Introduction The tactics of surgical treatment of patients with humeral shaft fractures have beenactively discussed in special scientific literature. The development of new osteosynthesis methods requires their careful comparative evaluation. Purpose To compare the treatment results in the three comparable clinical groups of patients with fractures of the humeral diaphysis in its upper and middle thirds after using a minimally invasive osteosynthesis with a helical plate (MIHPO), locked intramedullary osteosynthesis (LIO) and conventional plating osteosynthesis (CPO). Materials and methods 92 patients with fractures of the humeral diaphysis in its upper and middle thirds were divided into three groups, comparable in number, sex, age, mechanism of injury, location and nature of fractures, according to the osteosynthesis performed: MIHPO (33 patients), LIO (33 Patient) and CPO (26 patients). Terms prior to surgery, intervention time, image intensifier time (IIT), restoration of the humerus anatomy, functional results using DASH and Constant systems, and complications were compared. Control examinations were performed at 1, 6, 12, 18 and 24 weeks after the operation. Clinical, radiographic and statistical methods of study were used. Results Duration of the operation in all three groups did not differ significantly. The IIT was significantly less (p less 0.001) in the MIHPO group when compared to LIO. The lowest residual angulation and translation after the osteosynthesis was observed in the CPO group while in MIHPO and LIO groups these findings were not significantly different. The dynamics of restoring the functions of the damaged limb on the DASH and Constant scales did not differ significantly in three groups at all time-points of follow-ups. After 24 weeks, fracture consolidation was noted in all the patients in the MIHPO and CPO groups and in 31 (91.7 %) patients in the LIO group. Six events (18 %) of complications of two types were observed in four patients of MIHPO group (12 %). Ten patients in LIO group (30 %) had 15 complications (45 %) of 6 kinds and 9 complications (35 %) of three kinds were noted in eight CPO patients (30 %). Conclusion The MIHPO method is safe and effective. Its results are comparable with the techniques of LIO and CPO in frequency and timing, functional results. However, it results in a lower incidence of complications. Therefore, it can be recommended for a wider application on the appropriate indications.

Purpose Experimental study of the effect of Micellate on the processes of reparative regeneration on the model of comminuted tibial fractures. Materials and methods The paper analyzes the results of studies carried out on 20 mongrel dogs in whom comminuted tibial fractures were modeled. To stimulate osteogenesis, a complex of minerals called Micellate was used. Results It was found that Micellate acts selectively and restores the lack of the bone tissue mineral component. The regenerate remodels into an organotypic bone in a shorter time. Conclusion After a detailed study of the mechanisms of action and clinical trials, the preparation might find application both in the correction of osteopenia and osteoporosis that develop in the process of fracture consolidation, and for the prevention of fractures caused by the loss of the mineral component of bone tissue as a result of metabolic disturbances.

Objective Blood serum biochemical parameters (total protein and lactate) were evaluated to monitor posttraumatic condition of polytrauma patients. Material and methods The study included 22 polytrauma patients. Depending on severity of trauma the patients were divided into three groups; in the first group, the ISS being up to 15 (n = 6, mean age, 36.4 ± 13.0 years); in the second, the ISS measuring from 16 to 24 (n = 8, mean age 34.5 ± 11.6 years); and in the third, the ISS being more than 25 (n = 8, mean age 38.6 ± 8.7 years). Venous blood total protein and lactate concentration was measured during posttraumatic period. Results The findings showed intergroup statistically significant differences in the level of total protein with minimal decrease in patients of the first group, and maximum decrease in the third group. No intergroup statistically significant differences were observed in lactate concentration of the study groups. An extent of hypoproteinemia was found to have greater correlation with severity of trauma than lactacidemia. Hypoproteinemia was shown to be caused by intense catabolism during the first 3 days after trauma, and by low protein production for more than 3 days. Conclusion Serum total protein in polytrauma patients was shown to be a more meaningful measure to evaluate severity of polytrauma and monitor therapeutic interventions as compared to lactacidemia.

Introduction An Achilles tendon injury is a most common trauma (up to 47 %) among all subcutaneous ruptures of the tendon. Objective Improve outcomes of early subcutaneous ruptures of Achilles tendon using minimally invasive surgical procedure. Material and methods The review included outcomes of 47 patients treated for early "classic" subcutaneous rupture of the Achilles tendon at trauma and orthopaedic department № 1 Samara State Medical University from 2009 to 2016. Algorithm of diagnosis included clinical assessment, dynamic ultrasound examination, comprehensive stride assessment (podometry), electromyography of triceps surae muscle, and thermography of tibiae. Visualization of the rupture site, less trauma to the surrounding soft tissues (skin, paratenon), reliable adaptation of Achilles fragments were considered when devising a suturing technique. Results No infection was observed at the site of surgical intervention at the early postoperative stage. Functional recovery of the patients indicated to symmetrical force in the triceps surae muscle, restored thermal balance at thermography, and absence of limping at podometric assessment at 6-month follow-up. Conclusion Minimally invasive surgical procedure offered to treat patients with early “classic” subcutaneous ruptures of Achilles tendon allowed for early reliable restoration of the ankle function.

Surgical repair of unstable proximal humerus fractures involves accurate reduction of the humerus tubercles, reconstruction of rotator cuff muscles and tendons, stable bone fixation to be performed shortly after injury to ensure functional recovery of the shoulder joint. Objective To evaluate the efficacy of surgical treatment with fixation shape memory constructs and through porous titanium nickelide implants used for patients with proximal humerus fractures and a different injury-to-surgery interval. Material and methods Surgical treatment with titanium nickelide constructs was performed for 71 patients with proximal humerus fractures. Thirty (42.3 %) patients had comminuted intra- and juxta-articular fractures, 26 (36.6 %) cases were unifocal and metadiaphysial injuries and 15 (21.1 %) had greater tuberosity fractures. 21 (29.6 %) patients had associated rotator cuff tears. An injury-tosurgery interval was 1 to 10 days in 52 (73.2 %) patients and 11 to 30 days in 19 (26.8 %) cases. Results Consolidation of realigned bone was achieved in all the patients at 4-to-6-month follow-up. Shoulder joint function recovered in 50 (96.2 %) patients who were surgically treated in the first 10 days of injury and in 14 (73.7 %) out of 19 patients who had procedure performed between 11 and 30 days post injury. There were statistically significant differences in the groups (χ2 = 8.391, p = 0.015). Conclusions Accurate bone reduction and shoulder ligament repair performed early after the injury provided restored function to the shoulder joint in 96.2 % of the cases. Preoperative delays showed reduction in favourable outcomes of the surgical intervention by 21.1 %.

Introduction This article is devoted to the problem of total knee arthroplasty in patients with severe valgus deformity (Krackow type III). Methods We analyzed mid-term results of 12 total knee arthroplasties combined with sliding osteotomy of the lateral femoral condyle and distalization of the lateral collateral ligament. Treatment results were measured with KSS and WOMAC scores. Results We had excellent and good results in 11 cases but one was complicated with periprosthetic fracture of the femur. Discussion Up-to-date, there are various techniques of soft-tissue release in total knee arthroplasty proposed. These techniques differ in the point of release and the power of effect. However, an adequate balance is not always achievable in severe valgus deformity. Therefore, implants providing enhanced frontal stabilization are required (CCK/VVC).

Purpose To evaluate outcomes of surgical treatment of patients with tumors of long bones of upper limbs using a single-stage repair of bone defects with tailored bone substitute implants manufactured with 3D printing technique. Materials and methods Clinical and radiological assessment of 22 patients with tumors of long bones of upper limbs was produced after surgical treatment that included removal of neoplasm and one-stage bone plasty using a tailored implant manufactured with three-dimensional printing (Patent RU 2598769). Bone cement and Recost bone substitute (Patent RU 2518753) were used to produce an implant. All patients were evaluated preoperatively and at 12-month follow-up using the 36-item Short Form Health Survey (SF-36), Musculoskeletal Tumor Society (MSTS) Rating Scale and visual analogue scale (VAS). Results Postoperatively, all patients showed pain reduction and improved function of the upper limb. No radiographic evidence of implant migration was observed throughout the followup. Evaluation of benign patients at one year after surgical intervention showed average 71.4 ± 6.6 of SF-36, 2.5 ± 1.5 of VAS, and 65.1 ± 8.3 % of MSTS scoring system; malignant cases demonstrated average figures of SF-36 39.2 ± 4.3, VAS 4.8 ± 1.4, and 41.8 ± 5.2 % at MSTS rating scale. Conclusion Surgical treatment of patients with tumors of the humerus, ulna and radius using one-stage plasty of bone defects with tailored 3D-printed bone substitute implants has shown to be an efficient method in improving an affected upper limb function and patient’s quality of life. The use of 3D printing to manufacture implants allows for precise and single-stage repair of bone defects of any shape, size and complexity with the technique making surgery easier to perform.

Objective To reveal personalized predictive criteria of idiopathic osteoarthrosis of the hip joint. Material and methods The study included 100 unrelated patients with grade III–IV idiopathic osteoarthritis of the hip joint, aged 61.3 ± 8.5 years, Russian citizens of Zabaykalsky Krai. Control group consisted of 100 patients of matching age (60 ± 8.3 years), ethnic background and geographic range. Exclusion criteria for the patients were other types of osteoarthritis (post-traumatic, rheumatoid, etc.), acute inflammatory diseases and exacerbations of chronic conditions, and osteoporosis. Clinical, laboratory (polymorphism of genes determined for TLR2-753Arg > Gln, TLR6-249Ser > Pro, FCGR2A-166His > Arg, DEFB1-52G > A, DEFB1-20G > A, TGFb1-25Arg > Pro, TNFα-308G > А, IL4-589C > Т) and radiological methods were employed in the study. Results Statistically significant differences between patients with idiopathic coxarthrosis and control group were observed in carriers of -166Arg genotype / Arg FCGR2A gene (χ2 – 99.2, p less 0.0001, OR – 255.2); -52A genotype / A genes of DEFB1 (χ2 – 58.7, p less 0.0001, OR – 11.2); -20A genotype / A genes of DEFB1 (χ2 – 42.2, p less 0.0001, OR – 8.3) and 589T genotype / T genes of IL4 (χ2 – 49.7, p less 0.0001, OR – 25.2). The detailed personalized analysis of polymorphisms identified in coxarthrosis group showed an early onset and rapid progression of the disease (under 40 years of age) at a simultaneous carriage of 3 and 4 homozygous mutants in the study polymorphisms, whereas carriage of 2 and over homozygous mutants in SNPs genes was not detected in controls. Conclusion Identification of -166Arg genotype / Arg gene of FCGR2A, -52A genotype / A genes of DEFB1, -20A genotype / A genes of DEFB1 and -589T genotype / T genes of IL4 in residents allows for prediction of idiopathic coxarthrosis.

Introduction The use of lower extremity nerve blocks at the lower tibia was reviewed in children with congenital and acquired pathology to provide prolonged analgesia after a foot corrective surgery. Material and methods The study included 49 patients with congenital malformations (congenital clubfoot, flat and valgus foot, vertical talus, longitudinal ectromelia) who underwent corrective surgical procedures. Patients were divided into 2 groups. Sedation, drug-induced sleep, spinal anesthesia, regional anesthesia at the lower third of tibia were produced for the patients of index group. Control group had sedation, drug-induced sleep and spinal anesthesia. The Face, Legs, Activity, Cry, Consolability scale (FLACC) was used to assess pain in the children. In addition to that, a dose of opioid pain relievers (Tramadol) administered on the first postoperative day and satisfaction with anesthesia and analgesia were also considered. Results Index group showed longer-term FLACC scores at a low level with less consumption of narcotic and sedating drugs. No complications were observed with regional anesthesia of the foot. Conclusion Lower extremity peripheral nerve blockade at the lower third of tibia has shown to provide efficient postoperative analgesia in surgical correction of pediatric foot deformities.

Introduction Infection after total joint replacement is a severe complication that accounts for 40 % with reoperations. An in-depth study from a European country measured the direct costs due to revision of infected hip prosthesis and calculated these at just over €32000 per patient. This represents a substantial need for the timely diagnosis of infection. Material and methods Clinical and radiological assessments were performed for 73 patients with periprosthetic joint infection after total hip replacement. Of them, 43 (59 %) patients underwent two-stage revision hip joint arthroplasty using preformed spacer and 30 (41 %) patients had resection arthroplasty with application of the Ilizarov external fixator. Results Clinical and radiographic findings used as the basic diagnostic tool for prosthetic joint infection and the choice of the most reliable surgical treatment could provide remission of purulent inflammatory process in 85 to 89 % of the cases and improve functional condition of the limb by at least 24 %. Discussion Patients with periprosthetic joint infection after hip arthroplasty constitute a challenging clinical group with the need of comprehensive clinical and instrumental examination with clinical and radiological assessments being an integral part in the diagnosis of prosthetic joint infection. Radiographs and fistulograms are practical in evaluating a clinical situation, identifying periprosthetic joint infection to make careful preoperative assessment and planning. At the same time, the use of the W.G. Paprosky femoral deficiency classification is useful in determining a volume of surgical debridement, choosing an optimal treatment of periprosthetic joint infection and hardware for the performance.

Purpose Search for laboratory criteria of pathological process monitoring in patients with chronic osteomyelitis of the tibia at the stages of its management using the method of transosseous distraction osteosynthesis. Materials and methods Biochemical parameters of blood serum were studied in 15 patients with chronic posttraumatic osteomyelitis of the tibia. Sequester necrectomy with subsequent osteosynthesis of the tibia with the Ilizarov apparatus was performed in all patients at the first stage. At the second stage, the defect was filled in with distraction regenerate according to Ilizarov. Depending on the bone defect size, the patients were divided into two groups. The defect size was from 3 to 5 cm in patients of the first group (n = 7, mean age 42.4 ± 6.9 years). In the patients of the second group (n = 8, mean age 37.5 ± 7.8 years) the size of the defect was from 7 to 12 cm. Results It was found that the changes in the activity of the bone isoenzyme of acid phosphatase (TRAP), alkaline phosphatase, creatine phosphokinase, lactate and C-reactive protein (CRP) did not differ significantly between the groups during their treatment. At the same time, the concentration of CRP, sialic acids and the activity of TRAP in the first stage perids of treatment was significantly increased in patients of both groups relative to the reference norm. In patients of the second group, the concentration of sialic acids was higher than the values of group 1 and the reference group in the periods of 7-21 days of fixation. Nevertheless, at the beginning of the second stage of treatment (distraction), the level of all the studied parameters was not significantly different from the norm. Conclusion Normalization of TRAP activity, concentration of CRP and sialic acids values can be attributed to additional diagnostic features on the basis of which it is possible to start the second stage of treatment (distraction) in patients with chronic osteomyelitis of the tibia.

The literature reviews the status of the issue of prosthetic application for partial hand and finger truncation and deficiencies in Russia. Special attention is paid to functional prostheses. Active prostheses that were previously produced or available at present were analyzed. The possibilities of using 3D printing for hand prosthetics are shown. Objective and subjective quality evaluation methods of functional prosthetics are presented.

A historical review on the experimental modeling of fat embolism syndrome is presented. Problems of diagnosis, prevention and prognosis, as well as the effectiveness of medication therapy and osteosynthesis at the stages of treatment in experimental animals are highlighted.

Emergency procedures aimed at rapid reduction and fixation and spanning of periarticular fractures has been termed “damage control orthopaedics”. In severely injured patients, early definitive fixation of fractures may not be appropriate. Recent studies showed that in multiple trauma, DCO is the best option for management of patients who are unstable and in extremis. The paper presents a case of such a control in a 34-year-old patient who sustained polytrauma on 20.10.2016. Primary medical care was conducted at a local hospital. Ten hours after the injury, the patient was transported to the Bari-Ilizarov orthopaedic centre for further management. On admission, he was in a traumatic shock. Radiographic study showed a comminuted fracture of the left femur, medial condylar fracture of the ipsilateral femur, comminuted fractures of both bones of the shin, left wrist sprain, and contusion of the head. Osteosynthesis of the left femoral shaft was performed with a Kuntscher nail and additionally with the Ilizarov fixator. When patient’s condition stabilized on the next day, osteosynthesis of the tibia was performed with the Ilizarov apparatus and the wrist was fixed with a plaster cast.

An extensive bone defect of the knee joint (BDKJ) is one of indications to amputation and exo-prosthesis. Reconstructive procedure with the Ilizarov method is an alternative. We present a case of a female patient with BDKJ of 16 cm, shortening of the right lower extremity of 12 cm, 6 cm hypotrophic distraction regenerate bone of the right lower leg and chronic osteomyelitis of the right femur. The total length of treatment was 67 months (51/2 years). The length of osteosynthesis including distraction and fixation stages was 43 months (31/2 years). Complications developed during the treatment did not interfere with a good anatomical and functional outcome achieved.

Giant meniscal cysts are quite rare. Clinical manifestations of the medial meniscal cyst are frequently either asymptomatic or with a mild pain. The most reliable diagnostic method is magnetic resonance imaging (MRI) or computed tomography (CT). Single cases of observation and surgical treatment of giant cysts were reported in the literature. Long course of the disease leads to degenerative changes in the knee and development of osteoarthritis. The article presents an outcome of successful treatment of a patient with grade III knee osteoarthritis and a giant medial meniscal cyst. The formation gradually grew in the knee area for 9 years. The dimension of the cyst was over 11 cm in diameter. The surgical treatment which included the excision of the meniscal cyst followed by knee arthroplasty provided a good clinical result.

We present a clinical case of total hip arthroplasty in a 32-year-old female patient with posttraumatic acetabulum. Radiographs on admission showed postoperative condition, dislocated head of the left femur, misshaped pelvic ring, deformity and nonunion of the acetabular roof. Shortening of the left lower limb was 5cm. Range of motion in the left hip joint was sharply limited. The first phase of treatment included correcting osteotomy at the nonunion site, bone reduction, anterior column stabilization with pre-curved plate fixed with 5 screws. Pelvic bones consolidated. Cementless total hip replacement was performed at the second stage. Finally, lower limb length was equalized with the range of motion improved in the hip joint.