Abstract: For today, the methods of fixation of the tibiofibular syndesmosis are represented by a positional screw and a Tight Rope system. These methods of fixation are designed for the safe conduct of full-fledged rehabilitation measures in the early postoperative period.
The purpose: to search for a functionally dynamic fixator of tibiofibular syndesmosis to reduce the treatment time of patients.
Material and methods: 270 people underwent surgery in the period from 2019 to 2022. 260 people were included in the study. A partial-threaded screw was installed in all patients as a fixator of tibiofibular syndesmosis. The follow-up was on 0.5; 1.5; 3; 6 and 12 months after surgery. The results were evaluated according to the AOFAS, VAS and OMAS scales.
Results: The rapid dynamics of recovery of ankle joint function were noted. After 2 weeks from surgery, the average AOFAS value was 80.2 points, and after 1.5 months 92.4 points. The average value of VAS was 2-4 points. The average OMAS value it was 90.5 and 100.3 after 1.5 and 3 months, respectively. Screw failure was recorded in 4 patients (1.5%) between 6 and 12 months after surgery without secondary tibial divergence.
Conclusion: the use of a partially threaded screw significantly reduces the risk of mechanical failure of fixation during active rehabilitation of patients from the earliest stages of the postoperative period, and there is no need for stage-by-stage removal of the screw in a regulated time.

Objective of the study: This study aims to compare the effectiveness of different treatment methods in elderly patients who have suffered a fracture of the proximal femur.
Materials and methods: The research was conducted between 2022 and 2024 at the state autonomous healthcare institution “City Clinical Hospital No. 7 named after M.N. Sadykov” (Kazan, Russia). The study included 150 patients randomised to four groups. Group 1: patients after osteosynthesis with restorative treatment (n=37), Group 2: patients after osteosynthesis without restorative treatment (n=38), Group 3: patients after endoprosthesis with restorative treatment (n=38), Group 4: patients after endoprosthesis without restorative treatment (n=37). Rehabilitation treatment included physical therapy (PT) and physiotherapy. All patients received basic medical therapy, including non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics.
Results: The mean pain scores (VAS) at baseline were 8.0±0.5 (group 1), 7.9±0.4 (group 2), 7.8±0.3 (group 3) and 7.7±0.4 (group 4). After one month of treatment, the values decreased to 3.9±0.3, 5.4±0.4, 4.1±0.3 and 5.8 ± 0.5, respectively. After three months, the values were 1.5±0.2, 3.7±0.3, 1.8±0.2 and 4.2±0.4, respectively. The analysis showed a significant improvement in patients who received restorative treatment compared to those who did not receive restorative treatment (p< 0.001). Additionally, similar significant improvements were seen on the Harris Scale, the Quality of Life Scale (SF-36), and Motor Assessment Scale. In general, rehabilitation treatment resulted in reduced pain and enhanced functional performance in patients with fractures of the proximal femur. Conclusion: Our study confirmed a significant improvement in outcome in patients with proximal femoral fractures treated with surgery combined with physiotherapy and exercise. These data are important for developing clinical recommendations and optimising standards of care for this group of patients.

Rationale: The technique of operative limb lengthening has a severe complication as an insufficient bone regenerate. This complication continues to occur frequently, although the technique of operative lengthening of segments and replacement of bone defects has been used since the middle of the 20th century.
The aim of the study was to investigate the influence of soft tissue volume on qualitative and quantitative X-ray morphometric indices of distraction bone regenerate during Ilizarov lengthening of the lower leg bones in patients with achondroplasia.
Materials and Methods. The study included 10 patients with achondroplasia who underwent lengthening of both tibiae for the first time in the Ilizarov Center. The average age was 7 years. The average lengthening value was 67 mm. All patients were operated and supervised by an orthopedic surgeon with more than 10 years of experience. In all patients, tibial osteotomies were performed at the level of the metaphyseal zones minimally invasively. Distraction was started on the 4th day and continued at the rate of 1 mm/day.
Results. By the end of the distraction phase in 2 patients the distraction regenerate corresponded to type II according to the Ru Li X-ray classification [1], in 3 patients - to type III, in 4 patients - to type IV (at least in 1 of the projections), in 1 patient - to type V. Regenerate remodeling occurred in all patients. The maximum reduction of the muscle volume per 1 mm of length from the initial one was 32.4% on the average. The diameter of the narrowest part of the distraction regenerate (at least in 1 projection) ranged from 3.3 to 20.9 mm.
Conclusion. A statistically significant (at n=42, Spearman's correlation coefficient was 0.420 at p=0.05) medium-explicit relationship between muscle volume per 1 mm of length and the smallest diameter of the distraction regenerate was found. The derivative is expressed by the formula y=0.006x+8.3. Based on this expression, the minimum desired diameter of the distraction regenerate can be calculated.

Repair of a posterior root injury of the medial meniscus is a common procedure. In the presence of varus deformity, various variants of corrective osteotomies are required to improve clinical and functional outcomes. Proximal fibular osteotomy (PFO) is an alternative.
Objective of this study was to evaluate the effectiveness of PFO in combination with refixation of the posterior root of the medial meniscus.
Materials and Methods. Two groups of patients with injury of posterior root medial meniscus were studied in a prospective randomised study. Meniscus root refixation was performed in both cases, PFO was performed in the first group and not in the other. For analysis, we evaluated pain syndrome by 100-point VAS, clinical and functional status by Lysholm scale and measured HKA and MAD angle before and after surgery.
Results. In both groups, the Lysholm score increased in 2.0 and 2.1. In group 1, 81.2% excellent results and 18.8 satisfactory results were obtained. In group 2, 71.9% excellent results, 25.0% satisfactory and one (3.1%) unsatisfactory. In the group of patients with PFO, an increase in HKA angle of 1.34 ± 0.65°. and a decrease in MAD of 45.00 ± 29.40 mm. was noted. When analysing the relationship between HKA angle and Lysholm index, statistically significant differences and markedly close direct correlation of these parameters were obtained.
Conclusion. Combination of meniscus root refixation with PFO is a promising method of treatment, because.

Introduction: there are several biological and mechanical approaches for compensation of extensile bone deficiency during primary and revision total knee arthroplasty (TKA) including metal augments, cones, sleeves, structural allografts, impaction bone auto/allografting and mega-prosthesis. If bone defect extends to metadiaphysial area of femur or tibia the number of surgical options becomes more limited.
Materials and methods: here are discussed the technical issues and mid-term outcome of replacing the distal femoral metaepiphysis by structural allograft during primary TKA due to non-union after several unsuccessful attempts of internal and external fixation in patient with end-staged osteoarthritis. At a follow-up examination after 36 month, the patients complaints, clinical and functional state of the knee joint were studied using the KSS and WOMAC questionnaires, and radiographs were also assessed.
Result: three years later, the patient used a cane when walking, minor pain in the knee joint occurred after covering 5-10 blocks, the range of motion was 0°/0°/100°. Functional assesment of the joint on the KSS scale - 80 points (good), WOMAC -27 points (good). On control radiographs, the position of the endoprosthesis components is correct, stable, and fusion of the structural allograft with the femur has ocurred.
Сonclusion: the use of a structural allograft of the distal metaepiphysis of the femur in case of extensive defects of the third type or the absence of a metaepiphysis makes it possible to compensate for the existing deficiency of bone mass and achieve stable fixation of the components of the endoprosthesis.

Introduction: Scapula fractures are a rare injury of the musculoskeletal system, and their treatment still presents challenges in many aspects. The topographical and anatomical features of the scapular region, the lack of the unified and agreed-upon classification of scapular injuries, discrepancies in existing indications for surgical treatment of fractures of this location, and the insufficient use of minimally invasive surgical approaches to the scapula in modern practice — all these factors do contribute to the ongoing uncertainty in approaches to the diagnosis and treatment of scapular fractures.
The aim of the research: To determine modern aspects in the diagnosis and treatment methods of scapular fractures, analyze the results of various studies describing the methods of diagnosis and treatment of scapular fractures, formulate the main guidelines for managing patients with scapular fractures, and identify areas requiring further research.
Materials and methods: An analysis of various medical literature sources containing data from both original and external studies on the topic of diagnosis and treatment of scapular fractures was conducted, including articles, monographs, and journals. The electronic medical and general scientific databases were used as sources: PubMed, ScienceDirect, and eLIBRARY.
The results of the study: Scapular fractures are a rare injury that come in many variations. Comprehensive radiological imaging, including the use of "scapular" projections to assess the glenopolar angle and CT with 3D reconstruction, is a key aspect of diagnosing scapular fractures. The use of AO and Ideberg classifications is a reliable method for stratifying intra-articular and extra-articular scapular fractures. Physicians agree that extra-articular scapular fractures with significant displacement and intra-articular fractures with any displacement are indications for surgical intervention, provided there are no contraindications based on the patient's somatic status. The long-term complications of both surgical and conservative treatment of scapular fractures most commonly manifest as impaired functionality of the upper limb. The main reason for this is the predominant use of more traumatic approaches and the lack of rehabilitation that takes into account the biomechanical features of the scapula. Considering the results of the analysis of literary sources, one can conclude that aspects related to indications for surgical treatment and rehabilitation of patients require further clarification and study. The literary sources do not contain coordinated information on specific figures for acceptable fragment displacement. Rehabilitation of patients with scapular fractures is mentioned in very few articles. Postoperative management protocols for patients also require improvement through further research. Only in this way is it possible to create a comprehensive algorithm for the diagnosis and treatment of patients with scapular fractures.

Total hip arthroplasty (THA) is clinically one of the most successful surgeries, with its frequency steadily increasing due to the growing incidence of primary coxarthrosis [1,2]. It is estimated that around 5% of these procedures are complicated by instability and dislocations, despite the positioning of the prosthetic head within the "safe zone" [15-18]. With this prosthesis positioning, complications are most commonly found in patients with a rigid spine [37]. Preoperative assessment, including radiography of the lumbar spine and hip joint in lateral view in standing and sitting positions, with evaluation of sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, and other parameters of the spinopelvic complex, allows for more precise planning of prosthesis positioning and reduces the risk of dislocation [13, 19]. Spinal stiffness may be increased in patients over 65 years old, in cases of ankylosing spondylitis, or following prior spinal fusion. In such cases, it is recommended to increase cup inclination and anteversion to compensate for the reduced posterior pelvic tilt in the sitting position [46]. In this review, we present various classifications of spinopelvic complex deformities and recommendations for cup positioning in total hip arthroplasty. A more personalized approach can reduce the risk of prosthetic instability and the number of revision surgeries [55].