ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

Professor D. AT. Yaremenko is an outstanding representative of the Sytenko School of Orthopedics and Traumatology (on his 90th birthday)

V. O. Thankut — 2024-12-26

Professor D. AT. Yaremenko is a talented scientist and an experienced orthopedic traumatologist, an outstanding specialist in diagnostic and treatment problems deformities of the foot, organization of prosthetic and orthopedic support and rehabilitation for the consequences of injuries and diseases of the musculoskeletal system systems.

FRACTURES OF THE FEMORAL HEAD (CLINICAL LECTURE)

Maxim Golovakha — 2024-12-26

Fractures of the femoral head are often associated with hip dislocation. A high percentage of unsatisfactory functional treatment outcomes and complications (such as aseptic necrosis, heterotopic ossification, osteoarthritis, etc.) remains a challenge. Objective. To analyze the available information on the treatment approaches for femoral head fractures associated with hip dislocation using the Pipkin classification. Methods. A search of modern literature sources was conducted in the PubMed and Scopus databases using the following keywords: fracture, femoral head, Pipkin, hip joint, diagnosis, treatment, osteosynthesis. Results. The Pipkin classification enables the systematization of treatment approaches for patients and, when applied correctly, reduces the rate of complications and improves functional outcomes. Computed tomography is an essential procedure in diagnosing femoral head fractures associated with hip dislocation to facilitate the prompt reduction of the dislocation. The specific features of blood supply and the risks of aseptic necrosis formation, considered in the Pipkin classification, influence the treatment strategy, along with the type of fracture. For type I fractures, both conservative and surgical methods are possible. For type II fractures, screw fixation is preferred: using hidden compression screws, self-compressing headless screws, or bioresorbable screws. For type III fractures, urgent surgery is required, typically open reduction with primary endoprosthesis replacement. For type IV fractures, if the fracture type permits, open reduction and osteosynthesis are recommended. In postoperative care, early functional treatment is critical, with partial weight-bearing for 6–12 weeks, and avoiding excessive flexion of the hip beyond 45°–50°. Conclusions. A properly selected treatment strategy during the initial admission can reduce recovery times and improve treatment outcomes.

FEATURES OF REMOVAL OF STABLE FEMORAL STEMS OF HIP ENDOPROSTHESES

Volodymyr Filipenko — 2024-12-26

The increase in the number of primary arthroplasty procedures has led to an increase in revision arthroplasty for periprosthetic infection and fractures of hip stems. The problem of removing stable stems remains relevant, as the lack of a unified approach leads to an increase in the duration of operations, an increased risk of complications and worsening of treatment outcomes. Objective. To review the existing methods and find out the most optimal approaches to the removal of stable stems of hip arthroplasties of different types of fixation. Methods. A systematic literature review was conducted using the electronic databases PubMed, Scopus, Web of Science for the period 1986–2023. 28 publications were analyzed. The authors’ own clinical experience was used (171 revision interventions from 2013 to 2024). Results. The method of removal depends on the type of fixation and design of the endoprosthesis stem. The main methods are: use of special instruments, window osteotomy, extended proximal osteotomy, transfemoral osteotomy. The choice of method depends on the specific situation, starting with the least traumatic approach. Conclusions. Removal of stable stems requires an individual approach and careful planning. Cemented polished stems are usually easier to remove, but there may be difficulties with the removal of the cement mantle. Cementless stems with distal fixation often require more aggressive methods. The choice of method should be based on the principle of minimal trauma, taking into account the possibility of further revision arthroplasty. It is recommended to have several alternative surgical plans. The proposed methodology of intraoperative actions allows optimizing the decision-making process, which contributes to improving the results of revision hip arthroplasty.

CURRENT TRENDS OF SURGICAL TREATMENT INTERVERTEBRAL HERNIAS AND LUMBAR STENOSIS THE SPINE

Oleksandr Barkov — 2024-12-26

Objective. On the basis of a study of scientific literature on the treatment of patients with intercho-ribbus hernias and stenosis of the spinal canal of the lumbar spine to determine the tendencies of development of methods of performing surgical treatment of these diseases and the conditions of their appointment. Methods. The literature search was performed in the PubMed database. The inclusion criteria were original clinical studies in English. Results. We selected and studied 47 studies. Conclusions. The advantages of modern endoscopic spine surgery include less tissue damage, lower blood loss, less damage to the epidural blood supply with less fibrosis, shorter hospital stay, and early cosmetic recovery. Percutaneous endoscopic partial discectomy (PEPD) allows to avoid significant damage to the skin, muscles, plates and synapses, excessive load on the dura mater, it is performed under local anesthesia. This type of discectomy is more suitable for the treatment of foraminal and extraforaminal hernias, when the transforaminal approach facilitates visualization of the lesion. In the middle type hernias, the limitations of the intervertebral opening and the interference of the solid meninge when performing this technique leads to the worst clinical results. In general, after PEPD, the results are better than after microdiscectomy. Surgical treatment of lumbar spinal stenosis is mainly performed using single-channel endoscopic surgery, which allows for complete preservation of the physiological structure of the lumbar spine with minor surgical trauma and rapid postoperative recovery. The disadvantages are a small field, as well as the difficulty of expanding the boundaries of decompression. One of the most recent developments in the treatment of intervertebral hernias is unilateral biportal endoscopic discectomy (UBED). The effectiveness of discectomy and release of nerve roots in the spinal canal is higher than that of percutaneous endoscopic interlaminar partial discectomy, but UBED is longer, with greater actual blood loss during surgery

SURGICAL TREATMENT OF BONE DEFECTS OF THE EXTREMITIES AFTER GUNSHOT INJURIES

Аnton Rodionov — 2024-12-26

According to various authors, in wartime, injuries to the limbs as a result of combat trauma account for 44 to 70 % of all musculoskeletal injuries. In approximately 80 % of wounded, gunshot bone fractures are characterised by the presence of a bone defect of varying size. Despite certain difficulties and complications in the treatment of bone defects, orthopedic surgeons have quite effective methods of treating this pathology. However, a promising area of treatment is the technology of manufacturing an individual implant using 3D-printing of the scaffolds of existing bone defects and double-plate osteosynthesis with autobone grafting. Objective. To present the possibilities of surgical treatment of wounded with bone defects of the limbs as a result of gunshot wounds. The preliminary results of surgical treatment of 2 wounded with diaphyseal bone defects due to gunshot wounds of the upper and lower extremities, who were treated in the trauma department of the Military Medical Clinical Centre of the Eastern Region in 2022–2024, were analysed. To improve the functional results of treatment, we proposed three stages of rehabilitation treatment and implemented appropriate rehabilitation measures. To replace bone defects, we used the «double-plating» method with autobone grafting and individual implants made by 3D-printing. The results of surgical treatment were evaluated by clinical, radiological and functional data. It was found that fixation with two plates in combination with autogenous bone grafting ensures stable fixation, which helps to consolidate the bone defect and restore the functional capacity of the limb, and the use of individual implants made by 3D-printing allows to replace the lost bone tissue, which leads to the restoration and preservation of the functional state of the damaged limb.

Partial resection as a treatment for mucoid degeneration of the anterior cruciate ligament: a case report

Krishna Amith Kumar — 2024-12-26

Mucoid degeneration of the anterior cruciate ligament (MDACL) is an uncommon degenerative disease. Objective. To present a case of mucoid degeneration of the anterior cruciate ligament diagnosed using Magnetic Resonance Imaging and treated with arthroscopic resection. Methods. In our case report, we examined the medical history of a patient and developed a list of clinical manifestations observed in our case. Magnetic Resonance Imaging is the most efficient approach for differentiating between mucoid degeneration of the anterior cruciate ligament and other knee joint disorders. Results. Our patient presented with a 3-month history of right knee discomfort. The age of the patient was 28 years old. There were no indications of edema or instability, although his knee flexion ranged from 0°–100°. We diagnosed MDACL using MRI and arthroscopic findings. In T2-weighted images, the ACL exhibited an abnormally elevated signal with a mass-like structure of its fibres. In T2-weighted coronal images, the association between the fibres and the aberrant soft tissue was discernible. Based on normal preoperative findings, this case was diagnosed and presented. Magnetic Resonance Imaging revealed a celery-stalk-like appearance of the anterior cruciate ligament suggesting mucoid degeneration of the anterior cruciate ligament, with additional joint effusion. Upon arthroscopy, the anterior cruciate ligament appeared homogenous and hypertrophied with a bulbous lateral portion. The yellow and sclerotic lesions on the lateral portion of the anterior cruciate ligament were excised precisely. Conclusions. In the present case, arthroscopic resection of a degenerating ACL that is causing pain demonstrated good results. In some cases it could lead to subjective progressive laxity after the surgery. The prognosis is dependent on the age of the patient and what other injuries they might have. MDACL should be considered when there is unusual discomfort in the spine and limited flexing. MRI and arthroscopy both pointed to the same diagnosis.

OPTIMIZATION OF TREATMENT TACTICS FOR PATIENTS WITH COMBINED UNSTABLE INJURIES OF THE PELVIS AND LONG BONES OF THE LOWER LIMBS

Olexander Buryanov — 2024-12-26

Treatment of polytrauma patients with multiple fractures in general and «pelvis + lower extremities» in particular is a complex, topical and debatable problem today. Combined injury of the pelvis and TBI is observed in 16.9–58.7 % of cases, pelvis and lower limbs — in 49.2 %, pelvis and upper limbs — in 32.2 %, pelvis and chest organs — in 21.2–45.7 %, pelvis and bdominal organs — in 31.5–43.9 %, pelvis and spine — in 9 %. Objective. To improve treatment outcomes in patients with combined pelvic and lower extremity injuries by optimizing treatment tactics. Methods. The clinical study is based on the examination and treatment of 38 patients with combined injuries of the pelvis and lower extremities between 2014 and 2023. The average age of the patients was (41.4 ± 16.3) years. Typing of fractures of the pelvis and long bones of the lower extremity was carried out according to the AO classification, and the condition of patients was assessed according to the TS scale. Results. Guided by the provisions of the "damage control" concept, the nature of surgical interventions for victims with multiple and combined pelvic injuries can be presented in the following sequence: stabilizing, restorative, reconstructive, or reconstructive-restorative. Stabilizing surgical interventions are part of the resuscitation complex, the purpose of which is to preserve life by reducing pain reactions and blood loss. Conclusions. Unstable combined pelvic ring injuries require initial multidisciplinary treatment aimed at stopping or limiting life-threatening bleeding. The use of compressive devices (pelvic belt, Seattle technique) is a mandatory component of staged treatment. Individual treatment tactics and their extent depend on the overall condition of the patient, however, the basic principle of the first stage is to ensure the stability of the pelvis: in type B damage, of the anterior semi-ring, in type C damage, of both semi-rings, which has a positive effect on the anatomical and functional result and allows to avoid dangerous prognosis for life.

THE IMPACT OF POST-TRAUMATIC STRESS DISORDER ON THE PAIN PERCEPTION IN A PERIOPERATIVE PERIOD IN SERVICEMAN

Kseniia Lyzohub — 2024-12-26

An estimation of psycho-emotional state allows to further select appropriate distinctive strategy of treatment, moreover protect complications due to feeling of pain is a subjective reaction. Objective. To identify the relationship between intensity of pain syndrome before and after surgical intervention depending on initial psycho-emotional condition. Methods. The psychological state of 138 servicemen who had upper limb injuries was studied. Assessment was conducted using the Mississippi scale for combat-related posttraumatic stress disorder and the PSM 25 psychological distress scale. The average age the patients was (40,5 ± 10,6). Pain intensity was assessed using a visual analogue pain scale (VAS).The pain assessment was studied 2 hours before and 24 hours after surgery. Results. According to the Mississippi PTSD scale, the normal control group (first) had an average score of (62,92 ± 9,16), psychiatric patent group up to (88,13 ± 8,47), PTSD patients’ group had an average score of (119,66 ± 5,50). Data obtained on the PSM 25 scale, namely the low stress group had an average score of (60.73 ± 24.5), the medium group up to (95.33 ± 29.8), and the high group had an average score of (123 ± 29.7). The pain assessment according to the VAS: the average score in the first group was (4.4 ± 1.6), in the second — (5.75 ± 2.0), in the third — (6.8 ± 1.6). The amount of 1% morphine solution administered postoperatively was significantly different between the first and second groups (p = 0.03). No significant difference was found when comparing the second and third groups. Conclusions. The largest percentage of military personnel had a medium level of stress, the development and clinical manifestation of PTSD was detected in 6.52 % of the studied. The pain indicator before the operation depended on the initial psycho-emotional condition of the patient. Keywords. Post-traumatic stress disorder, pain, analgesia, postoperative period.

Does the type and length of nail affect the stability of fixation of subtrochanteric fractures under low displacement forces?

Ortaç Güran — 2024-12-26

The treatment of subtrochanteric fractures is a highly contentious area, given the complex biomechanical properties and displacing muscle forces involved. Indeed, the debates cover almost all aspects of the treatment. Objective. To evaluate the biomechanical properties of three distinct intramedullary nails in order to identify the most reliable fixation method for subtrochanteric reverse oblique femur fractures. Methods. An osteotomy was performed in accordance with the 31A3 (intertrochanteric reverse oblique) fracture model on 24 synthetic femur bone models. Following the achievement of anatomical reduction, each group was fixed with a distinct implant system: An A-PFN (220 mm in length), an A-PFN (280 mm in length), and a cephalomedullary nail (360 mm in length). The evaluation of all models was conducted under both single and cyclic loading conditions, and an assessment of the fracture lines and total femur displacements was performed. Results. No significant correlation was observed between the groups with regard to fracture line displacement (p > 0.05). However, a notable distinction was evident in total femur displacement between the groups under both single and cyclic loading conditions (p < 0.001 and p = 0.004, respectively). Post-hoc analyses demonstrated that the discrepancies between the group comparisons were between the A-PFN (220 mm in length) and the other two fixation methods. Conclusions. Both short and long nails provide adequate and similar stability in an anatomically reduced reverse-oblique subtrochanteric fracture model. This suggests that anatomical reduction is more crucial than implant selection in subtrochanteric single-line fractures. While longer implants do not affect the displacement of the fracture line, they do affect the total displacement of the femur, creating a more rigid femur.

RESULTS OF TREATMENT OF PATIENTS WITH PERSISTENT CONTRACTURE OF THE SHOULDER JOINT AFTER ROTATOR CUFF REPAIR

Sergiy Strafun — 2024-12-26

Contracture of the shoulder joint is one of the complications that ccurs after rotator cuff repair. The aim of the work is to investigate and compare the results of conservative and surgical treatment of patients with persistent contracture of the shoulder joint 6 months after shoulder rotator cuff repair. Methods. We included 51 patients who had resistant contracture of the shoulder joint of varying grade within 6 months after the operation. Conservative treatment was performed in 27 patients, surgical treatment under arthroscopic control was performed in 24 patients. In our study, we assessed the function of the shoulder using the Constant Shoulder Score and VAS scales before the start of treatment (i.e., 6 months after first surgery) 3 and 6 months after the start of treatment (i. e., 9 and 12 months after first surgery). Results. 3 months after the start of treatment, in the group where surgery was performed, the average functional result according to the Constant Shoulder Score scale was better than in the group where patients were treated conservatively and ranged within (16.4 ± 5.9) points, while in the group with conservative treatment the average functional result was (28.1 ± 6.7) points (p = 0.048). 6 months after rotator cuff repair in the group with conservative treatment the average functional result according to the Constant Shoulder Score scale was (23.1 ± 7.1) points, while in the group where surgery was performed it was (12.1 ± 6.3) points (p = 0.03). Conclusions. Performing arthroscopy with removal of scars from the s houlder joint a nd s ubacromial s pace, s elective c apsulotomy, subacromial decompression and excision of the coracoid-brachial ligament in patients with resistant contracture of the shoulder joint, which persists 6 months after the rotator cuff repair, provides better average functional results according to the Constant Shoulder Score scale and a lower level of pain syndrome according to the VAS scale in 3 and 6 months after first surgery compared to patients who continued conservative treatment.

BIOMECHANICAL PARTICULARITIES OF KNEE JOINT FLEXION DEFOMATION IN RHEUMATOID ARTHRITIS PATIENTS

Sergiy Herasymenko — 2024-12-26

Objective. To research biomechanical particularities of knee joint flexion defomation in rheumatoid arthritis patients. Methods. The work is based on the analysis of the preoperative examination of 23 patients with RA with multi-plane deformations of the lower limb, who were treated in our clinic in the period from 2021 to 2024. The average age of the examined patients was (49.14 ± 6.37) years old. The quantitative assessment of contractures and computed tomography (CT) of the knee were performed on the patients. Results. As can be seen from the obtained results, the stresses in the contact zone on the lateral condyle of the tibial plateau increase by 36.71 % in conditions of flexion contracture of the knee 30°, on the medial condyle of the tibial plateau — by 36.64 %. It was established that the load on the condyles of the tibial plateau increased by 12.8 % in forced passive flexion of the knee joint by 6°, as a result of passive extension by 3° — the load on the condyles of the tibial plateau increased by 95.2 %, which is a critical and can lead to the degradation of bone tissue in the contact area and increase the risks of secondary arthrosis. Conclusions. The simulated solid 3D-model of the knee joint was developed and demonstrates that in the knee joint flexion position of 30º, according to the radius of curvature of the mediaal and lateral condyle, the contact area on the medial condyle of the tibial plateau is 2 times larger than that on the lateral one and is shifted slightly backwards. The standing with one support under the weight of a body 60 kg (600 N) in conditions of flexion contracture in the knee joint in a position of 30°, there is an increase in contact stresses on the external condyle of the tibial plateau by 36.71 %, on the internal condyle — by 36.64 %, which contributes to the progression of the clinical picture of RA with an increase in the phenomena of osteoarthritis specifically in the back parts of the knee joint.

THE TREATMENT OF KNEE JOINT INSTABILITY IN CONGENITAL LIMB DEFORMITIES

Yevhenii Yakushkin — 2024-12-26

The defect in the formation and subsequent genesis of crossed ligaments manifests as knee joint instability and is accompanied by a range of consequences of congenital developmental disorders of the lower limbs. Objective. To analyze and summarize the knowledge and practical experience in treating children with knee joint instability due to congenital developmental disorders of the lower limbs at the Children’s Orthopedic Clinic of the State Institution «Institute of Spine and Joint Pathology named after Prof. M. I. Sytenko of the National Academy of Medical Sciences of Ukraine». Methods. A prospective study was conducted on patients treated from 2019 to 2024, with a retrospective control group (32 healthy children) treated from 2008 to 2019. Results. Surgical intervention was performed using the classical SUPER knee procedure. Our team identified shortcomings and therefore added the Yamamoto procedure, as well as a combination of the Yamamoto procedure and tibial tuberosity transfer to improve treatment outcomes. Additionally, to correct moderate axis deformities of the limb, the method of hemiepiphysiodesis using our patented metal construction and instrumentation was preferred. Adequate rehabilitation treatment is a key stage in restoring knee joint function, as it reduces the risk of complications such as joint contractures and stagnant vascular manifestations in the lower limbs. Conclusions. Early and high-quality surgical treatment allows for the prevention of knee joint instability and enhances its functional capabilities. The modifications made to the SUPER knee procedure have improved knee joint stability in the postoperative period compared to the classical technique, as evidenced by the absence of medial instability and a lower degree of anterior displacement. Comprehensive treatment increases the functionality of the knee joints and reduces further degenerative changes, thereby improving the patient’s quality of life.

Comparative study between lateral shelf acetabuloplasty and combined procedure of lateral shelf acetabuloplasty with trochanteric epiphysiodesis in cases of Legg-Calves-Perthes disease — a retrospective study

Pulin Bihari Das — 2024-12-26

Legg-Calves-Perthes disease (LCPD) has a poor outcome leading to disability and early onset of osteoarthritis. Patient aged less than 8 years have usually good prognosis and are usually managed conservatively. The primary goal is to achieve spherical and congruent femoral head to reduce the chance of further subluxation of femoral head and secondary arthritis of the hip. Methods. The study aimed to analyze the radiological and functional outcomes of group-A (LSA) and group-B (LSA and trochanteric epiphysiodesis) in cases of LCPD. Our study retrospectively analyzed 80 patients (45 in Group-A and 35 in Group-B) between 2008 and 2018, 63 patients were boys and 17 patients were girls. Patients who did not respond to the conservative treatment over the course of 6 months and patients with Caterall type-II and III were taken into the study. Radiological parameters like Center edge angle, sharp angle, medial joint space distance, epiphysis height ratio, acetabular coverage, neck-shaft angle, articulo-trochanteric distance was noted for comparing radiological outcome. Results. Most of the patients in both the groups were Catterall-III — 66.25 % and Catterall-II — 33.75 %. According to Stulberg classification, excellent outcome was seen in 22.2 % of group A patients & 37.1 % of group B patients. Similarly, 15.5 % patients in Group A and 5.7 % patients in Group-B had bad outcome. Radiological and functional assessments were evaluated preoperatively and postoperatively till skeletal maturity which showed significant improvement in Group-B. 4 (8.8 %) patients in group-A and 3 (8.5 %) patients in group-B developed non-union & graft resorption was seen. Conclusions. Lateral shelf acetabuloplasty along with trochanteric epiphysiodesis helps in improving the neck shaft angle, gait, containment of subluxated head and maintains its congruity along with physiological remodeling. We recommend this combined procedure in cases of LCPD to counter the complications of early-onset arthritis and femoral head subluxation.

EXPERIMENTAL EVALUATION OF THE EFFECTIVENESS OF CO2 APPLICATION IN A CARRAGEENAN MODEL OF INFLAMMATION: NEW PERSPECTIVES IN THE TREATMENT OF OSTEOARTHRITIS

Viktor Shtroblia — 2024-12-26

Osteoarthritis (OA) is a chronic degenerative joint disease that leads to pain and limited mobility. Inflammation is a key pathogenetic factor in OA, which is accompanied by the activity of pro-inflammatory cytokines. One of the most promising methods of treating inflammation is carboxytherapy (CO₂), which has low toxicity and physiological safety, but its interaction with other anti-inflammatory drugs is not well understood. Objective. To evaluate the anti-inflammatory effect of CO₂ in animal models of carrageenan inflammation and to study its combined use with diclofenac and chondroitin. Methods. The study was conducted on 56 Wistar rats, which were randomly divided into 7 groups. Inflammation was modelled by injecting carrageenan into the limb of the animals. Prophylactic injections of anti-inflammatory drugs (diclofenac, chondroitin) were performed intraperitoneally and CO₂ subcutaneously one hour later. The size of the edema was analysed 1, 2, 3 and 5 hours after the injection. The rectal temperature of the animals was also measured to determine the overall inflammation. Results. One hour after the administration of carrageenan, the volume of the limb in group VII decreased to (0.429 ± 0.020) ml (p < 0.001), and in group VI — to (0.441 ± 0.017) ml (p < 0.001). After 2 hours, the maximum decrease in limb edema was observed in group VII — (0.491 ± 0.017) ml (by 52 %, p < 0.001), and in group VI — (0.495 ± 0.012) ml (by 38 %, p < 0.001). After 5 hours, the size of the limb edema in group VI decreased to (0.559 ± 0.030) ml (by 51 %, p < 0.001), and in group VII — to (0.571 ± 0.016) ml (by 46 %, p < 0.001). Rectal temperature in group VI decreased to (37.7 ± 0.3) °C (by 1.5 °C, p < 0.001), and in group VII — to (38.3 ± 0.2) °C (by 0.9 °C, p < 0.001). Conclusions. Carboxytherapy has a pronounced anti-inflammatory effect, which is manifested in the reduction of edema and temperature, especially when combined with diclofenac or chondroitin. Further research may be aimed at studying the possible mechanisms of the positive effect of CO₂, optimising therapeutic regimens and determining the long-term effects of carboxytherapy.

CHANGES IN FEMORAL BONE MINERAL DENSITY WITH ALLOGRAFT DURING REGENERATION DEPENDING ON BIOLOGICAL THERAPY AND RAT AGE

Petro Vorontsov — 2024-12-26

In orthopedic and trauma surgery, bone defects are an increasing clinical problem in daily practice. To fill them, many advantages have bone allografts (BA), namely a large stock of transplantation material. Purpose of the study: to evaluate changes in bone mineral density (BMD) of the femur of rats after filling a distal metaphyseal defect with an bone allograft in combination with the simultaneous administration of mesenchymal stromal cells (MSCs) or platelet-rich plasma (PRP) depending on age. Methods. The model of the hole defect in the metaphysis of the femur in rats (aged 3 and 12 months) investigated BMD in terms of filling BA, including, with the simultaneous administration of MSCs or PRP during surgery. Results. In rats with an unfilled defect — the immutability of BMD during the experiment. Compared with 3-month-old rats in 12-months-old rats with BA BMD was 1.11 times higher on the 14th day (p < 0.05), and on the 90th day it was 1.11 times lower (p < 0.05), on the 28th day it was not differed. In the 3-month-old rats with A and MSC showed a 1.20-fold lower BMD (p < 0.05) on the 28th day, and on the 90th day BMD did not differ compared to the group with BA. BMD in 12-monthold rats with BA and MSC did not differ from the group with BA. In in 12-month-old rats with BA and PRP BMD was 1.18 times (p < 0.05) higher on the 28th day and on the 90th day — 1.14 times (p < 0.05) compared to the BA group, and in 3-month-old rats did not differ for all terms. Conclusions. In the case of filling a bone defect with a bone alograft in 12-month-old rats, the increase of BMD of the femur is slower than in 3-month-old rats. The use of BA with MSCs in younger rats causes a delay in bone regeneration on the 28th day, but does not disrupt this process, according to BMD on 90th day compared to rats with BA, and in older rats does not significantly change BMD during the study. Filling defect BA with PRP promotes the growth of femoral BMD in older rats from the 28th d ay, b ut i n y ounger r ats it d oes n ot c ause significant changes compared to the group with BA.

Regulation of reparative processes of proximal femur fractures by correction of arterial hypertension (experimental study)

Sergiy Pavlov — 2024-12-26

Objective. To study the regulation of reparative processes of proximal femur fractures at intramedullary osteosynthesis against concomitant arterial hypertension correction (by IFN-γ and biochemical parameters). Methods. The experiment involved 36 rats from two groups: healthy normotensive rats and rats with genetically determined arterial hypertension (SHR). Animals of both groups were divided into subgroups. The rats of subgroups 1.2, 2.2, and 2.4 underwent closed mini-invasive intramedullary osteosynthesis after a simulated proximal femur fracture. Rats of subgroups 2.3 and 2.4 were corrected for arterial hypertension with enalapril. The levels of IFN-γ, total protein, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were determined in the serum of the animals. In the animal groups bone density indices were measured and the relative area of newly formed bone tissue in the bone callus was determined. Results. The level of IFN-γ was elevated after surgery in animals of all groups. The level of this cytokine was higher in SHR rats compared to the same values in intact animals. Administration of enalapril decreased the concentration of IFN-γ. A multidirectional change in the levels of biochemical indices in the blood of animals was demonstrated. It was found that bone mineral density was significantly reduced in the SHR animals group compared to intact animals. According to histomorphometric analysis, the largest relative area of newly formed bone tissue in the bone callus was in intact rats. The relative area of bone trabeculae in the animal group receiving enalapril therapy was greater than in the untreated group. Conclusions. Correction of concomitant arterial hypertension leads to optimization of repair processes of the proximal femur fractures in an experiment.