TERRA ORTHOPAEDICA

The Use of Neurovascularized Flaps in Plastic Surgery of Gunshot Defects of the Hindfoot

S.S. Strafun, V.H. Shypunov, N.O. Borzykh, M.A. Zahovenko — Fri, 21 Jun 2024 00:00:00 +0300

Summary. Background. Gunshot fractures of the bones of the foot make up 12% of the total number of injuries of the lower extremities and in 37% of cases are accompanied by a defect in the tissues of the foot, which is considered as a predictor of amputations at the level of the lower leg. Restoring the function of foot support is possible only when reconstructive plastic surgery – neurovascularized flaps – is performed.

Objective: to study the frequency of ischemic complications of flaps during plastic surgery of extensive defects of soft tissues of the rear part of the foot with “sural” and “plantar” flaps in the case of gunshot polystructural injuries of the foot.

Materials and Methods. A retrospective analysis of the treatment of 43 injured with gunshot extensive defects of the soft tissues of the hindfoot from 2014 to 2023 and at different times of injury was carried out: up to 3 days – 10 cases; from 3 to 10 days – 22 cases; from 10 to 20 days – 11 cases. In 23 (53%) cases there was a defect of the loading surface of the heel area. In 20 (47%) cases there was a defect of the posterior, non-load-bearing surface of the heel area, which in 3 (7%) cases was accompanied by damage to the Achilles tendon. In 27 (63%) cases, the tissue defect was combined with a foot bone fracture: calcaneal bone – 4 (9.3%), calcaneus and tarsal bone – 3 (6.9%), calcaneus and metatarsal bone – 4 (9.3%). The decision regarding the use of the type of flap for plastic surgery of the soft tissue defect of the hindfoot depended on the location of the defect and the results of instrumental examination. Doppler imaging was performed to determine blood flow in the medial plantar artery and in the basin of the small and great saphenous veins, and to determine the presence of a perforator of the peroneal artery.

Results. The assessment of the development of ischemic complications of the “sural” and “plantar” flaps was carried out during the first 10 days. Complications associated with a violation of blood supply of flaps occur in 18.6% of cases. The “sural” flap compared to the “plantar” flap is more prone to ischemic complications (21% versus 14%).

Conclusions. The use of neurovascularized flaps in plastic surgery of soft tissue defects of the foot makes it possible to cover large defects without the involvement of microsurgery. In some cases, the surgery is accompanied by the development of irreversible ischemic changes. Nevertheless, performing such surgeries makes it possible to save the foot and buy time before making a decision for amputation.

Assessment of the Effectiveness of Surgical Treatment of Lumbar Spinal Stenosis

V.I. Melenko — Fri, 21 Jun 2024 00:00:00 +0300

Summary. Background. Lumbar spinal stenosis, which is one of the main causes of disability in older patients, occurs in countries with different levels of income. There has been a surge of endoscopic procedures in recent years, which requires further study.

Objective: to compare the results of surgical treatment of lumbar spinal stenosis of patients operated on using different methods.

Materials and Methods. Data from examination and treatment of patients (n=43) who underwent surgical intervention for lumbar spinal stenosis. In the clinical part, the following methods were used: pain intensity was assessed using the visual analogue scale (VAS, cm); patients' satisfaction and quality of life were assessed using the Oswestry Low Back Pain Questionnaire – Oswestry Disability Index (ODI). The Oswestry Questionnaire (version 2.0) allowed us to determine the level of impairment in the quality of life of patients in points and as a disability index.

Results. In group I (UBE/ULBD), the index of back pain before surgery was 5.3±1.3, in group II (open decompression) it reached 5.8±1.4 and in group III (decompressive laminectomy with transpedicular fixation) it was 5.5±1.1 cm (p>0.05). In the postoperative period, the index of back pain decreased in group I (UBE/ULBD) from 5.3±1.3 cm to 1.4±0.6 cm (p < 0.05), and improvement was observed within 6 months up to 0.5±0.3 cm (p < 0.05); in group II, the index decreased from 5.8±1.4 to 2.1±0.7 cm with positive dynamics over 6 months to 0.6±0.3 cm (p < 0.05); in group III, the level of pain after surgery remained relatively high (4.1±0.8), but there was an improvement to 1.2±0.9 (p < 0.05) within 6 months. The level of pain in the lower extremity in group I (UBE/ULBD) decreased from 4.7±1.1 cm to 2.3±1.0 cm and to 1.1±0.4 cm during 6 months of follow-up (< 0.05); in group II, the level of pain decreased from 5.1±1.2 cm to 1.1±0.9 cm, with improvement to 1.2±0.3 cm within 6 months (< 0.05); in group III, the pain index in the lower extremity before surgery was 5.1±1.2 cm and remained quite high (3.2±1.1 cm) in the early postoperative period and slightly higher (1.4±0.9) compared to other groups after 6 months (<0.05). Assessing the quality of life of patients, the following was found: group I showed positive dynamics, namely ODI improved from 52.7±19.8% before surgery to 10.7±5.4% after 6 months; in group II, ODI improved from 57.9±15.4% before surgery to 15.0±4.1% after 6 months; in group III, ODI was 51.2±16.6% before surgery and 20.3±8.1% after 6 months, which means that at the time of the last survey, patients with transpedicular fixation required additional rehabilitation interventions for recovery.

Conclusions. Analysis of the data showed that the indicators of pain in the lower limbs and back, as well as the quality of life in the early and late follow-up periods slightly differed in group I (endoscopic decompression (UBE/UBLD)) and group II (open decompression), but significantly worsened in group III (decompression laminectomy with transpedicular fixation). Decompressive laminectomy with transpedicular fixation requires additional rehabilitation interventions for patients for full recovery.

Surgical Application of a Four-Screw Plate for Locking the Physial Section of the Knee Joint in Children Whose Growth Continues

I.H. Hertsen, S.M. Martsyniak, V.V. Zinchenko — Fri, 21 Jun 2024 00:00:00 +0300

Summary. Background. The classic method of surgical treatment of knee joint deformity in the coronal plane is fixation of the epimetaphyseal area using an eight-shaped 2-screw plate according to the concept of guided growth. To improve this technique, we developed, patented and applied a butterfly-like 4-screw quad plate. We also hypothesized that the 4-screw plate would result in faster controlled correction of angular knee deformities than the 2-screw plate.

Objective: to improve surgical treatment of children with axial deformity of the knee area, whose growth continues.

Materials and Methods. A retrospective analysis of the treatment of 37 children with deformity of the knee in the coronal plane, who were implanted with a 2-screw or 4-screw bone plate, was carried out. The study cohort included both genu varum and genu valgum of both primary and secondary etiology. In dynamics, a comparative analysis of X-ray morphometric parameters obtained from panoramic radiographs of the lower extremities was carried out. Also, depending on the type of implant, the rate of deformity correction and the incidence of complications were compared.

Results. We found that the use of a 4-screw plate compared with a 2-screw plate was associated with a shorter interval between implantation and removal, i.e., faster correction. This was confirmed by the indicators of correction of mechanical axis deviation, lateral distal femoral angle and medial proximal tibial angle. No statistically significant difference between the two types of implants was found in the incidence of complications of surgical treatment.

Conclusions. Analysis of the rate of correction of clinical and radiomorphometric indicators of deformation of the knee joint in the coronal plane depending on the age periodization of the child’s ontogenesis showed an advantage in the surgical use of a 4-screw quad plate compared to the use of a 2-screw quad plate for fixation of the epimetaphyseal area.

Integration of Mixed Reality Technologies into the Hip Joint Arthroplasty Technique

O.S. Zubkov, V.P. Torchynskyi — Fri, 21 Jun 2024 00:00:00 +0300

Summary. Background. This article is dedicated to analyzing the application of a mixed reality technology in total hip arthroplasty. The relevance of the study is determined by the increasing need to enhance the accuracy and safety of surgical interventions, which ensure the restoration of joint functions and improvement of patients' quality of life.

Objective. The study focuses on the development and clinical testing of the mixed reality-based navigation system for positioning the acetabular component of the endoprosthesis.

Materials and Methods. The research includes simulation modeling and preclinical trials demonstrating significant advantages of the developed system compared to traditional methods.

Results. The main findings of the study showed a significant reduction in the average and maximum deviations of implant positioning angles, indicating increased accuracy and potential ability to reduce the risk of postoperative complications.

Conclusions. The research emphasizes the potential of integrating mixed reality technologies into orthopedic surgery, particularly in total hip arthroplasty procedures, contributing to the development of more efficient and safe surgical techniques.

Tactics of Treatment of Tourniquet Syndrome after Gunshot Wounds

Fri, 21 Jun 2024 00:00:00 +0300

Summary. The objective of our study was to develop a differentiated approach to the treatment of tourniquet syndrome based on the severity and stages of its development. The work was based on a retrospective analysis of 30 wounded with tourniquet syndrome of the upper and lower extremities, who were treated at the Military Medical Clinical Center of the Northern Region. All the wounded were hospitalized from the combat zone; all were males, aged 33.8±0.4 years. After admission to the Military Medical Center of the Northern Region (Role 3), anamnestic data were collected, clinical symptoms as well as laboratory and additional research methods were analyzed. To form a differentiated approach to the treatment of tourniquet syndrome, the analysis of the following indicators was carried out: the duration of the tourniquet (up to 3 hours, 3.1-6 hours, 6.1 hours and more), the place of tourniquet application (shoulder, thigh), local clinical manifestations (edema, paresthesia, hypoesthesia, anesthesia, hypothermia, contracture of the joints of the hand or foot), laboratory indices (creatinine, alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, potassium, and myoglobin), assessment of peripheral pulse, diuresis, ultrasound examination of muscles, ultrasound examination of the kidneys and inferior vena cava to calculate infusion therapy, radiographic and thermal imaging studies at the site of injury, and intraoperative visual evaluation of the muscles (viable muscles, partial or widespread rhabdomyolysis). Based on the analysis of the obtained data, a classification and treatment algorithm of tourniquet syndrome were developed, which enabled to take a rational approach to the treatment of this category of patients based on determining the severity and stages of its development.

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

Fri, 21 Jun 2024 00:00:00 +0300

Summary. The literature review is devoted to the main methods of critical bone defects replacement of the tibia. A search in the PubMed database for the period 2007-2023 was carried out. Preference was given to the material of 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 rigid inclusion or exclusion criteria were used to select articles for full text review. Instead, a subjective assessment was made of the relevance of individual articles to the overall narrative and surgical technique review, which ultimately resulted in 43 articles being referenced. Two additional references were found, independent of the initial search.

Surgical Treatment Tactics of Injuries of the Anterior Cruciate Ligament in the Acute Period (Literature Review)

O.O. Kostrub, R.I. Blonskyi, O.V. Volos — Fri, 21 Jun 2024 00:00:00 +0300

Summary. The article presents a theoretical and practical rationale for modern aspects of the clinical picture, diagnosis and treatment of anterior cruciate ligament injury in the acute period, according to domestic and foreign literature.

Traumatic Dislocations of the Sternoclavicular Joint, Methods of their Conservative and Surgical Treatment (Literature Review)

I.R. Sorokivskyi, Yu.A. Kulyk — Fri, 21 Jun 2024 00:00:00 +0300

Summary. Treatment of traumatic dislocations of the sternoclavicular joint is not well defined, the results are contradictory, with a high percentage of recurrences and complications, and no differentiated approach to the choice of surgical treatment is developed, which indicates the relevance of this problem. This review describes the known methods of conservative and surgical treatment of this injury, and their effectiveness is evaluated.

Objective: based on the analysis of literature on dislocation of the sternoclavicular joint, to evaluate the effectiveness of conservative and surgical treatment.

Materials and Methods. The review is based on the data obtained by searching the Medline, PubMed, and EMBASE databases for the period 1951-2024.

Results. We analyzed 87 sources of literature related to the treatment of traumatic dislocations of the sternoclavicular joint, of which 35 sources were identified as having quantitative characteristics and meeting the purpose of the analysis (anatomy and biomechanics – 7, conservative treatment – 7, surgical treatment – 22).

Conclusions. Dislocations of the sternoclavicular joint account for 1% of the total number of dislocations and 3% of the upper extremity dislocations. The problem is the complexity of the anatomical area, low treatment efficiency, and a high rate of recurrence and complications. The main method of conservative treatment is closed reduction of the dislocation using the two techniques described below: abduction traction and the principle of a lever (caudal traction) with subsequent immobilization of the limb. Today, the choice of the optimal method of surgical treatment remains a controversial issue. There are a large number of methods of surgical fixation of the sternoclavicular joint, which may indicate the imperfection of each of them.