Introduction. Routine endoprosthesis production does not have ready solutions for such rare locations as forearm bones, scapula, and breastbone. In the last decade, 3D printing of personalized implants has been actively developing. Its benefits are accurate anatomical compliance with the resected segment, quick manufacturing time, and low cost. Oncoortopedics finds use of more additional technologies.
Aim. To show through clinical observations the advantages of qualitatively new biologically and mechanically compatible implants used to replace bone defects in anatomically complex locations and to promote the use of such endoprosthesis in clinical practice.
Materials and methods. Organ-saving treatment using personalized implants manufactured using 3D printing technology was performed in 7 patients with bone tumors: 3 with primary bone tumors (sarcomas) and 4 with metastases. Tumor lesions were localized in the humerus in 2 cases, in the scapula in 2 cases, in the breastbone in 2 cases, and in the distal part of the radius in 1 case. The implants were designed based in the spiral computed tomography data. For implant manufacturing, direct metal laser sintering (DMLS) was used. Titanium alloy Ti6Al4V certified for production of medical implants was used as the material. Design and manufacturing took 3 weeks.
Results. Morphological examination showed negative tumor resection margin in all patients. All 7 patients are alive. No intraoperative complications were reported. Follow up varied between 1 and 8 months. During follow up, disease progression was not observed. Mean functional score per the Musculoskeletal Tumour Society score (MSTS) was 80 % (between 72 and 94 %).
Conclusion. Development of qualitatively new Russian oncological implants using 3D-printing technology is one of the most important areas in bone pathology.

The article presents current trends in surgical treatment for oncological endoprosthesis of the shoulder joint. The main benefits and disadvantages of the 2 main techniques used in shoulder joint endoprosthesis are analyzed. Possibilities of their use in certain groups of patients are considered.
Aim. To systemize and analyze the results of using anatomical and reverse endoprosthesis, consider possibilities of optimization of selection of treatment tactics.

Introduction. Breast cancer is the most common cancer. Success in early diagnostic and system treatment is achieved. All the same mastectomy with reconstruction is the best option for some patients. Seroma is common complication after reconstructive plastic surgery.
Aim. To analyze efficiency of using fibrin sealant criofit at donor zone after autologous breast reconstruction in decreasing seroma incidences.
Materials and methods. This is randomised controlled clinical trial of fibrin sealant criofit effect on assessing of seroma incidences, timing of drain removal at donor zone after autologous breast reconstruction in comparison with control group. Surgical technic, drains removal criteria and patients characteristics were identical in both groups.
Results. Average drain fluid volume on the first day (150.9 ± 40.7 ml vs 190.6 ± 60.7 ml; p <0.001) and second day (152.6 ± 53.3 ml vs 184.9 ± 90.3 ml; p = 0.04) after surgery was significantly lower in experimental group. Average number of days of drainage in criofit group was significantly lower (6.3 ± 1.1 days vs 7.4 ± 2.1 days; p = 0.01). Seroma incidences in experimental group was lower in comparison with control group (10 % vs 23 %). It was statistically significant.
Conclusion. We aimed to asses the efficiency of fibrin sealant criofit at donor zone after autologous breast reconstruction. Criofit decrese the volume of serous draining in first days after surgery, number of days of drainage and seroma incidences significantly. But more powerful clinical trials are needed. Study limitations are small sample, changes in surgery team, small observation period.

Neurofibromatosis is a neurocutaneous syndrome characterized by the development of tumors of the central or peripheral nervous system including the brain, spinal cord, organs, skin, and bones. There are three types of neurofibromatosis: type 1 (96 of cases), type 2 (3 % of cases), and schwannomatosis (less than 1 % of cases). The NF1 gene is located on chromosome 17q11.2, which encodes for a tumor suppressor protein, neurofibromin, that functions as a negative regulator of Ras / MAPK (mitogen-activated protein kinase) and PI3K (phosphoinositide 3-kinases ) / mTOR (mammalian target of rapamycin) signaling pathways. The NF2 gene is identified on chromosome 22q12, which encodes for merlin, a tumor suppressor protein related to the proteins ezrin, radixin and moesin that modulates the activity of PI3K/AKT, Raf/MEK/ERK, and mTOR signaling pathways. In contrast, molecular insights on the different forms of schwannomatosis remain unclear. Inactivating mutations in the tumor suppressor genes MARCB1 and LZTR1 are considered responsible for a majority of cases. Recently, treatment strategies to target specific genetic or molecular events involved in their tumorigenesis are developed. This study discusses molecular pathways and related targeted therapies for neurofibromatosis type 1, type 2, and schwannomatosis and reviews recent clinical trials which involve neurofibromatosis patients. The aim of the study is to present the features and pathophysiology of neurofibromatosis, as well as modern diagnostic and therapeutic strategies related to this pathology. 

Background. Currently, endoprosthesis of large bones and joints is the standard of treatment for patients with tumors in the bones and joints of the upper and lower limbs and pelvis. However, the problem of integrated medical rehabilitation of these patients remains unsolved. In the postoperative period, patients frequently experience such functional abnormalities as limited mobility in the operated joint, pain, deceased locomotor activity in the joints due to prolonged bedrest leading to muscle hypotrophy. These abnormalities interfere with return to full social life affecting patients’ quality of life and making rehabilitation very important.  

Aim. To evaluate the effect of rehabilitation on patients’ quality of life and social adaptation after oncological endoprosthesis.  

Materials and methods. The study included 57 patients: 27 (47 %) males and 30 (53 %) females. Mean age was 46 years (19–71 years). In 10 patients, tumors were localized in the bones of the upper limb; in 6 patients, in the pelvic bones; in 41 patients, in the bones of the lower limb. Tumor volume varied between 24 and 3,783 cm3 (median 631 cm3 ). Pathological fractures were observed in 13 (24.5 %) patients, their risk – in 13 (24.5 %) patients. Patient activization was started at day 1–14 after surgery, passive working out of the operated limb on day 2–14. For quality of life evaluation, The Short Form-36 (SF-36) was used allowing to determine patients’ health. Functional results were analyzed using the Musculoskeletal Tumour Society score (MSTS), rehabilitation potential using the Tampa Scale of Kinesiophobia covering both physical and psychological components. Social status was evaluated based on patient’s occupation and social adaptation. 

Results. Performance of active rehabilitation activities after onco-orthopedic intervention allows 72 % of patients to achieve good and excellent functional results per the MSTS scale (60–97 %) under condition of protective regimen observation, as well as positively affects physical and psychological parts of quality of life. Use of Tampa Scale of Kinesiophobia allows to correct psychological and/or physical parts of kinesiophobia in a timely fashion. Adequately performed rehabilitation allows 46 % of patients to remain socially active, continue working.  

Conclusion. Scale of surgical intervention, presence of pathological fracture, as well as postoperative complications, affect both functional results and quality of life of patients which in this period in most observations is higher than prior to onco-orthopedic treatment. Tampa Scale of Kinesiophobia allows to evaluate patient motivation towards postoperative recovery and provide psychological help in a timely manner which decreases rehabilitation time. 

The article presents a review of the literature on the topic of interventional treatment of pain in oncological practice. The epidemiology, classification and mechanism of oncological pain are presented. Aspects of the use of interventional methods of pain syndrome treatment, including neurolysis and blockade, are considered. The technique, indications, contraindications, complications are described for each minimally invasive intervention.