Editorial Comment on the Article by P.A. Ivanov et al. “A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps”

In the editorial comment on the article A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps the advantages and disadvantages of the authors method are discussed. The advantages include availability, low cost, convenience and reliability. At the same time, it may lead to excessive devascularization of bone fragments with the risk of delayed union or even non-union. Only a comparative study on a large number of patients can confirm or refute these concerns. The comment also contains a brief review of articles on this issue.

95th Anniversary of the First Russian Society of Orthopedic Surgeons

95 years ago, namely on October 12, 1926, through the efforts of 27 founders, including professors G.I. Turner, A.L. Polenov, R.R. Vreden and G.A. Albrecht, the first scientific society of orthopedic surgeons of Leningrad and the Leningrad region was created in our country, which continues to be an indispensable platform for the training of scientific personnel, the exchange of practical experience and research results directed by authoritative figures of domestic traumatology and orthopedics, the successors of the Leningrad school of orthopedic surgeons. The article summarizes the results of the societys work during four periods of its activity: the first period of formation (19261933), the second period work in the pre-war, war and post-war years (19341950), the third period the intensive development of traumatology and orthopedics (19501990) and the fourth period the modern rapid development of the specialty (since 1990). The main aim of the current activity and new areas of work are formulated.

Nikolay Gavrilovich Fomichev 1941-2021

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Classification of Proximal Tibial Fractures and Algorithm of Intramedullary Nailing: Efficacy Evaluation

Background. Intramedullary nailing of proximal tibial fractures is challenging due to difficulties with fracture reduction and achievement of stable fixation. Preoperative planning based on proximal fragment length, fracture pattern and bone quality evaluation is a prerequisite for a successful operation. However, there is no classification that could adequately access these factors and guide us towards the most effective methods of fracture reduction and fixation with intramedullary nail. The purpose of this study was to evaluate a classification of extra-articular proximal tibial fractures and algorithm for intramedullary nailing in clinical conditions. Materials and Methods. We compared the treatment outcomes before (Group 1) and after (Group 2) the introduction of the new PFL-TN classification algorithm of intramedullary nailing of proxamal tibial fractures. The group 1 included 43 patients from 18 to 71 years old (males 28; females 15; average age 44.52.0 years). The group 2 included 42 patients from 18 to 72 years old (males 30; females 12; average age 46.12.0 years). The data analysis was carried out after a minimum follow-up period of 12 months. The results were analyzed by the following criteria: reduction quality assesed with reduction quality scale, number of complications, quality of life with SF-36 questionnaire and leg function with LEFS scale. Results. The introduction of the proposed algorithm allowed to reduce the number of late complications by more than 5 times, and the number of required additional surgical interventions by more than 4 times compared to with a control group. The introduction of the proposed algorithm made it possible to improve the functional outcomes 1 year after surgery from 83.58 to 93.29% (p = 0.00002) by the LEFS scale, and the patients quality of life from the 77.501.88 to 86.712.03 points (p = 0.00072) and from the 81.251.88 to 86.842.26 points (p = 0.00116) by the physical and role functioning scales SF-36 questionnaire. Conclusion. The proposed algorithm, based on the new classification, allows to optimize the surgical technique of intramedullary nailing of proximal tibial fractures.

Intraosseous Injection of Autologous Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for Treatment of Knee Osteoarthritis

The aim of the study was to determine the effectiveness of autologous bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) intraosseous injection in the treatment of patients with knee OA stages II-III. Materials and Methods. The multicenter randomized study involved 40 patients (27 women, 13 men, average age 67.07.8 years, BMI 32.74.8, duration of disease 17.33.7 months) with knee OA of stages II-III according to the Kellgren-Lawrence (K-L) classification. Patients of the main (BMAC group) group (n = 19) underwent a single intraosseous injection of BMAC, in the comparison group (n = 21) a PRP injection (PRP group). The results were evaluated after 1, 3, 6, 12 months with the verbal rating scale (VRS), VAS, Leken and WOMAC scales. Results. Comparison of the results in the groups on the VRS showed that at an earlier time (3 and 6 months), the preferences of patients were in favor of the treatment of BMAC (65% and 55% positive reviews) before PRP (55% and 45% positive reviews), whereas after 12 months the differences were insignificant. Analysis of VAS indicators in patients of both groups indicated a more pronounced decrease in the severity of pain syndrome after BMAC intraosseous injection. The analysis of the Leken scale indicators showed in favor of BMAC throughout the entire observation period, the differences were most pronounced in the first 3 months of observation. The ratio of the values of the WOMAC index in both patients groups indicated statistically significant differences that persisted in all periods of follow-up, the increase in indicators occurred to a lesser extent after the introduction of BMAC compared with PRP. Conclusion. A single intraosseous BMAC injection has an advantage over a similar PRP injection in terms of pain, knee function and physical activity of patients at all follow-up periods. Both methods of treatment are equally safe.

Scapula Dyskinesis

Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

Editorial Comment on the Article by Mushkin M.A. et al. “Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases”

The editorial comment evaluates the current state of issue of medical care at urgent states caused by pathological vertebral fractures and spinal cord compression in patients with spine destructive diseases. The rare occurrence of pathology and the deficiency of objective data determine the lack of consensus on the medical care for this category of patients. The article by M.A. Mushkin et al helps to understand how the prehospital pause affects the outcomes of emergency decompression and stabilization procedures in patients with tumor and infectious diseases of the spine, as well as to determine how much time the surgeon has at his disposal. The author of the comment believes that close cooperation of orthopedic surgeons, neurosurgeons, oncologists is necessary to solve this problem. Even despite the absence of oncologists in the staff of emergency hospitals, telemedicine allows to receive methodological support in a timely manner for making a correct decision for each patient. Interaction between clinicians, radiologists and pathologists is equally important. An important aspect is continuity in patient care. An urgently performed spinal cord decompression is only a stage of the complex treatment. Such patients should be provided with accurate routing depending on the diagnosis and the treatment early outcome.

Total Talar Replacement with Ceramic Implant in Combination with Tibial Component of Ankle Endoprosthesis: A Case Report

Background. Surgical treatment of patients with talus posttraumatic aseptic necrosis and its consequences usually includes tibiotalocalcaneal arthrodesis with various foot joints according to additional indications. This type of surgical treatment has number of significant disadvantages: traumatic surgical technique, permanent loss of movement in functionally significant joints, high risk of non-union, high frequency of residual deformities, the need for long periods of limb immobilization. The question arises: how to overcome the existing disadvantages and improve the results of talus posttraumatic aseptic necrosis treatment? A potential solution to this problem is the total talus endoprosthetics. Clinical case. A 64-year-old patient came to the clinic complaining of pain and deformity of the right foot and ankle area. After the examination, talus posttraumatic aseptic necrosis was diagnosed. The patient underwent ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis, a course of rehabilitation treatment was performed. Results. The VAS and AOFAS scales indicators showed a significant improvement both in the pain decrease (from 75 mm before surgery to 10 mm after), and in the functional state according to AOFAS by 2.2 times (from 36 to 80 points 20 months after surgery). By the last follow-up the patient could take more than 8000 steps a day. Conclusion. Considering the good clinical result achieved, the ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis can be considered a promising method of treatment of this severe pathology.

Comment to the Article by O.A. Kaplunov et al. “Hypotrophic Clavicle Pseudoarthrosis Treatment: A Case Report”

In the comment on the article Treatment of Hypotrophic Nonunion of the Clavicle: A Clinical Case, the reasons for the failure of primary and refixation of the clavicle closed fracture are analyzed in detail. A 70-year-old patient got a fracture of the middle third of the left clavicle diaphysis as a result of a fall. He underwent four surgical treatment options: plate osteosynthesis; plate osteosynthesis + bone autoplasty; plate osteosynthesis + vascularized fibular flap reconstruction; external osteosynthesis. A month after the fourth attempt of surgical treatment, fusion, improvement of the function of the right upper limb and the quality of life of the patient were achieved. Technological inaccuracy, namely, the lack of the fragments fixation stability due to the incorrectly chosen length of the plate, as well as an incomplete assessment of the anamnesis and the identified cognitive behavioral features of the patient, are considered as possible reasons for the treatment failure. The author of the comment highlights modern approaches to the treatment of clavicle fractures, and also briefly dwells on the theory of fracture fixation in general. He pays special attention to biological and mechanical factors affecting fractures healing. The author considers the compliance with the basic principles of osteosynthesis to be the main factor in achieving good results in fracture treatment.

Features and results of knee arthroplasty after osteosynthesis of intra-articular fractures forming its bones

The purpose of the study - to find out surgical intervention features, the function restoration dynamics and clinical results after primary total knee replacement (TKA) in patients with a history of osteosynthesis of intra-articular fractures, to assess the risk of complications and to suggest measures for their prevention. Material and methods. The study includes a retrospective (100 observations) and prospective (40 observations) comparative analysis of the results of primary TKA in patients with a history of osteosynthesis of intra-articular fractures (MOS) of the bones forming the knee joint (main group) and without them (comparison group). Adapted Russian-language versions of the KSS, WOMAC and FJS-12 score scales were used to study the clinical and functional results of the TKA, the incidence of any complications after arthroplasty and the X-ray position of the endoprosthesis components on the KRESS scale were evaluated. Statistical analysis of the data obtained was carried out in accordance with generally accepted methods. Results. Statistically significant differences were revealed between the patients of the main and the comparison groups according to the following indicators: the patients of the main group were 8 years younger, the duration of the operation time, the volume of intraoperative blood loss, the need for implantation of structures with an increased degree of mechanical coupling between the components of the endoprosthesis, the number of postoperative complications were greater in the patients of the main group. Functional results on the KSS and WOMAC scales did not have statistically significant and clinically differences, when assessing the satisfaction of TKA on the FJS-12 scale, statistically significantly worse results were obtained in the main group. TKA in patients with a history of MOS for intraarticular fractures of the knee joint area statistically and clinically significantly increased the amplitude of movements in the knee joint - from 89 to 108 , that is, by 19 , the function recovery dynamics according to the KSS, WOMAC and FJS-12 scales was slowed down at 3 and 6 months, and according to the WOMAC and FJS-12 scales and by 12 months after surgery. Conclusion. The trauma and subsequent surgical treatment of intra-articular fractures of the knee joint leads to an earlier development of posttraumatic arthritis of the 3rd degree, functional results have no statistically significant differences, satisfaction with the results of TKA in this category of patients is less, and the number of postoperative complications, are greater. A history of MOS significantly slows down the dynamics and degree of recovery of function in the early postoperative period.