There is still no consensus as to whether decompression of the suprascapular nerve should be performed routinely with suture the supraspinatus tendon.

   Purpose: to investigate the effect of the release of the supra-scapular nerve during arthroscopic suture the supraspinatus tendon.

   Materials and methods: The study included 60 patients. Patients were divided into 2 groups. Group 1 consisted patients who have arthroscopic suture the supraspinatus tendon with supra-scapular nerve release. Group 2 included patients with the same operation without performing the release. The assessment was carried out before the operation by DASH, VASH scales, and then at the terms of 1, 6, 12 months after the operation and the degree of dystrophy according to the Gutalier classification in MRI T1 weighted mode before the operation, and then 3, 6, 12 months after the operation.

   Results: A difference was found in the DASH estimate at 1 month (p-level <0.01). A difference was found in the assessment of VAS at 1 month (p-level = 0.01). The difference between the groups in the assessment of fatty degeneration according to the Gutal classification was detected at 3 months (p-level = 0.03). There was no difference in other control points.

   Discussion: there is really no consensus it is necessary to complement the operation of arthroscopic suture supraspinatus tendon with suprascapular nerve release in the superior notch, however, from our own experience we saw positive results in the first month after the operation and decided to introduce this technique into our routine practice in order to improve results in early recovery period after suture supraspinatus tendon.

   Conclusion: According to the results of our study, we can say that during the operation suture supraspinatus tendon, the additional release of the suprascapular nerve improves the pain level indicators in the early stages of 1-3 months.

   The aim of this research was to study the immediate and long-term outcomes of revision total knee replacement (reTNR) using metaphyseal fixators (sleeves and cones), and to design the algorithm for choosing a metaphyseal fixator.

   Material and methods. The research involved 134 patients who underwent revision knee arthroplasty. The patients were divided into two groups according to the type of metaphyseal fixator used for their surgeries: sleeves (Group 1) – 97 patients, and cones (group 2) – 37 patients. The outcomes were evaluated at their discharge from the hospital, 6, 12, 24 months after surgeries. The implants survival was analyzed with the Kaplan - Meier estimate. Reoperation with the complete replacement of the implant or its components was considered a critical event.

   Results. The analysis of the implants survival rate revealed no statistically significant differences between the groups (Logrank (the Mantel-Cox) test, p=0.108). We designed the algorithm for metaphisal fixator selection in revision knee arthroplasty and implemented it into practice.

   Conclusion. The implantation of metaphyseal sleeves or cones to replace extensive bone defects in reTNR surgeries presents similar outcomes in the mid-term. The introduction of the algorithm for choosing a metaphyseal fixator that takes into account the bone defect size, patient’s age and activity is a step towards improving the outcomes of reTNR.

   Treatment of fracture-dislocations of the forearm and external lateral rotational instability of the elbow joint is challenging. The authors proposed a dynamic fixation device, manufactured during surgery, which can improve the results of treatment of this pathology.

   The purpose of the study was to study the effectiveness of using the author's method of surgical treatment and a special implant in the treatment of fracture-dislocations of the forearm bones.

   Materials and Methods: A retrospective analysis of the results of treatment of patients with closed isolated fracture-dislocations of the elbow joint was conducted in the period from 2009 to 2019; the study included 23 patients (14 women and 9 men), with an average age of 47.8 ± 12.1 years. The patients were operated on using the author's dynamic stabilizer; the average preoperative period was 7.6 ± 3.9 days.

   Results. Pain syndrome on the VAS scale before surgery was 5.9 ± 1.0 points, on the first day after surgery it increased to 7.8 ± 0.9 points and then gradually slowly decreased by the 14^th day after surgery to 2.0 ± 0.7 points. Dynamometry of hand strength at 3 months (35.8 ± 5.0 kg) by 12 months (55.8 ± 7.1 kg) increased by 35.8 %. Results on the MEPS scale from 1.5 to 12 months increased from 49.7 ± 4.4 to 87.7 ± 8.9 points by 43.3 %, the DASH scale at 1.5 months was 31.8 ± 10.3 points and at 12 months decreased to 18.5 ± 10.2 points (by 41.8 %).

   Conclusion: In the treatment of fracture-dislocations of the forearm, early surgical intervention using an original metal structure is effective, which allows you to begin early rehabilitation without using immobilization, obtain good functional results, avoiding the formation of post-traumatic instability and
contractures in the elbow joint.

   Objective: to improve diagnostics and results of treatment in patients with hip-spine syndrome (HSS).

   Materials and methods. This study is prospective, and in it we included 100 patients with coexisting hip OA and lumbar spine stenosis with problems in right surgery tactics. All patients underwent clinical examination. We performed needle EMG and intraaticular injections under ultrasound control with ropivocaini 7,5 mg – 3,0. We divided our patients into two groups, in main group (55 patients) surgeries were based on needle EMG and on VAS after injections. In the second group (45 patients) we chose surgery depending only on VAS dynamic after injections. The clinical results before and after surgeries were rated depending on Oswestry, Harris and VAS scores.

   Results. In the main group depending on results of needle EMG and VAS after ultrasound-guided injections we formed patients into 4 subgroups. In subgroups 1.1-1.3 THA, spinal surgery or both were chosen as surgery treatment, the resuts in 3 moths were good. In subgroup 1.4 we discovered a neuro-muscular disease due to needle EMG results, no surgery was performed. In the control group we formed two subgroups – K1 and K2. In K1 subgroup there was a pain reduction (VAS 40 mm and more) and we performed a THA with bad results in 6 (of 29) patients. In K2 subgroup there were no pain reduction after intraarticular injections, neurosurgeons performed spinal surgeries witn bad results in 3 pateients (of 16).

   Discussion. Our examination algorithm in patients with HSS In control group, where the surgery type was based only on intraarticular anesthetic injection, 9 of 45 patients had bad results after surgery (THA or spinal surgery), and that is same as descrided in literature.

   Conclusion. Our examination algorithm in patients with coexisting hip and lumbar spine pathology is based on performing needle EMG and ultrasound-guided hip injections with local anesthetics. If there are denervation sings in paraspinal and low limbs` muscles we recommend spinal surgery first, THA then only if needed. If there are no signs of denervation – we recommend THA only. This algorithm helps to improve the diagnostics and surgical treatment results.

   Introduction. The problem of replacing femoral defects after gunshot fractures is one of the most difficult in traumatology and orthopedics.

   The purpose of the study was to compare the results of surgical treatment of patients with gunshot defects of the femoral diaphysis using additive technologies and the method of compression-distraction osteosynthesis according to Ilizarov.

   Material and methods. During the period from 2019 to 2023, a prospective single-center sequential controlled study was conducted, which included twenty wounded patients with gunshot circular defects of the middle third of the femoral diaphysis (more than 7 cm). The main group (I - 8 wounded) had femoral defects replaced using additive technology - an individually manufactured implant filled with auto- and allografts and fixed with a locking intramedullary pin; the control group (II - 12 wounded) had femoral defects replaced using the compression-distraction method osteosynthesis according to Ilizarov. The age of the patients was 29.3 ± 3.3 years, the size of the bone defect was 9.8 ± 2.4 cm. The severity of the condition on the VHS-SP scale was estimated at an average of 12.2 ± 1.5 points.

   Results. The duration of inpatient treatment for patients in group I was significantly shorter compared to group II: 62.1 ± 12.7 and 112.0 ± 37.0 days, respectively. The average time for anatomical restoration or integration of a 3-D implant for 7 patients in group I who completed treatment with a positive result was 170.9 ± 19.7 days. While in group II, replacement of the defect with bone transport and fusion of fragments was achieved after 275.7 ± 76.7 days. The return of the wounded to the previous level of physical activity and to military service without changing the fitness category was achieved in 5 (62.5 %) people out of 8 in group I and in 7 (58.3 %) out of 12 in group II - the differences are not statistically significant. According to the LEFS scale, a more rapid and complete recovery was observed in group I compared to group II: after 12 months, these indicators increased to 70.9±6.1 and 61.43±6.9 points, respectively.

   Conclusion. The use of additive technologies in the treatment of gunshot defects of the femur makes it possible to quickly reconstruct the bone and obtain a weight-bearing limb, reduce the time of hospital treatment and return the wounded to duty, but the long-term consequences of this treatment require further study.

   Introduction: The shoulder joint has an anatomical predisposition to damage to the tendons of the rotator cuff and damage to the tendon of the long head of the biceps (LHB). A combination of several diseases is also possible. It is worth noting that isolated pathology of the LHB occurs infrequently. In most cases, it is combined with damage to the tendons of the rotator cuff.

   We study the results of treatment of patients with pathology LHB in combination with damage to the rotator cuff.

   Methods: A prospective analysis of the results of surgical treatment of 115 patients with pathology the LHB with concomitant damage to the supraspinatus tendon (SSP) and the subscapularis tendon (SSC) aged 18 to 79 years was carried out. All patients underwent surgical treatment – arthroscopic suture of the rotator cuff in combination with tenotomy or tenodesis LHB. The influence of factors was analyzed: the gender and age of the patient, the fact of injury or degenerative processes, the level of physical activity, the timing before surgery, the specifics of rehabilitation. The functional results of treatment were evaluated using questionnaires: the Visual-Analog Scale (VAS), the American Shoulder and Elbow Score (ASES) questionnaire, the Single Assessment Numerical Evaluation (SANE) questionnaire, and the Return to Activity Scale (VA).

   Results: as a result of surgical treatment of 115 patients, the majority of patients (97.4 %) noted the overall high efficiency of the performed intervention, including 16/115 people (13.9 %) noted sufficient effectiveness, 3/115 (2.6 %) were dissatisfied with the results. In the overall structure of positive results of surgical treatment in the "tenodesis" group (TD), according to ASES, it was 92.29 - 11,174, in the "tenotomy" group (TT) – 93.79 - 7,769. According to YOUR - 8.7 mm - 1,812 mm in and 6.1 mm - 1,187 mm. The return to the previous activity level of 1.78 - 0.502 points in the "TT" group and 1.83 - 0.425 points - "TD", which indicates the high efficiency of the surgical treatment. It was also revealed that the patient's gender, age, the presence of injury or degenerative changes, the level of physical activity of the patient do not affect the outcome of the final treatment.

   Conclusion: in the treatment of patients with damage to the end, it is advisable to perform a tenodesis procedure. Tenodesis can be performed in the proximal parts of the inter-tubercular furrow with the help of a nodal anchor retainer with a single-stage seam of the rotator cuff. At the same time, it is also important to pay great importance to the rehabilitation of the patient.

   Introduction. Patellofemoral arthritis is a common orthopedic pathology, manifesting, as a rule, at a young, most able-bodied age. To restore the biomechanics of the patellofemoral joint and create optimal conditions for the regeneration of articular cartilage, in most cases, combined methods of surgical treatment are used. However, it should be noted that the currently used methods do not provide for the correction of all pathological changes in the patellofemoral junction, therefore further study of these problems and the development of new methods of surgical treatment are required.

   The purpose: to evaluate the clinical effectiveness of a new method of surgical treatment of patients with patellofemoral arthritis at different times in the postoperative period.

   Materials and methods. The study assessed and analyzed the results of surgical treatment of 27 patients with verified osteoarthritis of the patellofemoral joint for the period from 2020 to 2022. inclusive. The age of the patients ranged from 18 to 60 years, averaging 33 ± 1.4 years. All patients underwent surgical intervention developed by the staff of the Department of Traumatology, Orthopedics and Extreme Surgery named after Academician of the Russian Academy of Sciences A. F. Krasnova Federal State Budgetary Educational Institution of Higher Education SamSMU of the Ministry of Health of Russia a new method of surgical treatment of patellofemoral arthritis (RF patent for invention No. 2761744 dated December 13, 2021). The results of treatment of patients were assessed at 3, 6 and 12 months after surgery. Treatment results were assessed using a visual analogue pain scale, WOMAC and Kujala scales, which made it possible to assess pain, stiffness, knee joint function and quality of life of patients.

   Results. Analysis of the results of surgical treatment of patients using scales demonstrated a pronounced positive trend in mid- and late-term results. This indicates a correlation between functional restoration of the knee joint and improvement in the quality of life of patients in late follow-up after surgical treatment.

   Conclusion. The use of a new method of surgical treatment of patients with patellofemoral arthritis ensures the creation of optimal conditions for early mobilization, functional development of the knee joint and pain reduction. The proposed method of surgical treatment of patellofemoral arthritis can be recommended for use in clinical practice from the standpoint of clinical and functional restoration of the knee joint and improving the quality of life of patients.

   Gunshot wounds of the extremities are a pressing and severe problem in the modern world. This is due to the nature of combat operations, high-velocity wounding projectiles and the use of new types of weapons. These circumstances require the use of the entire arsenal of modern methods of treating gunshot wounds of the extremities to speed up the recovery of the victim.

   Purpose of the study: to show the possibilities of consistent use of physical and orthobiological methods in the treatment of gunshot wounds of the limb.

   Clinical case. The experience of treating a wounded man, A., 36 years old, with a gunshot shrapnel wound of the lower extremities with extensive soft tissue defects is presented. In the complex treatment of gunshot wounds, methods of physical influence (laser therapy, vacuum therapy) and the orthobiological method (fibrin glue enriched with platelets) were used.

   Conclusion. The combination of physical and orthobiological methods of local impact on gunshot wounds makes it possible to achieve cleansing and relief of inflammation sufficient for successful suturing or dermatoplasty with a split autograft; it is promising and requires further study in the complex treatment of combat wounds of the extremities.

   Relevance. Tarsal coalition is a condition characterized by fusion of the bones of the posterior part of the foot and is most often clinically manifested in adolescence. Fusion of the bones of the posterior part of the foot disrupts the formation of the normal skeleton of the foot and leads to rigid deformation, severe pain syndrome and a decrease in the level of activity of patients. The results of the available treatment tactics are ambiguous, which necessitates the search for new methods to solve this problem.

   Aim. The paper presents the medium-term results of hemiendoprosthetics of the middle articular facet of the calcaneus with an original model of an implant made of zirconium ceramics in a patient with a fibrous coalition between the talus and calcaneus in combination with concomitant surgical techniques.

   Materials and methods. To assess the objective condition in the pre- and postoperative periods, the patient underwent stress radiography, computed multispiral tomography (MSCT), magnetic resonance imaging (MRI), and dynamic pedobarography. To assess the patient's subjective condition before surgery and after 12 months, a questionnaire was performed using a visually analog scale (VAS), AOFAS Ankle Hindfoot (AOFAS AH).

   Results. According to the survey data, a decrease in the intensity of pain syndrome and an increase in patient activity are determined. Your score before treatment was 9 points, 12 months after the treatment was 1 point. The indicators of the AOFAS AH scale before and after the treatment were 21 and 90 points, respectively. The correct position of the hemiendoprosthesis is determined on control instrumental studies, no signs of instability of the implant were revealed.

   Conclusion. The short-term results allow us to conclude that hemiendoprosthetics in combination with subtalar arthroeresis and plasty of the tendon of the posterior tibial muscle are highly effective as a method of treating patients with tarsal tarsal-calcaneal coalition. This technique allows you to maintain movement in the elbow joint and reduce the severity of the pain syndrome. Further work is planned on the use of hemiendoprostheses of the middle articular facet in patients with talon-heel coalitions of the foot.

   About 5-6 % of all fractures occur in damage to the proximal humerus. Treatment depends on many factors, including the degree of fracture displacement, the patient's activity level, associated injuries and diseases, age, fracture type, and bone quality. The most acceptable surgical options are open reduction and internal fixation (ORIF), minimal invasive plate osteosynthesis (MIPO).

   Purpose of the study: to compare the results of studies of minimally invasive and open techniques of osteosynthesis of the proximal humerus.

   Materials and methods: PubMed, EMBASE, Cochrane Library, ScienceDirect, WebOfScience were searched to find all relevant studies in the period 2015-2023. In addition, the literature lists of relevant studies were searched. There were no linguistic restrictions.

   Results: Selected 24 studies by design were retrospective studies, 9 articles were devoted only to the MIPO technique, 1 clinical case was bilateral ORIF. A total of 1698 patients were analyzed in the studies. The mean follow-up period was 25.2 months. The mean age of the patients was 61.3 ± 8 years. The most common complications were avascular necrosis of the humeral head, subacromial impingement, screw perforation, infection of the postoperative wound area, varus collapse (loss of medial support), nonunion, and axillary nerve injury. Compared to ORIF, MIPO has advantages in terms of operative time, tuberculum major reposition, blood loss, postoperative pain, early postoperative shoulder function, and cosmetic outcome. MIPO requires a longer intraoperative x-ray time. MIPO requires a longer intraoperative x-ray time and is not indicated for multifragmentary fractures according to few articles. There was no significant difference in complication rates between these methods.

   Conclusion: Until now, ORIF is the standard osteosynthesis technique for complex multifragmentary fractures. However, it does not differ significantly from the minimally invasive technique. The MIPO technique shows itself to be promising and requires an expansion of indications for use.