Dmitriy B. Barsukov, P. Bortulev, S. Vissarionov, I. Pozdnikin, T. Baskaeva
BACKGROUND: Slipped capital femoral epiphysis is one of the most severe diseases of the hip joint in children and is characterized by the displacement of the proximal femoral epiphysis, occurring as a result of a decrease in the mechanical strength of its growth plate. Some pathological processes in the hip joints and lumbosacral spine cause changes in the position (vergence) of the pelvis in the sagittal plane and the development of degenerative dystrophic diseases. The analysis of the spinepelvis relationships in children with slipped capital femoral epiphysis may provide the basis for the development of new approaches to the surgical correction of the deformity of the hip component of the affected joint. AIM: To assess the radiological parameters of the frontal and sagittal spinepelvis relations in children with proximal femur deformity in slipped capital femoral epiphysis. MATERIALS AND METHODS: The study included 30 patients (30 hips) aged 1114 years with a severe form of slipped capital femoral epiphysis characterized by the presence of a posterior displacement of the epiphysis of 60 combined with the downward displacement of no more than 10 in one of the joints and absence of displacement (pre-slip stage) in the other. Patients underwent clinical and radiological examinations. The radiographs taken in the standing position were used to assess the values of thoracic kyphosis and lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), and spinesacral angle (SSA). The obtained data were subjected to statistical processing. RESULTS: The patients had pelvic retroversion (decreased values of the PI and SS indices and increased PT index) and formed hypolordotic type of vertical posture according to P. Roussouly classification. In addition, thoracic hyperkyphosis occurred, and the SVA shifted to the front, which can be considered a mechanism of trunk balance compensation for the existing pelvic retroversion and reduction of lumbar lordosis to maintain the ability to move in an upright position. CONCLUSIONS: Children with this severe form of slipped capital femoral epiphysis are characterized by pelvic retroversion, decreased lumbar lordosis and increased thoracic kyphosis, positive trunk imbalance, and PT toward the affected limb. Planning and reconstructive restorative interventions on the affected hip joint should consider existing pathological changes to restore the correct spinepelvis relationships and prevent degenerative dystrophic processes in the lumbosacral spine.
{"title":"Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis","authors":"Dmitriy B. Barsukov, P. Bortulev, S. Vissarionov, I. Pozdnikin, T. Baskaeva","doi":"10.17816/ptors111772","DOIUrl":"https://doi.org/10.17816/ptors111772","url":null,"abstract":"BACKGROUND: Slipped capital femoral epiphysis is one of the most severe diseases of the hip joint in children and is characterized by the displacement of the proximal femoral epiphysis, occurring as a result of a decrease in the mechanical strength of its growth plate. Some pathological processes in the hip joints and lumbosacral spine cause changes in the position (vergence) of the pelvis in the sagittal plane and the development of degenerative dystrophic diseases. The analysis of the spinepelvis relationships in children with slipped capital femoral epiphysis may provide the basis for the development of new approaches to the surgical correction of the deformity of the hip component of the affected joint. \u0000AIM: To assess the radiological parameters of the frontal and sagittal spinepelvis relations in children with proximal femur deformity in slipped capital femoral epiphysis. \u0000MATERIALS AND METHODS: The study included 30 patients (30 hips) aged 1114 years with a severe form of slipped capital femoral epiphysis characterized by the presence of a posterior displacement of the epiphysis of 60 combined with the downward displacement of no more than 10 in one of the joints and absence of displacement (pre-slip stage) in the other. Patients underwent clinical and radiological examinations. The radiographs taken in the standing position were used to assess the values of thoracic kyphosis and lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), and spinesacral angle (SSA). The obtained data were subjected to statistical processing. \u0000RESULTS: The patients had pelvic retroversion (decreased values of the PI and SS indices and increased PT index) and formed hypolordotic type of vertical posture according to P. Roussouly classification. In addition, thoracic hyperkyphosis occurred, and the SVA shifted to the front, which can be considered a mechanism of trunk balance compensation for the existing pelvic retroversion and reduction of lumbar lordosis to maintain the ability to move in an upright position. \u0000CONCLUSIONS: Children with this severe form of slipped capital femoral epiphysis are characterized by pelvic retroversion, decreased lumbar lordosis and increased thoracic kyphosis, positive trunk imbalance, and PT toward the affected limb. Planning and reconstructive restorative interventions on the affected hip joint should consider existing pathological changes to restore the correct spinepelvis relationships and prevent degenerative dystrophic processes in the lumbosacral spine.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84204445","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}
G. V. Pyatakova, O. V. Okoneshnikova, S. Vissarionov
BACKGROUND: The situational approach is a promising direction in the study of the determinants of mental development and behaviors in modern psychological research. This study considered the possibility of using a situational approach in the study of psychological problems of children and adolescents with orthopedic diseases and discussed the objective and subjective characteristics of the life situation associated with orthopedic diseases and surgical treatment. AIM: The study aimed to examine the peculiarities of life situations in adolescents with various orthopedic diseases. MATERIALS AND METHODS: The study involved adolescents aged 1217 years diagnosed with idiopathic scoliosis (n = 54) and juvenile chronic arthritis (n = 44) and healthy adolescents (n = 43). Clinicalpsychological and psychodiagnostic methods were used. Mathematical and statistical data processing was carried out. RESULTS: The life situation of adolescents with idiopathic scoliosis and juvenile chronic arthritis was characterized by events that cause traumatic experiences. Objective factors of the life situation and traumatic life events presented in the mental picture of the disease of adolescents agree with the pronounced emotional problems of patients with orthopedic diseases. Compared with healthy adolescents, adolescents with orthopedic diseases had higher general index of PTS, which indicates a pronounced subjective difficulty of the life situation of adolescents with orthopedic diseases. The results are confirmed by the severity of the subjective negative emotional reactions to certain characteristics of the disease. The objective and subjective characteristics of the life situation of adolescents with idiopathic scoliosis and juvenile chronic arthritis may determine the degree of difficulty and the degree of risk in the occurrence of emotional trauma for illness, hospitalization, and treatment. CONCLUSIONS: Understanding the life difficulties of adolescents with orthopedic diseases can improve the prediction of behavioral problems and adaptation opportunities in hospital settings and provide timely psychological assistance to adolescents with severe orthopedic diseases, taking into account situational variables.
{"title":"Psychological analysis of the life situation of adolescents with orthopedic diseases","authors":"G. V. Pyatakova, O. V. Okoneshnikova, S. Vissarionov","doi":"10.17816/ptors109419","DOIUrl":"https://doi.org/10.17816/ptors109419","url":null,"abstract":"BACKGROUND: The situational approach is a promising direction in the study of the determinants of mental development and behaviors in modern psychological research. This study considered the possibility of using a situational approach in the study of psychological problems of children and adolescents with orthopedic diseases and discussed the objective and subjective characteristics of the life situation associated with orthopedic diseases and surgical treatment. \u0000AIM: The study aimed to examine the peculiarities of life situations in adolescents with various orthopedic diseases. \u0000MATERIALS AND METHODS: The study involved adolescents aged 1217 years diagnosed with idiopathic scoliosis (n = 54) and juvenile chronic arthritis (n = 44) and healthy adolescents (n = 43). Clinicalpsychological and psychodiagnostic methods were used. Mathematical and statistical data processing was carried out. \u0000RESULTS: The life situation of adolescents with idiopathic scoliosis and juvenile chronic arthritis was characterized by events that cause traumatic experiences. Objective factors of the life situation and traumatic life events presented in the mental picture of the disease of adolescents agree with the pronounced emotional problems of patients with orthopedic diseases. Compared with healthy adolescents, adolescents with orthopedic diseases had higher general index of PTS, which indicates a pronounced subjective difficulty of the life situation of adolescents with orthopedic diseases. The results are confirmed by the severity of the subjective negative emotional reactions to certain characteristics of the disease. The objective and subjective characteristics of the life situation of adolescents with idiopathic scoliosis and juvenile chronic arthritis may determine the degree of difficulty and the degree of risk in the occurrence of emotional trauma for illness, hospitalization, and treatment. \u0000CONCLUSIONS: Understanding the life difficulties of adolescents with orthopedic diseases can improve the prediction of behavioral problems and adaptation opportunities in hospital settings and provide timely psychological assistance to adolescents with severe orthopedic diseases, taking into account situational variables.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83688059","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. Orlov, Y. Nashchekina, A. Nashchekin, O. N. Ozeryanskaya, S. D. Mirzametov, D. Svistov
BACKGROUND: At present, metal implants are widely used in neuro-orthopedics, of which titanium alloys are of particular interest. A team of authors developed an original combined implant for posterior spinal fusion as an import substitution, which can be used from one-way access during minimally invasive operations on the lumbar spine. The implant was manufactured at the Endocarbon Enterprise in Penza. For better osseointegration, it is made of VT6 alloy and titanium nickelide. The middle part of the implant is laser-treated to create an uneven surface in the hope of better integration in the tissues of the body. This study was conducted to assess the cytotoxicity and biocompatibility of this implant for its further application in clinical practice. AIM: To determine the cytotoxicity of an interspinous implant made of titanium alloys for its further introduction into spinal surgery. MATERIALS AND METHODS: To determine the cytotoxicity of titanium samples of interspinous implants, a methyltetrazolium test was conducted to assess the viability of stromal cells in the presence of a nutrient medium after incubation with the test material. The biocompatibility of the material was analyzed using scanning electron microscopy of samples 1 and 7 days after cell culture. RESULTS: The viability of cells cultured in the presence of a nutrient medium after incubation with samples of titanium VT6 was 105% and that of titanium nickelide was 98%, which were comparable to the viability of cells in a standard nutrient medium. With electron microscopy, after 1 day of cultivation, cells form a monolayer on a titanium surface, all cells were well spread out and formed intercellular contacts, and after 7 days of cultivation, the number of cells increased and they formed a dense monolayer. CONCLUSIONS: The interspinous implant, which includes alloys of titanium VT6 and titanium nickelide, is biocompatible with cultured cells and can be introduced into spinal surgery.
{"title":"Biocompatibility of an interspinous implant made of titanium alloys","authors":"V. Orlov, Y. Nashchekina, A. Nashchekin, O. N. Ozeryanskaya, S. D. Mirzametov, D. Svistov","doi":"10.17816/ptors104011","DOIUrl":"https://doi.org/10.17816/ptors104011","url":null,"abstract":"BACKGROUND: At present, metal implants are widely used in neuro-orthopedics, of which titanium alloys are of particular interest. A team of authors developed an original combined implant for posterior spinal fusion as an import substitution, which can be used from one-way access during minimally invasive operations on the lumbar spine. The implant was manufactured at the Endocarbon Enterprise in Penza. For better osseointegration, it is made of VT6 alloy and titanium nickelide. The middle part of the implant is laser-treated to create an uneven surface in the hope of better integration in the tissues of the body. This study was conducted to assess the cytotoxicity and biocompatibility of this implant for its further application in clinical practice. \u0000AIM: To determine the cytotoxicity of an interspinous implant made of titanium alloys for its further introduction into spinal surgery. \u0000MATERIALS AND METHODS: To determine the cytotoxicity of titanium samples of interspinous implants, a methyltetrazolium test was conducted to assess the viability of stromal cells in the presence of a nutrient medium after incubation with the test material. The biocompatibility of the material was analyzed using scanning electron microscopy of samples 1 and 7 days after cell culture. \u0000RESULTS: The viability of cells cultured in the presence of a nutrient medium after incubation with samples of titanium VT6 was 105% and that of titanium nickelide was 98%, which were comparable to the viability of cells in a standard nutrient medium. With electron microscopy, after 1 day of cultivation, cells form a monolayer on a titanium surface, all cells were well spread out and formed intercellular contacts, and after 7 days of cultivation, the number of cells increased and they formed a dense monolayer. \u0000CONCLUSIONS: The interspinous implant, which includes alloys of titanium VT6 and titanium nickelide, is biocompatible with cultured cells and can be introduced into spinal surgery.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73634544","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. Kozhevnikov, S. Kralina, A. S. Kuznetsov, I. Gribova
BACKGROUND: Treatment of high congenital hip dislocation in older children remains controversial in terms of the choice of the method of reducing the femoral head to the level of the acetabulum. In most cases, significant shortening of the hip is performed to eliminate dislocation, which leads to secondary deformities. AIM: This study aimed to evaluate the results of treatment of high hip dislocation in older children, in which pre-reduction skeletal traction and economical shortening of the femoral segment are rationally combined to lower the femoral head. MATERIALS AND METHODS: From 2011 to 2021, we observed 13 patients aged 513 years with grade 4 high unilateral congenital hip dislocation according to the international Tonnis classification. RESULTS: The treatment results were traced for 19 years. When assessing hip joint function according to McKay criteria, excellent and good results were obtained in 84.6% of the patients. X-ray evaluation by Severin also included 84.6% in groups 1 and 2. Signs of avascular necrosis of the femoral head according to the criteria of Kalamchi and MacEwen were detected in four patients (group 1, n = 2; group 2, n = 1; group 3, n = 1). The difference in the length of the n/limbs in eight patients was 1.5 cm on average, and in the remaining children, a clinically insignificant asymmetry was observed in the length of the n/limbs, i.e., 0.50.7 cm. CONCLUSIONS: The choice of the method of surgical correction of high hip dislocation largely depends on the age of the child. In children aged 5 years, with a significant displacement of the femoral head and limb shortening, a combination of reduction methods is rational, i.e., use of preoperative skeletal traction with economical shortening of the femoral segment, open reduction, and correction of the acetabulum. The optimal combination of the distraction method and surgical correction makes it possible to achieve successful reduction and a good functional result.
{"title":"On the treatment of high unilateral congenital hip dislocation in older children: Minimizing the inequality of limb length","authors":"O. Kozhevnikov, S. Kralina, A. S. Kuznetsov, I. Gribova","doi":"10.17816/ptors107945","DOIUrl":"https://doi.org/10.17816/ptors107945","url":null,"abstract":"BACKGROUND: Treatment of high congenital hip dislocation in older children remains controversial in terms of the choice of the method of reducing the femoral head to the level of the acetabulum. In most cases, significant shortening of the hip is performed to eliminate dislocation, which leads to secondary deformities. \u0000AIM: This study aimed to evaluate the results of treatment of high hip dislocation in older children, in which pre-reduction skeletal traction and economical shortening of the femoral segment are rationally combined to lower the femoral head. \u0000MATERIALS AND METHODS: From 2011 to 2021, we observed 13 patients aged 513 years with grade 4 high unilateral congenital hip dislocation according to the international Tonnis classification. \u0000RESULTS: The treatment results were traced for 19 years. When assessing hip joint function according to McKay criteria, excellent and good results were obtained in 84.6% of the patients. X-ray evaluation by Severin also included 84.6% in groups 1 and 2. Signs of avascular necrosis of the femoral head according to the criteria of Kalamchi and MacEwen were detected in four patients (group 1, n = 2; group 2, n = 1; group 3, n = 1). The difference in the length of the n/limbs in eight patients was 1.5 cm on average, and in the remaining children, a clinically insignificant asymmetry was observed in the length of the n/limbs, i.e., 0.50.7 cm. \u0000CONCLUSIONS: The choice of the method of surgical correction of high hip dislocation largely depends on the age of the child. In children aged 5 years, with a significant displacement of the femoral head and limb shortening, a combination of reduction methods is rational, i.e., use of preoperative skeletal traction with economical shortening of the femoral segment, open reduction, and correction of the acetabulum. The optimal combination of the distraction method and surgical correction makes it possible to achieve successful reduction and a good functional result.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74363759","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 G. L. Oppedisano, L. Y. Artyukh, N. R. Karelina
This medico-historical analysis focused on the formation of present classifications of congenital hand deformities. Its implementation became possible thanks to the study of 163 literary sources, the search of which was carried out in the scientometric databases of Scopus, PubMed, Google Scholar, and Web of Science. The depth of the exploration has exceeded 180 years (from 1829 to 2017). Those dates make obvious that the initial steps in the systematization of regarded vices were taken in 18th19th centuries. Publications at that time became the foundation that pushed many scientists to develop the wide range of descriptive classifications. The complexity of their practical use required the creation of fundamentally different concepts of dividing anomalies. It became possible due to the discovery of the embryogenesis of the hand. The result of long-term studies was the acceptance of the actual method of the systematization of upper limb defects by IFSSH in 2014. The comprehension of stages, preceding its formation, is quite important for the medical community and facilitates the assessment of individual patients features.
这医学史分析的重点是形成目前的分类先天性手畸形。它的实施得益于对163个文献来源的研究，在Scopus、PubMed、Google Scholar和Web of Science等科学计量数据库中进行了搜索。勘探深度超过180年(1829年至2017年)。这些日期清楚地表明，对公认的恶习进行系统化的最初步骤是在18 - 19世纪采取的。当时的出版物成为推动许多科学家发展广泛的描述性分类的基础。由于实际应用的复杂性，需要创建根本不同的划分异常的概念。由于发现了手的胚胎发生，这才成为可能。长期研究的结果是2014年接受IFSSH系统修复上肢缺损的实际方法。对阶段的理解，在其形成之前，对医学界来说是非常重要的，有助于评估个体患者的特征。
{"title":"Classifications of congenital hand deformities: View through the prism of time","authors":"Mikhail G. L. Oppedisano, L. Y. Artyukh, N. R. Karelina","doi":"10.17816/ptors110992","DOIUrl":"https://doi.org/10.17816/ptors110992","url":null,"abstract":"This medico-historical analysis focused on the formation of present classifications of congenital hand deformities. Its implementation became possible thanks to the study of 163 literary sources, the search of which was carried out in the scientometric databases of Scopus, PubMed, Google Scholar, and Web of Science. The depth of the exploration has exceeded 180 years (from 1829 to 2017). Those dates make obvious that the initial steps in the systematization of regarded vices were taken in 18th19th centuries. Publications at that time became the foundation that pushed many scientists to develop the wide range of descriptive classifications. The complexity of their practical use required the creation of fundamentally different concepts of dividing anomalies. It became possible due to the discovery of the embryogenesis of the hand. The result of long-term studies was the acceptance of the actual method of the systematization of upper limb defects by IFSSH in 2014. The comprehension of stages, preceding its formation, is quite important for the medical community and facilitates the assessment of individual patients features.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85203841","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: EhlersDanlos syndrome (EDS) is a group of hereditary pathological conditions caused by various disorders of collagen biosynthesis. The study analyzed the results of multistage surgical treatment of early scoliosis in patients with severe spinal deformities due to EDS. No similar observations have been found in the literature. CLINICAL CASES: Four patients with a verified diagnosis of EDS and progressive spinal deformities were subjected to multistage surgical treatment using the VEPTRII instrumentation, which included periodic distractions and final spinal fusion with segmental instrumentation. Stage-by-stage surgical treatment was initiated from the age of 3 to 6 years. In 3 of 4 cases, the kyphotic component prevailed over the scoliotic one (86140 vs. 21110). The number of staged distractions ranged from 6 to 10. The age of the final stage (correction and dorsal fusion) was 914 years (surgery was performed in three of four cases). The primary correction was 3056, the loss of correction before the final stage was 1435, and the correction during the final stage was 2240. A significant correction of the frontal and sagittal imbalances of the spine was noted. Blood loss during the final fusion was 540750 mL, and the operation time was 310350 min. Ten complications occurred, of which 9 were associated with implants and disappeared during staged distractions. No neurological and vascular complications occurred. DISCUSSION: Scoliosis occurring in the first decade of life in patients with EDS is characterized by early-onset, rapid progression, and tendency to form a significant kyphotic component of spinal deformity. CONCLUSIONS: Multistage treatment of early scoliosis in patients with EDS using VEPTRII tools allows for obtaining quite satisfactory results and has not severe complications. The final fusion gives a significant corrective effect; however, new research and accumulation of data are needed to optimize the treatment process.
{"title":"Multistage surgical treatment of early-onset scoliosis in patients with Ehlers-Danlos syndrome: A series of observations","authors":"M. Mikhaylovskiy, V. A. Suzdalov","doi":"10.17816/ptors111126","DOIUrl":"https://doi.org/10.17816/ptors111126","url":null,"abstract":"BACKGROUND: EhlersDanlos syndrome (EDS) is a group of hereditary pathological conditions caused by various disorders of collagen biosynthesis. The study analyzed the results of multistage surgical treatment of early scoliosis in patients with severe spinal deformities due to EDS. No similar observations have been found in the literature. \u0000CLINICAL CASES: Four patients with a verified diagnosis of EDS and progressive spinal deformities were subjected to multistage surgical treatment using the VEPTRII instrumentation, which included periodic distractions and final spinal fusion with segmental instrumentation. Stage-by-stage surgical treatment was initiated from the age of 3 to 6 years. In 3 of 4 cases, the kyphotic component prevailed over the scoliotic one (86140 vs. 21110). The number of staged distractions ranged from 6 to 10. The age of the final stage (correction and dorsal fusion) was 914 years (surgery was performed in three of four cases). The primary correction was 3056, the loss of correction before the final stage was 1435, and the correction during the final stage was 2240. A significant correction of the frontal and sagittal imbalances of the spine was noted. Blood loss during the final fusion was 540750 mL, and the operation time was 310350 min. Ten complications occurred, of which 9 were associated with implants and disappeared during staged distractions. No neurological and vascular complications occurred. \u0000DISCUSSION: Scoliosis occurring in the first decade of life in patients with EDS is characterized by early-onset, rapid progression, and tendency to form a significant kyphotic component of spinal deformity. \u0000CONCLUSIONS: Multistage treatment of early scoliosis in patients with EDS using VEPTRII tools allows for obtaining quite satisfactory results and has not severe complications. The final fusion gives a significant corrective effect; however, new research and accumulation of data are needed to optimize the treatment process.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82740234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Grankin, S. I. Golyana, N. Avdeychik, A. V. Safonov, T. I. Tikhonenko, N. Galkina, E. A. Zakharyan, K. A. Afonichev, Anastasia I. Arakelian
BACKGROUND: Extensive and deep limb defects remain a difficult problem of reconstructive surgery in children. Free microsurgical flaps are used to resolve this problem. Free flaps can be complex in composition and include muscles and bone parts, which allow replacing large and multicomponent limb defects. The technique is used in patients with posttraumatic deformities, burns, acquired limb deformities, and congenital deformities of the extremities. AIM: To retrospectively analyze free flaps in children for the replacement of limb defects. MATERIALS AND METHODS: This single-center retrospective study analyzed 120 cases of microsurgical autotransplantation of free flaps to replace defects of the upper and lower extremities in children. The patients were children aged 117 years who had injuries and burns, acquired limb deformities, and congenital limb deformities. RESULTS: The average age of the patients was 9.5 years, and 72% of the patients were boys. Moreover, 95% of the children had posttraumatic deformities, burns, and acquired pathologies. Free latissimus dorsi flaps were used in 70% of the patients. The recipient area was the upper limb in 53% of the cases. The survival rate of free flaps was 96%. The general surgical complications were inflammation, pneumothorax, deformities, and specific vascular thrombosis. CONCLUSIONS: Replacement of extensive limb defects with free flaps remains a practical method in children.
{"title":"Free flaps to replace extensive and deep limb defects in children","authors":"D. Grankin, S. I. Golyana, N. Avdeychik, A. V. Safonov, T. I. Tikhonenko, N. Galkina, E. A. Zakharyan, K. A. Afonichev, Anastasia I. Arakelian","doi":"10.17816/ptors114719","DOIUrl":"https://doi.org/10.17816/ptors114719","url":null,"abstract":"BACKGROUND: Extensive and deep limb defects remain a difficult problem of reconstructive surgery in children. Free microsurgical flaps are used to resolve this problem. Free flaps can be complex in composition and include muscles and bone parts, which allow replacing large and multicomponent limb defects. The technique is used in patients with posttraumatic deformities, burns, acquired limb deformities, and congenital deformities of the extremities. \u0000AIM: To retrospectively analyze free flaps in children for the replacement of limb defects. \u0000MATERIALS AND METHODS: This single-center retrospective study analyzed 120 cases of microsurgical autotransplantation of free flaps to replace defects of the upper and lower extremities in children. The patients were children aged 117 years who had injuries and burns, acquired limb deformities, and congenital limb deformities. \u0000RESULTS: The average age of the patients was 9.5 years, and 72% of the patients were boys. Moreover, 95% of the children had posttraumatic deformities, burns, and acquired pathologies. Free latissimus dorsi flaps were used in 70% of the patients. The recipient area was the upper limb in 53% of the cases. The survival rate of free flaps was 96%. The general surgical complications were inflammation, pneumothorax, deformities, and specific vascular thrombosis. \u0000CONCLUSIONS: Replacement of extensive limb defects with free flaps remains a practical method in children.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80802453","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. Avdeychik, E. A. Zakharyan, D. Grankin, A. V. Safonov
BACKGROUND: The shortening of the forearm in children with congenital radial clubhand and multi-plane deformity of the ulna is challenging to treat by surgery. The literature shows single studies using the Ortho-SUV frame for the correction of forearm deformity in multiple exostosis chondrodysplasia and patients with posttraumatic deformities. CLINICAL CASE: A 17-year-old patient with congenital radial clubhand who had a relapse of hand deviation undergo correction of forearm deformity. The elimination of radial hand deviation and ulnar deformity correction in the distal part with subsequent elongation were performed. DISCUSSION: No data on the use of the Ortho-SUV frame for the correction of ulnar multiplanar deformity in radial clubhand are available. Indicators, i.e., fixation index, osteosynthesis index, lengthening, and complications, were compared with the indicators used for ulnar elongation with a small angle of radial deviation of the hand. CONCLUSIONS: Personalized plan of forearm deformity correction based on the anatomical features of the congenital radial clubhand and X-ray indicators allowed achieving good cosmetic and functional results.
{"title":"Use the Orto-SUV frame in children with congenital radial clubhand: A clinical case","authors":"N. Avdeychik, E. A. Zakharyan, D. Grankin, A. V. Safonov","doi":"10.17816/ptors109904","DOIUrl":"https://doi.org/10.17816/ptors109904","url":null,"abstract":"BACKGROUND: The shortening of the forearm in children with congenital radial clubhand and multi-plane deformity of the ulna is challenging to treat by surgery. The literature shows single studies using the Ortho-SUV frame for the correction of forearm deformity in multiple exostosis chondrodysplasia and patients with posttraumatic deformities. \u0000CLINICAL CASE: A 17-year-old patient with congenital radial clubhand who had a relapse of hand deviation undergo correction of forearm deformity. The elimination of radial hand deviation and ulnar deformity correction in the distal part with subsequent elongation were performed. \u0000DISCUSSION: No data on the use of the Ortho-SUV frame for the correction of ulnar multiplanar deformity in radial clubhand are available. Indicators, i.e., fixation index, osteosynthesis index, lengthening, and complications, were compared with the indicators used for ulnar elongation with a small angle of radial deviation of the hand. \u0000CONCLUSIONS: Personalized plan of forearm deformity correction based on the anatomical features of the congenital radial clubhand and X-ray indicators allowed achieving good cosmetic and functional results.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84205774","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}
Alexey Georgievich Baindurashvili, MD, PhD, Doctor of Medicine, Professor, Full member of the Russian Academy of Sciences, President of H. Turner National Medical Research Center for Childrens Orthopedics and Trauma Surgery, laureate of the Russian Federation Government Prize, Honored Doctor of the Russian Federation, and Chief Pediatric orthopedic and trauma surgeon of St. Petersburg, celebrates his 75th anniversary.
{"title":"Alexey Georgievich Baindurashvili","authors":"","doi":"10.17816/ptors109503","DOIUrl":"https://doi.org/10.17816/ptors109503","url":null,"abstract":"Alexey Georgievich Baindurashvili, MD, PhD, Doctor of Medicine, Professor, Full member of the Russian Academy of Sciences, President of H. Turner National Medical Research Center for Childrens Orthopedics and Trauma Surgery, laureate of the Russian Federation Government Prize, Honored Doctor of the Russian Federation, and Chief Pediatric orthopedic and trauma surgeon of St. Petersburg, celebrates his 75th anniversary.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"20 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72398360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Fractures of the bones of the hand and wrist account for 25% of all fractures in children, whereas the phalanges are the most common localization of these injuries and account for 15%30% of all fractures of the upper limb. To fix fractures of the neck of the middle and main phalanx of the fingers, traumatologists resort to retrograde osteosynthesis with a spoke, which in all cases passes through the articular surface of the distal fragment, thereby blocking the joint adjacent to the fracture. This significantly complicated postoperative rehabilitation to restore movements. AIM: This study aimed to comparatively analyze the results of extra-articular osteosynthesis of fractures of the distal metaphysis of the main phalanx of childrens fingers. MATERIALS AND METHODS: A prospective cohort study included 52 children with fractures of the main phalanx of the fingers. The study cohort of children was divided into two groups. The main group included 29 children who underwent osteosynthesis of the distal fragment of the phalanx with spokes according to the authors method without passing them through the distal or proximal interphalangeal joint. The comparison group included 23 children who, during osteosynthesis, had spokes carried out retrogradely, through the articular surface of the distal phalanx fragment. The total volume of the restored active movements in the proximal interphalangeal joint was compared after 3, 6, and 12 weeks from the moment of surgery, including local signs of inflammation in the needle insertion site after 3 and 7 days from the moment of surgery. RESULTS: In the main group, signs of inflammation were found only in 10% of the cases, whereas in the comparison group, more serious signs were observed, such as the release of exudate along the spokes in two cases on day 3. The average values of the amplitude of movements at week 3 in the main group are more than two times higher than the average values of the comparison group, 12.06 and 5.56, respectively. The volume of movements in the main group was restored more than two times more efficiently, and in several patients, by week 12, it was restored to 100 of the total volume of active movements in the joint (p 0.05). CONCLUSIONS: The authors method of extra-articular and antegrade osteosynthesis of the fractures of the neck of the main phalanges in children made it possible to achieve better functional results in comparison with the standard method.
{"title":"Treatment of fractures of the main phalanx of the fingers in children","authors":"I. I. Gordienko, N. Tsap, S. Kutepov","doi":"10.17816/ptors108751","DOIUrl":"https://doi.org/10.17816/ptors108751","url":null,"abstract":"BACKGROUND: Fractures of the bones of the hand and wrist account for 25% of all fractures in children, whereas the phalanges are the most common localization of these injuries and account for 15%30% of all fractures of the upper limb. To fix fractures of the neck of the middle and main phalanx of the fingers, traumatologists resort to retrograde osteosynthesis with a spoke, which in all cases passes through the articular surface of the distal fragment, thereby blocking the joint adjacent to the fracture. This significantly complicated postoperative rehabilitation to restore movements. \u0000AIM: This study aimed to comparatively analyze the results of extra-articular osteosynthesis of fractures of the distal metaphysis of the main phalanx of childrens fingers. \u0000MATERIALS AND METHODS: A prospective cohort study included 52 children with fractures of the main phalanx of the fingers. The study cohort of children was divided into two groups. The main group included 29 children who underwent osteosynthesis of the distal fragment of the phalanx with spokes according to the authors method without passing them through the distal or proximal interphalangeal joint. The comparison group included 23 children who, during osteosynthesis, had spokes carried out retrogradely, through the articular surface of the distal phalanx fragment. The total volume of the restored active movements in the proximal interphalangeal joint was compared after 3, 6, and 12 weeks from the moment of surgery, including local signs of inflammation in the needle insertion site after 3 and 7 days from the moment of surgery. \u0000RESULTS: In the main group, signs of inflammation were found only in 10% of the cases, whereas in the comparison group, more serious signs were observed, such as the release of exudate along the spokes in two cases on day 3. The average values of the amplitude of movements at week 3 in the main group are more than two times higher than the average values of the comparison group, 12.06 and 5.56, respectively. The volume of movements in the main group was restored more than two times more efficiently, and in several patients, by week 12, it was restored to 100 of the total volume of active movements in the joint (p 0.05). \u0000CONCLUSIONS: The authors method of extra-articular and antegrade osteosynthesis of the fractures of the neck of the main phalanges in children made it possible to achieve better functional results in comparison with the standard method.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"2012 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86418795","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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