Functional outcomes and synovial fluid (SF) cytokine concentrations in response to platelet-rich plasma (PRP) or stromal vascular fraction (SVF) post-treatments following open wedge high tibial osteotomy (HTO) in 20 patients with knee osteoarthritis (OA) were examined. Six weeks after surgery, the knees of 10 patients were injected with autologous PRP (PRP subgroup), while another 10 patients were injected with autologous SVF (SVF subgroup) and monitored for 1.5 years. Pain assessment (VAS score) and functional activity (KOOS, KSS, Outerbridge, and Koshino scores) were applied. PRP subgroup performed better compared with the SVF subgroup according to KOOS, KSS, and VAS scores, while the SVF subgroup demonstrated better results according to Outerbridge and Koshino testing and produced more pronounced cartilage regeneration in the medial condyle and slowed down cartilage destruction in its lateral counterpart. SF was collected before and one week after PRP or SVF injections and tested for concentrations of 41 cytokines (Multiplex Assay). In the PRP subgroup, a significant decrease in IL-6 and CXCL10 synovial concentrations was accompanied by an increase in IL-15, sCD40L, and PDGF-AB/BB amounts. The SVF subgroup demonstrated a significant decrease in synovial TNFα, FLT-3L, MIP-1β, RANTES, and VEGF concentrations while SF concentrations of MCP-1 and FGF2 increased. Both post-treatments have a potential for increased tissue regeneration, presumably due to the downregulation of inflammation and augmentation of synovial growth factor concentrations.

Treatment results for 7 patients who were operated on for neglected locked posterior subluxation of the humeral head with reverse Hill-Sachs lesion during 2013-2016 are presented. Surgical intervention included the open reduction of subluxation and transposition of thelesser tubercle of the humerusto a defect zone. Mean followup period was 14±3 months. Range of motion in shoulder joint and its function were restored almost completely with only small restriction in external rotation. No recurrence of subluxation was observed. All patients returned to professional and day-to-day activity.

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus. Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area.

Introduction. Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often is seen after shoulder joint trauma. It can be also occurred as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. Endoscopic surgical technique of decompression is an effective less traumatic alternative to open procedures. Goal. Improve the results of treatment of patients with axillary nerve neuropathy. Material and methods. The results of endoscopic transcapsular axillary nerve decompression in 5 patients, which were operated from 2018 to 2021 year, with the clinics of axillary nerve neuropathy. The mean age of the patients was 44.414.9. Patients were performed endoscopic axillary nerve decompression. Statistical analysis was made according to Mann-Whitney U test. Results. According to VAS-scale the severity of pain syndrome before the surgery was 64.6 points, 6 months after decreased to 1.4 0.5 points (p0.05). According to DASH scale the function of the of shoulder joint before the surgery was 77,6 6,9 points, 6 months after decreased to 12 5,2 points (p0.05). According to BMRC scale (M0-M5) strength of the deltoid muscle was 2 0,4 points, after increased to 4,4 0,5 points (p0.05). Range of motion in a shoulder was: flexion 107 45,6, extension 102 49, external rotation 22 13,6; 6 months after: flexion 154 25,6, extension 156 22,4, external rotation 50 8 (p0,05). The thickness of deltoid muscle according to US before the surgery was 7.21.04 mm., after 6 months - 11.81.44 mm (p0.05). Conclusion. The results characterize the method of endoscopic transcapsular axillary nerve decompression as a reproducible, minimally invasive and effective technique for pain relief, can treat neurological and intraarticular pathology, promotes early restoration of the function of upper limb.

Background: Distal femoral fractures are a widely spread problem in traumatology, which can be caused by both a high-energy trauma and a low-energy trauma in senile patients with osteoporosis. The conservative treatment shows little promise. The surgical treatment of patients is still a challenge for orthopedic surgeons regarding both the technical aspect and a high risk of complications. There are several surgical methods with the use of plates and nails, but there is still no universal conception of the surgical treatment. Aim: comparative analysis of methods of intramedullary retrograde osteosynthesis and bone osteosynthesis in the treatment of fractures of the distal femur. Methods: In this study, we evaluated the treatment results of 46 patients who underwent osteosynthesis for intraarticular fractures of the distal femur using an intramedullary retrograde nail. The evaluation was carried out based on such parameters as the duration of the operation and the time from the moment of injury to the operation, the intraoperative blood loss and the function of the knee joint. On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of the treatment. Reducing the operation time when installing a retrograde intramedullary nail was achieved with a relatively simple technique for installing this type of a fixator and the use of minimally invasive approaches. Results: On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of treatment. Reducing the operation time when installing a retrograde intramedullary nail was due to a relatively simple technique for installing this type of fixator and the use of minimally invasive approaches. One year after the surgery, the following mean values were achieved: 78 (6485) points according to the KSS knee score, 85 (6889) points according to the KSS function score, 3.1 (1.34.2) cm for the severity of pain syndrome according to the VAS scale, 105 (88120) degrees for the flexion in the knee joint. However, a number of post-op complications were observed: deep vein thrombosis of lower extremities was found in 6 (13.1%) patients, formation of a false-joint was seen in 3 (6.5%) patients, 1st grade arthritis of the knee joint was detected in 36 patients (78.2%), 2nd grade arthritis was observed in 10 patients (21.8%). 3rd grade arthritis was not detected. 3.5 years after the operation, none of the patients needed a knee joint replacement. Conclusion: Retrograde intramedullary osteosynthesis in type C distal femoral fractures promotes early rehabilitation, a complete recovery of the knee joint function and healing of the fracture, and represents an effective method of treatment.