ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS

Violation of consolidation of the femur after untimely dynamization of the intramedullary blocking rod

Diomyd Chabanenko — 2021-10-12

Violation of femoral fracture consolidation after blocking intramedullary osteosynthesis is a fairly common pathology, and requires the attention of physicians due to its prevalence. There are several reasons for this complication: it is the instability in the system «bone-implant», and the untimely dynamization of the locking nail. Methods. This article presents a case of fracture violated consolidation after blocking intramedullary osteosynthesis caused a nonunion due to nail failure. Results. Patient was injured on 29.12.2018, as a result of a traffic accident. 01.15.2019, the surgery was performed: closed reduction, blocking intramedullary osteosynthesis of the fracture of the middle shaft of the right thigh, static fixation of the nail. Next visit to the clinic was on 02.01.2020, because of pain in the middle third of the thigh, problems with axial weight-bearing on the right leg, limitation of the flexion in the right knee joint. Control radiographs demonstrated no signs of consolidation of the femoral shaft fracture, and migration of the distal locking screw. 08.01.2020 revision surgical treatment was performed. Given the presence of 5 mutually perpendicular holes in the distal part of the nail, two of them were locked in the anterio-posterior view by the free hand method, the migrated screw in the distal part of the nail was replaced, and the nail was dynamized in the proximal part taking into account its design features. Conclusions. To normalize the consolidation processes in patients with nonunion femoral fractures, bone physiology and the positive effect of autocompression should be considered. The described case demonstrates the necessity for timely dynamization of the blocking nail, which confirms our own observations and literature data. Despite the fact that the dynamization of the nail was performed 1 year after blocking intramedullary osteosynthesis, fracture consolidation occurred 5 months after its implementation. Key words. Femoral fracture, blocked intramedullary osteosynthesis, disorders consolidation, dynamization of the construction.

Features of medical care in patientswith elbow joint gunshot wounds

Aleksandr Loskutov — 2021-10-12

Gunshot wounds of the elbow joint are the third most common after knee and shoulder injuries. Features of the anatomical and functional structure of the elbow joint, the close location of the vascular and nervous formations, favorable conditions for the development of infection determine the severity of gunshot wounds and cause the complexity of its treatment. Objective. To evaluate the frequency and nature of the elbow joint gunshot wounds in the structure of the general combat injuries, as well as to determine the volume of medical care and direction of treatment of such injuries in the conditions of the regional hospital as a stage of care. Methods. A retrospective study included 1 809 patients (96.0 % of men, mean age (33.7 ± 0.2) years). Firearms limb injuries were detected in 1 013 (56.0 %) of all victims, of which the elbow joint — 25 (2.47 %). Mines and explosives injuries were in 22 (88 %) of the patients, bullet — in 3 (12 %). Results. Tactics of treatment of elbow joint gunshot wounds depended on the severity of the condition of the victims and the nature of concomitant traumatic injuries. In the structure of combat injury of the elbow joint the majority was combined (52 %) and multiple (40 %) injuries and was accompanied by gunshot fractures in 60 %. In patients who were in severe state, applied the tactics of Damage control in two stages. At the first stage the fractures were fixed with plaster splints or external fixation devices (EF), the wounds were not subjected to full surgical debridment (SD), but only washed with antiseptics and the visible foreign bodies were removed. In patients with soft tissue injuries wounds the primary SD was performed according to general principles, injured nerves were not restored. In the second stage, after patient is stabilized, the repeated SD of the wound was performed. After their uncomplicated healing the EF was removed and the method of fixation was changed to internal osteosyntesis. Conclusions. It is recommended to perform stabilization of intra-articular gunshot fractures of the elbow joint with EF and after uncomplicated wound healing go to the internal osteosynthesis. Key words. Elbow joint, gunshot wounds, treatment.

Comparative analysis of weight-bearing function of lower extremities in children with recurrences of congenital equinovarus clubfoot after surgical treatment by «traditional» methods and Ponseti method

Sergij Khmyzov — 2021-10-12

Congenital equinovarus clubfoot (EVC) is the second most common congenital anomaly of the musculoskeletal system in children and one of the most common causes of childhood disability in Ukraine. The frequency of EVC reaches 1–3 cases per 1 000 newborns (35–40 % of all foot deformities). Objective. To determine the features of the children ability with EVC recurrences, before and after surgical treatment by «traditional» methods and Ponseti method. Methods. Biomechanical examinations of 65 children with EVC recurrences were performed. They were divided into two groups: group I (33 patients) — treated by «traditional» methods, which provided initial surgery, in order to completely correct all components of the deformity; group II (32 patients) — treatment by Ponseti method. Weight-bearing function was studied for all patients, before treatment, after 6 and 12 months after surgery, with statography. Results. It was determined that the standing parameters in the groups were not statistically different. After 6 months after the treatment, according to the statograms, the weight-bearing displacement remained, under the conditions of two weight-bearing standing towards the contralateral limb, in both groups of patients. In group I, after treatment, this parameter did not change (p = 0.924), and in group II it decreased by (2.7 ± 4.7) % (p = 0.013). Weight-bearing on the operated limb in both groups, in 12 months from surgery increased by 45 %. Conclusions. In patients, after treatment of EVC recurrences by Ponseti method, the weight-bearing function indicators, in the case of two weight-bearing standing, changed statistically significant. During the recovery process, when patients began to load the operated foot, a slight deterioration of standing parameters was observed in patients of group I in 6 months from surgery. In patients of group II, a complete restoration of statographic parameters occurred earlier, in 6 months, a normalization of weight-bearing and stability was observed. Thus, it can be argued that the use of Ponseti method in the complex treatment of EVC allows to restore the ability of weight bearing much earlier than with the «traditional» method. Key words. Congenital talipes equinovarus, children, Ponseti method, statography.

The value of the plate mechanical properties in a case of thoracoplasty at the congenital pectus excavatum

Valerii Dihtiar — 2021-10-12

Surgical treatment of a congenital pectus excavatum (CPE) includes using of a plate that holds the correct anatomical shape of the chest for a long time. Before implanting the plate behind a sternum, it is bent so that after correcting the deformation, it reproduces shape of the ribs on both sides and fits close to them. Displacement and rotation are the most frequent complications after plate implantation. Therefore, mechanical properties of the plate, such as: strength, ability to withstand the load during surgery and in the long term period — is one of the main guarantees to obtain the good result. Objective. To study the mechanical properties of the plate which is used for thoracoplasty at CPE under conditions comparable to real loads in order to gain maximal correction. Methods. Experimental bending tests were performed on 5 standard plates of 2.5 mm thick, 13 mm width and 200 mm length, made from titanium Ti6–AL4–V (according to ISO 5832-3). All plates were bent with a special surgical instrument according to the anatomical shape of a chest, using method of surgery by D. Nuss. All plates supports were placed on a distance from the fixing screws. The force of bending load was applied to the middle of the plate, gradually increasing from 150 to 600 H with a step 50 H. At each value of the loading we measured the height of the plate edge elevation. Results. Under load conditions of 600 H, the elevation of a plate edge did not exceed 3 mm and was equal to (2700 ± 177) μcm. In a case of twice lower loads (300 H), value of lifting edge of the plate decreased in three times and was (700 ± 85) μcm. Changes that happened under loading were the same for all five types of the plate. Conclusions. It is proved that the plates can fully withstand corrective loads with a minimal deformation after thoracoplasty. The discrepancy between the plate shape in the lateral parts to the restored thorax is caused by the changing of configuration of the last one and increasing in the anteroposterior size. Key words. Plate, mechanical properties, thoracoplasty.

MRI analysis of ACL tendon graft Intracanal Incorporation with polypropylene mesh implantation

Maxim Golovakha — 2021-10-12

Hamstring tendon graft remains one of the most popular for ACL reconstruction (ACLR). However, its disadvantage is long term ligamentation process and intracanal incorporation and delayed rehabilitation. One of the methods for stimulation of connective tissue growth is the implantation of polypropylene mesh (PPM), which are widely used in hernioplasty. Objective. To compare the MRI data dynamics of intracanal incorporation of tendon graft with implantation of PPM in bone canals. Methods. For evaluation of graft reconstruction in the femoral and tibial canals we used criteria based on the analysis of MRI images in PD FS and STIR sequences: the nature of the signal from the graft in the center of bone canal; general view of the graft; the nature of the MRI signal from the tissues around the graft on the tendons-bone border; the presence of synovial fluid in the canals and bone edema around them. Results of MRI of 75 patients who underwent «all-inside» ACLR with semitendinosus graft were analyzed. In the study group (40 patients) were compared to control group (35 patients) additionally implanted PPM around the ends of the tendon graft. Results. Intracanal graft incorporation in the group of patients with implantation of PPM occurred faster. The nature of the signal from the center of the bone canal and on the bone-tendon border progressed significantly faster in all observed terms. In the research group there was not presence of synovial fluid in the canals along the graft. Conclusions. Implantation of PPM around the ends of the ACL tendon autograft immersed in bone canals, leads, according to MRI data, to faster intra-canal incorporation. Key words. Knee joint, anterior cruciate ligament, arthroscopy.

Treatment of patients with complicated fractures of the distal humerus using the fixators of limited-contact multiplanar osteosynthesis

Petro Bilinskyi — 2021-10-12

Treatment of distal humerus fractures is a complex problem in traumatology. The result of treatment depends on the choice of fixator according to the fracture area. Objective. To improve the technology of treatment in patients with complicated distal humerus fractures with fixators of small contact and multiplanar osteosynthesis and to evaluate its efficacy. Methods. 39 patients were treated for the period 2000–2020 with distal humerus nonunion (types 12-B1, 12-C1, 12-C2) and 23 patients with complicated above- and transcondylar humerus fractures (types 13-A2, 13-C1, 13-C2). Fixation of bone fragments of the distal humerus was made with device for fixation (Patent 17502 UA). It is a shaped plate with a groove on which half rings with threaded holes are stabilized. For the osteosynthesis of above- and transcondylar humerus fractures we used V-shaped plate with the possibility to regulate branch spreading width as for the condylar size (Patent 33358 UA). Autografting was performed as for necessity. Results. Plate osteosynthesis was performed mainly through anterior approach with minimal tissues traumatization. Release of radial nerve we made as for necessity. This device provides the stable fixation even in a case of short distal fragment. Device for bone fragments fixation was placed on the posterior condylar surface and lower part of the humerus through olecranon osteotomy. Osteosynthesis with suggested device is one of the options with bone autografting and can be method of choice at repeated surgery. Follow-up period was 1–2 years and later. In 60 patients we obtained good results with completed bone union. Conclusions. Suggested device can be used in cases of distal humerus nonunion. It allows to decrease the damage of surgery, to avoid many complications. Key words. Complicated fractures of the distal humerus, devices for limited-contact multiplanar osteosynthesis.

Retrospective medico-social analisys of the results of treatment patients with the concequences of long bone fractures

Volodymyr Tankut — 2021-10-12

The problem of long bones fractures treatment remains actual, despite a significant number of studies carried out on this topic. Such fractures of the musculoskeletal system occur more often and are accompanied by various complications, significantly compromise the quality of patients life and often lead to the disability. Objective. To analyze different types of traumatic injuries in patients with the consequences of long bone fractures, to evaluate the effectiveness of diagnostics, treatment and to analyze the state of disability. Methods. A retrospective medical and social analysis of the results of treatment of 333 patients (232 (69.6 %) men, 101 (30.4 %) women) with the consequences of long bone fractures, based on the obtained study group in the Kharkiv Regional Center for Medical and Social Expertise № 2, for the period 2018–2019. Results. Three main methods of surgical treatment were analyzed: internal fixation (ORIF), blocking intramedullary nailing (IMN) and treatment with external fixation devices (EF). They were applied in the following rate: ORIF — 204 (61.3 %) cases, IMN — 98 (29.4 %), EF — 31 (9.3 %). The most typical complications of the treatment of patients with fractures of the long bones were delayed union or nonunion, neuropathies of the treated extrimities, joint contractures, osteoarthritis of adjacent joints, deformities of affected extrimities, osteomyelitis. Causes of disability were: 63 % — severity of injuries, 46 % — different posttraumatic complications, 6.5 % — iatrogenic complications. Among the latter, the most common were: diagnostic — 7.1 %, incorrect method of treatment — 29.7 %, iatrogenic incorrect surgery methods — 45 %. Conclusions. The data obtained showed that the improvement of organization measures for the prevention of complications and disability in patients with consequences of long bones fractures could help to increase the efficiency and quality of specialized medical help. Key words. Fractures, long bones, limbs, consequences, complications, disability.

Morphometry of the shoulder joint and justification of new modular reverse shoulder endoprosthesis sizes using computed tomography data

Mykola Korzh — 2021-10-12

Reverse shoulder arthroplasty is effective surgery because most of patients have positive long-term results. However, the search for the «perfect» endoprosthesis continues. Objective. To justify the dimensions of a new modular reverse shoulder endoprosthesis using additive technologies based on spiral computed tomography data. Methods. Two data sets of healthy shoulder joints (right — R, left — L) of 100 patients obtained on a spiral computed tomography AQUILION 128 sections (Toshiba, Japan) were processed. Each set consisted of 11 morphometric parameters — linear and angular values. For each of them, three data samples (combined, R and L) are calculated: minimum, maximum, mode, median, mean, standard deviation, distribution asymmetry coefficient. Pearson’s correlation coefficient was calculated, cluster analysis was performed. Results. It is proved that most of the parameters of R and L data sets can be considered homogeneous and can be analyzed as a combined group of 200 cases. It was found that the width and height of the glenoid are more homogeneous data sets, and the value of the endosteal diameter of the humerus decreases in the distal direction. The cervical-diaphyseal angle averages 137.4° ± 4.66°. The correlation between different parameters is more pronounced within most clusters than in the sample as a whole. Conclusions. It is necessary to create different sizes of the distal part of the conical stem, to which securely fix a wide proximal part, as well as in different sizes, in the form of a cup for fixing the liner. The height of the proximal part of the reverse shoulder endoprosthesis should be not less than 20 mm, the diameter of the base of the proximal parts of the stem — 38, 40, 42 mm. It is proposed to use a conical stem of the implant with a wider proximal part, to create the angle 135° between the cup of the proximal part and the stem. Three standard sizes of basic glenoid plates with a diameter of 26, 30, 32 mm are defined. Key words. 3D-printing, arthroplasty of the shoulder joint, glenoid, cluster analysis, correlation analysis.

Modelling of degenerative changes in paravertebral muscles for studying of its influence on spine diseases

Volodymyr Radchenko — 2021-10-12

An important component of the development of degenerative changes in the spine is damage and disruption of the vital activity of the paravertebral muscles. Objective. Based on the analysis of biochemical parameters of laboratory rats serum we evaluated the suitability of the studied models of dystrophic muscle tissue lesions for further study of the development of degenerative-dystrophic disorders in the spinal motor segments. Methods. Simulated: group I (5 female rats) — alimentary obesity by keeping for 3 months. on a high-calorie diet (hyperlipidemic diet); group II (5) — ischemia by ligation for 45 days of large back rectus muscles the with suture material that is not absorbed. Control — 5 intact animals of the same age and sex, which were kept on a standard diet. Serum levels of glycoproteins, haptoglobin, total chondroitin sulfates (CHS), glucose, cholesterol, low-density lipoproteins, triglycerides, total lipids, activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline and acid phosphatases, creatine phosphokinase were defined, thymol test was determined. Parameters were processed by the Fisher–Student method. Results. In the I group of rats, the content of glycoproteins, total cholesterol and lipids, low-density lipoproteins, triglycerides, glucose, CHS, ALT and AST activity, thymol test values were increased and the level of creatine phosphokinase activity was decreased. In animals of group II, an increase in serum activity of creatine phosphokinase, glycoproteins and CHS was recorded. Conclusions. Changes in the serum biochemical parameters of white rats recorded on a hyperlipidemic diet indicate the development of fatty degeneration, including in muscle tissue. Biochemical signs of degenerative processes in muscle tissue have been identified as a result of simulation of paravertebral muscle ischemia. Key words. Muscle, disorders, degeneration, spine, modeling, hyperlipidemia, ligation, biochemistry.

Margaryta Ivanivna Hohol

Staff of "ORTHOPAEDICS, TRAUMATOLOGY AND PROSTHETICS" — 2021-10-12

On January 23, 2021, Margarita Ivanivna Khokhol celebrated her 90th birthday. and a wise woman.

Lev Mykolajovych Ankin

Staff of "ORTHOPAEDICS, TRAUMATOLOGY AND PROSTHETICS" — 2021-10-12

January 12 marked the 85th anniversary of the outstanding personality. known to a scientist in the field of trauma and orthopedics to Lev Mykolayovych Ankin.

Natalia Oleksandrivna Ashukina

Staff of "ORTHOPAEDICS, TRAUMATOLOGY AND PROSTHETICS" — 2021-10-12

N.O. Ashukina made a significant contribution to the bot of the trade union of the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, The functioning of the internal audit system organization and information support branches of the institution in international scientometric bases.

The impact of hip-spine relations on the results of total hip arthroplasty (literature review)

Mykola Korzh — 2021-10-12

Spine balance can alter THA outcomes, but the exact mechanism is not yet well recognized. We aimed at bridging the gap between hip and spine surgeons with an up-to-date analysis of the best available literature review concerning to data as for total hip arthroplasty results of those patient with concomitant spine disorders. In total hip arthroplasty accurate acetabular cup placement is essential for impingement free and stable range of motion. For decades, hip surgeons have relied on traditional safe acetabular zones to reduce prosthetic instability. Nevertheless, hip dislocation is one of the most common complications following total hip arthroplasty. Numerous studies have shown that patients with abnormal spinopelvic mobility due to degenerative spinal diseases and after spinal fusion surgery had an increased rate of dislocations after THA. In our review we described the main spine-pelvic parameters, such as pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis etc. and spino-pelvic motions and how they can change in standing and sitting postures. Measurements of these parameters are necessary for presurgical planning before hip arthroplasty especially those patients who had previously made spine fusion. A review of literature shows that sagittal pelvic kinematics, but not the pelvic incidence, influences the risk of prosthetic impingement or dislocation. Pelvic position is dynamic during gait and other daily living activities. Variations in anteroposterior pelvic tilt affects the resulting spatial orientation of the acetabulum. Recommendations for cup positioning are switching from a classic Lewinneck safe zone to a patient-specific approach, with the standing cup orientation giving way to a new parameter of interest: the functional orientation of the cup. Thus, functional cup anterversion should be taken into consideration. Abnormal spinopelvic mobility is a risk factor for THA dislocation. Thus patients with combined spine and hip pathology are at higher risk for further complications and they should be identified and screened more carefully. Key words. Spine-pelvic relations, sagittal alingement, hip arthroplasty, dislocation

Knee joint instability in conditions of congenital malformations of the lower extremities

Sergij Khmyzov — 2021-10-12

It is impossible to find out the number of patients with knee joint instability (KJI) in case of congenital malformations of the lower extremities (CMLE). Children, adolescents and young people usually adapt well to this abnormality, so they rarely present with symptoms of instability, even with positive tests. The main reasons for the manifestation of KJI in CMLE are inadequate loading, injuries of the lower extremity and surgical correction. Objective. Based on the assessment of the scientific literature to define the KJI terminology, to identify the main causes of its development and clinical manifestations in conditions of CMLE, to identify trends in the treatment tactics. Methods. More than 500 articles from international libraries PubMed, NCBI, Google Scholar, Medscape, MedlinePlus were searched and analyzed. Taken into account the rarity of the abnormality and the small amount of research in recent years, the depth of the search was 25 years. Results. KJI in children with CMLE may be a consequence of congenital structural features of the lower extremity (isolated malformation in the form of agenesis of the cruciate ligaments or inferiority of the ligament of the knee joint in complex abnormality) and complication of surgical correction of longitudinal defects of the extremities. As the abnormality is not well studied, the tactics for such patients still remain the topic of discussion. The expediency of surgical stabilization of the knee joint has not been conclusively proven due to the fact that in the case of its anomalies certain adaptive mechanisms are formed, which on the one hand are not appropriate to violate, and on the other hand, the current level of medicine allows to promote patients’ functional capabilities, inducing KJI progressing. Conclusions. Children with CMLE adapt well to the concomitant KJI, so in everyday life and prior to surgical correction of CMLE, it does not bother patients. Particular attention should be paid to the stability of the knee joint both before and during prolongation and correction of deformity. The variability and severity of CMLE determines the implementation of multi-stage surgical treatment and surgical stabilization of the knee joint to improve extremity function may be one of them. Key words. Children, knee joint instability, congenital malformations, lower extremities, surgical treatment.

Comparative evaluation of polymethylmethacrylate and composite bone cements. Review of the experimental studies results

Oleg Vyrva — 2021-10-12

Current article is a review of experimental studies of different bone cements types and their combinations. Providing of bone fragments stable fixation at osteosynthesis in cases of difficult multifragmental fractures, arthroplasties and other implants using especially in the osteoporosis conditions is a main task of orthopaedic surgery procedures. Polymethylmethacrylate (PMMA) is the first material that is answered to these requirements. The evolution of bone cements resulted in creation of a new composite substance — combination of PMMA and β-threecalciumphosfates (β-TCPh). Combination of these two components allowed to provide high bioabsorbal, osteoconductive and osteointegrative properties along with sufficient durability. In the analyzed works the properties of composite cement CalCemex were evaluated in vivo experiment. It was found that in the case of PMMA penetration of bone tissue into the polymer structure did not occur. Under the conditions of using bone cement with β-TCF admixture, the formation of bone tissue was observed not only on the surface of the implant, but also in the external and internal pores. It is the presence of pores in CalCemex that the authors explain the possibility of penetration of cellular elements, blood vessels and bone formation. Moreover, β-TCPh is included into this material and it is bioresorbed by osteoclasts. This leads to the release of calcium and phosphorus ions and, consequently, simplifies the attachment of the newly formed bone to the bone cement. We assume that composite cement like CalCemex type is a promising material for the treatment of various types of fractures and replacement of bone defects. It should be mentioned that research in this area is ongoing and intensive work is underway to synthesize and study the results of clinical application of composite bone cements with maximum bioactive properties that will not only strengthen bone tissue but also perform osteointegrative function. Key words. Bone cement, polymethylmethacrylate, β-threecalciumphosfates, experiment.

Molecular hydrogen as a possible therapeutic factor in complex rehabilitation therapy in patients with muscular skeletal disorders (literature review)

Vasyl Makolinets — 2021-10-12

The paper presents an analysis of foreign scientific and medical data on the therapeutic factor — molecular hydrogen. The effectiveness of its application in the complex therapy of many diseases is revealed. The effect is achieved due to the small size of the molecule, which passes through biological membranes and inhibits dangerous free radicals in the mitochondria, as well as in the nucleus, which reduces the possibility of DNA damaging. Molecular hydrogen neutralizes oxidants in the brain due to its ability to cross the blood-brain barrier. It normalizes the functions and metabolic processes in the body and, as an antioxidant, is selective: it does not affect the useful free radicals involved in important metabolic processes and selectively eliminates only the most dangerous oxidants — hydroxyl radicals. Interacting with them, hydrogen converts them into water molecules without the formation of by-products and chain reactions. Unlike other known antioxidants, molecular hydrogen does not disrupt normal metabolism, does not cause negative changes in cells, activates the body’s own antioxidant systems. The possibility and expediency of the use of molecular hydrogen in the case of pathology of the musculoskeletal system has been confirmed. The peculiarities of its effect on bone and cartilage tissue in the experiment are shown. It has been determined that the use of molecular hydrogen is a new pharmacological strategy aimed at the selective removal of ONOO—, and can be an effective method in the treatment of joint diseases. Because cartilage receives nutrients through a diffusion-loading mechanism, and molecular hydrogen penetrates rapidly into tissues, it can be useful for the prevention of diseases of joints of degenerative origin. It reduces oxidative stress and slows down the reduction of matrix proteins and inhibition of proteinase degradation. Its effectiveness has been proven after injuries to the spinal cord, muscles and tendons, comorbid diseases such as hypertension, coronary heart disease, diabetes and metabolic syndrome. Key words. Molecular hydrogen, hydrogen water, hydrogen inhalations, joint diseases, consequences of musculoskeletal injuries, comorbid pathology.