Post-traumatic Contracture Research Articles

Downregulation of interleukin 11 regulates the transforming growth factor-β/ERK1/2 signaling pathway to inhibit articular capsule fibrosis and alleviate post-traumatic articular capsule contracture

BackgroundPost-traumatic capsular contracture is a common complication of joint injury and surgery. Post-traumatic capsular contracture is associated with fibrosis characterized by excessive differentiation and proliferation of myofibroblasts and abnormal secretion and accumulation of extracellular matrix. Previous studies have suggested that IL11 plays a role in myocardial fibrosis. We thus hypothesized that IL11 may play a fibrotic role during capsular contracture, in order to discover new targets for preventing joint capsule contracture MethodsWe constructed a post-traumatic contracture model by excessively extending the knee joint and fixing the joint in the flexion position, and a post-traumatic joint capsule contracture model was constructed in the wild-type, IL11-/-, IL11R -/-, α-SMA-cre-IL11fl/fl, α-SMA-cre-IL11Rfl/fl mouse strain, with wild-type mice without any treatment of the knee joint as the control group. Fibrotic markers and the expression of IL11 and IL11R in knee joint tissue were detected in each group of mice. The NIH3T3 cell line was used for in vitro analyses. The expression of fibrosis markers, IL11, TGFβ and ERK1/2 were detected by western blot, ELISA and RT-qPCR. ResultsInhibition of IL11 inhibited ERK1/2 phosphorylation, reduced the secretion of collagen in the joint capsule, and inhibited the excessive differentiation and proliferation of myofibroblasts in the post-traumatic joint capsule contracture, thus alleviating the joint capsule contracture and obtaining better joint mobility. ConclusionDownregulation of IL11 in traumatic joint capsule contracture inhibits ERK1/2 phosphorylation, thus significantly relieving joint capsule contracture. Our findings indicate the TGFβ/IL11/ERK1/2 axis is an important pathway for the differentiation of fibroblasts into myofibroblasts. Anti-IL11 treatment is an effective means to prevent traumatic joint capsule contracture.

Mast Cell Involvement in the Pathogenesis of Selected Musculoskeletal Diseases.

In recent years, there has been a noteworthy revival of interest in the function of mast cells (MCs) in the human body. It is now acknowledged that MCs impact a wide array of processes beyond just allergies, leading to a shift in research direction. Unfortunately, some earlier conclusions were drawn from animal models with flawed designs, particularly centered around the receptor tyrosine kinase (Kit) pathway. Consequently, several subsequent findings may have been unreliable. Thus, what is now required is a re-examination of these earlier findings. Nevertheless, the remaining data are fascinating and hold promise for a better comprehension of numerous diseases and the development of more effective therapies. As the field continues to progress, many intriguing issues warrant further investigation and analysis. For instance, exploring the bidirectional action of MCs in rheumatoid arthritis, understanding the extent of MCs' impact on symptoms associated with Ehlers-Danlos syndrome, and unraveling the exact role of the myofibroblast-mast cell-neuropeptides axis in the joint capsule during post-traumatic contractures are all captivating areas for exploration. Hence, in this review, we summarize current knowledge regarding the influence of MCs on the pathogenesis of selected musculoskeletal diseases, including rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, gout, muscle and joint injuries, tendinopathy, heterotopic ossification, and Ehlers-Danlos syndrome. We believe that this review will provide in-depth information that can guide and inspire further research in this area.

Soft tissue reconstruction of the thumb: Classification of defects and standardisation of treatment

The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects. This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (< 3 cm), medium (4-8cm) and large defects (> 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction. After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects. Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.

Surgical Treatment of Closed Fractures of Long Bones of Extremities with Polytrauma

The purpose of the study was to improve the functional results of treatment of patients with closed fractures of long bones of the extremities with polytrauma. Materials and methods. The results of treatment of 95 patients with fractures of long bones of the extremities with polytrauma were analyzed. Among them there were 70 (73.9%) men and 25 (26.1%) women. The victims had one or more closed fractured of the long bones of the limbs. Persons of young and able-bodied age from 31 to 50 years old prevailed – 47 (48.9%) patients. Results and discussion. Active restorative treatment was started on the second and third days after the operation at the beginning of passive movements in the joints then, as the postoperative wound healed, on the sixth and seventh days, it was active. Depending on the nature of the fractures various implants were used, in most cases, low-contract ones, which in a particular case allow achieving maximum anatomical reposition and achieving stable fixation of fragments, which provides the possibility of an early start in the development of the joint. In the immediate postoperative period in 11 patients with open fracture type B3, superficial suppuration of the soft tissues around the pins was noted, which was easily dealt with using a device for injecting drugs into the infected pin channel. Four patients with granulating wounds of the lower leg underwent autodermoplasty with a free skin graft, all 100% were healed. Phlebothrombosis developed in three patients with hip fractures: they underwent an urgent operation by angiosurgeons – vessel plexization. Long term results of treatment in terms of 8 months to 5 years were studied in 76 patients. Treatment outcomes were assessed with some criteria (union, neuro vascular disorder, varus or valgus, rotation, shortening of the limb, movement in the knee and hip joint, pain, walking hanging activity). Four patients developed chronic osteomyelitis, they underwent seguestrectomy with sub segment recovery. Delayed consolidation was noted in six patients with complex fractures (type C). Two patients developed a defect in the bones of the lower leg up to 5 sm, they subsequently underwent lengthening of the segment. Post-traumatic contracture was noted in four patients. Three patients had persistent leg edema, chronic post-traumatic thrombophletitis, equinus deformity of the feet, significant chromate – the result was rated as “poor”. According to the results of ratings as “excellent”, “good”, “satisfactory” and “poor”, quantitative designations were assigned as 5, 4, 3, 2 points, respectively. In the 76 patients studied, the long-term results were assessed as follows: in 24 (31.6%) patients the result was regarded as excellent (5 points), in 37 (48.7%) patients it was good (4 points), in 12 (15.8%) %) – satisfactory (3 points), in 3 (3.4%) – poor (2 points). Conclusion. As a result of the use of low-contact on-bone plates in the osteosynthesis of complex comminuted fractures of long bones, with combined injuries, 90.3% gave excellent and good functional results. With a combined chest injury, intramedullary osteosynthesis with a pin with reaming is contraindicated, due to the risk of developing fat embolism. In these patients, it is necessary to operate with bone plates

Comparative analysis of osteopathic correction and standard comprehensive rehabilitation of patients with posttraumatic contractures of the upper limb joints

Introduction. Prolonged immobilization of the upper limb after various injuries leads to persistent contracture. Contractures of the upper limb joints are a severe orthopedic pathology that leads to a long-term decrease in working capacity and permanent disability. In the absence of treatment, the persistent changes in the articular elements can develop. Patients with contractures of the upper limb joints get treatment for a long time in polyclinics and hospitals, but the treatment does not always lead to the desired results. At the same time, an essential condition for treatment in outpatient medical institutions is the possibility of daily self-care and independent movement of the patient, as well as daily visits to a medical institution, but it is not always possible. In this regard, the search for treatment methods with comparable effectiveness, but requiring a signifi cantly smaller number of medical procedures and, accordingly, visits to specialized institutions, is relevant. Osteopathic correction could potentially be among these methods.The aim of the study is to compare the effectiveness of osteopathic correction and standard complex rehabilitation of patients with post-traumatic contractures of the upper limb joints.Materials and methods. The study involved 40 patients suffering from post-traumatic contractures of the upper extremities. Two groups were formed by the method of simple randomization: the main group (20 people who received osteopathic correction — 3 sessions with a frequency of 1 time in 7 days), and the control group (20 people who received standard complex rehabilitation, which included physiotherapy, physiotherapy exercises and mechanotherapy, daily for 10 days). The osteopathic status, the motion range of the upper limbs joints, and the hand muscles strength were assessed in all patients at the beginning and at the end of the study.Results. A statistically signifi cant (p<0,05) increase in the motion range and the hand muscles strength was found in both groups at the end of the study. In patients of the main group, receiving osteopathic correction, a statistically signifi cant decrease (p<0,05) in the detection frequency of some regional and local somatic dysfunctions was observed.Conclusion. The obtained results indicate the comparable results of the osteopathic correction of the upper limb joints post-traumatic contractures, and of the standard complex rehabilitation. Since osteopathic correction of post-traumatic contractures is carried out once every 7–10 days, it can be recommended for patients who, for various reasons, cannot regularly visit outpatient rehabilitation departments for a long time.

Pre-expanded muscle-sparing Latissimus Dorsi free flap: An ideal option for the reconstruction of extensive anterior knee contractures

Extensive and complex contractures in the anterior knee area can pose a significant challenge for reconstruction due to insufficient skin and soft tissue coverage and poor cosmetic and functional outcomes using traditional methods. We presented our experience with pre-expanded muscle-sparing latissimus dorsi (LD) free flap as an alternative option for large-scale anterior knee reconstruction. From January 2016 to December 2020, we applied this surgical technique in six patients with large postburn or post-traumatic contractures of the anterior knee. After tissue expansion of several months, the expanded muscle-sparing LD free flap was harvested and transferred to resurface the lesions. Operative procedures, postoperative complications, and long-term outcomes were evaluated. A total of six patients aged 7 to 32 years (mean: 20 years) were reconstructed successfully without any major complication. The flap ranged from 20×8cm to 40×16cm. All donor sites were primarily closed. Follow-up (range: 12 to 24 months) evaluation showed satisfactory results in both cosmetic and functional aspects. Pre-expanded muscle-sparing LD free flap is a reliable and effective choice for extensive anterior knee contracture reconstruction with satisfactory esthetic and functional outcome. It can provide substantial amount of soft tissue coverage with minimal complications and donor-site morbidity. Furthermore, it offers a good basis for next-step orthopedic surgery, such as total knee arthroplasty (TKA).

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

Physical treatment of posttraumatic elbow contractures in children – our experience

The most common complications of elbow trauma are contractures and neurovascular injuries. The complications can be a result of the initial injury, but they can also be a result of a surgical treatment. In addition to orthopedic treatment of elbow fractures, physical therapy and rehabilitation play a significant role in treatment of posttraumatic contractures. To determine the effects of physical therapy and rehabilitation of posttraumatic elbow contractures in children. This was a retrospective cross-sectional study conducted in the University Clinic for Physical Medicine and Rehabilitation, Skopje in the period 01.01.2021 – 01.07.2022. A total of 52 children were included, at the age between 2 and 13 years who had a posttraumatic elbow contracture, limited range of motion, pain and/or limitations in accomplishing daily activities. Depending on the clinical finding, children underwent a relevant physical therapy (kinesitherapy, functional therapy, electrotherapy, thermotherapy, hydrotherapy and magnetotherapy) in duration of three weeks. For assessing the effects of the rehabilitation therapy, the range of motion of the elbow and forearm was examined along with the Flynn’s scale in all children, prior to and after completion of the physical treatment. Applied physical treatment resulted in a significant improvement in all analyzed movements such as: elbow flexion (p=0.00001), elbow extension (p=0.00001), forearm pronation (p=0.00001), forearm supination (p=0.0000) and Flynn’s scale (p=0.0000). After completion of the rehabilitation treatment, excellent results were registered in 41 (85%) children, moderate in 10 (19.23%) and favorable in 1 (1.92%). Timely and adequate application of physical therapy and rehabilitation can significantly improve the final outcome in treatment of posttraumatic elbow contractures in children. A combination of different physical procedures adequately applied and personalized can significantly improve the range of motion of the elbow.

Surgical repair of post-traumatic finger contracture in a child

To present the experience of management of the digital flexion contractures. We present a case of 5 yrs old boy child, Patient with post-traumatic contracture of Ring finger of left hand last 3 months. Multiple continuous Z-plasty performed to correct deformity. Careful assessment and early prompt correction results in return of normal hand function. Early treatment of contractures with Z-plasty results in the improvement of finger mobility.

Pleiotropic Effects of Simvastatin and Losartan in Preclinical Models of Post-Traumatic Elbow Contracture.

Elbow trauma can lead to post-traumatic joint contracture (PTJC), which is characterized by loss of motion associated with capsule/ligament fibrosis and cartilage damage. Unfortunately, current therapies are often unsuccessful or cause complications. This study aimed to determine the effects of prophylactically administered simvastatin (SV) and losartan (LS) in two preclinical models of elbow PTJC: an in vivo elbow-specific rat injury model and an in vitro collagen gel contraction assay. The in vivo elbow rat (n = 3–10/group) injury model evaluated the effects of orally administered SV and LS at two dosing strategies [i.e., low dose/high frequency/short duration (D1) vs. high dose/low frequency/long duration (D2)] on post-mortem elbow range of motion (via biomechanical testing) as well as capsule fibrosis and cartilage damage (via histopathology). The in vitro gel contraction assay coupled with live/dead staining (n = 3–19/group) evaluated the effects of SV and LS at various concentrations (i.e., 1, 10, 100 µM) and durations (i.e., continuous, short, or delayed) on the contractibility and viability of fibroblasts/myofibroblasts [i.e., NIH3T3 fibroblasts with endogenous transforming growth factor-beta 1 (TGFβ1)]. In vivo, no drug strategy prevented elbow contracture biomechanically. Histologically, only SV-D2 modestly reduced capsule fibrosis but maintained elevated cellularity and tissue hypertrophy, and both SV strategies lessened cartilage damage. SV modest benefits were localized to the anterior region, not the posterior, of the joint. Neither LS strategy had meaningful benefits in capsule nor cartilage. In vitro, irrespective of the presence of TGFβ1, SV (≥10 μM) prevented gel contraction partly by decreasing cell viability (100 μM). In contrast, LS did not prevent gel contraction or affect cell viability. This study demonstrates that SV, but not LS, might be suitable prophylactic drug therapy in two preclinical models of elbow PTJC. Results provide initial insight to guide future preclinical studies aimed at preventing or mitigating elbow PTJC.

Treatment of posttraumatic contractures of the proximal interphalangeal joints in the fingers

Post-traumatic contractures of the proximal interphalangeal joint are a common problem. They arise as a result of a violation of the delicate balance between the bone and soft tissue structures of the joint. The treatment of this pathology is complicated and leads to full function restoration only in 36% of patients.
 The literature review presents the analysis of domestic and foreign scientific literature devoted to the treatment of post-traumatic contracture of the finger joints. The purpose is to systematize the methods and, subsequently, derive a unified approach to the treatment of this pathology.
 In total, 67 papers were collected in foreign and domestic scientific databases, in English and Russian language, in the period limited to December, 2021. They describe 8 extended treatment methods, both conservative and surgical. The non-surgical methods include physiotherapy, the use of various types of fixatives, injections of hyaluronic acid preparations and platelet-rich plasma, followed by exercise therapy. The surgical methods are represented by arthrodesis, arthroplasty, arthrolysis and joint distraction using an external fixation device. The techniques are described in the order of increasing effectiveness, each of them is used with varying success and cannot be considered as a gold standard treatment for this pathology. In the studied literature, the possible combination of the techniques was not mentioned, thought it could be possible, if we consider the pathogenetic mechanisms of the development of contractures, and may provide better treatment results.

Сучасні хірургічні методи лікування постраждалих з вогнепальними пораненнями кінцівок

Подано можливості етапного лікування вогнепальних ран у 254 пацієнтів з використанням терапії негативним тиском, ультразвукової кавітації і мікробіологічного дослідження ранового вмісту. Розглянуто підходи в комплексному лікуванні на підставі бактеріологічних властивостей вогнепальних поранень. Аналіз результатів лікування показав, що метод комплексного лікування вогнепальних ран м’яких тканин кінцівок з використанням апарату вакуумної аспірації, ультразвукової кавітації для очищення ран, збагаченої тромбоцитами плазми, для локальної стимуляції репаративних процесів дає можливість скоротити тривалість лікування до 8,0 ± 2,8 дня, знизити кількість ускладнень на 30,0 ± 1,2 %, що дозволяє рекомендувати цей метод лікування даної патології.

Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess

PurposeTo generate an evidence-based opioid-prescribing guideline by assessing the pattern of total opioid consumption and the factors that may predict opioid consumption following arthroscopic release of elbow contracture and to investigate whether the use of continuous passive motion (CPM), as compared to physical therapy (PT), was associated with a decrease in pain and opioid consumption after arthroscopic release of elbow contracture.MethodsData collected from a randomized controlled trial that compared continuous passive motion (CPM) (n = 24) to physical therapy (PT) (n = 27) following arthroscopic release of elbow contracture was analyzed for opioid use. Fifty-one participants recorded their daily opioid consumption in a postoperative diary for 90 days. Multivariate analysis was performed to identify factors associated with opioid use. Recommended quantities for postoperative prescription were generated using the 50th percentile for patients without and the 75th percentile for patients with factors associated with higher opioid use.ResultsThe median total opioid prescription was 437.5-mg morphine milligram equivalents (MMEs) (58 pills of 5 mg oxycodone) and the median total opioid consumption was 75 MMEs (10 pills of 5-mg oxycodone). Twenty-two percent of patients took no opioid medication, 53% took ≤10 pills, 69% took ≤20 pills and 75% took ≤30 pills. Predictors of higher opioid use were preoperative opioid use, age <60 years and inflammatory arthritis. The total opioid consumption appeared similar between the CPM and the PT group. Seventy-five percent of patient’s home opioid requirements would be satisfied using the following guideline: Patients undergoing contracture release for osteoarthritis or post-traumatic contracture should be given a prescription for 10 pills of 5 mg oxycodone or its equivalent at discharge. Patients with inflammatory conditions or those taking preoperative opioids should be prescribed 30 pills of 5 mg oxycodone or its equivalent.ConclusionThis study suggests that most patients undergoing arthroscopic release of elbow contracture use relatively few opioid pills after surgery. Use of an evidence-based guideline could decrease opioid prescriptions substantially, while still effectively treating patients’ pain.

Особливості відновлення м’язів за умов експериментальної післятравматичної контрактури

The frequency of traumatic injuries of the maxillofacial area and the degree of their severity, have been increasing in recent years. The introduction of modern methods of treatment made it possible to improve the results of treatment and shorten its duration. Myogenic contractures develop as a complication after facial injuries, soft tissue injuries, in particular, masticatory muscles. The gastrocnemius muscle of a rat has the same striated structure as the pterygoideus medialis muscle of a person. The purpose of the work is to study the regeneration of striatal muscles with post-traumatic contractures on the basis of combined treatment of laboratory rats. Materials and methods. The study was carried out on 45 sexually mature 12 months old outbred white male rats, which weighed 180-200 g. In animals, reflex post-traumatic muscle contractures (traumatic myositis) resulting from the slaughter of calf muscles (without violating the integrity of muscle tissue) were simulated on the posterior left leg. The rats were divided into two groups. Group 1 included 21 animals that did not receive treatment and whose wounds healed by secondary intention. Group 2 included 24 rats that received combined treatment: on the 2nd day after surgery – general (oral) administration of the drug with the active substance cyclobenzaprine hydrochloride – 0.15 mg, once a day with daily procedures of magnetic laser therapy on the affected hind limb. Results and discussion. Depending on the signs of pain behavior (changes in behavior, restriction of movement, increased sensitivity, pain), the intensity of myogenic pain syndrome was assessed (low, moderate, high, very high). It was found that the use of combined treatment (magnetic laser therapy and the use of cyclobenzaprine hydrochloride) led to the normalization of behavioral and motor reactions by the 28th day: 56% of rats didn’t feel any pain and 44% had a low level of pain. The animals with the same trauma, which weren’t treated, showed a high and moderate level of pain. On the 28th day these animals could lean on their hind limbs while they were moving. However, they could not fully move due to a sharp restriction of their left hind limb function. The obtained results are the basis for the development of new approaches to improving the methods of prevention and rehabilitation treatment of contractures using magnetic laser therapy and central muscle relaxants. Conclusion. It was found that the use of magnetic laser therapy and cyclobenzaprine hydrochloride inhibited the development of an acute inflammatory reaction in the damaged muscle tissue of the hind limb of animals, accelerated and optimized reparative processes, which prevented excessive, functionally significant growth of connective tissue

Экспериментальное исследование механических свойств ахиллова сухожилия кроликов в процессе его восстановления после травмы

Актуальность. Проблема лечения больных с повреждениями сухожилий остается нерешенной. Неудовлетворительные результаты после хирургического лечения, по данным разных авторов, составляют от 15 до 62 %. Функциональный результат после хирургического восстановления поврежденных сухожилий трудно прогнозировать из-за высокого риска образования рубцового блока, препятствующего их свободному скольжению. Спайки нарушают растяжимость сухожилий, что, в свою очередь, сказывается на их прочности. Цель: исследовать в эксперименте прочностные свойства ахилловых сухожилий после их хирургического восстановления с дальнейшим использованием различных медикаментозных препаратов. Материалы и методы. Проведены исследования механических свойств ахилловых сухожилий кроликов, на которых была создана модель их частичного повреждения путем пересечения на 1/2 диаметра. Травмированное сухожилие ушивалось сухожильным швом. В ходе эксперимента изучали 5 групп препаратов ахилловых сухожилий кроликов с пяточной костью по 3 препарата в каждой группе. 1-я группа — контрольная. После выполнения сухожильного шва рану ушивали. Во 2-й группе животным вокруг сухожильного шва вводили препарат нолтрекс. В 3-й группе вводили препарат гиалуроновой кислоты, в 4-й — препарат лидазы. 5-я группа — норма, препараты неоперированных ахилловых сухожилий интактных животных. Все животные были выведены из эксперимента на 60-е сутки. По результатам испытаний рассчитывали величину модуля упругости и предел прочности препарата. Результаты. Наибольшее удлинение под действием растягивающей нагрузки величиной 30 Н было достигнуто на препаратах неоперированных ахилловых сухожилий кроликов — 2,96 ± 0,22 мм. Наименьшая величина удлинения была получена на препаратах контрольной группы — 0,83 ± 0,37 мм. Остальные группы препаратов показали промежуточные значения. Наибольшим значением модуля упругости обладают препараты ахиллова сухожилия кроликов контрольной группы — 0,216 ± 0,123 МПа. Наименьшее значение модуля упругости выявлено при изучении нетравмированных препаратов ахиллова сухожилия — 0,051 ± 0,004 МПа. Наибольшей прочностью обладали препараты контрольной группы (величина предельно допустимой нагрузки 81,81 ± 0,34 Н). Наименьшую прочность продемонстрировали препараты нетравмированных ахилловых сухожилий кроликов (величина предельно допустимой нагрузки 69,72 ± 0,18 Н). Выводы. В процессе восстановления ахиллова сухожилия кроликов после травмы наблюдается увеличение значений показателей, характеризующих прочностные свойства тканей, — модуля упругости, предельно допустимой нагрузки и предела прочности. Величина показателей, характеризующих пластические свойства тканей, уменьшается, что может стать одной из причин развития посттравматических контрактур. Наилучшие показатели с точки зрения пластичности тканей наблюдались в группе препаратов ахиллова сухожилия кроликов, леченных с помощью гиалуроновой кислоты. Наихудшие — в контрольной группе.

Surgical Treatment of Persistent Contractures of the Interphalangeal Joints of the Fingers

Summary. Relevance. The treatment of the consequences of intraarticular injuries of fingers is still one of the problems that requires further solution. Objective: to improve the results of surgical treatment of post-traumatic persistent contractures of the interphalangeal joints of the fingers. Materials and Methods. To analyze the effectiveness of the proposed treatment approach The results of treatment of 77 patients with post-traumatic contractures of the joints of the fingers, distributed into clinical groups and subgroups, depending on the severity of the injuries and the type of applied clinical rehabilitation program, were analyzed. Patients of the main groups were treated according to the proposed clinical rehabilitation program, indicators were analyzed before treatment, 3 months and 1 year after treatment using a point system for assessing the functional state of the hand and the QuickDASH scale. Results. According to the results of the analysis of 77 patients with the consequences of injuries of the interphalangeal joints using 2 systems for assessing the function of the interphalangeal joints, it was found that treatment of severe and moderate arthrogenic contractures with the method of distraction arthroplasty and corrective osteotomy improves functional results by achieving congruent relationships in joints and mobilization of the ligamentous apparatus. Conclusions. Comprehensive treatment according to the proposed clinical rehabilitation program allows to increase the number of immediate positive results in the main subgroups of both groups to 22 (68.8%) versus 5 (11.1%) in the comparison subgroups (p&lt;0.001) on a rating scale, and excellent and good results on the QuickDASH scale up to 20 (62.5%) and 12 (37.5%) versus 1 (2.2%) and 41 (91.1%) cases, respectively (p&lt;0.001). When studying the long-term results of surgical treatment of arthrogenic contractures of the interphalangeal joints, positive results were obtained in 37 (63.8%) patients, satisfactory in 20 (34.5%) and unsatisfactory in 1 (1.7%) case according to the rating scale; 27 (46.6%) excellent, 30 (51.7%) good and 1 (1.7%) satisfactory results showed QuickDASH scale.

PrEvention of Posttraumatic contractuRes with Ketotifen 1 (PERK 1): A Randomized Clinical Trial.

To assess the use of ketotifen fumarate (KF) to reduce posttraumatic contractures after elbow fractures and/or dislocations. Randomized clinical trial. Three hospitals in Calgary, Canada, including one Level 1 trauma center. Adults (n = 151) sustaining operative or nonoperatively managed isolated distal humerus or proximal radius ± ulna fractures or elbow dislocations within 7 days of injury. KF 5 mg (n = 74) or lactose placebo (PL, n = 77) orally twice daily for 6 weeks. Primary outcome elbow flexion-extension arc range of motion (ROM) at 12 weeks postrandomization. Safety measures including serious adverse events and radiographic fracture line disappearance from 2 to 52 weeks postrandomization. The elbow ROM (mean, confidence interval) was not significantly different between KF (122 degrees, 118-127 degrees) and PL (124 degrees, 119-130 degrees) groups (P = 0.56). There was a significant difference in elbow ROM at 12 weeks postrandomization comparing operative (117 degrees, 112-122 degrees) versus nonoperative groups (128 degrees, 124-133 degrees) irrespective of intervention (P = 0.0011). There were 11 serious adverse events (KF = 6, PL = 5) that were those expected in an elbow fracture population potentially taking KF. There was no statistically significant difference in the rates of these events between the groups. The disappearance of fracture lines over the course of time was similar between groups. There was one nonunion in each group. In a population of operative and nonoperatively managed elbow fractures and/or dislocations KF did not reduce posttraumatic contractures. The administration of KF in this population was not found to result in a significantly higher number of major adverse events when compared with placebo. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

METHOD OF FORENSIC ASSESSMENT OF RISK FACTORS OF TREATMENT FAILURE OUTCOMES AS AN ELEMENT OF QUALITY MANAGEMENT OF MEDICAL CARE

The aim: The aim of this research was to study causes of the development of adverse outcomes in isolated femоral diaphyseal fractures. Materials and methods: A retrospective analysis of the protocols of clinical and radiological examination of 21 patients was performed. Based on the initial expert assessment, these patients have not been established the severity of injuries due to the development of complications in the postoperative period. Conclusions: Patient-dependent, implant-dependent, and surgery-dependent causes that caused a violation of the stability of osteosynthesis (95.2%) were identified. This led to a secondary displacement of bone fragments (71.4%), delayed fracture consolidation (61.9%), the formation of pseudarthrosis (38.1%), the development of post-traumatic osteomyelitis (14,3), migration of screws from the osseous plate (47.6%), and the development of post-traumatic contracture of the knee joint (81.0%).

Use of a modified Outerbridge-Kashiwagi procedure for the treatment of posttraumatic elbow sequelae

To review our 10-year experience treating posttraumatic sequelae of the elbow using a modified Outerbridge-Kashiwagi (O-K) procedure. Twenty-one patients with posttraumatic sequelae of the elbow treated using the technique were evaluated clinically using the Mayo Elbow Performance Score, range of motion testing, and pain level. We noted the presence of preoperative and postoperative ulnar nerve symptoms, complications, and reoperations. Open contracture release was selected to address either removal of hardware or ulnar nerve pathology. At a mean of 39 months (range, 12-116 months), the Mayo Elbow Performance Score improved from 52 to 84 (P < .0001)and the mean arc of motion improved from 44° to 98° (P < .0001). At the final follow-up, 90% of patients reported no pain or mild pain, and 81% of patients had a satisfactory objective result. In 15 of 21 cases (71%), it was necessary to mobilize the ulnar nerve. After contracture release, 1 patient developed new onset ulnar nerve symptoms. Three patients underwent reoperation: 2 for recalcitrant contracture and 1 for new onset ulnar nerve symptoms. The mini-open O-K procedure is safe and effective in restoring function in patients with retained hardware and posttraumatic contracture. Posttraumatic arthritic patients often require both removal of hardware and neurolysis of the ulnar nerve. The mini-open O-K procedure allows complete access to the elbow joint, which facilitates release for both intrinsic and extrinsic contracture.

Posttraumatic contracture of the elbow and cubital tunnel syndrome associated with heterotopic ossification in the anterior oblique ligament of the medial collateral ligament: A case report

Posttraumatic contracture of the elbow and cubital tunnel syndrome associated with heterotopic ossification in the anterior oblique ligament of the medial collateral ligament: A case report