E. Petrova, S. Trofimova, O. Agranovich, T. Markova
BACKGROUND: Nail–patella syndrome is an autosomal dominant disease caused by LMX1B mutations, characterized by a combination of dermatological and musculoskeletal abnormalities. The classic tetrad of the nail–patella syndrome includes hypoplasia of the nail plates, absence or hypoplasia of the patella, elbow joint contractures, often accompanied by posterior subluxation of the radial head, presence of “iliac horns” on radiographs of the pelvic bones, and renal changes. However, its diagnosis and treatment are not described in sufficient detail in domestic and foreign literature. AIM: This study aimed to analyze the variability of clinical and radiological manifestations in children with nail–patella syndrome. MATERIALS AND METHODS: Nine patients with nail–patella syndrome were examined and treated (aged 4 months to 14 years). All children presented to the H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery with a diagnosis of congenital multiple arthrogryposis. The examination results excluded this diagnosis. The diagnosis of nail–patella syndrome has been verified. RESULTS: Various variants of the nail–patella syndrome have been identified, with lesions to only the elbow joints (n = 3), damage to the upper and lower extremities (n = 5), and damage to only the lower extremities (n = 1). All patients had hypoplasia of fingernail plates. However, the pathognomonic sign – “iliac horns” on radiographs of the pelvic bones – was noted only in 33% of cases. Regarding functional disorders of the kidneys, proteinuria was observed in one patient, which appeared at the age of 15 years. In two cases, the parents suffered from this disease. A genetic examination was performed in three patients: a pathogenic variant in LMX1B was detected in a heterozygous state. All patients underwent conservative treatment for knee and elbow joint contractures and foot deformities. When casting, the presence of dislocation of the radial head or patella was considered. Surgical treatment was performed on five patients. The results of surgery on the lower extremities (knee contractures, foot deformities, and hip dislocation) were good in 87% of the cases. Recurrence of flexion contractures in the elbow joints was observed both after conservative and after surgical treatment in all cases; however, their severity varied. CONCLUSIONS: Clinical observations were considered to attract the attention of doctors of different specialties to a rare pathology. Moreover, a molecular genetic study is recommended for the timely diagnosis of the nail–patella syndrome, determining the treatment techniques and disease prognosis.
{"title":"Clinical and radiological variants of the nail–patella syndrome: Why is it important to make a correct diagnosis?","authors":"E. Petrova, S. Trofimova, O. Agranovich, T. Markova","doi":"10.17816/ptors630082","DOIUrl":"https://doi.org/10.17816/ptors630082","url":null,"abstract":"BACKGROUND: Nail–patella syndrome is an autosomal dominant disease caused by LMX1B mutations, characterized by a combination of dermatological and musculoskeletal abnormalities. The classic tetrad of the nail–patella syndrome includes hypoplasia of the nail plates, absence or hypoplasia of the patella, elbow joint contractures, often accompanied by posterior subluxation of the radial head, presence of “iliac horns” on radiographs of the pelvic bones, and renal changes. However, its diagnosis and treatment are not described in sufficient detail in domestic and foreign literature. \u0000AIM: This study aimed to analyze the variability of clinical and radiological manifestations in children with nail–patella syndrome. \u0000MATERIALS AND METHODS: Nine patients with nail–patella syndrome were examined and treated (aged 4 months to 14 years). All children presented to the H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery with a diagnosis of congenital multiple arthrogryposis. The examination results excluded this diagnosis. The diagnosis of nail–patella syndrome has been verified. \u0000RESULTS: Various variants of the nail–patella syndrome have been identified, with lesions to only the elbow joints (n = 3), damage to the upper and lower extremities (n = 5), and damage to only the lower extremities (n = 1). All patients had hypoplasia of fingernail plates. However, the pathognomonic sign – “iliac horns” on radiographs of the pelvic bones – was noted only in 33% of cases. Regarding functional disorders of the kidneys, proteinuria was observed in one patient, which appeared at the age of 15 years. In two cases, the parents suffered from this disease. A genetic examination was performed in three patients: a pathogenic variant in LMX1B was detected in a heterozygous state. All patients underwent conservative treatment for knee and elbow joint contractures and foot deformities. When casting, the presence of dislocation of the radial head or patella was considered. Surgical treatment was performed on five patients. The results of surgery on the lower extremities (knee contractures, foot deformities, and hip dislocation) were good in 87% of the cases. Recurrence of flexion contractures in the elbow joints was observed both after conservative and after surgical treatment in all cases; however, their severity varied. \u0000CONCLUSIONS: Clinical observations were considered to attract the attention of doctors of different specialties to a rare pathology. Moreover, a molecular genetic study is recommended for the timely diagnosis of the nail–patella syndrome, determining the treatment techniques and disease prognosis.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alevtina S. Tochilina, Dmitriy V. Ryzhikov, S. V. Vissarionov
BACKGROUND: Conservative treatment of children with carinatum is currently an urgent and unresolved problem despite the wide range of techniques available. Conservative treatment stops the progression of deformation and reduces the degree of deformation or eliminates it. Methods of evaluating treatment results include clinical (photo–video assessment, questionnaire survey, and chest measurements) and instrumental diagnostics (radiography, computed tomography [CT], and 3D scanning); however, no method of correction and orthosis that would consider all the tasks of conservative treatment, method of evaluating conservative treatment, and uniform protocol have been established. AIM: This study aimed to analyze the literature containing information on the conservative treatment of patients with pectus carinatum. MATERIALS AND METHODS: The study presents the results of a search in PubMed, Cochrane, and eLibrary using combinations of operators and keywords. A total of 54 foreign and domestic sources were extracted, and the search was not limited retrospectively. RESULTS: Orthosis is effective and positively perceived by doctors and patients. The most modern designs in the treatment of carinatum included dynamic orthoses FMF-DCS and Braceworks (Calgary). Recent studies have reported a strong correlation between 3D scanning and CT to assess treatment outcomes. However, no single option for conservative correction of deformity allowed for achieving all treatment goals. The assessment of the effectiveness of orthosis using photos, videos, and questionnaire, and chest measurement is subjective. CONCLUSIONS: The disadvantages of prosthetics determine the need to develop a clear treatment algorithm, methodology, and objective assessment of treatment outcomes, requiring further research.
{"title":"Bracing of children with pectus carinatum: A literature review","authors":"Alevtina S. Tochilina, Dmitriy V. Ryzhikov, S. V. Vissarionov","doi":"10.17816/ptors625475","DOIUrl":"https://doi.org/10.17816/ptors625475","url":null,"abstract":"BACKGROUND: Conservative treatment of children with carinatum is currently an urgent and unresolved problem despite the wide range of techniques available. Conservative treatment stops the progression of deformation and reduces the degree of deformation or eliminates it. Methods of evaluating treatment results include clinical (photo–video assessment, questionnaire survey, and chest measurements) and instrumental diagnostics (radiography, computed tomography [CT], and 3D scanning); however, no method of correction and orthosis that would consider all the tasks of conservative treatment, method of evaluating conservative treatment, and uniform protocol have been established. \u0000AIM: This study aimed to analyze the literature containing information on the conservative treatment of patients with pectus carinatum. \u0000MATERIALS AND METHODS: The study presents the results of a search in PubMed, Cochrane, and eLibrary using combinations of operators and keywords. A total of 54 foreign and domestic sources were extracted, and the search was not limited retrospectively. \u0000RESULTS: Orthosis is effective and positively perceived by doctors and patients. The most modern designs in the treatment of carinatum included dynamic orthoses FMF-DCS and Braceworks (Calgary). Recent studies have reported a strong correlation between 3D scanning and CT to assess treatment outcomes. However, no single option for conservative correction of deformity allowed for achieving all treatment goals. The assessment of the effectiveness of orthosis using photos, videos, and questionnaire, and chest measurement is subjective. \u0000CONCLUSIONS: The disadvantages of prosthetics determine the need to develop a clear treatment algorithm, methodology, and objective assessment of treatment outcomes, requiring further research.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141833999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olga V. Filippova, Ekaterina N. Provorova, Y. Proshchenko
BACKGROUND: Congenital giant melanocytic nevi (CMN) occur approximately in 1 of 250,000–500,000 newborns. According to foreign literature, the risk of malignancy of a melanocytic nevus varies widely within 5%–42%. AIM: This study aimed to identify possible risk factors for CMN in children and determine the most common location and actual list of examination. MATERIALS AND METHODS: The study enrolled 104 mother–child pairs, where the children had CMN. The control group included 60 mother–child pairs, in which the children had no CMN. RESULTS: CMN were located on the head in 42.4% of cases, which was the most frequent localization. The most frequent localizations also included the trunk and simultaneous location of nevi on several body segments. Abnormalities in thyroid hormone levels were noted in 12.5% of the mothers. The frequency of large nevi in the grandparents of children with CMN (13.5%) was significantly higher than that in their parents (mother, 1.9%; father, 2.9%). In addition, 19.2% of the children were examined by an oncologist or are on a dispensary register with an oncologist. Moreover, 4.8% of the patients were observed by a neurologist. Magnetic resonance imaging was performed once in 19.2% of the children, who underwent genetic testing. No foci of melaniform cell accumulation in the nervous tissue were detected in any examined child. CONCLUSIONS: The most common location of CMN is the head and torso – areas of risk of damage to the central nervous system by melanoform cells. The survey results of parents of the main group identified the following as risk factors for CMN development in children: a history of miscarriage or frozen pregnancy, thyroid hormone abnormalities, CMN in grandparents, ARVI during pregnancy, particularly in the first trimester, and visiting a solarium and using long-lasting gel polishes during pregnancy.
{"title":"Risk factors for the development of congenital giant nevi in children","authors":"Olga V. Filippova, Ekaterina N. Provorova, Y. Proshchenko","doi":"10.17816/ptors631696","DOIUrl":"https://doi.org/10.17816/ptors631696","url":null,"abstract":"BACKGROUND: Congenital giant melanocytic nevi (CMN) occur approximately in 1 of 250,000–500,000 newborns. According to foreign literature, the risk of malignancy of a melanocytic nevus varies widely within 5%–42%. \u0000AIM: This study aimed to identify possible risk factors for CMN in children and determine the most common location and actual list of examination. \u0000MATERIALS AND METHODS: The study enrolled 104 mother–child pairs, where the children had CMN. The control group included 60 mother–child pairs, in which the children had no CMN. \u0000RESULTS: CMN were located on the head in 42.4% of cases, which was the most frequent localization. The most frequent localizations also included the trunk and simultaneous location of nevi on several body segments. Abnormalities in thyroid hormone levels were noted in 12.5% of the mothers. The frequency of large nevi in the grandparents of children with CMN (13.5%) was significantly higher than that in their parents (mother, 1.9%; father, 2.9%). In addition, 19.2% of the children were examined by an oncologist or are on a dispensary register with an oncologist. Moreover, 4.8% of the patients were observed by a neurologist. Magnetic resonance imaging was performed once in 19.2% of the children, who underwent genetic testing. No foci of melaniform cell accumulation in the nervous tissue were detected in any examined child. \u0000CONCLUSIONS: The most common location of CMN is the head and torso – areas of risk of damage to the central nervous system by melanoform cells. The survey results of parents of the main group identified the following as risk factors for CMN development in children: a history of miscarriage or frozen pregnancy, thyroid hormone abnormalities, CMN in grandparents, ARVI during pregnancy, particularly in the first trimester, and visiting a solarium and using long-lasting gel polishes during pregnancy.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"58 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Kokushin, V. V. Sokolova, Vadim V. Kirilenko, Natalya A. Guryevа, L. L. Sharafutdinova
BACKGROUND: Diseases of the musculoskeletal system in children and their dynamics and structure are urgent health problems and have important scientific and practical significance. The epidemiological features of the detectability of pathology in different regions are of interest for detailed consideration. AIM: This study aimed to conduct a comparative characterization of the primary morbidity of children with diseases of the musculoskeletal system in St. Petersburg in the 2017–2022 period. MATERIALS AND METHODS: Official collections of statistical reports of the Central Research Institute of Organization and Informatization of Healthcare from 2017 to 2022 were analyzed. Indicators of diseases of the musculoskeletal system and connective tissue in children were analyzed, and a comparative assessment of the ratio of the probabilities of detecting pathologies in general and for individual nosologies presented in the collections in St. Petersburg and the Russian Federation was performed. Digital analysis was performed in Microsoft Office 2010 programs (Word and Excel). RESULTS: The indicators of primary morbidity in St. Petersburg from 2017 to 2022 exceeded the national and regional averages and had a negative upward trend. In all age groups, over 6 years, the odds ratio in favor of St. Petersburg increased with arthropathies in general and deforming dorsopathies and decreased with spondylopathies and systemic connective tissue lesions. Moreover, in children aged 0–14 years, the chances of detection in St. Petersburg increased with respect to reactive arthropathies and fell with juvenile arthritis, whereas in adolescents the increase concerned juvenile arthritis and the decrease in reactive arthropathies. In rheumatoid arthritis, a transition was noted – the probabilities of detection have become lower in favor of the regions in Russia. CONCLUSIONS: In St. Petersburg, an unfavorable trend in the probabilities of detecting diseases of the musculoskeletal system and connective tissue was registered among children. A two-stage increase in indicators was found in 2017–2019 and 2020–2022, and the rate of increase in the detectability of most nosologies during the COVID-19 pandemic exceeded the prepandemic values, indicating the conjugacy of the studied group of diseases with organizational limitations in the outpatient unit, quality and specificity of differential diagnosis, and viral component. The identified features indicate the need for a reassessment of organizational measures and management decisions.
{"title":"Comparative analysis of the detection of diseases of the muscular system in minors of Saint Petersburg","authors":"D. Kokushin, V. V. Sokolova, Vadim V. Kirilenko, Natalya A. Guryevа, L. L. Sharafutdinova","doi":"10.17816/ptors623155","DOIUrl":"https://doi.org/10.17816/ptors623155","url":null,"abstract":"BACKGROUND: Diseases of the musculoskeletal system in children and their dynamics and structure are urgent health problems and have important scientific and practical significance. The epidemiological features of the detectability of pathology in different regions are of interest for detailed consideration. \u0000AIM: This study aimed to conduct a comparative characterization of the primary morbidity of children with diseases of the musculoskeletal system in St. Petersburg in the 2017–2022 period. \u0000MATERIALS AND METHODS: Official collections of statistical reports of the Central Research Institute of Organization and Informatization of Healthcare from 2017 to 2022 were analyzed. Indicators of diseases of the musculoskeletal system and connective tissue in children were analyzed, and a comparative assessment of the ratio of the probabilities of detecting pathologies in general and for individual nosologies presented in the collections in St. Petersburg and the Russian Federation was performed. Digital analysis was performed in Microsoft Office 2010 programs (Word and Excel). \u0000RESULTS: The indicators of primary morbidity in St. Petersburg from 2017 to 2022 exceeded the national and regional averages and had a negative upward trend. In all age groups, over 6 years, the odds ratio in favor of St. Petersburg increased with arthropathies in general and deforming dorsopathies and decreased with spondylopathies and systemic connective tissue lesions. Moreover, in children aged 0–14 years, the chances of detection in St. Petersburg increased with respect to reactive arthropathies and fell with juvenile arthritis, whereas in adolescents the increase concerned juvenile arthritis and the decrease in reactive arthropathies. In rheumatoid arthritis, a transition was noted – the probabilities of detection have become lower in favor of the regions in Russia. \u0000CONCLUSIONS: In St. Petersburg, an unfavorable trend in the probabilities of detecting diseases of the musculoskeletal system and connective tissue was registered among children. A two-stage increase in indicators was found in 2017–2019 and 2020–2022, and the rate of increase in the detectability of most nosologies during the COVID-19 pandemic exceeded the prepandemic values, indicating the conjugacy of the studied group of diseases with organizational limitations in the outpatient unit, quality and specificity of differential diagnosis, and viral component. The identified features indicate the need for a reassessment of organizational measures and management decisions.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"55 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Kenis, A. Baindurashvili, Andrey V. Sapogovskiy, E. Melchenko, Aleksandr N. Kasev, Pavel S. Shpulev
BACKGROUND: In children, sports aims to obtain positive emotions and improve health and personal development. Sports injuries are associated with various risk factors, such as sex, age, previous injuries, and early specialization. AIM: This study aimed to analyze published data on the epidemiology, etiology, pathogenesis, and diagnosis and treatment of musculoskeletal injuries and associated pain in children engaged in sports. MATERIALS AND METHODS: The literature regarding the epidemiology, diagnosis, and treatment of pain in children involved in sports was explored. The literature search garnered 64 publications, including original articles, reviews, and normative documents. RESULTS: For most athletes, pain commonly occurs during training and competition. Injuries are an inherent risk when playing sports. However, coaches and parents can minimize the risk of injury by ensuring that they choose the right sports activities, use appropriate equipment, follow the rules, use safe practice, and provide adequate supervision. The negative consequences of sports injuries must be balanced with the social, psychological, and health benefits of sports participation. CONCLUSIONS: Treatment of injuries and analgesia must be implemented effectively to prevent pain from becoming chronic and reduce psychological burden on the young athletes.
{"title":"Musculoskeletal injuries and pain in children involved in sports: A literature review","authors":"V. Kenis, A. Baindurashvili, Andrey V. Sapogovskiy, E. Melchenko, Aleksandr N. Kasev, Pavel S. Shpulev","doi":"10.17816/ptors633296","DOIUrl":"https://doi.org/10.17816/ptors633296","url":null,"abstract":"BACKGROUND: In children, sports aims to obtain positive emotions and improve health and personal development. Sports injuries are associated with various risk factors, such as sex, age, previous injuries, and early specialization. \u0000AIM: This study aimed to analyze published data on the epidemiology, etiology, pathogenesis, and diagnosis and treatment of musculoskeletal injuries and associated pain in children engaged in sports. \u0000MATERIALS AND METHODS: The literature regarding the epidemiology, diagnosis, and treatment of pain in children involved in sports was explored. The literature search garnered 64 publications, including original articles, reviews, and normative documents. \u0000RESULTS: For most athletes, pain commonly occurs during training and competition. Injuries are an inherent risk when playing sports. However, coaches and parents can minimize the risk of injury by ensuring that they choose the right sports activities, use appropriate equipment, follow the rules, use safe practice, and provide adequate supervision. The negative consequences of sports injuries must be balanced with the social, psychological, and health benefits of sports participation. \u0000CONCLUSIONS: Treatment of injuries and analgesia must be implemented effectively to prevent pain from becoming chronic and reduce psychological burden on the young athletes.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"59 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valentin A. Neverov, Honored Physician of the Russian Federation, Doctor of Medical Sciences, Professor, celebrates his 80th birthday. V.A. Neverov is the president of the Russian Association of Traumatologists-Orthopedists of St. Petersburg and Leningrad Region, a member of the editorial board of the journals Grekov’s Bulletin of Surgery and Traumatology and Orthopedics of Russia, and a member of the dissertation council on traumatology and orthopedics. His main scientific research focuses on reconstructive and restorative surgery of the musculoskeletal system and hip arthroplasty.
俄罗斯联邦荣誉医生、医学博士、教授瓦伦丁-A-涅沃夫（Valentin A. Neverov）迎来了自己的 80 岁生日。瓦伦丁-A-涅沃夫是俄罗斯圣彼得堡和列宁格勒州创伤骨科医生协会主席，《格雷科夫外科公报》和《俄罗斯创伤骨科》杂志编委会成员，创伤骨科论文委员会成员。他的主要科研方向是肌肉骨骼系统的重建和修复手术以及髋关节置换术。
{"title":"Valentin A. Neverov","authors":"","doi":"10.17816/ptors633118","DOIUrl":"https://doi.org/10.17816/ptors633118","url":null,"abstract":"Valentin A. Neverov, Honored Physician of the Russian Federation, Doctor of Medical Sciences, Professor, celebrates his 80th birthday. V.A. Neverov is the president of the Russian Association of Traumatologists-Orthopedists of St. Petersburg and Leningrad Region, a member of the editorial board of the journals Grekov’s Bulletin of Surgery and Traumatology and Orthopedics of Russia, and a member of the dissertation council on traumatology and orthopedics. His main scientific research focuses on reconstructive and restorative surgery of the musculoskeletal system and hip arthroplasty.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"59 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. A. Novikov, V. V. Umnov, Dmitriy S. Zharkov, O. V. Barlova, A.R. Mustafaeva, S. V. Vissarionov
BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both method
{"title":"Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy","authors":"V. A. Novikov, V. V. Umnov, Dmitriy S. Zharkov, O. V. Barlova, A.R. Mustafaeva, S. V. Vissarionov","doi":"10.17816/ptors631798","DOIUrl":"https://doi.org/10.17816/ptors631798","url":null,"abstract":"BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. \u0000AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. \u0000MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. \u0000RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. \u0000CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both method","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. G. Toriya, S. V. Vissarionov, V. A. Manukovskiy, P. A. Pershina
BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.
{"title":"Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies","authors":"V. G. Toriya, S. V. Vissarionov, V. A. Manukovskiy, P. A. Pershina","doi":"10.17816/ptors632132","DOIUrl":"https://doi.org/10.17816/ptors632132","url":null,"abstract":"BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. \u0000AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. \u0000MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. \u0000RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. \u0000CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 116","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141833862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.
{"title":"Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review","authors":"S. V. Vissarionov, Gleb A. Bolshakov","doi":"10.17816/ptors626703","DOIUrl":"https://doi.org/10.17816/ptors626703","url":null,"abstract":"BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. \u0000AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. \u0000MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. \u0000RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. \u0000CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"52 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: At every step of clubfoot treatment using the Ponseti method, pitfalls leading to complications, both minor and potentially dangerous, may occur. Any doctor involved in the treatment of clubfoot may encounter similar difficulties in their practice; however, publications devoted to this problem are limited, and in some cases, experts cannot reach a consensus regarding the interpretation of actions that entail undesirable consequences. AIM: This study aimed to analyze pitfalls and complications associated with the Ponseti method for the treatment of clubfoot using modern literature data. MATERIALS AND METHODS: Articles were searched for in PubMed, Science Direct, Google Scholar, and eLibrary databases using the following keywords: idiopathic clubfoot, Ponseti method, serial casting, bracing, Achilles tenotomy, pitfalls, and complications. The search was performed without language restrictions. Most of the studies included were published no more than 10 years ago. RESULTS: Current literature data present on the pitfalls and complications encountered in the treatment of clubfoot using the Ponseti method. The review also covered associated complications and unfavorable prognostic factors. The restrictive measures during the COVID-19 pandemic have affected the treatment of clubfoot. CONCLUSIONS: Analysis of the causes of pitfalls and complications and control of unfavorable prognostic factors will help reduce complications of clubfoot treatment using the Ponseti method and optimize orthopedic care for children.
{"title":"Pitfalls and complications in the treatment of clubfoot by the Ponseti method: A literature review","authors":"Denis V. Derevyanko, S. Trofimova","doi":"10.17816/ptors626786","DOIUrl":"https://doi.org/10.17816/ptors626786","url":null,"abstract":"BACKGROUND: At every step of clubfoot treatment using the Ponseti method, pitfalls leading to complications, both minor and potentially dangerous, may occur. Any doctor involved in the treatment of clubfoot may encounter similar difficulties in their practice; however, publications devoted to this problem are limited, and in some cases, experts cannot reach a consensus regarding the interpretation of actions that entail undesirable consequences. \u0000AIM: This study aimed to analyze pitfalls and complications associated with the Ponseti method for the treatment of clubfoot using modern literature data. \u0000MATERIALS AND METHODS: Articles were searched for in PubMed, Science Direct, Google Scholar, and eLibrary databases using the following keywords: idiopathic clubfoot, Ponseti method, serial casting, bracing, Achilles tenotomy, pitfalls, and complications. The search was performed without language restrictions. Most of the studies included were published no more than 10 years ago. \u0000RESULTS: Current literature data present on the pitfalls and complications encountered in the treatment of clubfoot using the Ponseti method. The review also covered associated complications and unfavorable prognostic factors. The restrictive measures during the COVID-19 pandemic have affected the treatment of clubfoot. \u0000CONCLUSIONS: Analysis of the causes of pitfalls and complications and control of unfavorable prognostic factors will help reduce complications of clubfoot treatment using the Ponseti method and optimize orthopedic care for children.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"59 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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