Background. Posterolateral corner (PLC) injuries remain a challenging clinical problem that often determines treatment outcome in patients with multiligamentous knee injuries; insufficient attention to this region leads to persistent varus-rotational instability. The choice between repair and reconstruction, the timing of intervention, and technical solutions remain debatable. The aim of the study was to summarize current concepts of surgical treatment of PLC injuries based on an analysis of contemporary literature. Materials and methods. Relevant literature from PubMed, Scopus, and Google Scholar for 2022–2026 was analyzed using topic-related search terms on PLC injuries, together with classic sources from earlier years; this narrative review covers conservative approaches, surgical repair and reconstruction, the rehabilitation protocol, and complications. Results. Isolated grade I–II injuries respond well to nonoperative treatment, whereas complete tears require surgical management. An acute injury (within 3 weeks) with preserved tissues may be treated with repair, often with augmentation, whereas a chronic injury requires plastic reconstruction; for complete tears, reconstruction shows a higher success rate than isolated primary repair. Anatomic reconstruction of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon outperforms non-anatomic techniques such as biceps tenodesis; among anatomic techniques, the tibial-based approach is more often used clinically, whereas the fibular-based technique with two femoral tunnels shows the lowest residual laxity in biomechanical studies. Rehabilitation includes six weeks of immobilization, restriction of isolated hamstring weightbearing for up to four months, and return to sport at approximately six months. The main complications of surgical treatment are persistent instability, common peroneal nerve injury, deep vein thrombosis, and surgical site infection. Fixed-length popliteus tendon graft fixation is non-anatomic, because the tendon’s length changes with tibial rotation during knee flexion, which has been confirmed by data from 3D modeling with axial weightbearing. Conclusions. Posterolateral reconstruction, especially anatomic one, provides better functional outcomes than isolated repair; at the same time, current techniques only partly reproduce popliteus complex physiology and still require more precise graft fixation points and tensioning.
Background. Degenerative cervical spine disorders are one of leading causes of chronic pain and neurological deficit. Altered load distribution between the anterior and posterior support structures is considered an important biomechanical factor in their development. Quantifying load distribution in the intact spine is necessary to study degeneration and plan interventions with minimal impact on adjacent segments. The purpose was to assess load distribution between the discs, joints, and ligaments from C2-C3 to C6-C7 during flexion and extension, and to compare intradiscal pressure with the stress state of annulus fibrosus sectors. Materials and methods. A finite-element C0-Th1 cervical spine model was built from computed tomography data. A vertical 50 N force representing head weight was applied to the occiput while motion from +54.9° flexion to –44.5° extension was prescribed (176 states). Load distribution was determined using a free-body diagram, and the annulus fibrosus was analyzed by sectors. Results. In the loaded neutral position, the discs transmitted from 39 % of the external load at C4-C5 to 77 % at C6-C7, whereas the facet joints transmitted 28–57 %. The facet path dominated at C4-C5, while disc transmission dominated at C2-C3 throughout the range. Intradiscal pressure was 0.147–0.294 MPa. During flexion, the facets disengaged, and tension in the posterior ligamentous complex produced an opposing reaction; consequently, the vertical component of disc-transmitted force reached approximately twice the external load: the pressure rose to 0.940 MPa at C5-C6. During extension, the facets carried most of the load at the mid- and lower-cervical levels. Peak contact pressure increased three- to fivefold and reached 10.62 MPa at C3-C4. The horizontal contact-force component was –124.2 N, directed posteriorly, and reflected substantial shear. At C5-C6, relatively low intradiscal pressure coincided with an increase in equivalent stress to 8.2 MPa and tensile maximum principal stress in the anterior annulus sector. The global model response was consistent with published data: C2-C7 range of motion was 59.1°, and the maximum reaction moment was 2.42 N · m. Conclusions. Load distribution between the support structures depends on head position and segmental level. These data may provide a reference for assessing the effects of degenerative changes and surgeries. Intradiscal pressure does not fully characterize the state of peripheral annulus and should be supplemented by equivalent and principal stress analysis.
Background. The choice of optimal approach to treating pleural empyema currently remains debatable, and treatment tactics vary from medical to surgical methods, depending on the severity of the disease. The study is aimed at improving the surgical treatment of post-traumatic pleural empyema resulting from combat injuries of the chest by implementing video-assisted thoracoscopic surgery (VATS) techniques with intraoperative ICG-fluorescent visualization of viability and objective determination of extent of lung parenchyma resection. Materials and methods. The outcomes of surgical treatment were analyzed in 26 wounded with post-traumatic pleural empyema who were inpatients at the Shalimov National Scientific Center of Surgery and Transplantation of the National Academy of Medical Sciences of Ukraine in 2022–2025. All wounded were divided into two groups by time randomization method depending on the applied surgical tactics, surgical approach and method of intraoperative determination of lung parenchyma viability. The study group included 16 patients who underwent VATS with pleurectomy, decortication and, according to indications, atypical resection of damaged lung parenchyma using ICG-fluorescent assessment of its perfusion and viability. The comparison group included 10 patients who underwent similar interventions using thoracotomy, and tissue viability and the extent of resection were determined based on standard visual-tactile examination. The frequency of postoperative complications and repeated surgical interventions was analyzed. Kaplan-Meier analysis was used to assess the dynamics of postoperative pneumonia occurrence and to compare the probability of remaining free of this complication between the study groups. Results. The incidence of postoperative pneumonia was 18.8 % in the study group and 90.0 % in the comparison group (p = 0.001). Kaplan-Meier analysis confirmed statistically significant intergroup differences in time to development of postoperative pneumonia (log-rank = 16.983; p < 0.001). There were no cases of postoperative air leak and repeated surgical interventions in the study group, while in the comparison group, their frequency was 20.0 % each. Exudative pleurisy requiring pleural puncture was observed in 6.2 and 30.0 % of patients, respectively, but the differences in these indicators did not reach statistical significance. Conclusions. The better postoperative indicators in the study group indicate the benefit and prospects of using VATS in combination with intraoperative ICG-fluorescence imaging as surgical treatment for post-traumatic pleural empyema due to combat injuries of the chest.
Background. Some researchers estimate that bone metastases may affect up to 70 % of cancer patients, 20 % of whom may require surgery. Bone metastases cause pain, pathological fractures, spinal cord or nerve root compression, and life-threatening hypercalcemia and may require surgery, radiation therapy, or drug treatment. The management of metastatic bone disease depends mainly on the type of primary tumor and the organ involved. If there is a risk of fracture or if pathological bone fractures have occurred, then bone stabilization or joint reconstruction with removal of the affec-ted bone and surrounding tissues is necessary. Surgical treatment of metastatic skeletal lesions is performed using either arthroplasty or osteosynthesis. This article compares the results of intramedullary, extramedullary, reinforced osteosynthesis, and transosseous extrafocal osteosynthesis of long tubular bones in metastatic tumors, with the aim of identifying clinical situations in which osteosynthesis is considered the best method of bone stabilization. The purpose of the study was to compare treatment outcomes for patients with metastatic bone tumors when using metal osteosynthesis with intramedullary rods, extramedullary plates, and reinforced metal osteosynthesis in comprehensive regimens with those when using transosseous extrafocal osteosynthesis in comprehensive regimens for restoring limb function, reducing pain, and improving patients’ quality of life in the long-term. Materials and methods. The outcomes of surgical treatment were analyzed in 32 patients (14 men and 18 women, for the period 2017–2025) with metastatic tumors of long tubular bones who were treated with various osteosynthesis methods. The study group consisted of 15 participants who underwent comprehensive treatment for metastatic tumors of long tubular bones of the extremities using surgical treatment: metal osteosynthesis with intramedullary rods, extramedullary plates, as well as reinforced metal osteosynthesis with bone cement. The comparison group included 17 patients who underwent comprehensive treatment for metastatic tumors of long tubular bones of the extremities using surgical treatment: transosseous extrafocal metal osteosynthesis with rod devices for external fixation. In both groups, the functional result of the operated limb was determined according to the Musculoskeletal Tumor Society (MSTS) staging system. Assessment of pain at the site of metastatic lesion before and after treatment was carried out according to the survey on the R.G. Watkins scale. Quality of life of patients who underwent surgical treatment was evaluated according to the EORTC QLQ-C30 system (score scale from 0 to 4). Survival was determined by the Kaplan-Meier method. Results. As a result of the treatment of 15 patients in the study group with metastatic bone tumors using metal osteosynthesis with intramedullary rods, extramedullary plates, as well as reinforced metal osteosynthesis with bone cement, postoperative complications were observed in 2 (13.3 %) cases, and relapses of the metastatic tumor in 2 (13.3 %). As a result of the treatment of 17 patients in the comparison group with metastatic bone tumors using transosseous extrafocal osteosynthesis with external fixation devices, postoperative complications were observed in 3 (17.6 %) patients, and relapses of the metastatic tumor in 3 (17.6 %). The functional result of the operated limb (according to the MSTS) in the study group was from 72.3 to 85.8 %. The functional result of the operated limb in the comparison group was from 65.4 to 72.9 % (p < 0.05). In the postoperative period, the pain syndrome in the study group (according to the R.G. Watkins scale) decreased from 93.4 to 26.6 %, and in the comparison group — from 88.2 to 52.9 % (p > 0.05). The quality of life of the patients in the study group in the postoperative period improved from 28 to 82 points and in the comparison group — from 26 to 68 points (p > 0.05). The three-year overall survival in the study group was 48.8 ± 14.6 %, in the comparison group, it was 26.6 ± 11.3 % (p < 0.05). Conclusions. 1. The use of osteosynthesis techniques in metastatic tumors of long tubular bones allowed to restore the function and weight-bearing of the limb in 93.8 % of cases. 2. Surgical treatment using osteosynthesis techniques in metastatic tumors of long tubular bones allowed to reduce pain syndrome, restore limb function and improve the quality of life of patients, as well as conduct additional specific therapy. 3. Based on the analysis of the anatomical and functio-nal results of the limb, the justification of palliative surgical treatment has been proven, namely the use of various metal osteosynthesis techniques in pathological fractures of the long bones of the limbs.
Background. Combat injuries of the lower extremities are associated with a high incidence of polymicrobial wound infections caused by multidrug-resistant pathogens. Timely and objectively substantiated identification of wound bacteria remains a critically unresolved issue and an extremely important and in-demand diagnostic tool for military traumatology under the conditions of Russian aggression against Ukraine from 2022 to the present. Materials and methods. A retrospective analysis was conducted of bacteriological studies of 35 wounded military patients (100 % male) with gunshot and blast injuries to the distal tibia who were treated in the Department of Traumatology and Orthopedics of the Municipal Non-Profit Enterprise “Kyiv City Clinical Hospital 8”. A total of 84 bacteriological studies and 1,188 antibiogram data points were analyzed. Susceptibility categories were determined according to EUCAST criteria. A bacteriological culture containing ≥ 2 pathogens was considered polymicrobial. Duration of observation was the interval between the first and last dated bacteriological study. Clinical observation included wounded service members who were admitted to the department between days 2 and 21 after wounding and who passed through 2–3 evacuation hospitals corresponding to NATO Role II-Role III level, before arriving at the final facility, where the first bacteriological analysis of contamination of the lower-leg wound defect was performed. Results. Bacterial contamination was identified in 21/35 patients (60.0 %). Overall resistance was 41.9 % (498/1,188). Dominant pathogens: Staphylococcus aureus (19 isolates; 25.7 %), Klebsiella pneumoniae (13 isolates; 67.4 %), Acinetobacter baumannii (11 isolates; 75.2 %). Methicillin-resistant S. aureus (MRSA) was confirmed in 2 wounded patients. Carbapenem-resistant K. pneumoniae (CRKP) was found in 5 patients, and carbapenem-resistant A. baumannii (CRAB) in 6. Polymicrobial bacteriological cultures were found in 11/35 (13.1 %) wounded people. Median duration of microbiological observation was 31 days (range 2–608); in three patients, it exceeded 150 days, with the number of serial cultures reaching 7 to 11 studies. Conclusions. Bacterial pathogens obtained from the wound surface of gunshot and blast lower-leg wounds of Ukrainian service members (June 2023 — May 2026) were analyzed. Dominance of multidrug-resistant and extensively drug-resistant microorganisms was established, with S. aureus, A. baumannii, and K. pneumoniae predominating. The data document a significant burden of CRAB, CRKP, and MRSA in combat lower-leg injuries, consistent with studies by other Ukrainian authors, who note that in Ukraine, antimicrobial resistance is one of the most pres-sing threats to national security in the healthcare sector. Weaknesses of standard bacteriological diagnosis based on the phenotypic method were also identified, which make it impossible to prescribe reserve antibiotics — agents that should be administered based on the results of genetic analysis of bacterial resistance in the infected wound and assessment of virulence/biofilm-formation genes at the site of the lower-leg wound defect. Thus, the question arises of developing advanced diagnostic algorithms for combat trauma pathogens and implementing molecular diagnostic methods for a broad spectrum of pathogens of lower-leg wound defects, together with identification of virulence factors/resistance genes of the identified microorganisms. This will preserve the health of wounded service members, reduce the length of hospital stay, enable the application of appropriate etiopathogenetic antibiotic therapy and control the spread of resistant strains in Ukraine.
