Operative treatment of displaced fractures of the acetabulum

Backround. Total hip replacement in cases of traumatic changes of the acetabulum refers to cases of difficult primary arthroplasty and requires detailed preoperative planning and accurate restoration of anatomical relationships in the operated joint. 
The aim of the study was to evaluate the structure of pathological changes in the acetabulum in patients with posttraumatic hip arthrosis, to develop a method for their detailed description and to determine the tactics of choosing the type of acetabulum implant. 
Methods. The results of treatment of 194 patients with the consequences of acetabulum fractures who underwent total hip arthroplasty in the period from 2014 to 2022 were analyzed. The study was conducted in two stages, at the first stage, the structure of pathological changes, such as defect, deformation, changes in the center of rotation and offset (relatively healthy contralateral joint), was analyzed. A method was developed for choosing the tactics of implantation of the acetabulum component, based on a detailed description of the defect and deformation of the acetabulum. The second stage analyzed the results of treatment of patients for whom planning and surgical treatment was carried out in the period from 2020 to 2022 using the proposed method. 
Results. During the first stage of the study, it was revealed that the magnitude of the change in the indicators of the displacement of the rotation center and offset changes by more than 8 mm. statistically significantly increases the likelihood of complications by 17.9%. The restoration of the rotation and offset center reduces the number of complications by 22.3%. The proposed method makes it possible to statistically reliably restore anatomical relationships in the operated hip joint and reduce the number of complications by 10%. 
Conclusion. The proposed method allows us to qualitatively and quantitatively describe pathological changes in the bone tissue of the acetabulum. Depending on the degree of displacement of the center of rotation, the walls of the acetabulum and the nature of the defect of the supporting bone tissue, the surgeon can determine the tactics of surgical treatment.

Total Hip Arthroplasty in Patients With Post-Traumatic Bone Defects and Acetabular Deformities

The article presents the evidences of the hypothesis according to which severity of condition of the injured with combined shocking trauma influences the quality of hospital diagnostics in early period, of traumatic disease. We studied the sampling of injured delivered to the hospital with shocking trauma and died, in early period, of traumatic disease. Forensic medical examination was a reference diagnostic method. It was established that frequency of hypodiagnostics at hospital stage makes 36 %, hyperdiagnostics 4 %. Organization of specialized assistance to the injured with combined shocking trauma will contribute to improving the quality of diagnostics.

Оценка тяжести шокогенной травмы в остром периоде травматической болезни

The topical issue of treatment of patients with unstable pelvic injuries, despite the extensive coverage of this issue in the recent literature, until now is no doubt. Damage to the pelvic ring involves a threat to the life of the patient, while the damage to the acetabulum leads to disability. Because of low-impact external fixation device, speed of use, broad anti-shock features in urgent circumstances, the use of this method is promising. Results of treatment of 18 patients with unstable pelvic lesions (type C according to AO), who underwent stabilization of the damage with a modular external fixations apparatus fixing a damaged pelvis and hip joint by the scheme «pelvis — hip». In this group of patients can be reduction fragments of the acetabulum, which eliminates the need for traditional open osteosynthesis. In 72 % of cases were received good and satisfactory outcomes.

Роль аппарата внешней фиксации при переломах костей таза с повреждением вертлужной впадины

В условиях современной урбанизации как во всем мире, так и в России чрезвычайные ситуации не имеют тенденции к снижению частоты. Увеличивающийся транспортный поток и возрастание дорожно-транспортных происшествий приводят к росту травматизма. Вместе с тем в общей структуре травматизма увеличивается и удельный вес повреждений таза. При анализе структуры политравмы повреждения таза констатируются в 17–39 % случаев. Несмотря на такую частую верификацию травм таза, консервативные и хирургические методы лечения этой патологии далеко не всегда приводят к положительным результатам. Летальность при сочетанных повреждениях таза может достигать 80 %. Среди пациентов, перенесших травму таза, до 50 % становятся инвалидами. Обзор литературы по вопросам диагностики и лечения переломов костей таза позволит ознакомить специалистов, занимающихся этой проблемой, с современными классификациями переломов костей таза, со стандартами обследования и лечения пострадавших, с принципами медицинской эвакуации и с возможностями оптимизации оказания медицинской помощи пострадавших с переломами тазового кольца. Представленный обзор литературы поможет сориентироваться в состоянии этого вопроса на сегодняшний день.

Диагностика и лечение переломов костей таза

Proximal femoral fractures (PFF) are one of the most common reasons for admission of patients to a traumatological and orthopedic hospital. For the vast majority of patients with PFF, such injury means a loss of the previous degree of mobility. 
Clinical guidelines are the main working tool of a practicing physician, both a specialist and a narrow practice doctor. Conciseness, structuredness of information about a particular nosology, methods of its diagnosis and treatment, based on the principles of evidence-based medicine, allow to give in a short time one or another answer to a question of interest to a specialist, to achieve maximum efficiency and personalization of treatment. These clinical guidelines include data on the classification, clinical presentation, diagnosis, and treatment of proximal femoral fractures. In addition, they provide methods for the rehabilitation of patients with this pathology.

/pdf/fractures-of-the-proximal-femur-clinical-features-diagnosis-1ftqvfrh.pdf

Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version)

In the structure of pelvic bone injuries, acetabular fractures are the most complex type and, according to different authors, account for up to 20% [1]. The severity of these injuries is confirmed by the fact that early descriptions of acetabular fracture were based only on the results of autopsies of patients who had suffered a combined injury. Thus, as early as 1788, Callisen reported an acetabular fracture, but without a detailed description of the nature of the injury. In 1909, Schroeder provided a detailed report of 49 cases of acetabular fractures reported in the literature. Most of them were described during autopsies of patients who died from complications associated with hemorrhagic shock or the onset of sepsis [2]. Fractures of the acetabulum in most observations are the result of high-energy impacts, usually as a result of traffic accidents; therefore, the mechanism of injury determines the combined and multiple nature of the injuries in the victims. A significant proportion of acetabular fractures (up to 60%) are accompanied by fragment displacement and dislocation of the femoral head, in which the most severe tissue changes occur [3].

Management of complex acetabulum fractures and their consequences

Introduction 
This article is devoted to the problem of total knee arthroplasty in patients with severe valgus deformity (Krackow type III). 
Methods 
We analyzed mid-term results of 12 total knee arthroplasties combined with sliding osteotomy of the lateral femoral condyle and distalization of the lateral collateral ligament. Treatment results were measured with KSS and WOMAC scores. 
Results 
We had excellent and good results in 11 cases but one was complicated with periprosthetic fracture of the femur. 
Discussion 
Up-to-date, there are various techniques of soft-tissue release in total knee arthroplasty proposed. These techniques differ in the point of release and the power of effect. However, an adequate balance is not always achievable in severe valgus deformity. Therefore, implants providing enhanced frontal stabilization are required (CCK/VVC).

http://ilizarov-journal.com/files/2017_3_06.pdf

Efficiency and safety of sliding osteotomy of the lateral femoral condyle in total knee arthroplasty in patients with fixed valgus deformity (Krackow type III)

Relevance. About 800 thousand people die every year as a result of injuries and their consequences, in the Russian Federation the frequency of injuries is 12 %. Fractures of the humerus diaphysis account for 1-5 % of the total number of traumatic injuries of the skeleton, at the same time, there is no tendency to reduce injuries in modern society, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Among the reasons for the unsatisfactory results of osteosynthesis, iatrogenic ones are distinguished: inconsistency from a biomechanical point of view, the choice of an unsuitable metal structure, insufficiently correct comparison of the ends of bone fragments and neglect of contraindications to the use of submerged structures with increased contamination of the wound with open fractures. Non-infectious complications of primary osteosynthesis include false joints, improperly fused fractures, untenable osteosynthesis, as well as fractures and migrations of implanted metal structures. The described complications are the basis for repeated (revision) surgery, or rheosteosynthesis. The purpose of this study is to analyze the historical aspects of the development of osteosynthesis and rheosteosynthesis methods, as well as to determine the prospects for their further development.Materials and methods. In the process of writing the article, the analysis of data from literary sources published in the period from 2016 to 2023 was carried out.Results. Speaking about the choice of osteosynthesis technique, it should be noted that no recommended and maximally described techniques will be able to fully cover the variety of situations that arise during osteosynthesis operations, therefore, first of all, a positive outcome depends on the experience of the surgeon and his ability to make situational decisions. Each of the methods used has both advantages and disadvantages, and which treatment tactics the surgeon would not prefer - there is always a risk of complications and, as a result, an unsatisfactory result. In such cases, patients undergo revision operations of osteosynthesis (rheosteosynthesis), minimizing or completely eliminating bone defects. The complexity of correcting the consequences of injuries of the humerus diaphysis is due to the variety of conditions leading to the development of various kinds of bone defects or false joints, as well as in a limited number of techniques that can fully repair the damage in a short time. Taking into account the rather long periods of consolidation of fragments, rehabilitation of patients with this type of pathology implies the use of devices capable of providing stable fixation and the possibility of early restoration of upper limb functions for fastening bone fragments. As a rule, revision surgical interventions include excision of scars from the interfragmental area or corticotomy, removal of deformation (if present), rimming of the medullary cavity and intramedullary osteosynthesis, to which, in rare cases, fixation with a short plate may additionally be applied. The range of revision surgical interventions may include rheosteosynthesis in combination with: segment elongation and corrective osteotomies, bone alio- and autoplasty, with bone elongation on a nail in an external fixation device.Conclusion. The development of modern technologies of osteosynthesis and osteosynthesis of the diaphyses of long tubular bones in general, and the humerus in particular, has passed a serious evolutionary path. In recent decades, methods and technologies of osteosynthesis have been actively developing and improving. With the development of knowledge in the field of the mechanism of bone fusion, implant designs and installation technologies are changing, new modifications of operative accesses are being developed. When choosing the method of fixation of bone fragments, minimally invasive osteosynthesis techniques are becoming increasingly popular. Currently, combinations of different rheosteosynthesis methods are being actively introduced, which significantly expands their capabilities, in comparison with their application separately.

Flistory and prospects of development of methods of osteosynthesis and osteosynthesis of the humerus diaphysis

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Papers

Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version)

Management of complex acetabulum fractures and their consequences

Efficiency and safety of sliding osteotomy of the lateral femoral condyle in total knee arthroplasty in patients with fixed valgus deformity (Krackow type III)

Flistory and prospects of development of methods of osteosynthesis and osteosynthesis of the humerus diaphysis