Vol 4, No 2 (2016)

Articles
Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants
Baskov V.E., Kamosko M.M., Barsukov D.B., Pozdnikin I.Y., Kozhevnikov V.V., Grigoriev I.V., Bortulev P.I.

Abstract

Background. Transposition of the acetabulum after pelvic osteotomy is the most effective surgical method to treat dysplastic hip joint disorders in patients of different ages. According to Salter, iliac osteotomy of the pelvis is the main surgical method used to correct dysplastic acetabulum in 7- and 8-year-old children. In older patients, the pubic symphysis and pelvic ligaments become more rigid, which significantly limits the degree of rotation of the acetabulum. In these cases, a triple pelvic osteotomy is performed to enhance the mobility of the acetabular fragment. This pubic bone osteotomy is performed near the femoral neurovascular bundle, which may be damaged during the procedure.

Aim. To describe a technique for transposition of the acetabulum after iliac and ischial osteotomy of the pelvis, which was developed to reduce trauma, prevent vascular complications, and increase postoperative stability of the pelvic ring.

Materials and methods. A method developed by the authors for transposition of the acetabulum after iliac and sciatic pelvic osteotomy is described in detail. The surgical method was performed 99 times on 89 children with dysplastic hip joint disorders, and the results are presented.

Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):5-11
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Should arthroscopy in adolescents: Three years of clinical experience
Brianskaia A.I., Baindurashvili A.G., Konev M.A., Prokopovich E.V., Nikitin M.S., Sergeeva P.P.

Abstract

Background.

Shoulder joint injuries and shoulder instability often occur in adolescents.

Materials and methods. 

During a 3-year period, we performed arthroscopic surgery on 42 patients with shoulder joint injuries.

Results and discussion. 

The majority (76.2%) of the patients on whom we performed arthroscopic shoulder joint surgery were male. This is likely due to more aggressive physical activity among males. Most of the patients were injured during exercise (n = 27, 64.3%). Arthroscopy is a highly effective surgical method for the treatment of shoulder joint injuries. Prolonged non-operative treatment with no well-established indications and an incorrect diagnosis can lead to rapid progression of degenerative and dystrophic changes of the shoulder joint and may result in shoulder joint dysfunction.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):12-15
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Reconstruction of the hip joint in children after septic coxitis
Teplenkiy M.P., Oleinikov E.V., Bunov V.S.

Abstract

Background.

Surgical treatment of destructive dislocations is problematic, and controversial. Treatment options range from active monitoring to complex multistage reconstruction protocols.

Materials and methods.

The results of treatment of 17 children with disruptive dislocation of the hip (class IV according to the Choi classification) are presented. The mean age at which treatment was started was 6.3 ± 0.5 years (range: 3-9 years). Treatment strategies included formation of the weight-bearing contact of the proximal femur and acetabulum and ilium osteotomy using an Ilizarov frame. The follow-up period lasted from 2 to 11 years. Clinical results were assessed using Colton’s criteria. Assessment of the radiology findings included the anatomy relations and congruence of the articular surfaces. The patients were divided into two groups, according to age, for data analysis.

Results.

The majority (88%) of the children had positive anatomical and functional outcomes. The functional results were good (12-15 points), satisfactory (9-11 points), and unsatisfactory (8 points) for 3, 5, and 1, respectively, among 3-6 year olds and 2, 6, and 0, respectively, among 7-9 year olds. The distribution of joint congruence types I, III, and IV was 2, 4, and 3, respectively, in the younger group and 1, 6, and 1, respectively, in the older group.

Conclusion.

The use of reconstructive surgery using the Ilizarov apparatus in children with a defect of the proximal femur creates conditions for the adaptation of incongruent articular components without causing decompensation of the joint.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):16-23
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Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis
Umnov V.V., Umnov D.V.

Abstract

Aim.

To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed.

Materials and methods.

Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet) between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve.

Results.

Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes.

Conclusion.

This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):24-28
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A multidisciplinary approach for the treatment of complication of hematogenous osteomyelitis in children
Garkavenko Y.G., Semyonov M.G., Troschieva D.О.

Abstract

Background.

Severe orthopedic complications of osteomyelitis occurred in 22%–71.2% of children with osteomyelitis in previous studies. At the same time 26.5% of children with complications of osteomyelitis, according to data of The Turner Scientific and Research Institute for Children’s Orthopedics, have multiple bone lesions. The challenges involved in the orthopedic treatment of musculoskeletal system disorders are diverse and complex. In some cases, inadequate attention is paid to the need to treat the facial bones of the skull, temporomandibular joint (TMJ), and jaw bones.

Aim.

The aim of this paper is to demonstrate the need for a variety of options and to determine the best strategies for comprehensive medical rehabilitation, involving orthopedic and maxillofacial surgeons and other healthcare providers, for children with complications of osteomyelitis, who had destruction of the long tubular bones of the jaw.

Materials and methods.

Between 2011 and 2015 26 children (10 males and 16 females) aged 1.5–17 years with multiple localized lesions after osteomyelitis were treated in The Turner Scientific and Research Institute for Children’s Orthopedic. In addition to severe orthopedic disorders, there has been a loss of TMJ, which resulted in severe functional impairment and impaired development of the facial bones of the skull.

Results.

There was a individualized approach to the treatment of pediatric patients with complications of osteomyelitis. Early diagnosis and proper treatment prevented severe changes in the musculoskeletal system and maxillofacial area in pediatric patients.

Conclusion.

The modern concept of comprehensive medical rehabilitation of children with complications of osteomyelitis should include an interdisciplinary approach involving orthopedic and maxillofacial surgeons. Early diagnosis in children ensures the timely formation of individualized rehabilitation programs, designed to improve the anatomical and functional characteristics of the affected bones. Along with comprehensive orthopedic treatment, bone-reconstructive surgery of the facial bones of the skull should be focused on restoration of chewing function, external respiration, speech, and facial esthetics.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):29-36
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Surgical correction of spinal deformity with the use of transpedicular screw spinal systems in children with idiopathic thoracic scoliosis
Nadirov N.N., Belyanchikov S.M., Kokushin D.N., Murashko V.V., Kartavenko K.A.

Abstract

Aim.

To compare the results of surgical correction of spinal deformity in children with idiopathic thoracic scoliosis with the use of transpedicular screw spinal systems with different pedicle screw placement.

Material and methods.

Thirty-one patients (14–17 years) with spinal curvature with a Cobb angle from 40° to 79° were operated on. Surgical correction of the deformity was performed using two methods, depending on the possible placement of a pedicle screw. The first group included 16 patients for whom the transpedicular support elements were placed on both sides, throughout the completely deformed spine. The second group included 15 patients for whom the pedicle screws were not placed for two or more vertebrae on the concave side of the curve, at the top of the main curve.

Results.

The mean percent correction of the spinal deformity for the first and second groups was 92.5% and 82.6%, respectively. The mean percentage of derotation of the apical vertebra for the first and second groups was 73.9% and 23%, respectively.

Conclusion.

The use of data based on the anatomical and anthropometric features of the vertebral body with scoliosis facilitates selection of the best option for correction of thoracic curve in children with idiopathic scoliosis using pedicle multi-support metal construction. The use of the spinal pedicle system for correction of spinal deformity in children with idiopathic scoliosis enabled a uniform load distribution along the support elements of the metal construction and maintained the correction in the late postoperative follow-up period.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):37-44
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The characteristics of patients and hospital procedures for pediatric trauma in Saint Petersburg
Baindurashvili A.G., Shapiro K.I., Kagan A.V., Vishniakov A.N., Fedorov S.V., Drozhzhina L.A.

Abstract

This study presents health statistics for a specialized trauma department in a large pediatric hospital in St. Petersburg. Data relating to patients treated in the trauma department for any injuries and with injuries of the musculoskeletal system were analyzed separately. Injuries of the musculoskeletal system, accounted for 67.3% of all children hospitalized in the trauma department. We also identified patients with injuries of the musculoskeletal system who were treated in non-specialized departments of the hospital (accounting for 4.1% of patients in these departments). Detailed characteristics of the pediatric trauma departments, the characteristics of children hospitalized with injuries of the musculoskeletal system, methods for diagnosis, treatment, and rehabilitation are described. The challenges of rehabilitation for children with injuries and the need to increase the hospital capacity are also described.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):45-53
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Treatment of flexion contracture of the knee joint in children with arthrogryposis: A literature review
Mulevanova S.A., Agranovich O.E.

Abstract

Knee joint lesions are observed in 58%-90% of patients with arthrogryposis. Majority of these cases involved flexion contracture of the knee. Ambulation is possible with a deficit of knee extension of 15-20°. Currently there is no standardized treatment in global practice, which makes the treatment of this disease extremely challenging. Clinicians must take into account the degree of flexion contracture, segmental level of the spinal cord lesion, and the age of the child when considering treatment options. In this study, national and international literature relating to the clinical profile, classification, and conservative and surgical treatment of this condition were reviewed. The following treatments have been considered for this condition: casts, extensor osteotomy, arthrolysis of the knee, the use of external fixation devices, and hemi-epiphysiodesis. The high probability of relapse for flexion contracture of the knee joint in children with arthrogryposis has been described.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):54-60
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A clinical case study of long-term injury of the thoracic and lumbar spine
Zaretskov V.V., Arsenievich V.B., Likhachev S.V., Shul’ga A.E., Stepukhovich S.V., Bogomolova N.V.

Abstract

Overestimation of the efficacy of conservative treatment of spine injuries children often leads to unsatisfactory long-term results. The effective correction of post-traumatic spinal column deformities occurs in patients who undergo the operation in the early post-traumatic period. While choosing treatment strategies for children, higher reparative opportunities, which provide early fracture consolidation, including those in faulty positions, should be considered. This study presents a case of surgical treatment for uncomplicated injury of the thoracic and lumbar spine, with long-term compression fragmental fracture of the L1 vertebra body in a 12-year-old child. Due to the long-standing character of the injury right thoraco-frenotomy was conducted with partial L1 vertebral body and resection of the adjacent discs, deformity correction of the thoracic and lumbar spine with a transpedicular system, and ventral spondylodesis with an autograft. This extensive intervention was justified by the peculiarities in the vertebral body damage and the post-traumatic segmental kyphotic deformity that resulted from delayed medical treatment. An anterior approach was chosen to achieve immobilization at the site of the damage before correction using the transpedicular system. Surgical correction of long-term spinal injuries in children, with the use of a combined approach, is usually laborious and traumatic. The prevention of rigid post-traumatic spine deformities with the help of timely diagnostics and appropriate treatment, including surgery, should be a priority to prevent such cases.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):61-66
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International Standards for Neurological Classification of Spinal Cord Injuries (ASIA/ISNCSCI scale, revised 2015) 67
Vissarionov S.V., Baindurashvili A.G., Kryukova I.A.

Abstract

Standardization of neurological examination and diagnosis in the case of spinal injury is currently an important challenge in neurotraumatology. At present, most organizations, worldwide, that are involved with spinal injuries, apply the International Standards for Neurological Classifications of Spinal Cord Injury (ISNCSCI), drafted by American Spinal Injury Association (ASIA) and approved in 1992. The ASIA/ISNCSCI scale is a quantitative system for estimation of the neurological status of spinal cord injury patients. The ASIA/ISNCSCI scale has been repeatedly updated and revised since 1992. The 2015 version of the ISNCSCI on the American Spinal Injury Association website is demonstrated in this study, and the form and testing instruction are translated into Russian.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):67-72
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Henry Ivanovich Turner - founder of pediatric orthopedics in Russia
Baindurashvili A.G., Solovyova K.S., Zaletina A.V.

Abstract

This study presents the organizational, clinical, and scientific activities of Henry Turner, the founder of pediatric orthopedics. In 1910, Henry Turner presented a report to the All-Russian Congress about the “Basic principles of care for cripples, which are subject to obligatory care on the part of the state.” He pointed out the deficits in the activities of charitable shelters, where there was neither treatment nor education, and he advocated for main organizational principles for institutions for crippled children. Counseling and medical aid for children in the “Shelter for cripples and paralytics,” organized under the leadership of Henry Turner, facilitated the conversion of the shelter into an “Institute for vocational rehabilitation of physically handicapped children,” with 200 beds, in 1932. In connection with the 50th anniversary of the scientific and medical work of Professor Henry Turner, the Institute was named after him. The plight of pediatric patients was the subject of his constant care and attention; it was his lifework. The Institute’s staff continue Henry Turner’s vision of “orthopedics of the soul,” and not only treat but also teach and nurture children, to help form their personalities and to give them a joy and sense of life.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(2):73-77
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