TERRA ORTHOPAEDICA

Initial Experience with Infrared Thermography for Assessing Bone Tissue Viability in Gunshot Fractures of the Extremities Involving Articular and Periarticular Regions

E.M. Khoroshun, S.I. Panasenko, Yu.V. Klapchuk, V.V. Nehoduiko — Tue, 01 Sep 2026 00:00:00 +0300

Summary. Background. Infrared thermography (IRT) is widely used in vascular medicine, orthopedics, traumatology, the diagnosis of inflammatory conditions, and the assessment of inflammatory process development [12]. To date, scientific literature contains no studies specifically addressing the assessment of bone tissue viability in combat trauma using IRT. Existing studies have primarily focused on evaluating perfusion and delineating areas of soft-tissue necrosis, as well as the early detection of infectious inflammation [2, 7, 9, 12]. Objective. To evaluate the diagnostic capability of IRT as a method for intraoperative assessment of bone tissue viability in periarticular gunshot fractures associated with bone and soft-tissue defects. Materials and Methods. The study included 10 clinical cases of comminuted periarticular gunshot fractures with primary bone and soft-tissue defects. Thermographic examinations were performed using a portable FLIR C5 camera (FLIR Systems, USA). Bone fragment viability was assessed based on central temperature, temperature gradient (ΔT), the bleeding test, and the presence of cold zones. Results. The study demonstrated that, in 72% of cases, IRT enabled differentiation of viable bone areas from avascular fragments, allowing preservation of bone structures and primary reconstruction. In 28% of cases, occult areas of necrosis (ΔT > 4.0°C) were identified, providing an indication for limited or radical resection of nonviable fragments and helping to prevent the subsequent development of chronic osteomyelitis. Conclusions. IRT proved effective for assessing changes in bone fragment viability over time. This initial experience with IRT for assessing bone tissue viability in periarticular gunshot fractures demonstrates improved intraoperative planning of the extent of surgical intervention and indicates a consistent trend toward optimizing treatment outcomes in patients with complex combat-related joint injuries.

Comparative Assessment of the Susceptibility of Multidrug-Resistant Clinical ESKAPE Bacterial Strains to the Biodegradation Products of MZZ-P and MZZ-MB Alloys

O.S. Movchan, B.A. Koteliukh, D.L. Kyryk — Tue, 01 Sep 2026 00:00:00 +0300

Summary. Background. Antibiotic resistance of microorganisms belonging to the ESKAPE group is one of the leading threats to modern medicine, particularly in the context of implant-associated infections in orthopedics and traumatology. The search for new biomaterials with inherent antibacterial properties is a promising strategy for preventing such complications. Objective. To compare the antibacterial activity of the biodegradation products of MZZ-P and MZZ-MB alloys against multidrug-resistant clinical ESKAPE bacterial strains. Materials and Methods. The study was performed using multidrug-resistant strains of Staphylococcus aureus (MRSA), Enterococcus faecalis (VRE), Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Antibiotic susceptibility was determined according to EUCAST standards using the disk diffusion and serial dilution methods. The antimicrobial activity of alloy biodegradation products was assessed based on their bacteriostatic and bactericidal effects over a 72-hour incubation period, followed by subculturing on Mueller–Hinton agar. Statistical analysis was performed using the Wilcoxon test. Results. The biodegradation products of both alloys demonstrated pronounced antibacterial activity against all tested strains. A progressive decrease in the number of microbial colonies during incubation was observed, indicating a bactericidal effect. The MZZ-MB alloy demonstrated statistically significantly higher efficacy compared to MZZ-P (p < 0.05), particularly against Gram-negative non-fermenting bacteria. Conclusions. The biodegradation products of MZZ-P and MZZ-MB alloys exhibited strong bactericidal activity against multidrug-resistant ESKAPE pathogens. These findings support their potential use as biodegradable implants for the prevention of implant-associated infections.

Shockwave Therapy After Lavage in Gartner Type II Calcific Rotator Cuff Tendinopathy

V.O. Biliavskyi, O.S. Strafun — Tue, 01 Sep 2026 00:00:00 +0300

Summary. Background. Ultrasound-guided percutaneous irrigation of calcific deposits (lavage) is widely used for calcific rotator cuff tendinopathy, but the added value of focused extracorporeal shockwave therapy (ESWT) after lavage in Gartner type II deposits remains insufficiently studied. Objective. To compare lavage followed by focused ESWT with lavage alone in patients with Gartner type II calcific rotator cuff tendinopathy. Materials and Methods. A prospective comparative cohort study. Group A received lavage, three focused ESWT sessions, a subacromial corticosteroid injection, and physiotherapy; group B received the same without focused ESWT. The primary outcome was total SPADI at 6 months. Results. Sixty-six patients (32 in group A and 34 in group B) with comparable baseline characteristics were analyzed. At 6 months, group A showed superior outcomes for total SPADI (9.57 vs 28.81%; difference −19.24), SPADI pain and disability subscales, and numeric-scale pain at night, at rest, and during activity (all p < 0.01). Residual deposit was smaller in group A (1.43 vs 3.93 mm; p < 0.001). Complete resorption of the calcific deposit was achieved in 62.5% vs 26.5% of patients (OR 4.63), near-complete resorption (≤ 2 mm residual calcification) in 75.0% vs 32.4% (OR 6.27), and significant subjective improvement in 62.5% vs 11.8% (OR 12.50). In both groups, the calcific deposit size decreased significantly, while the difference in absolute reduction was non-significant (p = 0.215). Conclusions. The addition of focused ESWT after lavage was associated with better pain relief, functional recovery, and ultrasound-assessed calcification resorption at 6 months. Because of the non-randomized study design, these findings should be interpreted as associative.

Results of Surgical Treatment of Patients with Stage II Rotator Cuff Arthropathy According to Hamada

S.S. Strafun, S.V. Bohdan, I.V. Shyshka, R.O. Serhiienko, M.P. Hofman — Tue, 01 Sep 2026 00:00:00 +0300

Summary. Background. Surgical treatment of rotator cuff arthropathy (RCA) of the shoulder joint remains challenging and insufficiently studied because these patients develop biomechanical disorders in the shoulder joint associated with superior migration of the humeral head and fatty degeneration of the rotator cuff muscles. Objective. To compare the outcomes of different surgical treatment options in patients with Hamada stage II RCA. Materials and Methods. A total of 391 patients with RCA of varying severity were treated. Hamada stage II RCA was identified in 130 patients (33.2%); these patients were included in the present study. The mean age was 64.1 ± 19.4 years. The patients were divided into five groups according to the surgical procedure performed. Shoulder function was assessed using the Constant Shoulder Score and VAS before surgery and at 6 and 12 months postoperatively. Results. At 6 months, the best mean Constant Shoulder Score among all patients with Hamada stage II RCA was observed in the group where the upper capsule was restored (20.9 ± 14.3 points). Slightly poorer results were obtained in the group where reverse shoulder arthroplasty was performed (23.8 ± 5.1 points), whereas the poorest results were observed in the group where rotator cuff tendons were repaired (38.4 ± 12.1 points). Conclusions. The greatest mean increase in shoulder function according to the Constant Shoulder Score at 12 months after the surgery was observed in the group that underwent reverse shoulder arthroplasty and restoration of the upper capsule of the shoulder joint. The smallest mean increase in shoulder function according to the Constant Shoulder Score was observed in the group that underwent rotator cuff tendon repair or shoulder debridement. Based on these findings, these surgical procedures do not appear appropriate for patients with stage II RCA.

Professional Burnout Among Orthopedic Surgeons During Wartime: The Ukrainian Experience

S.V. Tymoshenko, A.V. Slabko — Tue, 01 Sep 2026 00:00:00 +0300

Summary. Background. Since the beginning of Russia’s full-scale invasion of Ukraine, the working conditions of orthopedic surgeons have changed substantially. These changes have been accompanied by increased emotional and physical demands and a higher risk of professional burnout. Objective. To assess the level of burnout among orthopedic surgeons in Ukraine during wartime and to analyze its association with clinical workload and various social and professional factors. Materials and Methods. An anonymous cross-sectional study was conducted among 147 orthopedic surgeons from different regions of Ukraine. Burnout was assessed using the Copenhagen Burnout Inventory (CBI), including personal, work-related, and client-related subscales. Data were presented as medians and interquartile ranges (IQR). Non-parametric statistical methods were applied. Results. Moderately high burnout levels were observed: median personal burnout, 62.5 (IQR 50.0–75.0); work-related burnout, 67.86 (57.14–78.57); and client-related burnout, 58.33 (50.0–75.0). Female surgeons, younger physicians, and those working in regions close to the front line had significantly higher burnout levels (p < 0.05). Surgical workload was not significantly associated with burnout (p > 0.05), whereas consultation workload showed a weak but statistically significant association with certain burnout indicators. Conclusions. Professional burnout among orthopedic surgeons during wartime is multifactorial and is more strongly associated with organizational and social factors than with surgical workload itself.

Gunshot Injuries of the Peripheral Nerves of the Extremities: Features of Diagnosis and Treatment (Methodological Recommendations)

S.S. Strafun, A.S. Lysak, I.M. Kurinnyi, V.V. Haiovych, Yu.A. Kulyk — Tue, 01 Sep 2026 00:00:00 +0300

Summary. Gunshot injuries of the peripheral nerves of the extremities are a part of severe polystructural combat trauma and are characterized by specific features of the injury mechanism, diagnosis, and reconstructive treatment. The main types and characteristics of gunshot injuries to peripheral nerves, methods of clinical and instrumental diagnosis, optimal timing and principles of surgical repair, as well as approaches to reconstructive treatment of the consequences of trauma are presented.

90 years of professional development: anniversary plenum of the Ukrainian Association of Orthopedic and Traumatologists

Editorial Board — Tue, 01 Sep 2026 00:00:00 +0300

90 років професійного розвитку: ювілейний пленум Української асоціації ортопедів-травматологів