TERRA ORTHOPAEDICA

Application of the Mangled Extremity Severity Score and Hannover Fracture Scale-98 in Patients with Ballistic Injuries of the Lower Extremity

A.P. Liabakh — 2026-05-12

Summary. Assessing the severity of ballistic limb injury remains a relevant clinical problem, as it determines the treatment strategy—reconstruction or amputation.

Objective. To determine the diagnostic value of the Mangled Extremity Severity Score (MESS) and Hannover Fracture Scale-98 (HFS-98) as tools for establishing indications for amputation in patients with ballistic injuries of the lower extremity.

Materials and Methods. The study included 177 patients with ballistic injuries of the lower extremity (183 cases) aged 37.0 ± 0.7 years (range 20–63 years). The cohort comprised 174 males and 3 females; the mean time from injury was 284.9 ± 18.7 days. Types of combat trauma included mine-blast injuries (88 cases), shrapnel wounds (86 cases), and bullet wounds (9 cases). Two groups were formed: patients with a reconstructed limb (group I, 89 cases) and those who underwent major amputation (group II, 94 cases). The Gustilo-Anderson classification of open injuries, MESS, and HFS-98 were applied. Convergent validity, discriminative ability, sensitivity, specificity, and diagnostic accuracy of MESS and HFS-98 were studied.

Results. The mean scores of numerical indicators for groups I and II were, respectively, 5.8 and 8.4 for MESS, and 13.2 and 23.1 for HFS-98. The convergent validity between MESS and HFS-98 was 0.85. The discriminative ability (ROC-analysis) was 0.9 for both scoring systems. Sensitivity, specificity, and diagnostic accuracy, according to logistic regression and ROC-analysis, were 0.74, 0.89, and 0.79 at a threshold of ≥ 7 for MESS and 0.82, 0.74, and 0.79 at a threshold of > 17 for HFS-98.

Conclusions. The high diagnostic accuracy and discriminative ability of MESS and HFS-98 support their use for determining indications for amputation in patients with ballistic injuries of the lower extremity. Exceeding the threshold value of ≥ 11 proposed by the developers of HFS-98 requires further investigation.

Comorbid Profile of Patients with Shoulder Osteoarthritis as a Prognostic Factor for Clinical Outcomes of Combined Extracorporeal Shock Wave Therapy and Physical Rehabilitation Methods

V.O. Fishchenko — 2026-05-12

Objective. To characterize the structure of comorbid conditions in patients with shoulder osteoarthritis and assess their significance in predicting clinical outcomes of the combined application of extracorporeal shock wave therapy and McKenzie physical rehabilitation methods.

Materials and Methods.Clinical outcomes of combined extracorporeal shock wave therapy and McKenzie rehabilitation methods were analyzed in 34 patients with shoulder osteoarthritis (39 cases). The mean age was 57.69 ± 11.38 years. Treatment outcomes were assessed using the Oxford Shoulder Score. Comorbidities were evaluated using the Charlson Comorbidity Index. Statistical analysis was performed using StatSoft Statistica 13, with significance set at p ≤ 0.05.

Results. Factors significantly associated with poorer long-term outcomes included heart failure (τ = −0.55, p = 0.0000008), peripheral vascular disease (τ = −0.34, p = 0.002), transient ischemic attacks (τ = −0.24, p = 0.03), bronchial asthma (τ = −0.23, p = 0.04), chronic obstructive pulmonary disease (τ = −0.28, p = 0.01), gastric and/or duodenal ulcer disease (τ = −0.27, p = 0.02), liver cirrhosis without portal hypertension (τ = −0.31, p = 0.006), uncomplicated diabetes mellitus (τ = −0.46, p = 0.00004), and higher Charlson Comorbidity Index values (τ = −0.68, p = 0.000000001). Predictors of excellent outcomes included low Charlson Comorbidity Index values (OR = 5.69, CI 1.31–24.63, p = 0.01). Good outcomes were associated with heart failure (OR = 10.21, CI 1.07–97.46, p = 0.01) and diabetes mellitus without peripheral complications (OR = 8.63, CI 1.35–54.95, p = 0.01). Satisfactory outcomes were associated with chronic obstructive pulmonary disease (OR = 23.25, CI 1.77–305.46, p = 0.007) and high Charlson Comorbidity Index values (OR = 23.25, CI 1.77–305.46, p = 0.007).

Conclusions. Combined use of extracorporeal shock wave therapy and McKenzie physical rehabilitation methods is highly effective in the treatment of degenerative-dystrophic shoulder joint diseases. Assessment of comorbidities is advisable when selecting the optimal treatment strategy.

Biomechanical Rationale for Differentiated Treatment of Proximal Tibial Fractures

A.M. Syvak — 2026-05-12

Objective. The study aims to analytically validate and develop an anatomically accurate three-dimensional model of the knee joint for biomechanical analysis of load distribution in various types of proximal tibial fractures, considering the impact of injury localization on the risk of post-traumatic instability.

Materials and Methods. The geometry of the knee joint was reconstructed from CT data using the SolidWorks software environment. Numerical analysis was performed in ANSYS (Static Structural) using the finite element method (FEM). The model included the femur and tibia, menisci, anterior and posterior cruciate ligaments, as well as medial and lateral collateral ligaments. Materials were assumed to be isotropic and linearly elastic. Three mesh variants were analyzed: 30,001; 501,090; and 1,006,936 elements. A load of 750 N was applied to the superior surface of the femur, while the tibia was fixed in a cantilever manner. Contacts were bonded. Mesh quality was assessed using Skewness and Orthogonal Quality metrics. FEM model verification was performed by comparison with analytical calculations based on the equivalent stiffness of a spring system.

Results. A FEM model accurately reproducing the biomechanics of the knee joint under conditions of segmental fractures was developed. The highest stress values were observed in cases involving the anterolateral and posterolateral segments (G and H), where maximum fragment displacement and peak loading on ligaments and menisci were recorded. The mesh with 501,090 elements was considered optimal for analysis, as it ensured high accuracy with moderate computational cost.

Conclusions. FEM modeling with consideration of fracture localization enables identification of critical load zones and prediction of instability at the stage of preoperative planning. The results may be integrated into clinical protocols to guide the choice of surgical strategy—from fixation to combined soft tissue reconstruction.

The Role of Intermediate Screws in the Bone-Screw-Rod Construct for A1 Fractures of the Thoracolumbar Junction

O.S. Nekhlopochyn — 2026-05-12

Objective. To evaluate the stress–strain state in an A1 fracture of the Th12 vertebra under flexion loading and to compare different configurations of short-segment transpedicular fixation.

Materials and Methods. A detailed finite element model of the Th9–L5 spinal segment with an A1 fracture of the Th12 vertebral body was developed. Four fixation configurations were analyzed: M1 with short screws without intermediate screws; M2 with long screws without intermediate screws; M3 with short main screws with additional short intermediate screws placed into the Th12 vertebral body; and M4 with long main screws with additional short intermediate screws placed into the Th12 vertebral body. Flexion was simulated by applying a 350 N load. The evaluation criterion was the equivalent von Mises stress.

Results. In the Th12 vertebra, increasing screw length in constructs without intermediate screws led to an increase in stress from 1.6 to 2.3 MPa, whereas in constructs with intermediate screws stress remained at 1.6–1.7 MPa. In the L1 vertebra, changes were minimal. At the vertebral endplates, stress at the inferior endplate of Th11 ranged from 1.9 to 2.1 MPa, while at the superior endplate of L1 stress decreased from 8.3 to 7.7 MPa. At the screw entry zones, stress in the Th11 pedicle decreased from 8.0 to 5.6–5.7 MPa; at the Th12 pedicle it remained approximately 2.1 MPa; at the L1 pedicle, stress increased with long screws from 10.3 to 11.1 MPa regardless of the presence of intermediate screws. In the rods, the use of intermediate screws increased stress by nearly 2.2 times—from 170–172 to 380–383 MPa.

Conclusions. Intermediate screws provide local stress reduction and stabilization of the injured level but increase stress in the rods. Fixation strategy should therefore be individualized: M3–M4 are preferable when prioritizing protection of the bone–screw interface and the fracture zone, whereas M1–M2 may be chosen when minimizing rod loading is critical, with careful selection of caudal screw length.

Results of Surgical Treatment of Patients with Stage I Rotator Cuff Arthropathy According to Hamada

S.S. Strafun — 2026-05-12

Introduction. Treatment of rotator cuff arthropathy (RCA) remains a complex and unresolved problem, particularly in younger patients.

Objective. The aim of the study was to compare the outcomes of different surgical treatment options for patients with stage I RCA according to Hamada.

Materials and Methods. The study included 121 patients with stage I RCA according to Hamada. The age of the patients ranged from 45 to 75 years, with a mean age of 60.9 ± 16.2 years. The patients were divided into two groups depending on the surgical intervention performed: group I included patients with rotator cuff tendon repair (open or arthroscopic), while group II comprised rotator cuff tendon repair (infraspinatus and/or subscapularis) combined with superior capsule reconstruction using a graft from the long head of the biceps tendon or fascia lata (eight-layer technique), performed either through an open approach or arthroscopically.

Results. At 12 months after surgery, patients who underwent arthroscopic rotator cuff repair demonstrated better mean functional outcomes according to the Constant Shoulder Score compared to those who underwent open repair (p=0.063). Similarly, in the group where superior capsule reconstruction was performed arthroscopically, the mean functional outcomes according to the Constant Shoulder Score were better than in the group with open reconstruction (p=0.055).

Conclusions. The mean short-term outcomes (6–12 months) in patients of both groups with stage I RCA according to Hamada improved compared to preoperative values, as assessed by the Constant Shoulder Score and VAS, regardless of the surgical technique used.

Diagnostic and Therapeutic Approaches to Physical Therapy for Idiopathic Scoliosis in Children and Adolescents (Literature Review)

S.M. Martsyniak — 2026-05-12

Summary. In pediatric orthopedics, scoliotic spinal deformity is among the most extensively studied conditions, as it represents one of the most common problems encountered in pediatric orthopedic practice. Despite the high prevalence of the disease, there is no consensus regarding the optimal management of patients with idiopathic scoliosis. The choice of treatment modality and the timing of treatment initiation are of particular importance, as inadequate or delayed treatment is often associated with progression of spinal deformity. Among the available treatment options, physical therapy is a key component of conservative management and is applied depending on the clinical presentation and severity of the deformity. This approach is based on the concept of scoliosis as a three-dimensional deformity of the spine in the frontal, sagittal, and transverse planes. Given the wide range of physical therapy techniques, clinicians frequently are faced with the challenge of selecting the most appropriate approach. This review summarizes current physical therapy methods for idiopathic scoliosis in children and adolescents, with the aim of supporting informed selection, prescription, and monitoring of physical therapy in order to optimize treatment outcomes.

Diabetic Foot Osteoarthropathy: Clinical Features, Diagnosis, and Treatment

V.M. Piatkovskyi — 2026-05-12

Summary. Diabetic osteoarthropathy (DOA) of the foot is currently a relatively common complication of diabetes mellitus. The article outlines the clinical and radiological diagnosis of DOA, classifications of disease stages and lesion localization, and principles of conservative and surgical treatment.

To the 100th anniversary of the birth of Professor Oleg Alexandrovich Bukhtiarov

Editorial Board — 2026-05-12

To the 100th anniversary of the birth of Professor Oleg Alexandrovich Bukhtiarov

Prof. Berezka M.I.

Editorial Board — 2026-05-12

Prof. Berezka M.I.

Prof. Ankin L.M.

Editorial Board — 2026-05-12

Prof. Ankin L.M.