TERRA ORTHOPAEDICA

Branding of the State Institution “Institute of Traumatology and Orthopedics of NAMS of Ukraine”

2025-08-15T14:40:33+03:00

Objective. This work aimes to highlight general aspects of healthcare facility branding and to announce the creation of a new logo for the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine.” To define and coordinate the key features of our institution’s brand image, the nominal group technique was applied, which is a structured process of group problem-solving and decision-making. A competition was announced to develop the new logo, after which all previous names of the institution were reviewed. As a result, three letters — І, Т, О — remained consistent in nearly all versions. The prototype for the new logo was inspired by the well-known and successful iPhone logo. The new logo is the inscription “іТО” with gray color accents. This is our institute’s first experience in branding. These three letters, at first glance, evoke in patients a range of associations with certain expected benefits and values they hope to receive by choosing our institution.

Traumatic Injuries of the Upper Extremities in Civilian Victims of Modern Combat Actions

2025-08-15T14:48:53+03:00

Introduction. The increasing number of terrorist attacks and military conflicts targeting civilians has posed a unique challenge to healthcare professionals worldwide. Objective. This study aimed to determine the clinical and nosological structure of upper extremity girdle injuries among civilian victims of modern armed conflicts. Materials and Methods. To carry out our study, we analyzed traumatic injuries to the skeletal bones in 137 civilian patients injured during modern hostilities in Ukraine who were treated in healthcare facilities located in the frontline zone between 2014 and 2023. Results and Discussion. During the full-scale invasion in 2022, a shift was observed in the distribution of upper extremity girdle injuries among civilian victims of modern warfare. The most significant increase was found in patients with hand injuries — their number rose by 7.7 times compared to the pre-war period. A notable increase was also recorded in patients with scapular fractures: while this injury was observed in 1.5% of victims during earlier conflicts, its incidence rose to 8.7% during the full-scale war. In our opinion, this increase resulted from a greater number of mine-explosive injuries affecting a broader segment of the civilian population. The incidence of forearm diaphysis fractures rose more than 2.5 times. An increase was also noted in patients with fractures of the distal forearm, although at a lower rate of 1.4 times. A slight increase was also observed in patients with clavicle fractures. Conclusions. The analysis of the distribution of upper extremity injuries among civilian patients injured in modern armed conflicts revealed significant shifts associated with changes in injury mechanisms, increased intensity of combat operations, and the prevalence of mine-explosive injury during the full-scale invasion.

Modeling the Function of Shoulder Joint Muscles During the Abduction of the Upper Limb

2025-08-15T15:11:44+03:00

Introduction. The functioning of the shoulder muscles during shoulder joint arthroplasty cannot be overestimated. Current strategies for muscle preservation during arthroplasty include: 1) minimally invasive approaches, 2) precise positioning of endoprosthesis components, and 3) early mobilization and postoperative rehabilitation. Objective. This study aimed to evaluate the force contribution of individual muscles of the shoulder girdle during upper limb abduction in the shoulder joint. Materials and Methods. The model comprises six joints: acromioclavicular (articulatio acromioclavicularis - ac), sternoclavicular (articulatio sternoclavicularis - sc), glenohumeral (articulatio glenohumeralis - gh), humeroulnar (articulatio humeroulnaris - hu), humeroradial (articulatio humeroradialis - hr), and radiocarpal (articulatio radiocarpalis - rc). Force generation during upper limb abduction was assessed both without load and with a 2 kg weight. Results. The analysis revealed that the main muscle responsible for the abduction of the upper limb is m. deltoideus (acromial part). This portion of the deltoid muscle develops maximal force during the abduction of the arm. Other muscles mainly serve as stabilizers, maintaining the humeral head within the glenoid cavity, with their force directed opposite to the movement. It should be noted that the activity of the muscles studied in this work was most prominent within the abduction range of 30° to 50°, depending on their functional role during the movement. Beyond 50°, the scapula and its associated musculature become actively involved. Conclusions. The maximum force during abduction of the upper limb is generated by m. deltoideus (acromial part). As the abduction angle increases beyond 30°–50°, there is a decrease in rotator cuff muscle force or a transition to a “support mode.” These findings improve our understanding of the shoulder girdle muscle biomechanics and are significant for movement physiology.

Combat-Related Elbow Injuries: A Retrospective Analysis Of Surgical Outcomes

2025-08-15T15:17:19+03:00

Summary. Combat-related surgical injuries of the elbow joint are a significant issue in modern warfare, as they involve damage to bone structures, nerves, and soft tissues, complicating their treatment and rehabilitation. This study presents a retrospective analysis of 30 patients with gunshot injuries to the elbow joint who were treated at the Severe Polystructural Trauma Department between 2022 and 2025. The mean age of the patients was 35.0 ± 9.1 years. Upon admission, 20 patients (69.0%) already had an external fixation device applied to the humerus and forearm. Bony defects of the distal epiphysis of the humerus were diagnosed in all 30 patients, including 12 (40.0%) – with a lateral condyle defect, 11 (36.7%) – with a medial condyle defect, and 7 (23.3%) – with massive condylar defects. Soft tissue defects requiring flap closure were found in 13 patients (44.83%). Neural structure damage was identified in 18 patients (62.07%), including 12 cases (41.38%) of ulnar nerve injury, 8 (27.59%) – of radial nerve injury, 4 (13.79%) – with combined ulnar and radial nerve injury, and 5 (17.24%) – with injury to all three nerves. Restoration of anatomical structures and function of the elbow joint was performed through soft tissue defect closure using flaps, humeral condyle reconstruction with autografts from the iliac crest, and subsequent rehabilitation according to international protocols. The Liverpool Elbow Score was used to assess elbow joint function and treatment effectiveness both before surgery and two months after reconstruction, allowing for evaluation of the degree of functional recovery.

Surgical Treatment of Three-Dimensional Flexion Contractures of the Proximal Interphalangeal Joints of the Long Fingers Using a Direct Lateral Skin-Fatty Digital Flap with Randomized Blood Supply

2025-08-15T15:22:13+03:00

Objective. The purpose of the study was to evaluate the possibility of closing defects of the covering tissues that arise during the elimination of three-dimensional dermato-teno-arthrogenic contractures of the proximal interphalangeal joint using a direct lateral skin-fatty digital flap with randomized blood supply, and to develop a surgical approach enabling elimination of all contracture components and one-stage closure of palmar skin defects of the finger. The article presents the outcomes of surgical treatment of patients using the developed method.

Materials and Methods. Fifteen patients with post-traumatic persistent three-dimensional dermato-teno-arthrogenic contractures of the proximal interphalangeal joints, affecting 18 long fingers, were under supervision. All patients underwent clinical, laboratory, and radiological examinations. All patients underwent reconstructive and restorative surgery on 18 long fingers: tenolysis, arthrolysis, tendon lengthening (if necessary), and closure of covering tissue defect, which arose during the surgery, with direct lateral skin-fatty digital flaps with randomized blood supply.

Results. Outcomes of the surgical treatment for persistent dermato-teno-arthrogenic contractures of the proximal interphalangeal joint were evaluated according to standard orthopedic and surgical principles.

Conclusions. Closure of soft-tissue defects over functionally significant structures of the finger is possible when using an “H”-shaped approach for tenolysis and arthrolysis, combined with the elevation and transposition of a direct lateral skin-subcutaneous digital flap with randomized blood supply. The technical simplicity and reliability of this method for closing palmar skin defects that occur during the elimination of persistent three-dimensional contractures of the proximal interphalangeal joints using a direct lateral digital skin-subcutaneous flap with randomized blood supply allows it to be recommended for use.

Differential Diagnosis of Pain Phenomena in the Residual Limb (Literature Review)

2025-08-15T15:31:29+03:00

Objective. Analysis of the literature devoted to etiology and pathogenesis, clarification of definitions, and differential diagnosis of pain phenomena in the residual limb.

Materials and Methods. This publication is a descriptive literature review based on an analysis of available literature sources retrieved from library databases of the National Library of Ukraine named after V.I. Vernadsky, PubMed, and the Cochrain Database.

Results and Discussion. Conclusions. Pain phenomena in the residual limb include phantom limb pain, phantom limb sensations, and stump pain. One type of pain may progress into another and be aggravated by a third, which complicates their diagnosis and the choice of treatment methods. Phantom limb pain is the most common; it is the main cause of physical limitations and disability, tends to become chronic, is difficult to treat, and affects the quality of life. The pathogenesis is complex and is associated with functional reorganization in the primary somatosensory cortex. The current literature on the topic is quite fragmented and contradictory. The studies presented do not characterize the current patient population, which has significantly changed over the past few years. This highlights the need for further study of the issue.

Modern Aspects of the Use of Computer-Assisted External Fixation Devices (Literature Review)

2025-08-15T15:52:23+03:00

Summary. The use of computer-assisted external fixation devices (CAEF) is an effective and minimally invasive method for correcting multiplanar deformities and bone defects in both children and adults. They allow for a higher degree of correction compared to the classic Ilizarov apparatus, while reducing the incidence of complications. Among the most effective CAEF systems are the Taylor Spatial Frame (TSF) and the Orthex Hexapod System. Additionally, the robotic Auto Strut system demonstrates high correction accuracy with minimized errors. The most common complications associated with CAEF use include superficial infections, temporary joint contractures, and delayed consolidation, which are generally managed conservatively.

April Theses 2025

2025-08-15T15:55:35+03:00

April Theses 2025

75th anniversary of the birth of Alexander Evgenievich Loskutov

2025-08-15T16:00:50+03:00

75th anniversary of the birth of Alexander Evgenievich Loskutov