Corrective lower limb osteotomies are innovative and efficient therapeutic procedures for restoring axial alignment and managing unicompartmental knee osteoarthritis. This review presents critical insights into the up-dated clinical knowledge on osteotomies for complex posttraumatic or congenital lower limb deformities with a focus on high tibial osteotomies, including a comprehensive overview of basic principles of osteotomy planning, biomechanical considerations of different implants for osteotomies and insights in specific bone deformity correction techniques. Emphasis is placed on complex cases of lower limb osteotomies associated with ligament and multiaxial instability including pediatric cases, computer-assisted navigation, external fixation for long bone deformity correction and return to sport after such osteotomies. Altogether, these advances in the experimental and clinical knowledge of complex lower limb osteotomies allow generating improved, adapted therapeutic regimens to treat congenital and acquired lower limb deformities.
Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. Approximately 85% of OI cases are caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2), which affect the quantity or structure of collagen. The remaining percentage of cases is caused by mutation in the proteins responsible for posttranslational modification, processing and crosslinking of collagen, bone mineralization, and osteoblast differentiation. In the past decade, new recessive, dominant, and X-linked inheritance. As a result, new types of OI were added to the Sillence classification, and a new genetic classification consisting of XVIII types is formed. Treatment of patients with OI is a complex task which requires a multidisciplinary care. Pharmacological treatment is based on bisphosphonate treatment, which increases the bone mineral density. In this article, we will describe other approaches in which the effectiveness is studied. Surgical treatment of the fractures and deformities of the extremities showed a positive effect on the patients’ quality of life, despite existing complications. There are a lot of debates about the choice between telescopic and non-telescopic fixators. Rehabilitation plays huge role in the recovery process after fracture and surgeries. Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. Approximately 85% of OI cases are caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2), which affect the quantity or structure of collagen. The remaining percentage of cases is caused by mutation in the proteins responsible for posttranslational modification, processing and crosslinking of collagen, bone mineralization, and osteoblast differentiation. In the past decade, new recessive, dominant, and X-linked inheritance. As a result, new types of OI were added to the Sillence classification, and a new genetic classification consisting of XVIII types is formed. Treatment of patients with OI is a complex task which requires a multidisciplinary care. Pharmacological treatment is based on bisphosphonate treatment, which increases the bone mineral density. In this article, we will describe other approaches in which the effectiveness is studied. Surgical treatment of the fractures and deformities of the extremities showed a positive effect on the patients’ quality of life, despite existing complications. There are a lot of debates about the choice between telescopic and non-telescopic fixators. Rehabilitation plays huge role in the recovery process after fracture and surgeries.
Partial rotator cuff tears are the most common pathology of the shoulder joint. Diagnostic of such conditions is a challenging problem for trauma surgeon.Purpose of the study is to analyze the diagnostic significance of manual tests and the standard MRI of the shoulder joint.Materials and Methods. The study is a retrospective analysis of disease history data of 25 patients (15 males, 10 females) treated at the authors’ hospital during the period from 2014 to 2017. Examination was performed according to a standard protocol: assessment of shoulder range of motion, palpation, manual examination, including “full/empty can” test, a painful arc symptom and the Hawkins – Kennedy test. All patients underwent MRI of the shoulder joint. The mean age of patients was 50.8 years. Shoulder joint arthroscopic inspection was considered the gold standard for diagnostics.Results. After data analysis, the following results were obtained: sensitivity of the “full can” test was 68%, the accuracy was 68%; “empty can” test sensitivity and accuracy were 76%, respectively. MRI sensitivity for diagnostics of supraspinatus tendon ruptures was 84% with the accuracy of 84%. The combination of the Hawkins – Kennedy test with the symptom of painful arch demonstrated accuracy and sensitivity of 64%. The study evaluated the effectiveness of MRI for diagnostic of the rupture type: sensitivity for injury from the joint surface — 80%, from the subacromial space — 70%; specificity for ruptures from the articular surface — 90% and from the subacromial space — 93%. The accuracy was 84% for both types of ruptures.Conclusions. Combined application of manual tests and MRI of the shoulder joint allows to diagnose partial rotator cuff tears in the majority of cases.
Calcific tendinitis of the rotator cuff is a common disorder and can be successfully treated with non-operative techniques in most cases, although surgical management should be considered in some patients for adequate calcium removal. No clear consensus exists regarding whether the involved tendinous portion to be repaired or not with suture following the deposit removal. The purpose of this study is to evaluate and compare results of re-fixation and debridement of the rotator cuff tendons after calcium removal. Material and methods The study is a retrospective analysis of case histories, operation protocols, magnetic resonance images and radiographs of the shoulder of 19 consecutive patients diagnosed with calcific tendinitis that was surgically treated at our clinic between 2013 and 2016. The median age of the patients was 52 years. All patients were divided into two groups depending on the surgical treatment performed. Calcium deposit was removed and the rotator cuff sutured in patients of the main group, and calcium was removed and the rotator cuff debrided in controls. Results Outcomes were rated as excellent with OSS in 58.3 %, as good in 33.3 % and satisfactory in 8.4 % of the patients in the main group. Controls showed 28.6 % of excellent outcomes and 71.4 % of good results. Excellent ASES shoulder scores were recorded in 91.6 % of the patients in the main group and 8.4 % had satisfactory results. Excellent results were achieved in 71.4 % of controls and 28.6 % had good results. No poor outcomes were observed in the patients. No statistically significant differences were found between the groups. All patients of the main group completely regained the function up to 100 % at a follow-up visit. However, the median time required to regain function by 50 % was 3 months (interquartile range 2:6) after surgery in patients of the main group and 1.5 months in controls. There was a correlation revealed between persistent history of calcific tendinitis and dimensions of the deposit according to the Bosworth classification. Conclusion A type of calcium deposit identified with radiological classifications was shown to have no impact on outcomes. Patients who underwent no repair of the rotator cuff achieved 50 % recovery of the shoulder function almost twice as quickly as those with repaired tendon. No statistically significant differences in outcomes were found between the groups but patients of the main group showed higher scores measured with patient-reported outcomes. More research needs to be carried out on a variety of techniques before definitive conclusions can be made on strategies of surgical treatment of calcific tendonitis.
Реферат American Shoulder and Elbow Surgeons standardized assessment form (ASES)-одна из наиболее часто используемых специализированных шкал для оценки состояния плечевого сустава. Однако до настоящего времени шкала не валидирована на русском языке. Целью работы является кросс-культурная адаптация и валидация шкалы оценки функции плечевого сустава ASES. Материал и методы. В исследование были включены 93 пациента с различной патологией плечевого сустава, медиана возраста-49 лет, в том числе 39 мужчин и 54 женщины. Первым этапом была проведена языковая и культурная адаптация опросника ASES, в результате чего была получена его максимально приближенная версия. Далее была проведена оценка психометрических свойств опросника (надежность, валидность). Были изучены эффекты максимальных и минимальных значений (floor and ceiling effects), оценен коэффициент внутреннего постоянства альфа Кронбаха и воспроизводимости. Для оценки воспроизводимости использовали метод «тест-ретест», для которого было отобрано 20 пациентов. Эти пациенты заполняли опросник ASES при первичном обращении к травматологу-ортопеду и повторно через 7 дней, полученные данные оценивали с помощью коэффициента внутриклассовой корреляции (ICC-intra-class correlation coefficient). В рамках работы была проведена оценка валидности полученной шкалы, в том числе для оценки критериальной валидности оценивали взаимосвязь результатов исследуемого опросника с результатами валидизированного в России опросника DASH. Результаты. В рамках исследования получена оценочная шкала, полностью соответствующая оригинальной версии с незначительными лингвистическими и культурными особенностями. Медиана значений результатов по шкале ASES-68,7 [32,6; 93,8], максимальных и минимальных баллов по шкале получено не было. Русскоязычная версия опросника обладает хорошими психометрическими свойствами. Внутренняя согласованность-альфа Кронбаха 0,72. Общий внутриклассовый коэффициент корреляции анкеты ASES (ICC) составил 0,95 (р<0,05). Статистически значимых различий между общей группой исследуемых пациентов и группой «тест-ретест» по полу, возрасту и виду патологии плечевого сустава выявлено не было. Коэффициент корреляции между шкалами ASES и DASH составил 0,9; индекс GRI-3,05. Заключение. Адаптированная русская версия анкеты ASES обладает хорошими психометрическими свойствами и может быть рекомендована к применению для оценки функционального состояния пациентов с патологией плечевого сустава и динамики изменений в процессе лечения. Ключевые слова: патология плечевого сустава, шкала оценки, ASES, DASH.
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