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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.

Defects of the thumb negatively impact physical and mental health, lead to depression, inferiority complex and hopelessness in the future. The aim of the study was to explore long-term results of thumb reconstruction using autologous transplantation of the second toe with microvascular anastomoses. Material and methods Second toe transplantation for thumb reconstruction was performed for 54 patients. There were 48 male and 6 female patients aged from 12 to 55 years. When analyzing the long-term results of surgical treatment of patients. The anatomy and functionality of the repaired finger was evaluated at a long term measuring the range of motion in the joints, muscle strength of the hand and major types of hand grips. Results The autograft completely healed with opposition of the reconstructed thumb and the rest fingers restored in 51 patients. The autograft failed in three cases treated with less functional methods. Conclusion Microsurgical reconstruction technologies used for a lost thumb facilitated rapid recovery of the finger and significantly improved functions of the injured hand as an entity. Free second toe transplantation using microvascular anastomoses for the thumb reconstruction allowed the patient regain basic gripping functions and improve cosmesis of the injured hand.

Background. Plausible predictions of future mortality and disability are useful aids in making decisions about priorities for medical research. Recent advances in medicine have led to the fact that some countries, such as Japan, have the highest life expectancy in the world. Osteoporotic fractures make a significant contribution to the development of morbidity and mortality in the aging population. Despite an active study of the mechanisms of the development of pelvic organ prolapse and disorders of bone mineral density separately, the general background of these diseases has previously been little studied. Aim. To study bone density according to densitometry data in peri- and postmenopausal women. Materials and methods. To carry out this study, 2 groups of women were formed. The first (experimental) group included 76 women admitted for routine surgical treatment of genital prolapse, the second group (control) 68 women without clinical manifestations of pelvic floor descent, who underwent a medical examination by a gynecologist on an outpatient basis. Results. Analysis of extragenital diseases in women included in the study showed a high prevalence in the experimental group of hypertension (p=0.028), osteochondrosis (p=0.001), scoliosis (p=0.028), hemorrhoids (p=0.013). Also, women in this group more often noted stretch marks on the skin (p=0.002) and were more often operated on for other diseases (p=0.043), which indicates the association of genital prolapse with undifferentiated connective tissue dysplasia and hypertension. The diagnosed severe osteoporosis (according to 1 or more densitometry indicators, where the T-score is less than -2.5) had a direct correlation with the duration of menopause. For a detailed analysis of the factors influencing severe osteoporosis in peri- and postmenopausal women, logistic regression analysis and ROC analysis were performed. The independent variable was the presence of severe osteoporosis, and the dependent variables were: stage according to POP-Q, the presence of hypertension, the presence of diabetes mellitus in history. Conclusion. This study confirms the presence of a comorbidity decrease in bone density according to densitometry and the presence of hypertension (p=0.028) and genital prolapse. According to the ROC analysis, an increase in the stage of genital prolapse according to the POP-Q classification increases the risk of developing severe osteoporosis.

Different intramedullary implants are used to prevent the fractures of the proximal femur due to osteoporosis or tumors. The aim of the study is assessment of the ultimate load on the femur with a telescopic or isoelastic intramedullary implant attached in its proximal part on the basis of a finite element modeling. The load on the femur corresponds to the action of a human’s own weight. Assessment of the ultimate load is carried out using the damage parameter for finite element, evaluated by the ratio of the main maximum strain and critical deformation for cancellous bone tissue. It has been identified that after using of the telescopic and isoelastic implants, the ultimate load on the femur increases approximately by 48 % and 81 %, respectively, compared with the intact femur. It is indicated that the fracture localization after implant attachment is observed in the area located below the greater trochanter that corresponds to the results of clinical observations.

Surgical resection of giant cell tumor of the left ulna diaphysis is presented. Circular resection and same-stage autoplasty with a vascularized left-side fibula fragment was performed. In the late postoperative period, there was no recurrence of the tumor. Full function of the left upper limb was achieved.

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).

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