N.N. Priorov Journal of Traumatology and Orthopedics

The extensive use of explosive munitions in modern warfare has led to a change in the distribution of sanitary losses and to greater severity of organ and tissue injuries. Improvements in the medical evacuation system have resulted in the formation of a specific group of wounded patients, whose defining characteristic is the presence of extensive combined gunshot tissue defects of the extremities. In this context, there has arisen a need to refine the concept of medical care for the wounded and to define a new multidisciplinary field. Analysis of the scientific data on combat-related surgical trauma and the authors’ experience revealed discrepancies between established military medical doctrine and contemporary requirements for specialized surgical care. In this work, a new treatment concept and the term “military reconstructive surgery of the extremities” are proposed. The concept of military reconstructive surgery of the extremities represents a system of interrelated principles and methods for the diagnosis and treatment of patients with combat-related extremity injuries. The term “military reconstructive surgery of the extremities” denotes a set of interdependent and mutually conditioned actions aimed at providing specialized medical care to wounded patients with combat-related extremity injuries in order to achieve the maximum possible restoration of the anatomy and function of the damaged extremities. Military reconstructive surgery of the extremities constitutes a component of specialized surgical care that requires a multidisciplinary approach and a complex of specialized diagnostic and therapeutic equipment, and represents a logical continuation of military field surgery.

BACKGROUND: Despite the development of modern reconstructive surgical techniques, a number of controversial issues remain related to the lack of a unified approach to the management of traumatic fractures of the orbital walls and to the choice of a particular method for their reconstruction. Many surgical rehabilitation methods are often technically complex or require expensive consumables.

AIM: This study aimed to develop a technique for restoring the natural position of the globe in patients with posttraumatic orbital deformities using superelastic biocompatible nickel–titanium implants.

METHODS: A single-center, observational, longitudinal pilot study was conducted using a consecutive sample of 20 patients after traumatic injuries of the facial skeleton with isolated fractures of the inferior and medial orbital walls. In all cases, restoration of the orbital walls and the natural position of the globe was performed using thin-profile superelastic nickel–titanium implants. The study was prospective in nature; qualitative outcomes of restoration of the natural position of the globes were assessed. Follow-up and evaluation of rehabilitation quality were performed using instrumental methods according to the following diagnostic algorithm: ophthalmologic examination; assessment of endoprosthesis position performed intraoperatively using a C-arm and at all stages of rehabilitation using computed tomography; evaluation of reparative processes in the implantation zone using Karl Storz 30° and 45° endoscopes on postoperative day 10. The study design included elements of experimental control, as the technique had not previously been applied in patients with orbital wall fractures. All patients were informed about the nature and technique of the surgery.

RESULTS: In all operated patients, the anatomical position and visual function of the globe were preserved or restored. The described method allows fabrication of an implant that maximally conforms to the reconstructed area, which reduces time and simplifies its placement, thereby decreasing the duration and improving the overall quality of the surgical procedure.

CONCLUSION: The method developed and presented in this study demonstrated high effectiveness and stability. In all operated patients, the anatomical position and visual function of the globe were preserved or restored.

BACKGROUND: The increasing number of knee arthroplasty procedures and associated complications underscores the need for the implementation of technologies that enhance the precision of implant component positioning and improve functional outcomes.

AIM: This study aimed to assess the precision of robotic knee arthroplasty in comparison with the manual technique based on clinical, radiological, and stabilometric data.

METHODS: This cohort-controlled interventional single-center prospective randomized open-label study included 60 patients (aged 18–75 years) with stage III knee osteoarthritis. The patients were randomly assigned to the robotic arthroplasty group (30 individuals) or the manual arthroplasty group (30 individuals). Evaluation was performed 6 months postoperatively using clinical (VAS, ROM), radiological (LDFA, MPTA, rotational parameters), and stabilometric indicators. High-precision scales and 3D modeling were used to analyze the mass of the cement mantle.

RESULTS: The robotic technique demonstrated superiority in the precision of component positioning: deviations of less than 1° in LDFA and MPTA were recorded in 93% and 66% of patients, respectively (compared with 23% and 9.4% in the manual technique group). The mean range of motion was 109° versus 106.2°, and the VAS pain score was 3.7 versus 4.2. The robotic technique ensured lower variability in cement mass and cement mantle thickness.

CONCLUSION: Robotic arthroplasty surpasses the manual technique in terms of component positioning precision, cement mass distribution, and functional outcomes. Despite the absence of statistically significant differences (p > 0.05), the observed trends in favor of the robotic approach render it preferable for widespread clinical application.

BACKGROUND: Childhood obesity is a major and growing public health problem worldwide, leading to significant metabolic and cardiovascular complications later in life. It is strongly associated with impaired postprandial glucose regulation, hyperinsulinemia, and elevated triglyceride levels, which together indicate insulin resistance and increased cardiometabolic risk. Physical exercise is a cornerstone of obesity management, with continuous and intermittent exercise modes showing potential in improving glucose and lipid metabolism. However, comparative evidence on their specific effects in obese children remains limited, warranting further investigation.

AIM: This study aimed to evaluate the effect of continuous versus intermittent exercises on postprandial glucose, insulin, and triglyceride levels in obese children.

METHODS: Fifty obese children aged 12–15 years were randomly assigned to either the continuous exercise group or the intermittent exercise group. The continuous group received 30 minutes each of treadmill and cycling exercises, while the intermittent group performed short bouts of activity with rest intervals, for 12 weeks. Outcomes were measured using postprandial glucose levels, insulin sensitivity, and triglyceride levels.

RESULTS: Both continuous and intermittent exercise programs produced significant reductions in postprandial glucose, insulin, and triglyceride levels, along with improved insulin sensitivity (p < 0.05) compared to baseline. However, intergroup comparisons revealed no statistically significant differences in the magnitude of improvement between continuous and intermittent exercise groups (p >0.05).

CONCLUSION: Both continuous and intermittent exercises effectively improve postprandial metabolic parameters in obese children. These findings suggest that either modality may be incorporated into pediatric obesity management programs based on individual preferences, practicality, and adherence, thereby enhancing metabolic health and reducing future cardiovascular risk.

BACKGROUND: Currently, there are several platforms for remote physician–patient interaction aimed at developing telemedicine services in the Russian Federation. Given the high prevalence of degenerative spine diseases in the population, the frequent need for medical care, including surgical interventions, and the growing workload on healthcare providers, there is a clear need to automate monitoring and data collection specifically for this patient cohort.

AIM: The work aimed to develop automated interaction scenarios between a healthcare facility, physicians, and patients during the perioperative period using the example of a spine surgery department and to evaluate the effectiveness of their implementation.

METHODS: Eight patient data collection scenarios were developed on the Medsenger platform. These scenarios were adapted to the specific characteristics of the clinical entities of patients with degenerative spine disorders, the type of planned surgical intervention, the scope of preoperative examination, and the collection of clinical data.

RESULTS: During the first quarter of 2025, 89% of patients (317/356) activated their accounts, indicating a high level of engagement in the treatment process. Test results of more than 92% of patients (224/242) were successfully reviewed by a physician in advance. Moreover, preliminary review of examination results reduced the duration of the physician’s assessment in the admission ward from 40 to 20 minutes (a twofold reduction). Preliminary evaluation of diagnostic data by the admitting physician also reduced the number of hospitalization cancellations by sevenfold compared with the previous year. Remote completion of the required clinical questionnaires substantially reduced the workload of nursing staff: previously, questionnaires had been completed on paper or in electronic form under their supervision.

CONCLUSION: The development of Medsenger platform scenarios is challenging and requires substantial effort and time; however, with appropriate adaptation, routine use of the platform considerably facilitates the routine work of the ward’s staff. Comprehensive data collection from hospitalized patients, as well as dynamic monitoring of clinical data, constitutes the basis for conducting scientific research and creating disease registries.

BACKGROUND: Treatment of patients with pelvic bone sarcomas is associated with a high rate of complications and poor outcomes. During reconstructive procedures in patients with malignant periacetabular tumors, modular hip endoprostheses incorporating a cup with a conical stem are increasingly used.

CLINICAL CASE DESCRIPTION: A total of 15 cases of periacetabular resections with acetabular reconstruction using a modular LUMiC endoprosthesis were analyzed in patients aged 19–71 years with primary malignant tumors of the pelvic bones. The distribution by sex, age, and diagnosis was as follows: 14 men (93.3%) and 1 woman (6.7%); mean age, 47.1 years; chondrosarcoma in 11 cases (73.3%), osteosarcoma in 3 cases (20.0%), and epithelioid hemangioendothelioma in 1 case (6.7%). A combined surgical approach and an ilioinguinal–femoral approach were used in 10 and 5 patients, respectively. Resections in zones PI–II, PII, PII–III and PI–II–III were performed in 2, 5, 6, and 2 patients, respectively. Complications during a mean follow-up of 37.2 months (6–64 months) developed in 40.0% of cases. Mortality was 6.7% (one patient died in the early postoperative period due to acute myocardial infarction). Deep periprosthetic infection was detected in 3 patients (20.0%) at 3 and 12 weeks and 19 months; the endoprostheses were removed: neoarthrosis was created in 2 cases and interiliac–abdominal amputation was performed in 1 case. Dislocation in the early postoperative period occurred in 1 case (6.7%) due to violation of the orthopedic regimen and was managed by closed reduction. One patient (6.7%) developed persistent sciatic nerve neuropathy in the early postoperative period. No tumor progression was observed during the follow-up period. Aseptic loosening of the endoprostheses was not observed. Functional outcome according to the MSTS score was good or excellent in 10 of 15 cases, with a mean score of 69.7% (range, 16.7%–90%).

CONCLUSION: Modular hip endoprostheses incorporating a cup with a conical stem appear to be a promising option for surgery in patients with primary malignant periacetabular pelvic tumors. However, according to our results and international data, the incidence of postoperative infectious complications (up to 25%) and dislocations (up to 19%) remains relatively high, indicating the need for further investigation.

BACKGROUND: In almost all cases, removal of benign intraosseous tumors requires reconstruction of the post-resection bone defect. Autologous bone grafts are considered the ideal graft material. However, their use is limited by the amount and volume of available tissue. Allogeneic grafts, in contrast, not only possess sufficient structural characteristics and quantity but can also be combined to match the specific dimensions and site of the lesion.

CLINICAL CASE DESCRIPTIONS: This paper presents clinical cases derived from a study conducted at the Department of Pediatric Bone Pathology and Adolescent Orthopedics of the Priorov National Medical Research Center of Traumatology and Orthopedics. The study analyzed treatment outcomes in 309 children aged from 1 year 10 months to 17 years inclusive with benign bone lesions. Analysis of medical records showed that allografts were used both as standalone materials and in combination with each other and with autografts. Cortical bone strips and cancellous bone chips were the most frequently used graft types, either alone or in combination. A recurrence-free postoperative course with organotypic remodeling of the allografts was observed in 93.85% of patients. Pediatric patients diagnosed with bone cysts underwent surgery using mechanically and ultrasonically processed lyophilized allogeneic biografts to fill the post-resection cavity after removal of the pathological focus. When the lesion was located in a long bone (humerus), cortical bone strips were used; when localized in cancellous bone (calcaneus), cancellous powder was applied. In both cases, at a 2-year follow-up, no recurrence was detected, and organotypic remodeling of the grafts was observed.

CONCLUSION: The obtained results demonstrate the feasibility and necessity of using mechanically and ultrasonically processed lyophilized allogeneic bone biografts for filling post-resection bone cavities after removal of benign bone tumors. These biografts can be used both individually and in various combinations without compromising surgical outcomes. The minimal risk of recurrence and infection, along with complete organotypic remodeling of the grafts, makes them the material of choice in pediatric and young patients, as such surgical intervention does not adversely affect subsequent procedures that may be required at the same anatomical site.

Fractures of the distal radius metaphysis–epiphysis are among the leading injuries of the musculoskeletal system, and most fractures in this anatomic region are still regarded as an outpatient injury, which results in malunion. Another important reason for poor outcomes in such fractures is insufficient attention to injuries of the surrounding soft tissues and anatomical structures. At present, longitudinal, angular, and rotational displacements of the distal metaphysis–epiphysis are well studied; however, coronal-plane fragment displacement has recently also been considered, which likewise affects the development of distal radioulnar joint instability. In the coronal (radial) type of displacement, the distal fragment—the distal radius metaphysis–epiphysis—shifts radially, and the proximal fragment—the radial diaphysis—shifts ulnarly, with a decrease in the interosseous space. The injured and unreconstructed anatomy of the distal radius metaphysis–epiphysis leads to distal radioulnar joint incongruity and dysfunction of both the primary (triangular fibrocartilage complex) and secondary (distal interosseous membrane) static stabilizers and, of course, the dynamic stabilizer (pronator quadratus). With persistent coronal displacement, the function of both static and dynamic stabilizers is impaired. Among the primary static stabilizers, the radioulnar ligaments are affected first, leading to capsular laxity and separation of the articular surfaces. Among the secondary static stabilizers—particularly the distal interosseous membrane of the forearm—tension decreases, which in turn reduces tension in the distal radioulnar joint capsule and contributes to dorsal joint instability. Under these conditions, the function of the dynamic stabilizer is also impaired; recently, it has been assigned an important role in the development of distal radioulnar joint instability during rotational movements. All of the above constitutes the biomechanical chain of the development of distal radioulnar joint instability. In this review article, the authors sought to use one type of displacement as an example to demonstrate injury to wrist joint structures (the distal interosseous membrane and the distal oblique ligament) that affect subsequent functional outcomes.

The literature review is devoted to surgical treatment of patients with deformities and defects of the hindfoot caused by diabetic Charcot neuroosteoarthropathy. The severity of this disease is often due to the unstable nature of the deformity, high risk of purulent complications and limb amputation. The purpose of this review was to determine, based on literature data, the optimal method of fixation when performing arthrodesis for diabetic Charcot neuroosteoarthropathy with damage to the hindfoot and ankle. This review presents the main methods of reconstructive interventions for localization of the pathological process in the area of the hindfoot and assesses the advantages and disadvantages of each method in this category of patients. The search for publications was conducted in the PubMed database and the eLibrary electronic scientific library, using the following keywords: hindfoot, ankle joint, bone defects, charcot foot, diabetic neuroosteoarthropathy, arthrodesis, tibiotalocalcaneal arthrodesis. The search depth was from 2000 to 2024 inclusive. Despite the variety of methods for treating diabetic Charcot neuroosteoarthropathy at the level of the hindfoot and ankle joint described in the literature, there is currently no consensus on the methods of fixation and the technique of arthrodesis, especially in the presence of ulcerative defects. The issue of treating Charcot’s foot in the presence of pronounced bone defects and methods of their replacement, using allo- and autologous bone material, also remains open. Further studies, long-term clinical trials should evaluate the prospects for performing arthrodesis in case of deformation of the hindfoot and ankle joint in diabetic Charcot’s neuroosteoarthropathy, which will give a clearer picture of recommendations on the tactics of treating patients with this pathology.

This review addresses practical issues of rational pharmacotherapy and adjuvant treatment of osteoarthritis before and after total knee arthroplasty (TKA). The review analyzes the mechanisms underlying complications associated with total knee arthroplasty, the role of comorbid conditions in the development of osteoarthritis and TKA-related complications, and current approaches to phenotyping and endotyping of osteoarthritis for predicting postoperative complications and selecting optimal strategies for preoperative management and postoperative rehabilitation. Particular attention is paid to the mechanisms of action of components and to the personalized selection of disease-modifying and adjuvant therapies at different stages of patient management before and after total knee arthroplasty. The review describes recommended dosing regimens, maximum daily doses, and maximum durations of use for selected structure-modifying drugs and adjuvant therapies for osteoarthritis before and after total knee arthroplasty, based on data from clinical studies and in accordance with instructions for medical use. One of the key aspects of a multimodal, staged approach to managing patients with knee osteoarthritis before and after total knee arthroplasty is the personalized selection of structure-modifying drugs and adjuvant therapies, taking into account individual patient characteristics, including age, comorbidities, and drug tolerability. Standardization of pain assessment, evaluation of biomarkers of structural modification of articular cartilage, and a personalized approach to drug selection are essential for achieving effective and safe management of patients with knee osteoarthritis undergoing total knee arthroplasty, reducing the risk of adverse drug reactions, and improving treatment satisfaction and quality of life after surgical intervention.

The biomechanics of the pelvic ring is essential for the treatment of injuries involving this anatomical region of the human body. Its study, with detailed knowledge of surgical anatomy, provides clinicians with a better understanding of the pathological destabilizing forces acting on the injured segment both at the moment of trauma and throughout the stages of surgical rehabilitation. This work aimed to present the fundamentals of a contemporary spatial and functional approach to the surgery of pelvic ring injuries. This lecture, intended primarily for trauma surgeons, describes both static and dynamic loads acting on the pelvis, as well as the corresponding changes occurring within the structures of the pelvic complex. The material examines the interaction of anatomical structures (the pelvis, lower extremities, and the lumbopelvic junction) that underlies the restoration of the injured patient’s functional capacity during surgical treatment. The relevance of this topic is driven by the high incidence of pelvic ring injuries (including those resulting from high-energy mechanisms), the complexity of their management, and the substantial functional impairments that arise following damage to this structure. Understanding the biomechanical principles governing pelvic ring function is critically important for the development of effective methods of surgical stabilization and rehabilitation. The review addresses the anatomical and functional characteristics of the pelvic ring as a closed biomechanical system, mechanisms of axial load transmission through the sacroiliac joints and the pubic symphysis, the role of the ligamentous apparatus in maintaining stability during various types of movement, and the biomechanical consequences of pelvic ring integrity disruption in injuries of different etiologies. The practical importance of this work is in the development of biomechanically grounded algorithms for selecting osteosynthesis techniques in pelvic ring injuries, which may reduce the risk of postoperative complications, optimize the timing of weight-bearing recovery, and improve patients’ quality of life in the long term. The findings may be applied in traumatology, orthopedics, and rehabilitation medicine to refine pelvic trauma management protocols and to prevent post-traumatic deformities.

On December 12–13, 2025, the 12^th All-Russian Priorov Forum was held in a ceremonial setting at the Monarch Hotel in Moscow. The forum was dedicated to the 140^th anniversary of the birth of Academician Nikolai N. Priorov. This report highlights the key events of the Forum.