On July 14, 2022, at the age of 95, the world-famous orthopedic surgeon Jean-Jacques Cheneau, the creator of the famous corset for the conservative treatment of scoliosis, passed away.
{"title":"Jean-Jacques Cheneau (1927–2022)","authors":"","doi":"10.17816/ptors109610","DOIUrl":"https://doi.org/10.17816/ptors109610","url":null,"abstract":"On July 14, 2022, at the age of 95, the world-famous orthopedic surgeon Jean-Jacques Cheneau, the creator of the famous corset for the conservative treatment of scoliosis, passed away.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"319 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77129907","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}
Lofty El-Adwar Khaled, Taha Kotob Hesham, Abdel Razek Amin, A. Mohamed
BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts. AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts. MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips. RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shentons line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shentons line (78.75%), and finally femoral head coverage (70%). CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.
{"title":"Reliability of the computed tomography criteria after closed reduction of developmental dislocation of the hip","authors":"Lofty El-Adwar Khaled, Taha Kotob Hesham, Abdel Razek Amin, A. Mohamed","doi":"10.17816/ptors107096","DOIUrl":"https://doi.org/10.17816/ptors107096","url":null,"abstract":"BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts. \u0000AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts. \u0000MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips. \u0000RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shentons line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shentons line (78.75%), and finally femoral head coverage (70%). \u0000CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73009595","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}
Cerebral palsy is a neurological disease accompanied by orthopedic complications. To date, orthopedic treatment of cerebral palsy remains one of the basic approaches. Knowledge of history is the key to understanding the present and a bridge to the future. It gives us insight into the evolution of understanding of the problem, views on the possibilities of treatment, and personalized approach to the patient. The article describes the evolution of knowledge and approaches of treatment to children with cerebral palsy from ancient times to the present day. The main milestones of the neuro-orthopedic approach to diagnosis and treatment are reflected. In improving the surgical treatment of children with cerebral palsy, it is necessary to rely on a multidisciplinary approach, early detection of orthopedic pathology, personalization, taking into account the psychological and social effect of surgical treatment, and development and improvement of surgical techniques. The lecture was presented at a scientific conference with international participation Correction of motor disorders in the complex of medical habilitation of children with cerebral palsy. Saint Petersburg, November 2021, 2019.
{"title":"Orthopedic management of cerebral palsy: past, present, and future","authors":"A. Baindurashvili, V. Kenis","doi":"10.17816/ptors109464","DOIUrl":"https://doi.org/10.17816/ptors109464","url":null,"abstract":"Cerebral palsy is a neurological disease accompanied by orthopedic complications. To date, orthopedic treatment of cerebral palsy remains one of the basic approaches. Knowledge of history is the key to understanding the present and a bridge to the future. It gives us insight into the evolution of understanding of the problem, views on the possibilities of treatment, and personalized approach to the patient. The article describes the evolution of knowledge and approaches of treatment to children with cerebral palsy from ancient times to the present day. The main milestones of the neuro-orthopedic approach to diagnosis and treatment are reflected. In improving the surgical treatment of children with cerebral palsy, it is necessary to rely on a multidisciplinary approach, early detection of orthopedic pathology, personalization, taking into account the psychological and social effect of surgical treatment, and development and improvement of surgical techniques. \u0000The lecture was presented at a scientific conference with international participation Correction of motor disorders in the complex of medical habilitation of children with cerebral palsy. Saint Petersburg, November 2021, 2019.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79585447","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, L. Gorobets, A. Dimitrieva, Alisa A. Zhmurova-Kriventsova, I. Bychkov, G. Baydakova, T. Markova, E. Zakharova
BACKROUND: Mucopolysaccharidoses are a group of lysosomal storage diseases belonging to orphan diseases. Certain types of mucopolysaccharides have a typical musculoskeletal findings and radiological changes. The mucopolysaccharidosis IVB is a rare type. Thus, 95% of cases of the mucopolysaccharidosis IV are subtype A. CLINICAL CASE: Сlinical and radiological changes and genetic examination were performed to a 9-year-old patient with sensorineural deafness who applied to a medical institution with complaints of right hip pain and limping. DISCUSSION: Based on complaints and radiological changes of the hip joints, the patient was initially diagnosed with LeggCalvePerthes disease. The presence of a symmetrical bilateral process, pathognomonic changes in the acetabulum and femoral heads, and an atypical clinic of LeggCalvePerthes disease made us suspect mucopolysaccharidos. Enzymatic analysis revealed a significant decrease in the beta-D-galactosidase enzyme activity. In addition, two compound heterozygous variants in the GLB1 gene were identified: the pathogenic variant c.808TG, inherited from the father, and an insertion of a mobile genetic element, inherited from the mother. Only one variant in the GLB1 gene was detected in the brother (born in 2009), and none of the above GLB1 variants was detected in the older brother (born in 2003). Moreover, the proband (with clinical mucopolysaccharidos IVB) and his brother (born in 2009) (without mucopolysaccharidos IVB) inherited pathogenic CDH23 variants (c.6992TC and c.805CT) from their mother and father, respectively, which is consistent with their having sensorineural hearing loss. CONCLUSIONS: The uniqueness of this clinical case is the presence of the rare type of mucopolysaccharidos and the separate genetic cause of sensorineural hearing loss in a single patient. The diagnosis of mucopolysaccharidos IVB in the proband was confirmed by biochemical and molecular genetic tests, and the diagnosis of CDH23-associated sensorineural deafness in the proband and brother (born in 2009) was confirmed by molecular genetic testing.
背景:粘多糖病是一类溶酶体积存性疾病，属于孤儿病。某些类型的粘多糖具有典型的肌肉骨骼表现和放射学改变。粘多糖病IVB是一种罕见的类型。临床病例:Сlinical一名9岁感音神经性耳聋患者以右髋关节疼痛和跛行为主诉到医疗机构就诊，对其进行了影像学改变和遗传检查。讨论:基于主诉和髋关节的影像学改变，患者最初被诊断为LeggCalvePerthes病。对称双侧突的存在、髋臼和股骨头的病理改变以及LeggCalvePerthes病的不典型临床使我们怀疑是粘多糖。酶分析显示β - d -半乳糖苷酶活性显著降低。此外，还鉴定了GLB1基因的两个复合杂合变异体:遗传自父亲的致病性变异体c.808TG和遗传自母亲的可移动遗传元件的插入。在弟弟(2009年出生)中仅检测到GLB1基因的一个变异，而在哥哥(2003年出生)中未检测到上述GLB1变异。且先证者(临床粘多糖性IVB)及其兄弟(2009年出生)(无粘多糖性IVB)分别从其母亲和父亲遗传了CDH23致病性变异(c.6992TC和c.805CT)，这与他们患有感音神经性听力损失相一致。结论:该病例的独特之处在于罕见的粘多糖类型和单个患者的感觉神经性听力损失的单独遗传原因。先证者经生化及分子遗传学检测确诊为粘多糖性IVB，先证者及其兄弟(2009年出生)经分子遗传学检测确诊为cdh23相关性感音神经性耳聋。
{"title":"Mucopolysaccharidosis IVB and sensorineural deafness associated with the CDH23 gene: A unique clinical case","authors":"V. Kenis, L. Gorobets, A. Dimitrieva, Alisa A. Zhmurova-Kriventsova, I. Bychkov, G. Baydakova, T. Markova, E. Zakharova","doi":"10.17816/ptors108730","DOIUrl":"https://doi.org/10.17816/ptors108730","url":null,"abstract":"BACKROUND: Mucopolysaccharidoses are a group of lysosomal storage diseases belonging to orphan diseases. Certain types of mucopolysaccharides have a typical musculoskeletal findings and radiological changes. The mucopolysaccharidosis IVB is a rare type. Thus, 95% of cases of the mucopolysaccharidosis IV are subtype A. \u0000CLINICAL CASE: Сlinical and radiological changes and genetic examination were performed to a 9-year-old patient with sensorineural deafness who applied to a medical institution with complaints of right hip pain and limping. \u0000DISCUSSION: Based on complaints and radiological changes of the hip joints, the patient was initially diagnosed with LeggCalvePerthes disease. The presence of a symmetrical bilateral process, pathognomonic changes in the acetabulum and femoral heads, and an atypical clinic of LeggCalvePerthes disease made us suspect mucopolysaccharidos. Enzymatic analysis revealed a significant decrease in the beta-D-galactosidase enzyme activity. In addition, two compound heterozygous variants in the GLB1 gene were identified: the pathogenic variant c.808TG, inherited from the father, and an insertion of a mobile genetic element, inherited from the mother. Only one variant in the GLB1 gene was detected in the brother (born in 2009), and none of the above GLB1 variants was detected in the older brother (born in 2003). Moreover, the proband (with clinical mucopolysaccharidos IVB) and his brother (born in 2009) (without mucopolysaccharidos IVB) inherited pathogenic CDH23 variants (c.6992TC and c.805CT) from their mother and father, respectively, which is consistent with their having sensorineural hearing loss. \u0000CONCLUSIONS: The uniqueness of this clinical case is the presence of the rare type of mucopolysaccharidos and the separate genetic cause of sensorineural hearing loss in a single patient. The diagnosis of mucopolysaccharidos IVB in the proband was confirmed by biochemical and molecular genetic tests, and the diagnosis of CDH23-associated sensorineural deafness in the proband and brother (born in 2009) was confirmed by molecular genetic testing.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84996516","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}
Svetlana N. Lyneva, Tatyana I. Menschchikova, A. Aranovich
BACKGROUND: Despite studies on various issues of distraction osteosynthesis, many morphological aspects of this problem are still insufficiently studied and remained debatable. AIM: To determine the features of the reparative activity of the regenerate and analyze the content of some osteotropic growth factors in children with achondroplasia. MATERIALS AND METHODS: Growth factors were determined in serum and blood plasma using equipment from Thermo Fisher (USA). Factor concentrations were determined using ELISA kits: PDGF-AA (RD Systems, USA), PDGF-BB (RD Systems, USA), IGF-1 (Immunodiagnostic systems, USA), IGF-2 (Mediagnost, Germany), TGF-1 (eBioscience, USA), and TGF-2 (eBioscience, USA). The structural state of the tibial regenerate was determined using by ultrasonography (HITACHI, Japan). Patients with achondroplasia aged 912 years (n = 32) were examined at the beginning of distraction (1020 days), in the middle of distraction (2140 days), and at the end of distraction (4163 days). RESULTS: The ultrasound method showed the dynamic formation of the structural state of the distraction regenerate at the studied stages of distraction. At the same stages of distraction, the concentration of osteotropic growth factors was assessed. CONCLUSIONS: The serum content of osteotropic growth factors in the blood of children with achondroplasia differs from age-normative values. Growth factors that play a key role in osteogenesis, IGF-1, BMP-4, TGF-1, and TGF-2 were reduced, whereas the expressions of IGF-2 and BMP-6 were compensatory increased. At the end of the distraction period, the values of all studied growth factors exceeded the initial values, regardless of their preoperative values and their dynamics at the stages of distraction. The assessment of the dynamics of the concentration of osteotropic growth factors in the blood of patients with achondroplasia during the distraction period and natural growth period indicate the presence of a commonality of processes during the distraction period and prenatal growth of the tibia. Our comprehensive ultrasound study of the structural state of the distraction regenerate of the tibia and biochemical studies of growth factors in the blood of patients with achondroplasia at the age of 912 years made it possible to identify the features of reparative osteogenesis of the distraction regenerate of the tibia and the physiological effect of osteotropic growth factors from the viewpoint of the process of reparative regeneration.
{"title":"Features of the reparative osteogenesis of the distraction of the tibial regenerate and osteotropic growth factors in patients with achondroplasia at the age of 9–12 years","authors":"Svetlana N. Lyneva, Tatyana I. Menschchikova, A. Aranovich","doi":"10.17816/ptors108618","DOIUrl":"https://doi.org/10.17816/ptors108618","url":null,"abstract":"BACKGROUND: Despite studies on various issues of distraction osteosynthesis, many morphological aspects of this problem are still insufficiently studied and remained debatable. \u0000AIM: To determine the features of the reparative activity of the regenerate and analyze the content of some osteotropic growth factors in children with achondroplasia. \u0000MATERIALS AND METHODS: Growth factors were determined in serum and blood plasma using equipment from Thermo Fisher (USA). Factor concentrations were determined using ELISA kits: PDGF-AA (RD Systems, USA), PDGF-BB (RD Systems, USA), IGF-1 (Immunodiagnostic systems, USA), IGF-2 (Mediagnost, Germany), TGF-1 (eBioscience, USA), and TGF-2 (eBioscience, USA). The structural state of the tibial regenerate was determined using by ultrasonography (HITACHI, Japan). Patients with achondroplasia aged 912 years (n = 32) were examined at the beginning of distraction (1020 days), in the middle of distraction (2140 days), and at the end of distraction (4163 days). \u0000RESULTS: The ultrasound method showed the dynamic formation of the structural state of the distraction regenerate at the studied stages of distraction. At the same stages of distraction, the concentration of osteotropic growth factors was assessed. \u0000CONCLUSIONS: The serum content of osteotropic growth factors in the blood of children with achondroplasia differs from age-normative values. Growth factors that play a key role in osteogenesis, IGF-1, BMP-4, TGF-1, and TGF-2 were reduced, whereas the expressions of IGF-2 and BMP-6 were compensatory increased. At the end of the distraction period, the values of all studied growth factors exceeded the initial values, regardless of their preoperative values and their dynamics at the stages of distraction. The assessment of the dynamics of the concentration of osteotropic growth factors in the blood of patients with achondroplasia during the distraction period and natural growth period indicate the presence of a commonality of processes during the distraction period and prenatal growth of the tibia. Our comprehensive ultrasound study of the structural state of the distraction regenerate of the tibia and biochemical studies of growth factors in the blood of patients with achondroplasia at the age of 912 years made it possible to identify the features of reparative osteogenesis of the distraction regenerate of the tibia and the physiological effect of osteotropic growth factors from the viewpoint of the process of reparative regeneration.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87147503","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}
S. Vissarionov, M. S. Asadulaev, E. Orlova, P. Ivanova, A. S. Shabunin, T. Murashko, Mikhail A. Khardikov, V. G. Toriya, T. S. Rybinskikh, Kristina N. Rodionova, D. Kokushin
BACKGROUND: Treatment of children with congenital deformity with unsegmented rod and rib synostosis is an important and topical problem to date. Topical publications present the results of surgical correction efficacy and analysis of treatment complications. The extremely important aspect of treatment efficacy assessment regarding changes in the function of external respiration is still topical. AIM: This study aimed to analyze the treatment results of children with congenital scoliosis and unilateral segmentation disorder of the lateral surfaces of the vertebral bodies and rib synostosis. MATERIALS AND METHODS: This is a retrospective monocenter cohort study of the treatment outcomes of 30 patients aged 114 years. In the preoperative period, external respiration was evaluated by pulse oscillometry, multi-slice computed tomography, digital X-ray imaging of the craniopelvis in two projections. All patients underwent expanding thoracoplasty with osteotomy of the rib synostosis and fixation with a rib-costal or rib-vertebral distractor. Control studies were performed every 6 months after the surgical intervention. The average follow-up period was 2 years. Nonparametric analysis was applied to estimate the obtained data. RESULTS: The median (Me) age at the start of treatment was 6 years (interquartile range, 4.25; IQR hereafter). The Me scoliosis before treatment was 74 (IQR, 22.75). The Me scoliosis correction after the first stage of treatment was 16 (IQR, 11) and the second correction achieved 6 (IQR, 13). The Me kyphosis was 15 (IQR, 32), the first intervention improved kyphosis by 4 (IQR, 16), and the second by 6 (IQR, 11). Complications were represented by the destabilization of the metal construct in six cases, and trophic disorders of soft tissues were noted in four. The assessment of external respiratory function using IOM demonstrates reliable improvement of resistive component, reactive component, and frequency dependence of the resistive component (p 0,01). CONCLUSIONS: The assessment of the external respiratory function in young children and analysis of reference values may allow their use as absolute indications for surgical treatment in children with congenital scoliosis with unsegmented bar and rib synostosis.
{"title":"Assessment of the efficacy of treatment for children with congenital scoliosis with unsegmented bar and rib synostosis","authors":"S. Vissarionov, M. S. Asadulaev, E. Orlova, P. Ivanova, A. S. Shabunin, T. Murashko, Mikhail A. Khardikov, V. G. Toriya, T. S. Rybinskikh, Kristina N. Rodionova, D. Kokushin","doi":"10.17816/ptors109182","DOIUrl":"https://doi.org/10.17816/ptors109182","url":null,"abstract":"BACKGROUND: Treatment of children with congenital deformity with unsegmented rod and rib synostosis is an important and topical problem to date. Topical publications present the results of surgical correction efficacy and analysis of treatment complications. The extremely important aspect of treatment efficacy assessment regarding changes in the function of external respiration is still topical. \u0000AIM: This study aimed to analyze the treatment results of children with congenital scoliosis and unilateral segmentation disorder of the lateral surfaces of the vertebral bodies and rib synostosis. \u0000MATERIALS AND METHODS: This is a retrospective monocenter cohort study of the treatment outcomes of 30 patients aged 114 years. In the preoperative period, external respiration was evaluated by pulse oscillometry, multi-slice computed tomography, digital X-ray imaging of the craniopelvis in two projections. All patients underwent expanding thoracoplasty with osteotomy of the rib synostosis and fixation with a rib-costal or rib-vertebral distractor. Control studies were performed every 6 months after the surgical intervention. The average follow-up period was 2 years. Nonparametric analysis was applied to estimate the obtained data. \u0000RESULTS: The median (Me) age at the start of treatment was 6 years (interquartile range, 4.25; IQR hereafter). The Me scoliosis before treatment was 74 (IQR, 22.75). The Me scoliosis correction after the first stage of treatment was 16 (IQR, 11) and the second correction achieved 6 (IQR, 13). The Me kyphosis was 15 (IQR, 32), the first intervention improved kyphosis by 4 (IQR, 16), and the second by 6 (IQR, 11). \u0000Complications were represented by the destabilization of the metal construct in six cases, and trophic disorders of soft tissues were noted in four. The assessment of external respiratory function using IOM demonstrates reliable improvement of resistive component, reactive component, and frequency dependence of the resistive component (p 0,01). \u0000CONCLUSIONS: The assessment of the external respiratory function in young children and analysis of reference values may allow their use as absolute indications for surgical treatment in children with congenital scoliosis with unsegmented bar and rib synostosis.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"219 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79814784","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: Impaired occlusal relationships of dental rows can cause adaptive changes in the entire musculoskeletal system, including the feet. Thus, studying the biomechanics of the feet with the possibility of changing the medical rehabilitation program of patients with dentomaxillofacial anomalies of various geneses is important. AIM: To investigate the plantographic characteristics of the feet in adolescents with congenital cleft lip and palate and combined dentomaxillofacial anomaly with a mesial ratio of dental rows and analyze patterns of distribution of plantar pressure before and after reconstructive operations on the jaws and restoration of facial harmony. MATERIALS AND METHODS: The study included 31 patients of both sexes aged 1517 years, who were divided into two groups. The first group consisted of 15 patients with congenital cleft lip and palate after the early stages of reconstructive surgery (cheilorhinoplasty and uranoplasty) and developed a combined dentomaxillofacial anomaly. The second group, with milder lesion, included 16 patients with combined dentomaxillofacial anomaly and do not have congenital cleft lip and palate. Patients had skeletal forms of mesial ratios of dental rows. To correct the bite and restore the aesthetics of the face, all patients underwent simultaneous bone reconstructive (orthognathic) surgery on the upper and lower jaws, including genioplasty in some of them, to restore the normal relationship of the jaw bones and harmonize the face. The plantographic characteristics of the feet were studied in patients before surgery and 16 months after surgery. The results of these two groups were compared with a pantographic examination of 18 healthy children (control group) without these pathologies in the maxillofacial region and without impairment of the supporting function of the foot. RESULTS: The first and second groups had a significant decrease in the indices of support on both feet before surgery: t, up to 85 (normal, 96); m, up to 16 (normal, 23); and s, up to 20 (normal, 24), which indicate a decrease in the spring function of the transverse and longitudinal arches and impairment of the supporting function of the feet. It was most pronounced in patients with congenital cleft lip and palate. Deviations in the magnitude of the Clark angle were multidirectional on the left and right feet, which indicated an abnormally high asymmetry of the load distribution between the feet. Functional relationships between the foot arches were pathologically enhanced to values of rs = 0.83 (normal, rs = 0.14), which indicated a formed pathological support strategy of the feet. After reconstructive operations on the jaws, the biomechanics of the feet in patients with combined dentomaxillofacial anomaly (without congenital cleft lip and palate) tended to normalize. CONCLUSIONS: It is necessary to consider the possible aggravating effect of the feet with a modified support strategy on the condition of the dentofacial area.
{"title":"Impaired supporting function of the feet in adolescents with congenital cleft lip and palate with a mesial ratio of dentition","authors":"I. Nikityuk, M. G. Semenov, Sofia A. Botsarova","doi":"10.17816/ptors106389","DOIUrl":"https://doi.org/10.17816/ptors106389","url":null,"abstract":"BACKGROUND: Impaired occlusal relationships of dental rows can cause adaptive changes in the entire musculoskeletal system, including the feet. Thus, studying the biomechanics of the feet with the possibility of changing the medical rehabilitation program of patients with dentomaxillofacial anomalies of various geneses is important. \u0000AIM: To investigate the plantographic characteristics of the feet in adolescents with congenital cleft lip and palate and combined dentomaxillofacial anomaly with a mesial ratio of dental rows and analyze patterns of distribution of plantar pressure before and after reconstructive operations on the jaws and restoration of facial harmony. \u0000MATERIALS AND METHODS: The study included 31 patients of both sexes aged 1517 years, who were divided into two groups. The first group consisted of 15 patients with congenital cleft lip and palate after the early stages of reconstructive surgery (cheilorhinoplasty and uranoplasty) and developed a combined dentomaxillofacial anomaly. The second group, with milder lesion, included 16 patients with combined dentomaxillofacial anomaly and do not have congenital cleft lip and palate. Patients had skeletal forms of mesial ratios of dental rows. To correct the bite and restore the aesthetics of the face, all patients underwent simultaneous bone reconstructive (orthognathic) surgery on the upper and lower jaws, including genioplasty in some of them, to restore the normal relationship of the jaw bones and harmonize the face. The plantographic characteristics of the feet were studied in patients before surgery and 16 months after surgery. The results of these two groups were compared with a pantographic examination of 18 healthy children (control group) without these pathologies in the maxillofacial region and without impairment of the supporting function of the foot. \u0000RESULTS: The first and second groups had a significant decrease in the indices of support on both feet before surgery: t, up to 85 (normal, 96); m, up to 16 (normal, 23); and s, up to 20 (normal, 24), which indicate a decrease in the spring function of the transverse and longitudinal arches and impairment of the supporting function of the feet. It was most pronounced in patients with congenital cleft lip and palate. Deviations in the magnitude of the Clark angle were multidirectional on the left and right feet, which indicated an abnormally high asymmetry of the load distribution between the feet. Functional relationships between the foot arches were pathologically enhanced to values of rs = 0.83 (normal, rs = 0.14), which indicated a formed pathological support strategy of the feet. After reconstructive operations on the jaws, the biomechanics of the feet in patients with combined dentomaxillofacial anomaly (without congenital cleft lip and palate) tended to normalize. \u0000CONCLUSIONS: It is necessary to consider the possible aggravating effect of the feet with a modified support strategy on the condition of the dentofacial area.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79760132","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}
A. Alexandrov, P. V. Goncharuk, A. Evdokimov, L. Y. Idris, A. A. Smirnov, R. Khagurov, N. N. Samorukova, N. Y. Alexandrova
BACKGROUND: The hand and its distal phalanges, especially in children, are among areas mostly exposed to trauma while contacting the environment. Injuries causing loss of soft tissue and bone component are both challenging and interesting. This report presents the treatment results of children with soft tissue and bone defects of distal phalanges, in which reconstructions including combination of regional flaps, bone, and nailbed grafts were performed. CLINICAL CASE: This report presents clinical cases of the surgical treatment of 4- and 6-year-old children with fingertip injuries who underwent reconstructions including the combination of regional flaps, bone, and nailbed grafts. A combination of the scrap graft was performed in the first case with antegrade homodigital island flap and in the second case with thenar flap. The results were assessed 6 and 7 months after surgery. DISCUSSION: The primary aim of the surgical treatment of children with distal phalangeal defects is coverage of those defects. The restoration of the bone component of the defect is recommended to prevent postoperative deformations of the distal phalanges. Fingertip replantation or microsurgical transplantation of vascularized tissue complexes are technically difficult and require thorough care and monitoring of the childs condition in the postoperative period as all these measures may fail. CONCLUSIONS: The possibility to combine the scrap bone and nailbed graft with existing reliable surgical methods open new prospects for the successful treatment of fingertip injuries.
{"title":"Two clinical cases of the reconstruction of distal phalanges of hand in children by combination of the regional flap and scrap bone and nailbed graft","authors":"A. Alexandrov, P. V. Goncharuk, A. Evdokimov, L. Y. Idris, A. A. Smirnov, R. Khagurov, N. N. Samorukova, N. Y. Alexandrova","doi":"10.17816/ptors108022","DOIUrl":"https://doi.org/10.17816/ptors108022","url":null,"abstract":"BACKGROUND: The hand and its distal phalanges, especially in children, are among areas mostly exposed to trauma while contacting the environment. Injuries causing loss of soft tissue and bone component are both challenging and interesting. This report presents the treatment results of children with soft tissue and bone defects of distal phalanges, in which reconstructions including combination of regional flaps, bone, and nailbed grafts were performed. \u0000CLINICAL CASE: This report presents clinical cases of the surgical treatment of 4- and 6-year-old children with fingertip injuries who underwent reconstructions including the combination of regional flaps, bone, and nailbed grafts. A combination of the scrap graft was performed in the first case with antegrade homodigital island flap and in the second case with thenar flap. The results were assessed 6 and 7 months after surgery. \u0000DISCUSSION: The primary aim of the surgical treatment of children with distal phalangeal defects is coverage of those defects. The restoration of the bone component of the defect is recommended to prevent postoperative deformations of the distal phalanges. Fingertip replantation or microsurgical transplantation of vascularized tissue complexes are technically difficult and require thorough care and monitoring of the childs condition in the postoperative period as all these measures may fail. \u0000CONCLUSIONS: The possibility to combine the scrap bone and nailbed graft with existing reliable surgical methods open new prospects for the successful treatment of fingertip injuries.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82646190","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: The etiology and pathogenesis of the development of LeggCalvePerthes disease, despite intensive research, remains not fully understood. Most studies have concluded about the multifactorial genesis of the development of hip osteochondropathy. Moreover, a complete understanding of all elements of pathogenesis leading to the manifestation and the progressive development of aseptic necrosis make it possible to develop targeted antiresorptive therapy. At present, several studies have investigated impaired functioning of signaling pathways that influence bone homeostasis during the development of LeggCalvePerthes disease. In addition, impaired metabolism in avascular necrosis is characterized by significant complexity and heterogeneity, which is based on aseptic inflammation associated with ischemic stress. Concepts of antiresorptive therapy were developed based on the results of studies on the pathogenesis of LeggCalvePerthes disease. Nevertheless, these treatment algorithms have not achieved wide practical application and require further investigation. AIM: This study aimed to conduct a literary analysis of the molecular basis of the etiology and pathogenesis of LeggCalvePerthes disease and assess the prospects of therapy aimed at correcting bone homeostasis disorders. MATERIALS AND METHODS: Data sources were PubMed, Medline, Scopus, Web of Science, and RSCI databases, without language restrictions. RESULTS: The relationship between ischemic stress and the induction of a cytokine cascade with a predominance of the biological actions of proinflammatory cytokines, with parallel activation of intracellular regulatory networks that determine osteoresorptive processes, including due to pyroptosis, is shown. Data on the possibility of various variants of targeted antiresorptive therapy with the use of genetically engineered drugs are presented. CONCLUSIONS: The pathogenesis of LeggCalvePerthes disease is characterized by significant genetic heterogeneity with the induction of various mediators of inflammation, angiogenesis, and osteogenesis, depending on the disease stage. Investigating features of impaired bone homeostasis regulation in the case of LeggCalvePerthes disease at the molecular and cellular level opens up opportunities for the development and clinical application of personalized therapy.
背景:LeggCalvePerthes病的病因和发病机制，尽管深入研究，仍未完全了解。大多数研究都认为髋关节骨关节病的发生是多因素的。此外，对导致无菌性坏死的表现和进展的发病机制的所有因素的全面了解，使开发有针对性的抗吸收治疗成为可能。目前，一些研究已经调查了在LeggCalvePerthes病的发展过程中影响骨稳态的信号通路功能受损。此外，缺血性坏死的代谢受损具有显著的复杂性和异质性，这是基于与缺血性应激相关的无菌性炎症。抗吸收治疗的概念是基于对LeggCalvePerthes病发病机制的研究结果而发展起来的。然而，这些处理算法还没有得到广泛的实际应用，需要进一步的研究。目的:本研究旨在对LeggCalvePerthes病的病因和发病机制的分子基础进行文献分析，并评估旨在纠正骨稳态紊乱的治疗前景。材料和方法:数据来源为PubMed、Medline、Scopus、Web of Science和RSCI数据库，无语言限制。结果:缺血应激与细胞因子级联的诱导之间的关系显示，促炎细胞因子的生物作用占主导地位，细胞内调节网络的平行激活决定骨吸收过程，包括由于焦亡。数据的可能性的各种变体的靶向抗吸收治疗与使用基因工程药物提出。结论:LeggCalvePerthes病的发病机制具有显著的遗传异质性，根据疾病分期，可诱导多种炎症、血管生成和骨生成介质。在LeggCalvePerthes病的情况下，从分子和细胞水平研究骨稳态调节受损的特征，为个性化治疗的发展和临床应用开辟了机会。
{"title":"Molecular foundations of the etiology and pathogenesis of Legg-Calve-Perthes disease and prospects for targeted therapy: A literature review","authors":"N. Shabaldin, A. V. Shabaldin","doi":"10.17816/ptors101679","DOIUrl":"https://doi.org/10.17816/ptors101679","url":null,"abstract":"BACKGROUND: The etiology and pathogenesis of the development of LeggCalvePerthes disease, despite intensive research, remains not fully understood. Most studies have concluded about the multifactorial genesis of the development of hip osteochondropathy. Moreover, a complete understanding of all elements of pathogenesis leading to the manifestation and the progressive development of aseptic necrosis make it possible to develop targeted antiresorptive therapy. At present, several studies have investigated impaired functioning of signaling pathways that influence bone homeostasis during the development of LeggCalvePerthes disease. In addition, impaired metabolism in avascular necrosis is characterized by significant complexity and heterogeneity, which is based on aseptic inflammation associated with ischemic stress. Concepts of antiresorptive therapy were developed based on the results of studies on the pathogenesis of LeggCalvePerthes disease. Nevertheless, these treatment algorithms have not achieved wide practical application and require further investigation. \u0000AIM: This study aimed to conduct a literary analysis of the molecular basis of the etiology and pathogenesis of LeggCalvePerthes disease and assess the prospects of therapy aimed at correcting bone homeostasis disorders. \u0000MATERIALS AND METHODS: Data sources were PubMed, Medline, Scopus, Web of Science, and RSCI databases, without language restrictions. \u0000RESULTS: The relationship between ischemic stress and the induction of a cytokine cascade with a predominance of the biological actions of proinflammatory cytokines, with parallel activation of intracellular regulatory networks that determine osteoresorptive processes, including due to pyroptosis, is shown. Data on the possibility of various variants of targeted antiresorptive therapy with the use of genetically engineered drugs are presented. \u0000CONCLUSIONS: The pathogenesis of LeggCalvePerthes disease is characterized by significant genetic heterogeneity with the induction of various mediators of inflammation, angiogenesis, and osteogenesis, depending on the disease stage. Investigating features of impaired bone homeostasis regulation in the case of LeggCalvePerthes disease at the molecular and cellular level opens up opportunities for the development and clinical application of personalized therapy.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78840953","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}
S. Bogdanov, A. Aristov, S. N. Kurinnyy, Vladislav A. Nikishev, M. L. Mukhanov, Anastasia L. Vedeneeva
BACKGROUND: The traumatic avulsion of fingers is a severe injury that requires emergency replantation. In the case of crush mechanism and degloving, direct vessel repair, and reconstruction may be impossible. It appears fair to use indirect revascularization by enveloping the phalanges after osteosynthesis with blood-supplied tissues. The most accessible anatomically and functionally are the lower abdominal flap and abdominal pocketing of the hand; the flap pedicle was cut and the hand was released. Staged surgeries could be required for functional and aesthetic reconstruction of acceptable soft tissue envelop of the hand. CLINICAL CASE: This is a clinical case of successful treatment of traumatic avulsion of II, III, IV fingers on the right hand by phalanx osteosynthesis and abdominal pocketing. The restoration of the functionally and aesthetically acceptable finger was achieved. DISCUSSION: There is a high risk of necrosis and stump formation after the replantation of severely injured fingers when there was any possibility for direct vessel repair. Another method is the indirect revascularization by blood vessel ingrowth from the flap through the fracture line. This saves the injured limb segment. CONCLUSIONS: The presented technique of abdominal pocketing allows the replantation of the avulsed and degloved fingers without microsurgical vascular operation and restores them. It appears fair to recommend this technique as a salvage surgery in the case of severely injured soft tissues of the avulsed hand fingers.
{"title":"Abdominal pocketing for the child’s fingers for hand replantation: A clinical case","authors":"S. Bogdanov, A. Aristov, S. N. Kurinnyy, Vladislav A. Nikishev, M. L. Mukhanov, Anastasia L. Vedeneeva","doi":"10.17816/ptors106806","DOIUrl":"https://doi.org/10.17816/ptors106806","url":null,"abstract":"BACKGROUND: The traumatic avulsion of fingers is a severe injury that requires emergency replantation. In the case of crush mechanism and degloving, direct vessel repair, and reconstruction may be impossible. It appears fair to use indirect revascularization by enveloping the phalanges after osteosynthesis with blood-supplied tissues. The most accessible anatomically and functionally are the lower abdominal flap and abdominal pocketing of the hand; the flap pedicle was cut and the hand was released. Staged surgeries could be required for functional and aesthetic reconstruction of acceptable soft tissue envelop of the hand. \u0000CLINICAL CASE: This is a clinical case of successful treatment of traumatic avulsion of II, III, IV fingers on the right hand by phalanx osteosynthesis and abdominal pocketing. The restoration of the functionally and aesthetically acceptable finger was achieved. \u0000DISCUSSION: There is a high risk of necrosis and stump formation after the replantation of severely injured fingers when there was any possibility for direct vessel repair. Another method is the indirect revascularization by blood vessel ingrowth from the flap through the fracture line. This saves the injured limb segment. \u0000CONCLUSIONS: The presented technique of abdominal pocketing allows the replantation of the avulsed and degloved fingers without microsurgical vascular operation and restores them. It appears fair to recommend this technique as a salvage surgery in the case of severely injured soft tissues of the avulsed hand fingers.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77939524","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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