Vol 10, No 4 (2003)

Original study articles

The most important tasks of organizing a pediatric traumatological and orthopedic service in Russia (based on the report at the symposium of pediatric traumatologists and orthopedists of Russia)

Malakhov O.A., Andreeva T.M., Tarasov V.I., Gribova I.V.


Main indices characterizing pediatric traumatologic and orthopedic care in the Russian Federation are presented. Rates of children traumata and skeletomuscular pathology are given. One of the directions to perfect the specialized traumatologic and orthopedic care for children is the creation of special regional program.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):3-7
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Optimal technologies in the diagnosis and treatment of orthopedic pathology in children and adolescents, errors and complications. Symposium of pediatric traumatologists-orthopedists of Russia (September 17-19, 2003, Volgograd)


The symposium was attended by 212 pediatric orthopedic traumatologists from 53 administrative territories of Russia. The program of the symposium included the following questions:
1. injuries and morbidity of the musculoskeletal system in children and adolescents, organization of specialized care;
2. optimal technologies for the treatment of injuries and their consequences, congenital and acquired diseases of the musculoskeletal system, benign bone tumors. Errors in diagnosis and treatment, ways to overcome the complications that have arisen;
3. new technologies for diagnosis, treatment and rehabilitation.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):8-9
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Specialized medical care for children with injuries and diseases of the musculoskeletal system in the pediatric field hospital

Rozinov V.M., Petlakh V.I., Yandiev S.S., Burkin I.A., Shabanov V.E.


The results of traumatologic and orthopaedic care rendered to children at Pediatric Field Hospital in Chechen Republic during the period from April 16,2001 to July 6,2002 were analyzed. Within that period 4061 outpatient consultations were conducted,447 patients were treated at the hospital,554 surgical interventions were performed and 33 patients were consulted in the leading clinics of the Russian Federation by means of telemedical technologies. All patients had injuries and diseases of loco-motor system. The experience of Pediatric Field Hospital is indicative of the efficacy of the presented model of the organization of specialized orthopaedic and traumatologic care under conditions of nonfunctioning regional public health.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):10-13
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Specialized Rehabilitation Center for Pediatric Orthopedics and Traumatology

Dudin M.G., Falinskiy A.A., Leonova S.F.


Issues of the organization of the work on the rehabilitation of children with loco-motor pathology are reviewed on the example of St. Petersburg Rehabilitation CenterOgonyok”. The tasks of such centres include the conservative treatment of children with loco-motor system pathology with simultaneous provision of education process. The structure, list of members of staff as well as characteristics of the material and technical basis including therapeutic and diagnostic units are presented. The advantages of the rehabilitation centers over specialized health centers are shown.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):14-17
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The problem of childhood disability due to orthopedic pathology and the tasks of an orthopedist during medical rehabilitation

Solovieva K.S., Bityukov K.A.


Based on the analysis of different documentation it was detected that children with orthopaedic pathology made up 17.1%) of total invalids population. The main causes of pediatric invalidity due to orthopedic pathology are presented. Program of individual medical rehabilitation is suggested.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):18-22
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Ultrasonographic evaluation of the state of the hip joints in newborns

Eskin H.A., Mikhaylova L.K.


Two hundred fifty newborns (110 girls and 140 boys) were examined with ultrasonography. The method of acetabular index measurement was used to assess the hip joint status. High efficacy of sonography in differentiation of true and false-positive Marks-Ortholani symptom was noted. High correlation between sonography data and radiography ones was detected. Absence of irradiation, possibility of examination in real time and repeated examinations make sonography one of the main methods for hip joint screening.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):23-27
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Mistakes and complications in the conservative treatment of congenital hip dislocation in children

Malakhov O.A., Levanova I.V., Kralina S.E., Sharpar V.D.


Retrospective analysis of treatment of 183 patients, aged 1 month-18 months, with congenital hip dislocation was performed. 146 patients had failed hip reduction. It was detected that in 134 cases (91.8%) inadequate treatment and/or wrong management and behavior of parents took place. Failed treatment with Frejka pillow, abductive splint, Pavlic device, functional plaster bandage, closed reduction were considered. Main mistakes in application of those methods as well as violation of treatment tactics were described. It was shown that repeated failed femoral head reductions were unfavorable factors for the following development of hip joint.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):28-33
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Conservative treatment of children with congenital hip dislocation

Bakhteeva N.K., Vinokurov V.A., Norkin I.A., Persova E.A.


Long-term results of conservative treatment of 612 children (710 joints) with congenital hip dislocation showed that the highest complication rate was detected in Lorenz procedure. Authors suggest the device to reduce hip dislocation without traumatization but with preservation of joint movement during treatment. Movements rotating the hip inside promote epiphysis centration into acetabulum that decreases the risk of dystrophic process development. In 91.4% of cases excellent and good results were achieved in children over 4 months who were treated using that device in combination with physiotherapy. Rational tactics for conservative treatment of congenital hip dislocation was elaborated. Authors believe that the suggested treatment complex allows to delay by 10-15 years the early coxarthrosis development in children and adolescents.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):34-37
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Restoration of the integrity of the proximal femur in osteolysis of the neck with separation of the head from the femur and dislocation of the trochanteric region

Belokrylov N.M.


New surgical reconstructive method of proximal femur in separation of head resulted in neck osteolysis and dislocation of trochanteric region was described. In significant femur dislocation first stage is its descending with external fixation device. Then open reconstruction is performed and unloading is continued using the same device. In 4 children that method was used successfully.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):38-40
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Electrical stimulation of osteogenesis in the treatment of juvenile epiphysiolysis of the femoral head

Shein V.N.


In 11 children with juvenile femoral head epiphysiolysis complex treatment included electrostimulation of osteogenesis by 20 mA bipolar impulse current. It was noted that in all cases the pathologic process was stopped and normal bone structure was restored.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):41-43
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Tendon-muscle plastic surgery in the treatment of contractures of the shoulder joint in children with natal and postnatal injuries of the brachial plexus

Merkulov V.Y., Yeltsin A.G.


During the period 1980 through 2003,55 patients aged 3—17 years, with adductive internal rotation shoulder contractures resulted from natal and neonatal brachiplex injury were operated on. Sixty six surgical procedures including Chizhik-Poleiko, Episcopo, Meyer operations, derotation humerus osteotomy, shoulder lavsanodesis were performed. Good results were achieved in 39 patients (70.9%), satisfactory resultsin 15patients (27.3%o) and unsatisfactory resultin 1 patient (1.8%). It is shown that the most effective procedures are various types of tendon- muscular plasty directed to the restoration of shoulder function. The best results have been achieved in children under 10 years. Indications and contraindications to derotation humerus osteotomy are detected.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):44-47
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Longitudinal growth of a congenitally shortened lower limb after its surgical lengthening

Popkov D.A., Shchurov V.A.


Based on the results of treatment of 150 patients, aged 2-15 years,5 types of growth rate changes of the lengthened segment in early and long-term postoperative periods were detected. Stimulation of longitudinal growth takes place after primary lengthening of the segment, performed prior to prepuberty growth leap when conditions for weigh bearing of lengthened limb and its functional activity exist and are being created. Repeated lengthening of segment, significant limitation of functional load as well as reconstructive operation on foot bones exert negative influence on the following growth. Stimulation of longitudinal growth of lengthened segment is accompanied by the increase of contractive muscular capacity and peripheral hemodynamics indices in long-term period.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):48-53
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The concept of the use of artificial correction of movements in orthopedics, traumatology and prosthetics

Vitenzon A.S., Petrushanskaya K.A.


Principles and methods of artificial movement correction (AMC) with muscle electrostimulation during pathologic gait were considered. It was shown that the most important peculiarity of AMC was phase conformity of artificial and natural irritation as well as construction of muscles at movement. Electrostimulation in M zone, when muscle activity at movement is the maximum one, is obligatory. The main functions of AMC were detected: i.e. therapeutic, diagnostic and prognostic. Indications and contraindications for FMC application as well as technological operation were determined. Clinical and instrumentation evaluation of AMC results in certain pathologic changes of loco-motor system, i.e. crus stump, III degree of scoliotic deformity, non-union and pseudoarthrosis of bone crus is given.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):54-58
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The use of new corsets in the treatment of patients with idiopathic scoliosis II-III degree

Skoblin A.A., Alekseenko I.G.


At Federal Center of Invalid Expertize and Rehabilitation 175 adolescents with II-III degree idiopathic scoliosis were under the treatment. To increase the efficacy of conservative treatment new fixative-reclination corset with springing inserts as well as new functional corrective corset were worked out and those corsets were applied for the treatment of patients. In patients with II degree deformity correction of primary arch was from 37%o in thoracic to 80% in lumbar scoliosis. In patients with III degree deformity correction made up from 29% in thoracic to 61% in combined scoliosis. Those data were obtained at radiologic examination in terms under 3 years.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):60-64
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Massive blood loss and coagulation hemostasis in the surgical treatment of scoliosis in children and adolescents

Vetrile S.T., Zakharin R.G., Bernakevich A.I., Vasiliev S.A., Kuleshov A.A.


In 95 patients, operated on for scoliosis, coagulation status was studied using standard tests (activated partial thromboplastin time, prothrombin decrease by Quick, normalized prothrombin ratio, antithrombin III, ethanol and orthophenothroline tests, ХП-a dependent fibrinolysis) pre-, intra- and postoperatively. It was shown that coagulation disturbances developed already during the hemodilution process. Consumption of coagulation factors took place during operation and at early postoperative period. Blood loss by drainage was marked during 48 hours after operation. Maximum changes of coagulation indices were registered on 2—5 day after operation. Use of fresh-frozen plasma, e-aminocaproic acid to decrease of blood grainage loss was grounded.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):64-68
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Experimental model of hereditary spinal deformity

Zaydman A.M., Borodin P.M., Rusova T.V., Korel A.V., Sakharov A.V.


Model of spine deformity-like SheuermannMau disease was obtained by crossing of two lines of mice with known genetic defects. Results of morphologic and ultrastructural studies permitted to extra-polate the obtained data, with certain prudence, on clinical manifestations of investigated pathology and to explain the main pathogenic mechanisms of process development.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):69-73
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The use of plastic material "perfoost" in the clinic of pediatric bone pathology

Snetkov A.I., Lekishvili M.V., Kasymov M.A., Ilina V.K., Batrakov S.Y., Vasiliev M.G., Avakyan A.M., Pavlov R.P., Fazilova A.A.


Osseous-plastic material «Perfoost» — demineralized lyophilized perforated allografs- was elaborated at CITO in 1997. Study of mechanical characteristics showed that «Perfoost» grafts had high plasticity. Mechanical stiffness allowed to use that material for substitution of marginal bone defects. Study in vitro showed high efficacy of cloning that was indirect evidence that demineralized allografts had osteoinductive properties. Between 1998—2002 at the Department of bone pathology for children and adolescents 121 patients, aged 1—18, with primary tumor, tumor-like diseases and systemic inherited skeleton pathology were operated on with «Perfoost». Follow up period ranged from 1 years to 4 years 10 months. In vast bone defects demineralized allografts were used in combination with frozen cortical implants and metallosteosynthesis. Restoration of bone tissue was achieved in the period from 8 to 12 months. In patients with fibrous dysplasia who underwent extensive bone resection, the time of bone restoration increased by 16 months. Good and satisfactory results were observed in 98,3% of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):74-79
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Teratological variants of congenital triphalangism of the 1st finger in children

Agranovich O.E., Shvedovchenko I.V., Golyana S.I.


 ased on examination of 56 patients, aged 8 months - 16 years, heterogeneity of congenital thumb three-phalangism was detected. Two forms of that pathology were defined: simple form (brachymesophalangeal, pseudothreephalangism, dolichophalangeal) and complex form (three-phalangism with combination of 1st radius hypoplasia and with combination of radial polydactyly). The main radiologic criteria to delimit one form from the other one are the following: longitudinal and transverse sizes of 1st metacarpal bone; location of 1st metacarpal bone epiphysis; sizes and shape of additional phalangx; longitudinal size of 1st radius: volume of 1st intermetacarpal interval. Detection of malformation type is of importance for the choice of treatment tactics.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):80-83
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Experience in the treatment of skeletal trauma associated with craniocerebral injuries in children

Yakhyaev Y.M., Gadzhimirzaev G.A.


Experience in treatment of 125 children with limb fractures combined with craniocerebral injuries is presented. Algorithm of diagnostic measures to improve the quality of diagnosis was elaborated. Seventy one patients (56.8%) were treated conservatively: 54 patients with skeletal traction,6 patients with adhesive plaster traction,11 — with plaster of Paris traction. Fifty four patients (43.2%) underwent surgical treatment: 25 patients had intramedullar osteosynthesis,24 patientsfixation of fragments by pins,5 patientsby Ilizarov device. Long term results were assessed at 1—7 years follow-up. Results showed the efficacy of osteosynthesis in relation to skeletal traction. However, at early posttraumatic period when craniocerebral injury is extremely severe, surgical treatment should be limited by skeletal traction and plaster of Paris immobilization. Use of early osteosynthesis gives the decrease of hospitalization term by 7.8 day and fixation termsby 10.2 day.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):84-85
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Successful replacement of an infected bone defect in a child with a biocompatible composite material

Krasnoyarov G.A.


Treatment of post-traumatic osteomyelitis of long bones in children is a difficult task. Elimination of a purulent-necrotic focus, stabilization of bone fragments, and creation of optimal conditions for continued bone growth are the main factors in achieving a good anatomical and functional result [7]. The problem becomes much more complicated when, after the removal of large bone sequesters, a defect is formed that requires replacement.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):86-87
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Features of the treatment of lower limb deformities in children with systemic diseases of the musculoskeletal system

Lapkin Y.A., Konyukhov M.P.


The analysis of conservative and surgical treatment results of more than 200 children with systemic diseases of loco-motor system showed that complications and deformity recurrence were mainly caused by the inadequate treatment tactics as well as the use of traditional orthopaedic techniques with no account of the systemic nature of the pathology. The most common mistakes in conservative treatment included the prolonged use of plaster cast, attempts to petform one-step reposition ofjoint dislocations and underestimation of osteoporosis severity. In surgical treatment the typical mistakes were the attempts to restore the joint function to the detriment of the joint stability and weight bearing function of the extremity, use of tenoligamentocapsulotomy in cases when either correction of bone deformities or the application of Ilizarov device were indicated. The rate of complications was significantly lower when the deformity correction was followed by additional joint stabilization using transposition of muscles and plasty of ligamentous system.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):88-93
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Congratulations to the hero of the day! Mikhail Alexandrovich Berglezov


August 2, 2003 marked the 75th birthday and 52 years of medical and scientific activity of a prominent orthopedic traumatologist, Honored Scientist of the RSFSR, Doctor of Medical Sciences, Professor Mikhail Alexandrovich Berglezov.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):13-13
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Congratulations to the hero of the day! Sergei Timofeevich Zatsepin


Sergei Timofeevich Zatsepin, the largest domestic orthopedist-traumatologist, surgeon, and bone pathologist, has turned 80. It would seem that just recently we congratulated him on his 75th birthday (see Bulletin of Traumatology and Orthopedics, No. 3/98), and here is a new, even more wonderful anniversary! The past 5 years, like the whole life of Sergei Timofeevich, were filled with scientific research, active practical activities.

N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(4):73-73
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