Introduction: chondral and osteochondral articular cartilage defects is a significant clinical pathology affecting young, employable population. It's necessary to develop clinical efficacy domestic constructs.

Purpose: to examine the effect of two- and five-component membranes on the properties and rate of cartilage regeneration in the experiment. A literary research was carried out to substantiate the rational choice of experimental animals and the experimental cartilage defects characteristics.

Materials and methods: prospective experimental pilot research. Two study groups were formed (n=13), osteochondral defect models of the rat femur articular surface were surgically created and replaced with two- and five-component membranes developed by Sechenov University. The macroscopic and histological evaluation were performed after euthanasia in terms of 7, 30, 60, 120 days. The defects depth and average value were evaluated at each term. Change of defects depth was measured at each term, the cell density in regenerates was calculated.

Results: both membranes were therapeutically efficacious in the replacement of defects, there was noticed the formation of fibrous cartilage tissue.

Conclusion: the clinical result is satisfactory, further improvement direction of these constructs can be associated with MACI method.

Rationale. Trapeziometacarpal joint osteoarthritis is a widespread hand joints pathology in the general population of people. This surgical treatment often consists in affected trapezium removal with reconstructive techniques implementation that ensure affected hand first finger stability. These surgical interventions results dissatisfaction lies in first metacarpal bone base migration and, as a result, pain syndrome recurrence.

The purpose is to compare the distance between first metacarpal bone base middle and scaphoid distal pole in patients after rhizarthrose surgical treatment using first carpometacarpal joint resection suspension interposition autotendoplasty method with patients indicators who additionally used a suspension technique.

Materials and methods. In City Clinical Hospital №29 named N.E. Bauman upper limbs surgery department from 2017 to 2022 85 patients with first carpometacarpal joint osteoarthritis according to Eaton-Littler’s and Kellgren-Lawrence’s classification system (stage II–IV) surgical treatment was performed. 52 patients underwent first carpometacarpal joint resection suspension interposition autotendoplasty, while in case of 33 patients the suspension technique was not used. Treatment results evaluation was carried out of X-ray data 12 months after surgery.

Results. In first carpometacarpal joint resection suspension interposition autotendoplasty group a slight the distance between first metacarpal bone base middle and scaphoid distal pole decrease was observed: by 12,3% from the original index – while in suspension component absence group a pronounced first metacarpal bone base proximal migration was observed: by 38,8% compared with X-ray gap preoperative indicators .

Conclusion. Resection suspension interposition autotendoplasty use is an effective way to maintain the joint height.

Introduction. Medializing osteotomy of the calcaneus is vastly used by an orthopedic society in practice as part of the surgical correction of valgus deformity of the calcaneus, which is observed in patients mainly with acquired flatfoot. However, acquired flatfoot in adults often has a similar clinical picture to post-traumatic valgus deformity of the calcaneus, which makes it possible to use medializing osteotomy of the calcaneus for deformities of various origins.

Aim: to improve the results of treatment of patients with post-traumatic valgus deformity of the calcaneus.

Materials and methods. Retrospective non-randomized study. Using the method of copying from medical records, a sample of 55 patients with post-traumatic valgus deformity of the calcaneus, who underwent medializing calcaneal osteotomy (MCO) from January 2012 to December 2020, was formed. At the follow-up examination, a physical examination, identification of complaints, assessment of pain, function and radiographs were performed. In order to objectively assess the results, the FAOS questionnaire was used.

Statistical processing. The results were recorded in a Microsoft Excel 2007 table. Quantitative indicators are presented as the average value of the indicator and its standard deviation, qualitative indicators - as the percentage of occurrence of the characteristic. Statistical processing was carried out using the IBM SPSS STATISTICA 23.0 program. To assess the significance of the results among independent groups after surgery, the Kraskes-Wallis test was used, and in the groups before and after surgery, the Wilcoxon test was used.

Results. The patients were conditionally divided into 3 groups depending on the postoperative angle of deformation of the calcaneus at the control examination: group 1 “valgus” (angle >0 degrees; n=18); Group 2 “moderate varus” (0<angle<5 degrees; n=17); Group 3 “varus” (angle>5 degrees; n=20). The groups were comparable to each other according to these characteristics (p<0.05). The average age of the patients was 49.6±4.6. The average follow-up period was 23.5±8.7 months. Average BMI 28.6±3.2. In all groups, according to the FAOS questionnaire, statistically significantly (p<0.05) better results were obtained at the follow-up examination than before surgery. Statistically significant differences in postoperative results between groups according to the FAOS questionnaire based on the assessment of the “pain” and “other symptoms” subscales were obtained in the “moderate varus” group. In the “other symptoms” subscale of the FAOS, the mean change in scores for the “varus” group (n = 19) was 6.6 (range -40.7 to 46.4), for the “moderate varus” group (n = 16) was 25.9 (range 3.6 to 78.6) and 11.0 (range -32.1 to 46.4) for the valgus group (n= 18). The average change in the “pain” subscale according to FAOS for the “varus” group (n=16) was 27.9 (range from -8.3 to 63.9), for the “moderate varus” group (n=17) was 41.2 (range from 5.6 to 66.7) and for the “valgus deformity” group (n=18) was 22.3 (range from -58.3 to 63.9).

Discussion. The “moderate varus” position of the calcaneus was found to be the most functional.

Conclusions. The use of MCO in patients with post-traumatic valgus deviation of the calcaneus shows optimal results and deserves wider use in this cohort of patients. However, the result can be improved by intraoperatively placing the calcaneus in a moderate varus position.

Introduction. Additive technologies have gained widespread popularity in the medical field, particularly in orthopedics where biomodelling has proven to be highly effective in expanding the capabilities of surgeons.

Purpose of the study. Improving the results of treatment for patients with complex deformities of the shoulder joint through the use of additive technologies in shoulder endoprosthetics.

Materials and methods. Our study presents a clinical case of a 54-year-old patient, M, diagnosed with stage III shoulder deforming osteoarthritis. The patient underwent shoulder joint endoprosthetics using additive technologies. A custom-designed titanium implant with an osteoinductive surface and pre-set directional screws was developed and manufactured. The observation period was 12 months. Before the surgery and during follow-up examinations at 3, 6, and 12 months, interviews, physical examinations, range of motion measurements, and objective assessments of the patient's condition using the VAS, SF-36, and UCLA questionnaires were conducted.

Results. The application of a personalized approach and additive technologies allowed for the restoration of shoulder joint function and a significant improvement in the patient's quality of life. Significant improvements were obtained according to all questionnaires (p<0.05), and restoration of shoulder joint range of motion and deltoid muscle tone were also noted.

Conclusion. The results obtained in the application of additive technologies in this patient demonstrate excellent results in all studied indicators, which are not always achievable with routine endoprosthesis of the shoulder joint in patients with complex deformities. This study proves the effectiveness of a modern personalized approach and helps improve the treatment outcomes for patients of orthopedic profile.

Introduction. Fractures of the tibial plateau are one of the most complex intraarticular fractures of the extremities. High rate of unsatisfactory treatment results of these injuries is associated with the complexity of the injury itself as well as with poor preoperative planning and execution of surgery.

Aim of the study: to analyze anatomical and mid-term clinical outcomes of patients with intraarticular fractures of the tibial plateau who underwent surgical treatment at the level 1 trauma center of the Interdistrict Clinical Hospital of Vsevolozhsk from 2020 to 2022.

Materials and Methods. Study enrolled 60 patients with 62 intraarticular fractures of the proximal tibia who received surgical treatment. All patients underwent a CT scan of the knee joint. Fracture type was determined according to the AO/ASIF classification, the J. Schatzker’s classification modified in 2018, and the column classification. Follow-up examinations took place at 6 and 12 months after surgery. We assessed the radiographs, functional outcome according to the Lysholm and KSS scales, and the complications.

Results. Anatomical reduction of the articular surface of the tibial plateau was achieved in 49 patients (79%). At 6 months, the functional outcome according to Lysholm scale (Me and Q1; Q3, respectively) was 73 (68; 78) points, according to KSS - 73 (70; 78) points. At 12 months the median score according to Lysholm scale was 92 (86; 95), and according to KSS scale - 93 (88; 95), which corresponds to an excellent functional result.

Conclusion. Fracture osteosynthesis of type 41 C as well as types 41 B2.1 and B3.1 with impression of the posterolateral fragment requires precise topical diagnostics of the injury using pre- and postoperative CT, extended surgical approaches and their combinations, anatomic reduction of bone fragments, reconstruction of bone defect and stable fixation with combination of plates and screws.

Introduction: More than 20% of shoulder dislocations occur in individuals over 40 years of age. Current treatment algorithms for shoulder dislocation management include conservative treatment with immobilization and subsequent rehabilitation, which leads to an unsatisfactory result (decreased function, pain) in more than 50% of older patients. It is associated with damage to the rotator cuff tendons (RCT) and subsequent muscle degeneration.

The aim of the study was to improve the results of the diagnosis and treatment for patients over 45 years of age with primary traumatic dislocation of the shoulder with varying degrees of RCT damage.

Materials and methods: 85 patients (60.2±11.4 years, 44 men, 41 women). Inclusion criteria: first-time dislocation, consent to participate in the study. Radiographs and magnetic resonance imaging (MRI) of the shoulder joint were performed with assessment of the subacromial space and acromiohumeral index (AHI). Next groups were formed: Comparison group 1 (rehabilitation treatment of full-thickness RCT damage, 18 people), comparison group 2 (rehabilitation treatment of partial-thickness RCT damage, 21 people), study group (surgical treatment of full-thickness RCT damage, 24 people). Also, to reduce damage to the RCT muscles, 2 comparable groups were randomly formed: group taking a mixed amino acids (leucine:isoleucine:valine) and group taking placebo.

Results: a significant correlation between the AHI and the width of the subacromial space (Pearson's rxy = 0.895, p <0.001) was obtained, the approximation value was 0.7902. ROC analysis revealed the optimal threshold value of the API - the probability of absence of narrowing of the subacromial space <6 mm on MRI increases with API ≥ 1.26 (sensitivity and specificity 94.8% and 86.5%). Comparing the treatment results according to the ASES, DASH, UCLA questionnaire scales, the treatment results in the treatment and comparison groups 2 are significantly better than in the comparison group 1, and there are no differences between the study and comparison groups 2. Amino acid supplementation did not reduce basal rates of muscle membrane damage compared with placebo.

Conclusion: AHI assessment is applicable for RCT injuries diagnosis; MRI is recommended for patients over 45 years of age with a shoulder dislocation. For full-thickness tendon injuries, surgical refixation is optimal; In case of partial-thickness damage, conservative rehabilitation is recommended. Comparison of treatment methods for partial-thickness tendon injuries requires further analysis.

Irreparable anterior-superior rotator cuff tears are less common than postero-superior cuff tears and spoted for approximately 5 to 20% of all tears [1,2]. Nowadays various "joint-saving" interventions have been described that can be used while the articular cartilage of the shoulder joint is safe. Muscle-tendon transfers are an option for young, active patients with irreparable ruptures of the rotator cuff. Biomechanicaly the transfer of the tendon of the latissimus dorsi muscle is the most beneficial intervention for the treatment of specialized patients [7, 25-27]. Given the above data, the search for methods that simplify and accelerate the procedure and increase the strength of the latissimus dorsi muscle and the reliability of its intraoperative fixation is very relevant.

The aim is to test and apply in private practice a new method of arthroscopically assisted latissimus dorsi tendon transfer for the treatment of relevant patients.

Material and methods. In the period from 2021 to 2022, 9 interventions were performed according to the method protected by the patent: “Method of surgical treatment of massive irreparable rotator cuff tears using arthroscopically assisted technique of transposition of the latissimus dorsi muscle” No. RU 2791403 C1.

Results. After 6 months of follow-up, all patients were able to return to their daily activities. The average increase on the ASES scale was 49.08, on the DASH scale 52.57, on the SST scale 5.7. All patients noted a decrease in pain syndrome, according to the questionnaires, the average decrease was 4.6. One infectious complication was noted.

Conclusion. The use of the latissimus dorsi tendon transfer is a significant alternative to reverse shoulder arthroplasty with proper selection of patients. This direction requires further research aimed at studying the results, as well as the transition to fully arthroscopic techniques.

Background. Currently there are many articles that describe the most specific symptoms, diagnostic tests and studies aimed at verifying the diagnosis of tunnel neuropathies. However, the problem of a low level of awareness among doctors who do not have enough experience in such pathologies treatment still exists. Often incorrect diagnoses are made, which not only do not alleviate the patient clinical symptoms but, on the contrary, aggravate it.

Review purpose. To determine and identify the main diagnostic criteria that allow to differentiate the most common tunnel syndromes of the upper limb.

Results. After analyzing the most common forms of upper limb tunnel syndromes, we have formed a table of «differential diagnosis» of the main symptoms and diagnostic criteria of the described conditions.

Conclusion. Developed table of «differential diagnosis» of the most common upper limb tunnel syndromes makes it possible to simplify the process of their verification, which can significantly reduce the rate of making incorrect diagnoses.

Introduction. The management of patients with the consequences of ankle injuries is a crucial issue due to the constant worldwide increase in the incidence of this pathology within the population, a large number of complications and poor outcomes of surgical rehabilitation, and thereby frequent disabilities.

The aim of this research was to analyze the current state of the problem of managing patients with consequences of ankle injuries by arthrodesis through Russian and foreign experience.

Material and methods. We reviewed the articles retrieved mostly from the electronic databases (Medline, PubMed, eLIBRARY, Cochrane, SpringerLink, and Web of Science) by keywords ankle fractures, arthrodesis, intra-articular tibial fracture, ankle joint, post-traumatic osteoarthritis, crusarthrosis.

Results. The study features the aspects of contemporary understanding of managing the patients with consequences of ankle injuries. The most common adverse outcome of the ankle injuries management is post-traumatic crusarthrosis (up to 60%). We present the descriptions of surgical interventions used to treat post-traumatic crusarthrosis as well as ankle arthrodesis options (compressive and non-compressive, arthroscopic arthrodesis) as the "gold standard" in the treatment of this pathology. The positive and negative aspects of the surgical methods are outlined, and unresolved issues are highlighted.

Discussion. Arthrodesis of the ankle joint is recognized by most authors as the "gold standard", however, some issues remain controversial and yet unresolved. The need to treat tibia and talus articular surfaces, use osteoplastic materials, remove the articular cartilage as well as the methods of fixation in arthrodesis and others are discussed, but all authors point to the indisputable advantages of ankle arthrodesis: its efficacy, ease, reproducibility and low cost of the method.

Conclusion. Despite some unresolved issues, ankle arthrodesis is an effective surgery for post-traumatic stage III-IV ankle osteoarthritis.

Relevance. Vertebral hemangioma (VH) is a combined group of spine vascular formations that destruct bone tissue of vertebrae. The clinically relevant VH forms cause pain syndrome or neurological deficit due to the progressive decrease of support ability in the affected vertebra or its pathologic fracture that occure within the clinical course of 3.6-10.9 percent of all aggressive VH. No algorithm for the surgical management of fractures in VH was found in the available studies.

The objective of this study was to determine the range of surgical techniques used for fractures in hemangioma affected vertebrae. Three case reports are presented. The available sources of 1983-2020 contain 15 studies on pathologic fractures associated with VH including 6 case reports and 9 reviews. They describe 3 anterior corpectomies with autograft bone substitutes, 1 vertebroplasty (kyphoplasty), 5 decompressions and anterior fixation with a hardware, 5 transpedicular fixations (TPF) and open vertebroplasties, 1 TPF and laminectomy. 80 percent of the outcomes featured the complete regression of neurological deficit. However, in 20 percent of the outcomes the neurological deficit never regressed completely due the long time that passed since the fractures occurred. We present three case reports that demonstrate the unique practice of surgical management for pathologic fractures in VH and involve L1 transcutaneous transpedicular balloon kyphoplasty, two-stage surgical treatment (L3-L5 transcutaneous transpedicular fixation and L4 neoplasm biopsy + anterior corporodesis); C7 vertebroplasty. The outcomes featured the complete reversal of pain syndrome in 1 post-op year without any loss in the induced stability.

Conclusion. It has been reported that aggressive VH bring the risk of pathologic fracture, particularly in biomechanically vulnerable vertebrae. The uncomplicated pathologic fractures and minor vertebral compressions can be managed with minimally invasive methods like vertebro- or kyphoplasties. If a non-supportive vertebral body has to be reconstructed or the decompression of spinal canal structures is indicated, the metal spondylosynthesis has to be adequate to lesion morphology and structure of the fracture. However, the available sources contain no conventional algorithm of choosing the management tactics for pathologic fractures in VH making further research on this subject relevant.