The aim of this work is to develop a system of surgical treatment of intra- and periarticular fractures of lower limb bones for improving the results and reducing the number of postoperative complications. Material and methods Short- and long term results of surgical treatment of 390 patients with periand intraarticular lower limb fractures treated at a trauma department 1 of hospital # 24 in the period between 2010 and 2014 were analyzed according to a similar schedule of requirements to recovery of anatomic and functional parameters of the hip, knee and ankle joint. There were 198 men (50.8 %) and192women (49.2 %). Radiological, clinical and statistical research methods were used. Statistical methods included estimation of significance of differences for parametric and non-parametric criteria, assessment of the relationship signs on the Pearson’s coefficient of linear correlation. To study the results of hip treatment the Harris Hip Score (H. W. Harris, 1969) was used, in the region of the knee – P. S. Rasmussen scale (1973), and in the ankle – of E. Mazur (2006) which include subjective and objective criteria. Results Good functional outcomes were obtained in 87.1 % of femoral neck fractures, in extra-articular fractures of the proximal femur– in 76.2 %, in intra-articular fractures of the distal femur – in 75.0 %, intra-articular fractures of the proximal tibia - in 78.3 %, intra-articular fractures of the distal tibia in 96.6 % of cases. Conclusion Implementation in the clinical practice of the system of surgical treatment of peri- and intraarticular fractures, including improved diagnostics, practical orientation of injury systematization, algorithms for clinical diagnostic search, consecutive use of external and internal osteosynthesis, rational technique of joint arthroplasty, new technologies of osteosynthesis with a differentiated choice of metal fixators, a modified proximal femoral metal fixator, approaches to joints, methods for bone defect plasty; all these factors combined with the method of perioperative management of patients and early active rehabilitation achieved the prevalence of excellent and good anatomical and functional results for each studied location of injurie in main subgroups in comparison with the control ones.

Purpose Improve results of surgical management of intra-articular impression distal radius fractures (DRF). Material and methods Retrospective study of 69 patients with intra-articular impression DRF surgically treated between 2011 and 2015 was performed. Inclusion criteria were impression intra-articular epimetaphyseal or metadiaphyseal defects seen on CT scan, open reduction and plating, and follow-up period of at least 36 months. Two groups of patients were identified to compare the effectiveness of new surgical technologies and bone grafting of impression defect applied in index group (n = 35) and conventional surgical technology with no graft in the control group (n = 34). Radiological, clinical and statistical methods of study were used. Parametric and non-parametric statistical tests were employed to evaluate significant differences. The difference between radial inclination (RI) and palmar tilt (PT) was measured to assess reduction persisted. DASH questionnaire (1996) was an outcome measure used for functional assessment. Results Intra-articular impression DRF were mostly seen in older adults and females with mean age of 48.9 ± 16.3 years. There were 14 (20.3 %) male and 55 (79.7 %) female patients. D.L. Fernandez type II fracture was most common (43.5 %). RI radiometric parameters measured 13.34 ± 0.43 ° in index group and 9.33° ± 0.51° (p = 0.003) in the control group at 3-month follow-up. RI was noted to decrease in the control group and showed maximum values of 3.71° ± 0.31°, p less 0.05 at 3-month follow-up. Excellent and good results were observed in index group at 36-month follow-up measuring DASH score of 94.2 % vs. 61.8 %, p less 0.05. Conclusion Surgical repair of intra-articular impression DRF combined with new approach and modern bone grafting materials facilitated restoration of optimal radiometric parameters of the distal radius with bone graft preventing secondary impression and providing reliable bone fixation with the possibility of early rehabilitation.

Background Review of the effectiveness of different methods used to repair clavicle injury allows for identifying rational aspects of treatment factors that would directly reflect key pathogenetic mechanisms. A greater part of surgical treatment options have been reported to lead to faster recovery of the patients’ structural and functional stereotypes in majority of the cases. Purpose Improve outcomes of surgical treatment of middle-third clavicle fractures. Material and methods Experimental bench tests of various osteosynthesis technologies using original interlocking intramedullary nail for clavicle fracture and a clinical study of 104 patients with middle-third clavicle fractures were carried out. Original IM nail was applied to repair clavicle fracture in index group (n = 48) and the fractures were plated in control group (n = 56). The DASH questionnaire was used to evaluate results of surgical intervention at 3, 6 and 12 months. Results Original IM nail and plate with angular stability showed comparable characteristics in stability. Original compression interlocking intramedullary nail offered to treat middle-third clavicle fractures showed improvements in outcomes of the patients. Discussion The algorithm developed for diagnosis, treatment and rehabilitation of clavicle fractures showed better results of treatment providing easier social reintegration into everyday life. Clinical findings demonstrated significantly improved DASH scores and lower complications rate in index group (p = 0.038).

Purpose To study the dynamics of tibial cortical plate density during treatment of tibial fractures with transosseous osteosynthesis using computed tomography Material and methods Multislice computed tomography was used to study the density of the cortical plate in 35 patients with closed tibial fractures managed with Ilizarov fixation at various stages of treatment. The results showed that the density of the cortical plate of the intact tibia in patients with tibial fractures had topographic differences. It was greater in the diaphysis region that in the metaphysis (p less 0.01). Total density values of the cortical plate differed from the indices in the middle zone, in the lateral and medial parts. The density of the cortical plate in patients with tibial fractures decreased both in the intact and in the injured limb during treatment, but fluctuations of density did not exceed 150-200 HU. Conclusion The method of multislice computed tomography enables a dynamic study of cortical plate density and degree of its restructuring during treatment of fractures to solve the issue of fixation and rehabilitation period duration.

Introduction The rate of effusion or hemarthrosis after arthroscopic operation is in the range of 0.16 – 15.7 %. Changes in the operated joint are reflected in the composition and properties of the synovium. So, the study of hemo-synovial fluid will assess the severity of pathological changes and the effectiveness of treatment. Purpose The aim of the research was to study the changes in the hemo-synovial fluid of the operated knee joint and evaluate the effectiveness of treatments applied to hemosynovitis. Materials and methods The study included 79 males between the age of 18 and 60 years. At each puncture after full evacuation, the cavity was treated by the author's method in 38 patients of group 1 (patents on invention of Russia № 2457833 and №2460545), which consisted in the lavage of the joint cavity with an isotonic sodium hydrocarbonate solution cooled down to +5 °С until the fluid was clear followed by intraarticular introduction of 3.0 ml of the mixture consisting of solutions for injections of 5 % ascorbic acid, 5 % unithiol and 0.5 % novocain, taken in equal volumes 1:1:1. At each puncture after full evacuation in 41 patients of group 2, intraarticular introduction of 3.0 ml of 0.5 % novocain solution for injections was performed. The efficiency was studied with magnetic resonance imaging in 24 men (12 subjects from each group) on 3rd and 7th days after arthroscopy. The pH, relative density, level of lipid hydroperoxide, concentration of common SH-groups and cytosis were defined in the hemo-synovial fluid. Results It was revealed that inflammatory changes develop in the operated knee joint after arthroscopic resection of the meniscus. Discussion The treatment technique proposed for knee joint hemosynovitis reduces faster the severity of the inflammatory reaction, lipid peroxidation and increases concentration of thiol antioxidants.

Purpose Evaluate efficacy of the technique offered for the treatment of patellar dislocation at terminal knee extension. Material and methods The review included 67 patients (84 knee joints) with patellar dislocation at terminal knee extension. Surgical planning with the use of Ilizarov module was based on radiological assessment, CT scans and patients’ age. Outcomes of surgical treatment of patients with patellar dislocation at terminal knee extension were followed from 1 to 13 years. Results Evaluation criteria of efficient treatment included absence of patellar dislocation, improved knee function and supportability of the limb, relief of knee pain, and the patella being fully engaged with the femoral trochlea on radiographs and CT scans of the knee joint. Conclusion The approach to the treatment of patellar dislocation at terminal knee extension facilitated excellent and good results in 97.6 % of the cases. Reoperation was required for two patients to ensure good outcome. Preoperative calculations and accurate technical performance are important for patellar tendon transfer to avoid adverse effects.

Introduction The Ilizarov method of non-free bone plasty has been widely used for management of lower limb long bones after resection of primary tumors. Analysis of errors and complications by using this method is a demanded and relevant task. Purpose We retrospectively studied the errors and complications by using the method of Ilizarov non-free bone toplasty in patients with primary neoplasms in lower limb long bones. Material and methods Rehabilitation of 133 patients with primary tumors of lower limb long bones was analyzed. All of them were treated with the Ilizarov method of compression-distraction osteosynthesis for bridging post-resection defects. Results Our retrospective study revealed organizational, tactical, technical errors and complications, which we observed during clinical and rehabilitation stages. Conclusion Systematization of errors and associated complications allowed us to develop recommendations for their prevention and treatment.

An incidence and severity of adverse effects of postoperative care of patients with osteogenesis imperfecta (OI), the treatment and outcomes are essential elements for the study of the nosologic group in addition to clinical review of surgical outcomes. Purpose was to examine complications of surgical orthopaedic treatment, reconstructive procedures and follow-up period of patients with OI types III and IV. Material and methods The study included 43 patients aged 33 months to 46 years (14.4 ± 9.74 years). Clinical and radiological features of OI types III and IV were observed in 14 and 29 cases, correspondingly. To analyse the complications the patients were subdivided into three groups depending on the technique applied and patients’ age. Group I was composed of skeletally mature patients aged 16 years and older with radiological physeal closure who underwent combined osteosynthesis of elastic intramedullary nailing and Ilizarov external fixation of lower limbs. Group II included skeletally immature patients aged less than 16 years with radiologically visible physis who underwent combined osteosynthesis of elastic intramedullary nailing and Ilizarov external fixation of lower limbs. Group III included skeletally immature patients aged less than 16 years with radiologically visible physis who underwent elastic intramedullary nailing alone. Results From a variety of techniques used to correct lower limb deformity in patients with severe OI the combination of elastic intramedullary nailing and Ilizarov external fixation with acute multi-level deformity correction of lower limbs was shown to be most efficacious in children and adults due to lower risk of complications associated with surgical treatment, osteosynthesis and the condition.

Introduction Osteogenesis imperfecta (OI) is a group of rare and relatively diverse genetic disorders, characterized by frequent fractures, bone deformities, low bone mineral density and osteopenia. Frequent fractures, bone deformities, and nonunion are among orthopedic problems in OI patients. Varus deformity of the femoral neck, scoliosis, protrusion of the acetabulum, static deformities of the feet are considered separately. The main goal of surgical treatment of the limb deformities and fractures in OI patients is restoration and maintenance of their motor activity, autonomy and preservation of quality of life in severe OI types. The purpose of this study was to assess the deformities in the lower extremities and other accompanying orthopedic disorders, as well as the somatic status of patients with severe OI types (Sillence’s types III and IV) at the point of admission to operative orthopedic treatment. Material and methods Between 2003 and 2016, we examined 43 patients with severe OI (types III and IV) which were admitted for operative correction of deformities of the lower and upper extremities, nonunion, and varus deformity of the femoral neck. The average age at the time of admission was 14.4 ± 9.74 years (from 2 years 9 months to 46 years). Results Treatment of fractures was conservative in most cases; however, osteosynthesis with wires or flexible nails was used, followed by their removal in 4 patients; bone plates were applied in 4 patients; osteosynthesis with the Ilizarov apparatus was used in 3 cases, and intramedullary osteosynthesis with rigid rods in 4 patients. Regular administration of bisphosphonate preparations was conducted in 9 patients. Last dose of the drug was introduced at least 4 months before admission to surgical treatment. Thirteen patients had undergone reconstructive surgeries on the bones of lower extremities to correct the deformities. Conclusion Deformities of the lower limbs in patients with severe OI types are complex and multilevel, which implies the need for multilevel orthopedic interventions to correct them. High incidence of fractures and a complex nature of severe bone deformities result in the loss of the skills to move independently, or even its initial absence. Inadequate surgical interventions, untimely performed, non-telescopic nature of osteosynthesis, and absent bisphosphonate therapy contribute to the formation of additional orthopedic problems and aggravation of the loss of autonomy in such patients, which may complicate subsequent specific orthopedic surgical treatment.

Background Slipped capital femoral epiphysis remains a diagnostic problem despite numerous papers written on the subject. Radiographic imaging is important in the confirmation of the diagnosis. Purpose Explore changes in the proximal femur at early clinical manifestations of slipped capital femoral epiphysis (SCFE) to further study patterns and localisation of pathological process. Material and methods The imaging findings from the conventional radiological and magnetic resonance examinations are presented, patterns of displacements and structural abnormalities in the proximal femur described. Results MRI is the most informative imaging modality for detecting SCFE at early stages. Conclusion In our opinion MRI can be used to detect and predict a slip of the femoral head.

Introduction A scientifically-based knowledge on the incidence, dynamics of detection and structure of congenital malformations of the musculoskeletal system (CMMS) has both practical and scientific significance. For many years, the Turner Institute has close scientific and practical ties with the state public health institution "Diagnostic Medical and Genetic Center" of St. Petersburg which carries out a regional monitoring of congenital disorders in St.Petersburg. Our objective was to present regional statistical data on the CMMS detection and structure in newborns and children of the first and second years of life, morbidity and disability in children aged 0-17 years in connection with congenital malformations of the musculoskeletal system, to study the proportion of CMMS patients in the orthopedic clinic and their need for surgical, including high-tech, treatment, and dispensary follow-ups in outpatient orthopaedic settings. Material and methods Regional statistics of St. Petersburg on prevalence, dynamics and structure of congenital malformations of the musculoskeletal system in children born in St. Petersburg in 2001–2015 were analyzed. The statistical data on the prevalence of congenital malformations of the musculoskeletal system in children aged 0–17 years in St. Petersburg were studied. Based on the studies conducted at the Turner Institute in 2014–2016, the proportion of patients treated for congenital malformations of the musculoskeletal system was revealed as well as their need for surgical treatment. Peculiarities of dispensary follow-ups of CMMS patients at orthopedic consultations of children's clinics of St. Petersburg were analyzed. Results and discussion The prevalence and structure of congenital malformations of the musculoskeletal system in 783,000 children born in St. Petersburg in the period of 2001–2015 are presented in accordance with blocks Q65–Q79 of ICD-10. Diagnostic results of congenital malformations of the musculoskeletal system in newborns (2.70 ‰) and in children of the same group until they reached three years of age (4.21 ‰) were studied in dynamics. Infacnts and children up to 17 years old with congenital malformations of the musculoskeletal system are under regular supervision of orthopedic surgeons. Disability due to congenital anomalies and malformations takes the third place among all the diseases detected in patients aged 0-17 years, established by pediatric medical and social expert boards of St. Petersburg. At the clinic of the Turner Institute, the proportion of patients with CMMS among all admitted patients was 38.6 %. Among them, 78 % of patients with CMMS received surgical treatment, of which 80 % of operations were performed using high technologies. Conclusions Statistics on congenital malformations of the musculoskeletal system in newborns and children under 3 years old and a high level of their disability shows the need in a specialized care for these children, including high-tech surgical treatment.

Introduction Hematogenous osteomyelitis and malignant bone tumours are not rare and present a clinical and radiological variety of bone changes. Morphological patterns can be studied at large institutions having relevant medical facilities for the diagnosis of bone lesions. Despite the advanced technologies of recent decades used to verify the pathological conditions differential diagnosis of infectious diseases and malignant bone tumors is still a problem for medical science and practice. Material and methods The study included 96 patients with hematogenous osteomyelitis and 31 patients with malignant bone tumour characterised by atypical clinical manifestations that required differential diagnosis. A.Wald’s consecutive analysis was used to compare the findings of clinical, laboratory and instrumental examinations. Results Mathematical model for differential diagnosis of hematogenous osteomyelitis and malignant bone tumour was developed with database of 127 patients. 13 differential diagnostic criteria were identified and quantified including patients’ gender, age, comorbidities, localisation of the pathological process, results of laboratory tests, etc. An algorithm for differential diagnosis of hematogenous osteomyelitis and malignant bone tumour was devised. Immune parameters in blood of 63 patients were evaluated with prognostic purposes. Conclusion Practical evaluation of differential diagnosis of hematogenous osteomyelitis and malignant bone tumour showed accuracy of primary diagnosis of 89.2 % at outpatient phase and 91.6 % in the retrospective group that resulted in a reduced workup procedure and referral to a tertiary hospital.

Material and methods The article discusses the features of the changes in the dynamic characteristics of the foot-support interaction in patients with foot amputation defects that reflect the state of their stato-dynamic function and the success of compensating of its disorders with prosthetic orthopedic products. The importance of this issue is due to a large number of patients with this pathology, difficulties in their prosthetic fitting, lack of a unified approach to prosthetic orthopedic support and subsequent evaluation of its quality. Result The results of locomotion disorders in patients with a unilateral foot stump and the effect of a prosthetic orthopedic shoe insole were estimated using the method of intra-footwear dynamobaroplantography. Conclusion Instrumental biomechanical studies allowed obtaining objective data on local overloads of the foot stump, bilateral asymmetry of load distribution and partial compensation of them with the use of prosthetic orthopedic products.

The development of the limbs in patients with congenital segmental defects is associated with defects in the vascular system of the same segment. In this case, vascular endothelial growth factors that participate in physiological angiogenesis may have effect on bone tissue formation in ontogenesis and participate in endochondral ossification. In this regard, the aim of the study was to compare the quantitative changes in growth factors (VEGF) and the contractile properties of arterioles under conditions of discrete distraction for congenital pathology of the lower leg bones. Materials and methods Subjects of the study were 12 patients with congenital pseudarthrosis of the lower leg (ICD-10 Q 74.0). Their serum was analyzed using an enzyme immunoassay. Microcirculation in the calf skin was examined by laser flowmetry (BLF21, Transonic Systems Inc., USA). We used the findings obtained from the study of blood serum in 103 somatically healthy people for control. Results Significant imbalance in serum concentrations of endothelial factors and their receptors was detected in the subjects with congenital pathology. As a result of surgical treatment, the imbalance of secretion of vascular growth factors and their receptors increased. Vasodilator effect in the precapillary vessels in the zone of the operated segment in patients with congenital pathology was not revealed by surgical intervention.

Object of study The existing variety of cervical spine pathologies resulted in a huge number of nosologic classifications and complicates their interpretation. Purpose Based on the analysis of patients with various surgical pathologies of the cervical spine, we suggest a syndromic approach to their evaluation to simplify the choice of a therapeutic algorithm. Study design Retrospective monocentre multicohort study and literature review Materials and methods A retrospective analysis of 336 patients aged 0.9 to 77 years with cervical spine surgical pathology who underwent interventions at the Ilizarov center between 2010 to 2017 was performed. Results Based on the analysis of the symptoms that led to the surgical interventions, the following clinical syndromes were identified: compression-ischemic syndrome, instability syndrome, imbalance syndrome. Conclusion The proposed concept of assessing syndromes identifies the pathology of the cervical spine regarding its clinical manifestations. The use of the syndromic approach will facilitate intra- and interdisciplinary interaction, as well as allows for tactical decisions.

Purpose Carry out a comparative study of the effectiveness of surgical treatment of patients with grade I degenerative spondylolisthesis treated with rigid transpedicular and dynamic interlaminar fixation. Material and methods Surgical treatment of patients with grade I degenerative spondylolisthesis at L4 vertebra was reviewed. The inclusion criteria were as follows, L4 spondylolisthesis measuring up to 5 mm; translation of ≤ 3 mm; L4-L5 segmental kyphosis of ≤ 17 degrees, local scoliosis of ≤ 10 degrees, absence of severe osteoporosis (T-score of > – 2.5). Decompression and dynamic stabilization of the spine was produced in group I (n = 24) with Coflex and Interfix implants. Group II included 20 patients who underwent transpedicular fixation and posterolateral spondylodesis. Standard and functional spondylography, MRI were performed for all the cases. Modified Pfirrmann grading system was used to assess intervertebral disk degeneration. L4 vertebral slippage and lumbar lordosis, intervertebral disc height, L4-L5 angle, translation at lumbar flexion/extension were measured. Results Oswestry Disability Index (ODI) score was insignificantly lower in the group of dynamic fixation. Pain intensity in the leg and the spine was comparable at follow-up. Adjacent segment syndrome was not common in group I and graded not more than Pfirrmann V. Both groups showed slight changes in lumbar lordosis. Advantages of dynamic interlaminar fixation included decrease in surgical trauma, blood loss and surgical time, and lower risk of complications avoiding overstress to adjacent level. Conclusion The use of interlaminar fixation for selective patients with grade I degenerative spondylolisthesis showed advantages over rigid transpedicular fixation. However, further research is needed for extended indications to the fixators to be used for this cohort of patients.

A review of the literature on the comparative evaluation of the effectiveness of various techniques of posterior cervical foraminotomy is presented. Fully endoscopic posterior foraminotomy is considered to be a good alternative to standard methods of cervical discectomy for lateral "soft" intervertebral disc herniation with monoradicular syndrome. Along with similar clinical efficacy, the procedure has the merits that are common for minimally invasive interventions. The study focuses on technical aspects of fully endoscopic posterior cervical foraminotomy. A detailed and illustrated description of the surgical technique is given. A clinical case demonstrates its performance and outcome.

We present present-day trends in the compensation of post-traumatic defects of long bones according to the Russian literature sources. The relevance of the problem due to the growth in the number of injuries in general and in the severity of trauma is highlighted. The basic directions in the solution of the problem of compensation of bone defects are shown. The merits and shortcomings of the available techniques as well as modern implantation materials based on hydroxyapatite, bioceramics and titanium alloys are analyzed. It has been pointed out that interdisciplinary interaction with the involvement of experts in the field of tissue engineering technologies, physicians, biologists, physicists, industry specialists and a sufficient financial support is needed to create optimal implants.

Purpose To assess osteoconductive properties of carbon fibre implants used in surgery of spine injuries and disorders. Materials and methods Two clinical cases from a multicentre prospective study on nanostructured carbon fibrous implants applied for a variety of spinal pathology are presented. Results The usage of highly porous carbon fibre implant resulted in bone and carbon fusion in the clinical instances whereas implants with a residual porosity of 7–12 % showed no fusion between bone and carbon. The patients had satisfactory clinical condition and quality of life. Discussion Carbon fibrous implant characteristics are close to those of bone tissue, being inert and osteoconductive along with high mechanical strength that ensure bone and carbon fibrous fusion with highly porous implant.

A clinical case of a 70-year-old female patient with periprosthetic humeral fracture is reported. A new distal posterior humeral plate devised at our institution for nonunions and comminuted fractures of the distal humerus was used in the case. The treatment resulted in fracture healing and functional recovery of the limb at the pre-periprosthetic fracture level. Technical features of the fixator and surgical technique are described in details with cortical allograft practice used to augment thin cortical bone around the stem.