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Background EFECE Systems are newly-defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models.Methods Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in Group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In Group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique. Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated.Results After 5 experiments with the EFECE Syste...

We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee. OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees. We consider that skin staples are the skin closure of choice for both hip and knee replacements.

Femoroacetabular impingement (FAI) is associated with decreased hip function and early hip osteoarthritis. Surgical treatment is often required to halt the process of mechanical degeneration. The study investigated the short-to-midterm results of using a modified anterolateral mini-open and arthroscopic osteochondroplasty in the treatment of cam-type FAI. Thirty-six patients (39 hips), with the mean age of 43.6 years, who had cam-type FAI, were operated by a mini-open and arthroscopy-assisted osteochondroplasty via the Watson-Jones interval between 2002 and 2016. Radiographic parameters and Harris hip scores were retrospectively analyzed after a mean follow-up of 44 months. Of the 39 hips, the mean Harris hip score significantly improved from 61.1 preoperatively to 84.2 postoperatively (P < 0.01). There were nine hips (23%) undergoing total hip arthroplasty (THA) at a mean of 22 months (range, 3~64 months) due to progression of hip osteoarthritis. The 5-year survival for hip pres...

Background: Although many literature studied the effect of many factors on the prognosis of the early-onset Blount disease, studies that were written on the prognostic factors affecting late onset tibia vara are still limited. Purpose: The aim of this study is to evaluate the prognostic value of the Langenskiold classification system for late onset tibia vara. Methods: Twenty children from the Sporting Health Insurance Student Reference Hospital-Alexandria, with a diagnosis of late onset tibia vara were evaluated for the effect of the Langenskiold staging system on the prognosis after they all had been treated by gradual correction by Ilizarov technique using the so called "juxta-articular hinge assembly" after a mean follow-up period of 4.9 years (range : 4-6, SD 0.75). Results: The difference in varus recurrence rates between the "low grade group" and "high grade group" was found to be statistically significant (p = 0.008) as will be discussed later. There was no statistically significant relation between the age of the patients at the time of operation, sex, length of the follow up period and the degree of pre-operative varus deformity angle (DA) and the recurrence (p > 0.05). Conclusion: We concluded that Langenskiold staging system is a reliable, reproducible and a good prognostic factor for late onset tibia vara.

High-energy trauma may result in uncommon open injuries around the elbow joint. The management of these injuries can be difficult. Fourteen patients were treated between 1999 and 2003 and their injuries consisted of Monteggia fracture-dislocations combined with segmental fractures of the ulna or fractures of the forearm bones and/or various more complex trauma such as neural injuries, bone comminution and severe soft tissue injuries around the elbow. Eight of them (57%) were multiply injured with severe additional injuries. All patients underwent surgery within first 4-6 hours. Internal fixation, external fixation or a combination of both methods were used to stabilize fractures while open wounds had secondary closure. Additional operations were required in 6 patients. The functional results according to the Mayo Elbow Performance Index were excellent or good in eleven patients, and fair or poor in the remaining three. The patients with fair and poor results had suffered from severe...

Ethnicity can confound results in pharmacogenomic studies. Allele frequencies of loci that influence drug metabolism can vary substantially between different ethnicities and underlying ancestral genetic differences can lead to spurious findings in pharmacogenomic association studies. We evaluated the application of principal component analysis (PCA) in a pharmacogenomic study in Canada to detect and correct for genetic ancestry differences using genotype data from 2094 loci in 220 key drug biotransformation genes. Using 89 Coriell worldwide reference samples, we observed a strong correlation between principal component values and geographic origen. We further applied PCA to accurately infer the genetic ancestry in our ethnically diverse Canadian cohort of 524 patients from the GATC study of severe adverse drug reactions. We show that PCA can be successfully applied in pharmacogenomic studies using a limited set of markers to detect underlying differences in genetic ancestry thereby maximizing power and minimizing false-positive findings.

Broken stems are particularly challenging in revision hip arthroplasty, as no standard extraction instruments fit anymore. Well-integrated uncemented stem remnants can be particularly arduous to remove. Stem fatigue failure is not rare with modular stems. Since these are particularly useful in revision hip arthroplasty, increasing numbers of broken stems are to be expected. Usually applied techniques using cortical fenestration distally to the tip of the stem or using an extended transfemoral approach cause supplementary bone defects impairing reconstruction. We present a relatively simple and reproducible revision technique, using a limited standard approach and only regular orthopedic instruments, to extract the remnants of broken uncemented femoral stems in hip arthroplasty. This technique was applied successfully and without complications in 6 cases, permitting eventually the reimplantation of even shorter stems.

WHO declared SARS-CoV-2 as a pandemic disease on 11 th March 2020. Due to global lockdown and restricted social movements, there is a rising curve in the morbidity of health of non-SARS-CoV-2 orthopaedic rheumatology patients and an impairment in the functional quality of life necessitating a pandemic response protocol into action in all fields of patient care. The development of ideal strategies and recommendations for the management of orthopaedic rheumatologically predisposed population and principles to be followed in their practice is the need of the hour. We hereby give a comprehensive list of strategies that can be followed in orthopaedic rheumatology practice by encompassing the recommendations given by the European League Against Rheumatism (EULAR), The American College of Rheumatologists (ACR), and Indian Association of Orthopaedic Rheumatology-Indian Orthopaedic Association (IORA-IOA). SARS-CoV-2 pandemic has put enormous pressure on patients with Rheumatic Diseases (RD) due to their innate weakness and shared treatment protocols in management. Though RD needs a multidisciplinary approach, which remains a challenge in this pandemic scenario, these strategic recommendations would aid in their optimal care amidst the adversity of SARS-CoV-2.

Introduction: Fractures of proximal humerus is still unsolved fractures in many ways. The Proximal humeral internal locking system (PHILOS) plate fixation provides greater angular stability, works as a locked internal fixator and provides better anchorage of screws in osteoporotic bone, early joint mobilisation and good functional outcome. Considering these advantages and the scarcity of data on the efficacy and the functional outcome following internal fixation with PHILOS plate for displaced proximal humerus fractures, the present study was planned. Materials and Methods: This study was conducted from October 2014 to October 2016. 30 cases who sustained proximal humerus fractures were enrolled in the study. Through delto-pectoral approach, the fracture site was reduced and fixed with PHILOS plate. Follow up was done at 6 wks, 12 wks and 6 months. Patients were evaluated for 1.Range of motion of the Shoulder. 2. Complications. 3. Clinical union. 4. Radiological union. The final assessment was done using DASH score for outcome. Results: Excellent outcome was noted in 20%, good in 47%, fair in 26% and poor in 7%. The outcome was independent to side of fracture (p=0.935), mode of injury (p=0.914) and type of fracture (0.562) as no statistically significant association was noted. 90% patients had clinical and radiological union at three months. The range of motion at first, second and third follow ups showed gradual increase in mean flexion, abduction, external rotation and internal rotation. Conclusion: PHILOS plate provides a high degree of angular and axial stability eliminating screw loosening and backout. The divergent and convergent orientation of the screws engaging in the humeral head prevent pull out and failure of fixation. The PHILOS plate is an ideal construct and a stable implant to use for fractures of the proximal humerus in Neer's 2-part, 3-part, and 4-part and osteoporotic fractures.

In this study, by taking full advantage of digital X-ray and information technology, we have developed a semiautomated procedure to template hip implants, by making use of digital templating techniques. Using this approach, a software system called OrthoHip TM has been developed. The OrthoHip TM templating process uses a similar technique to that used by an orthopaedic surgeon, using manual templates over general X-ray films. From an image of patient's X-ray, the OrthoHip TM template helps in quickly and easily selecting to the approximate template size needed. The visual templating features then allow the user to quickly review multiple template sizes against the Xray and to thus obtain a nearly precise image of the implant size required. The system can assist by templating the patient's image and generating database reports that can accompany the patient's notes. The software system was implemented in Java programming, using object-oriented techniques to manage the graphics and objects. The approaches for image scaling used in this research also will be discussed. The study compared the results of the semi-automated (using digital templating) method to the conventional or observational method to demonstrate the accuracy and the utility of the system.

Previous studies examining the influence of gait analysis on surgical decision-making have been limited by the lack of a control group. The aim of this study was to use data from a randomized controlled trial to determine the effects of gait analysis on surgical decision-making in children with cerebral palsy (CP). 178 ambulatory children with CP (110 male; age 10.3±3.8

Background: Bicondylar tibial plateau fractures present a therapeutic challenge to the orthopaedic trauma surgeon, both in terms of the osseous injury as well as the concomitant soft-tissue insult. Double Plating with single incision or dual incisions provides more insult to the compromised soft tissue. However, single locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique.Methods: The Study was held at Razi Orthopedic hospital in Kuwait. Between May 2012 and November 2013, 20 patients with a mean age of 37.65 years (Range from 24-57 years) with Bicondylar tibial plateau fractures with or without metaphyseal extension. Patients were diagnosed clinically, checked with standard X-rays; CT was done for all cases. Patients were treated by single lateral anatomically contoured locked plate through LISS or Polyaxial locking plate systems with or without additional screws from medial side. Radiological evaluation and functional assessment was done according to the Rasmussen Knee score. Patients were followed-up for an average of 12 months.Results: Union was achieved in all patients with a mean knee range of motion of 1.5°-130° (range: 0°-10° for extension lag, range: 100°-135° for flexion). The mean Functional Rasmussen Knee score at 6 month follow up (25.32 ± 1.53 SD) ranged from (23.0-28.0). The mean Functional Rasmussen Knee score at last follow-up was (28.33 ± 1.57 SD) ranged between (25.0-30.0) with significant P value (P value <0.001). The mean Anatomical Rasmussen Knee score at 6 month follow up (16.11 ± 1.56 SD) ranged from (14.0 - 18.0). The mean Anatomical Rasmussen Knee score at last follow-up was (16.67 ± 1.37 SD) ranged from (14.0 - 18.0) with insignificant P value (P value 0.096). Of the 20 patients, one patient had  wound  related  problems,  one  patient  had  preoperative  compartment  syndrome,  one  patient  suffered  from  hardware  irritation  and  one  patient had fixation failure upon which revision with double plating done for him. Conclusions: Surgical treatment of bicondylar tibial plateau fractures with the single lateral locked plate that was evaluated in our study can lead to a good functional and anatomical outcome and considered an effective system for providing fracture stabilization provided that the correct surgical technique is used. Awareness of potential hardware complications is essential.

Purpose: The purpose of this study was to perform a systematic review of the available literature to define the level of quality evidence for determining the sensitivity and specificity of different radiographic views in detecting knee osteo-arthritis and to determine the impact of different grading systems on the ability to detect knee osteoarthritis. Methods: A systematic review of the literature was conducted to identify studies that evaluated the standing anteroposterior (AP) and 45 posteroanterior (PA) views for tibiofemoral and patellofemoral arthritis and those comparing the use of the Kellgren-Lawrence versus the joint space narrowing (JSN) radiographic grading systems using arthroscopy as the gold standard. A comprehensive search of PubMed, Scopus, CINAHL, the Cochrane Database, Clinicaltrial.gov, and EMBASE was performed using the keywords " osteoarthritis, " " knee, " " x-ray, " " sensitivity, " and " arthroscopy. " Results: Six studies were included in the evaluation. The 45 flexion PA view showed a higher sensitivity than the standing AP view for detecting severe arthritis involving either the medial or lateral tibiofemoral compartment. There was no difference in the specificities for the 2 views. The direct comparison of the Kellgren-Lawrence and the JSN radiographic grading systems found no clinical difference between the 2 systems regarding the sensitivities, although the specificity was greater for the JSN system. Conclusions: The ability to detect knee osteoarthritis continues to be difficult without using advanced imaging. However, as an inexpensive screening tool, the 45 flexion PA view is more sensitive than the standing AP view to detect severe tibiofemoral osteoarthritis. When evaluating the radiograph for severe osteoarthritis using either the Kellgren-Lawrence or JSN grading system, there is no clinical difference in the sensitivity between the 2 methods; however, the JSN may be more specific for ruling in severe osteoarthritis in the medial compartment. Level of Evidence: Level I, systematic review of Level I studies.

Keywords: primary total knee arthroplasty total knee replacement systematic review satisfaction dissatisfaction a b s t r a c t Background: Dissatisfaction following total knee arthroplasty (TKA) is common. Approximately 20% of patients report dissatisfaction following primary TKA. This systematic literature review explores key factors affecting patient dissatisfaction following TKA. Methods: Six literature databases published between 2005 and 1 January 2016 were searched using 3 key search phrases. Papers were included if the study investigated patient dissatisfaction in primary unilateral or bilateral TKA. Information from each article was categorized to the domains of socioeconomic , preoperative, intraoperative, and postoperative factors affecting patient dissatisfaction. Results: This review found that patient dissatisfaction pertains to several key factors. Patient expectations prior to surgery, the degree of improvement in knee function, and pain relief following surgery were commonly cited in the literature. Fewer associations were found in the socioeconomic and surgical domains. Conclusion: Identifying who may be dissatisfied after their TKA is mystifying; however, we note several strategies that target factors whereby an association exists. Further research is needed to better quantify dissatisfaction, so that the causal links underpinning dissatisfaction can be more fully appreciated and strategies employed to target them.

BACKGROUND: Although scaphoid fractures are treated uneventfully with cast treatment, immobilization with cast is associated with complication like wrist stiffness and functional morbidity to the patient. Fixation with Herbert Screw though technically demanding procedure can yield excellent results and prevents complication like non-union and loss of wrist function in fracture of fractures. OBJECTIVES: To assess the outcome of scaphoid fracture after operative management following Herbert screw fixation in patient attending Institute of Orthopaedics & Traumatology, Rajiv Gandhi Government General Hospital & Madras Medical College between March 2017 – August 2018. MATERIALS & METHODS: All scaphoid fracture, treated between the above period and those previously treated patients were followed up retrospectively. Ten patients with scaphoid fractures were treated with Herbert screw. All of them were male. Serial radiographs were taken to assess radiographic union and functional outcome was assessed using Modified Mayo wrist score. RESULTS: Out of 10 patients, 7 scaphoid had waist fractures and two had proximal pole factures and one with distal pole fracture. 8/10 scaphoid fractures were treated with open reduction and Herbert screw fixation either by volar approach or by dorsal approach and rest two by percutaneous approach. All fractures maintained good alignment post operatively. Seven (70%) patients had excellent results with normal wrist range of motion, two (20%) patients had good results and one (10%) patient had fair outcome. Radiological union was seen in all cases with average duration to union noted in the study was 7.2 weeks (range: 6-10 weeks). We encountered complications like scar sensitivity in 2 cases and wrist pain in 2 and stiffness in 3 cases. CONCLUSION: Our study has shown that internal fixation using the Herbert screw results in rapid symptomatic relief and functional recovery with sufficient stability to allow normal use of the wrist. Orientation of the screw and length of the screw plays a major role in preventing the late complications like arthritis and wrist pain.

We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees. We consider that skin staples are the skin closure of choice for both hip and knee replacements.

The purpose of this study is to review the updated evidence comparing outcomes between minimally invasive surgery (MIS) and conventional open surgery (COS) for lumbar spinal stenosis (LSS). Methods: All randomized controlled trials (RCTs) published from January 2005 to August 2016 were identified through PubMed and MEDLINE databases. Only RCTs including patients with LSS and with direct comparison between COS and MIS were selected for analysis. The intra-and post-operative effects of different MIS and COS on patients with LSS were evaluated for any differences. Results: We reviewed 10 RCTs comparing the effect of MIS and COS for LSS. Most trials showed that MIS rendered a shorter duration of hospital stay, lower reoperation rate, visual analogue scale (VAS), 36-Item Form Health Survey (SF-36) score, creatinine phosphokinase-skeletal muscle (CPK-MM) levels and a higher Japanese Orthopaedic Association (JOA) score. However, the intergroup differences were not statistically significant for all comparisons and were only present for selected mild cases of spinal stenosis. Conclusions: This systematic review suggests that MIS reduces operating time, duration of hospital stay and CPK-MM levels. However, the evidence for these parameters is weak. Moreover, there is no conclusive evidence that MIS reduces reoperation or has better improvement in pain and outcome scores like VAS, SF-36 and JOA scores. The evidence is limited due to poor standardization of MIS definition, methodology and details of surgeon experience. MIS techniques should not be studied as a group, as each procedure is vastly different from each other.

Background Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA). Methods Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measur...

In and around 2002-5 a number of tools and concepts to enhance training were being designed and piloted in orthopaedic centres. These tools eventually formed the basis for the trauma and orthopaedic curriculum which was written in 2005-6 and approved by PMETB in September 2006.
The slides in this presentation form a record of what became the key elements of the first trauma and orthopaedic curriculum and the response of orthopaedic trainees and trainers to these proposed innovations.

This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA

Tout prête à croire à une inflammation  : une main ou un pied rouge, enflé, réellement plus chaud, des sensations de brûlures cuisantes à l’intérieur de l’articulation. Autant de symptômes d’un syndrome effroyable, laissant, au petit matin, la personne épuisée après une nuit sans repos. A Budapest, après trois jours de délibérations, une réunion consensuelle de 38 experts valide les critères diagnostiques précis de ce syndrome : le syndrome douloureux régional complexe (SDRC de … Budapest). PAS incurable.

In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb and hip surgery was evaluated and results obtained were compared with those using hyperbaric bupivacaine. Methodology: Two hundred patients scheduled for lower limb and hip surgery were randomly divided into two groups of 100 patients each. These patients received a spinal injection of either 3ml (15mg) of 0.5% hyperbaric ropivacaine or 3ml (15mg) of 0.5% hyperbaric bupivacaine using 25G Quincke type spinal needle. The parameters studied were -onset and total duration of sensory block, onset and total duration of motor block, quality of intraoperative anaesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The mean onset of sensory block (6±1.3min vs. 3±1.1min; p value<0.05) and motor block (13±1.6min vs. 9±1.3min; p value< 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in ropivacaine group (160±12.9min) than in bupivacaine group (260±16.1min; p value <0.05). The mean duration of motor block was also shorter in ropivacaine group compared to bupivacaine group (126±9.2min vs. 174±12.6min; p value<0.05). Conclusion: The quality of anaesthesia was excellent in both the groups. In conclusion, a solution of ropivacaine (hyperbaric) can be used for spinal anaesthesia and is comparable with hyperbaric bupivacaine in terms of quality of block, but has shorter recovery profile.

Reverse obliquity and transverse fractures of the proximal femur represent a distinct fracture pattern in which the mechanical forces displace the femur medially thus increasing the risk of fixation failure. There is a paucity of published literature in this area of trauma. This study constitutes the largest series of such fractures.

Using a retrospective analysis of prospectively collected data from a single institution, 101 reverse obliquity and transverse fracture patterns were identified from 3336 consecutive hip fractures. All surviving patients were followed up for 1 year.

Of 100 patients treated operatively, 59 were treated with 135° sliding hip screws (SHS), 19 with a Medoff plates modification of the SHS, three with a sliding hip screw and trochanteric stabilising plate and 19 with intramedullary sliding hip screw devices. Nine fracture fixation-healing complications occurred, with cut-out being the commonest complication (seven cases). Cut-out of the implant was associated with femoral medialisation and a larger tip to apex distance.

This fracture pattern is a challenge for the orthopaedic surgeon with a high risk of fracture healing complications. The 135° SHS and the intramedullary devices had similar failure rates.

Background: Emerging longitudinal data appear to demonstrate an alarming trend towards an increasing prevalence of osteolysis-induced mechanical failure, following total knee replacement (TKR). Even with high-quality multi-plane X-rays, accurate pre-surgical evaluation of osteolytic lesions is often difficult. This is likely to have an impact on surgical management and provides reasonable indication for the development of a model allowing more reliable lesion assessment. The aim of this study, using a simulated cadaver model, was to explore the accuracy of rapid spiral computed tomography (CT) examination in the non-invasive evaluation of peri-prosthetic osteolytic lesions, secondary to TKR, and to compare this to conventional X-ray standards. Methods: A series of nine volume-occupying defects, simulating osteolytic lesions, were introduced into three human cadaveric knees, adjacent to the TKR implant components. With implants in situ, each knee was imaged using a two-stage conventional plain X-ray series and rapidacquisition spiral CT. A beam-hardening artefact removal algorithm was employed to improve CT image quality. After random image sorting, 12 radiologists were independently shown the series of plain X-ray images and asked to note the presence, anatomic location and 'size' of osteolytic lesions observed. The same process was repeated separately for review of the CT images. The corresponding X-ray and CT responses were directly compared to elicit any difference in the ability to demonstrate the presence and size of osteolytic lesions. Results: Access to CT images significantly improved the accuracy of recognition of peri-prosthetic osteolytic lesions when compared to AP and lateral projections alone (P = 0.008) and with the addition of bi-planar oblique X-rays (P = 0.03). No advantage was obtained in accuracy of identification of such lesions through the introduction of the oblique images when compared with the AP and lateral projections alone (P = 0.13)

Афонское наследие: Научный альманах («The Athonite Heritage», a Scholar’s Anthology). Вып. 1 – 2: Материалы международной научной конференции «Русь и Афон: тысячелетие духовно-культурных связей», Чернигов, 28-29 ноября 2014 г. Киев – Чернигов: Издание Международного института афонского наследия в Украине, 2015. – 512 стр., илл.

Первый выпуск научного альманаха «Афонское наследие» («The Athonite Heritage») вышел в свет в рамках издательских проектов Международного института афонского наследия в Украине (МИАНУ).

На его страницах авторитетне учене из разных стран пытаются тщательно рассмотреть историю взаимоотношений Киевской Руси и стран Центрально-Восточной Европы по мировым центром православного монашества и мистицизма на Афоне.

В первом выпуске альманаха опубликованы материалы международной научной конференции «Русь и Афон: тысячелетие духовно-культурных связей», состоявшейся в Чернигове (Украина) 28-29 ноября 2014 г. Посвящен 1000-летию древнерусского монашества на Афоне и 220-летию преставления преп. Паисия Величковского (+28 ноября 1794 г.).

Выпуск направлен на системное и разностороннее освещение истории и духовно-культурного наследия Святой Горы Афон в развитии славянских стран и Киевской Руси. Призван расширить представления о тысячелетней духовной и культурной связи Киевской Руси и Афона, о влиянии афонских традиций на многие пласты духовной, культурной и даже политической жизни славянского мира.

Главный редактор альманаха – директор Международного института афонского наследия в Украине Шумило Сергей Викторович.

Альманах рассчитан на ученых, преподавателей, священнослужителей, студентов, аспирантов и всех, кто интересуется церковной историей и афонским наследием.

В состав редакционной коллегии альманаха вошли: профессор Оксфордского университета,  митрополит Диоклийский Каллист Уэр (Оксфорд, Великобритания); ректор Киевской духовной академии и семинарии, митрополит Броварской Антоний Паканич  (Киев, Украина); директор Института археологии НАНУ, д.и.н., академик НАНУ П. П. Толочко (Киев, Украина); член-корреспондент Афинской академии, д.и.н., профессор А.-Э. Тахиаос (Салоники, Греция); старший научный сотрудник Оксфордского центра византийских исследований, ответственный секретарь Международного общества «Friends of Mount Athos» д-р Грэхем Спик (Оксфорд, Великобритания);  директор Международного института афонского наследия в Украине С. В. Шумило (Киев, Украина), и другие.

Рекомендован к печати Ученым советом Черниговского национального педагогического университета им. Т.Г. Шевченко и Рецензионной комиссией Украинской Православной Церкви (ВВ 01-15-05-14).

Свидетельство о государственной регистрации: Серия КВ № 21259-11059-Р от 20 марта 2015 г.

Афонское наследие: Научный альманах («The Athonite Heritage», a Scholar’s Anthology). Вып. 1 – 2: Материалы международной научной конференции «Русь и Афон: тысячелетие духовно-культурных связей», Чернигов, 28-29 ноября 2014 г. Киев – Чернигов: Издание Международного института афонского наследия в Украине, 2015. – 512 стр., илл.

Anterior lumbar interbody fusion (ALIF) has become a widely recognized surgical technique for degenerative pathology of the lumbar spine. Spinal fusion has evolved dramatically ever since the first successful internal fixation by Hadra in 1891 who used a posterior approach to wire adjacent cervical vertebrae in the treatment of fracture-dislocation. Advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation and improved surgical technique. The controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists. Despite being an established treatment modality, current indications of ALIF are yet to be clearly defined in the literature. This article discusses the current literature on indications on ALIF surgery.

Introduction: Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in the development of thumb arthritis. Stabilization of the CMC joint with reduction of joint subluxation theoretically reduces the risk of arthritis. The hypothesis of this study is that activation of the first dorsal interosseous (FDI) muscle will reduce CMC subluxation of the metacarpal as measured by fluoroscopy.

Methods: Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011).

Results: Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74). In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0-0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7 cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.

Conclusion: The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis.

Patellofemoral instability is initially treated conservatively and surgical treatment is reserved for resistant cases. Reconstruction of medial patellofemoral ligament has gained popularity these days as it attempts at restoring soft tissue anatomy and biomechanics of medial patellar restraint back to normal. Here we describe our novel transverse patella single tunnel and femoral interference screw technique to reconstruct the medial patel- lofemoral ligament using free autologous gracilis and semitendinosus grafts.

Background: Medical photography is used clinically for patient evaluation, treatment decisions, and scientific documentation. Although standards for medical photography exist in many branches of medicine, we have not encountered such criteria in publications in the area of orthopedics.

Fractures of the tibial shaft are important for the reason that they are common and controversial. The exposed anatomical location of the tibia makes it vulnerable to the direct blow and high energy trauma as a result of motor vehicle accidents, thus resulting in comminuted fractures, which are frequently open with significant loss of skin and soft tissues. Because of the high prevalence of complications associated with these fractures, management often is difficult and the optimum method of treatment remains a subject of controversy.

For years, bioengineers and orthopaedic surgeons have applied the principles of mechanics to gain valuable information about the complex function of the anterior cruciate ligament (ACL). The results of these investigations have provided scientific data for surgeons to improve methods of ACL reconstruction and postoperative rehabilitation. This review paper will present specific examples of how the field of biomechanics has impacted the evolution of ACL research. The anatomy and biomechanics of the ACL as well as the discovery of new tools in ACL-related biomechanical study are first introduced. Some important factors affecting the surgical outcome of ACL reconstruction, including graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing, are then discussed. The scientific basis for the new surgical procedure, i.e., anatomic double bundle ACL reconstruction, designed to regain rotatory stability of the knee, is presented. To conclude, t...

Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity. Besides conventional vertebral cement augmentation techniques balloon kyphoplasty has become a popular tool to address painful thoracic and lumbar compression fractures. It showed improved pain reduction and lower complication rates compared to standard vertebroplasty. Interestingly the results of two placebo-controlled vertebroplasty studies question the value of cement augmentation, if compared to a sham operation. Even though there exists now favourable data for kyphoplasty from one randomised controlled trial, the absence of a sham group leaves the placebo effect unaddressed. Technically kyphoplasty can be performed with a transpedicular or extrapedicular access. Polymethyl methacrylate (PMMA)-cement should be favoured, since calcium phosphate cement showed inferior biomechanical properties and less effect on pain reduction especially in less stable burst fractures. Common complications of kyphoplasty are cement leakage and adjacent segment fractures. Rare complications are toxic PMMA-monomer reactions, cement embolisation, and infection.

Background: The optimal treatment of osteonecrosis of the femoral head has not been established yet. The aim of this study was to report preliminary clinical results of focal anatomic-resurfacing implantation for the treatment of osteonecrosis of the femoral head. Methods: Five patients (four male, one female) with seven surgical procedures, ages between 37 and 52 with an average age of 45.2 (+/− 7.2), diagnosed as femoral head avascular necrosis and who were unresponsive to conservative management or had failed previous surgical treatments were treated with a focal anatomic femoral head resurfacing between the years 2011-2012 and were retrospectively reviewed. Five patients with at least two years of follow-up, one left hip, two right hips, and two patients with bilateral hip surgery were included in this review. After safe surgical dislocation of the hip, full exposure of the femoral head was established. A focalresurfacing implant matching patient anatomy and femoral head curvature was performed accordingly. Neither intraoperative or postoperative complications nor revision ensued. Visual analogue scores and Harris Hip Scores were recorded both preoperatively and at postoperative 2 years for all seven surgeries. Results: The mean follow-up period was 26.6 +/− 3.8 months, with a range between 24-33 months. The mean visual analogue scores were 8.9 +/− 0.9 preoperatively and 2.3 +/− 1.0 postoperatively at year two (p = 0.017). Harris Hip Scores at postoperative follow-up were found to improve significantly from good to excellent scores (86.0 +/− 7.9), compared with preoperative poor scores (26.7 +/− 11.8) (p = 0.018). The clinical improvements in visual analogue scores (VAS) and Harris Hip Scores were also found to correlate with each other (p < 0.05). Conclusions: In the present study, the alternative technique of focal anatomic hip resurfacing with HemiCAP® yielded preliminary successful results for the treatment of osteonecrosis of the femoral head. To the best of our knowledge, this is the first case series in the literature, reporting functional clinical results with the use of a focal anatomic-resurfacing implant for the treatment of focal femoral head osteonecrosis.

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, a...

Background: Current literature has shown the mechanism of how indirect fractures occur but has not determined what factors increase the risks of such fractures. The objective of this study is thus to determine the effect of clothing and soft tissue thickness on the risk of indirect fracture formation. Methods: Twenty-five fresh red deer femora embedded in ballistic gelatine were shot with varying distances off their medial cortex with a 5.56 × 45 mm North Atlantic Treaty Organization (NATO) bullet while being filmed with a slow-motion video. We compared the effect of two different gelatine depths and the effect of denim cloth laid onto the impact surface of the moulds.

To compare the outcome of bicompartmental knee arthroplasty (BKA) versus total knee arthroplasty (TKA) in patients with medial and patellofemoral knee osteoarthritis. Records of 17 women and 10 men with medial and patellofemoral osteoarthritis of the knee who underwent BKA (n=15) or TKA (n=12) were reviewed. All surgeries were performed by the same surgeon. Patient haemoglobin level, length of hospital stay, range of motion, and visual analogue score for pain were recorded, as were the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the SF-36 score. Patients treated with BKA were younger than those treated with TKA (mean age, 52 vs. 60 years; p=0.006). BKA resulted in longer mean operating time (99 vs. 85 minutes, p=0.025), less mean intra-operative blood loss (reduction in haemoglobin level) [1.2 vs. 2.4 g/dL, p=0.003), and greater mean postoperative range of movement (125 vs. 116 degrees, p=0.019). The mean Knee Society scores, W...