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}
BACKGROUND:PIEZO1 and PIEZO2 are mechanosensitive ion channel proteins; in humans, they are encoded by genes with identical names. PIEZO proteins convert mechanical signals into biochemical cellular responses following transduction. Recent data highlight the importance of this family of ion channel proteins in the regulation of physiological processes; however, many mechanisms remain unknown. Modern studies have proven thatPIEZO2mutations lead to the development of various forms of distal arthrogryposis. AIM:To analyze publications containing information onPIEZO2gene and its role in the development of distal forms of arthrogryposis. MATERIALS AND METHODS:This study analyzed the results ofaliterature search in the open scientific literature databases of PubMed, Cochrane Library, and eLibrary. Consequently, 40 foreign, and domestic scientific sources were extracted from 1969 to 2022. RESULTS:This study showed the relationship betweenPIEZO2mutations and the development of the distal forms of arthrogryposis. The study also presented the types of distal arthrogryposis and their clinical manifestations depending on the mutation of this gene.PIEZO2mutations with decreased function cause distal arthrogryposis with impaired proprioception and taction (autosomal recessive type of inheritance).PIEZO2mutations with gain-of-function cause distal arthrogryposis of types 3 and 5 (autosomal dominant inheritance). CONCLUSIONS:Anintegrated approach to the diagnosis and molecular genetic study will allow us to choose the best techniques and treatment of patients with this pathology. The results are useful for doctors of various specialties.
{"title":"PIEZO2 gene and its role in the development of distal arthrogryposis: A literature review","authors":"Varvara V. Chernyavskaya-Haukka, O. Agranovich","doi":"10.17816/ptors121809","DOIUrl":"https://doi.org/10.17816/ptors121809","url":null,"abstract":"BACKGROUND:PIEZO1 and PIEZO2 are mechanosensitive ion channel proteins; in humans, they are encoded by genes with identical names. PIEZO proteins convert mechanical signals into biochemical cellular responses following transduction. Recent data highlight the importance of this family of ion channel proteins in the regulation of physiological processes; however, many mechanisms remain unknown. Modern studies have proven thatPIEZO2mutations lead to the development of various forms of distal arthrogryposis. \u0000AIM:To analyze publications containing information onPIEZO2gene and its role in the development of distal forms of arthrogryposis. \u0000MATERIALS AND METHODS:This study analyzed the results ofaliterature search in the open scientific literature databases of PubMed, Cochrane Library, and eLibrary. Consequently, 40 foreign, and domestic scientific sources were extracted from 1969 to 2022. \u0000RESULTS:This study showed the relationship betweenPIEZO2mutations and the development of the distal forms of arthrogryposis. The study also presented the types of distal arthrogryposis and their clinical manifestations depending on the mutation of this gene.PIEZO2mutations with decreased function cause distal arthrogryposis with impaired proprioception and taction (autosomal recessive type of inheritance).PIEZO2mutations with gain-of-function cause distal arthrogryposis of types 3 and 5 (autosomal dominant inheritance). \u0000CONCLUSIONS:Anintegrated approach to the diagnosis and molecular genetic study will allow us to choose the best techniques and treatment of patients with this pathology. The results are useful for doctors of various specialties.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"678 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74758613","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}
O. Agranovich, Zoya E. Agranovich, Evgenia Ermolovich, E. Petrova, A. Shestakova, E. Blagovechtchenski
BACKGROUND:The pathology of upper limb deformities often leads not only to impaired self-ability but may be one of the factors that lead to the development of specific difficulties inachild at various stages of learning. Deficiency of visual-motor integration and/or its subcomponents (visual perception and motor coordination) are the risk factors for academic failure. Children aged 3 years with arthrogryposis multiplex congenita and obstetric palsy are have delayed speech development and behavioral disorders, which require correction, including speech therapy atanearly age. AIM:To examine the features of the organization of correctional and developmental education of children with arthrogryposis multiplex congenita and obstetric palsy, depending on their speech development and motor disorders, and assess the features of speech development of children with obstetric palsy. MATERIAL AND METHODS:From 2020 to 2022, we examined 46 children aged 615 (average age, 9.57 2.91) years with upper limb deformities caused by arthrogryposis multiplex congenita and obstetric palsy. Speech therapy and orthopedic and statistical methods were used. RESULTS:The study included 25 children (54.3%) with arthrogryposis multiplex congenita and 21 (45.7%) with obstetric palsy. In addition, 5.09 4.34 procedures were performed for the correction of orthopedic pathology. Most of the patients had mild (n= 17, 36.9%) and moderate (n= 20, 43.5%) functional disorders of the upper extremities, and 30 (65.2%) had problems with hand function. Moreover, 11 (23.9%) children had delayed speech development atanearly age. Speech pathology was detected in 41 (89.1%) children (general speech underdevelopment,n= 20, 43.9%; lexical-grammatical underdevelopment,n= 12, 26.1%; and phonetic-phonemic underdevelopment,n= 9, 19.8%. Dysarthria was the main speech pathology in 25 patients of different age groups (54.3%). Moreover, 18 (52.9%) schoolchildren had impaired writing ability. The speech pathology in patients with arthrogryposis multiplex congenita and obstetric palsy were the same. These groups differed from each other by the form of learning (p 0.05). CONCLUSIONS:Children and adolescents with arthrogryposis multiplex congenita and obstetric palsy have special educational needs and often need speech therapy assistance taking into account the specific orthopedic pathology.
{"title":"Provision of speech therapy assistance and organization of education for children with obstetric palsy and arthrogryposis multiplex congenita with impaired upper limb function","authors":"O. Agranovich, Zoya E. Agranovich, Evgenia Ermolovich, E. Petrova, A. Shestakova, E. Blagovechtchenski","doi":"10.17816/ptors325969","DOIUrl":"https://doi.org/10.17816/ptors325969","url":null,"abstract":"BACKGROUND:The pathology of upper limb deformities often leads not only to impaired self-ability but may be one of the factors that lead to the development of specific difficulties inachild at various stages of learning. Deficiency of visual-motor integration and/or its subcomponents (visual perception and motor coordination) are the risk factors for academic failure. Children aged 3 years with arthrogryposis multiplex congenita and obstetric palsy are have delayed speech development and behavioral disorders, which require correction, including speech therapy atanearly age. \u0000AIM:To examine the features of the organization of correctional and developmental education of children with arthrogryposis multiplex congenita and obstetric palsy, depending on their speech development and motor disorders, and assess the features of speech development of children with obstetric palsy. \u0000MATERIAL AND METHODS:From 2020 to 2022, we examined 46 children aged 615 (average age, 9.57 2.91) years with upper limb deformities caused by arthrogryposis multiplex congenita and obstetric palsy. Speech therapy and orthopedic and statistical methods were used. \u0000RESULTS:The study included 25 children (54.3%) with arthrogryposis multiplex congenita and 21 (45.7%) with obstetric palsy. In addition, 5.09 4.34 procedures were performed for the correction of orthopedic pathology. Most of the patients had mild (n= 17, 36.9%) and moderate (n= 20, 43.5%) functional disorders of the upper extremities, and 30 (65.2%) had problems with hand function. Moreover, 11 (23.9%) children had delayed speech development atanearly age. Speech pathology was detected in 41 (89.1%) children (general speech underdevelopment,n= 20, 43.9%; lexical-grammatical underdevelopment,n= 12, 26.1%; and phonetic-phonemic underdevelopment,n= 9, 19.8%. Dysarthria was the main speech pathology in 25 patients of different age groups (54.3%). Moreover, 18 (52.9%) schoolchildren had impaired writing ability. The speech pathology in patients with arthrogryposis multiplex congenita and obstetric palsy were the same. These groups differed from each other by the form of learning (p 0.05). \u0000CONCLUSIONS:Children and adolescents with arthrogryposis multiplex congenita and obstetric palsy have special educational needs and often need speech therapy assistance taking into account the specific orthopedic pathology.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75844385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. G. Toriya, S. Vissarionov, M. Savina, A. Baindurashvili
BACKGROUND:Patients with cervical spinal cord injury have the highest risk of developing respiratory dysfunction and associated complications such as pneumonia, atelectasis, and respiratory failure. Respiratory dysfunction is the leading cause of comorbid, somatic, and infectious pathology, and mortality following traumatic cervical spinal cord injuries. Mechanical ventilation of the lungs is the standard treatment for such patients; however, it is associated with atrophy and diaphragm dysfunction. AIM:To analyze literature data on the use of electrical stimulation techniques of the spinal cord, nerves, and muscles for the correction of respiratory disorders in patients with cervical spinal cord trauma. MATERIALS AND METHODS:This study presented the results of the search and analysis of peer-reviewed articles that examined the effects of various electrical stimulation techniques on respiratory function in patients with cervical spinal cord injury. ScienceDirect, Google Scholar, and PubMed were searched from 2000 to 2022. RESULTS:Currently, new treatment options are available for patients with tetraplegia, with reduced ventilatory function. Many studies have shown the positive effect of electrostimulation techniques on ventilatory function such as reduced time spent on mechanical ventilation and reduced incidence of infections and other lung complications. CONCLUSIONS:Electrical stimulation promotes neuromuscular plasticity and results in improved spontaneous activation of the diaphragm and respiratory muscles. Electrostimulation inacomprehensive rehabilitation program of patients with traumatic spinal cord injuries at the cervical level is currently employed to promote weaning from mechanical ventilation and prevent accompanying complications such as respiratory failure, pneumonia, and atelectasis. In addition to invasive electrical stimulation of the diaphragmatic nerve and/or spinal cord, existing less invasive electrostimulation techniques require further investigation in patients with spinal cord injury and respiratory dysfunction.
{"title":"Electrostimulation as a method of correction of respiratory disorders in patients with cervical spinal cord injury: A review","authors":"V. G. Toriya, S. Vissarionov, M. Savina, A. Baindurashvili","doi":"10.17816/ptors191378","DOIUrl":"https://doi.org/10.17816/ptors191378","url":null,"abstract":"BACKGROUND:Patients with cervical spinal cord injury have the highest risk of developing respiratory dysfunction and associated complications such as pneumonia, atelectasis, and respiratory failure. Respiratory dysfunction is the leading cause of comorbid, somatic, and infectious pathology, and mortality following traumatic cervical spinal cord injuries. Mechanical ventilation of the lungs is the standard treatment for such patients; however, it is associated with atrophy and diaphragm dysfunction. \u0000AIM:To analyze literature data on the use of electrical stimulation techniques of the spinal cord, nerves, and muscles for the correction of respiratory disorders in patients with cervical spinal cord trauma. \u0000MATERIALS AND METHODS:This study presented the results of the search and analysis of peer-reviewed articles that examined the effects of various electrical stimulation techniques on respiratory function in patients with cervical spinal cord injury. ScienceDirect, Google Scholar, and PubMed were searched from 2000 to 2022. \u0000RESULTS:Currently, new treatment options are available for patients with tetraplegia, with reduced ventilatory function. Many studies have shown the positive effect of electrostimulation techniques on ventilatory function such as reduced time spent on mechanical ventilation and reduced incidence of infections and other lung complications. \u0000CONCLUSIONS:Electrical stimulation promotes neuromuscular plasticity and results in improved spontaneous activation of the diaphragm and respiratory muscles. Electrostimulation inacomprehensive rehabilitation program of patients with traumatic spinal cord injuries at the cervical level is currently employed to promote weaning from mechanical ventilation and prevent accompanying complications such as respiratory failure, pneumonia, and atelectasis. In addition to invasive electrical stimulation of the diaphragmatic nerve and/or spinal cord, existing less invasive electrostimulation techniques require further investigation in patients with spinal cord injury and respiratory dysfunction.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85739617","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: Congenital knee dislocation is a very rare musculoskeletal disease, and it occurs in approximately 1 per 100,000 live births. Many researchers note that the treatment of congenital knee dislocation should begin with conservative methods, during which various complications arise. AIM: This study aimed to compare the clinical and radiological classifications of congenital knee dislocation and show the results of the treatment of this deformation using a Von Rosen splint and plaster corrections. MATERIALS AND METHODS: The study included 58 patients (34 boys and 24 girls) with congenital knee dislocation (83 knee joints). Congenital knee dislocation with arthrogryposis and other systemic pathologies were not included in the study. Before treatment, all patients were assessed for the severity of congenital knee dislocation according to the Tarek and J. Leveuf system. To evaluate the obtained results, nonparametric statistics were used. To search for differences between groups, the KruskalWallis test and the median test were used. To search for correlations, Spearman coefficients were used. Statistica v10 was used for statistical analysis. RESULTS: Clinical and radiological data were compared. In both groups, after conservative treatment, excellent and good results were obtained in nearly 98% and satisfactory in 2%. After conservative therapy, surgical treatment was required in 2 of 37 knee joints with the initial severity of Tarek III deformity. CONCLUSIONS: The severity of the deformity according to the Tarek system makes it possible to predict the effectiveness of the conservative treatment of congenital knee dislocation at a statistically significant level.
{"title":"Comparison of the clinical and radiological pictures in patients with congenital knee dislocation during treatment","authors":"","doi":"10.17816/ptors111181","DOIUrl":"https://doi.org/10.17816/ptors111181","url":null,"abstract":"BACKGROUND: Congenital knee dislocation is a very rare musculoskeletal disease, and it occurs in approximately 1 per 100,000 live births. Many researchers note that the treatment of congenital knee dislocation should begin with conservative methods, during which various complications arise. \u0000AIM: This study aimed to compare the clinical and radiological classifications of congenital knee dislocation and show the results of the treatment of this deformation using a Von Rosen splint and plaster corrections. \u0000MATERIALS AND METHODS: The study included 58 patients (34 boys and 24 girls) with congenital knee dislocation (83 knee joints). Congenital knee dislocation with arthrogryposis and other systemic pathologies were not included in the study. Before treatment, all patients were assessed for the severity of congenital knee dislocation according to the Tarek and J. Leveuf system. To evaluate the obtained results, nonparametric statistics were used. To search for differences between groups, the KruskalWallis test and the median test were used. To search for correlations, Spearman coefficients were used. Statistica v10 was used for statistical analysis. \u0000RESULTS: Clinical and radiological data were compared. In both groups, after conservative treatment, excellent and good results were obtained in nearly 98% and satisfactory in 2%. After conservative therapy, surgical treatment was required in 2 of 37 knee joints with the initial severity of Tarek III deformity. \u0000CONCLUSIONS: The severity of the deformity according to the Tarek system makes it possible to predict the effectiveness of the conservative treatment of congenital knee dislocation at a statistically significant level.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78876998","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}
Mikhail N. Dolgopolskii, V. A. Koriachkin, D. Zabolotskii, R. R. Safin
BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain. AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology. MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion. RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block. CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.
背景:椎旁麻醉是一种古老的区域麻醉技术，已有100多年的历史。一般来说，椎旁麻醉被用于成人疼痛治疗的强镇痛工具。椎旁麻醉不是一种简单的诱导区域麻醉的方法，因为它有几个并发症。椎旁麻醉一直是小儿外科的严重禁忌症。目前，超声技术的进步，通过发现手术治疗疼痛的新可能性，使椎旁麻醉在骨科和创伤学实践中成功地应用于儿童。目的:本研究旨在评估椎旁麻醉作为儿科骨科和创伤学麻醉的重要组成部分的现状和近期前景。材料和方法:研究数据来自公共科学来源，在PubMed, Crossref, Google Scholar, Scopus和RSCI数据库中检索，没有语言限制。资料检索的深度为90年(至1932年)。在本研究中，根据所获得的信息进行分析和综合，构建分析结论。结果:各种病例报告和病例回顾描述了胸椎和腰椎旁麻醉在小儿骨科和创伤学以及重建手术中的应用经验，并表明胸椎旁麻醉(联合全身麻醉)是目前的首选方法，与胸椎硬膜外阻滞和高背矫直肌阻滞相竞争。结论:超声控制下椎旁麻醉腰大肌间室阻滞是骨盆骨科手术中最可靠、最合适的区域麻醉方法。
{"title":"Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review","authors":"Mikhail N. Dolgopolskii, V. A. Koriachkin, D. Zabolotskii, R. R. Safin","doi":"10.17816/ptors114995","DOIUrl":"https://doi.org/10.17816/ptors114995","url":null,"abstract":"BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain. \u0000AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology. \u0000MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion. \u0000RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block. \u0000CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73675681","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: Diabetes insipidus is characterized by the kidneys inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the diseases clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period. CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided. DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the CVICVII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin. CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.
{"title":"A clinical case of transient diabetes insipidus with high spinal trauma","authors":"Dmitrii A. Sibiryakov, M. Pavlova","doi":"10.17816/ptors159383","DOIUrl":"https://doi.org/10.17816/ptors159383","url":null,"abstract":"BACKGROUND: Diabetes insipidus is characterized by the kidneys inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the diseases clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period. \u0000CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided. \u0000DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the CVICVII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin. \u0000CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"6 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78648406","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}
BACKGROUNG: A situation in which despite an obvious ulnar fracture, radial head dislocation is not diagnosed, resulting in a missed Monteggia fracture is not uncommon. Unsatisfactory results of the treatment of this pathology have prompted several researchers to search for an optimal treatment strategy. AIM: This study aimed to conduct a systematic review of literature data on missed Monteggia fractures and dislocations in children by studying the main therapeutic and tactical approaches to this problem. MATERIALS AND METHODS: A literature search was conducted in the Cochrane Database, Science Direct, Google Scholar, PubMed, and eLibrary information bases, and the search depth was 10 years. Moreover, 46 sources were selected based on the criteria. The main characteristics revealing the problem were identified, divided into four semantic groups, according to which the literature was analyzed: initial data on the condition of patients at the time of seeking medical help, status before and after treatment, and treatment methods. RESULTS: The average age of the children was 8.4 years. The average interval from injury to the surgical treatment of missed Monteggia fracture was 15.3 months, and 883 clinical cases presented in sources with known treatment techniques were analyzed. Thus, open reduction of the radial head in combination with the restoration or reconstruction of the annular ligament and ulnar osteotomy is one of the most common methods (n = 482, 54.6%). The second most frequent application was the above-described approach, but without manipulations on the annular ligament (n = 273, 30.9%). Bone osteosynthesis and external fixation apparatus were the most widely used stabilization methods in 350 (67.8%) and 149 (28.9%), respectively. The most common complications were associated with the deterioration of the functional status after surgery. CONCLUSIONS: Accurate diagnosis of injury and early correction of existing disorders is the key to reducing the frequency of missed Monteggia fractures. Surgical treatment is the main method of treating children with this injury, in which the restoration of the ulnar anatomy and the ratios in the brachial and proximal radiocarpal joints are the most important, providing a more physiological development of the segment with the growth of the child.
{"title":"Missed Monteggia fractures in children – the current state of the problem: A systematic review","authors":"Aigul R. Gubaeva, V. Zorin","doi":"10.17816/ptors112287","DOIUrl":"https://doi.org/10.17816/ptors112287","url":null,"abstract":"BACKGROUNG: A situation in which despite an obvious ulnar fracture, radial head dislocation is not diagnosed, resulting in a missed Monteggia fracture is not uncommon. Unsatisfactory results of the treatment of this pathology have prompted several researchers to search for an optimal treatment strategy. \u0000AIM: This study aimed to conduct a systematic review of literature data on missed Monteggia fractures and dislocations in children by studying the main therapeutic and tactical approaches to this problem. \u0000MATERIALS AND METHODS: A literature search was conducted in the Cochrane Database, Science Direct, Google Scholar, PubMed, and eLibrary information bases, and the search depth was 10 years. Moreover, 46 sources were selected based on the criteria. The main characteristics revealing the problem were identified, divided into four semantic groups, according to which the literature was analyzed: initial data on the condition of patients at the time of seeking medical help, status before and after treatment, and treatment methods. \u0000RESULTS: The average age of the children was 8.4 years. The average interval from injury to the surgical treatment of missed Monteggia fracture was 15.3 months, and 883 clinical cases presented in sources with known treatment techniques were analyzed. Thus, open reduction of the radial head in combination with the restoration or reconstruction of the annular ligament and ulnar osteotomy is one of the most common methods (n = 482, 54.6%). The second most frequent application was the above-described approach, but without manipulations on the annular ligament (n = 273, 30.9%). Bone osteosynthesis and external fixation apparatus were the most widely used stabilization methods in 350 (67.8%) and 149 (28.9%), respectively. The most common complications were associated with the deterioration of the functional status after surgery. \u0000CONCLUSIONS: Accurate diagnosis of injury and early correction of existing disorders is the key to reducing the frequency of missed Monteggia fractures. Surgical treatment is the main method of treating children with this injury, in which the restoration of the ulnar anatomy and the ratios in the brachial and proximal radiocarpal joints are the most important, providing a more physiological development of the segment with the growth of the child.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"200 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86989254","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}
R. Raupov, S. Vissarionov, Gumru A. Babaeva, Yulia G. Noyanova, L. Sorokina, M. Kostik
BACKGROUND: Enthesitis-related arthritis is one of the subtypes of juvenile idiopathic arthritis and is characterized by the involvement of the joints, enthesitis, and axial skeleton (sacroiliitis and spondylitis). The clinical variability of enthesitis-related arthritis and similar manifestations with orthopedic diseases present difficulties in diagnosis. AIM: To present the clinical features of enthesitis-related arthritis and issues of differential diagnosis based on literature analysis. MATERIALS AND METHODS: A literature search was conducted in the open electronic databases of eLibrary, PubMed, and Cochrane Library. In total, 46 foreign and 4 Russian publications were analyzed, which were limited to 19812021. The keywords used in the literature search were as follows: enthesitis, enthesitis-related arthritis, juvenile spondyloarthritis, and SAPHO syndrome. Own archive data for instrumental investigations were used in the article. RESULTS: The clinical manifestations can be variable, and laboratory tests do not always allow us to prove the inflammatory nature of the pain syndrome. The most priority diagnostic tests were imaging methods, namely, magnetic resonance imaging and ultrasonography. The greatest diagnostic difficulty was found in patients in whom enthesitis prevailed over arthritis, and in some cases, it was the only disease manifestation. The classification criteria used for the diagnosis of EAA were considered. The differential diagnosis of enthesitis included various orthopedic diseases. Ultrasound diagnostics of joints and enthesis should be performed in every patient with local pain musculoskeletal symptoms, which allows patients to be correctly routed. CONCLUSIONS: The alertness of both orthopedists in relation to enthesitis-related arthritis and the awareness of rheumatologists of the most common orthopedic diseases that affect the entheses are necessary.
{"title":"Enthesitis-related arthritis in children: A literature review of the clinical features and differential diagnosis","authors":"R. Raupov, S. Vissarionov, Gumru A. Babaeva, Yulia G. Noyanova, L. Sorokina, M. Kostik","doi":"10.17816/ptors119532","DOIUrl":"https://doi.org/10.17816/ptors119532","url":null,"abstract":"BACKGROUND: Enthesitis-related arthritis is one of the subtypes of juvenile idiopathic arthritis and is characterized by the involvement of the joints, enthesitis, and axial skeleton (sacroiliitis and spondylitis). The clinical variability of enthesitis-related arthritis and similar manifestations with orthopedic diseases present difficulties in diagnosis. \u0000AIM: To present the clinical features of enthesitis-related arthritis and issues of differential diagnosis based on literature analysis. \u0000MATERIALS AND METHODS: A literature search was conducted in the open electronic databases of eLibrary, PubMed, and Cochrane Library. In total, 46 foreign and 4 Russian publications were analyzed, which were limited to 19812021. The keywords used in the literature search were as follows: enthesitis, enthesitis-related arthritis, juvenile spondyloarthritis, and SAPHO syndrome. Own archive data for instrumental investigations were used in the article. \u0000RESULTS: The clinical manifestations can be variable, and laboratory tests do not always allow us to prove the inflammatory nature of the pain syndrome. The most priority diagnostic tests were imaging methods, namely, magnetic resonance imaging and ultrasonography. The greatest diagnostic difficulty was found in patients in whom enthesitis prevailed over arthritis, and in some cases, it was the only disease manifestation. The classification criteria used for the diagnosis of EAA were considered. The differential diagnosis of enthesitis included various orthopedic diseases. Ultrasound diagnostics of joints and enthesis should be performed in every patient with local pain musculoskeletal symptoms, which allows patients to be correctly routed. \u0000CONCLUSIONS: The alertness of both orthopedists in relation to enthesitis-related arthritis and the awareness of rheumatologists of the most common orthopedic diseases that affect the entheses are necessary.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80788252","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}
E. A. Zakharyan, Bagauddin H. Dolgiev, Nikolay G. Chigvariya, D. Grankin, K. A. Afonichev, Y. Garkavenko, A.I. Arakelyan, Aleksandr P. Pozdeev
BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children. AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children. MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed. RESULTS: The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications). CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.
背景:带血管腓骨移植物在儿童肢体重建干预中的应用是儿童广泛骨缺损替代的一个有前途的方向。目的:本研究旨在系统回顾有关腓骨碎片显微外科移植治疗儿童长骨缺损的文献。材料与方法:在library、PubMed、Google Scholar等系统中检索文章，检索时间范围为10年(自20122022年起，最后查询时间为11/08/2022年)。俄语搜索引擎中搜索关键词为:儿童骨缺损置换(replacement of bone defects in children)和儿童腓骨移植(fibula transplantation in children)，英语搜索引擎搜索关键词为:显微外科手术(microsurgical)和腓骨(fibula)、微血管(microvascular)和腓骨(bone and defect)。对已发表的文献进行整理后，对17篇文献进行分析。结果:该研究共分析了690例患者(平均年龄12 - 2.6岁)。647例(占93.7%)患者以恶性肿瘤为主。良性病变也有，占所有患者的0.87%:骨髓炎2.0%;先天性病理，2.17%，创伤，1.45%。平均随访时间为4.8 - 2.4年。肿瘤患者的生存率为78.4%。供体侧并发症占所有并发症的14.7%。受体区并发症较为常见，占所有并发症的85.3% (n = 457例)。研究中报告的主要并发症类型为移植物骨折或移植物骨水平骨折(占所有并发症的35.7%)。结论:使用带血管的腓骨碎片置换大面积骨缺损，可实现一期肢体重建，对于各种特征的大节段缺损具有良好的远期效果。尽管有并发症，这项技术是少数能够同时进行肢体重建的技术之一。采用显微外科腓骨自体移植的决定是基于外科医生的偏好和手术经验。
{"title":"Treatment of long bone defects in children: Microsurgical transplantation of a fibular fragment for replacement of long bone defects: A systematic review","authors":"E. A. Zakharyan, Bagauddin H. Dolgiev, Nikolay G. Chigvariya, D. Grankin, K. A. Afonichev, Y. Garkavenko, A.I. Arakelyan, Aleksandr P. Pozdeev","doi":"10.17816/ptors115230","DOIUrl":"https://doi.org/10.17816/ptors115230","url":null,"abstract":"BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children. \u0000AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children. \u0000MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed. \u0000RESULTS: The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications). \u0000CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82754346","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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