N.N. Priorov Journal of Traumatology and Orthopedics
ISSN (print): 0869-8678, ISSN (online): 2658-6738 Founder: National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov Editor-in-Chief: Sergey P. Mironov, academician of RAS, Doctor of Sc. Frequency / Access: 4 issues per year / Subscription Included in: White List (4th level), Higher Attestation Commission List, RISC
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Retrospective multicenter study of injuries associated with personal mobility devices in Moscow
BACKGROUND: The use of personal mobility devices is associated with a high risk of injury, with the number of injuries increasing in direct proportion to the growing popularity of personal mobility devices and the number of trips taken. This situation necessitates research into injury patterns to enable the implementation of preventive measures and the development of unified treatment algorithms. Russian scientific sources mainly present isolated data based on small samples, which complicates analysis and systematization. AIM: This study aimed to assess the level, distribution, and temporal changes of injuries associated with personal mobility devices in the largest Russian metropolis (Moscow); to identify trends and risk factors affecting the safety of personal mobility devices operation; and to initiate the systematization of clinical data on personal mobility device-related injuries across the Russian Federation. METHODS: It was a multicenter, non-randomized, retrospective, anonymized study of personal mobility device-related injuries. The analysis was based on reports and medical records from patients treated in 5 outpatient and 7 inpatient facilities of the Moscow City Health Department. The study sample comprised 4678 patients aged 18–89 years, divided into two groups: the first included 3302 patients (70%) who received outpatient medical care or refused hospitalization, and the second included 1376 patients (30%) who were admitted for inpatient treatment. Methods of retrospective analysis, stratification, and statistical data processing were applied. RESULTS: Hospitalized patients accounted for 1376 cases (30%), with a mean age of 35 years (range: 18–86). Most participants were of working age, of both sexes, with no marked gender predominance. However, hospitalized patients were significantly older than outpatients (p < 0.05). The gender distribution did not differ between groups (p > 0.05). In the group hospitalized for inpatient treatment, injuries resulting from bicycles, e-bikes, scooters, e-scooters and other personal mobility devices (rollerblades, unicycles, Segways, hoverboards), which constituted less than 1% of the overall distribution, accounted for 330 (24%), 69 (5%), 234 (17%), 660 (48%), and 83 cases, respectively. The mean length of hospital stay was 4.76 days. Among outpatients, injuries resulting from bicycles, scooters, e-scooters and other personal mobility devices (rollerblades, unicycles, Segways, hoverboards), which constituted less than 1% of the overall distribution, accounted for 765 (23%), 667 (20%), 1583 (48%), and 287 (9%) cases. Across all personal mobility devices, e-scooters ranked first in injury incidence, dominating the shared mobility market over the past five years. Falls accounted for 79% of all injuries. By the nature of the injuries, in the outpatient group, isolated injuries accounted for 2628 cases (79%), whereas multiple, combined, or associated injuries accounted for 674 (21%) cases. In inpatients, isolated injuries occurred in 1045 (76%) cases, and multiple, combined, or polytrauma injuries occurred in 331 (24%) cases. CONCLUSION: This study analyzed personal mobility device-related injuries treated in Moscow healthcare facilities and determined the distribution of injuries by etiology, nature, and type of medical care provided. The study represents the first step toward systematizing clinical data on personal mobility device-related injuries in Russia for the subsequent development of optimal solutions for prevention and treatment.
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Surgical management of proximal humeral fractures
BACKGROUND: Current clinical guidelines for the treatment of proximal humeral fractures standardize each case based solely on the type of injury. However, there is no systemic approach to the choice between performing humeral osteosynthesis or shoulder arthroplasty, based on a comprehensive assessment of objective diagnostic criteria. AIM: The work aimed to develop a diagnostic algorithm with the aim of enabling a differentiated approach to the surgical treatment of proximal humeral fractures. METHODS: This pilot, single-center, cohort, retrospective, observational study with a complete sample compared quantitative and qualitative data from two groups of patients. Outcomes of 50 patients with proximal metaepiphyseal humeral fractures treated surgically between 2019 and 2022 were analyzed. All patients underwent multislice computed tomography of the shoulder joint. Computed tomography data were used to calculate Hounsfield units of the humeral fracture fragments. Prognostically, Hounsfield units values below 65, corresponding to significant reduction in bone density due to regional or systemic osteoporosis, indicated a poor outlook for osteosynthesis, with elevated risks of implant instability, secondary fragment displacement, and nonunion of the fracture site. In cases with satisfactory bone density values, osteosynthesis techniques for humeral fractures were applied. Reverse shoulder arthroplasty was performed in patients with fractures unsuitable for reconstruction. Functional, clinical, and radiological outcomes of surgical treatment were assessed in both groups. Functional and clinical outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Retrospective follow-up showed no adverse osteosynthesis outcomes such as nonunion or avascular necrosis of the fragments. No purulent-inflammatory complications occurred. Fracture consolidation was achieved, and favorable functional outcomes were observed in all patients treated with either osteosynthesis or shoulder joint arthroplasty. CONCLUSION: Measurement of Hounsfield units of bone fragments represents an objective quantitative criterion for assessing bone tissue density and predicting the feasibility of humeral fracture osteosynthesis.
Reverse shoulder arthroplasty for glenoid deformities: a retrospective cohort study
BACKGROUND: Reverse shoulder arthroplasty is increasingly becoming the standard surgical treatment for shoulder joint conditions. To our knowledge, in cases of glenoid deformities, lateralization of the scapular component of the shoulder prosthesis plays an important role. Several methods are used to achieve the scapular component lateralization, one of which is the use of a patient-specific metallic augment. We present the treatment outcomes of patients who underwent standard reverse shoulder arthroplasty without glenoid modeling versus those treated with a patient-specific metallic augment. AIM: The work aimed to evaluate the outcomes of reverse shoulder arthroplasty performed using the standard technique and with a patient-specific metallic augment in patients with glenoid deformities. METHODS: It was a single-center retrospective cohort study. Between 2019 and 2024, 62 patients with scapulohumeral osteoarthritis and associated glenoid deformities were treated in the Department of Traumatology and Orthopedics No. 1 of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics (Moscow). A total of 31 patients underwent standard reverse shoulder arthroplasty, whereas the remaining 31 received implantation of a patient-specific metallic augment manufactured using additive technologies. Demographic and radiographic data, surgical technique, operative time, blood loss, and complications were recorded. Patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Functional outcomes were assessed using the ASES, DASH, UCLA, Constant, and VAS scores. RESULTS: Of the 62 patients, 19 (30.64%) were men and 43 (69.36%) were women. Glenoid deformities were classified according to Walch as B1 in 31, B2 in 19, and B3 in 12 patients. The abduction angle was 120.6 ± 6.9° at the first postoperative assessment and 173.2 ± 6.8° at the final follow-up, compared with 83.4 ± 12.8° preoperatively (p < 0.05). In the patient-specific metallic augment group, compared with the control group, postoperative abduction, flexion, and external rotation improved, and the time to achieve full range of motion of the shoulder joint was reduced. CONCLUSION: Both techniques resulted in comparable improvements in functional outcomes. However, the use of a patient-specific augment was associated with a higher frequency of achieving full shoulder joint range of motion, supporting the need for further evaluation of this technique.
Early minimally invasive drainage in nonspecific lumbar spondylodiscitis
BACKGROUND: The effectiveness of minimally invasive puncture drainage of the destruction zone and paravertebral abscesses in nonspecific pyogenic spondylodiscitis has not been sufficiently studied. AIM: To evaluate the effectiveness of treating acute nonspecific lumbar spondylodiscitis by percutaneous drainage of the inflammatory focus with targeted antibiotic therapy compared with conventional empirical antibiotic therapy followed by surgical treatment. METHODS: A single-center, retrospective, controlled, cohort pilot study analyzed qualitative data from 63 patients (33 women and 30 men, mean age 56.79 years) with primary nonspecific monosegmental (39 patients) and polysegmental (24 patients) lumbar spondylodiscitis. A total of 34 patients underwent empirical antibiotic therapy followed by open debridement, whereas 29 patients received early minimally invasive debridement with percutaneous drainage of the destroyed disc and psoas abscess followed by targeted antibiotic therapy. Vertebral involvement was assessed according to the Pola classification. Neurological status, laboratory parameters including bacteriological tests, duration of hospital stay, and findings of magnetic resonance imaging and computed tomography were evaluated. Functional status was assessed using the Visual Analog Scale for pain, the Rivermead Mobility Index, and the Oswestry Disability Index at baseline and at the end of treatment. Follow-up lasted at least 6 months after discharge. RESULTS: In acute nonspecific vertebral osteomyelitis, early (within the first 24 hours of admission) percutaneous biopsy of the lesion with closed drainage, compared with empirical antibiotic therapy with subsequent surgery in cases of failure, increased pathogen verification from 41.1% to 89.7% (p < 0.01), reduced overall treatment duration from 71.1 ± 16.6 to 46.3 ± 18.3 days (p < 0.01), and decreased the risk of delayed segmental instability from 41.0% to 20.6% (p < 0.01), with comparable mortality, hospital stay duration, and patients’ functional status at treatment completion. The use of minimally invasive methods with targeted antibiotic therapy did not require any open procedures throughout the treatment period, whereas in the empirical therapy group, subsequent open drainage of abscesses and destruction sites was performed in 76.4% of cases. CONCLUSION: Minimally invasive diagnostics and drainage of pathological foci are effective in treating nonspecific lumbar spondylodiscitis without neurological complications, including cases complicated by sepsis.
Decision support system for the treatment of surgical site infections in trauma and orthopedic patients
BACKGROUND: Despite the availability of clinical guidelines for managing patients with surgical site infections, data on the adherence of real clinical practice to these protocols in Russian hospitals remain limited. Data on how noncompliance with clinical guidelines influences outcomes in patients with surgical site infections are also limited. AIM: This study aimed to develop a clinical decision support system for personalized selection of surgical strategies and antibiotic therapy in surgical site infections, and to evaluate adherence of the provided therapy to clinical guidelines for the diagnosis and treatment of surgical site infections in trauma and orthopedic practice. METHODS: It was a single-center retrospective continuous uncontrolled observational study of data from patients hospitalized at the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russia, between January 2024 and May 2025. Eligible patients had clinical signs of postoperative wound inflammation, fever (body temperature > 37.5 °C) persisting for three or more days after surgery, a positive wound culture, or a consultation with a clinical pharmacologist regarding antibiotic therapy. The study endpoints included compliance of surgical strategy and antibiotic therapy with clinical guidelines (choice of drug, dosage, and duration). Adherence to therapy was assessed by comparing prescriptions with approved surgical site infection treatment protocols using the clinical decision support system. Compliance with guidelines was analyzed in the overall cohort as well as in subgroups of acute and chronic infection. RESULTS: The study included 90 patients, of whom 84 met surgical site infection criteria (31 with acute and 53 with chronic surgical site infections). Full adherence to clinical guidelines was observed in 20 cases (24%) (13 acute, 7 chronic). In 25 cases (30%), the choice of antimicrobial agent did not comply with the recommended one; in 7 cases (8%), the drug was appropriate, but the regimen did not comply with dosing recommendations. In 58 cases (64%), the duration of antibiotic therapy was shorter than recommended, with 16 patients (28%) not receiving antibiotics at the outpatient stage. Patients with chronic infections were significantly more likely to have insufficient antibiotic therapy duration (p < 0.0001) and inappropriate drug choice (p = 0.036) compared with those with acute infection. Microbiological cultures were obtained from 82 patients, of whom 33% were already receiving antibiotic therapy at the time of sampling. CONCLUSION: In a trauma and orthopedic hospital setting, there is a clear need for clinical decision support systems based on clinical guidelines, seamlessly integrated into clinicians’ workflow, particularly regarding antibiotic therapy strategies.
Results of a six-year monitoring of antimicrobial resistance in major pathogens of fracture-related infection of long bones and chronic osteomyelitis following transosseous osteosynthesis
BACKGROUND: The growing resistance of pathogenic strains involved in fracture-related infection substantially limits the effectiveness of antibiotic therapy and represents a serious public health concern. AIM: This study aimed to determine and assess trends in antimicrobial resistance of the major pathogens isolated from patients with long bone fracture-related infection and chronic osteomyelitis, as its sequela, treated with transosseous osteosynthesis between 2019 and 2024. METHODS: An observational, single-center, retrospective analysis of antimicrobial resistance patterns of the major pathogens isolated from 247 patients treated between 2019 and 2024 was performed. The obtained data were statistically analyzed using Pearson’s χ2 test. RESULTS: More than 60% of methicillin-susceptible Staphylococcus aureus (MSSA) and 70% of methicillin-susceptible Staphylococcus epidermidis (MSSE) and Corynebacterium strains were resistant to fluoroquinolones. Methicillin-resistant Staphylococcus epidermidis (MRSE) demonstrated stable susceptibility to vancomycin, teicoplanin, and linezolid. Enterococcus faecalis remained susceptible to ampicillin (94.4%), vancomycin, linezolid, and tigecycline (100%). Multidrug-resistant strains predominated among nonfermenting Gram-negative bacteria and Klebsiella pneumoniae, whereas extended-spectrum β-lactamase producers were most common among Enterobacteriaceae. In 2024, pandrug–resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) resistant to vancomycin were identified for the first time. Multidrug resistance was mainly observed in Gram-negative bacteria, particularly among nonfermenters such as Acinetobacter baumannii and Pseudomonas aeruginosa. Gram-positive pathogens, especially MSSE, remained highly susceptible to the tested antibiotics. CONCLUSION: Combination therapy with vancomycin and meropenem remains effective due to the high susceptibility of Gram-positive bacteria to vancomycin and Enterobacteriaceae to carbapenems. However, the increasing resistance among Gram-negative pathogens will require revision of the current treatment regimen in the near future.
Modeling a clinical instrumental system for objective assessment of foot function in patients with post-traumatic deformity of the ankle and calcaneus
BACKGROUND: Gait alterations in patients after surgery on the ankle and foot are associated with biomechanically driven complications. The surgery outcomes depend on an accurate assessment of the anatomical and functional characteristics of the foot. Clinical gait analysis was performed using the computerized hardware-software system F-Scan Mobile. AIM: This study aimed to evaluate biomechanical gait parameters in patients with deformities of the ankle and foot before and after surgery. METHODS: A single-center, prospective, non-randomized, controlled, experimental, quantitative, cohort study was conducted at the Department of Traumatology and Orthopedics No. 4 of the Priorov National Medical Research Center of Traumatology and Orthopedics (Moscow) during 2022–2024. A total of 102 patients with ankle arthrosis and post-traumatic calcaneal deformity were treated, including 68 men and 34 women, a mean age of 39 ± 17.61 years. All patients also underwent biomechanical assessment of functional foot parameters. RESULTS: Treatment outcomes in patients included in the study were assessed 12 and 24 months after surgery. The mean follow-up period was 22.3 ± 9.42 months. The mean visual analog scale score before surgery was 6.5 ± 3.63, and 1.6 ± 0.81 after surgery, indicating a significant reduction in pain (p < 0.05). The mean AOFAS hindfoot score increased from 38 ± 23.31 preoperatively to 88 ± 10.55 postoperatively, with a significant improvement in questionnaire scores (p < 0.05). Subjective evaluation of treatment outcomes: 56 patients (54.9%) rated the results as excellent, 30 (29.4%) as good, 14 (13.7%) as satisfactory, and 2 (1.9%) as unsatisfactory. CONCLUSION: The clinical model for biomechanical gait assessment provides objective data on the structure of the gait cycle in unilateral foot lesions and allows evaluating the adequacy of adaptive motor skills in patients before and after surgery, as well as during long-term follow-up. Patients were satisfied with the treatment outcomes, confirmed both clinically and through biomechanical assessment.
Evaluation of the wear rate of the acetabular component in total hip arthroplasty using russian ultra-high-molecular-weight polyethylene
BACKGROUND: Russian ultra-high-molecular-weight polyethylene has previously demonstrated, in tribological pin-on-disk tests, a coefficient of friction comparable to commercial ultra-high-molecular-weight polyethylene grades Gur1020 and Gur1050 (Chirulen). From a clinical perspective, wear values of prosthetic components obtained under conditions simulating in vivo performance in accordance with GOST R ISO 14242-1—including kinematics, loading, and lubrication—are critical in the selection of orthopedic implants. AIM: This study aimed to investigate the wear rate of experimental ultra-high-molecular-weight polyethylene liners in the hip joint bearing pair of a total hip prostheses according to GOST R ISO 14242 (Parts 1 and 2). METHODS: It was a pilot single-center study; the object was the hip joint bearing pair with a total sample of four specimens. The study was experimental, with both quantitative and qualitative data obtained and monitored at 0.5, 1, 2, 3, 4, and 5 million cycles. The study control was both descriptive and quantitative, accounting for before–after values. Wear testing of hip prosthesis bearing pairs, one component of which was ultra-high-molecular-weight polyethylene manufactured by Engineering Polymers (Russia), was carried out in accordance with GOST R ISO 14242 (Parts 1 and 2) using a hip prosthesis wear simulator (Center for Technical Safety of Materials, Equipment, and Complex Systems, ElectronTest Group, Russia), which enabled evaluation of the wear resistance of the bearing pair. Wear mechanisms were analyzed using scanning electron microscopy, roughness assessment, and deviation from sphericity of the hip joint bearing components. RESULTS: Baseline deviations from sphericity and surface roughness of the bearing components complied with GOST R ISO 7206-2. After 5 million cycles according to GOST R ISO 14242-2, the mean wear rate across three test pairs was 19.8 ± 2.1 mg/ million cycles, which, according to published data, is lower or comparable to wear rates reported in similar studies. Abrasive and fatigue wear of the inner surface of the liners was typical of ultra-high-molecular-weight polyethylene under these test conditions, manifested by polishing, scratching, particle detachment, and adhesion. CONCLUSION: The experimental Russian ultra-high-molecular-weight polyethylene demonstrated a low wear rate compared with imported commercial analogs available on the Russian market, which, when used as an acetabular component material, will ensure the long-term clinical effectiveness of total hip prostheses.
Genetic risk factors for musculoskeletal injuries and disorders in athletes of the national teams of the Russian Federation
BACKGROUND: A high incidence of musculoskeletal injuries and disorders is a major challenge in elite sports. Although the contribution of genetic factors to individual risk is well recognized, the spectrum and frequency of associated genetic variants in a key population—athletes representing national teams of the Russian Federation—remain insufficiently studied, which limits the development of personalized preventive approaches. This work aimed to fill this knowledge gap. AIM: The work aimed to determine the frequency and distribution of gene variants associated with the risk of musculoskeletal injuries and disorders among athletes of the Russian national teams. METHODS: A cross-sectional retrospective study was conducted in athletes of national teams of the Russian Federation aged 18–40 years who provided written informed consent and underwent comprehensive medical examination (CME) in accordance with established procedures. The exclusion criterion was the absence of signed informed consent or incomplete CME data. Study groups were formed based on CME findings: the case group included athletes with a history of at least one musculoskeletal injury or disorder, whereas the control group comprised athletes without any documented musculoskeletal condition. The study was performed at the National Center for Sports Medicine (NCSM) and the Center of Sports Preparation (CSP), both under the Federal Medical-Biological Agency of Russia. Participants were enrolled, and retrospective data were collected from electronic CME databases between 2021 and 2024. RESULTS: Among 152 athletes, 94 (61.8%) had a history of musculoskeletal injuries or disorders. Several genetic associations with outcome were identified for a number of variants. The highest odds ratios (ORs) were observed for the A allele of the IL18RAP gene (rs1420100, OR 31.81; p = 0.003) and the C allele of the FGF10 gene (rs1448037, OR 57.16; p = 0.003). Protective effects were shown for the G allele of the MIR608 gene (rs4919510, OR 0.06; p = 0.006) and the A allele of the MMP3 gene (rs650108, OR 0.10; p = 0.010). Additional significant associations were identified for variants in GDF5 (rs143383, OR 20.36; p = 0.002), VEGFA (rs1570360, OR 28.31; p = 0.003), and COL3A1 (rs1800255, OR 13.22; p = 0.007). CONCLUSION: There were significant differences in the distribution of specific genetic variants between athletes with or without musculoskeletal injuries or disorders. The findings are consistent with the expected biological effects of these genes. The findings can be integrated into the medical and biological support system for athletes.
Diagnosing low-grade central osteosarcoma using a neural network mathematical model: a case report and review
BACKGROUND: Diagnosing low-grade central osteosarcoma is associated with a significant challenge because, according to radiological and histological findings, the condition closely resembles various benign lesions, most commonly being misdiagnosed as fibrous dysplasia. Convolutional neural network-based mathematical models have been successfully applied for the automated analysis of digital histopathological images, including tumor classification, regions of interest segmentation, and identification of morphological features of malignancy. CASE DESCRIPTION: This paper presents a clinical case of a 33-year-old female patient in whom, following a pathologic fracture of the femoral diaphysis, the lesion was long misinterpreted as fibrous dysplasia. Upon re-evaluation of histological slides and repeat biopsy at the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics, the diagnosis of low-grade central osteosarcoma with areas of dedifferentiation and formation of high-grade osteosarcoma foci was established. For additional diagnostic confirmation, a convolutional neural network (ResNet-101)-based mathematical model previously developed by the authors for automated detection of pathologic mitoses on digital histopathological images was applied. The model analyzed scanned slides (Leica Aperio CS2, ×400), identifying several structures with a high probability of pathologic mitoses (maximum confidence scores: 99% and 92%), consistent with the conclusions of two experienced pathologists, thereby confirming the malignant nature of the lesion. CONCLUSION: This paper presents a clinicopathological and radiologic description of the condition, discusses diagnostic challenges and similarities with fibrous dysplasia and other benign lesions, and evaluates the potential and limitations of artificial intelligence techniques in pathology for rare low-mitotic tumors. Emphasis is placed on the role of neural network analysis as an auxiliary tool for improving reproducibility and sensitivity of mitosis detection, the need for multicenter model validation, and the implementation of stain normalization and interpretability of results for clinical application.
Radiofrequency echographic multispectrometry: a promising method for the diagnosis of osteoporosis and the assessment of low-energy fracture risk
Osteoporosis is a metabolic skeletal disease characterized by reduced bone mass, impaired microarchitecture, and an increased risk of fractures. Low-energy fractures resulting from osteoporosis lead to severe complications and patient mortality, diminish quality of life, and represent a serious medical, social, and economic burden for society. Timely diagnosis of the disease and prediction of fracture risk remain largely unresolved issues, requiring the development and implementation of new technologies. Radiofrequency echographic multispectrometry is an innovative ultrasound-based technique for diagnosing osteoporosis and assessing fracture risk. Its main advantage over other ultrasound densitometry methods is the assessment of bone status not in peripheral skeletal sites, but in the principal regions used for diagnosing the disease—the lumbar vertebrae and the proximal femur. Unlike dual-energy X-ray absorptiometry, considered the gold standard, radiofrequency echographic multispectrometry does not measure bone mineral density but instead assesses integral parameters of bone status by comparing the spectra of ultrasound signals reflected from the bone surface in patients with osteoporosis, healthy individuals, and individuals with a history of low-energy fractures. An important advantage of radiofrequency echographic multispectrometry is the portability of its equipment, which increases accessibility in remote regions and for less mobile patient groups. International studies have demonstrated a high level of concordance between radiofrequency echographic multispectrometry and dual-energy X-ray absorptiometry findings, providing the basis for recommending this new technique for clinical use in patients with osteoporosis in several countries. At the same time, the different underlying principle of the method offers potential benefits that still require further validation. This article reviews the potential applications and unresolved issues of radiofrequency echographic multispectrometry based on analysis of the current scientific data. The authors also present several clinical examples of radiofrequency echographic multispectrometry application in patients with osteoporosis and hereditary systemic diseases and discuss the outcomes of its use.
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