Using an Autograft from the Fibula Diaphysis in the Surgical Treatment of Patients with Fractures of the Proximal Humerus on the Background of Critical Osteoporosis

The frequency of unsatisfactory results of surgical treatment of patients with a fracture of the proximal humerus remains high and is up to 40 %. This is primarily due to the early instability of the metal structure against the background of osteoporosis and as a consequence of non-fusion of the fracture and the formation  of a false joint. The aim of the study was to evaluate the effectiveness and safety of a new surgical method for treating patients with a fracture of the proximal humerus against the background of critical osteoporosis. After the approval of the local ethics Committee, 2 groups of 10 patients were formed in the clinic: the patients of  main group were operated by the proposed method; the group of clinical comparison was operated by the standard method. In all clinical cases, fractures of the proximal humerus were consolidated on control radiographs. VAS assessment the pain syndrome in the early postoperative period showed that there were no  statistically significant differences in the shoulder joint area in the groups. Three months after surgery, when assessing the volume of movement in the shoulder joint (without the participation of the scapula), there was a statistically significant improvement in the main group: abduction – by 35° and external  rotation – by 25° (p<0.05). When assessing the range of motion of the operated shoulder joint using the ASES scale, a  statistically significant improvement was observed in the main group by 11.6 points after 3 months after  surgery. According to the assessment of the patient›s functional recovery according to the DASH scale, the indicators in the main group were statistically significantly better, which indicates a complete recovery of the shoulder joint function. Thus, the use of the proposed new method, in comparison with other known technologies for surgical treatment of fractures of the proximal humerus, allows achieving a more rigid and stable fixation of bone fragments in the aftermath of trauma and the presence of regional osteoporosis

OPTIMIZATION OF SURGICAL TREATMENT OF CHRONIC POSTTRAUMATIC ANTEROMEDIAL INSTABILITY OF SHOULDER JOINT AT THE BONE DEFECT OF ARTICULAR PROCESS OF THE SCAPULA

Main reason of shoulder joint instability is bone defect of scapula cavity. The number of unsatisfactory outcomes after surgical treatment is still high. The aim. of the research was to improve surgical technique of treatment of patients with chronic posttraumatic anteromedial instability of shoulder joint at the bone defect of articular process of the scapula. Open controlled prospective randomized research was carried out in the clinics of SCRRS SB RAMS. Clinical effectiveness of proposed medical technology was proved on the basis of analysis of operative treatment of 34 patients during 6 months after the operation. We used Bristow - Latarjet bone plastics for comparison

Single and Double Bundle Arthroscopic Reconstruction of Anterior Cruciate Ligament (Review of Literature)

Researches performed in the past 20 years show the necessity of the restoration of anatomic position of anterior cruciate ligament as the main stabilizing structure of the joint in combination with the restoration of other injured elements and correction of deformities, which affect the outcomes of the treatment.Complexity of the restoration of anatomic position of torn anterior cruciate ligament is caused by its wide area of contact in combination with relatively small sectional area through the joint cavity. More detailed study of topographic anatomy of anterior cruciate ligament allowed the researchers to explain this phenomenon, which pushed them closer to the solution of the problem.Systemic anatomy of anterior cruciate ligament include two bundles - anteromedial bundle and posterolateral bundle. Double bundle plasty of anterior cruciate ligament restored anatomy to its nearly normal condition, but single bundle plasty is used much more often because of its simpler technique. However, the researchers still cannot reach a consensus in the choosing of single or double beam plasty at the restoration of anterior cruciate ligament

Historical outline on the treatment of patients with chronic posttraumatic instability of shoulder joint (review of literature)

Systematic analysis of literature concerning treatment of patient with chronic posttraumatic instability of shoulder joint in historical aspect was realized. Main tendencies of development of surgical orthopedics including evolution of both palliative and. reconstructive surgical methods for shoulder joint were revealed. On the basis of more than 50 literature sources we managed to estimate progress of scientific researches from the point of view of evidence-based medicine. By the end of 1980s main directions in correction of described nosology which were determined by the level of device-dependent visualization were formed. Necessity of brand new change in mini-invasive surgery of deep and chronic injuries of shoulder joint structures according to the literary data caused, future creation of a new direction based on advanced extended data of pathogenesis of shoulder joint instability

Old laceration of deltoid muscle (case report)

Traumatic isolated injury of deltoid muscle is a rare nosological orthopedic injury that occurs in 1,3 % of all shoulder joint injuries. In normal state function of shoulder joint is provided by deltoid muscle up to 50 % of capacity in scapular area. Degree of abolition of function of shoulder joint depends on the degree of deltoid muscle injury. Differential diagnosis is necessary to conduct with other traumatic injuries accompanied with such upper limb dysfunctions as chronic posterior humerus head dislocation, injury of rotatory cuff tendon, chronic complete or partial disorder of deltoid muscle integrity. The article contains clinical case of diagnostics and surgical treatment of the patient with isolated old deltoid muscle injury of more than 2 years accompanied with combined contracture of shoulder joint. Check-up examination in 6 months after the operation showed full restoration of a function of upper limb and no complaints. Results of control MRT examination of shoulder joint in 11 months after the operation showed full adhesion of tendomuscular autograft with acromial process of scapula

Latissimus Dorsi Transposition in Supraspinatus Tendon Retraction (Patte III) and Thomazeau Grade 3 Fatty Degeneration (Clinical Case)

Introduction. The proportion of injuries of the rotational cuff is from 65 to 84 % of all injuries of the shoulder joint. This pathology is more often registered in people over 60 years old. It is far from always that during initial visits, patients are given the correct diagnosis. Most patients are treated conservatively with short-term improvement or without dynamics. The main diagnostic method is an MRI of the shoulder joint, where we can see soft tissue structures. The proportion of massive rupture of the tendons of the supraspinatus muscle is 10-40 % of all ruptures of the rotator cuff.The more time passes from the moment of injury to surgical treatment, the more pronounced are the retraction and degenerative changes in tendons. A special category is occupied by patients with chronic rupture of the tendon of the supraspinatus muscle with a retraction of more than 5 cm (Patte grade III) and Thomazeau grade 3 fatty degeneration.In this category of patients, it is not possible to re-insert the tendons of the rotational cuff of the shoulder.Objective: to evaluate the clinical effectiveness of surgical treatment of a patient with retinal tendon retraction (Patte grade III) and Thomazeau grade 3 fatty degeneration.Materials and methods. The clinical case is presented: a man with a chronic total rupture of the tendon of the supraspinatus, infraspinatus muscle (Patte grade III) and Thomazeau grade 3 fatty degeneration. Secondary upper subluxation of the head of the humerus is revealed. The patient underwent surgical treatment: transposition of the latissimus dorsi muscle on the large tubercle of the humerus.Results. Six months after the operation, the patient restored the function of the upper limb, pain was stopped. Conclusion. Given the functional result, transposition of the latissimus dorsi tendon can be considered the technique of choice for inoperable tendon rupture of the supraspinatus muscle

Our First experience of Using Biodegradable Implants in Latarjet – Bristow Surgical Procedure at Chronic Posttraumatic Anterior Shoulder Insta

Background. Multi-layer spiral computed tomography shows that the main cause of shoulder instability is glenoid cavity bone defect. The aim of our research was to assess the effectiveness and safety of biodegradable implants in the treatment of patients with chronic posttraumatic anterior shoulder instability under conditions of bone defect of glenoid cavity margin by the restoration of anatomic shape and structure of scapula articular surface.Materials and methods. We performed a pilot study based on the results of surgical treatment of 7 patients using 4.5 mm biodegradable compressing screws. In preoperative period, all patients had standard two-dimensional X-rays and MSCT with 3D-reconstruction. In postoperative period, all patients had check-up X-ray right after the surgery and MRI in 3 months after the surgery.Results. The results of the treatment were assessed by common clinical criteria, functional criteria, X-ray evidence and intraand postoperative complications. We registered strong functioning of an arm and an increase in the range of motions. Data from Rowe/Zarins and DASH questionnaires showed that the patients totally recovered. X-ray evidence showed consolidation of non-free autograft to the zone of scapula bone defect without osteolysis or widening of a drilled hole. We did not observe either a failure of union, or any formation of false joint, or any screw fractures in bone tissue. Beyond that, we did not observe any complication in postoperative period and early postoperative complications in particular.Conclusion. Pilot study with use of modern biodegradable implants in osteoplastic stabilization of shoulder joint at recurring instability showed their effectiveness and safety in patients of young and active working age. However, considering small number of patients in pilot study we cannot extrapolate our results to all similar and analogue cases of using biodegradable implants. In this regard, it is necessary to perform major multicenter clinical randomized study for further long-term observation and detection of possible unwanted side effects