normal rabbits. One cortical layer of the anterior shaft surface of their left radius was perforated by drilling. St. Aureus suspension of 0.5 ml in the concentration of 10–5 CFU/ml was injected into the medullary canal. The events of a local inflammatory reaction such as swelling, local hyperemia, temperature elevation, fistula formation were observed by day 7 in all the animals. Necrosequestrectomy was performed two weeks later. A standard defect of 0.5-cm was filled in with three different materials. A carbon nanostructured implant, a ceramic implant and allogenic bone bio-implant were used. Results X-ray and biomechanical studies during the experiment found that the use of the carbon implant for filling osteomyelitic defects provided optimization of bone tissue regeneration as compared with the use of allogenic bone and ceramic implants. Complete consolidation and formation of a block at the implant to bone border occurred by the end of week 4. Radiographic borders between the bone and the nano-carbon implant disappeared by week 6. The results of the biomechanical study revealed the comparable parameters of the breaking force in Group 1 and the control group of normal animals but a significant reduction in breaking force in Groups 2 and 3. Conclusion The use of nano-structured carbon material for filling osteomyelitic defects accelerated regenerated bone formation and provided positive osseointegration at the boneto-implant border when compared with the other bone-substitute materials studied.

Purpose To study the morphological features of bone regeneration by using a local injection of autologous red bone marrow in the conditions of an experimentally produced pseudarthrosis. Materials and methods The study was conducted on thirty (30) white laboratory rats that were bred at the Sitenko Institute for Spine and Joint Pathology of the Ukraine National Academy of Medical Sciences (6 months old, weight of 250-270 g). The experiment was conducted according to the international rules of experimental animals protection. The protocol of the experimental studies was approved by the ethics board of the Sitenko Institute for Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine. Results Culturing of mesenchymal stromal cells requires high-tech laboratory equipment and takes a long period of time. Therefore, their widespread clinical use is limited. Native bone marrow that contains mesenchymal stromal cells is easily available. The process of its preparation and transplantation is not technologically difficult. Therefore, it has advantages for being used for stimulation of reparative osteogenesis in bone fractures or in disorders of reparative osteogenesis. Conclusion The study found that autologous red bone marrow stimulated bone tissue development in the zone of pseudarthrosis. The area of bone tissue was 22.8 % larger as compared with the bone area in the untreated animals. There were no pseudarthrosis-related cavities in the regenerate structure in the cases of red bone marrow injection into the zone of traumatic injury. The features of reparative process were the following: angiogenesis activation, enchondral ossification accompanied by cancellous bone tissue formation with a network of bone trabeculae, and decrease in the destructive manifestations in the maternal bone parts located above and below the injury area.

Purpose To study the biocompatibility of implantation calcium phosphate (CP) materials from bovine bone tissue and its dependence on their composition Materials and methods The authors studied the biocompatibility of three implantation calcium phosphate materials obtained by an original technology on experimental animals (dogs). The materials obtained from bovine bone tissue by its demineralization and sedimentation out of the CP salts solutions. Serum proteins (SP) of the molecular mass of 20-30 kDa that were isolated from blood serum of the dogs with active osteogenesis were added to CP composition in order to improve the characteristics of biocompatibility. The isolation was performed using the methods of salting-out, dialysis and gel permeation chromatography. CP materials and their composites were implanted into the defects of long bone metaphyses. The study was performed using the methods of infrared spectroscopy, X-ray electron probe microanalysis, and light and scanning electron microscopy. Chemical composition of CP materials, reparative osteogenesis character and its intensity were determined quantitatively and qualitatively. The diameter of the implant particles of the tissues that filled the cancellous defect area were evaluated histomorphometrically. Results It was found that the implanted materials differed in biodegradation, osteoinduction and osteoconduction properties. CP materials that were the closest to bone tissue by their composition had a higher degree of biocompatibility Conclusion The proposed CP materials can be used in clinical practice for filling posttraumatic defects and correction of the pathological conditions accompanied by osteoporosis or bone loss.

The review of the specialized literature showed that the incidence of intra-articular tibial condylar fractures that are located in the posterior tibial parts is rather high. However, the most commonly used classifications do not always provide with an accurate architectonics of such fractures. Therefore, three- and four-column classifications of the discussed fractures were proposed. Accurate reduction of bone fragments of the posterior tibial plateau from the standard approaches is rather difficult technically due to an inadequate visualization of the fracture zone. Thus, posterolateral and posterior approaches to the tibial plateau were introduced through which not only the visualization of the posterior tibial plateau structures but also their osteosynthesis with a support plate is possible. The authors analyzed the scientific publications related to the main surgical approaches to the tibial plateau and their use for osteosynthesis of the fractures in this area. It appeared that the most adequate reduction and fixation of the fragments of the posterior tibial plateau is provided by posterolateral and posterior approaches. Despite the risk of damage to major vessels and nerves by using these approaches their widespread introduction in practice is promising. However, further scientific studies are required that would be aimed at substantiation and improvement of the techniques of the posterior approach to the knee as well as at updating the indications for each of them.

The authors describe a rare case of bone pathology in the tibial metaphysis bone tissue in a 75-year old female patient who underwent surgical treatment for a giant-cell tumor with further osteoplasty about 40 years ago. The biopsy material from the pathological focus was mainly represented by connective tissue. Cartilaginous and bone structures were not numerous. Pathological mineralization was a typical histological manifestation of degenerative changes in the pathological focus. There were no signs of the giant-cell tumor recurrence as well as no signs of inflammatory process. Persistence of unconsolidated osteoplastic material for a long time was the cause of severe right-side gonarthrosis that required knee arthroplasty.

The authors present a clinical case of a successful surgical treatment of a soft-tissue defect in a female patient with pelvic bone fractures and a severe extensive defect of the femoral soft tissues by using traction appliances fixed to the Ilizarov fixator. The method of transosseous osteosynthesis was used for treatment. Secondary sutures were applied after soft tissue necrectomy and the ligature ends were fixed to the mentioned traction appliances. Optimal rate and rhythm of distraction was produced in the process of dermotension. The traction of the wound ends towards each other started on the second day after surgery with the rate of 0.5 mm 6–8 times a day and continued 15 days. A 30-cm long juxtaposition of the wound edges was achieved. It enabled to use interrupted sutures. The integumentary tissue defect of the area over 1500 cm2 was eliminated. The remaining wound areas that measured 5.0 cm × 10.0 cm and 8.0 cm × 12.0 cm in size were eliminated using the Tyrš dermoplasty. The patient’s skin biomechanical condition was evaluated by acoustic velocimetry in order to prevent skin overstretching. Microcirculation of tissues in the wound and that of the stretched skin was controlled by ultrasound high-frequency Dopplerography. The healing of the wound soft-tissue defect using graduated dermotension is associated with redistribution of stresses in the integumentary tissue and with formation of its new mechano-biological status. Indirect signs of skin overstretching near the wound edges were not revealed. Three types of blood flow in the wound tissue were recorded with ultrasound Dopplerography: microcirculatory, arterial, and venous with a clear respiratory wave. The calculated index of differences near the wound edge and in the wound soft tissues varied from 5.0 to 23.0 relative units that is typical for an active granulation process. Good anatomic and functional results were achieved clinically. Static and locomotor functions of the lower limb recovered completely. The patient was satisfied with the cosmetic and functional results. The technique of dermotension using the Ilizarov fixator was used at the Center’s clinic in 19 patients with open fractures of long bones that were accompanied with soft tissue defects of various sizes.