Evaluation of clinical efficacy and safety of the Ilizarov apparatus for external fixation (literature review)

Purpose A retrospective analysis of clinical efficacy and safety of using the external fixation apparatus of G.A. Ilizarov's design. Materials and methods Analysis and evaluation of clinical data was performed using 107 literary sources. 4.200 clinical cases were studied to evaluate effectiveness, and 6.274 cases to assess safety. Results The analysis revealed a high clinical efficacy of using the Ilizarov apparatus for external fixation (various assemblies) in solving a wide range of practical problems in the field of traumatology and orthopedics. According to the results of the study, its high clinical treatment effectiveness was confirmed both on the use of the method in general (about 95 % of positive outcomes), and in specific nosological groups of patients (not lower than 90 % of positive outcomes). After having assessed the available data on the safety in the application of the Ilizarov apparatus for external fixation (various assemblies), we can conclude that the rates of adverse events, recorded in the literature analyzed, can be considered acceptable. Among all those events, the events classified as adverse effects of the product amounted to 17.03 % (5 ÷ 95 % CI: 16.11 ÷ 17.97 %). © Soldatov Yu.P., Stogov M.V., Ovchinnikov E.N., Gubin A.V., Gorodnova N.V., 2019. © 2019 Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics

GENESIS OF HYPOXIC CONDITIONS IN PATIENTS WITH OPEN FRACTURES OF SHIN BONES IN DYNAMICS OF TREATMENT BY ILIZAROV’S METHOD

Indices of energy metabolism in blood serum and partial oxygen and. carbon dioxide pressure in the injured limb tissues were studied in dynamics in 32 patients with open leg fractures (Kaplan-Markova type I-II B, C) during their treatment with the Ilizarov method. It was revealed that circulatory hypoxia, complicated by hemic hypoxia and followed by tissue hypoxia developed sequentially in the tissues of the injured limb segment in the posttraumatic period

Hafnium Hydride Hfh Is a Possible Analogue of Boron Carbide B4c In the Protection Control System of Fast Reactors

Рассмотрено потенциальное применение гидрида гафния HfH в качестве поглощающего материала в стержнях СУЗ быстрых реакторов взамен штатному карбиду бора B4C. Была смоделирована ячейка активной зоны быстрого реактора. Обнаружено, что при равном количестве поглощающего материала в ячейке СУЗ физическая эффективность может с одной стороны сильно различаться, с другой быть эквивалентной между HfH и В4С. Моделирование показало, что кольцевая форма поглощающего элемента обладает преимуществом в физической эффективности, по сравнению с цилиндрической формой. Приведено распределения потока нейтронов в поглощающем материале и его макросечения для рассмотрения принципиальной возможности использования HfH в быстрых реакторах. Предварительно прогнозируется потенциальный экономический эффект использования HfH в быстрых реакторах на примере БН-800.The potential use of hafnium hydride HfH as an absorbing material in the control rods of fast reactor instead of the standard boron carbide B4C is considered. The cell of the fast reactor core was modeled. It was found that with an equal amount of absorbing material in the cell, the physical efficiency can, on the one hand, vary greatly, and on the other hand, it can be equivalent between HfH and B4C. The simulation showed that the annular shape of the absorbing element has an advantage in physical efficiency, compared with the cylindrical shape. The distribution of the neutron flux in the absorbing material and its macro-cross section are given to consider the fundamental possibility of using HfH in fast reactors. The potential economic effect of using HfH in fast reactors is previously predicted using the example of BN-800

Pathomorphological and pathochemical characteristic of the osteomyelitis focus in patients with diabetic osteoarthropathy (Charcot foot)

BACKGROUND: Osteomyelitis in diabetic osteoarthropathy occurs in 65 % of cases, and it is the main cause of non-traumatic amputations. The choice of optimal treatment technologies should be based on understanding the pathogenetic characteristics of this disease.AIM: To study the pathomorphological and pathochemical picture of osteomyelitic focus in patients with diabetic neuroosteoarthropathy.MATERIALS AND METHODS: Object — 20 patients (55.3±9.33 years) with Type 2 diabetes mellitus, diabetic neuroosteoarthropathy, chronic osteomyelitis of the foot bones. The treatment consisted in surgical debridement of the purulent focus with the material collection for pathomorphological and biochemical studies, and in reposition and alignment of bone fragments with the leg and foot fixation using the Ilizarov fixator in order to form bone ankylosis of the compromised joint.RESULTS: Subacute and acute course of chronic osteomyelitis was registered in 80 % of cases. As for the pathohistological changes in bone tissue, the following ones were the most significant: necrosis and the presence of an inflammatory infiltrate of varying severity depending on the phase of the inflammatory process. The articular cartilage structure was broken in all the cases. Activation of osteoclasts was observed in the osteomyelitis focus, especially in the subchondral zone. There was no subchondral bone plate in most cases, or only its fragments remained. Pathohistological examination of the soft tissues associated with the osteomyelitis focus indicated the presence of mirocirculatory and denervation disorders due to necrosis and hyalinosis of a significant part of microvessels against the background of compensatory hypervascularisation and chronic inflammation, narrowing and obliteration of the lumens of feeding arteries, almost complete absence of nerve elements in the tissues or their destructive changes. An increase in the activity of lytic enzymes was revealed in the interstitial environment of the tissues surrounding the osteomyelitis focus (138-fold increase in the activity of acid phosphatase, interstitial osteolytic index was 7.2-fold higher than blood serum index).CONCLUSION: The pathomorphological signs of chronic osteomyelitis subacute and acute processing were observed in most patients. Breaking the articular cartilage structure was accompanied by invasion of vessels, inflammatory infiltrate, and by activation of osteoclasts in the subchondral zone. Destructive changes of vessels and nerves in the soft tissues associated with the osteomyelitis focus can be etiopathogenetic factors of this disease development. The technologies for stopping this process should be based on obligatory debridement of the focus with sequestrnecrectomy, with regular monitoring of the operated segment condition

Changes of biochemical parameters of blood serum and daily urine in patients with aseptic loosening of hip endoprosthesis

In order to study metabolic abnormalities in aseptic loosening of hip endoprosthesis performed biochemical analysis of blood serum and daily urine in 31 patients. Statistically significant changes in local and systemic metabolism are revealed, which are in the growth of osteolytic processes, hypoxia, antioxidant, and vitamin deficiency. Thereby, pathogenetic mechanisms of aseptic instability are studied, on the basis of the received facts recommendations about prevention of this complication are madeС целью изучения метаболических нарушений при асептической нестабильности эндопротеза тазобедренного сустава проведено биохимическое исследование сыворотки крови и суточной мочи у 31 пациента. Выявлены статистически значимые изменения местного и системного метаболизма, заключающиеся в росте остеолитических процессов, гипоксии, антиоксидантной и витаминной недостаточности. Таким образом, изучены патогенетические механизмы асептической нестабильности, на основе полученных данных даны рекомендации по профилактике данного осложнения

Stimulation of Osteogenesis by Direct Electric Current (Review)

Background. Stimulation of osteogenesis in the treatment of certain orthopedic and trauma pathologies is a necessary element to ensure the best clinical outcome. The purpose of the present analytical review is to analyze the literature data in respect of evaluating the approaches and possibilities to stimulate osteogenesis using direct current. Methods. The search for literature data was performed in the open electronic databases of scientific literature PubMed and eLIBRARY under the following keywords and their combinations: “osteogenesis”, “reparative osteogenesis”, “direct electric current”, “orthopaedics”, “traumatology”, “electric current” (in Russian as well as in English language ). Results. According to some fundamental research, the stimulating effect of direct current lies is both in stimulating differentiation and proliferation of osteoblasts, and in stimulating differentiation of stem cells, mainly mesenchymal stem cells of bone marrow and adipose tissue, in the process of osteogenesis. The following stimulating technologies were developed and clinically tested to date: 1 — direct exposure of bone to the direct current; 2 — capacitive coupled stimulation; and 3 — inductive coupled (electromagnetic) stimulation. Analysis of clinical practice demonstrated that the first technology is most effective in terms of osteoreparation, but less safe than technology 2 and 3. It should be noted that there are no clear indications and modes of application for the abovementioned methods. Based on the data collected in the present analysis, technology 1 is considered by authors as the most promising. Safety of technology 1 can be enhanced by application of metal implants as electrodes in case those are planned to be used for medical reasons: wires, rods, staples, fixators, etc. Conclusion. Use of electric current to stimulate bone formation is a promising method which requires clarification in respect of indications and application modes

Bone Xenografts in Trauma and Orthopaedics (Analytical Review)

Purpose of the analytical review — to evaluate the application experience of bone xenografts in trauma and orthopaedics surgery. Methods. Data search was performed in the electronic databases of PubMed and eLIBRARY with depth of 20 years. Results. The authors identified 13 papers which described the application experience of bone xenografts in trauma surgery and orthopaedics. The highest efficiency (from 92 to 100%) was reported for cases of xenografts use to replace defects in intraarticular fractures and revision arthroplasty. Unsatisfactory outcomes were related to cases with no integration and graft rejection. The least efficiency (from 41,9 to 46,1%) was reported in reconstructive foot surgery. No effect of bone xenografts was observed for replacement of defects in cases of pseudoarthrosis. The most frequent complication was graft material infection. The summarized literature data provided the calculated share of complications following xenograft use of 7,53% (18 out of 239 cases, CI 5-95%, 4,53-11,21). Two areas were identified for improvement of technical and biological properties of bone xenografts: 1. Modification of original xeno-matrix (enhancement of purification technique, alteration of structure of chemical composition of the bone matrix); 2. Augmentation of matrix volume by additional elements (biologically active agents, stem cells). It’s noted that demand for xenografts in traumatology and orthopaedics can increase after refining and expanding the indications for clinical use. Conclusion. Bone xenografts used in the modern trauma surgery and orthopaedics to replace bone defects in revision arthroplasty as well as in certain fracture types. Such material is relatively safe and its ability to be modified allows to improve its biological properties