Currently, there is a clear increase in the frequency and severity of various types of injuries, both domestic and road transport, industrial, which is primarily associated with global technical progress, the availability of various household and industrial appliances, as well as information workload, which affects attentiveness of people in everyday life, on the roads and at work. Among these injuries, injuries to the distal part of the lower extremities confidently occupy their position, reaching, according to various authors, 10% of all injuries of the musculoskeletal system. Not the last place among these cases is occupied by injuries accompanied by a violation of the integrity or complete damage to the soft tissues of the calcaneal region. There are also frequent cases of trophic defects in this area associated with a violation of neurovegetative innervation in the proximal lower extremities against the background of post-traumatic scarring of tissues, micro-and macro-angiopathy. In this connection, the function of the lower extremities, the ability to support and, as a result, the quality of life is impaired, as well as the infection quite often joins. We have considered the most effective surgical interventions, based on the results of reviewing the latest articles in the PubMed search database.

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Background. There are few cases of entire femur modular replacement with hip and knee joints in patients with periprosthetic joint infection (PJI) in literature. They report encouraging results in patients of elderly and senile age. We present case of a copper-coated femoral spacer implantation to 50-year-old patient with multiple PJI episodes and osteomyelitis of the entire femur.Clinical presentation. A 40-year-old male patient after resection of the proximal part of the right femur for fibrotic osteodysplasia underwent total hip arthroplasty with replacement of 15 cm of the femur. In December 2010 (20 months after implantation), instability of the femoral component developed, revision arthroplasty was performed with stem recementation. After 4 months, sinus tract formed in the area of the postoperative scar. After another 4 months, the head of the prosthesis was dislocated. In September 2011, the endoprosthesis components were removed and a unipolar cement spacer was implanted. The limb immobilized in a hip spica cast. Methicillin-sensitive S. epidermidis (MSSE) was detected in the preoperative joint aspiration puncture and periprosthetic tissues. After 3 months (December 2011), patient underwent revision total hip arthroplasty (25 cm defect was replaced). 5 years of PJI remission followed. In November 2016 after PJI recurrence the endoprosthesis was removed, and an articulating spacer was implanted. P. aeruginosa was detected in periprosthetic tissues. For the past 2.5 years there were periodically sinus tracts formations. In August of 2019 spacer’s migration resulted in an intercondylar fracture of the right femur. In September 2019, spacer was removed, and MSSE was detected in the surrounding tissues. An articulating cement spacer based on an oncological modular total femur coppercoated endoprosthesis was implanted. At each control examination during the year copper concentration in blood serum was determined, it did not exceed 900–1200 mcg/l. No local or systemic side effects were detected. The patient started working 3 months after surgery. After 6 months poor functioning sinus tract formed in the postoperative scar area in the lower third of the thigh. 1.5 years after the operation, the functional condition is satisfactory.Conclusion. The use of the copper-coated spacer based on modular total femur endoprosthesis with hip and knee joints in a patient with multiple PJI allowed to improve the function of the limb and reduce the severity of the infectious process. No local or systemic toxic effects of copper were detected.

The article presents the results of the first stage treatment of 32 patients with long-term non-healing defects of lower leg and heel soft tissues. There were 14 women and 18 men. The patients age ranged from 28 to 65 years old. We used sural fasciocutaneous flap on a distal base to replace defects in all patients. All flaps survived and provided good functional results of the restored skin of the foot and lower leg. In all cases, the sural nerve was included in the flap. In three cases, marginal ischemia of the flap was observed. The use of surgical interventions according to the developed method for long-term non-healing defects of lower leg and heel soft tissues made it possible to achieve complete injury healing.

Current research is describing new ways of applying silver and copper sputters that increase the biocompatibility of materials and help fight or prevent peri-implant infection more effectively. In this paper, we have collected options for the use of coating implants with silver and copper, described in various scientific publications. Also, in this work, we included articles describing new techniques for applying silver and copper to implants. Silver coating of implants has a high antibacterial activity and is actively used in modern traumatology and orthopedics. Keywords: periprosthetic infection, peri-implant infection, silver coating, copper coating, knee replacement.