Bone ice skates in the medieval Novgorod (based on archaeological research of the Institute of Archaeology RAS in 2018–2019)

The article summarizes available information on bone ice skates and presents the results of research and classification of the collection of skates of the 11th–15th centuries found by the Novgorod Expedition of the Institute of Archaeology RAS. Medieval ice skates are small bone runners made from the tubular bones of large domestic animals. All objects show traces of the specific processing of original bones: cut off epiphyses and a flattened plantar side (sliding surface). The amount of accumulated archaeological material, instrumental study of wear pattern on the working surface, experiments in the use and manufacture of skates, numerous ethnographic parallels in the use of bone skates in a number of countries almost up to the present day, as well as the fact of skating on bone shoes recorded in a 12th century source, make it safe to say that, in functional terms, ice skating was one of the forms of winter pastime and was a part of the Novgorod dwellers’ everyday life.

A Multidisciplinary Journey towards Bone Tissue Engineering

Millions of patients suffer yearly from bone fractures and disorders such as osteoporosis or cancer, which constitute the most common causes of severe long-term pain and physical disabilities. The intrinsic capacity of bone to repair the damaged bone allows normal healing of most small bone injuries. However, larger bone defects or more complex diseases require additional stimulation to fully heal. In this context, the traditional routes to address bone disorders present several associated drawbacks concerning their efficacy and cost-effectiveness. Thus, alternative therapies become necessary to overcome these limitations. In recent decades, bone tissue engineering has emerged as a promising interdisciplinary strategy to mimic environments specifically designed to facilitate bone tissue regeneration. Approaches developed to date aim at three essential factors: osteoconductive scaffolds, osteoinduction through growth factors, and cells with osteogenic capability. This review addresses the biological basis of bone and its remodeling process, providing an overview of the bone tissue engineering strategies developed to date and describing the mechanisms that underlie cell–biomaterial interactions.

PROLONGATION OF CLEANSING DAMAGED TISSUES FROM DETRITUS USING EXOSOMES OF MULTIPOTENT STROMAL CELLS

Objective. To study the effect of exosomes of multipotent mesenchymal stromal cells (EMSCs) on soft tissues damaged during implantation of a metal screw into the bone. Methods. A defect (2 mm in diameter and 4 mm in depth) was created in the tibial proximal condyles of outbred rabbits. Metal screws were implanted into the defect by preliminary injection of saline (control, n=9 animals) or 19.2 μg of EMSCs per limb (experiment, n=10 rabbits). After 3, 7 and 10 days following the operation, the animals were taken out from the experiment; histological sections of soft tissues from the condyle surface, stained by hematoxylin and eosin were studied using light microscopy. Results. The use of water cooling in the process of introducing the metal implant into the tibial proximal condyle does not lead to complete removal of small bone fragments, which are subsequently either eliminated outward with wound discharge, or are destroyed and are subjected to lysis by macrophages. As a result of the EMSC effect on soft tissues near the site of damage, the activity of the postoperative inflammation reduces, leads to a slowdown in the resorption of hemorrhages, the elimination of fibrin clots, detritus and small bone fragments. Even on the 10^th day after using EMSCs in the postoperative wound a structureless detritus with a small number of infiltrating cells was present, as well as a significant number of multinucleated macrophages with fused cytoplasm, non-viable lysed striated muscle symplasts and bone fragments with a low degree of degradation. Conclusion. Suppression of inflammation by EMSCs delays the clearance of the postoperative wound, promotes the prolongation of the repair process and the attachment of the granulomatous component to the inflammation. The using EMSCs in the process of intraosseous implantation may be recommended only to control the activity of the inflammatory process and only after maximum preliminary cleansing of the postoperative wound from detritus, including non-viable muscle tissue and bone fragments. What this paper adds It has been firstly shown that after the experimental use of exosome of multipotent mesenchymal stromal cells to influence the regeneration of surgical trauma of soft tissues after intraosseous implantation, it is possible to reduce the activity of the inflammatory reaction, which leads to a slowdown of resorption of hemorrhages, elimination of fibrin clots, detritus and small bone fragments and, accordingly, prolongation of cleansing damaged tissue and delayed repair.

JESS IN THE TREATMENT OF HAND AND FOOT INJURIES –AN USEFUL ARSENAL AS DAY CARE MANAGEMENT TOOL.

BACKGROUND: Small bone fractures of hand and feet are very common in a developing country like India and consist of 15% to 20% among all patients presenting at trauma centre and orthopaedic opds. Small bone fractures such as fractures of phalanx or metacarpals are often tend to be overlooked and of deemed as less serious in nature. However even a small deformity or disability of hand and feet can hamper the functional and psychological wellbeing of a person in long term. The purpose of this study is to evaluate the functional outcome and complications associated with application principles of JESS (Joshi's External Stabilization System) xation in phalanx, metacarpal and metatarsals and their management as a day care procedure. MATERIAL AND METHODS: This prospective observational study was done over a period of 1 year on 21 patients for injuries of metacarpal, phalanx and metatarsals and followed up for a minimum period of 3 months post frame removal. RESULTS: Young patients constituted almost 60% of the study population. RTA, assault and industrial / factory setup injury is most prevalent mode of injury. Over all closed injury patients had better functional outcome than open fractures. CONCLUSION: JESS is a versatile, easy to use system that can be applied at a very average set up. Optimum management of comminuted, open and unstable small bone fractures of hand and feet is possible with JESS. We advocate more extensive use of such a low cost and versatile system in Indian setup where cost of treatment is a major factor for going forward with a treatment option.

A STUDY ON STABILIZATION OF COMPOUND SMALL BONE FRACTURES OF HAND AND FOOT WITH JESS FIXATOR

Background : The fractures of small bones of hand and foot should not be more complicated and damaging compared to the damage caused by the injury itself. The goal is to achieve good stability of the bone and joint, which allows early motion without resulting in the residual instability and malunion. These fractures of small bones of hand and foot can be treated with an external xator that allows fracture reduction attaining normal alignment. we took up the study with an aim to access the overall function and complications in treating open small bones of hand and foot with JESS xator. Methods: We performed a prospective study on 20 adult patients (14 males and 6 females) with small bone fractures of hand and foot, who attended outpatient or admitted in inpatient in the department of orthopaedics, government general hospital, Kakinada from October 2017 to august 2019. We excluded closed fractures and severely crushed fractures with neurovascular and tendon injuries. Results: 5 Results are recorded based on Duncan et al. criteria for ngers. For toes, the results are graded based on a total active range of movements. Most of the cases (n=17) showed radiological union within 12 weeks. Two cases took more than 20 weeks to heal. Whatever be the radiological union, the frame is removed mostly by 15 days postop (n=18) and by a maximum period of 21 days (n=6). the results are found to be excellent in 40% of cases, good in 44% cases, fair in 8% and poor results are seen in 8% cases. We had extensor lag as the most common complication (60%, n=15), 2 cases with malunion (8%) and one case (4%) with supercial infection. Conclusion: Hand serves many functions of precise movement, grip, grasp, touch etc. though these are small bones their fracture are not to be neglected and should be managed with utmost care. Jess is simple to operate, cheap, easily available, and has less complication rate. It makes the postoperative management simple and effective. It allows early mobilization, which prevents joint stiffness. Removing the frame at end of second postoperative week allows good functional results and doesn't compromise the stability of fracture.

Complications associated with hyperextension bicondylar tibial plateau fractures: a retrospective study

Background Hyperextension bicondylar tibial plateau fracture (HBTPF) is a particular form of tibial plateau fracture which has gained increasing interest recently but were rarely documented. In this study, we reported the characteristics, clinical intervention, and therapeutic outcomes of HBTPF patients. Methods From May 2015 to October 2017, clinical data of consecutive patients with bicondylar tibial plateau fractures (BTPF) who underwent surgical treatment in our hospital were retrospectively studied. The patients were allocated to either the HBTPF group (study group) or the non-HBTPF group (control group) based on the radiological features, and inclusion and exclusion criteria. Demographics, characteristics of knee joint injuries, complications, and outcomes were compared between the two groups. Results In total, 59 patients were included in this study. Among them, 17 patients with HBTPF were identified and 42 patients were diagnosed as non-HBTPF. No differences in age, sex, cause of injury, side of injury, site of injury, nerve injury, operation time, and treatment time and incision complication between HBTPF and non-HBTPF group. The incidence rate of popliteal artery injury in HBTPF group was 29.4 %, which was significantly higher than that of non-HBTPF group. Small bone chips on the lateral film were found in 94.1 % of the patients in HBTPF group, which was significantly higher than that of non-HBTPF group. The range of motion (ROM) and hospital for special surgery (HSS) score of HBTPF group were significantly lower than those of non-HBTPF group. Conclusions HBTPF is a severe injury with a higher incidence rate of popliteal artery injury and worse outcomes than non-HBTPF. Small bone chips at the anterior margin of the proximal tibia on the lateral plain film might be a characteristic of HBTPF.

Post-traumatic cerebrospinal fluid rhinorrhea and Transcranial approach surgical outcomes.

Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material & Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of > 93%