Введение. Лечение пациентов с высокоэнергетическими травмами костей конечностей является трудной задачей. Цель. Представлен случай этапного лечения пациента с огнестрельным переломом костей голени. Материалы и методы. Первым этапом выполнена стабилизация перелома внешним фиксатором. Второй этап направлен на купирование инфекционного процесса-резекция некротических тканей, установка антибактериального спейсера, замещение дефекта мягких тканей. Третий этап-реконструктивная операция для замещения костного дефекта и консолидации костей голени. Результаты и обсуждение. Сформированная мембрана Масколе, компрессионный остеосинтез по Илизарову и несвободная аутопластика фрагментом малоберцовой кости позволили восстановить опорность голени в достаточно короткий срок. Заключение. Комбинация стимулирующих эффектов различных хирургических техник позволяет получить хороший результат в тяжёлых клинических ситуациях. Ключевые слова: дефект кости, метод Илизарова, аутотрансплантат, мембрана Масколе Introduction High-energy tibial fractures are challenging injuries to treat. Objective We report a case of a tibial gunshot fracture treated at several stages. Material and methods The fracture was first stabilized with external fixation device. The second stage aimed at the arrest of infection consisted of excision of necrotic tissues, placement of antibacterial spacer and repair of compromised soft tissues. Reconstructive surgery was produced at the third stage of treatment to address bone defect and provide consolidation. Results and discussion The Masquelet induced membrane technique, compression osteosynthesis with the Ilizarov frame and non-free autograft using fibular fragment facilitated recovery of supporting tibia functions within a relatively short period of time. Conclusion The combination of stimulating effects from different surgical techniques is useful to ensure a good outcome in a severe clinical case scenario.

Abstract. Introduction The Covid-19 pandemic has led to quite significant changes in the length of hospital stay of orthopedic patients. Meanwhile, there has been a tendency for early discharge after arthroplasty for quite some time due to the increasing burden on health care systems that became possible due to the implementation of accelerated rehabilitation protocols. This study is dedicated to the effect of discharge terms on the incidence of postoperative complications. Material and methods A retrospective study of 1,837 patients who underwent primary/revision THA and TKA at our center in 2020 was carried out. The impact of the pandemic was assessed by comparing the duration of hospitalization, the incidence of complications and functional status in patients operated on before and after the introduction of epidemiological restrictions. Purpose of the study To assess the impact of the Covid-19 pandemic on the length of patients’ hospital stay after knee and hip arthroplasty. Results The total duration of hospitalization after primary THA was reduced by 35 % (from 11.8 ± 3.3 to 7.7 ± 2.6 bed-days), and by 38 % (from 19.9 ± 7.5 to 12.8 ± 6.3 bed-days) after revision THA. The overall readmission rate (for surgical and nonsurgical complications) after primary THA was 4.1 % before the pandemic and 4.3 % during the pandemic; for primary TKA it was 2.1 % and 5.1 %, respectively; for revision THA – 13.9 % and 4.5 %, revision TKA – 4.4 % and 9.8 %, respectively. Comparative assessment for each diagnosis separately did not show significant difference. Evaluation of the questionnaire survey using the Oxford hip/knee score also showed the absence of a statistically significant relationship between the time of discharge and the functional state of the operated joint. The interviewing of patients regarding the infection with coronavirus yielded positive answers in 22 % (n = 419). The onset of symptoms during hospitalization or within 14 days after discharge was noted by 4 % of respondents (n = 75). Conclusion The incidence of complications and unfavorable outcomes did not depend on the length of hospital stay after THA and TKA.

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Abstract. Introduction Analysis of publications on primary hip replacement shows lower survival rates in patients with acetabular injuries. With the lack of a unified system for assessing post-traumatic acetabular deformities, authors tend to use the available classifications of acute pelvic trauma (AO/ ASIF, Young & Burgess, Tile, etc.) and acetabular osteolysis (AAOS, DGOT, Gross and Saleh, Paprosky), which we think can be inappropriate with the classifying systems meant for different patterns of acetabular deficiency. Material and methods CT scans of 117 patients with posttraumatic acetabular deformities were reviewed prior to total hip replacement (THR) performed for posttraumatic grade III coxarthrosis. The displacement of acetabular walls was determined with the measurements tabulated and analyzed. Results An original "ASPID" classification of post-traumatic deformities based on the findings obtained was offered with use of three assessment criteria: localization of the deformity, extent of displacement and the integrity of the pelvic ring. The ASPID classification can be used for the localization of the deformity with anterior (A), superior (S), posterior (P) and inner acetabular walls (I) to be identified. Measurements of displacement ranging 0-5 mm suggests grade 0 displacement; 6-15 mm, grade 1 displacement and greater than 15 mm, grade 2 displacement. The integrity of the pelvic ring evaluated from the involvement side as D0 suggests maintained pelvic integrity and D1, broken pelvic integrity. An acetabular hardware would be marked with 'H'. Conclusion ASPID classification is easy to use and has shown to be practical for planning of primary THR after acetabular fracture.

Introduction Distal femoral fractures are a challenging medical and social problem as they may occur at any age. All the available osteosynthesis types can be used to treat such injuries. However, despite the disadvantages, fixation with plates has been the most common and developed. Aim of study was to analyze the world literature and summarize the information regarding the use of plate fixation in the treatment of distal femoral fractures, identifying unresolved issues and promising directions. Materials and methods The following sources were used for collecting the information: Pubmed and E-library databases, publications of Elsevier, Springer and other publishing companies, materials of the Russian National Library, AO Surgery Reference on line. Results A review of global literature demonstrated that a minimally invasive approach which allows for bone fragment blood flow and stable fixation with a locking compression plate (LCP) are the most important factors that can improve the quality of treatment with plating. Discussion Plate fixation is still the most preferred method in the treatment of distal femoral fractures. In most severe injuries, accompanied by the medial support loss (33–A3, 33–C2 and 33–C3 fracture types according to AO classification), the use of not only the lateral but also the medial plate to achieve stable osteosynthesis has been discussed. Conclusion Further advance of the technology for treating these injures may be associated with designing an “anatomical” medial plate and a method for its minimally invasive implantation. Development of a lateral plate which could provide the stability similar to bilateral osteosynthesis seems even more prospective. Undoubtedly, such a plate would be useful in limb reconstruction surgery as well, for changing the external fixation to internal one after deformity correction and limb lengthening.