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Introduction The advancement of surgery is set against a backdrop of continuous development and surgical innovations have transformed the way clinical care is delivered. Revision surgery might be required to address complications of primary arthroplasty. The first stage of revision arthroplasty would involve removal of an implant and placement of an antibiotic-impregnated cement spacer to maintain the joint space and stability, prevent soft tissue retraction, provide local antibiotic release and preserve bone tissue for revision implantation at the final stage of revision. Custom-made articulating spacers are a promising tool for optimizing the first stage of revision arthroplasty. The objective was to summarize the current data and present comprehensive information about spacers used in two-stage revision arthroplasty including manufacturing techniques, physical and chemical properties, clinical applications, the possibility of customization within the first stage of revision arthroplasty, current and promising directions for research. Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), the Cochraine Library (www.cochranelibrary.com) between 2018 and 2023 using search words and phrases: total arthroplasty, complications, revision arthroplasty, articulating spacer, periprosthetic joint infection, additive manufacturing, 3D printing. Results A comparative analysis of factory supplied, home-made, dynamic and static spacer models showed that the choice of articulating spacers for revision arthroplasty of major joints is of great relevance. Advantages of factory-made spacers include standardized range of sizes, the reliability and availability for medical institutions. They are characterized by limited use in repair of severe bone defects. Discussion Custom-made articulating spacers enable specific tailoring to accommodate individual defects. Despite high expectations from custom-made spacers, development of optimal technologies for rapid prototyping is essential. Investments in research and development in this area have the potential to create innovative solutions that can significantly improve the results of revision arthroplasty. Conclusion The paper explores the importance of systemization of knowledge about spacers and the role of new research in improving the design and functionality. Progress in the field of materials science, additive technologies and a personalized approach to spacer manufacturing can expand possibilities of revision arthroplasty and the effectiveness. Personalized approaches and improved methods of local drug delivery that provide controlled release of antibiotics can improve the results of treatment of periprosthetic joint infections.

Introduction Thermal injury to the palmar surface of the hand is usually complicated by flexion desmogenic contracture of the finger joints. This condition is more complicated with significant wound areas and depths of soft tissue destruction. Conventional surgical methods and soft tissue reconstructions may fail to provide full restoration of the hand function. The objective was to present the optimal treatment strategy for patients with scar flexion contractures of the fingers after thermal injury to the palmar surface of both hands using a pediatric case report. Material and methods A child aged 2 years and 4 months underwent surgical treatment to include excision of scars, skin grafting of both hands with a vascularized fasciocutaneous flap raised with the radial artery. Result The patient could regain all types of hand grip on both sides 12 years after surgical treatment. Both hands were aesthetically acceptable. Discussion Treatment of patients with thermal injury and substantial soft tissue damage is a complex disease process. Conservative treatment and surgical procedures using non-vascularized skin flaps are normally used for the condition. These approaches are associated with cicatricial and arthrogenic flexion contracture of the finger joints. The radical treatment includes thorough wound debridement and early flap coverage and wound closure using a flap with an axial-pattern blood supply, free flaps and reverse-flow flaps. The surgical approach helps to avoid flexion contracture of the fingers initiating early restoration of professional, social stereotypes and stereotypes in everyday life. Conclusion The clinical observation has shown the possibility of one-stage organ-preserving surgical treatment using flaps with an axial blood supply.

Introduction. Study of different treatments effectiveness of these injuries allows to distinguish the rational side of medical factors, which directly reflect the key pathogenetic mechanisms. A substantial portion of the currently used methods of clavicle fractures surgical treatment allow one to achieve rapid recovery of structural and functional patterns of the patient in most cases.The purpose of the study is to improve the results of surgical treatment of patients with fractures of the clavicle in the middle third. Material and methods. The study included 104 patients with fractures of the clavicle in the middle third.In the main group (48 patients) the clavicle lockable rod of the original design was used for osteosynthesis, in the comparison group (56 patients) plate osteosynthesis was performed.Results and discussion. The proposed technology of operative treatment of clavicle fractures in the middle third using the original hip compression-locking rod must improve the results of treatment in this group of patients. The developed algorithm of diagnostics, treatment and rehabilitation of patients with clavicle fractures allows to improve the results of treatment, provides domestic and social reintegratie patients. Conclusion. Analysis of the clinical studies results have revealed a reliable advantage of the results on a scale DASH and a lower frequency of complications in the main group (p

Background Review of the effectiveness of different methods used to repair clavicle injury allows for identifying rational aspects of treatment factors that would directly reflect key pathogenetic mechanisms. A greater part of surgical treatment options have been reported to lead to faster recovery of the patients’ structural and functional stereotypes in majority of the cases. Purpose Improve outcomes of surgical treatment of middle-third clavicle fractures. Material and methods Experimental bench tests of various osteosynthesis technologies using original interlocking intramedullary nail for clavicle fracture and a clinical study of 104 patients with middle-third clavicle fractures were carried out. Original IM nail was applied to repair clavicle fracture in index group (n = 48) and the fractures were plated in control group (n = 56). The DASH questionnaire was used to evaluate results of surgical intervention at 3, 6 and 12 months. Results Original IM nail and plate with angular stability showed comparable characteristics in stability. Original compression interlocking intramedullary nail offered to treat middle-third clavicle fractures showed improvements in outcomes of the patients. Discussion The algorithm developed for diagnosis, treatment and rehabilitation of clavicle fractures showed better results of treatment providing easier social reintegration into everyday life. Clinical findings demonstrated significantly improved DASH scores and lower complications rate in index group (p = 0.038).