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Trauma (Travma)
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This is an Open Access Journal

Open Access journal
ISSN (Print) 1608-1706 - ISSN (Online) 2307-1397
Published by Publishing House Zaslavsky

[9 journals]

Analysis of the results of monocondillary endoprosthesis in conditions of
low bone density of bone tissue
- Authors: V.O. Movchaniuk, Р.М. Zhuk, O.D. Karpinska, M.Yu. Karpinsky
  Pages: 4 - 16
  Abstract: Background. Pain is the main cause of joint arthroplasty, but for many patients it allows to restore functional capacity. Self-report questionnaires reflect people’s perceptions and satisfaction with their own health. Moreover, physical functions are better characterized by patients themselves than by physicians. The purpose was to determine the effectiveness of the developed method of monocondylar knee arthroplasty in conditions of low bone density. Materials and methods. 3 groups of patients were studied: Group I — 59 (67.8 %) people, patients with normal bone density, who were operated on by the classical method of monocondylar endoprosthesis; Group II — 6 (6.9 %) patients with low bone density, who underwent monocondylar endoprosthesis according to the author’s method, Group III — 22 (25.3 %), patients with low bone density who underwent monocondylar endoprosthesis knee joint according to the classical method. All patients before and one year after arthroplasty were surveyed according to the KOOS questionnaire. Results. Prior to treatment, patients experience significant discomfort with the knee joint, which is manifested in the presence of pain during movements of the knee joint — flexion and extension, walking not only on the stairs but also on a flat surface. Patients in most cases complain of swelling of the knee joint, pain at night and after a long rest. Symptoms are more pronounced in elderly patients — over 65 years, and in patients with low bone density — osteoporosis, which is a complicating factor. The condition of patients after arthroplasty also depends not only on the quality of the operation, but also on the patient’s age, ie, the older the patient, the greater the likelihood of worse results, as well as the presence of comorbidities, especially osteoporosis. Worse endoprosthesis outcomes in group III patients were due to complications that led to revisions in some patients. Conclusions. In patients of group II, who underwent monocondylar endoprosthesis according to the new method, the results were close to the results of group I — patients without osteoporosis. Due to the fact that in group II there were quite elderly patients, the results of arthroplasty were slightly lower, but close to the results of group I and better than in patients of group III. There were no complications in patients of group II. The author’s technique of monocondylar knee arthroplasty allows to obtain good results not only against the background of osteoporotic changes, but also to increase the age limit of operated patients and can be offered for wider use.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.885
  Issue No: Vol. 23, No. 2 (2022)
The work of the lower limb muscles under conditions of the knee flexible
contract
- Authors: V.O. Fishchenko, Khaled Jamal Saleh Obeidat
  Pages: 17 - 24
  Abstract: Background. Flexion contracture of the knee joint is a pathological condition that negatively affects the musculoskeletal function of the lower limb and significantly impairs the patient’s quality of life. A change in the natural anatomical relationships in one joint leads to a change in the load in the adjacent joints and provokes the development of degenerative changes. Purpose of the work: using a walking model to study the work of the muscles of the lower limb in conditions of knee joint contracture of varying severity. Determine the minimum required muscle strength of the lower limb for a normal stride. Materials and methods. Muscle dysfunction in contractures of the knee joint was investigated, which was modeled by limiting the extension of the hip to 10°, 15° and 20°. The analysis was carried out for the muscles of the right lower limb, comparing the obtained indicators with the indicators of the base model (the same limb without limitation of extension). Results. Contracture of the knee joint not only disrupts the function of the knee joint itself, but also, due to the versatility of the work of most of the two-joint muscles of the thigh and lower leg, pathologically affects the function of the hip and ankle joints. The extensors of the lower leg suffer more than others with contractures of the knee joint. This is due to the fact that in order to ensure correct gait, full extension of the lower leg is necessary, and these muscles need to develop strength that can overcome contracture. For example, with a 20° contracture for knee extension, the model should develop a force of 2250 N, but in reality, according to Delp (1990), the maximum possible isometric force is 780 N, which is almost 3 times less. Semitendinosus is one of the muscles that most of all affects the functionality of the hip joint; its obvious overstrain can be traced in the models. The work of m. gracilis and m. sartorius is significantly disrupted. With the excess of their functional capabilities in contractures of the knee joint,
  m. biceps femoris – short head. The maximum tension that this muscle is able to develop is 400 N, while in models with contractures of the knee joint the force required for normal walking reaches 900 N, which naturally the muscle is not able to develop in real conditions. Conclusions. Contracture of the knee joint leads to a change in the biomechanics of the entire lower limb. Limiting the mobility of the knee joint leads to an increase in changes in the work of the muscles, forcing them to work either under conditions of constant tension or, conversely, turning them off from work, which leads to a sharp violation of the gait. Knowing the effect of contracture of the knee joint on the work of the muscles of the lower limb, it is possible to predict the course of the development of the pathological process, to determine which muscle groups are most affected. Taking into account the peculiarities of their functioning with varying degrees of limitation of the knee joint mobility, it is possible to determine which muscle group needs correction before and after surgery.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.886
  Issue No: Vol. 23, No. 2 (2022)
Substantiation of the optimal length and shape of the plate for the
correction of congenital funnel-shaped deformity of the chest
- Authors: M.O. Kaminska, V.A. Dihtiar, O.V. Yaresko
  Pages: 25 - 28
  Abstract: Background. In thoracoplasty of congenital funnel-shaped deformity of the chest (СFSDC), the method according to D. Nuss is common, when the correction of the deformation is carried out by the retrosternal plate. However, the selection of the plate still focuses on the anatomical size of the chest and does not take into account the individual parameters of deformation of СFSDC, namely the width and depth of the cavity, and the shape of the plate is given imperatively, which affects treatment results. Purpose of the work: to carry out mathematical substantiation of the optimal dimensions of the length and shape of the plate for thoracoplasty СFSDC depending on the individual size of the funnel-shaped deformation of the patient to achieve maximum correction. Materials and methods. To mathematically substantiate the parameters of geometrization of anatomical and structural-qualitative features of funnel-shaped deformation of the thorax, calculations of the magnitude of loads on the arch-plate and elements of the sternocostal complex were performed. Results. It was found that the result of the study justifies the study of geometrization of anatomical and structural-qualitative features of chest deformation and determination of geometric parameters of the plate-arc according to individual anatomical dimensions of width and depth of СFSDC. The research served as a basis for the development of a method for modeling the thoracic arch-plate for the correction of funnel-shaped deformation of the chest. Conclusions. Mathe-matical modeling, research and calculations of indivisible multi-support plate with different span lengths as in thoracoplasty, allows to reduce the maximum torque Mmax by 11 %, by reducing the span lengths. Based on mathematical calculations, the optimal length of the plate L is the size 2D, where D is the width of the funnel-shaped deformation and is the distance between the support ribs, the height of the arc bend at the level of the support ribs should be 1/2 H, where H is equal to the funnel depth. The obtained data are of great practical importance in determining the optimal length and shape of the plate in thoracic thoracoplasty СFSDC.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.887
  Issue No: Vol. 23, No. 2 (2022)
Biomechanical aspects of functional treatment of scoliotic spine
deformation
- Authors: A.F. Levitsky, O.А. Buryanov, Т.М. Omelchenko, М.О. Ovdiy, N.Р. Letucha, І.А. Subbota, M.Yu. Karpinsky
  Pages: 29 - 39
  Abstract: Introduction. Scoliotic spinal deformity has been and is the subject of numerous developments and studies by various medical professionals. Patient management actively includes in its program such a powerful factor as functional treatment for both patients after surgery and for patients who are indicated for surgery. The purpose was improving the results of physio-functional treatment of patients with scoliotic disease by experimental-clinical justification of the effectiveness of various physical exercises used in the treatment of patients. Materials and methods. Mathe-
  matical models of the spine with C-shaped and S-shaped scoliotic deformations were developed, which were used to analyze the stress-strain state. 17 different exercises were tested, including 12 asymmetric ones; 3 — symmetrical and 2 — derotation. Of these: 6 exercises we use for the cervical-thoracic type; 8 exercises for the chest; 8 exercises for thoracolumbar; 12 exercises for lumbar and 10 exercises for S-shaped deformity of the spine. Results. The creation of a mathematical model made it possible to study the stresses ari-sing from spinal deformations under different load variants. We got a clear idea of the distribution of internal stress in the vertebral motor segments. It was found that most of the exercises of our complex contribute to the creation of compression forces on the convex side of the deformed spine and the formation of distraction forces on the concave side. Similar data confirm the indicators of anthropometric research. All the above suggests the feasibility of developing complexes of functional treatment, taking into account the location of the top of the curvature of the spine. Undoubtedly, no experimental study reflects the full range of anatomical and physiological processes of a living organism. However, in general, the creation of a mathematical model allowed to develop the provisions of differentiated application of kinesitherapy in a particular clinical situation, and the results of the development became part of the clinical and biomechanical rationale for functional treatment of scoliotic pathology. Conclusions. The study using a mathematical model allowed us to study the differentiated effect of kinesitherapy methods on spinal deformity depending on its apex. This study allowed to biomechanically substantiate the indications and contraindications for the use of various physical exercises in the treatment of scoliosis. The study made it possible to improve the methodological approach to the development of therapeutic gymnastics complexes, taking into account the topical features of spinal deformity.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.888
  Issue No: Vol. 23, No. 2 (2022)
The modern regenerative technologies in the treatment of osteoarthritis of
the large joints
- Authors: O.I. Olifirenko, H.I. Hertsen, O.S. Movchan, R.O. Serhiienko, Yu.Ye. Bursuk
  Pages: 40 - 46
  Abstract: In 2018–2021, 114 patients with the diagnosis of knee osteoarthritis of grade 1–3 according to the Kellgren and Lawrence classification underwent treatment. The diagnosis was verified radiologically, specified by magnetic resonance imaging, intraoperative arthroscopically. The patients underwent treatment according to the developed algorithm using minimally invasive regenerative techniques: platelet-rich plasma, bone marrow concentrate (BMC) and hyaluronic acid. The control group was not provided for a number of ethical and technical reasons. Based on the assumption that “osteoarthritis is a progressive disease”, stable positive changes in the subjective assessment of the knee joint and the absence of signs of progression during instrumental examination can be considered a success of this technique. Treatment outcomes were assessed in 1, 3, 6, 9 and 12 months using the Knee and Osteoarthritis Outcome Score, Western Ontario McMaster Universities OA Index, International Knee Documentation Committee, data from repeated magnetic resonance imaging and direct macroscopic examination du-
  ring repeated arthroscopies. According to the international subjective scales for assessing joint function and pain, patients after treatment with injectable regenerative agents showed a steady improvement in follow-up of up to 12 months. Based on the clinical results, it can be concluded that the developed treatment regimen is a mo-dern regenerative therapy that helps to repair damaged areas of the musculoskeletal system due to the effect of a balanced complex of mesenchymal stem cells, growth factors, cytokines. The developed algorithm of obtaining and applying BMC is safe and rational.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.889
  Issue No: Vol. 23, No. 2 (2022)
Features of anatomy, classification of traumatic injuries of the thoracic
spine (literature review)
- Authors: S.O. Teslenko
  Pages: 47 - 53
  Abstract: Spinal fracture is a pathological condition that occurs due to a violation of the anatomical integrity of the spine. An analysis of the literature on the thoracic spine has shown that it differs markedly from other departments both anatomically and functionally. The thoracic vertebrae are anatomically different from the cervical and lumbar vertebrae, although the upper and lower vertebrae are adjacent. The main function of the thoracic spine, along with the ribs and sternum is to protect the chest, so damage to this complex can not be considered separately from each other. There are several classifications of thoracic spine injuries. Today the most common are: AO/ASIF classifications (Arbeitsgemeinschaft fur Osteosynthesenfragen/Association for the Study of Internal Fixation); Load-sharing classification McCormack et al. and the Thoracolumbar Injury Severity Score (TLISS). All of them are additions and developments of the previous one and involve in the classification more and more signs of injuries of the thoracic spine, both morphological and neurological. Given the peculiarities of thoracic spine injuries and their anatomy, surgical treatment requires special care in the choice of tactics and tools.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.890
  Issue No: Vol. 23, No. 2 (2022)
Comprehensive analysis of fractures of the clavicle in the middle third
(literature review)
- Authors: G.I. Herzen, V.V. Krizevskiy, A.N. Gapon, O.S. Movchan, S.V. Dybkalyuk, A.I. Protsyk, G.G. Bilonozhkin, R.М. Ostapchuk
  Pages: 54 - 59
  Abstract: Clavicle fractures are a common injury, reaching over 5–11 % of all skeletal fractures. In most cases (up to 70–80 %), fractures are observed in the region of the middle third of the bone due to the anatomical features of the clavicle and the localization of the attachment of the tendon-ligamentous apparatus to it. Over the past decades, the historically traditional principles of treating clavicle fractures have changed significantly; in the middle third, surgical methods have received more specific indications, have been effectively improved and have become prevalent. This paper pre-
  sents current data on epidemiology, practical anatomy, examination and treatment of patients with fractures of the clavicle in the middle third.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.891
  Issue No: Vol. 23, No. 2 (2022)
Animal models of immobilization contractures. Overview of methods and
trends
- Authors: V.O. Fishchenko, Ayham Khasawneh
  Pages: 60 - 67
  Abstract: Contractures are chronic loss of joint mobility caused by structural changes in bone tissue, including muscles, ligaments and tendons. They develop when these normally elastic tissues are replaced by inelastic tissues. The most common cause of contractures is immobilization. Contracture is a complex clinical problem because the nature of the injury often does not correlate with the degree of functional impairment, which makes it difficult to predict the risk of pathology. The study of the causative factors of contracture in patients may not be a common clinical practice for certain reasons, both related to the ethical side of the problem and the lack of time factor of observation. Animal models allow to study the pathogenesis of the disease and allow to evaluate treatment strategies. However, no animal model has been developed to assess the elbow joint, which is necessary to fully study and understand the clinical problems associated with this complex joint. The paper presents the main methods of modeling immobilization contractures in animals. There are 2 main approaches to modeling joint contractures — traumatic and non-traumatic. Traumatic, is surgical methods of fixation with needles, hooks, plates, etc. give a reliable fixation, but are often accompanied by complications such as edema, inflammation, infection of the area of intervention, as well as interfere with the purity of the experiment, when it is necessary to exclude tissue damage around the joint. Non-traumatic methods of modeling contractures, is with the help of exclusively external means of fixation exclude some of the negative effects of surgical methods, but are accompanied by insufficient reliability for a long time. Also, external fixation can cause swelling, skin irritation and other negative manifestations. Both methods of modeling contractures require constant monitoring during the experiment to level and prevent possible complications.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.892
  Issue No: Vol. 23, No. 2 (2022)
AOSpine Thoracolumbar Spine Injury Classification System in determining
the treating tactics of thoracolumbar junction traumatic injuries
(literature review)
- Authors: O.S. Nekhlopochyn, M.V. Vorodi, Ie.V. Cheshuk
  Pages: 68 - 78
  Abstract: The anatomical features of the thoracolumbar junction determine the significant predisposition of this area to traumatic injuries. The treatment tactics thoracolumbar junction lesion is quite controversial. A large number of methods have been proposed to demonstrate their effectiveness in various types of da-mage. However, a single concept that defines a specific method of treatment for a certain set of pathomorphological changes has not yet been formed. The trend of the last ten years is the development and active introduction into clinical practice of tactically oriented clinical classifications of traumatic injuries of sertain part of the spine. These classifications consider a number of heterogeneous factors and providе а clinician with a more or less clear scheme of therapeutic measures. As to the thoracolumbar junction, such a classification is AOSpine Thoracolumbar Spine Injury Classification System. The scheme was developed in order to characterize injuries of the entire thoracic and lumbar spine, while the features of the thoracolumbar junction, as in the previously proposed classifications, are practically not taken into account. The classification is based on the assessment of 3 basic criteria: the morphological cha-
  racteristics of the fracture, the neurological status of the patient, and clarifying clinical modifiers. The hierarchy of the distribution of types of traumatic injuries corresponds to an increase in the severity degree. There are 3 main types: compression injuries; failure of the
  posterior or anterior ligamentous complex; damage accompanied by displacement in any plane. When developed the prurpose was the creation of a fairly simple, universal and well-reproducible classification in order to reflect global surgical preferences and determine the most rational approach to treatment. This review provides a detailed description of all damage options. It has been established that despite the high reproducibility of the results, the classification actually remains a descriptive tool, without assuming the definition of any tactics for each specific classified case. The thoracolumbar spine injury severity scale, which is based on the AO classification, is considered as a tool for quantitative assessment of the severity of injury. The scale, based on the sum of points characterizing a certain damage, allows you to make a choice in favor of either surgical or conservative treatment. The scheme proposed by the Spine Section of the German Society for Orthopaedics and Trauma is considered as the most detailed algorithm for the treatment of injuries to the thoracolumbar spine. The algorithm is based on the AOSpine Thoracolumbar Spine Injury Classification System, but uses a number of additional morphological modifiers, which made it possible to more adequately determine the most rational treatment method for a particular type of injury.
  PubDate: 2022-07-08
  DOI: 10.22141/1608-1706.2.23.2022.893
  Issue No: Vol. 23, No. 2 (2022)