ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS
http://otp-journal.com.ua/
<div id="focusAndScope"> <p><img src="http://otp-journal.com.ua/public/site/images/nataliya_ashukina/-0.jpg" width="300" height="424" align="left" /></p> <div align="justify"> <p><strong><em><span style="color: #008000; font-size: medium;"> ISSN(p):</span></em></strong> 0030-5987</p> <div align="justify"> <p><strong><em><span style="color: #008000; font-size: medium;"> ISSN(e):</span></em></strong> 2518-1882</p> </div> <div align="justify"> </div> <div align="justify"> <div align="justify"> <p><strong><em><span style="color: #008000; font-size: medium;">Identifier in the register of media entities - </span></em></strong>R03-01369.</p> <p><strong><em><span style="color: #008000; font-size: medium;">Field of Science:</span></em></strong> Medical Sciences</p> <p><strong><em><span style="color: #008000; font-size: medium;">Periodicity:</span></em></strong> 4 times a year</p> <p><strong><em><span style="color: #008000; font-size: medium;">Languages of Publications:</span></em></strong> Ukrainian, English </p> </div> <div align="justify"> <div align="justify"> <div align="justify"> <div align="justify"> <div align="justify"> <p align="right"> </p> <p align="right"> </p> </div> </div> </div> </div> </div> </div> </div> </div>Редакція журналу «Ортопедія, травматологія та протезування»en-USORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS0030-5987<p style="text-align: justify;">The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of <a href="http://creativecommons.org/licenses/by/4.0">Creative Commons Attribution License</a>, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.</p> <p style="text-align: justify;">Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.</p> <p style="text-align: justify;">The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).</p>USING 3D PRINTING FOR OPEN REDUCTION OF CHRONIC POSTERIOR SHOULDER DISLOCATION (CASE FROM PRACTICE)
http://otp-journal.com.ua/article/view/296499
<p align="justify">Objective. An example of the treatment of a patient with chronic posterior dislocation of the shoulder, previously operated on by the Latarge technique due to recurrence of anterior instability, is given. Methods. The patient presented with an old fixed posterior dislocation of the left shoulder joint, large bone defect of the front part of the head (reverse Hill-Sachs). The patient has already undergone 2 operations on the left shoulder due to chronic anterior dislocation of the humeral head: 2018 — arthroscopy and capsuloplasty according to Bankart; 2020 — arthrotomy with Latarje transposition (due to recurrence of anterior instability). The peculiarity of this case is a bone block with screws located on the front surface of the glenoid made a massive defect front part of the humeral head. Planning performed on the basis of a CT scan of the shoulder joint in the FreeformPlus program. Assessment of functioning performed on the QuickDASH and Constant scales. The results. To improve the performance of intraoperative osteoplasty of the defect, a plastic model of the humeral head was printed for simulating bone graft and osteosynthesis. According to the QuickDASH scale before the operation, the patient had 45 points, that is, a significant decrease in the function of the upper limb — constant discomfort, pain. After surgery for 2 days — 35 points, 6 weeks — 12, and 3 months. — 12 points, that is, the patientʼs quality of life has improved significantly. According to the Constant scale before the operation, there were 16 points, of which: pain — 6, household activity — 2, range of motion — 8. After surgery on the 2nd day, a total of 33 points: pain — 10, household activity — 7, range of motion (passive) — 16, after 6 weeks — 80 points, this result remained after 3 months. Conclusion. The use of three-dimensional planning and an individual tool greatly facilitated the main stages ofsurgical intervention in the case of chronic posterior dislocation of the humeral head and made it possible to quickly and conveniently prepare a bone graft and install it in the defect. The printed navigation made it possible to perform a stabilizing osteosynthesis, ensure high patient satisfaction and a good functional result.</p>Maxim GolovakhaStanislav Bondarenko
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2024-01-162024-01-164939710.15674/0030-59872023493-97Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)
http://otp-journal.com.ua/article/view/296504
<p align="justify">Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up</p>Bohdan RomanyshynAlexander SchchurovskyG. Ulrich Exner
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2024-01-162024-01-1649810210.15674/0030-59872023498-102MULTICENTRIC OSTEOSARCOMA AS A RARE TYPE OF OSTEOSARCOMA (CASE REPORT)
http://otp-journal.com.ua/article/view/296511
<p align="justify">Multicentric osteosarcoma (M-OGS) is classified as a special type of osteosarcoma, which is characterized by multicentric bone lesions without visceral organs involvement in the tumor process. Synchronous type of the lesion is noted when several foci of osteosarcoma are diagnosed at the same time, whereas metachronous type may develop additional foci 6 months after the primary tumor diagnosis. This type of osteosarcoma is very rare with only a few articles describing this pathology. Objective. Present a clinical case of rare pathology — multicentric osteosarcoma. Materials and methods. Clinical, radiological, pathomorphological data of a patient with multicentric osteosarcoma. Data on the results of treatment of the patient. Results. Multicentric osteosarcoma It accounts for about 1.5 % of all cases reported worldwide. Fuchs et al described a multifactorial etiology of this pathology, considering it a part of hereditary diseases, such as Rothmund-Thomson, Li-Fraumani, Bloom syndromes. Patients with Pagetʼs disease or McCuneAlbright syndrome have also been diagnosed with multicentric M-OGS. Tumor genetic predisposition has been described as one of the etiology factors, where a genetic mutation is detected. While studying the nature of multicentric M-OGS, various scientists have created classifications of this lesion. Taking to account all clinical and radiological data, a differential diagnosis comes to multiple metastatic lesions of carcinoma, chronic recurrent osteomyelitis and hyperphosphatasia. Conclusions. Multicentric osteosarcoma is a highly malignant and aggressive tumor that has a characteristic clinical presentation in the form of multiple bone lesions without visceral organs involvement. Mandatory patient monitoring after a comprehensive treatment allows to detect a spread of tumor process, as well as verify this rare pathology and choose the best treatment course. </p>Yanina GolovinaOleg Vyrva
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2024-01-162024-01-16410310810.15674/0030-598720234103-108RECOVERY OF STABILIZING MUSCLES THAT PROVIDE A VERTICAL POSITION OF THE TRUNK IN PATIENTS WITH POST-TRAUMATIC DEFORMITIES OF THE LONG BONES OF THE LOWER LIMBS IN THE DISTANT PERIOD
http://otp-journal.com.ua/article/view/296489
<p align="justify">Rehabilitation treatment in the case of posttraumatic deformities of long bones of lower extremities (PDLBLE) in the distant period after trauma is aimed at the restoration of support ability of lower extremity while walking and standing. Objective. To work out the set of the exercises targeted on the restoration of muscle-stabilizer function in patients with (PDLBLE) Methods. Research group — 40 patients who received closed injuries of the long bones of the lower limbs, initial trauma occured 6–12 months ago. Among them were 21 women. (52.5 % of persons; age 27–73 years) and 19 men (47.5 % of people, age 29–77 years). The comparison group included 40 healthy volunteers, among which there were 12 women (30 % of persons; age 24–50 years) and 28 men (70 % of people, age 31–49 years). The assessment was carried out before and after rehabilitation for 2 weeks. Parameters evaluated: pain scores on VAS, the results of restoring the support ability using the scale of Tyazhelov O. A. Results. The results of observations are given, where in addition to descriptive statistics (minimum, maximum, average meanings), parameters of support ability and VAS, in patients and volunteers before and after treatment, cumulative group indicators (CG) were calculated for each group at the beginning (CG0) and 2 weeks after rehabilitation (CG1); the «rehabilitation» coefficient as a ratio of group indicators before and after treatment was calculated as well. Cumulative group indicator after rehabilitation (CG1) increased to 2 995 points, which indicates an increase in support ability. Cumulative group VAS score after rehabilitation (CG1) decreased to 116 points from 200 points before rehabilitation — reduction of pain in patients. After rehabilitation, volunteers showed a slight increase in the cumulatory group indicator (CG1) to 3 917 points. Conclusions. The system of rehabilitation of patients with PDLBLE in the remote period after injuries proved its effectiveness in restoring muscle-stabilizers vertical position of the trunk, pelvis, lower limbs and pain reduction.</p>Volodymyr StaudeKonstantyn RomanenkoAnna Staude
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2024-01-162024-01-164798610.15674/0030-59872023479-86THE HISTORY OF THE FORMATION AND ACTIVITY OF THE KHARKOV REGIONAL BRANCH OF THE ALL-UKRAINIAN PUBLIC ORGANIZATION «UKRAINIAN ASSOCIATION OF ORTHOPEDIC SURGEONS»
http://otp-journal.com.ua/article/view/296546
<p align="justify">The article is devoted to the Kharkiv regional branch of the All-Ukrainian public organization "Ukrainian Association of Orthopedic Surgeons and Traumatologists".</p>Volodymyr FilipenkoSvitlana ZolotarovaOlena Shevchenko
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2024-01-162024-01-16413313710.15674/0030-598720234133-137Methodological principles of diagnosis verification and treatment tactics determination in combat limb injuries with bone defects
http://otp-journal.com.ua/article/view/296416
<p align="justify">Objective. To develop a classification system for long bone defects resulting from combat limb injuries, establish criteria for predicting pathological fractures, and determine indicators for assessing the feasibility of converting the fixation method in combat-related injuries. Methods. The modern literature regarding the treatment of combat-related long bone defects resulting was analyzed in three databases: PubMed, Scopus, and Web of Science. The analysis was conducted using keywords such as combat injuries, bone defect, non-union, auto- and allograft transplantation, Ilizarov method — bone transport, Masquelet method — induced membrane, and fixation method replacement. The clinical material used for this study was derived from the evaluation and treatment of 457 patients with long bone defects at the III–IV medical intervention stage. Results. The determination of modern perspectives on the fundamental issues of combat injuries, combined with the analysis of treatment outcomes for such patients, enabled the development and validation of a classification of bone defects that incorporates the volume of bone tissue loss. Furthermore, a prognostic table for the risk of pathological fractures in cases of bone defects and a scoring scale for assessing the feasibility of fixation method conversion have been introduced and applied. Conclusions. The proposed classification allows the verification of all types of long bone defects. Its application in clinical practice offers the possibility of obtaining optimal and standardized treatment methods for different types of bone defects, thus improving outcomes by choice of appropriate technologies for their replacement. The objectification of fracture risk factors identification for bone defects enables the choice of the method and means of segment stabilization. The assessment of the feasibility of the fixation method change allows the evaluation of the patientʼs condition and the local status, facilitating the determination of the potential for method conversion — transition from external fixation devices to intramedullary osteosynthesis, significantly reducing complications during this stage.</p>Olexandr BurianovVolodymyr KvashaYuriy SobolevskiyYurii YarmoliukYurii KlapchukDmytro LosValentyn КupriiGennadii Kolov
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2024-01-162024-01-16451310.15674/0030-5987202345-13BIOMECHANICAL ASPECTS OF TRANSPEDICULAR FIXATION IN THE THORACOLUMBAR JUNCTION AREA: THE INFLUENCE OF LATEROFLEXION
http://otp-journal.com.ua/article/view/296420
<p align="justify">The paradigm shift in surgery of the injured spine during the last few decades is characterized by the active implementation of the principle of stabilization without fusion. This approach significantly expands the possibilities of surgical interventions in terms of the completeness of decompression and spinal axis restoration, but also it determines higher requirements for the reliability of the fixation systems and the uniformity of load distribution on both metal systems and bone structures. Objective. To determine the features of load distribution in the area of the thoracolumbar junction after resection of one vertebra, as well as the effect of the transpedicular screw length and cross-links of the stabilization system. Methods. Mathematical finite-element model of the thoracolumbar human spine was developed. The model simulated the state after surgical treatment of a traumatic injury to the thoracolumbar junction with significant damage to the body of the ThXII vertebra. We studied 4 variants of transpedicular fixation (using monocortical screws and long bicortical screws, as well as two cross-links and without them). Results. When analyzing the stress-stain state of the model, we found that the most loaded bone structures during lateroflexion are the vertebral bodies. For the LII vertebral body, the load values were 17.2, 16.2, 16.3, and 15.5 MPa, respectively, for models with monocortical screws without cross-links, bicortical screws without cross-links, monocortical screws and cross-links, and bicortical screws and cross-links. The peak loads on the transpedicular screws were recorded on those implanted in the body of the ThXI vertebra (24.8, 25.7, 22.8 and 24.3 MPa, respectively, for the considered models) and in the body of the LII vertebra (20.2, 24.6, 19, 7 and 23.7 MPa). Conclusions. The use of long transpedicular screws causes less stress on the bony elements than the short screws. At that time stresses on the screws themselves and the bone tissue around them increase. Сross-links help to reduce stress at all control points on models with both short and long transpedicular screws.</p>Oleksii NekhlopochynVadim VerbovIevgen CheshukMykhailo KarpinskyOlexander Yaresko
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2024-01-162024-01-164142110.15674/0030-59872023414-21TWO-STAGE SURGICAL TREATMENT OF LARGE AND RIGID SPINAL DEFORMITIES (ANTERIOR MOBILIZATION OF THE CURVATURE AND POSTERIOR INSTRUMENTATION OF THE SPINE)
http://otp-journal.com.ua/article/view/296424
<p align="justify">The choice of method of surgical treatment of large and rigid spinal deformities remains debatable. Objective. To evaluate the results of two-stage surgical treatment of large and rigid spinal deformities (anterior mobilization of the curvature and posterior instrumentation of the spine). Methods. Seventeen patients, the average age of which was 17.7 years (from 12 to 38 years), the average follow-up period was 36 months. Distribution of patients by etiology: 13 — idiopathic scoliosis, 2 — neurofibromatosis, and 2 — congenital kyphoscoliosis. All patients underwent two-stage surgical treatment (anterior mobilization of the curvature and posterior correction of the deformity), evaluation of the results of correction and complications was performed retrospectively. Results. The average deformation of the spine in the frontal plane before the operation was 103° ± 10° according to Kob (from 90° to 126°), after the anterior mobilization — 85° ± 8° (from 74° to 104°), which is (17.6 ± 3.3) % of correction (from 13.7 to 24.5 %), and at the time of completion of the posterior correction of the deformity — 40° ± 22° (from 2° to 78°), in percentage terms it amounted to (62.1 ± 20.61) % correction (from 19.6 to 97.8 %). Statistical significance according to the T- criterion had the following indicators: 63.4 ± 19.6 (M ± SD); t = 13.344; p = 0.001. Conclusions. Two-stage surgical treatment of large and rigid spinal deformities is a modern technique for achieving spinal deformity correction and obtaining the desired cosmetic result. Carefully performed anterior mobilization with the subsequent use of the system of stretching the patient in bed, allows to increase the mobility of the spine and gradually adapt the tissues and spinal cord to the next posterior correction of the spine, which significantly reduces the risks of neurological complications, as well as obtaining the most satisfactory correction results.</p>Oleksandr BarkovVolodymyr RadchenkoYelizaveta KatsalapInga Fedotova
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2024-01-162024-01-164223010.15674/0030-59872023422-30PUNCTURE LASER MICRODISCECTOMY IN THE TREATMENT OF SEQUESTERED HERNIATION OF LUMBAR INTERVERTEBRAL DISCS
http://otp-journal.com.ua/article/view/296431
<p align="justify">Objective. to improve the results of treatment of sequestered herniation of lumbar intervertebral discs by the puncture laser microdiscectomy (PLM) method. Methods. During the period from 2000 to 2023, 132 patients with sequestered lumbar disc herniations were operated on by the PLM method. There were 88 males and 34 females. The age of the patients was from 23 to 64 (42.3 ± 3.5) years. Surgeries were performed using a C-arc operating fluoroscope. The laser pulse duration — 0.3–0.5 sec, and radiation exposure — 500–600 J. Approach to the sequestrum was mainly posteromedian transdural. For laterally located sequestra, posterolateral approach was used. The efficacy of PLM was assessed by pain intensity reduction according to the VAS scale one month after surgery, and according to the McNab scale 3 months after surgery. Results. One month after PLM, the maximum reduction of radicular pain intensity was noted in patients with posteromedian hernias, to a lesser extent — with paramedian hernias, and the least pronounced — with lateral hernias. However, no statistically significant differences in pain intensity one month after surgery depending on hernia location were found (p > 0.05). As for the intensity of lumbar pain, in all groups, regardless of hernia location, it significantly decreased and did not exceed 1 point after one month. 3 months after surgery, 95 (71.9 %) patients had an excellent result according to the McNab scale, 13 (9.8 %) — good, 7 (5.3 %) — satisfactory, 17 (12.8 %) — unsatisfactory, indicating that the PLM method of sequestered hernias can be quite effective in a certain selection of patients. According to our data, positive results can reach 81.8 % (95 % CI 74.2–87.9 %) (CI — confidence interval). Conclusions Sequestered hernias, which can be operated by the PLM method, should not exceed 9 mm in height on axial sections, should have a smooth rounded lenticular shape without signs of migration. The positive effect of PLM of sequestered hernias reached 81.7 %. The results were better with PLM of posteromedian hernias.</p>Mykola Zorin
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2024-01-162024-01-164313510.15674/0030-59872023431-35CHANGES IN INDICATORS OF THE COAGULATION SYSTEM AND MARKERS OF INFLAMMATION IN THE BLOOD OF PATIENTS WITH DEGENERATIVE DISEASES OF LARGE JOINTS IN THE CASE OF TOTAL ARTHROPLASTY
http://otp-journal.com.ua/article/view/296434
<p align="justify">Predicting the risk of developing thrombotic complications is an extremely important task when planning total arthroplasty of large joints (TAJ). Objective. Based on the retrospective analysis of the results of the biochemical examination of patients with degenerative diseases of large joints before and after TAJ, determine the changes in the markers of the hemostasis system and inflammatory processes, which are the most informative for the preoperative prediction of the development of hypercoagulable conditions. Methods. In the blood serum of 39 patients with degenerative diseases of the hip and knee joints of III–IV stages according to Kellgren–Lawrence before and after TAJ, the following were investigated: prothrombin time, international normalized ratio (INR); the content of fibrinogen, soluble fibrin-monomeric complexes (SFMC), D-dimer, antithrombin III, glycoproteins (GP), sialic acids, C-reactive protein (SRP), seroglycoides, haptoglobin; activated partial thrombin time (APTT), fibrinolytic activity (FA). The control group consisted of 30 practically healthy donors. The results. Before TAJ, the serum content of GP patients was 28.80 % higher than the control indicators; haptoglobin — by 20.00; CRP — 82.88; SFMC — 33.60; fibrinogen — 60.32; D-dimer — 41.04 %. The INR was reduced by 25.40 %, the content of antithrombin III — by 21.90 %, FA slowed down by 63.00 %. After TAJ, the content of total HP in the blood serum ofpatients exceeded the indicator of the control group by 55.80 %, sialic acids by 35.60 %; seroglycoides — 55.26; haptoglobin — 61.42; CRP — 151.33 %. An additional reduction of 10.58 %, prothrombin time, APTT — by 15.40 %, antithrombin III activity — 19.10 %, increase in fibrinogen content — 34.90 % was observed; D-dimer — 25.10; SFMC — 36.18; prolongation of FA time — by 29.30 %. Conclusions. To prevent the development of thrombophilic conditions after TES, it is necessary to monitor the most informative markers: increase in FA time, content of fibrinogen, D-dimer, SFMC and haptoglobin.</p>Volodymyr FilipenkoStanislav BondarenkoFrieda LeontyevaVladyslav TuliakovOleksandr Vysotskyi
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2024-01-162024-01-164364210.15674/0030-59872023436-42BIOCHEMICAL MARKERS OF BLOOD SERUM AND ARTICULAR CARTILAGE IN DIFFERENT FORMS OF IDIOPATHIC COXARTHROSIS PROGRESSION
http://otp-journal.com.ua/article/view/296445
<p align="justify">Deformation due to arthrosis of the hip joint affects 40 % of the total number of patients with osteoarthritis, which is from 7 to 25 % of the adult population. For the activity of the pathological process evaluation we studied biochemical changes in the metabolism of collagen, namely: glycosaminoglycans (GAG), hydroxyproline (HP) fractions, collagenase, hyaluronidase activity, etc. Objective. To determine the biochemical changes in blood serum and articular cartilage depending on the form of progression of idiopathic coxarthrosis. Methods. 23 patients were examined (8 (34.8 %) men, 15 (65.2 %) women, age 45‒75 years and more) with idiopathic arthrosis of the hip joint IV stage (Kellgren–Lawrence). Progression forms of idiopathic coxarthrosis were distinguished: group I — rapid (the period from the initial to the final stage of the disease was 5 years and less), II — moderate (5‒10 years), III — slow (over 10 years). Collagenase activity, HP fractions, total GAG content were determined in patients’ blood serum, and collagen content was determined in the cartilage tissue of the femoral head. Results. Compared with the age reference norm in the blood serum of patients of group I activity collagenase increased to 114 %, in II and III — 122 and 135 %, respectively; the content of the free fraction of GP — up to 111, 169, 128 %, respectively; GAG concentrations — up to 110, 122, and 135 %, respectively; protein-bound HP was reduced to 60% in group II, up to 84 % — in group III. In cartilage tissue, the GAG content decreased in group III to 63 %, II — 55 %, I — 47 %; collagen — 32, 25, 24 % in accordance. Conclusions. The course of idiopathic coxarthrosis is determined by metabolic changes in the components of the organic basis of connective and cartilaginous tissues in blood serum. The most profound changes were found in the synthetic phase of HP metabolism, especially in the group with a rapid course disease. A decrease in the content of organic components of connective tissue (GAG and collagen) was determined</p>Sadrudin MagomedovOleksiy KalashnikovLarisa PolishchukTaisiya KuzubVolodymyr Zayets
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2024-01-162024-01-164434710.15674/0030-59872023443-47EFFECT OF CHANGES IN THE LENGTH OF THE COMPONENTS OF THE MUSCULOTENDINOUS ELEMENT OF THE ELBOW FLEXOR MUSCLES ON THE ISOMETRIC FORCE AND JOINT TORQUE
http://otp-journal.com.ua/article/view/296455
<p align="justify">Immobilization of the joint leads to the formation of immobilization contracture, which is accompanied by a decrease in the elasticity of tendons and muscles, i.e. loss of full contraction and stretching. The torque in human joints is one of the key indicators in assessing rehabilitation. Objective. To study the effect of changes in the strength, length of muscles and tendons of the elbow joint on the torque in flexion. Methods. The basic OpenSim model arm26 was used for modeling. To determine the change in the length of the components of the muscle-tendon element (MTE), their length was determined at a 90° angle of elbow flexion. The decrease in muscle strength was considered a loss per day for elbow flexors — 1.2 %, extensors — 1.1 %. The decrease in strength was calculated for a period of immobilization of 45 days. Three models were created: Normal — a model without changes in muscle parameters; Contracture — a change in the length of muscles and tendons; Contracture + muscle (CM) — an additional decrease in muscle strength. Results. The obtained data of torques when changing the length of the MTE components showed their increase in conditions of unchanged isometric muscle strength. But this option is not possible after immobilization of the limb. Therefore, it is closer to the real model of СM, in which the torque is significantly reduced by the amount of decrease in muscle strength. These models show a tendency that the change in the components of the MTE due to immobilization increases the joint torque and, when trying to apply excessive force during joint development, can lead to traumatic consequences. During immobilization, the flexor muscles shorten, which prevents the patient from fully extending the elbow joint. Conclusions. This work on predicting the elbow joint torque generated by the muscles can be useful in studying specific clinical situations with elbow joint contractures, but cannot be fully transferred to practice due to the significant conventionality of the model parameters. However, the modeling method can show trends in changes in muscle function parameters when their geometry changes.</p>Olexiy TyazhelovOlena KarpinskaMykola RykunOleksandr Branitskyi
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2024-01-162024-01-164485510.15674/0030-59872023448-55A REVIEW OF 2021 AND 2022 AAOS GUIDELINES FOR MENISCAL ARTHROSCOPIC PROCEDURES IN OSTEOARTHRITIS
http://otp-journal.com.ua/article/view/296460
<p align="justify">For many decades, arthroscopy was considered the least invasive of all existing surgical methods of treating patients with gonarthrosis, however, carried out at the beginning of the XXI century randomized clinical trials (RCTs) demonstrated the futility of isolated lavage and debridement for this category of patients. The purpose of this work is to show trends in the indications for debridement and partial meniscectomy in patients with osteoarthritis in the 2021–2022 AAOS guidelines. Methods. AAOS 2021, 2022 recommendations for the treatment of osteoarthritis (without arthroplasty). The strength of recommendations depends on the number and quality of studies that may or may not recommend surgery. The results. In 2021, the third edition of the AAOS clinical guidelines for the treatment of osteoarthritis was released, which was supported by four studies. They suggest that arthroscopic partial meniscectomy be used for the treatment of meniscal tears in patients with concomitant mild or moderate osteoarthritis in whom physical therapy or other nonsurgical treatments have been ineffective. The 2022 AAOS guidelines reviewed 216 osteoarthritis situations and indications for arthroscopic procedures. The developed criteria are aimed at covering the most common clinical scenarios faced by qualified specialists treating osteoarthritis of the knee joint. The final decision on any particular criterion must take into account all the circumstances presented by the patient, as well as the needs and resources specific to the area or institution. Conclusions. The 2021 AAOS guidelines do not recommend arthroscopy with lavage and/or debridement in patients with a primary diagnosisof knee osteoarthritis. According to AAOS 2022 recommendations, arthroscopic interventions are suitable for young people with arthrosis of the knee joint in one or 2–3 departments. Arthroscopy as a method of choice for the treatment of terminal gonarthrosis has exhausted itself: most studies prove the ineffectiveness of lavage, debridement, microfracturing of the subchondral bone, and partial meniscectory.</p>Olena BaburkinaMaryna BludovaOleg Ovchynnikov
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2024-01-162024-01-164566210.15674/0030-59872023456-62DETERMINATION OF THE RISK OF OBTAINING UNSATISFACTORY RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH STATIC DEFORMITIES OF THE FOREFOOT WHEN USING VARIOUS SURGICAL APPROACHES
http://otp-journal.com.ua/article/view/296486
<p align="justify">The main method of treatment of static deformations of the forefoot (SDPVS) is surgical. The most static deformities of the foot in its front part most often include valgus deformity of the first toe — Hallux valgus (HV), hammer-like deformities of 2–4 toes, and Taylor's deformity. Objective. To assess the effectiveness of surgical treatment of SDPVS and to determine the risk of obtaining an unsatisfactory result with different surgical approaches. Methods. The treatment of 565 patients (1009 feet) was analyzed, the main group — 729 feet, control 280 feet. The groups of patients differed in the methods of surgical treatment of deformities of the forefoot. The choice of surgical intervention in the main group was carried out according to the algorithmized system of surgical treatment of patients with SDPVS. Results. The results of treatment of patients with static deformities of the front part of the foot in the main group were significantly (p < 0.001) better than the results in the control group of patients. In the main group, good results accounted for 55.0 % of cases, satisfied — 39.2 %, unsatisfactory — 5.8 %, compared to the control group — 26.1 %, 43.2 and 30.7 %, respectively. The reduction of the relative risk of obtaining an unsatisfied result (RRR) in the main group when using the proposed algorithmized system of treatment of SDPVS is 68 %. In the treatment of combined VDPPS with deformities of 2–5 toes, the risk of an unsatisfactory result is higher compared to isolated VDPPS in both groups. The risk of an unsatisfactory treatment result in patients with combined HV deformity and deformities of 2–5 toes in the control group is 15.9 % higher (RR = 0.159 ± 0.174) than in the main group. The use of the proposed approach to the selection of surgical treatment tactics based on the developed algorithmized system of surgical treatment of SDPVS can reduce the relative risk of obtaining unsatisfactory treatment results by 84 % (RRR = 0.841).</p>Dmytro Prozorovskiy
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2024-01-162024-01-164637010.15674/0030-59872023463-70Effect of magnesium deficiency on bone health
http://otp-journal.com.ua/article/view/296513
<p align="justify">Objective. To assess the impact of magnesium deficiency on bone metabolism based on an analytical analysis of current literature, as well as to systematize data on the impact of magnesium deficiency on the development of osteoporosis, bone regeneration, and to consider it as a risk factor for fracture. Methods. The review is based on the analysis of literature sources from PubMed, Scopus, Web of Science, Cochrane Library, Google, Google Scholar, and RLNS. The search was conducted by keywords: magnesium, deficiency, magnesium and bone tissue, magnesium and osteoporosis, magnesium and fractures, magnesium and bone regeneration. Results. Magnesium is a key element in the metabolic and regulatory processes of the body. Its effects on bone tissue are direct and indirect. The direct magnesium effect on genes involved in osteogenesis is accompanied by proliferation of mesenchymal stem cells and osteoblasts, but magnesium deficiency leads to their reduction and apoptosis. In case of magnesium deficiency, the number and activity of osteoclasts increases. Magnesium regulates bone mineralization in a concentration-dependent manner. Magnesium deficiency increases bone resorption and affects osteopenia and osteoporosis, which can occur indirectly through decreased vitamin D levels, increased biosynthesis of parathyroid hormone, increased oxidative stress and biosynthesis of proinflammatory cytokines. However, data on bone mineral density at different skeletal sites in magnesium deficiency are ambiguous. Magnesium deficiency is considered a risk factor for fracture. It is of great importance for bone regeneration, affecting in various ways: it stimulates the proliferation and differentiation of mesenchymal stem cells and osteoblasts, periosteum cells, increases the movement of osteoblasts to the area of traumatic bone injury, and activates signaling pathways. At the early stage of regeneration magnesium has a positive effect on macrophages, its specificity of action is inhibition of transformation of M2 macrophages into M1 at the tissue-specific stage of regeneration. One of the mechanisms stimulating regeneration may be the effect of magnesium on axons, release and increase of calcitonin-related polypeptide α. Conclusions. Since hypomagnesemia is a potentially modifiable factor, this opens up prospects for maintaining bone health and requires further research in this area.</p>Ninel DiedukhNataliia GrygorievaAnna Musiienko
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2024-01-162024-01-16412112710.15674/0030-598720234121-127EPIDEMIOLOGICALRISK FACTORS OF RECURRENCE OF LUMBAR INTERVERTEBRAL DISC HERNIATION AFTER PRIMARY DISCECTOMY (LITERATURE REVIEW)
http://otp-journal.com.ua/article/view/296543
<p align="justify">Primary discectomy for a lumbar intervertebral disc herniated (LDH) is usually accompanied by a rapid regression of clinical symptoms, however, in 5–15 % of cases, an X-ray positive recurrence of the hernia with corresponding orthopedic disorders is registered, which leads to repeated surgical intervention. Objective. Determination of risk factors for recurrence of LDH and their frequency under the conditions of various methods of primary discectomy based on a scientific analysis of the relevant literature. Methods. The material of the research is articles containing the definition of risk factors for the recurrence of a LDH after primary discectomy, for the period 2013–2023 in PubMed, Google Scholar, Medline databases using medical subject headings and keywords «recurrent lumbar disc herniation, surgical interventions, percutaneous endoscopic lumbar discectomy, microdiscectomy, laminectomy, discectomy, spondylodesis». The research method is a systematic review of relevant literature sources. Results. Early and long-term results of primary discectomy for intervertebral disc herniation using decompression (open discectomy, microendoscopic discectomy, percutaneous discectomy, laminectomy, minidiscectomy, endoscopic discectomy) and decompression-stabilization (discectomy combined with spondylodesis) techniques are traced in the literature. The most successful were: 1 year after the operation — endoscopic discectomy (12.4 % of reoperations) and spondylodesis (11.8 %); 10 years after the operation — laminectomy (14 %) and spondylodesis (10 %). The highest rates of revision discectomy: 1 year after the operation — laminectomy (18.6 %); 10 years after surgery — open discectomy and endoscopic discectomy — 16 % each. Conclusions. Recurrent intervertebral disc herniation is an early complication of primary discectomy, the frequency of which varies depending on the surgical technique and the timing of the postoperative period. The most reliable risk factors are male gender, age younger than 50 years, diabetes mellitus, and smoking.</p>Volodymyr RadchenkoValentyn PiontkovskyiVira KolesnichenkoMaksym GolbaumOlexandr ChernyshovOleksandr Palkin
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2024-01-162024-01-16412813210.15674/0030-598720234128-132Biotechnological aspects of the working-out and manufacturing of living bone equivalent
http://otp-journal.com.ua/article/view/296493
<p align="justify">Objective. To handle biotechnological aspects in manufacturing processes of three-dimensional living bone equivalent for restoration of critical sized bone defects for innovative treatment of combat-related casualties. Methods. To fabricate living bone equivalent we used devitalized xenogeneic bone scaffolds (DBM chips) and autologous fibrin hydrogel seeded with autologous cultured bone marrow-derived multipotent mesenchymal stem/stromal cells (BM-MSCs). Quality/identity control of cell cultures was assured by donor and cell culture infection screening (IFA, PCR), flow cytometry (cell phenotype), karyotyping (GTG banding), functional assays (CFU assay, multilineage differentiation assay). Results. The BM-MSC cultures had a normal karyotype and appropriate phenotype, multilinear differentiation potential and functional properties, appropriate CFU frequency and hadn’t any signs of cell senescence. The FDA/PI combined staining showed the demineralized bone chips’ regular seeding with viable cells. Conclusions. An actual regenerative medicine approach to organ-saving transplantation of the three-dimensional living bone equivalent for combat-related casualties requires further preclinical and clinical approbation for thorough studies on the bone integrity restoration, forming new bone tissue in a site of bone defect, and duration of rehabilitation period compared to the gold standard of the conventional bone defect cure.</p>Dmytro ZubovIurii PoliachenkoOleksandr KostrubRoman BlonskyiOleksandr MagomedovOleksii DolgopolovIvan Zasadnyuk
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2024-01-162024-01-164879210.15674/0030-59872023487-92EXPERIENCE OF THE SEGMENTAL BONE DEFECTS' TREATMENT FOR PATIENTS WITH COMBAT TRAUMA USING THE METHOD OF DISTRACTION OSTEOGENESIS
http://otp-journal.com.ua/article/view/296488
<p align="justify">Upper and lower limb injuries resulting from battlefield trauma is a complex multidisciplinary problem. Efficacy of the treatment of segmental bone defects in patients with combat trauma is a subject of analysis for improving its results. Purpose. An analysis of the modern treatment strategies of the segmental bone defects in patients with battlefield trauma under conditions of distraction osteogenesis (based on data available in the literature and own clinical experience). Methods. Analytical review of scientific works and analysis of treatment results of 39 patients with segmental bone defects associated with battlefield trauma and treated using distraction osteogenesis were conducted. Results. Patients with segmental limbs defects require special attention of a multidisciplinary team of specialists to identify reconstructive opportunities to save the limb. Distraction osteogenesis — is an effective method of treating of segmental fractures and shortening of the limbs, infectious complications that led to bone defect formation. Bone transport with ring external fixator (ExFix) is considered as a classical method. Authors analyzed and illustrated with three clinical cases their own results of application of different distraction osteogenesis technique. Conclusions. Different types of ExFix can be applied independently or in combination with internal fixators. The use of an intramedullar nail along which distraction osteogenesis is carried out allows to provide better control of the axis of the limb and transported fragment, reduce the residence time in the ExFix, and, moreover, external fixation devices with a simpler configuration can be used. Transport along the plate allows to maintain proper axial relationships in the presence of short periarticular fragments and improve the quality of fixation but it also increases the risks of FRI and re-operations.</p>Serhiy HariyanOleksandr TsybulskyiVasyl MakhovskyiZoia Salii
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2024-01-162024-01-164717810.15674/0030-59872023471-78PROBLEMATIC ISSUES OF THE TREATMENT OF DIAPHYSEAL GUNSHOT FRACTURES OF LONG BONES OF EXTREMITIES
http://otp-journal.com.ua/article/view/296547
<p align="justify">Due to the military conflict in Ukraine, the problem of treating gunshot fractures has become acute, which requires an urgent solution. Objective. On the basis of own experience, to determine the primary problems in the treatment of gunshot diaphyseal fractures of the long bones of the limbs and evaluate the preliminary results. Methods. The treatment process and its results were analyzed in 128 victims with gunshot fractures of long limb bones for the period 08.2022–08.2023. Classical methods of clinical, X-ray and laboratory investigations were used. The assessment was carried out according to the AO classification, that was supplemented with new options for tangent and perforated bone injuries, as well as the volume of destruction of adjacent soft tissues. Wounds of all the patinets were treated using vacuum aspiration, the fragments were fixed with external devices manufactured by Biomet, Stryker, ТОВ «Ейч Ві Орто», ОРТОПАК. Results. The analysis showed that 64 (50 %) of the wounded had a need to take additional measures to preserve or improve the position of the fragments: improvement of the geometry of the external apparatus, replacement of the apparatus with a more perfected one, with a plate or intramedular osteosynthesis; replacement of the apparatus with a plaster bandage or orthosis. Conclusions. Based on the study, it can be argued, that most gunshot diaphyseal fractures of long bones are multifragmental and accompanied with destruction of predominantly peripherally located soft tissues. At the same time, the periosteum with a layer of adjacent muscles for the most part retains integrity, viability and connection with the surface of the fragments. The basic and rational method of fixation of fragments for diaphysical gunshot fractures it is necessary to consider external osteosynthesis with schanz-screws devices. According to our preliminary data, the use of external fixator treatment led to fracture healing in 84% of patients with gunshot hip fracture, 56 % — tibia fracture, 59 % — humerus fracture, and 44 % — forearm fractures.</p>Mykola KorzhOlexii PopsuishapkaValerii LytvyshkoIgor ShevchenkoYaroslav DoludaStanislav GubskyiAnastasiia HrytsenkoDmytro MikhanovskiyOlexii MarushchakMykola TokhtamyshevZorik Arutunan
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2024-01-162024-01-16410912010.15674/0030-598720234109-120