Introduction Distal radial metaepiphysis (DRME) with the respecting joints and soft-tissue envelope is responsible for most important motions of orientation and stabilization of radiocarpal joint (RCJ), hand and forearm. Objective to assess techniques, terms and results of displaced DRME fractures. Material and methods Retrospective study included 85 patients more than 18 years of age who were treated for displaced DRME fractures between 2012 and 2015. Surgical treatment was performed for 36 (42.4 %) patients and 49 (57.6 %) patients were treated conservatively. Results Conservative treatment was used 1.8 times more for AO/ASIF type A fractures and 2.2 times less for AO/ASIF type C fractures. Complications rates were significantly 1.7 times less with surgical treatment as compared to conservative methods (χ2 = 4.14; df = 1; p = 0.041). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Mayo Wrist Score were used to assess long-term outcomes of 2 to 4 years. According to Mayo Wrist Score there were 52 (61.2 %) excellent (90-100 points), 17 (20 %) good (80-90 points) and 14 (16.5 %) fair (60–80 points) results with mean DASH score of 2.7, 11.9 and 26.1, respectively. Two (2.6 %) patients had poor outcomes (with less than 60 points) with mean DASH score of 44.25. Conclusions Radiological signs of fracture instability and differentiated approach to conservative and surgical treatments are essential to prevent complications in repair of DRME.

Objective To show that some achondroplasia cases of surgical locomotor reconstruction require repeated tibial lengthening to achieve optimal anthropometric parameters and review dynamics in reparative osteogenesis during repeated tibial lengthening using optical densitometry. Material and methods A group of patients who underwent double tibial lengthening included 25 achondroplasia and hypochondroplasia patients who underwent treatment at the Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics” from 2000 to 2013. Results Review of dynamics in reparative osteogenesis revealed no specific course of the procedure. Conclusions Medical, ergonomic and esthetic aspects of achondroplasia treatment can partially be addressed by approaching anthropometric parameters to the biomechanical, ergonomic and esthetic standards through repeated lengthening of lower limb segments.

Introduction Management of osteochondral lesions of the talus trochlea involves surgical debridement of the necrotic cartilage and underlying bone, and then repair of the defect with an osteochondral autologous graft. The use of MSCT, MRI allows us to detect changes in the ankle joint at the initial stage, when the salvage operation is effective. Purpose Histological substantiation of the possibility to use osteochondral autologous grafts from the pre-Achilles area of the calcaneus for management of osteochondral defects in the damaged talus trochlea. Material and methods We substantiate a new technique for obtaining an osteochondral autologous graft to repair osteochondral defects of the talar trochlea resulting from various lesions by means of a morphological study of the following microslides: cartilage and underlying bone tissue of the talar trochlea (cadaver material), necrotic area of the talus, and the cartilage portion of the pre-Achilles area of the calcaneus. For comparison, preparations of the cartilage tissue from the lateral condyle of the femur were investigated. Results Investigations of the specimens of the pre-Achilles cartilage of the calcaneus revealed a large number of chondrocytes in the extracellular matrix, presence of its all cartilage zones (superficial, middle, and deep ones). This was a proof that this cartilage was preserved both structurally and functionally. Conclusion On the basis of the findings, it is assumed that pre-Achilles area cartilage can be considered as an autograft material.

Introduction Repair of the subscapularis attachment with reverse total shoulder replacement is important for internal rotation, in particular. Objective Evaluate subscapularis plasty techniques to improve shoulder internal rotation with reverse total shoulder arthroplasty. Material and methods Long-term results of shoulder arthroplasty using reverse systems were reviewed in 50 patients at 6 months to 6 years following the procedure. The patients reported problems with shoulder internal rotation and daily living chores having hand behind back with shoulder internal rotation restored to 68º and subscapularis muscles strength improved to 70 %. Technique of plasty lengthening of the subscapularis was offered to improve shoulder internal rotation with reverse total shoulder replacement. The method was used for 6 patients including 3 males and 3 females. Results Intraoperative measurements showed at least 90º of the passive shoulder internal rotation and 30º of external rotation. The practice allowed for subscapularis lengthening of 2 to 2.5 cm of intraoperative measurements. Clinical examination at 7 months to 1 year showed grade III mobilisation with the shoulder internal rotation in four patients following reverse shoulder arthroplasty and subscapularis plasty, and grade IV mobilisation in two patients. Constant Shoulder Score showed improvement of the shoulder by 67 % and measured 86 points with the Shoulder Rating Questionnaire. Shoulder internal rotation measured 3.4 ± 1.4 N/m that indicated to 83% improvement in subscapularis strength. Conclusion The technique offered showed functional improvements in shoulder internal rotation, anterior shoulder stabilization and the possibility with early rehabilitation.

Introduction Surgical treatment of acute periprosthetic infection is possible with the technique of debridement and replacement of only modular components of the implant, provided that the implant is stable. Positive outcomes by using this technique in the acute infection phase range between 85 and 100 % while in the chronic phase they the success range is only 0–50 %. This is explained by the ability of bacteria to form biofilms on metal and polyethylene implant surfaces. Material and methods We conducted the analysis of the treatment results in 35 patients with acute periprosthetic infection of the hip and knee joints. They all had joint debridement with replacement of the modular components of their implants. The implant elements removed were examined for the presence of biofilms and its pathogenic microorganisms. Results Laboratory methods of investigation revealed that irreversible biofilm types were found on the surface of the removed components of the implants in all patients if periprosthetic infection was manifested for more than 2 weeks. Arrest of the infectious process was achieved only in 10 patients (66.7 %) with knee pathology and in 11 patients (55 %) with infected hip joint area. Discussion The main cause of acute postoperative and hematogenic infection of joints is an isolated gram-positive microflora, which is observed in more than 50 % of cases. Irreversible biofilm types on the surface of the implant components in the patients with the duration of periprosthetic infection for more than 2 weeks explain the high rate of purulent process recurrence which reaches 33.3 % after debridement in infected knees and 45 % after debridement in the hip joints. Conclusion It seems worth reviewing the indications for the technique of debridement by which not all the elements of the implant are changed and reduce its use if infection lasts for more than 2 weeks. However, this assumption requires further study.

Purpose Improvement of the results of surgical rehabilitation of adolescent patients with cerebral palsy with subluxation and dislocation of the hip with the help of hip joint arthroplasty. Materials and methods The work is based on a retrospective analysis of the treatment outcomes in 12 children with cerebral palsy at the age of 13 to 17 years who underwent a total hip replacement surgery. The indication for the operation was the presence of a severe deformity of the joint components that could not be reconstructed and was accompanied by severe pain, loss of limb weight-bearing, significant limitation of motor abilities in patients over the age of 13 years. The components with cementless fixation were used. All patients underwent adductorotomy on the affected side. Results Neurological and vascular complications were not observed. Dislocation of the head and instability of the implant components was not observed. All patients showed an increased motor activity, relief of pain, a significant increase in the joint range of movements. Good and satisfactory functional results were obtained. The best results were obtained in level I-III patients according to the GMFCS system. Children of level IV achieved pain relief, improvement in the sitting posture, facilitation of care for them. Unsatisfactory results were not obtained. There were no complications during the operation and in the postoperative period. Conclusion According to the results, hip joint arthroplasty can be recommended for the rehabilitation of adolescent patients suffering from cerebral palsy.

Objective To substantiate and evaluate differentiated algorithms of diagnosis and treatment tactics of emergency specialized medical care provided for patients with spinal diseases at a surgical department. Material and methods The review included 1336 patients with degenerative, tumour metastatic and infection non-specific spinal diseases. An index group consisted of 865 patients who received treatment at specialized municipal centre for emergency spinal surgery; control group included 471 patients who received treatment at multidisciplinary municipal hospitals (р > 0.05). Results Parameters of neurological status and spondylogenic abscess with systemic inflammatory response syndrome were primary selection criteria for treatment tactics employed for all types of nontraumatic spinal pathology. In absence of indications to emergency surgical intervention the choice of treatment tactics relied on evaluation of vertebral column instability or potential risk of instability identifying indications to delayed surgical treatment. Emergency interventions were indicated for spinal tumours and infections, while spinal degenerative diseases required delayed and elective surgery. Conclusion Multilevel syndrome-based approach is suggested to determine the tactics of emergency diagnostic search and emergency specialized medical care. The combination and types of pathological syndromes of the first and second orders decide on specific content of diagnostic and therapeutic measures to be taken.

Introduction Assessment of patients' psychoemotional condition (PEC) is a standard aspect of clinical care within traumatic spinal cord injury (SCI) rehabilitation. Materials and methods The evaluation was performed for 40 patients with SCI aged more than one year and ASIA grades B, C, D. HAM (Health, Activity, Mood) tests, the Beck Depression Inventory (BDI) and the Spielberger-Khanin Anxiety Scale were used to assess psychoemotional conditions in the patients. Results Patients with traumatic SCI did not reveal high level of state anxiety and depression at a long-term follow-up with evidently limited motor function (ASIA grades B, C). Even the presence of baseline trait anxiety did not result in severe psychoemotional disorders like depression. This can be described as a regulating effect of the autonomic nervous system through both recovery and compensation of autonomic dysfunctions employing reparative and adjustment mechanisms including coping efforts. Conclusions The majority of the patients could successfully cope with consequences of SCI at mid- and long-term follow-up. Most of them were able to adapt to the circumstances, learn to live with a new status, and successfully overcome SCI related physical, psychological and social difficulties.

Presented is visualisation of normal anatomic intra-articular structures simulating meniscus injury based on comparative analysis of magnetic resonance imaging scans of the knee joint to differentiate from true pathological conditions.

Cytokine imbalance is important for pathogenesis of osteoarthritis. Objective To assess serum and synovium cytokine level in patients with deforming osteoarthritis of the knee joint depending on the size of the medial tibial condyle defect. Material and methods Immunoenzyme technique was used to measure cytokine concentration in peripheral blood and synovium of 74 patients with grade III gonarthritis. Results Serum concentration of IL–1β and IL–4 were significantly higher in presence of small, moderate and extensive condylar defects than that in the control group. Concentration of IL–8, IL–10, TNFα was higher in absence of the defect than that in the controls and there was no statistically significant differences in the groups with small and moderate defects. The highest concentration of the cytokines was observed in the group with defects sized more than 10 mm. Synovium concentration of IL–1β, IL–10 was minimum in absence of condylar defect and there was a tendency of increased concentration with a defect measuring less than 5 mm and it substantially increased with defects measuring more than 6 mm. Synovium concentration of IL–8 was higher than that of the serum but there was no statistically significant differences between IL–6 and synovium TNFα concentration. Conclusions The magnitude of the condylar defect was shown to influence over synovium and serum cytokine concentration. Concentration of both cytokines was the highest with condylar defect sized more than 50 % of the condylar area and 6 mm deep.

Introduction The number of knee arthroplasties continues to increase in the recent years. Poor quality of implants, technical mistakes, excessive load, injury and osteoporosis are among the causes of their instability that have been most cited in the literature. Mechanical causes of instability may be associated with the changes in the peroxydation processes. Purpose To identify peroxidation products and study the activity of catalase, the main antioxidant enzyme,in the synovial fluid of the knee joint harvested prior to arthroplasty and investigate them as possible prognostic criteria of implant instability in primary arthroplasty Materials and methods Samples of the synovial fluid from 270 patients with gonarthrosis accompanied by defects of the articular surface (stage 3) during the operation of primary knee arthroplasty were harvested. Material of this prospective study was synovial fluid components of 70 patients from this cohort assigned progressively to two groups according to similar age, implant used and stability. Group 1 were patients (n = 35, mean age 67.4 ± 3.1 years) with implant instability developed within 3 years postoperatively. Group 2 patients (n = 35, mean age 69.4 ± 2.8 years) had stable implants. Control group 3 (cadaver material) was without any articular pathology that was recorded by an expert (n = 30, age of 68.4 ± 1.92 years). For a predictive value of the research, biochemical tests of the synovial fluid components were studied. Results Changes in the synovial fluid components in groups 1 and 2 that diverged in different directions were in the products of lipid peroxidation (malondialdehyde) and the activity of catalase. In patients of group 1, catalase activity was increased almost 2-fold, and in patients of group 2 it was reduced by 30% relative the control group. The content of malonic dialdehyde was increased only in group 2. Conclusions The parameters of lipid peroxidation products and the activity of the antioxidant enzyme system in the synovial fluid seem to be possible criteria for predicting instability after knee arthroplasty.

Objective To explore metabolism and microcirculation of the hand in patients with remote effects of severe cold injury treated with the Ilizarov method using functional tests. Material and methods Metabolism and microcirculation of the hand were studied in 19 patients with remote effects of severe cold injury treated with the Ilizarov method. The patients’ age ranged from 24 to 46 years (32.8 ± 2.9 years). Control group consisted of 14 normal peers. Depending on finger stump length, presence of contractures in adjacent joints and postlengthening basal syndactyly techniques employed for treatment included finger stump lengthening (4 observations of less than 30 mm stumps and 10 observations of more than 30 mm stumps); finger stump lengthening followed by plasty of web space in 3 patients; finger stump lengthening and repair of adduction contracture in 2 cases. Laser Doppler Flowmetry (LDF) BLF21 (Transonic Systems Inc., U.S.A.) was used to assess microcirculatory function. Local vascular occlusion test was applied, blood flow recorded at rest and after 3 minute ischemia, and Peak Capillary Blood Flow Index calculated (PBFI, % = CBFpeak/CBFrest × 100 %), Δ t, sec – period from occlusion relief to maximal runup of capillary blood flow. A Doppler ultrasound (DUS) using diagnostic Minimaxdoppler K device (St.Petersburg) was used to assess peripheral hemodynamics of finger and stump arteries. Results DUS showed signs of vasoconstriction of digital arteries. Period of CBF semi-recovery and length of reactive hyperemia were sharply decreased. Transcutaneous polarography showed prevailing anaerobic metabolism with two-fold decrease in рО2 half-life and two-fold increase in рО2 semi-recovery, and oxygen exhaust was recorded within 2 minutes. Conclusion It was concluded that evaluation of capillary blood flow using laser Doppler flowmetry with a 3-minute vascular occlusion test was the method of choice for examination of patients with sequelae of severe cold injury of limb segments. The method allowed for assessing preclinical extent of ischemia, disorders in vascular reactivity of pre-capillary portion. A tailored approach to distraction rate under control of objective and subjective findings and microhemodynamics is essential for patients treated with transosseous distraction osteosynthesis using Ilizarov external fixator. Medications targeting the relief of vasoconstriction prescribed for patients with sequelae of cold injury treated with Ilizarov traction demonstrated hardly noticeable effect due microcirculation recourses had been largely consumed by the method of transosseous osteosynthesis. We suggest that preventive angiogenic and neurotrophic therapies can be efficient at pre-distraction stage.

Introduction The number of chondrocytes in the articular cartilage of the femoral condyles and talus junction surface in the conditions of distraction osteosynthesis of the tibia with the Ilizarov apparatus combined with plating was estimated. Material and methods Seven dogs underwent tibial lengthening at a daily rate of 1 mm for 4 steps and to 14–16 % of the initial length of the segment with the use of the Ilizarov apparatus and plating. Stages of the study were days 30 and 90 in the fixation phase when only plating was left. Histomorphometry of semi-thin sections of the articular cartilage was carried out with the help of an Opton photomicroscope (Germany), DiaMorf software complex (Russia) and VideoTest-Master morphology program. The proportion of chondrocytes (N ch, %), the proportion of empty lacunae (NN em.lac, %), and isogenic groups (NN is.gr, %) were determined in the total sample volume of 200 lacunae. A control group was articular cartilage of five intact dogs. Results The articular cartilage of both articular surfaces retained the zonal structure. Disorder in the homogeneity of the superficial part of the surface zone and destruction of a part of chondrocytes were noted. In the articular cartilage of the femoral condyles, the Nch value was lower than in the control animals by 5.74 %. NN em.lac was increased 2.3 times while NN is.gr values decreased to 2.06 % in the femoral condyle articular cartilage after 30 days of fixation period with the plate. After 90 days of fixation, the N ch values were lower with respect to the controls by 3.73 %. Low values of NN is.gr (4.3 %) and high values of NN em.lac (27.54 %) were maintained. In the articular cartilage of the talus, N ch was lower than in the control group by 1.98 %; NN em.lac increased 1.5 times and NN is.gr decreased to 4.7 % relative to controls after 30 days of fixation. After 90 days, the value of NN em.lac remained at the same level as in the previous experiment stage. The values of NN is.gr were comparable with the control group. Conclusion The technique of distraction osteosynthesis of the tibia in combination with plating is of low traumatic effect on the adjacent joints. A comparative analysis of quantitative parameters of the articular cartilage revealed that the most vulnerable site was the articular cartilage of the femoral condyles.

Purpose To reveal a possible effect of subdermal injections of cerebrolysin on the parameters of healing and histomorphometric characteristics of the biological model of an extended fasciocutaneous flap with axial blood supply. Materials and methods A flap based on the superficial inferior epigastric artery (SIEA) and extended to the cranial side according to a template with an area of 18 cm2 was formed in 29 rats. After 90 minutes of femoral artery clipping, it was re-planted at the site of SIEA origination. After the operation, microinjections of cerebrolysin (0.1 ml) were performed subdermally. Four of them were injected in the mezhangiosomal zone in group Cer 1, and six were uniformly distributed over the area of the flap in group Cer 2. Comparison groups (Comp 1 and Comp 2) had injections of saline in similar number and zones. Negative control group had flaps without injections. Conditional normal sites were contralateral areas of the skin. Twelve days after the operation, the animals are euthanized. The methods of the study were computer planimetry, histomorphometry, and immunohistochemistry. Results In groups Cer 1 and Cer2, when compared with the negative control and placebo, relative areas of the epidermal defects associated with partial flap necrosis or delayed wound healing (2.15 % and 0.23 % vs. 13.72 % and 11.33 %, respectively) were reliably reduced. In Cer 1, hypovascularization of the hypodermis, thinning of the epidermis and dermis were noted. In Cer 2, compared with the control and Cer 1, the largest thickness and capillarity of the dermis and hypodermis were revealed, as well as the thickness of the epidermis and the numerical density of the skin appendages. Discussion The pronounced decrease in polymorphic cell infiltration of the dermis and hypodermis in the experimental groups indicates that the angiogenesis in the dermis stimulated by subdermal microinjections of cerebrolysin occurred by inhibition of inflammatory reactions and was caused by the direct action on endothelial cells. Conclusion To optimize the healing of fasciocutaneous flaps with axial blood supply in cases where their area exceeds the territory of the blood supplying artery, it is advisable to use microinjections of cerebrolysin uniformly distributed over the entire area of the flap, including its angiosomal and interangiosomal zones.

An articular cartilage lesion in large joints is a frequent pathology of the locomotor apparatus. More than 50 % of visits to a traumatologist or an orthopaedic surgeon in outpatient clinics are associated with pain in large joints. Conservative methods of treatment have not undergone significant changes lately whatcannot be said about surgical interventions. Methods of chondrogenesis stimulation and restoration of the cartilaginous layer by repair of its defect with cell technologies continue to develop. This article reviews the literary sources on modern methods of treating articular cartilage lesions.

Introduction Dual-energy X-ray absorptiometry (DEXA) provides a quantitative estimation of the projectional bone mineral density (PBMD) with minor radiation exposure and in a cost-effective way. It is one of the ways for a dynamic control of stem integration into the host bone after total hip arthroplasty (THA). Osteocytes are considered to play the key role in the regulation of implant integration process. Hence, DEXA could be used for estimation of functional activity and directions for regulation of osteocytes activities in the periprosthetic area. Purpose Current study presents the results of chronologic and biological PBMD in the periprosthetic zone after THA in two patients with a perspective for a future use of such an approach to reveal a local response of tissue to the implant. Material and methods PBMD was studied daily for 10 days with PRODIGY densitometer after THA in a 54-year old patient with posttraumatic right hip osteoarthrosis and a 59-year old patient with right femoral neck fracture nonunion. Cementless ZIMMER implants were used. Results In the first patient, oscillatory BMD alterations in the Gruen zones ranged from 2.4 to 11.6 % with an average wavelength of 4.6 days. In the second patient, the alterations were within the range of 2.3–8.7 % with an average wavelength of 4.5 days. PBMD changes in the adjacent Gruen zones occurred asymmetrically with some oscillational phase lagging relative to each other. After approximation of the results by linear trend, PBMD increased by 1.7 % on average in all Gruen zones in the first patient, except zones 2 and 3, and its mean growth was 1.7 %. On the contrary, PBMD decreased in all the zones in the second patient, except zones 4 and 7. Mean decrease was 1.7 %. Conclusion Chronobiological approach opens up possibilities for evaluation of structural and functional skeleton reorganization in the periprosthetic zone after THA. Further research is needed for a deeper insight into this complex issue.