Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

BACKGROUND: One of the most important tasks and challenges of modern vertebrology is determining optimal approaches to the surgical treatment of children with congenital spinal deformities. The relevance of this issue is associated with characteristic features of the disease, including the formation and progression of pathological curvature, rapid and steady deterioration of the spinal column during the child's growth and development, formation of compensatory counter-curves, and a substantial reduction in quality of life and life expectancy in this category of patients.

AIM: This work aimed to evaluate the efficacy and accuracy of patient-specific 3D-printed guide templates in the surgical correction of congenital thoracic and lumbar spinal deformities in preschool-aged children.

METHODS: A comparative analysis of surgical outcomes was performed in 40 patients (aged 3–7 years) with isolated vertebral formation defects. The patients were divided into two groups: the main group (n = 20), in which pedicle screws were inserted using patient-specific 3D-printed guide templates, and the control group (n = 20), in which the freehand technique was used. The following parameters were assessed: operation duration, extent of fixation, accuracy of screw placement according to the Gertzbein–Robbins scale, and the degree of deformity correction measured using the Cobb method.

RESULTS: In the main group, a significant reduction was observed in the time required for pedicle canal preparation (29.7 ± 4.2 s vs. 72.4 ± 6.8 s; p = 0.027) and screw insertion time (36.3 ± 3.5 s vs. 49.2 ± 5.2 s; p = 0.039), as well as a reduction in the extent of fixation (1.4 vs. 2.05 segments; p = 0.013). Accurate pedicle screw placement (grade 0) was achieved in 64.6% of cases in the main group and 23.3% in the control group (p < 0.0001). Correction of kyphotic deformity was significantly greater when guide templates were used (p = 0.024).

CONCLUSION: The use of patient-specific 3D-printed guide templates improves the accuracy of pedicle screw placement, reduces operation time and the extent of fixation, and ensures the safety and reproducibility of surgical correction of congenital spinal deformities in young children.

BACKGROUND: Flexible flatfoot with Achilles tendon shortening represents a distinct form of rigid flatfoot. Conservative treatment of this condition includes stretching of the triceps surae muscle to increase ankle dorsiflexion. The authors hypothesized that the effectiveness of stretching in children with flatfoot may depend on the correctness of exercise performance.

AIM: This work aimed to analyze the relationship between the effectiveness of stretching in children with flexible flatfoot and Achilles tendon shortening and the correctness of home exercise performance.

METHODS: This was a prospective, comparative, observational study that included 43 children aged 7–17 years with flexible flatfoot and Achilles tendon shortening. All patients were advised to perform stretching exercises according to a standard protocol. Parents were asked to record a video of the exercises being performed to monitor the correctness of exercise performance. Based on treatment outcomes, patients in the main group were divided into two subgroups depending on clinical effectiveness.

RESULTS: The most frequent protocol violations were related to foot position, including external rotation (60.5% of patients) and hyperpronation (41.9%). Knee flexion during the exercise was observed in 27.9% of patients, whereas knee hyperextension was observed in 20.9%. A significant association was found between the quality of exercise performance and the clinical effectiveness of conservative treatment. Patients with regular and persistent violations of the stretching protocol demonstrated less pronounced positive trends in both ankle dorsiflexion range and FPI-6 (Foot Posture Index) scores. Based on the obtained data, the most typical exercise performance errors were identified, which allowed developing a more precise protocol for instructing parents and patients.

CONCLUSION: Detailed instruction and careful monitoring of exercise performance may improve the overall effectiveness of conservative treatment in children with flatfoot.

BACKGROUND: Despite many years of treatment experience and continuing research interest in approaches to the management of patients with congenital equinocavovarus foot deformity, this condition remains a relevant problem in pediatric orthopedics. Currently, there is no monitoring of children with congenital clubfoot in the Russian Federation. However, the functionality of the Medical Information and Analytical Center of Saint Petersburg allows obtaining data and analyzing anonymized medical records of patients with congenital clubfoot who received treatment in state medical organizations of the city.

AIM: This work aimed to assess the incidence of congenital clubfoot in children of Saint Petersburg and to analyze the completeness of the registry data of pediatric patients with congenital clubfoot (International Classification of Diseases, 10th Revision code Q66.0) who received treatment in medical organizations of Saint Petersburg during 2020–2024.

METHODS: The frequency of congenital clubfoot in the pediatric population of Saint Petersburg was assessed using birth data from the statistical bulletin of the Federal State Statistics Service Administration for Saint Petersburg. Based on the disease registries of the Medical Information and Analytical Center, Saint Petersburg, a separate subgroup of pediatric patients was identified and created. The inclusion criterion was the presence of the International Classification of Diseases, 10th Revision code Q66.0 in the medical records of outpatient and inpatient municipal and federal medical institutions of Saint Petersburg.

RESULTS: During 2020–2024, among 254,581 newborns in Saint Petersburg, 229 were born with idiopathic congenital clubfoot; the proportion of patients unjustifiably included in the registry remarkably decreased from 40.6% in 2020 to 10.6% in 2024. The incidence rate during this period was 0.900 (95% CI 0.790–1.024). In the medical records related to conservative treatment of children with congenital clubfoot, the treatment stages were documented most completely, whereas information on the severity of foot deformity was provided in a smaller percentage of cases. Information on recurrence of foot deformity during therapy was the least complete; in most observations, it was impossible to determine precisely the time at which the recurrent deformity was recorded and the subsequent treatment strategy.

CONCLUSION: The study revealed epidemiological indicators of congenital clubfoot prevalence in the pediatric population that are comparable with worldwide data, which indicates high coverage of pediatric patients with this congenital condition in the registry. Implementation of the study recommendations, as well as development of appropriate electronic tools for documentation of information, including registries, will undoubtedly contribute to improvement of the quality of and control over medical care provided to children with congenital clubfoot.

BACKGROUND: The medical and pharmaceutical industries are strategically important sectors for ensuring national security and the sustainable development of healthcare. Traumatology and orthopedics, particularly in children, have historically been associated with innovation and a substantial number of inventions. Given the restricted population in pediatric medicine and the relatively small sector of institutions and specialists providing care to the pediatric population, assessment of trends in innovative activity in pediatric traumatology and orthopedics is relevant.

AIM: This study aimed to examine the quantitative and qualitative characteristics of patent activity in the Russian Federation in the area of innovative products for pediatric traumatology and orthopedics.

METHODS: Information on patents was collected and analyzed using the databases and registers of Russian Federal Service for Intellectual Property (Rospatent) and Russian Federal Service for Surveillance in Healthcare (Roszdravnadzor). Leading scientific journals publishing research in pediatric traumatology and orthopedics in the Russian Federation were analyzed. The information was assessed for the period of 2019–2024.

RESULTS: A total of 295 registered intellectual property objects in the field of pediatric traumatology and orthopedics were identified; of these, 209 patents concerned children only, and 86 patents concerned both children and adults. The mean annual number of patents was 49 ± 6.7. The largest proportion of patents was devoted to new methods of treatment and diagnosis, accounting for 76.4% of all developments. The share of medical devices did not exceed 20%. Under 8% of developments and the results of their use were described in scientific publications. Information on developments that completed authorization with Roszdravnadzor was almost absent.

CONCLUSION: The most relevant innovations concern the treatment of conditions of the lower extremities and spine in children. The main trends are the prevailing advances in diagnostic and treatment methods, short effective patent life, a low proportion of completed authorization procedures, and limited reporting on the clinical experience of these innovations in scientific publications.

Analgesia in pediatric traumatology and orthopedics is one of the key challenges. The choice of method should be regulated, including by approved clinical guidelines. This article analyzes current Russian clinical guidelines as of 2026. An information search was performed in the full texts of the guidelines using the keywords обезболивание (pain management), анальгезия (analgesia), анальгетики (analgesics), нестероидные противовоспалительные средства (nonsteroidal anti-inflammatory drugs), наркотические анальгетики (opioid analgesics), and шкала (scale). The search results were summarized for subsequent analysis. At the time of the study, 36 clinical guidelines directly related to pediatric traumatology and orthopedics were registered. In 20 guidelines, pain management for musculoskeletal injuries is recommended both in the preoperative and postoperative periods. In musculoskeletal disorders, pain management is considered either separately in the preoperative and postoperative periods or in both periods. Among pain assessment scales, the visual analog scale was mentioned most frequently (7 guidelines). Opioid analgesics were proposed for use in 19 clinical guidelines, paracetamol in 32, and ibuprofen in 31. Thirty-five guidelines included references to other analgesics (most often nonsteroidal anti-inflammatory drugs without specification of a particular agent). Paracetamol and ibuprofen were the most frequently mentioned drugs in clinical guidelines, recommended for pain management both during the acute phase of injury and following surgery. Taking into account the different profiles of these drugs and their different pharmacodynamic and pharmacokinetic properties, a combined dosage form including both agents was developed. The rapid onset of paracetamol together with the prolonged action of ibuprofen makes their combination effective for fast and sustained analgesic effect.

Swimming, both as a recreational and professional sport, is widely practiced in Russia and globally. This sport is unique in that it combines strength exercises for the upper and lower extremities with cardiovascular training without weight-bearing load. However, the high repetition of movements characteristic of the conventional freestyle stroke may predispose professional swimmers to musculoskeletal injuries, predominantly of the shoulder joint. The lack of comprehensive information in the Russian scientific data on swimmer’s shoulder determines the relevance of this review. For this scientific review, articles in Russian and English published between 1974 and 2025 were selected from PubMed, Google Scholar, CyberLeninka, and Google using the following keywords: плечо пловца (swimmer’s shoulder), плавание (swimming), ротаторная манжета плеча (rotator cuff), импинджмент-синдром плечевого сустава (shoulder impingement syndrome), спорт (sport). A total of 56 sources were included, 18 of which were published within the past 10 years. The incidence of musculoskeletal injuries of various localizations in swimmers ranges from 2.6 to 4.0 cases per 1000 hours of swimming, with shoulder injuries leading (23%–51% and 33%–41% in men and women, respectively). Despite advances in sports medicine and rehabilitation, a global trend toward an increase in shoulder injuries among swimmers has been observed. Swimmer’s shoulder is a collective term describing multiple conditions accompanied by pain in the shoulder joint in athletes engaged in swimming. The main etiologic factors in the development of swimmer’s shoulder are high training intensity and the lack of a well-designed and balanced training program, which affect overall muscle balance, the scapulothoracic articulation, the rotator cuff, and shoulder joint motion. The most common mechanisms of shoulder pain in swimmers are impingement syndrome, anteroinferior instability, scapular dyskinesis, and rotator cuff muscle imbalance. Shoulder pain persisting for 1 month during intensive training is experienced by 91% of junior athletes and is most often associated with impingement syndrome or supraspinatus tendinopathy. As a rule, active rest, temporary reduction or cessation of swimming, and the use of nonsteroidal anti-inflammatory drugs make it possible to relieve pain and allow the athlete to return to training shortly. In cases of labral tear, rotator cuff tear, or shoulder instability, surgical treatment is indicated. Timely and accurate diagnosis and treatment, together with a rational training regimen both in water and on land, allow the athlete to avoid severe shoulder injuries and resume training.

Contrary to the conventional view of their functional autonomy, the skeletal and nervous systems exhibit unique molecular, physical, and ontogenetic similarities. This review considers selected aspects of the mechanisms of bidirectional regulation, within which the nervous system actively controls bone tissue metabolism and structural remodeling by regulating the differentiation of mesenchymal stem cells into osteoblasts, activation of osteoclasts, and the functional activity of skeletal system cells. In turn, bone tissue performs not only a supporting function but also acts as an endocrine organ capable of modulating the expression of neuronal genes and the synthesis of key neurotransmitters, thereby influencing cognitive functions, memory, and learning ability. Despite promising results, research into the bidirectional interaction between the skeletal and nervous systems remains at its conception stage. Further identification of shared biomarkers and signaling pathways will make it possible to develop fundamentally new approaches to the prevention and treatment of skeletal system disorders as well as neurodegenerative diseases. This perspective not only challenges classical concepts of physiology but also opens interdisciplinary avenues for biomedical research.