Tranexamic acid can be used to treat postoperative bleeding after total hip endoprosthesis surgery. The relevance of this study is determined by the need to conduct research to identify the most effective and safe method of administering the drug.

Objective: The aim of this work is to propose a simplified and optimal method of «Tranexam» usage.

Materials and methods: A prospective study was conducted on 120 patients who underwent primary unilateral total hip endoprosthesis. The patients were divided into two groups. Patients from the first group were administered with tranexamic acid according to the proposed method, which is to parenterally administer tranexamic acid in a fixed dose of 1000 mg not earlier than 30 minutes and not later than 1 hour before the surgery, then later optionally administer the drug while not exceeding the dosage of 2000 mg. The second group consisted of patients who were not administered with tranexamic acid.

Results: Comparison of the two groups provided strong evidence for the use of tranexamic acid.

Conclusions: The study showed that usage of tranexamic acid significantly reduces the risk of increased blood loss and does not increase the risk of thromboembolic complications when administered parenterally according to the method proposed in this study.

Relevance. Post-traumatic osteoarthrosis (PTOA) is a multifactorial disease caused by mechanical and biological changes. It mainly features the degeneration of the articular cartilage and subchondral bone, and changes in the properties of synovial fluid; its viscosity decreases which requires correction. When entering the joint, the bioactive substances consisting of polynucleotides break into simple nucleotides, nucleosides, and nucleobases, which, as is known from the published studies, are present in the extracellular environment in physiologic concentrations, and are fundamental substrates for joint cell regeneration.

The objective of this study is to investigate the impact of polynucleotides as injectable proliferants on the presentations of simulated PTOA.

Materials and methods. The experiment involved white outbred male rats. The intensity of lipid peroxidation was assessed by lipid hydroperoxides (LHP) accumulation in the serum of the animals, and antioxidant system activity by thiol status (TS). To assess the synthetic osteoblasts activity osteocalcin (OC) content was determined, and the articular cartilage metabolism was defined by hyaluronan (HN) content.

Results. On Day 7 of the experiment, the PTOA simulation was confirmed by the changes in the levels of serum markers. Resulting from intra-articular administration of polynucleotide-based proliferates on Day 28 the decrease in HPL was observed while TS was increased. The polynucleotides didn’t cause any imbalance the regulation mechanisms of the joint osteochondral component which was confirmed by a decrease in OC and HN values on Day 28 versus the comparison group.

Conclusion. The experiment findings suggest the onset of degenerative changes as early as on Day 7 of PTOA simulation. Polynucleotides injected as proliferants are substances capable of supporting physiological restoration in osteochondral structures as well as redox reactions in articular tissues in simulated PTOA.

Meniscus injuries are one of the most important causes of premature osteoarthritis in the knee. Meniscal rupture affects local biomechanical properties and load distribution of the joint. In order to reconstruct the integrity of the meniscal structure and enhance regeneration of meniscal tissue a personalized scaffold may be used. The choice of materials and method of scaffold fabrication remain challenges for researchers. Polycaprolactone is considered as a suitable material for meniscal scaffold due to its biocompatibility and good mechanical characteristics.

Purpose of the study is to evaluate the feasibility of polycaprolactone filament use to create a knee joint meniscus scaffold using 3D printing technology.

Materials and methods: a meniscus scaffold virtual prototype was created and scaffold was constructed after model using a polycaprolactone filament (molecular weight = 50kDa) on an FDM 3D printer Flashforge Guider 2s. The evaluation of the material was carried out by imaging the scaffold on a OLYMPUS SZ51 optical microscope. The study of destruction temperature was performed using a synchronous thermal analyzer STA 6000 and investigation of the chemical structure of the IR-Fourier spectroscopy of multiple disturbed total internal reflection (MNPVO) on the Spectrum Two ("Perkin-Elmer", USA).

Results: The temperature of the 3D printer extruder changes the physicochemical properties of polycaprolactone, which limits the ability to control the size of pores and scaffold beams. The characteristics of the final product do not allow its subsequent modification.

Conclusions: polycaprolactone based meniscal scaffolds manufacturing should be done on 3D printer with adjustable extruder temperature

The implantation of the short-segment pedicle screw fixation hardware (PSFH) is a standard surgery for the management of thoracolumbar spine injuries. The disadvantage of this technique is the frequent implant failure along with the deformity and back pain recurrence. The intermediate PSFH supplemented with another two screws inserted into the fractured vertebrae has been described in the studies; however no outcomes of PSFH supplemented with just one intermediate screw and thus ensuring further anterior fusion without rearranging the system have even been presented.

Methods. We analyzed the surgical outcomes of 109 (71 men, 38 women) 36 (29; 43.5) years old patients with Th12, L1, L2 type A3 (78) or A4 (31) AOSpine fractures using retrospective, single-center, non-randomized methods. The patients were divided into two groups: Group I – 58 patients with the standard 4 screws short-segment fixation hardware; Group II – 51 patients who had their PSFH supplemented with another pedicle screw inserted into the fractured vertebrae. The outcomes were assessed by the severity pattern of pain and kyphotic deformity, the anterior column height, the implant failure and the loss of correction. The computer tomography findings were used to design solid finite element models of the spines and PSFH layout options including biomechanic bone-hardware simulation. This involved the simulation of the loading for the operated area that corresponded to normal physiology.

Results. The patients were comparable in their age and height, their division was determined by the level and type of their fractures, the anterior column height of the fractured vertebra, and the severity of back pain. The post-surgery follow-up revealed significant (p<0.05) positive differences in the patients who had their implants supplemented with additional pedicle screws. The 4-screw PSFH is biomechanically less stable than the 5-screw one and the load on the vertebrae osseous tissue in 5-screw PSFH is less loaded. Therefore, the PSFH layout that ensures lesser stress should be preferred.

Conclusion. The positive outcome of management with intermediate PSFH can be ensured by unilateral inserting of the screw into the fractured vertebra. Unlike the PSFH with two intermediate screws, that with just one ensures corpectomy or fusion avoiding PSFH rearrangement.

Justification: Treatment of cartilage in the focus of chondropathy during arthroscopic interventions is one of the methods of treatment of gonarthrosis. The laser method of cartilage treatment has an advantage over the rest (cold plasma, mechanical) since it allows you to produce more accurate and less voluminous effects.

Purpose: the aim of this work is to improve the results of treatment of gonarthrosis by including laser treatment of cartilage in the focus of chondropathy in the treatment complex.

Materials and methods: 35 patients with local cartilage injuries of the knee joint were treated. Patients of the main group (20 people) underwent arthroscopic treatment of foci of chondropathy using the laser method, patients of the comparison group (15 people) – using mechanical and cold plasma techniques. The initial examination was performed before the operation. Repeated examination 3 and 6 months after the operation. The examination included a clinical examination by an orthopedic surgeon, an MRI of the knee joint and a questionnaire on the VAS, LFI, and WOMAC scales.

Results: All patients noted positive dynamics, which was reflected in increased tolerance to physiological and athletic loads, as well as in the average values of the evaluation scales. However, in the main group, the indicators of the scales changed more significantly than in the comparison group. Also, in patients of the main group, there was a partial restoration of cartilage thickness in the focus of chondropathy and a decrease in the depth of damage to the subchondral bone, which was not observed in patients of the comparison group.

Conclusion: Arthroscopic laser treatment of foci of chondropathy reduces the risks of progression of osteoarthritis, which makes it the method of choice in the treatment of local chondropathy, as having high efficiency in stimulating the regeneration of cartilage tissue.

Justification: Osteoarthritis is one of the most common diseases that lead to disability. Arthroscopic laser treatment of articular cartilage is an effective and promising method of treating osteoarthritis, but its technique can be improved due to the results of this study.

Purpose: to experimentally evaluate the absorption and scattering coefficients of laser radiation with wavelengths λ=1.55 microns and λ=0.97 microns in articular cartilage tissues and to establish the role of these radiations in the mechanism of laser exposure in the treatment of chondropathy.

Materials and methods: Thin slices with a thickness of 100 microns and 200 microns were made from samples of pig cartilage tissue. The slices were exposed to laser radiation with wavelengths λ=1.55 microns and λ=0.97 microns. The "method of mobile integrating spheres" was used to measure the optical properties of images.

Results: When passing through cartilage tissue, the absorption coefficient for radiation λ=0.97 microns was 0.14±0.02 mm-1 for radiation λ=1.55 microns - 0.8±0.1 mm-1. The scattering coefficient for radiations with λ=0.97 and with λ=1.55 was 19±2 mm-1 and 3.7±0.4 mm-1, respectively.

Conclusion: 1) When passing through the thickness of articular cartilage, the absorption coefficient (μa) of laser radiation with λ = 0.97 microns is significantly lower than that of laser radiation with λ = 1.55 microns. 2) When passing through the thickness of articular cartilage, the scattering coefficient (μs) of laser radiation with λ= 0.97 microns is significantly higher than that of laser radiation with λ = 1.55 microns. With laser treatment of the focus of chondropathy with combined radiation λ=0.97 microns + λ=1.55 microns, radiation λ=1.55 microns «smoothes» the surface of articular cartilage in the focus of chondromalacia, allowing to achieve restoration of the structure of the articular surface, and the radiation parameters λ=0.97 microns in the thickness of articular cartilage allow to trigger photobiomodulation mechanisms in the articular cartilage and the underlying subchondral bone.

Abstract. Past time, in the literature there has been an increasing interest of using minimally invasive volar approach for surgical treatment of patients with distal radius fractures allowing, on the one hand, not to damage vascularity of bone fragments and active stability of distal radioulnar joint, and on the other hand – giving possibility to do all repositional and fixational steps.

The aim of the study is to assess results of minimally invasive volar approach for surgical treatment of patients with distal radius fractures.

Material and Methods. We analyzed results of surgical treatment of 68 patients (48 female and 20 male) with distal radius fractures treated in the period from November 2015 to December 2021 using minimally invasive volar approach. In all cases for fixation we used volar locking plate. The mean age was 39,26±7,66 years (21-58 years). Fractures were classified according to Fernandez classification system as type I – 41 cases (60,3%), type II – 12 cases (17,6%) and type III – 15 cases (22,1%). The minimal follow-up after the surgery and discharge was 3 months, until the final functional result. X-rays (consolidation’s signs, volar tilt, radial height, radial inclination, joint congruency as well as distal radioulnar joint congruency), functional (flexion/extension of the wrist, forearm rotation and grip strength) and cosmetic results were evaluated during follow-up period. The overall results were assessed on the basis of Gartland & Werley score.

Results. Primary union of distal radius was achieved within 6 weeks after the surgery in 66 patients (97,1%), confirmed by X-rays. In 2 cases (2,9%) we didn’t achieve bone union even after 6 months, that was detected as false joint of distal radius and required re-operation. After 3 months according to Gartland & Werley score 52 patients (76,5%) had an excellent results, 14 (20,6%) – good, 2 (2,9%) – fair. There were no poor results. In 3 cases (4,4%) there were sensitive problems in the field of thenar due to intraoperative damage of palmar branch of median nerve during surgical approach. There were no any complications. The cosmetic result was excellent in all cases.

Conclusions. The usage of minimally invasive volar surgical approach for plate fixation of distal radius fractures is spectacular and effective tool of treatment result’s improvement for patients with such kind of trauma. The possibility of preservation of m. pronator quadratus, bone vascularity, contributing to bone healing, lower risk of infectional complications, faster functional recovery and better patient’s satisfaction about cosmetic result are the main arguments for using such technique.

The choice of treatment methods for patients with fractures of the trochanteric region of the femur, as well as specific surgical tactics, is justified. According to a number of researchers, hip arthroplasty is an alternative to osteosynthesis in such injuries, especially in patients with limited functional capacity and a poor medical history. The primary results of endoprosthesis and intramedullary blocked fixation constructions in elderly patients with obesity were compared.

Purpose of the study. To evaluate the clinical efficacy of intramedullary osteosynthesis and endoprosthesis in obese patients with vertebral fractures of the proximal femur.

Materials and methods. The study was carried out on the basis of the Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan. A total of 76 patients aged 66 to 91 years were operated on. Two techniques were used in the treatment. 46 patients who underwent primary hip arthroplasty (THA) and 30 patients who underwent blocked intramedullary osteosynthesis (BIOS) with proximal femoral nail of gamma-nail type.

Results. – A comparative study with a relatively small sample showed that there was no statistically significant difference in the duration of surgery between patients with normal BMI and obese patients with different surgical approaches.

– Blood loss rates in both groups were less than the critical level (p<0.05). The study expectedly confirmed that the higher the patient's BMI, the longer the duration of surgery and the greater the blood loss.

– The presented material suggests that arthroplasty can be used for vertebral fractures of the proximal femur if there are no relevant surgical contraindications.

– The relative difficulty of performing blocked intramedullary pinning, difficulty in activating and rehabilitating obese patients, and risks of early loading of the injured limb lead to the search for alternative methods of surgical treatment of acetabular femoral fractures.

– Using the advantages of hip arthroplasty is the most important factor of favorable outcome of treatment and life preservation for this complex group of patients.

Introduction. Osteoarthritis (OA) is one of the most spread joint pathologies. Timely diagnostics of this disease at the early stages plays an important role for planning following treatment tactics. Unfortunately, the available clinical methods lack the ability to detect cartilage changes at the initial grades of OA.

The aim of the study. To study the capabilities of optical spectroscopy, in particular – its usage in intraoperative diagnostics of the cartilage condition.

Materials and methods. Analysis of the literature data about methods for diagnosing changes in cartilage tissue, with further conducting our own clinical experiment – intraoperative application of the spectroscopy to assess the cartilage condition at 33-year-old patient Sh. with the defect of the cartilage tissue, according to the MRI investigation and visual examination during the arthroscopic surgery.

Results. Existing imaging methods, that can be used in vivo, require further development for usage in the early diagnosis of osteoarthritis, while NIR-spectroscopy is suitable for this task.

Conclusion. The spectroscopy method is a promising direction in the diagnostics of cartilage condition, which can be used intraoperatively without damaging the cartilage tissue.

Introduction: This article is devoted to one of the most urgent problems in traumatology and orthopedics – the diagnosis and treatment of chronic osteomyelitis of limb bones. Every year this problem does not lose its relevance, high numbers of osteomyelitis detectability remain, cases of post-traumatic and postoperative osteomyelitis are gradually increasing in number, which in a high percentage of cases lead to permanent disability.

Materials and methods: The paper presents current trends in the diagnosis and treatment of this disease. The purpose of the review is to review and present current trends in the diagnosis and treatment of osteomyelitis based on the analysis of domestic and foreign literature. During the work, more than 1000 literature sources from domestic and foreign scientific citation databases were analyzed.

Conclusions and discussion: Based on the analysis of the literature, the following conclusions can be drawn that despite the emerging high-tech and innovative methods and taking into account the increasing operational activity, injuries of the civilian population, the high level of military trauma, this problem requires the development and implementation of new methods, algorithms and concepts for the diagnosis and treatment of chronic osteomyelitis. The development of such techniques, algorithms and concepts contribute not only to accurate diagnosis and early detection, but also to finding the optimal solution for the treatment of chronic osteomyelitis.

Introduction. Over the past centuries, there has been a significant improvement in the quality of life of people, medical care and, in general, the social status of a person, and as a result, an increase in older people. However, this generally positive fact is the reason for the increase in the incidence of a number of chronic diseases in the general population, including osteoporosis. Bone fractures are a common injury in elderly and senile people against the background of osteoporosis. Fractures of the femoral neck are recognized as the most difficult in treatment and rehabilitation due to the high level of mortality and complications. In this regard, the prediction of osteoporosis and osteoporotic fractures is an urgent problem.

Purpose: to consider the current state of the problem and the effectiveness of using a prognostic assessment of the level of vitamin D in the blood for the occurrence of femoral neck fractures to justify the feasibility of conducting this kind of research.

Materials and methods: analysis and synthesis of articles in the amount of 31 sources of the MEDLINE, Scopus, CyberLeninka and eLIBRARY databases for the period from 2010 to 2022.

Conclusions: among the prognostic factors of a femoral neck fracture and an increase in the body's reparative potencies, many studies indicate a sufficient level of vitamin D in the blood serum. It is noted that bone health, maintenance of calcium and phosphorus homeostasis in the body depends on the level of vitamin D. It acts as a protector of osteomalacia. It has been proven that the required level of vitamin D in the blood promotes bone mineralization, prevents the development of osteoporosis and reduces the risk of osteoporotic fractures. This, of course, led to the fact that doctors began to increasingly prescribe vitamin D. Numerous epidemiological and interventional studies have found an association between vitamin D and certain bone and non-bone pathologies, with an increase in incidence with age. Against the background of vitamin D deficiency, markers of bone tissue metabolism and its structural and functional organization change. Thus, the features of the effect of vitamin D on bone and muscle tissue, the frequency of falls, and the reduction in the risk of developing osteoporosis and osteoporotic fractures, especially in older age groups, have been proven. Prognostic markers (in particular, the concentration of vitamin D) can serve as additional indicators of the probable development and complicated course of osteoporosis. Therefore, in modern predictive medicine, regular screening for the detection of the level of vitamin D in the blood in older age groups is necessary.