TERRA ORTHOPAEDICA

The Results of Surgical Treatment of Intervertebral Disc Herniation in Lumbar Spine Depending on Localization According to MSU

2025-01-08T12:58:16+02:00

Summary. Background. The dependence between the results of surgical treatment and the localization of a hernia is understudied. Understanding this interrelation may help us determine the adequacy of the surgical technique applied depending on the localization of an intervertebral disc protrusion.

Objective. The objective of our study was to compare the results of surgical treatment of intervertebral disc protrusions depending on their location according to the Michigan State University (MSU) classification, using different methods.

Material and Methods. We applied different methods for surgical treatment of patients with intervertebral disc protrusions in the lumbar spine: 93 patients underwent interlaminar microdiscectomy (mean age of the patients was 41.9±11.6 years), 92 underwent unilateral biportal endoscopy via interlaminar approach, and 13 had transforaminal monoportal discectomy. The mean age of the patients surgically treated using endoscopic methods was 43.1±13.1 years. Based on the MRI visualization, disc protrusions were assessed using the MSU classification according to their location by size in the axial plane. To analyze the results, we used standardized VAS and Oswestry scales on the first day, one month, and six months after the surgery.

Results. At all stages of the research, foraminal protrusions type C according to the MSU classification demonstrated the worst results. This fact may be associated with the use of the interlaminar approach, while the transforaminal approach allowed us to obtain good results in this category of patients. The quality of life according to the Oswestry scale within six months after the surgery appeared twice as bad for both methods compared to the non-foraminal location of protrusions (10.5±0.7 compared to 5.2±4.4). Patients with large 2C protrusions had significant worsening of their quality of life but less pain syndrome compared to the patients with 1C protrusions.

Conclusions. Clinical results of both methods demonstrate their comparative efficiency. The obtained data about the higher effectiveness of endoscopic discectomy compared to the microsurgical technique appear convincing in the early postoperative period but remain ambiguous at the later follow-up stages. Taking into account that this method is as good as microsurgery according to technical characteristics and possibilities, this technology may be used instead of the standard method of removing intervertebral disc protrusions.

Comparative Analysis of Efficacy and Complications after Unilateral Biportal Endoscopic Discectomy and Interlaminar Microdiscectomy

2025-01-08T13:11:11+02:00

Summary. To date, existing literature, including systematic reviews and meta-analyses, has demonstrated successful clinical outcomes with low complication rates for endoscopic biportal discectomy. However, these studies are limited, and quite a few similar studies have been covered in the scientific space in Ukraine, which highlights the need for further research in this direction.

Objective. The objective of our study was to conduct a comparative analysis of treatment outcomes and complications after unilateral biportal endoscopic discectomy and interlaminar microdiscectomy in the treatment of herniated intervertebral discs of the lumbar spine.

Material and Methods. The study was conducted at the Department of Neurosurgery of the Spine and Spinal Cord of the Ivano-Frankivsk Regional Clinical Hospital from May 2021 to June 2023. The sample included 276 patients with herniated intervertebral discs of the lumbar spine, divided into two groups according to the type of intervention: unilateral biportal endoscopic discectomy (n=159) and interlaminar microdiscectomy (n=117).

Results. The results of our study showed that the severity of back pain after 1 month was lower in the endoscopic discectomy group compared to the interlaminar microdiscectomy group; however, after 6 months, the differences were not statistically significant (p > 0.05). Intergroup comparison revealed no significant differences in the manifestations of pain syndrome in the leg at both 1 month (t St = 1.65 at t Cr =1.98, p > 0.05) and 6 months (t St = 1.88 at t Cr =1.98, p > 0.05). The duration of surgery was on average shorter when using endoscopic access compared to interlaminar microdiscectomy (р ≤ 0.01), and blood loss was reduced by 63.1% during endoscopic access (p < 0.001). No significant differences in intraoperative complications were observed between the methods; among postoperative complications, cases of paresthesia were observed more often in the interlaminar microdiscectomy group (42 cases, 35.8%) compared to the unilateral biportal endoscopic discectomy group (28 cases, 17.6%) (p < 0.05).

Conclusions. Our study revealed no differences between interlaminar microdiscectomy and unilateral biportal endoscopic discectomy in terms of the number of intraoperative complications (except for postoperative paresthesia). Similarly, the duration of hospital stay was shorter in the groups where endoscopy was used.

Biomechanical Analysis of the System “External Fixation Device – Bone” Behavior at the Stages of Tibial Diaphyseal Fracture Healing

2025-01-08T13:51:59+02:00

Summary. The use of external fixation devices for the treatment of diaphyseal fractures of the tibia has become the standard. However, most external fixation device (EFD) modifications have insufficient stiffness. Therefore, there is a need to develop an EFD design that could provide early limb loading with an optimal range of interfragmentary motion. A related challenge lies in determining the strength of bone regeneration during fracture healing, which cannot be objectively assessed in a clinical setting. However, these values can be calculated using the Finite Element Method (FEM).

Objective. The objective of our work was to study the biomechanical behavior of the proposed “External Fixation Device – Tibia” system at the stages of bone regeneration under the condition of its loading by body weight using the FEM.

Material and Methods. A computer simulation was carried out, at the initial stage of which a semi-full-scale prototype of the “External Fixation Device – Tibia” bone fragments fixation system was developed. Based on it, the next step was to create solid 3D models of the tibia and the EFD using the SolidWorks software package (Dassault, France). The EFD design used in the work consisted of 4 semi-rings (160 mm), 9 connecting beams (150 mm), two through pins (5 mm), 2 spongiosis screws (5 mm), 2 cortical screws (5 mm), and 6 clamps. All the components of the EFD were made of AISI320 stainless steel.

Results and Discussion. Simulation computer modeling of the fixation capabilities of the proposed EFD showed that its stiffness is sufficient to provide a controlled load on the damaged limb within 20-24% of body weight from the first days of formation of granulation cartilage regenerate. It should be noted that the supporting function of the fibula is restored within 5-6 weeks after its fusion and is approximately 17-30% of the body weight. Therefore, in general, a controlled load on the limb can reach 50% of the body weight after 6 weeks of treatment. Subsequently, when mature bone tissue is formed around the fracture (most often within 8-17 weeks), the load on the limb can reach 130% of the body weight, which ensures the patient’s movement without additional support.

Conclusions. The performed computer simulation modeling makes it possible to determine the behavior of the biomechanical environment of the proposed “External Fixation Device – Bone” system and allows to establish the amouth of limb loading in the process of developing a scientifically based rehabilitation program to create optimal conditions for fracture healing. The proposed design of the EFD can be used for the final treatment of diaphyseal fractures of the tibia and provides for the possibility of early loading on the “External Fixation Device – Bone” system.

Characteristics of the Floating Hip in Patients with Polytrauma

2025-01-08T13:59:37+02:00

Introduction. The term “floating hip” refers to a group of injuries characterized by ipsilateral fractures of the bones on both sides of the joint, which are thus devoid of skeletal communication.

Objective. The objective of our work was to determine the clinical and nosological characteristics of patients with a floating hip and polytrauma and its impact on the choice of treatment for this category of patients.

Material and Methods. The study analyzed the treatment of 77 patients with ipsilateral hip fractures resulting from polytrauma. The patients were treated in the Polytrauma Department of the Kyiv City Clinical Emergency Hospital in the period from 2014 to 2023 and met the selection criteria for our study.

Results. Among the patients of our study, 55 (71.4%) were males and 22 (28.6%) were females. In 100.0% of cases, the cause of the floating hip was severe high-energy trauma. Among the study group, 46 (59.7%) cases were caused by road accidents, 27 (35.1%) by falls from a height, and 4 (5.2%) by criminal injuries. A direct blow was the mechanism of injury in 100.0% of cases. Among patients with polytrauma, the most common fractures were simple fractures of the acetabulum of type C (47.4%) and type B (36.8%), as well as fractures of the anterior wall of type B (60.0%) and the posterior wall of type B (53.8%) and type C (38.5%). The analysis of hip fractures in patients with a floating hip and polytrauma indicated that the diaphyseal part of the femur was damaged most often, which was found in 53.2% of the study sample, with type B fractures prevailing (58.5%). Injuries to the proximal part of the thigh were detected in 40.3% of patients, with type A being the most common (41.9%).

Conclusions. The analysis of the clinical and nosological characteristics of the floating hip in polytrauma patients indicates the need to develop and implement a new, more adapted classification of such injuries in patients with polytrauma.

Advancements and Prospects in Personalized Navigation Systems for Knee Arthroplasty: A Literature Review

2025-01-08T14:06:00+02:00

Introduction. Traditional methods of knee arthroplasty are based on mechanical alignment, which ensures long-term component survival but does not always meet patients’ functional needs. Recent studies indicate that personalized alignment approaches, such as kinematic and functional alignment, can improve functional outcomes and reduce complication rates. These methods consider the natural axes of movement and the anatomy of the knee joint, contributing to the restoration of joint anatomy and function. Individualized navigation systems represent a modern approach to knee arthroplasty using three-dimensional preoperative models based on CT or MRI. This method improves the accuracy of fitting the prosthesis components, considering the patient’s individual anatomical features and biomechanical parameters.

Objective. The objective of this literature review is to analyze the literature on using advanced navigation systems and evaluate their effectiveness, advantages, and prospects in personalizing knee joint arthroplasty.

Material and Methods. Using PubMed, Scopus, and Web of Science databases, we reviewed 22 scientific studies on various navigation systems for knee joint arthroplasty. Studies were selected based on patient numbers, statistical significance, clear inclusion and exclusion criteria, and availability of objective treatment outcome data. This allowed for a detailed analysis and comparison of different navigation methods.

Results. Total knee arthroplasty (TKA) is one of the most effective surgical treatments for knee osteoarthritis. However, the accuracy of prosthesis implantation remains a critical factor for the long-term success of the surgery. Deviations in placement can lead to increased wear of components and a higher risk of complications. Traditionally, standard tools and techniques based on anatomical landmarks are used for prosthesis placement. In recent years, individualized navigation systems (INS) based on preoperative three-dimensional modeling of the patient’s individual anatomy have been introduced. INS aim to improve the accuracy of knee joint component placement, reduce time of surgery, and lower the risk of complications.

Conclusions. The use of patient-specific surgical instruments and resection tools in primary and revision knee joint arthroplasty improves surgical and rehabilitation outcomes. This development allows for a 30% improvement in implant positioning accuracy and a 10% reduction in CO₂ emissions. Standardizing research methods and increasing surgeon experience may contribute to a better understanding of the long-term benefits of individualized navigation systems in knee joint arthroplasty. Despite the identified advantages of INS, further research is needed to determine the long-term clinical outcomes and cost-effectiveness of these systems. The application of INS is especially important in cases of significant deformities and bone defects.

Case Report of an Intermuscular Thenar Lipoma with a Literature Review

2025-01-08T14:13:53+02:00

Summary. Lipomas are the most common benign tumors found in the hand, with those exceeding 4 cm in size classified as giant lipomas. However, large lipomas in the hand are rare due to their visibility and limited subcutaneous tissue in this area. When they do occur, they can interfere with hand function. Typically, lipomas in the dominant hand are detected early and surgically removed. We present a case of a giant lipoma in the hand, notable for its unusually large size and the fact that it remained asymptomatic until the time of presentation.

Abstracts for the Scientific and Practical Conference, Neuroorthopedics of the Lower Limb in Children: The View of a Neurologist and Orthopedist, 11–12 October 2024, Chernivtsi

2025-01-08T14:36:02+02:00

Abstracts for the Scientific and Practical Conference, Neuroorthopedics of the Lower Limb in Children: The View of a Neurologist and Orthopedist, 11–12 October 2024, Chernivtsi

Review of the Book «Plantar Fasciitis»

2025-01-08T14:39:08+02:00

Review of the Book «Plantar Fasciitis»