Background. Suprascapular nerve neuropathy combined with massive rotator cuff tears presents significant challenges in both diagnosis and treatment. Modern diagnostic methods allow for sufficiently accurate detection of neurological impairments. This condition involves several pathophysiological mechanisms. Routine MRI enables the assessment of the morphology of the scapular notch and allows clinicians to suspect suprascapular nerve neuropathy. The aim of the study — to identify the anatomical features of the scapular notch on MRI in patients with suprascapular nerve neuropathy combined with massive rotator cuff tears, and to assess their impact on the extent of rotator damage, the severity of pain, and functional impairment. Methods. The study included 19 patients with traumatic injuries of the rotator cuff tendons and muscles combined with the clinical signs of suprascapular nerve neuropathy, including 15 men and 4 women. The mean patient age was 58.7 years. During the clinical examination, patients completed standardized questionnaires: VAS, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and ASES. All patients underwent pre- and postoperative shoulder MRI to assess the morphological features of the suprascapular notch, as well as electromyography (EMG) to diagnose conduction impairments within the suprascapular nerve innervation zone. Results. Suprascapular nerve neuropathy in patients with rotator cuff injuries is more commonly observed in those with a deep and relatively narrow U-shaped scapular notch, particularly in the presence of posterosuperior tears of the supraspinatus and infraspinatus tendons (Collin type D), combined with pronounced tendon retraction (Patte grade 3). EMG revealed impaired impulse conduction within the suprascapular nerve innervation zone in all patients, demonstrated by altered M-responses from the supraspinatus and infraspinatus muscles. The analysis showed that both the morphology type of the notch and the extent of the tear were statistically significant predictors of functional status as assessed by the ASES score. Notably, the morphology of the notch showed a slightly greater contribution to predicting functional limitations. Conclusion. The strong correlation identified between the morphology of the scapular notch and the severity of rotator cuff tears supports the hypothesis that a narrow notch creates neurological preconditions for the development of chronic pain and impaired innervation of the rotator cuff muscles. This should be taken into account when developing diagnostic and treatment algorithms for patients with this pathology.

Background. The relevance of this study is determined by the need for an objective assessment of the current state of the trauma and orthopedics service in the Russian Federation and the search for effective tools that can support informed management decisions in this field. The aim of the study — to conduct a preliminary analysis of the performance of trauma and orthopedics services in three federal districts of Russia based on the data from an automated information system for collecting annual reports. Methods. Data for the analysis were obtained from the automated information reporting system (AIRS). To demonstrate the capabilities of this system, we analyzed not all available indicators, but only those what were most relevant to the research question. Results. At the time of writing, information was available on the performance of 644 (44.1%) inpatient and outpatient trauma and orthopedics units out of 1460 registered in the system. The highest reporting completeness (61.1-71.7%) was observed in the North Caucasian, Northwestern, and Southern Federal Districts, as these districts are supervised by the Vreden National Medical Research Center of Traumatology and Orthopedics and began working with the AIRS one year earlier than the others. Not all regions within these districts participated in filling out the AIRS: in the Northwestern Federal District, data were provided by 10 out of 11 regions; in the North Caucasian Federal District, by 7 out of 7; and in the Southern Federal District, by 7 out of 8. At present, information from inpatient facilities is reported more completely than from outpatient clinics: data are available for 218 inpatient facilities and 210 outpatient institutions. Conclusion. The analysis of the results demonstrated that data from the AIRS make it possible to elevate the assessment of the current state of trauma and orthopedics services in any region to a new qualitative level by providing detailed information on the nature of injuries and therapeutic interventions. A fundamental component of decision-making regarding patient routing should be an understanding of the highly specialized aspects of service operations and the key challenges in delivering specialized care. As the number of organizations contributing data to the AIRS increases, the validity of the information will improve, and the analytical capabilities for evaluating the performance of trauma and orthopedics services will expand. With long-term functioning, the accumulated database will enable not only screening studies but also the monitoring of processes over time.

Background. Anterior pelvic ring fractures, including pubic symphysis disruption and pubic rami fractures, represent a complex clinical challenge in traumatology. They are associated with significant pain syndrome, loss of weight-bearing function, and often with damage to the anterior abdominal wall caused by stomas, drains, etc. There remains a strong demand in pelvic surgery for effective treatment methods that provide stable bone fixation in this anatomical region, shorten rehabilitation, and improve functional outcomes with minimal complications. The aim of the study — to demonstrate a new method of simultaneous fixation of pubic symphysis disruption and pubic rami fractures using the nail-plate combination. Surgical technique. A 10-cm Pfannenstiel incision was made directly along the superior edge of the pubic symphysis, followed by vertical incision of the aponeurosis and dissection of the prevesical space. After revision of the symphyseal rupture zone, the identified diastasis was reduced using Weber or small Jungbluth forceps. Sequential fixation of the pubic rami fractures was then performed with interlocking nails on both sides, but without inserting the locking screws. Without removing the guide from the last inserted nail, a plate was positioned so that its midpoint corresponded precisely to the midline of the reduced pubic symphysis. The nail was then interlocked with two 3.5-mm cortical screws through the plate holes. The guide was removed and connected to the remaining nail (the nail ends usually protrude 1-2 mm from the entry points and are easily palpable). Conclusion. The method of combined fixation using the nail-plate system is a technically feasible and safe approach for the treatment of pubic symphysis disruptions and pubic rami fractures.

Background. Traditional socket prostheses suffer from several limitations, including skin complications, unstable fixation, and restricted patient mobility. Osseointegrated exoprostheses represent a promising alternative as they attach to the human body via an implant surgically placed in the residual bone. This solution provides secure fixation and is particularly effective for patients with short or pathological residual limbs. The aim of the study — to evaluate the biocompatibility and safety of a domestically developed osseointegration system for femoral exoprosthetics using a large animal model. Methods. A customized titanium osseointegrated implant, adapted based on CT data, was placed in one sexually mature minipig using a two-stage surgical protocol. During the 3-month observation period, a comprehensive set of clinical, laboratory, and radiographic examinations was performed. The study also involved routine stoma care and bacteriological monitoring. At the end of the period, an implant pull-out test was conducted. Results. The animal was able to endure weight-bearing on the prosthesis while standing and walking. Body weight increased by approximately 10 kg. The implant pull-out force was 400 N, indicating the formation of a mechanical bond with the bone. Manageable complications were noted during the observation, specifically the development of anemia and asymptomatic bacterial colonization of the stoma with Staphylococcus spp. at 107 CFU/ml. There were no clinical signs of infection or systemic inflammatory response. Conclusion. The study demonstrated the feasibility of the successful and safe application of the evaluated osseointegration system in a large animal model. The observed complications were not critical. The findings confirm the biocompatibility and functionality of the system, justifying the need for further expansive preclinical studies.

Background. Percutaneous pedicle screw fixation is a modern method of stabilizing the thoracic and lumbar spine. Systematic analysis of errors and complications makes it possible to identify risk predictors, improve screw installation techniques, and reduce the incidence of postoperative complications. The aim of the study — to analyze errors and complications during percutaneous pedicle screw fixation of the thoracic and lumbar spine and to identify risk factors for their development. Methods. A retrospective study was conducted on 228 patients (median age 38.5 years) with single-level injuries of the thoracic and lumbar spine who underwent surgery between 2003 and 2023. The patients were divided into two groups: the main group, in which reposition of the damaged segment was performed to the calculated target parameters, and the control group, in which target parameters were not calculated. The following factors were assessed: sex, age, time from injury, morphology of injury, neurological status, and volume of surgical intervention. Morphometric parameters were analyzed using CT scans: AVH — anterior vertebral body height; PVH — posterior vertebral body height; angle α — segmental angle; A-VDCH — anterior vertebral-disc complex height; P-VDCH — posterior vertebral-disc complex height. The time to complication onset was analyzed using the Kaplan-Mayer method. The impact of risk factors was assessed by building a regression model. Results. Complications were detected in 32 (14.0%) patients: intraoperative — in 2 (0.9%), early postoperative — in 8 (3.5%), late (mechanical) — in 22 (9.7%). Statistically significant differences in the incidence of complications were found between the groups (χ2 = 7.471, p = 0.006). The risk of complications in the control group was 3.9 times higher than in the main group (HR = 3.948; 95% CI 1.326-11.757; p = 0.014). Conclusions. The most common complications were mechanical ones caused by errors in spinal reposition. Restoration of the calculated target parameters, including the measurements of the vertebral-disc complex and segmental angle, significantly reduced the incidence of complications in patients with thoracic and lumbar spine injuries.

Background. The impact of regular sports activities and specific types of sports on the effectiveness of conservative treatment for adolescent idiopathic scoliosis (AIS) has not been sufficiently studied. Understanding this relationship is essential for personalizing programs of physiotherapeutic specific scoliosis exercises (PSSE) and preventing deformity progression. The aim of the study — to compare the results of conservative therapy for adolescent idiopathic scoliosis among rhythmic gymnasts, swimmers, and patients not engaged in regular sports activities, as well as to evaluate the influence of sport type on changes in frontal and sagittal trunk balance parameters and flexibility. Methods. A retrospective analysis was performed on 54 patients: 21 rhythmic gymnasts (Group 1), 11 swimmers (Group 2), and 22 non-athletic patients (Group 3, control). The groups were comparable in terms of key anthropometric and radiological parameters. All patients underwent PSSE according to the BSPTS Rigo method. TLSO bracing was used when indicated. Before and after treatment, the Cobb angle, thoracic kyphosis, lumbar lordosis, sagittal index, angle of trunk inclination (ATI), and flexibility (sit-and-reach test) were assessed. Results. Significant intergroup differences were found only for the Cobb angle (H = 9.366; p = 0.007) during treatment. Post-hoc analysis revealed that gymnasts showed a statistically significantly greater reduction in Cobb angle compared with the control group (p 0.0167). Differences between the control group and swimmers, as well as between gymnasts and swimmers, did not reach statistical significance after adjustment. No significant intergroup differences were found for other parameters (thoracic kyphosis, lumbar lordosis, sagittal index, flexibility, body mass, and height). Intragroup analysis demonstrated a statistically significant decrease in Cobb angle and ATI among gymnasts, and improved flexibility in both gymnasts and the control group. Deformity progression greater than 5° occurred less frequently in athletes (3.1%) than in non-athletic patients (27.3%; p = 0.0144). Conclusion. Conservative treatment based on physiotherapeutic specific scoliosis exercises is effective in all patients with adolescent idiopathic scoliosis. Rhythmic gymnasts demonstrated a more pronounced correction of frontal plane deformity and a greater reduction in trunk inclination compared with non-athletic patients. Swimming did not show advantages for correction of deformities in either the frontal (Cobb angle) or sagittal (lordosis, kyphosis) planes.

Background. Distal femoral fractures traditionally present in two distinct populations: young males with high-energy trauma and elderly females with low-energy injuries. Despite inherent differences between these groups, direct outcome comparisons remain limited. The aim of the study — to compare complication rates between surgically treated high- and low-energy distal femoral fractures and to assess whether injury mechanism independently influences outcomes. Methods. A retrospective review of surgically treated distal femoral fractures at a single center over a decade was conducted. Cases were categorized into high- and low-energy mechanisms. Patient demographics, comorbidities, fracture characteristics, fixation methods, and annual incidence were analyzed. Primary outcomes included nonunion, infection, and hardware failure. Results. A total of 162 cases were analyzed, with an overall complication rate of 12.3%: nonunion (6.8%), infection (3.1%), and hardware failure (2.5%). Complication rates were comparable between high- and low-energy groups (p = 0.551). Conclusions. Despite distinct demographic profiles and injury mechanisms, complication rates were similar between groups, suggesting a complex balance of risk factors. This finding challenges the assumption that injury mechanism predicts outcomes and emphasizes the importance of personalized perioperative care addressing patient-specific risk factors rather than injury mechanism alone.

Background. One of the main causes of revision hip arthroplasty is aseptic loosening of prosthetic components. A non-invasive method for early detection of this complication is the assessment of prosthesis condition using a triaxial accelerometer — acoustic arthrometry. The aim of the study — to evaluate the potential of acoustic arthrometry for early diagnosis of aseptic loosening of prosthetic components and polyethylene liner wear in hip prostheses. Methods. The study was performed using a custom-designed device for non-invasive registration of vibrational and acoustic oscillations in the area of the implanted joint. Interpretation and analysis of the obtained acoustic signatures were performed using MATLAB software. Acoustic emission recordings were obtained from 120 patients: 40 with diagnosed aseptic loosening of prosthetic components, 40 with polyethylene liner wear, and 40 control patients with no complaints regarding prosthesis function. Predictors of aseptic loosening and polyethylene wear were identified using regression analysis. Results. In a multivariate risk model of polyethylene liner wear, ROC analysis demonstrated optimal sensitivity (91.7%) and specificity (84.6%) of the proposed method. For diagnosing aseptic loosening of prosthetic components, the sensitivity and specificity were 79.5% and 65.8%, respectively. Conclusion. Specific acoustic signatures analyzed using the developed evaluation criteria (Peak, Asymmetry, Width) correlated with radiographic findings and showed high specificity (84.6%) and sensitivity (91.7%). These results support the feasibility of using acoustic arthrometry as a screening tool for early detection of prosthetic component loosening and polyethylene wear.

Background. Vertebral body replacement is one of the key surgical methods for the treatment of spinal tumors. One of its most common complications is vertebral body implant subsidence. The aim of the review — to compare the subsidence rates of various types of vertebral body implants used in the surgical treatment of thoracic and lumbar spinal tumors in order to determine the optimal reconstruction methods for patients with spinal tumors. Methods. A systematic literature review was conducted in accordance with the PRISMA guidelines. The search was performed in the PubMed, Google Scholar, and eLIBRARY databases. Studies were included if they involved vertebral body replacement in patients aged 18 years and older with oncologic lesions, provided a clear definition of subsidence, and analyzed risk factors. Various implant types were evaluated, including expandable, mesh, 3D-printed commercial, and patient-specific prostheses. Results. Thirteen studies were included in the analysis (12 retrospective and 1 prospective) comprising a total of 661 patients. The highest subsidence rates were observed with titanium mesh cages, ranging from 63.8 to 71.4%. Expandable implants demonstrated more favorable outcomes, with subsidence rates from 5.3 to 35.3%. The results for 3D-printed implants were the most inconsistent, ranging from 0 to 100% across studies. The follow-up period varied from 7.4 to 101 months. Conclusions. Expandable implants demonstrate the most favorable subsidence rates in vertebral body replacement for patients with spinal tumors. The high subsidence rates of titanium mesh cages may be attributed to a mismatch between the elastic modulus of the implant and bone tissue. 3D-printed implants require further investigation to optimize their design and clinical use. An individualized approach to prosthesis selection considering risk factors is essential.