Femoral Segments Research Articles

IN-HOSPITAL OUTCOMES OF FEMORAL-POPLITEAL BYPASS SURGERY ABOVE AND BELOW THE KNEE JOINT GAP USING THE “KEMANGIOPROTEZ” VASCULAR XENOGRAFT

HighlightsReconstructive interventions on the arteries of the lower extremities remain an extremely common type of treatment for arteriosclerosis obliterans. Research in this area will help determine the indications for implantation of understudied but effective vascular xenografts, which have a number of significant advantages over other types of prostheses and surgical treatment methods. AbstractAim. To analyze in-hospital outcomes of femoropopliteal bypass grafting above and below the knee joint gap using the “KemAngioprotez” vascular xenograft.Methods. The retrospective study included 115 patients undergoing infrainguinal arterial reconstructions (femoral segment) using the “KemAngioprotez” epoxy-treated vascular xenograft (CJSC NeoKor, Kemerovo) for chronic arterial occlusive disease of the lower extremities from 2012 to 2022.Results. 7 patients (6.1%) suffered thrombosis in vascular xenograft, including 2 cases (20%) with the point of formation of the distal anastomosis below the knee joint gap, 5 cases (4.8%) – above the gap (p = 0.113). Of the analyzed predictors of 30-day thrombosis and other complications in this period, the number of functioning arteries of the leg and the type of antiplatelet therapy were statistically significant. There were no fatal outcomes. 3 patients (2.6%) undergone repeated arterial reconstruction to restore peripheral blood flow. 2 patients (1.7%) with coronary artery disease and a history of myocardial infarction suffered perioperative myocardial infarction. 12 patients (10.4%) had lymphorrhea. 6 (5.2%) patients had postoperative wound diastasis; 2 (1.7%) patients had marginal necrosis.Conclusion. In-hospital outcomes of infrainguinal revascularization of the lower extremities using the “KemAngioprotez” epoxy-treated vascular xenograft are comparable with bypass with autologous veins. This may be due to the satisfactory implantation properties of the vascular xenograft. Further multicenter prospective randomized studies are required to study the main limitation of the use of vascular prosthesis according to the literature – the tendency towards degeneration.

Subtrochanteric shortening osteotomy in adult sickle cell disease patients with cemented total hip arthroplasty for hip deformities secondary to childhood osteonecrosis: is healing a challenge?

Hip deformity is frequent after childhood osteonecrosis in patients with sickle cell disease (SCD). When they are adults, they present a challenge as candidates for total hip arthroplasty (THA) because of abnormal bone development, their relative youth, and also because of their disease. Performing subtrochanteric osteotomy associated with THA is technically challenging, and healing of osteotomies has never been reported in this population with frequent osteonecrotic bone, whether using cemented or uncemented arthroplasties. We retrospectively analyzed 59 cemented THA with femoral corrective osteotomies (subtrochanteric shortening and transverse derotational osteotomy) performed on hip deformities between 1984 and 2018 in 59 sickle cell adult patients. The patient's age at the onset of osteonecrosis was an average of 8.4 years (6 to 10 years), and at the time of the THA was 28.6 years (19 to 41 years). All the patients had a minimum followup period of six years. Endocrinopathy was frequently associated to SCD Data and consequences were evaluated on bone union. The mechanical variables, such as the length of the resected femur, limb lengthening, the location of the osteotomy site, the size of the stem bridging the osteotomy, and any complications, were also analyzed. The average length of the resected femoral segment was 38.4mm. The length of the femoral stem (bridging the osteotomy) was average 13cm. The mean osteotomy union time was 10.6 months. Twenty-four osteotomies healed in six months, six in nine months, and 29 in twelve months, while five required bone grafts at nine months. The union time of the osteotomy was average 10.6 months. Complications included four cases of transient nerve palsy, and five intraoperative femur perforations. No statistically significant relationship was found between osteotomy union time and mechanical variables. The severity of endocrinopathy associated with sickle cell disease prolonged the healing time. In three cases, cement leakage into the osteotomy gap occurred without resulting in non-healing. Cemented THA, combined with a subtrochanteric femoral shortening with transverse derotational osteotomy, has a long union time but is effective for adult hip deformities of patients with sickle cell patients.

Femoropopliteal Bypass Surgery for Total Calcification of the Iliofemoral Segment

Calcification of the lower extremities arteries is an unfavorable factor for vascular surgery. Extensive lesions of the femoral segment are an indication for femoropopliteal bypass surgery. Calcification of the femoral arteries complicates the construction of a proximal anastomosis because it precludes clamping the arteries. In addition to technical difficulties in the construction of an anastomosis, significant calcification increases the risks of bleeding and embolic complications and the duration of surgery. In cases of total calcification of the femoral and iliac arteries, balloon occlusion during the construction of an anastomosis makes it possible to occlude the arteries without clamping, which reduces the risks of perioperative complications. We report a case of femoropopliteal bypass surgery in a patient with total calcification of the iliofemoral segment and occlusion of the superficial femoral artery.

Cold Storage of Human Femoral Arteries for Twelve Months: Impact on Mechanical Properties

This biomechanical pre-clinical study aimed to assess the consequences on mechanical properties of long term cold storage (+2 to +8 °C) of arterial allografts. Femoropopliteal arterial segments were collected from multiorgan donors and stored at+2 to +8 °C for twelve months in saline solution with added antibiotics. Mechanical characterisation was carried out using two different tests, with the aim of defining the physiological modulus and the maximum stress and strain borne by the sample before rupture. These characterisations were carried out after zero, six, and twelve months of storage for each sample (T0, T6, and T12, respectively). For comparison, the same tests were performed on cryopreserved femoropopliteal segments after thawing. Twelve refrigerated allografts (RAs), each divided into three segments, and 10 cryopreserved allografts (CAs) were characterised. The median (interquartile range [IQR]) Young's modulus was not statistically significantly different between the storage times for cold stored allografts: RAT0, 164 (150, 188) kPa; RAT6, 178 (141, 185) kPa; RAT12, 177 (149, 185) kPa. The median (IQR) Young's modulus of the CA group (153; 130, 170 kPa) showed no significant differences from the RA groups, irrespective of storage time. Furthermore, median (IQR) maximum stress and strain values were not significantly different between the different groups: for maximum stress: RAT0, 1.58 (1.08, 2.09) MPa; RAT6, 1.74 (1.55, 2.36) MPa; RAT12, 2.25 (1.87, 2.53) MPa; CA, 2.25 (1.77, 2.61) MPa; and for maximum strain: RAT0, 64% (50, 90); RAT6, 79% (63, 84); RAT12, 72% (65, 86); CA, 67% (50, 95). Cold storage for up to twelve months appears to have no impact on the mechanical characteristics of human arterial allografts. Therefore, this preservation method, which would greatly simplify routine care, seems feasible. Other indicators are being studied to verify the safety of this preservation process before considering its use invivo.

Influence of Timing of Stenting on Condition of Venous Valves of Lower Extremities, Frequency and Severity of Development of Post-Thrombotic Disease

INTRODUCTION: Acute deep vein thrombosis (DVT) of the lower extremities (LE) is a life-threatening condition, accompanied by high rates of disability among people of working age. Despite early detection of DVT and the use of recommended antithrombotic therapy, damage to the venous wall, development of valvular reflux and post-thrombotic disease (PTD) inevitably occur. The clinical picture of PTD becomes evident after the development of valve incompetence, which leads to vertical venous reflux and chronic venous hypertension. Timely elimination of venous obstruction can preserve the functionality of valve structures, which will subsequently help reduce the frequency and severity of PTD. AIM: To evaluate the impact of the timing of stenting on the condition of the venous valves, the frequency and severity of the development of PTD in patients with acute DVT of LE. MATERIALS AND METHODS: A prospective interventional study included 49 patients with acute iliofemoral thrombosis. After selective thrombolysis, 25 patients underwent early (within 7 days) and 24 patients underwent delayed (7–30 days) stenting. The incidence and severity of PTD was assessed on the Villalta scale at 3, 6 and 12 months. The effect of treatment on the condition of the venous valves of the LE was assessed at 12 months. On ultrasound examination, reflux was assessed using a scoring system. RESULTS: At 12 months, 2 (8%), 13 (52%), and 10 (40%) patients who underwent delayed stenting, developed severe, moderate, or mild PTD, respectively. In the early stenting group, 6 (25%) patients had no symptoms of PTD, 15 (62.5%) and 3 (12.5%) developed mild and moderate PTD, respectively (p = 0.0005). At 12 months, in the early stenting group, the absence of reflux was recorded in 6 (25%) patients, 4 (17%) patients had valve reflux in the femoral segment, and 14 (58%) in the popliteal segment. In the delayed stenting group, valvular incompetence of both segments was detected in 12 (48%) patients; in 4 (16%) and 9 (36%) patients, the valves of the femoral and popliteal veins were preserved; there were no patients without reflux in both segments. Treatment results for this indicator were better if early stenting was performed (p = 0.0005). CONCLUSION: Early stenting after selective thrombolysis in patients with proximal DVT of LE leads to a decrease in the incidence and severity of symptoms of PTD, and can reduce the incidence of reflux in the deep veins.

Feasibility of Reduced Iodine Loads for Vascular Assessment Prior to Transcatheter Aortic Valve Implantation (TAVI) Using Spectral Detector CT.

Reduced iodine loads for computed tomography (CT)-based vascular assessment prior to transcatheter aortic valve implantation (TAVI) may be feasible in conjunction with a spectral detector CT scanner. This prospective single-center study considered 100 consecutive patients clinically referred for pre-TAVI CT. They were examined on a dual-layer detector CT scanner to obtain an ECG-gated cardiac scan and a non-ECG-gated aortoiliofemoral scan. Either a standard contrast media (SCM) protocol using 80 mL Iohexol 350 mgI/mL (iodine load: 28 gI) or a body-mass-index adjusted reduced contrast media (RCM) protocol using 40-70 mL Iohexol 350 mgI/mL (iodine load: 14-24.5 gI) were employed. Conventional images and virtual monoenergetic images at 40-80 keV were reconstructed. A threshold of 250 HU was set for sufficient attenuation along the arterial access pathway. A qualitative assessment used a five-point Likert scale. Sufficient attenuation in the thoracic aorta was observed for all patients in both groups using conventional images. In the abdominal, iliac, and femoral segments, sufficient attenuation was observed for the majority of patients when using virtual monoenergetic images (SCM: 96-100% of patients, RCM: 88-94%) without statistical difference between both groups. Segments with attenuation measurements below the threshold remained qualitatively assessable as well. Likert scores were 'excellent' for virtual monoenergetic images 50 keV and 55 keV in both groups (RCM: 1.2-1.4, SCM: 1.2-1.3). With diagnostic image quality maintained, it can be concluded that reduced iodine loads of 14-24.5 gI are feasible for pre-TAVI vascular assessment on a spectral detector CT scanner.

Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum.

The aim of this study was to investigate factors determining the final outcomes of hemipercutaneous epiphysiodesis using transphyseal screw (PETS) for the genu valgum, especially focusing on postoperative courses after screw removal. Fifty-five patients with idiopathic genu valgum treated with hemi-PETS were included. The mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured to calculate the degree of correction and rebound. Regarding factors related to surgical techniques, the number of screw threads beyond the physis, the moment arm of the screw, and screw insertion angles were measured. In 54 femoral segments (randomly selected in bilateral cases), hemi-PETS was performed with a growth remaining of 2.0±0.6 years. The screw was removed after 6.5±2.1 months, and the degree of correction was 5.0±1.5 degrees. The mean rebound angle was -0.4±2.4 (the negative value means further correction after screw removal). A late time of surgery and an extreme peripheral position of a screw were associated with the growth inhibition. In 50 tibial segments (also randomly selected in bilateral cases), a screw was inserted with a growth remaining of 2.0±0.6 years and removed after 6.3±1.9 months. The degree of correction was 2.9±1.7 degrees during the interval, and the rebound angle was 0.8±1.7 degrees. An earlier time of surgery and a greater correction angle before screw removal were associated with the rebound phenomenon. Growth inhibition of >1.6 degrees was observed in about one-fourth of femoral segments. An extreme peripheral position of a screw should be avoided when performing hemi-PETS at the distal femur. We also recommend not performing hemi-PETS at distal femur with too short a period of growth remaining. Level III-retrospective comparative series.

Evaluation of simultaneous bilateral femoral distraction osteogenesis with antegrade intramedullary lengthening nails in achondroplasia with rhizomelic short stature: a retrospective study of 15 patients with a minimum follow-up of 2 years.

Bilateral femoral distraction osteogenesis in patients with achondroplasia is insufficiently reported. We aimed to perform the first study that exclusively analyzed simultaneous bilateral femoral distraction osteogenesis with motorized intramedullary lengthening nails via an antegrade approach in patients with achondroplasia focused on reliability, accuracy, precision, and the evolving complications. In this retrospective singlecenter study we analyzed patients with achondroplasia who underwent simultaneous bilateral femoral lengthening with antegrade intramedullary lengthening nails between October 2014 and April 2019. 15 patients (30 femoral segments) of median age 14 years (interquartile range [IQR] 12-15) were available for analysis. The median follow-up was 29 months (IQR 27-37) after nail implantation. The median distraction length per segment was 49 mm (IQR 47-51) with a median distraction index of 1.0 mm/day (IQR 0.9-1.0), and a median consolidation index of 20 days/cm (IQR 17-23). Reliability of the lengthening nails was 97% and their calculated accuracy and precision were 96% and 95%, respectively. The most common complication was temporary restriction of knee range of motion during distraction in 10 of 30 of the lengthened segments. 1 patient was treated with 2 unplanned additional surgeries due to premature consolidation. The method is reliable and accurate with few complications.

Petal-shaped femoral lobes facilitate gliding in orchid mantises

To glide in forest canopies, arboreal vertebrates evolved various skin-derived aerodynamic structures, such as patagial membranes or webbing, but no comparable structure has been reported from wingless arboreal arthropods.1,2,3 Orchid mantises (Hymenopus coronatus) have been traditionally considered a textbook example of flower mimicry for ∼200 years due to their highly expanded, petal-shaped femoral lobes. However, the empirical evidence substantiating the petal-mimicry function of the femoral lobes has not been entirely conclusive.4,5,6 Observational and experimental evidence suggests that these lobes do not contribute to flower mimicry for luring pollinators6,7 and likely serve other functions.7,8 After observing their aerial escape initiated with active jumping, we hypothesized that orchid mantises can glide and that their femoral lobes are used for gliding. Through behavioral investigations and morphological analyses, we show that orchid mantis nymphs are excellent gliders, exhibiting the shallowest gliding trajectories observed in terrestrial invertebrates.9,10,11,12,13 The lobe extensions on their femoral segments are cambered airfoils, which increase the mantis projected area by ∼36% and play a vital role in the aerodynamic underpinning of the observed gliding. Despite a 165-fold increase in body mass throughout ontogeny, older female mantis nymphs maintained a persistent gliding capability. We further showed a notable 40%-56% reduction in wing loading attributed to the positive size allometry of these lobes, indicating a clear promotion of gliding throughout ontogeny. This is the first documentation of gliding-adapted "leg wings" in a wingless arthropod. The evolution of such structures is potentially common among arboreal arthropods and demands a systematic re-examination.

Distal femoral torsion is correlated with higher-grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion.

To describe the characteristics of femoral torsion in patients with different segmental torsion types and to evaluate the correlations between segmental torsion and the morphology of the femoral condyles and trochlea in patients with patellar dislocation and increased femoral torsion. Between January 2021 and March 2023, 69 patients were included and classified into two groups according to the femoral segment contributing the most to total torsion: 32 patients in Group A (femoral neck and shaft torsion) and 37 patients in Group B (distal torsion). Trochlear dysplasia was evaluated using Dejour's classification and sulcus angle. The morphology of the femoral condyles was evaluated using the lengths and ratios of the medial and lateral condyles. Correlations between femoral torsion and morphology were evaluated. Total torsion was significantly correlated with femoral neck and shaft torsion (r = 0.882, P < 0.001) and distal torsion (r = 0.262, P = 0.030). Femoral neck and shaft torsion was significantly increased with increasing total torsion. The trochlear sulcus was flatter and more dysplastic, and the anterior condyles were shorter in Group B. Distal torsion was significantly correlated with the lengths of the medial and lateral anterior condyles (r = - 0.567, P < 0.001; r = -0.701, P < 0.001), sulcus angle (r = 0.611, P < 0.001) and Dejour trochlea type (r = 0.512, P = 0.001), while femoral neck and shaft torsion showed no correlations. Femoral torsion is a complex of femoral neck and shaft torsion and distal torsion, especially femoral neck and shaft torsion. Distal torsion was significantly correlated with a flatter trochlear sulcus, higher-grade trochlear dysplasia, and shorter anterior condyles. The new findings highlighted the importance of the segmental evaluation of femoral torsion, which would facilitate understanding of the anatomical characteristics of femoral torsion in patients with patellar dislocation and increased femoral torsion and may lead to improvement in the surgical options regarding femoral torsion. Level III.

Three-dimensional femur morphology analysis for the optimal location of subtrochanteric osteotomy with an implanted Wagner cone stem in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip

BackgroundThis study aimed to accurately evaluate the matching of proximal and distal femoral segments and fitting of the femur–femoral stem in patients with Crowe type IV developmental dysplasia of the hip (DDH) who have undergone subtrochanteric osteotomy at different locations with an implanted Wagner cone stem to improve the rate of the bone union at the osteotomy site.MethodsThree-dimensional femur morphology of 40 patients with Crowe type IV DDH was evaluated at each cross-section to determine the femoral cortical bone area. This study focused on five osteotomy lengths (2.5, 3, 3.5, 4, and 4.5 cm). The overlapped area between the proximal and distal cortical bone segments was defined as the contact area (S, mm2), and the contact area to distal cortical bone area ratio was defined as the coincidence rate (R). Three indicators were used to evaluate the matching and fitting of the osteotomy sites with the implanted Wagner cone stems: (1) higher S and R between the proximal and distal segments; (2) the effective fixation length of the femoral stem at the distal segments being at least 1.5 cm; and (3) osteotomy did not involve the isthmus.ResultsIn all groups, S significantly decreased in the two proximal levels above the 0.5 cm level below the lesser trochanter (LT) compared with those below this level. In comparison, at osteotomy lengths from 2.5 to 4 cm, R significantly decreased in the three proximal levels. The optimal osteotomy levels ranged from 1.5 and 2.5 cm below the LT for an appropriately sized stem.ConclusionsSubtrochanteric osteotomy at the optimal level not only ensures fitting of the femur–femoral stem but also meets the requirements of a higher S and R to ensure adequate reduction and stabilization at the osteotomy site, which may contribute to the bone union. Although the optimal osteotomy level varies with the size of the femoral stem and the length of the subtrochanteric osteotomy, the optimal osteotomy levels for an appropriately sized Wagner cone femoral stem implantation range from 1.5 to 2.5 cm below the LT.

Endogenous intoxication, oxidative stress and antioxidant system in acute lower limb ischemia

Aim. To study features of endogenous intoxication syndrome (EI), oxidative stress (LPO) and antioxidant defence (AOS) in patients with acute lower limb ischemia (LLI).Materials and methods. Some parameters of EI, LPO and AOS were studied. EI syndrome was studied in 86 patients with LLI who underwent complex examination and treatment in 2020-2021 in the Department of Vascular Surgery of the RNCfCS. POL and AOS parameters were studied in 14 patients out of 86. There were 51 (59.3%) men and 35 (40.7%) women, mean age was 56.0±5.8 years. Acute occlusion of the iliofemoral segments was noted in 33 (38.4%) patients, in 32 (37.2%) - the femoral segment, and in 21 (24.4%) - the popliteal and femoral vessels. In all cases, ischemia had a unilateral localization - on the right in 59 (68.6%) cases and on the left in 27 (31.4%) cases. In 52 (58.1%) cases, there were clinical signs of grade II b ischemia, and in 36 (41.9%) cases - grade III A (according to V.S. Saveliev, 1987). The average duration of ischemia was 77.9±28.3 hours.Results and discussion. In all cases of LLI before revascularization, there were signs of acute inflammatory reaction and EI syndrome in the form of increased ESR (42.3±7.1 mm/h), CRP concentration (16.1±4.2 mg/L), fibrinogen (8.5±0.9 g/L) and leukocytosis (12.7±1.5×109/L). Also, all patients had a slight elevation of blood glucose against the background of EI (7.5±1.8 mmol/L), a significant increase of creatinine concentration (128.9±6.1 µmol/L), urea (9.2±0.6 mmol/L) and aminotransferases as compared to normal indices. Results of LPO and AOS indices study in 14 patients showed that in LLI, malondialdehyde (MDA) increases 2.6-fold (3.9±0.1 μmol/L), diene conjugate increases 3.7-fold (0.77±0.04 units a/mL). However, after the elimination of ischemia, there was no significant decrease for 12.2±2.4 days, which confirms the presence of reperfusion syndrome. AOS indices - superoxide dismutase (20,8±1,0 u/l) and catalase (128,9±11,2 μl/l) increased 1,2 and 1,1 times in the examined patients cohort, respectively. Statistically significant associations were established between the following indices: Ischemia level and urea (r=0.89), Ischemia level and white blood cell count (r=-0.82), Hb and Er (r=0.99), Hb and creatinine (r=0.79), Hb and urea (r=0.79), Er and urea (r=0.79), creatinine and Er (r=0.90), ACTV and creatinine (r=-0.77), creatinine and urea (r=0.90).Conclusion. Acute lower limb ischemia is accompanied by ischemia-reperfusion damage manifested by endogenous intoxication syndrome, impaired glucose metabolism and activation of lipoperoxidation processes and antioxidant system. After the elimination of acute ischemia, there is not always a significant decrease in lipid peroxidation and some inflammation parameters. Therefore, prolonged use of antioxidants in the reperfusion period is recommended.

SURGICAL TREATMENT OF EARLY POSTOPERATIVE COMPLICATIONS OF ENDOVASCULAR REVASCULARIZATION OF A MULTI-LEVEL STENOTIC-OCCLUSIVE ATHEROSCLEROTIC LESION OF THE FEMORAL-DISTAL ARTERIAL BED

The use of endovascular techniques remains the only chance to restore blood flow under the conditions of a distal stenotic-occlusive process. Nevertheless, under the conditions of endovascular reconstructive surgery of the distal arterial bed, unsatisfactory results occur in 6-32% of cases in the form of thrombosis or restenosis of the reconstruction segment due to the progression of signs of limb ischemia.&#x0D; The aim is to improve the results of endovascular revascularization of multilevel atherosclerotic stenotic-occlusive femoral-distal arterial bed by surgical treatment of postoperative complicated forms of revascularized infrainguinal arterial bed.&#x0D; Materials and methods. 164 patients with multilevel stenotic-occlusive lesions of the femoral-distal arterial bed were under observation. Ultrasound dopplerography was used to select the volume of reconstructive intervention. Endovascular angioplasty of the femoral-popliteal segment (I stage) was performed with Pan Medical (PEKICO), OPTA PRO (Cordis) balloon catheters. In 41.10% of observations, balloon angioplasty of the femoral segment was continued with the placement of a stent - a self-expanding Smart ControL stent (Cordis), a self-expanding Carbostent stent (Flype), a self-expanding stent - Vascular stent (BARD) was used. Endovascular angioplasty of the arteries of the tibial segment (II stage) was performed using long balloons (80-150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific). 76 intraluminal and 33 subintimal angioplasty were performed. When performing subintimal angioplasty, CompleteSE (Medtronic), Smart (Cordis) and CompleteSE (Medtronic) stents were used. In 40 patients, angioplasty was performed on two arteries of the leg, in 33 - on one of the tibial arteries. At the first stage, an open reconstruction of the femoral-popliteal segment was performed - the formation of a femoral-popliteal autovenous shunt. In 20 (21.98%) observations, the proximal anastomosis was formed at the level of the bifurcation of the thoracic cavity during simultaneous deep fundoplasty. In 36 (39.51%) observations, the distal anastomosis of the autovenous shunt was formed at the level of the PCA by the end-to-end type. A 6F Check-Flo Performer (USA), Balton (EU) introducer was used to ensure the change of the balloon catheter. Long balloons (80-150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific) were used, CompleteSE stents (Medtronic) – 23 cases, Smart (Cordis) – 24 observations.&#x0D; Conclusions. The early postoperative period of endovascular revascularization of a multilevel stenotic-occlusive lesion of the femoral-distal arterial bed is complicated by thrombosis of the popliteal-tibial segment in 15.9% of observations. Thrombosis of the popliteal segment is detected 2.7 times more often after endovascular angioplasty of one of the tibial arteries during endovascular revascularization of a multilevel stenotic-occlusive lesion of the femoral-distal arterial bed than during endovascular angioplasty of two tibial arteries. The effectiveness of the use of rheological thrombus extraction by the Angiojet system in the surgical treatment of postoperative thrombosis of the popliteal segment, which is formed in 15.9% of observations after endovascular revascularization of a stenotic-occlusive lesion of the femoral-distal arterial bed, is equal to 84.6%.

On the treatment of high unilateral congenital hip dislocation in older children: Minimizing the inequality of limb length

BACKGROUND: Treatment of high congenital hip dislocation in older children remains controversial in terms of the choice of the method of reducing the femoral head to the level of the acetabulum. In most cases, significant shortening of the hip is performed to eliminate dislocation, which leads to secondary deformities.&#x0D; AIM: This study aimed to evaluate the results of treatment of high hip dislocation in older children, in which pre-reduction skeletal traction and economical shortening of the femoral segment are rationally combined to lower the femoral head.&#x0D; MATERIALS AND METHODS: From 2011 to 2021, we observed 13 patients aged 513 years with grade 4 high unilateral congenital hip dislocation according to the international Tonnis classification.&#x0D; RESULTS: The treatment results were traced for 19 years. When assessing hip joint function according to McKay criteria, excellent and good results were obtained in 84.6% of the patients. X-ray evaluation by Severin also included 84.6% in groups 1 and 2. Signs of avascular necrosis of the femoral head according to the criteria of Kalamchi and MacEwen were detected in four patients (group 1, n = 2; group 2, n = 1; group 3, n = 1). The difference in the length of the n/limbs in eight patients was 1.5 cm on average, and in the remaining children, a clinically insignificant asymmetry was observed in the length of the n/limbs, i.e., 0.50.7 cm.&#x0D; CONCLUSIONS: The choice of the method of surgical correction of high hip dislocation largely depends on the age of the child. In children aged 5 years, with a significant displacement of the femoral head and limb shortening, a combination of reduction methods is rational, i.e., use of preoperative skeletal traction with economical shortening of the femoral segment, open reduction, and correction of the acetabulum. The optimal combination of the distraction method and surgical correction makes it possible to achieve successful reduction and a good functional result.

The use of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitis disease

Deep vein thrombosis is one of the most formidable conditions, which can subsequently cause pulmonary embolism and trigger the development of post-thrombophlebitic disease. The aim of our work was to evaluate the result of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitic disease. PatientG., 33years old, was admitted to the Department of Vascular Surgery of the City Clinical Hospital No.7 of Kazan on January1, 2021 on an emergency basis with complaints of severe swelling and pain in the right lower limb.Upon admission, the patient underwent ultrasound Doppler scanning of the veins of both lower extremities and X-ray tomography of the chest and abdominal cavities with contrast, according to which the diagnosis of acute iliofemoral phlebothrombosis on the right with thrombus flotation in the common iliac vein for 7cm was made. According to vital indications, the surgery transjugular thrombectomy from the iliofemoral segment using a proximal venous trap and subsequent implantation of a venous stent into the right common iliac vein was performed. In the postoperative period, the patient received anticoagulant therapy. Aday after the operation, a control ultrasound of the veins of the lower extremities and the inferior vena cava, X-ray tomography of the organs of the chest and abdominal cavity were performed. On the 5th day, the patient was discharged in asatisfactory condition under the supervision of a surgeon at the place of residence. Analysis of the results of surgical treatment of a patient with post-thrombophlebitic disease complicated by acute iliofemoral phlebothrombosis using antegrade venous thrombectomy with stenting showed that the patency of the stented iliac-femoral segment was maintained for up to 12months. Thus, the proposed method of surgical treatment allows us to safely remove floating and occlusive thrombi from the iliocaval and femoral segments, implant stents, and thereby restore the patency of the segment, reducing the risk of possible repeated thrombosis, embolic and post-thrombophlebitic complications.

Treatment of congenital hip dislocation before the walking age

The worst type of hip developmental dysplasia, known as congenital hip dislocation (CHD), is characterized by acetabular cavity, proximal femoral segment, and ligamentus capsule apparatus dysmorphisms that result in partial or total loss of the hip joint's relationship. We provide the following example: Hip dislocation has been diagnosed in a male infant 2 months old. The patient underwent progressive abduction followed by longitudinal skin traction using the Morel technique. After performing an artrography on the hip while under general anesthesia, which revealed a reducible and stable hip, we continued with spica cast immobilization in a human position. To promote proper joint development, improve standing posture, enhance gait, and correct pelvic and spinal imbalances, the treatment aims to reduce joint dislocation and rebuild joint relationships. To gradually clean the structures and lower the risk of distant avascular necrosis (AVN) of the femoral head development, slow and gradual traction is applied to Morel's bed.

Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia.

Performing subtrochanteric osteotomy with cemented components in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging and not widely reported. This study aimed to evaluate the mid-term outcomes of cemented stem total hip arthroplasty (THA) with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH. Data collected from patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018 were retrospectively evaluated. The cemented Lubinus SP II femoral component and the cementless CombiCup acetabular component were used together in all cases. These data, including Harris hip scores, limb length discrepancy (LLD), severity of limp, Trendelenburg test, bone union, length of the resected femur, limb lengthening, level of the osteotomy site, and length bridging the osteotomy site, as well as complications, were analyzed. A paired Student t-test was used to analyze continuous variables, categorical data were compared using Fisher's exact probability test, and correlation analysis was performed using Spearman's rank correlation coefficient. Among 14 included patients (10 females and four males), the mean age was 60.4 years (range, 47-73). The mean follow-up period was 49.1 months, and no patient was lost to follow-up. The mean Harris hip score improved from 40.7 to 87.7. The mean LLD decreased from 52 to 12.7 mm. The mean length of the excised femoral segment was 38.4 mm, and the mean length of limb lengthening was 27.1 mm. The mean distance between the osteotomy site and the lesser trochanter was 21.1 mm after surgery. The mean length of the femoral stem bridging the osteotomy site was 97.6 mm. Finally, the mean osteotomy union time was 10.6 months. No statistically significant correlation was found between the osteotomy union time and these factors. No neurological deficits were noted. Delayed union was observed in one patient, and postoperative dislocation was observed in two patients. Cement leakage into the osteotomy gap was observed in one patient, however, no revisions were required, and no signs of loosening or migration were observed. Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective in treating patients with Crowe IV DDH. Rather than leading to nonunion, cement leakage may negatively affect bone healing.

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment.

Femoral torsion can be evaluated from different femoral segments. The pathological thresholds for femoral torsion of different segments and the influence of segmental femoral torsion on patellofemoral alignment remain unknown. To compare femoral torsion between patients with recurrent patellar dislocation and healthy individuals, to determine the statistical physiological range and pathological thresholds of femoral torsion in different segments, and to investigate the influence of femoral torsion on patellofemoral malalignment. Cross-sectional study; Level of evidence, 3. We retrospectively reviewed the records of patients with patellar dislocation who received surgical treatment in our department between 2019 and 2020. Healthy participants were recruited as the control group. The control patients were asymptomatic and had no history of lower extremity disorders. The differences in femoral torsion between the study and control groups were compared. The diagnostic capacity of femoral torsion in different segments and their correlation with patellar tilt were investigated. The mean value and 95% CI of femoral torsion in different segments were established using data from healthy volunteers. A total of 60 patients with patellar dislocation and 100 healthy volunteers were included in this study. The total, mid, and distal femoral torsion values differed significantly between the study and control groups (P < .01). Total femoral torsion had the highest diagnostic value (area under the receiver operating curve = 0.733). Total torsion (r = 0.432; P < .001), mid torsion (r = 0.242; P = .002), and distal torsion (r = 0.324; P < .001) showed significant correlations with patellar tilt. The pathological thresholds of excessive femoral torsion of the total, proximal, mid, and distal femoral segments were 24.73°, 46.68°, -6.55°, and 14.92°, respectively. Patients with patellar dislocation had greater femoral torsion than healthy individuals in multiple femoral segments. Excessive mid, distal, and total torsion was associated with more significant patellar tilt.

Motorized Plate Lengthening of the Femur in Children: A Preliminary Report.

Limb lengthening by distraction osteogenesis can be performed with motorized internal devices, but intramedullary implants risk avascular necrosis of the femoral head in young children. A method of internal limb lengthening using a motorized expandable plate has been developed and preliminary results are presented. Seven skeletally immature patients (ages 2.7 to 9.7y) with congenital femoral deficiencies underwent femoral lengthening with the use of a magnetic expandable plate. Surgical details, lengthening parameters, Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion index, and complications were reviewed and classified according to the modified Clavien-Dindo system. An average lengthening was 4.1cm (range, 3.3 to 4.4cm) comprising 18% of initial femoral segment length (range, 14% to 21%). The average lengthening phase was 50.2 days (range, 40 to 57d) and weight-bearing was initiated at an average of 13 weeks from surgery (range, 8 to 18wk). Limb deformities and length discrepancies were of moderate complexity, with an Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion score of 6.57 (range, 6 to 7). Complication rates were comparable to previously reported methods of femoral lengthening. One patient underwent reoperation for patellar instability and 1 patient experienced radiographic hip subluxation which was observed. Small magnitude varus was observed in regenerate in 3 of 7 cases, none requiring treatment. Preoperative planning consisted of careful localization of the corticotomy site, acute deformity correction at the lengthening site in 3 cases, and implant orientation. Limb lengthening with motorized internal plates is feasible for young children with congenital femoral deficiency for whom intramedullary lengthening is unsafe or if external fixation is to be avoided. However, the fundamental principles of distraction osteogenesis and risks of lengthening for congenital discrepancies remain unchanged. Specific considerations herein include: careful planning of implant length and positioning, adjacent joint protection with adjunctive means, and mitigating deformity of the regenerate during distraction. Level IV, retrospective case series.

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft.

Objective To investigate the treatment and clinical efficacy of postoperative plate fracture and in situ fracture of the femoral stem. Methods We have retrospectively analyzed the clinical data, revised surgery information, and clinical efficacy of patients with postoperative plate fracture of the femoral stem in our hospital. A total of 33 cases were included whose original fractures were located in the upper and cadaveric femur and treated with paralleling intramedullary pins for revision surgery, as well as patients whose original fractures were located in the lower femur which were fixed with retrograde intramedullary nailing or anatomical locking and compression splints in the distal femur. For the selection of bone grafting, the original fracture site with Fernadez-Esteve scab grades I and II was treated with an autologous iliac bone graft. Postoperatively, patients were evaluated for fracture healing time, the clinical outcome of the affected limb, and complications in the iliac bone donor area. Results All patients were followed up until fracture healing, and all patients achieved clinical healing with a healing rate of 100% and a mean healing time of 6.3 months. No internal fixation failure such as rebreakage or loosening of the internal fixation occurred in all patients during the follow-up period. According to the Tohner-Wrnch criteria, 23 cases were excellent, 10 cases were good, and 0 cases were poor, with an excellent rate of 100%. Complications in the autologous iliac bone donor area amounted to 36.7%. Conclusion For patients with original fractures located in the upper femoral segment or cadre, it is recommended to perform revision surgery with a paralleling intramedullary pin, while patients with original fractures located in the lower femoral segment are fixed with the retrograde intramedullary nailing or an anatomical type of distal femoral locking and compression splint. Patients with postoperative plate fractures of the femoral stem do not require routine autologous bone grafting for revision surgery.