Introduction The functional anatomy of the forearm sets up requirements for the choice of fixation constructs and medical technologies of osteosynthesis to be used for particular localization and pattern of injury. Objective was to evaluate the effectiveness of intramedullary nailing, plating, external fixation and combined techniques used to repair forearm shaft fractures of different severity based on comparative analysis of outcomes. Material and methods Outcomes of 153 patients with forearm shaft fractures treated with IM nailing, plating, external fixation (controls, n = 78; 51.0 %) and combined osteosynthesis with shape memory devices (index group, n = 75; 49.0 %) were comparatively analyzed using criteria offered by Anderson L.D.(consolidation time) and Grace T.G., Eversman W.W. (functional results) and statistical methods. Patients sustained either an isolated fracture of one bone (n = 62; 40.5 %) or combined both bones forearm injuries (n = 44; 28.8 %). A subgroup of complicated injuries included 25 (16.3 %) patients with fracture-dislocations and 22 (14.4 %) patients with multiple fractures (bifocal, comminuted, bone loss of at least 5.0 cm). Results Plating of isolated and combined forearm injuries showed significant advantages over intramedullary nailing with square nail (χ2 = 5.329, p = 0.021). Intramedullary nailing appeared to be more efficacious when supported by thermomechanical memory devices and could be comparable with the results achieved with plating (χ2 = 0.070, p = 0.792). Combined techniques with thermomechanical memory devices were practical for multiple fractures and fracture-dislocations (χ2 = 6.649, p = 0.010). Conclusions Intramedullary nailing with square nails was shown to be efficient in 50.0 % of patients with transverse, oblique fractures of one or both forearm bones and in 20.0 % of fracture-dislocations. The bone consolidated and function recovered in 85.3 to 95.2 % of the patients with of one or both forearm bones fractures repaired either with plating or combined methods with the use of shape memory constructs. Patients with fracture-dislocations, comminuted and segmental fractures showed good results in 75.0 % of the cases addressed with external fixation and external fixation combined with shape memory devices, and in 42.9 % of cases repaired with plating.

The purpose of this study was to improve the treatment results of multicomminued fractures of the distal humerus metaepiphysis through the development of a compression device that provides stable osteosynthesis of small fragments. Materials and methods Clinical testing of the device developed for osteosynthesis of small fragments in multicomminuted fractures of the distal humerus metaepiphysis (patent of Ukraine for useful model #12560) was conducted. Treatment sample included 104 persons with multicomminued fractures of the distal humerus metaepiphysis admitted to the Donetsk national medical university and national trauma center of Donetsk. Results Osteosynthesis of small fragments in multicomminuted metaepiphyseal fractures of the distal humerus with the help of the developed by us compression device enabled to reduce and stabilize small bone fragments, provided the possibility of early movements in the joint and resulted in good outcomes. Conclusions Osteosynthesis of small fragments with application of the developed by us compression device in patients with multicomminued fractures of the distal humerus metaepiphysis showed high efficiency. The mean score was 82.67 ± 5.59 points, which corresponds to good results of treatment.

Introduction Aseptic loosening of the acetabular component is one of the most common late complications of total hip arthroplasty. Current principles of its treatment consist in replacement of the loosened cup and of the head-and-liner friction couple. There is no unified opinion regarding the stem if it is stable and well-aligned. Methods We have analyzed examination and treatment results of 16 patients with isolated aseptic loosening of the acetabular component that underwent total revision. The results of treatment were assessed using the Harris Hip Score and Oxford Hip Score questionnaires on the 10th postoperative day, and then at follow-ups after three, six and 12 months. Results The average duration of the operation was 132.5 [115; 150] minutes. Intraoperative blood loss ranged from 600 to 2500 ml and averaged 900 ml [750; 1450]. Analysis of hematological parameters (RBC, HGB, HCT) showed moderate anemia in 14 patients (87.5 %) and only two patients (12.5 %) had mild anemia on the 10th postoperative day. The mean volume of erythrocyte mass transfusion was450 ml [300; 775]. The final results of treatment were assessed as fair with Harris Hip Score after 12 months. The Oxford Hip Score results of treatment were in the range from 30 to 39 points after 12 months that confirmed the need for additional conservative measures for hip joint stability. Conclusion Surgical treatment of isolated aseptic loosening of the acetabular component requires differentiated tactical solutions for defining the scope of hip revision.

Introduction Extra-articular corrective rotational femoral osteotomies enable to completely restore or approximate to the normal the spatial position of the femoral epiphysis and its balance with the acetabulum in patients with most common types of slippage in moderate stable slipped capital femoral epiphysis (SCFE). Aim Evaluation of the effectiveness of a new corrective femoral osteotomy technique that excludes hip subluxation and bayonet deformity of the proximal femur during surgery in children with SCFE. Materials and methods Pre- and postoperative findings of clinical and radiographic examination of 80 patients aged from 11 to 15 years with most common types of moderate stable femoral epiphyseal slippage were analyzed. The technique of corrective femoral osteotomy developed which was applied in 40 patients (40 interventions) differs in spatial position of the rotation axis of the proximal femur and type of bone cut. Results Subluxation and bayonet deformity of the proximal femur in the affected joint were obtained in none of the 24 cases with a maximum anterior rotation of the proximal femur fragment (45°) operated with the new technique while with the Imhauser osteotomy, previously used in group 2, they were seen in eight and 12 out of 24 cases, respectively. Average postoperative follow-up period was four years (range, 2-7 years). Clinical examination and X-ray study after this surgery showed no signs of coxarthrosis in 38 out of 40 cases after two years, and in 9 cases out of 10 after six years. Conclusions New method of corrective femoral osteotomy avoids hip subluxation and bayonet deformity during the surgery of the proximal femur as well as reduces (or completely avoids) lower limb residual shortening. This technique is relatively simple, shorter in time and less invasive than previous modifications. It also prevents femoroacetabular impingement in many clinical cases.

Purpose Develop a technology of manufacturing silicone sockets for functional hand prosthesis. Methods The technology of fabricating sockets for functional hand prosthesis made of high temperature vulcanization (HTV) silicone was developed and tested for the first time in the practice of domestic prosthetics, including the traditional stages of molding, positive reproduction, and manufacturing of sockets. However, there are technological peculiarities in each of the stages that enable to manufacture a comfortable individual full-contact socket for hand prosthesis made of silicone that was successfully used in active and functional prostheses and prostheses with external power in patients with congenital and amputation hand defects. Results The technology has a number of advantages over traditional ones, as it provides comfortable conditions for full contact and partial loading of the residual segment of a clubshaped hand stump in the liner socket of the prosthesis. These properties of the liner socket allow the production of the most skeletonized carrying socket made of composite material for reliable attachment of the components of functional hand prostheses to it. Conclusion Successful trials of the liner sockets of the hand prosthesis made from HTV silicone created the conditions for a wider application of this silicone brand in the manufacture of a new generation of sockets for upper and lower limb prosthesis.

Introduction Achondroplasia is the most common skeletal dysplasia with limb shortening that can be symptomatically be treated with the Ilizarov method developed in the 20th century. Achondroplasia patients were shown to have medical and surgical possibilities for height increase with indications being controversial, and psychological and social implications to be considered. Objective The purpose of the study was to review our own data and reported findings on possibilities, results and complications of Ilizarov treatment of achondroplasia patients. Material and methods Outcomes of 750 achondroplasia patients treated at the Kurgan Ilizarov Center between 1976 and 2017 were reviewed. The patients’age ranged from 4 to 23 years. Results Long-term outcomes were followed up in all the cases. Radiography was used to assess limb elongation at follow-ups and MRI, MSCT and US were optional. Ten-to-fifteen-year follow-ups showed persisted length gain, early osteoarthritis of the hip and knee joints due to baseline articular changes, completely restructured femur and tibia at the distraction site, normal anatomy and area of muscle cross-section, normal structure and thickness of tibial muscles. Social and psychological profile appeared to improve. We have data from the patients who underwent limb lengthening 30 years ago. Many of them are employed, have family and children. Conclusion The findings suggest that achondroplasia patients, a comparatively small group of short statured people, have good reasons to feel empowered, get social support, make parents happy and contribute to the success of the country. The Ilizarov method has turned the idea of height increase into an accomplishment for benefits of doctors and patients being an achievement of orthopaedic world to address orthopaedic, social, psychological and philosophical issues.

The objective of the study was to evaluate cytokine concentration and profile of lipid peroxidation in synovial fluid of patients with osteoarthritis and concomitant defects of articular surfaces. Material and methods Synovial fluid samples were taken from 102 patients with osteoarthritis of the knee joint. Patients with rheumatoid arthritis, osteoarthritis of a post-traumatic etiology, and somatic diseases that could affect results of the study were excluded from the study. Thirty control samples originated from deceased donors of both genders. Synovial fluid was extracted in compliance with Ministry of Health Order No. 694 dtd July 21, 1978, p. 2.24 "Guidelines of forensic medical examination in the USSR". Results Findings of laboratory studies showed statistically significant differences in synovial fluid cytokine levels depending on absence or presence of defects on the tibial condyles. Biochemical tests revealed greater changes in lipid peroxidation in patients with articular defects. Total level of lipid peroxidation products resulting in the formation of conjugated dienes (CD), malondialdehyde (MDA) was shown to increase in both groups of patients being significantly higher in patients with defects on articular surfaces. Primary (conjugated dienes) and secondary (malondialdehyde) lipid peroxidation products accumulated in the synovial fluid of the patients with the levels being significantly increased in both groups with no changes in the CD/MDA ratio. Patients with defects on articular surfaces demonstrated increased formation of primary products, and non-defect group showed greater formation of secondary products. Antioxidant enzyme, catalase, appeared to me more active in patients of Group I. Conclusion The findings can be used to evaluate defects on articular surface and identify strategies of medication therapy.

Purpose Obtaining quantitative and informational characteristics of biofilms formed by clinical strains of Klebsiella pneumoniae in vitro on the surface of a cover glass. Materials and methods In vitro biofilm formation on the surface of the cover glass was studied for clinical Klebsiella pneumoniae strains, isolated in a monoculture (ESBL +) (n = 3) and in associations with Staphylococcus aureus (n = 6) in 9 patients with chronic osteomyelitis of long bones harvrested from fistulae in the preoperative period or from the infection focus during surgery. Results Monocultures of K. pneumoniae (BLRS +) differed by their lower adhesive ability when compared to strains of K. pneumoniae isolated from associations with S. aureus. The highest adhesive activity on the surface of the cover glass was observed in a mixed culture of K. pneumoniae + S. aureus. Informational characteristics depended on the type of biofilms formed. Common to biofilms was the absence of changes in the maximum possible structural diversity. Significant differences between the existing structural diversity of biofilms formed by monocultures of K. pneumonia, K. pneumonia isolated from associations and a mixed culture of K. pneumoniae + S. aureus were noted. Conclusion The absence of pronounced variability of information indicators during the experiment within each microbial community indicates the tendecy of all systems of emerging biofilms to preserve stability.

Purpose To study concentrations of metabolites and growth factors as well as hematological parameters in patients with delayed lower limb fracture healing Material and methods Concentrations of several metabolites and growth factors as well as hematological parameters were studied in 13 patients with a delay in healing of femoral and tibial fractures after 7 to 11 months following injury. Seven patients with consolidated diaphyseal femoral and tibial fractures examined 10 to 12 months after the injury were a control group. Ten healthy subjects that did not have any history of fractures were a reference group. Results Unlike individuals of control and reference groups, patients with delayed fracture healing showed significantly higher concentrations of lactate, triglycerides, TGF-α and TGF-β2 in their serum while IGF-1 levels were significantly lower. Hematology tests did not show differences between the groups. Conclusion Local hypoxia, acidosis and expression of GFs that support osteolysis were the main pathophysiological processes that could cause the delay in long-bone fracture healing.

Introduction The study of pathogenesis and improving the diagnosis of aseptic necrosis of the femoral head (ANFH) is one of the challenging problems of regenerative orthopedics. ANFH is a polyetiologic disease characterized by a local increase in the resorption activity of osteoclasts along with inhibition of activity of mesenchymal cells and osteoblasts, which lead to a significant loss of bone tissue. In this connection, it seems to us relevant to study biochemical and clinical markers of bone resorption and remodeling as diagnostic criteria for ANFH. The purpose of the study was to identify the relationship of some biochemical markers of bone tissue metabolism that reflect the balance between resorption and remodeling with clinical ones (gender, age, T- and Z-criteria), evaluate specifically the deficit of vitamin D in patients with ANFH. Materials and methods Clinical and biochemical study included 195 people with a verified diagnosis of aseptic necrosis of the femoral head who had not previously received vitamin D preparations. They were 87 men and 108 women aged 18 to 88 years. Results In the course of the study, the deficiency of vitamin D of varying severity was revealed in 69.7% of the subjects diagnosed with ANFH. Vitamin deficiency in males was higher than in women, 71.2% and 68.5 % respectively (p = 0.02). The average content of vitamin D was 26.5 ng/ml in women and 26.7 ng/ml in men which is lower than the optimal level (> 30 ng/ml). In addition, low values of vitamin D in women before and during the postmenopausal period were almost equal (68% and 68.7 %). In males over 50 years of age, the same tendency was observed: vitamin D deficiency was revealed in 64.6 % of men under 50 years and in 75.9 % over 50 years of age (p = 0.12). The most significant in magnitude and incidence of factorial connections with clinical characteristics were such biochemical parameters as Ca2+, (25OH)D and 1.25 (OH)2D in women and parathyroid hormone, osteocalcin, DPD in men. Discussion Analysis of correlations of biochemical indicators with clinical characteristics established that such indicators as the content of Ca2+, (25OH)D and 1.25 (OH)2D in women, and parathyroid hormone, osteocalcin and DPD in men were the most significant. In women, the most related clinical feature was age. Age correlated with the content of Ca2+, Ca, parathyroid hormone, DPD. It can be assumed that this is due to the biological aging of the female organism (menopause, osteoporosis). Conclusion The factor analysis enabled to determine the main groups of parameters that influence the variation of clinical and biochemical parameters in women and men diagnosed with ANFH, and also to identify the links between biochemical indicators and clinical features. This circumstance makes it possible to conduct a complex and differentiated assessment of metabolic disorders and to justify rational treatment tactics.

The purpose was to evaluate the effect of bone substitute materials on mechanical properties of trabecular bone adjacent to the joint. Material and methods A total of 21 female chinchilla rabbits weighing 3-3.5 kg was used for the experimental study. A bilateral impression fracture was simulated in the medial tibial condyle and surgically augmented with one of the bone substitution materials: beta-tricalcium phosphate, xenoplastic material and carbon nanostructures. The animals were sacrificed at 6, 12 and 24 weeks postsurgery. Uniaxial compression test was performed to determine mechanical properties of the tibial fragments. Bone microstructure was evaluated with scanning electron microscopy. Statistical data analysis was performed with nonparametric tests. Results Beta-tricalcium phosphate augmentation of the bone interface led to slow resorption accompanied by formation of adequate high-grade bone tissue with mechanical properties gradually increasing with greater observation time that indicated to the bone substitute integrated well with the host bone of the impression bone defect. Xenoplastic augmentation resulted in rapid resorption accompanied by formation of immature bone with mechanical properties declining at 6 to 12 weeks of observation. Carbon nanostructure augmentation of the bone interface caused perifocal bone resorption and absence of osteointegration with mechanical properties declining at 12 to 25 weeks of observation.

Objective The purpose of the study was to explore bone formation processes and survival of percutaneous implants under various external compression of the bone. Material and methods 30 chinchilla male rabbits were used in the study. Tibia of the species was amputated at the upper third and an implant was surgically implanted with the distal part extending through the skin. A compression device was attached to the implant and loading provided to the bone next day after surgery. Five magnitudes of compression loading were used for animals subdivided into 5 groups comprising 6 species in each of the groups. Compression device with constantly maintained loading was attached to the limb during 6 weeks. Results Animals of groups I and II showed no case of the implant falling out throughout the whole period of observation. An implant fell out of the bone in one species of Group III after 56-day implantation, two and four species of Groups IV and V, correspondingly, 3 to 4 days after removal of compression device. Osseointegration was shown to improve in species of Groups I and II due to active angiogenesis in peri-implantation area. Conclusion Therefore loads of greater than 105260 Н/m2 applied to the bone result in decreased implant osseointegration whereas less intensive loading tends to improve osseointegration.

Introduction Reduction of the period of limb lengthening with the Ilizarov method and preservation of limb functions in large elongations are the tasks to be solved by modern traumatology and orthopedics. The aim was to study the functional state of the limb, dynamics of the tibial regenerate formation, histostructural changes in the articular cartilage and the tibial nerve under the conditions of automatic high-frequency elongation of the tibia with the method of transosseous distraction osteosynthesis at a rate of 3 mm using a preliminary Z-shaped achillotomy. Material and methods The 24-hour high-fractional mode provided with automatic distractor was used to lengthen tibiae of 12 adult mongrel dogs with the method of transosseous distraction osteosynthesis. Distraction rate was 3.0 mm per day in 120 steps. To prevent formation of foot equinus, a Z-shaped achillotomy was performed. Methods of light microscopy, morphometry and X-ray electron probe microanalysis were used to study the distraction regeneration in the tibia, the articular cartilage of the medial condyle of the femur and the tibial nerve. Results During the periods of distraction and fixation, the regenerate was characterized by a normotrophic structure with a large proportion of bone component which provided the limb support function after 45 days of the experiment. Thirty days after the removal of the apparatus, a newly formed bone of a typical structure was seen in the distraction gap. Achillotomy helped prevent equinus deformity of the foot and flexion contractures of the knee joint and the metatarsal joint. However, histostructural changes in the articular cartilage were detected at the stages of osteosynthesis. Despite the restoration of the thickness of the cartilage, there was a decrease in the number of isogenic groups and the presence of cells with chondoptosis by the end of the experiment. Not a single case of neuropathy of the tibial nerve was revealed histologically due to prevention of overstretching of the anterior surface of the tibia by an increase in the length of the calcaneal tendon with tenotomy. The proportion of destructively altered nerve fibers in all animals did not exceed 5 %. Necrobiotic changes in the epineural vessels were compensated by hypervascularization of the epineurium and endonevria, as a result of which the majority of nerve conductors retained their normal structure, numeric density, and restored dimensional characteristics at the end of the experiment. Conclusions The conditions of the experiment provide for functional restoration of the limb, promote active reparative osteogenesis and structural adaptation of the tibial nerve, do not cause any gross destructive changes in the articular cartilage and reduce the period with the Ilizarov frame on by 30 % as compared with the classical variant.

There is no general consensus among experts regarding terminology, pathogenesis and treatment of heel spurs. Surgical treatment of heel spur is considered for patients who have not responded adequately after 6-12 months of conservative therapy. Although there is no evident association between the presence of osteophyte in the heel and plantar heel pain removal of exostosis is still viewed by many experts as the main purpose of surgical management. Another option includes plantar fascia release surgery aimed to relieve tension of plantar aponeurosis and improve pain. Surgical treatment of the proximal plantar fasciosis is reserved for degenerative, non-inflammatory cases to increase collagen regeneration and plantar fascia vascularity.

The article presents a literature review on intrauterine bone fractures in fetuses suffering from osteogenesis imperfecta. Prenatal ultrasound investigation of the condition is made to identify pathologically changed bone tissue including shortened and deformed limb segments and ribs, bone fractures and callus formation and widened intracranial sutures. Comprehensive clinical, paraclinical and radiological evaluations are produced after the birth to determine treatment strategy. Skeletal fractures in newborns are treated conservatively. With diagnosis of osteogenesis imperfect established medical treatment with bisphosphonates is administered to inhibit osteoclast-mediated bone resorption, facilitate bone mineralization and lower fracture incidence. The case report describes fractures of both femurs and left tibia in a female newborn suffering from osteogenesis imperfecta type III diagnosed in utero with ultrasonographic screening. The case presented highlights infant’s trauma-focused status, radiological findings and the treatment performed.

Objectives The purpose of the study was to evaluate long-term follow-ups of stabilized acromioclavicular joint (ACJ) dislocations using button dynamic system applied via arthroscopic technique or mini-open. Material and methods The review included follow-ups of 40 patients (39 males, 1 female) who underwent 40 ACJ stabilization procedures with Arthrex DogBone button between 2014 and 2017 using arthroscopy (n = 28) or mini-open technique (n = 12). The mean age of the patients was 34 years (range, 15 to 59 years). Patient reported outcomes were evaluated with UCLA shoulder rating scale, American Shoulder and Elbow Surgeons (ASES) shoulder score and the Constant Shoulder Score (CSS). Coraco-Clavicular Distance (ССD) was measured on preand postoperative anteroposterior views. Postoperative AP view was used to measure Clavicular Tunnel Distance (CTD). Arthroscopy patients had available preoperative radiographs (n = 21), postoperative radiographs (n = 26) and patient reported outcomes (n = 18). Mini open group had available preoperative radiographs (n = 2), postoperative radiographs (n=8) and patient reported outcomes (n = 8). Results One hundred percent of Arthroscopy/Mini open (26/26) cases were rated as excellent and good on UCLA shoulder rating scale at a long-term follow-up. One hundred percent of Arthroscopy patients (18/18) were rated as excellent and good; 75 % (6/8) of Mini-open cases evaluated as excellent and 25 % (2/8) as good on ASES shoulder score. Sixty seven percent of Arthroscopy (12/18) patients were rated as excellent and 33 % (6/18) as good; 62 % (5/8) of Mini open cases evaluated as excellent and 38 % (3/8) as good. Neither fair nor poor results were observed in both groups. No statistically significant differences were detected in median scores between Arthroscopy and Miniopen groups (p > 0.05). Preoperative radiographs showed Tossy grade IV dislocation (n = 3) and Tossy grade III (n = 20). Distal clavicle fracture was diagnosed in 2 cases. Median preoperative CCD radiologically measured 15.5 mm in both groups (n = 23). Median postoperative CCD and CTD radiologically measured 6.12 mm and 28.9 mm in both groups (n = 35), correspondingly. Decrease in postoperative CCD was significantly different (p = 0.0003). No statistically significant differences in postoperative CCD were detected between Arthroscopy and Miniopen groups (p > 0.05). Statistically significant differences in preoperative CCD were observed in both groups (n = 15) using weight-bearing/no weight-bearing AP views (P = 0.0009). Conclusion Stabilization of dislocated ACJ with dynamic systems is the method of choice providing excellent and good outcomes rated by UCLA rating scale, ASES shoulder score and CSS at long-term follow-up. One-stage surgical treatment is an advantage of dynamic systems with no need of construct removal. Standard and weighted stress radiographs of the involved side indicate to ACJ injury in comparison with contralateral side. Further research is needed for a longer term follow-up with the bone reduction maintained with dynamic system.

Introduction Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy. However, functional motor limitations aggravate after their physiological growth completion and the risk of pain increases. The aim of this work was to study the literature on the problem of surgical orthopedic treatment in adolescents and adults with cerebral palsy belonging to GMFCS levels I-IV of motor disorders as well as to make a preliminary analysis of the surgical orthopedic treatment performed in this category of patients at our institution. Materials and methods The results of multi-level single-event interventions were studied in 165 patients older than 16 years. The sample for analysis included cases that met the following criteria: age of 16 years and older, spastic types of cerebral palsy, GMFCS levels I–IV. In addition, some patients underwent botulinum therapy during the stages of surgical treatment. Results The maximum functional effect was manifested 12–24 months after the surgery if proper early and subsequent rehabilitation was provided. According to the Gillette Functional Assessment Questionaire, motor abilities improved in 81.3 %. Multilevel interventions included 2.3–3.5 elements on average during one surgical session. Current literature postulates the implementation of multi-level single-event interventions and indications for surgery and follow-up control are studied at a motion analysis laboratory. Conclusion Multi-level orthopedic interventions are indicated for patients who have completed physiological growth. Techniques of such interventions should provide early functional activity. Surgical orthopedic treatment in adult patients with cerebral palsy should be performed by the staff and at an institution that specialize in neuro-orthopedics