Objective To retrospectively review surgical repair of juxta-articular distal femur fractures and posttraumatic conditions. Material and methods The review included 65 patients with juxta-articular distal femur fractures and posttraumatic conditions repaired with plating (n = 44), intramedullary nailing (n = 16) and transosseous osteosynthesis (n = 5) between 2009 and 2016. The patients were divided into 2 groups depending on time of injury. SOI-1 was used for outcome measure. Results Functional recovery was observed in 71 to 97 % (average, 89.1 ± 0.6 %) of the first group at short-term followup and an average of 94.7 ± 0.45 % of anatomical and function norm at a long term. Short-term anatomical and functional outcomes ranged from 63 to 93 scores in the second group and were an average of 82 ± 0.7 % of the norm. Conclusion Better outcomes were obtained in the first group (an average of 94.7 ± 0.45 % of anatomical and functional norm). Plating with accurate bone reduction and reliable fixation provided throughout consolidation phase showed better outcomes in both groups of patients. Intramedullary nailing was practical for straightforward supracondylar injuries type 33А1. Transosseous osteosynthesis could be advocated for open and gunshot injuries to minimize risk of infection and provide stable bone fixation.

Objective To review outcomes of lower limb injuries repaired with half-pin fixator. Material and methods The study included 28 patients with fractured femur and tibia due to multiple and combined injuries treated with half-pin fixator of the own construct. Mean patients’ age was 43.4 years (range, 19 to 68 years). The patients were followed up clinically for 12 to 26 months. Mean external fixation period was dependent on consolidation signs and type of fracture. Results АО/ASIF type A fractures healed within 12 to 14 weeks and types B and C required 14-to-16-week fixation. Full consolidation was observed in 25 cases (89.3 %). One patient (3.6 %) with bilateral tibial fracture has developed no healing and been followed up. Malunion was noted in 2 cases (7.2 %) due to early frame removal. Three patients (10.7 %) developed pin tract infection that was arrested with locally injected antibiotics at pin sites and changing dressings. Conclusion Application of half-pin fixator devised for transosseous osteosynthesis of long bones can be the method of choice for this cohort of patients. The half-pin fixator used to repair multiple and combined injuries can stabilize general condition of the patients and provide the possibility with early ambulation regaining motion in the joints.

Objective To review external fixation used at preparation stage of primary and revision hip arthroplasty in complicated cases of rigid hip deformity to optimize patient outcomes. Material and methods Outcomes of 15 patients with considerable limb length discrepancy of lower limbs were reviewed. Shortening of 7 to 10 cm was observed in ten cases, and five had 5-to-7-cm discrepancy. All patients underwent two-staged surgical treatment including Ilizarov external fixation at the first stage followed by total hip replacement at the second phase. The external fixator was taken off at the end of distraction on the day of implant placement. The patients were followed up within 29 ± 17 months on average and maximum 57 months of two-staged surgical treatment. Results The Harris hip score measured 21 ± 9 prior to external fixation and 77 ± 13 after arthroplasty. The usage of external fixation allowed for limb length equalization in all the cases adapting soft tissues for the next arthroplasty surgery. No infection was reported. Four of fifteen patients developed dislocation of the prosthetic head (3 early and 1 delayed dislocations); two patients underwent closed reduction and another two had a revision arthroplasty to stabilize the joint. Conclusion External fixation devices used at preparation stage of primary and revision hip arthroplasty can be advocated for complicated rigid hip deformity to recover supportability of the leg, equalise limb length, adapt soft para-articular tissues, realign the centre of rotation and improve treatment outcomes.

Introduction The purpose of this work was to study the results of orthopedic correction performed according to the principles of one-stage multilevel surgical intervention in cerebral palsy patients with hip dislocation. Material and methods We studied the results of operative orthopedic treatment in 50 children suffering from cerebral palsy (GMFCS levels IV and V, mean age 6.2 ± 1.4 years at the beginning of treatment) who underwent multilevel interventions with the purpose of hip joint reconstruction and correction of other orthopedic complications of cerebral palsy in the knee and foot. The parameters of the orthopedic status were studied as well as such radiographic data as the Reimers index, acetabular index, acetabular frontal depth index, projection neck-to-shaft angle, Wiberg index, tibiotalar angle, angle of the talocalcaneal divergence in the sagittal and frontal planes, coverage of the head of the talus with the navicular bone. The mean follow-up period was 2.8 ± 1.7 years. Results Patients underwent 91 reconstructive interventions during the study period involving 461 surgical elements (5.07 per operation on average). The goals of the pathology correction were achieved in all cases. In all patients, by the end of the first year after the operation, hip abduction was more than 30 degrees and flexion was more than 100 degrees. Comfortable sitting posture and correct passive symmetrical verticalization, pain relief in everyday life were reported in all cases. The shape and position of the foot made it possible to use comfortable regular footwear during verticalization, as well as during walking. By the end of the second follow-up year, a decrease in hip abduction to 20 ° was detected in only two patients. In two cases, a partial recurrence of foot valgus was observed which occurred by axial limb loading and required the use of an orthotic appliance. All radiological indicators examined after the treatment remained within the limits of normal values during the follow-up period. But there was a mild tendency to reduction of hypercorrection achieved which was within the normal boundaries. Conclusion Multilevel operations in children with severe types of cerebral palsy and hip dislocation as the leading pathology are aimed at achieving correction of all orthopedic problems in the lower limbs. The result of such interventions is not only normal anatomical parameters but also the creation of conditions for rehabilitation measures, especially postural management, which is extremely important for normal hip joint development and prevention of hip subluxation and dislocation recurrence in children.

Introduction Hip dislocation, accompanied by pain and segment malposition that affects the sitting posture and excludes passive verticalization, has been recognized as the main cause that worsens the quality of life in patients with severe types of cerebral palsy (GMFCS levels IV and V) with unreconstructable hip dislocation. The purpose of this study was to assess the orthopedic status of patients with spastic types of cerebral palsy that correspond to GMFCS functional levels IV and V with dislocated unreconstructable hip, as well as to examine their somatic status at admission for operative orthopedic treatment. Material and methods A continuous series of patients (41 patients, mean age 14.1 ± 2.3 years) with severe types of cerebral palsy that were admitted for palliative surgical treatment of femur dislocation and associated contractures and deformities in lower limb segmentswas studied. Orthopedic and somatic status was examined; radiological studies of the hip, knee joints, and feet were conducted. Results Changes in the femoral and acetabular components of the hip joints, detected with X-rays and CT, showed a nonreconstructable hip and confirmed the indications for palliative interventions. Clinically significant contractures and deformities in the knee joints and feet that required surgical treatment were present in 61 and 70.7 % of cases, respectively to levels. In this series of patients, concomitant diseases were found in all cases. Deficits of body mass index were present in 41.7 % of cases with GMFCS level IV and in 76.5 % of cases with GMFCS level V. Conclusion Severe pain and lower limb malposition is the leading symptomatic complex in patients with severe types of cerebral palsy of GMFCS levels IV and V that need correction. X-ray and CT findings in our series testified unreconstractable hip joint. In most cases, there were clinically significant deformations and contractures of the knee, ankle and foot that required a simultaneous correction. Thus, surgical interventions in such situations should be performed at several anatomic levels according to the principles of one-stage multilevel intervention. All patients in the study group had concomitant diseases and bone mass index deficits were observed. The situation with regard to concomitant diseases and body weight deficiency is more unfavorable in patients with GMFCS level V.

Introduction Total hip replacement is a gold standard for dysplastic coxarthritis treatment. Deformations in the bony structures that form the hip joint and develop directly due to the pathology and after surgical interventions, as well shortened or lengthened soft tissues, scars, the necessity of bringing the femoral head down result in a significant number of postoperative complications. This study aimed to develop an algorithm of medication therapy for such patients in the postoperative period, based on pathogenic mechanisms that would enable to reduce complications. Objective To study long-term results of treatment in patients with coxarthritis in stages 3-4 and dysplastic hip type 1, 2, 3 (Crowe) according to clinical, EMG and X-ray studies, as well as dual energy X-ray absorptiometry (DEXA) and modified Harris scale scores after total hip replacement and administration of medication therapy. Materials and methods The study was performed in 258 patients with dysplastic coxarthritis in stage 3-4 and DHD types 1, 2, 3 (Crowe) after total hip replacement surgery who were divided into two groups according to the medication therapy administered. Patients of the main group received vitamins, anticholinesterase drugs, NSAIDs, antibiotics, anticoagulants, inhibitors of osteoclasts, and calcium supplements. The comparison group patients were administered NSAIDs, antibiotics, anticoagulants, and calcium supplements. The study was conducted 2 years after their operative treatment with clinical and radiological, EMG and densitometric methods. Results It was found that the use of anticholinesterase drugs and vitamins improves axonal conduction and neuromuscular transmission of the sciatic nerve in patients with dysplastic coxarthritis. Inhibitors of osteoclasts, calcium and vitamin D3 improve the indices of bone mineral density. Conclusions Administration of the drug complex developed improves functional results in patients with dysplastic coxarthritis after total hip replacement.

Introduction Patients after unilateral lower limb amputation have the compensatory overloading of the contralateral (intact) limb which can lead to an additional decline in their quality of life. Purpose To determine reliable biomechanical indicators of the intact extremity overloading in patients with prosthesis and to draw attention to the need of providing them with orthopedic support means Methods Databases of the biomechanical tests saved with a software system "DiaSled-M-Skan" were studied. Statistical differences in the parameters of interaction between support feet were defined for 4 groups with different grades of static and dynamic functional disorders. Group 1 was control group (without dysfunctions in the lower extremities); group 2 wore prosthesis after transtibial amputation while group 3 had prostheses after transfemoral amputation; and group 4 patients wore prostheses for an excessively short stump of the femur or had higher level of amputation. Results Parameters of foot interaction were determined that were the most sensitive to functional depression of the truncated extremity: coefficients of bilateral asymmetry for duration of foot support and bilateral asymmetry of conditional work for a step. They permitted to determine the level of overloading in the intact foot. In patients on prosthesis after transfemoral amputation (group 3) duration of the roll over the intact foot was one third longer and the conditional work for a step was two times greater than with the artificial one. Discussion Results of the research prove the existence of a compensatory mechanical overload of the intact foot in patients after unilateral lower limb amputation. This indicates that there is a need of continuity in the work of the prosthetist and the orthopedist. A timely indication to wear an orthopedic insole for patients with prosthesis after unilateral amputation reduces the risk of an intact limb overload, pathological changes in its joints and intact foot deformity.

Asymmetry of paraspinal muscle tone is incorporated in pathogenesis for spinal deformities having diagnosis information value and it can be hypothesised to be involved in curve aggravation. Objective To evaluate diagnostic information value of EMG envelope algorithm for paraspinal muscles in postural stereotypes of patients with scoliosis grades III and IV. Material and methods Profiles of postural asymmetry (computer optical topography) and bioelectrical tone (EMG envelope algorithm) of paraspinal muscles were reviewed in 115 patients with scoliosis grades III and IV of different etiology using V.D.Chaklin methodology. The patients aged 6 to 32 years with mean age of 16.2 ± 6.14 years). Results The sampling population showed normal symmetrical distribution of profiles in the asymmetry of superficial paraspinal muscle tone with evidently asymmetrical distribution of spinal curve. Surgical elimination of spinal deformity resulting in appropriate correction of postural profiles made no statistically significant impact on orthostatics distributing quantitative and qualitative bioelectrical parameters of paraspinal muscles. No contingency and specific differences were observed in paraspinal muscle tone depending on postural asymmetry and etiology of the curve. Conclusion The hypothesis that asymmetry of superficial paraspinal muscle tone aggravates with the curve progression is not supported. No correlation between profiles of postural and muscle tone asymmetry was observed in patients with scoliosis grades III and IV. Diagnostic information value of EMG envelope algorithm is patient-specific and be identified in the postural systems that cannot support motor stereotypes using motor programmes without additional compensation muscle activity due to particular circumstances.

Introduction Currently, there is no single concept of interspinous process stabilization. Some authors consider the procedures to be a trade-off for the elderly population with vague morphological changes and neurogenic claudication whereas others do not support the practice, and still others offer it as an alternative to conservative and conventional surgical treatment for lumbar spinal stenosis (LSS). Material and methods The study included 22 patients with LSS. The patients were followed for 6 months. The clinical outcomes measures were neurological assessment, the Wong-Baker pain rating scale, Oswestry Disability Index (ODI). Radiographic evaluation and statistical analysis were also used. Surgical treatment included distraction laminoplasty and placement of interspinous dynamic fixator. Results Interspinous dynamic fixation and distraction laminoplasty resulted in regression of neurological deficiency and did not lead to deterioration of segmental and local imbalance. Clinical assessment of pain, radicular motor and sensory deficit and intermittent neurogenic claudication was performed. Morphological evaluation showed relative central spinal canal stenosis, foraminal stenosis and enduring degenerative spondylolisthesis (grades I and II). Conclusion Interspinous dynamic fixation is the method of choice for patients with lumbar spinal stenosis in presence of specific morphological and clinical manifestations.

Background With the extensive research literature on kyphoscoliosis diagnostic criteria remain clinical in patients with neurofibromatosis type I. Paraspinal muscles have been under-evaluated in the cohort of patients. Objective To compare ultrasonographic and morphological measurements of paraspinal muscles at the apex of kyphoscoliosis in patients with neurofibromatosis type I. Material and methods The study included 10 patients who underwent surgical correction of spine deformity. Ultrasound measurements of paraspinal muscles were produced preoperatively. Muscle biopsy specimen was obtained intraoperatively at the apex of the deformity and histologically evaluated with optical microscope. Results Ultrasonographic examination of paraspinal muscles showed typical hypertrophy at the kyphosis site, bilaterally impaired striation and high acoustic impedance in patients with neurofibromatosis. Morphological evaluation revealed fibrosis of endomysium and perimysium, extensive areas of fibrosis and adipocytes replacing muscular fibres that translated into a great number of hyperechogenic hypertrophic bundles of fibres on ultrasonographic images. Conclusion Ultrasonographic findings of paraspinal muscles (hypertrophy, impaired muscle striation, high acoustic impedance) are on par with pathomorphological manifestations (revealed fibrosis of endomysium and perimysium, extensive areas of fibrosis and adipocytes replacing muscular fibres). The findings indicate to degeneration of muscle tissue with malfunction to follow. Ultrasound imaging allows for examination of paraspinal muscles, measuring thickness of superficial and deep muscles, acoustic impedance to identify fibrous changes and replacement of muscles by adipose tissue.

Purpose To reveal a possible effect of platelet-rich plasma (PRP) on healing and histostructure of extended fasciocutaneous flaps 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 produced in 24 rats. After one-and-half hour femoral artery clipping for temporary ischemia, it was re-perfused and re-planted at the site of SIEA origination. After the operation, six microinjections of platelet-rich plasma (0.1 ml) were performed subdermally that were equally distributed on the flap. Comparison group had injections of saline in the similar number and zones. Control group had flaps without injections. Reference norm sites were skin contralateral areas. Twelve days after the operation, the animals are euthanized. Methods of the study were computer planimetry, histomorphometry, and immunohistochemistry. Results When compared with the control and placebo groups, a more than ten-fold reduction in the area of epidermal defects that were associated with delayed wound healing and necrotic complications was achieved. Polymorphic cell infiltration of the dermis decreased 1.7 times under the conditions of PRP microinjections when compared with the control group. Numerical density of capillaries in the subpapillary plexus doubled, and the number of dermal papillae increased 1.5 times. Discussion Enhancement of capillarization of the superficial skin structures proceeded with inhibition of inflammatory reactions and was probably caused by direct action of growth factors of platelets on endothelial cells. Conclusion PRP microinjections are able to effectively prevent partial necrosis of the extended fasciocutaneous flap based on axial blood supply, accelerate epithelization of the wound along the flap perimeter, and maintain the normal plasticity of the epidermis. There was no significant effect of the drug on the state of deep flap structures (subcutaneous fat and skin appendages).

Acetabular fractures are often complex injuries and the result of high-energy trauma increasing in recent years with the increased use of high-speed motor vehicles. Acetabular fractures account for 7 to 25 % of all pelvic injuries and are associated with significant morbidity. The complex nature of these fractures requires multi-staged treatment with the usage of various methods of osteosynthesis, their combination including primary reconstructive joint replacement. In spite of the improved techniques and new technologies rehabilitation of the patients is a particularly challenging problem. Material and methods Literature searches were performed on several databases: PubMed, Scopus, еLibrary.ru and others. Search keywords included “acetabular injury”, “consequences of acetabular fracture”, “acetabular osteosynthesis”, “total hip replacement”, “nonunion of acetabulum”, “hip arthroplasty in patients with consequences of acetabular injury”. Objective To do analytical review on the subject “Treatment of consequences of acetabular injuries”. Conclusion Types of acetabular injuries and methods of treatment are described in the available literature. Nevertheless, the findings showed no systemic approach to rehabilitation of the patients and there is a need to improve the existing practice and devise new techniques and algorithms of treatment.

Our literature review analyzes the available studies on the effect of long- and short-term lumbo-sacral orthotic (LSO) treatment on the muscles of the back.We reviewed the existing diagnostic approaches to evaluation of muscle changes, including surface EMG, measurements of muscle strength and tolerance, and findings on muscle ultrasound study. It has been revealed that none of the available works confirmed a significant negative effect of LSO, both by shortand long-term application, or atrophic changes in the muscles. Thus, we may conclude that there are no significant data on the effect of the LSO treatment on the main parameters that are measured and reflect spinal muscles weakness and/or atrophy.

Introduction Infection is a devastating complication after joint arthroplasty. In most cases of purulent infection, surgeons are forced to perform revision of the artificial joint. This is caused by the ability of microorganisms to adhere on the implant surface. Periprosthetic infection is a heavy burden both for patients due to a significant level of the disease recurrence and for medical institutions because of high medical treatment costs. Methods The analysis of the treatment outcome in a female patient with bilateral periprosthetic hip infection was conducted. One- and two-stage revisions were performed. Results The treatment measures stopped the purulent inflammatory process (according to Delphi) and restored the functional state of both hip joints (HHS of 79 points on the left and 93 points on the right side). Discussion Treatment of periprosthetic infection is a complex clinical task, which requires a personalized and comprehensive approach that includes implementation of the basic principles of diagnosis and treatment of the disease, understanding of this pathology, and teamwork. One- and two-stage revisions provide a successful arrest of periprosthetic infection and functional restoration of the affected joint.

Coverage of lower extremity wounds, especially those in the distal leg, present challenges to the reconstructive surgeon. The present case illustrates a surgical technique utilizing a distally based reverse soleus muscle flap for coverage of an anterior leg wound deficit with exposed bone. The wound failed conservative wound care and was at risk of a below the knee amputation. The wound was first debrided to healthy bleeding tissue. The Truelok TL External Fixator was then applied for stabilization of the muscle flap. The medial portion of the soleus muscle was dissected with care to preserve its vascular supply and transposed to cover the wound defect. This was followed by utilization of the Integra Bi-Layer Matrix to control the vapor loss of the wound, act as a bacterial barrier, and provide a scaffold for cellular invasion and capillary growth. A wound VAC was applied to promote granular tissue formation. Following post-operative wound care, a split-thickness skin graft was later applied. The limb was salvaged and wound closure was achieved within three months. The patient began ambulating in a patella tendon bearing orthosis within four months. The reverse soleus muscle flap provides a viable option for ankle wound and anterior leg coverage, especially in medically frail patients. Due to a high degree of versatility, reliability, minimal donor site morbidity, less operating time, low cost and good functional gain; this procedure is highly suitable for the treatment of complex middle and lower leg defects. It should be considered in the reconstruction of soft tissue defects about the ankle, especially when the surgeon has exhausted all other conservative and surgical options.

Pain is managed effectively with traditional means of anesthesia with the use of narcotic and non-narcotic medication in tibial correction and lengthening with the Ilizarov method. However, in many cases, traditional analgesics are not sufficient. Therefore, soft tissue manual technique of myofascial release was applied and showed a rather high degree of pain relief.