TERRA ORTHOPAEDICA

Characteristics of Ipsilateral Lower Limb Injuries in Patients with Polytrauma

2025-12-24T21:07:40+02:00

Introduction. Ipsilateral fractures of the femur and tibia involving the diaphyseal, metaphyseal, and intra-articular segments of the bones are referred to as a «floating knee». A floating knee typically results from high-energy trauma, during which patients sustain severe and sometimes life-threatening injuries.

Objective. Our study aimed to determine the causes of different types of ipsilateral lower limb fractures and their distribution in patients with polytrauma.

Materials and Methods. The study included 67 patients with verified ipsilateral femoral and tibial fractures with polytrauma. This cohort was treated at Odesa City Clinical Hospital No. 11 between 2013 and 2023.

Results. Analysis of the study cohort revealed that the traumatogenesis of injuries among patients with ipsilateral injuries of the lower extremities resulting from polytrauma was similar across the groups. In the first group, road traffic accidents prevailed as the cause of injury, accounting for 79.5% of cases. Catatrauma was observed in 18.2% of patients, while domestic trauma occurred in 2.3%. In the second group, road traffic accidents accounted for 78.3% of cases, and catatrauma for 21.7%; no domestic injuries were reported in this group.

Conclusions. Ipsilateral injuries of the lower extremities are severe injuries resulting from high-energy trauma, with road traffic accidents and catatrauma being the prevailing causes. In the study cohort, the most frequent combination was craniocerebral and thoracic trauma, which significantly complicated the provision of medical care to this category of patients. Among patients with ipsilateral injuries of the lower extremities resulting from polytrauma, Fraser type I injuries were the most common, indicating the peculiarities of the treatment of this type of fractures in patients with polytrauma.

The Nature of Tendon Injuries of the Rotator Cuff and the Long Head of the Biceps in Patients With Different Grades of Rotator Cuff Arthropathy

2025-12-24T21:13:19+02:00

Introduction. Rotator cuff arthropathy is a disease of the shoulder joint characterized by insufficient function of the rotator cuff, degenerative changes in the shoulder joint, and migration of the humeral head.

Objective. The aim of this study was to determine the nature of damage to the rotator cuff tendons and the long head of the biceps in patients with different grades of rotator cuff arthropathy.

Materials and Methods. The study included 91 patients aged 35 to 80 years with varying grades of rotator cuff arthropathy at the time of examination.

Results. The development of rotator cuff arthropathy requires a damage to the supraspinatus tendon in combination with injuries to other tendons of the shoulder.

Conclusions. Rotator cuff arthropathy Grade I requires injury to the supraspinatus tendon in combination with damage to the upper part of the tendon of the subscapularis muscle or in combination with damage to the tendon of the infraspinatus muscle, or in combination with damage to both the upper part of the tendon of the subscapularis muscle and the tendon of the infraspinatus muscle. In patients with rotator cuff arthropathy Grade II, in addition to the injury combinations characteristic of Grade I, damage to the lower part of the tendon of the subscapularis muscle and partial or complete ruptures of the tendon of the long head of the biceps are more common. In patients with rotator cuff arthropathy Grade III, damage to the tendon of the long head of the biceps occurs significantly more frequently than in patients with rotator cuff arthropathy Grade I or II (p ≤ 0.05).

The Analysis of Trauma Character and Severity in Patients with Shoulder Girdle Combat Injuries

2025-12-24T21:20:23+02:00

Introduction. According to various studies, limb injuries caused by combat trauma account for 44% to 70% of all injuries to musculoskeletal system.

Objective. This study aims to analyze shoulder girdle injuries in patients with combat-related surgical trauma who underwent surgical treatment.

Materials and Methods. A retrospective analysis was conducted on 733 patients with combat-related surgical trauma of the limbs, including 378 patients (51.6%) with upper limb injuries and 355 patients (48.4%) with lower limb injuries. All patients received inpatient treatment at the Department of Severe Skeletal Trauma of the State Institution «Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine» from August 1, 2022, to December 31, 2024.

Results. During this period, surgical treatment was performed in 63 patients with shoulder girdle combat-related surgical trauma, accounting for 8.6% of all limb injuries and 16.7% of upper limb injuries. The mean age of patients was 34.7±8.1 years. By injury type, gunshot wounds were observed in 35 patients (55.6%), mine-blast injuries in 13 patients (20.6%), other injuries in 8 patients (12.7%), shrapnel wounds in 4 patients (6.3%), and road traffic accident (RTA) injuries in 3 patients (4.8%). Fractures were classified into three groups: fractures and dislocations involving the clavicle in 28 patients (44.4%), scapular fractures in 17 patients (27.0%), and combined fractures of the clavicle and scapula in 18 patients (28.6%). Bone defects were observed in 43 patients (68.3%), with a mean defect length of 4,7±3,8 cm. Gunshot wounds to soft tissues involving shoulder girdle muscles and tendons were found in 54 patients (85.7%). Nerve injuries were diagnosed in 14 patients (22.2%). Major vascular injuries requiring surgical intervention, according to accompanying documentation, were found in 3 patients (4.8%).

Conclusions. The analysis of combat-related shoulder girdle injuries demonstrated a high incidence of multi-structural injuries, particularly among working-age males (96.8%), requiring complex surgical interventions and prolonged rehabilitation. The most common injuries were fractures of the clavicle (44.4%) and scapula (27.0%), along with soft tissue injuries involving muscles (85.7%) and nerves (22.2%), which significantly complicate treatment and rehabilitation.

Total Hip Arthroplasty After Acetabular Fractures

2025-12-24T21:24:16+02:00

Relevance. The consequences of acetabular fractures most often manifest as coxarthtrosis and/or aseptic necrosis of the femoral head. One of the most important issues is proper positioning of the artificial hip socket, which depends on anatomical conditions.

Objective. This study aims to analyze the outcomes of total hip arthroplasty (THA) in patients with sequelae of acetabular fractures and to compare functional results depending on the complexity of acetabular component positioning.

Material and Methods. Seventy patients aged 24–67 years with sequelae of acetabular fractures who underwent THA were divided into two groups: group I (31 cases), when the positioning of the acetabular component was not problematic; group II (39 cases), when the positioning of the acetabular component of the prosthesis was technically difficult. Functional outcomes were assessed in all patients 2–15 years after surgery using the Harris Hip Score (HHS).

Results. Baseline HHS scores were significantly higher in group I compared with group II (55.7 ± 11.7 vs. 35.9 ± 10.4; p < 0.001, two-sample t-test). Final THA outcomes were also significantly better in group I than in group II (94.3 ± 4.6 vs. 90.6 ± 8.7; p = 0.026, two-sample t-test). However, consideration of the minimal clinically important difference (MCID) for HHS indicated a clinically insignificant difference.

Conclusions. Accurate restoration of anatomy, particularly the hip joint’s center of rotation, is a key success factor ensuring proper prosthesis function, stability, optimal muscle biomechanics, and implant longevity. An individualized and differentiated approach to THA in patients with sequelae of acetabular fractures allows for good and excellent anatomical and functional treatment outcomes, with the average HHS values exceeding 90 percent.

Analysis of the Stress–Strain State of a Model of the Tibia With a Comminuted Fracture of the Proximal Tibia Under Different Variants of Osteo-synthesis Under Bending Load in the Sagittal Plane

2025-12-24T21:30:13+02:00

Introduction. Fractures of the tibial plateau are intra-articular injuries. The current debatable issue is the selection of a plate based on its functional capacity, which depends on the nature of the fracture and the position of the implant, and requires further study.

Objective. The study aims to investigate the stress values in a model of comminuted fractures of the proximal tibia under different types of stabilization when exposed to bending load in the sagittal plane.

Materials and Methods. A finite element model of the proximal epimetaphysis of the tibia with a comminuted fracture was created. Three variants of osteosynthesis were studied: (1) a plate on the medial side,

(2) a plate on the lateral side, and (3) two plates on both sides. A bending force was applied to the tibial plateau, acting from posterior to anterior.

Results. A plate applied on the lateral side provides the lowest stress levels in the bone elements of the model within the fracture zone. The exception is the bone fragments around the fixing screws passing through this plate, where the stress level exceeds 35.0 MPa. A plate applied on the medial side provides minimal stress around its fixing screws, but the stresses on the outer bone surfaces in the fracture zone increase and are several times higher than in the model with the lateral position of the plate; however, in absolute values, these stresses do not exceed 11.1 MPa. The variant of fixation with two plates provides the most optimal distribution of stresses in the model. Unilateral plate application may also be considered, taking into account the nature of the fracture, the number and size of fragments, technical difficulties of plate placement, etc.

Conclusions. Under bending load in the sagittal plane, osteosynthesis with two plates provides the lowest stresses. The exception is the area around the screws, where stresses in the bone fragments remain increased. In models with unilateral fixation of fragments, the main difference lies in stress levels near the screws: with the medial position of the plate, these values are several times lower than with the lateral position.

Analysis of the Structure of Combat-Related Injuries to the Nerves of the Upper Limb in Modern Combat Operations

2025-12-24T21:35:57+02:00

Introduction. Firearm-related extremity injuries account for up to 60% of all combat-related trauma in modern warfare. Approximately one-third of these injuries are accompanied by fractures, while peripheral nerve damage of varying severity is diagnosed in about 40% of cases.

Objective. This study aims to characterize the patterns of combat-related peripheral nerve injuries sustained during modern military operations, with particular attention to the challenges of diagnosis and management across different stages of medical evacuation.

Materials and Methods. We analyzed the injuries of 163 male patients with firearm-related peripheral nerve damage of the upper limb. The mean age of the patients was 34±8.6 years. The diagnostic protocol included radiography, electroneuromyography, and ultrasonography of both the affected nerve and the muscles of the arm and forearm.

Results. Nearly 95% of patients sustained peripheral nerve injuries from fragmentation shells resulting from rocket–artillery and other remotely operated weapons. The majority of gunshot wounds were localized in the middle and distal third of the shoulder (42.3%), in the forearm (25.4%), and in the elbow joint area (14.9%). Among peripheral nerve injuries of the upper limb, radial nerve damage was most common (36.2%). Consequences of open fractures of the humerus were present in 45.1% of cases; fractures of the ulna and radius were associated with nerve injury in 19.8% and 17%, respectively.

Conclusions. Grade III–IV nerve injuries (according to Sunderland) occurred in 55.1% of patients, and complete anatomical nerve disruption was observed in 42.2% of cases. Nerve defects measuring 3–6 cm were recorded in 53 patients (56.7%) – this range is generally considered favorable for surgical reconstruction. In 9.6% of cases, nerve defects exceeded 12 cm. At earlier stages of medical evacuation, injured nerves were rarely repaired, and the diagnosis of such injuries was insufficient.

ORTHOFEST KYIV 2025: Інноваційні підходи до лікування поліструктурної травми кінцівок

2025-12-24T21:37:35+02:00

ORTHOFEST KYIV 2025: Інноваційні підходи до лікування поліструктурної травми кінцівок

60 років Королькову Олександру Івановичу

2025-12-24T21:39:03+02:00

60 років Королькову Олександру Івановичу