Introduction. The most effective method of treatment of patients with severe forms of coxarthrosis is endoprosthetics, the success of which directly depends on the correctness of preoperative planning based on knowledge of the morphology of the acetabulum in normal and pathological conditions. The aim of the investigation was to reveal the morphological features of the acetabulum in osteoarthritis of the hip joint, determining the technology of implant bed preparation for the prosthesis cup. Materials and methods. The study was conducted on 19 macerated pelvic preparations and 72 direct projection pelvic radiographs in 72 patients with stage III osteoarthritis of different etiology aged from 41 to 70 years (61.5 ± 1.4). Hyperplastic coxarthrosis was observed in 21 (29.2%), protrusion in 23 (31.9%), and dysplastic in 28 (38.9%) cases. Clinical, radiological, morphometric, and statistical methods of investigation were used. Methods of descriptive statistics were used. Results. The following data were obtained during morphometric studies: In hyperplastic coxarthrosis, the bottom thickness was 11.9±1.83 mm with an acetabular index (IVI) of 0.51±0.019; in protrusion coxarthrosis, the bottom thickness was significantly reduced and was 5.7 ± 0.93 mm, IVI of 0.66 ± 0.039; in dysplastic coxarthrosis, the bottom thickness was 14.5 ± 1.18 mm, IVI 0.42 ± 0.024 respectively. Discussion. Studies on acetabulum morphometry are being conducted worldwide; among residents of different countries, data on the depth of the acetabulum differ, the morphometric data obtained by us are relevant in terms of the variational anatomy of the population of the Ural region. The morphological features of acetabulum affect the technology of preparing the implant bed for the prosthesis cup, so the preoperative design of implantation is relevant. The proposed method of finding the center of rotation of the deformed acetabulum makes it possible to determine the required thickness of augments to compensate for bone defects in the area of the acetabulum floor and arch. Conclusions. The morphological features of the acetabulum in hyperplastic, dysplastic, and protrusion coxarthrosis determine the technology of implant bed preparation for a prosthetic cup.

Introduction. Despite the large number of ankle arthrodesis operations performed, to date, no unified approaches to the algorithm for selecting surgical treatment tactics, orthopedic implants, and postoperative management of patients have been developed. The debate over the choice of surgical technique is still ongoing. Objective of the investigation — to carry out a comparative analysis of the treatment results of patients with posttraumatic osteoarthritis of the ankle joint depending on the performed arthrodesis technique. Material and methods. 90 patients aged 30-65 years (mean age 52+6.2 years) with posttraumatic cirrhosis of stages III-IV (according to Kellgren & Lawrence) were under observation. The outcome of surgical treatment was assessed using the AOFAS scale. Depending on the tactics of surgical treatment, the patients were divided into 2 groups: 1) arthrodesis was  performed using arthroscopic technique, open operations with the Ilizarov apparatus and locking rods (retrospective, 62 patients); 2) arthrodesis was performed using advanced techniques and devices (prospective, 28 patients). Results and Discussion. Complete bone ankylosis was detected in 88,9% of cases depending on the choice of surgical technique. The use of modern methods of treatment resulted in the high percentage of good results — 92,8%. According to the literature, the use of effective modern fixators and arthrodesis methods enables to achieve 93% of good clinical results. Our data are comparable to the scientific sources. The use of an arthrodesis pin was especially effective (100% positive results). Conclusion. Taking into account the wider spread of minimally invasive techniques, further study of long-term results of treatment in patients treated with these techniques is required.

The aim of the work was to assess the relationship between venous insufficiency and osteoarthritis of the knee joint. Materials and Methods. The study included 214 knee joints from April 2018 to March 2021 in 107 subjects (19 men, 88 women), mean age of patients was 54.6 ± 8.6 years (range, 40 to 73 years). The study group included 61 patients diagnosed with knee osteoarthritis; the control group included 46 healthy volunteers without knee joint disease complaints. Demographic and clinical characteristics of all study participants were taken into account. The venous system of the lower extremities was assessed by ultrasound Doppler imaging. The results were assessed by standard radiography based on the Kellgren-Lawrence classification and ultrasonography. Pain severity was assessed using the Likert scale, and functioning was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. Venous insufficiency was detected in 40.9% of patients in the group of patients with knee osteoarthritis and in 15.2% of the control group (p=0.007). There was no statistically significant difference in cartilage thickness and Kellgren-Lawrence classification for the presence of venous insufficiency (p>0.05). However, the percentage of radiological medial tibial sclerosis was higher in patients with venous insufficiency in the osteoarthritis group (60%, p>0.05). Overall WOMAC scores were similar in both groups, whereas WOMAC pain scale scores were higher in patients with deep venous insufficiency (p>0.05). Discussion. Previously, researchers have found that patients with knee OA develop symptoms of chronic VH more frequently than their healthy peers, that VH and OA share common risk factors, and that the risk of these diseases increases with age. Our results showed no difference in the incidence of VN between groups after correction depending on age. Our results are consistent with the literature in that deep venous system lesions increase the risk of intraosseous hypertension to a greater extent than superficial venous system lesions. Conclusion. The evidence of increased radiological medial tibial sclerosis and higher WOMAC pain scale scores in patients with venous lesions in osteoarthritis create the hypothesis that venous pathology may affect the intraosseous bone microenvironment, leading to pain and early subchondral bone lesions, which manifest as subchondral sclerosis.

Introduction. The literature review deals with the current state of the problem of the hip replacement (HR), in patients with rheumatoid arthritis (RA) are considered in order to systematize the accumulated experience. Materials and methods. A search was conducted for relevant scientific publications over the past ten years in the databases of evidence-based medicine Cochrane Lirary, PubMed and the electronic scientific library e-library. According to the selected keywords, 100 publications were selected and analyzed. Results and discussion. RA is a systemic autoimmune disease characterized by synovial inflammation, symmetrical erosive-destructive polyarthritis, progressive destruction of the joints with the development of severe deformities, as well as a wide range of extra-articular somatic and hematological manifestations. It was revealed that HR allows you to restore musculoskeletal function and significantly reduce pain, but in patients with RA it has a large percentage of local and general complications. As a result of severe connective tissue lesions, long-term hormonal and immunosuppressive therapy, the structure of bone tissue and the anatomy of articulated bones change significantly. The protrusio acetabula with significant medialization of the center of rotation of the hip joint require a special reconstructive hip replacement. The minimizing surgical trauma, the osteoplasty protrusion defect of acetabula, stability fixation of the prosthesis, specialized preoperative preparation, reducing the activity of the inflammatory process, the prevention of periprosthetic infection and the prevention of venous thromboembolism, the correction of anemia are becoming increasingly relevant. Conclusion. It has been established that the normalization of the joint rotation center, the restoration of the offset with bone grafting of the protrusion defect, reliable primary fixation of the cementless acetabular component of the prosthesis, provide biomechanical conditions for long-term and painless functioning of the implant. Perioperative management of such patients should include a multidisciplinary approach.

The work presents information about V.D. Chaklin, corresponding member of the USSR Academy of Medical Sciences, laureate of the USSR State Prize, honored scientist of the RSFSR, Professor, about the chair of traumatology, orthopedics and military surgery at the Ural State Medical University in 1934, the clinical base of which became the Research Institute of Traumatology. The staff of the department under the guidance of Professor V.D. Chaklin carried out pedagogical and scientific activities, made a great contribution to the development of methods of reconstructive surgery. There are monographs by V.D. Chaklin and theses defended by the staff of the department. From the beginning of Great Patriotic War professor V.D. Chaklin was appointed the main traumatologist of Evacuation Hospital Administration of Sverdlovsk Regional Dispensary, headed the courses of medical personnel improvement in traumatology and orthopedics, was the adviser of Evacuation Hospitals, continuing to direct the work of UNITO and the department. V.D. Chaklin during his work in Sverdlovsk created the institute and chair of traumatology and orthopedics, the formation of the Ural scientific school of traumatology and orthopedics began, he brought up pupils — doctors and candidates of sciences, left 13 monographs for future generations.

The Ilizarov bone reconstruction method involves bone reconstruction and the formation of new bone. It is based on the biological phenomenon of distraction osteogenesis, which is used to lengthen bone and correct deformities. Ilizarov bone grafting is a lifesaving procedure for a number of conditions, including large bone defects and orthopedic infection complications. The method has given rise to new developments in bone reconstruction surgery based on the regenerative potential of bone tissue. The acceleration of distraction regenerate consolidation is one of the objectives of modern research in the field of new bone formation.

Based on the analysis of the treatment results of 133 patients with primary tumors of the lower limb long tubular bones, we describe the errors and complications of the Ilizarov method. We identified and analyzed the main groups of errors (organizational, tactical, and technical) and studied the treatment complications associated with them. These complications are not accompanied by significant anatomical and functional disorders, in the vast majority are treated by conservative measures and do not lead to the necessity to stop osteosynthesis. Systematization of errors and related complications determines a set of therapeutic and preventive measures for their prevention, while providing a more effective and high-quality rehabilitation of patients, reducing the time of hospital treatment of patients with tumor pathology of the long tubular bones.

In the work the review of actual literature sources concerning modern methods of treatment of osteochondral injuries was carried out, the features of anatomical and physiological structure of the talus, features of its blood supply were considered, etiological factors of formation of osteochondral injuries of the talus were presented, the high prevalence of ankle joint ligament apparatus injuries all over the world was noted. On the basis of the articles studied, topical problems of diagnostics and treatment of aseptic necrosis of the talus block and dissecting osteochondritis of the ankle joint were noted. The method of mosaic autochondroplasty of bone-cartilage graft is described, its differences from alternative methods with the use of allograft or juvenile cartilage graft are noted, and the features of all described methods are noted. Ceramic material based on lanthanum zirconate showing high osteointegrative properties is presented, which has been suggested for promising research in the field of osteochondral replacements.

The use of platelet-based biological materials attracts special attention in regenerative medicine. The aim of the work was to study the peculiarities of mechanical properties of the system «peri-implant bone tissue-implant» depending on the morphofunctional properties of platelets under conditions of titanium rod implantation into the femur bone of rabbits. The number of platelets, mean volume (MPV), thrombocrit, ratio of large platelets to their total number, and ADP-induced aggregation were determined. During mechanical testing, we determined the maximum load on the «peri-implant bone-implant» system and its elastic properties. According to the result of preoperative determination of the morphofunctional characteristics of the platelets, the rabbits were divided into 2 groups: low platelet potential (LTP) and high platelet potential (HPP). Determination of the mechanical parameters of the «peri-implant bone tissue-implant» system showed that the maximum load in the NTP group was lower than in the VTP group, at the same time, no significant differences were found in the parameter characterizing elasticity (Elastic). The number as well as the morphofunctional characteristics of the circulating platelets in the blood have a significant impact on the strength characteristics of the newly formed peri-implant bone tissue.

Hip arthroplasty (THA) is a frequently performed operation in patients with rheumatoid arthritis (RA), which can significantly improve the quality of life of this category of patients. In order to determine the main reasons and peculiarities of revision surgeries in patients with RA, this study was conducted. We analyzed 10 medical charts of the patients with RA who underwent revision surgery in Ekaterinburg Regional Clinical Hospital #1 from 2007 till 2021. We used clinical, radiological and statistical methods. Harris scale was used to assess the function of the hip joint. The leading cause of revision interventions was aseptic instability of component. The result of revisions was considered good in six cases, satisfactory in one case, and unsatisfactory in three cases. The peculiarities of the course and drug therapy of RA explain the leading role of aseptic instability among the causes of revision THA in patients with RA. A significant proportion of satisfactory and unsatisfactory outcomes of revision interventions require both the improvement in endoprosthesis designs and new materials with improved osseointegrative characteristics for bone grafting.

A complex of rehabilitation measures for 72 patients with rheumatoid arthritis after total hip arthroplasty is presented. Complex restorative treatment was carried out: physical treatment aimed at restoring muscle function; physical and manual treatment aimed at reducing pain syndrome, teaching the correct load on the operated limb when walking with crutches and the recommended amplitude of movements in the joint. Stabilometry was performed on the BioMera platform, a complex for diagnostics, treatment, and rehabilitation of patients with motor pathologies «Trust-M». Methods of descriptive statistics were used. The main attention was paid to restoration or retraining of patients after hip arthroplasty to a normal dynamic walking stereotype. Patients were trained both to walk with and without crutches, to perform a normal walking cycle with the maximum possible observance of its normalized periods when transitioning to walking without support. For this purpose, the patient and others were familiarized with the rules of the normal walking pattern.

The paper presents the medium-term results of the use of periarticular osteotomies of the tibia and femur in the treatment of deforming knee arthrosis (KA) against the background of lower limb deformities. The aim of the study was to evaluate the effectiveness of osteotomy combined with one-stage endoscopic organ-sparing interventions in the treatment of gonarthrosis. The object of the study was 74 patients with deforming osteoarthritis (DOA) of KA II-III degrees. Selection criteria: changes in the load axis of the limb in the frontal and sagittal planes, degenerative changes of the joint predominantly in one department (medial, lateral), the presence of contracture not more than 10˚. The study group did not include patients with degenerative damage to two parts of the knee joint, pronounced patellofemoral arthrosis, and flexion contracture of more than 10°. Preoperative planning and selection were performed on the basis of clinical examination, radiography, MRI, and CT scan data. Surgical treatment was performed in one surgical session: when correcting a varus deformity, osteotomy was performed first, and arthroscopic intervention, including ligament plasty, was performed second; when correcting a valgus deformity with femoral osteotomy, primary KA arthroscopy followed by osteotomy was optimal. As a result of the treatment, excellent and good results were achieved in the majority of patients in the medium-term period.

The rapid development of medical technologies makes the attitude to anterior cruciate ligament (ACL) reconstruction constantly reconsidered. In our work, we evaluated the results of surgical treatment of patients after ACL reconstruction using different options of graft fixation. We retrospectively analyzed the treatment of 125 patients with anterior instability of the knee joint. No great difference in the results of choosing the method of ACL graft fixation was revealed. The «all-inside» technology seems more promising. Correct positioning of the bone canals is very important. In the case of simultaneous meniscus injury it is necessary to perform a suture in order to preserve an important passive stabilizer of the knee joint.

Chronic posttraumatic osteomyelitis is a difficult-to-cure disease of the musculoskeletal system. The relationship between the course of the disease and the presence of type 2 diabetes mellitus has been revealed. It is necessary to predict the time of remission after initial diagnosis in this concomitant pathology. The paper includes data on the rehabilitation outcome of 57 patients with Ciery-Mader 3A (group 1) and 3B (group 2) osteomyelitis. Type 2 diabetes mellitus was a factor of systemic deficiency in wound healing in group 2. Clinical, radiological, and descriptive statistics methods were used. In patients with chronic osteomyelitis and concomitant type 2 diabetes mellitus, the risk of recurrence of purulent inflammatory process in the first year of follow-up increased by 20%. In the absence of systemic compromising factors, purulent process recurrence became more likely in the long-term follow-up periods up to 5 years.

Patients who have undergone severe elbow trauma often develop various complications. Heterotopic ossification is considered to be the most severe complication, which leads to severe impairment of upper limb function due to the formation of severe contractures and ankylosis in the elbow joint. The paper presents the results of surgical treatment of the elbow joint in a patient with «immature» ossification against the background of aged dislocation of the forearm, non-unionized fracture of the radial head, and stage II osteoarthritis. Analysis of the outpatient follow-up of the patient after injury revealed gross diagnostic and treatment errors. As a result of medical errors, inadequate treatment of injuries in the early stages after injury was prescribed, which contributed to the formation of heterotopic ossification and resulted in functional failure of the joint. During surgery, the ossification located in the ulnar fossa was removed via a small posterior access to the elbow joint, the remaining tissues of the joint were not affected, thorough hemostasis was performed, and a Volkov-Oganesian joint-distraction device was applied to provide a physiological range of motion in the elbow joint. Postoperative long-term rehabilitation ensured restoration of the elbow joint function with the patient's return to professional activities.

Although the first description of spondylolisthesis dates back to 1782 (by the Belgian obstetrician Herbinaux) and the evolution of various diagnostic and treatment modalities has undergone many changes, the choice of surgery for this pathology remains controversial. The aim of this work was to determine the optimal surgical access for the treatment of spondylolysis spondylolisthesis depending on the degree of vertebral displacement. The results of treatment of 11 patients with spondylolysis spondylolisthesis who underwent surgical treatment in the period from 2017 to 2021 at the State Medical Institution of the Siberian Branch of the City Clinical Hospital 40 were reviewed. In all cases, despite different methods of surgery (ALIF+MIS TPF or PLIF), positive clinical and radiological treatment results were achieved.

Adequate treatment of patients with combined trauma requires not only medical care at the highest level, but also coordination of organizational and logistical processes. We performed a retrospective analysis of the results of treatment of 256 patients with concomitant trauma in the regional trauma center from 2019 to 2021. The analysis included patients older than 18 years with (ISS) ≥18 and (AIS)>3 in two or more anatomical areas of the body. The average index of injury severity (ISS) was 30.5. Victims with combined trauma had a predominance of craniocerebral, chest, abdominal, and spinal trauma. The lethality rate was 15.2%, and the ISS of the deceased victims was 40.7. Victims with severe combined trauma do not tolerate time-consuming and traumatic operations, and «damage control» tactics are used for this group. To reduce the mortality rate it is necessary to transport patients with severe combined trauma from the scene to a level 1 trauma center. Only in a large multidisciplinary hospital with strong resource, therapeutic and human resource potential, it is possible to save victims with severe combined trauma.

The paper presents an analysis of the provision of specialized trauma care to trauma patients using the example of the trauma hospital of an urban multidisciplinary hospital for the period from 2017 to 2019, describing the algorithm for providing specialized medical care to trauma patients at the hospital stage implemented in clinical practice. Implementation of the developed algorithm for providing specialized care to patients with trauma allows us to significantly reduce the length of hospital stay, decrease the average bed-day rates in trauma departments, increase surgical activity, and reduce postoperative mortality in the trauma hospital.

Issues of shoulder joint surgery, in particular, with recurrent instability and pathology of the rotator cuff, especially with its «irrecoverable» injuries, are currently of considerable practical interest to traumatologists and orthopedists. In this article, we will present our experience in treating patients with this pathology in the period 2020-2021. The results of treatment were assessed by the DASH-score scale, were evaluated at 6 and 12 months after the operations. Arthroscopic and open surgery of the shoulder joint are popular and effective methods of treating patients. The number of these interventions is steadily increasing. The problematic issue remains the ignorance of outpatient doctors, and the fact that arthroscopic surgery of the shoulder joint is a rather expensive method in terms of consumables, equipment, which is hardly covered by means of compulsory medical insurance.