TERRA ORTHOPAEDICA

Analysis of Early Surgical Treatment of Incorrectly Consolidated Gunshot Fractures of the Scapula

H.V. Telepenko — 2024-10-08

Objective. The objective of our study was to analyze the structure of incorrectly consolidated gunshot fractures of the scapula and early outcomes of surgical treatment.

Material and Methods. We analyzed 10 cases of incorrectly consolidated gunshot fractures of the scapula in Ukrainian Armed Forces servicemen, received as a result of combat operations, and early outcomes of surgical treatment. The main indications for surgical treatment were as follows: severe impairment of function of the upper limb due to pain, fractures of the articular surface of the scapula with displacement of fragments over 2 mm, fractures of the acromion with displacement of more than 8 mm, and damages to muscles and skin. In addition to radiography in standard projections, preoperative examination included computed tomography (CT). Evaluation of functional outcomes was carried out within 1 to 4 months according to the Oxford Shoulder Score (OSS) scale. The average period of postoperative survey was 2.6 months.

Results. Incorrect consolidation of fractures was caused by a long period of preoperative preparation and conservative treatment of wounds in patients due to openness and infection of bullet wounds in 2 patients and shrapnel wounds because of mortar, artillery, tank and rocket attacks in 8 patients. Staged treatment until wound healing was carried out in hospitals and military hospitals of Ukraine using VAC (Vacuum-Assisted Closure) devices. Four cases were right-sided and six were left-sided; 7 of 10 cases were intra-articular fractures with displacement of fragments of the articular surface by 2 mm or more. The average duration of injury at the time of surgery was 4.2 months (range from 2 to 8 months). In addition to eliminating displacements and deformities of incorrectly consolidated fractures and osteosynthesis of fragments, the treatment included replacing the soft tissue defect of the shoulder and shoulder girdle with a non-free thoracodorsal musculocutaneous flap on a neurovascular pedicle in 3 of 10 patients. Seven patients had an isolated wound to the scapula area. Three of 10 patients had a combined wound to the scapula with a defect of the humeral head, upper third of the humerus, and acromial end of the clavicle. These patients underwent implantation of an articulating spacer, restoration of the configuration of the proximal end of the humerus, and reconstruction of the rotator muscles to make possible the shoulder joint arthroplasty. The average value according to the results of a survey of patients on the OSS scale was 20.2 (±4.39) points before surgery and 34.1 (±7.56) points after surgery, which can be considered a good result according to the OSS scoring system.

Conclusions. The analysis of the early outcomes showed that reconstructive treatment of gunshot old fractures of the scapula creates biomechanical prerequisites for restoring the function of the upper limb, reduces pain syndrome, and allows for active postoperative rehabilitation.

Differentiated Approach to Surgical Treatment of Gunshot Diaphyseal Shin Fractures

A.V. Kalashnikov — 2024-10-08

Background. The roots of problems in the treatment of gunshot fractures to extremities lay in the high-energetic character of these traumas, the frequency of infectious complications, high rate of slow consolidations, and occurrence of pseudoarthroses and bone tissue lesions.

Objective. The objective of the study was to improve the treatment results of patients with gunshot fractures of the shin bones based on the development of a differentiated approach to the treatment of such injuries.

Material and Methods. The study is based on the results of examination and treatment of 128 patients with dominant combat shin traumas. The patients were divided into two groups. The first group (control group) included 68 patients who underwent treatment with an external fixation device (EFD). The second group (study group) included 60 patients who underwent the extrafocal osteosynthesis replaced by an internal, mostly intramedullary one. To assess the functional outcomes of treatment, we applied the LEFS (Lower Extremity Functional Scale) in the dynamics of the therapy, namely in 3, 6, 12, and 18 months after the injury.

Results. Mean values in both groups during the first two to three weeks showed no statistically significant difference, and their average score according to the LEFS scale was 15.75 points. The most significant differences were observed in the period from 6 to 12 months after the injury, 39.4±2.4 (EFD) and 57.3±2.1 (intramedullary nailing). After 18 months, excellent results showed 20.7% of patients from the study group and 15.8% of the control group (61 – 80 LEFS scores). Good results had 43.2% and 33.1%, respectively (41 – 60 LEFS scores). 28.1% and 39.3%, respectively, showed satisfactory results (21 – 40 LEFS scores). Poor results showed 8.0% of patients of the study group and 11.8% of the control group (p<0.05).

Conclusions. The analysis of treatment outcomes of patients with gunshot diaphyseal shin fractures demonstrates that conversion, when used according to indications and following criteria to the replacement of the method of fixation, reduces the incidence of complications in both the early and late postoperative periods, fastens consolidation of gunshot diaphyseal shin fractures by 4.5±2.3 weeks, reduces the frequency of fracture consolidation disorders by 10.6%, and improves the functional results of the patients by 15.0%.

Microflora of Secretions in a Surgical Hospital of Orthopedics and Traumatology Profile for 2021-2023 (SI “ITO NAMS of Ukraine”)

O.B. Liutko — 2024-10-08

Summary. Healthcare-associated infections (HAIs), namely, surgical site infections, early postoperative and subsequent in-hospital infections, are the most common undesirable phenomenon in the world. According to statistics, at least one case of HAIs is diagnosed in every 100 hospitalized patients in hospitals of 7 developed and 15 other countries of the world at any given time. The occurrence of such complications during the treatment of a patient in a hospital leads to the need of additional diagnostic tests, additional courses of antibiotics, and unplanned surgical intervention. Worsening of the prognosis of treatment may occur due to the formation of the so-called resistant microflora in such patients, with a real probability of spreading the infection in the hospital. Prevention of HAIs in practice occurs through planned infection control in operating rooms and procedure rooms in clinical departments and qualified timely diagnostic work of certified microbiological laboratories in hospitals.

Objective. The objective of the study was to determine the spectrum of microflora of secretions for three years (2021-2023) in orthopedic and trauma patients due to changes in modern injuries received more often because of military aggression and to propose the identified differences as criteria for prescribing antibacterial drugs in complex inpatient treatment. The work shows that over the past three years (2021-2023), the ratio of gram-positive and gram-negative microorganisms in the study material almost did not change and averaged 1.65. The peculiarity of the analyzed period was an increase in the number of methicillin-resistant staphylococci by 1.3 times. The spectrum of gram-negative clinical strains has changed, namely, the number of Kl.pneumoniae clinical strains with a high level of polyresistance has increased by 2.5 times. The obtained data made it possible to identify the spectrum of microflora of secretions in orthopedic and trauma patients with modern infectious complications, which prompts us to make changes in the standards of antibacterial treatment protocols, and to plan the needs for certain antibiotics in hospitals with personalization of their prescription to improve the effectiveness of treatment and reduce the risk of development of antimicrobial resistance.

Infectious Complications after Osteosynthesis of Long Bones of the Lower Limbs: Clinical and Nosological Aspects

H.B. Kolov — 2024-10-08

Summary. The number of complications in the treatment of bone fractures, including infectious ones, remains significant. Therefore, there is a need to carry out all measures aimed at improving the treatment results for this category of patients.

Objective. The objective of our study was to determine the frequency and structure of infectious complications in patients after osteosynthesis of the long bones of the lower limbs depending on the location and type of osteosynthesis.

Material and Methods. For our study, 140 cases of infectious complications after osteosynthesis of long bones of the lower limbs were analyzed.

Results. An integral analysis of the distribution of the retrospective array of studies based on localization in the femur revealed that the infectious process is most often localized in patients with 32B hip fractures. This type of damage was observed in 29.0% of patients of the general array, where it took the first place. Infectious complications after plate osteosynthesis also prevailed, but were detected less often, in 21.2% of cases. Among the patients after blocking intramedullary osteosynthesis, 32B was detected in more than half of the cases, which is 2.5 times more often than among the patients with plate fixation. Similar results were found in patients with damage to the shin.

Conclusions. The results of the analysis indicate that in cases of infectious complications after osteosynthesis of the bones of the lower extremities, damage to the diaphyseal part of the hip was detected most often. This indicates that the development of infectious complications was significantly influenced by the patient’s condition and the intervention performed.

Effectiveness of Practical Skills Training on the Original Design Knee Joint Phantom

V.S. Sulyma — 2024-10-08

Background. Simulation training is a crucial aspect of intern training in Orthopedics surgery. Providing a practical and reproducible training environment, it helps interns avoid critical errors when working with future patients.

Objective. The objective of our study was to design, manufacture, implement in education course and evaluate the effectiveness of a knee joint phantom for training knee joint puncture.

Material and Methods. The knee joint phantom was created using Fusion 360 software and was printed using FDM technology on a Tevo Tarantula Pro printer with a Cura slicer with an insert container capable of repeated filling with various imitated liquids. To achieve a higher level of realism, the soft tissues were fully replicated. The phantom was fixed on two supports under the femoral and knee segments with a hinge, which provides the possibility of movements in the joint at different angles. 30 ordinators were involved in the study and divided into two groups: group I included 15 ordinators who conducted training on a knee model from the beginning of the 2nd year; group II consisted of 15 ordinators who conducted training from the beginning of the 1st year. The effectiveness of practical training was evaluated through statistical analysis of the results of OSCI, with a phantom being used.

Results. The mean score was 3.9±2.7 and 4.8±2.8 in group I and group II, respectively, with the maximum possible result of 5.5, which indicates the effectiveness of simulation training with the help of a manufactured knee joint phantom. A small number of participants were included in the study, so no significant difference in learning outcomes between the comparison groups was established (p=0.09492).

Conclusions. Simulation training with a knee phantom is an efficient method for educating orthopedic surgeons on how to perform manipulations on the knee joint. This training also aids in identifying those who have acquired the skill at a lower level. This approach can prevent potential errors when performing manipulations and minimize complications in the treatment of patients with knee joint pathology.

Biological Treatment of Knee Osteoarthritis. The Role of Mesenchymal Stem Cells and Platelet‐Rich Plasma

I. M. Zazirnyi — 2024-10-08

Summary. Osteoarthritis (OA) is the most common joint disease, which is associated with growing population ageing. Beyond conventional medical and surgical interventions, there is an increasing number of “biological” therapies. These therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. The aim of this review was to analyze current evidence regarding mesenchymal stem cells (MSCs) therapy and platelet-rich plasma (PRP). There is some evidence to suggest symptomatic improvement with MSCs injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI, and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. Although controlled studies have been conducted to evaluate effectiveness in OA, they have been often of small size, limited statistical power, uncertain blindness, and using various methodologies. These deficiencies leave open the question of whether they have been validated as effective therapies in OA. The conclusions of this review are that all biological interventions definitely require clinical trials with robust methodology to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.

Main Surgical Methods of Critical Tibial Bone Defects Replacement (Literature Review). Part II

M.P. Hrytsai — 2024-10-08

Summary. This part of literature review is devoted to the main methods of critical bone defects replacement of the tibia, which cannot be repaired by using bone autoplasty. A search in the PubMed database for the period 2010 - 2023 was carried out, with preference given to the material from the last 5 years; the advantages and disadvantages of the most popular methods of treatment are shown. This article provides a descriptive, non-systematic review of the current literature on methods of tibial bone defect replacement and possible directions for future research. A thorough search in the PubMed database was performed using relevant search terms, with peer-reviewed articles in English identified and evaluated. No strict inclusion or exclusion criteria were used to select articles for a full-text review. Instead, a subjective assessment of the relevance of individual articles to the overall narrative and surgical techniques review was made, which ultimately resulted in 40 articles being referenced.

Epidemiology, Classification and Treatment of Femur and Tibia Fractures around Total Knee Arthroplasty (Literature Review)

I.M. Zazirnyi — 2024-10-08

Summary. Periprosthetic fractures around total knee arthroplasty (TKA) are difficult to treat due to complex fracture morphology, high proportions of injuries associated with osteopenia, and the variability of injury patterns. Periprosthetic fractures associated with TKA are defined as fractures around the knee joint (femur, tibia, or patella) occurring within 5 cm of the intramedullary stem of the prosthesis or 15 cm of the joint. The incidence is estimated to be between 0.3% and 2.5% after primary TKA and up to 28% after revision TKA. There are several surgical and nonsurgical risk factors associated with postoperative periprosthetic fractures. Distal femoral periprosthetic fractures following TKA are the most common and reported to occur in 0.2–1.8% of patients after primary TKA. Tibial periprosthetic fractures have a reported prevalence of 0.07–0.1% in primary and 0.36% in revision knee arthroplasties. Patella fractures are the second most common periprosthetic fractures following TKA, with prevalence ranging from 0.68% to 1.19%, and are usually associated with a resurfaced patella. Several classification systems of periprosthetic fractures around TKA have been published and some treatment recommendations have been provided. However, most systems are subject to criticism and use different classification systems for the tibia, patella, and the femur.A variety of treatment methods are available for periprosthetic fractures. Conservative treatment can include protected weight bearing, splinting, or traction. Surgical treatment commonly involves closed intramedullary nailing or open reduction and internal fixation by plates. In cases of significant bone loss, a revision TKA may be indicated. In general, treatment must be guided based on the stability of the implant and the remaining bone quality, as determined by the presence of osteolysis and the location of the fracture.

СПОДВИЖНИЦЬКА ДІЯЛЬНІСТЬ ІЛЛІ ОСИПОВИЧА ФРУМІНА (1876-1945) (до 105-річчя з дня заснування інституту)

Г.В. Гайко — 2024-10-08

СПОДВИЖНИЦЬКА ДІЯЛЬНІСТЬ ІЛЛІ ОСИПОВИЧА ФРУМІНА (1876-1945) (до 105-річчя з дня заснування інституту)

TERRA ORTHOPAEDICA

Analysis of Early Surgical Treatment of Incorrectly Consolidated Gunshot Fractures of the Scapula

Differentiated Approach to Surgical ­Treatment of Gunshot Diaphyseal Shin Fractures

Microflora of Secretions in a Surgical Hospital of Orthopedics and Traumatology Profile for 2021-2023 (SI “ITO NAMS of Ukraine”)

Infectious Complications after Osteosynthesis of Long Bones of the Lower Limbs: Clinical and Nosological Aspects

Effectiveness of Practical Skills Training on the Original Design Knee Joint Phantom

Biological Treatment of Knee Osteoarthritis. The Role of Mesenchymal Stem Cells and Platelet‐Rich Plasma

Main Surgical Methods of Critical Tibial Bone Defects Replacement (Literature Review). Part II

Epidemiology, Classification and Treatment of Femur and Tibia Fractures around Total Knee Arthroplasty (Literature Review)

СПОДВИЖНИЦЬКА ДІЯЛЬНІСТЬ ІЛЛІ ОСИПОВИЧА ФРУМІНА (1876-1945) (до 105-річчя з дня заснування інституту)

Differentiated Approach to Surgical Treatment of Gunshot Diaphyseal Shin Fractures