Vladimir A. Novikov, Valery V. Umnov, Dmitriy S. Zharkov, Dmitriy V. Umnov, Alexey V. Zvozil, Olga V. Barlova, Sergei V. Vissarionov
BACKGROUND: A combination of movement disorders with contractures in the joints is a feature of upper limb lesions in patients with spastic forms of cerebral palsy. As part of the spastic hand syndrome, contractures are differentiated into primary and secondary. Primary contractures are caused by muscle spasticity, whereas secondary contractures are caused by the structural shortening of the muscle motor segment in relation to the bone, which can subsequently lead to deformities of articular surfaces. In theory, the use of diagnostic blockade as a mandatory procedure in patient examination before selective neurotomy of the peripheral nerves on the upper limb makes it possible to optimize the result of tone-lowering treatment because of the accurate selection and exact category of patients in whom neurosurgical treatment can be effective.
AIM: To assess the prognostic effectiveness of diagnostic blockade for modeling the result of selective neurotomy of the motor branches of the musculocutaneous nerve in patients with cerebral palsy.
MATERIALS AND METHODS: This longitudinal prospective study included an examination of 31 patients aged 517 years with spastic forms of cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic blockade of the n. musculocutaneus under ultrasonography and neurostimulation. Before and after the diagnostic blockade and after the neurosurgical treatment, each patient was examined for the amplitude of passive and active joint movements, muscle tone, hand functionality, and dynamometry.
RESULTS: Results of the data analysis showed a significant relationship between the state of the elbow joint during the simulation of surgical treatment and after neurosurgical treatment.
CONCLUSIONS: The study showed the high prognostic effectiveness of diagnostic blockades when deciding on the techniques of treating tonic flexion contractures of the elbow joint as part of the spastic arm syndrome. The diagnostic blockade of the musculocutaneous nerve during the planning of surgical treatment makes it possible to create a reliable temporal model of selective neurotomy of the motor nerve branches.
{"title":"Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the musculocutaneous nerve in patients with cerebral palsy","authors":"Vladimir A. Novikov, Valery V. Umnov, Dmitriy S. Zharkov, Dmitriy V. Umnov, Alexey V. Zvozil, Olga V. Barlova, Sergei V. Vissarionov","doi":"10.17816/ptors465738","DOIUrl":"https://doi.org/10.17816/ptors465738","url":null,"abstract":"BACKGROUND: A combination of movement disorders with contractures in the joints is a feature of upper limb lesions in patients with spastic forms of cerebral palsy. As part of the spastic hand syndrome, contractures are differentiated into primary and secondary. Primary contractures are caused by muscle spasticity, whereas secondary contractures are caused by the structural shortening of the muscle motor segment in relation to the bone, which can subsequently lead to deformities of articular surfaces. In theory, the use of diagnostic blockade as a mandatory procedure in patient examination before selective neurotomy of the peripheral nerves on the upper limb makes it possible to optimize the result of tone-lowering treatment because of the accurate selection and exact category of patients in whom neurosurgical treatment can be effective.
 AIM: To assess the prognostic effectiveness of diagnostic blockade for modeling the result of selective neurotomy of the motor branches of the musculocutaneous nerve in patients with cerebral palsy.
 MATERIALS AND METHODS: This longitudinal prospective study included an examination of 31 patients aged 517 years with spastic forms of cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic blockade of the n. musculocutaneus under ultrasonography and neurostimulation. Before and after the diagnostic blockade and after the neurosurgical treatment, each patient was examined for the amplitude of passive and active joint movements, muscle tone, hand functionality, and dynamometry.
 RESULTS: Results of the data analysis showed a significant relationship between the state of the elbow joint during the simulation of surgical treatment and after neurosurgical treatment.
 CONCLUSIONS: The study showed the high prognostic effectiveness of diagnostic blockades when deciding on the techniques of treating tonic flexion contractures of the elbow joint as part of the spastic arm syndrome. The diagnostic blockade of the musculocutaneous nerve during the planning of surgical treatment makes it possible to create a reliable temporal model of selective neurotomy of the motor nerve branches.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135198213","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}
Seidali S. Abdaliyev, Daniyar Zh. Yestay, Sergei V. Vissarionov, Daulet T. Baitov, Serik Zh. Serikov, Alexandr Yu. Chsherbina
BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients.
AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy.
MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 318 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group.
RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to GertzbeinRobbins classes CE was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups.
CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.
{"title":"Computed tomography-guided intraoperative navigation in children with congenital scoliosis versus freehand/fluoroscopy methods","authors":"Seidali S. Abdaliyev, Daniyar Zh. Yestay, Sergei V. Vissarionov, Daulet T. Baitov, Serik Zh. Serikov, Alexandr Yu. Chsherbina","doi":"10.17816/ptors473150","DOIUrl":"https://doi.org/10.17816/ptors473150","url":null,"abstract":"BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients.
 AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy.
 MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 318 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group.
 RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to GertzbeinRobbins classes CE was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups.
 CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135198456","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: Infectious complications in pediatric traumatology and orthopedics are relatively rare. Publications on this issue are less common than in the adult population. However, the resulting complications often lead to a persistent anatomical and functional defect, bearing the economic burden and legal consequences.
AIM: To analyze a clinical series of pediatric patients with infectious complications of injuries and surgical interventions in the skeletal system.
MATERIALS AND METHODS: A retrospective analysis of the clinical series of patients over 5 years was conducted. The study involved children aged 18 years. A sample of 34 children was included. The average age was 13.5 (minmax, 417 years). Patients with infectious and inflammatory complications after mechanical and/or surgical trauma, availability of a complete data archive (anamnesis, radiation therapy, and medical documentation), traced relief of inflammatory phenomena, and achievement of remission of the chronic process for more than 6 months were included.
RESULTS: Infectious complications of injuries were noted in 26 (76%) patients, complications of orthopedic interventions in 8 (24%), and open injuries in 9 (34%). The injuries were isolated in 11 (42%) children, multiple trauma in 5 (19%), and combined in 10 (39%) patients. Defects of large skeletal segments were common: the thigh in 8 (24%) patients, humerus in 5 (15%), shin in 5 (15%), and spine in 4 (12%). Five (15%) had infection of the pelvic bones, and one patient had infectious complications in the lower jaw, collarbone, elbow joint, knee joint arthritis, and foot bones. Superficial infection of the surgical intervention area was noted in 3 cases (9%), deep infection in 27 (79%), and posttraumatic osteomyelitis in 4 (12%). The average duration of the diagnostic pause was 33 days, and the therapeutic pause was 36 days. Antibacterial prophylaxis before surgery for closed injuries and orthopedic operations was carried out in only 17 patients. Bacteriological verification was not performed in 8 (23.5%) patients with complications. In 9 (26%) patients, it was not possible to identify a microbial agent in the presence of a clinical picture. The structure of pathogens correlates with the literature data on the problem in the adult population. In 10 out of 25 positive bacteriological studies, polyresistant strains were isolated. Thirty-three children underwent surgery, and the basic principle is radical surgical rehabilitation. The average number of interventions performed was 3 (minmax, 112). Stable relief of the infectious and inflammatory process has been achieved in all cases. The average period of inpatient treatment was 39 days, recovery was achieved in 24 (71%) children, and persistent anatomical and functional defect and disability were noted in 10 (29%) children.
CONCLUSIONS: Infectious complications in pediatric traumatology should be considered a complex multidisciplinary problem, and part of the
{"title":"Infectious complications in pediatric traumatology and orthopedics (analysis of clinical series)","authors":"Vyacheslav I. Zorin, Maksim E. Zuev","doi":"10.17816/ptors430201","DOIUrl":"https://doi.org/10.17816/ptors430201","url":null,"abstract":"BACKGROUND: Infectious complications in pediatric traumatology and orthopedics are relatively rare. Publications on this issue are less common than in the adult population. However, the resulting complications often lead to a persistent anatomical and functional defect, bearing the economic burden and legal consequences.
 AIM: To analyze a clinical series of pediatric patients with infectious complications of injuries and surgical interventions in the skeletal system.
 MATERIALS AND METHODS: A retrospective analysis of the clinical series of patients over 5 years was conducted. The study involved children aged 18 years. A sample of 34 children was included. The average age was 13.5 (minmax, 417 years). Patients with infectious and inflammatory complications after mechanical and/or surgical trauma, availability of a complete data archive (anamnesis, radiation therapy, and medical documentation), traced relief of inflammatory phenomena, and achievement of remission of the chronic process for more than 6 months were included.
 RESULTS: Infectious complications of injuries were noted in 26 (76%) patients, complications of orthopedic interventions in 8 (24%), and open injuries in 9 (34%). The injuries were isolated in 11 (42%) children, multiple trauma in 5 (19%), and combined in 10 (39%) patients. Defects of large skeletal segments were common: the thigh in 8 (24%) patients, humerus in 5 (15%), shin in 5 (15%), and spine in 4 (12%). Five (15%) had infection of the pelvic bones, and one patient had infectious complications in the lower jaw, collarbone, elbow joint, knee joint arthritis, and foot bones. Superficial infection of the surgical intervention area was noted in 3 cases (9%), deep infection in 27 (79%), and posttraumatic osteomyelitis in 4 (12%). The average duration of the diagnostic pause was 33 days, and the therapeutic pause was 36 days. Antibacterial prophylaxis before surgery for closed injuries and orthopedic operations was carried out in only 17 patients. Bacteriological verification was not performed in 8 (23.5%) patients with complications. In 9 (26%) patients, it was not possible to identify a microbial agent in the presence of a clinical picture. The structure of pathogens correlates with the literature data on the problem in the adult population. In 10 out of 25 positive bacteriological studies, polyresistant strains were isolated. Thirty-three children underwent surgery, and the basic principle is radical surgical rehabilitation. The average number of interventions performed was 3 (minmax, 112). Stable relief of the infectious and inflammatory process has been achieved in all cases. The average period of inpatient treatment was 39 days, recovery was achieved in 24 (71%) children, and persistent anatomical and functional defect and disability were noted in 10 (29%) children.
 CONCLUSIONS: Infectious complications in pediatric traumatology should be considered a complex multidisciplinary problem, and part of the","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135198461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. A. Novikov, V. V. Umnov, D. V. Umnov, Alexey V. Zvozil, D. S. Zharkov, A.R. Mustafaeva, S. Vissarionov
BACKGROUND:Posture disorders and spinal deformity in the sagittal plane (kyphotic deformity of the thoracic region and lumbar hyperlordosis in combination with pelvic inclination) are quite common in patients with cerebral palsy. However, their relationship with the frontal indicators of the hip joint is not reported in the scientific literature. AIM:To reveal the relationship between the radiographic frontal indicators of the hip joint and the indicators of the spinal-pelvic sagittal balance in patients with cerebral palsy. MATERIALS AND METHODS:Atransverse study of the X-ray parameters of the hip joints in the frontal plane and sagittal vertebral-pelvic profile was performed in 46 patients with cerebral palsy aged 515 (mean age, 8.2 3.6) years. RESULTS:Asignificant difference from the norm was found in the following parameters: cervical-diaphyseal angle, pelvic tilt angle, pelvic tilt angle, sacral tilt angle, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis deviation (p 0.05). The Sharp angle, migration index, Wiberg angle, and thoracic kyphosis were normal. Measurements of the frontal radiographic parameters of the right and left hip joints do not differ significantly from each other. The pelvic tilt showedapositive and strong correlation with pelvic tilt (p= 0.71).Apositive and moderate correlation was found determined betweenasequential chain of related elements of the axial skeleton, namely, sacral inclination-lumbar lordosis (p= 0.66) and lumbar lordosis-thoracic kyphosis (p= 0.41). The deviation of the sagittal vertical axis negatively correlated with lumbar lordosis (p= 0.69) and thoracic kyphosis (p= 0.38). The results demonstrateanegative and weak correlation between SDA and sacral tilt (p= 0.40). CONCLUSIONS:The results of this study indicateacorrelation between the inclination of the sacrum and the lumbar spine in patients with cerebral palsy, which confirms the main theories of the formation of excessive lumbar lordosis of the spine in these patients and allows us to develop pathogenetic preventive measures against spinal deformities. In this study, we failed to identifyasignificant relationship between the frontal radiographic parameters of the hip joint and sagittal pelvic-vertebral profile. However, hip joint instability inachild with cerebral palsy can playasignificant role in the occurrence and development of sagittal spinal deformities.
{"title":"Correlation between frontal X-ray parameters of the hip joint and sagittal vertebral-pelvic profile in patients with cerebral palsy","authors":"V. A. Novikov, V. V. Umnov, D. V. Umnov, Alexey V. Zvozil, D. S. Zharkov, A.R. Mustafaeva, S. Vissarionov","doi":"10.17816/ptors321909","DOIUrl":"https://doi.org/10.17816/ptors321909","url":null,"abstract":"BACKGROUND:Posture disorders and spinal deformity in the sagittal plane (kyphotic deformity of the thoracic region and lumbar hyperlordosis in combination with pelvic inclination) are quite common in patients with cerebral palsy. However, their relationship with the frontal indicators of the hip joint is not reported in the scientific literature. \u0000AIM:To reveal the relationship between the radiographic frontal indicators of the hip joint and the indicators of the spinal-pelvic sagittal balance in patients with cerebral palsy. \u0000MATERIALS AND METHODS:Atransverse study of the X-ray parameters of the hip joints in the frontal plane and sagittal vertebral-pelvic profile was performed in 46 patients with cerebral palsy aged 515 (mean age, 8.2 3.6) years. \u0000RESULTS:Asignificant difference from the norm was found in the following parameters: cervical-diaphyseal angle, pelvic tilt angle, pelvic tilt angle, sacral tilt angle, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis deviation (p 0.05). The Sharp angle, migration index, Wiberg angle, and thoracic kyphosis were normal. Measurements of the frontal radiographic parameters of the right and left hip joints do not differ significantly from each other. The pelvic tilt showedapositive and strong correlation with pelvic tilt (p= 0.71).Apositive and moderate correlation was found determined betweenasequential chain of related elements of the axial skeleton, namely, sacral inclination-lumbar lordosis (p= 0.66) and lumbar lordosis-thoracic kyphosis (p= 0.41). The deviation of the sagittal vertical axis negatively correlated with lumbar lordosis (p= 0.69) and thoracic kyphosis (p= 0.38). The results demonstrateanegative and weak correlation between SDA and sacral tilt (p= 0.40). \u0000CONCLUSIONS:The results of this study indicateacorrelation between the inclination of the sacrum and the lumbar spine in patients with cerebral palsy, which confirms the main theories of the formation of excessive lumbar lordosis of the spine in these patients and allows us to develop pathogenetic preventive measures against spinal deformities. In this study, we failed to identifyasignificant relationship between the frontal radiographic parameters of the hip joint and sagittal pelvic-vertebral profile. However, hip joint instability inachild with cerebral palsy can playasignificant role in the occurrence and development of sagittal spinal deformities.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"291 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79475315","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.I. Arakelyan, V. Zorin, E. A. Zakharyan, M. S. Nikitin, S. Semenov
BACKGROUND:Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation ofanosteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology. AIM:To evaluate the efficacy of treatment inasmall clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area. MATERIALS AND METHODS:Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was10 (611)months, withamaximum duration of 12 months. RESULTS:The observation results demonstrateahigh efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans. CONCLUSIONS:The use of orthobiological technologies isanactively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.
{"title":"Prospects for the use of platelet-rich plasma in the complex treatment of stage II–III osteochondritis dissecans of femoral condyles in children: A preliminary report","authors":"A.I. Arakelyan, V. Zorin, E. A. Zakharyan, M. S. Nikitin, S. Semenov","doi":"10.17816/ptors121338","DOIUrl":"https://doi.org/10.17816/ptors121338","url":null,"abstract":"BACKGROUND:Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation ofanosteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology. \u0000AIM:To evaluate the efficacy of treatment inasmall clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area. \u0000MATERIALS AND METHODS:Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was10 (611)months, withamaximum duration of 12 months. \u0000RESULTS:The observation results demonstrateahigh efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans. \u0000CONCLUSIONS:The use of orthobiological technologies isanactively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"223 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89033395","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, Dmitry Y. Vybornov, P. V. Goncharuk, A. Evdokimov, L. Y. Idris, Alexander A. Smirnov, R. Khagurov, N. Y. Alexandrova
BACKGROUND:Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Onlyafew publications explored this problem in children. In this study, we presentasurgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the antenna procedure and the reverse-flow homodigital island flap. CLINICAL CASES:Aseries of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, andanacceptable appearance, and function of the fingers were achieved. DISCUSSION:Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases. CONCLUSIONS:We consider the combination of the antenna procedure and reverse-flow homodigital island flap asajustified method. However, issues raised in this technique require further investigation.
{"title":"Hook nail deformity correction by the combination of the antenna procedure and reverse-flow homodigital island flap: Description of clinical cases","authors":"A. Alexandrov, Dmitry Y. Vybornov, P. V. Goncharuk, A. Evdokimov, L. Y. Idris, Alexander A. Smirnov, R. Khagurov, N. Y. Alexandrova","doi":"10.17816/ptors321717","DOIUrl":"https://doi.org/10.17816/ptors321717","url":null,"abstract":"BACKGROUND:Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Onlyafew publications explored this problem in children. In this study, we presentasurgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the antenna procedure and the reverse-flow homodigital island flap. \u0000CLINICAL CASES:Aseries of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, andanacceptable appearance, and function of the fingers were achieved. \u0000DISCUSSION:Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases. \u0000CONCLUSIONS:We consider the combination of the antenna procedure and reverse-flow homodigital island flap asajustified method. However, issues raised in this technique require further investigation.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83746932","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. Vissarionov, A. V. Zaletina, Y. Lapkin, Elena N. Schepina
BACKGROUND:Increasing rates of childhood trauma, poisoning, and sequelae of environmental exposure not only reduce the quality of life of children and their families but also lead to disability and death. Statistical analysis of childhood trauma data makes it possible to define risk age groups among children and adolescents, identify the causes of the decrease or increase in the rates, estimate the level of medical care, and make necessary management decisions. AIM:To assess the state of childhood trauma in St. Petersburg and its changes in 5 years (20162020) and the provision of inpatient trauma care. MATERIALS AND METHODS:Data on childhood trauma in St. Petersburg were analyzed based on the analysis of 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:From 2016 to 2019, the frequency of trauma, poisoning, and sequelae of environmental exposure in children of St. Petersburg slightly increased. In 2020, owing to the COVID-19 pandemic, childhood trauma rates decreased, and the most significant decrease in trauma rates was recorded at 32%36% in adolescents aged 1517 years. Despite the overall decrease in childhood trauma in 2020, the structure of trauma due to environmental exposure revealedan81% increase in transport accidents, compared with previous years, anda39% increase in trauma due to injuries with undetermined intentions. For 5 years, the number of beds was reduced, and by 2020, the provision of trauma, and orthopedic beds for children in St. Petersburg was 1.4 beds per 10 thousand children, which corresponds to the data for Russia. CONCLUSIONS:The incidence of traumatic injuries slightly increased in children in St. Petersburg, mostly in children aged 04 years, and mortality from environmental exposure also increased in adolescence.Acorrelation was found between the COVID-19 pandemic andadecrease in the number of visits and hospital admissions of children with trauma to medical institutions. Moreover, the incidence of severe, high-energy injuries that require more serious treatment approaches also increased, as evidenced by the annual increase in the number of surgical interventions in children with traumatic injuries. The new form of statistical reporting does not allow us to determine all causes of trauma. The provision of trauma care for children in St. Petersburg remains atanappropriate level.
{"title":"Trauma rates in children in Saint Petersburg and inpatient trauma care","authors":"A. Baindurashvili, S. Vissarionov, A. V. Zaletina, Y. Lapkin, Elena N. Schepina","doi":"10.17816/ptors159389","DOIUrl":"https://doi.org/10.17816/ptors159389","url":null,"abstract":"BACKGROUND:Increasing rates of childhood trauma, poisoning, and sequelae of environmental exposure not only reduce the quality of life of children and their families but also lead to disability and death. Statistical analysis of childhood trauma data makes it possible to define risk age groups among children and adolescents, identify the causes of the decrease or increase in the rates, estimate the level of medical care, and make necessary management decisions. \u0000AIM:To assess the state of childhood trauma in St. Petersburg and its changes in 5 years (20162020) and the provision of inpatient trauma care. \u0000MATERIALS AND METHODS:Data on childhood trauma in St. Petersburg were analyzed based on the analysis of 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:From 2016 to 2019, the frequency of trauma, poisoning, and sequelae of environmental exposure in children of St. Petersburg slightly increased. In 2020, owing to the COVID-19 pandemic, childhood trauma rates decreased, and the most significant decrease in trauma rates was recorded at 32%36% in adolescents aged 1517 years. Despite the overall decrease in childhood trauma in 2020, the structure of trauma due to environmental exposure revealedan81% increase in transport accidents, compared with previous years, anda39% increase in trauma due to injuries with undetermined intentions. For 5 years, the number of beds was reduced, and by 2020, the provision of trauma, and orthopedic beds for children in St. Petersburg was 1.4 beds per 10 thousand children, which corresponds to the data for Russia. \u0000CONCLUSIONS:The incidence of traumatic injuries slightly increased in children in St. Petersburg, mostly in children aged 04 years, and mortality from environmental exposure also increased in adolescence.Acorrelation was found between the COVID-19 pandemic andadecrease in the number of visits and hospital admissions of children with trauma to medical institutions. Moreover, the incidence of severe, high-energy injuries that require more serious treatment approaches also increased, as evidenced by the annual increase in the number of surgical interventions in children with traumatic injuries. The new form of statistical reporting does not allow us to determine all causes of trauma. The provision of trauma care for children in St. Petersburg remains atanappropriate level.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86876586","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}
N. Khusainov, D. Kokushin, A. Filippova, S. Vissarionov
BACKGROUND:Congenital cervical spinal deformities due to hemivertebrae are rare and serious entities that are difficult to solve because of anatomical obstacles in the cervical region and the lack of treatment experience of such patients. AIM:To analyze current literature dedicated to the surgical treatment of patients with congenital scoliotic deformities. MATERIALS AND METHODS:We searched for studies evaluating the results and surgical management of patients with cervical hemivertebrae. The literature search was performed using keywords and similar articles in PubMed, Science Direct, and Google Scholar. The depth of the search was 50 years. RESULTS:No studies have explored the issue of the surgical management of patients with congenital cervical scoliotic deformities because of the rarity and complexity of treatment. Still, data are sufficient to developanefficient and safe algorithm. CONCLUSIONS:Despite the complexity and lack of treatment experience in such patients, modern technologies for perioperative planning and surgical management allow for remarkable improvement of patients quality of life without serious complications.
{"title":"Cervical hemivertebrae: A literature review on the evolution of surgical management and its results","authors":"N. Khusainov, D. Kokushin, A. Filippova, S. Vissarionov","doi":"10.17816/ptors321403","DOIUrl":"https://doi.org/10.17816/ptors321403","url":null,"abstract":"BACKGROUND:Congenital cervical spinal deformities due to hemivertebrae are rare and serious entities that are difficult to solve because of anatomical obstacles in the cervical region and the lack of treatment experience of such patients. \u0000AIM:To analyze current literature dedicated to the surgical treatment of patients with congenital scoliotic deformities. \u0000MATERIALS AND METHODS:We searched for studies evaluating the results and surgical management of patients with cervical hemivertebrae. The literature search was performed using keywords and similar articles in PubMed, Science Direct, and Google Scholar. The depth of the search was 50 years. \u0000RESULTS:No studies have explored the issue of the surgical management of patients with congenital cervical scoliotic deformities because of the rarity and complexity of treatment. Still, data are sufficient to developanefficient and safe algorithm. \u0000CONCLUSIONS:Despite the complexity and lack of treatment experience in such patients, modern technologies for perioperative planning and surgical management allow for remarkable improvement of patients quality of life without serious complications.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73889541","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:Ahuman tail isarare congenital malformation that corresponds to the protrusion on the dorsal side of the lumbar, sacrococcygeal, and paraanal regions. This study aimed to demonstrate three rare clinical cases ofatail-shaped formation caused by the protrusion ofanelongated coccyx in children. CLINICAL CASES:These patients asked for medical assistance for pain felt in the sitting position and daily discomfort because this formation barely contains any tissues other than the coccyx. The patients had no signs of neurological and lower urinary tract insufficiency. In all cases, the retroposition of the coccyx without its typical anterior angulation was determined based on radiographic and magnetic resonance imaging (MRI) signs. In one case, the coccyx was represented by four elongated vertebrae withoutatypical decrease in the size of the vertebrae in the caudal direction. In two cases,anangular deformity of the coccyx occurred at the level of CoIIIwith intercoccygeal angles of 138 and 140. DISCUSSION:The tail-like formations could be classified as pseudo-tails according to the classification by Dao and Netsky (1984) and type Ia human tails according to the classification by Tojima and Yamada (2020). CONCLUSIONS:The most important feature of tail-shaped formation is the connection with occult dysraphic malformations, which requiresacomprehensive preoperative examination in each case (neurological examination, radiography, computed tomography, and MRI). Careless surgery may lead to serious consequences that significantly impair patients quality of life.
{"title":"“Human tail”: Case reports of coccyx retroposition in children","authors":"S. Trofimova, D. S. Buklaev, T. Murashko","doi":"10.17816/ptors397591","DOIUrl":"https://doi.org/10.17816/ptors397591","url":null,"abstract":"BACKGROUND:Ahuman tail isarare congenital malformation that corresponds to the protrusion on the dorsal side of the lumbar, sacrococcygeal, and paraanal regions. This study aimed to demonstrate three rare clinical cases ofatail-shaped formation caused by the protrusion ofanelongated coccyx in children. \u0000CLINICAL CASES:These patients asked for medical assistance for pain felt in the sitting position and daily discomfort because this formation barely contains any tissues other than the coccyx. The patients had no signs of neurological and lower urinary tract insufficiency. In all cases, the retroposition of the coccyx without its typical anterior angulation was determined based on radiographic and magnetic resonance imaging (MRI) signs. In one case, the coccyx was represented by four elongated vertebrae withoutatypical decrease in the size of the vertebrae in the caudal direction. In two cases,anangular deformity of the coccyx occurred at the level of CoIIIwith intercoccygeal angles of 138 and 140. \u0000DISCUSSION:The tail-like formations could be classified as pseudo-tails according to the classification by Dao and Netsky (1984) and type Ia human tails according to the classification by Tojima and Yamada (2020). \u0000CONCLUSIONS:The most important feature of tail-shaped formation is the connection with occult dysraphic malformations, which requiresacomprehensive preoperative examination in each case (neurological examination, radiography, computed tomography, and MRI). Careless surgery may lead to serious consequences that significantly impair patients quality of life.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87907588","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. M. Guryanov, Vladimir I. Studenov, Andrey A. Averyanov, T. Bykov, Andrey P. Klimov, M. A. Guryanova
BACKGROUND:In cerebral palsy, shortening of the triceps muscle of the lower leg leads to impaired coordination and gait and orthopedic consequences that disrupt the quality of life and complicate rehabilitation. Many surgical techniques are aimed at eliminating contractures and restoring ankle joint movements. However, treatment results are not always satisfactory, and the number of complications remains high, such as recurrence of deformation and failure of the tendon suture after tenotomy. AIM:To analyze the results of calcaneal tendon lengthening plastic surgery with the original tendon suture technique in patients with cerebral palsy complications and consider the features of surgical technique onaclinical example. MATERIALS AND METHODS:This study describes the lengthening plastic surgery of the calcaneal tendon with the original tendon suture technique performed in four patients with complications of cerebral palsy. The clinical observations of the surgical treatment ofa30-year-old patient with spastic paresis of the triceps muscle of the left tibia were presented. The treatment results were followed from 1 to 12 months postoperatively. The amplitude of active and passive movements in the joints, muscle tone, presence and nature of postoperative complications, and functional outcome were evaluated. RESULTS:The results 1 year after the operation were evaluated as good in two initially more severe cases and excellent in two cases. In all patients, decreased pain level, restoration of movements, decreased hypertension, and hypotrophy of the triceps muscle of the lower leg were observed, and no complications were noted. CONCLUSIONS:The results revealed data on the pathogenetic validity of calcaneal tendon elongation in patients with spastic paralysis of the triceps muscle of the lower leg. The proposed original method of surgical treatment ensures the correct anatomical comparison and density of the contact of the tendon ends, reduces the tone of the calf-flounder complex, preserves joint physiological mobility, begins early rehabilitation, and reduces the likelihood of relapse.
{"title":"Elongating achilloplasty and the original tenorraphy technique for cerebral palsy","authors":"A. M. Guryanov, Vladimir I. Studenov, Andrey A. Averyanov, T. Bykov, Andrey P. Klimov, M. A. Guryanova","doi":"10.17816/ptors352489","DOIUrl":"https://doi.org/10.17816/ptors352489","url":null,"abstract":"BACKGROUND:In cerebral palsy, shortening of the triceps muscle of the lower leg leads to impaired coordination and gait and orthopedic consequences that disrupt the quality of life and complicate rehabilitation. Many surgical techniques are aimed at eliminating contractures and restoring ankle joint movements. However, treatment results are not always satisfactory, and the number of complications remains high, such as recurrence of deformation and failure of the tendon suture after tenotomy. \u0000AIM:To analyze the results of calcaneal tendon lengthening plastic surgery with the original tendon suture technique in patients with cerebral palsy complications and consider the features of surgical technique onaclinical example. \u0000MATERIALS AND METHODS:This study describes the lengthening plastic surgery of the calcaneal tendon with the original tendon suture technique performed in four patients with complications of cerebral palsy. The clinical observations of the surgical treatment ofa30-year-old patient with spastic paresis of the triceps muscle of the left tibia were presented. The treatment results were followed from 1 to 12 months postoperatively. The amplitude of active and passive movements in the joints, muscle tone, presence and nature of postoperative complications, and functional outcome were evaluated. \u0000RESULTS:The results 1 year after the operation were evaluated as good in two initially more severe cases and excellent in two cases. In all patients, decreased pain level, restoration of movements, decreased hypertension, and hypotrophy of the triceps muscle of the lower leg were observed, and no complications were noted. \u0000CONCLUSIONS:The results revealed data on the pathogenetic validity of calcaneal tendon elongation in patients with spastic paralysis of the triceps muscle of the lower leg. The proposed original method of surgical treatment ensures the correct anatomical comparison and density of the contact of the tendon ends, reduces the tone of the calf-flounder complex, preserves joint physiological mobility, begins early rehabilitation, and reduces the likelihood of relapse.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90761732","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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