Rotator cuff tears are one of the most common musculoskeletal injuries and account for about 20 %. Massive rotator cuff tears account for up to 40 % of all tears. There is no single approach in the treatment of patients with massive rotator cuff tears. We have developed a new method of surgical treatment of these patients – arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. The aim of the study. To assess the effectiveness of surgical treatment of patients with massive rotator cuff tears who had arthroscopically assisted transposition of the latissimus dorsi tendon using an autograft of a 1/2 of the tendon of the long peroneal muscle. Materials and methods. The study included 15 patients with Patte stage III and Thomazeau grade 2–3 massive rotator cuff tears, who had arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. Results. The article presents the long-term results of surgical treatment of patients using the developed method. The following criteria were evaluated: average age; time since injury; duration of surgery. Functional outcome was assessed using the ASES (American Shoulder and Elbow Surgeons) scale. Taking into account the indicators on the ASES functional scale 1 year after surgical treatment, the following results were obtained: excellent – in 14 (93.3 %) patients, satisfactory – in 1 (6.7 %) patient. Conclusion. The developed method allows us to restore the function of the shoulder joint as early as it possible, to reduce the severity of the pain syndrome and to improve the quality of life of patients.

We examined 38 patients (35 women and 3 men aged 30–40 years) with stage 2 and 3 hallux valgus in the department of traumatology and orthopedics of the Irkutsk Scientific Centre of Surgery and Traumatology to study the electroneuromyographic parameters during stimulation of the peripheral nerves of the lower extremities. All patients underwent electroneuromyographic study of peripheral nerves (n. tibialis and n. peroneus) to clarify the nature of their injuries. In 10 patients, the parameters of the monosynaptic H-reflex were additionally studied. Analysis of electroneuromyographic parameters in patients with hallux valgus demonstrated a deterioration in the peripheral nerves functioning, which was more pronounced for the tibial nerve (n. tibialis). At the same time, the parameters of the monosynaptic H-reflex obtained in patients with hallux valgus indicate the presence of a neurological deficit observed in the compression of the L5–S1 roots of the spinal cord in lumbar osteochondrosis. The results of the study suggest the presence of a single pathogenetic mechanism for the development of degenerative processes in the spinal joints (osteochondrosis) and limbs (deforming osteoarthrosis of large and small joints).

Approximately 6 thousand endoprosthesis surgeries of hip, knee and spine stabilization are annually performed in older patients in the Irkutsk region. Patients require a second stage of medical rehabilitation — in a specialized rehabilitation unit. The article presents the technology of medical rehabilitation, which is used for this group of patients, including assessment of rehabilitation prognosis, application of physical rehabilitation methods, correction of somatic pathology and psychological status.Aim: to improve the immediate and long-term results of hip and knee endoprosthetics, spine stabilization surgeries by developing a system of rehabilitation measures based on individual patient parameters and aimed at optimal restoration of function.Materials and Methods. The focus of the investigation was on the patients from the Medical Rehabilitation Department, Clinical Hospital of the ISC SB of the RAS. Patients affected with coxarthrosis, gonarthritis, osteochondrosis of the spine, who had undergone joint replacement or stabilizing spinal surgery in the Medical Rehabilitation Department of Irkutsk Scientific Center of Surgery and Traumatology, 5–7 days before transfer to the Medical Rehabilitation Department of Clinical Hospital of the ISC SB of the RAS. The subjects also underwent clinical, paraclinical, locomotive, physical examination and laboratory test; physical activity assessment and estimation of indicators of the integral rehabilitation scale, the medical rehabilitation scale and the physical activity scale were performed as well. In the course of medical rehabilitation, patients received physiotherapeutic appointments, physiotherapy exercises, correction of somatic pathology, and correction of psychological status.Results. In 2020–2021, 240 older patients were treated in the Medical Rehabilitation Department after large joints arthroplasty and spinal reconstructive surgeries. The technology of medical rehabilitation was used for these patients. As a result, pain syndrome was eliminated, contracture of the operated joint was stopped, locomotor function improved, patients' physical activity and self-care ability were optimized, and somatic disorders were corrected. In addition, our own scales have been developed and improved: the Integral Rehabilitation Orthopedic Scale, the Individual Physical Activity Scale.Conclusion. Implementation of this rehabilitation technology has significantly optimized the outcomes of large joints arthroplasty or spinal reconstructive surgeries.

Background. To date, the problem of choosing the optimal graft for anterior cruciate ligament (ACL) reconstruction and the methods for its formation is one of the main trends in the surgical treatment of patients with anterior knee joint instability. The aim. To compare the results of the anterior cruciate ligament reconstruction using the known method and the new proposed method for autograft formation. Materials and methods. The results of treatment of ACL injury in 44 patients were assessed. In the main group (19 patients), an original technique of ACL reconstruction from 1/2 of the width of m. peroneus longus tendon was used. In the control group (25 patients), ACL reconstruction was performed using a graft from the m. semitendinosus tendon prepared by the Lubowitz method. Results. The mean difference in the circumference of the distal third of the hip in the main group was 1.57 ± 1.162 cm and was statistically significantly better than in the control group, where the mean difference in the hip circumference was 4.74 ± 1.7207 cm.The range of motion of the knee joint in the main group 3 months after the surgery was 128.42 ± 9.287°, and in the control group mean flection was 109.6 ± 9.120°.The functional results in the main group were assessed by the Lisholm scale and were statistically significantly better than the results in the control group. The functional results by the AOFAS (American Orthopedic Foot & Ankle Society) scale in the main group were 100 points before the surgery and at all terms after the surgery: this indicates that the use of 1/2 of the width of m. peroneus longus tendon does not cause the its functional impairement. Conclusion. Anterior cruciate ligament plasty with use of 1/2 of the width of m. peroneus longus tendon prepared by the proposed method showed statistically significantly better results compared to the preparation of autograft from semitendinous muscle tendon using known method.

The article presents the experience of surgical treatment of a rare pathology of the upper limb – the pseudarthrosis of the middle third of the radial shaft with a bone defect in combination with the pseudarthrosis of the middle and lower third of the shaft of the ulna of the forearm. Determination of reasonable and well-considered treatment tactics is of great importance in the treatment of patients aimed at restoring the anatomy and function of the injured upper limb. A feature of this case is the formation of several false joints at different levels of the forearm bones, the presence of a bone defect of 2.5 cm, which required its replacement with an autograft, and a previously performed surgical intervention using transosseous osteosynthesis. The applied tactics of surgical treatment consisted of several stages: bone osteosynthesis of the ulna with opening of the medullary canals of the ulna; replacement of a bone defect in the area of the pseudarthrosis of the radius with an autograft from the iliac crest using combined stress osteosynthesis in combination with transosseous osteosynthesis. The results of surgical treatment of false joints and bone defects depend on the correct treatment tactics, according to the indications, and the correct implementation of the selected treatment tactics. The surgical tactics of treatment used in this clinical situation made it possible to create conditions for the fusion of fragments of the radius and ulna bones, as well as to replace the defect of the radius, as a result of which the anatomy and function of the damaged segment were successfully restored.

Radial fracture is the most common trauma to the musculoskeletal system and accounts for 50 % of traumatic injuries to the bones of the upper limb. Disability in patients with fractures of the forearm bones ranges from 6 to 8 months, so the choice of the most effective method of treatment is very relevant. Currently, an important point is the tendency of optimizing the transosseous method by eliminating the disadvantages and looking for new advantages of external fixation. Bone fracture and associated surgical intervention are always accompanied by varying degrees of changes in the links of the central nervous system, hemodynamics and metabolism. In order to study the bioelectrical activity of the brain in 47 patients with a fracture of the radial diaphysis treated in the Traumatology Department of the Irkutsk Scientific Centre of Surgery and Traumatology, in the pre- and postoperative period we compared EEG indicators of two variants of the layout of the external fixation apparatus (EF): wire and rod. Analysis of the rhythms of bioelectrical activity of the brain in both groups in the preoperative period revealed a normal zonal distribution with the dominance of the alpha rhythm on the EEG, which generally reflects a rather high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the group of patients with a wire-mounted EF device in the postoperative period, EEG indices significantly differed from the values of the norm and ndicators in the group with a rod-shaped arrangement. A decrease in the amplitude of alpha and beta rhythms was noted, as well as a shift in the frequency of bioelectric activity towards slow waves, which is a sign characteristic of discirculatory encephalopathy. An EEG study using the method of transosseous osteosynthesis with EF devise of a rod assembly showed its greater efficiency compared to the use of an EF device of a wire assembly during treatment and rehabilitation. Thus, the study of the bioelectric activity of the brain is a reliable method for assessing its functional state after an injury, as well as the effectiveness of the treatment.

Purpose To perform the comparative assessment of the mechanical strength of models of semitendinosus and peroneus longus tendon grafts prepared using the GraftLink technique. Materials and methods Tendon material was collected on the base of the Irkutsk Regional Bureau of Forensic Medicine. The main stage of the mechanical strength study of graft models was carried out at the National Research Irkutsk State Technical University, the Department of Strength of Materials, using universal tension testing desk-standing machine Shimadzu AGS-10kNXD. The mechanical strength of graft models of tendon of the semitendinosus and peroneal longus muscles, prepared by a known method (GraftLink technique) was defined. Statistical data processing was carried out using the statistical software Statistica for Windows 10.0 (StatSoft Inc., USA; license holder is the Irkutsk Scientific Center of Surgery and Traumatology). We used a nonparametric method for defining the statistical significance of differences, i.e. the Mann-Whitney test. Differences in the compared groups were considered statistically significant in p < 0.01. Results The mechanical strength of the graft harvested from the semitendinosus muscle tendon according to the known technique averaged out at 351.8 ± 133.0 N, and the mechanical strength of the graft from the half of the peroneus longus tendon, prepared in a known manner, averaged out at 632.4 ± 193.7 N. Statistically significant differences were revealed (p <0.01). Discussion Our study is the only one that shows the results of studying the mechanical strength of allografts prepared by two different techniques. In addition, we identified two phases of the graft rupture, when the free end of the graft being the weakest site of the graft ruptures during the first phase Conclusion The rupture of the graft from the half tendon of the peroneus longus muscle, prepared using the GraftLink technique, occurred at a force of 632.4 ± 193.7 N, which is 1.8 times more than the graft from the semitendinosus muscle prepared using the GraftLink technique.

Transosseous osteosynthesis continues to occupy a leading position among the methods of treatment of damage to the tubular bones of the extremities. This article presents a survey of 47 patients: 22 men and 25 women aged 25 to 60 years with fractures in the middle third of the radial shaft with displacement of bone fragments. The peculiarity of the external fixation device we used is that all transosseous elements are represented by 1.5 mm pins, inserted through both cortical layers of each bone, at levels from I and VIII. The pins are inserted simultaneously through both bones, thus excluding the rotational function of the forearm.The essence of the study is a comparative analysis of the blood system parameters in patients with diaphyseal injuries of the radial bone, operated by the transosseous osteosynthesis method using the external fixation device of pin configuration. Any damage to the body, (a fracture or related surgery), is accompanied with various changes in the system of hemodynamics and metabolism.The laboratory blood tests performed in the group of patients with damage to the radial shaft treated with transosseous osteosynthesis by external fixation device of pin configuration, revealed certain regularities in changing of blood parameters: increased number of platelets, increased level of fibrinogen and level of soluble fibrin complexes, which promotes the activation of the internal mechanism of blood clotting.

Fractures associated with osteoporosis, due to the high prevalence and high percentage of related complications, are a serious problem for modern traumatology and orthopedics. Among all injuries of the upper extremities, fractures in the proximal humerus occur in 32-65 % of cases. Fractures of the proximal humerus account for 4-5 % of all fractures and 50 % of fractures of the humerus. The aim of the research was to develop a new method for the surgical treatment of fractures of the proximal humerus against the background of osteoporosis and to evaluate the clinical effectiveness of the new method. A pilot study was conducted to evaluate the clinical efficacy and safety of surgical treatment of patients with a fracture of the proximal humerus. The results showed that the new "Method for the surgical treatment of patients with a fracture of the proximal humerus" is clinically effective and safe. Additional intramedullary bone stabilization of the proximal humerus with a fibular autograft allows for more rigid and stable fixation of fragments, especially in the presence of critical osteoporosis. The early restoration of passive and active movements in the shoulder joint made it possible to fully restore the function of the limb in a severe fracture of the proximal section.

Background. Multi-layer spiral computed tomography shows that the main cause of shoulder instability is glenoid cavity bone defect. The aim of our research was to assess the effectiveness and safety of biodegradable implants in the treatment of patients with chronic posttraumatic anterior shoulder instability under conditions of bone defect of glenoid cavity margin by the restoration of anatomic shape and structure of scapula articular surface.Materials and methods. We performed a pilot study based on the results of surgical treatment of 7 patients using 4.5 mm biodegradable compressing screws. In preoperative period, all patients had standard two-dimensional X-rays and MSCT with 3D-reconstruction. In postoperative period, all patients had check-up X-ray right after the surgery and MRI in 3 months after the surgery.Results. The results of the treatment were assessed by common clinical criteria, functional criteria, X-ray evidence and intraand postoperative complications. We registered strong functioning of an arm and an increase in the range of motions. Data from Rowe/Zarins and DASH questionnaires showed that the patients totally recovered. X-ray evidence showed consolidation of non-free autograft to the zone of scapula bone defect without osteolysis or widening of a drilled hole. We did not observe either a failure of union, or any formation of false joint, or any screw fractures in bone tissue. Beyond that, we did not observe any complication in postoperative period and early postoperative complications in particular.Conclusion. Pilot study with use of modern biodegradable implants in osteoplastic stabilization of shoulder joint at recurring instability showed their effectiveness and safety in patients of young and active working age. However, considering small number of patients in pilot study we cannot extrapolate our results to all similar and analogue cases of using biodegradable implants. In this regard, it is necessary to perform major multicenter clinical randomized study for further long-term observation and detection of possible unwanted side effects.

This article presents the experience of surgical treatment of rare pathology of the upper limb – pseudoarthrosis of the middle third of the diaphysis of the radius, defect pseudoarthrosis of the upper and middle third of the ulnar diaphysis. The definition and compilation of an accurate model and treatment tactics are critical to restoring the anatomy and function of the injured upper limb. The rarity of this case was the size of the ulna defect, which was up to 4.0 cm, the scarring and cicatricial changes in the soft tissues and muscles of the right forearm, due to the severity of the injury and the multitude of surgical interventions on the right forearm. The chosen treatment tactics consisted of several successive stages: resection of the zone of false joint of the right radial bone, combined transosseous osteosynthesis of the right radius bone, resection of the false elbow joint of the right ulna with replacement of the defect with autograft from the lower third of the fibula, combined strained osteosynthesis and transosseous osteosynthesis by external fixation apparatus with rod configuration of the right ulna. The results of surgical treatment of false joints depend on the determination of the correct indications for a certain type of surgical intervention and the competent implementation of the planned treatment plan. The chosen treatment tactics allowed us to successfully restore the anatomy and function of the damaged segment, thus rehabilitating the patient.

We analyzed the results of the treatment of patients after arthroscopic restoration of anterior crucial ligament injuries. The analysis showed good outcome of the treatment. We assessed the results of the treatment of 65 patients after arthroplasty of anteriorcrucial ligament in 2016–2017. The study was conducted in 6 months after the surgery. Good and excellent results (Lysholm scale) were obtained in 90,2 % of patients. Mean Lysholm scale result was 91 point (from 85 to 100 points). The results of anterior drawer test and Lachman test showed anterior instability of knee joint in 8 patients (++).19 patients had positive “pivot-shift” test. Vertical position of femoral canal that compensates antero-posterior shin misalignment but not entirely compensates rotation in knee joint stability is the possible reason for a large amount of positive “pivot-shift” test results. That’s why it is important to take into account anatomic features while restoration of anterior crucial ligament. Most of the patients restored their former level of physical activity with full social integration. Our research showed that exercise therapy and discipline of a patient have a huge significance in the rehabilitation of patients with this pathology.

The first description of surgical treatment of anterior cruciate ligament injuries has become known about a hundred years ago. At the beginning, complete ruptures of the anterior cruciate ligament was treated by open restoration with arthrotomy. At present, open ACL plasty is practically out of use, except for single cases. In recent decades, worldwide, surgical treatment of knee ligament injuries has been performed with arthroscopic techniques. It has long been proven that arthroscopic operations are able to restore the primary anatomy of the damaged joint, combining anatomical validity and minimal traumaticity, pathogenetic justification and high functional efficiency. For more than 50 years, surgeons have been offered many different materials and methods for ACL reconstruction, but nevertheless there is currently no consensus on the choice of rational treatment tactics and the percentage of unsatisfactory results remains significant. Based on the data of modern authors, it can be concluded that the issue of knee joint ligaments damage not only does not lose its relevance, but, on the contrary, due to the increased interest in active lifestyle, it becomes more and more popular and studied. The article presents various views on the basic methods of arthroscopic restoration of the anterior cruciate ligament of the knee joint at the present stage of the development of surgery.

Incidence rate of primary synovial chondromatosis of the shoulder joint makes 15–28 %. It is a rare benign lesion of synovial membrane of the joint featured by multiple foci of cartilaginous metaplasia in tissues of the membrane. Dif- ferential diagnostics should be conducted with the diseases, accompanied by formation of intra-articular loose bodies (secondary chondromatosis) at osteochondritis dissecans, osteochondral fracture of the humeral head, and tuberculous rheumatism. But the critical role belongs to histopathology report and molecular genetic analysis. Synovial chondroma- tosis most frequently afflicts one of the major joints (knee, hip, elbow, or shoulder). The pathology develops mainly in young men. Published descriptions of the development of this shoulder joint lesion are very sparse. Diagnostics becomes possible only on the grounds of histological examination of cartilage flaps removed from the joint. Present treatment of synovial chondromatosis includes removal of intra-articular cartilage bodies, either with open surgery or by arthro- scopic approach. The authors of the article present the clinical example of diagnostics and surgical treatment of the patient with primary synovial chondromatosis. The disease, aged more than 4 years, was accompanied with limited movements in the shoulder joint. Postoperative check-up examination established restored volume of movements and no pain syndrome in the joint. The patient came back to everyday routine and amateur sport. Therefore, adequate volume of surgical intervention excludes the recurrence of the disease in early and remote postoperative period. The patient is able to work and participate in routine physical activity.

We studied the use of Ortho-SUV hexapod in the treatment of 15patients with lower limb false joints. All patients were at active working age – from 22 to 50years. In 12patients, the period from the moment of trauma was 1 to 3years, in 3patients – 3 to 6years. 5patients had femoral false joints, 10patients – shin false joints. In 98% of cases, the formation of false joints was caused by inadequate treatment of initial trauma. In 100% of cases, false joint localized at diaphyseal level and was accompanied with shortening of injured segment for 2.5±1.0cm in 13patients, and for 0.5 and 0.8cm in 2cases. We also registered recurvatum and valgus deformity in 5patients, recurvatum and varus deformity in 8patients, and antecurvatum and varus deformity in 2patients. Combined contracture in knee and ankle joint was found in 90% of patients. Using combined transosseous osteosynthesis along with Ortho-SUV hexapod allowed us to correct hip deformity for 35±10days and ankle deformity – for 20±5days on the average. When shortening of femoral bone for more than 5.0cm, the deformity was corrected in two stages. At the first stage, we reconstructed the length of a segment using methods of transosseous osteosynthesis at discrete-continuum distraction. At the second stage, we corrected deformity using Ortho-SUV hexapod within specified time limits. Duration of femoral and shin false joint consolidation was 194±16days. We registered inflammatory complications in the areas of transosseous elements contacting soft tissues in 3(0.2%)patients. These complications didn’t have an effect on the treatment results.

The article presents the study of features of formation and remodeling of distraction graft of rabbits' forearm bones at the passage of transosseous elements through acupuncture points. The aim of the work was to develop and perform quantitative estimation of regenerative process at the healing of forearm bone fractures using morphometric researches. We studied morphofunctional changes of graft on different stages of ossification using morphoscopy and morphometry and compared their quantitative characteristics with the ones in intact bone. Used index systems of estimation of regeneration processes at the healing of forearm bone fractures allow to reveal larger degree of statistical significance of obtained results not only in comparison with intact bone but also in over the time of experiment. Using quantitative variables and index estimation of regenerative processes at the healing of forearm bone fractures allow not only to objectify character of their changes but also to predict variability of its value.

Purpose. To study the possibility of using gamma-scintigraphy for evaluation of bone tissue vascularization and formation in the zone of regenerated bone in order to determine the proper rate of distraction, the periods of bone fragment fixation, and to analyze the efficiency of acupuncture point (APP) stimulation effect on the process of regeneration. Materials and Methods. The features of vascularization, formation and remodeling the distraction regenerated bone substance of forearm bones in the rabbits when inserting transosseous elements through APP studied experimentally using gamma-scintigraphy. One of the forearms underwent 1-mm lengthening by the Ilizarov method. Results. The prolonged APP irritation with the inserted transosseous elements has been demonstrated to result in acceleration of vascularization of the regenerated bone, as well as in intensification of formation of the bone substance, both of which by their characteristics are most similar to the parameters of intact animals’ structures. Conclusion. The results of the study using gamma-scintigraphy of distraction regenerated bone of forearm bones are an objective measure of its vascularization evaluation with the help of which combined with the known techniques (radiography and multispiral computed tomography /MSCT/) the degree of regenerated bone maturity and the process of osteogenesis can be evaluated.

The study involved using morphometry in quantitative and qualitative evaluation of reconstruction of rabbit forelimb distracted bone graft The dynamics of bone graft remodeling process revealed during the experiment showed that relative vascular volume in the bonegraftwas 70 % increased, cell number was 60 % higher, meanwhile relative volume of tissue structures in the bone graft was lower than in the noninvoived bone. All those parameters can indicate that there is an ongoing process of osteogenesis in the graft.

During our experimen tal study, we researched peculiarities of formation and remodeling of distraction forelimb bone graft in rabbits at insertion of transosseous elements through acupuncture points (stimulation of biologically active points). One of the forelimbs was lengthened on 10 mm by Ilizarov method. Using morphoscopy and morphometry we studied morphofunctional changes in the bone regenerate at different stages of experiment during stimulation of biologically active points and compared these quantitative characteristics with parameters of the intact bone.