Vol 4, No 1 (2016)

Articles
Experience of using the ilizarov external fixator in the treatment of children with recurrent congenital clubfoot
Kozhevnikov V.V., Voronchikhin E.V., Grigoricheva L.G., Radimova Z.N.

Abstract

Introduction: Congenital clubfoot is a complex orthopedic problem, and the frequency of recurrence or secondary deformities may reach up to 60% in some cases.

Purpose: To determine indicators for the surgical treatment of recurrent foot deformity using the Ilizarov external fixator and to evaluate the effectiveness of this approach.

Materials and Methods: The feet of 78 children with recurrent congenital clubfoot were analyzed using X-ray and ultrasound to investigate their clinical and functional characteristics. According to the characteristics of the deformity, we performed tenoligamentocapsulotomy combined with tarsal osteotomies and tendon plastics. Furthermore, we determined the indicators for the surgical treatment of foot deformity using the Ilizarov external fixator.

Results: In total, 33 children (56 feet) were treated using a distraction external fixator combined with tenoligamentocapsulotomy. Following treatment, long term results were assessed using a three-point scale: good, satisfactory, and unsatisfactory. The number of children of 8 years of age whose treatment was graded as either good or satisfactory was higher than children who were over 9 years of age. Functional recovery was also better in the younger age group.

Conclusion: By determining specific indications for different treatment methods, physicians are able to apply an individual approach for diagnosing and treating recurrent congenital clubfoot. Good and satisfactory long term results were obtained in approximately 90 % of cases.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):5-10
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Underlying causes of poor outcomes in the treatment of children with fractures of the capitulum of the distal humeru
Kuptsova O.A., Baindurashvili A.G., Nikitin M.S.

Abstract

This study aimed to determine the causative factors underlying poor outcomes in the treatment of children with fractures of the capitulum of the distal  humerus.

Materials and Methods: We conducted a retrospective analysis of community-based treatment of 36 patients with fractures of the capitulum of the distal humerus who presented to the Department of rehabilitation between 2010 and 2015 owing to poor treatment outcomes. Analysis only involved patients presenting with an extensive dataset with regard to their treatment, including X-rays taken at the time of the injury and at subsequent stages of treatment.

Results: It was found that there had been inaccuracies at the stage of diagnosis in 47.2% of patients, errors in the selection of treatment in 13.9%, and errors in post-operative management in 38.9%.

Conclusion: When interpreting radiographs, it is important that physicians clearly assess the degree of displacement when evaluating fractures of the capitulum of the distal humerus. Dislocated fractures require the most accurate reposition. When choosing a treatment method, it is important to predict the possibility of post-traumatic complications. Accumulating evidence of clinical errors indicates that more attention should be paid to the treatment of elbow fractures during the postgraduate education of specialists.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):11-16
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Treatment of pediatric craniofacial injuries in a municipal ambulance hospital setting
Semenov M.G., Emirbekov E.A., Kirichenko K.N., Pinevskaya M.V., Podyakova Y.A.

Abstract

Aim: To improve treatment outcomes for children with combined craniofacial injuries

Materials and Methods: This study involved a retrospective analysis of treatment outcomes from 43 children with combined craniofacial trauma who were admitted to Rauhfus Children's City Hospital No. 19 from 2012 to 2015. Analysis involved the age and gender of patients along with the mechanism of injury, areas sustaining injury, and methods of examination and treatment.

Results: All patients underwent full surgical treatment in the early stages.

Conclusions: Managing patients with concomitant craniofacial trauma requires a multidisciplinary approach. Treatment inevitably requires surgery, which needs to be performed as early as possible to avoid posttraumatic deformities and optimize functional and esthetic outcome.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):17-25
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Treatment of wrist deformities in children with arthrogryposis multiplex congenita
Kochenova E.A., Agranovich O.E., Savina M.V.

Abstract

Introduction: Treatment of wrist contractures in children with arthrogryposis multiplex congenita (AMC) is extremely problematic because of the high incidence of recurrence. This study aimed to improve the outcome of wrist contracture treatment in children with AMC.

Materials and Methods: A total of 90 patients (162 wrists) were examined and treated. Patients were assessed using a number of clinical, radiological, and electrophysiological examinations. There are several different clinical variants of wrist contracture, including flexion contracture of the wrist, flexion contracture associated with ulnar deviation, and isolated ulnar deviation of the wrist. Patients were divided into three groups according to the level of spinal cord lesion: С6-С7, С5-С8, and С5-Th1. As the number of damaged spinal cord segments increased, the amplitude of passive and active movements, degree of passive correction, muscle power, and wrist function decreased. Surgical treatment involved the following three approaches: tendon transfers, tendon transfers and carpal wedge osteotomy, and tendon transfers with carpal wedge osteotomy and shortened osteotomy of the forearm.

Results: Analysis of treatment results showed that patients with segmental spinal cord lesions at the  С6-С7 and С5-С8 level were mostly associated with a good outcome, whereas patients with lesions at the  С5-Th1 level achieved satisfactory outcomes.

Conclusions: Patients with segmental lesions of the spinal cord at the С6-С7 and С5-С8 level were associated with restoration of active wrist extension up to the neutral position or more and were expected to achieve significant improvement of hand function. Patients with spinal cord lesions at the C5-Th1 level exhibited significant lesions of the muscles, along with bone deformities. Consequently, surgical treatment could only achieve functional wrist position with minimal improvement of hand function. Using differential approaches in the treatment of wrist contracture that are selected by determining the level of spinal cord lesion will enable physicians to predict the outcome and improve the function and appearance of the wrist.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):26-36
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Specialized traumatological and orthopedic care for children through public-private partnership programs in the Novosibirsk region
Mylnikova T.A.

Abstract

Aim: To evaluate the feasibility of an organizational model of specialized traumatological and orthopedic care for children using public–private partnership mechanisms in the Novosibirsk region.

Material and Methods: Data from patients visiting the Federal State Novosibirsk Research Institute of Traumatology and Orthopedics between 2011 and 2015 were acquired from “Medassist,” the local medical information system. Data were subsequently analyzed to identify the relative extent of medical care provided.

Results: This study included results from an organizational model of specialized traumatological and orthopedic care for children developed via public–private partnership mechanisms that have been implemented in the Novosibirsk region since 2011. A number of institutions were involved in this model of medical care for children with traumatological and orthopedic pathology, including the Federal State Novosibirsk Research Institute of Traumatology and Orthopedics, Clinic “NIITO” (a non-governmental medical organization), and various other primary health care organizations, including children’s polyclinics and hospital outpatient departments. This model allowed us to create a closed (full) cycle of provision for specialized traumatological and orthopedic care, from primary treatment to the completion of rehabilitation with dynamic supervision throughout. This was accomplished by combining various clinical stages, including the specialized clinic, hospital, rehabilitation organization, and outpatient clinic. The main areas of this model include timely and reliable detection; determination of treatment indicators; appropriate definition of treatment terms; and the provision of specialized medical care, including high technology input, rehabilitation, and dynamic monitoring.

Conclusions: Implementation of an organizational model of specialized traumatological and orthopedic care for children in the Novosibirsk region using mechanisms associated with public–private partnerships has proved to be very positive. Application of the model allowed improvements in the availability of specialized traumatological and orthopedic care for children to ensure succession in the stages of medical care and to increase the number of cases entering rehabilitation. Therefore, this model demonstrates the viability of providing medical care to the population through the mechanisms of public–private partnership.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):37-42
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Congenital pseudarthrosis of the clavicle: a clinical and radiological examination
Pozdeev A.P., Sukharskaya J.B.

Abstract

Results of the clinical and radiological examination of 20 children aged between 2 years and 13 years with congenital pseudarthrosis of the clavicle are presented. In 35% cases, malformations of the cardiovascular and musculoskeletal systems were identified. The most common variants of the affected clavicle were shortening, localization of nonunion in the distal part of its middle third, and thinning. Less frequent deformations included thickening of the ends of the bone fragments with moderate sclerosis of all bone fragments and normal bone structure of the diaphysis; deformity of bone fragments (in 60% cases) mainly in the frontal plane; and the displacement of bone fragments in the cranial direction. These changes need to be considered when planning surgery.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):43-47
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Conservative treatment of children with vertebral compression fractures of the thoracic and lumbar spine in the Russian Federation: a literature review
Baindurashvili A.G., Vissarionov S.V., Pavlov I.V., Kokushin D.N., Lein G.A.

Abstract

Various options for medical treatment of children with compression fractures of the thoracic and lumbar spine include unloading of damaged segments by simultaneous or gradual reclination (e.g., functional traction and reclination of the spine); measures aimed at building and strengthening the muscular “corset” of the back; and the use of orthotic devices of various designs (e.g., fixating-discharging, fixating-correcting corsets, orthoses on a modular basis). Questions regarding the early and late use of orthotics in patients with compression fractures of the vertebral bodies are discussed. Literature analysis, considering different methods used in the treatment of these patients in terms of their effectiveness to restore the height and shape of the damaged spinal segment revealed the absence of a differentiated approach for choosing treatment and selection criteria for orthopedic management.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):48-56
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Guided growth for correction of axial deformities of the knee in children: a literature review
Morenko E.S., Kenis V.M.

Abstract

Literature review was performed for axial deformities of the knee in children and possible correction by guided growth, which aims to restore the mechanical axis of the lower limbs by targeting the growth plate. In 2004, P. Stevens proposed temporarily blocking the bone growth plate with metal plate and two screws. The method includes the extraperiosteal placement of the metal plate at a certain segment of the growth plate (i.e., at the top of or in plane with the deformity). Its advantages are minimal invasiveness, higher accuracy and reliability, and ease and efficiency of use. In addition, there is a negligible risk of possible complications. The method of guided growth is a preferable alternative to osteotomy for the correction of the axial deformity of the knee joint in children and should be more widely used in the everyday practice of pediatric orthopedic surgeons.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):57-62
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Use of general life quality questionnaires for assessing the effectiveness of treatment of children with fractures of long bones of the lower extremities: a literature review
Patlatov A.A.

Abstract

WHO experts recommend including quality of life measures when evaluating the results of surgical treatment in the postoperative period. Quality of life measures help to determine not only the quality of treatment but also the completeness of medical and social rehabilitation. We reviewed the research of international authors, who had used general questionnaires to study quality of life of children with long bones fractures of the lower extremities. We suggest using general questionnaires-PedsQLTM 4.0 (for children aged 2-18 years) and QUALIN (for children aged between 3 months and 3 years) as tools to evaluate treatment results in this population. Presentation of the results of studies using international efficiency indicators, in particular the assessment of quality of life, provides the basis for reliable summary of the international clinical experience.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):63-71
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Algorithm for treatment of children of first months of life with brachial plexus birth palsy
Kriukova I.A., Khusainov N.O., Baindurashvili A.G., Ikoeva G.A., Garkavenko Y.E.

Abstract

Aim. We present the algorithm for treatment designed specially for medical doctors who are involved in treatment process of children with brachial plexus birth palsy during first few months of their life.

Materials and methods. We analyzed domestic and foreign literature which highlights the problem of brachial plexus birth palsy.

Results. Key-moments of diagnostic and treatment of these patients were discovered. Based-upon them algorithm was developed.

Conclusion. Integration of developed algorithm in clinical practice is essential for understanding the etiology, pathogenesis, natural history, differential diagnostic and prior treatment by medical doctors of different specialties to improve the quantity of medical service.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(1):72-77
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