Introduction Supracondylar and intercondylar fractures of the distal femur are often attributed to high energy trauma. Treatment of such severely comminuted fractures is challenging. Poor overlying soft tissue, bone loss in the presence of severe comminution and intercondylar extension makes implant selection difficult. Unilateral knee spanning external fixators and hybrid fixators can lead to knee joint stiffness and the issue of bone loss is difficult to deal with them. Ilizarov ring fixator is reserved for severely comminuted fractures and injuries with poor overlying soft tissue. It can effectively manage the bone loss and facilitates limb length restoration, promotes early weight bearing and mobilization. Aim To study the role of the Ilizarov ring fixator in management of severely comminuted supracondylar and intercondylar fractures of the distal femur. Material and Method A total of 13 (all male patients) consecutive patients with severely comminuted supracondylar and intercondylar fractures of the distal femur were treated from December 2013 to March 2016. There was one case with A3 type, one with C1, five cases with C2 and six cases with C3 type as per AO/ASIF Classification. Gustilo-Anderson classification was used for compound fractures. Four cases of C3 type required limited open reduction. Results All patients completed one-year follow-up. Average fracture union time was 20 weeks. Pin tract infection (n = 7) was a frequent complication. Patients with C3 Type of fracture had more restriction in knee flexion (n= 5). No case had limb length discrepancy more than 2.5 cm. No case of nonunion or premature fixator removal due to infection was noted in the series. Conclusion Ilizarov ring fixator can be considered as one of the reliable treatment options for severely comminuted distal femoral fractures with intra-articular extension.

Purpose Identification of personalized diagnostic criteria of consolidation disorders in limb bone fractures. Materials and methods 108 patients at the age from 20 to 40 years (according to WHO classification) with limb bone fractures were included into the study. Group 1 were patients (n = 62) with uncomplicated fractures. Group 2 (n = 46) included patients with consolidation disorders. The presence of acute or chronic associated diseases was the exclusion criteria. Clinical, laboratory and instrumentation findings (210 parameters) were assessed in a multivariate predictive regression model. These parameters were studied at admission, then on days 2, 5, 10 and 90 of the study. Statistic processing was performed using STATISTICA 6.1 software package (StatSoft, Russia). Results The multivariate regression analysis used revealed high association of -25Pro/Pro genotype of TGFβ1 gene and -2073Т/T genotype of EGFR-2073A > T gene in patients with consolidation disorders that ran as delayed consolidation type (p less 0.0000001). Conclusion The combination of genotypes -25Pro/Pro of TGFβ1 gene and -2073Т/T of EGFR gene can be used as one of the markers of consolidation disorder in limb bone fractures, and that will enable to use personalized prophylactic programs to prevent such complications.

Purpose To improve the treatment effectiveness of long-bone posttraumatic osteomyelitis through the development and implementation of pathogenetically substantiated surgical and medicamental measures according to the stages of multiple organ dysfunction syndrome. Materials and methods Group 1 consisted of 176 (69 %) patients requiring large-volume surgical intervention (debridement of fistulae and bone sequestrae by segmental resection). Group 2 consisted of 79 (31 %) patients with traumatic osteomyelitis requiring small-volume surgical intervention (debridement of fistulae and bone sequestrae by removing a small bone part, parietal resection). Results The revealed hemodynamical, immunological, biochemical, and rheovasographic changes indicated traumatic osteomyelitis as stages I-II syndrome of polyorganic dysfunction. The average period of the hospital stay for patients with traumatic osteomyelitis of the leg was 44.6 ± 0.7 days of bed occupancy compared to 54.4 ± 0.7 days for the control group. An increase in the number and duration of remission periods was also observed (the participation of patients with traumatic osteomyelitis in working activity after undergoing complex rehabilitation-restorative treatment amounted to 77.4 %). Conclusion According to the author’s observation, the proposed complex of measures for the treatment of pyogenic complications due to injuries, in view of the current opinions on the pathogenesis of the multiple organ dysfunction syndrome, contributed to more favorable postoperative outcomes by decreasing the number of recurrences. Therefore, the periods of in-patient treatment were reduced.

Purpose Proper treatment of forearm bone gap non-union should achieve both biological stimulation of the bone and elastic mechanical stability. The use of Ilizarov technique enhances the healing of a non-union providing osteogenic, osteoconductive and an optimal stability with the Ilizarov fixation. We retrospectively reviewed 26 patients affected by forearm bone non-union and treated with the Ilizarov fixation. Materials and Methods Twenty six patients were treated for gap non-unions of forearm bones with the Ilizarov compression distraction device from 2000 to 2015 in BARI-ILIZAROV ORTHOPAEDIC CENTRE. Results All the difficult non-unions healed in a mean of 7 months, ranging from 5 to 12 months. At the latest follow- up, forearm functions were satisfactory. Conclusion The Ilizarov compression distraction device is a fantastic tool in promoting the healing of forearm nonunions, even if the bones are very atrophic.

Introduction Posttraumatic osteoarthritis of the wrist (WOA) is of importance among the diseases of the proximal hand. There are few studies in which the dependence between clinical and morphological parameters in patients with posttraumatic osteoarthritis due to a non-united fracture of the scaphoid was studied. Purpose To identify the dependence between several clinical parameters on the one hand and morphological parameters of the wrist tissue condition, on the other hand, in patients with consequences of scaphoid nonunion. Materials and methods Material were 94 resected samples of the wrist tissues that included the scaphoid obtained from 55 patients in whom the WOA was associated with the consequences of scaphoid fracture nonunion. The following parameters were studied: anamnesis and symptoms, roentgenometric and morphological findings that were graded. Correlation dependence between them was also investigated. Results Pathological changes in the wrist tissues were characterized by qualitative and quantitative varieties. They were the consequences of traumatic blood supply disorders in the scaphoid and joint capsule. They manifested themselves as inflammatory, productive-reparative and dystrophic-destructive changes (DDC). Maximum values of Pearson’s association coefficient were revealed between the parameters: time since injury – scaphoid surface DDC in pseudoarthrosis zone (ra = + 0.438; p less 0.01); pain – scaphoid osteonecroses (ra = +0.320; p less 0.05); wrist contracture – hypertrophy of the villi of the wrist capsule synovial layer (ra = +0.320; p less 0.1). Conclusion Pathohistological and morphometrical studies allowed us to reveal some previously unknown differences and dependences important for understanding the pathogenesis, improvement of diagnosis and prediction of the WOA course which was a result of scaphoid fracture nonunion.

Purpose Develop a complex of treatment and diagnostic measures in order to improve the results of total hip replacement in patients with femoral neck pseudarthrosis. Material and Methods Treatment results of 102 patients with pseudarthrosis of the femoral neck in the age range between 20 and 83 years who underwent total hip replacement were studied. Rehabilitation treatment for peripheral neuropathies according to the developed method was used in 38 (37.3 %) patients. Massage and exercise therapy only were administered in 64 (62.7 %) patients. Clinical, radiographic, electroneuromyography and densitometry methods were used in the current study. Results Before the operation, peripheral neuropathies of different severity grades were revealed in the lower extremities of 81 % of patients. Osteopenia was revealed in 16 %, and osteoporosis in 84 %. Diagnostic criteria of the level and severity of the lesions in the lower extremities nerves before and after total hip replacement were developed in order to distinguish a group of patients at risk of neurological complications. Conclusion The method of rehabilitative treatment developed by us provided good functional results in 91.3 % of patients.

Introduction There have not been highly effective and equally safe tools available to relieve pain and improve joint function in patients suffering from osteoarthritis. Purpose Explore the efficacy of intra-articular application of autologous platelet-rich plasma (PRP) in the treatment of patients affected by grade 2 osteoarthritis of the knee. Material and methods The study was designed as a single-arm prospective randomized trial. A total of 60 patients with grade 2 osteoarthritis according to the J. Kellgren and J. Lawrence grading scale (1957) were enrolled in the study. Patients were divided into two clinical groups, with 30 subjects in each group. Index clinical group was treated using three 2 mL intra-articular applications of PRP performed once over a 3-week period. Control group was given three intra-articular injections of 2 mL hyaluronic acid (HA) applied once a week. Outcome measures included verbal rating scale of treatment effectiveness (VRSte), 100-point pain visual analogue scale (VAS), and Lequesne scale taken at 1-, 3-, 6- month follow-up. Results Measurement with VAS showed decrease in pain from 50.5 ± 5.38 to 9.8 ± 3.39 (p less 0.05) in index group one month after intra-articular applications of PRP. Analgetic effect persisted at a 6-month follow-up without statistically considerable changes. Control group showed decrease in pain from 46.8 ± 6.49 to 19.73 ± 5.84 (p less 0.05) scores one month after intra-articular applications of HA and decline in scores of 27.76 ± 7.72 (р less 0.05) at 6– month follow-up. Index group demonstrated considerable reduction in Lequesne score from 10.88 ± 1.63 to 4.2 ± 1.23 (p less 0.05) one month after treatment that persisted at 6-month follow-up. Control group also showed reduction in Lequesne score from 9.9 ± 1.6 to 4.7 ± 0.66 (p less 0.05) at one-month follow-up that remained nearly the same 6 months after treatment. Conclusion Our findings suggest that intra-articular application of PRP in the treatment of patients with grade 2 osteoarthritis of the knee can provide pain control and functional improvement to a greater extent as compared to HA injections throughout 6-month follow-up.

Purpose Using chronobiological methodology and on the basis of individual analysis, to determine the character of changes in the reproducibility error (RE) of double-energy X-ray absorptiometry (DEXA) by assessment of the projection bone mineral density in the Gruen zones in patients after total hiparthroplasty in the early postoperative period. Materials and methods Eight men and two women were examined. Results RE value was changed in oscillation manner. It was hypothesized that it is caused by tremor. On this basis, a theoretical physical model was proposed which considers the mechanisms of X-ray radiation attenuation by passing through bone tissue. According to the model, the tremor changes the length of X-ray path in the bone tissue. The fact that bone structure is characterized by parts with high and low atom density was taken into account in the model. It is especially strongly manifested in the areas of the trabecular bone. Theoretical modeling allowed us to suggest the physical mechanisms of tremor effect on X-ray radiation passing through bone structures as well as to demonstrate the dependence of the study results on tremor-related spatial vibrations of bone structures Conclusions These findings should be taken into account when investigating the projection mineral density of bone tissue in the periprosthetic zone after hip arthroplasty

Purpose Review the dynamics in morphological characteristics of femoral muscles in patients with THR who followed different rehabilitation programs. Materials and methods Radiological and ultrasonographic assessment was used in 43 patients with THR and pain at the side of the operative intervention.Nineteen outpatients of the index group had manual therapy using the authors’ soft tissue manipulation technique. Control group included 24 patients aged 37 to 74 years (mean age of 57.3 ± 2.3 years) who were treated with standard method employing exercise therapy, massage with ischemic compression of trigger points, physioprocedures, nonsteroidal anti-inflammatory drugs, chondroprotective and vascular agents, and vitamins of B-group. Results The findings showed changes in optical density of the femoral soft tissues following a course of manual therapy that was likely to be related to the improved ROM in the hip and further decrease in muscle tone and better microcirculation in the interest area. Ultrasonographic assessment of periarticular muscles of the operated hip demonstrated an increase in the belly thickness of the target muscle with decreased echogenicity and recovered oblique and longitudinal fiber striation after the course of manual therapy. Control group exhibited no changes in the radiological and sonographic manifestations. Conclusions Manual therapy applied for pain arrest showed to be effective in patients with THR and can be advocated as a part of rehabilitation measures.

Objective Improve outcomes of complex treatment of children with Legg-Calve-Perthes disease. Material and methods Pre- and postoperative assessment of 90 patients with Legg-Calve-Perthes disease and severe epiphyseal involvement was reviewed. The age of the patients ranged from 6 years to 14 years. Corrective femoral osteotomy was performed for the patients who were followed up for 10 years. The patients were subdivided into two groups depending on the extent of bone coverage (EBC) of the femoral head straight after the surgery: group I (n = 60), EBC ≥ 1.0; group II (n = 30), EBC less 1.0. Results Regardless of the type of corrective femoral osteotomy group I showed positive clinical and radiological dynamics, and improved capital improvement, in particular; group II (archive material, cases who underwent surgery until 1998) demonstrated negative dynamics with considerably deformed femoral head. Conclusion Corrective femoral osteotomy remains the procedure of choice for patients with LCP disease, and femoral head remodeling can be provided with the extent of bone coverage index measuring one and over.

Introduction The problem of spondylolysis and spondylolisthesis in children is caused by many factors, with difficulties in producing a timely clinical diagnosis appearing to be the most significant of these factors. Materials and methods Overall, 98 children between the age of 3 and 18 years with the diagnosis of spondylolysis and spondylolisthesis of the lower lumbar vertebrae were examined. The patients’ complaints, medical histories, and the results of clinical and radiation diagnosis were evaluated. Results It was determined that the pathology occurred with greater frequency in boys (65.3 %). Diagnosis occurred with the same frequency in children aged 10–15 years and 15–18 years (39.79 % and 41.85 %), respectively. Conclusion Spondylolysis and spondylolisthesis need further study to reduce the problem severity not only in the pediatric population but in adult patients as well.

Objective To review economic aspects of treatment of patients with chronic posttraumatic osteomyelitis of the humerus. Material and methods Costeffectiveness of treatment of chronic posttraumatic osteomyelitis of the humerus using the method of transosseous osteosynthesis with the Ilizarov apparatus was evaluated. Medical expenses were compared with standard financial expenditures as established by regulations of medical assistance provided to the patients with osteomyelitis. Results Treatment of patients with the method of controlled transosseous osteomyelitis being highly effective, have shown to entail considerable economic losses due to the severe pathology, multiple stages of previous treatment performed untimely and inadequately. Conclusions Economic losses can be reduced through thorough preadmission examination of patients including bacterial culture and antibiotic sensitivity tests, decreased preoperative period, optimal choice of treatment tactics and quality care, to be followed by outpatient course.

The authors analyzed the scientific publications that deal with the problems of treating injured persons with extensive degloving injuries to integumentary tissues. The majority of literature sources available for the last 10 years were published abroad. They particularly discuss the use of not only anamnesis and clinical methods for the diagnosis of open and closed degloving injuries of integumentary tissues but also a great variety of instrumental and radiological techniques. Their treatment is optimized by participation of different specialists, including plastic surgeons. It enables not only to avoid pyo-septic complications but also to achieve the best possible aesthetic outcomes in most cases. The Russian literature on the problems of diagnosis, treatment and rehabilitation of injured persons with extensive degloving injuries of integumentary tissues is extremely scarce. Upon summarizing the data of foreign and Russian literature, we conclude that there is no consensus on an optimal choice of the terminology, no classification and, as a consequence, there are no unified approaches to treatment. The above points prove the fact that management of extensive degloving injuries to integumentary tissues remains the topic of further studies.

The authors present a literature review related to surgical orthopedic treatment of hip dislocation in patients with severe cerebral palsy (GMFCS IV, V) in the age of 10 years and older. They discuss indications, special features, results, advantages and disadvantages of surgical interventions such as resection arthroplasty of the proximal femur, valgus support osteotomy of the femur, hip joint arthroplasty and arthrodesis.

Literature review in intraoperative neurophysiological monitoring during spinal deformity correction showed that the increase in the number of neuromonitoring modalities is viewed as a major trend with the technique. This makes the testing procedure more complicated and generates controversies in interpretations of the findings. Algorithmization of monitoring and formalization of the findings can be practical in addressing methodological problems.

The authors present a case of mucopolysaccharidosis type VI in a child. Low incidence rate of mucopolysaccharidosis in pediatric population, its difficult differential diagnosis and treatment suggests that this description of the disease pathology and treatment with the analysis of errors and complications in an 11-year-old child would be of interest for orthopedists, neurologists, anesthesiologists, and pediatricians.

Proper component positioning in total knee arthroplasty is important for long-term implant survival, while malposition can result in a large number of complications. A clinical instance of malpositioned implant and the solution are described.