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Introduction Femoral neck fractures (FNF) are frequent injuries and not rarely complicated by non-union, implant failure, and avascular necrosis. Some of these fractures represent a dilemma for trauma surgeons. Which fracture should be fixed? Which replaced with a prosthesis? How? The aim of this narrative review is to investigate the literature in order to provide the most updated and evidence-based knowledge about FNF’ treatment. Materials and methods A literature research has been performed to find the essential key points to consider when dealing with FNF and their treatment. The most representative papers and the new meta-analysis were matched with authors’ experience to give a concise but comprehensive view of the problem. Timing, age, comorbidities, vascularization of the femoral head, displacement, instability, comminution of the fracture, bone quality, and surgeon experience seem to be the major topics to consider in the decision making. We then focus on the optimal fixation or replacement as suggested by the literature. Results Age is the main independent factor to consider. Timing seems essential in the elderly population to reduce mortality and important in the younger patients to reduce complications. Vascular supply should be always considered. Displacement, instability, and comminution of the fracture are negative prognostic factors for fixation as well as, theoretically, bone quality. In the elderly hip replacement is mostly indicated. A stable and solid fixation is mandatory to allow early mobilization. Sliding Hip Screws (SHS) seem preferable to cannulated screws for displaced/unstable (Pauwels II-III, posterior comminution) and basicervical fracture patterns or in smokers. There is a tendency toward Total Hip Arthroplasty (THA) also in the elderly if the patient is an indipendent ambulator without severe comorbidities. Dual mobility cups are gaining popularity in THA for FNF. Conclusions FNF are frequent injuries and represent, in some cases, a dilemma for the trauma surgeon. Age, timing, comorbidities, bone quality, femoral head vascularization, fracture displacement, intrinsic instability, and comminution as surgeon experience should be carefully evaluated before surgery. A case-to-case analysis of the patient-related factors helps the surgeon to make the right choice and reduce the well-known complications.

Intraosseous schwannoma is extremely rare that it is not often considered among differential diagnosis for an osteolytic lesion, especially in long bones of the extremities. Amounting to less than 0.2% of all primary bone tumours and less than 200 cases reported so far, with only 3 cases involving the humerus, we hereby report the fourth case. In addition to its rarity, this was the only case of an intraosseous schwannoma involving the humerus bone which presented with a pathological fracture in a 45-year-old woman after sustaining a trivial trauma. Radiological examination revealed a geographic type of osteolytic lesion in distal shaft region of the left humerus. Only a histopathological examination helped in revealing and confirming the diagnosis of an intraosseous schwannoma. Treatment of the tumour with complete excision with bone graft reconstruction and osteosynthesis yields good results with very low risk of recurrence.

Background Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. Methods In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. Results The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. Conclusions This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.

Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which require customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

Background A lack of scientific information regarding the risk factors and diagnosis of peri-implant atypical femoral fracture (PI-AFF) exists. We report a case series of developed PI-AFF with a nail or plate construct wherein prior femoral fractures were already healed after osteosynthesis. This study aimed to identify the cause and risk factors of PI-AFF and to devise a preventive method based on this. Methods We identified 11 PI-AFFs displaying features of AFFs. All patients were ambulant females (mean age, 74.9 years). The mean T-score of the femur measured by DEXA (Dual Energy X-ray Absorptiometry) scan was 3.5. Osteosynthesis was performed with a plate and an intramedullary nail in six and five patients, respectively. Possible risk factors were investigated, including the used implant, the medication of bisphosphonate, the characteristics of previous fracture (AFF or non-AFF), and the co-existence of AFF on the contralateral side. Results The PI-AFFs developed at an average of 6.6 years from the time of prior fracture. All fractures were located at the screw through the plate or nail. Regarding anatomic locations, seven and four fractures were at the subtrochanteric area and diaphysis, respectively. Diaphyseal PI-AFFs occurred in plating cases, all of which were associated with excessive femoral bowing. Subtrochanteric PI-AFFs included all five patients with nail fixation, which occurred near a proximal interlocking screw. Six of the 11 patients were on bisphosphonate treatment before or at the time of fracture. The duration of bisphosphonate treatment was 6 years on average. Concerning the previous femoral fractures, seven and four patients were AFF and non-AFF, respectively. Considering the pathology on the contralateral leg, eight had suffered diaphyseal AFF. Four patients were treated nonoperatively. Seven patients needed an operation; 6 of them healed after reconstruction nailing, and one needed hip arthroplasty because of the associated displaced femoral neck fracture. Conclusions PI-AFFs may develop through the screw hole at the subtrochanteric or diaphyseal area due to femoral fragility and stress riser effect of the implant. An improved osteosynthesis strategy may be necessary to avoid PI-AFFs when fixing osteoporotic femoral fractures.

Introduction: Factors related to mortality after intertrochanteric femur fractures (ITFF) have been investigated intensively in the literature except for radiographic osteoporotic hip morphology. The aim of this study is to investigate the relationship between mortality and radiographic osteoporotic hip morphology of patients with ITFF. Patients and methods: Patients who underwent surgery between the dates of January 2012 and June 2018 due to ITFF were retrospectively reviewed. Osteoporotic status of the proximal femur was determined based on Singh Index grading and Dorr classification systems on preoperative anteroposterior pelvis radiographs of contralateral hips. The mortality rates of the patients were measured at 1st, 3rd, 6th, and 12th months. For controlling the confounders, multiple regression analysis was performed. Results: A total of 321 consecutive ITFFs were included in the study. The mean age of the patients was 81.5 ± 6.6 years. All patients were treated with osteosynthesis utilizing a cephalomedullary nail. The overall mortality rates at 1st, 3rd, 6th, and 12th months were 7.2%, 13.4%, 16.2%, 22.7%, respectively. There was 2.196 (1.140 - 4.229) folds increase in the mortality rate of patients with the Dorr type C femurs at 6th month (p=0.019). However, Singh index grade was not significantly associated with mortality. Conclusion: Patients with Dorr type C femur seem to have 2.1 times increased mortality at 6th months following ITFFs. A simple anteroposterior pelvis radiograph obtained during the initial evaluation of the patients may be used to estimate the mortality rate after ITFF.

Introduction Nonunion of distal femur is a complex problem with the added burden of poor bone stock, osteopenia, and joint contracture. Various procedures are described ranging from osteosynthesis using auto/allograft, to use of mega prosthesis. Use of vascularized corticoperiosteal flap based on descending genicular artery and superomedial genicular artery is a new technique to provide living vascular graft for the nonunion site. Although few free corticoperiosteal flap reconstructions have been reported in the past for these distal femur nonunions, this flap has seldom been used as a pedicled variety. Through this article, we aimed at highlighting the main obstacles faced while using pedicled corticoperiosteal flap for these patients given its dearth in literature. Materials and Methods Five patients of at least two previously failed osteosynthesis for distal femur fracture non-union were selected for performing corticoperiosteal flaps. The intraoperative findings that were both favourable and unfavourable were documented along with the outcome of procedure in the form of callus formation or fracture healing. Results Dissection of the flap was more tedious in these cases than when performed for a different indication in a virgin territory. However, despite the previous trauma resulting in decreased pliability of their vessels, all flaps were viable at the end of procedure with favourable cosmetic and functional outcomes. Conclusion Despite the complexities in flap harvest, use of the less morbid and technically easier “Pedicled corticoperiosteal flap” and osteosynthesis along with the auto technique is a worthwhile option for retaining the native joint with favourable outcome in non-unions of distal femur.

Background . Nowadays, due to the development of different methods of osteosynthesis, sometimes the same types of fractures could be treated using several possible options of the osteosynthesis. This fact was reflected in the Clinical Recommendations for the Bone Fractures Treatment, adopted by the Plenum of the Ukrainian Association of Orthopaedists and Traumatologists 15.05.2013. Taking into consideration the possibility of such choice, investigation of the place of the every method of osteosynthesis, and external transosseous osteosynthesis as one of the examples, in the practice of traumatological department of the city hospital may be useful and important. The purpose of the study was to determine the frequency of the external transosseous osteosynthesis for the treatment of bone fractures and their consequences in the practice of traumatological department of the city hospital and its comparison with the frequency of the internal osteosynthesis. Materials and methods. Retrospective study based on the materials of the traumatological department of the City Hospital N 3, Kramatorsk (February, 2015 — January, 2017) was carried out. A total selection of all cases of external osteosynthesis (72 cases) during this period and its correlation with the number of internal osteosynthesis was performed. Results. External transosseous osteosynthesis was used as a main method for bone fractures treatment in 53 cases (73.6 %), in the treatment of bone fractures consequences in 11 (15.3 %) cases, as a way of temporary fixation in 8 (11.1 %) cases. During the studied period the number of operations of the external transosseous osteosynthesis amounted to 31.9 % of the total number of operations on similar segments (72 operations from 226; 1 : 2.14). External fixation prevailed in the treatment of diaphyseal fractures of the tibia (26 of 47 cases; 1.24 : 1), fractures of the distal radius epimetaphysis (2 : 1) and the calcaneal bone (2.5 : 1). The ratio of the external and internal osteosynthesis in the treatment of the ankle injuries amounted 1 : 2.93 (14 vs 41). Conclusions. External osteosynthesis amounts to 31.9 % of the total number of the osteosynthesis. It was used as the main type of treatment in 88.9 % cases, in 11.1 % as a way of temporary fixation. The most frequent indications for its using were diaphyseal fractures of the tibia, ankle injuries, fractures of the distal radius.

Остеосинтез (osteosynthesis; греч. osteon (кость) + synthesis (соединение)) — это хирургическое соединение отломков костей в правильном положении с целью стабильной фиксации до полной их консолидации (костного сращения) и восстановления целости и функции кости. Обследовано 34 больных в возрасте 17–58 лет с гнойными осложнениями после остеосинтеза при переломах длинных костей, в том числе у 29 мужчин и 5 женщин. В сыворотке кpови больных определяли следующие биохимические показатели: активность коллагеназы, фpакции гидpоксипpолина, гликозаминогликаны, кальций, фосфор и электролиты (Na+, K+, Ca++).Результаты исследования показывают, что у больных с гнойными осложнениями после остеосинтеза длинных костей при рецидиве воспалительного процесса усиливается катаболическая фаза метаболизма основных компонентов органической основы костной ткани. Об этом свидетельствуют показатели, отражающие синтетическую и катаболическую фазы метаболизма основных компонентов соединительной ткани — коллагена и гликозаминогликанов. Данные, полученные при исследовании минерального обмена, отражают нарушения минерализации костной ткани, что подтверждается показателями содержания общего кальция, ионизированного кальция, фосфора и электролитов.

Технології накісткового остеосинтезу з використанням пластин і гвинтів, розроблені Асоціацією з вивчення остеосинтезу (АО), в останні десятиріччя набули заслуженого визнання та популярності в усьому світі. Ці методики постійно знаходяться в динаміці розвитку, основна тенденція якого — зменшити травматичність хірургічного втручання та негативний вплив імплантату на регенеративні можливості ушкодженої кісткової тканини. Цьому приділяється основна увага у новій стратегічній концепції розвитку системи АО в цілому, відповідно до якої реалізовані ідеї застосування накісткових пластин з обмеженим контактом, використання гвинтів з кутовою стабільністю, технологій субфасціального мостоподібного остеосинтезу. У поєднанні з малотравматичною хірургічною технікою (використання раціональних хірургічних доступів, спеціального інструментарію та інтраопераційного моніторингу за допомогою електронно-оптичного перетворювача) це дозволяє значно зменшити необхідність девіталізації кісткових відламків, але, зрозуміло, не вирішує питання принципово: технологічно травматичну операцію неможливо виконати атравматично. Розглядаючи згадані тенденції розвитку накісткового остеосинтезу дещо абстраговано, легко дійти висновку, що в теперішньому вигляді він фактично являє собою заглибний позаосередковий однобічний остеосинтез. На прикладі хірургічного лікування переломів плечової кістки пропонується розглянути, до чого фактично призводять протиріччя між травматичністю хірургічного втручання та вимогами біологічної фіксації. На нашу думку, плечовий сегмент є для цього найбільш зручним та адекватним, тому що переломи плечової кістки всіх локалізацій можуть мати показання до накісткового остеосинтезу; плечовому сегменту не властиві негативні особливості кровообігу (на відміну від проксимального відділу стегна, дистального відділу гомілки), що впливають на тактику лікування; при відсутності навантаження вагою тіла простіше виконати рекомендований функціональний режим. Мета — уточнити наукові дані про пріоритетність вимог біологічної фіксації при диференціації показань до застосування методів лікування переломів плечової кістки; на клінічних прикладах хірургічного лікування переломів плечової кістки висвітлити проблеми, пов’язані з девіталізацією кісткової тканини в процесі остеосинтезу з подальшим аналізом особливостей хірургічних технологій щодо вимог біологічної фіксації. Цей аналіз доводить, що слід завжди пам’ятати про ту хитку рівновагу, що існує між ідеальною репозицією кісткових відламків і створенням стабільної системи «фіксатор-сегмент» і тяжкістю хірургічної травми. У випадку порушення цієї рівноваги сповільнене зрощення або відсутність зрощення призводить до руйнування фіксаторів. Не принижуючи грандіозних досягнень АО, диференціації показань до вибору методів лікування переломів слід приділяти увагу, орієнтуючись не тільки на можливість анатомічної репозиції і фіксації, а в першу чергу на відповідність обраної методики вимогам біологічного остеосинтезу.

Введение. Выбор оптимальной методики остеосинтеза внесуставных переломов большеберцовой кости продолжает обсуждаться в научной литературе. При открытых переломах, высокоэнергетической травме, повреждениях мягких тканей, особенно в нижней трети голени, нередко используется метод наружной фиксации. Отказ от более широкого его применения объясняется опасениями воспалительных осложнений и неудобствами для больного. Цель исследования: анализ опыта применения наружного чрес­костного остеосинтеза при внесуставных переломах костей голени и обоснование показаний к его использованию. Материалы и методы. Проведен ретроспективный анализ лечения 67 пострадавших с внесуставными переломами большеберцовой кости методом наружного остеосинтеза. Изучены осложнения и результаты лечения. Проанализированы показания к применению, при которых преимущества метода превосходят неудобства, связанные с наличием внешнего модуля. Результаты. Несросшиеся переломы отмечены у 4 (5,9 %) пострадавших, воспалительные осложнения — у 2 (2,9 %), контрактуры голеностопного сустава — у 4 (5,9 %). Хороший результат отмечен у 55 (80,9 %) пострадавших, удовлетворительный — у 8 (11,1 %), неудовлетворительный — у 5 (7,3 %). Пациенты в период лечения сохраняли мобильность, возможность самообслуживания, осуществляли осевую нагрузку и движения в суставах. Анализ показаний к применению наружного остеосинтеза показал, что при некоторых ситуациях (переломы, сопровождающиеся травматическими или трофическими нарушениями со стороны мягких тканей; переломы большеберцовой кости типа С, двойные (тройные) переломы; перелом костей голени как компонент политравмы; внесуставные переломы костей обеих голеней; лечение несросшихся переломов и дефектов костей) преимущества, которые обеспечивает применение внешней фиксации, превышают неудобства, связанные с наличием наружной конструкции. Выводы. Таким образом, наружный чрескостный остеосинтез является эффективным методом лечения внесуставных переломов костей голени. Опасения, связанные с высокой частотой воспалительных осложнений и неудобствами пребывания в аппарате, при использовании современных конструкций являются преувеличенными. Условием эффективного применения метода является использование конструкций, предусматривающих возможность осевой нагрузки и движений в суставах, этапного воздействия на костные фрагменты, строгое соблюдение технологии вмешательства.

Optimal treatment options for proximal humerus fractures (PHFs) are still debated because of persisting high fixation failure rates experienced with locking plates. Optimization of the implants and development of patient-specific designs may help improve the primary fixation stability of PHFs and reduce the rate of mechanical failures. Optimizing the screw orientations in locking plates has shown promising results; however, the potential benefit of subject-specific designs has not been explored yet. The purpose of this study was to evaluate by means of finite element (FE) analyses whether subject-specific optimization of the screw orientations in a fixed-angle locking plate can reduce the predicted cutout failure risk in unstable 3-part fractures.FE models of 19 low-density proximal humeri were generated from high-resolution computed tomographic images using a previously developed and validated computational osteosynthesis framework. The specimens were virtually osteotomized to simulate unstable malreduced 3-part fractures and fixed with the PHILOS plates using 6 proximal locking screws. The average principal compressive strain in cylindrical bone regions around the screw tips-a biomechanically validated surrogate for the risk of cyclic screw cutout failure-was defined as the main outcome measure. The angles of the 6 proximal locking screws were optimized via parametric analysis for each humerus individually, resulting in subject-specific screw orientations (SSO). The average peri-implant strains of the SSO were statistically compared with the previously reported cohort-specific (CSO) and original PHILOS screw orientations (PSO) for females vs. males.The optimized SSO significantly reduced the peri-screw bone strain vs. CSO (6.8% ± 4.0%, P = .006) and PSO (25.24% ± 7.93%, P.001), indicating lower cutout risk for subject-specific configurations. The benefits of SSO vs. PSO were significantly higher for women than men.The findings of this study suggest that subject-specific optimization of the locking screw orientations could lead to lower cutout risk and improved PHF fixation. These computer simulation results require biomechanical and clinical corroboration. Further studies are needed to evaluate whether the potential benefit in stability could justify the increased efforts related to implementation of individualized implants. Nevertheless, computational exploration of the biomechanical factors influencing the outcome of fracture fixations could help better understand the fixation failures and reduce their incidence.

We report a case of a 49-year-old patient with an isolated dorsal radial dislocation of the right trapezium that occurred in a context of polytrauma. At first, the lesion went unnoticed. The diagnosis was made 1 month later because of persistent pain in the thumb. An open reduction of the dislocation was carried out, and osteosynthesis using scaphoid-trapezium and trapeziotrapezoid pinning was conducted under fluoroscopic control. The patient was immobilized for 3 months after surgery. After 4 years, the mobility of the thumb was complete and painless.

The study analyzed 20 cases of fracture shaft of hummers treated with Dynamic Compression Plate. There was a male preponderance in our study 17 (85%). Almost Also 13% of patients treated by functional bracing end up with cosmetically unacceptable angulation of>15%, whereas all operative procedures achieve good alignment of the fractured bone was observed. The rate of union in Plate osteosynthesis is 93% and the time of union is 16 - 20 weeks, and more than 90% united in 18 weeks and 7% went for non union.

Проведен анализ 42 случаев неудовлетворительного остеосинтеза различными фиксаторами при переломах шейки бедренной кости (ПШБК). Анализировалось влияние многих факторов на сращивание фрагментов: качество репозиции, травматичность оперативного вмешательства, начало и величина нагрузки. Разработано устройство для остеосинтеза переломов проксимального отдела бедра (УОППОБ, пат. Украины № 22283). Оно обеспечивает самокомпрессирующий эффект фрагментов, минимально травмирует их, создает условия для сращения. Предложены методики применения УОППОБ при псевдоартрозах и ПШБК. Они с положительным результатом применены у 176 пациентов.

Актуальність. Стаття присвячена тактиці хірургічного лікування постраждалих з ушкодженням периферичних нервів унаслідок вогнепальних поліструктурних поранень верхньої кінцівки. Визначено, що особливістю вогнепальних ушкоджень нервів є нерівномірність ураження в різних ділянках або на декількох рівнях у різних анатомічних ділянках, що диктує персоніфіковані підходи до лікування. Метою дослідження було удосконалення хірургічної тактики лікування поранених з ушкодженням периферичних нервів унаслідок вогнепальних поліструктурних ушкоджень верхніх кінцівок. Матеріали та методи. Проаналізовані результати хірургічного лікування 202 поранених з ушкодженням периферичних нервів унаслідок вогнепальних поліструктурних ушкоджень верхніх кінцівок. Результати. Важливими аспектами у лікуванні таких пацієнтів є: обов’язкова стабілізація кісткових уламків при вогнепальному переломі перед відновленням нерва, адекватне заміщення м’якотканинних дефектів, що відкриває можливості для створення сприятливих умов оточення ушкодженого нерва та стимуляції регенерації останнього з відновленням тканини «ковзання». Висновки. Своєчасне, раннє відновлення периферичних нервів, яке виконувалось одночасно з остеосинтезом та заміщенням дефекту тканин, дозволяє отримати раннє відновлення функції верхньої кінцівки.

The problem of complications and the frequency of poor outcomes in the surgical treatment of ankle fractures with ti-biofibular syndesmosis (TFS) rupture (4.8–36.8 % of cases) remains significant. It was interesting from a scientific and practical point of view to conduct a clinical study to determine the effectiveness of the newly developed method of metal osteosynthesis for tibial fractures with TFS rupture, which would combine stability of tibial fixation and not limit the elastic qualities of TFS. The aim of the study: to determine the effectiveness of combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia. Materials and methods. On the basis of own clinical researches and data of literature sources, the method of the combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia is developed. The effectiveness of the proposed technique was evaluated 6 months after surgery on the Kitaoka scale. We have examined 12 patients with tibial fractures type 44 B1, B2 and B3 according to the AO classification, who underwent surgery using our methods. Results. The high efficiency of using the technique of combined stable-elastic fixation for unstable injuries of the ankle joint due to trans-syndesmotic fractures of the tibia has been determined. Good and excellent treatment results 6 months after surgery were observed in all 12 people (100 %), with excellent outcomes observed in 75 % of cases. There were no satisfactory and unsatisfactory treatment results. Conclusions. The study proves the high efficiency of the proposed method for combined stable-elastic fixation of ankle injuries in unstable trans-syndesmotic fractures of the tibia with TFS damage. There were 75 % excellent and 25 % good results within 6 months after surgery. A wider introduction of this technique into the practice of traumatologists of Ukraine is proposed., Вагомою залишається проблема ускладнень і частота незадовільних результатів при хірургічному лікуванні переломів кісточок із розривом міжгомілкового синдесмозу (МГС) — 4,8–36,8 % випадків. Цікавим з наукової та практичної точки зору було проведення клінічного дослідження з метою визначення ефективності нової розробленої методики металоостеосинтезу переломів кісточок гомілки з розривом МГС, яка поєднувала б в собі стабільність фіксації малогомілкової кістки та не обмежувала еластичні якості МГС. Мета: визначити ефективність методики застосування поєднаної стабільно-еластичної фіксації нестабільних ушкоджень гомілковостопного суглоба при черезсиндесмозних переломах малогомілкової кістки. Матеріали та методи. На підставі власних клінічних досліджень та даних літературних джерел розроблений спосіб поєднаної стабільно-еластичної фіксації нестабільних ушкоджень гомілковостопного суглоба при черезсиндесмозних переломах малогомілкової кістки. Ефективність запропонованої методики оцінена через 6 місяців після виконання оперативного втручання за шкалою Kitaoka. Обстежені 12 хворих з переломами кісточок гомілки типу 44 В1, В2, В3 (класифікація АО), яким оперативне втручання було здійснено за запропонованою нами методикою. Результати. Визначена висока ефективність використання технології поєднаної стабільно-еластичної фіксації нестабільних ушкоджень гомілковостопного суглоба при черезсиндесмозних переломах малогомілкової кістки. Добрий та відмінний результати лікування через 6 місяців після операції відзначено в усіх 12 осіб (100 %), причому відмінний результат лікування був у 75 % випадків. Задовільних та незадовільних результатів лікування не відзначено. Висновки. Дослідження доводить високу ефективність застосування запропонованого авторами способу поєднаної стабільно-еластичної фіксації ушкоджень гомілковостопного суглоба при нестабільних черезсиндесмозних переломах малогомілкової кістки з ушкодженням МГС. Відзначено 75 % відмінних та 25 % добрих результатів у термін 6 місяців після оперативного втручання. Пропонується більш широке впровадження цієї методики в практику травматологів України.

Проведено аналіз ефективності та оцінку діагностичної цінності використання адитивних технологій при доопераційній підготовці хворих із ортопедо-травматологічною патологією. Матеріалом дослідження було 3D-моделювання та виготовлення пластикових прототипів у лабораторії медичного 3D-друку ДУ «Інститут травматології та ортопедії НАМН України» в 45 пацієнтів відповідного медичного профілю. Визначено високу діагностичну цінність 3D-моделювання та прототипування в доопераційній підготовці хворих із різною ортопедо-травматологічної патологією. Використання адитивних технологій дало можливість досягти добрих і відмінних функціональних результатів у всіх 45 обстежених хворих у ранньому післяопераційному періоді, що доводить високу ефективність 3D-моделювання та прототипування й може бути рекомендовано як незамінний метод при підготовці до складних реконструктивних ортопедо-травматологічних втручань., Проведены анализ эффективности и оценка диагностической ценности использования аддитивных технологий при дооперационной подготовке больных с ортопедо-травматологической патологией. Материалом исследования было 3D-моделирование и изготовление пластиковых прототипов в лаборатории медицинской 3D-печати ГУ «Институт травматологии и ортопедии НАМН Украины» у 45 пациентов соответствующего медицинского профиля. Определена высокая диагностическая ценность 3D-моделирования и прототипирования в дооперационной подготовке больных с различной ортопедо-травматологической патологией. Использование аддитивных технологий позволило достичь хороших и отличных функциональных результатов у всех 45 обследованных больных в раннем послеоперационном периоде, что доказывает высокую эффективность 3D-моделирования и прототипирования, а методика может быть рекомендована как незаменимый метод при подготовке к сложным реконструктивным ортопедо-травматологическим вмешательствам., Background. The analysis of the effectiveness and evaluation of the diagnostic value of the use of additive technologies in the preoperative preparation of patients with orthopedic and trauma pathology were carried out. Materials and methods. The research material was 3D modeling and production of plastic prototypes in the laboratory of medical 3D printing of the Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine in 45 patients of the corresponding medical profile. Results. The conducted research proves the high diagnostic value of 3D modeling and prototyping in the surgical preparation of patients with different orthopedic and traumatic pathology. The use of additive technologies has allowed achieving good and excellent functional results in all 45 patients in the early postoperative period, which proves its high efficiency and can be recommended as an indispensable method in preparing for complex reconstructive orthopedic and traumatic interventions. With regard to the prospects for the expansion of the spectrum of orthopedic pathology, where additive technologies are used, the urgent need is the production of plastic prototypes in the early stages of aseptic necrosis of the femoral head and the preparation for its tunneling, multiplane deformations of the limbs in preparation for osteotomy, etc. Conclusions. The conducted research has determined the high diagnostic value of the use of additive technologies in the surgical preparation of patients with different orthopedic and traumatic pathology. 3D simulation and manufacturing of a plastic prototype allows you to choose the optimal design of implants and determine their correct spatial location during the preparation for surgical intervention, reduce the time of surgical intervention, reduce the number of intraoperative complications. This technology can be recommended for implementation in the centers involved in revision and complex endoprosthetics, osteosynthesis and oncorthopedics.

Objective To reveal noteworthy characteristics of intramedullary (IM) nail breakage in pertrochanteric femur fractures. Materials and methods The data from 6 patients with IM nail breakage in our hospital between August 2008 and May 2018 were reviewed retrospectively. With an additional 64 cases reported in articles in the PubMed database prior to October 2019, a total of 70 cases were reviewed and analysed; epidemiological patient data and data on the initial trauma, fracture type, nail selected for the original surgery, time from surgery to breakage, mechanism and location of breakage, status of fracture healing, salvage treatment and prognosis were assessed. Results Seventy patients with pertrochanteric fractures, including 2 stable fractures and 68 unstable fractures, experienced IM nail breakage at a mean of 9.4 months after the initial surgery. Among them, 9 (12.9%) occurred within 3 months, 23 (32.9%) between 3 and 6 months and 38 (54.3%) after 6 months. The mean age was 72.3 years, and 16 (22.9%) patients were younger than 65 years old. When nail breakage occurred, 66 fractures (94.3%) exhibited delayed union/non-union. Self-dynamisation was found in 12 cases (17.1%). The salvage procedures included 4 partial/total implant removal procedures, 17 hemi/total hip arthroplasty procedures, 3 conservative treatment procedures, and 46 revised osteosyntheses, of which 7 cases (15.2%) sustained secondary implant failure. No significant differences were found between the failure rates of IM nails and extramedullary(EM) devices (odds ratio [OR], 3.429; 95% confidence interval [CI], 0.632–18.877; p = 0.330). Conclusion IM nail breakage is a rare complication lack of time regularity and mostly occurs in unstable pertrochanteric fractures in the presence of delayed union/non-union. Osteosynthesis revision can be conduct by a new IM nail or EM device but considerable secondary failure rate is noteworthy. Self-dynamisation may be a warning sign of nail breakage.

Background Olecranon osteotomies are frequently used to expose distal humeral intraarticular fractures. The step-cut olecranon osteotomy (SCOOT) is an augmented version of the oblique olecranon osteotomy, which has recently been evaluated biomechanically with tension band wiring (TBW) fixation. However, complications with TBW are common. In this study, we, therefore, compared the mean load to failure of TBW with compression screws for SCOOT fixation. We hypothesized a higher load to failure for the compression screw group. Methods We performed a SCOOT on 36 Sawbones. Eighteen were fixed with TBW, and another 18 with two compression screws. The humeroulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna, while the humeroulnar joint is in a fixed position. Eight models of each fixation group were tested at 20��, and eight at 70�� of flexion by isometrical loading until failure, which was defined as either a complete fracture or gap formation of more than 2 mm at the osteotomy site. Results At 20�� of flexion, mean load to failure was similar between the TBW group (1360 �� 238 N) and the compression screw group (1401 �� 261 N) (P = .88). Also, at 70�� of flexion, the mean load to failure was similar between the TBW group (1398 �� 215 N) and the compression screw group (1614 �� 427 N) (P = .28). Conclusions SCOOTs fixed with TBW and compression screws showed similar loads to failure. A SCOOT fixed with compression screws might be a valuable alternative for surgeons when treating intraarticular distal humeral fractures. However, future in vivo studies are necessary to confirm our results in a clinical setting.

Background. Restoration of the pelvic bones and acetabulum anatomy after fracture is an important criterion for functional outcome. Often, the reduction of flat pelvic bones is not an easy task. The authors proposed a method of reduction using a special support site of two or three 3.5 mm cortical screws for Matta bone forceps. The aim of the study was to demonstrate a new way of pelvic bones fragments reduction. Method Description. Three clinical situations are presented when a new method was used: 1) reduction of a pointed fragment of the acetabulum posterior column transverse fracture; 2) reduction of the acetabulum quadrilateral plate fragments with medial displacement and 3) reduction the rupture of the pelvic bones in the sacroiliac joint with the vertical displacement. Previously, a support site was created in one of the fragments from two or three not fully twisted 3.5 mm cortical screws. One of the Matta bone forceps branches was placed on the formed site, and the second on another fragment and the displacement was eliminated. Then the final osteosynthesis was performed with pelvic plates and/or cannulated screws according to the surgical plan. Before closing the wound the support site was removed. Conclusion. The proposed method has shown its effectiveness during the reduction of the flat bones fragments, as it allows you to compress the spongy bones of the pelvis with a thin cortical layer stronger, compared with existing methods during which fragments splitting and pulling out anchor screws in the branches of reduction forceps can occur. The developed method of reduction demonstrated convenience and reliability.

The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment. The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach. Materials and Methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman`s posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery. Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p

The number of elderly people is constantly increasing all over the world. They are most often the patients who need orthopedic surgeries like arthroplasty, osteosynthesis and others. It is knownthat the process of bone regeneration depends on the patient’s age. However, certain characteristics of bone regeneration process depend on the age remain unclear, which is important for developingthe best strategies for treatment of elderly patients. Objective. Тo identify age-related features of bone regeneration and to establish possible ways of influencing them in order to optimize the boneregeneration in elderly patients. Methods. Literature search was performed in the PubMed database. Inclusion criteria were original experimental and clinical studies in English. The search depth is accepted for 20 years. Results. It has been experimentally and clinically shown that bone tissue regeneration slows down with age, which is more pronounced in women. According to scientific information, this involves two signaling pathways — Notch and Wnt/β-Catenin, the activity of which is suppressed with age. However, the regulation of regeneration is a cascade of signaling pathwaysand macromolecules. The expression of growth factors after fracture changes at older age compared to a younger one. In particular,a decrease in the expression of TGFβ-1 was clinically revealed. In addition, in older patients after fracture, an increase in macrophage colony-stimulating factor and VEGF was recorded. It has been experimentally established that a combination of a slowdownin bone tissue regeneration with a decrease in the content of Indian Hedgehog, Sonic Hedgehog, BMP-2, 4, -7 proteins and MMP-9 in bone callus has been established. Among the ways to overcome the delayed bone regeneration in elderly patients can be the use of modern technologies of cell and gene therapy, inhibitors of macrophages, biologically active factors at certain stages of bone regeneration. For cell therapy, it is important to take into account the age of the cell donor because of the high probability of functional disorders in cells from older donors., Кількість людей похилого віку постійно збільшується у всьому світі. Саме вони найчастіше є пацієнтами, яким виконують ортопедичні операції — ендопротезування,остеосинтез тощо. Відомо, що процес регенерації кістки залежить від віку людини та, імовірно, уповільнюється з його збільшенням. Проте залишаються нез’ясованими певні особливості процесу відновлення кістки залежно від віку, що важливо для розроблення кращих стратегійлікування пацієнтів похилого віку. Мета. Виявити вікові особливості репаративного остеогенезу та встановити можливі шляхи впливу на них для оптимізації регенерації кістки в пацієнтів похилого віку. Методи. Пошук літератури виконано у базі даних PubMed. Критеріями включення були оригінальні експериментальні та клінічні дослідження англійською мовою. Глибина пошуку прийнята 20 років. Результати. Експериментально та клінічно показано, щорегенерація кісткової тканини уповільнюється з віком і має більший прояв у жінок. За науковою інформацією, у цьому задіяні два сигнальних шляхи — Notch s Wnt/β-катенін, активність яких пригнічується з віком. Проте регуляція регенерації — це каскад сигнальних шляхів і макромолекул. Експресія факторів росту після перелому змінюється у старшому віці порівняно з молодшим. Зокрема, клінічно виявлено зниження експресії TGFβ-1. Крім того, у пацієнтівстаршого віку після перелому зафіксовано підвищення макрофагального колонієстимулювального фактора і VEGF.Експериментально встановлено поєднання уповільнення регенерації кісткової тканини зі зниженням вмісту в кістковому мозолі білків Indian Hedgehog, Sonic Hedgehog, BMP-2, -4, -7 та желатинази MMP-9. Серед шляхів подоланнясповільненої регенерації кістки в пацієнтів похилого віку може бути використання сучасних технологій клітинної та генної терапії, інгібіторів макрофагів, біологічно активних чинників на певних стадіях репаративного остеогенезу.Для клітинної терапії важливим є врахування віку донора клітин через високу ймовірність функціональних порушень у клітинах від донорів старшого віку.

Metastatic bone disease of the distal extremities, also known as acrometastasis, is very rare. Thus, there is very limited information regarding the clinical manifestations and methods of surgical treatment. The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival. As metastatic bone disease is generally uncurable, the goal of surgical treatment is to provide the patient with good function with as few complications as possible. In this article, we discuss the clinical manifestation of acrometastases, the methods of surgical intervention, and the expected clinical outcome. Non-surgically managed pathological fractures generally remain ununited; therefore, conservative treatment is reserved for patients with poor general condition or dismal prognosis. The current evidence suggests that in lesions of the lower arm and leg, osteosynthesis (plate and screw fixation or intramedullary nail) is the most common method of reconstruction, whereas local excision or amputation are more commonly used in cases of more distal lesions (such as ankle, foot and hand). Following surgery most patients receive adjuvant radiotherapy, even though its role is poorly documented. Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome. Further studies are needed in order to provide stronger clinical evidence and improve decision-making, in an effort to optimize the patients’ quality of life and avoid the need for revision surgery.

Objetivos: Comparar el tratamiento de pacientes con fracturas oblicuas o espiroideas largas de metacarpianos, mediante reducción abierta y fijación interna con tornillos interfragmentarios solos o placas y tornillos. Materiales y Métodos: Se realizó un estudio retrospectivo comparativo entre 2 grupos de pacientes: uno con 24 pacientes tratados con tornillos interfragmentarios solos y otro con 17 pacientes tratados mediante osteosíntesis con placas y tornillos. En ambos, se utilizó un abordaje longitudinal dorsal, y se les indicó inmovilización posoperatoria con valva de yeso y rehabilitación con el mismo equipo de terapistas ocupacionales. Tras un seguimiento mínimo de 12 meses, se evaluaron los resultados con el puntaje DASH, la movilidad activa total, la distancia pulpejo-palma y la fuerza con dinamometría comparativa. Se consideró significativo un valor p

Актуальность. За последние двадцать лет произо-шли значимые изменения в лечении переломов плечевой кости (ППК). В остеосинтезе появилось много высокотехнологических средств. Многочисленные мастер-классы, краткосрочные курсы недостаточно освещают проблемные вопросы остеосинтеза этими фиксаторами. Результаты лечения ППК довольно часто, к сожалению, оставляют желать лучшего. Цель работы — анализ биомеханических аспектов современных фиксаторов для остеосинтеза ППК, причин осложнений и неудовлетворительных результатов их применения. Материалы и методы. Анализ доступных литературных данных, рентгенограмм интересных случаев, историй болезни пациентов с осложнениями и негативными результатами остеосинтеза ППК интрамедуллярными блокирующими стержнями, LCP-пластинами. Результаты. Результат лечения ППК в значительной степени зависит от понимания процесса репаративной регенерации. Наметилась тенденция механистического подхода в лечении переломов костей и их последствий. При переломах хирургической шейки ПК применяют фигурные LCP-пластины. Они предусматривают введение в головку кости минимум 4 блокированных винтов. Нередко это приводит к развитию асептического некроза. Отсутствие анатомической репозиции отломков, а также проведение в головку ПК 5–7 винтов приводит к деформирующему артрозу плечевого сустава. Подобные осложнения мы наблюдали у 10 пациентов. Введение большого количества винтов в головку кости может осложниться изломом фиксатора на грани перепада напряжения пластины. В сложных случаях ППК и при осложнениях остеосинтеза другими фиксаторами у 170 пациентов мы применяли разработанное нами устройство для фиксации костных отломков. Оно защищено патентом Украины № 17502, устраняет вредное давление пластины на кость, осуществляет стабильный остеосинтез при максимально возможной короткой пластине. Блокировка винтов в пластине при недостаточно репонированных фрагментах заканчивается развитием псевдоартроза. Частым осложнением применения LCP-пластин является эффект сварки между головкой винта и пластиной. На фоне остеопороза кости LCP-пластина фактически выполняет роль протеза, что усиливает явления остеопороза. При позднем удалении LCP-пластины в таких случаях возможна рефрактура ПК. Выводы. Таким образом, остеосинтез LCP-пластинами переломов ПК имеет значительные преимущества перед традиционными контактными пластинами. Осложнения и отрицательные результаты остеосинтеза могут возникнуть при применении их не по показаниям, нарушении методики, техники оперативного вмешательства и правильности ведения послеоперационного периода.

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.

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.

A clinical case study is presented to describe the use of the minimally invasive plate osteosynthesis (MIPO) tech-nique, using the PRCL-M system with 11-hole locking compression and reconstruction plate with 6 locking screws. Virtual preoperative planning using the CorelDRAW version X5 vector program for digital design was employed to reduce the possible complications that could arise in an intervention. The subject was a 6-month-old male American Bull canine, presented with evident claudication in the right hind limb. Radiographic plates re-vealed a short oblique complete fracture at the proximal diaphysis of the right tibia and fibula, a low energy trauma occasioned by a motorcycle road traffic accident. This osteosynthesis case was resolved with OPMI. This mini-mally invasive technique is widely accepted for fractures of this nature, with satisfactory clinical results, owing to the flat surface of the medial border of the tibia. In this case, osteosynthesis and early healing resulted in a rapid recovery that was observed during postoperative care, without secondary complications.

Background Ankle fractures are the most common traumatic bone injuries of the lower limb. Over 50% of ankle fractures occur at the syndesmosis level (type AOB). The goal of treatment is to achieve an anatomical reduction and appropriate stabilization. The present study aimed to evaluate the clinical-functional and radiological results, and complications of minimally invasive reduction and fixation technique for ankle fractures type AO B. The surgical technique also is detailed. Material and methods A prospective analysis of 451 patients undergoing surgery for Type AO B displaced ankle fracture was performed. All patients were treated with minimally invasive surgery. The following times were recorded: time between trauma and osteosynthesis, hospitalization length, surgical time, and exposure time to fluoroscopy. Age and gender, mechanism of injury, and characteristics of fractures were recorded. For functional outcome, AOFAS score, VAS, and Weber score were used. Radiographic analysis was performed. The average follow-up was 112 months. Results Mean age was 48.2 years old. Average length of stay in hospital was 5.72 hours. Mean duration of the surgery was 32.8 minutes. Average fluoroscopic exposure time during surgery was 9.25 seconds. Mean bone union time was 38.2 days. Weber’s score was on average 1.5/24 points and the long-term follow-up AOFAS score was on average 97.5/100. Postoperative complications incidence was 2.7%. Conclusions Distal fibula fixation with the MIPO technique presented good functional outcomes and could be helpful in the avoidance of the complications associated with conventional open reduction and internal fixation. However, it needs more exposition to intraoperative fluoroscopy. Level of evidence : II.

Background. In relation with the COVID-19 new coronavirus infection epidemic that began in Russia in the spring of 2020, a completely new group of patients appeared: patients whose coronavirus infection was combined with the proximal femur fractures. In the course of practical work, hospital doctors had to gain experience in treating these complex patients, solve new organizational and medical tasks. The aim of the study was to evaluate the results of treatment of patients with the proximal femur fractures in combination with coronavirus infection in a «covid» hospital at the hospital stage, 30-day and 6-month terms. Materials and Methods. The retrospective study is based on the collection and generalization of data from 64 patients with the proximal femur fractures in combination with confirmed coronavirus infection who underwent inpatient treatment from 16.03.2020 to 31.05.2021. 38 (59.4%) patients had a femoral neck fracture, 26 (40.6%) had a fracture of the trochanter region. Forty (62.5%) patients underwent surgical treatment (hip replacement was performed in 23 cases, osteosynthesis was performed in 17 cases), 24 (37.5%) patients did not undergo surgery. Results. With conservative treatment, the hospital mortality rate was 41.6%, the 30-day mortality rate was 72.7%, and the 6 — month mortality rate was 95.5%. During surgical treatment, the hospital mortality rate was 5.0% (2 patients died). Early postoperative complications were detected in 5 (12.5%) patients. Thirty-one (77.5%) patients walked or stood with a walker on their own at the time of discharge; 7 (17.5%) patients could not be activated. The thirty-day mortality rate in the group of patients who underwent surgical treatment was 8.6%, and the 6-month mortality rate was 32.1%. Conclusion. Surgical treatment of patients with the proximal femur fractures in combination with coronavirus infection is much more difficult than the treatment of patients without infectious pathology. However, despite number of unresolved problems, surgical treatment of such patients is possible with good results and should be actively applied.

A systematic review search was based on the PICOS approach, as follows: population: cleft lip and palate patients; intervention: Le Fort I osteotomy; comparator: different surgical protocols; outcome: stability, recurrence or surgical complications; study designs: only case reports were excluded from the review. No restrictions were placed on language or year of publication. Risk of bias was analyzed, heterogeneity was assessed, and subgroup analysis was performed using a level of significance of 1% (p = 0.01). The search identified 248 citations, from which 29 studies were selected and a total of 797 patients enrolled. The level of agreement between the authors was considered excellent (k = 0.810 for study selection and k = 0.941 for study eligibility). Our results reported a mean maxillary advancement of 5.69 mm, a mean vertical downward/upward of 2.85/−2.02 mm and a mean clockwise rotation of 4.15°. Greater surgical relapse rates were reported for vertical downward movement (−1.13 mm, 39.6%), followed by clockwise rotation (−1.41°, 33.9%), sagittal (−0.99 mm, 17.4%) and vertical upward (0.11 mm, 5.4%) movements. No relevance was found regarding the type of cleft, the type of Le Fort I osteotomy, concomitant bone grafting, surgical overcorrection, postoperative rigid or elastic intermaxillary fixation, or retention splint. Study limitations were heterogeneity and the low number of high-quality studies. In spite of reported high relapse rates, Le Fort I osteotomy for maxillary reposition is the first-choice procedure for selected cleft lip and palate patients in whom extensive maxillary movements are not required, because of its safety and its three-dimensional movement versatility in one-step surgery. Otherwise, distraction osteogenesis should be considered as the gold standard treatment.

Radial fracture is the most common trauma to the musculoskeletal system and accounts for 50 % of traumatic injuries to the bones of the upper limb. Disability in patients with fractures of the forearm bones ranges from 6 to 8 months, so the choice of the most effective method of treatment is very relevant. Currently, an important point is the tendency of optimizing the transosseous method by eliminating the disadvantages and looking for new advantages of external fixation. Bone fracture and associated surgical intervention are always accompanied by varying degrees of changes in the links of the central nervous system, hemodynamics and metabolism. In order to study the bioelectrical activity of the brain in 47 patients with a fracture of the radial diaphysis treated in the Traumatology Department of the Irkutsk Scientific Centre of Surgery and Traumatology, in the pre- and postoperative period we compared EEG indicators of two variants of the layout of the external fixation apparatus (EF): wire and rod. Analysis of the rhythms of bioelectrical activity of the brain in both groups in the preoperative period revealed a normal zonal distribution with the dominance of the alpha rhythm on the EEG, which generally reflects a rather high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the group of patients with a wire-mounted EF device in the postoperative period, EEG indices significantly differed from the values of the norm and ndicators in the group with a rod-shaped arrangement. A decrease in the amplitude of alpha and beta rhythms was noted, as well as a shift in the frequency of bioelectric activity towards slow waves, which is a sign characteristic of discirculatory encephalopathy. An EEG study using the method of transosseous osteosynthesis with EF devise of a rod assembly showed its greater efficiency compared to the use of an EF device of a wire assembly during treatment and rehabilitation. Thus, the study of the bioelectric activity of the brain is a reliable method for assessing its functional state after an injury, as well as the effectiveness of the treatment.

BACKGROUND This study evaluated the results of intramedullary osteosynthesis with titanium elastic nail (TEN) in the surgical treatment of Monteggia lesions in children aged 12 and under. METHODS Patients who underwent surgery with the TEN method between 2013 and 2019 were screened retrospectively. The inclusion criteria were patients who failed conservative treatment, a history of acute trauma (

Background Plate fixation is an established treatment for Neer type II and V distal clavicle fractures; however, residual coracoclavicular (C-C) separation after osteosynthesis for unstable distal clavicle fractures has rarely been discussed. This study aimed to reveal the extent of postoperative C-C separation after plate fixation for distal clavicle fractures and to evaluate the relationship between residual C-C separation and the risk of postoperative complications. Methods We retrospectively reviewed 60 patients with a displaced distal clavicle fracture that was treated with a Scorpion plate without C-C reconstruction and successfully united. Distal clavicle fractures were divided as per the Neer classification into type IIA (12 patients), IIB (36 patients), and V (12 patients) groups. The modified C-C distance ratio at the time of injury and after bone union, and the postoperative complications (plate-related pain, delayed union, infection, and contracture) were compared among the three groups. Results The mean postoperative modified C-C distance ratio was 115.0% ± 12.0%; this ratio was significantly larger in the type IIB and V groups than in the type IIA group (P = .021 and P = .006, respectively). However, there was no significant difference in the frequency of postoperative complications among the three groups. Conclusions Our study demonstrated that a certain degree of C-C separation remained after plate fixation for Neer type II and V distal clavicle fractures, even when bone union was achieved. The postoperative residual C-C separation was greater for the type IIB and V groups than for the type IIA group; however, this difference may not affect postoperative complications.

Objective The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. Methods Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. Results The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). Conclusion The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. Level of evidence Level III, Therapeutic Study.

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, like arthroplasty, if needed.

Introduction The indications on extraction of osteosynthesis material (EMO) are not well defined in the current literature deriving in relative indications, depending on experiences, customs or patient's request. The aim of this article is to assess the beliefs, indications, usual practice and perceived complications of surgeons in Spain regarding OME. Methods We conducted a questionnaire of 44 questions covering general demographics, general and subjective opinion on implant removal, specific attitudes by implant type and anatomical location, and personal habits. Results 164 questionnaires were received. The most frequent indications are patellar and olecranon locks and elastic nails in children. 56% remove the implant at the patient's request, 31% always remove it in children, 28% do it in asymptomatic patients to avoid possible surgical problems, 14% to avoid a possible peri-implant fracture and 9% by simple preference. The most frequent intraoperative complications are surgery longer than expected, bone growth over the implant, rounded screw head core, cold fusion, difficulty in finding the implant and impossibility to remove part of the implant. The most frequent postoperative complication was persistence of symptoms 39.8%. Conclusion The results provide information to advise the patient regarding the expected clinical outcome and intra and postoperative complications. The surgeon should cautiously indicate extraction in the asymptomatic patient given the high rate of complications.

Objective: To disseminate a rehabilitation protocol with early mobilization and ambulation, with no external supports, reducing the time until full weight-bearing and providing greater postoperative comfort. Methods: We prospectively assessed a series of 68 patients, with level of evidence IV, mean age of 33.3 years. We performed open reduction with ankle lateral approach (Kocher) and internal fixation with an interfragmentary compression screw and a one-third locked tubular plate for neutralization. All patients were subjected to a rehabilitation protocol with early mobilization and weight-bearing. Results: No fracture displacements were observed on the postoperative radiographic controls, neither loosening nor ruptures of implants. There was no need to change rehabilitation guidelines either due to pain or to other subjective limitation. Conclusion: We can state that early joint mobilization and controlled progressive support, with appropriate osteosynthesis, resulting in an early return to everyday activities, both work and sports ones. Level of Evidence IV; Therapeutic Studies; Case Series.

Ошиқ-болдир бўғимининг жарохатлари травматолог-ортопед амалиётида кўп учрайдиган патологиялардан бири бўлиб, у таянч-ҳаркат тизимининг 20% ташкил этади. Мехнатга лаёқатли кишиларда ошиқ-болдир бўғими бойламларининг жарохатланиши 12% дан 40% гача учрайди, тўпиқларнинг синиши оқибатида дельтасимон бойлам ва болдирлараро синдесмоз ажралишининг 30% холларида қониқарсиз натижа кузатилади. Тадқиқот мақсади. Болдирлараро дистал синдесмоз бойламининг узилишида турғун-остеосинтез натижаларининг таҳлили.

Objective: To characterize the epidemiological profile of patients treated at a hospital service with diagnosis of open fracture of the ankle and foot. Methods: Retrospective, descriptive, epidemiological, observational study of open fractures of the ankle and foot selected by convenience sampling in a hospital service in São Paulo, state of São Paulo, Brazil, from March 1, 2017, to March 1, 2019, totaling 109 patients. Data collection was conducted for the analysis of variables included in patients’ medical records. Results: The medical records of 700 patients with open fractures were assessed. Of these patients, 13.2% (109 patients) had open fractures of the ankle and foot. There was a predominance of male young adults (70.8%) and of left lower limb fractures (51.85%). Most cases were classified as Gustilo and Anderson type II fractures (42.6%). Motorcycle accidents (44.45%) predominated, and students and professional motorcyclists were the most frequent occupations (37.04%). The most adopted stabilization method was osteosynthesis (internal fixation) (44.45%), and primary amputation was required in 3.7% of the cases. Conclusion: Male young adults were the most affected by fractures of the ankle and foot, and traffic accidents were the leading cause. Most patients had an educational attainment of complete elementary education. Most fractures were classified as Gustilo and Anderson type II. Greater severity was observed in patients with associated injuries in other body segments and who developed early complications during hospitalization. Level of Evidence IV; Prognostic Studies; Case Series.

Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. The majority affect the femur, humerus and occasionally the tibia. Surgery is typically the first line treatment as healing under conservative treatment is unlikely. The most important goal is to relieve pain and the preservation or restoration of function. For correct assessment of indications, analysis of the fracture pattern and oncological aspects including dignity, entity, prognosis, metastatic status and the general condition of the patient need to be taken into consideration. Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.

Purpose ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal. Methods A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed. Results The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia). In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance. Conclusion Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth. Evidence Level III, retrospective.

Background. Fractures of the bones of the facial skeleton, in particular the midface area, are one of the most frequent reasons for patients to apply to maxillofacial inpatient care, not only in Ukraine but also abroad. Along with more modern treatment technologies (osteosynthesis using titanium miniplates and minigrid for fixation bone fragments), methods of repositioning of fragments with subsequent tamponade of the maxillary sinus with iodoform tampon and without tamponade and fixation of fragments are used. A certain group of patients is treated conservatively, which is associated with their reluctance to undergo surgery, minimal displacement of fragments or minimal cosmetic and functional impairments. The purpose of the study. Comparative evaluation of the results of treatment of patients with fractures of the midface area by repositioning the fragments of the zygomatic-orbital complex without fixating the fragments and their subsequent fixation by tamponade of the maxillary sinus with iodoform tampon. Object and methods of research. The comparison was made of the results of treatment of 70 patients with fractures of the midface area, among which 13 patients were treated by the method of repositioning fragments of the zygomatic-orbital complex (ZOC) without fixation and without maxillary sinus tamponade, 29 patients underwent repositioning of ZOC fragments with subsequent fixation of fragments with iodoform tampon – the tamponade of the maxillary sinus was performed on the affected side. For comparison, the results of conservative treatment of 28 patients with fractures of the midface area were used. Results. It was found that the reliable (χ2=11.43; p

Background: Maxillofacial injuries can be classified according to its anatomical location of the involved bone and by the degree of involvement like simple, compound or comminuted. Regardless of the site of involvement and nature of trauma the fracture can be addressed by closed and open methods of reduction. Objective: The aim of this retrospective study was to record the incidence and factors associated with plate removal in patients with maxillofacial trauma. Materials and Methods: Records of 280 cases managed for maxillofacial trauma in the last (5 years) period from January 2010 to Dec 2014 by open reduction and internal fixation (ORIF) with osteosynthesis plates were analyzed at a tertiary health care facility. Logistic regression analysis was done to find an association between the variables studied and incidence of plate removal. Results: 32 cases (11.42%), 55 number of implants underwent removal of plates due to reasons ranging from infection(50%), Plate exposure(9.375%), treatment failure(15.625%), palpability(12.50%), and persistent pain(12.50%), Zygomatic buttress and Parasymphysis sites had highest incidence of plate removal compared to other sites. Being a female [OR 9.87(4.21–10.72)], age groups of 46-60 [OR 6.39(4.43-9.62)], 31-45 [OR 11.25(6.81-13.77)] and 15-30 [OR 10.01(5.74-12.22)], infra orbital rim among sites [OR 2.03 (1.48-4.67)] significantly increased the odds of incidence of plate removal. Conclusion: In our retrospective analysis, the overall incidence of plate removal was 11.42%. Maximum plate removals were from Zygomatico-Maxillary Buttress and Symphysis and Parasymphysis regions. Infection was found to be the most common cause of plate removal.

En el presente caso clínico de estudio se pretende ampliar el conocimiento en el manejo de las fracturas multifragmentarias de paleta humeral. Hoy en día los manejos definitivos de estas fracturas conllevan un gran desafío para el especialista en traumatología, tomando en consideración la limitante que sufre al no contar en muchas ocasiones con el material necesario para desarrollar con éxito los procedimientos, es por ello que ponemos de manifiesto el presente caso clínico con resultados favorables para la funcionalidad del miembro afecto. Dado la complejidad de la fractura el paciente fue ingresado al servicio de ortopedia y traumatología donde se le desarrollaron exámenes imagenologicos complementarios, mismos que demostraron el nivel de daño en la articulación del codo, una vez planteado el problema presente en la extremidad se debate con el equipo médico las diferentes formas de abordaje y soluciones con el material de osteosíntesis, decidiendo por un abordaje posterior con osteotomizacion del olecranon, mismo que nos permitiría un gran campo de visión, posterior al proceso de reducción se decide alta médica y valoraciones periódicas por el servicio de consulta externa para su seguimiento y rehabilitación exitosa.

Introduction: The treatment of humeral pallet fractures in adults is usually surgical, and the use of two plates to reconstruct the two abutments is recommended. The purpose of this study was to evaluate the clinical, radiological, and functional outcomes of surgically treated humeral pallet fractures. Materials and Methods: This was a prospective, single-center study from January 2014 to December 2017 of patients over 15 years of age operated on for humeral pallet fracture and followed regularly over a period of at least 6 months at CHU-SO (Togo). Results: Thirty-four (34) patients including 25 males and 9 females were treated and followed during this period. The average age of the patients was 42 years and the age group most affected was 16-30 years (41.17%). The right side was the most affected (76%) and road accidents were the main etiology found. Type C lesions (55.9%) were predominant, followed by type A lesions (26.5%). The posterior approach was the most common (76.34%). Olecraniotomy was performed in 55.88% of cases. The screw plate was the most commonly used stabilization material. We obtained 76.5% consolidation, 5 cases of malunion and 3 cases of pseudarthrosis. Evaluation according to the Mayo Elbow Performance Score showed 79.4% excellent and good results and 11.7% poor results. Conclusion: Humeral palmar fractures are complex injuries due to the violence of the etiological mechanisms. Surgical treatment offers satisfactory results despite the slow pace of management. Early management and rigorous and intense rehabilitation will further improve these results.

Introduction Fractures of the proximal humerus are frequent and are widely studied with regards to their treatment indications. The aim of this article is to establish a correlation between the size of the epiphyseal fragment in fractures of the proximal humerus and the probability of loss of reduction after a surgical procedure Methods A total of 47 surgically treated proximal humeral fractures were reviewed. Preoperative CT scans were used to evaluate the size of the epiphyseal fragment of the fracture. Postoperative X-rays were analyzed to assess complications, especially loss of reductions. Mean age was 61 years old (29–91 years) Results In total, 42 shoulders were evaluated. The average size of the epiphyseal fragment was 38.3 mm (32–50 mm) the largest longitudinal length; and 19.9 mm (12–30 mm) the largest cross-sectional length. The most frequent complication observed was loss of reduction. The statistical analysis showed significance that patients with smaller cross-sectional size of the epiphyseal fragment presented more complications (p = 0.034), and based on the graph and ROC curve, a value of 15.5 mm was considered as the cutoff value for failure Conclusion A cross-sectional length of the epiphyseal fragment of less than 15.5 mm indicates a higher probability of loss of reduction in fractures of the proximal end of the humerus after extra-medullary osteosynthesis.

Background: The purpose of this study was to compare shoulder outcomes and function after humeral shaft fractures treated with plates and screws vs. antegrade nailing. Methods: A group of 27 patients treated with plates and a group of 30 patients (previously published) who had undergone antegrade locked intramedullary nailing, all with acute humeral shaft fractures, were retrospectively compared. Final shoulder range of motion (ROM), full shoulder ROM recovery rate, functional outcomes, residual pain, complications, and elbow flexion-extension range were also analyzed. Results: There were a total of 57 patients: 27 cases in the plate (P) group and 30 in the nail (N) group (average age, 41.9 years).There were 66.7% men in group N and 63.0% in group P. The average age was 38 years (interquartile range [IQR] 28) in group N and 37 years (IQR 55) in group P. There were no differences in follow-up between groups, which averaged 28 months (IQR 7) in group P and 30 months (IQR 2) in group N (P = .385). There was no difference in both groups in elbow flexion-extension. Group P had a full shoulder ROM (66.6% vs. 40.0%; P = .02) and excellent Rodríguez-Merchán scoring (66% vs. 40.0%; P

The purpose of this case report was to describe a cat with generalized bone dysplasia, resembling osteopetrosis and Albers-Schönberg disease in humans. A 1-year-3-month-old, intact male, domestic shorthair cat had a 9-month history of multiple bone fractures without known trauma. Most fractures were treated conservatively and two by osteosynthesis. Bone healing occurred but recurring fractures eventually led to euthanasia. Radiographs, computed tomographic imaging, postmortem analysis and histopathologic examination revealed a generalized increase in bone density and mass with preservation of bone shape, obliteration of the bone marrow cavity and persistence of cartilage and primary trabeculae. Abuse and secondary bone diseases were excluded. History, diagnostic bloodwork, radiographs, computed tomographic imaging and histopathologic examination supported the diagnosis of inherited osteopetrosis and strongly resembled Albers-Schönberg disease in humans. The presence of osteoclasts suggested that the underlying pathology might be found in osteoclast dysfunction, deficient number of osteoclasts, inadequate recruitment of osteoclasts, or other micro environmental changes. In (young) cats that are presented with recurring fractures and the possible suspicion of abuse, inherited osteopetrosis should be considered as a differential diagnosis.