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Vol 11, No 4 (2023)

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Organization of trauma and orthopedic care

Current issues in the diagnostics of hip dysplasia in newborns in the regions of the Russian Federation

Baskov V.E., Vissarionov S.V., Filippova M.S., Kenis V.M., Bortulev P.I.

Abstract

BACKGROUND: Early diagnostics of hip dysplasia in newborns are important medical and social problems because untimely treatment of these children leads to severe irreversible pathological disorders of the hip joint, dysplastic coxarthrosis, and consequently disability. Anamnesis data of patients from the Department of Hip Pathology of H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery show that late diagnoses of the dysplastic pathology of the hip joint are not rare, which does not tend to decrease in number.

AIM: To identify and analyze the causes of the late diagnosis of dysplastic hip joint pathology in newborns in the Russian Federation.

MATERIALS AND METHODS: Statistical data from 64 regions of the Russian Federation were collected and analyzed to study the causes of untimely diagnosis of dysplastic hip joint pathology in newborns.

RESULTS: According to the information received, 3,456,207 children were born in 64 regions of the Russian Federation between 2019 and 2021. Of these children, 108,737 (3.1%) were diagnosed with hip dysplastic pathology of varying severity (acetabular dysplasia, subluxation, and dislocation), and 3,943 cases (3.6%) had untimely diagnosis.

CONCLUSIONS: Late diagnosis is primarily caused by the untimely appearance of patients for ultrasound screening and initial examination by an orthopedist. The secondary reason is the understaffing of medical organizations with specialists–orthopedists and specialists in Doppler ultrasound examination. To reduce the number of cases of late diagnosed or missed dysplastic hip pathologies and improve the quality of orthopedic care for children in the Russian Federation, strengthening health education must be recommended among parents and staff of medical organizations with orthopedic and ultrasound specialists.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):439-448
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Clinical studies

Assessment of the serum concentration of growth factors and the informativeness of ultrasonography in studying the structural conditions of the osteoarticular system in children with type III osteogenesis imperfecta

Luneva S.N., Menshchikova T.I., Aranovich A.M., Vykhovanets E.P., Matveeva K.P.

Abstract

BACKGROUND: The treatment of patients with osteogenesis imperfecta requires dynamic monitoring of the structural state and metabolism of the long bones. In the available literature, practically no data are available on the use of ultrasonography to assess the skeletal system in children with osteogenesis imperfecta. Increased expression of the members of the transforming growth factor-β superfamily in the serum has been described in several congenital bone diseases; however, this has not yet been examined in children with type III osteogenesis imperfecta.

AIM: To examine the serum concentrations of growth factors in children with type III osteogenesis imperfecta relative to healthy children and evaluate the informativeness of ultrasonography for assessing the state of the osteoarticular system in type III osteogenesis imperfecta and justify the feasibility of its use in this pathology.

MATERIALS AND METHODS: Children aged 3–7 years with type III osteogenesis imperfecta (= 12) were examined. In the blood serum, bone-mineral metabolism parameters were determined on a Hitachi/BM 902 analyzer (Japan), and the contents of growth factors and their receptors were determined by enzyme-linked immunosorbent assay on a Thermo Fisher Scientific analyzer (USA). Ultrasound examinations were performed using an AVISUS Hitachi device (Japan). Statistical processing was carried out using the Attestat program (I.P. Gaidyshev). Quantitative data are presented as medians and quartiles (Me [Q1; Q3]) for samples with non-normal distribution. In cases with normal distribution, quantitative data are presented as M ± σ, p < 0.05.

RESULTS: In patients with osteogenesis imperfecta, the degree of bone tissue mineralization and bone turnover rates were higher and the collagen content was lower than those of their healthy peers. Fibroblast growth factor-basic underwent the greatest changes; a decrease in the content of the vascular endothelial growth factor (VEGF)-R3 receptor was accompanied by multiple increases in VEGF and VEGF-R2. Ultrasonography identified areas of deformation and multiple fractures in the area of the diaphyses and metaphyses of the femur, tibia, hip, and knee joints.

CONCLUSIONS: Predominance was noted toward the production of growth factors responsible for the activation of osteoclastogenesis. The content of growth factors responsible for osteoclast inhibition and osteoblast activation is normal or slightly changed. Ultrasonography has demonstrated high informativeness in a detailed assessment of the osteoarticular system in patients with osteogenesis imperfecta, which allows us to recommend this noninvasive technique for wider use in this disease.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):449-459
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Influence of the modified Dunn procedure on the spine–pelvis relationship in children with severe slipped capital femoral epiphysis

Barsukov D.B., Bortulev P.I., Pozdnikin I.Y., Baskaeva T.V.

Abstract

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is one of the most severe hip joint diseases in children. It is characterized by the development of unilateral or bilateral deformity of the proximal femoral epimetaphysis of varying degrees. The pronounced deformity of the femoral component of the affected joint leads to pelvic retroversion, decreased lumbar lordosis, increased thoracic kyphosis (TK), and formation of type I (hypolordotic) vertical posture according to the Roussouly classification, contributing to degenerative and dystrophic processes in the lumbosacral spine. At present, no data in the literature present the effect of surgical treatment on frontal and sagittal spine–pelvis relationships in the patients examined.

AIM: To perform a comparative radiological evaluation of the sagittal spine–pelvis relationship in children with severe SCFE before and after the modified Dunn procedure.

MATERIALS AND METHODS: The study included 30 patients (30 hip joints) aged 14–18 years with severe SCFE characterized by a posterior epiphysis displacement of >60° and downward of no more than 10° in one of the joints and no displacement (preslip stage) in the other. All children underwent the modified Dunn procedure on one side and fixation of the epiphysis of the femoral head with a cannulated screw on the other side. Before and after surgery, the patients underwent clinical and radiologic examinations. Standing radiographs were used to evaluate lumbar lordosis, TK, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). The obtained data were analyzed statistically.

RESULTS: At the examination 3–3.5 years after the abovementioned interventions, a pronounced increase was noted in the mean PI value, which began to correspond to type III (harmonious) of upright posture according to the Roussouly classification. A change was noted in the mean values of positional indices PT (decreased) and SS (increased), and pelvic retroversion disappeared. The mean global lumbar lordosis (GLL) and lumbar lordosis increased, which led to a decrease in TK and the mean value of TK. All clinical observations showed a significant decrease in the mean global sagittal balance index (the sagittal vertical axis (SVA)) and absence of torso imbalance.

CONCLUSIONS: After performing the modified Dunn procedure on the one side and fixation of the epiphysis of the femoral head with a screw on the other side, children with severe SCFE demonstrated improvements in all the studied indices of sagittal spine–pelvis ratios. Consequently, the type of vertical posture according to the Roussouly classification changes from type I (hypolordotic) to type III (harmonious), and the probability of degenerative and dystrophic process development in the lumbosacral spine decreases.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):461-472
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Postural balance impairment of the trunk in adolescents with mesial ratio of dentition before and after surgical treatment in the presence and absence of congenital cervical spine abnormalities

Nikityuk I.E., Botsarova S.A., Semenov M.G., Murashko T.V., Vissarionov S.V.

Abstract

BACKGROUND: In the presence of mandibular malformations and malocclusion, an abnormal morphology of the cervical spine is often detected. Latent neurological abnormalities in patients with possible disorders of spinal cord conduction function are promising in assessing the degree of postural balance impairment, which is well diagnosed by stabilometry.

AIM: To evaluate the dynamics of postural stability in adolescents with the mesial ratio of dentition, with and without congenital cervical spine abnormalities, before and after reconstructive operations on the jaws with a constructive bite.

MATERIALS AND METHODS: Clinical, radiographic, and two-platform stabilometric studies were conducted in 31 patients aged 15–17 years with combined dentomaxillofacial anomalies, having a mesial ratio of dentition. The main group included 10 adolescents with various congenital cervical spine abnormalities detected by multispiral computed tomography (CT). The control group included 21 patients who did not have CT signs of cervical spine abnormalities. The stabilometric parameters of the movement of the general body pressure center and the pressure centers of the contralateral lower extremities were evaluated in these patients before surgical correction of the bite and from 1 month to 1 year after it.

RESULTS: In the main group, postural balance impairment was noted, which was more pronounced before surgical treatment than those in the control group. This was manifested by frontal–sagittal violations of postural stability, pathological increase in the areas of statokinesiograms, linear velocities of the centers of pressure, and abnormally severe asymmetry of stabilometric parameters between the contralateral lower extremities. After the surgical correction of the bite, signs of postural balance deterioration were recorded in the control group: a significant increase in the coefficient, i.e., a sharp change in the direction of movement of the general center of pressure from 18% [15%–20%] to 23% [15%–31%], and the asymmetry of the linear velocities of the centers of pressure of the contralateral lower extremities significantly increased from 0.9 [0.3–1.6] to 2.2 [0.9–4.4] mm/s. In the main group, a positive trend was observed—a change in these parameters toward normalization: that is, a tendency to decrease the coefficient and a significant decrease in the rate of the centers of pressure.

CONCLUSIONS: To improve the quality of comprehensive diagnostics and medical rehabilitation of adolescents with congenital and combined dentomaxillofacial anomalies, additional radiographic examination of the cervical spine in combination with stabilometric and kinematic assessment of posture is necessary.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):473-486
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Experimental and theoretical research

Comparative evaluation of contusion spinal cord injury models from ventral and dorsal approaches in rabbits in an experiment

Shabunin A.S., Savina M.V., Rybinskikh T.S., Dreval A.D., Safarov V.D., Safonov P.А., Fedyuk A.M., Sitovskaia D.A., Dyachuk N.M., Baidikova A.S., Konkova L.S., Vlasova O.L., Vissarionov S.V.

Abstract

BACKGROUND: Contemporary experimental models for spinal cord injury studies are mainly based on spinal cord injury in rats and mice. Modeling of experimental spinal cord injuries is generally performed from the dorsal approach, which excludes its injury as a result of compression by the fragments of the fractured vertebral body and significantly restricts the application of the results obtained from clinical practice.

AIM: To develop and create contusional spinal cord injury model from the ventral approach with its subsequent comparison with the contusional spinal cord injury model from the dorsal approach.

MATERIALS AND METHODS: The study examined 20 female Soviet Chinchilla rabbits weighing 3.5–4.5 kg. The rabbits were subjected to standardized spinal cord injuries from the ventral and dorsal approaches at the LII level. Somatosensory- and motor-evoked potentials, H-reflex, were recorded in all experimental animals before injury, immediately after, and 3 and 8 h after injury. Histological studies were also performed using qualitative and semiquantitative analyses of biopsy samples of damaged areas and assessing the number of dystrophic neurons over time. The results of neurophysiological and histological examinations of the spinal cord in cases of ventral and dorsal trauma were statistically processed.

RESULTS: When modeling spinal cord injury from the ventral approach, in comparison with the model from the dorsal approach, more significant damage is detected. As a result of the injury factor, the dysfunction of both neurons at the traumatization level and peripheral neurons below the injury zone was revealed; however, as histological examinations have shown, in contrast to the dorsal approach, mild hemorrhage was observed in the ventral approach.

CONCLUSIONS: The results obtained indicate a more significant and strict contusion mechanism of the spinal cord injury model from the ventral approach and the maximum proximity of the resulting model in a clinical situation. In the future, the experimental model of the contusional spinal cord injury in a laboratory animal can be used in chronic experiments.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):487-500
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Exchange of experience

Prevention of ankle joint deformities in children on the side of fibular graft intake for microsurgical transposition

Ryzhikov D.V., Vissarionov S.V.

Abstract

BACKGROUND: Reconstructive operations of the musculoskeletal system in children may require the removal of a massive autograft for microsurgical bone grafting. The traditional donor site is the diaphyseal part of the fibula. In the late postoperative period, these patients may develop complications such as a valgus deformity of the ankle joint on the side of the donor fibular defect.

AIM: To analyze the effectiveness of surgical methods for the prevention of hallux valgus of the ankle joint after free transplantation of a fragment of the fibula to replace limb-bone defects in children.

MATERIALS AND METHODS: The treatment results of 11 patients aged 11–16 years (6 girls and 5 boys), in whom an autograft from the fibular diaphysis was used to replace defects in long tubular bones were analyzed. Two patients had a femoral defect as a result of previously transferred hematogenous osteomyelitis. A congenital false joint of the femur was found in 2 patients, bones of the lower leg in 6, and the ulna in 1. The distal fragment of the resected fibula was stabilized by an autograft from the iliac bone, in eight and three cases at the level of the diaphysis and metaphysis of the specified fragment, respectively. The size of the resected fragment in % of the total length of the fibula and the level of distal osteotomy were considered. The presence and magnitude of the proximal displacement of the fragment and the position of the ankle joint gap were evaluated at least 5 years after surgery.

RESULTS: In this study, ≥5 years after the intervention, proximal displacement of the distal fragment of the fibula was absent in only one patient. In the remaining 10, the displacement value did not exceed 3.5 mm. Valgus deformity in the ankle joint of >5° from the initial position developed in two patients. Its progression was prevented by temporary hemiepiphysis of the distal epiphysis of the tibia using a 4.0-mm diameter spongiose screw, whereas in up to 16 months, the valgus deformity progression stopped and decreased to initial values.

CONCLUSIONS: Fibular resection in the optimal variant should preserve the distal part of the bone as much as possible, and the stability of the ankle joint increases with synostosis of the shin bones in the distal diaphyseal section without bringing the bones closer together. When a clinically significant valgus deformity appears (>5° from the initial position) with the preservation of the function of the distal growth zone of the tibia, the use of temporary transphyseal hemiepiphysiodesis of the tibia for correction is optimal.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):501-506
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Is the psoas compartment block effective in eliminating pain in children after hip surgery?

Vissarionov S.V., Koriachkin V.A., Zabolotskii D.V., Safin R.R., Bortulev P.I., Baskaeva T.V., Dolgopolskii M.N.

Abstract

BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently.

AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control.

MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale.

RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated.

CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):507-516
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Clinical cases

Nonbacterial osteomyelitis of the vertebral bodies and frontal bone: A description of a rare clinical case and a review of the literature

Kozhevnikov A.N., Zorin V.I.

Abstract

BACKGROUND: Nonbacterial osteomyelitis is a chronic autoinflammatory skeletal disorder of unknown origin characterized by sterile bone lesions and presenting more frequently in children. Spinal manifestations are often common in nonbacterial osteomyelitis; however, cases with skull involvement, except for the mandible, are generally rare.

CLINICAL CASE: Herein, we report the case of an 11-year-old girl presenting with multifocal thoracic vertebral and frontal bone lesions, which led to destructive sinusitis. Nonbacterial osteomyelitis was diagnosed after a bone biopsy, which showed no evidence of granuloma, malignancy, or histiocytes. The histopathological findings were nonspecific inflammatory changes. Ibandronic acid was used to treat nonbacterial osteomyelitis. Clinical signs begin to improve after the first infusion. After the fourth infusion of ibandronic acid, the inflammation was reduced and frontal bone structure and thoracic vertebrae were restored.

DISCUSSION: Bisphosphonate therapy can be used in nonbacterial osteomyelitis when response to nonsteroidal anti-inflammatory drugs is not optimal. The efficacy of bisphosphonate therapy reaches 75%. However, bisphosphonate therapy in nonbacterial osteomyelitis has not been developed. The paper contained literature about rare cases with skull involvement and problems in bisphosphonate therapy in pediatric nonbacterial osteomyelitis.

CONCLUSIONS: Nonbacterial osteomyelitis is a treatable condition, whose care depends on a referral to a rheumatologist.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):517-527
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Osteoid-osteoma of trapezium bone in a child (clinical case)

Avdeychik N.V., Golyana S.I., Grankin D.Y., Nilov A.D., Chernyavskaya-Haukka V.V.

Abstract

BACKGROUND: Osteoid osteoma is a benign neoplasm of bones with a diameter of up to 1.5 cm. It is most common in children in the second decade of life and at the age of 20–30 years, predominantly in men. In large neoplasms (>1.5 cm) with a histological study identical to osteoid osteoma, the pathological process is regarded as osteoblastoma or giant osteoid osteoma. The tumor is most often located in long tubular bones and on the hand in 5%–15% of the patients. Differential diagnosis is carried out with rheumatoid arthritis, inflammation, and other neoplasms. Various options for the treatment of osteoid osteoma, both conservative and operative, have been proposed.

CLINICAL CASE: A 17-year-old patient underwent surgical treatment for trapezium bone neoplasm and pronounced chronic pain syndrome.

DISCUSSION: The identification and treatment of osteoid osteoma remain challenging, which is associated with the similarity of clinical symptoms and ineffectiveness (in the initial stages of its development) of X-ray examination. Thus, computed tomography is necessary to identify a pathological structure. If a formation on the hand is detected, surgery (tumor resection) is advised; if necessary, bone grafting of the defect is performed. After surgical treatment, relapse may occur within 7 months, which is associated with incomplete tumor removal. To confirm the diagnosis, a pathomorphological study is necessary.

CONCLUSIONS: Chronic pain syndrome requires a thorough examination of the patient and a differential diagnosis. Surgical treatment allows the restoration of hand functions and alleviates the tumor-associated pain syndrome.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):529-536
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Phenotypic variability in children with Bruck syndrome type 2: Clinical cases

Trofimova S.I., Kochenova E.A., Agranovich O.E., Buklaev D.S., Merkuryeva E.S., Markova T.V.

Abstract

BACKGROUND: Bruck syndrome is a rare disorder that features osteogenesis imperfecta, combined with severe congenital joint contractures often with pterygia, short stature, severe limb deformities, and progressive scoliosis. Its two forms, Bruck syndrome types 1 and 2, have similar clinical manifestations without osomal recessive inheritance and are caused by pathogenic variants of the nucleotide sequences in the FKBP10 and PLOD2 genes, respectively.

CLINICAL CASES: The article demonstrates phenotypic and radiographic features as well as laboratory values of siblings with Bruck syndrome type 2 (a 10-year-old boy and a 13-year-old girl) born to healthy parents in a consanguineous marriage. The boy had congenital flexion contractures of the knee and elbow joints, few fractures, and severe kyphoscoliosis. The girl had no congenital joint contractures but had kyphoscoliosis, more severe osteoporosis, and a history of having more fractures than her younger brother.

DISCUSSION: The cases demonstrated the significant phenotypic intrafamilial variability of Bruck syndrome type 2, caused by a newly identified homozygous variant c.1885A>G (p.Thr629Ala) in PLOD2, which consists of varying degrees of osteoporosis, and the presence and severity of contractures.

CONCLUSIONS: The description of the given clinical observation was made to draw attention to a rare pathology and expand doctors’ knowledge about the variability of clinical manifestations of Bruck syndrome. Genetic diagnostics is necessary for the timely diagnosis of Bruck syndrome, determining the prognosis and developing patient management techniques.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):537-545
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Clinical and radiological characteristics of two patients with osteoporosis–pseudoglioma syndrome caused by a pathogenic homozygotic variant in the LRP5 gene

Merkuryeva E.S., Markova T.V., Kenis V.M., Kadyshev V.V., Nagornova T.S., Noskova E.V., Dadali E.L.

Abstract

BACKGROUND: Osteoporosis–pseudoglioma syndrome (OMIM #259770) is an ultrarare autosomal recessive disease characterized by congenital or infant blindness, severe osteoporosis, and spontaneous bone fractures. The syndrome is caused by pathogenic variants in the LRP5 gene, which encodes a protein involved in the transmission of signals in the Wnt/β-catenin signaling pathway. To date, 77 pathogenic variants associated with osteoporosis–pseudoglioma syndrome have been registered in LRP5, mainly localized in the second and third beta-propeller domains of the protein, which have a high affinity for the Wnt ligand.

CLINICAL CASES: Two siblings presented with clinical manifestations of osteoporosis–pseudoglioma syndrome caused by a pathogenic homozygous missense variant c.1481G>A (p.Arg494Gln) in LRP5. The phenotype of the patients was characterized by a combination of blindness, low bone-mineral density, short stature, and fractures and deformities of long tubular bones and the spine.

DISCUSSION: The rarity of the osteoporosis–pseudoglioma syndrome and the similarity of the clinical manifestations of various skeletal disorders and their genetic heterogeneity lead to a late diagnosis and treatment.

CONCLUSIONS: We are the first to present the clinical, radiological, and genetic characteristics of two siblings with clinical manifestations of osteoporosis–pseudoglioma syndrome. Its rarity necessitates detailed description of the clinical and genetic characteristics of this syndrome. Molecular genetic testing is an important part of a comprehensive diagnosis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):547-556
pages 547-556 views

Scientific reviews

Neurogenic heterotopic ossification: A review. Part 2

Novikov V.A., Khodorovskaya A.M., Umnov V.V., Melchenko E.V., Umnov D.V.

Abstract

BACKGROUND: Neurogenic heterotopic ossification is characterized by the formation of bone tissue in the soft tissues of the body caused by severe brain or spinal cord injury of various etiologies. In neurogenic heterotopic ossification, the hip joints are most often affected.

AIM: To analyze publications on the instrumental diagnosis, surgical and nonsurgical methods of treatment, and prevention of neurogenic heterotopic ossification of the hip joints.

MATERIALS AND METHODS: In the second part of our review, we analyzed the literature on modern diagnostics, surgical and conservative methods of treatment, prevention of the formation and recurrence of neurogenic heterotopic ossification of the hip joints. Data were searched in scientific literature databases, namely, PubMed, Google Scholar, Cochrane Library, CrossRef, and eLibrary, without language restrictions.

RESULTS: Modern diagnostic methods allow the screening of hip neurogenic heterotopic ossification in patients at high risk of their formation, with further verification of the diagnosis by computed tomography or magnetic resonance imaging. Despite the lack of consensus on the timing of hip neurogenic heterotopic ossification removal at present, surgical treatment is the most effective method, which allows the removal or reduction of the volume of neurogenic heterotopic ossification. Most cases require controlling the pain syndrome and improving the quality of life of the patients. Despite the common etiologic factor (damage to the central nervous system), nonsurgical methods of the prevention and treatment of patients with neurogenic heterotopic ossification of the hip joints have different effectiveness because of spinal cord injury, cerebral trauma, and cerebral palsy.

CONCLUSIONS: Randomized controlled trials will help to establish the efficacy of conservative treatment methods to prevent the formation and recurrence of hip joint neurogenic heterotopic ossification, taking into account the cause of central nervous system lesions.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):557-570
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Correction of proximal femoral deformities in children by a guided growth technique: A review

Kuznetsov A.S., Kozhevnikov O.V., Kralina S.E.

Abstract

BACKGROUND: After surgical treatment of proximal femoral deformities in children, secondary deformities can often develop. They can be corrected successfully by epiphysiodesis — a method of working with growth zones.

AIM: To analyze the literature about the development of epiphysiodesis, a proximal femoral technique, and the results of its use in pediatric patients with hip joint pathologies.

MATERIALS AND METHODS: The results of using epiphysiodesis for treating secondary deformities in children with hip joint pathologies were analyzed. The literature search was performed in open electronic scientific databases eLibrary and PubMed for the period from 1933 to 2022.

RESULTS: Most authors reported good and satisfactory results in the correction of secondary proximal femoral deformities in children. They also suggested that the development of these deformities could be prevented by epiphysiodesis in time frames, which should be chosen correctly. However, no consensus has been established on the timing of surgical intervention and methods of its implementation.

CONCLUSIONS: Proximal femoral deformities in children, such as valgus deformity of the femoral neck and its recurrence, consequences of Kalamchi type II avascular necrosis, and hypertrophy of the greater trochanter, were corrected for a long time by a complex surgical intervention–intertrochanteric osteotomy of the femur. Improvement in examination methods and a deeper understanding of the growth zone functioning of the proximal femur allow orthopedists to introduce into practice less invasive and less traumatic but effective methods for correcting these proximal femoral deformities by controlled blocking of the growth zones.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(4):571-582
pages 571-582 views


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