Orthopaedic Traumatology Research Articles

Method to obtain PRP and L-PRP for the use in routine medical practice of orthopedic traumatologist

The paper presents the results of experimental study of two methods for blood processing to obtain platelet-rich plasma (PRP). Due to the widespread clinical use of platelet-rich plasma in orthopedics and traumatology, a differential approach to the use of PRP and leukocyte- and platelet-rich plasma (L-PRP) has become relevant. Most commercial kits for PRP preparation significantly increase the cost of treatment. In addition, the main attention is focused on the concentration of platelets in the final product and the marketing features of a particular kit (separating gel, tube shape, anticoagulant, activator, etc.). The role of leukocytes in the features of the regenerative effect of platelet-rich plasma stays out of focus. The blood of volunteers was processed in two different ways and the cellular composition of the obtained products was analyzed. Sample No. 1 was used as a control for the baseline blood cell composition. Sample No. 2 was centrifuged in a sterile plastic tube, platelet rich plasma was collected manually. Sample No. 3 was centrifuged in a sterile modified syringe, platelet rich plasma was collected using a closed technique by means of connectors together with a rich layer. The results of statistical analysis showed that there were obtained totally different biological products with different concentrations of platelets and leukocytes. The first sample (control) had platelet concentration of (228.69 ± 39.15) × 109/l and leukocyte concentration of (5.18 ± 1.32) × 109/l. In the second sample (tube + manual sampling), platelet concentration was (429.38 ± 79.92) × 109/l and leukocyte concentration — (0.85 ± 0.34) × 109/l. The third sample (syringe plunger + closed vacuum collection) had platelet concentration of (541.15 ± 85.49) × 109/l and leukocytes of (6.56±1.92)×109/l. The data are given without regard to –12.5% deviation on dilution with citrate dextrose. As the result of the work, orthopedic traumatologists can use the simplest non-commercial methods for obtaining PRP and L-PRP in their practice depending on nosology and clinical tasks.

Случай огнестрельного ранения нижней трети левого предплечья у ребенка 9 лет из охотничьего ружья. Ампутация или реконструкция?

The article presents and describes a clinical case of a gunshot wound of the left forearm of a 9-year-old child — a rare case in the practice of traumatologists and pediatric surgeons in peacetime, which occurred during hunting. The child had an open multi-splintered fracture of the lower third of both bones of the left forearm with damage and defect of the radial and ulnar artery, radial, ulnar and median nerves, damage and defect of over 15 cm of the extensor tendons of the left hand and fingers, soft tissue defect and the presence of foreign objects. There was no blood supply, movement and sensitivity on the left hand. Radiographs of the left forearm and hand in front and lateral projections revealed multi-splintered fractures of the lower third of both bones of the left forearm with the presence of foreign objects (pellet). There was a question of reconstruction or amputation of the forearm. Collectively, at a consultation of doctors consisting of: an orthopedic traumatologist, an angiosurgeon, a neurosurgeon, a pediatric surgeon and a pediatric anesthesiologist-resuscitator, it was decided to reconstruct the forearm. Primary surgical treatment of a gunshot wound, restoration of the radial and ulnar arteries, radial median and ulnar nerves were performed; extra-focal osteosynthesis of the left forearm was performed according to G.A. Ilizarov technique. One month after cleansing the wound and the formation of granulations, free autodermoplasty with a full-layer skin flap was performed. An objective examination 4 months after the dismantling of the Ilizarov apparatus revealed that the limb was warm, moderate swelling of the hand remained, and tactile and motor sensitivity were registered. With extensive defects of the soft tissues, vessels and nerves of the limb with gunshot wounds, it is necessary to involve an orthopedic traumatologist, an angiosurgeon, a neurosurgeon, a combustiologist, an anesthesiologist, a plastic surgeon and a medical psychologist.

Functional Outcome of Monorail Fixator as a Primary and Definitive Mode of Fixation in Open Fractures of Tibia- An Interventional Study

Introduction: Open fractures of the tibia are associated with massive soft tissue injury and bone loss with high rates of infection and non union resulting in poor treatment outcome. The treatment goals include prevention of infection, soft tissue coverage, and fracture stabilisation with simultaneous mobilisation of nearby joints, enabling early return to function. The management in open fractures continues to be a topic of debate in orthopaedic traumatology with various treatment options, having their own set of complications. Aim: To assess the functional outcome of open tibial fractures with a monorail fixator using Radiographic Union Scale in Tibial fracture (RUST) score and modified Johner and Wruh’s criteria. Materials and Methods: This prospective interventional study of 30 cases was conducted from November 2018-October 2020 in Government Medical College, Patiala, Punjab, India. The patients of open tibial fractures of type 2, type 3A, 3B (male=27, female=3) as classified by Gustilo-Anderson were included in this study. Patients were operated for monorail system to assess the stability of monorail fixator, total time taken in fracture union and compliance with range of motion of joints. On follow-up patients were also assessed for pin track infection and postoperative surgical site infection by taking swab for culture and antibiotic sensitivity. Statistical analysis was performed using the statistical software Statistical Package for the Social Sciences (SPSS) 25.0 (SPSS 25.0). In this study, quantitative data was expressed as mean values with Standard Deviation (SD) and categorical data were expressed as frequencies with percentages. Results: Present study had shown excellent to good results in 27 cases (90%) with minimum surgery time of 52.17±14.24 minutes. Full weight bearing with fixator was allowed in 5.37 days and fracture union occurred at 31.8±5.8 weeks. RUST score of 2 was seen in 33.33% and score 3 in 63.33% of patients respectively. Only one patient (3.33%) had shown score 1, which was treated with removal of fixator, debridement, sequestrectromy and fracture fixation with ring fixator and bone grafting. The bacteriology positivity was seen in six cases (n=2 was positive for Escherichia coli and n=4 was positive for Staphylococcus aureus). Conclusion: Present study demonstrated the benefits of monorail fixator as a primary and definitive mode of fixation in open tibial fractures with early full weight bearing over a stable construct and minimal complications.

Medical expert evaluation of medical care for patients with musculoskeletal injuries

The objective of the study is to analyze 220 forensic medical examinations on criminal and civil cases and pre-investigation checks concerning the quality of emergency trauma care, involving an orthopedic traumatologist as a member of the expert panel. The main aspects of the forensic evaluation of medical care for patients with musculoskeletal injuries are described, including a thorough review of medical documentation data, completeness of past and present medical history in the medical records, injury mechanism, and completeness of the trauma course description in the medical records. The reasons for the forensic examinations, the causes of the main types of defects in medical care, and their relation to adverse outcomes were determined.

Региональные особенности обеспеченности врачебными кадрами в области травматологии и ортопедии в Казахстане

The purpose of the study: to assess the degree of availability of medical personnel in the field of traumatology and orthopedics in Kazakhstan.Methods. In this work, an analysis was made of the number of orthopedic traumatologists in Kazakhstan for 2019-2020. A comparative analysis of the indicators of the number and traumatologists-orthopedists by region was carried out.Results. A low availability of orthopedic traumatologists was revealed in a number of regions of Kazakhstan: in 2020, in Atyrau, Mangystau regions and in the West Kazakhstan region, the number of orthopedic traumatologists was 0.3 per 10 thousand of the population. In the Kyzylorda region, this indicator was 0.4 per 10 thousand people. The highest rates of the number of traumatologists-orthopedists are observed in the cities of Almaty and Nur-Sultan.Conclusion.There is a significant uneven distribution of specialists in the field of traumatology and orthopedics in the regions of Kazakhstan. To address the issue of lack and uneven distribution of human resources in the field of traumatology and orthopedics, it is necessary to improve the system of training, distribution and remuneration of traumatologists-orthopedists in Kazakhstan.Keywords: medical personnel, traumatologists-orthopedists, healthcare system, availability of human resources.

Prevention of adverse events following the use of local anesthetics in traumatology and orthopedics

The article analyzes the frequency of development of adverse toxic reactions when using local anesthetics in the practice of an orthopedic traumatologist; based on the conclusions of commission forensic medical examinations conducted in the framework of criminal proceedings on the death of patients, the features of the onset of LAST syndrome are studied, which significantly increases the medical risk for the patient and the legal risk for the doctor. An analytical study of scientific publications on the possibilities of using the local anesthetic Articaine-Binergia 20 mg/ml in the daily work of both polyclinic and inpatient doctors to ensure the safety of medical activities was conducted.

Tibial pilon fracture treatment with staged open reduction and internal fixation with LCP versus primary hybrid fixation: A randomized prospective study

Introduction: Distal tibial fractures remain one of the most substantial therapeutic challenges for orthopedic traumatology. Despite the advances that have been made in management, these fractures can be challenging to deal with, especially when associated with significant soft-tissue injury. Treatment of pilon fractures ranges from nonoperative to various operative options. Among operative, the two most controversial methods include the Staged procedure using open reduction internal fixation and using a primary hybrid fixator. Objective: This study aims to compare the outcomes of tibial pilon fracture treatment with staged open reduction and internal fixation with LCP and primary hybrid fixation and evaluate its results. Material & Methods: This Prospective Randomized comparative study was done in a tertiary level health care center. The patients were included in the study after fulfilling inclusion and exclusion criteria. The patients were then randomized in either of the two groups and treated accordingly by a single orthopaedic surgeon to avoid the bias. Follow-up was done after 3 weeks and then reviewed every one month up to 6 months. At 6 months IOWA score was assessed. Fracture union was assessed based on clinical and radiographic criteria. Clinically the ability to fully weight bear with no pain at the fracture was considered to represent the clinical union. Results: According to the IOWA ankle score, 32% in group A and 40% in group B had an excellent results, 40% in group A and 52% in group B had a good results, 20% in group A and 8% in group B had a fair result and 8% had a poor result in group A due to deep infections (osteomyelitis) in bone. The mean IOWA Ankle Score at the Final follow-up in Group A was 82.64±10.27 and of Group B was 86.96±5.07, which was non-significant. In terms of functional results, the excellent result was observed in 8 patients in Group A and 10 in Group B. Conclusion: The management of pilon fracture with both of them procedure were equally effective, but aims was to reduce surgical tissue trauma, deep infection and preservation of periosteal vascular integrity and osteogenic fracture haematoma all cause early union, which was much more possible by hybrid fixator group.

Clavicle Dislocations in Family Physians Practice

Dislocations of the clavicle are one of the most common injuries in people of different age groups, which require prompt diagnosis and timely treatment to prevent the development of complications, therefore, acknowledgment of general practitioners-family doctors in diagnosis and medical care for patients with dislocations of the clavicle is a necessary component of the professional competence. Aim: to provide up-to-date information for distance self-learning of general practitioners – family doctors on the diagnosis and treatment of clavicle dislocations and conduct a test assessment of the acquired knowledge. Materials and methods. The analysis of scientific and methodological medical literature and clinical cases from the practice of orthopedic traumatologists, concerning anatomy, classification, mechanisms of development, diagnosis, clinical picture, conservative and principles of surgical treatment of patients with dislocated clavicle is given in the article. Results. A team of authors – orthopedic traumatologists – presented a review of the literature data and clinical cases of dislocation of the clavicle, on the basis of which educational material was formed for distance self-learning of the general practitioners – family doctors. The modern data on the mechanisms of development of dislocation of the clavicle, classification, clinical picture, depending on the type of dislocation are presented; recommendations for conservative treatment and indications for surgical intervention are given. Tests for self-control of knowledge after studying the presented material are given. Conclusions. Knowledge of the management of patients with clavicle dislocation is a necessary component of the formation of professional competencies of a general practitioner – family doctor. The presented article for distance learning provides all the necessary up-to-date information to provide such knowledge.

The problem of osteoporotic fractures of the femur in children with cerebral palsy

The problem of osteoporotic fractures of the femur in children with cerebral palsy

Marika Daniilidou, MD. The First Female Orthopaedic Surgeon in Greece.

Dr Marika Daniilidou was born in 1902 in Asia Minor. Her family was forced to immigrate to Greece, in 1922. Despite the horrendous difficulties of the era, she pursued undergraduate and postgraduate studies in the University of Berlin, Germany, and she specialized in orthopaedic surgery. In 1937, she became the first female certified orthopaedic surgeon in Greece. In 1947, she was the only female orthopaedic surgeon among the 22 founders of the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST). She became a true role model for the next generations of Greek women surgeons.

Andrey Ivanovich Krasnov. 29.04.1947–15.11.2021

On November 15, 2021, at the age of 75, an outstanding orthopedic traumatologist, Honored Doctor of the Russian Federation, Candidate of Medical Sciences, associate professor of the Educational and Methodological Department of the FSBI "NMIC of Pediatric Traumatology and Orthopedics named after G. I. Turner" of the Ministry of Health of Russia, associate Professor of the Department of Pediatric Traumatology and Orthopedics of the I. I. Mechnikov Northwestern State Medical University of the Ministry of Health of Russia Andrey Ivanovich Krasnov passed away.

ANALYSIS OF THE COURSE OF PREGNANCY IN PATIENTS WITH PELVIC BONE FRACTURES

The different aspects of the consequences of pelvic fractures in pregnant women are of scientific and practical interest not only for orthopedic traumatologists, but also for obstetricians and gynecologists.

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Перипротезные переломы проксимального отдела бедренной кости: современные концепции

With the increasing demand for total hip arthroplasty in trauma and orthopedic departments, there is a sharp increase in periprosthetic fractures. Considering the high morbidity and mortality associated with these fractures, the orthopedic traumatologist must be prepared to address this problem. This article provides an algorithmic approach that will make it easy to classify and deliver the correct treatment.

MANAGEMENT OF FRACTURES AROUND ANKLE JOINT

Aim:To study the functional outcome and results of surgical treatment of Bimalleolar fractures of the ankle. Introduction: Malleolar fractures are one of the most common fractures in orthopaedic traumatology. Malleolar fractures necessitate accurate reduction and stable internal xation. Materials And Methods: 30 patients with fresh Bimalleolar fractures were studied. The fractures were classied based on Lauge–Hansen's classication in adults. Surgical techniques used were open reduction and internal xation of lateral malleolus with semi-tubular plate or Tension band wiring and then the medial malleolus with malleolar screws or Tension band wiring. Results: At the end of the study, excellent to good results were seen in 23(76.7%) cases, 6(20%) cases had fair results, and 1(3.3%) had unfortunate results. Conclusion: 1. Good anatomical reduction is essential for good clinical outcomes, irrespective of the type of fracture. 2.The results are satisfactory in 90% of patients treated by open reduction and internal xation.

Evaluation of the effectiveness of the use of low-traumatic surgical access in the reverse shoulder arthroplasty

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance.
 AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty.
 MATERIALS AND METHODS: In the period 20172020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months.
 RESULTS: In the main group, excellent results (25 points on DASH) were observed in 73 patients, good results (2650 points) in 10 patients. In 1 patient, the results were assessed as satisfactory (5175 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result).
 CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.

Complete Traumatic Laceration of the Sciatic Nerve Secondary to Acetabular Fracture: A Case Report

BACKGROUND Sciatic nerve injury in acetabular fractures is a rare event, with the majority of cases being transient neuropraxias. To date there are no published cases of complete traumatic sciatic nerve lacerations due to acetabular fracture with associated hip dislocation. We describe a case of such an event confirmed at the time of acetabular fracture fixation. CASE PRESENTATION The patient was a 37-year-old polytraumatized victim involved in a motor vehicle accident who presented with multiple injuries including left acetabular fracture with associated femoral head dislocation. The patient had absent function of both divisions of the sciatic nerve on initial evaluation. She was hemodynamically unstable on arrival requiring multidisciplinary intervention and transfer to the intensive care unit after temporization of her multiple system injuries. Following adequate resuscitation and improved hemodynamic status she was taken to the operating room for definitive orthopaedic fixation of her pelvis, acetabulum, and multiple long bones. Intraoperatively the sciatic nerve was identified, found to be completely lacerated. Direct repair was performed. Following discharge to a long term rehabilitation facility on post-trauma day 53 she was lost to follow up for 6 months when she presented to the emergency department for abdominal pain. Her pelvic and acetabular hardware was radiographically stable showing fracture union, and her lower extremity neurological examination was unchanged from her preoperative exam. CONCLUSION Injury to the sciatic nerve associated with pelvic and acetabular trauma is relatively rare and is most often neuropraxic. To our knowledge there is no reports in the literature on complete lacerations in this context, and there is a paucity in the literature on managing such injuries. Orthopaedic traumatologist must be aware of the possibility of this presentation in order to manage it appropriately and counsel patients accordingly.

Хирургические доступы при лечении пациентов со свежими переломами вертлужной впадины

Abstract. Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average 3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures is the combined anterior and posterior approach.

Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture.

To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches. Retrospective cohort study. Twelve Level 1 North American trauma centers. Eighty adults 18-65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation. Thirty-two modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons. Reduction quality as assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs. No difference was observed in the rate of acceptable reduction by modified Smith-Petersen (81%) versus Watson-Jones (81%) approach (risk difference null, 95% confidence interval -17.4% to 17.4%, P = 1.00) with 90.4% panel agreement (Fleiss' weighted κ = 0.63, P < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith-Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10-2.52] vs. RR = 0.87 [95% CI 0.70-1.08], P = 0.006). No difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson-Jones anterolateral approach versus a modified Smith-Petersen anterior approach was performed by orthopaedic trauma surgeons. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Expect postoperative care disruptions for orthopaedic trauma patients during the COVID-19 pandemic: a retrospective review of patient care trends

Background: With the global COVID-19 pandemic arriving in New York City (NYC) public health measures were instituted to prevent disease spread. Orthopaedic trauma continued despite the pandemic, and patients were left attempting to obtain postoperative care while the city’s focus shifted to the pandemic. The purpose of this study was to evaluate postoperative care of patients treated for orthopaedic trauma during the COVID-19 pandemic in NYC and identify areas for improvement in the event of an expected second wave. Methods: All patients who received operative care for orthopaedic trauma during the pandemic time period by two fellowship-trained orthopaedic traumatologists were identified, and their records were reviewed. Results: Forty-nine patients were included for analysis. Six patients (12%) tested positive for COVID-19. Six of 24 patients (25%) who were recommended to be discharged to inpatient rehabilitation refused. Of the 31 patients discharged home, nine patients (29%) refused in-home services. Thirteen of 31 patients (42%) reported a delay in receiving outpatient physical therapy, and five patients (16%) reported difficulty filling prescriptions. There were 1,814 scheduled visits in the orthopaedic trauma clinic from March to May 2019 with 1,126 attended visits (62%). During the pandemic there were 295 scheduled visits with 175 attended visits (59%, P=0.367). At the peak of the pandemic in April 2020 there were 58 scheduled visits with 27 attended visits (47%, P=0.017). Conclusions: Patients treated for orthopaedic trauma during the COVID-19 pandemic were at increased risk of improper discharge, delay in outpatient services, and absent follow-up, which may together pose an increased risk of adverse events. Level of Evidence: Level IV.