Background. About 40 % of patients diagnosed with coxarthrosis annually seek medical help and receive social support due to this disease. Increased use of an expensive surgery for treatment of coxarthrosis and projected growth of its prevalence in the population determine the relevance of socio-economic analysis.

The aim of the study. To assess the value and structure of economic damage caused by the delivering health and social care to patients with coxarthrosis at the state level of the Russian Federation.

Methods. To assess economic damage, we used the average annual number of various categories of patients and disabled people with coxarthrosis in the Irkutsk region for 2008–2017. Three main categories were identified: patients who visited the outpatients’ clinic; patients with total hip replacement; disabled people due to coxarthrosis. For each category, we calculated weighted average damage per  1  conventional patient, taking into account direct and indirect costs and subsequent multiplication by the average annual number of individual categories of patients. Calculations were performed in 2017 prices.

Results. The average annual socio-economic damage from coxarthrosis amounted to 1.39 (1.34÷1.43) billion rubles or 0.1 % of the gross regional product. The most of the damage (64.4 %) were indirect costs associated with disability due to coxarthrosis, 22.2  % of the total amount were the costs of hip replacement surgery, 13.4 % were the costs of outpatient visits. Indirect economic losses due to disability in patients of working age were 4.2 times higher than losses due to disability of oldage pensioners.

Conclusion. The results of the study confirm the economic feasibility of surgical treatment of coxarthrosis, especially in patients of working age.

Hydrogels are a class of dimensional hydrophylic polymer networks capable of absorbing and retaining large amounts of water. Natural and synthetic components can serve as a material for the hydrogel production. Hydrogels have unique physico-chemical properties, which are determined by the material composition and concentration, its density, crosslinking methods, and production approaches. This review article describes natural materials used for the production of hydrogels having different properties.

The natural components of hydrogels are collagen, elastin, gelatin, chitosan, dextran, hyaluronic acid, alginate, silk fibroin and glycosaminoglycans. These components are considered biodegradable and biocompatible, since they do not have a toxic effect on tissues. Natural materials provide good cell adhesion, the spread of bioactive signals as well as they affect the behavior of cells in vitro and in vivo. To obtain hydrogels, physical and chemical methods of crosslinking are used, which determine the properties of the final product. Also, hydrogels can be further modified by various active molecules, growth factors that increase their biological functionality. To date, hydrogels made of natural materials are widely used in ophthalmology, neurosurgery, in the treatment of skin wounds, in various cardiovascular pathologies, in restoring the volume of circulating blood, some cartilage defects, targeted delivery of pharmacological drugs, active molecules, etc. Thus, hydrogels produced from natural components are an extremely promising material for cellular technologies and tissue engineering.

Despite the search and development of new antimicrobial drugs with antibiotic or antiseptic properties, the spread of multidrug-resistant strains of microorganisms remains a serious problem in the treatment and prevention of infectious diseases (wound, postoperative and burn infections, preoperative preparation of the surgical and injection fields, hygienic disinfection of the hands of surgeons, medical personnel, etc.). This review of modern domestic and foreign literature sources is devoted to the analysis of data on the prospects of using antiseptics with iodine and iodides as antimicrobial agents. In modern conditions, there is an increasing number of scientific works devoted to the study and development of various drugs, distinguished by their diversity and their specific application. Antimicrobial iodine-containing compounds can be applied to a wide range of  materials such as textile, plastics, metals, ceramics to make them resistant to microbial and biofilm growth. The article summarized the literature data on the high antimicrobial activity of  iodine both in neutral carriers and in synergy with substances already possessing similar properties. Such complex preparations lose their toxicity to a large extent, having prolonged action with the preservation of their properties. The main mechanisms of antimicrobial action of iodine and iodine compounds are determined by their strong oxidizing ability. Attention is drawn to the spectrum of activity of iodine preparations. Along with the antimicrobial effect, they can promote regeneration processes. In general, innovative iodine preparations with antibacterial and fungicidal properties are promising for medical and other purposes.

Background. There are no specific morphological signs for sporadic multiglandular disease (MGD) in primary hyperparathyroidism (PHPT).

The aim of the study. To study the structure of the morphological substrate of primary, secondary and tertiary hyperparathyroidism and to assess the effectiveness of morphological criteria in the diagnosis of sporadic multiglandular disease in primary hyperparathyroidism.

Methods. The study included 69  patients; 18  patients with PHPT and sporadic multiglandular disease (n_preparation  =  31) formed the main group, 51  patients (n_preparations  =  104) – the comparison group. The comparison group was divided into 3 subgroups: 1) patients with PHPT and solitary parathyroid gland (PTG) lesions – 26 patients (n_preparations = 26); 2) patients with secondary hyperparathyroidism (SHPT) – 15 patients (n_preparations = 48); 3) patients with tertiary hyperparathyroidism (TGPT) – 10 patients (n_preparations = 30).

Results. The morphological structure of the comparison groups is homogeneous: group  1 is represented by parathyroid adenoma (26  (100  %)), groups  2 and  3 – by hyperplasia (48 (100 %) and 30 (100 %), respectively). Most of the PTG specimens of the main group are represented by hyperplasia (25 (80 %)), and in 1/5 cases – by adenomas (6 (19.4 %)). Sporadic multiglandular disease in PHPT was characterized by a predominant frequency of detecting the absence of a capsule and a rim of unchanged tissue, as well as the presence of adipocytes (p_χ2 < 0.01). Components of the  PTG morphological structure make it possible to identify changes specific to  the  sporadic multiglandular disease in PHPT, with a diagnostic efficiency of 76.5–90.3 %.

Conclusion. Sporadic multiglandular disease in any clinical variant of hyperparathyroidism is characterized by a high prevalence of hyperplasia – 80 % in PHPT and 100  % in SHPT and  TGPT. The following morphological criteria for sporadic multiglandular disease in PHPT have been established: the presence of adipocytes in the PTG parenchyma (diagnostic efficiency (DE) – 90 %)); absence of a capsule (DE = 78 %) and a rim of unchanged gland tissue (DE = 76 %).

Background. The development of the adjacent level syndrome and, as a consequence, adjacent segment degenerative disease are currently the most common complications of decompression and stabilization surgery with the development of segmental instability.

The aim of the study. To conduct a comprehensive neuroimaging assessment of  the proximal adjacent segment after rigid fixation and dynamic stabilization in degenerative lumbar disease.

Materials and methods. We conducted a prospective multicenter study of the results of surgical treatment of 274 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent monosegmental decompression and stabilization surgery using the TLIF (transforaminal lumbar interbody fusion) technique and open transpedicular rigid fixation, as well as open hemilaminectomy with stabilization of the operated segments with nitinol rods. The study included radiography, diffusion-weighted magnetic resonance imaging and computed tomography (dualenergy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level.

Results and discussion. Combination of the initial proximal segment degeneration in the form of  facet joints degeneration (density of cartilaginous plate  – 163.5 ± 14.2 HU, density of external facet – 709.35 ± 13.6 HU, density of internal facet – 578.1  ±  12.1  HU), Pfirrmann III, IV  grade degeneration of intervertebral disc and a measured diffusion coefficient of less than 1300 mm²/s cause high risks of developing adjacent segment degenerative disease, which regulates the use of monosegmental dynamic fixation with nitinol rods, or preventive rigid fixation of the adjacent segment.

Conclusion. Using complex neuroimaging in the preoperative period makes it possible to predict the results of surgical treatment, take timely measures to prevent degenerative diseases of the adjacent segment, and to carry out dynamic monitoring of processes in the structures of the spinal motion segment.

The aim. To study the effectiveness of using monosegmental fixation systems in surgeries involving resection of part of the facet joint in patients with posterolateral and foraminal hernias in the lumbar spine.

Materials and methods. The study included 40  patients with degenerative diseases of the lumbar spine who underwent medial facet resection and the removal of posterolateral or foraminal disc hernia. Among them, 10  patients underwent unilateral single-level transpedicular fixation with interbody fusion using titanium cage (UTPF cage group), and the other 10 patients underwent unilateral monosegmental transpedicular fixation (UTPF group). The remaining 20 patients underwent bilateral transpedicular fixation (BTPF group). The amount of intraoperative blood loss, duration of surgery and length of hospital stay, as well as the frequency of perioperative complications in the groups were assessed. Visual analogue scale (VAS) pain score, Oswestry index and McNab score were assessed before and 6 and 12 months after surgery.

Results. Intraoperative blood loss in the UTPF  cage and UTPF groups was less than in the BTPF group, as was the duration of surgery; the differences were statistically significant (p < 0.05). Indicators of VAS score and Oswestry Quality of Life Index in the studied groups indicated the effectiveness of the technology.

Discussion. Unilateral decompressive and stabilizing surgeries in patients with posterolateral and foraminal hernias of the lumbar spine can reduce the duration of the surgery, the volume of blood loss and the severity of pain in the postoperative period due to adequate decompression of the neurovascular formations of the spinal canal and stabilization of the spinal motion segment, which prevents the relapse of the disease and provides early rehabilitation of patients.

Conclusion. Unilateral transpedicular fixation is acceptable and safe for lumbar degenerative diseases and improves the quality of life of the patients.

Lymphoma is a heterogeneous group of lymphocyte malignancies that may involve lymphatic tissue, bone marrow, or extranodal sites. The lecture provides a  brief overview of the current state of the problem of diagnosis and treatment of primary testicular lymphoma. Primary testicular lymphoma (PTL) is a rare lymphoid malignancy. Though it is rare, PTL is the most common type of testicular tumor in men over 60 years of age. The most common histological type is diffuse large B-cell lymphoma. To date, there are no well-documented etiological or risk factors for PTL. In contrast to other common testicular neoplasms, there was no statistically significant association of PTL with cryptorchidism, trauma, chronic orchitis, or infertility. Ultrasound is generally the first-line imaging method used to characterize testicular lesions. PTL manifests itself in the form of a hypoechoic formation, which can take the form of either a single large formation or multiple small formations that occupy most of the testicular parenchyma or completely replace it. Systemic treatment, including orchiectomy, chemotherapy, radiation therapy, and intrathecal prophylaxis, is necessary for all patients with PTL. In addition to achieving complete remission, the goal of PTL treatment is to prevent recurrences in the contralateral testis and central nervous system. The presented information is supplemented by our own observation and images. Personal medical data is published with the written consent of the patient. In our case, the patient’s age was 38 years, which does not fall into the specified age group for primary testicular lymphoma. In our opinion, the publication of this clinical case and analysis of scientific literature on this topic are relevant.

The article provides a theoretical review of scientific publications devoted to the rehabilitation of patients with unstable pelvic ring injuries; the features of pelvic ring damage are considered based on the specifics of the traumatic injury, the frequency of occurrence and the severity of the consequences. It is emphasized that prolonged pain syndrome due to pelvic ring injuries and the duration of the  rehabilitation period negatively affect the physical and  psycho-emotional state of  a  patient. At the same time, pelvic ring injuries are most relevant among the working population, and  their  consequences are quite serious, including disability and death. Consequently, the  possibility of optimizing rehabilitation measures for patients with unstable injuries, aimed at restoring the functions of the musculoskeletal system in static conditions and while walking, is currently one of the urgent tasks of theoretical and practical traumatology. The possibilities of  verticalization of  patients and the use of axial load on the lower limbs in the postoperative period are considered as the main rehabilitation measures. It is noted that in the case of resolving the issue of axial load in case of unstable pelvic ring injury, the intensity of such load and the timing of the start of its use should be determined individually, depending on the physical condition of a patient, the characteristics of the injury and the presence of concomitant injuries. Treatment for unstable pelvic ring injuries most commonly is carried out in most cases through the use of various methods of surgical treatment and restoration of the pelvic anatomy. Based on the results of the theoretical study, it is necessary to state that, despite the obvious significance of postoperative treatment, the adequate organization of which largely determines its final result, it was revealed that the material for studying this issue is insufficient due to specific approaches to verticalization and axial load on the lower limbs, depending on type of pelvic ring injury, taking into account the individual characteristics of the injury in a particular patient.

The aim. To compare the incidence of knee arthroplasty in patients receiving standard treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in combination with symptomatic slow acting drugs for osteoarthritis (SYSADOA), or combination of NSAIDs and SYSADOA with low-dose radiation therapy (LDRT) in patients with stage 0–2 knee osteoarthritis (OA).

Materials and methods. The article presents the results of randomized controlled study of 292 patients with confirmed knee OA according to Altman’s criteria (1991) and Kellgren – Lawrence radiographic stages 0–2 who were randomized into two groups. The control group (n = 146) received standard therapy of NSAIDs + SYSADOA. Patients of the study group (n  =  146) received combination of standard therapy and  LDRT up to a total dose of 4.5  Gy. The  cumulative risk of knee arthroplasty was assessed using actuarial analysis and the Kaplan – Meier method. Attributable (AF) and population attributable (PAF) fractions were calculated to assess LDRT preventive potential.

Results. The total observation period was 2131.2 person-years. Knee arthroplasty was performed in 4.1 % (n = 6) of patients in the study group against 7.5 % (n = 11) in the control group. The  incidence density ratio was 0.60 (95%  CI: 0.18–1.88), which corresponds to a risk reduction by 67 %, but the differences were not statistically significant due to the small number of cases (p = 0.340). The AF was 40 % while the PAF was 21 %.

Conclusions. The use of LDRT reduces the risk of knee arthroplasty by two-thirds and has the potential to prevent 21 % cases of knee arthroplasty in patients with knee OA. A study on a larger sample is required.

The problem of aseptic talus necrosis consists of the following features: a) manifestation of the disease in the form of acute articular syndrome without typical symptoms; b) inevitable serious consequences in the form of disfiguring deforming arthrosis of the ankle joint, development of gross deformities of the rearfoot, etc., resulting in disability. The lack of methods for monitoring the dynamics of the disease also plays an important role. This is particularly so with such an important issue as the substantiation of stopping immobilization and allowing the load on the foot in order to avoid collapsed talus and subsequent complications. It is believed that treatment started before radiographic changes helps to avoid severe complications, but for a number of reasons patients arrive already at the stage of late severe destructive changes. All of the above explains the high relevance of the problem of treatment of patients with aseptic talus necrosis. The importance of the presented clinical case and the value of this information can be considered several points: its  example demonstrates the possibility of early diagnosis of severe talus damage cause by aseptic necrosis; based on objective data, a substantiation was made for allowing the load on the leg with body weight in the complex of rehabilitation measures; the possibility of regression of pathological changes associated with aseptic talus necrosis and the dynamics of the course of aseptic talus necrosis with a favorable outcome were demonstrated, which is confirmed by modern research methods. Thus, the need for magnetic resonance imaging has been confirmed for all referred patients with a clinical picture of local articular syndrome in the ankle joint, the possibility of complete regression of avascular necrosis symptoms in case of conservative treatment at the early stages and the possibility of resolving the load on the leg in the complex of rehabilitation treatment have been demonstrated.

Distal biceps tendon injuries mainly occur in men from the active groups of population. Among the athletes and military personnel, the incidence rate is 2–10  % of  the  upper limb tendon injuries. Comparative studies have shown the achievement of better functional results in surgical treatment, while maintaining overall complication rate of 4.6–25 %.

The aim. To demonstrate a new reinsertion technique with two cortical buttons in case of complete rupture of distal biceps tendon as part of a clinical case.

Materials and methods. The article presents a clinical case of surgical treatment of a patient with complete rupture of dominant limb distal biceps tendon which was more than 2 weeks old and was accompanied by lacertus fibrosus provocation and persistent muscle retraction.

Results. We obtained the following clinical results by the week 24 after the surgery: VAS (Visual Analogue Scale) score – 1  cm, ASES (American Shoulder and Elbow Surgeons) score – 99  points, DASH (Disabilities of the Arm, Shoulder and Hand) score – 15 points. Dynamometry results: Dex. 85; sin. 90 (2daN); range of motion corresponds to the same of a healthy joint. MRI at 1.5 T shows no signs of synostosis or heterotopic ossification; MSCT shows no signs of migration of cortical buttons in comparison with intraoperative X-ray control.

Discussion. Extracortical methods of distal biceps tendon positioning in anatomical reinsertion have lower strength indicators, comparable with the use of transosseous sutures and anchor fixators. A larger area of contact of the studied zone in case of minimal tendon compression in the area of proximal radioulnar space or inside the formed radial bone canal provides high strength indicators and reduces the risk of repeated injury.

Conclusion. The scores of the scales (VAS, DASH, ASES) turned out to be better than when using other common methods. The technique of dipping distal biceps tendon stump into the formed oval canal of the “anatomical impression” using the proposed method meets the objectives of careful attitude to the tendon and provides the largest area of its contact with the bone.

Surgical interventions that do not directly affect the urinary system can cause excretory dysfunction of kidneys.

The aim. To establish the prevalence, risk factors and clinical significance of acute kidney injury after primary hip replacement performed in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology.

Materials and methods. We carried out a retrospective analysis of the case histories of 109 patients who underwent primary total hip replacement under conditions of subarachnoid anesthesia in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology in 2021.

Results. Postoperative changes in serum creatinine in 8 patients of the study group met the KDIGO (The Kidney Disease: Improving Global Outcomes) criteria for acute kidney injury. Initial indicators of renal excretory function in the subgroup with acute kidney injury were not different from those in the entire group.

Statistically significant correlation was established between acute kidney injury and indicators of oxygen-carrying capacity of blood – initial and minimal postoperative hemoglobin concentration.

Acute kidney injury in patients of the study group had a minimal effect on the clinical course of the early postoperative period. None of the patients required renal replacement therapy, re-transfer from the specialized unit to the intensive care unit or any specific treatment. The duration of postoperative stay of patients with acute kidney injury in the clinic did not increase.

Conclusions. Acute kidney injury was detected in 7.3  % of patients who underwent primary total hip replacement. Risk factors for the development of postoperative acute kidney injury in  patients of the study group included relatively low initial and  minimal postoperative blood hemoglobin concentrations, which may indicate prerenal mechanism of acute kidney injury pathogenesis. Implementation of the main steps of the “renal protocol” in patients with initial glomerular filtration rate over 45 ml/min/1.73 m² allows avoiding the development of severe clinically significant forms of postoperative acute kidney injury and complications associated with it in the early postoperative period of primary total hip replacement.

Rotator cuff tears are one of the most common musculoskeletal injuries and account for about 20 %. Massive rotator cuff tears account for up to 40 % of all tears. There  is  no  single approach in the treatment of patients with massive rotator cuff tears. We have developed a new method of surgical treatment of these patients – arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle.

The aim of the study. To assess the effectiveness of surgical treatment of patients with massive rotator cuff tears who had arthroscopically assisted transposition of the latissimus dorsi tendon using an autograft of a 1/2 of the tendon of the long peroneal muscle.

Materials and methods. The study included 15  patients with Patte stage  III and Thomazeau grade 2–3 massive rotator cuff tears, who had arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle.

Results. The article presents the long-term results of surgical treatment of patients using the developed method. The following criteria were evaluated: average age; time since injury; duration of surgery. Functional outcome was assessed using the ASES (American Shoulder and Elbow Surgeons) scale. Taking into account the indicators on the ASES functional scale 1 year after surgical treatment, the following results were obtained: excellent – in 14 (93.3 %) patients, satisfactory – in 1 (6.7 %) patient.

Conclusion. The developed method allows us to restore the function of the shoulder joint as early as it possible, to reduce the severity of the pain syndrome and to improve the quality of life of patients.

Background. An in-depth analysis of the scientific works of scientists and medical practitioners allows us to conclude that locked nail intramedullary osteosynthesis is  the optimal and the most effective method of treating closed diaphyseal fractures of the lower leg bones, which is caused by the high stability of osteosynthesis and minimal damage to soft tissues during surgery. The processes of microcirculation changes in the early postoperative period by various metal structures, including a locked intramedullary nail, still remain unexplored. In particular, there is insufficient data on the use of a locked intramedullary nail.

The aim of the study. To identify the features of changes in microcirculation indices of injured lower leg bones during fixation of fragments with a locked intramedullary nail in the early postoperative period.

Materials and methods. The microcirculation of the lower limb segment was studied in 25 patients using laser Doppler flowmetry. Data from 25 healthy volunteers were used as a comparison group.

Results. It was found that in the early postoperative period, from day 1 to day 10, in patients with diaphyseal fractures of the lower leg bones operated with locked nail intramedullary osteosynthesis, there is a decrease in the cardiac range, an increase in the share of the shunt component of microcirculation compared to the nutritional share, as well as an increase in more than 1 ratio of the cardiac and respiratory range amplitude, which indicates an ischemia type of local circulatory disorder. Compensation of ischemia is done by anastomoses, since the bypass rate is increased.

Conclusion. In case of surgical treatment with locked nail intramedullary osteosynthesis, in the early postoperative period, an ischemic type of compensated local circulatory disorder develops. The regeneration process takes place under conditions of reduced arterial microcirculation blood flow and stable venous outflow, as well as the inclusion of anastomoses to compensate for destroyed vessels, which is associated with nail damage to the internal blood flow of the bone endosteum and intraosseous nutrient artery during the surgery.

Rotator cuff injury is a common pathology: up to 20 % of the population over 45 years of age has ruptures of varying severity, and up to 40 % of these ruptures are large and massive. The gradual development of tendon degeneration and fatty degeneration of muscle tissue and the asymptomatic course of the disease often lead to late medical attention when secondary arthropathy of the shoulder joint develops. With age, the probability of having a rupture increases, reaching 51 % in people over  80  years of age. The main diagnostic tools are radiography and  magnetic resonance imaging of the shoulder joint combined with clinical examination. Conservative treatment for massive injuries is ineffective, and the risk of worsening rotator cuff tendinopathy to rupture reaches 54 %. There are three main directions in the surgery of rotator cuff injuries: tendon reconstruction or replacement of their defect with grafts; muscle transfer; shoulder arthroplasty. Subacromial balloon spacer and tenogenic patches are also used. Each of these methods has a number of disadvantages and limitations. The frequency of repeated ruptures of reconstructed tendons reaches 45 %. Muscle transfer is extremely demanding on the skill of the surgeon and is associated with high risks of neurological complications. Arthroplasty imposes a number of significant restrictions on the patient, reducing the  quality of life, and prosthesis components wear increases the risk of complications, especially during revision interventions. The use of the subacromial spacer is limited by its high cost and lack of  long-term follow-up of treatment outcomes. Tenogenic patches have not undergone clinical trials, being an experimental technique.

There is no single approach to the treatment of massive rotator cuff ruptures. The results are contradictory, the advantages of each of the methods are balanced by their disadvantages, which provides a wide window of opportunity in the studying, optimizing classical and introducing new methods of treatment of this pathology.

The aim. To study the frequency and treatment options for dysfunction of the dynamic stabilization system of the lumbar spine.

Materials and methods. We carried out a retrospective analysis of the treatment of 58  patients with degenerative pathology of the lumbar spine and instability of the spinal motion segments, who were treated at the neurosurgical unit of the Irkutsk Scientific Centre of Surgery and Traumatology in 2011–2020. The stability of spinal motion segment was assessed using X-ray imaging, magnetic resonance imaging and multi-layer spiral computed tomography of the lumbar spine. Revision surgery was performed in 7 out of 58 previously operated patients using the dynamic fixation system of spinal motion segments “Coflex” (Paradigm Spine LLC, Germany).

Results. Revision surgery was performed in 7 out of 58 patients with dynamic fixation of the spinal motion segments with an interosseous implant due to an increase in pain syndrome. In 1 patient, the reason for repeated surgery was primary instability of the hardware caused by a fracture of the spinous process. In the delayed period, 4 patients had an X-ray picture with heterotopic ossification of the implant and instability of PDS. In two observations, a recurrence of intervertebral hernia was diagnosed at the level of the operated spinal motion segment. During revision surgery, a facetectomy was performed with stabilization by a peek cage, followed by pain management and clinical manifestation regression.

Conclusion. The conducted study shows that a number of patients after discectomy and dynamic stabilization of the spine using “Coflex” system have inconsistency and  heterotypic ossification of  the implant and neoarthrosis. Implantation of a lumbar peek cage while maintaining the “Coflex” device makes it possible to form a rigid interbody fusion, which means it is sufficient and justified surgical technology for treating the failure of the dynamic stabilization system.

Background. Femoral diaphysis fractures are one of the most common and significant injuries to the bones of the limbs. Locked intramedullary osteosynthesis makes it possible to reduce the injury rate of the surgery and its length, as well as to carry out early rehabilitation of patients.

The aim of the study. To conduct a continuous retrospective single-purpose comparative study of  the results of treatment of patients with femoral diaphysis fractures treated with locked intramedullary osteosynthesis and extramedullary osteosynthesis for 10 years. This study did not include patients with double femoral fractures treated by osteosynthesis using a combination of two implants – locked intramedullary implant and extramedullary implant.

Material and methods. We conducted a retrospective study of the results of treatment of patients from 2011 to 2020. During this period, we treated 794 patients aged from 16 to 77 years with femoral diaphysis fractures. The share of people of working age was 75 %. The patients were divided into two groups depending on the method of surgical treatment. Group 1 included 500 patients who had surgical treatment using locked intramedullary osteosynthesis. Group 2 included 294 patients who had surgical treatment using extramedullary osteosynthesis.

Results. In patients of group 1 treated with locked intramedullary osteosynthesis, good anatomical and functional treatment results were achieved in 70 % of cases; satisfactory treatment results – in 25.2 % of cases, unsatisfactory results – in 4.8 %. In the group 2, good results were achieved in 61.9 % of cases, satisfactory – in 29.6 %, unsatisfactory – in 8.5 %.

Conclusion. The obtained results of treatment of femoral diaphysis fractures show the undeniable advantage of using locked intramedullary osteosynthesis compared to extramedullary osteosynthesis.

Background. Brachymetatarsia is a rare disease characterized by abnormal shortening of one or more metatarsal bones. The clinical picture is most often dominated by complaints of aesthetic dissatisfaction, as well as pain in the forefoot caused by mechanical dysfunction. A radical way to solve the problem is surgical treatment.

The aim. To demonstrate a rare clinical observation of a patient with bilateral brachymetatarsia of both feet.

Materials and methods. The article presents a case of stepwise treatment of a patient with bilateral brachymetatarsia with shortening of the III and IV metatarsal bones in combination with hallux valgus.

Results and discussion. According to the protocol, the patient underwent stepwise reconstruction of the forefoot of both feet with intervention on all five metatarsal bones. After all the rehabilitation measures, there was a complete restoration of all functions of both lower limbs after the surgery, and the patient was satisfied with the aesthetic result of the surgical treatment.

Conclusions. The obtained result of treatment of a patient with bilateral brachymetatarsia allows us to conclude that the use of this group of techniques is acceptable with the obligatory preoperative calculation of the necessary shortening and lengthening of the metatarsal bones, focusing on the parameters of the metatarsal formula of the forefoot, even in combination with other deformities.

The high incidence rate and wide range of musculoskeletal pathologies determine the improvement of the diagnostic process. Late diagnosis leads to complications, which in turn increase the percentage of disability. Therefore, the search for the most informative method with the least radiation load on the patient remains an urgent problem for radiologists. Cone beam computed tomography (CBCT) is a modern and  promising technique that has already found wide application in dentistry and otorhinolaryngology. Among the advantages of CBCT are: three-dimensional image; high spatial resolution; low radiation dose. Thanks to technical improvements in equipment and the introduction of new image processing protocols, it has become possible to expand the indications for conducting the researches, including the researches based on imaging of the upper and lower extremities. Based on the results of a CBCT study, we can evaluate: the shape and contour of the bone; solution of continuity of the bone and malposition of bone fragments; the structure of bone tissue and  the  pathological processes occurring in it (destruction, osteoporosis, osteosclerosis); joint congruence and changes in  articular surfaces surrounding soft tissues. Therefore, CBCT can be introduced into the diagnostic process of bones and joints diseases. The use of this technique will find wide application in traumatology and orthopedics (fractures, dislocations, post-traumatic deformities, aseptic necrosis, osteoarthritis), rheumatology (rheumatoid arthritis, polyarthropathy, juvenile arthritis, gout), surgery (osteomyelitis), oncology (benign and malignant bone tumors) both in the adult population and in pediatric practice. This paper presents a review of the literature, which examines the degree of development of the issue of using CBCT and describes study protocols and protocols for processing the obtained images in the diagnosis of musculoskeletal diseases.

Background. The most severe category of fractures of the proximal humerus are  intra-articular injuries which are accompanied with humeral head ischemia caused by an injury and aggravated by surgical intervention. Due to frequent disruption of vascularization with subsequent necrosis of the humeral head, there is a need to stimulate reparative osteogenesis in intra-articular injuries to prevent ischemic changes in the humeral head.

The aim of the study. To improve the results of surgical treatment of intra-articular fractures ofthe proximal humerus based on the development of a new osteosynthesis technique using non-free osteomuscular graft.

Material and methods. We analyzed the results of treatment of 48patients with 11- C1 and 11-C2 intra-articular fractures of the proximal humerus, who had hospital treatment at the emergency department of traumatology of the Novosibirsk City Clinical Hospital No.  1 and were subsequently observed on an outpatient basis. An  analysis of literature data using search words was carried out in the PubMed and eLibrary databases.

Results. According to the data obtained during the study, the functional and radiological results of the patients who were treated using the method of reparative stimulation with a non-free osteomuscular graft from the coracoid process are statistically significantly higher than the results of the control group.

Conclusion. Using autoplasty with a non-free osteomuscular graft from the coracoid process improves the results and reduces the risk of developing post-traumatic aseptic necrosis of the humeral head.

The prevalence of rotator cuff tears according to the literature ranges from 20 % to 40 %, and this injury occurs more often in people over 60 years of age. Massive rotator cuff tears account for 10–40 % of all rotator cuff tears. Massive rotator cuff tears are considered to be tears with a diastasis of more than 5 cm or tears involving two or more tendons. With such injuries, the kinematics of the shoulder joint changes: proximal subluxation of the humeral head and arthropathy of the shoulder joint occur, which subsequently causes pseudoparalysis. The main clinical manifestations are pain and dysfunction of the shoulder joint. Patients may experience a loss of active range of motion in the shoulder joint while maintaining passive range of motion. There is currently no unified approach to the choosing the tactics for surgical treatment. The most common options include partial rotator cuff repair, subacromial balloon plasty, replacement of tendon defects with allografts and autografts, proximal shoulder joint capsule plasty, muscle-tendon transfers, and shoulder joint arthroplasty. However, according to the literature data, the frequency of re-ruptures after surgery ranges from 11 % to 94 %. Despite the large number of methods for the treatment of massive rotator cuff tears, there are no clear algorithms for managing patients and choosing one or another surgical tactics. In addition, there is a high percentage of unsatisfactory outcomes of treatment. Taking all of these factors into account, the problem of improving the treatment of patients with massive rotator cuff tears remains relevant and timely.

Background. Among patients who have undergone coronary artery bypass surgery (CABG), the proportion of people with diabetes mellitus (DM) is about 40 %. To date, the problem of choosing the optimal method of surgical myocardial revascularization, which can provide the best result in this cohort, remains completely unresolved.

The aim of the study. To assess the in-hospital and long-term results of bimammary and traditional bypass surgery in patients with type 2 diabetes mellitus.

Methods. From September 2018 to December 2021, 176 CABG surgeries were performed in patients with coronary heart disease (CHD) and type 2 diabetes at the Federal Center for Cardiovascular Surgery (Krasnoyarsk). Group 1 (n = 45) included patients who underwent myocardial revascularization using two mammary arteries; group 2 (n = 131) included patients who underwent myocardial revascularization using traditional technique. After propensity score matching, 45 patients were selected into each group, comparable by basic preoperative characteristics.

Results. In group  1, cardiopulmonary bypass surgeries were performed in 23 (51.1 %) patients (group 1CPB), off-pump surgeries – in 22 (58.2 %) (group 1OP); in group  2, all patients underwent cardiopulmonary bypass surgeries. Hospital mortality was recorded in group 2 in 1 (2.2 %) case. Deep sternal infection developed in 1 (4.5 %) patient in group 1OP. Long-term survival in group 2 was 85.3 %, in group 1CPB – 83.3 % (p = 0.689), in group 1OP – 84.2 % (p = 0.739). 84.2 % of patients in group 2 and 100 % in groups 1CPB and 1OP had no cardiovascular events (p = 0.144 and p = 0.145, respectively).

Conclusion. Bimammary bypass surgery in patients with type 2 diabetes is a safe and effective method of surgical treatment of coronary artery disease in both shortand long-term period and may be the operation of choice in patients with multivessel disease. There were no differences in patient survival up to 45 months; bimammary revascularization was associated with 100 % absence of cardiac mortality.

Background. In 15–25 % of cases, the cause of primary hyperparathyroidism (PHPT) is multigland parathyroid disease. The complexity of clinical and laboratory prognosis, low efficiency of imaging methods, inaccurate assessment of the radicality of the surgery are the components of the problem of this variant of the disease. Quality of life (QOL) is an important criterion for the effectiveness of surgical treatment. A study of the QOL in patients with multigland parathyroid disease in PHPT has not been previously conducted in our country.

The aim of the study. To assess the quality of life of patients with single- and multigland parathyroid disease in sporadic primary hyperparathyroidism before and after parathyroidectomy (PTE).

Methods. As part of a prospective observational study, the quality of life of 64 patients with PHPT before and after PTE was assessed using SF-36 (Short Form 36) questionnaire: main group (n  =  13) – patients with multigland parathyroid disease; comparison group (n = 51) – patients with single-gland parathyroid disease. The quality of life indicators of the patients were compared with those in a sample of the Irkutsk region population similar in gender and age.

Results. Before performing PTE, the quality of life of patients with PHPT was lower than that of the Irkutsk region population. The greatest decrease in both health components was registered in the main group. In 90 % of patients, the quality of life improved after PTE, while in the main group changes were established 1 year after the surgery, in the comparison group – 6 months after the surgery. Transient complications (laryngeal paresis) and disease outcomes (hypocalcemia, hypoparathyroidism) did not interfere with the improvement of quality of life in both groups. When persistence was detected, no significant improvement in QOL was established.

Conclusion. The quality of life of patients with PHPT is significantly reduced. PTE improves the QOL of these patients, and only persistence of the disease does not allow this to be achieved. Therefore, surgical tactics aimed at reducing the frequency of persistence will achieve a decent quality of life in the majority of patients with multigland parathyroid disease in PHPT.

Over the past decade, in global practice, the frequency of using high-resolution multi-layer spiral computed tomography (MSCT) for assessing the state of cancellous and cortical bone tissue has significantly increased. Using high-resolution MSCT makes it possible to assess X-ray bone density at various times after replacement of cortical plate defects with osteoplastic materials.

The aim of the research. To study the restoration of cortical bone density in the area of osteoplasty using tissue-engineered construct in the experiment.

Materials and methods. In an in vivo experiment on New Zeland White (NZW) rabbits, perforation defects of cortical bone were formed in the femoral diaphysis. Three study groups were set up: group 1 – without bone defect replacement; group 2 – with  bone defect replacement with deproteinized cancellous bone; group  3  – with bone defect replacement with tissue-engineered construct based on deproteinized cancellous bone with stromal vascular fraction of adipose tissue. Follow-up periods were 2, 4 and 6 weeks after the surgery. The X-ray density of cortical bone tissue was measured in Hounsfield units (HU). Fragments of deproteinized human cancellous bone were used alone and in combination with the stromal vascular fraction of NZW rabbit adipose tissue as a bone-replacing material for bone defect replacement.

Results. Cortical plate density the in the area of the defect in the group 3 by the week 6 is on average 1.3 times lower than that of the intact cortical plate and corresponds to D1 according to Misch classification. Cortical plate density in the area of the defect on the side of medullary canal by the week 6 in the group 3 corresponds to D1 according to Misch classification and is equal to 1351.25 ± 221.18 HU (1052; 1805), which is 1.5  times higher than in group  2 (D2 according to Misch classification; p < 0.05). The obtained results indicate an earlier restoration of X-ray bone density when using a tissue-engineered construct (group 3) compared to the same indicators in groups 1 and 2.