Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

About

‘Pediatric Traumatology, Orthopaedics, and Reconstructive Surgery’, a scientific academic journal published four times a year since 2013. The Journal founders are the Turner Scientific Research Institute for Children's Orthopedics of Ministry of Healthcare of Russian Federation and Eco-Vector LLC.

The target audience of the journal is researches, physicians, orthopedic trauma, burn, and pediatric surgeons, anesthesiologists, pediatricians, neurologists, oral surgeons, and all specialists in related fields of medicine.

Editor-in-Chief

Baindurashvili A.G., MD, PhD, Professor (ORCID: 000-0001-8123-6944)

The journal publishes:

  • Results of domestic and international clinical and experimental research, research and information about new diagnostic methods and treatment of patients with surgical diseases, burns and their consequences, injuries and disorders of the musculoskeletal system;
  • lecture notes on journal topics, articles on organization (and management) of trauma and orthopaedic care, case studies, literature reviews, abstracts of papers, published in international journals;
  • Information on past and upcoming scientific conferences and events.

Indexation

The Journal is included into the “List of leading scientific peer-reviewed journals, where principal data of applicants for scientific degree has to be published”.

The journal is indexing in the following international databases and directory editions:

The journal is registered with Federal Service for Supervision of Communications, Information Technology and Mass Media and Federal Service for Monitoring Compliance with Cultural Heritage Protection Law PI № FS77-54261, May 24, 2013.

On the cover – drawing of the patient from the H.Turner National Center for Children’s Orthopedics.

Announcements

 

Nina Davydovna Kazantseva

07.07.2021
Posted: 07.07.2021

AnniversarIe

11.01.2021
Posted: 11.01.2021

AnniversarIe

11.01.2021
Posted: 11.01.2021
 
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Current Issue

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Vol 9, No 2 (2021)

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Original studies

Oxford ankle foot questionnaire: Localization in Russia
Kenis V.M., Dimitrieva A.J., Suponeva N.A., Piradov M.A., Yusupova D.G., Zimin A.A., Zaitsev A.B., Derevianko D.V., Polekhina N.V., Ramchandani N., Bundhun P.
Abstract

BACKGROUND: According to literature data, the Oxford Foot Questionnaire for children is a valid instrument for the assessment of complaints and therefore requires adaptation in Russian.

AIM: Russian localization of the Oxford Ankle Foot Questionnaire.

MATERIALS AND METHODS: Localization of the questionnaire was gradually carried out in accordance with international standards. To specify the accuracy of anatomical comprehension of the lower extremity, 35 children aged 5–16 years old and their parents were interviewed preliminary. For final validation of the Russian version, the pilot testing was performed in 20 children aged 5–16 years and their parents.

RESULTS: As all the interviewed children correctly anatomically specified the “leg,” 91.4% of them correctly pointed out the “foot,” and only 20.0% of children, and 57.0% of the parents were able to find the “ankle joint,” we translated the phrase “ankle and foot” as “стопа.” This was represented in the title and text of the questionnaire items. The final questionnaire version survey illustrated that, generally, children and their parents answered all questions without any difficulties, and additions and clarifications were not essential.

CONCLUSIONS: This Russian version of the Oxford Ankle Foot Questionnaire is the only instrument used for the assessment of different foot complaints in children aged 5–16 years and parents’ opinion on how much the existing pathology affects the physical, social, and emotional components of children’s complaints.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):135-142
pages 135-142 views
Validation and cultural adaptation of the Russian version of the Pedi-IKDC questionnaire
Ivanov I.A., Eltsin A.G., Mininkov D.S.
Abstract

BACKGROUND: Questionnaires are standard tools used for examination of patients. Obtained data provide information about knee function disturbance and level of the quality of life. Young patients with various knee injuries also needed examination questionnaires. In worldwide practice, the Pediatric International Knee Documentation Committee (Pedi-IKDC) is more often used by doctors. However, if the doctor wants to use foreign questionnaire in his/her practice, the questionnaire should be validated and culturally adaptable.

AIM: This study aimed to enable the validation and cultural adaptation of the Russian version of the Pedi-IKDC questionnaire based on the English version for children and adolescent.

MATERIALS AND METHODS: This questionnaire was translated from English by professional medical translator and by orthopedic surgeon. The Lysholm questionnaire was also used to control the adequacy of Pedi-IKDC results. Statistical analysis was performed to process data.

RESULTS: Cronbach’s alpha was 0.902, which means that questions have high level of consistency. The high correlation of results between the Lysholm and Pedi-IKDC questionnaire also proves the adequateness and objectiveness of the results.

CONCLUSIONS: The proposed Russian version of the Pedi-IKDС questionnaire gives effective, objective, and adequate results. It is a good tool for knee assessment in children.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):143-151
pages 143-151 views
Comparative analysis of the quality of life of children with congenital scoliosis after surgical treatment: Extirpation of the hemivertebra from dorsal and combined access
Kokushin D.N., Khardikov M.A., Vissarionov S.V., Sokolova V.V., Khusainov N.O., Zaletina A.V.
Abstract

BACKGROUND: Congenital scoliosis with disorders of the formation of the vertebrae is the most common cause of pronounced deformities of the spine in early childhood. This pathology can be treated surgically using various techniques that differ in invasiveness, severity of the condition in the postoperative period, achieved result of deformity correction, and nature of the long-term prognosis. Numerous studies have assessed the quality of life of patients who underwent surgery for acquired deformities, trauma, and degenerative and neoplastic diseases of the spine in adults. However, features of the child’s quality of life following surgical technique for congenital scoliosis have not been sufficiently studied.

AIM: This study aimed to compare the quality of life of children with congenital scoliosis of the thoracolumbar localization after extirpation of the hemivertebra from the dorsal and combined approaches.

MATERIALS AND METHODS: An intergroup prospective analysis of the results of a survey of 60 patients with congenital deformity of the spine against the background of an isolated violation of the formation of the thoracic or lumbar vertebra was carried out. Patients underwent standard surgical treatment. Patients were divided into two groups according to the surgical approach to the abnormal vertebral body: dorsal group (n = 28) and combined group (n = 32). The average age of the patients was 75 (min–max, 26–196) months. The follow-up period was 18 months after surgery. To assess the quality of life, a specialized Russian version of the PedsQL v4.0 questionnaire and a modified visual analog scale were used.

RESULTS: After surgical treatment of congenital spinal deformity, quality of life indicators decreased more than two times than the results of a preoperative survey. At 18 months postoperatively, the physical activity and psychoemotional state were restored to the preoperative level, while patients of the combined group had a higher satisfaction score on the quality of life (p < 0.05).

CONCLUSIONS: The combined approach provides the best correction of congenital deformity of the spine and allows maintaining of the achieved result throughout the observation period. In the early postoperative period, the combined group demonstrated a significant decrease in the level of satisfaction with the quality of life, while the pain syndrome was higher than that in the dorsal group. Dynamic observation revealed the leveling of these differences and a subsequent increase in the level of satisfaction with the quality of life of these patients.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):153-162
pages 153-162 views
Our experience of total hip arthroplasty in adolescents with consequences of acute hematogenous osteomyelitis
Imomov K.D., Baskov V.E., Neverov V.A., Bortulev P.I.
Abstract

BACKGROUND: Currently, the number of adolescents with terminal stages of coxarthrosis of various origins who underwent total hip joint arthroplasty has increased, as the use of modern implant models with a long service life has narrowed the age limit and expanded the indications for this intervention.

AIM: This study aimed to assess the effectiveness of total hip arthroplasty in adolescents with stage 3 coxarthrosis caused by acute hematogenous osteomyelitis.

MATERIALS AND METHODS: The study analyzed preoperative data and postoperative clinical, radiological, and functional examination data of 40 patients aged 13–18 (15 ± 1.2) years with stage 3 coxarthrosis caused by acute hematogenous osteomyelitis. The study group was composed of 21 (52.5%) boys and 19 (47.5%) girls. The control group consisted of 32 patients with stage 3 post-traumatic coxarthrosis, aged 12–18 (15.4 ± 1.7) years, of which 14 (43.75%) were girls and 18 (56.25%) were boys.

RESULTS: The long-term functional results were evaluated using the Harris hip score (14). The average Harris hip scores before and after arthroplasty were 44.87 ± 5.65 and 80 ± 7.61 (p < 0.05), respectively. In the comparison group, the mean Harris hip scores before and after surgery were 33.73 ± 4.28 and 89.47 ± 5.60 points, respectively (p < 0.05). The postoperative follow-up duration was 5 ± 3 M ± SD (95% confidence interval) years. No complications were observed in the early and late postoperative periods.

CONCLUSIONS: In adolescents, total hip arthroplasty is an effective surgical treatment for complications of acute hematogenous osteomyelitis. It quickly provides attainable, stable, and favorable outcomes, which improve the quality of life and social adaptation of adolescents.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):163-174
pages 163-174 views

Experimental and theoretical research

Experimental evaluation of the effectiveness of adipose mesenchymal stem cells in full-thickness skin wounds
Artsimovich I.V., Zinoviev E.V., Gostimskii A.V., Asadulaev M.S., Vissarionov S.V., Manukovskii V.A., Kostyakov D.V., Pyatakov S.N.
Abstract

BACKGROUND: Currently, numerous techniques or medical devices that allow complete or partial restoration of the lost skin within a short time remain as subjects of development. Many studies have shown the effectiveness of using stem cells in the treatment of full-thickness skin defects, but their use remains very limited. At present, there is no consensus among researchers about the advisability of the use of stem cells in the treatment of burns as well as about the method of their introduction.

AIM: This study aimed to examine the possibility of accelerating the reparative histogenesis of tissues in the zone of deep skin burns using cultures of adipogenic mesenchymal cells, as well as to evaluate the effectiveness of various methods of introducing cultures of these cells into the defect zone.

MATERIALS AND METHODS: An experimental study was carried out on small laboratory animals (rats). After simulating a grade III burn, mesenchymal stem cells were transplanted and superficially applied to the wound surface or injected under the fascia. In the control group, no wound treatment was performed. To assess the effectiveness of the wound-healing preparations, the appearance of wounds was assessed daily, the nature of the discharge and presence and type of granulations were noted, and the timing of scab rejection and wound healing was recorded. The wound area was assessed using a planimetric method. A histological examination of wound biopsies was carried out on days 7, 14, 21, and 28 of observation.

RESULTS: The application of adipogenic mesenchymal stem cells demonstrated the greatest efficiency on the developed burn model. Subfascial administration was less effective, but this method achieved a significant acceleration of wound healing in comparison with the control group. An increase in the healing index by 56.6% demonstrates the highest intensity of reparative regeneration in animals applied with adipogenic mesenchymal stem cells.

CONCLUSIONS: The preliminary results show that the application of adipogenic mesenchymal stem cells on the skin defect is more effective than subfascial administration based on the healing index. The use of adipogenic mesenchymal stem cells may substantially increase the effectiveness of the treatment of full-thickness skin defects.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):175-181
pages 175-181 views

Exchange of experience

First clinical experience of a new surgical technique including correction of bony alignment of first foot ray combined with reconstruction of muscle balance in case of adolescent hallux valgus
Fishkin M.V., Fomenko M.V., Schermann H.
Abstract

BACKGROUND: Hallux valgus deformity of the big toe in adolescents accounts for 22%–44% of all relevant cases. Despite a relatively large number of surgical treatment methods proposed to correct this deformity, treatment results are not always satisfactory. The problem of imbalance between the external traction of the abductor hallucis muscle and the contracted adductor muscle in hallux valgus remains controversial and is not covered in the literature.

AIM: This study aimed to examine the results of hallux valgus deformity treatment, following the suggested combined technique.

MATERIALS AND METHODS: Eight teenage patients (10 feet), aged 15 years on average, were assessed. Patients were undergoing treatment in the department of pediatric orthopedics of the Dana Hospital, Tel Aviv, within the period from 2015 to 2019. The average postoperative observation period was 30 months. This study suggested a new combined technique, including (1) modified oblique Chevron osteotomy with a V-shaped cut in the distal aspect of the first metatarsal with the dorsal wedge excision performed at the apex of its angulation, (2) valgus osteotomy of the medial cuneiform bone with the insertion of the V-shaped bone allograft, and (3) transfer of the dorsal portion of the pre-split tendon of abductor hallucis muscle to the base of the triangular medial capsular flap of the first metatarsophalangeal joint (MPJ). The tendon received optimal tension to restore the muscular balance.

RESULTS: This surgical technique provided safe and stable correction of the hallux valgus deformity, restored muscular balance, avoided movement restriction of the first MPJ, and restored the function and strength of the abductor halluces muscle that prevented the recurrence of the deformity. The number of good and excellent results was much greater than those in published reports.

CONCLUSIONS: Despite a relatively small group of patients, the suggested technique has shown improvements in hallux valgus deformity in adolescents.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):183-193
pages 183-193 views
Transposition of the great trochanter: A look at the problem
Pozdnikin I.Y., Bortulev P.I., Barsukov D.B., Baskov V.E.
Abstract

BACKGROUND: Multiplanar deformity of the proximal femur with a high position of the greater trochanter is one of the most common residual deformities of the hip joint. The Veau–Lamy transposition of the greater trochanter does not fully treat the mutual trauma of the components of the hip joint, as it only brings down the greater trochanter to provide tension for the gluteal muscles.

AIM: This study aimed to share the experience of performing transposition of the greater trochanter according to our proposed technique.

MATERIALS AND METHODS: The study included 15 patients (15 hip joints) aged 9–16 years with a high position of the greater trochanter of the femur, who underwent surgical treatment in the period from 2018 to 2019. In addition to the actual transposition of the greater trochanter, the intervention provided a modeling resection of the base (bed) of the greater trochanter and the formation of an offset of the femoral neck.

RESULTS: Patients were followed up for period of up to 30 months. All patients showed positive changes after surgical treatment with improvement of radiological and clinical parameters.

CONCLUSIONS: The proposed intervention allows restoration of the function of the gluteal muscles, improves the range of motion in the hip joint, and prevents and treats extra-articular impingement syndrome.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):195-202
pages 195-202 views

Clinical practice

Standard procedure for the pharmacotherapy of pain in childhood
Kollerová A.
Abstract

Physicians of all specialties encounter patients in pain. The basis of the philosophy of caring children is not to question the existence of pain but to predict, prevent, and adequately treat it. Acute pain services implement preventive and multimodal analgesic treatment to increase the analgesic effect at the lowest possible doses to minimize undesirable effects of individual drugs. However, this service cannot be provided in all hospitals 24 hours a day. This study provides a clear, color-coded recommendation for pain relief in children, which provides a quick, rational, and safe choice of analgesics or their safe and effective combinations and dosage for each age group.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):203-209
pages 203-209 views

Clinical cases

Recurrent posterior elbow dislocation caused by congenital abnormalities in a 7-year-old child
Proshchenko Y.N., Sigareva Y.A.
Abstract

BACKGROUND: Congenital posterior elbow dislocation in children is a rare and scarcely reported condition. Owing to the difficulties of an early primary diagnosis and the lack of a standardized management, we present a clinical case of an analysis of surgical treatment according to literature and based on our experience.

CLINICAL CASE: We present a case of congenital posterior elbow dislocation in a 7-year-old child. In the absence of a universal algorithm for surgical treatment, we performed an arthrotomy for visual assessment of articular surfaces, intervention on the capsule and tendons of m. brachialis, m. biceps brachii, m. brachioradialis, and modeling of the proximal epiphysis of the right radius.

DISCUSSION: We analyzed surgical treatment options and made an overview of the main stabilizers of the elbow joint that prevent elbow dislocations. There are few publications on this condition; to our knowledge, over the past 10 years, only two clinical cases of a similar pathology in children had been published. Not a single case of congenital elbow dislocation in the neonatal period has been described. We analyzed early clinical manifestations and possible causes of delayed primary diagnosis.

CONCLUSIONS: Recurrent posterior elbow dislocation of the congenital origin is associated with a functional deficiency of elbow joint stabilizers. In the neonatal period, these abnormalities are usually not detected. The first episode of dislocation may be triggered by a minor trauma without damaging the bone structures. Delayed primary diagnosis may be associated with the paucity of clinical symptoms and compensatory functionality in children. The decision on surgical correction should be based on the analysis of structural anatomical changes in the assessment, of which magnetic resonance imaging plays an important role.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):211-219
pages 211-219 views
Fingertip defects coverage using reverse-flow homodigital island flaps
Alexandrov A.V., Smirnov A.A., Gonchruk P.V.
Abstract

BACKGROUND: The hand has always been a highly organized tool in human’s daily and professional activity. Distal phalanges are most commonly exposed to trauma, which often cause defects that need to be covered through plastic surgery. One of the most reliable and universal methods for fingertip reconstruction is the reverse-flow homodigital island flap.

CLINICAL CASES: This series of clinical cases describe three children aged 7, 8, and 11 years who underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In all cases, mechanisms of injury were associated with crushing and rupture of soft tissues. All children underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In the first case, evaluation results at 6 months after surgery revealed 4 mm in the Weber’s test and phalanx length deficit of 2 mm. In the second case, the assessment performed 1 month after surgery revealed 5 mm in the Weber’s test and the length of the operated phalanx corresponds to the contralateral one. In the third case, results of the 2-month observation period revealed 4 mm in the Weber’s test and lengths of the operated and contralateral phalanges were the same.

DISCUSSION: The reverse-flow homodigital island flaps have irrefragable advantages among methods of surgical reconstruction of soft tissues of distal phalanges. These are single-stage reconstruction techniques that can possibly replenish sufficient amounts of soft tissues to the defect. A literature data analysis of the outcomes of the fingertip reconstruction through the reverse-flow homodigital island flaps revealed good and satisfactory results.

CONCLUSIONS: The method of the reverse-flow homodigital island flap has potential to take a significant place in pediatric traumatology and reconstructive surgery.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):221-228
pages 221-228 views
A complex scalp resurfacing utilizing Integra® as temporary dressing in aplasia cutis congenita
Yap P., Mohamad Shah N., Mat Saad A.Z., Wan Sulaiman W., Mat Johar S.N.
Abstract

BACKGROUND: Aplasia cutis congenita is a rare newborn malformation characterized by focal absence of skin. It possesses difficulty in reconstruction surgery for neurosurgeons and plastic surgeons. We report a challenging case of aplasia cutis congenita who received treatment in our center.

CLINICAL CASE: A 2-year-old boy, presented to Plastic and Reconstructive Surgery, Hospital USM, with bilateral vertex defect with encephalocele who received a series of surgical interventions since 1 month old. Unfortunately, he returned after 2 years with a chronic nonhealing scalp wound associated with dura defect and cerebral spinal fluid leakage. The wound was debrided and the swab culture result showed no organism growth. Part of the wound bed with dura defect was repaired using a small piece of transplanted fascia lata and Integra® was applied.

DISCUSSION: There is scarcity in the medical literature on the reconstructive technique of aplasia cutis congenita. In the case we described here, we successfully managed the wound with multiple application of dermal substitute (Integra®) dressing with negative pressure wound therapy and split-thickness skin graft.

CONCLUSIONS: Management of aplasia cutis congenita with skull defect remains a controversy. Its management varies depends on its pattern and underlying condition. We successfully develop a new simple method in treating scalp accutilizing Integra®.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):229-234
pages 229-234 views

Review

Use of torso orthoses in the treatment of congenital spinal deformities: A literature review
Redchenko I.А., Vissarionov S.V., Gusev M.G., Lein G.A., Pavlov I.V.
Abstract

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature.

AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine.

MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature.

RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses.

CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):235-244
pages 235-244 views
Use of blood-supplied fibula grafts with a functioning growth zone for the reconstruction of limb bone defects in pediatric patients: A literature review
Lukyanov S.A., Proshchenko Y.N., Zorin V.I.
Abstract

BACKGROUND: Restoration of significant anatomical and functional bone defects is one of the most urgent problems of reconstructive surgery in children. Various options for plastic surgery of bone defects are considered. However, some publications present both positive and negative aspects of using vascularized bone autotransplants.

AIM: This study aimed to conduct a systematic analysis of foreign literature data on the use of blood-supplied fibular grafts with a functioning growth zone.

MATERIAL AND METHODS: A systematic literature search was performed in the PubMed information data base and Google Scholar from 1988 to February 7, 2021. Based on the criteria for the selection of literature sources, 21 literary sources were identified. In the analysis, special attention was paid to the age of patients at the time of reconstructive surgery, type of vascularized bone graft used with vessels that are part of the feeding leg, follow-up period, complications in the area of the surgical intervention, as well as the functional result and functioning of the graft growth zone.

RESULTS: In this study, 21 articles comprised the sample, of which 14 were descriptions of clinical observation and seven were descriptions of clinical series. These publications include information on the follow-up of 54 patients with an average age of 6.86 years (min–max, 1–15 years). The average duration of postoperative follow-up was 56 months (min–max, 6–22 years). Indications for surgical interventions were extensive bone defects formed as a result of the tumor process (n = 44), trauma (n = 4), infectious process (n = 1), and birth defects (n = 5).

CONCLUSIONS: In pediatric orthopedics, bone-vascularized fibular grafts with a functioning growth zone are used for the reconstruction of extensive bone defects in complex clinical situations if standard bone auto-/alloplasties are impossible. According to the literature, this technique allows us to achieve satisfactory functional results in most cases. Despite the positive functional results, postoperative complications are quite common in patients.

 
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):245-256
pages 245-256 views

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