Background. Reverse arthroplasty is an effective method of treating severe injuries and diseases of the shoulder joint. In cases of severe osteoporosis, defects and deformities of the glenoid, there are risks of incorrect installation and instability of the components of the endoprosthesis. In the literature data, the problem of osteoporosis in the endoprosthetics of the shoulder joint and methods of its solution are rather poorly reflected, which was the reason for this study.The aim: to develop algorithms for diagnosing the state of the bone tissue of the articular cavity of the scapula and methods for solving its deviations during reverse shoulder arthroplasty.Materials and methods. Forty-eight patients who underwent reversible shoulder joint replacement were examined in the Department of Adult Orthopedics of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. A standard preoperative examination of patients developed in the department was performed, as well as additional calculations of bone density in Hounsfield units and according to X-ray densitometry were performed. The parameters of bone density of the glenoid (in HU) were compared with the data of densitometry.Results. According to the results of densitometry, the patients were divided into groups. A direct dependence of the bone density of the glenoid and the indicators of densitometry was revealed. Algorithms of treatment and preoperative preparation of patients with bone density deficiency for reverse shoulder arthroplasty have been developed.Conclusions. In the studied groups, 100 % of patients with indicators below 139 HU were diagnosed with osteoporosis or osteopenia, and patients with more than 257 HU had normal bone mineral density.

Wide application of cell therapy particularly platelet enriched plasma (PRP) in modern orthopaedics enabled to improved treatment results in certain orthopaedic diseases and injury consequences. Treatment results for 7 patients (2 men and 5 women) with osteochondral lesions of talus (OLT) are presented. Mean age of patients was 26 years, mean duration of disease — 4 years. By Brendt and Harty roentgenologic classification I—II degree of OLT was diagnosed in 1 and III—IV degree — in 6 patients. In all patients mosaic chondroplasty of talus with implantation of PRP gel was performed. Postoperatively mean AOFAS index raised from 53 to 92. Follow up period made up around 2 years.

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Purpose of study: to evaluate the results of distal humeral epimetaphyseal intra-articular fractures treatment by the proposed combined osteosynthesis technique.Patients and methods. From 2014 to 2017 thirty three patients (21 male, 12 female) aged 22-68 years were treated for the distal humeral epimetaphyseal intra-articular fractures of types 13B1.2 — 13B3.3, 13C1.3 and 13C3.1t by AO/OTA classification. The technique included open reposition, transchondral osteosynthesis using titanium alloy (n=18) and biodegradable (n=15) cannulated screws followed by the application of the external fixation hinge distraction system. The results were evaluated roentgenologically and by DASH Score. Results. Follow up period made up from 3 to 12 months. Fracture consolidation was achieved in all patients. Functional treatment results were evaluated by DASH Score. In 30 patients the results were assessed as excellent, in 3 — good. No poor results were recorded.Conclusion. The advantages of the proposed technique are the early initiation of active and passive movements in the operated joint to prevent contracture and posttraumatic arthrosis development, reduction of risks of fracture fragments secondary displacement and screw migration, joint unloading owing to articular surfaces dosed distraction, ensuring of the operated joint stability. The result did not depend on the type of cannulated screw used.

BACKGROUND: Reverse shoulder arthroplasty is one of the surgical treatment methods of the shoulder joint injuries and diseases accompanied by pronounced changes in the anatomy of the articular structures. Considering the positive aspects of reverse shoulder arthroplasty, the indications for this operation are expanding over time. However, during this operation, errors are possible that lead to early dislocation of the endoprosthesis, compression of the metaglene to the scapula, screw instability and migration of the scapular component. Given the lack of a generally recognized clear algorithm of actions in these complex cases, the problem of reversible shoulder arthroplasty in case of defects in the articular surface of the scapula are relevant. AIM: To develop and evaluate the effectiveness of the method of compensating for the lack of bone tissue of the scapula in the reverse shoulder arthroplasty MATERIALS AND METHODS: In the Department of Adult Orthopaedics of the N.N. Priorov National Research Medical Center, reverse shoulder arthroplasty was performed in patients with scapular bone mass deficiency, who needed to fill in both marginal defects for the installation of metaglene with the correct angle of inclination, and the replacement of extensive defects with the necessary level of glenosphere lateralization. RESULTS: Follow-up of patients who underwent glenoid remodeling using bone autoplasty and subsequent shoulder reverse artroplasty within a period of 6 to 24 months. Remodeling and osseointegration of the grafts were determined, without signs of metaglene instability by the end of the 3rd month after the operation. The complex of rehabilitation measures and the time of recovery of movements in the operated joint did not differ from those of conventional reverse arthroplasty. CONCLUSION: Given the high efficiency of the proposed algorithm, the method used to compensate for the lack of bone tissue of the scapula in shoulder reverse arthroplasty can be recommended for implementation in a wide clinical practice.