Vol 1, No 1 (2013)

The analysis of the results of surgical treatment of 32 patients with congenital spinal de formity against lateral and posterolateral hemivertebrae in the area of the thoracolumbar junction was carried out. The patients' ages ranged from 1.2 to 4 years old, 11 boys and 21 girls. Terms of postoperative follow-up were from 2 to 10 years. The angle of scoliosis before surgery was from 26 to 52, kyphosis - from 12 to 56. Surgical intervention was performed with the combined approach in the amount of extirpation of abnormal vertebrae with surrounding disks, deformity correction with dorsal metalwork, corporodesis and posterior fusion with local bone autograft. Metal structure was removed in 1.5-2 years after surgery. Correction of scoliosis was 94-100 %, kyphotic - 82-90 %. The progression of deformation, neurological complications and joining of the dysplastic process were not observed. In assessing of the long-term results, scoliosis curve ranged from 0 to 8 (average - 4.2), kyphotic from 0 to 10 (average - 5.1). The progression of the spinal deformity with hemivertebrae in the area of the thoracolumbar transition requires early surgical elimination of the defect with a full radical correction of congenital deformation, restoration of the anatomy of the spinal canal and the physiological curves of the spine at the level of deformation with fixation of a minimum number of spinal motion segments with metal construction and bone plastic stabilization (front and posterior spinal fusion).

Congenital clubfoot requires complete correction before the period of verticalization. Conservative methods are priority in treatment. The most effective method is Ponseti method that allows correcting all the deformations even in severe clubfoot. However, if clubfoot is accompanied with abnormal anatomy of foot or significant changes in functional ability of muscles, operative treatment is inevitable. The extent of surgical intervention depends on the severity of detected abnormalities and is determined individually. The use of ultasound, radiographic, and CT investigations, according to indications, contributes to the diagnostics. The indication for surgery is the lack of effect of conservative treatment after 10-12 cast correction in children over the age of 4 months. Diagnostic criteria for deciding in favor of surgery are: availability of fibrous coalition, the deformation of the talar or the sphenoid bone, the anomaly in the point of attachment of the tendon of the tibialis anterior muscle, lack of the repositioning of navicular bone on the talar head. Orthosis supply and rehabilitation treatment depend on the extent of surgical intervention.

Complex treatment of children with cleft lip and palate is complicated and multi-step. Treatment is conducted by high-skilled specialists. The organization and execution of this complex are possible only at the large specialized center. Coordinator of this work is the maxillofacial surgeon. The performance of rehabilitation circuits includes preoperative orthodontic and orthopedic treatment, operative intervention (reconstructive and plastic surgery), orthodontic and orthopedic treatment after operation. Post-operative conservative treatment prevents the development of secondary deformities of the nose and upper lip. Professional psychological help and long supervision promote the achievement of good social adaptation of patients with congenital cleft lip and palate, improvement of their health.

The article contains the results of the analysis of radiographs of the foot and ankle in 84 children with malformations of the fibula. We found that infants’ relation to the ankle joint is often normal, as in the sagittal and frontal planes. With increasing age the number of posterior subluxation increases as well as anteriorly, laterally. Also dislocations of the foot were presented. The most significant relationships were violations of the subtalar joint. There were pronation, supinatsion, positions of calcaneus bone and its lateroposition, which was the most frequent cause of valgus deformity. Also we found a violation of the form of the talus such as a flattening of the block, smoothing of the neck. In rare cases of the varus deformity of the foot abnormalities of the tarsal bones were observed.

In the paper we discussed and analyzed the issues that confront practicing orthopedists with the most mysterious and at the same time the most studied vertebral column lesion in children and adolescents - idiopathic scoliosis. Nowadays a great amount of information on its various aspects has been already accumulated, but a practical output in the form of a system of effective treatment has not been yet found and (we can’t even speak about) there is no speech at all about the prevention (prophylactic) of the disease (scoliosis). On the basis of the own many year’s experience with this category of patients and the results of a comprehensive multi-faceted survey, the authors acquired the right to form their own point of view on the etiology and pathogenesis of the three-plane deformation in orthograde human (homo erectus). In this paper, the authors present their reflections on the history of the study of scoliosis, the terminology, statistical indicators and the existing views on its origins. Concerning argumentation on the own findings (conclusions) and views on the disease the authors plan to tell in the following sections.

This article is a brief historical review of distraction osteogenesis development in hand surgery. It describes the key steps in the evolution of methods beginning with immobilization and external fixation up to the distraction method in orthopaedics and its introduction in hand surgery.