TERRA ORTHOPAEDICA

Surgical Treatment of Fractures of the First Metacarpal Bone

2025-04-30T15:43:19+03:00

Background. The peculiarities of the anatomical and functional structure, the high incidence of trauma to the first metacarpal bone, and unsatisfactory treatment outcomes have led to numerous studies on the pathology of this localization. These studies provide opportunities for improving treatment methods and minimizing trauma during different stages of medical care.

Objective. This study aimed to conduct a retrospective analysis of the surgical treatment of first metacarpal fractures based on literature and clinical studies.

Materials and Methods. The study was based on data obtained from searches in the bibliographic databases Medline, PubMed, and EMBAS. A total of 29 literature sources dedicated to the surgical treatment of first metacarpal fractures were identified.

Results and Discussion. A selective retrospective analysis of treatment outcomes for first metacarpal fractures in medical institutions of Dnipro and Kryvyi Rih revealed that among 43 patients, the conservative treatment method was preferred in 27 cases, while surgical treatment was chosen in 16 cases. The obtained data indicate a tendency toward favoring closed reduction methods and plaster immobilization, as well as limited use of open reduction and internal fixation with mini-plates and percutaneous fixation with external fixation devices.

Conclusions. Fractures of the first metacarpal bone with intra-articular and peri-articular localization remain a relevant issue actively discussed in the literature, with no universally accepted solution due to the persistence of complications and functional disorders in the post-traumatic period. The variety of conservative and surgical methods currently used for treating fractures of the first metacarpal bone highlights the need for clear indications for their application, prioritizing techniques that ensure stable fragment fixation and early functional recovery. A retrospective analysis of treatment outcomes for first metacarpal fractures based on data from medical institutions demonstrates a stronger tendency toward conservative treatment, frequent use of Kirschner wire fixation, and rather limited application of osteosynthesis with external fixation devices and mini-plates.

Evaluation of Shoulder Joint Capsule Changes and Their Correlation with Joint Cartilage Damage in an Experimental Model of Omarthrosis

2025-04-30T15:50:57+03:00

Introduction. Minimally invasive animal models of joint damage enable the study of the key pathogenetic mechanisms of shoulder arthrosis and the identification of dominant factors that influence the development of structural disorders in the most common forms of slowly progressive human arthrosis.

Objective. This study aims to determine the relationship between morphological signs of damage to the articular cartilage of the shoulder joint and its capsule in an experimental model of enzymatic joint damage.

Materials and Methods. In a rabbit model of enzymatic joint injury, changes in the morphology of the capsule and articular surfaces of the shoulder joint were examined 4 months after the injection of collagenase.

Results. Collagenase injection into the shoulder joint caused damage to the cartilage and synovial membrane, followed by changes in capsule density and an increase in its thickness. A strong positive correlation was found between changes in the synovial membrane and the intensity of cellular inflammatory infiltration, as well as between synovial membrane condition and degeneration of articular cartilage. Remodeling of the fibrous matrix of connective tissue initiates fibrotic changes in the shoulder joint capsule.

Conclusions. Omarthrosis progression factors create a closed vicious circle of structural shoulder joint disorders, reinforcing each other. This circle can only be broken surgically by performing a selective capsulotomy of the shoulder joint.

Clinical Diagnosis of Pulley Lesion Injuries in Patients with Shoulder Joint Contracture

2025-04-30T15:56:04+03:00

Introduction. The diagnosis of Pulley Lesion injuries predominantly relies on MRI findings. Clinical diagnosis of this condition is often undervalued, and many clinicians do not use clinical tests to identify Pulley Lesion injuries.

Objective. This study aims to determine the sensitivity and specificity of clinical tests for the diagnosis of ligamentous injuries of the long head of the biceps tendon (Pulley Lesion) in patients with secondary adhesive capsulitis (AC).

Materials and Methods. We examined and surgically treated 54 patients with secondary AC resulting from Pulley Lesion at the Department of Microsurgery and Reconstructive Surgery of the Upper Limb. All patients underwent the following clinical tests: active and passive range of motion loss test in all planes, Carbone test (coracoid pain test), external rotation test (Wolf test), stretch after passive external rotation (Noboa test), O’Brian’s SLAP test, and Compression rotation test.

Results. High sensitivity for diagnosing secondary AC due to Pulley Lesion was demonstrated by the O’Brian’s SLAP test (sensitivity 85%, specificity 61%), while the Compression rotation test showed a sensitivity of 86% and specificity of 59% (p≤0.05). Tests for diagnosing idiopathic AC in early stages did not show high sensitivity or specificity in patients with secondary AC resulting from Pulley Lesion.

Conclusions. We did not identify any high-sensitivity or high-specificity clinical test for diagnosing secondary AC resulting from Pulley Lesion injury.

Features of the Comprehensive Application of Nuclear Magnetic Resonance Therapy and Physical Rehabilitation Techniques for Degenerative-Dystrophic Shoulder Joint Diseases

2025-04-30T16:00:58+03:00

Objective. This study aims to characterize the role of risk factors associated with the progression of degenerative-dystrophic shoulder joint diseases in predicting clinical outcomes of the combined application of nuclear magnetic resonance therapy and McKenzie physical rehabilitation techniques.

Materials and Methods. Clinical outcomes of the combined use of nuclear magnetic resonance therapy and McKenzie rehabilitation techniques were analyzed based on 21 cases of degenerative-dystrophic shoulder joint diseases involving 18 patients treated at the “VinProfiMed” rehabilitation center. The study group included 11 males (61.11 %) and 7 females (38.89 %), with a mean age of 58.28±11.59 years. Unilateral omarthrosis was diagnosed in 15 patients (83.33 %), while bilateral omarthrosis was observed in 3 patients (16.67 %). Clinical outcomes were assessed using the Oxford Shoulder Score questionnaire.

Results. The average treatment score was 41.29±5.18, indicating excellent outcomes. Excellent results were achieved in 14 patients (66.67 %), good results were noted in 6 patients (28.57 %), and 1 patient showed satisfactory results (4.76 %). Significantly better outcomes were observed in male patients (τ=+0.45, p=0.004), younger patients (τ=-0.44, p=0.005), particularly those of middle age (τ=+0.40, p=0.01), in cases of primary omarthrosis (τ=+0.37, p=0.02) at stages I and II of the disease (τ=+0.34, p=0.03 for both). Males had significantly higher odds of achieving excellent outcomes (p=0.03, OR=9.17, CI (1.00–84.35)), as did patients with primary omarthrosis (p=0.01, OR=15.00, CI (1.14–197.52)). Good clinical outcomes were more likely to occur in individuals with stage III disease (p=0.02, OR=13.75, CI (1.02–184.81)) and unilateral lesions (p=0.03, OR=2.64, CI (2.90–13.90)).

Conclusions. The study demonstrated the high effectiveness of the combined application of nuclear magnetic resonance therapy and physical rehabilitation techniques in patients with degenerative-dystrophic shoulder joint diseases. Relative indications and contraindications for the proposed treatment regimen were developed, enabling improved clinical effectiveness of conservative treatment approaches for degenerative-dystrophic shoulder joint conditions.

Mistakes and Complications in Reverse Shoulder Arthroplasty

2025-04-30T16:04:29+03:00

Background. In recent decades, the number of reverse shoulder arthroplasties has increased significantly, and the number and diversification of complications has also increased.

Objective. This study aims to analyze the structure and nature of mistakes and complications that occur during reverse shoulder arthroplasty.

Materials and Methods. We observed 21 patients (20 males and 1 female) aged 36 to 81 years (mean age 54.61 ± 11.89 years) who underwent reverse shoulder arthroplasty. Among them, 16 cases of complications and 5 mistakes were identified.

Results. In 2 patients, strategic mistakes led to the development of complications. The complications were diverse. The most common was prosthesis dislocation (5 cases, 23.8% of the total number of complications and mistakes). Purulent-necrotic complications were observed in 4 patients (19%), aseptic instability of the prosthesis components occurred in 3 patients (14.3%), acromion stress fractures due to overload were noted in 2 patients (9.5%), and secondary adhesive capsulitis with severe adduction and internal rotation contractures was observed in 2 patients (9.5%).

Conclusions. The most common complications following reverse shoulder arthroplasty were prosthesis dislocation and purulent-necrotic complications. The main causes of dislocation were uncompensated shortening of the humerus and significant medialization and, in some cases, inclination of the prosthesis head. A strategic mistake in reverse shoulder arthroplasty is performing the procedure in patients with total traumatic injury to the deltoid muscle or irreparable damage to the axillary nerve (n. axillaris). An important tactical mistake is neglecting, when possible, the complete restoration of the rotator cuff, which significantly reduces flexion and rotational movements in the shoulder joint.

Partial Replacement of the Talus with a Titanium Augment in a Patient with Osteochondral Defect

2025-04-30T16:18:19+03:00

Summary. A case of replacement of an osteochondral defect of the talus in an 18-year-old patient using a 3D-printed titanium alloy augment is presented. The follow-up period was 2 years. The clinical and radiological outcomes were good. The function of the operated foot was comparable to that of the contralateral healthy foot.

Biological Properties of Magnesium Alloys and Alloying Elements Suitable for the Development of Biodegradable Implants for Osteosynthesis (Literature Review)

2025-04-30T16:17:29+03:00

Background. In recent years, countries such as Japan, China, the United States, and others have been actively searching for bioresorbable materials for osteosynthesis that do not require removal. According to preliminary data, biodegradable osteosynthesis fixators possess osteoinductive and osteoproliferative properties, positively influencing bone healing at the fracture site. Currently, osteosynthesis involves the use of implants made of steel and titanium alloys. The main disadvantage of such fixators is the need for a secondary surgical procedure to remove them, which extends the patient’s disability period.

Objective. This study aims to analyze and summarize scientific research on the effects of metal ions on bone tissue regeneration, vascularization, and surrounding tissues when using biodegradable materials for osteosynthesis of fractures at the current stage.

Materials and Methods. Based on data from the scientometric databases Scopus and Web of Science, a systematic approach, along with bibliosemantic and analytical methods, was applied.

Results and Discussion. Modern tissue engineering is gradually shifting from the use of bioinert materials to the development and implementation of biodegradable materials capable of actively stimulating tissue regeneration. It has been established that metal ions play a key role in the biological processes of the human body. In particular, zinc (Zn), boron (B), and zirconium (Zr) ions have significant potential in stimulating the development and regeneration of bone tissue. They contribute to biochemical reactions involved in bone metabolism, enhance regenerative processes, and positively influence the activity of osteoblasts, osteoclasts, immune system cells, endothelial cells, and fibroblasts. The degradation products of magnesium (Mg)-based implants play an important role in shaping the bone microenvironment, participating in complex interactions between osteoblasts, osteoclasts, endothelial cells, and immune cells. This contributes to effective bone tissue regeneration.

Polivoda O.M. Anniversary

2025-04-30T16:21:08+03:00

Polivoda O.M. Anniversary