N.N. Priorov Journal of Traumatology and Orthopedics
ISSN (print): 0869-8678, ISSN (online): 2658-6738 Founder: National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov Editor-in-Chief: Sergey P. Mironov, academician of RAS, Doctor of Sc. Frequency / Access: 4 issues per year / Subscription Included in: White List (4th level), Higher Attestation Commission List, RISC
Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal exclusive license to first publication. Authors are able to distribute the manuscript and/or the article in accordance with Self-Archiving policy of the journal (see details). The manuscript can be accepted for publication only by decision of the Editor-in-Chief and the Editorial board of the journal in accordance with the Manuscript stelection policy of the journal (see details). Published Article will be distributed in print and electronic version an will be available under subscription with Delayed Open Access or in Immediate Open Access under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). The access model depends on the publisher's decision or is determined by a separate Open Access publishing agreement with the authors. An exclusive license for publication granted by authors allows the publisher to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in the journal and/or databases (local or in the Internet) of the publisher and/or other persons, at the discretion of the publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the journal and/or databases of the publisher or other persons, at the discretion of the publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the publisher under this License Agreement, including patent rights to any process, method etc., described by the Authors in the manuscript, as well as trademark rights, are reserved for the Authors. All the Copyright statements for authors are present in the standart Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'N.N. Priorov Journal of Traumatology and Orthopedics'. - DOWNLOAD the print-version of the License Agreement. READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “N.N. Priorov Journal of Traumatology and Orthopedics” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “N.N. Priorov Journal of Traumatology and Orthopedics” (further-the Journal) in accordance with the conditions stated below. I. General Provisions This Agreement, in accordance with clause 2 of Article 437 of the Civil Code of the Russian Federation, is a public offer (hereinafter referred to as the Offer) requiring full and unconditional acceptance (Acceptance), which, in accordance with Article 438 of the Civil Code of the Russian Federation, means the sending by the Author of his/her materials by way of uploading the same to the online electronic system designed to accept manuscripts for consideration, and subsequently posted in the corresponding section of the Journal’s website on the Internet information and telecommunications network (hereinafter referred to as the Internet). In accordance with the current legislation of the Russian Federation regarding the observance of copyright on electronic information resources, all materials found in a website, including submitted and published in electronic journals, may not be reproduced in whole or in part in any form (electronic or printed) without the prior written permission of the Publisher. Prior permission can be given by publishing an article in the open access with Creative Commons license. The journal requires license users to reference the original source, i.e., the publication, if the Author permits use of the public materials in the context of other documents. II. Terms used in the Agreement “Author” refers to an individual (or individuals) whose creative work has led to the creation of the manuscript of a scientific Article, or to a representative of these persons. “Manuscript” is the result of intellectual activity in the form of a scientific work containing text, graphic and numerical data, audiovisual information, program code and other elements submitted by the Author for publication in the Journal; it is also the mean “a draft of an Article submitted by the Author to be published in the Journal”. “Offer” is the current agreement (an offer to the author for the publication of an Article in the Journal). “Publication” is the process of placement of an Article in the Journal. “Article” is the manuscript that has been published in the Journal (after successful selection, editing, type-setting, copyediting, proofreading, translation). “Acceptance of the offer” refers to the full and unconditional acceptance of the offer on the terms specified in paragraph 3 of this agreement (the Author accepts offer by submitting a Manuscript to the Publisher via the online electronic submission system on the Journal’s Internet website). “Journal” is a scientific peer-reviewed periodical registered as a mass media entity in the Roskomnadzor register of the Russian Federation and ISSN-center. “Submission” is an electronic appeal of the Author to the Publisher for the publication of an Article in the Journal by uploading the manuscript and accompanying materials to the online electronic submission system on the Journal’s Internet website). “Publisher” refers to Eco-Vector, which is the Publisher of the journal. Article metadata includes the information that are intended for inclusion in International Scientific Databases and search engines, namely the following: title of the Article; information about each of the Authors (surname and first name; patronymic; place of work with the postal address indicated, contact information (e-mail)); abstract; keywords; thematic rubricator: UDC (Universal Decimal Classification) or other library and bibliographic classification and subject indexes; list of references. “Editorial board” is the creative team that prepares the journal for publication. “Parties” refers to the Author and the Publisher. “Author Guidelines” are the requirements for Articles published in the Journal, posted in the “For authors” section of the Journal’s Internet website. III. Subject of the Agreement (Offer) Under this agreement, the Author grants the Publisher, free of charge for the entire period of validity in accordance with the legislation of the Russian Federation, an exclusive license to use the Article created by the former for publication in the Journal, as well as the rights to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in Journals and/or databases (local or in the Internet) of the Publisher and/or other persons, at the discretion of the Publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the Journal and/or databases of the Publisher or other persons, at the discretion of the Publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the Journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the Publisher under this Agreement, including patent rights to any process, method etc., described by the Author in the Article, as well as trademark rights, are reserved for the Author. The territory where the rights to the Article are allowed to be used is the whole world. The validity of this Agreement commences only if the manuscript of the Article is accepted for publication in the Journal and only from the moment of sending a notification of acceptance of the Article for publication to the Author from the official e-mail of the Journal. The rights are granted by the Author to the Publisher free of charge; the publication of the Article in the Journal does not entail any financial deductions to the Author. If the Publisher decides to reject the Submission or refuse to publish the Article in the Journal (i.e., retraction of the published Article), this Agreement becomes invalid. The decision to refuse publication will be sent to the Author at the e-mail address specified in the Submission. IV. Rights and Duties of the Parties The Author guarantees that: s/he holds the copyright the exclusive rights to the materials submitted to the Publisher as part of the manuscript of the Article; the rights granted to the Publisher under this agreement have not been previously transferred and will not be transferred to third parties in the future during the duration of the Agreement; the manuscript contains all references to the cited authors and/or publications (materials) provided for under the current copyright legislation; the Author has obtained all the necessary permissions for all information and other materials s/he holds no copyright to and that are used in the manuscript of the Article; the Article manuscript contains only materials permitted to be published in the open press in accordance with the current legislative acts of the Russian Federation, and its publication and distribution will not lead to the disclosure of secret (confidential) information (including state secrets); the Author has informed co-authors about the terms of this Agreement and has received their consent to execute this Agreement under the terms provided for in the Agreement. The Author carries certain obligations under the terms of the Agreement: s/he should prepare and submit the manuscript of the Article in accordance with the Author Guidelines posted on the Journal’s website; the Author should not use an electronic copy of the Article for commercial purposes and in other journal publications without the consent of the Publisher; in the process of preparing a manuscript for publication, the Author is obligated to undertake the following: make corrections to the text of the manuscript that have been marked by the peer-reviewers and accepted by the editorial board, and/or as necessary, upon the request of the Publisher and the editorial board, finalize the manuscript of the Article; revising and proofreading the manuscript of the Article in accordance with the editorial recommendations; suggest only the minimum of corrections to the type-setted (layout) Article. The Author has the following rights and duties: Use preprint or prior-to publication versions of an unpublished Article in the form and content accepted by the Publisher for publication in the Journal. Such prior-to-publish versions can be placed as electronic files on the personal websites of the Author (co-authors) or on the protected external websites of the employers of the Author; however, the Author cannot use the unpublished version(s) for commercial sale or for systematic external distribution by a third party (i.e., post on social media). The author or co-authors must, in turn, carry out certain duties, namely: include the following warning in the prior-to-publish version: “This is prior-to-publish version of the article accepted for publication in (Journal’s name), © Eco-Vector (year)”; provide the corresponding electronic link to the Publisher’s website at https://journals.eco-vector.com/ and/or via the DOI. Copy or transfer a copy of the published Article in whole or in part to colleagues free of charge for their personal or professional use, for the promotion of academic or scientific research, or for informational purposes of the Author’s employer. Use materials from a published Article in a book written by one of the co-authors. Use figures, tables and text excerpts from the Article for his or her (or co-authors’) own training purposes, or to include them in other published works in printed or electronic format by a third party, or to submit them in electronic format on an internal computer network, or on the public website of the Author (co-authors) or his/her employer. Include the Article in educational collections for use in the classroom, either for free distribution to the Author’s (co-authors’) students or in electronic format on a local server for access by students as part of the training course, as well as for internal training programs at the institution of the Author’s employer. The Publisher, for its part, is obliged to: publish the Author’s article in the Journal in printed and electronic form in accordance with the terms of this Agreement; if necessary, as so decided by the Journal’s editorial board, provide the Author with the proofreading of the manuscript and make a reasonable editing; provide to the Author the unlimited access to the final electronic version of the published Article (Version of Record) through the online electronic submission system on the Journal’s Internet website; comply with the Author’s rights as provided for by the current legislation, as well as protect them and take all necessary measures to prevent copyright infringement by third parties. The Publisher has a right to: conduct an expert evaluation of the manuscript (peer-reviewing and editorial evaluation) and invite the Author to make the necessary changes (revisions) to the manuscript; provide editing, copyediting, type-setting, proofreading, tagging, indexation and translation of the Article’s manuscript without altering the main content; in any subsequent authorized use by the Author (and/or other persons) of the Journal and/or Article (including any separate part or fragment thereof), require that a link to the Journal, Publisher, Author or other copyright holders, the title of the Article, the Journal’s volume/issue, and the year of publication be specified in the Journal; post preliminary and/or advertising information about the upcoming publication of the Article in the media and other information sources; make changes to the offer in accordance with the procedure established by the offer. The editorial board of the Journal, headed by the editor-in-chief, has the exclusive rights to select and/or reject materials sent to the Journal editorial office for publications purposes. The manuscript sent by the Author to the Journal editorial office is not subject to return. The editorial board of the Journal does not enter into correspondence about rejection of submissions. In all cases not stipulated and not provided for in this agreement, the parties are obliged to be guided by the relevant current laws of the Russian Federation. V. Acceptance of the Offer and Execution of the Agreement. Terms of the Agreement The Author accepts the Offer by submitting the manuscript on the Article to the Publisher through the electronic manuscript submission system on the Journal's Internet website. Acceptance of the offer by the author creates an Agreement in writing (Articles 438 and 1286.1 of the Civil Code of the Russian Federation) on the terms of the offer. This Agreement is valid for the duration of the exclusive rights to the Article. When transferring (alienating) the exclusive right to the Article by the Author to a third party, this Agreement does not terminate. VI. Procedure for changing and terminating the Agreement The Publisher has the right to unilaterally change the terms of this Agreement, in advance, at least 10 (ten) calendar days before the entry into force of the intended relevant changes, but with notice to the Author through the Journal’s website or by e-mail to the Author’s e-mail address specified in the Author’s Submission. The changes will take effect from the date specified in the relevant notification. If the Author rejects the changes to the terms of this Agreement, s/he has the right to notify the Publisher by sending a written notification through the online manuscripts submission system, making sure that the same is sent to the official e-mail address of the editorial office. This Agreement may be terminated prematurely, either by agreement of the parties at any time, or on other grounds provided for in this Agreement. The Author has the right to unilaterally withdraw from the execution of this Agreement by sending the Publisher a corresponding notification in writing at least 60 (sixty) calendar days in advance before the expected date of publication of the Article in the Journal. Termination of the Agreement for any reason does not release the parties from liability for any violation of the terms of the Agreement that occurred during the validity period. VII. Responsibility The parties are responsible for non-fulfillment or improper fulfillment of their obligations under the Agreement in accordance with the current relevant legislation of the Russian Federation. All information provided by the Author must be reliable. The Author is expected to provide accurate and complete the information to the Publisher. When using false information received from the Author, the Publisher is not responsible for the negative consequences caused by his actions on the basis of the false information provided. With regard to the content of the Article, the Author is solely responsible for compliance with the requirements of the laws of the Russian Federation pertaining to advertising, copyright and related rights’ protection, protection of trademarks and service marks, and the protection of consumer rights. The Publisher does not bear any responsibility under the agreement: for any actions that are a direct or indirect result of Author’s illegal actions; for any loss incurred by the Author, regardless of whether the Publisher could have foreseen the possibility of such losses or not. The Publisher is released from liability for violation of the terms of the Agreement if such violation is caused by force majeure, including actions of state authorities (including the adoption of legal acts), fire, flood, earthquake, other natural disasters, lack of electricity and/or computer network failures, strikes, civil unrest, riots, etc. VIII. Dispute resolution Disputes and disagreements will be resolved by the parties through negotiations, and in case of failure to reach an Agreement they will strive to seek resolution in accordance with the current legislation of the Russian Federation. If there are unresolved disagreements, the parties agree to resolve the disputes in court at the jurisdiction covered by the Publisher’s location in accordance with the current legislation of the Russian Federation. IX. Miscellaneous All notifications, messages, requests, etc. (with the exception of documents that must be sent as originals in accordance with the laws of the Russian Federation) are considered received by the Author if they were transmitted (sent) by the Publisher through the Journal’s website (including by publication), fax, e-mail based on the address specified in the Submission, and other communication channels. The parties recognize the legal force of notifications, messages, requests, etc., transmitted (sent) by the above methods. In the event of claims against the Publisher related to the violation of the exclusive copyright and other intellectual property rights of third parties when creating an article or in connection with the execution of this Agreement by the Author, as well as in connection with the use of the Article by the Publisher in accordance with the Agreement, the author undertakes: To immediately take measures to resolve disputes with third parties soon after receiving Publisher’s notification, and if necessary, enter into legal proceedings on the Publisher’s side and take all appropriate actions needed to exclude the Publisher from the list of defendants; To reimburse the publisher for the legal costs incurred and expenses and losses caused by the application of measures to secure the claim and execute a court decision, and the money paid to a third party for the violation of exclusive copyright and other intellectual property rights, as well as other losses incurred by the Publisher in connection with the Author’s non-compliance with the guarantees provided by them under this Agreement. X. Legal address and details of the Publisher Eco-Vector Address: 191186, St. Petersburg, Aptekarsky Pereulok, 3 letter A, room 1N TIN: 7806423692; KPP: 784101001; OGRN: 1099847039907.
Sequential osteosynthesis in the context of modern armed conflicts
BACKGROUND: Limb injuries remain the most prevalent combat injuries in modern armed conflicts, accounting for 55% to 75% of all cases. The transosseous compression-distraction osteosynthesis technique developed by Ilizarov has long been used in Russia to treat this patient population. However, given the current rate of mass casualty admissions to central military medical facilities, there is a growing need to improve treatment quality while shortening treatment time. Sequential internal osteosynthesis is one way for improving care. Antibiotic-coated implants reduce the risk of infectious complications during sequential osteosynthesis. AIM: This study aimed to assess the efficacy of sequential osteosynthesis in the treatment of gunshot fractures of long bones of the limbs in the current armed conflict setting, based on our clinical experience and global scientific data. METHODS: The study is based on an analysis of treatment outcomes in 320 patients with upper and lower limb injuries who received specialized medical care at the Department of Traumatology and Orthopedics of the N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation. Patients were divided into three groups based on the osteosynthesis technique used. All patients were male, aged 18 to 59 years, with a mean age of 32.2 ± 9.02 years. Stepwise X-ray examinations were performed in all patients following osteosynthesis. Functional outcomes of humeral fracture treatment were assessed using the DASH score, whereas functional outcomes of femoral and tibial fracture treatment were evaluated using the Neer–Grantham–Shelton scale. RESULTS: The study included 90 patients (28.125%) with humeral fractures and 230 patients (71.875%) with lower limb injuries associated with femoral or tibial fractures. Shrapnel wounds and/or blast injuries predominated in 288 cases (90%). An intergroup comparison showed that antibiotic-coated implants significantly (p < 0.0167) accelerated the transition from external to internal fixation and reduced the risk of infectious complications. CONCLUSION: Sequential osteosynthesis has proven to be an effective two-stage treatment for long bone fractures in wounded individuals. In the context of modern armed conflict, it is considered the primary approach to managing isolated and multiple uncomplicated gunshot fractures, provided that established guidelines are strictly followed. Furthermore, given the recent advances in traumatology and orthopedics, antibiotic-coated implants can be used to reduce the risk of infectious complications.
版权所有 © Eco-Vector, 2025 https://creativecommons.org/licenses/by-nc-nd/4.0/
Minimally invasive treatment for spinal osteoid osteomas
BACKGROUND: Osteoid osteomas are benign bone-forming tumors that frequently affect the spine. The primary treatment method is surgical removal of the neoplasm. However, if osteoid osteomas are anatomically difficult to access, surgical intervention may require extensive resection of unaffected bone, resulting in loss of vertebral support and the need for further stabilization. Alternative techniques, such as percutaneous radiofrequency ablation and laser thermal ablation, are highly effective; however, their use is limited due to the proximity of the spinal cord and neural structures. Therefore, advanced navigation systems, as well as minimally invasive and endoscopic approaches, are required to enable localized osteoid osteoma resection without destabilizing the spinal segment. This approach prevents damage to supporting structures, especially when the tumor is located in the middle supporting column of the vertebra, eliminating the need for internal fixation. AIM: The work aimed to review surgical treatment options in children with confirmed spinal osteoid osteomas and to assess the outcomes of minimally invasive and open surgeries, including in patients with lesions in the middle supporting column. METHODS: The study included 36 patients diagnosed with spinal osteoid osteoma. The age range was 8 to 18 years. Surgical outcomes were evaluated based on the chosen approach, extent of resection, and the use of internal fixation. RESULTS: Radiofrequency ablation was successfully performed in four patients with lesions located in thermally accessible areas. Open surgeries were performed in 32 cases. The most challenging cases were reported in seven patients with tumors located in the middle supporting column. Patients who underwent minimally invasive procedures had a shorter recovery period than those who had conventional (open) surgery. CONCLUSION: A personalized surgical strategy, taking into account tumor location and optimal access route, with the use of advanced minimally invasive techniques, allows for optimal treatment outcomes in children with spinal osteoid osteomas. This approach ensures complete tumor resection with minimal surgical intervention, while preserving spinal column function.
Total hip arthroplasty in patients with Gaucher disease: characteristics and outcomes
BACKGROUND: Avascular necrosis of the femoral head (ANFH) is the indication for total hip arthroplasty (THA) in patients with Gaucher disease (GD). Due to the rarity of GD, the surgical procedure and long-term outcomes in large patient populations have been insufficiently studied. AIM: This study aimed to analyze the perioperative period as well as medium- and long-term outcomes of THA in patients with GD. METHODS: A retrospective, single-center study was conducted in 26 patients with GD who underwent 30 primary THAs and 9 revision hip arthroplasties between 2005 and 2023. RESULTS: Good and excellent THA outcomes were achieved in 87% of cases, with follow-up periods ranging from 1 to 10 years (median: 7 years). Unsatisfactory results during the 10-year follow-up were due to periprosthetic infection (2 cases) and aseptic loosening (3 cases). Both cases of periprosthetic infection were caused by osteoarticular tuberculosis, which was not detected at the prehospital stage. High intraoperative blood loss was associated with the duration of enzyme replacement therapy (ERT). Blood loss of >1000 mL was reported in 57%, 22%, and 0% of surgeries when ERT lasted less than 5 years, 5–10 years, and more than 10 years, respectively (p = 0.047). Implant survival without revision 3, 6, and 12 years post-surgery was 97%, 93%, and 61%, respectively. At 12 years, the survival rates for cemented and uncemented implants without revision were 33% and 67%, respectively. Twelve years post-surgery, implant survival without revision was 43% for the CoCr/PE bearing surface and 83% for other combinations (ceramic/ceramic, ceramic/PE, and modified metal / PE). CONCLUSION: THA improves quality of life in patients with GD after ANFH. Uncemented implants with ceramic-on-ceramic, ceramic-on-polyethylene, or modified metal-on-polyethylene bearings demonstrated greater longevity and lower revision rates. A high risk of perioperative hemorrhagic complications was observed in patients who received ERT for less than 5 years. The risk of periprosthetic infection was 6.7%, and tuberculosis should be ruled out in such cases.
Surgical outcomes in patients with spinal deformities associated with neurological deficit
BACKGROUND: The surgical treatment in patients with spinal deformities associated with neurological deficit remains a subject of debate. Existing research is mostly limited to case-control studies or case series, with no statistical assessment of treatment outcomes. The absence of a standardized surgical approach and the scarcity of statistically significant outcome data highlight the relevance of further research into this topic. AIM: The work aimed to assess treatment efficacy in patients with spinal deformities associated with neurological deficit. METHODS: A retrospective analysis of surgical treatment outcomes was conducted in 51 patients with spinal deformities associated with neurological deficit. Patients were divided into three groups based on the surgical technique used. All patients underwent standard diagnostic examinations. Based on CT myelography findings, individualized 3D models of the spine and spinal cord were created (n = 23), and customized implants were manufactured (n = 8). Patient questionnaires were used, and neurological status was assessed using the Frankel, ASIA, and FIM scales. RESULTS: A significant regression of neurological deficit was observed in patients classified as Frankel B, C, or D. Motor function improved within days after surgery, whereas sensory function improved on average within six months. Spinal cord decompression at the site of maximal stenosis was found to be a key factor influencing neurological deficit regression. CONCLUSION: Postoperative neurological deficit regression is determined by its severity and duration prior to surgery, as well as adequate spinal cord decompression at the site of maximal spinal stenosis. Patient-specific 3D models of the spine and spinal cord are a valuable tool for assessing local spinal cord compression.
Lumbar decompression and stabilization in degenerative disease: essential preoperative examinations
BACKGROUND: There is currently no mandatory set of preoperative examinations for patients undergoing elective lumbar spine surgery for degenerative disorders, making it difficult to account for critical predictors and achieve predictable clinical and radiological outcomes. AIM: The work aimed to define the scope of preoperative examinations in patients scheduled for decompression and stabilization surgery for degenerative lumbar spine disease. METHODS: A retrospective cohort analysis was performed to identify predictors of successful outcomes following single-level decompression and stabilization. Based on the identified predictors and their threshold values, a set of essential preoperative examinations for decompression and stabilization surgery planning was developed. The effectiveness of the predictive model and the feasibility of the proposed set of preoperative examinations were assessed in a prospective patient cohort. RESULTS: Multivariate analysis identified the following as significant predictors of treatment success: preoperative ODI score, preoperative HADS score, DN4 score, presence of interbody fusion, postoperative lower lumbar lordosis angle, bone mineral density in HU, and postoperative segmental angle. The threshold value for lower lumbar lordosis (Low LL, L4–S1) was 26° (sensitivity, 71.7%; specificity, 91.3%); the segmental angle (SL) threshold was 7° (sensitivity, 87.9%; specificity, 70.6%). The proposed set of essential preoperative examinations for single-level decompression and stabilization surgery planning includes clinical scales (ODI, HADS, DN4), standing spinal radiographs, and lumbar CT and MRI. This set of essential preoperative examinations resulted in a 9.3% increase in clinical success rate (from 74.8% to 84.1%). CONCLUSION: The set of essential preoperative examinations includes three questionnaires (ODI, HADS, and DN4) and three imaging modalities (standing radiographs, lumbar CT, and lumbar MRI), all of which are typically available at specialized spinal surgery centers. This set is recommended for routine use by spine surgeons, given its role in achieving predictable success following single-level decompression and stabilization surgery of the lumbar spine.
Biomechanical evaluation of foot function after distraction subtalar arthrodesis: a prospective study
BACKGROUND: Conservative or inadequate surgical treatment of intra-articular, depressed calcaneal fractures with fragment displacement may result in significant orthopedic complications. Subtalar arthrodesis is indicated after calcaneal fractures with progressive osteoarthritis. Distraction subtalar arthrodesis is recommended in cases of severe depression of the posterior articular facet to restore hindfoot alignment. AIM: The work aimed to improve the surgical management strategy for post-traumatic calcaneal deformities. METHODS: Between 2021 and 2024, 27 patients with severe post-traumatic calcaneal deformities underwent surgery at the Department of Traumatology and Orthopedics No. 4, N.N. Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia. The cohort included 7 women and 20 men, with a mean age of 35 years (22–56 years). All procedures were performed by the same surgeon. The mean time from injury to surgery was 24.8 months (9–72 months). RESULTS: Treatment outcomes in patients included in the study were assessed 12 and 24 months after surgery. The mean follow-up period was 26.2 months (12–56 months). The mean preoperative visual analog scale (VAS) score was 5.1 (2–9), which decreased to 0.8 (0–3) postoperatively, indicating a significant reduction in pain (p > 0.001). The mean AOFAS hindfoot score was 42 preoperatively (39–72) and 85 postoperatively (60–92), with an improvement in questionnaire scores (p > 0.001). Complications were reported in 13 patients; two patients required revision surgery. Dynamic pedobarography showed an increase in peak and mean pressure integrals across the foot. The mean heel contact time decreased significantly from 640 ± 166 ms preoperatively to 515 ± 141 ms postoperatively (p < 0.003). These values were comparable to those of the contralateral healthy foot: 530 ± 177 ms, respectively. CONCLUSION: Distraction subtalar arthrodesis was performed in patients with severe post-traumatic calcaneal deformity (talus inclination angle <8°). Distraction was essential to restore the height of the calcaneus and normal anatomical relationships of the hindfoot as a whole. Patients were satisfied with the outcomes, which were confirmed not only clinically and radiographically, but also biomechanically via dynamic pedobarographic assessment.
Rehabilitation after shoulder arthroplasty
BACKGROUND: Reverse shoulder arthroplasty is an effective surgical treatment for severe degenerative and post-traumatic conditions of the shoulder joint. However, despite its proven clinical efficacy, the optimal scope of medical rehabilitation required to maximize functional outcomes and quality of life remains unclear. AIM: This study aimed to assess the efficacy of a specialized medical rehabilitation program after reverse shoulder arthroplasty based on modern techniques, including isokinetic dynamometry and biofeedback training. METHODS: A comparative cohort study was conducted in 33 patients with omarthrosis who underwent reverse shoulder arthroplasty. The patients were divided into two groups. The treatment group (n = 17) underwent a structured rehabilitation program developed by the authors, whereas the control group (n = 16) did not receive organized rehabilitation. The primary endpoint was recovery of shoulder joint function, including range of motion, muscle strength, coordination, and patient-reported quality of life. Assessment methods included goniometry, isokinetic dynamometry, evaluation of complex coordinated movement abilities, volumetric analysis of upper limb motion using a spherical motion sector, and patient questionnaires (DASH, PSS, SF-36). RESULTS: Patients who underwent the medical rehabilitation program had significantly better functional outcomes than the control group. Abduction range was 150° [150°–160°] in the treatment group vs. 107.5° [93.75°–140°] in the control group (p < 0.001). Flexion range was 160° [150°–165°] in the treatment group vs. 120° [107.5°–133.8°] in the control group (p < 0.001). External rotation range was also greater in the treatment group: 45° [40°–55°] vs. 25° [20°–36.3°], p < 0.001. Abduction strength reached 23.6 Nm [19.3–32.4] in the treatment group vs. 16.7 Nm [9.93–20.6] in the control group (p = 0.005). The spherical motion sector volume in the treatment group was 230,778 cm³ [207,921–268,565], exceeding that of the control group: 126,952 cm³ [107,894.25–151,971.3], p = 0.001. Correlation analysis revealed a strong positive relationship between shoulder joint range of motion and coordination parameters (r = 0.78, p < 0.001), as well as muscle strength (r = 0.71, p < 0.001). Moreover, higher patient-reported satisfaction scores (SF-36) were associated with increased muscle strength and greater external rotation range (r = 0.63, p = 0.002). CONCLUSION: Implementing a comprehensive, personalized rehabilitation program after shoulder arthroplasty significantly improves functional outcomes. Optimized medical rehabilitation programs will improve the quality of medical care and long-term clinical outcomes in patients following reverse shoulder arthroplasty.
Conservative treatment of chronic nonbacterial osteomyelitis using zoledronic acid in children
BACKGROUND: Currently, there is no etiological treatment for chronic nonbacterial osteomyelitis. The insufficient efficacy of all available treatment modalities remains a major concern. Among the most effective approaches are genetically engineered therapy and bisphosphonate treatment. Pamidronate is the most frequently reported option in scientific publications. However, given pamidronates’ lower efficacy compared to zoledronic acid, we developed a treatment protocol that includes zoledronic acid at a dose of 0.05 mg/kg every 3 months, three infusions in total, along with active vitamin D metabolites and calcium carbonate. AIM: This study aimed to demonstrate the efficacy of zoledronic acid in the treatment of chronic nonbacterial osteomyelitis. METHODS: The study included 22 children aged 6 to 17 years. A prospective pilot study was conducted to assess the efficacy of zoledronic acid in children with chronic recurrent multifocal osteomyelitis. All patients underwent biopsy with morphological and microbiological verification of the diagnosis, as well as laboratory and imaging assessments before and 3, 6, and 12 months after treatment. Clinical disease activity was assessed using a visual analog scale for pain and the PedsQL 4.0 quality of life questionnaire. RESULTS: Preliminary treatment outcomes in patients receiving this regimen are promising. Pain was significantly reduced, quality of life improved, and the number of bone lesions decreased, with clinical remission achieved in all patients. CONCLUSION: Zoledronic acid rapidly inhibits osteoclast activity, leading to both clinical and radiological remission, as evidenced by decreased pain, reduction of bone marrow edema on MRI, and sclerosis of lytic lesions. Given the reduced osteoclast activity in the post-injection period, this therapy must be combined with active vitamin D metabolites and calcium carbonate to maintain calcium-phosphorus homeostasis.
Autologous bone marrow aspirate concentrate in the treatment of early-stage avascular necrosis of the femoral head
BACKGROUND: The use of bone marrow aspirate concentrate in the treatment of avascular necrosis improves outcomes and may delay or prevent joint replacement. However, the method of preparation of bone marrow aspirate concentrate determines both the cellular composition and treatment outcomes. AIM: This study aimed to assess the efficacy and safety of a novel method for obtaining bone marrow aspirate concentrate for the treatment of early-stage avascular necrosis of the femoral head (ANFH). METHODS: The study included 35 patients (64 hip joints) with ARCO stage II–IIIA ANFH. Treatment at the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics involved core decompression combined with administration of bone marrow aspirate concentrate obtained using an original method. The follow-up period was 12 months. Functional outcomes (HHS, WOMAC), pain (VAS), quality of life (SF-36), and ANFH stage and activity (MRI of both joints ≥1.5 T before and 3, 6, and 12 months after treatment; CT before and 6 and 12 months after treatment) were assessed. RESULTS: The proposed method significantly increased cell yield in the bone marrow aspirate concentrate after centrifugation compared to native bone marrow. Following treatment, HHS and WOMAC scores improved significantly, as did pain intensity according to VAS. Progression from stage II to IIIA by ARCO was observed in 4 hips (4 patients), and from stage IIIA to IIIB by ARCO in 5 hips (4 patients). After 12 months, the necrotic lesion size remained stable in all joints. Total hip arthroplasty was required in 4 patients (5 hips; 7.7% of all joints). CONCLUSION: The proposed method for obtaining bone marrow aspirate concentrate enables the injection of the desired amount of cells into the femoral head, restoring normal cellular composition. The efficacy of bone marrow aspirate concentrate has been demonstrated in early-stage avascular necrosis of the femoral head (ARCO stage II), which was observed in the majority of patients in our cohort.
Opportunistic screening for osteoporosis using artificial intelligence services
BACKGROUND: An osteoporosis (OP) diagnosis technique based on routine CT examinations, which allows detecting radiological signs of OP, is currently being actively implemented. Given the issue of underdiagnosed compression fractures (CFs) on CT images, radiologists could benefit from artificial intelligence (AI) services. AIM: This study aimed to assess the potential use of AI services for OP diagnosis based on routine CT findings for opportunistic screening. METHODS: The project involved three health facilities (HFs). Chest CT scans obtained in these HFs between October 2022 and October 2023 in patients over 50 years of age were selected, in which AI services detected signs of OP (CFs and/or reduced vertebral bone density). All cases were re-evaluated by radiologists to identify potential errors made by the service. The final list of patients eligible for dual-energy X-ray absorptiometry (DXA) to confirm osteoporosis was provided to attending physicians in each participating HF. RESULTS: Over a 12-month period, AI services analyzed 5394 CT scans. CFs and/or reduced vertebral bone density were identified in 1125 patients. Patients with a previously confirmed OP, as well as those who refused or were unable to undergo further testing, were excluded. A total of 66 patients underwent DXA. Age ranged from 54 to 86 years; the median (Q1–Q3) age was 70 (62–74) years; the male to female ratio was 21% and 79%, respectively. According to DXA findings, bone mineral density (BMD) values consistent with OP, osteopenia, and normal BMD were reported in 26 patients (39.4%), 37 patients (56.1%), and 3 patients (4.5%), respectively. Diagnostic performance metrics were calculated for both DXA and CT-based vertebral bone density assessment, with sensitivity of 0.71 vs. 0.91, specificity of 0.80 vs. 0.55, and accuracy of 0.76 vs. 0.67, respectively. Significant differences were observed between osteoporosis, osteopenia, and normal BMD groups, as well as between age-norm groups and those identified by AI services (p < 0.001). CONCLUSION: The results support the use of AI services for diagnosing OP based on routine CT examinations as part of opportunistic screening.
Arthroscopic surgery for synovial chondromatosis of the hip joint
BACKGROUND: The hip joint is an essential anatomical and functional component of the human skeleton, providing support and mobility for the lower limbs. Hip joint disorders significantly impair quality of life. Hip joint diseases are a major concern in modern medicine, particularly considering the increased life expectancy and prevalence of degenerative conditions. Recent studies demonstrate that hip arthroscopy for chondromatosis and other joint pathologies provides favorable clinical outcomes, high patient satisfaction, and low recurrence rates. AIM: This study aimed to assess the efficacy of hip arthroscopy in the treatment of synovial chondromatosis, including the development and implementation of a novel surgical technique, assessment of clinical outcomes, patient satisfaction, and recurrence rates, and analysis of postoperative rehabilitation. METHODS: This was a single-center, prospective, interventional, controlled study. It included patients with synovial chondromatosis of the hip treated at the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics between October 29, 2012, and July 25, 2024. Medical interventions included preoperative assessment (medical history, physical examination, MRI), surgical treatment (placement of a damper system on the hip joint, hip arthroscopy with removal of intra-articular loose bodies, coblation of affected capsular areas, and joint debridement), and personalized rehabilitation (exercise therapy to restore joint range of motion). The 12-year follow-up period enabled the assessment of both short- and long-term treatment outcomes. The primary endpoint was improved hip function and pain reduction. Assessment methods included pre- and postoperative clinical examinations, follow-up MRI, and assessment of joint mobility. RESULTS: The study included 9 patients, all of whom completed follow-up. The mean age was 37 years. The findings demonstrated improved hip function, pain reduction, and absence of intra-articular loose bodies on follow-up MRI. Long-term follow-up allowed for the assessment of recurrence risk and confirmed the long-term efficacy and safety of the arthroscopic technique, contingent on adherence to postoperative recommendations and exercise therapy. CONCLUSION: Arthroscopy was effective in the treatment of synovial chondromatosis, with favorable clinical outcomes, high patient satisfaction, and low recurrence rates.
Microbiological monitoring of major pathogens in infected long bone fractures treated with external osteosynthesis
BACKGROUND: The development of fracture-related infection disrupts osteoreparative processes at the fracture site, which may result in the need for repeated surgical interventions. It is well known that the etiology of fracture-related infection involves microorganisms, whose spectrum may vary considerably across healthcare facilities. Staphylococcus aureus and coagulase-negative staphylococci are the predominant pathogens in this condition, whereas Gram-negative bacteria, anaerobes, and fungi are less common. AIM: The work is aimed to determine the spectrum and changes of major pathogens in patients with long bone fracture-related infection and post-traumatic chronic osteomyelitis treated with external osteosynthesis from 2019 to 2024. METHODS: A single-center retrospective analysis was conducted based on microbiological findings in 247 patients with long bone fracture-related infection and chronic osteomyelitis as its sequela, all treated with external osteosynthesis. The spectrum of major pathogens and their changes over time were examined. The statistical analysis was performed using Pearson’s chi-square(χ2) test. RESULTS: Positive cultures were obtained in 70.4% of cases, whereas 29.6% were negative. A total of 230 microorganisms were identified: 158 (68.7%) Gram-positive, 71 (30.9%) Gram-negative, and 1 (0.4%) fungal isolate. Monomicrobial infections were revealed in 76.4% of cases, whereas in 23.6% of cases, the infection was polymicrobial. A microbial shift was observed in 18.4% of patients: in 15.5% during treatment and in 2.9% upon recurrence. DISCUSSION: The major causative pathogens of fracture-related infection were S. aureus (36.9%), S. epidermidis (10%), K. pneumoniae (9.1%), E. faecalis (7.8%), A. baumannii (6.1%), P. aeruginosa (4.3%), E. cloacae and Corynebacterium (3.5% each). Between 2019 and 2024, the incidence of MRSE and E. faecalis increased from 0.6% to 5.7% and 8.2%, respectively; Corynebacterium from 0% to 3.2%; K. pneumoniae from 2.8% to 12.7%; and E. cloacae from 1.4% to 9.9%. A microbial shift during treatment was observed in patients with open fractures and extensive soft tissue defects. Microbial composition showed unpredictable variation. In cases of recurrence, the primary isolate was often replaced by MSSA, E. faecalis, or Corynebacterium. CONCLUSION: Despite an increasing proportion of MRSE, E. faecalis, Corynebacterium, K. pneumoniae, and E. cloacae in the etiological structure of fracture-related infection, S. aureus remains the predominant pathogen.
Masquelet technique in a patient with defect nonunion of the ulna
INTRODUCTION: Orthopedic trauma surgeons face major challenges when dealing with defect nonunions of the upper limb. In cases of treatment failure in forearm pseudarthroses, the incidence of secondary osteomyelitis and bone defects can reach 22% and 7%, respectively. The conventional approach, which includes surgical debridement of the bone cavity, single-stage grafting of the defect, and fragment fixation, is frequently ineffective. According to various authors worldwide, the Masquelet technique has demonstrated favorable outcomes with minimal complications. This method consists of two stages: first, a biological membrane is formed around the defect using a cement spacer; second, the spacer is replaced with an autologous bone graft after the membrane has formed. This technique has several advantages, including improved vascularization and favorable conditions for osteointegration. CASE DESCRIPTION: We present a successful case of surgical treatment in a patient with defect nonunion of the ulna and chronic osteomyelitis, following failed previous attempts at osteosynthesis and defect grafting. The first stage included modeling resection of the ulnar bone ends to bleeding surfaces, tunnelization, placement of a gentamicin-loaded spacer overlapping the fragment ends, and stabilization using an external fixation device. The second stage consisted of removing the external fixation device and cement spacer, autografting the defect zone with cancellous bone harvested from the iliac crest, closing the graft with the induced membrane, and osteosynthesis of the ulna using a locking compression plate (LCP). CONCLUSION: The Masquelet technique, when applied step by step in complex cases of forearm bone defect replacement, allows for the restoration of both the ulna and the anatomical and functional integrity of the forearm, improving limb function and facilitating the patient’s return to everyday life and work.
Single-stage treatment of chronic subtalar dislocation: a case report
BACKGROUND: Chronic subtalar dislocation can develop in patients with severe, long-standing flatfoot or in those with neuroarthropathy or neglected trauma. We report a rare case of chronic subtalar dislocation, wherein treatment was effectively performed employing subtalar joint complex arthrodesis, involving the talo-navicular and talo-calcaneal joints and cuboido-talar pseudoarthrisis. CLINICAL CASE DESCRIPTION: A 55-year-old female patient was referred to the specialist orthopedic clinic with complaints of progressively worsening right ankle pain for 12 months. She had been diagnosed with acquired flatfoot five years prior, which had since deteriorated. Computed tomography revealed lateral dislocations of both the subtalar and talonavicular joints. A single-stage surgery using cannulated screws was performed for achieving arthrodesis. Within just 4.5 months of this procedure, the patient was able to bear weight and walk independently. CONCLUSION: Incorporating talo-cuboid fusion is crucial for a stable outcome. The outcome seems to be unaffected by subtalar dislocation duration, provided the soft tissue and skin coverage are manageable.
Potential use of SMART implants in traumatology and orthopedics: a review
This review presents current scientific data on the use of biosensors in traumatology and orthopedics. Biosensors are specialized devices that detect various physicochemical parameters in the body. These parameters can be used to monitor, predict, and manage a variety of processes in orthopedic and trauma care. Technological advances enable the integration of biosensors and the development of customized implants. Their introduction has marked a significant breakthrough in trauma and orthopedic surgery, particularly with the emergence of SMART (Self-Monitoring Analysis and Reporting Technology) implants, which integrate microchips, wireless connectivity, and data analysis algorithms. With the expected increase in surgeries and the growing need for implants, technological progress in this field is bound to continue and accelerate. Existing issues such as implant instability, infectious complications, and nonunions further underscore the relevance of this topic and the need for further research. This analytical review was conducted using medical scientific databases and search engines, including PubMed (MEDLINE), Google Scholar, and eLibrary. The review addresses the following aspects: relevance, types of biosensors, their clinical applications, and prospects in traumatology and orthopedics. The review aims to improve understanding of biosensor uses in this medical field.
Partial-thickness rotator cuff tears: a systematic review
Partial-thickness tears of the rotator cuff (RC) of the shoulder joint (SJ) are a common condition that causes pain and limits SJ function, significantly reducing quality of life. The prevalence of such tears reaches up to 32% among SJ injuries and disorders. Among all isolated RC tendon injuries, supraspinatus tendon lesions are predominant, accounting for up to 13%. This work aimed to conduct a systematic review of research assessing radiographic parameters of SJ bone anatomy as risk factors for RC injury, as well as the outcomes of surgical treatment for partial-thickness RC tears. A search was conducted in the eLIBRARY, PubMed, and Scopus databases. The search depth was 10 years (2013–2023). The inclusion criteria for the quantitative analysis were a mean follow-up duration of at least 6 months and a minimum of 10 cases per study. Following a keyword-based screening, 18 publications were included in the quantitative analysis. The most significant radiographic risk factors for RC tears included the critical shoulder angle (CSA), lateral acromial angle (LAA), and acromial index (AI). Two principal surgical techniques for managing Ellman grade III partial-thickness RC tears were identified: tear completion and transtendinous tendon repair. Both techniques yielded satisfactory outcomes; however, it remains unclear which method should be preferred. Although the majority of studies report a direct association between CSA and RC injury, this parameter requires further investigation, as angular values obtained from radiographs without adherence to the Suter–Henninger protocol may differ significantly from those obtained in accordance with the protocol, as well as from CT or MRI findings. The majority of publications did not consider parameters like LAA and AI to be key predictors of RC injury. The analyzed outcomes of surgical treatment for partial-thickness RC tears showed no significant differences despite the use of different surgical techniques, such as tear completion and transtendinous tendon repair. However, this issue requires further investigation, including subsequent assessment of tendon healing quality based on MRI findings.
版权所有 © Eco-Vector, 2025 https://eco-vector.com/for_authors.php#07
Enhanced recovery after surgery (ERAS) protocols are actively evolving in modern surgical practice. The primary goal of ERAS is to standardize perioperative care and improve rehabilitation potential. ERAS effectiveness has been demonstrated across various surgical fields. Historically, spine surgery was considered challenging for ERAS implementation. However, over the past decade, this perception has changed significantly, and ERAS protocols have become widely used in spine surgery. Initially, the use of ERAS in spine surgery was limited to lumbar spine procedures. Over time, however, ERAS began to be actively implemented in cervical spine surgery, neuro-oncology, and spine surgery in older and comorbid patients. Studies have shown that ERAS reduces length of hospital stay, treatment costs, perioperative opioid use, and complication rates. This review highlights the key features of ERAS in spine surgery.
Potential use of medical thermography in the prevention and diagnosis of perioperative complications in emergency trauma care
Body temperature is one of the key indicators for diagnosing a variety of surgical and trauma-related conditions. Infrared thermography is one of the most relevant and widely used methods in modern clinical practice. This technique has not yet received general acceptance, and its use is currently underrepresented in the scientific community. The aim of this study was to analyze existing data on the practical significance and role of medical thermography in diagnosing and predicting postoperative complications in trauma patients. An analysis of both Russian and international publications was conducted to explore the potential and future prospects of medical thermography in current trauma practice. In orthopedic and trauma practice, infrared thermography is more commonly used to diagnose chronic musculoskeletal conditions such as scoliosis, osteoporosis, and osteochondrosis. In acute traumatic injuries, it is more commonly used for intraoperative and postoperative monitoring to prevent complications or enable their early detection, as treatment outcomes largely depend on timely and adequate diagnosis and identification of the primary injury. Opinions within the scientific community on the use of medical thermography remain divided. On the one hand, the vast majority of researchers studying the potential of medical thermography consider it a valuable supplement to conventional imaging methods. However, despite its numerous advantages and significant application potential, the technique has yet to be widely adopted. Infrared thermography is a promising diagnostic tool in modern medicine, especially in traumatology. Conducting more studies to explore its capabilities could help raise awareness and promote its integration into trauma care practice.
Staff of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics during the World War II
This paper commemorates the staff members of the Center of Traumatology and Orthopedics who served during World War II. When the war broke out, many employees, including physicians, nurses, and orderlies, were mobilized. Doctors led trauma teams within specialized medical support units and served in military hospitals, selflessly contributing to the collective victory. Forty-seven staff members of the Center of Traumatology and Orthopedics are World War II veterans. Their wartime and professional accomplishments live on in the memory of their descendants and students.
On the 80th anniversary of Vladimir P. Abeltsev
A brief biography and an overview of the scientific achievements of Vladimir P. Abeltsev, in celebration of his 80th birthday.
Eduard V. Ulrikh, an outstanding pediatric surgeon and orthopedic traumatologist, passed away on June 2, 2025, at the age of 87. He was one of the pioneers of Russian spinal surgery and the founder of the Saint Petersburg school of pediatric spinal surgeons. His colleagues and students are devastated by this irreparable loss.
On May 16, 2025, Professor Vyacheslav Vasilievich Klyuchevsky, the prominent traumatologist and orthopedist, Honored Scientist of the Russian Federation, founder of the Yaroslavl School of Traumatology and Orthopedics, honorary member of the Association of Traumatologists and Orthopedists of Russia, Doctor of Sciences in Medicine, passed away at the age of 86 years. His students, followers, and colleagues mourn this profound and irreparable loss.