Orthopaedic Traumatology Research Articles

The register of surgeries in 1925. To the 100th anniversary of Saint-Petersburg State Pediatric Medical University

2025 will a year of the 100th anniversary of Saint Petersburg State Paediatric Medical University and a year of the 120th anniversary of the clinical hospital. The article presents a register of surgeries which were performed in 1925 in the surgical clinic of the University. The articles reviews nosological structure of surgical patients, surgical procedures and anesthesia techniques used one hundred years ago. In the article, one can also find brief historical biographical notes about surgeons who were at the origins of the department and clinic of pediatric surgery of Saint Petersburg State Medical University: N.E. Berg, V.N. Katin-Yartsev, M.A. Toporkova, V.D. Sokolov, V.L. Magsky, A.I. Savshinsky and many others. The role of outstanding orthopedic traumatologist Prof. Roman R. Vreden, who founded the department and headed the surgical clinic of the University (then the Institute of Maternal and Infant Health) from 1925 to 1934 is underlined separately. Dr. Nikolai E. Berg, one of the founders of paediatric surgery, worked at the clinic and subsequently at the department from 1905 to 1949, including the war years and the Leningrad siege. Little information has been found on functioning of the surgical clinic in 1905–1925. There is a lot of work ahead with archives so as to study the history of the clinic and department of paediatric surgery in Saint-Petersburg State Paediatric Medical University.

Development of a Surgical Difficulty Score for Open Reduction Internal Fixation of Pilon Fractures.

To identify characteristics that contribute to surgical complexity in pilon fractures and to develop a machine learning (ML) Pilon Surgical Difficulty Score (PSDS) based on these factors. Retrospective cohort study. Academic Level I trauma center. Pilon fractures (OTA/AO Type 43) in adult patients treated with open reduction internal fixation. Various patient, injury, and radiological characteristics were assessed. Surgical difficulty was measured using 2 outcomes: (1) operative time and (2) perceived difficulty. Perceived difficulty was determined using the opinion of 16 fellowship-trained orthopaedic traumatologists on a 10-point scale. Significant predictors of difficulty were determined using univariate analyses. ML models were used to develop a PSDS for both operative time and surgical difficulty. One hundred operatively fixed pilon fractures were included. Predictors of operative time were age, OTA/AO classification, articular comminution, articular impaction, bone loss, delay to surgery, poor quality reduction, number of approaches, and number of articular fragments. Predictors of perceived difficulty included OTA/AO classification and delay to surgery. Operative time PSDS had a mean absolute error of 64 minutes and a 60-minute buffer accuracy of 59%. Perceived difficulty PSDS had a mean absolute error of 1.7 points and a 2-point buffer accuracy of 63%. ML was used to generate accurate PSDSs for operative time and difficulty for pilon fractures. Future work should aim to clinically validate these PSDSs, so they may improve patient outcomes. Level III Diagnostic.

Diagnostic performance of digital tomosynthesis for postoperative assessment of acetabular fractures and pelvic ring injuries.

Digital tomosynthesis (DTS) has broad non-orthopaedic applications and has seen limited use within orthopaedics for imaging of the wrist. The utility of DTS for assessing reduction and hardware placement following operative treatment of pelvic ring injuries and acetabular fractures has not previously been investigated. All operatively treated acetabular fractures and pelvic ring injuries that underwent surgical fixation within a one-year time span received both a computed tomography (CT) scan and a DTS scan as part of their routine postoperative imaging workup. Three orthopaedic traumatologists independently reviewed the images for face-value clinical utility. Radimetrics and PCXMC software were utilized on a subset of the study population's DTS and CT studies to calculate the effective and organ radiation doses delivered. 52 patients (22 acetabular fractures, 22 pelvic ring injuries, 7 pelvic ring and acetabular fractures, 2 femoral head & acetabular fractures) were included. DTS was considered adequate to assess reduction 83% of the time, hardware position 83% of the time, and sufficient to replace the CT scan 67% of the time. DTS was associated with an 8.3 times lower effective radiation dose than CT. All organ doses were lower for DTS than CT. DTS appears to have face-value clinical utility for assessing reduction and hardware position following surgical treatment of acetabular fractures and pelvic ring injuries. Given that DTS is associated with significantly lower radiation doses to patients, further study utilizing more objective criteria is warranted.

Efficiency of the decision support system for determining the severity of scoliotic spinal deformity by the analysis of radiographs

BACKGROUND: In 2020, a decision support system was developed at expense of grant from Innovation Promotion Fund and integrated into medical base of prosthetic and orthopedic center “Sсoliologic.ru.” It is the first computer program for determining severity of scoliotic spinal deformity in analysis of radiographs. AIM: To evaluate performance of a computer program for determining Cobb angle by comparing obtained automated data with manual measurement data by various specialists. MATERIALS AND METHODS: From medical base of prosthetic and orthopedic center “Sсoliologic.ru,” 411 digital radiographs of spine of children and adolescents were selected, which were drawn by a radiologist (BP-etalon), an orthopedic traumatologist with 5 years of experience and experience in vertebrology (OO), and an orthopedic traumatologist with less than 1 year of experience and no experience in vertebrology (OB) and computer program (KP). The number and proportion of exact matches and mean absolute percentage error (MAPE) of results of measuring the Cobb angle of reference data were compared with indicators obtained by OO, OB, and KP in, for various types of scoliosis according to the classification of Rigо, as well as in determining the main arc. Bland–Altman graphs were used. The mean absolute deviation (MAD) and MAPE for the main arc with magnitude ranging from 20° to 50° were calculated. RESULTS: The exact matches of KP with standard were 21%. Hence, every fifth measurement of the Cobb angle on X-ray, calculated automatically, was identical to standard. The highest proportion of matches with standard was noted in OO (33%), and the lowest in OB (16%). The highest accuracy of KP was found at types E1 and E2, and the arc of 3 was 30% and 24%, respectively. The proportion of KP matches with standard increased to 61%, with an error of 3°, and to 75%, with an error of 5°; with an error of 7°, the proportion of matches reached 84%. Moreover, the proportion of coincidences of a non-experienced researcher increased from 34% to 58%. When determining magnitude of the main arc of scoliosis, OO increased his/her accuracy by almost 2,6 times, KP by 2,1 times, and OB by 1,5 times. The MAD of KP for all major arcs was 3.8°. Good reliability of the obtained KP indicators compared to the reference (ICC = 0.9) was noted. CONCLUSIONS: The use of a computer program may be recommended for automated determination of Cobb angle, because current algorithm of computer program has been found to be accurate compared to reference measurement. Its accuracy was significantly higher than that of novice orthopedic traumatologists with no experience in vertebrology.

Features of the state of bone tissue in children with cerebral palsy. Part 1. Etiological aspects. A literature review

BACKGROUND: The growth of the human body is the most significant period of development of the bone tissue, because it is during this period that the size, shape, and architectonics of bone are formed against the background of increasing body weight and increasing physical exertion. Considering a number of pathological factors of the underlying disease (alimentary, neurological, hormonal, stress, and physical), bone tissue in children with cerebral palsy grows and develops with deviations from the norm. АIM: To present up-to-date generalized information about the features of bone tissue in children with cerebral palsy to orthopedic traumatologists, neurologists, and physical therapy specialists. MATERIALS AND METHODS: Studies on the problem of bone tissue condition in patients with cerebral palsy were analyzed. Data published over the past 20 years were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language restrictions. RESULTS: In the last 20 years, the number of studies about pediatric osteoporosis has increased. The gold standard for determining the level of bone mineral density is dual-energy X-ray absorptiometry. However, its use in children has presented some difficulties and limitations. In children, the relationship between bone mineral density values and the risk of fractures has not been well studied, which does not allow us to discuss about osteoporosis based on densitometric bone mineral density data alone. In patients with cerebral palsy, a decrease in bone mineral density and bone mass during growth was found. Previous studies showed that the main factors associated with a decrease in bone mineral density in this group of patients include neuroendocrine causes due to growth retardation against the background of CNS damage, alimentary factors, decreased calcium and vitamin D concentrations, systemic use of glucocorticoids, intake of antiepileptic drugs, decreased motor activity, and low muscle mass. Increasing serum vitamin D concentrations does not have a positive effect on bone mass, although increasing serum calcium concentrations is associated with an increase in bone mineral density. CONCLUSIONS: Identifying and correcting factors leading to decreased bone mineral density in children with cerebral palsy can improve bone health in this group of patients. The absence of a relationship between bone mineral density values and the risk of fractures in children with cerebral palsy does not allow us to discuss about osteoporosis based only on bone mineral density densitometric data. There may be more factors leading to an increased risk of bone fractures in children with cerebral palsy that require further study.

L5-S1 facet joint pathology in pelvic ring injuries.

The authors believe that the L5-S1 facet joint injury in the setting of pelvic fractures is underappreciated by orthopedic traumatologists. The purpose of this study was to draw attention to the L5/S1 facet joint in the setting of pelvic ring injuries. This was a retrospective comparative study of all patients greater than or equal to 18years of age with an acute pelvic ring injury (AO/OTA 62 B to C) presenting to a single level I trauma center. The primary objective was to determine demographic and injury characteristics associated with L5-S1 facet joint injuries in patients with pelvic ring injuries. The secondary objective was to determine the proportion of L5-S1 facet joint injuries that were missed on initial radiographic workup. There were 476 patients included in the analysis, 53 (11.1%) of whom had an L5-S1 facet joint injury. Patients with an L5-S1 injury were more likely to be younger (44.1 vs. 53.2years, p = 0.001) and experience a high energy mechanism of injury (95.0% vs. 78.0%, p = 0.002). Certain injury patterns were associated with L5-S1 facet joint injuries: any sacral fracture (96.2% vs. 73.8%, p < 0.001), Denis zone 2 fractures (43.4% vs. 20.1%, p < 0.001), Denis zone 3 fractures (34.0% vs. 4.7%, p < 0.001), bilateral displaced sacral fractures (18.9% vs. 3.5%, p < 0.001), and L5 transverse process fractures (64.2% vs. 18.0%, p < 0.001). Only 16.0% of radiology reports identified an L5-S1 injury. Orthopedic traumatologists should scrutinize imaging for L5-S1 facet joint injuries in the presence of pelvic ring injuries, especially in patients with certain sacral fracture patterns.

Surgical Treatment of the Frontal Plane Distal Humerus Fractures

The frontal plane fractures of the distal humerus are rare. The small intraarticular fragments, the commonly encountered osteoporosis and the specific anatomy make the successful osteosynthesis a challenge. For a period of 15 years in First Clinic of Orthopaedic Traumatology 27 patients with capitulotrochlear fractures were treated. Of them, 12 women and 3 men were followed. The fractures were classified after Dubberley as follows: Type 1А - 1, type 2А - 2, type 2В - 3, type 3А - 5, type 3В – 1, and type 4В - 3. A plethora of surgical exposures were used - extended lateral, paratricipital, a combination of medial and lateral, dorsal with olecranon osteotomy. Primary TEA was performed in 3 patients: Type 3A - 1, type 3В – 1, and type 4В - 1. The patients were followed for a period of 12 months to 8 years. The results were evaluated by the MEPS, DASH and McGowan scores. The final ROM, compared to the contralateral side, was recorded. The average scores are comparable with the ones in a number of publications in the referent literature. As evaluated by MEPS, excellent results were found in 53% of patients, good – in 27%, fair in 7%, and poor –in 13%. The most serious problem was the elbow stiffness. Early deep infection was found in 1 patient with type 4B fracture. Ectopic ossification Hastings type I was found in 1 patient. The modern surgical treatment is based on anatomical reduction through fracture type-specific surgical exposure and rigid osteosynthesis. The treatment of choice for irreparable fractures is total elbow arthroplasty (TEA). We discuss the fixation devises, the surgical exposures and the osteosynthesis construct. Our own osteosynthesis preferences are centered around the fixation in the frontal plane and the additional augmentation with sagittal plane implants.

Implementation of an Acute Pain Service in the Orthopedic Traumatology Department of the University Hospital of Batna.

Background and Objectives. Effective management of postoperative acute pain (POP) in surgical settings requires well-organized approaches. Our goal was to establish an economic model of the Acute Pain Service (APS), to ensure appropriate treatment of POP in adults undergoing orthopedic and traumatological surgery at the University Hospital Center of Batna between 2015 and 2017. Materials and Methods. A descriptive and evaluative study was conducted as part of a quality assurance initiative to establish a acute pain service (APS) between 2015 and 2017. This study focused on organization, training, information dissemination, and pain assessment. Participants included five medical practitioners, 37 paramedical professionals, as well as 104 patients audited before the PAS implementation and 136 patients audited after its establishment. All patients underwent orthopedic and traumatological surgeries. Results. The survey involved 5 physicians and 37 healthcare providers. The results of the reevaluation audit showed that practitioners acquired skills in 86% of cases, common protocols for managing postoperative pain (DPO) were present in 100% of cases, patient information was provided in 77% of cases, and the quality of DPO management was rated as good in 54% of cases. Conclusion. Implementing an organizational framework based on quality assurance principles led to a significant enhancement in postoperative pain management following the introduction of a functional analgesia unit of the acute pain service (APS).

Intraoperative computerised tomography scan for percutaneous fixation of the pelvis: a retrospective case series

PurposeFractures and dislocations of the pelvic ring are complex injuries that when treating require meticulous attention to detail and often specialized technical skill. These injuries can be the result of high-energy trauma, particularly in younger patients, or low energy trauma more often found in the elderly. Regardless of mechanism, these injuries lie on a spectrum of severity and can be treated conservatively or surgically. Percutaneous fixation under fluoroscopic guidance is the preferred standard technique when treating these fractures. This technique can be challenging for a variety of reasons including patient characteristics, intra-operative image quality, fracture morphology, among others.MethodsThis retrospective study evaluated the use of intra-operative computed tomography (CT) using an O-arm imaging system for critical evaluation of fluoroscopic-guided screw placement in twenty-three patients. We retrospectively reviewed all cases of patients who were treated by three fellowship-trained orthopaedic traumatologists during a one-year span. Patients undergoing percutaneous pelvis fixation using both standard fluoroscopy and intraoperative CT with the Medtronic O-arm® (Minneapolis, MN) imaging system. Additionally, procedures performed included open reduction internal fixation (ORIF) of the pelvic ring, acetabulum, and associated extremity fractures.ResultsTwenty-three patients were included in this study. On average, the use of intraoperative CT added 24.4 min in operative time. Five patients (21.7%) required implant adjustment after O-arm spin. Fourteen patients underwent additional post-operative CT. No secondary revision surgeries were attempted after any post-operative CT.ConclusionsOur study suggests that intra-operative CT scan, compared to post-operative CT scan, can be utilized to prevent take-back surgery for misplaced implants and allow for adjustment in real-time.

Standardization and Reproducibility of Dynamic Stress Testing for Occult Pelvic Ring Instability.

Examination under anesthesia (EUA) (stress fluoroscopy) is commonly done after pelvic ring injury to identify occult instability because unstable disruptions may displace causing morbidity. The force applied during EUA for these injuries has not been standardized. The purpose of this study was to examine the forces used during the EUA by experienced orthopaedic trauma pelvic surgeons. Orthopaedic traumatologists performed simulated EUA on a cadaver at two North American pelvis and acetabular courses using internal rotation (IR), external rotation, and push-pull maneuvers while wearing a handheld dynamometer to measure force. All surgeons used a comparable method, and each performed EUA multiple times. Maximum forces were measured in Newton (N). Eighteen surgeons participated. Four had been practicing for <5 years, six for 5 to 10 years, six for 11 to 20 years, and two for >20 years. Surgeons applied a force ranging from 40.4 to 374.9 N during IR, 72.9 to 338.4 N during external rotation, and 25 to 323 N during push-pull, with notable variability seen between surgeons. Three surgeons (18%) had >50-N variability on serial trials of a single EUA maneuver (IR). This is the first study evaluating the forces applied during pelvic EUA used to assess ring stability. Notable variability existed among surgeons performing EUA and in serial examinations by the same surgeon. Additional study is needed to standardize the displacement measured and threshold for instability that guides management.

Case Study on the Advancements in Diagnosis and Treatment Technologies for Military Personnel with Complex Explosive Injuries

Case(s): A 51-year-old military personnel with severe limb injury from mortar shelling, admitted to Orthopedic Traumatology Department, Ternopil Regional Hospital, Ukraine.Conclusions: Explosive injuries typically arise from the detonation of devices such as landmines, improvised explosive devices, or grenades, causing harm through blast, fragmentation, and thermal effects. Despite a delayed presentation to medical care, the patient underwent multiple debridement procedures, including Vacuum-Assisted Closure therapy, and vascular reconstruction, leading to limb salvage. This case underscore needs for timely medical care, addressing risks of mine blasts and cold weather injuries through training.

Complications and Revision Surgery in Orthopedics Focusing on Traumatology.

Orthopedic traumatology, a vital component of orthopedic surgery, poses significant challenges in managing complications and necessitating revision surgeries. These challenges impact clinical outcomes, healthcare economics, and patient well-being. This study aimed to provide insights that informed clinical decision-making and improved patient outcomes by thoroughly examining the range of complications encountered in orthopedic traumatology. Specifically, the research focused on the indications, techniques, and outcomes of revision surgeries. This retrospective cohort research looked at orthopedic traumatology complications and revision procedures over a thorough two-year period from March 2021 to March 2023 at Hayatabad Medical Complex in Peshawar, Pakistan. The following information was gathered from 316 patients receiving orthopedic surgery for traumatic injuries: demographics, kinds of trauma, surgical methods, complications, indications, methods, and results of revision surgery. For data analysis, chi-square tests and descriptive statistics were used, with the goal of finding patterns and correlations within the research population. The average age of the 316 patients was 42.5 years, and 64.76% of them were male (n = 192). The most frequent kind of trauma (n = 218; 69.01%) was fractures, which were mostly brought on by falls (n = 147; 46.52%). The most common surgical method (n = 138; 43.67%) was found to be internal fixation, which was followed by external fixation (n = 67; 21.20%). The most common complication (n = 78; 24.68%) was surgical site infection, which resulted in revision procedures mostly for infection (n = 68; 21.52%) and implant failure (n = 56; 17.72%). Debridement was the most often used revision approach (n = 95; 30.10%), and it was substantially correlated with surgical outcomes, such as increased function (31%) and full resolution (36%). This research emphasizes the need to maximize patient outcomes for improved well-being and highlights the crucial role that careful care plays in managing complications and revision operations in orthopedic traumatology.

Sustainable Waste Management in Orthopedic Healthcare Services

It is estimated that globally medical surgical specialties, including orthopedics, produce large amounts of hospital waste. However, the possibilities of recycling materials are not well highlighted. Orthopedic hospitals can collect larger volumes of recyclables that could be kept out of landfills. The general objective of this study is to identify the categories and related amounts of waste and recyclable materials produced by the main types of medical interventions in orthopedics. The specific objective is to evaluate the amounts of waste produced in the preoperative and intraoperative periods, but also their recycling potential. For one month, we analyzed eight types of orthopedic medical interventions, of which five were surgical and three were nonsurgical. These were performed at the County Emergency Clinical Hospital of Targu Mures in Romania. For surgical interventions, the waste was collected separately in the preoperative and intraoperative periods. Waste was divided into recyclable, nonrecyclable, and biological categories. The waste bags were weighed with a portable scale. The main results are the average amounts of recyclable waste produced per case in the eight types of medical interventions. The secondary results show the average amounts per case of nonrecyclable, biological, and total waste. To test for statistically significant differences between the types of medical interventions, we performed an analysis of variance. Seventy-four cases were included in the study. An amount of 466.2 kg of waste was collected, with an average mass of 6.3 kg per case. During the preoperative period, 130.3 kg of waste was produced, of which 78% was recyclable. During the intraoperative period, 303.8 kg of waste was produced and only 11% was recyclable. Trauma surgery produced the largest amount of waste, followed by arthroplasty. A quarter of orthopedic waste is recyclable, and the greatest potential for recycling is preoperative waste, which can be effectively recycled at three-quarters. Through effective recycling programs, the ecological footprint of orthopedic–traumatology interventions can be reduced.

Local injection therapy with hyaluronic acid preparations: in focus of rheumatologists and orthopedic traumatologists

Hyaluronic acid (HA) is an effective and safe medication for local injection therapy (LIT) widely used in the treatment of osteoarthritis (OA) of large joints. The therapeutic effect of HA is determined both by the replacement of the lubricating function of natural hyaluronate (viscosupplementation), which leads to an improvement in the biomechanical parameters of the joint, and by the biological effects that unfold when interacting with cellular receptors (CD44, RHAMM, etc.), resulting in an anti-inflammatory, anti-nociceptive and anabolic effect of HA. HA therapy has a reliable evidence base. According to a number of clinical studies and meta-analyses, LIT with HA – reduces pain intensity by 28–54 % and improves the function of the affected joint by 9–32 % compared to baseline over a 12-24 week observation period. Repeated administration of HA can delay the need for orthopedic surgery. HA extremely rarely causes serious adverse events and can also be prescribed to patients with concomitant diseases. The use of HA for the treatment of OA is included in Russian and several foreign clinical guidelines (in particular OARSI and ESCEO). A new direction in LIT for OA is therapy with combined (hybrid) HA preparations containing high molecular weight (HMW) and low molecular weight (LMW) fractions. A new HA preparation has appeared in our country, which is a stabilized, highly purified hydrogel containing 80 % HMW HA (molecular weight – 30,000 kDa) with transverse "crosslinking" BDDE (innovative ECHATM technology) and 20 % "uncluttered" linear HA (molecular weight – 1500 kDa). This product is characterized by favorable rheological parameters, which guarantee a long-term improvement in the biomechanics of the affected joint and a rapid onset of biological effects, reduction in pain and inflammation and activation of the synthesis of natural hyaluronate.

Iatrogenic Sciatic Nerve Injury in Posterior Acetabular Surgery: Surgeon More Predictive Than Position.

To identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher-Langenbeck approach and to evaluate if variation among individual surgeons exists. Retrospective cohort. Level I trauma center. Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022. The prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and the presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high-volume (>1 patient/month) and low-volume surgeons. A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39 years, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% confidence interval [CI], 1.9%-4.9%) and lateral (3.3%, 95% CI, 1.3%-8.1%) positions (P = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for positions (odds ratio 1.0, 95% CI, 0.3-3.9). Transverse fracture pattern was associated with increased palsy risk (odds ratio 3.0, 95% CI, 1.1-7.9). Individual surgeon was significantly associated with iatrogenic palsy (P < 0.02). Surgeon and the presence of a transverse fracture line predicted iatrogenic nerve palsy after a posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the Kocher-Langenbeck approach for acetabular fixation in the position they deem most appropriate, as the position was not associated with the rate of iatrogenic palsy in this series. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intracapsular neck of femur fractures secondary to civilian gunshot injuries: an inter- and intra-observer agreement study on classification and treatment using the AO/OTA classification

PurposeNumerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures.Patients and methodsEighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10–12 weeks later by the same 18 reviewers to test intra-observer reliability.ResultsThe Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment.ConclusionThe AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.

Concentrations of Bioelements (Zn, Cu, Fe, Cr, Mg, Mn) in Serum and Bone Tissue of Aging Men Undergoing Hip Arthroplasty: Implications for Erectile Dysfunction.

Background: Erectile dysfunction (ED) stands out as one of the most prevalent sexual disorders in men, with its incidence progressively escalating with age. As delineated by the International Consultation Committee for Sexual Medicine on Definitions/Epidemiology/Risk Factors for Sexual Dysfunction, the prevalence of ED among men under 40 years is estimated to be within the range of 1-10%. The aim of this study was to determine the relationship between the concentration of bioelements (Zn, Cu, Fe, Cr, Mg, and Mn) in the serum and bone tissue and the concentration of selected hormones in men with and without erectile dysfunction. Materials and methods: The retrospective cohort study included 152 men who underwent total hip arthroplasty for hip osteoarthritis at the Department of Orthopaedic Traumatology and Musculoskeletal Oncology at the Pomeranian Medical University in Szczecin. Certain exclusion criteria were applied to ensure the integrity of the study. These included individuals with diabetes, a history of cancer, alcohol abuse, liver or kidney failure, New York Heart Association (NYHA) class III or IV heart failure, and those taking medications that affect bone metabolism, such as mineral supplements, neuroleptics, chemotherapeutic agents, immunosuppressants, corticosteroids, or antidepressants. Patients with hypogonadism or infertility were excluded from the study. Results: The study showed an association between bioT concentrations and Cu concentrations in both patients with and without erectile dysfunction. A correlation between bioactive testosterone and Cr concentrations was also observed in both groups. Patients with erectile dysfunction showed a relationship between bioT concentration and Zn concentration, TT concentration and Mn concentration, FT concentration and Zn concentration, and E2 concentration and Cr concentration. An analysis of elemental concentrations in bone tissue showed an association between FT and Mg and Mn concentrations, but only in patients with erectile dysfunction. In patients without erectile dysfunction, a correlation was observed between FT and Cu concentrations. A correlation was also observed between bioT concentrations and Mg, Mn, and Zn concentrations, but only in patients with erectile dysfunction. In patients without erectile dysfunction, a correlation was observed between bioT and Cu concentrations. Conclusions: Studying the relationship between the concentration of bioelements (Zn, Cu, Fe, Cr, Mg, and Mn) in the serum and bone tissue and the concentration of selected hormones in men may be important in explaining the etiology of the problem. The study of the concentration of Zn and Cu in bone tissue and serum showed that these two elements, regardless of the place of accumulation, may be related to the concentration of androgens in men.

Anxiety and Depressive Symptoms in Moroccan Patients Following Major Lower Limb Amputation: A Three-Month Follow-Up.

Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression symptoms changed during the three months following the amputation. A prospective longitudinal observational study was conducted between October 1, 2019, and January 1, 2021, in the Department of Vascular Surgery and the Department of Orthopedic Traumatology of the Ibn Sina Hospital Center in Rabat, Morocco. The study assessessymptoms of anxiety and depression in patients who have undergone a major lower limb amputation over a three-month interval. In patients who had undergone a major lower limb amputation, the prevalence of anxiety and depression symptoms was very high immediately postoperatively (47.4% and 79.2%, respectively), with a significant decrease in these symptoms. Three months later, anxiety was reported in 24.4% of cases, and depressive symptoms in 65.1% of cases. Age, amputation level, stump pain, phantom limb pain, re-amputation, and emergency amputation were all associated with an increased risk of anxiety and depression. The patient's psychological preparation prior to the amputation, the anesthetic technique used during the procedure, the patient's mobility, and the patient's post-amputation professional status were all protective factors. Our research findings bolster the necessity of promptly evaluating and managing anxiety and depression in the initial three months following major lower limb amputation. Thus, we believe that amputee patients ought to receive a formal psychological evaluation, which could be helpful, particularly for those whose anxiety or depression symptoms did not improve after three months.

The Russian Version of the Michigan Hand Outcomes Questionnaire: Cross-Cultural Adaptation and Validation

Background. The Michigan Hand Outcomes Questionnaire (MHQ) is one of the most commonly used specialized scales to assess function, pain, aesthetic component, and overall patient satisfaction with their hands and wrists. However, to date, the scale has not been validated into Russian.&#x0D; Aim of the study — validation and cross-cultural adaptation of the Russian-language version of the questionnaire for patients with hand diseases MHQ.&#x0D; Methods. Validation and cultural adaptation were carried out in several stages: forward translation, back translation, formation of a preliminary version, pilot testing (pretesting), formation of the final version, with the help of which 50 patients were interviewed, of which 29 men (58%) and 21 women ( 42%), whose average age was 52.72 (25–84) years. Next, the psychometric properties of the questionnaire were assessed: validity, ceiling and floor effects, internal consistency (Cronbach’s α), reproducibility, completion rate. Patients completed the MHQ questionnaire upon initial visit to an orthopedic traumatologist and again the next day. Reproducibility was assessed using the intra-class correlation coefficient (ICC). Validity was assessed by studying the relationship between the results of the questionnaire under study and the results of the DASH questionnaire validated in Russia.&#x0D; Results. As part of the study, a rating scale was obtained with good psychometric properties: validity — 0.726, p0.001; Cronbach’s α 0.9, 95% CI (0.65–0.97); reproducibility — 0.92 (0.87–0.96); occupancy rate — 100%; the ceiling effect is observed in 42 questions 1–20, 22–27, 35, 37, 38, 42, 46–57, the floor effect in 13 questions — 17, 20, 28–32, 39–41, 43–45.&#x0D; Conclusions. The results of the study of the validity and retest reliability of the Russian version of the MHQ scale indicate that it is a reliable and reliable tool for assessing the function, pain, aesthetic component and overall satisfaction of patients with respect to their hands and wrists, which can be widely used by domestic researchers in practical and scientific activities.

Management, Anatomical and Functional Outcomes of Malleolar Fractures at the District Teaching Hospital of Oueme-Plateau in Benin (DTH-OP)

Introduction: Malleolar fractures are commonly treated in orthopedic traumatology. The purpose of this study was to describe the management and evaluate the anatomical and functional outcomes of these fractures. Patients and Methods: In this study, 106 patients were treated for malleolar fractures. The mean age was 41.8 years, with 70 men (66%) and 36 women (34%). Therapeutic methods were either orthopaedic (n=57; 54%) or surgical (n=49;46%). The initial anatomical results were evaluated according to Lecestre et Ramadier, criteria and the functional results were assessed using the AOFAS score. Results: Anatomical reduction was performed on 65 (61.3%) patients, of whom 28 (26.4%) were treated orthopedically and 37 (34.9%) underwent osteosynthesis. At the last follow-up, of the 79 patients (74.5%) reviewed, 41 (51.9%) had excellent functional results and 17 had good results. Conclusion: At DTH-OP, malleolar fractures are relatively common. The treatment is either orthopedic or surgical depending on the type of fracture and the patient's financial ability to bear the costs.