Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

‘Pediatric Traumatology, Orthopaedics, and Reconstructive Surgery’, a scientific academic journal published four times a year since 2013.

  • Since 2016 the journal publishes papers in Russian and English in parallel
  • Since 2018 in Chineze in additional
  • Special issues (conference proceedings) are published in Russian.

The Journal founders are as follows:
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.


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.


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.

Current Issue

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Vol 11, No 1 (2023)

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Clinical studies

The choice of pelvic osteotomy technique in young children with hip dysplasia
Bortulev P.I., Baskaeva T.V., Vissarionov S.V., Barsukov D.B., Pozdnikin I.Y., Poznovich M.S., Baskov V.E., Kornyakov P.N.

BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy.

AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique.

MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 2–4 years (3.1 ± 0.45) with grade II–IV hip dysplasia, according to the supplemented classification of Tönnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neck–shaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO).

RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation.

CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p > 0.05), and reduction of possible secondary deformities.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):5-16
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Principles of the differential diagnosis of achondroplasia and pseudoachondroplasia
Markova T.V., Kenis V.M., Melchenko E.V., Reshchikov D.A., Alieva A.E., Osipova D.V., Bessonova L.A., Nagornova T.S., Vasserman N.N., Ogorodova N.Y., Shchagina O.A., Dadali E.L.

BACKGROUND: Achondroplasia and pseudoachondroplasia are hereditary systemic skeletal dysplasias characterized by a certain similarity of clinical manifestations; however, they have different etiopathogenetic mechanisms and confirmation methods for molecular genetic diagnosis. Their common phenotypic features often make differential diagnosis difficult during the clinical examination of patients, planning DNA diagnostics, and appropriate time detection of neurosurgical and orthopedic complications.

AIM: This study aimed to identify differential diagnostic criteria for achondroplasia and pseudoachondroplasia and optimize the strategy for their molecular genetic diagnosis.

MATERIALS AND METHODS: A comprehensive examination of 76 children from 74 unrelated families aged 1 month to 18 years with phenotypic signs of achondroplasia and pseudoachondroplasia was conducted. To clarify the diagnosis through genealogical and amnestic analysis, clinical and neurological examination data according to the standard method and radiographic data were used. Molecular genetic confirmation of diseases was conducted by searching for hotspot mutations in the FGFR3 gene, assessing the number of GAC repeats located in exon 13 of the COMP gene, and new-generation sequencing of the target panel consisting of 166 genes responsible for hereditary skeletal pathology.

RESULTS: Based on a comparative analysis of the specific phenotypic characteristics, the criteria for the differential diagnosis of achondroplasia and pseudoachondroplasia were identified. The leading signs of achondroplasia are disproportionate nanism from birth, macrocrania, and facial dysmorphism, which are not specific to pseudoachondroplasia. Certain radiological features are essential in the differential diagnosis of pseudoachondroplasia, which should be considered when referring to patients for molecular genetic analysis. A deletion of the GAC repeat c.1417_1419del in the COMP gene was identified in 27% of patients with pseudoachondroplasia. Thus, the analyses of these two mutations in FGFR3 and COMP were conducted first. In the absence of target mutations, further diagnostic search should be continued with a target panel consisting of 166 genes responsible for hereditary skeletal pathology or whole-exome sequencing.

CONCLUSIONS: The analysis of the clinical, radiological, and molecular genetic characteristics of patients with achondroplasia and pseudoachondroplasia, together with the literature data analysis, made it possible to clarify the differential diagnostic criteria for these diseases and optimize the algorithm for their molecular genetic diagnosis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):17-28
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Restoration of elbow active flexion in children with amyoplasia: What is the better age to do the operation?
Agranovich O.E., Petrova E.V., Trofimova S.I., Batkin S.F., Kochenova E.A., Kenis V.M., Sapogovskiy A.V., Melchenko E.V., Afonichev K.A., Blagoveschenskiy E.D.

BACKGROUND: The absence of active elbow flexion is the most common problem in children with amyoplasia, leading to daily living difficulties. Many variants of muscle transfer are used for the restoration of active elbow flexion. The pectoralis major and latissimus dorsi muscles are the most used muscles for this purpose; however, the optimal age for these operations is not reported in the literature.

AIM: This study aimed to determine the optimal age of children with amyoplasia for the restoration of active elbow flexion.

MATERIALS AND METHODS: The retrospective study involved 61 patients (90 upper limbs) with amyoplasia (30 [49%] girls and 31 [51%] boys) who were examined and treated between 2011 and 2020. In 46 (51.1%) cases, we used major muscles, and in 44 (48.9%) cases, the latissimus dorsi muscle was used as a donor muscle. All patients were divided into four groups: group 1 included children aged 1–3 years (n = 17, 27.9%); group 2, 3–7 years (n = 30, 49.2%); group 3, 7–11 years (n = 8, 13.1%), and group 4, 12–18 years (n = 6, 9.8%). The clinical examination of the patients was conducted before and after the operation (≥6 months). Statistical data processing was performed using Statistica 10 and SAS JMP 11. To describe the numerical scales, the average value and standard deviation (M ± SD) were used.

RESULTS: The age of the patients at the time of surgery was 5.16 ± 3.72 years, and the postoperative follow-up period was 41.93 ± 30.13 months. Elbow flexion contractures were observed mainly in groups 1–3 (p < 0.05). The greatest changes in indicators such as the strength of forearm flexor muscles, active elbow flexion, and function of the elbow were noted in group 1 (p < 0.05). The same postoperative indicators were worse in group 4 than in younger patients (p < 0.05). Groups 3 and 4 had less strength of the donor muscles than groups 1 and 2 (p < 0.05).

CONCLUSIONS: The retrospective analysis of the results of the restoration of active elbow flexion in children with amyoplasia allowed us to recommend these operations in children aged 1–3 years. The prevention of elbow flexion contractures and the formation of a new stereotype of movement help improve the self-ability of these patients and the treatment results.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):29-38
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Comparison of the clinical and radiological pictures in patients with congenital knee dislocation during treatment
Kruglov I.Y., Rumyantsev N.Y., Baindurashvili A.G., Omarov G.G., Rumiantceva N.N., Razmologova O.Y., Vorobeva O.M., Pervunina T.M., Kagantsov I.M.

BACKGROUND: Congenital knee dislocation is a very rare musculoskeletal disease, and it occurs in approximately 1 per 100,000 live births. Many researchers note that the treatment of congenital knee dislocation should begin with conservative methods, during which various complications arise.

AIM: This study aimed to compare the clinical and radiological classifications of congenital knee dislocation and show the results of the treatment of this deformation using a Von Rosen splint and plaster corrections.

MATERIALS AND METHODS: The study included 58 patients (34 boys and 24 girls) with congenital knee dislocation (83 knee joints). Congenital knee dislocation with arthrogryposis and other systemic pathologies were not included in the study. Before treatment, all patients were assessed for the severity of congenital knee dislocation according to the Tarek and J. Leveuf system. To evaluate the obtained results, nonparametric statistics were used. To search for differences between groups, the Kruskal–Wallis test and the median test were used. To search for correlations, Spearman coefficients were used. Statistica v10 was used for statistical analysis.

RESULTS: Clinical and radiological data were compared. In both groups, after conservative treatment, excellent and good results were obtained in nearly 98% and satisfactory in 2%. After conservative therapy, surgical treatment was required in 2 of 37 knee joints with the initial severity of Tarek III deformity.

CONCLUSIONS: The severity of the deformity according to the Tarek system makes it possible to predict the effectiveness of the conservative treatment of congenital knee dislocation at a statistically significant level.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):39-48
pages 39-48 views
Results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children
Dimitrieva A.Y., Kenis V.M., Klychkova I.Y., Sapogovskiy A.V., Kozhevnikov V.V.

BACKGROUND: To date, there is no consensus regarding the diagnostics of flatfoot in children and approaches to its classification and treatment.

AIM: This study aimed to demonstrate the results of the first Russian consensus, performed according to the Delphi method, for the diagnostics and treatment of flatfoot in children.

MATERIALS AND METHODS: The study was conducted in accordance with the principles of the Delphi survey and the RAND/UCLA and participated by 22 experts in their field. The questionnaire consisted of four main sections, namely, general clinical assessment, flatfoot diagnosis, classification approach, and treatment, including 179 close-ended and 11 open-ended statements in both rounds. A 5-point Likert scale was used to rank responses. The level of agreement was determined as follows: ≥70% of the experts agrees, the statement is accepted; <55%, rejected; 55%–69%, reassessment by experts in subsequent rounds. To assess agreement among experts, parameters such as general agreement, agreement without doubt by experts, and percentage of doubting experts were calculated. Mean (M), standard deviation (SD), and Cronbach’s alpha were calculated.

RESULTS: The statement was accepted with an agreement without doubt by experts ≥ 70%, with Cronbach’s alpha of ≥ 0.8. According to the survey data, in the two rounds using 179 close-ended statements, 96 statements were accepted, 63 were rejected, and no consensus was reached on 20.

CONCLUSIONS: This scientific work presents the results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children with a unique number of experts (n = 22). The lack of agreement on some of the statements, even among experts, showed that consensus was a necessary first step toward standardizing the diagnosis and treatment of flatfoot in children.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):49-66
pages 49-66 views
Footprint analysis in flatfoot assessment
Sapogovskiy A.V., Ovechkina A.V., Abramov I.A., Agranovich O. ., Shubina A.I., Budkevich T.G.

BACKGROUND: A flatfoot is the most common condition in the practice of a pediatric orthopedist. A flatfoot is primarily diagnosed based on the assessment of the degree of the foot flattening. Along with clinical examination, footprint analysis is often used in practice due to the safety of this study and convenience and ease of implementation.

AIM: This study aimed to determine how much footprints can correlate with the clinical assessment of flatfoot in children and which footprint indices are the most valuable in flatfoot assessment.

MATERIALS AND METHODS: The study included the survey results of 76 children aged 7–15 years of the St. Petersburg 49th school “School of Health” for 2021–2022. In this study, anthropometric data, clinical parameters (value of the heel valgus, arch angle, and Friedland index) and footprint indices and angles (Schwartz and Clarke angle, Chippaux–Smirak index, Staheli index, Cavanagh and Rodgers index, and Irwin index) were analyzed. In the study, the average values were calculated, and correlation and regression analyses were performed.

RESULTS: The footprint parameters did not have moderate and strong correlations with clinical parameters. Footprint parameters that assessed the area of the barefoot zone on the footprints (Irwin index and Cavanagh and Rodgers index) showed statistically significant moderate and strong correlations among plantographic parameters. Among linear and angular footprint parameters, the Chippaux–Smirak index showed statistically significant moderate and strong correlations.

CONCLUSIONS: The footprint criteria weakly correlated with the foot shape criteria in a clinical assessment, which does not allow us to interpolate the footprint’s data to the clinical evaluation data of the foot. The Cavanagh and Rodgers index, Irwin index, and Chippaux–Smirak index had statistically significant moderate and strong correlations with other indices, which makes them more valuable in the assessment of feet according to the footprint analysis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):67-74
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Сase report

A clinical case of transient diabetes insipidus with high spinal trauma
Sibiryakov D.A., Pavlova M.S.

BACKGROUND: Diabetes insipidus is characterized by the kidneys’ inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the disease’s clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period.

CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided.

DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the CVI–CVII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin.

CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):75-80
pages 75-80 views


Missed Monteggia fractures in children – the current state of the problem: A systematic review
Gubaeva A.R., Zorin V.I.

BACKGROUNG: A situation in which despite an obvious ulnar fracture, radial head dislocation is not diagnosed, resulting in a missed Monteggia fracture is not uncommon. Unsatisfactory results of the treatment of this pathology have prompted several researchers to search for an optimal treatment strategy.

AIM: This study aimed to conduct a systematic review of literature data on missed Monteggia fractures and dislocations in children by studying the main therapeutic and tactical approaches to this problem.

MATERIALS AND METHODS: A literature search was conducted in the Cochrane Database, Science Direct, Google Scholar, PubMed, and eLibrary information bases, and the search depth was 10 years. Moreover, 46 sources were selected based on the criteria. The main characteristics revealing the problem were identified, divided into four semantic groups, according to which the literature was analyzed: initial data on the condition of patients at the time of seeking medical help, status before and after treatment, and treatment methods.

RESULTS: The average age of the children was 8.4 years. The average interval from injury to the surgical treatment of missed Monteggia fracture was 15.3 months, and 883 clinical cases presented in sources with known treatment techniques were analyzed. Thus, open reduction of the radial head in combination with the restoration or reconstruction of the annular ligament and ulnar osteotomy is one of the most common methods (n = 482, 54.6%). The second most frequent application was the above-described approach, but without manipulations on the annular ligament (n = 273, 30.9%). Bone osteosynthesis and external fixation apparatus were the most widely used stabilization methods in 350 (67.8%) and 149 (28.9%), respectively. The most common complications were associated with the deterioration of the functional status after surgery.

CONCLUSIONS: Accurate diagnosis of injury and early correction of existing disorders is the key to reducing the frequency of missed Monteggia fractures. Surgical treatment is the main method of treating children with this injury, in which the restoration of the ulnar anatomy and the ratios in the brachial and proximal radiocarpal joints are the most important, providing a more physiological development of the segment with the growth of the child.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):81-94
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Treatment of long bone defects in children: Microsurgical transplantation of a fibular fragment for replacement of long bone defects: A systematic review
Zakharyan E.A., Dolgiev B.H., Chigvariya N.G., Grankin D.Y., Afonichev K.A., Garkavenko Y.E., Arakelyan A.I., Pozdeev A.P.

BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children.

AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children.

MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 2012–2022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: “replacement of bone defects in children” and “fibula transplantation in children,” and in the English-language search engines, “microsurgical and fibula,” “microvascular and fibula,” and “bone and defect” were used. After sorting the published studies, 17 publications were analyzed.

RESULTS: The study analyzed a total of 690 patients (mean age 12 ± 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 ± 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications).

CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):95-104
pages 95-104 views
Enthesitis-related arthritis in children: A literature review of the clinical features and differential diagnosis
Raupov R.K., Vissarionov S.V., Babaeva G.A., Noyanova Y.G., Sorokina L.S., Kostik M.M.

BACKGROUND: Enthesitis-related arthritis is one of the subtypes of juvenile idiopathic arthritis and is characterized by the involvement of the joints, enthesitis, and axial skeleton (sacroiliitis and spondylitis). The clinical variability of enthesitis-related arthritis and similar manifestations with orthopedic diseases present difficulties in diagnosis.

AIM: To present the clinical features of enthesitis-related arthritis and issues of differential diagnosis based on literature analysis.

MATERIALS AND METHODS: A literature search was conducted in the open electronic databases of eLibrary, PubMed, and Cochrane Library. In total, 46 foreign and 4 Russian publications were analyzed, which were limited to 1981–2021. The keywords used in the literature search were as follows: enthesitis, enthesitis-related arthritis, juvenile spondyloarthritis, and SAPHO syndrome. Own archive data for instrumental investigations were used in the article.

RESULTS: The clinical manifestations can be variable, and laboratory tests do not always allow us to prove the inflammatory nature of the pain syndrome. The most priority diagnostic tests were imaging methods, namely, magnetic resonance imaging and ultrasonography. The greatest diagnostic difficulty was found in patients in whom enthesitis prevailed over arthritis, and in some cases, it was the only disease manifestation. The classification criteria used for the diagnosis of EAA were considered. The differential diagnosis of enthesitis included various orthopedic diseases. Ultrasound diagnostics of joints and enthesis should be performed in every patient with local pain musculoskeletal symptoms, which allows patients to be correctly routed.

CONCLUSIONS: The alertness of both orthopedists in relation to enthesitis-related arthritis and the awareness of rheumatologists of the most common orthopedic diseases that affect the entheses are necessary.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):105-120
pages 105-120 views
Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review
Dolgopolskii M.N., Koriachkin V.A., Zabolotskii D.V., Safin R.R.

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain.

AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology.

MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion.

RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block.

CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):121-130
pages 121-130 views

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