Alina M. Khodorovskaya, A. Y. Efimtsev, Olga E. Agronovich, Margarita V. Savina, V. Zorin, S. A. Braylov, Anastasia I. Arakelian, Sergey A. Lukyanov, Aleksandr S. Grishchenkov, Yana A. Filin, D. Vcherashniy, Victoria V. Morozova
BACKGROUND: Diffusion-tensor magnetic resonance imaging allows visualizing the conductive pathways of the brain and spinal cord and assessing their structure and integrity and has found wide application in practical medicine. Currently, brachial plexus diffusion-tensor magnetic resonance imaging is not a routine research technique, and very few studies have described its use in children and adolescents. AIM: This study aimed to evaluate the possibility of brachial plexus diffusion-tensor magnetic resonance imaging application in pediatric patients with obstetric brachial plexus palsy sequelae and identify correlations between the diffusion-tensor magnetic resonance imaging parameters of brachial plexus and parameters of electrophysiological study of the upper extremities in these patients. MATERIALS AND METHODS: A complex examination of 50 patients was performed. The main group included 30 patients aged 6–17 years, with contractures and secondary deformities of the bones of the shoulder girdle and upper limbs caused by unilateral obstetric brachial plexus palsy. The control group included 20 patients aged 7–17 (10.1 ± 2.1) years without clinical signs, and anamnestic data indicated the presence of damage to the brachial plexus and peripheral nerves of the upper limbs. RESULTS: No significant differences in diffusion-tensor magnetic resonance imaging parameters of the right and left brachial plexus were found in the control group. Significant differences in fractional anisotropy of the C5–C8 tracts on the side of the damaged brachial plexus were detected compared with those on the side of the undamaged brachial plexus. On the side of the injured brachial plexus, nonlinear correlations were found between the fractional anisotropy of the tracts of the spinal nerve and its branches and the amplitude of sensory responses from the sensory nerve, which originated from the anterior branches of this spinal nerve, and between the volume of the branches of the tracts of the spinal nerve and the amplitude of соmpound motor responses from the muscles, which were innervated by the anterior branches of this spinal nerve. CONCLUSIONS: Diffusion-tensor magnetic resonance imaging allows for the evaluation of the structural changes in the SNs that participate in the formation of the brachial plexus. The results can be used for further studies of diffusion-tensor magnetic resonance imaging of brachial plexuses in various pathologies in pediatric patients.
{"title":"Diffusion-tensor magnetic resonance imaging in patients with consequences of obstetric brachial plexus palsy","authors":"Alina M. Khodorovskaya, A. Y. Efimtsev, Olga E. Agronovich, Margarita V. Savina, V. Zorin, S. A. Braylov, Anastasia I. Arakelian, Sergey A. Lukyanov, Aleksandr S. Grishchenkov, Yana A. Filin, D. Vcherashniy, Victoria V. Morozova","doi":"10.17816/ptors630087","DOIUrl":"https://doi.org/10.17816/ptors630087","url":null,"abstract":"BACKGROUND: Diffusion-tensor magnetic resonance imaging allows visualizing the conductive pathways of the brain and spinal cord and assessing their structure and integrity and has found wide application in practical medicine. Currently, brachial plexus diffusion-tensor magnetic resonance imaging is not a routine research technique, and very few studies have described its use in children and adolescents. \u0000AIM: This study aimed to evaluate the possibility of brachial plexus diffusion-tensor magnetic resonance imaging application in pediatric patients with obstetric brachial plexus palsy sequelae and identify correlations between the diffusion-tensor magnetic resonance imaging parameters of brachial plexus and parameters of electrophysiological study of the upper extremities in these patients. \u0000MATERIALS AND METHODS: A complex examination of 50 patients was performed. The main group included 30 patients aged 6–17 years, with contractures and secondary deformities of the bones of the shoulder girdle and upper limbs caused by unilateral obstetric brachial plexus palsy. The control group included 20 patients aged 7–17 (10.1 ± 2.1) years without clinical signs, and anamnestic data indicated the presence of damage to the brachial plexus and peripheral nerves of the upper limbs. \u0000RESULTS: No significant differences in diffusion-tensor magnetic resonance imaging parameters of the right and left brachial plexus were found in the control group. Significant differences in fractional anisotropy of the C5–C8 tracts on the side of the damaged brachial plexus were detected compared with those on the side of the undamaged brachial plexus. On the side of the injured brachial plexus, nonlinear correlations were found between the fractional anisotropy of the tracts of the spinal nerve and its branches and the amplitude of sensory responses from the sensory nerve, which originated from the anterior branches of this spinal nerve, and between the volume of the branches of the tracts of the spinal nerve and the amplitude of соmpound motor responses from the muscles, which were innervated by the anterior branches of this spinal nerve. \u0000CONCLUSIONS: Diffusion-tensor magnetic resonance imaging allows for the evaluation of the structural changes in the SNs that participate in the formation of the brachial plexus. The results can be used for further studies of diffusion-tensor magnetic resonance imaging of brachial plexuses in various pathologies in pediatric patients.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"53 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650049","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}
Andrey V. Sapogovskiy, O. Agranovich, V. Kenis, S. Trofimova, E. Petrova
BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited. AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening. MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test. RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period. CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.
{"title":"Dynamics of feet dorsiflexion after percutaneous Achilles lengthening for correction of flat feet in children","authors":"Andrey V. Sapogovskiy, O. Agranovich, V. Kenis, S. Trofimova, E. Petrova","doi":"10.17816/ptors630489","DOIUrl":"https://doi.org/10.17816/ptors630489","url":null,"abstract":"BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited. \u0000AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening. \u0000MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test. \u0000RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period. \u0000CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649631","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}
Yury A. Novosad, Polina A. Pershina, A. S. Shabunin, M. S. Asadulaev, Olga L. Vlasova, S. V. Vissarionov
BACKGROUND: Despite expanding research, the development of materials for replacing bone defects remains an urgent problem in orthopedics and traumatology. Thus, one of the most important tasks is to create conditions for proper trophicity of the bone implant. AIM: To analyze modern approaches to bone scaffold vascularization and evaluate their adequacy in in vivo models. MATERIALS AND METHODS: The article presents a literature review dedicated to the methods of vascularization of bone scaffolds. A literature search was performed in PubMed, ScienceDirect, eLibrary, and Google Scholar databases from 2013 to 2023 using keywords, and 271 sources were identified. After exclusion, 95 articles were analyzed, and the results of 38 original studies and one literature review were presented. RESULTS: Regardless of the initial vascularization method of scaffolds, bone implants show distinct osteoinductive features and promote advanced bone tissue regeneration. Constructs based on solid polymers and calcium–phosphate compositions also perform osteoconductive functions. Mesenchymal stem cells are used as the main cell type, as well as vessel-type cells, which in cooperation also have a positive effect on bone-defect remodeling. Bone morphogenetic proteins are used for directed differentiation in the osteogenic direction, and vascular endothelial growth factor is used for differentiation in the vascular pathway. CONCLUSIONS: At present, no method for vascularization of scaffolds has been approved universally. In addition, no evidence supported the comparative effectiveness of vascularization methods, whereas animal model studies have demonstrated a positive effect of prevascularized patterns on the recovery rate of minor and critical defects.
{"title":"In vivo application of prevascularized bone scaffolds: A literature review","authors":"Yury A. Novosad, Polina A. Pershina, A. S. Shabunin, M. S. Asadulaev, Olga L. Vlasova, S. V. Vissarionov","doi":"10.17816/ptors622772","DOIUrl":"https://doi.org/10.17816/ptors622772","url":null,"abstract":"BACKGROUND: Despite expanding research, the development of materials for replacing bone defects remains an urgent problem in orthopedics and traumatology. Thus, one of the most important tasks is to create conditions for proper trophicity of the bone implant. \u0000AIM: To analyze modern approaches to bone scaffold vascularization and evaluate their adequacy in in vivo models. \u0000MATERIALS AND METHODS: The article presents a literature review dedicated to the methods of vascularization of bone scaffolds. A literature search was performed in PubMed, ScienceDirect, eLibrary, and Google Scholar databases from 2013 to 2023 using keywords, and 271 sources were identified. After exclusion, 95 articles were analyzed, and the results of 38 original studies and one literature review were presented. \u0000RESULTS: Regardless of the initial vascularization method of scaffolds, bone implants show distinct osteoinductive features and promote advanced bone tissue regeneration. Constructs based on solid polymers and calcium–phosphate compositions also perform osteoconductive functions. Mesenchymal stem cells are used as the main cell type, as well as vessel-type cells, which in cooperation also have a positive effect on bone-defect remodeling. Bone morphogenetic proteins are used for directed differentiation in the osteogenic direction, and vascular endothelial growth factor is used for differentiation in the vascular pathway. \u0000CONCLUSIONS: At present, no method for vascularization of scaffolds has been approved universally. In addition, no evidence supported the comparative effectiveness of vascularization methods, whereas animal model studies have demonstrated a positive effect of prevascularized patterns on the recovery rate of minor and critical defects.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"12 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712983","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}
Darya V. Gorodilova, T. Markova, V. Kenis, E. Melchenko, A. D. Akinshina, N. Y. Ogorodova, O. Shchagina, E. Dadali, S. I. Kutsev
BACKGROUND: Diastrophic dysplasia (OMIM #222600) is a rare congenital autosomal recessive skeletal dysplasia associated with homozygous or compound-heterozygous variants in the sulfate transporter gene SLC26A2. Clinical and radiological descriptions of diastrophic dysplasia in patients of different ages will help improve the diagnosis and orthopedic treatment. AIM: To describe clinical and genetic characteristics of Russian patients with diastrophic dysplasia caused by previously described and newly identified pathogenic SLC26A2 variants. MATERIALS AND METHODS: A comprehensive examination of 28 Russian patients from 28 unrelated families aged 3 months to 34 years with clinical and radiological signs of diastrophic dysplasia was performed. To confirm the diagnosis, genealogical analysis, clinical examination, radiography, and targeted research of SLC26A2 using direct Sanger sequencing were performed. RESULTS: Typical clinical and radiological signs sufficient for diagnosing diastrophic dysplasia in newborns have been identified, which included rhizo/mesomelic shortening of the upper and lower extremities, congenital clubfoot, hand anomalies, multiple dislocations, and joint contractures. In our patients, 14 SLC26A2 variants were identified, 9 of which were first discovered. The most common variant identified in Russian patients with diastrophic dysplasia was c.1957TA (p.Cys653Ser), which accounted for 50% of the alleles. CONCLUSIONS: Clinical and genetic analyses of Russian patients with diastrophic dysplasia made it possible to identify the core clinical and radiological signs and evaluate the polymorphism of the clinical manifestations of the disease. In contrast to previously examined patients from European populations (including Finland with the largest number of patients with diastrophic dysplasia), 50% of the cases in the Russian population are caused by the c.1957TA (p.Cys653Ser) homozygous or compound-heterozygous variant.
{"title":"Clinical, genetic, and orthopedic characteristics of large group of patients with diastrophic dysplasia","authors":"Darya V. Gorodilova, T. Markova, V. Kenis, E. Melchenko, A. D. Akinshina, N. Y. Ogorodova, O. Shchagina, E. Dadali, S. I. Kutsev","doi":"10.17816/ptors626039","DOIUrl":"https://doi.org/10.17816/ptors626039","url":null,"abstract":"BACKGROUND: Diastrophic dysplasia (OMIM #222600) is a rare congenital autosomal recessive skeletal dysplasia associated with homozygous or compound-heterozygous variants in the sulfate transporter gene SLC26A2. Clinical and radiological descriptions of diastrophic dysplasia in patients of different ages will help improve the diagnosis and orthopedic treatment. \u0000AIM: To describe clinical and genetic characteristics of Russian patients with diastrophic dysplasia caused by previously described and newly identified pathogenic SLC26A2 variants. \u0000MATERIALS AND METHODS: A comprehensive examination of 28 Russian patients from 28 unrelated families aged 3 months to 34 years with clinical and radiological signs of diastrophic dysplasia was performed. To confirm the diagnosis, genealogical analysis, clinical examination, radiography, and targeted research of SLC26A2 using direct Sanger sequencing were performed. \u0000RESULTS: Typical clinical and radiological signs sufficient for diagnosing diastrophic dysplasia in newborns have been identified, which included rhizo/mesomelic shortening of the upper and lower extremities, congenital clubfoot, hand anomalies, multiple dislocations, and joint contractures. In our patients, 14 SLC26A2 variants were identified, 9 of which were first discovered. The most common variant identified in Russian patients with diastrophic dysplasia was c.1957TA (p.Cys653Ser), which accounted for 50% of the alleles. \u0000CONCLUSIONS: Clinical and genetic analyses of Russian patients with diastrophic dysplasia made it possible to identify the core clinical and radiological signs and evaluate the polymorphism of the clinical manifestations of the disease. In contrast to previously examined patients from European populations (including Finland with the largest number of patients with diastrophic dysplasia), 50% of the cases in the Russian population are caused by the c.1957TA (p.Cys653Ser) homozygous or compound-heterozygous variant.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"19 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715390","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}
Alina M. Khodorovskaya, O. Agranovich, Margarita V. Savina, Y. Garkavenko, D. Y. Grankin, E. Melchenko, Bagauddin H. Dolgiev, S. А. Braylov, Elena V. Kanorskaya, Victoria V. Morozova
BACKGROUND: Currently, the eponym “Poland syndrome” has become a universal term for clinicians for all pectoral muscle developmental disorders with symbrachydactyly and without. Misinterpretation of the diagnosis in patients with pectoral muscle underdevelopment can narrow the diagnostic search, making it difficult to genetically verify the diagnosis. Thus, this study was conducted. CLINICAL CASE: We present the results of our clinical observation of a 17-year-old adolescent with complaints of restricted movement in the joints of the right hand, right shoulder joint, shortening of the right upper extremity, and chest wall deformity. Orthopedic examination and computed tomography indicated the presence of Poland syndrome, severe Sprengel’s deformity (soft tissue form), severe left-sided keel chest deformity, kyphoscoliosis of the thoracic spine, and Scheiermann–Mau disease. The focal neurological symptoms and associated structural and functional changes in the medulla oblongata were characteristic of the extended Mebius syndrome. DISCUSSION: Modern hypotheses of pathogenesis, clinical features, and possibilities of diagnostics of this syndrome are considered. CONCLUSIONS: The variety of clinical manifestations of the Poland–Mebius syndrome and the current lack of clear genetic markers for both the Mebius syndrome and Poland syndrome hindered the establishment of a consensus among researchers, that is, whether the Poland–Mebius syndrome is an independent disease or a group of individual phenotypic features that are components of previously known syndromes. Further molecular genetic studies may provide a basis for the designation of Poland–Mebius syndrome as a separate entity.
{"title":"Poland–Mebius syndrome: A clinical case and review of the literature","authors":"Alina M. Khodorovskaya, O. Agranovich, Margarita V. Savina, Y. Garkavenko, D. Y. Grankin, E. Melchenko, Bagauddin H. Dolgiev, S. А. Braylov, Elena V. Kanorskaya, Victoria V. Morozova","doi":"10.17816/ptors623349","DOIUrl":"https://doi.org/10.17816/ptors623349","url":null,"abstract":"BACKGROUND: Currently, the eponym “Poland syndrome” has become a universal term for clinicians for all pectoral muscle developmental disorders with symbrachydactyly and without. Misinterpretation of the diagnosis in patients with pectoral muscle underdevelopment can narrow the diagnostic search, making it difficult to genetically verify the diagnosis. Thus, this study was conducted. \u0000CLINICAL CASE: We present the results of our clinical observation of a 17-year-old adolescent with complaints of restricted movement in the joints of the right hand, right shoulder joint, shortening of the right upper extremity, and chest wall deformity. Orthopedic examination and computed tomography indicated the presence of Poland syndrome, severe Sprengel’s deformity (soft tissue form), severe left-sided keel chest deformity, kyphoscoliosis of the thoracic spine, and Scheiermann–Mau disease. The focal neurological symptoms and associated structural and functional changes in the medulla oblongata were characteristic of the extended Mebius syndrome. \u0000DISCUSSION: Modern hypotheses of pathogenesis, clinical features, and possibilities of diagnostics of this syndrome are considered. \u0000CONCLUSIONS: The variety of clinical manifestations of the Poland–Mebius syndrome and the current lack of clear genetic markers for both the Mebius syndrome and Poland syndrome hindered the establishment of a consensus among researchers, that is, whether the Poland–Mebius syndrome is an independent disease or a group of individual phenotypic features that are components of previously known syndromes. Further molecular genetic studies may provide a basis for the designation of Poland–Mebius syndrome as a separate entity.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"21 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715731","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: In children, injuries are the focus of attention both for the increasing incidence and necessity of pain management, and pain can be indicate the severity of injuries or serious complications that worsens the treatment results. Despite the obvious problem, information available in the literature regarding the theoretical and practical aspects of acute pain in children is often contradictory and needs to be systematized. AIM: To present current information about the epidemiology, physiology, diagnosis, and treatment of acute pain in children to pediatric orthopedic and trauma specialists. MATERIALS AND METHODS: Selective analysis and narrative review of relevant studies analyzing the epidemiology, diagnosis, and management of acute pain in children were performed. RESULTS: Although various pain assessment tools are available, the clinical assessment of acute pain in children remains challenging. The use of these tools depends on the child’s age, cognitive and communication skills, and pain location. The term oligoanalgesia has been used to describe inadequate pain relief in the emergency department. Oligoanalgesia in children has negative physiological and psychological effects, sometimes with long-term consequences, and may negatively affect their future pain experiences. Parents often underestimate their child’s pain level and have serious misunderstandings about how children express pain. The World Health Organization has developed recommendations for pain management in children. Ibuprofen and paracetamol are recommended as analgesics for mild-to-moderate pain in children aged 3 months. This choice considered extensive data on the effectiveness and safety. CONCLUSIONS: Personalized management strategies utilizing biopsychosocial approach will ensure that children are treated comprehensively according to their unique pain status.
{"title":"Current concepts in the diagnosis and management of acute pain in children","authors":"V. Kenis","doi":"10.17816/ptors627283","DOIUrl":"https://doi.org/10.17816/ptors627283","url":null,"abstract":"BACKGROUND: In children, injuries are the focus of attention both for the increasing incidence and necessity of pain management, and pain can be indicate the severity of injuries or serious complications that worsens the treatment results. Despite the obvious problem, information available in the literature regarding the theoretical and practical aspects of acute pain in children is often contradictory and needs to be systematized. \u0000AIM: To present current information about the epidemiology, physiology, diagnosis, and treatment of acute pain in children to pediatric orthopedic and trauma specialists. \u0000MATERIALS AND METHODS: Selective analysis and narrative review of relevant studies analyzing the epidemiology, diagnosis, and management of acute pain in children were performed. \u0000RESULTS: Although various pain assessment tools are available, the clinical assessment of acute pain in children remains challenging. The use of these tools depends on the child’s age, cognitive and communication skills, and pain location. The term oligoanalgesia has been used to describe inadequate pain relief in the emergency department. Oligoanalgesia in children has negative physiological and psychological effects, sometimes with long-term consequences, and may negatively affect their future pain experiences. Parents often underestimate their child’s pain level and have serious misunderstandings about how children express pain. The World Health Organization has developed recommendations for pain management in children. Ibuprofen and paracetamol are recommended as analgesics for mild-to-moderate pain in children aged 3 months. This choice considered extensive data on the effectiveness and safety. \u0000CONCLUSIONS: Personalized management strategies utilizing biopsychosocial approach will ensure that children are treated comprehensively according to their unique pain status.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713635","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. V. Umnov, Dmitriy S. Zharkov, V. A. Novikov, Dmitriy V. Umnov
BACKGROUND: The study comprehensively describes the issues of the normal biomechanics of the first toe, first metatarsophalangeal joint, and first ray when walking. Understanding the fundamental processes of the functioning of these structures is a leading aspect in the study of the etiopathogenesis of hallux valgus and is important in treatment planning. AIM: To analyze the literature concerning the kinematic and kinetic indicators of the first toe, first metatarsophalangeal joint, and first ray of the foot when walking in the final support phase. MATERIALS AND METHODS: The characteristics of periods, gait phases, kinetic and kinematic movements were analyzed. RESULTS: To perform a “push-off” when walking, sufficient extension of the first toe in the first metatarsophalangeal joint is necessary, which is fully accomplished only in combination with flexion and eversion of the first ray of the foot. Muscular control of the position of the first toe in the first metatarsophalangeal joint is carried out by the short and long flexors of the first toe with the sesamoid apparatus of the first metatarsal bone, whereas functions of the first ray and midfoot joints are stabilized by the peroneus longus muscle. CONCLUSIONS: The influence of kinematic and kinetic indicators of movements in the lower-limb joints in the horizontal plane on the flexion of the first ray and extension of the first toe in the metatarsophalangeal joint and the determination of the nature and volume of movements in midfoot joints in various phases of the gait cycle remains a pressing issue.
{"title":"Hallux valgus in children. Biomechanical aspect: A literature review","authors":"V. V. Umnov, Dmitriy S. Zharkov, V. A. Novikov, Dmitriy V. Umnov","doi":"10.17816/ptors626283","DOIUrl":"https://doi.org/10.17816/ptors626283","url":null,"abstract":"BACKGROUND: The study comprehensively describes the issues of the normal biomechanics of the first toe, first metatarsophalangeal joint, and first ray when walking. Understanding the fundamental processes of the functioning of these structures is a leading aspect in the study of the etiopathogenesis of hallux valgus and is important in treatment planning. \u0000AIM: To analyze the literature concerning the kinematic and kinetic indicators of the first toe, first metatarsophalangeal joint, and first ray of the foot when walking in the final support phase. \u0000MATERIALS AND METHODS: The characteristics of periods, gait phases, kinetic and kinematic movements were analyzed. \u0000RESULTS: To perform a “push-off” when walking, sufficient extension of the first toe in the first metatarsophalangeal joint is necessary, which is fully accomplished only in combination with flexion and eversion of the first ray of the foot. Muscular control of the position of the first toe in the first metatarsophalangeal joint is carried out by the short and long flexors of the first toe with the sesamoid apparatus of the first metatarsal bone, whereas functions of the first ray and midfoot joints are stabilized by the peroneus longus muscle. \u0000CONCLUSIONS: The influence of kinematic and kinetic indicators of movements in the lower-limb joints in the horizontal plane on the flexion of the first ray and extension of the first toe in the metatarsophalangeal joint and the determination of the nature and volume of movements in midfoot joints in various phases of the gait cycle remains a pressing issue.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712634","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: Aseptic necrosis of the femoral head in school-age children is a severe, rapidly progressive degenerative and dystrophic disease. A significant proportion of girls aged 10 years with osteonecrosis of the femoral head have been professionally engaged in rhythmic gymnastics. The relationship between professional sports, in particular rhythmic gymnastics, and the development of this pathology and the mechanism of impaired blood flow in the femoral head in such cases remains unclear. The severity of the course and serious consequences of this disease in the form of multidimensional deformities of the femoral head, early arthrosis of the hip joint, and persistent disability, require close attention. AIM: To analyze modern world literature data on the etiology, pathomechanics, and features of the course and treatment of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics. MATERIALS AND METHODS: A literature search on the problem of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics in the open information databases was conducted in PubMed, Science Direct, and Library with an analysis depth of 20 years. RESULTS: The analysis of publications on the osteonecrosis of the femoral head allowed us to talk about the etiological connection of this condition with professional rhythmic gymnastics, namely, high-intensity repetitive loads on the hip joint of a child. Studies using in vivo laser Doppler flowmetry and 3D computer modeling prove the occlusion of blood vessel branches encircling the femur under excessive mechanical stress on the femoral head and potentially unfavorable positions in the hip joint – overextension (hyperextension), external rotation, and abduction. CONCLUSIONS: Professional gymnastics can be a risk factor for the development of osteonecrosis of the femoral head. Frequent late disease diagnoses with the development of severe deformity of the femoral head and end-stage coxarthrosis requiring total hip replacement in adolescents determine the need for early identification of the causes of hip pain in children engaged in gymnastics. The findings will help improve treatment results and reduce the number of organ replacement interventions.
背景：学龄儿童股骨头无菌性坏死是一种严重、进展迅速的退行性和萎缩性疾病。在患有股骨头坏死的 10 岁女孩中，有相当一部分曾专业从事艺术体操运动。专业运动，尤其是艺术体操，与股骨头坏死之间的关系以及股骨头血流受损的机制尚不清楚。股骨头多维畸形、髋关节早期关节炎和持续性残疾是该病的严重病程和严重后果，需要密切关注。目的：分析有关专业从事韵律体操的儿童特发性股骨头无菌性坏死的病因、病理力学、病程特点和治疗的现代世界文献数据。材料与方法：以 20 年为分析深度，在 PubMed、Science Direct 和 Library 等开放信息数据库中对专业从事艺术体操的儿童股骨头特发性无菌性坏死问题进行了文献检索。结果：通过对股骨头坏死相关文献的分析，我们发现该病症的病因与专业艺术体操有关，即儿童髋关节受到高强度的重复负荷。使用体内激光多普勒血流测量仪和三维计算机模型进行的研究证明，在股骨头承受过大的机械压力以及髋关节的潜在不利位置--过伸（过度伸展）、外旋和内收的情况下，环绕股骨的血管分支会闭塞。结论：职业体操可能是股骨头坏死的一个危险因素。青少年股骨头严重畸形和终末期髋关节病的晚期诊断率很高，需要进行全髋关节置换术，这就决定了需要及早识别体操儿童髋关节疼痛的原因。这些发现将有助于改善治疗效果，减少器官置换干预的次数。
{"title":"Idiopathic aseptic necrosis of the femoral head in children who are professionally engaged in gymnastics: A literature review","authors":"I. Pozdnikin, P. Bortulev, Dmitrii B. Barsukov","doi":"10.17816/ptors625549","DOIUrl":"https://doi.org/10.17816/ptors625549","url":null,"abstract":"BACKGROUND: Aseptic necrosis of the femoral head in school-age children is a severe, rapidly progressive degenerative and dystrophic disease. A significant proportion of girls aged 10 years with osteonecrosis of the femoral head have been professionally engaged in rhythmic gymnastics. The relationship between professional sports, in particular rhythmic gymnastics, and the development of this pathology and the mechanism of impaired blood flow in the femoral head in such cases remains unclear. The severity of the course and serious consequences of this disease in the form of multidimensional deformities of the femoral head, early arthrosis of the hip joint, and persistent disability, require close attention. \u0000AIM: To analyze modern world literature data on the etiology, pathomechanics, and features of the course and treatment of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics. \u0000MATERIALS AND METHODS: A literature search on the problem of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics in the open information databases was conducted in PubMed, Science Direct, and Library with an analysis depth of 20 years. \u0000RESULTS: The analysis of publications on the osteonecrosis of the femoral head allowed us to talk about the etiological connection of this condition with professional rhythmic gymnastics, namely, high-intensity repetitive loads on the hip joint of a child. Studies using in vivo laser Doppler flowmetry and 3D computer modeling prove the occlusion of blood vessel branches encircling the femur under excessive mechanical stress on the femoral head and potentially unfavorable positions in the hip joint – overextension (hyperextension), external rotation, and abduction. \u0000CONCLUSIONS: Professional gymnastics can be a risk factor for the development of osteonecrosis of the femoral head. Frequent late disease diagnoses with the development of severe deformity of the femoral head and end-stage coxarthrosis requiring total hip replacement in adolescents determine the need for early identification of the causes of hip pain in children engaged in gymnastics. The findings will help improve treatment results and reduce the number of organ replacement interventions.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"6 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713180","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. Khominets, D. A. Konokotin, A. O. Fedotov, A. S. Grankin, Alexandr S. Vorobyev
BACKGROUND: The high frequency and recurrence of chronic patellar instability and the lack of unified treatment techniques indicate the need for a comprehensive individualized approach in the diagnosis and surgical treatment of patellar instability. AIM: To develop an algorithm and compare the anatomical and functional results of its use with those of traditional surgical treatment of patients with patellar instability. MATERIALS AND METHODS: The functional results of the treatment of 194 patients with patellar instability were compared. Two groups of patients were formed. The surgical treatment techniques of the main group (n = 93) were based on the results of the preoperative examination, considering risk factors of instability development, established as a result of retrospective analysis of the control group (n = 101). The effectiveness of the algorithm was compared with the techniques of patellar stabilization used from 2010 to 2015. The Kujala, IKDC 2000, and Lysholm scales were used to assess the functional results of treatment. RESULTS: Surgical treatment of instability aims to eliminate risk factors such as anomalies of the extensor apparatus of the knee joint and to repair or reconstruct damaged structures. Plasty of the medial patellofemoral ligament is the method of choice for patellar stabilization. In the case of dysplastic changes in the patellofemoral joint, combinations of proximal and distal knee joint surgeries were performed. Rotational lower-limb deformities were treated by corrective derotational osteotomy of the femur. Trochleoplasty was performed in cases of type B or D femoral block dysplasia. Patients with stiff lateral patellar retention underwent lateral release or extension tenotomy. In both groups, the functional status of the patients significantly (p 0.05) improved 12 months postoperatively. The mean values of the functional scales increased because of the increased number of patients with excellent and good scores in the group. Higher values were recorded in the main group (Kujala, p = 0.038; IKDC 2000, p = 0.021; Lysholm, p = 0.032). Patellar dislocation recurred in 2 (1.9%) patients in the control group (p = 0.172). CONCLUSIONS: The proposed algorithm helped verify the degree, type, and etiology of patellar instability and helped obtain better anatomofunctional treatment results in patients.
{"title":"Improving surgical treatment of patients with patellar instability","authors":"V. Khominets, D. A. Konokotin, A. O. Fedotov, A. S. Grankin, Alexandr S. Vorobyev","doi":"10.17816/ptors623726","DOIUrl":"https://doi.org/10.17816/ptors623726","url":null,"abstract":"BACKGROUND: The high frequency and recurrence of chronic patellar instability and the lack of unified treatment techniques indicate the need for a comprehensive individualized approach in the diagnosis and surgical treatment of patellar instability. \u0000AIM: To develop an algorithm and compare the anatomical and functional results of its use with those of traditional surgical treatment of patients with patellar instability. \u0000MATERIALS AND METHODS: The functional results of the treatment of 194 patients with patellar instability were compared. Two groups of patients were formed. The surgical treatment techniques of the main group (n = 93) were based on the results of the preoperative examination, considering risk factors of instability development, established as a result of retrospective analysis of the control group (n = 101). The effectiveness of the algorithm was compared with the techniques of patellar stabilization used from 2010 to 2015. The Kujala, IKDC 2000, and Lysholm scales were used to assess the functional results of treatment. \u0000RESULTS: Surgical treatment of instability aims to eliminate risk factors such as anomalies of the extensor apparatus of the knee joint and to repair or reconstruct damaged structures. Plasty of the medial patellofemoral ligament is the method of choice for patellar stabilization. In the case of dysplastic changes in the patellofemoral joint, combinations of proximal and distal knee joint surgeries were performed. Rotational lower-limb deformities were treated by corrective derotational osteotomy of the femur. Trochleoplasty was performed in cases of type B or D femoral block dysplasia. Patients with stiff lateral patellar retention underwent lateral release or extension tenotomy. In both groups, the functional status of the patients significantly (p 0.05) improved 12 months postoperatively. The mean values of the functional scales increased because of the increased number of patients with excellent and good scores in the group. Higher values were recorded in the main group (Kujala, p = 0.038; IKDC 2000, p = 0.021; Lysholm, p = 0.032). Patellar dislocation recurred in 2 (1.9%) patients in the control group (p = 0.172). \u0000CONCLUSIONS: The proposed algorithm helped verify the degree, type, and etiology of patellar instability and helped obtain better anatomofunctional treatment results in patients.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"49 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713613","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. Baindurashvili, S. V. Vissarionov, A. V. Zaletina, Y. Lapkin, Elena N. Schepina
BACKGROUND: The high prevalence of musculoskeletal system and connective tissue diseases, effects on the quality of life of children, and disability level are among the main medical and social problems. AIM: To assess the morbidity rates and provision of medical care to St. Petersburg children with musculoskeletal diseases between 2017 and 2021. MATERIALS AND METHODS: Data on the incidence of musculoskeletal diseases in children of St. Petersburg were analyzed based on the Federal statistical observation forms submitted by the St. Petersburg State Budgetary Institution Medical Center for Information and Analysis, collections of N.N. Priorov National Medical Research Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation “Trauma, orthopedic morbidity, the state of trauma and orthopedic care for the population,” edited by Acad. S.P. Mironov, RAS, and data from the Federal State Statistics Service. RESULTS: In Saint Petersburg, the morbidity rate of musculoskeletal and connective tissue diseases from 2017 to 2021 was 13%, excluding 2020, which was most likely due to the introduction of measures aimed at counteracting the spread of COVID-19 and the suspension of planned outpatient specialized care. The number of orthopedic beds for children decreased by 58, whereas the availability of beds for children remained at the same level and amounted to 4.3 beds per 10,000 children, which exceeded the indicator for the Russian Federation (1.0). The number of children with these disabilities increased 1.4-fold. Deaths of children due to musculoskeletal and connective tissue diseases were recorded in 2019 and 2020. CONCLUSIONS: The results of the 5-year observation period of musculoskeletal and connective tissue diseases in children in St. Petersburg revealed increasing incidence because of the increase in the number of children newly diagnosed with these diseases.
{"title":"Incidence of the musculoskeletal system diseases in children and the organization of specialized care in Saint Petersburg","authors":"A. Baindurashvili, S. V. Vissarionov, A. V. Zaletina, Y. Lapkin, Elena N. Schepina","doi":"10.17816/ptors626498","DOIUrl":"https://doi.org/10.17816/ptors626498","url":null,"abstract":"BACKGROUND: The high prevalence of musculoskeletal system and connective tissue diseases, effects on the quality of life of children, and disability level are among the main medical and social problems. \u0000AIM: To assess the morbidity rates and provision of medical care to St. Petersburg children with musculoskeletal diseases between 2017 and 2021. \u0000MATERIALS AND METHODS: Data on the incidence of musculoskeletal diseases in children of St. Petersburg were analyzed based on the Federal statistical observation forms submitted by the St. Petersburg State Budgetary Institution Medical Center for Information and Analysis, collections of N.N. Priorov National Medical Research Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation “Trauma, orthopedic morbidity, the state of trauma and orthopedic care for the population,” edited by Acad. S.P. Mironov, RAS, and data from the Federal State Statistics Service. \u0000RESULTS: In Saint Petersburg, the morbidity rate of musculoskeletal and connective tissue diseases from 2017 to 2021 was 13%, excluding 2020, which was most likely due to the introduction of measures aimed at counteracting the spread of COVID-19 and the suspension of planned outpatient specialized care. The number of orthopedic beds for children decreased by 58, whereas the availability of beds for children remained at the same level and amounted to 4.3 beds per 10,000 children, which exceeded the indicator for the Russian Federation (1.0). The number of children with these disabilities increased 1.4-fold. Deaths of children due to musculoskeletal and connective tissue diseases were recorded in 2019 and 2020. \u0000CONCLUSIONS: The results of the 5-year observation period of musculoskeletal and connective tissue diseases in children in St. Petersburg revealed increasing incidence because of the increase in the number of children newly diagnosed with these diseases.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"23 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716172","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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