N.N. Priorov Journal of Traumatology and Orthopedics

BACKGROUND: Age and comorbidities are considered independent preoperative predictors of mortality in proximal femoral fractures; however, their contribution remains debatable.

AIM: To assess the prognostic significance of age and Charlson Comorbidity Index (CCI) of the survival of older people with proximal femoral fractures.

MATERIALS AND METHODS: This retrospective prospective study included all cases of proximal femoral fractures that occurred between January 1, 2019, and December 31, 2019, in individuals over 50 years of age from the cities of Tver, Torzhok, Rzhev, VyshnyVolochek, and Kashin. ICD-10 codes: S72.0, S72.1, and S72.2. The CCI of each patient was calculated using an online calculator and clinical data obtained from patient and outpatient records. Statistical analysis. Survival was estimated using Kaplan–Meier curves and the average number of deaths per day per 1000 people. The follow-up interval was obtained in days from the time of injury to the event of death or last contact with the patient. The minimum observation period was 876 days, and the maximum was 1492 days.

RESULTS: The survival rate of patients decreased from younger to older age groups, both among those operated on and those who were not. Patients aged ≥85 years were at greatest risk (median survival: 257 days; 95% CI: 36.6–478.3). CCI was significantly associated with survival: the risk of death with CCI >3 was 3–6 times higher than that with CCI 2–3, depending on the follow-up interval. CCI reflected health status more than age: within the same age group, there were patients with different CCIs.

CONCLUSION: Using age and CCI simultaneously as predictors of mortality and more accurate indicators of health status will enable the planning of the utilization of additional medical and social resources in the preoperative and postoperative periods, thereby increasing survival.

BACKGROUND: Internal fixation of pilon fractures remains challenging despite the development of new technologies in medical imaging and implant design and various scientific investigations on this problem. A key point in therapeutic strategy is preoperative planning. Since the beginning of the twenty-first century, the procedure has changed dramatically from plain radiograph drawing to 3D models and internal fixation simulation in vitro.

AIM: This study aimed to evaluate 3D modeling in pilon fracture osteosynthesis preoperative planning.

MATERIALS AND METHODS: The study used open, prospective, randomized, and comparative analysis. We analyzed the data of 60 patients with pilon fractures who had undergone surgical treatment for pilon fractures between July 1, 2020, and December 12, 2021, in Moscow City Hospital No. 17. In 30 patients, 3D models were used in preoperative planning, and in another 30 patients, the traditional planning method was performed. The operation time, intraoperation, X-ray dosage, blood loss, fracture reduction quality, and long-term results were analyzed. Additionally, the surgeon’s comfort in applying the 3D model and ease of doctor–patient communication were assessed using questionnaires.

RESULTS: Results showed that 3D modeling in pilon fracture osteosynthesis preoperative planning has advantages over traditional preoperative planning.

CONCLUSION: Therefore, 3D planning is a promising novel method for distal tibial fracture internal fixation preoperative planning, which provides significant higher degree of fracture anatomy comprehension and facilitates reduction maneuvers and implant positioning.

BACKGROUND: Sagittal balance of the spine has received considerable development in recent years. However, most studies focused on the assessment of vertebral–pelvic parameters. The cervical spine has long received insufficient attention from researchers, but this trend has been changing. The study of cervical sagittal balance in children with Down syndrome is beneficial in approaching the preconditions of atlantoaxial instability.

AIM: To perform a comparative analysis of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children.

MATERIALS AND METHODS: Radiographs of the cervical spine in the neutral position in lateral projection and postural radiographs of 110 pediatric patients were analyzed retrospectively. The patients were divided into two groups: group 1 (normal), 60 children aged 4–17 years without spinal pathology, and group 2 (Down syndrome), 50 children aged 4–17 years with Down syndrome. The parameters of cervical sagittal balance (Oc-C2, Oc-C7, C1-C2, C2-C7, C2-C7H, C7S, Th1S, TIA, NT) and criteria for atlantoaxial instability (Nakamura angle, ADI, SAC-C1, SAC-C1/SAC-C4) were obtained, and data was statistically analyzed.

RESULTS: Significant differences in the parameters C7S, Th1S, and TIA increased in children with Down syndrome. These parameters are involved in cervical lordosis; however, no significant differences in cervical lordosis angles were found. Furthermore, significant differences were noted in the criteria of atlantoaxial instability ADI, SAC-C1, and SAC-C1/SAC-C4 toward their decreasing in children with Down syndrome.

CONCLUSION: In patients with Down syndrome, the indices of cervical lordosis are statistically greater than those in normal children. Moreover, the parameters of cervical lordosis in patients with Down syndrome do not differ from those in normal children. Therefore, during flexion, subcompensation of the cervical spine is observed in children with Down syndrome. Given the statistically smaller indicators ADI, SAC-C1, SAC-C1/SAC-C4, low neck muscle tone, and ligamentous hypermobility, these abnormalities can be considered as congenital predisposition factors for atlantoaxial instability in children with Down syndrome.

BACKGROUND: To evaluate shoulder joint pain, the study concentrated on evaluating the diagnostic accuracy of ultrasonography and magnetic resonance imaging.

AIM: By comparing the results from both modalities within the same patient group, the study aimed to identify potential challenges in image interpretation, underscoring the limitations of ultrasonography and magnetic resonance imaging.

MATERIALS AND METHODS: Patients with shoulder joint pain were included through purposive sampling. These patients underwent ultrasonography and magnetic resonance imaging, and the results were correlated. Various shoulder pathologies, including tendon tears, bursitis, degenerative changes, calcifications, and impingement, were analyzed.

RESULTS: The study comprised 35 patients who underwent ultrasonography and magnetic resonance imaging detecting pathologies such as subscapularis and supraspinatus tendon injuries, partial and full-thickness tears, peribicipital tendon fluid, subcoracoid and subacromial-subdeltoid bursitis, acromioclavicular joint degeneration, tendon calcification, and impingement. Comparative analysis showed varying sensitivities, specificities, positive predictive values, negative predictive values, and accuracy for different pathologies.

CONCLUSION: Compared with ultrasonography, magnetic resonance imaging demonstrated greater sensitivity and specificity in identifying conditions causing shoulder pain. Ultrasonography’s affordability, real-time capabilities, and ability to compare results with the unaffected side make it a useful first diagnostic step for shoulder pain. Ultrasonography, although a quick and cost-effective initial diagnostic tool, has limitations, including operator dependence and lower sensitivity in certain conditions. In contrast, magnetic resonance imaging is employed as a confirming measure or in instances where diagnosis is challenging. The study emphasized the complementary roles of ultrasonography and magnetic resonance imaging in the diagnosis of shoulder joint pain, with magnetic resonance imaging as the more accurate and complete imaging modality.

BACKGROUND: The combined course of avascular necrosis of the femoral head and septic arthritis of the hip joint is extremely rare and not always timely diagnosed. Analysis of specialized foreign literature revealed only single descriptions of clinical cases of combined lesions of the hip joint (avascular necrosis of the femoral head and septic arthritis). However, these studies do not describe the surgical treatment algorithms of patients. While analyzing the sources of domestic literature for the last 10 years, we did not encounter descriptions of such clinical cases.

CLINICAL CASE DESCRIPTION: A 38-year-old patient was diagnosed with avascular necrosis of the femoral head with concomitant septic arthritis of the hip joint. During the preoperative period, a diagnostic puncture of the hip joint with subsequent cytologic and microbiological examination of synovial fluid was performed. Growth of the Staphylococcus aureus strain was observed. Because primary hip arthroplasty was contraindicated and isolated conservative treatment of bacterial arthritis aggravated the course of avascular necrosis, the patient underwent two-stage surgical treatment. The first stage was femoral head resection with installation of a spherical cement spacer impregnated with antibiotics, and the second stage was total hip arthroplasty after the inflammatory process had subsided. The postoperative period of each surgical stage proceeded without complications. It was possible to achieve microorganism eradication; eliminate the chronic inflammatory process, which was confirmed clinically and laboratory; ensure the possibility of total hip arthroplasty; and restore the limb-bearing capacity, extent of motion in the joint, and quality of life of the patient.

CONCLUSION: The clinical observation confirms the need for detailed diagnosis in patients with an atypical course of avascular necrosis of the femoral head and demonstrates a successful treatment option in such cases.

Distal femur fractures in the elderly can lead to the exacerbation of chronic diseases and fatal outcomes similar to those observed in femoral neck fractures in the same category of individuals. Thus, this study aimed to determine the factors influencing the mortality of patients with distal femur fractures based on the analysis of foreign studies and results of treated patients. Review of foreign literature was conducted using the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, and Cochrane among articles in English, Chinese, Italian, and Russian, as well as through the Web of Knowledge. We analyzed publications for the last 10 years. Evaluation of treated patients included patients aged >60 years with distal femoral fractures between 2021 and 2023. Analysis of the literature data showed that distal femur fractures are accompanied by high mortality in patients in the first years after injury (from 18% to 35%), commonly in elderly patients without surgical treatment (90%–100%), and the presence of several concomitant diseases accompanied by contractures of the femur, knee joint, and false joint and displacement or fracture of the metal retainer. Early surgical treatment (first 48 h) is an effective treatment method that significantly reduces mortality after distal femur fracture (by 2.8 times).

On December 15 and 16, 2023, the X All-Russian Scientific and Practical Conference “Priorovsky Readings” dedicated to the 100^th anniversary of the birth of Academician Mstislav Vasilievich Volkov was held in a solemn atmosphere at the Radisson Slavyanskaya Hotel in Moscow. The report gives a brief overview of the event.

Brief biographical information and scientific achievements of Gennadiy P. Kotelnikov, congratulations on the 75^th anniversary.