Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

Божкова, С. А.; Tikhilov, Rashid M.; Andriyashkin, V. V.; Akhtyamov, I. F.; Belov, Mikhail V.; Дианов, С. В.; Касимова, А. Р.; Каплунов, О.А.; Kopenkin, Sergei S.; Маланин, Д А; Муштин, Н. Е.; Цед, А. Н.

doi:10.17816/2311-2905-1993

Traumatology and Orthopedics of Russia

2022

DOI: 10.17816/2311-2905-1993

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Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

С. А. Божкова¹,

Rashid M. Tikhilov²,

V. V. Andriyashkin

et al.

Abstract: The guidelines describe modern approaches to the prevention, diagnosis, and treatment of thromboembolic complications in patients with injuries and after musculoskeletal surgery, in accordance with the interdisciplinary draft of the Clinical Guidelines (2022) Deep vein thrombosis of the extremities, which has passed public hearings and is being approved by the Russian Ministry of Health. The guidelines are designed for doctors of various specialties to provide medical care to specialized patients: orthopedic s… Show more

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Cited by 7 publications

References 112 publications

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Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Tsed,

Mushtin,

Dulaev

et al. 2023

Traumatology and Orthopedics of Russia

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Background. Chronic hemodialysis significantly increases the risks associated with knee replacement. Among the late complications of knee arthroplasty in hemodialysis patients, deep periprosthetic joint infection (PJI) and aseptic loosening are more frequent. The frequency of revision interventions in patients with end-stage kidney disease (ESKD) is substantially higher compared to patients with normal kidney function. The aim of the study — based on the perioperative parameters and midterm outcomes to justify the primary knee replacement in chronic hemodialysis patients as complex case of arthroplasty. Methods. A retrospective randomized single-center cohort study was conducted, including 62 patients with various forms of knee osteoarthritis. Patients were divided into two groups: Group 1 — 29 (46.8%) patients with end-stage renal disease (ESRD) undergoing dialysis, Group 2 — 33 (53.2%) patients without kidney pathology. The average follow-up period in both groups was 3.7 years (min — 1, max — 6). The following parameters were assessed: patient age, length of hospital stay, morphocortical index, body mass index (BMI), duration of hemodialysis, functional assessment of the knee joint using the KSS Function Score and Forgotten Joint Score-12 (FJS-12), radiological results on the KRESS, and the frequency of various complications. Results. In Group 1, patients had significantly lower BMI compared to Group 2. Length of hospital stay in Group 1 were 1.7 times longer. According to the KSS Function Score, no significant differences were observed between the groups in the first 36 months after the operation. However, by the 4th year of follow-up, average KSS Function Score in Group 1 decreased to 77.3 points, which was due to infectious complications. The FJS-12 showed worse scores in Group 2, averaging 68.7 points. After more than three years post-operation, no statistically significant differences were observed between the groups, which was associated with an increase in the number of complications in Group 1. Results on the KRESS after 43 months did not differ between the groups and averaged 4.8 points. Group 1 had more orthopedic complications and cases of PJI, accounting for 7 out of 37. Conclusion. Age and constitutional characteristics of patients undergoing hemodialysis significantly differ from the normal population. The frequency of complications in Group 1 was 23.5%. These patients require the implantation of more constrained implant components and modular systems. Therefore, primary knee replacement in hemodialysis patients can be classified as a complex case of arthroplasty.

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Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Tsed,

Mushtin,

Dulaev

et al. 2023

Traumatology and Orthopedics of Russia

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Prevention of postoperative pain after total hip arthroplasty in patients with proximal femur fractures

Han,

Akhtiamov,

Ardashev

et al. 2023

jour

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Introduction Proximal femur fractures can be associated with nailing and total hip arthroplasty (THA). Treatment of elderly inpatients necessitates adequate postoperative pain relief. Obese patients require specific inpatient and outpatient treatments.The objective was to evaluate the effectiveness of pain relief in obese patients at the stages of rehabilitation after primary THA performed for a proximal femur fracture.Material and methods VAS score was compared in two groups of 60 clinical cases to evaluate the effectiveness of postoperative multimodal pain relief using the author's method.Results Comparable results of an effective and stable pain relief were obtained in the two groups by the time the patient was discharged from the hospital 5-6 days after THA. Multimodal analgesia with a glucocorticosteroid injected in the projection of the sacroiliac joint provided an effect being greater by 29 % than with use of opioids after two postoperative days and by 11 % after five postoperative days.Discussion Old age, comorbidities are associated with optimal surgical strategy. THA in patients with extra-articular proximal femur fractures can improve the rehabilitation potential early after surgery and general clinical and functional results providing high quality of life in the late rehabilitation period.Conclusion THA demonstrated a stable positive effect of pain relief in the study group of patients with proximal femur fractures, regardless of the weight and the height. Positive dynamics in pain relief was seen in patients with elevated BMI of any gradation, including those with BMI ≥ 40.

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Evaluation of the effectiveness of ankle arthrodesis options

Wang,

Akhtiamov,

Cai

et al. 2024

jour

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Introduction Treatment methods for late stages of ankle osteoarthritis are varied, but the issue of assessing the long-term results of various fixation methods has not yet been studied, and this issue is of great importance in clinical practice.Purpose To compare the effectiveness of the fixation methods commonly used for ankle arthrodesis in patients with advanced ankle osteoarthritis.Materials and methods Eighty-two patients with advanced ankle osteoarthritis were treated with ankle fusion between 2019 and 2023 at three major medical institutions. All patients underwent 12-month follow-ups. The patients were divided into four groups depending on the method of surgical fixation of bone fragments.Results Most patients showed a significant improvement in the function and a decrease in pain intensity after the arthrodesis operation. The comparison of the effectiveness of various surgical fixation methods found that external apparatus screw fixation is characterized by lower blood loss and a relatively short duration of the operation. Plate and screw fixation resulted in higher AOFAS and VAS scores at 3 months postoperatively. However, by the 12th month after surgery, the differences in these two indicators were insignificant.Discussion Despite the various complications that occur in ankle arthrodesis, it remains effective for most patients. Among them, the Ilizarov apparatus is more suitable for patients with compromised conditions in the surgical area. Each method of surgical fixation has its own advantages and shortcomings, but the difference in long-term effectiveness is small. Conclusion Ankle arthrodesis is an effective treatment for advanced ankle osteoarthritis. The choice of surgical method is still subject to the principle of individual approach.

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Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

Cited by 7 publications

References 112 publications

Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Prevention of postoperative pain after total hip arthroplasty in patients with proximal femur fractures

Evaluation of the effectiveness of ankle arthrodesis options

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