TERRA ORTHOPAEDICA

Development of a Questionnaire for Assessing the Quality of Treatment of Gunshot Injuries of the Shoulder Girdle

2026-02-24T13:04:07+02:00

Objective. This study aims to revise, simplify, and adapt international questionnaires for assessing upper limb function after gunshot injuries of the shoulder girdle, and to develop a tool for standardized evaluation of treatment quality.

Methods. An analysis of international upper limb function questionnaires was performed, followed by a critical review of their items. The content of the questionnaires was compared considering the patterns of sports and daily activities typical for the Ukrainian population. Based on the findings, a modified questionnaire was developed and adapted to the national context.

Results. The developed tool provides a unified and comprehensible mechanism for evaluating functional outcomes of treatment for gunshot injuries of the shoulder girdle. The pilot study included 20 patients who were offered both the adapted questionnaire and international analogues. Each participant completed four questionnaires: three international instruments and the adapted version. After score calculation and result interpretation according to the grading system of each questionnaire, all patients were assigned to the same outcome category based on their responses across all four scales. All respondents highlighted the advantages of the adapted version, including shorter completion time, clearer wording, and elimination of difficulties in interpreting certain questions.

Conclusions. The proposed adapted questionnaire may be recommended as an effective, valid, and user-friendly tool for standardized assessment of surgical treatment outcomes in patients with gunshot injuries of the shoulder girdle. Its application enhances the objectivity of evaluation and improves the consistency of clinical outcome reporting in this patient population.

Modeling of Scapular and Clavicular Muscle Function During Upper Limb Abduction

2026-02-24T13:10:35+02:00

Introduction. Modeling combined movements, such as upper limb abduction involving multiple joints and muscle groups, requires advanced mathematical tools; therefore, it is often represented as a sequence of motions in the glenohumeral, sternoclavicular, and acromioclavicular joints. Although this approach does not fully replicate anatomical movement, it provides valuable insight into the magnitude of muscle forces generated during limb abduction.

Objective. This study aimed to analyze the muscle forces responsible for scapular and clavicular movement during shoulder abduction.

Materials and Methods. Modeling was performed using the OpenSim software package based on the DAS3 model. The model included six joints: acromioclavicular, sternoclavicular, glenohumeral, humeroulnar, humeroradial, and radiocarpal. A total of 138 muscles were included. Movements in the sternoclavicular and acromioclavicular joints were simulated. The abduction of the upper limb was analyzed within a range of 0° to 90°.

Results. The sternoclavicular joint becomes active when shoulder abduction reaches approximately 30°. The force of the rhomboid muscles increases to 400 N at a clavicular elevation angle of approximately 20–25°. Subsequently, scapular rotation affects the rhomboid muscles, reaching a maximum force of 700 N at full shoulder abduction, with the torque increasing to 32 N·m. At the onset of scapular movement, the force vector of the upper fibers of the serratus anterior is directed toward the clavicle, causing a decrease in total force up to an elevation angle of 10°. With further clavicular movement, serratus anterior force increases to 370 N at an elevation angle of 20–25°, while the generated torque decreases from 30 N·m to 15 N·m. During clavicular elevation, the lower portion of the serratus anterior generates forces ranging from 475 N to 535 N at a maximum angle of 20° to stabilize the scapula. The corresponding torque increases to 50 N·m after 10° of clavicular elevation. The onset of the clavicular movement is accompanied by an increase in the total trapezius muscle force to 1150 N at a clavicular rotation angle of 10°. With further elevation, the muscle force decreases to 970 N. During scapular rotation, trapezius muscle force increases again to 1150 N at 90° of shoulder abduction. The levator scapulae muscle reaches a force of 200 N only at the initial stage of clavicular movement, while scapular rotation requires an increase in muscle force up to 160 N.

Conclusions. Modeling the function of muscles responsible for scapular and clavicular movement made it possible to determine the sequence of involvement of joints and corresponding muscles required to achieve shoulder abduction up to 90°. The obtained data allowed identification of potential functional disorders of the shoulder girdle in cases of clavicular or scapular injury, or combined trauma.

Features of Surgical Treatment of Lumbar Foraminal Stenosis

2026-02-24T13:17:38+02:00

Summary. Minimally invasive spine surgery is currently undergoing rapid development. New techniques for the treatment of degenerative-dystrophic diseases of the spine have been introduced; however, long-term treatment outcomes remain insufficiently studied. The use of unilateral biportal endoscopy in Ukraine is still limited, which makes research in this field particularly relevant.

Objective. This study aimed to analyze the outcomes of treatment and complications after unilateral biportal endoscopic decompression in patients with lumbar foraminal stenosis.

Materials and Methods. The study was conducted at the Endoclinic Medical Center in Rivne from January to July 2024. The study cohort consisted of 50 patients. All patients underwent unilateral biportal endoscopic decompression of the intervertebral foramen at the following levels: L3–L4 (n=1), L4–L5 (n=19), and L5–S1 (n=30).

Results. The results of our study showed that pain intensity according to the Visual Analog Scale (VAS) significantly decreased during the observation period. The preoperative score was 7.05±0.76 for the lumbar spine and 7.15±0.81 for the lower limb; on the second postoperative day, VAS scores decreased to 3.75±0.85 and 3.85±0.93, respectively. At 3 and 6 months after surgery, lower back pain intensity decreased to 1.75±0.85 and 1.65±0.87; a similar trend was observed for pain in the lower limbs (1.75±0.85 and 1.6±0.99). These results indicate a significant positive dynamics at all stages of follow-up. The Oswestry Disability Index (ODI) was 62.5±6.38% preoperatively and decreased to 21.7±4.21% one month after surgery; at 3 months it was 14±5.39% and 12.1±6.17% at 6 months of follow-up. Overall, excellent or good clinical outcomes were achieved in 84% of cases.

Conclusions. Unilateral biportal endoscopic decompression is an effective method for the treatment of lumbar foraminal stenosis. Compared with open surgical procedures, this technique offers a number of advantages.

Patient-Dependent Risk Factors for Nonunion of Long Bone Fractures After Metal Osteosynthesis

2026-02-24T13:25:15+02:00

Background. Delayed consolidation and nonunion after long bone fractures remain among the most severe complications in the surgical treatment of musculoskeletal injuries.

Objective. The study aims to determine the impact of patient-dependent risk factors for nonunion of long bone fractures after metal osteosynthesis and to rank these factors depending on fracture location.

Materials and Methods. A total of 165 patients who underwent metal osteosynthesis for long bone fractures (64 females and 101 males) and were treated for impaired reparative osteogenesis and nonunion were evaluated. The systematization of cases of nonunion of fractures was carried out according to the Weber-Cech classification. Patient-dependent factors (patient’s age, gender, smoking, alcohol abuse, overweight, use of nonsteroidal anti-inflammatory drugs, comorbidity) were studied.

Results and Discussion. The incidence of nonunion was higher in males than in females. The oligoplastic type of nonunion was more common than other types of impaired bone healing. A higher incidence of aplastic nonunion of humeral fractures was observed in females; for the lower extremities, oligoplastic nonunion most often occurred in males. Hyperplastic nonunion predominated exclusively in the group of segments of the lower extremities. Statistical analysis of risk factors for nonunion demonstrates a strong influence of smoking and the use of nonsteroidal anti-inflammatory drugs.

Conclusions. Smoking and the use of nonsteroidal anti-inflammatory drugs are the key factors influencing nonunion formation in long bone fractures. The distribution of prognostic factors for the formation of a false joint by morphological features demonstrates a homogeneous trend of ranking in the following areas: nonsteroidal anti-inflammatory drugs, age, smoking, gender, comorbidity, and alcohol consumption. The identification and ranking of these factors will allow for accurate clinical profiling of patients with long bone nonunion and for assessing the prognostic impact of these factors in individual clinical cases.

Principles and Outcomes of Conservative Treatment for Thumb Carpometacarpal Osteoarthritis

2026-02-24T13:30:16+02:00

Summary. The high prevalence of thumb carpometacarpal (CMC) osteoarthritis and the wide range of available conservative treatment options highlight the need for quantitative assessment of their effectiveness.

Objective. This study aimed to quantitatively evaluate the effectiveness of a multimodal conservative treatment program for thumb CMC osteoarthritis.

Materials and Methods. The outcomes of conservative treatment were evaluated in 270 patients with thumb CMC osteoarthritis (224 females and 36 males; median age 59 years, range 36–84, IQR 12). The treatment program included load modification, orthosis use, NSAIDs, physiotherapy, chondroprotective agents, and targeted therapeutic exercises. Changes in qDASH scores over time were assessed, as well as the rate of subsequent conversion to surgical treatment depending on the Eaton–Littler stage.

Results. Conservative treatment resulted in a reduction in upper-limb disability across all stages of the disease. In patients with stage I, median improvement in qDASH score was 7 points (range 4.5–9.1), with an interquartile range (IQR) of 4 points. For stage II, median improvement was 6.8 points (range 0–9.1), with an IQR of 4.6. Stage III demonstrated 5.7 points (range 4.5–13.7), with an IQR of 4.6, while stage IV showed 6.9 points (range 4.5–11), with an IQR of 4.6. High residual disability persisted in 52 patients (19%), requiring surgical intervention. Thus, initiating surgical treatment only after completing a structured conservative program demonstrates high effectiveness of this staged approach.

LOTOS 2025 — Lviv October Trauma Ortho Symposium

2026-02-24T13:32:53+02:00

LOTOS 2025 — Lviv October Trauma Ortho Symposium

Науково-практична конференція «Ампутації та протезування кінцівок: нові горизонти» 5 грудня 2025

2026-02-24T13:34:49+02:00

Науково-практична конференція «Ампутації та протезування кінцівок: нові горизонти» 5 грудня 2025