Introduction: the paper presents the differential diagnosis of Metatarsus adductus (MA) in children. Classifications and anatomy features, changes of the foot during the growth, the possibility of the deformity self-correction according to international data are analyzed. The systematic MA treatment and its historical evolution, depending on the age of the patient and the severity of the deformity, are demonstrated.

Aim: to demonstrate the diagnosis protocol and treatment algorithm for children from 0 to 18 years old with MA, accepted in the Yaroslavl region.

Materials and methods: we performed the literature review analysis of the following databases: PubMed, Google Schlolar, Elibrary, Cyberleninka for the last 10 years, and evaluated the results of treatment of children with MA in clinics in Yaroslavl, Russia over the past 20 years. For describing the etiology, pathogenesis, development of diagnostic methods and MA treatment, earlier publications were also used.

Conclusion: the treatment protocol for children with metatarsus adductus, accepted in the Yaroslavl region, takes into consideration the severity of the pathology and the reasonably necessary timing of the treatment start. It allows to correct foot deformity minimizing the amount of surgical treatment.

Rationale: Ruptures of the pectoralis major muscle have become increasingly common in clinical practice in recent years, due to the popularization of power sports among the young population. The main treatment method for this injury is surgical restoration of the point of fixation of the pectoralis major tendon (MPT) to the anatomical attachment site. This allows you to restore the strength of movement in the shoulder, as well as eliminate a cosmetic defect.

However, a fairly large percentage of patients with such trauma seek medical help in a timely manner, which entails the risk of not achieving the expected result and leads to technical difficulties intraoperatively.

Purpose of the study: We propose our technique for restoring the SBMS in case of traumatic avulsions based on the conducted preclinical and clinical research on the restoration of ruptures using decortication of the SBMS refixation zone and the introduction of autologous cells into the SBMS area. As well as supplementing the rehabilitation protocol with physiotherapeutic treatment (PTL) - laser therapy in Superficial pain mode.

Materials and methods: From 2010 to 2018. Surgical treatment was performed on 52 male patients aged 19 to 49 years (average age 29.77±6.34). All patients underwent open reinsertion of the pectoralis major tendon using the proposed surgical technique, as well as the introduction of autologous cells into the tendon area.

Conclusion:The use of the proposed technique for reinsertion of the pectoralis major tendon with local injection of autologous cells showed earlier recovery of patients, as evidenced by the indicators of rating scales and questionnaires. A restorative multidisciplinary approach aſter suturing the pectoralis major tendon using autologous cells shows a clear advantage in the speed of restoration of function of the damaged segment.

Introduction. Robot-assisted total knee arthroplasty is a rapidly evolving field, with new robotic systems currently emerging, so this article summarizes the status of robotic technology and discusses its advantages and disadvantages.

The purpose of the study was to compare the advantages and disadvantages of a new active robotic system and their impact on the overall duration of the operation.

Materials and methods. A prospective single-center study of the results of intraoperative timing was conducted in 45 patients (12 men and 33 women, with an average age of 65.9 ± 7.4 years, average BMI - 31.3 ± 4.7 kg/m² using CJ150 CUVIS Joint® for total knee arthroplasty, compared with T-Solution One.

Results. When conducting a comparative analysis, a statistically significant decrease in the total operation time was revealed when using the new CUVIS system - 33.7% less (111.5±15.9 min, 168.2±29.9 min, with p <0.001) than with T-Solution One.>

Discussion. The main problem of active robots was the increase in operation time, but we can say that the new generation of active robot is much “faster” than the previous one due to automated preoperative preparation, convenient interface and registration scheme, simple fixation of the robot, variable speed of movement of the cutter, smaller dimensions, and greater maneuverability.

Conclusion The future of total knee arthroplasty undoubtedly lies in robotic technologies, which are showing rapid growth, although to what extent and to what extent this will depend on further high-quality studies assessing long-term outcomes, complications, survival and cost-benefit analysis.

Introduction: Suturing the damaged parts of the meniscus through arthroscopic access is the only method of meniscus preservation. However, it does not always fuse. And this is the problem that we were interested in and prompted us to address it. Laser technology shows good results in various studies, and this served as a basis for the first stage of experimental work. We applied the laser technique, namely microperforation, on explants.

Purpose: To evaluate the result of experimental work of laser perforation by two-wave fiber laser device LSP - "IRE-Polus" (NTO "IRE-Polus", Russia) on meniscus explants in order to assess the use of laser technology in combination with arthroscopic suture of the knee joint meniscus to improve the treatment results.

Methods: Fragments of meniscus tissue extracted during surgical intervention of knee joint endoprosthesis were taken, laser processing was performed, followed by histologic examination.

Results: From all three investigated parameters of laser radiation exposure on meniscus tissue the mode of pulse-periodic exposure with a wavelength of 0.97 microns, power - 15 W at the input, wavelength of 1.56 microns power - 2 W at the output is the most optimal. At these parameters the focus of laser influence has the smallest diameter. There were no signs of coagulation and carbonization in the edges of the laser exposure focus. There was practically no edema of fiber bundles and fibers both at the periphery of the focus of laser exposure and in the nearest, adjacent areas, i.e., there was no mediated reaction. With this parameter of laser exposure, we were able to achieve a localized effect.

Conclusion: on the basis of histologic analysis, we came to the conclusion that the method is effective. The study of the combination of arthroscopic suture and laser perforation of meniscus injuries in comparison with the methods of mechanical traumatization (treatment with a shaver, rasp) and the influence of this method on cell proliferation and blood supply in the meniscus tear zone due to meniscus perforation requires further investigation in the clinical stage.

Introduction. Brachymetatarsia is a fairly rare pathology that is characterized by shortening of the metatarsal (or metatarsals) bones due to premature closure of the growth plate. However, most patients suffering from this pathology require surgical treatment.

Purpose of the study: to improve the results of treatment of patients with brachymetatarisis by introducing into surgical practice the method of simultaneous lengthening of the metatarsal bone using an autograſt from the tubular bones of the foot.

Materials and methods. This article presents a comparison of treatment results between two groups of patients. The main group of patients (40 patients, 50 feet) underwent simultaneous lengthening of the shortened metatarsal bone using autograſts from tubular bones of the foot. The control group of patients (25 patients, 33 feet) underwent distraction osteosynthesis of the metatarsal bone using an external fixation device.

Results. The results obtained during the study suggest the advantage of the method of one-step lengthening of the metatarsal bone using autograſts from tubular bones of the foot over the distraction method. Patients in the main group had a shorter healing period compared to the control group (8.1±1.3 and 16.2±2.4 weeks, respectively), and fewer complications. Also, patients of the main group in the early postoperative period noted a high cosmetic result of the operation.

Conclusions. By using the developed method of surgical treatment, we were able to significantly reduce the treatment time for patients, as well as achieve high aesthetic results.

The aim of the study was to analyze unsatisfactory outcomes and complications of treatment of patients with extensive soſt tissue defects of the hand.

Material and methods. The analysis of the treatment of 138 patients with extensive defects of the soſt tissues of the hand, with various types of skin graſting and with conservative methods. patients were divided into two groups: main (60), with soſt tissues of the injured hand with an axial type of blood supply flaps. The second group (44 patients) who used local tissue plastic and free skin plastic (split or full-layer) to close extensive soſt tissue defects of the hand. In 34 cases, wound defect healing was carried out by conservative methods (group 3).

Results. The structure of unsatisfactory outcomes and complications was dominated by contracture of the fingers joints with desmogenic and tenogenic origin, sensitivity and trophic disorders. The functional results of the upper limb studied according to DASH scales, the assessment of the quality of life according to the SF-36. A comparative assessment of anatomy, amplitude of movements in the fingers (flexion and extension), dynamometry and the state of the main types of grip carried out. At the same time, it was revealed that in the long-term period aſter surgery, the indicators significantly improved in both groups (p<0.01), but a statistically significant difference between the groups was also revealed in favor of the group of patients operated using vascularized flaps with an axial type of blood supply.> < 0.01), but a statistically significant difference between the groups was also revealed in favor of the group of patients operated using vascularized flaps with an axial type of blood supply.

Conclusion. A high proportion of unsatisfactory results of reconstruction of soſt tissues of the hand by traditional techniques, leading to a significant decrease in the functionality of the injured hand with extensive soſt tissue defects, motivate specialists to improve existing techniques.

Background. Hammertoe deformity is characterized by extension contracture of the metatarsophalangeal joint, flexion contracture of the proximal interphalangeal joint, and hyperextension of the distal interphalangeal joint. This condition is widespread, especially among women in the older age group. Hammertoe deformity, both isolated and in combination with concomitant foot deformities, is a pathology that leads to a decrease in the activity of patients, severe pain and difficulties in choosing shoes. Existing surgical treatment methods have disadvantages and limitations in application, which leads to the need to search for new treatment methods.

Aim. Analysis of short-term results of using an original joint-saving technique for the treatment of hammertoe deformity – Oblique Distal Osteotomy (KDO) using an immersion fixator.

Materials and methods. To assess the objective condition of the patient in the pre- and postoperative periods, radiographs were taken, photographs and video recordings were made to determine the range of motion in the Proximal interphalangeal joint (PIPJ). To assess the subjective state of the patient before treatment and 6 months aſter surgery, a survey was performed using the visually analog scale (VAS), AOFAS Forefoot (AOFAS FF) questionnaires and questions regarding the patients’ subjective assessment of the treatment performed.

Results. According to the survey data, a decrease in the level of pain syndrome is noted, and an increase in the patient’s activity is determined. The VAS score before treatment was 5.8 (4–7, SD=1.0) points, 6 months aſter surgery it was 1.4 (0–2, SD=0.8, p <0.05) points. Questionnaire results using the AOFAS FF scale increased from 80.4 (69–90, SD=7.7) to 91 (83–95, SD=4.1, p <0.05) points. 20 patients (83.3%) were satisfied with the cosmetic and functional results. In all patients, control radiographs showed consolidation of the osteotomy zones; no signs of migration of fixators were recorded. The range of motion in the foot joints in the group of patients at the time of control examinations was: in the PMJ joint — 17,9 ° (7 ° –30 °, SD= 6.4).

Conclusion. Short-term results of treatment of patients with hammertoe deformity using the KDO technique allow us to conclude that the results in the short-term postoperative period are satisfactory, the necessary correction of the deformity is achieved while maintaining movements in the proximal interphalangeal joints.

Introduction: The development of effective methods for Hallux Valgus, that provide a long-term reproducible result is a pressing issue in foot surgery. Currently, combined techniques addressing the complex biomechanical changes associated with the development of Hallux valgus show the most promising results.

Materials and Methods: This study presents a clinical observation of a 54-year-old patient (O.) with Hallux valgus toe and varus deviation of the first metatarsal bone. The patient underwent reconstructive surgery, including scarf osteotomy and Akin osteotomy. Intraoperatively, a significant thinning of the capsule and the medial ligamentous complex in the dorso-proximal part, with detachment from the fixation point to the head of the first metatarsal bone, was revealed. Medial collateral ligaments plasty of the first metatarsophalangeal joint was performed. The follow-up period was 12 months, including questionnaire surveys, physical examinations, assessments of movement amplitude, and objective evaluations using VAS, SF-36, and AOFAS questionnaires. The range of motion in the first metatarsophalangeal joint was 90 degrees for extension (dorsiflexion) and 30 degrees for flexion (plantar flexion).

Results: Preoperatively, pain was rated at 80 on the VAS, SF-36 at 35%, and AOFAS at 59. Post-surgery, significant improvements were observed in all questionnaires (VAS = 0, SF-36 = 95, and AOFAS = 100), along with the recovery of movement amplitude of the metatarsophalangeal joint. The intertarsal angle decreased from 21° to 8 degrees, and the Hallux Valgus angle reduced from 50° to 12 degrees. The radiographs showed no negative dynamics three months and one year post-surgery. The range of motion in the first metatarsophalangeal joint aſter surgery was 85 degrees for extension (dorsiflexion) and 15 degrees for flexion (plantar flexion).

Conclusion: Addressing the pathogenetic links in the development of Hallux valgus, coupled with the restoration of the ligamentous apparatus of the metatarsophalangeal joint, allows for a reliable long-term result. This study underscores the effectiveness of a modern personalized approach, contributing to improved outcomes in the treatment of orthopedic patients.

Background: Osteoarthritis of the ankle is a very common disabling disease, occurring in people of working age. In the early stages, conservative therapy can be effective, but if ankle arthritis progresses to the terminal stages, the question arises of choosing the right method of surgical treatment. Surgical treatment of late stages of ankle osteoarthritis mainly involves a choice between total ankle replacement and ankle arthrodesis.

The purpose of this article: To determine the best treatment for end-stage deforming osteoarthritis of the ankle based on available research data.

Materials and methods: A review of the literature over the past 10 years was carried out in such databases as PubMed, Scopus, Google Scholar, eLibrary. Articles, original studies, case reports, and previous systematic reviews of the literature were found.

Results: 338 studies were found reflecting the results of the discussed surgical treatment options. Aſter reviewing abstracts of articles, applying inclusion criteria and exclusion criteria, 25 articles were selected for a detailed review. Of these, 12 reflected the results of total arthroplasty, 8 – arthrodesis, and 5 studies directly comparing the two methods. The results of the comparison of studies are presented in the form of tables. Both methods of treating the terminal stages of deforming osteoarthritis of the ankle joint show good medium-term and long-term results. Aſter total arthroplasty, a higher overall rate of complications was noted, and aſter arthrodesis, a higher rate of revision surgeries was observed. Total ankle arthroplasty shows better functional result.

Discussion: Both methods of treatement of the terminal stages of deforming osteoarthritis of the ankle show good medium-term and long-term results. However, due to the high overall complication rate aſter total ankle replacement, it is not possible to clearly identify a preferable technique. Further studies of the long-term results of endoprosthesis replacement and arthrodesis of the ankle joint are necessary.

Aim: The aim of this literature review was to analyze the data of modern scientific literature outlining the indications, techniques, results and complications of supramalleolar osteotomies in treatment of ankle arthrosis.

Material and methods: The work analyzes articles published in such aggregators as PubMed, Medline, elibrary which cover data on supramalleolar osteotomies. Articles older than 10 years were not included. Previous literature reviews, clinical cases, trials with low number of cases were excluded.

Result: Patients with the presence of deformity at the level of the ankle joint have a high risk of pathological load distribution on the articular surfaces in the ankle joint, which ultimately leads to the development of asymmetric ankle arthrosis. Supramalleolar osteotomies allow for restoring the biomechanics of the joint with a reduction of pain syndrome and slowing down the degenerative changes in the joint. Most of authors of the world literature emphasize the high satisfaction of patients with this methods of treatment, demonstrate good short- and medium-term results, the analysis of which is presented in the article on the basis of current works of leading experts of the world.

Conclusion: Surgical techniques aimed at preserving the ankle joint in case of asymmetric arthrosis of the ankle joint with varus or valgus deformity are becoming more popular in modern orthopedic society. The conducted literature research showed that this operative treatment leads to good clinical results, corrects the hindfoot deformity and gives high results of patient satisfaction. Conservative treatment of ankle arthrosis does not bring expected results. Radical surgical techniques, such as ankle arthrodesis, can lead to a redistribution of the load on adjacent joints, which leads to secondary deformities and pain syndrome.