Saratov JOURNAL of Medical and Scientific Research

Traumatology and Orthopedics

Clinical and laboratory indices of periprosthetic infection in patients with knee endoprosthesis instability

Year: 2019, volume 15 Issue: №2 Pages: 283-286
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shpinyak S.P., Galashina E.A., Babushkina I.V., Girkalo M.V., Kauts O.A., Grazhdanov K.A.
Organization:
Summary:

 Objective: to make assessment of clinical and laboratory indices in patients with deep periprosthetic infection and knee endoprosthesises aseptic instability. Material and Methods. 80 patients with septic and aseptic instability of knee endoprosthesises have been surveyed. All patients were subjected to comprehensive clinical and laboratory examination (intra-articular fuid cytology and microbiology testing, joint tissue histology testing, ELISA was employed for determining the levels of skeletal tissue remodeling markers). Results. The complete combination of several examination criteria specifc for knee periprosthetic infection was

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Optimization of transpedicular spondylosynthesis application for type A3 lesions of the thoracolumbar transition: clinical experimental study

Year: 2019, volume 15 Issue: №2 Pages: 275-283
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Shchanitsyn I.N., Shulga A.E., Zaretskov A.V., Ivanov D.V.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky
Summary:

Objective: the optimization of transpedicular systems application for type A3 lesions of the thoracolumbar transition using computer simulation based on the fnite elements method. Material and Methods. The examination data (post-traumatic kyphotic deformation, intensity of pain syndrome, length of operation and extent of blood loss) of 81 prospec-tively enrolled male patients who in 2017–2018 had been operated for Th11-L2 vertebrae simple fractures of А3N0M1 type (AOSpine classifcation). The patients were divided into 3 groups in accordance with the type of intervention performed on them: short-segment (n=42), 8-screws polysegment (n=25) and 6-screws polysegment (n=14). Biome-chanical simulation based on the computer tomography data was performed for each variant of the metal construction arrangement. Results. In the process of biomechanical simulation with all the variants of the instrumented spine 3D- models loading 8-screws construction proved to be the most consistent one, at that the stability of polysegmental constructions exceeds that of bisegmental one by an order. The results of surgical management were evaluated in terms of up to a year following the intervention. The loss was less and the correction worked better with polysegmental fxation despite more complicated initial conditions for the correction compared to those of group 1 Conclusion. Biomechanical simulation shows prerequisites for the development of bisegmental systems instability as the equivalent stresses and peak displacements are higher compared to those of polysegmental fxation. The efciency analysis of application of various transpedicular fxations for type A3 thoracolumbar transition lesions attests to the advantage of polysegmental arrangements of transpedicular systems, at that the implantation of the 6- screws polysegmental system should be considered the frst choice on the number of indices.

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Quality of life in children with fat feet (planovalgus foot, longitudinal platypodia)

Year: 2019, volume 15 Issue: №2 Pages: 271-274
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Dokhov M.M., Sertakova A.V., Rubashkin S.A., Timaev M.Kh.
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Summary:

Objective: to evaluate the quality of life in children with fat feet using standard quality of life questionnaire technique. Material and Methods. 97 children with fat feet (mean age 9.7±1.2 y. o.) and 32 children with neutral position of the feet (control group) participated in the research. Both the fat foot and neutral position of the foot diagnoses were based on patients» clinical examination and instrumental methods of diagnosis. The questionnaire survey was conducted using the Oxford Ankle Foot Questionnaire (OAFQ) for children (7–17 y. o.) designed for evaluation of potential cost for treatment of children with foot and ankle joint pathologies. It is made up of 15 questions showing the quality of life (physical development, school life and exercise, emotional development) as well as problems with shoes selection. General central module of the Kiddy-KINDL Questionnaire covers various aspects of children»s life providing a fexible modular psychologically applicable method. The structure of the questionnaire scales consists of 24 questions united in evaluation groups. Results. In the group of fatfoot children the quality of life is reliably lower in terms of physical development and shoes selection. Flat feel has almost no impact on children»s emotional development as well as their social function; it doesn»t usually lead to fxation on disfguration. Conclusion. To evaluate every individual clinical case of decline in physical development quality and worsening of the emotional state in pediatric patients trauma orthopedists are recommended to employ various questionnaires that allow for detailed defning of lesions degree and quality for individual selection of the treatment method.

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Hemostasis test parameters in patients requiring revision knee arthroplasty

Year: 2018, volume 14 Issue: №2 Pages: 266-271
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
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Objective: comparative analysis of the blood coagulation system in patients requiring revision arthroplasty of the knee joint in connection with the developed infectious and aseptic complications after total arthroplasty. Material and Methods. 37 patients with complications of total knee replacement were examined. Patients were divided into 2 groups: 1st — with signs of suppuration (n=19); 2nd — withsigns of aseptic instability of the endoprosthesis components (n=18). The control group consisted of 22 conditionally healthy people. Studied screening coagulation: activated partial thromboplastin time, prothrombin time, fbrinogen concentration, thrombin time, antithrombin III, protein C, the content of soluble fbrin-monomer complexes and D-dimers. Results. There was an increase in activated partial thromboplastin time in patients of group 2, prothrombin time — in patients of groups 1 and 2 compared with the data obtained in the control group (p<0.001). An increase in the content of soluble fbrin- monomer complexes and D-dimers was recorded in the blood plasma of patients of the 1st and 2nd groups compared to their level in the control group (p<0.001). Conclusion. The data of local coagulogram tests in patients requiring revision arthroplasty of the knee joint refect the signs of maladaptation in the hemostatic system at the preoperative stage of examination. It is worth noting the lack of information content of the screening coagulogram, as its basic tests do not refect changes in the whole system of homeostasis, the search for new informative research methods remains relevant today.

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Bioflm formation by Staphylococcus strains isolated from various biological materials at infectious complications following total knee replacement

Year: 2019, volume 15 Issue: №2 Pages: 261-266
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Babushkina I.V., Bondarenko A.S., Mamonova I.A., Ulyanov V.Yu.
Organization: Saratov State Medical University
Summary:

Objective: to study Staphylococcus spp. Strains bioflm forming ability in vitro. These strains are infectious agents for implant-associated infection in patients following total knee replacement depending on the biomaterial under study. Material and Methods. Bioflm forming ability in vitro of 275 Staphylococcus spp. strains has been studied. Bioflm formation was performed using modiefed method of G. D. Christensen. Results. Bioflm forming ability was discovered in 51.2 % of the studied strains, at that it was reliably (p<0.05) higher forcoagulase-positive staphylococci compared to coagulase-negative ones. Staphylococcus strains isolated from sonication fuid obtained after removed prothesiscom- ponents ultrasonication and soft tissue bioptates were chatracterised with high ability for bioflm forming. This ability was reliably (p<0.05) higher than in strains isolated from wounds and aspirate. Interspecies diferences were observed in a group of strains isolated from bioptates: optical density of the S. epidermidis stains extracts was reliably (p<0.05) higher than that of S. aureus strains. Conclusion.Bioflm forming ability of Staphylococcus spp. strains isolated from patients with implant-associated infection depends on the biomaterial under study thus defning the most informative methods of microbiological study.

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Characteristics of clinical findings and diagnostics of acute cerebral venous circulation disorder in immediate period following neurosurgical intervention for peripheral lung cancer metastasis into brain

Year: 2019, volume 15 Issue: №1 Pages: 67-71
Heading: Traumatology and Orthopedics Article type: Case report
Authors: Bazhanov S.P., Ulyanov V.Yu., Matveeva O.V., Tolkachev V.S., Shuvalov S.D.
Organization: Saratov State Medical University
Summary:

A rare case of cerebral venous circulation disorder in a female patient with peripheral cancer metastasis of the right lung upper lobe to the area of precentral and postcentral gyri of the left cerebrum hemisphere in the immediate post- surgical period is present. It has been shown that the diagnostics of impaired circulation throuth the superficial cerebral veins is rather complicated due to the lack of clinical symptoms specificity and poor sensitivity of neurovisualization methods.

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Variability and connections of parameters characterizing hip dysplasia in 4-7-year-old children

Year: 2019, volume 15 Issue: №1 Pages: 61-66
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Zotkin V.V., Anisimova Е.А., Bakhteeva N.Kh., Anisimov D.l.
Organization: Saratov State Medical University
Summary:

Objective: to identify the variability and contingency of parameters characterizing the structure of the hip joint in children 4-7 years of age, among themselves and with the severity of dysplastic changes in the bone and soft tissue structures of the hip joint. Material and Methods. 132 children aged 4-7 years with dysplasia TBS with different degrees of severity of dysplastic changes (177 joints) were examined. The following characteristics of dysplasia joint were under the study: angular radiological parameters, cartilage defect, electroneuromyographic signs, indicators of the biomechanics of gait. The degree of dysplasia (mild, moderate, severe) was assessed by the method developed by the authors to determine the severity of hip dysplastic changes in points. Results. Light changes in the hip joint were diagnosed in 9 patients aged 4-7 years (15 joints); moderate dysplastic disorders were found in 74 patients (96 joints); pronounced signs of dysplasia were found in 49 patients (66 joints). The coefficient of variation of signs characterizing TDS dysplasia varies from 2.8 to 18.8%. The module of correlation coefficients characterizing the binding force of the studied features is in the range from 0.7 to 0.9. Conclusion. The angular radiological parameters, cartilage defect, electroneuromyographic signs, indicators of the biomechanics of gait characterized by considerable variability and are correlated with strong and close power among themselves and with the degree of dysplastic changes of the bone and soft tissue structures of TBS.

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The use of original device for positioning tools during the installation of femoral component of hip joint

Year: 2019, volume 15 Issue: №1 Pages: 57-61
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Varfolomeev D.l., Samoday V.G.
Organization: Voronezh State Medical University n.a. N.N. Burdenko
Summary:

Objective: to assess the accuracy of the femoral neck resection using the developed "Device for positioning tools for the installation of the femoral component of the hip prosthesis". Material and Methods. On the basis of the Department of traumatology and orthopedics of Voronezh state medical University n.a. N.N. Burdenko conducted experimental studies on 40 models of plastic bones. In the comparison group resection was performed using the proposed device, in the control group — using a standard guide. Results. Experimental studies have demonstrated higher accuracy of femoral neck osteotomy in the comparison group. The average value of the neck filing angle in the frontal plane in the comparison group was 3.2° higher than in the control group (p<0.05), and in the sagittal difference was 3.1°. The average distance from the line of the osteotomy to the apex of the greater trochanter in both groups was not significantly different (p=0.62). Conclusion. The use of the developed device allows to perform osteotomy of the femoral neck with high accuracy, as well as to control the position of the leg endoprosthesis, which helps to reduce the number of complications and improve the quality of life of patients.

Justification of intramedullary fixation devices modification and first clinical experience of application of the SarNIITO nails for femur shaft osteosynthesis

Year: 2019, volume 15 Issue: №1 Pages: 52-57
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Barabash А.Р., Norkin I.A., Barabash Yu.A., Ivanov D.V., Zuev P.P., Shpinyak S.P.
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Objective: to estimate the changes of effective stresses (by Mises) at three types of loads (axial, lateral and twisting) for various types of intramedullary nails synthesizing modeled fractures of A1; A3; B2 types at the level of femur bone middle third. Material and Methods. To solve the preclinical tasks computer simulation of biomechanical systems bone-fixing pin and method of finite elements were employed. Results. The nails developed by SarNIITO excel ChM and Fixion rods in stress-deformed condition, fatigue strength and stability of fixation of the examined types of fractures parameters of 12- 23%. Conclusion. The mechanical characteristics of SarNIITO nails proved to be of clinical use and may be recommended for patients with femur bone diaphysis fractures.

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Comprehensive comparative evaluation of results of surgical management of unstable distal tibia fractures

Year: 2019, volume 15 Issue: №1 Pages: 48-52
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Barabash Yu.A., Mandrov D.V., Balayan V.D.
Organization: Saratov Regional Clinical Hospital, Saratov State Medical University, Tuchkovskaya District Hospital
Summary:

Objective: to evaluate the outcomes of various methods of surgical interventions and functional properties of lower extremities in patients with complicated ankle fractures. Material and Methods. Clinical outcomes of 140 surgically managed patients with unstable bimalleolar and trimalleolar fractures were studied. 80 patients were managed with external fixation devices applied by original method (main group) and 60 patients were managed with submersible structures (comparison group). Results. Compared to submersible structures, the use of transosseous metalosteosynthesis has led to 100% ankle fracture unions. In early postsurgery period the index of average anatomic and functional result reached values of 93.4% corresponding to "good" and 6.6% corresponding to "satisfactory". Conclusion. It has been established with rheovasography data that transosseous osteosynthesis contributed to restoration of blood microcir-culation in the damaged segment of lower extremity in 8 weeks period after surgery and submersible structures in 6 months period.

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