Статьи журнала - Гений ортопедии

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"Ловушки" магнитно-резонансной томографии в диагностике повреждений менисков коленного сустава

"Ловушки" магнитно-резонансной томографии в диагностике повреждений менисков коленного сустава

Стулов Андрей Сергеевич, Тарасов Алексей Николаевич

Статья научная

На основе сравнительного анализа магнитно-резонансных томограмм коленного сустава представлена визуализация нормальных анатомических внутрисуставных структур, симулирующих повреждения менисков, от истинных патологических состояний.

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30 лет лаборатории радионуклидной диагностики

30 лет лаборатории радионуклидной диагностики

Свешников А.А.

Персоналии

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35 лет на пути к совершенству и качеству к юбилею РНЦ «ВТО»

35 лет на пути к совершенству и качеству к юбилею РНЦ «ВТО»

Шевцов В.И., Марченкова Л.О.

Статья

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85-й конгресс SOFCOT

85-й конгресс SOFCOT

Щурова Е.Н., Мишина Н.И., Солдатов Ю.П., Неретин А.С.

Краткое сообщение

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A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

Firas Ahmad Suleiman, Fadi Mohammad Al-Rousan

Статья научная

Purpose: to compare the result of using a stay stitch to bridge the nerve gaps with repair the nerve gap without using a stay stitch, to compare both ways on the length of graft, number of grafts and number of cables per graft. Methods: a comparative study between 2 groups of babies with OBPP in which each group consists of 15 infants. In all the patients in both groups, neuroma excision and nerve grafting was indicated. In group (A) the defects were measured directly after neuroma excision without any attempts to approximate the retracted ends of the nerves, this was followed by reconstruction of the gaps by cable grafts from the sural nerves using fibrin glue. Conversely, in group (B) we took measurements of the defects after using 1 or 2 bridging stay sutures through the posterior aspect of the epineurium just to overcome the retracted distance without any further tension on the nerve. This also was followed by reconstruction of the gaps by cable nerve grafts with the aid of fibrin glue. Results: in group (B), the cable grafts length can be shortened from (29.6mm to 14.2 mm) with average of (15.4 mm). The number of cables per graft increase from 2.2 to 3.2. The number of grafts used in reconstruction of the brachial plexus were more in group B than in group A. Conclusions: A simple bridging stay suture can prevent retraction of the nerve ends after repair with fibrin glue, working as an internal splintage to the repair site, decrease the length of the cable graft, increase the number of cables per graft, gives more opportunity to make more nerve grafts and the surgeon feel that his repair is more secure.

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A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

A new method to shorten the length of nerve graft and to secure the nerve repair (an intraoperative experience based on 30 cases of obstetrical brachial plexus palsy)

Al-Rousan Fadi Mohammad

Статья научная

Purpose: to compare the result of using a stay stitch to bridge the nerve gaps with repair the nerve gap without using a stay stitch, to compare both ways on the length of graft, number of grafts and number of cables per graft. Methods: a comparative study between 2 groups of babies with OBPP in which each group consists of 15 infants. In all the patients in both groups, neuroma excision and nerve grafting was indicated. In group (A) the defects were measured directly after neuroma excision without any attempts to approximate the retracted ends of the nerves, this was followed by reconstruction of the gaps by cable grafts from the sural nerves using fibrin glue. Conversely, in group (B) we took measurements of the defects after using 1 or 2 bridging stay sutures through the posterior aspect of the epineurium just to overcome the retracted distance without any further tension on the nerve. This also was followed by reconstruction of the gaps by cable nerve grafts with the aid of fibrin glue. Results: in group (B), the cable grafts length can be shortened from (29.6mm to 14.2 mm) with average of (15.4 mm). The number of cables per graft increase from 2.2 to 3.2. The number of grafts used in reconstruction of the brachial plexus were more in group B than in group A. Conclusions: A simple bridging stay suture can prevent retraction of the nerve ends after repair with fibrin glue, working as an internal splintage to the repair site, decrease the length of the cable graft, increase the number of cables per graft, gives more opportunity to make more nerve grafts and the surgeon feel that his repair is more secure.

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Autologous blood injection versus corticosteroid for tennis elbow

Autologous blood injection versus corticosteroid for tennis elbow

Bari Mofakhkharul, Shahidul Islam, Shetu Nazmul Huda, Mahfuzer Rahman

Статья научная

Goal. Compare the effectiveness of injections of autologous blood and injections of corticosteroids in the treatment of "tennis elbow." MATERIALS AND METHODS. 25 men and 35 women (mean age 35.2 years) with a "tennis elbow" were randomized for injections or autologous blood (2 ml of autologous venous blood mixed with 1 ml of 2% xylocaine hydrochloride) or a steroidal preparation of triamcinolone acetonide (1 ml - 40 mg, mixed with 1 ml of 2% xylocaine hydrochloride), which one surgeon did. We evaluated before (0 day) and after (after 15, 30, 60 days) treatment for the presence of pain in the elbow, the function and strength of flexion in the joint. The presence of pain in the elbow joint was evaluated after one year. Results. Infections, tendon ruptures and neurovascular damage were not identified. Five patients reported pain for up to three days after the injection of autologous blood. In both groups, the flexion force improved dramatically after treatment, but the recovery process was different. Compared with injections of autologous blood during the injection of a corticosteroid drug, the recovery occurred more quickly in the first 15 days, and then slightly slowed down to the 60th day. After the introduction of autologous blood, pain relief, function and flexion strength were steadily improved and eventually became more sophisticated. The conclusion. In comparison with injections of a corticosteroid drug, injections of autologous blood were more effective with a long period of control in terms of relief of pain, restoration of function and flexion strength. This is how we recommend this first-order injection technique, because it is simple enough, inexpensive and more effective.

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Cervical spine tropism CII-CIII anomaly

Cervical spine tropism CII-CIII anomaly

Gubin Aleksandr Vadimovich, Drozd Vadim Anatolevich, Burtsev Aleksandr Vladimirovich, Riabykh Sergei Olegovich

Статья научная

Study Design. 3 patients with CII-CIII tropism anomaly and unilateral subluxation were investigated and treated. Objectives. To demonstrate clinical and CT findings in children with the new anomaly in CII-CIII junction. Summary of Background data. A thorough in vivo research of CII-CIII junction became possible only after introduction of modern CT scanning technologies. We have not managed to find other clinical observations of this segment pathology in children in contemporary medical literature. Methods. We determined not typical cases of acute wryneck from the group of 262 children hospitalized in our clinic. X-ray and CT scans were used for evaluation of the problem. Results. From the group of patients with acute stiff-neck we selected three with the following symptoms: neck blocked and movement not possible; head advanced forward. On the lateral X-ray scans there were a cervical lordosis straightening and the pars interarticulares of the CII were overridden by the processus articularis superior of the CIII. The CT-scan of the cervical spine showed a unilateral subluxation of the CII segment in the forward direction. The articulation planes of the CII-CIII facets had different orientation on the left and right sides. Conclusion. We propose the hypothesis that non-symmetrical orientation of the articulation facet planes in the CII-CIII segment can cause a stiff-neck syndrome in children. In the described cases, the sole detected source of the pain syndrome and blocked neck was the tropism anomaly in the CII-CIII segment accompanied by a subluxation of the joint.

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Clinical and radiographic outcomes of medial open wedge high tibial osteotomy (MOWHTO) with Ilizarov technique in OA knee

Clinical and radiographic outcomes of medial open wedge high tibial osteotomy (MOWHTO) with Ilizarov technique in OA knee

Bari Mofakhkharul Bari, Islam Shahidul, Shetu Nazmul Huda, Rahman Mahfuzer

Статья

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Clinical assessment difference between patellar resurfacing and retention groups with grade IV osteoarthritis in total knee arthroplasty

Clinical assessment difference between patellar resurfacing and retention groups with grade IV osteoarthritis in total knee arthroplasty

Kamolhuja Eshnazarov, Jong Keun Seon, Eun Kyoo Song

Статья научная

Introduction. Despite the excellent clinical success with total knee arthroplasty (TKA), there is disagreement about whether or not to replace the patellar articular surface. This led to randomized controlled trials. Such studies are the most reliable source of evidence of the effectiveness of potential interventions. But most of these studies include the study of results at all degrees of osteoarthritis of the patellofemoral joint. Therefore, the authors conducted a prospective study to compare the clinical and radiological outcomes after TKA with the replacement of the patellar articular surface in patients with osteoarthritis of the patellofemoral joint of the fourth degree. Materials and methods. The study included 123 patients with Kellgren-Lawrence patellofemoral joint osteoarthritis. Patients were randomly assigned to groups, in one of which the patellar joint surface was replaced (62 cases), in the other case, they were not performed, i.e. retained the patella (61 cases). Among them were 114 patients who were observed for more than two years (group with replacement of the articular surface - 59 cases, the group without replacement - 55 cases). Preoperative and postoperative clinical data were evaluated and evaluated on the scale of the Hospital for Special Surgery Patellar (HSSP) (total score of 100, presence of pain in the anterior part of the knee, functional limitations, tenderness in palpation or pressure, crepitation , Q-force). Scales developed at the Special Surgery Hospital (HSS), and the WOMAC scale, as well as the volume of movements (ROM), were also used. Results. The mean HSSP score in the group with replacement of the patellar articular surface was 85 points and 83 points in the group without replacement, which showed no significant differences between the groups (p = 0.75). When assessing the presence of pain in the anterior part of the knee, there were also no significant differences between the groups (40 in the group with articular replacement, 36 in the group without replacement, p = 0.52). HSS scores improved to 94 points in the group with articular replacement and up to 95 in the group without replacement, which also indicated no significant difference (p = 0.92). The WOMAC score and the volume of movements were 32 and 128 ° ± 10.5 ° in the replacement group and 29 points and 126 ° ± 11.5 ° - in the group without replacement, there was no significant difference between the groups (p> 05) . The conclusion. Thus, identical good clinical outcomes without significant differences were achieved after TKA with and without replacing the patellar articular surface in patients with a high degree of osteoarthritis of the patellofemoral joint. TKA without replacing the articular patella surface is a good option in patients with a high degree of osteoarthritis of the patellofemoral joint.

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Congenital pseudoarthrosis of the tibia and treatment using the Ilizarov technique

Congenital pseudoarthrosis of the tibia and treatment using the Ilizarov technique

Al-Neqresh Hamdy, Ozbi Assia

Статья научная

Background: Congenital pseudoarthrosis of the tibia (CPT) is one of the most difficult problems in paediatric orthopaedic surgery. This is a rare condition, which is mostly associated with neurofibromatosis. Treatment options have varied greatly. Successful surgical treatment of tibial pseudoarthrosis is possible by the Ilizarov method. Patients and methods: 7 patients with CPT treated using the Ilizarov technique within the period from 1998 to 2008. RESULTS: Bone healing was achieved in all cases except one. (Union rate - 85,7 %). Conclsion: The Ilizarov technique is a comprehensive approach to all CPT aspects. Its use can end with very good results

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Damage control orthopaedics

Damage control orthopaedics

Bari Mofakhkharul, Islam Shahidul, Shetu Nazmul Huda, Rahman Mahfuzer

Статья научная

Emergency procedures aimed at rapid reduction and fixation and spanning of periarticular fractures has been termed “damage control orthopaedics”. In severely injured patients, early definitive fixation of fractures may not be appropriate. Recent studies showed that in multiple trauma, DCO is the best option for management of patients who are unstable and in extremis. The paper presents a case of such a control in a 34-year-old patient who sustained polytrauma on 20.10.2016. Primary medical care was conducted at a local hospital. Ten hours after the injury, the patient was transported to the Bari-Ilizarov orthopaedic centre for further management. On admission, he was in a traumatic shock. Radiographic study showed a comminuted fracture of the left femur, medial condylar fracture of the ipsilateral femur, comminuted fractures of both bones of the shin, left wrist sprain, and contusion of the head. Osteosynthesis of the left femoral shaft was performed with a Kuntscher nail and additionally with the Ilizarov fixator. When patient’s condition stabilized on the next day, osteosynthesis of the tibia was performed with the Ilizarov apparatus and the wrist was fixed with a plaster cast.

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Distraction osteogenesis techniques in treatment of acquired and congenital shortening of the hand bones using a modified external mini-fixator

Distraction osteogenesis techniques in treatment of acquired and congenital shortening of the hand bones using a modified external mini-fixator

Danilkin Mikhail Iurevich

Статья научная

Distraction osteogenesis according to Ilizarov is the most common method of bone lengthening and deformity correction including the hand and foot bones. This method forms the basis of the main techniques used for the hand bone lengthening. The author described the technical specifications of the mini-fixator developed for short tubular bones, demonstrated the diagrams of its application to finger phalanges and metacarpal bones, as well as he presented the illustrative clinical cases. The hand bone lengthening performed in 394 patients (566 segments of the hand) at the Center within the period of 1999 and 2012. The performed lengthening procedure improved the hand appearance and functions.

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Drainage versus non-drainage in primary total knee replacement: a comparative study

Drainage versus non-drainage in primary total knee replacement: a comparative study

Zaid Al-Eyadah

Статья научная

Goal. Compare the results in 80 patients who underwent total knee replacement, find out the advantages of using closed suction drainage and compare the results with those in the group where drainage was not used. Methods. A randomized prospective study was conducted in 2011 in group A (40 patients) without drainage and in group B (40 patients) with drainage. Total blood loss was significantly greater in patients who were drained (400 ml) compared to 200 ml in the group without drainage, although the latent amount of blood loss can not be accurately determined. Results. The statistical difference in terms of postoperative pain, ecchymosis or the frequency of cases of infection in the postoperative period in both groups was not. Conclusions. There were no clear evidence to support the use of drainage with total arthroplasty of the knee, despite this many surgeons prefer to use them.

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Hallux valgus: рентгенометрия костей стопы до и после хирургической коррекции

Hallux valgus: рентгенометрия костей стопы до и после хирургической коррекции

Алинагиев Бабек Джебраил Оглы, Теймурханлы Ф.А.

Статья научная

Результаты лечения 63 больных Hallux valgus изучены методом полипозиционной рентгенографии, которую выполняли до, после операции и на различных этапах фиксации аппаратом, а также в отдаленном периоде. У всех больных проводили рентгенометрические исследования. В зависимости от степени деформации первого луча больным производили различные виды остеотомий с фиксацией остеотомированных фрагментов устройством наружной фиксации. После устранения деформации отмечался длительный процесс перестройки в первой плюсневой кости, который можно разделить на два периода: ближайшие два месяца и год после окончания лечения. У 48 больных через год после окончания лечения процесс перестройки первой плюсневой кости был близок к завершению, были сформированы хорошо выраженные кортикальные пластинки, в области основания кости прослеживалась ячеистая структура, форма первой плюсневой кости приближалась к нормальной. У остальных больных процесс перестройки был незавершен, отмечались участки уплотнения в зонах остеотомий, кортикальная пластинка имела различную толщину и плотность, в области головки и основания кости ячеистая структура чередовалась с участками уплотнения и разрежения.

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Management of bone defect of humerus by Ilizarov method

Management of bone defect of humerus by Ilizarov method

Omer Ali Rafiq Barawi

Статья

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Management of congenital radial club hand by gradual correction

Management of congenital radial club hand by gradual correction

Gamal A. hosny, Abdel-salam A. ahmed

Статья научная

Introduction Severe congenital radial club hand is aesthetically unacceptable. This paper represents our experience in treating early and late diagnosed cases using gradual distraction by Ilizarov external fixator. Methods We treated 34 cases of congenital radial club hand with an age ranged from 1 to 15 years. There were 20 girls and eight bilateral cases. Three had been treated on both sides. So, we have treated 37 limbs. Nine cases had been operated before. Centralization alone was done in 12 cases and followed by lengthening in eight cases. Ulnar lengthening and gradual correction of wrist deformities were done for the rest of cases. The patients were followed clinically and radiographically with the following parameters: hand forearm angle, range of motion, daily functional activities, extent of lengthening achieved, and cosmetic improvement. Results The follow up ranged from 1 to 10 years. The magnitude of lengthening achieved ranged from 5 to 11 cm. The average healing index was 52.02 days/cm with cosmetic appearance satisfaction in all cases. Complications included; pin tract infection in 24 cases, flexion contractures of the elbow and fingers in 26 cases [which mostly disappeared during follow up], and spontaneous ulnocarpal fusion in 2 cases. Two cases suffered fracture in the regenerate zone. Conclusions The use of the Ilizarov method with gradual distraction of bone and soft tissues in treatment of radial club hand was effective in forearm lengthening with functional and cosmetic improvement.

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Management of forearm bone gap non-unions by Ilizarov technique

Management of forearm bone gap non-unions by Ilizarov technique

Bari M.M., Islam Shahidul, Shetu Nazmul Huda, Mahfuzer Rahman

Статья научная

Purpose Proper treatment of forearm bone gap non-union should achieve both biological stimulation of the bone and elastic mechanical stability. The use of Ilizarov technique enhances the healing of a non-union providing osteogenic, osteoconductive and an optimal stability with the Ilizarov fixation. We retrospectively reviewed 26 patients affected by forearm bone non-union and treated with the Ilizarov fixation. Materials and Methods Twenty six patients were treated for gap non-unions of forearm bones with the Ilizarov compression distraction device from 2000 to 2015 in BARI-ILIZAROV ORTHOPAEDIC CENTRE. Results All the difficult non-unions healed in a mean of 7 months, ranging from 5 to 12 months. At the latest follow- up, forearm functions were satisfactory. Conclusion The Ilizarov compression distraction device is a fantastic tool in promoting the healing of forearm non-unions, even if the bones are very atrophic.

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Microsurgical limb reconstruction utilizing Truelok TL external fixator:a case report

Microsurgical limb reconstruction utilizing Truelok TL external fixator:a case report

Rodriguez-Collazo Edgardo, Huey Jonathan

Статья научная

Coverage of lower extremity wounds, especially those in the distal leg, present challenges to the reconstructive surgeon. The present case illustrates a surgical technique utilizing a distally based reverse soleus muscle flap for coverage of an anterior leg wound deficit with exposed bone. The wound failed conservative wound care and was at risk of a below the knee amputation. The wound was first debrided to healthy bleeding tissue. The Truelok TL External Fixator was then applied for stabilization of the muscle flap. The medial portion of the soleus muscle was dissected with care to preserve its vascular supply and transposed to cover the wound defect. This was followed by utilization of the Integra Bi-Layer Matrix to control the vapor loss of the wound, act as a bacterial barrier, and provide a scaffold for cellular invasion and capillary growth. A wound VAC was applied to promote granular tissue formation. Following post-operative wound care, a split-thickness skin graft was later applied. The limb was salvaged and wound closure was achieved within three months. The patient began ambulating in a patella tendon bearing orthosis within four months. The reverse soleus muscle flap provides a viable option for ankle wound and anterior leg coverage, especially in medically frail patients. Due to a high degree of versatility, reliability, minimal donor site morbidity, less operating time, low cost and good functional gain; this procedure is highly suitable for the treatment of complex middle and lower leg defects. It should be considered in the reconstruction of soft tissue defects about the ankle, especially when the surgeon has exhausted all other conservative and surgical options.

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Radiological and morphological substantiation of using compression osteosynthesis for treating cranial bone fractures. Experimental canine data

Radiological and morphological substantiation of using compression osteosynthesis for treating cranial bone fractures. Experimental canine data

Diachkov Aleksandr Nikolaevich, Gorbach Elena Nikolaevna, Mukhtiaev Sergei Vasilevich, Chirkova Aleftina Mikhailovna

Статья научная

Optimizing the conditions for cranial bone fracture healing remains to be a relevant field of the current traumatology and orthopaedics. Purpose. To study the impact of compression on reparative osteogenesis when engrafting the resected flaps of calvarial bones. Materials and methods. Two groups of experiments performed in 20 adult mongrel dogs complying with all the requirements of the European Convention for the Protection of Vertebrate Animals used for Experimental and other Scientific Purposes. Dogs from Group 1 (n=10) underwent resection of the two sites of calvarial bones (the caudal flap preserved connections with surrounding soft tissues, the cranial flap - not preserved) of rectangular shape and 1.9×1.5 cm by size, they were laid into their former place and fixation performed with compression using thin wires with stoppers to the medial defect margin by transosseous osteosynthesis method. Compression produced by tightening fixing wires with the force of 40 kg. In Group 2 (n=10) bone flaps were laid into the defect without fixation. The investigations (clinical, radiological and histological) performed 7, 14, 21, 28 and 60 days after surgery. Results. Compression produced at the junction of the margins of free bone fragments and calvarial flat bone defect revealed to contribute to bone tissue formation in earlier periods of time. Conclusion. The results obtained in the present study formed the basis for using the technique of transosseous compression osteosynthesis in treatment of patients with cranial bone fractures in clinical departments of the Center.

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