Pediatric Traumatology, Orthopaedics and Reconstructive Surgery
Medical peer-review journal for practitioners and researchers. Editor-in-Chief: Baindurashvili A.G., MD, PhD, professor. Indexing: Russian Science Citation Index, SCOPUS, Google Scholar, Ulrich's Periodical directory, CNKI, Dimensions. Publishes quarterly from 2013. ISSN: 2309-3994 (Print); ISSN: 2410-8731 (Online)
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READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Pediatric Traumatology, Orthopaedics and Reconstructive Surgery” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Pediatric Traumatology, Orthopaedics and Reconstructive Surgery” (further-the Journal) in accordance with the conditions stated below. I. General Provisions This Agreement, in accordance with clause 2 of Article 437 of the Civil Code of the Russian Federation, is a public offer (hereinafter referred to as the Offer) requiring full and unconditional acceptance (Acceptance), which, in accordance with Article 438 of the Civil Code of the Russian Federation, means the sending by the Author of his/her materials by way of uploading the same to the online electronic system designed to accept manuscripts for consideration, and subsequently posted in the corresponding section of the Journal’s website on the Internet information and telecommunications network (hereinafter referred to as the Internet). In accordance with the current legislation of the Russian Federation regarding the observance of copyright on electronic information resources, all materials found in a website, including submitted and published in electronic journals, may not be reproduced in whole or in part in any form (electronic or printed) without the prior written permission of the Publisher. Prior permission can be given by publishing an article in the open access with Creative Commons license. The journal requires license users to reference the original source, i.e., the publication, if the Author permits use of the public materials in the context of other documents. II. Terms used in the Agreement “Author” refers to an individual (or individuals) whose creative work has led to the creation of the manuscript of a scientific Article, or to a representative of these persons. “Manuscript” is the result of intellectual activity in the form of a scientific work containing text, graphic and numerical data, audiovisual information, program code and other elements submitted by the Author for publication in the Journal; it is also the mean “a draft of an Article submitted by the Author to be published in the Journal”. “Offer” is the current agreement (an offer to the author for the publication of an Article in the Journal). “Publication” is the process of placement of an Article in the Journal. “Article” is the manuscript that has been published in the Journal (after successful selection, editing, type-setting, copyediting, proofreading, translation). “Acceptance of the offer” refers to the full and unconditional acceptance of the offer on the terms specified in paragraph 3 of this agreement (the Author accepts offer by submitting a Manuscript to the Publisher via the online electronic submission system on the Journal’s Internet website). “Journal” is a scientific peer-reviewed periodical registered as a mass media entity in the Roskomnadzor register of the Russian Federation and ISSN-center. “Submission” is an electronic appeal of the Author to the Publisher for the publication of an Article in the Journal by uploading the manuscript and accompanying materials to the online electronic submission system on the Journal’s Internet website). “Publisher” refers to Eco-Vector, which is the Publisher of the journal. Article metadata includes the information that are intended for inclusion in International Scientific Databases and search engines, namely the following: title of the Article; information about each of the Authors (surname and first name; patronymic; place of work with the postal address indicated, contact information (e-mail)); abstract; keywords; thematic rubricator: UDC (Universal Decimal Classification) or other library and bibliographic classification and subject indexes; list of references. “Editorial board” is the creative team that prepares the journal for publication. “Parties” refers to the Author and the Publisher. “Author Guidelines” are the requirements for Articles published in the Journal, posted in the “For authors” section of the Journal’s Internet website. III. Subject of the Agreement (Offer) Under this agreement, the Author grants the Publisher, free of charge for the entire period of validity in accordance with the legislation of the Russian Federation, an exclusive license to use the Article created by the former for publication in the Journal, as well as the rights to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in Journals and/or databases (local or in the Internet) of the Publisher and/or other persons, at the discretion of the Publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the Journal and/or databases of the Publisher or other persons, at the discretion of the Publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the Journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the Publisher under this Agreement, including patent rights to any process, method etc., described by the Author in the Article, as well as trademark rights, are reserved for the Author. The territory where the rights to the Article are allowed to be used is the whole world. The validity of this Agreement commences only if the manuscript of the Article is accepted for publication in the Journal and only from the moment of sending a notification of acceptance of the Article for publication to the Author from the official e-mail of the Journal. The rights are granted by the Author to the Publisher free of charge; the publication of the Article in the Journal does not entail any financial deductions to the Author. If the Publisher decides to reject the Submission or refuse to publish the Article in the Journal (i.e., retraction of the published Article), this Agreement becomes invalid. The decision to refuse publication will be sent to the Author at the e-mail address specified in the Submission. IV. Rights and Duties of the Parties The Author guarantees that: s/he holds the copyright the exclusive rights to the materials submitted to the Publisher as part of the manuscript of the Article; the rights granted to the Publisher under this agreement have not been previously transferred and will not be transferred to third parties in the future during the duration of the Agreement; the manuscript contains all references to the cited authors and/or publications (materials) provided for under the current copyright legislation; the Author has obtained all the necessary permissions for all information and other materials s/he holds no copyright to and that are used in the manuscript of the Article; the Article manuscript contains only materials permitted to be published in the open press in accordance with the current legislative acts of the Russian Federation, and its publication and distribution will not lead to the disclosure of secret (confidential) information (including state secrets); the Author has informed co-authors about the terms of this Agreement and has received their consent to execute this Agreement under the terms provided for in the Agreement. The Author carries certain obligations under the terms of the Agreement: s/he should prepare and submit the manuscript of the Article in accordance with the Author Guidelines posted on the Journal’s website; the Author should not use an electronic copy of the Article for commercial purposes and in other journal publications without the consent of the Publisher; in the process of preparing a manuscript for publication, the Author is obligated to undertake the following: make corrections to the text of the manuscript that have been marked by the peer-reviewers and accepted by the editorial board, and/or as necessary, upon the request of the Publisher and the editorial board, finalize the manuscript of the Article; revising and proofreading the manuscript of the Article in accordance with the editorial recommendations; suggest only the minimum of corrections to the type-setted (layout) Article. The Author has the following rights and duties: Use preprint or prior-to publication versions of an unpublished Article in the form and content accepted by the Publisher for publication in the Journal. Such prior-to-publish versions can be placed as electronic files on the personal websites of the Author (co-authors) or on the protected external websites of the employers of the Author; however, the Author cannot use the unpublished version(s) for commercial sale or for systematic external distribution by a third party (i.e., post on social media). The author or co-authors must, in turn, carry out certain duties, namely: include the following warning in the prior-to-publish version: “This is prior-to-publish version of the article accepted for publication in (Journal’s name), © Eco-Vector (year)”; provide the corresponding electronic link to the Publisher’s website at https://journals.eco-vector.com/ and/or via the DOI. Copy or transfer a copy of the published Article in whole or in part to colleagues free of charge for their personal or professional use, for the promotion of academic or scientific research, or for informational purposes of the Author’s employer. Use materials from a published Article in a book written by one of the co-authors. Use figures, tables and text excerpts from the Article for his or her (or co-authors’) own training purposes, or to include them in other published works in printed or electronic format by a third party, or to submit them in electronic format on an internal computer network, or on the public website of the Author (co-authors) or his/her employer. Include the Article in educational collections for use in the classroom, either for free distribution to the Author’s (co-authors’) students or in electronic format on a local server for access by students as part of the training course, as well as for internal training programs at the institution of the Author’s employer. 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The editorial board of the Journal, headed by the editor-in-chief, has the exclusive rights to select and/or reject materials sent to the Journal editorial office for publications purposes. The manuscript sent by the Author to the Journal editorial office is not subject to return. The editorial board of the Journal does not enter into correspondence about rejection of submissions. In all cases not stipulated and not provided for in this agreement, the parties are obliged to be guided by the relevant current laws of the Russian Federation. V. Acceptance of the Offer and Execution of the Agreement. Terms of the Agreement The Author accepts the Offer by submitting the manuscript on the Article to the Publisher through the electronic manuscript submission system on the Journal's Internet website. Acceptance of the offer by the author creates an Agreement in writing (Articles 438 and 1286.1 of the Civil Code of the Russian Federation) on the terms of the offer. This Agreement is valid for the duration of the exclusive rights to the Article. When transferring (alienating) the exclusive right to the Article by the Author to a third party, this Agreement does not terminate. VI. Procedure for changing and terminating the Agreement The Publisher has the right to unilaterally change the terms of this Agreement, in advance, at least 10 (ten) calendar days before the entry into force of the intended relevant changes, but with notice to the Author through the Journal’s website or by e-mail to the Author’s e-mail address specified in the Author’s Submission. The changes will take effect from the date specified in the relevant notification. If the Author rejects the changes to the terms of this Agreement, s/he has the right to notify the Publisher by sending a written notification through the online manuscripts submission system, making sure that the same is sent to the official e-mail address of the editorial office. This Agreement may be terminated prematurely, either by agreement of the parties at any time, or on other grounds provided for in this Agreement. The Author has the right to unilaterally withdraw from the execution of this Agreement by sending the Publisher a corresponding notification in writing at least 60 (sixty) calendar days in advance before the expected date of publication of the Article in the Journal. Termination of the Agreement for any reason does not release the parties from liability for any violation of the terms of the Agreement that occurred during the validity period. VII. Responsibility The parties are responsible for non-fulfillment or improper fulfillment of their obligations under the Agreement in accordance with the current relevant legislation of the Russian Federation. All information provided by the Author must be reliable. The Author is expected to provide accurate and complete the information to the Publisher. 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Miscellaneous All notifications, messages, requests, etc. (with the exception of documents that must be sent as originals in accordance with the laws of the Russian Federation) are considered received by the Author if they were transmitted (sent) by the Publisher through the Journal’s website (including by publication), fax, e-mail based on the address specified in the Submission, and other communication channels. The parties recognize the legal force of notifications, messages, requests, etc., transmitted (sent) by the above methods. In the event of claims against the Publisher related to the violation of the exclusive copyright and other intellectual property rights of third parties when creating an article or in connection with the execution of this Agreement by the Author, as well as in connection with the use of the Article by the Publisher in accordance with the Agreement, the author undertakes: To immediately take measures to resolve disputes with third parties soon after receiving Publisher’s notification, and if necessary, enter into legal proceedings on the Publisher’s side and take all appropriate actions needed to exclude the Publisher from the list of defendants; To reimburse the publisher for the legal costs incurred and expenses and losses caused by the application of measures to secure the claim and execute a court decision, and the money paid to a third party for the violation of exclusive copyright and other intellectual property rights, as well as other losses incurred by the Publisher in connection with the Author’s non-compliance with the guarantees provided by them under this Agreement. X. Legal address and details of the Publisher Eco-Vector Address: 191186, St. Petersburg, Aptekarsky Pereulok, 3 letter A, room 1N TIN: 7806423692; KPP: 784101001; OGRN: 1099847039907.
Innervation of Bones. Autonomic Innervation. Part Two (A Review)
The peripheral nerves are involved in bone development, repair, and remodeling. The sympathetic nervous system is a key link between the central nervous system and skeleton, as determined by various anatomical, pharmacological, and genetic studies of β-adrenergic receptor signaling in bone cells. This study reviewed publications on the contribution of the autonomic nervous system to bone tissue homeostasis. A search for English and Russian scientific publications was performed in PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary. In vitro and in vivo experiments showed that adrenergic neural structures promote bone loss by simultaneously enhancing bone catabolism and reducing bone anabolism. In contrast, cholinergic neural structure activation suppresses bone resorption, leading to increased bone mass. The effects of the autonomic nervous system on bone remodeling and their underlying mechanisms have been studied primarily in rodent models. However, the clinical relevance of the findings for human pathophysiology remains debatable. Regardless of their future validity and practical applicability, these data provide a promising basis for further studies.
Surgical Approaches to the Treatment of Children With Postischemic Deformities of the Femoral Head: A Review
Postischemic deformities of the femoral head resulting from Legg–Calvé–Perthes disease and avascular necrosis of the femoral head in children cause disruption of hip joint anatomy and function and early osteoarthritis. The choice of treatment and surgical timing remains a relevant clinical issue. This study reviewed Russian and international publications on surgical treatment of children with postischemic deformities of the femoral head, with the aim of systematizing current surgical techniques and evaluating their effectiveness and identifying promising directions for pediatric orthopedics. The search was conducted in PubMed, Cochrane Library, and eLibrary. Among 64 sources found (28 in Russian and 36 in English, published between 2000 and 2023), 48 focused on the surgical treatment of these deformities. Extra-articular procedures induce effective mid-term outcomes in correcting postischemic deformities, but may cause complications such as premature epiphyseal and greater trochanter growth plate closure, which impair joint congruency. In recent years, intra-articular procedures involving surgical hip dislocation have become widespread. This method provides the opportunity to directly assess the condition, shape, and structure of the femoral head during the intervention, allowing for the most effective restoration of its anatomy. The present study shows that gradual progression of multiplanar femoral head deformities in various hip disorders in children leads to persistent dysfunction and early disability if treatment is delayed or inadequate. Analysis of scientific data revealed that intra-articular interventions may be effective in the treatment of patients with postischemic femoral head deformities. However, a more objective evaluation of their impact on the further course of the disease requires an analysis of long-term treatment outcomes.
Surgical Correction of Kyphoscoliotic Spinal Deformity in a Child With Conradi–Hünermann Syndrome: A Case Report and Review
BACKGROUND: Conradi–Hünermann syndrome, also called X-linked dominant chondrodysplasia punctata type 2, is a rare genetic disorder. Its prevalence ranges from 1:100,000 to 1:400,000 live births, with a >95% female predominance. In pediatric vertebrology, particular interest is drawn to kyphosis and kyphoscoliosis, which rapidly progress and lead to severe deformities. However, in Russian scientific data, only a few studies have investigated the diagnosis and treatment of this syndrome. CASE DESCRIPTION: This report presents the medical history and genetic and clinical–radiological findings of a 3-year-3-month-old child with Conradi–Hünermann syndrome. The results of surgical treatment are provided, and possible approaches for selecting surgical strategies are discussed. DISCUSSION: The development of severe spinal deformity (Cobb angle: >50°) in the frontal and sagittal planes in younger patients (aged 2–5 years) is an unfavorable prognostic factor. For such patients, prompt surgical correction of spinal deformity at an early age, along with stabilization of the achieved result using multi-anchor instrumentation, is crucial for preventing neurological deficits and the rapid progression of curvature during the child’s subsequent growth. CONCLUSION: Early clinical and genetic diagnosis is required in children with suspected Conradi–Hünermann syndrome. Monitoring of the patient’s orthopedic status allows for timely referral to a spine specialist. Treatment for progressive kyphoscoliosis should include early surgical intervention. Deformity correction and stabilization with multi-anchor instrumentation without early spinal fusion may be used, followed by staged corrections if warranted.
Copyright (c) 2025 Эко-Вектор https://creativecommons.org/licenses/by-nc-nd/4.0
Ultrasound Criteria of Reparative Osteogenesis in the Distraction Regenerate of the Femur in Patients Aged 9–12 Years With Achondroplasia Undergoing Cross-Lengthening of the Femur and Contralateral Tibia
BACKGROUND: The relevance of longitudinal assessment of reparative osteogenesis is shown by the fact that the maturation of the femoral regenerate defines the timing of initiating contralateral tibial lengthening and overall hospital stay duration. AIM: This study aimed to identify ultrasound criteria of reparative osteogenesis in the femoral distraction regenerate that allow for the initiation of surgical treatment on the contralateral tibia in patients with achondroplasia. METHODS: Patients with achondroplasia aged 9–12 years (n = 37) were examined; at age 6–7 years, they had undergone the first stage of treatment, namely, bilateral tibial lengthening. At the second stage of treatment, femoral lengthening was performed first, followed by contralateral tibial lengthening. Femoral lengthening was achieved using double corticotomy. The distraction period lasted 63 ± 3 days, with a length gain of 6.5 ± 0.5 cm. Ultrasound (AVISUS Hitachi, Japan) of the bone regenerate was performed at days 7, 20, 30, and 60 after the start of distraction and then once monthly during fixation. Statistical analysis was conducted using variation statistics for small samples. Significance was set at p ≤ 0.05; differences were tested using the Wilcoxon W-test. RESULTS: During distraction, the number and size of linear echodense fragments in the intermediate zone of the regenerate increased. A growth zone in the central part of the regenerate was preserved in the form of a weakly mineralized layer with acoustic density of 65–85 AU to maintain distraction. Ultrasound by the end of the distraction period revealed narrowing of the echopositive zone of the regenerate, a decrease in connective tissue layers, and filling of the intermediate zone. At the beginning of the fixation period, the acoustic density of the fragments and regenerate reached 198 ± 9.0 and 158 ± 4.5 AU (p ≤ 0.05 vs. baseline), respectively, due to active mineralization, indicating the possibility of moderate physical loading of the limb and proceeding with surgery of the contralateral tibia. CONCLUSION: The ultrasound criteria of reparative osteogenesis in the femoral distraction regenerate that allow for the initiation of contralateral tibial lengthening in patients aged 9–12 years with achondroplasia include the following: the formation of characteristic zonal structure of the regenerate throughout the distraction period; absence of focal lesions in all visualized regenerate zones; a 50% increase in acoustic density of the regenerate by the end of distraction vs. the baseline; and a decrease in the echopositive zone width by the beginning of fixation to 45%–48% of the achieved lengthening.
Evolution of Conservative Treatment Methods for Developmental Dysplasia of the Hip: A Review
One of the key conditions for preventing dysplastic coxarthrosis among infants and young children is the timely and effective treatment of developmental dysplasia of the hip. Despite numerous studies on this subject, the incidence of severe complications remains high, leading to dysplastic coxarthrosis in 40%–86.3% of patients and to disability in 11%–38%, indicating the social significance of the problem. This study reviewed international scientific data on the conservative treatment of developmental dysplasia of the hip in infants and young children available in open-access databases (i.e., PubMed, Science Direct, Google Scholar, and eLibrary) covering the period from 1830 to 2025. Over the years, conservative treatment of developmental dysplasia of the hip has remained a pressing issue in pediatric orthopedics. At present, the functional method is recognized as the optimal treatment approach for developmental dysplasia of the hip in infants and young children. It involves gradual centering of the femoral head within the acetabulum and immobilization of the lower limbs while preserving joint mobility. In the past decade, numerous studies have been published on this subject. Furthermore, many studies have proposed refinements to the functional method and have developed and implemented new splint designs that maintain motor activity in the hip joints while avoiding excessive abduction of the femurs (>60°), thereby improving treatment quality and effectiveness. The evolution of conservative treatment methods for developmental dysplasia of the hip demonstrates fundamental principles of pediatric orthopedics that remain relevant today: early detection of condition, immediate initiation of functional treatment upon diagnosis, timely transition to surgical treatment in the absence of positive changes, timely identification of teratogenic dislocations requiring primary surgical correction, long-term follow-up until skeletal maturity, and rehabilitation to prevent early dysplastic coxarthrosis when indicated.
Polysyndactyly and Limb Malformations in a Newborn with Mohr Syndrome (OFD2): A Rare Orthopedic Perspective
BACKGROUND: Mohr syndrome (Oral-Facial-Digital Syndrome Type 2, OFD2) is a rare autosomal recessive condition characterized by craniofacial, oral, digital, and sometimes central nervous system and cardiac anomalies. Among these, digital anomalies such as polydactyly and syndactyly are of orthopedic significance due to their potential impact on limb function and quality of life. CASE DESCRIPTION: We report a full-term male newborn, first in birth order of non-consanguineous parents, who presented with respiratory distress and multiple congenital anomalies. Notable features included median cleft lip, hairy forehead, ocular hypertelorism, broad nasal bridge, and bilateral polysyndactyly of hands and feet with hallucial duplication. Systemic evaluation revealed Double Outlet Right Atrium (DORA) and Dandy–Walker malformation. A clinical diagnosis of Mohr syndrome was made based on phenotypic presentation without genetic testing. In this case, the limb anomalies were consistent with orthopedic features reported in Mohr syndrome. DISCUSSION: The bilateral postaxial and preaxial polydactyly, particularly with duplication of halluces and hand anomalies, is highly suggestive of OFD2 and differentiates it from OFD Type 1. Early identification of these musculoskeletal disorders enables timely orthopedic consultation. Literature review supports early surgical planning to prevent functional impairment in cases of syndromic polydactyly. CONCLUSION: In this rare case, Mohr syndrome (Oral-Facial-Digital Syndrome Type 2) was identified based on characteristic craniofacial features and digital anomalies. The child exhibited functional impairment due to limb deformities, prompting early orthopedic referral. This report emphasizes that when such a constellation of findings is observed, Mohr syndrome should be considered.
New Method for Determining the Anatomical Location of the Acetabulum in Children with Cerebral Palsy
BACKGROUND: At present, the available methods for studying the degree of acetabular deformity in patients with cerebral palsy allow for assessment of its shape alone. Moreover, disturbances in the spatial orientation of the acetabulum within the pelvic ring during joint destabilization remain unexplored. AIM: This study aimed to assess the spatial orientation parameters of the acetabulum relative to elements of the pelvic ring in stable and unstable hip joints in children with cerebral palsy using linear measurement techniques. METHODS: This cross-sectional study included 21 children (42 hip joints) with cerebral palsy aged 9–15 years. In all the patients, one hip joint was stable (21 joints, first group of joints), and the contralateral joint was unstable (subluxation or dislocation; 21 joints, second group of joints). The proposed method for determining acetabular spatial orientation was applied using four novel linear indices on spiral computed tomography, for stable and unstable joints. RESULTS: Testing of the null hypothesis revealed no significant group differences in acetabular spatial orientation. However, compared with the stable hip joints group, the second group with unstable hip joints demonstrated a decreased distance from the most anterior point of the first sacral vertebra (S1) to points on the anterior inferior iliac spine, ischial spine, and intersection of the Y-shaped cartilage growth zone with the obturator crest, and increased distance from S1 to the intersection of the Y-shaped cartilage growth zone with the pubic crest. Pairwise comparison within patients showed differences >5% in 33%–42% of cases, depending on the index. CONCLUSION: A new diagnostic technique for determining the spatial orientation of the acetabulum within the pelvic ring is proposed. This approach enables the detection of multiplanar acetabular displacement, independent of morphological changes. The discrepancy between group-level and individual data indicates the need for further research.
Main Causes of Coccydynia in Children and Adolescents: Impact of Sports on the Development of Pain Syndrome
BACKGROUND: Coccydynia is characterized by intense and persistent pain in the coccygeal region and often presents challenges in diagnosis and treatment owing to its low prevalence and diverse etiology among children and adolescents. AIM: This study aimed to analyze the causes of coccydynia in children and adolescents participating and not participating in sports. METHODS: The outpatient records of 906 patients presenting with coccygeal pain to a consultative and diagnostic department between January 2010 and March 2025 were reviewed. Medical history, physical examination findings, and imaging data were analyzed. RESULTS: The study included patients aged 9–18 years. There were 5.5 times more girls than boys. Most of the patients did not participate in sports. Traumatic coccydynia was identified in 37% of patients. In most cases, the injury resulted from falls onto the buttocks, typically at school or outdoors. Among the patients with traumatic coccydynia, only 5.1% were participating in sports. The causes of nontraumatic coccydynia included coccygeal instability, coccygeal retroversion, coccygeal spicule, and weight loss. In 40.7% of cases, the cause was not identified. Among the patients participating in sports, 64% of the cases of coccygeal pain were associated with coccygeal instability, which presented under conditions of chronic static or repetitive coccyx overload during training. CONCLUSION: The most common types of coccydynia in children and adolescents are traumatic and idiopathic. Coccygeal injuries during sports training occur twice as rarely as household injuries. In young athletes, repetitive excessive loads during equestrian sports, cycling, choreography, and ballet are associated with the development of coccygeal instability. The prevention of coccydynia among children participating in sports may involve proper exercise technique, gradual increase of load, and use of protective equipment.
Analysis of Surgical Techniques for Avulsion Fractures of the Distal Phalanges in Children
BACKGROUND: Avulsion intra-articular fractures account for up to 18% of all bony injuries of the distal phalanx among children. Currently, there is no unified approach for the surgical treatment of such injuries. The Ishiguro technique is an alternative to open reduction; however, experience with its use in pediatric traumatology is limited. AIM: This study aimed to determine the optimal surgical technique for avulsion intra-articular fractures of the distal phalanges in children by comparing the outcomes of open reduction with fixation of the peripheral fragment and of minimally invasive reduction with osteosynthesis using the Ishiguro method. METHODS: A prospective cohort study was conducted at Traumatology Departments Nos. 1 and 2 of the Children’s City Clinical Hospital No. 9, Yekaterinburg. Twenty-nine children with avulsion intra-articular fractures of the distal phalanges, with displacement greater than one-third of the articular surface, were included. In the main group (n = 15), minimally invasive reduction and osteosynthesis using the Ishiguro technique were performed; in the control group (n = 14), open reduction and fixation of the peripheral fragment with a wire were conducted. Local inflammatory changes were assessed on postoperative days 3 and 7. The range of motion in the distal interphalangeal joint was measured using a goniometer at 1, 2, and 4 weeks after implant removal. RESULTS: The main group demonstrated significantly more effective restoration of distal interphalangeal joint motion: 17.80° ± 7.43° versus 7.79° ± 3.40° at 1 week after implant removal (p < 0.001); 57.47° ± 13.11° versus 28.86° ± 12.09° at 2 weeks (p < 0.001); and 89 [85; 90]° versus 78.50 [77.25; 83.00]° at 4 weeks (p < 0.001). Macroscopic evaluation of pin entry sites on postoperative days 3 and 7 showed no significant differences between the groups (p > 0.05). Fracture consolidation was achieved in all cases. Peripheral fragment comminution was observed in one patient from the control group. CONCLUSION: The Ishiguro osteosynthesis technique may be recommended as the method of choice for treating children with intra-articular avulsion fractures of the distal phalanges owing to its technical reproducibility, minimal invasiveness, and favorable functional outcomes.
Correction of Knee Flexion Contracture in Children With Cerebral Palsy by Femoral Extension Osteotomy: Evaluation of the Sagittal Profile
BACKGROUND: Knee flexion contracture is one of the most common deformities in children with cerebral palsy, significantly affecting the patients’ gait, energy expenditure, verticalization, and quality of life. Knee flexion contracture can be corrected using either soft tissue procedures (hamstring lengthening) or bony interventions (femoral extension osteotomies). Soft tissue procedures are considered less invasive and are justified based on the underlying pathology. Some studies have reported their effect on sagittal balance, specifically an increase in anterior pelvic tilt. Femoral extension osteotomies have been regarded as sagittally neutral; however, most studies included them as part of combined interventions, which precludes assessment of the isolated effect of the osteotomy itself. This emphasizes the importance of investigating the impact of femoral extension osteotomies on global sagittal alignment in children with cerebral palsy. AIM: This study aimed to evaluate the effect of corrective femoral extension osteotomy on sagittal spinopelvic parameters in children with cerebral palsy and knee flexion contracture. METHODS: The study included 14 patients with cerebral palsy treated at the Turner National Medical Research Center for Children’s Orthopedics between 2022 and 2025. The patients underwent corrective supracondylar femoral extension osteotomy with plate fixation with angular stability (LCP PHP 90°). Overall, 26 osteotomies were performed. In three cases, a newly developed implant designed for patients with cerebral palsy with reduced bone density was used. Clinical outcomes (i.e., active extension deficit, contracture degree, and popliteal angle) and radiological parameters (i.e., pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis) were assessed preoperatively and at 6 months postoperatively. RESULTS: Significant correction of contracture and improvement in active knee extension were observed. Among the radiological parameters, only lumbar lordosis showed a significant change (+4.3° ± 13.5°, p = 0.049). Other parameters remained unchanged. No associations were found between the changes in clinical and radiological parameters. CONCLUSION: Femoral extension osteotomy is an effective method for correcting knee flexion contracture in children with cerebral palsy and does not cause global sagittal alignment disruption. The increase in lumbar lordosis is adaptive in nature and is not associated with signs of decompensation. Initial experience with the newly designed implant demonstrated technical reliability of fixation and promising applicability in patients with reduced bone density.
Comparative Analysis of Surgical Treatment Outcomes in Children With Unstable Distal Radius Fractures
BACKGROUND: Distal radius fractures are common injuries of the musculoskeletal system among children. Poor treatment outcomes in this group of patients require repeated interventions and are associated with limited functional activity of the upper limb. Therefore, the development of new surgical techniques for the treatment of unstable distal radius fractures in children, which minimize the risk of complications and improve rehabilitation outcomes, remains highly relevant. AIM: This study aimed to compare the surgical outcomes in children with unstable distal radius fractures treated using two different techniques. METHODS: Surgical treatment was performed in 83 children with unstable distal radius fractures. Group 1 underwent surgery using modified antegrade intramedullary osteosynthesis with a pre-bent Kirschner wire (patent No. 2835501; January 20, 2025) (n = 52). Conversely, group 2 was treated using retrograde intramedullary osteosynthesis with a Kirschner wire (n = 31). Outcomes were assessed at 1, 3, 6, and 12 months by evaluating postoperative complications, contractures of adjacent joints, operative time, and fracture healing rates. Statistical analysis was conducted using the Mann–Whitney test, Yates-corrected χ2 test, and Fisher’s exact test. RESULTS: The patients treated with retrograde intramedullary osteosynthesis with a Kirschner wire showed a higher incidence and severity of postoperative complications, with less favorable outcomes, compared with those who underwent the modified antegrade osteosynthesis technique. The proposed method did not present greater procedural complexity than did the classical approach, as confirmed by the absence of significant differences in operative time. Long-term functional outcomes were superior in children treated with the modified technique. This indicates that this approach is not only competitive but also preferable. CONCLUSION: This study supports the use of the proposed modified technique for the surgical treatment of children with unstable distal radius fractures, with the aim of decreasing postoperative complication risk and improving rehabilitation outcomes.
Surgical Treatment in a Teenager With Severe Pectus Carinatum: A Case Report
BACKGROUND: Pectus carinatum is a deformity of the sternum and costal cartilages and ranks second in prevalence among the types of chest wall deformities. According to various studies, its incidence ranges from 8% to 20%. This study presents the clinical outcome of minimally invasive thoracoplasty aimed at correcting a complex chest wall deformity in a teenager with a severe and rigid form of pectus carinatum. CASE DESCRIPTION: A 17-year-old patient underwent surgery for correction of severe pectus carinatum. The procedure was performed using a minimally invasive approach, with two T-shaped plates placed intra-extrapleurally and antesternally. DISCUSSION: Correction of severe pectus carinatum often employs radical techniques that involve subchondral resection of the deformed costal cartilages, sternal osteotomy and/or mobilization of the xiphoid process, and resection of the lower end of the sternal body, followed by osteosynthesis. Such approaches may be associated with complications such as massive blood loss, subcutaneous hematomas, trophic skin disorders, sternocostal instability, and unsatisfactory cosmetic outcomes. In minimally invasive thoracoplasty, regardless of the type of sternocostal deformity, complications such as cardiac arrhythmias, major neurovascular structure injury, and osteosynthesis implant instability or migration may occur. They may be minimized by controlled correction of the chest wall using external devices or stable fixation systems. However, compared with submammary approaches in radical thoracoplasty, minimally invasive thoracoplasty offers the advantages of decreased tissue trauma, stable sternocostal integrity, and good cosmetic results. CONCLUSION: This report presents the treatment outcome of a patient with severe pectus carinatum characterized by a sharp-angled, rigid deformity and ineffectiveness of comprehensive conservative treatment using modern bracing. The described minimally invasive surgical method offers clear advantages over radical approaches and may be recommended for certain patients with similar deformities.
A Photometric Method for Measuring Ankle Dorsiflexion Reproducibility in Young Athletes
BACKGROUND: Ankle dorsiflexion is one of the most important biomechanical indicators of the potential functional capacity of the foot. Its quantitative assessment is crucial in clinical evaluation, and in determining children’s readiness for sports and their potential risk of sports-related injuries. AIM: This study aimed to evaluate the reproducibility of a photometric method for measuring ankle dorsiflexion angles in young athletes in relation to the conventional goniometric method. METHODS: This study included 30 children aged 6–12 years who participated in regular sports activities and had not been diagnosed with orthopedic disorders. Dorsiflexion was measured by two independent specialists using goniometry and photometry based on anatomical landmarks. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). The agreement between the methods was analyzed using Bland–Altman plots. RESULTS: There were statistically significant differences (t-test: p = 0.04) in mean dorsiflexion angles between the goniometry measurement (17.15°) and the photometry measurement (18.1°). Photometry-based measurements exhibited higher inter-rater reliability (ICC = 0.91) than goniometry-based measurements (ICC = 0.78). CONCLUSION: These findings indicate that the photometric method of measuring ankle dorsiflexion in children is a reliable and reproducible tool that can be recommended for practical use and monitoring for physically active children.
Surgical treatment of knee flexion contracture in patients with cerebral palsy: a review
Knee flexion contracture is the most common lower limb deformity among patients with cerebral palsy, with a prevalence of 47%–53%. Its prolonged persistence leads to marked functional impairments, such as increased energy expenditure during walking and decreased motor activity in children, and the emergence of secondary orthopedic complications, which significantly affects patients’ quality of life. This review analyzed published scientific data on current surgical methods for the correction of knee flexion contracture in patients with cerebral palsy, evaluating their clinical effectiveness, determining frequency of complications, and identifying factors influencing the choice of optimal treatment strategy. The studies were determined using PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary. The search was conducted without language restrictions, covering the period from 1952 to 2024. Seventy-four sources were reviewed, including original articles and systematic reviews on surgical treatment of knee flexion contracture in patients with cerebral palsy. The primary surgical correction methods for knee flexion contracture in children with cerebral palsy are hamstring lengthening and distal femoral extension supracondylar osteotomy. Hamstring lengthening is considered the main surgical procedure and most appropriate option for patients of all age groups. Notably, femoral osteotomy has shown high clinical effectiveness in older patients, particularly in those with marked distal femoral deformities. Both methods yield favorable outcomes, but may be associated with certain complications. Furthermore, this review discusses alternative techniques, including tendon transfers and temporary hemiepiphysiodesis, and combined approaches. The conducted scientific data review confirmed the effectiveness of surgical treatment of knee flexion contracture in patients with cerebral palsy. However, in selecting a particular surgical procedure, individual anatomical and clinical features, the degree of contracture, and age-related patient characteristics should be considered.
On June 2, 2025, the outstanding pediatric surgeon—one of the founders of Russian spinal surgery and the founder of the Saint Petersburg school of pediatric vertebral surgeons—Professor Eduard V. Ulrikh, Doctor of Medical Sciences, passed away suddenly. He was 87 years old—only 87, because his sharp and lucid mind, firm handshake, brilliant erudition, unwavering will, remarkable capacity for work, selfless dedication to his profession, and keen intuition for identifying cutting-edge trends in spinal surgery remained unaffected by age.
Prevalence of Musculoskeletal Diseases Among Children in Saint Petersburg, Russia
BACKGROUND: Most musculoskeletal diseases are diagnosed in childhood, allowing for the prevention of chronic progression and subsequent disability in adulthood. In recent years, monitoring pediatric morbidity has gained increasing scientific and practical importance, leading to the reassessment of key organizational strategies. AIM: This study aimed to conduct a comparative analysis of the overall morbidity of musculoskeletal and connective tissue diseases among children in Saint Petersburg from 2017 to 2023. METHODS: Based on official statistical reports from 2017 to 2023, the prevalence of musculoskeletal and connective tissue diseases among children aged 0–14 years and adolescents aged 15–17 years in Saint Petersburg was compared with national averages in Russia. Morbidity trends were analyzed per 1,000 of the respective pediatric population. The analysis was carried out using a quantitative assessment of the odds ratio for the occurrence of musculoskeletal conditions, overall and by individual disease forms, as presented in the statistical bulletins. Statistical significance was inferred when the 95% confidence interval for the odds ratio did not include 1 (p < 0.05). Data analysis was performed using Microsoft Office 2010 (Word and Excel). RESULTS: The prevalence of musculoskeletal and connective tissue disorders among children in Saint Petersburg was extremely high, showing an upward trend and a widening gap compared with the national average in Russia. During the COVID-19 pandemic, the growth rates of most disease categories outpaced those of the preceding period. Among children aged 0–14 years in Saint Petersburg, the odds ratio showed an increase for reactive arthropathies (by 23.6%), deforming dorsopathies (by 27.4%), and other musculoskeletal conditions (by 23.0%). Among adolescents, increased odds were observed for juvenile arthritis (7.9%), arthropathies overall (13.3%), deforming dorsopathies (15.5%), and other disorders (22.7%). In contrast, both age groups showed a decreased likelihood of being diagnosed with spondylopathies. When assessing the significance of odds ratios and the validity of conclusions, preference should be given to the use of the smallest measurement units. CONCLUSION: An increase in the prevalence and odds of musculoskeletal and connective tissue disorders among children in Saint Petersburg was observed. This underscores the need to improve care pathways and adopt modern approaches to the prevention and treatment of these conditions in the region, as well as to strengthen the availability and quality of medical resources in other Russian regions.
Enchondromas of the hand in children: current concepts in etiopathogenesis, diagnosis, and treatment: a review
The prevalence of benign bone tumors among pediatric patients highlights the relevance of such investigations for orthopedic practice. This article focuses on hand enchondromas in children. Despite the relative frequency of this condition, the lack of clinical guidelines for this disease area underscores the relevance of the publication. A total of 69 full-text articles were selected from 387 sources identified through searches in CyberLeninka, eLibrary, PubMed, and Scopus from 1990 to 2023. This review presents current views on the etiopathogenesis, diagnostic and therapeutic challenges, and prognosis of hand enchondromas in children. Radiography and computed tomography are the primary diagnostic methods for hand enchondromas. Histological verification of diagnosis is mandatory. Particular attention should be given to surgical treatment strategies, including the optimal timing and extent of intervention, selection of grafting material, risk factors, and frequency of recurrence. The scientific data analysis enabled the systematization of data on the etiopathogenesis of hand enchondromas, identification of diagnostic priorities, clarification of diagnostic and differential diagnostic criteria, and refinement of approaches to treatment strategy and methods. The choice of treatment strategy, including the method and timing of intervention, should be individualized, taking into account tumor localization and histogenesis, as well as any additional diagnostic findings and the risk of complications. In recent years, specialists have tended to favor early surgical intervention over wait-and-see approaches, with the choice between autograft and allograft being determined by the clinical context. Autografts are considered the gold standard; however, the use of allografts for restoring the structural and functional integrity of bone in cases of injury is a reasonable and well-substantiated alternative, even in the light of the high risks of donor site morbidity. Such decisions should be made collaboratively, considering the opinions of the involved specialists, including orthopedic oncologists, radiologists, pathologists, and rehabilitation physicians.
Ischemic stroke of the cervical spinal cord: a review and case report
BACKGROUND: Ischemic spinal cord stroke is a rare condition, accounting for approximately 1% of all spinal cord strokes. The relevance of this publication is determined by the rarity of the condition, the complexity of differential diagnosis with other acute onset myelopathic syndromes, the severity of spinal stroke outcomes, and insufficient awareness among physicians regarding this condition in children. CASE DESCRIPTION: We present a clinical case of acute myelopathic syndrome in an 8-year-old child. Magnetic resonance imaging of the cervical spinal cord correlated with the clinical findings and indicated impaired circulation in anterior spinal artery at the cervical spinal level. DISCUSSION: Acute impairment of spinal cord circulation may be caused by systemic hypotension; occlusion of spinal cord-supplying vessels (traumatic, iatrogenic, thrombotic, or embolic); arterial dissection; arteriovenous malformations and fistulas; or hypercoagulable states. CONCLUSION: In pediatric patients presenting with acute myelopathic syndrome, ischemic stroke of the spinal cord should be considered in the differential diagnosis alongside inflammatory and infectious conditions, particularly in children with significant risk factors. Early recognition of acute impairment of spinal cord circulation is particularly important for timely neuroimaging, consultations with related specialists, and initiating etiotropic or symptomatic treatment upon identification of the underlying cause of acute spinal cord ischemia, as well as early rehabilitation.
Assessment of sagittal balance parameters in adolescents with severe thoracic idiopathic scoliosis
BACKGROUND: In recent years, the concept of sagittal balance has become increasingly important in the treatment of spinal deformities of various etiologies. However, the number of studies analyzing sagittal balance parameters in patients with idiopathic scoliosis is limited, especially those involving individuals with severe deformities. AIM: This study aimed to evaluate global and regional sagittal balance parameters in adolescents with severe thoracic idiopathic scoliosis. METHODS: The study included 45 patients aged 12–17 years diagnosed with thoracic idiopathic scoliosis (Lenke types 1, 2, and 3), presenting with a primary curve magnitude ranging from 80° to 150°, according to the Cobb method. Radiographic examinations were performed to assess both regional and global sagittal balance parameters, as well as characteristics of frontal plane spinal deformity. The patients were divided into two groups based on the global sagittal balance values. Descriptive, correlation, regression, and comparative statistical analyses of the data were conducted. RESULTS: A positive correlation was observed between the magnitude of frontal plane spinal deformity and thoracic kyphosis values. The regression analysis indicated that when the primary curve exceeded approximately 100°, thoracic kyphosis values tended to rise above 60°. Thoracic hyperkyphosis was the predominant sagittal deformity in these patients; however, neither thoracic kyphosis nor the primary curve magnitude in the frontal plane showed statistically significant correlation with any of the global sagittal balance indicators. These indicators correlated more strongly with spinopelvic parameters (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI–LL). CONCLUSION: Surgical treatment of severe idiopathic scoliosis should obligatorily consider correction methods that produce a corrective effect on the kyphotic component of the deformity. The development of pronounced anterior imbalance has been proven to be uncharacteristic for patients with thoracic idiopathic scoliosis, even with the largest primary curve magnitudes. The primary risk factors for its development were reduced PI and LL values. The development mechanism of the observed association in these patients remains unclear.
Clinical and MRI features of patellar instability in children
BACKGROUND: Patellar instability refers to recurrent dislocations and subluxations of the patella relative to the femoral trochlear groove. This condition is one of the most common disorders of the knee joint in pediatric patients. Both bone and soft tissue structures act as stabilizers of the patella, and alterations in any of these components may contribute to patella instability. Magnetic resonance imaging (MRI) findings related to the osteochondral and soft tissue structures of the patellofemoral joint in children with patellar instability, as well as their correlation with clinical presentation, are of practical interest. AIM: This study aimed to assess the key MRI features of the patellofemoral joint zone in pediatric patients with patellar instability and evaluate their clinical manifestations. METHODS: Epidemiological, clinical, and MRI data were analyzed for patients with patellar instability and anterior cruciate ligament injury. The study included 52 patients in the main group and 44 patients in the comparison group with anterior cruciate ligament injury. No statistically significant differences in age distribution were observed. RESULTS: Significant differences were identified between the groups in terms of Wiberg patellar type, presence of a patellar apprehension sign, and patellar hypermobility. Differences were also noted in the lateral inclination and depth of the trochlear groove, as well as in the frequency of clinical signs such as patellar apprehension and patellar hypermobility (p < 0.001). CONCLUSION: Trochlear dysplasia is a key predisposing factor for the development of patellar instability in pediatric patients. This study confirmed statistically significant differences in the parameters characterizing trochlear dysplasia, as well as the influence of this factor on patellar instability in children, including its correlation with clinical manifestations.
Transitional lumbosacral vertebrae in children with pelvic fractures: frequency of diagnosis and distribution of types and subtypes
BACKGROUND: Various aspects of transitional lumbosacral vertebrae in children remain relevant due to a lack of research on several critical issues. For instance, the frequency of diagnosis and the distribution of different types and subtypes of this condition in the pediatric population remain unknown. The clinical features, particularly pain as the main symptom, have not been sufficiently studied. Furthermore, effective and pathogenetically based approaches to the treatment and prevention of low back pain associated with transitional lumbosacral vertebrae in different pediatric groups have not yet been developed. AIM: The study aimed to determine the prevalence and structure of transitional lumbosacral vertebrae in children with pelvic fractures. METHODS: This study included 41 children who sustained pelvic fractures between 2022 and 2024, with transitional lumbosacral vertebrae in 10 patients. The diagnostic protocol adhered to the standard for patients with pediatric trauma and included mandatory computed tomography of the lumbar spine and pelvis. Pelvic fractures were classified according to the Tile/AO classification system. Acetabular fractures were assessed using the classification criteria proposed by Judet et al. Transitional lumbosacral vertebrae types and subtypes were categorized based on the Castellvi classification. RESULTS: The diagnostic frequency of transitional lumbosacral vertebrae was found to be 24.4% ± 6.7% of clinical cases. Subtype IIa was the most common, accounting for 50.0% ± 15.8% of cases, followed by subtype IIIb, which occurred in 30.0% ± 14.5% of patients. Subtypes Ia and IIb each represented 10.0% ± 9.4% of the observed cases. The study revealed that, unlike in adult patients, a distinguishing feature of the condition in children was the absence of the main symptom, namely, pain in the lumbosacral junction. CONCLUSION: The high diagnostic frequency of this condition, which often remains latent for some time, highlights the importance of targeted radiological assessment of the lumbosacral junction. Once transitional lumbosacral vertebrae are identified, patients should be informed of their presence to support the joint development of individualized strategies for preventing lumbosacral pain.
Assessment of amplitude-frequency characteristics of postural sway at the pressure centers of the contralateral lower limbs of young athletes
BACKGROUND: The development of instrument-based methods for the functional diagnostics of adaptive body changes in children engaged in sports activities is a currently relevant area of research. AIM: This work examined the amplitude characteristics of postural sway at the pressure centers of the contralateral lower limbs in young athletes in motionless standing positions across a frequency range. METHODS: Amplitude-frequency characteristics were analyzed during motionless standing in 18 children aged 7–10 years, of both sexes, who regularly participated in track and field. The postural sway parameters of the pressure centers under both feet were recorded using two stabilometric platforms. Measurements were collected in the low-frequency range (up to 1.0 Hz) for 20 seconds and the high-frequency range (1.0–6.0 Hz) for 1 second. The deviation angle α (°) of the sway axis of the lower limbs from the midline axis was determined. The first peak amplitudes and frequencies of sway were measured: а1, а2, and а3 (mm) and f1, f2, and f3 (Hz) in the low-frequency range, respectively; and А1, А2, and А3 (mm) and F1, F2, and F3 (Hz) in the high-frequency range. The control group comprised 18 children with typical daily physical activity levels. RESULTS: In young athletes, more favorable amplitude-frequency characteristics of postural sway at the low- and high-frequency ranges were identified compared with age-matched peers not engaged in sports and leading sedentary lifestyles. This effect was manifested by a frequency shift in sway, a reduction in all peak sway amplitudes at both the low- and high-frequency ranges, lower asymmetry of sway amplitudes, and the stable synchronization of pressure center oscillations across the entire frequency spectrum. CONCLUSION: Amplitude-frequency parameters of postural sway at the pressure centers of the contralateral lower limbs should be considered while training younger school-aged children for sports to prevent neuromuscular imbalance due to fatigue, and injuries.
Stress fractures in upper extremities of athletes: a review
Stress (overuse) fractures of the upper extremities are a relatively uncommon condition typically observed in athletes. Due to their gradual onset, typically mild clinical symptoms, and sometimes unremarkable imaging findings, such injuries are frequently overlooked. The article aims to present data on the pathogenesis, clinical presentation, diagnostics, and treatment strategies of COVID-19. A scientific data search was conducted in the PubMed (MEDLINE) database and via the Google search engine from 1975 to 2024 using combinations of the operators OR and the following keywords: стрессовые переломы (stress fractures), нагрузочные переломы (overuse fractures), верхние конечности (upper extremities), and спортсмены (athletes). A total of 70 sources were selected, including 22 published within the past decade. Stress (overuse) fractures are reported in approximately 40% of athletes, with 80%–95% occurring in the lower extremities and only 5%–20% occurring in the upper extremities. Stress fractures result from repetitive mechanical loading of the bone and are compounded by fatigue of the surrounding muscles, leading to an increase in the rate of bone resorption by osteoclasts to exceed the rate of new bone formation by osteoblasts. Magnetic resonance imaging is the primary diagnostic modality. In most cases, bone healing occurs with load restriction and activity modification (avoidance of repetitive trauma-inducing movements). Surgical intervention is often required in stage III gymnast wrist fractures, avulsion fractures of the medial epicondyle with displacement ≥10 mm, complete or partial tears of the ulnar collateral ligament of the elbow, olecranon fractures, and carpal bone fractures. Although relatively rare, upper extremity stress fractures can cause significant problems and hinder athletic progression. A thorough medical history, physical examination, and analysis of the mechanism of injury will allow clinicians to raise suspicion of this condition. Load restriction, elimination of provoking factors, gradual increase in training intensity, and improvement of sports technique, in most cases, allowed the patient to avoid surgical treatment and return to sports activities.
Alla Vladimirovna Ovechkina, Candidate of Sciences in Medicine, Assistant Professor, leading expert at the H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery of the Ministry of Health of the Russian Federation, and Honored Doctor of the Russian Federation, celebrates her 80th birthday. Alla Ovechkina has devoted over 50 years of her professional life to the H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery. In 1988–2025, she served as the center’s Scientific Secretary. She became an indispensable assistant to eight successive directors of the H. Turner Center with her energy, dedication, and impeccable professionalism. Alla Ovechkina’s scientific work has been focused on the conservative management of spinal disorders in children.
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Hallux valgus in equino-planovalgus foot deformity in children with cerebral palsy and its etiopathogenesis: a review (part 1)
BACKGROUND: Hallux valgus in children with cerebral palsy is an understudied problem. Treatment approaches are generally applied as a secondary measure, often after the child starts complaining at an older age following correction of contractures and other foot deformities. Moreover, there are no established methods for the early prevention or treatment of hallux valgus. Understanding the fundamental mechanisms of etiopathogenesis and biomechanical disturbances during gait is crucial for developing preventive and therapeutic strategies for this patient population. AIM: To analyze international studies of foot deformities in children with cerebral palsy and compare these findings with biomechanical studies in patients with idiopathic hallux valgus without neurological pathology. METHODS: Sixty-four scientific articles and publications retrieved from multiple databases without time restrictions were reviewed. RESULTS: Equinoplanovalgus foot deformity is a major etiopathogenetic factor in the development of hallux valgus in children with cerebral palsy. Biomechanical alterations associated with hallux valgus are characterized by limited dorsiflexion of the hallux, excessive dorsiflexion of the first ray, restricted supination of the hindfoot and midfoot, and increased plantar flexion of the ankle joint during the terminal stance phase. In equinoplanovalgus deformity, excessive pronation of the hindfoot and midfoot cannot be compensated because of the limited range of motion of the midtarsal joint, causing restricted midfoot supination and the inability to activate the locking mechanisms of the midfoot and forefoot during terminal stance. CONCLUSION: Any biomechanical disturbance within the complex multisegmental structure of the lower extremity that reduces hindfoot and midfoot supination, causes first ray eversion, and limits hallux dorsiflexion may contribute to deformity. The diversity of motor disorders, contracture patterns, and deformities in children with cerebral palsy indicates the need for further research aimed at identifying the specific factors involved in hallux valgus formation. Such findings may be beneficial for developing preventive and therapeutic strategies for early-stage deformities.
Role of genetic determinants in the development of congenital scoliosis: a review
BACKGROUND: Congenital scoliosis is a multifactorial disorder resulting from disturbances during vertebral embryogenesis. Defects occurring at any stage of fetal development may lead to congenital scoliosis and progressive spinal deformity. Recent studies highlighted genetic factors as crucial determinants of the development of this condition. AIM: To review the sources on the genetic basis of congenital scoliosis, focusing on molecular regulatory mechanisms, mutation frequencies, and the contribution of specific genes. METHODS: Sources were retrieved using keyword searches in PubMed, Google Scholar, Cochrane Library, Web of Science, Lens.org, and eLibrary over the past 25 years. The inclusion criteria were full-text availability, meta-analyses, systematic reviews, cohort studies of patients with congenital scoliosis, experimental animal models, and case–control studies. The exclusion criteria included lack of full-text access, patents, utility models, and studies without clinical data. Finally, 54 publications were selected for detailed analysis. RESULTS: The identified genes were categorized into four: susceptibility genes (LMX1A, PTK7, SOX9, TBX6, and TBXT); genes wherein mutations directly cause syndromes or monogenic disorders associated with scoliosis (FBN1); genes with copy number variations (DHX40, DSCAM, MYSM1, and NOTCH2); and genes showing abnormal methylation in patients with scoliosis (COL5A1, GRID1, GSE1, RGS3, SORCS2, IGH1, IGH3, IGHM, KAT6B, and TNS3). CONCLUSION: Analysis of scientific sources revealed the presence of predisposing genetic factors associated with the development of congenital scoliosis in its various phenotypic forms. Data from large-scale studies clarified the etiological factors and were beneficial for predicting the course of congenital scoliosis, and findings from studies with smaller samples may help define future directions for identifying genetic determinants of this disorder.
Combined reconstruction of femoral condylar osteochondral defects in adolescents: clinical cases and a review
BACKGROUND: A leading cause of femoral condylar lesions in children and adolescents is dystrophic processes resulting in subchondral bone destruction followed by overlying cartilage involvement. The most common pathological conditions include osteochondritis dissecans and corticosteroid-induced osteonecrosis. Currently, there is no consensus on the optimal surgical approach for treating osteochondral defects of the femoral condyles. CASE DESCRIPTIONS: Two clinical cases of adolescents with extensive osteochondral defects of the femoral condyles are presented. DISCUSSION: This article provides a review, existing classification systems, and an overview of surgical options for deep osteochondral defects of the femoral condyles. Existing methods induce good to excellent clinical outcomes. However, the absence of randomized and comparative studies of these treatment approaches does not allow for a clear determination of the optimal surgical strategy. In most contemporary studies, outcomes are assessed using indirect imaging methods, which negatively correlate with clinical results and may distort accuracy of treatment outcome interpretation. CONCLUSION: Osteochondral defects of the femoral condyles remain a critical problem in pediatric and adolescent orthopedics and traumatology. Considering the variety of existing surgical techniques (from revascularization osteoperforation to joint replacement), combined reconstruction using autologous bone grafts and collagen membranes may offer stable and favorable clinical and functional outcomes. TRANSLATE with x English Arabic Hebrew Polish Bulgarian Hindi Portuguese Catalan Hmong Daw Romanian Chinese Simplified Hungarian Russian Chinese Traditional Indonesian Slovak Czech Italian Slovenian Danish Japanese Spanish Dutch Klingon Swedish English Korean Thai Estonian Latvian Turkish Finnish Lithuanian Ukrainian French Malay Urdu German Maltese Vietnamese Greek Norwegian Welsh Haitian Creole Persian TRANSLATE with COPY THE URL BELOW <!--a id="TwitterLink" title="Share on Twitter"> <a-- id="FacebookLink" title="Share on Facebook"> </a--> Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back
Surgical treatment of severe pectus excavatum in an adolescent: a case report
BACKGROUND: Pectus excavatum is a malformation characterized by deformities of the cartilaginous parts of the ribs and sternum of varying severity and accounts for 75%–91% of all chest wall deformities. Surgical treatment of pectus excavatum in children remains an urgent issue, despite the considerable number of existing surgical correction techniques. These techniques are not universally applicable, especially for asymmetric and rigid forms, requiring ongoing modification and improvement. CASE DESCRIPTION: A 17-year-old patient underwent surgical correction of a severe pectus excavatum complicated by a history of cardiac surgery, namely, median sternotomy and mitral valve prosthesis placement. The surgical procedure involved the release of major vital anatomical structures, the use of an external fixation device providing high corrective force during surgery, and gradual intraoperative correction under cardiac function monitoring. DISCUSSION: Correction of severe pectus excavatum following prior median sternotomy is associated with a high risk of complications, including fatal events such as asystole or massive hemorrhage. In such cases, a minimally invasive thoracoplasty with an additional subxiphoid approach and sternal elevation using an external fixation device is recommended. Conventional sternal elevation techniques (e.g., bone hooks, sutures, and clamps) have been found to be not advisable for pronounced rigid deformities owing to the risk of sternal injury. Moreover, isolated thoracoscopy using the standard MIRPE technique does not ensure the integrity of intrathoracic structures, and traditional bar-flipping maneuver for immediate and forced correction of pectus excavatum is inappropriate. CONCLUSION: Patients with pectus excavatum exceeding the threshold for severe deformity, particularly those with previous cardiac surgery, require a treatment different from standard thoracoplasty. The presented approach, involving the release of major vital anatomical structures and gradual intraoperative correction under cardiac monitoring with an external fixation device, is recommended for managing such complex clinical cases.
Hip arthroplasty for bilateral pathologic hip dislocation in children
BACKGROUND: Pathologic hip dislocation is a severe complication of septic arthritis and hematogenous osteomyelitis of the proximal femoral metaphysis in young children. Bilateral involvement of the hip joints results in more severe anatomical and functional impairments, requiring greater treatment efforts. In such cases, rehabilitation may take years and involves staged surgical correction and continuous conservative management. Meeting these requirements is crucial, as insufficient or inadequate treatment may result in contractures, restricted hip mobility, and progression of secondary deformities. AIM: To analyze the outcomes of surgical treatment in children with bilateral pathologic hip dislocations treated with hip arthroplasty using demineralized osteochondral allografts and highlight rehabilitation aspects required to achieve favorable short- and long-term postoperative outcomes. METHODS: Surgical outcomes in 11 children (22 hip joints) aged 1.5–10 years with bilateral destructive pathologic hip dislocations who underwent hip arthroplasty using demineralized osteochondral allografts were analyzed. RESULTS: Long-term follow-up (1–12 years) demonstrated radiologically confirmed joint stability in 86.4% of cases and preservation of at least 80 of hip flexion range. CONCLUSION: Hip arthroplasty with demineralized osteochondral allografts in children with destructive pathologic hip dislocations is an effective method for restoring hip joint function, providing stability and preserving range of motion over the long term. A consistent, systematic, and comprehensive treatment approach is critical for successful rehabilitation and for restoration and long-term preservation of hip function in children with bilateral hip involvement.
Patient-specific 3D template with radiopaque markers for pediatric pedicle screw fixation: comparison with freehand technique
BACKGROUND: Accuracy and precision are crucial in pedicle screw implantation in children with congenital spinal deformities combined with thoracic cage anomalies. The use of patient-specific navigation templates supplemented with radiopaque markers significantly improves screw positioning accuracy and reduces the risk of complications. AIM: To evaluate the effectiveness of a novel patient-specific surgical template with radiopaque markers and accuracy of pedicle screw placement in children with congenital spinal deformities combined with thoracic cage anomalies, compared with the freehand technique. METHODS: The study included 26 patients (aged 4–9 years) who underwent surgery at a specialized center. The patients were grouped into two: group 1 (n = 13) underwent screw placement using the new template with radiopaque markers and group 2 (n = 13) underwent screw placement using the freehand technique. Screw placement accuracy was evaluated using the Gertzbein scale based on postoperative radiographs and computed tomography. Statistical analysis was performed using the Student’s t-test, with p < 0.05 indicating significance. RESULTS: In the navigation template group, 100% of screws were placed correctly (grade 0). In the freehand group, 80.5% of screws were correctly positioned; 16.9% showed deviations up to 2 mm (grade 1), and 2.6% showed deviations >2 mm (grade 2). The use of the navigation template significantly reduced the time required for bone canal preparation compared with the freehand method. CONCLUSION: Navigation templates with radiopaque markers demonstrate high accuracy and correctness in pedicle screw placement in children with congenital spinal deformities, reducing malposition risk and shortening operative time. Their widespread implementation may enhance the safety and effectiveness of surgical treatment in this patient population.
Differentiated stabilometric assessment of postural control in nonathlete children and comparison with young athletes
BACKGROUND: Monitoring the functional parameters of the musculoskeletal system is crucial for evaluating children’s adaptive responses to physical activity. Such health monitoring of children participating in sports should be systematic. Stabilometry is a promising method for the functional assessment of the musculoskeletal system in young athletes. AIM: To develop criteria for the differentiated assessment of postural control in children based on analysis of asymmetry in stabilometric parameters of the contralateral lower limbs centers of pressure and compare these findings with those obtained in young athletes. METHODS: A two-stage study of postural balance in healthy children was conducted using dual stabilometric platforms. In stage 1, a control group including 59 children aged 5–16 years who were not involved in sports and whose physical activity did not exceed routine daily levels was investigated to determine the range of normal stabilometric parameters. The children were divided into four age subgroups: 16 children aged 5–6 years, 13 aged 7–10 years, and 15 each aged 11–13 years and 14–16 years. In stage 2, 15 boys and girls aged 7–10 years who regularly trained at sports schools in Saint Petersburg were examined. RESULTS: In the control group, postural balance gradually improved with age starting from 5 to 6 years and reached its highest levels by age 14–16 years. In the main group, regular sports training with increased physical loads in children aged 7–10 years did not adversely affect postural balance or the balance between contralateral lower limbs. This may be associated with a gentle exercise methodology that provides balanced and age-appropriate training loads adjusted for the physiological characteristics of children. The quality of postural control was better in young athletes than in their nonathlete peers, with median stabilometric parameters of 80% and 72%, respectively (p < 0.05). Lower center of pressure velocities and smaller statokinesiogram areas were noted in athletes, showing more efficient postural balance. These findings indicate adaptive processes in the postural ontogenesis of children in the main group because of systematically graded physical loads on the musculoskeletal system. CONCLUSION: The functional asymmetry between the contralateral lower limbs should be considered, which is a physiological characteristic of growing children, particularly young athletes. This asymmetry is linked to age-related physiological differences in the centers of pressure movements of the left and right lower limbs associated with cerebral lateralization. Considering motor asymmetry of the contralateral lower limbs in training programs is advisable to prevent sports-related injuries.
Inversion injury of ankle joint and foot in children: association with sports participation and comorbidities (analysis based on medical information system data)
BACKGROUND: Ankle joint and foot injuries are the most common type of musculoskeletal trauma in children. Their mechanism of injury mainly determines the pattern of damage. AIM: To optimize the diagnosis and treatment of inversion injuries of the ankle joint and foot in children and assess their association with sports participation and comorbidities. METHODS: Outpatient medical records of patients treated at the consultative and diagnostic department between 2014 and 2023 were analyzed. Overall, 1518 cases involving ankle joint and foot injuries were determined, including 111 patients referred with a preliminary diagnosis of sprain and an inversion injury mechanism. RESULTS: The study included boys and girls aged 10–16 years, one-third of them participated in sports, primarily team and gymnastic disciplines. Recurrent inversion injuries occurred more often in children who participated in sports, which should be considered when planning training programs and return to sport. Analysis of the incidence of injuries associated with inversion trauma showed that ligament sprains were most common in nonathlete children (39%), whereas bone fractures predominated in children who participated in sports (38%). CONCLUSION: This study revealed a high incidence of bone and ligament injuries associated with inversion trauma in children and elucidated the contribution of sports participation to these injuries. The broader use of magnetic resonance imaging and ultrasound, along with the refinement and standardization of their protocols, improves the understanding of inversion injuries of the foot and facilitates development of more effective diagnostic and treatment algorithms.
Comparative analysis of arthroscopic techniques for fixation of tibial intercondylar eminence avulsion fractures in children
BACKGROUND: Avulsion fracture of the tibial intercondylar eminence is a rare injury, which commonly occurs in adolescents aged 8–14 years, and may result in disability caused by improper bone union. Several surgical techniques for the treatment of patients with such fractures have been developed, involving various methods of fixation for the avulsed fragment of the tibial intercondylar eminence. AIM: To evaluate the effectiveness of the novel technique for the treatment of type III tibial intercondylar eminence avulsion fractures according to the Meyers–McKeever–Zariczny classification in children with open growth plates and compare its outcomes to those of arthroscopically assisted reduction and fixation of the avulsed fragment using a Herbert screw. METHODS: Functional outcomes in 45 children aged 14–17 years with tibial intercondylar eminence fractures were analyzed at 3, 6, and 12 months after surgery. Group A included 22 children who underwent arthroscopic fixation with a Herbert screw. Group B comprised 23 children who underwent arthroscopic fixation using a self-tightening suture loop following the novel method. RESULTS: Group B demonstrated better anteroposterior and rotational stability of the knee than group A. Postoperative functional assessment scores (IKDC 2000, Lysholm Knee Scoring Scale, and Tegner Activity Scale) were significantly better in group B than in group A (p = 0.00006). In group A, postoperative complications were observed in 18.1% of cases (p ≤ 0.05), including screw fracture (4.5%) and aseptic synovitis due to a foreign body reaction (13.6%). No postoperative complications were noted in group B (p < 0.05). CONCLUSION: The proposed technique for treating tibial intercondylar eminence avulsion fractures in children with open growth plates is more reliable and safer compared with Herbert screw fixation and may be recommended for clinical practice.
Idiopathic avascular necrosis of the femoral head in young rhythmic gymnasts: a clinical and radiological assessment
BACKGROUND: Osteonecrosis of the femoral head is a severe and rapidly progressive degenerative-dystrophic disorder and is commonly detected in children professionally engaged in rhythmic gymnastics. It is characterized by destructive changes in the femoral head, resulting in hip joint function impairment and, consequently, poor clinical outcomes. The radiographic anatomy of the hip joints is insufficiently studied, especially considering the impact of intense and specific physical loads, course and progression of the disease, and reasons behind its delayed diagnosis and late initiation of treatment. AIM: To provide a clinical and radiological characterization of the hip joints in young rhythmic gymnasts diagnosed with idiopathic avascular necrosis of the femoral head and identify factors contributing to delayed diagnosis and late treatment initiation. METHODS: Medical histories and imaging findings of 45 young rhythmic gymnasts aged 12–17 years diagnosed with idiopathic avascular necrosis of the femoral head were analyzed. RESULTS: Most patients exhibited a severe clinical course due to total or subtotal involvement of the femoral head. Distinctive anatomical features of the hip joint in young rhythmic gymnasts included dysplastic morphology with impaired stability indices, valgus epiphyseal formation resembling a Kalamchi type II deformity, and a tendency toward acetabular retroversion. These characteristics contributed to the development of pathological changes, such as femoral head extrusion and deformation. Delayed diagnosis and initiation of treatment was due to insufficient awareness of this pathology among parents, coaches, and physicians; gradual development of clinical symptoms without a history of overt trauma; and diagnostic errors during the early stages of the disease. CONCLUSION: In adolescents, their congenital anatomical features of the hip joint contribute to a more severe course of avascular necrosis of the femoral head. Early differential diagnosis of hip pain in gymnasts, including the use of magnetic resonance imaging, is crucial to exclude femoral head osteonecrosis.
Diagnostic value of synovial calprotectin (S100A8/A9) in differential diagnosis of juvenile idiopathic arthritis and pigmented villonodular synovitis in children: preliminary results of a single-center study
BACKGROUND: Juvenile idiopathic arthritis is the most common chronic inflammatory musculoskeletal disease in children. Its most prevalent clinical subtype is oligoarthritis. Pigmented villonodular synovitis, also known as tenosynovial giant cell tumor, is a rare benign synovial disorder, which may clinically resemble oligoarthritis. Differential diagnosis between juvenile idiopathic arthritis and pigmented villonodular synovitis is challenging. Intra-articular steroids used in juvenile idiopathic arthritis therapy may induce negative effects in patients with pigmented villonodular synovitis. Orthopedic and surgical procedures used to rule out pigmented villonodular synovitis are burdensome for children. Magnetic resonance imaging may yield similar findings for both conditions at early stages. Several studies revealed that serum calprotectin is a promising biomarker for juvenile idiopathic arthritis. AIM: To assess synovial fluid calprotectin concentrations in children with oligoarthritis and pigmented villonodular synovitis. METHODS: The synovial fluid concentrations of calprotectin, interleukin-6, and tumor necrosis factor-alpha in 42 children with oligoarthritis and 12 children with diffuse pigmented villonodular synovitis of the knee joint were obtained by enzyme-linked immunosorbent assay. In patients with juvenile idiopathic arthritis, cytokine levels were determined at disease onset, and prior to therapeutic and diagnostic arthroscopy in those with pigmented villonodular synovitis. RESULTS: Synovial calprotectin significantly increased in children with oligoarthritis (108 [28.2; 237] μg/mL) compared to those with pigmented villonodular synovitis (1.53 [1.26; 1.69] μg/mL; p < 0.001). No statistically significant differences were found in synovial tumor necrosis factor-alpha and interleukin-6 concentrations between patients with juvenile idiopathic arthritis and those with pigmented villonodular synovitis. ROC analysis showed a synovial calprotectin threshold of >2.9 μg/mL for the diagnosis of juvenile idiopathic arthritis (AUC = 0.996 ± 0.00479; 95% CI: 0.926–1.000). CONCLUSION: In children, the differential diagnosis of oligoarthritis is often complicated by clinically similar nonrheumatic joint disorders. The main synovial proinflammatory markers cannot be used for the differential diagnosis of juvenile idiopathic arthritis and pigmented villonodular synovitis. Synovial calprotectin concentration is a promising biomarker of juvenile idiopathic arthritis.
BACKGROUND: Fractures of elbow joint bones are the most common type of fracture in children. Despite methodological advances in managing these injuries, adverse anatomic and functional outcomes are still common in clinical practice. AIM: The aim was to evaluate the structure of primary injuries and primary treatment strategies to evaluate the sequelae of elbow bone fractures in children. MATERIALS AND METHODS: Based on inclusion criteria, a retrospective cohort (n = 115) was formed. Clinical, historical and radiological data were evaluated in patients with sequelae of elbow fracture, admitted for surgical treatment in the clinic of the H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery of Russia in 2022–2023. The Shapiro–Wilk test (for less than 50 subjects) or the Kolmogorov–Smirnov test (for more than 50 subjects) were used to test the normality of quantitative parameters. The Pearson’s chi-squared test was used to compare percentages in the contingency table analysis. RESULTS: The mean age of patients in the study population was 11 years (ranging from 4 to 17 years). The duration of injury is 15.6 ± 1.0 months (min = 3; max = 65). Based on the structure of the sequelae, three groups were identified: patients with contracture (42 cases; 36.5%), patients with deformity (31 cases; 27%), and patients with both contracture and deformity (42 cases; 36.5%). Supracondylar fractures of the humerus (40%) and apophyseal fracture of the medial epicondyle (31%) were the most common primary injuries. Primary conservative treatment of the fracture was performed in 82 (71%) patients, primary surgery was performed in 33 (29%) children, and 17 patients were switched from conservative to surgical treatment. A total of 31 (27%) children had repeated procedures. CONCLUSIONS: Contractures are the most common adverse outcome of elbow fractures in children. Characteristics of conservative treatment and repeated procedures indicate a need for better training of pediatric trauma surgeons. Even today, despite the development of advanced algorithms, the main causes of adverse outcomes are still errors in diagnosis, care strategies, and intervention techniques.
Copyright (c) 2024 Эко-Вектор https://creativecommons.org/licenses/by-nc-nd/4.0/
Potential use of bisphosphonates in children with Legg–Calvé–Perthes disease with signs of osteoarthritis. Interim results from a single-center study
BACKGROUND: Legg–Calvé–Perthes disease is a multifactorial disease with a non-inflammatory and avascular mechanism of necrotic lesions. In some cases, children may have more aggressive disease with signs of osteoarthritis. This variant of Legg–Calvé–Perthes disease is characterized by active inflammation of the bone tissue and arthritis, often leading to severe deformity of the femoral head and early coxarthrosis. The problem of treating osteoarthritis in children with Legg–Calvé–Perthe disease is not solved due to the low effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs). Osteoclast inhibition therapy with bisphosphonates in adults with idiopathic aseptic necrosis of the femoral head has been pathogenetically accepted. The use of bisphosphonates in children with Legg–Calvé–Perthe disease and osteoarthritis has not been evaluated. AIM: The aim of the study was to evaluate the efficacy and safety of bisphosphonates in children with Legg–Calvé–Perthes disease who presented with signs of osteoarthritis. MATERIALS AND METHODS: The study used data on the treatment of 14 children (mean age 7.5 ± 2.4 years, 71.4% girls) with Legg–Calvé–Perthe disease (at the impression fracture stage) and active hip osteoarthritis. All children had torpid arthritis refractory to NSAID therapy and present for at least 3 months. Treatment included ibandronic acid at 1.0 mg and 1.5 mg per infusion every 3 months in children younger than 7 years old and older than 7 years old, respectively. Five consecutive infusions were performed in the study. Treatment outcomes were assessed at 6, 12, and 18 months based on combined clinical, imaging, and laboratory changes. A modified SCORING OF HIP MRI FOR JIA score was used to assess osteoarthritis activity. RESULTS: All children showed a decrease in hip pain after the first infusion of ibandronic acid. The inactive phase of osteoarthritis during bisphosphonate treatment was achieved in 78.5% (11) of children after three consecutive infusions and in 21.5% (3) of children after four infusions. Post-infusion reactions were reported in 85.7% (12) of children during the initial phase of bisphosphonate treatment and were transient. Serum erythrocyte sedimentation rate, C-reactive protein, interleukin-6, and tumor necrosis factor-alpha levels were within reference ranges in children with osteoarthritis. Only 28.5% (4) of patients were found to have 25(OH)Vitamin D deficiency at the time of osteoarthritis diagnosis. CONCLUSIONS: The use of bisphosphonates in children with Legg–Calvé–Perthes disease and osteoarthritis can be considered an innovative pathogenetic treatment option. The data obtained suggest the potential for the use of bisphosphonates in children with Legg–Calvé–Perthes disease. Further follow-up of children in the study group is needed to assess long-term outcomes.
Anatomy and biomechanics of posterolateral angle structures of the knee joint
BACKGROUND: Structural injuries of the posterolateral angle of the knee are rare. However, these conditions are characterized by high-energy etiologic mechanisms and cause rapidly progressive degenerative processes in the knee joint. There is currently no consensus on the need for reconstructing damaged posterolateral angle structures for effective knee stabilization with surgery. Understanding the effects of anatomical elements of the posterolateral angle on posterolateral knee rotational instability is of theoretical and practical importance. AIM: The aim of this study was to evaluate anatomy and morphometry of the popliteal tendon and the fibular collateral ligament, including their zones of attachment to the femur and the role of these structures in the posterolateral rotational and frontal instability of the knee joint. MATERIALS AND METHODS: A single-center comprehensive topographic and anatomical study used 50 unfixed anatomical specimens of the lower extremities (30 females, 20 males). The mean age was 30 to 60 years. Patients died from causes other than musculoskeletal disorders. Precise dissection of the posterolateral angle components (popliteus tendon and peroneal collateral ligament) was performed with detailed examination and documentation of the morphometric characteristics of the femoral attachment sites of the studied structures. The posterolateral angle structures were then sequentially dissected to determine their effect on posterolateral rotational instability and tibial varus deviation (varus stress test) and posterior tibial translation (posterior drawer test). RESULTS: After dissection of the fibular collateral ligament, the maximum varus deviation of the knee joint was 5° ± 3.0°. A more significant external rotation of the tibia of 11.0° ± 1.5° was achieved after popliteal tendon release. The intersection of the posterior cruciate ligament resulted in a maximum posterior tibial displacement relative to the femur by 9 (7.9–10.2) mm. CONCLUSIONS: This study evaluated in detail the anatomy and function of the posterolateral angle structures of the knee joint. The results obtained highlight the leading role of the popliteal tendon in the pathogenesis of posterolateral rotational instability and the fibular collateral ligament in the pathogenesis of the frontal (varus) instability of the knee joint, which is of great importance for the diagnosis and surgical treatment of these types of knee instability.
Copyright (c) 2024 Эко-Вектор https://eco-vector.com/for_authors.php#07
Additive technologies in surgical treatment of congenital spinal deformities in children: a literature review
BACKGROUND: Despite the availability of many surgical treatment options, the surgical management of congenital spinal deformities in preschool children remains a significant and pressing problem. Current techniques for transpedicular screw placement have some limitations. AIM: The aim of the study was to evaluate the results of surgical treatment of children with congenital thoracic and lumbar deformities with impaired vertebral development based on literature data. MATERIALS AND METHODS: This article reviews the literature on surgical techniques for congenital spinal deformities using additive technologies. Data searches were performed using keywords in the PubMed and eLibrary databases. A total of 396 papers were selected for 2000–2023, of which 51 were thematically relevant. RESULTS: It is too early to draw conclusions about the positive results of using additive techniques, especially in the surgical treatment of congenital deformities in preschool children with hemivertebrae, due to the small number of patients described in the literature by different authors. CONCLUSIONS: After reviewing several articles on the use of guides for transpedicular screw placement in congenital thoracic and lumbar anomalies in early preschool children with impaired vertebral development, it is concluded that this promising technique provides high accuracy of screw placement, reduces the number of complications, but further research is needed.
Transient brachial plexopathy in adults and children: a literature review
BACKGROUND: Transient brachial plexopathy such as burner or stinger syndrome is a mild injury of the brachial plexus caused by forced movements of the arm or cervical spine, less often by direct impact of a traumatic factor in the supraclavicular region. It occurs mainly in athletes involved in contact sports. Clinically, transient brachial plexopathy is characterized by a sudden, sharp, stabbing pain that spreads from the neck to the fingertips and usually lasts from a few seconds to several minutes. Considering the lack of Russian literature on this disease, this article will be useful for trauma orthopedists, neurologists, sports doctors, trainers and rehabilitation specialists. AIM: The aim of this paper was to review current data on the pathogenesis, diagnosis, and treatment of transient brachial plexopathy and ways to maintain the ability of patients to participate in sports. MATERIALS AND METHODS: Publications were searched in PubMed (MEDLINE) databases and Google from 1965 to 2024 using combinations of OR, AND operators and keywords such as “transient brachial plexopathy,” “stinger syndrome”, “burner syndrome”, “sports medicine”, “children.” A total of 49 papers were selected, 13 of which were published in the last 10 years. RESULTS: The disease is diagnosed in 18.8%–65.0% of American football and rugby players. Stinger syndrome is reported in children when they fall from a chair and hit their shoulder on a table, when they hit a wall while running, accompanied by a sharp tilt of the head to the opposite side of the shoulder lesion. It is also reported in patients with shoulder hypermobility. Transient brachial plexopathy is caused by damage to the C5–C6 roots of the spinal cord or upper trunk of the brachial plexus. The pain syndrome usually lasts from a few seconds to a few minutes. It may be accompanied by paresthesia, numbness, and weakness of the upper extremity. Most symptoms of stinger syndrome (55.5%) develop during competition and resolve less than 24 hours after the game (63.8%). If the stinger syndrome resolves quickly, the patient does not require further evaluation or treatment. Indications for imaging include attacks lasting more than one hour with associated neck pain, symptoms topically associated with local nerve root damage, and recurrent attacks. CONCLUSIONS: Early diagnosis and competent management of athletes with transient brachial plexopathy, as well as improved playing technique, may prevent or reduce recurrent attacks. It is important to remember that this disease can occur in both adults and children, even in everyday life.
Use of autologous mesenchymal stem cells derived from adipose tissue for the treatment of hyaline cartilage defects in laboratory animals: a literature review
BACKGROUND: Degenerative/dystrophic cartilage diseases are an epidemiologically important challenge in modern traumatology and orthopedics. The use of autologous mesenchymal stem cells to repair cartilage defects is currently the most promising treatment option. AIM: The aim of this paper was to review the literature on the use of adipose tissue-derived mesenchymal stem cells to repair articular cartilage defects in laboratory animals. MATERIALS AND METHODS: Recent and historical Russian and English literature was searched in Google Scholar, Cyberleninka, PubMed, eLibrary, Mendeley, Science Direct databases for over 20 years. A total of 113 papers were selected, and 25 papers that met the inclusion criteria were selected based on full-text materials and abstracts. RESULTS: Literature shows that autologous adipose-derived mesenchymal stem cells stimulate hyaline cartilage regeneration. The vast majority of studies show that the addition of both differentiated and undifferentiated cells accelerates cartilage repair, regardless of the composition of the vehicle matrix or gel. Adipose-derived mesenchymal stem cells can also be used as a stand-alone technology without any vehicles. CONCLUSIONS: There is still no ideal graft to restore cartilage tissue, despite a wide range of technologies, surgical techniques and materials for repairing cartilage defects. However, mesenchymal stem cells improve the rate of defect repair and may become a new therapeutic strategy for degenerative/dystrophic cartilage diseases.
Results of foot assessment in healthy preschool children: visual assessment, FPI-6, dorsiflexion: a population study
BACKGROUND: The reason for conducting this study was the lack of Russian literature on the relationship between visual foot assessment using the Foot Posture Index (FPI)-6 and foot dorsiflexion in preschool children. AIM: The aim was to evaluate the relationship between visual foot assessment, FPI-6 and dorsiflexion in healthy preschool children. MATERIALS AND METHODS: The study included 81 children aged 5–7 years (162 feet). All children were examined using visual foot assessment, FPI-6, assessment of passive dorsiflexion, Beighton hypermobility score, and anthropometric measurements (height/weight). Dorsiflexion was assessed with posterior segment stabilization and the knee joint in flexion and extension. The Kolmogorov–Smirnov test was used to assess the normality of the data distribution, followed by the use of parametric and non-parametric statistical tests. The analysis of variance (ANOVA) was used to compare the means of three groups. The Pearson’s test was used to assess correlations. RESULTS: Flat feet was diagnosed in 41.0% of children. There were 2 times more boys than girls in the group with flat feet and 1.5 times more girls in the group without flat feet. The FPI-6 scores of the same feet were at least 8 in children with flat feet and 0 to 4 in children without flat feet. Moderate to medium correlations were found between the clinical diagnosis of flat feet and FPI-6 scores. In 95% of the children aged 5–7 years, dorsiflexion with the knee joint in extension was 11.4°–34.2°. Mean dorsiflexion difference between flexed and extended knees was 24.1° ± 9.5°. ANOVA showed no significant difference in dorsiflexion between children with and without flat feet. CONCLUSIONS: The mean dorsiflexion in preschool children was 22.8° ± 5.7°. No reliable difference in dorsiflexion between children with and without flat feet was demonstrated. Gastrocnemius muscle retraction was evaluated quantitatively.
Ultrasound evaluation of the tibial graft structure during fixation with the Ilizarov device in patients with achondroplasia
BACKGROUND: Bone regeneration during fixation needs to be evaluated due to clinical measures taken to prevent possible complications, such as evaluation of the correct segment axis, verification of the equality of the extended and contralateral segments (with repeated lengthening), maintenance of fixation rigidity, functional control of the load on the operated limb, and the patient’s motor activity. All of these factors have a direct impact on the structure and maturation of the distraction graft and readiness for device removal. It is relevant to study the proximal graft in bilocal treatment based on the greatest elongation (5.5 [5.0; 6.0] cm) compared to the distal graft. Proximal graft maturation affects the timing of device removal. AIM: The aim was to evaluate the structure of the tibial distraction graft in achondroplasia patients of different ages during the fixation period. MATERIALS AND METHODS: AVISUS Hitachi (Japan) was used for ultrasound scanning with a 7.5 MHz linear sensor. The graft was evaluated using standard programs. The study included achondroplasia patients aged 6–9 years (group I, n = 15) and 10–15 years (group II, n = 15). The study was conducted at 5, 30, 60, and 90 days (with repeated limb lengthening) from the start of the fixation period. In group I of monolocal tibial lengthening, the elongation was 6.5 [6; 7] cm. For bilocal leg lengthening in groups I and II, the proximal graft elongation was 5.5 [5.0; 6.0] cm, and the distal graft elongation was 2.5 [2.0; 3.0] cm. RESULT: In groups I and II, a favorable course of osteogenesis was observed, with typical stages of graft formation. Group II showed slower development of typical structures, resulting in longer fixation times. Therefore, the fixation time was 55 ± 5 days (p ≤ 0.05) in group I and 63 ± 3 days (p ≤ 0.05) in group II (in case of favorable progression). The exception was 1 patient (out of 10 patients with repeated leg lengthening), who developed a hypoechoic cyst-like lesion in the graft midzone during distraction. The time to cortical plate formation increased to 85 ± 5 days (p ≤ 0.05). CONCLUSIONS: Ultrasound evaluation of tibial distraction regeneration during fixation showed that the activity of reparative osteogenesis during this period corresponds to the activity of reparative osteogenesis during distraction. Although it is not possible to fully visualize elongation achieved during fixation due to the formation of echo-dense fragments at the ends of the parent bone, ultrasound scanning allows evaluation of changes in graft filling, vascularization, and graft readiness for removal of the external fixation device.
Innervation of bones. Sensory innervation. Part I: a literature review
BACKGROUND: Bone remodeling is a complex multifactorial process regulated by endocrine, paracrine, and mechanical factors. Nearly two decades ago, research showed that the nervous system is also involved in regulating bone remodeling. However, there is a very limited number of Russian publications on bone innervation mechanisms. AIM: The aim of this paper was to review publications that address the role of sensory innervation in regulation of bone metabolism and some pathophysiology of bone pain. MATERIALS AND METHODS: Data were searched in English and Russian in PubMed, Google Scholar, Cochrane Library, Crossref, eLibrary databases. Information was analyzed and synthesized for the purposes of this paper. Most studies in this review were published within the last 20 years. RESULTS: All structural parts of the bone are innervated by sensory nerve fibers that are receptive to nociceptive information. The type of bone pain depends on both the location and the nature of the disease process. Pain signals from the bones to the central nervous system are transmitted by A-delta and C-fibers, each with its own conduction velocity, neurotransmitters, receptor characteristics, and functions. In addition, sensory nerves regulate bone homeostasis by expressing calcitonin gene-related peptide and substance P as their major neurotransmitters. Sensory nerves play a key role in development of primary and secondary ossification centers during endochondral and intramembranous ossification. Some studies show that nerve fibers are present in articular cartilage at some point in time. CONCLUSIONS: Sensory fibers are an important link in the nervous regulation of bone and cartilage metabolism. Impaired sensory innervation leads to impaired bone remodeling and slows endochondral ossification and, consequently, bone growth and development. This should be considered, especially in patients with early onset bone innervation disorders. To prescribe the correct treatment, it is important to understand pathophysiology of bone pain.
Evaluation of the efficacy of a novel customized guide with visual control function in children with congenital spinal deformity
BACKGROUND: The use of customized surgical guides for transpedicular screw placement improves the accuracy and safety of the procedure in children with congenital spinal deformities. AIM: The aim of the study was to develop and perform a comparative analysis of the effectiveness of a new surgical guide with cutouts for visual control during transpedicular screw placement in pediatric patients with congenital spinal deformities associated with thoracic curvatures. MATERIALS AND METHODS: The study included 30 patients with congenital deformities of the spine and thorax who underwent surgery between June 2022 and June 2023. The patients were divided into the group that used the new guide and the group that used the freehand technique. Screw placement accuracy was assessed using the Gertzbein scale based on postoperative computed tomography data. Results were compared using Student’s t-test for independent samples because the data were normally distributed, as verified by the Shapiro–Wilk test. Statistical significance was defined as a p < 0.05. RESULTS: The new guide demonstrated high accuracy, with 97.7% of screws placed without deviation (Grade 0). Only 2.3% of the screws deviated up to 2 mm (Grade I), which did not affect the complication rates. The freehand technique had lower accuracy rates; approximately 89.7% of the screws were placed correctly (Grade 0), 7.5% had a deviation of up to 2 mm (Grade I), and 2.8% had a deviation of more than 2 mm (Grade II and above). CONCLUSIONS: A new customized guide with visual control cutouts provides high accuracy, reliability and ease of use, making it a promising clinical tool for treating congenital spinal deformities.
Effects of a long-term triceps surae stretching program on the pennation angle of triceps surae heads in children with hypermobile flat foot and Achilles tendon shortening
BACKGROUND: Triceps surae retraction plays a key role in the pathogenesis of flat feet in children. This is a pennate muscle. The pennation angle is defined as the angle between triceps surae fascicles and aponeurosis. AIM: The aim of the study was to evaluate the effect of a long-term triceps surae stretching program on the pennation angle of the triceps surae head in children with flat feet and Achilles tendon shortening. MATERIALS AND METHODS: The study included a total of 82 children with hypermobile flat feet and Achilles tendon shortening. The pennation angle was measured by ultrasound. Triceps surae stretching was recommended for 6 months as a basic exercise. SPSS v.26.0 was used for statistical analysis of data. RESULTS: The study group included 63 children who performed stretching exercises and the control group included 19 children who did not perform stretching exercises at the required intensity. The study group showed a significant improvement in the Foot Posture Index (FPI)-6, while the control group showed no change. The baseline foot dorsiflexion was 4.84° ± 0.10° in the study group and 4.81° ± 0.17° in the control group. After 6 months of stretching, dorsiflexion was 11.34° ± 0.24° in the study group and 4.85° ± 0.19° in the control group (p < 0.01). The pennation angle of the triceps surae heads showed a significant increase in the medial head of the gastrocnemius and soleus muscles. CONCLUSIONS: A long-term stretching program in children with flat feet resulted in a significant increase in foot dorsiflexion. These changes were associated with morphological and functional muscle restructuring, manifested by a significant increase in the pennation angle of the medial head of the gastrocnemius and soleus muscles. Further research will identify the mechanisms underlying anatomical and functional muscle restructuring and their effects on anatomical foot parameters in flat feet.
Analysis of vertebrotomy treatment in children with congenital scoliosis with unsegmented rod and rib synostosis
BACKGROUND: Congenital anomalies of vertebral development account for 2%–11% of cases in the general structure of nosologies that cause spinal deformity. An unsegmented rod (unilateral violation of vertebral segmentation) is attributed to a prognostically unfavorable malformation. Rib synostosis causes the development of thoracic insufficiency syndrome. AIM: To analyze the results of treatment of children with congenital scoliosis caused by an unsegmented rod and rib synostosis by vertebrotomy. MATERIALS AND METHODS: This cohort, retrospective, monocenter study evaluated the treatment results of 55 patients. The patients were divided into two groups: group 1, children aged 2–8 years, the scope of intervention was wedge-shaped osteotomy of a non-segmented rod at the apex of the deformity, and group 2, children aged 8–18 years, the scope of intervention was wedge-shaped osteotomy at the apex of the deformity and two linear osteotomies of a non-segmented rod in the cranial and caudal directions. Clinical, radiological, and statistical research methods were used. RESULTS: Significant correction of scoliosis was achieved in 65.5% of patients aged 2–7 years (group 1) and 56.3% in children aged 8–18 years (group 2). Hypokyphosis of the thoracic spine was observed in the patients. The percentage of correction of kyphosis was 21.1% in group 1 and 19.1% in group 2. Lung volume increased by 27.9% (p = 0.01776) in group 1, and lung volume on the concave side increased by 23.5% (p = 0.04975) and on the convex side by 29.6% (p = 0.01073). Improvement in the overall respiratory impedance reached 47.3% (p < 0.05). In group 2, a insignificant increase was found in VVC by 12.6% (p = 0.3509) and FEV1 by 8.7% of the initial (p = 0.1534), as well as an increase in total lung volume of 13.3% (p = 0.1527) and the contribution of the lung along the concave side of 18.8% (p = 0.1535), and the lung along the convex side was 8.4% (p = 0.169), indicating no significant impact on lung development and function. CONCLUSIONS: In children with spinal deformity caused by a non-segmented rod with normal respiratory function, vertebrotomy at the apex of the deformity with subsequent correction and stabilization of the spinal deformity is recommended. Performing simultaneous multilevel osteotomies of a non-segmented rod allows for significant correction of rigid spinal deformity.
Efficiency of the decision support system for determining the severity of scoliotic spinal deformity by the analysis of radiographs
BACKGROUND: In 2020, a decision support system was developed at expense of grant from Innovation Promotion Fund and integrated into medical base of prosthetic and orthopedic center “Sсoliologic.ru.” It is the first computer program for determining severity of scoliotic spinal deformity in analysis of radiographs. AIM: To evaluate performance of a computer program for determining Cobb angle by comparing obtained automated data with manual measurement data by various specialists. MATERIALS AND METHODS: From medical base of prosthetic and orthopedic center “Sсoliologic.ru,” 411 digital radiographs of spine of children and adolescents were selected, which were drawn by a radiologist (BP-etalon), an orthopedic traumatologist with 5 years of experience and experience in vertebrology (OO), and an orthopedic traumatologist with less than 1 year of experience and no experience in vertebrology (OB) and computer program (KP). The number and proportion of exact matches and mean absolute percentage error (MAPE) of results of measuring the Cobb angle of reference data were compared with indicators obtained by OO, OB, and KP in, for various types of scoliosis according to the classification of Rigо, as well as in determining the main arc. Bland–Altman graphs were used. The mean absolute deviation (MAD) and MAPE for the main arc with magnitude ranging from 20° to >50° were calculated. RESULTS: The exact matches of KP with standard were 21%. Hence, every fifth measurement of the Cobb angle on X-ray, calculated automatically, was identical to standard. The highest proportion of matches with standard was noted in OO (33%), and the lowest in OB (16%). The highest accuracy of KP was found at types E1 and E2, and the arc of 3 was 30% and 24%, respectively. The proportion of KP matches with standard increased to 61%, with an error of 3°, and to 75%, with an error of 5°; with an error of 7°, the proportion of matches reached 84%. Moreover, the proportion of coincidences of a non-experienced researcher increased from 34% to 58%. When determining magnitude of the main arc of scoliosis, OO increased his/her accuracy by almost 2,6 times, KP by 2,1 times, and OB by 1,5 times. The MAD of KP for all major arcs was 3.8°. Good reliability of the obtained KP indicators compared to the reference (ICC = 0.9) was noted. CONCLUSIONS: The use of a computer program may be recommended for automated determination of Cobb angle, because current algorithm of computer program has been found to be accurate compared to reference measurement. Its accuracy was significantly higher than that of novice orthopedic traumatologists with no experience in vertebrology.
Slipped capital femoral epiphysis in children engaged in sports
BACKGROUND: Epiphysis displacement factors in slipped capital femoral epiphysis are defined as an external mechanical impact on the affected joint of different orientation and intensity, the nature of which may determine the type, direction, and severity of epiphysis displacement. There may be differences in the immediate causes of dislocation and in the nature of the course and timing of detection of the disease in children who were engaged in sports compared to those who were not engaged in sports. Identifying these differences may be beneficial for preventing the occurrence of epiphyseal displacement in slipped capital femoral epiphysis. AIM: To determine the immediate causes of epiphyseal displacement and the peculiarities of the course of SCFE in children practicing sports. MATERIALS AND METHODS: The study included 256 patients aged 11–14 years with slipped capital femoral epiphysis who were admitted at our center, from whom 68 patients were subsequently selected. The main group included 34 children who were engaged in sports and whose first symptoms of the disease appeared during training. The control group included 34 children who were not engaged in sports activities and whose first symptoms of the disease appeared for no apparent reason. Clinical, radiologic, and statistical methods of research were used. RESULTS: In the main group, no severe forms of slipped capital femoral epiphysis such as bilateral displacement, acute displacement with chronic displacement, and early complications of the disease were noted, whereas in the control group, the number of patients with such conditions was 6 (17.6%), 4 (11.8%), and 1 (2.9%), respectively. Additionally, in 2 (5.9%) children of the main group, an extremely rare “valgus” displacement of the epiphysis was detected. Both cases occurred in gymnast girls owing to the use of a special “split” sitting technique. CONCLUSIONS: Severe forms of slipped capital femoral epiphysis are less frequent in children who practiced sports than in those who were not engaged in sports. This is associated with earlier medical attention. “Valgus” displacement of the epiphysis is more common in children with slipped capital femoral epiphysis who practiced sports than in those who did not do sports. This may be attributed to the use of some of the most traumatic exercises in the training process.
Features of vertical body balance in children with asymmetric pectus excavatum before and after surgical correction
BACKGROUND: Currently, minimally invasive repair of pectus excavatum are being developed. However, studies on the physiological aspects of the patient’s body in response to surgery are limited. Recently, researchers have become interested in the functional diagnosis of the state of the musculoskeletal system in patients with this pathology. AIM: To assess the dynamics of vertical body balance in patients with severe right-sided pectus excavatum before and after minimally invasive reconstructive operations aimed at eliminating deformity. MATERIALS AND METHODS: Clinical radiation and stabilometric studies of 22 patients aged 13–16 years with right-sided pectus excavatum were conducted. Group A included patients with a low body mass index of 16.0 (15.3–17.7) kg/m2. Group B consisted of ten patients with normal body mass index values of 18.5 (17.7–20.4) kg/m2. In patients of both groups, an analysis of the stabilometric parameters of the movement of the general body pressure center and individually the pressure centers of the left and right lower extremities was performed before surgery and 1.5–2 years after. The patients underwent the same type of bone reconstructive surgery that is, minimally invasive repair of pectus excavatum. The stabilometric parameters of the patients were compared with similar parameters of 20 healthy children in the control group. RESULTS: In both groups of patients, a deterioration in vertical balance was recorded before surgery compared with healthy children. In group A, a relatively stable balance of the total body pressure center was revealed, with a deterioration in the movement parameters of the pressure centers of the left and right lower extremities. In contrast, in group B, the mechanism for ensuring a vertical stance was the opposite: a less stable balance of the general center of body pressure against the background of greater postural stability of the contralateral lower extremities was observed. This indicates heterogeneous locomotor strategies to ensure vertical balance in patients with different body mass indices. In the long term, to correct chest deformity after surgery, the patients of both groups showed opposite changes in the postural control system. In patients with a low body mass index, further deterioration was noted in vertical balance; the quality of balance function decreased from 78% to 69% (p < 0.05). Moreover, patients with normal body mass index showed an improvement in posture stability; the quality of balance function increased from 74% to 83% (p < 0.05). CONCLUSIONS: In patients with pectus excavatum with reduced body mass index, it is recommended to conduct an individual rehabilitation program after minimally invasive deformation correction to adapt them postoperatively and normalize the vertical balance of the body.