Osteoporosis is considered a serious public health and social concern that catches public attention worldwide. A set of recommendations for management of patients with fragility fractures were developed on an initiative of the European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopedics and Traumatology (EFORT) in December 2016. Authors have reviewed the recommendations through provision of health care practices in the Russian Federation. A protocol of hip fracture surgery within 48 hours of admission to trauma services for fragility cases represent a needful tool for optimization of medical care system. Specific techniques and implant designs for fracture fixation in osteoporotic bone are described with the focus on subsequent fractures prevention and fracture risk assessment. Effective rehabilitation is shown to rely on patient's understanding of the pathogenesis of the pathological process. Specific drug therapies and non-pharmacological treatment can be administered for osteoporotic patients with low-energy fractures.

Objective To develop magnetic resonance imaging (MRI) protocol for assessing acromioclavicular joint (ACJ) in patients with dislocation of the acromial end of the clavicle, grading severity of injury after trauma and evaluating outcome of surgical treatment. Material and methods MRI was performed for 15 patients with ACJ injury before and after treatment. Based on MRI findings patients were subdivided into three groups depending on the degree of ACJ injury. Results In addition to radiography MRI yields important findings on a complex of pathological changes in ligaments, muscles and subcutaneous tissues. The imaging showed edema and a partial-thickness injury to the trapezius muscle (n=7), swollen subcutaneous tissue (n=15), a glenoid labral tear (n=4) and a rotator cuff injury (n=7). Conclusion MRI has been particularly effective in characterizing ACJ injuries and associated changes in the bone and soft tissues. The capabilities of MRI in visualization of soft tissues have made this imaging modality invaluable in the assessment of outcomes of the dislocation of the acromial end of the clavicle.

Introduction The relevance of the problem is due to the growing requirements for storage and exchange of digital images in medicine and hip arthroplasty quality improvement. It is necessary to prove the higher clinical efficiency of the PACS system in planning the sizes of joint implant components. The aim of the work is a comparative assessment of the quality of planning the sizes of acetabular and femoral components using the PACS system and without it. Methods The material of the study was data on the sizes of acetabular and femoral components of the hip joint implant used in 2012 and in 2014-2017. The method of study is the choice of cases of surgical treatment of primary coxarthrosis. Results The results of the study showed a stable proportion of discrepancies by one or two sizes in 82.6–88.7 % of the total number of the components having differences in sizes. Since 2016, differences of measurements ±1 size were not revealed. The portion of absent discrepancies increased in 2017 (49.5 %); the portion of differences in the size of one of the components decreased from 51.5 % to 40.6 %, of both – from 30.3 % to 9.9 %. Deviations by more than two sizes decreased from 15.9 % to 11.8 %. Positive dynamics was more observed when the PACS system started to operate in 2014. Conclusion The study showed a complete correspondence in the sizes of the components planned and used in 49.5 % of cases when PACS was applied (2.2 times more than by “manual" planning). The difference in the size of one component was reduced by 14 %, of both – by 3.1 times, and of "more than 2 sizes"– by 1.3 times. Divergence of "less than one size" was excluded. Differences in one to two sizes were constant in the study period and probably are not related to the method of planning. Our results confirm that the quality of the selection of the dimensions of implant components improved after the introduction of the PACS system.

Purpose To assess the impact of increased body mass index on intraoperative indicators and early postoperative clinical and functional results in total knee arthroplasty Materials and methods We studied 74 patients with severe gonarthrosis. The patients were divided into four groups, depending on their body mass index (BMI). The first group consisted of 27 people (comparison group) with normal BMI (18.5–24.9). The second group included 22 persons with a BMI range of 25–34.9. The third group included 16 patients with BMI that ranged 35–39.9, and the fourth group included nine patients with BMI ≥ 40. Results The results of the study confirmed the fact of a slight increase in the duration of the operation and intraoperative blood loss in patients with obesity. However, a three-month period examination after surgery showed comparable efficacy of arthroplasty in reducing pain and functional outcomes achieved in all groups. Conclusion Total knee arthroplasty is effective in severe gonarthrosis in all patients, regardless of BMI. Anatomical and functional status of patients improved significantly in the postoperative period in all groups of the patients studied.

Introduction Total hip replacement and total knee replacement are one of the most commonly performed orthopaedic procedures and available assessment tools designed to measure functional outcomes are widely discussed in the literature. Organization and assessment of results of restorative treatment are important issues of total joint arthroplasty. The objective of the study was to evaluate functional status of patients after THR and non-operated subjects with coxarthrosis using scales and tests accepted as quality of life measures. Material and methods Clinical and functional status (pain intensity, impairment of limb function) was evaluated in 151 THR patients and non-operated coxarthrosis patients using WOMAC, VAS, Harris Hip Score, the Lequesne Index and McGill Pain Questionnaire. Result THR patients showed less pain intensity and stiffness as compared to controls (p less 0.05) with no significant differences in severity of functional disorders before and after THR (p > 0.05). Conclusion The findings suggested that deficits in function in THR patients required rehabilitation interventions at different postoperative time points.

Objective To evaluate the results of arthroscopic treatment of plica syndrome of the knee. Material and methods The study included 230 patients with plica syndrome of the knee. Their mean age was 40 ± 2,2 years. In 110 (47.8 %) patients, plica syndrome was combined with damage to the hyaline cartilage and in 75 (32.6 %) cases with Hoffa's fat pad hypertrophy. Forty-five (19.6 %) had synovitis and 53 (23 %) cases degenerative changes. Diagnosis and evaluation of results were based on R.M. Sherman and R.W. Jackson criteria, Lysholm Tegner Knee Scoring Scale, ultrasound, radiology, MRI and arthroscopy studies. Surgical treatment was performed with the technique developed at our clinic which included arthroscopic resection of the medial plica, shaving and coagulation. Results Postoperative period ran smoothly in 52 (22.6 %) patients. The average inpatient stay was 12 ± 2 days. Postoperativecomplications were recurrent synovitis (16 %), knee movement limitation (27.8 %), knee pain (49.6 %), limb muscle hypertrophy (57.4 %), and crepitus in the joint during movement (14.8 %). A combination of two or more of the complications occurred in 65 (28.3 %) patients. Knee function fully restored four to six months after the surgery. The average score on Lysholm Tegner Knee Scoring Scale after more than four years after surgery was 90 ± 5 points.

Objective To evaluate active elbow flexion restored with latissimus dorsi (LD) transfer in patients with arthrogryposis and determine the correlation with the level of segmental injury to the spinal cord. Material and methods Active elbow flexion was restored in 30 patients with arthrogryposis (44 upper limbs) using unipolar LD transfer performed between 2011 and 2018 at the Turner Scientific and Research Institute for Children’s Orthopaedics. The patients’ age at the time of surgery ranged from 1 year to 10 years with the mean age of 3.98 ± 2.35 years. Clinical and neurological assessment was performed for the patients. Statistical data analysis was produced. Results The patients were subdivided into three groups with regard to the level of segmental injury to the spinal cord including С6–С7 (n=8, 29.6 %, 13 limbs), С5–С7 (n=17, 54.5 %, 24 limbs) and С6 (n=5, 15.9 %, 7 limbs) levels. The patients were followed from 1 year to 7 years (3.2 ± 1.9). Postoperative passive and active elbow flexion was 100° ± 7.0° (min 80°, max 110°) and 90.5° ± 14.7° (min 40°, max 110°), respectively. Extension deficit of the elbow increased by 12.8° ± 4.8° (min 10°, max 20°) in 18 (51%) cases but made no impact on activities of daily living. The results of 20 patients (55.6 %) were rated good, 12 (33.3 %) were satisfied and 4 (11.1 %) had poor results. No correlation could be found between postoperative active flexion, extension deficit of the elbow and the level of segmental injury to the spinal cord in patients with involved levels of C6–C7 and C5–C7. Conclusions The LD can be regarded as the choice flap for restoration of active elbow flexion in patients with arthrogryposis and segmental involvement at С6, С6–С7, C5–C7 levels with baseline donor muscle strength grading 4 and over and passive elbow flexion of at least 90°.

Introduction Practical application of regenerative medicine to restore structural and functional properties of damaged tissues and organs using bioactive implants could solve complex problems in contemporary traumatology and orthopedics. Objective To improve treatment results in posttraumatic diaphyseal defects of lower extremities. Material and Methods Treatment outcomes of 19 patients with posttraumatic bone defects of the femur and tibia that averaged of 8.8 ± 3.5 cm were studied. In the main group (9 patients), osteosynthesis of fragments was performed sequentially, first with external fixation and then with intramedullary nailing. Bone defect was bridged by a combination of a biomimetic tissue with a spongy autograft from the iliac wing. In the control group (10 patients), the Ilizarov method of non-free bone plasty was used. Results The results were studied after follow-up of two years. Bone defects were covered in all patients of both groups. However, in the main group, the physiological load on the limb was possible, on average, 7.6 months after surgery, which required 61 % less operations as compared to the control group. Also, the rate of complications was 29.2 % lower in the main group. When assessing the functional results using the LEFS questionnaire, the patients of the main group experienced some minor difficulties in performing physical activities, and patients in the control group experienced moderate difficulties (average score 70.3 and 50.4, respectively). Conclusion The combination of biomimetic tissue with a spongy autograft from the iliac wing under the conditions of stable functional osteosynthesis enables to manage extensive defects of the femur and tibia and improve the functional outcomes.

Objective To review pathomorphological characteristics of the nerves of the palmar aponeurosis in Dupuytren’s contracture and develop a hypothesis of injury mechanisms. Material and methods The study included retrospective analysis of medical charts and surgical records of 123 patients with Dupuytren’s disease grades 2-4 who underwent partial aponeurectomy, light microscopic micrography of histological preparations of nerve trunks ofpalmar aponeurosis stained with hematoxylin and eosin. Results Three major types of nerve injury to palm aponeurosis were identified in Dupuytren’s disease including (1) active and residual perineuritis (41.6 %), (2) necrosis of endoneurial blood vessels and endoneurium (22%), and (3) fibromatosis of nerve sheath (37.4%). Higher rate of bilateral fascial fibromatosis and right-side involvement in unilateral fibromatosis (p less 0.05) was observed in Group 2 as compared to Group 3. The mean time interval of contracture formation was shorter in Group 3 by 21/2 years as compared to Groups 1 and 2 (p less 0.05). Discussion Perineurial lymphocyte and histiocyte infiltration was shown to be an additional criterion of fascial fibromatosis. Necrosis of endoneurial blood vessels was easily suspected in combination of bilateral fibromatosis (strong evidence for familial predisposition) and chronic hand injury of manual handling. Fibromatosis of nerve sheath indicated to aggressive course of the disease. Conclusion Pathomorphological characteristics of neuropathy in Dupuytren’s disease allowed assessment of fibromatosis and prognosis of the course of the disease in an individual patient to administer postoperative immunocorrective and neurally mediated therapy for optimization of wound healing and recurrence prevention.

Objective To explore causes of proximal junctional kyphosis (PJK) following instrumented fixation of lumbar spine in patients with degenerative scoliosis due to mineral bone density deficiency. Material and methods A retrospective analysis was conducted on 308 patients with degenerative lumbar scoliosis surgically treated with decompression of neural elements, deformity correction and stabilization of FSU using rigid transpedicular fixation systems. The patients were followed up for 2 years of surgery and were subdivided into 2 groups, those who developed PJK (n=132) and those who did not (n=176). Variable risk factors for PJK described in the literature were analyzed. They could be categorized into patient related factors (age, gender, osteoporosis, body mass index (BMI), smoking habits), surgical factors (type of osteotomy performed, a magnitude of lordosis correction, long fixation to the sacrum) and radiographic parameters (PI, TK, LL, SVA, PI-LL, PJA). Results Osteoporosis (53–33 %, p = 0.032), BMI >25 (51–37 %, p = 0.042) and greater than 30° lordosis correction (51–34 %, p = 0.038) were found to be statistically significant for PJK. Lumbar lordosis restored in more than 30% increases the risk of PJK by 2.3 times.The proximal junctional angle (PJA) ≥ 11° is a statistically significant risk factor for PJK and associated with increased occurrence of PJK by 2.9 times (p = 0.022). An increase in PJA by 1° increases the risk of PJK by 11.8 % (making the risk 1.118 times higher). Osteoporosis coupled with PJA entails a statistically significant impact on PJK (p = 0.002) with PJA increased by 1° in osteoporosis scenario increasing the risk of PKJ by 66.4 % (making the risk 1.664 times higher). Conclusion Osteoporosis, body mass index > 25 and a surgical correction of lumbar lordosis by more than 30° have been shown to be significantly associated with PJK in patients with lumbar curves. PJA of 11° is the significant risk factor for PJK making the occurrence of PJK 2.9 times higher (p = 0.022). Osteoporosis coupled with PJA entails a statistically significant impact on PJK (p = 0.002) with PJA increased by 1° in osteoporosis cases increasing the risk of PKJ by 66.4 %.

Injuries of the shoulder joint make up to 55 % of all large joint injuries, among which the rotator cuff tears is the most common. Partial rotator cuff tears diagnosis is a difficult task for the traumatologist. Purpose of this study is evaluation radiographic characteristics of the acromion in patients with partial rotator cuff tears. Material and methods Fourteen patients with verified partial rotator cuff tears and 14 patients with chronic instability of the shoulder joint were selected for retrospective analysis of illness history data and radiological results. The first (index) group consisted of 11 men and three women; the second (control) group consisted of 13 men and one woman. Patients with partial rotator cuff tear had it from the subacromial space. Radiographs of the shoulder joint were taken in standard projections (anteroposterior, Y-shaped) in this study. The following criteria were evaluated: lateral acromial angle (LAA), acromial index (AI), critical angle of the shoulder joint (CSA), size of the subacromial space and type of acromial process according to Bigliani. Results Significant age difference was found between the groups. There was no statistical difference between groups in LAA and AI. For CSA and size of the subacromial space, a significant difference was found between the groups. Dependence on the type of the acromial process was not found; the prevalence of types 2 and 3 of the acromial process according to Bigliani in the group of partial rotator cuff tears was observed. Conclusion There is an anatomical difference between patients with rotator cuff tears and chronic instability of the shoulder joint. Significance of the criteria of the critical shoulder angle (CSA) and the size of the subacromial space as a prognostic factor in partial rotator cuff tears was proven.

Introduction Intermittent claudication (IC) is a condition of ischemic symptoms in the lower limbs associated with increasing pain in limbs due to physical loading (walking, running and mounting) that relieves after some rest. Dosed walking is recommended as a primary treatment to prevent possible complications in such patients. The purpose of this work was to investigate the effect of different targeted footwear features on the biomechanics of human musculoskeletal system to define optimal footwear designs for reduction of loading on calf muscles and metabolic needs aimed at increasing painless walking distance. Method The study recruited 15 healthy male volunteers aged 25.3 ± 2.73 years for the analysis of kinematics, kinetics and EMG-activity during walking in various types of footwear. Eight subjects with IC were also included. Results were recorded using 16 cameras Oqus 3 + (Qualisys), four Force Platforms AMTI (USA), and an EMG system Noraxon (USA). Data were produced and analysed using QTM, Visual3D (C-Motion), and IBM SPSS Statistics. Results This study demonstrated that to reduce the load on the calf muscles and not to change the biomechanics of the knee and femur, the most potentially effective footwear were with the length of the beginning of roll over from the heel to the metatarsal area was equal to 55% of the foot length, shoe heel height of 4.5 cm, angle of lifting toes of 20 degrees (p less 0.05). Combination of those footwear conditions resulted in increase of pain-free walking distance by 39%. Conclusion The results showed the potential of the applied system of video analysis for designing orthopaedic footwear.

Purpose Hemodynamics of the hand arteries and microcirculation of the skin in patients with Dupuytren's contracture in grades 3-4 at the stages of treatment with the use of transosseous fixation was analyzed. Materials and methods Skin microcirculation using laser Doppler flowmetry as well as the microhemodynamics of the arcus palmaris superficialis and the digital arteries using pulse Doppler sonography were studied in 12 patients before surgery and following two to 11 months after the surgery of selective fasciectomy, arthrolysis and transosseous fixation. The state of the arteries of the palmar aponeurosis was verified histologically using light microscopy of paraffin sections of the surgical material. Results Before surgery, seven out of 12 patients had vasoconstriction of the digital arteries on the ulnar side of the hand and the palmar arch. Histologically, the arteries of the palmar aponeurosis were of small caliber (four or less layers of smooth muscle cells in the media) with signs of muscle hyperplasia and remodeling of the elastic membrane; larger arteries featured damage to the internal elastic membrane and neointimal thickening. Eight to 10 days after the intervention, there were no hemodynamic signs of vasoconstriction; volumetric systolic velocity was increased three times. At long-term follow-up after the surgery, the index of peak blood flow was increased 1.5 times (p less 0.05) relative to the values of the immediate postoperative period. Discussion In the postoperative period, the reactivity of the vessels of the precapillary flow was reduced and the spastic-stasis type of microcirculation prevailed. However, the potential of the microvascular bed was not impaired. Conclusion The method applied for treatment of Dupuytren's contracture provides correction of the deformity of the hand and elimination of vasoconstriction which is the most important trigger in the pathogenesis of fascial fibromatosis.

This paper presents a review on the methodology used to enable capturing pathological gait data via clinical video analysis which is used in diagnosis and treatment of individuals with functional disorders of the musculoskeletal system. Available literature sources were used to formulate recommendations for researchers and doctors in clinical study of walking and gait. Main patterns of placement of passive markers used in the clinical analysis of the gait in children with cerebral palsy were described. It was found that the IOR model is optimal for clinical analysis of the gait in patients that have low walking speed using a minimal capture system configuration (6 cameras). The method of Oxford Foot Model is described which is able to reflect in detail the biomechanics of foot parts during walking.

Purpose To conduct a meta-analysis based on the results of prospective cohort clinical studies that compare the outcomes of minimally invasive and open transforaminal lumbar interbody fusion in surgical treatment of patients with lumbar spine degenerative disease. Material and methods Pubmed, EMBASE, ELibrary and Cochrane Library databases were searched for randomized clinical trials published from 2008 to November 2018, which compared the results of minimally invasive (MIS-TLIF) and open (O-TLIF) techniques of transforaminal interbody fusion in treating patients with degenerative diseases of the lumbar spine. For dichotomous variables, the relative risk and 95% confidence interval were calculated; in turn, a standardized difference in mean values and their 95 % confidence intervals were used for continuous variables, using the random effects model. Results This meta-analysis included 14 prospective cohort studies, three of which were randomized controlled clinical trials. The results of surgical treatment of 1,324 patients with degenerative diseases of the lumbar spine were assessed. In the MIS-TLIF group, a reliably lower level of pain in the lumbar spine (p less 0.00001), better functional status by ODI (p less 0.0001), lower number of adverse effects (p = 0.01) were verified. At the same time, the rate of fusion (p = 0.98) and of secondary surgical procedures (p = 0.52) between the compared groups had no significant differences. Conclusion The MIS-TLIF method has significantly better long-term clinical outcomes in comparison with the O-TLIF method in terms of pain relief and functional status and a lower risk of consequences. There were no statistically significant differences in the rates of interbody fusion and repeated sur gical interventions between the compared groups of respondents.

We present a case of superior gluteal artery pseudoaneurysm following iliosacral screw placement into the posterior pelvis in a patient with vertically unstable pelvic fracture (OTA/AO 61C2.3(b,k)) who received anticoagulant therapy for deep venous thrombosis. The primary complaint was that of neuropathic pain the patient developed on the fourth postoperative day due to sciatic nerve irritated by a mass in the gluteal region. CT demonstrated intermuscular haematoma that was conservatively treated with analgesics, anticonvulsants, and antispasmodics. The therapy resulted in moderate positive effect. The gluteal mass was noted to grow at three months postsurgery. Ultrasonography showed turbulent blood flow inside the haematoma cavity and a diagnosis of pseudoaneurysm of the superior gluteal artery was made. Further observation revealed spontaneous decrease in the volume of pseudoaneurysm cavity and complete resolution at 5 months of surgery, and pain completely relieved at the time. No operative procedure was required for the pseudoaneurysm.