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.

The use of bidirectional knotless barbed sutures in TKA reduces the time of surgery, does not affect the volume of hidden blood loss or PPI occurrence.

A bstract The surgical technique of proximal tibial osteotomy for genu varum in adults has evolved from a procedure using closing wedges of estimated sizes with staple fixation in the 1960s to using standard trauma internal fixation implants and, more recently, to gradual correction with software-guided hexapod external fixators. In the last two decades, implant manufacturers have also produced anatomical implants specific for such corrective osteotomies. This study evaluates the limits of using such proprietary implants for proximal tibial osteotomy in genu varum. Materials and methods Scanograms (teleradiograms) of lower limbs of a patient were used to derive skiagrams (two-dimensional bony outlines of the extremities). From these, two-dimensional and three-dimensional models of varus deformities of the tibia with different values of mechanical medial proximal tibial angle (mMPTA, from 85° to 40°) were created. An analysis of the created deformity was carried out and a simulation for surgical correction was performed using an open wedge high tibial osteotomy with fixation using a proprietary (Tomofix, Synthes) implant. In addition, a 3D simulation technique was used to check the accuracy of the results obtained from the 2D simulation. Results In cases of mMPTA ≥80° with localisation of the apex of varus deformity at the level of the knee joint line, the standard technique used with the proprietary medial tibial plate produces good results. In cases of mMPTA ≤70°, fixation of the osteotomised fragments by the proprietary medial plate is poor owing to the anatomical contours of the implant. In these cases, a different type of osteosynthesis is needed. In cases of mMPTA ≤70°, the distance between the lower edge of the bone plate and the medial surface of the tibia after a proximal tibial osteotomy exceeds 11 mm and will result in unacceptable soft tissue tension around the implant. Mechanical axis deviation to the Fujisawa point produces mMPTA values outside the reference range of normal values. Conclusion An osteotomy of the proximal tibia using a prescribed technique linked to a proprietary implant achieves good results only if performed within a certain range of deformity values. Pronounced varus deformities require a fundamentally different approach. This study reveals that surgeons undertaking corrective proximal tibial osteotomies for genu varum need to perform a comprehensive analysis of the deformity to allow for appropriate selection of patients. This will enable a consideration of the size and other characteristics of the deformity that will reduce the technical complications that may arise if the correction was performed using the recommended technique linked to a proprietary implant. How to cite this article Solomin LN, Chugaev DV, Filippova AV, e t a l. ...

Основную часть пациентов с последствиями переломов пяточной кости составляют люди трудоспособного возраста, но у таких больных часто имеется постоянно существующий многокомпонентный болевой синдром, не позволяющий им вернуться к трудовой деятельности. Цель данного исследования -в ходе анализа зарубежной и отечественной литературы, а также по данным клинического и рентгенологического обследования пациентов выявить спектр всех возможных источников болевого синдрома. Для анализа литературы по данной тематике было отобрано 79 иностранных публикаций, выпущенных в период с 1993 по 2017 г., а также 22 отечественные публикации за период с 2008 по 2017 г. Клиническая часть исследования представлена 22 пациентами, прооперированными в период с 2016 по 2017 г. в клинике РНИИТО им. Р.Р. Вредена. Среднее значение по ВАШ болевого синдрома у обследованной группы пациентов до оперативного лечения составил 6,5±0,3 (4-9) балла. В результате анализа литературы и клинических наблюдений сформирован перечень возможных источников болевого синдрома, а также выделены рекомендации по их дифференциальной диагностике, что позволит практикующим травматологам-ортопедам выбирать более эффективную тактику лечения пациентов рассматриваемого профиля. Ключевые слова: последствия переломов пяточной кости, задний отдел стопы, болевой синдром, импинджмент-синдром, сухожилия малоберцовых мышц, икроножный нерв. Переломы пяточной кости составляют 60-70% от переломов костей заднего и среднего отделов стопы и около 2% от всех переломов костей скелета [1]. Лечение таких переломов требует значительного опыта хирурга, индивидуально подобранной тактики лечения и полноценного оснащения, но даже при соблюдении всех требований риск возникновения осложнений остается достаточно высоким. При анализе 108 случаев

Background: Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning—even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. Methods: We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. Results: The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). Conclusion: The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level of Evidence Level III, retrospective cohort study, case series.

Introduction. Subcutaneous rupture of achilles tendon is a frequent trauma and most patients with such pathology are men of working age. Even though it is not difficult to diagnose such ruptures, especially those that need surgical treatment, there are numerous cases when patients come to a surgeon with a big delay. In such cases, the rupture becomes «chronic» or «neglected» and can be no longer treated as an acute rupture. There are many techniques of operative treatment of chronic achilles tendon ruptures, but still there is no consensus on which technique is to be considered the most simple, effective and safe.The aim of this study is to evaluate the effectiveness of using peroneus brevis tendon as a graft for treatment of achilles tendon defects type 3 in Kuwada classification. Will this technique bring good and excellent results that are comparable with end-to-end suture after acute achilles tendon ruptures?Materials and methods. The present study includes 13 patients in which peroneus brevis was used for treatment of neglected achilles tendon rupture (group I) and 18 patients after end-to-end suture after acute achilles tendon rupture (group II). Group I consisted of patients with neglected rupture of achilles tendon that was not previously treated due to various reasons and with a significant defect.Results. Mean surgery duration in group I was 91.9±6.6 (Me — 100) min, in group II — 43.2±2.2 (Me — 45) (p = 0.0001). damaged limb was evaluated using achilles Tendon Total Rupture Score, mean post-op follow up was around 1 year. The results were: group I — 86.6±2.28 (Me — 87), group II — 93.4±1.01 (Me — 94) (p = 0.04). This means, that despite quite high scores in group I, they are still statistically worse than scores after suture of acute rupture in group II. There was no difference in post-operative complication rate between the groups (p0.05). The most common complication for both groups was range of motion restriction in ankle joint. None of the patients had ankle joint instability after surgery.Conclusion. Management of neglected ruptures of achilles tendon type 3 (in Kuwada classification) with peroneus brevis autologous graft is an effective and safe technique, that achieves good and excellent results in treatment of this group of patients, in absolute numbers is comparable to functional outcomes after end-to-end suture of acute achilles tendon ruptures, but statistically demonstrates significantly worse results.

Background. Results of numerous contemporary studies indicate that medial and lateral unicompartmental knee arthroplasty (UKA) are almost equally effective both in clinical and functional aspects with no statistically significant difference in most cases. Furthermore, both operations tend to reach the effectiveness of total knee arthroplasty (TKA), despite the common opinion that any UKA is a more complex and skill challenging surgery with a less predictable outcome. The purpose — to asses if UKA in the patients with end-stage lateral unicompartmental osteoarthritis is an effective surgical intervention that may allow obtaining good and excellent medium-term functional results, that are comparable to the results of the medial unicompartmental arthroplasty, and to see if there are any benefits in comparison to the total knee arthroplasty (TKA). Materials and Methods. 140 middle-aged and elderly adults with end-stage osteoarthritis underwent knee arthroplasty at Vreden National Medical Research Center of Traumatology and Cheboksary Federal Center of Traumatology, Orthopedics and Arthroplasty. Group I (lateral UKA) (the main ) consisted of 15 patients with knee arthritis and type I Krakow valgus knee deformity, who underwent the lateral UKA with a fixed all-polyethylene tibial component. Group II (medial UKA) included 58 patients with end-stage medial unicompartmental osteoarthritis, who underwent the medial UKA using an endoprosthesis of a similar design. Group III (TKA) was represented by 67 patients with gonarthrosis accompanied by type II Krackow valgus knee deformity, who underwent the total knee arthroplasty with cruciate retaining (CR) prosthesis. The comparison between the groups was carried out regarding the achieved range of motion, functional result (using Oxford Knee Score and Forgotten Joint Score), as well as the rate of different types of complications. Results. During the study, two main objectives were set. The first was to compare the outcomes of the lateral and medial UKA. It was revealed that the lateral UKA allowed the patients to obtain good function of the operated knee, with the best results among the compared groups on the Forgotten Joint Score. The second objective was to compare the results of the lateral UKA and TKA in the patients with type II Krackow knee valgus deformity. Here, our study revealed that the group of UKA (group I) compared to the TKA had better results according to Forgotten Joint Score (71.5±5.3 vs 65.2±7; p = 0.9) and had a slightly lower range of motion according to Oxford Knee Score (34.6±2.3 versus 35.9±2.2; p = 0.7). It is worth noting that in both cases the difference was not statistically significant. Conclusion. Despite the fact that the lateral UKA made it possible to achieve a good functional outcome, the integral score was the same as in the groups with the medial UKA and the total knee arthroplasty. The older patients were more satisfied with the results of the partial arthroplasty than with the results of the total.

Эффективность и безопасность скользящей остеотомии наружного мыщелка бедренной кости при артропластике коленного сустава у пациентов с фиксированной вальгусной деформацией III типа по классификации Krakow Д.В. Стафеев, Д.В. Чугаев, С.А. Ласунский, Н.Н. Корнилов, А.Д. Синеокий Федеральное государственное бюджетное учреждение «Российский научно-исследовательский институт травматологии и ортопедии им. Р.Р. Вредена» Министерства здравоохранения Российской Федерации, г. Санкт-Петербург, Россия Efficiency and safety of sliding osteotomy of the lateral femoral condyle in total knee arthroplasty in patients with fixed valgus deformity (Krackow type III)