Vol 4, No 3 (2016)

Articles
Analysis of long-bone deformity correction in adolescents using osteosynthesis by intramedullary interlocking nails: a preliminary report
Vilensky V.A., Bukharev E.V., Zubairov T.F., Pozdeev A.A., Pozdeev A.P., Sosnenko O.N.

Abstract

Aims. The purpose of this study was to analyze the initial experience with adolescents treated for long-bone deformities of the lower extremities of different etiologies using osteotomies and fixation by interlocking nails.

Materials and methods. We analyzed the accuracy of long-bone deformity correction using referent lines and angles, the time of consolidation, number of complications, and functional result.

Results. We found that the accuracy of femur deformity correction (dependent on the complicity of the deformity), as estimated by different parameters, varied from 77.8% to 91.7%. Simple deformities and deformities of moderate complicity had the most accurate correction; the group of complex multiplanar deformities of the femur had the least accurate correction. This group included five cases of residual deformity, in which three of these had an angle of residual deformity <10°. The accuracy of leg deformity correction was 90%. Evaluation of the functional results using the Lower Extremity Functional Scale indicated the high functionality of the method used.

Conclusions. Correction of long-bone deformities using intramedullary osteosynthesis by interlocking nails is an effective treatment of all types of femur and lower leg deformities. When treating complex deformities of the femur, the path to operative treatment should be complex and in most cases the nailing should be accompanied by intraoperative external fixation frame assistance.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):5-15
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Congenital radioulnar synostosis: symptom complex and surgical treatment
Prokopovich E.V., Konev M.A., Afonichev K.A., Prokopovich I.E., Kovzikov A.B., Nikitin M.S., Selizov V.V., Vinokurova T.S.

Abstract

Background. Congenital radioulnar synostosis (CRUS) is a rare musculoskeletal disease with a wide-ranging symptom complex. Attitudes toward surgical treatment of the disease is very diverse, ranging from complete negation to acceptance. When choosing a treatment method, high recurrence and complication rates should be taken into account.

Aims. To analyze the clinical implications of CRUS and to identify optimal treatment options.

Materials and methods. From 2008 to 2015, 54 patients (31 boys and 23 girls; aged 1–14 years) with CRUS were examined and treated. Presenting complaints and the possible factors leading to disease development were investigated; orthopedic examination, roentgenography, electromyography, and computed tomography were performed. The treatment approach was determined on the basis of the clinicoroentgenological presentation.

Results. All cases of CRUS were sporadic. In 43.7% patients, risk factors resulting in disease development were detected. Unilateral lesions were observed in 30 patients, whereas bilateral lesions were observed in 24 patients. According to the Cleary and Omer classification, the first type is the rarest; it is distinguished by the absence of bony fusion and close to average forearm positioning. In such cases, operative treatment is not necessary. For the second and third types, pronounced pronation forearm realignment requiring corrective derotational osteotomy of the radial bone is the main factor. For the fourth type, the main functional disorder is the restriction of the forearm flexion; treatment for this type involves resection of the radius head. We attempted to divide the synostosis 
(to achieve active movements) in five patients; however, we were unsuccessful. In three patients, synostosis recurrence occurred; and in two patients, active movements were not obtained after surgery. In four patients, radial nerve neuropathy was detected in the postoperative period after conservative therapy. In two patients, ulnar fractures occurred as a result of a fall; in one of these patients, fragment apposition was required.

Conclusions. Clinicoroentgenological manifestations of CRUS determine the treatment options. The most typical and important of these manifestations is the pronation positioning of the forearm. In such cases, it is reasonable to start operative CRUS treatment after 3 years. All variants of deformation are indicators for operation, and treatment options are determined by the degree of severity of the deformation. Attempts to form the forearm bone neoarthrosis in order to get rotational movements is not effective and can result in deformation recurrence.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):16-25
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Anterior cruciate ligament reconstruction in children with open growth plates
Sadykov R.S., Bogatov V.B., Norkin A.I.

Abstract

Introduction. Anterior cruciate ligament (ACL) tears are observed in 10%–32% of all traumatic lesions of the knee joint in children. Open growth plates are a serious problem in the treatment of ACL tears. Most modern methods of ACL reconstruction use transepiphyseal channels, which go through the growth plates. This may lead to angle deformity of the knee development, limb shortening and early arthritis.

Material and methods. We observed 12 patients (11–17 years old; mean age, 13.2 years) with ACL tears with opened growth plates, who were operated on between 2006 and 2010. ACL reconstruction was performed arthroscopically using the BTB-technique and synthetic grafts DONA-M.

Results. In all cases, we achieved poor results, especially when the operation was done by BTB. We avoided shortening of the leg, but arthritis was common and progressed quickly. When we tried stabilize the joint, we achieved the reverse effect – pain in the knee, with a decreased quality of life.

Conclusion. Our results demonstrate that ACL reconstruction in children with opened growth pates is not effective; we suggest performing the procedure after the growth has finished.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):26-31
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Evaluation of remote results of treatment of children with long-bone fractures of the lower extremities
Patlatov A.A., Garkavenko Y.E.

Abstract

Background. Evaluation of the effectiveness of treatment of long-bone fractures of the lower extremities should be comprehensive and include both subjective and objective indicators. In the developed countires, it is standard to assess the quality of life related to children’s health after trauma. According to the Russian literature, such assessment has not been studied. The aim of our study was to assess the quality of life in children, with long-bone fractures of the lower extremities, and to compare the results with data from the Lower Extremity Functional Scale (LEFS) and assessment system according to N.B. Duysenov.

Materials and methods. We examined 70 patients (age range, 8–18 years) with long-bone fractures of the lower extremities. Forty patients had a history of tibia fracture, and 30 patients had a history of femoral fracture. We determined the severity of the fractures using pediatric comprehensive classification of long-bone fractures (PCCF). We assessed the quality of life of the children using the Pediatric Questionnaire for Quality of Life 
(PedsQLTM 4.0).

Results. Trauma had a significant impact on the quality of life in children. The children evaluated their quality of life after injury more objectively; on all scales, their scores had the highest correlation with LEFS and assessment system according to N.B Duysenov. In most cases, parents underestimated the mental and physical burden of their child’s condition after injury. The values for the “physical functioning” assessment in children with severe trauma was the lowest, and was not significantly different between parents and children. Parents who were aware of the severity of the injury gave their child more attention, which positively affected the child’s psychological and social functioning. Children with severe trauma had higher values on the emotional, social and role functioning scale, compared to children with minor 
injuries.

Conclusions. The results of all functional scales in the quality of life assessment, as assessed by the children themselves at different times after injury, had the highest correlation with LEFS and assessment system according to N.B. Duysenov. LEFS is the most informative for examining the consequences of fractures of different severity. There were no significant differences among the children with fractures of varying severity using the assessment system according to N.B. Duysenov.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):32-40
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Emotional characteristics of mothers bringing up children with arthrogryposis
Pyatakova G.V., Agranovich O.E.

Abstract

Introduction. Arthrogryposis is a congenital disease that can cause feelings of deprivation in parents of affected children. Mothers of children with the disease may experience emotional trauma, manifested as post-traumatic stress disorder (PTSD) (a term coined by N.V. Tarabrina), anxiety and depressive manifestations. Mothers with such emotional problems may hinder the effective rehabilitation treatment of their children.

Aims. To examine the emotional characteristics of mothers of children with arthrogryposis.

Material and methods. In this study, the following methods were used: a scale that assesses the level of reactive and personal anxiety (C.D. Spielberg and J.L. Hanina); the Beck Depression Inventory; and the Gorovits Impact of Event Scale-R (N.V. Tarabrina). Case histories were also examined. Data were analyzed using Student's t-test. The study involved 58 mothers with children aged from 1 to 8 years old. Among these, 28 mothers had children suffering from arthrogryposis; the children of the remaining 30 mothers were apparently healthy.

Results. There was no difference in level of personal anxiety between the mothers of children with arthrogryposis and those with healthy children. The mothers of children with arthrogryposis suffered from severe situational anxiety and PTSD (including symptoms of intrusive invasion, avoidance, and hyper-arousal); the mothers of healthy children did not experience such emotional trauma. Mothers with negative emotional states of this kind may hinder the effective rehabilitation of their children with arthrogryposis. In such situations, the participation of a clinical psychologist who can provide the necessary psychological assistance on the basis of individual psychological diagnosis is required.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):41-46
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Trauma in children injured by physical violence
Solovyova K.S., Martynova M.V., Zaletina A.V., Kuptsova O.A.

Abstract

Introduction. In recent years, legislation has changed to include the rights of children injured because of physical violence. Trauma departments of St. Petersburg outpatient clinics admit children with injuries of varying severity after physical violence. The actions of medical institutions are always aimed at protecting the child.

Aims. The aim of the present study was to analyze the cases of children in connection with injuries sustained as a result of physical violence in 2014–2015, and to compare the results with those of previous studies (2007–2008).

Material and methods. In 2014–2015, the trauma department of City Children's Outpatient clinic No 62 treated 268 children, who had suffered from physical violence at home, on the street, or in educational institutions, which accounted for 1.6 per 1000 children living in the district, and 1.2% of all children admitted during 2 years.

Results. Compared to 2007–2008, the number of children who suffered from physical violence decreased by almost two times in 2014–2015; in addition, the severity of injuries slightly decreased but the frequency of hospital admission of victims remained high (38%) in 2007–2008. With regard to the circumstances in which the injury occurred, violence from strangers was lower, but violence among peers was higher.

Conclusions. Positive results have been achieved by a complex of measures, including the implementation of the Federal Law “On Basic Guarantees of the Rights of the Child” to improve the care and safety of children, and an investigation of each case of violence is conducted by local authorities for internal affairs.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):47-51
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Planning for corrective osteotomy of the femoral bone using 3D-modeling. Part I
Baindurashvili A.G., Baskov V.E., Filippova A.V., Bortulev P.I., Barsukov D.B., Pozdnikin I.Y., Voloshin S.Y., Baskaeva T.V., Poznovich M.S.

Abstract

Introduction. In standard planning for corrective hip osteotomy, a surgical intervention scheme is created on a uniplanar paper medium on the basis of X-ray images. However, uniplanar skiagrams are unable to render real spatial configuration of the femoral bone. When combining three-dimensional and uniplanar models of bone, human errors inevitably occur, causing the distortion of preset parameters, which may lead to glaring errors and, as a result, to repeated operations.

Aims. To develop a new three-dimensional method for planning and performing corrective osteotomy of the femoral bone, using visualizing computer technologies.

Materials and methods. A new method of planning for corrective hip osteotomy in children with various hip joint pathologies was developed. We examined the method using 27 patients [aged 5–18 years (32 hip joints)] with congenital and acquired femoral bone deformation. The efficiency of the proposed method was assessed in comparison with uniplanar planning using roentgenograms.

Conclusions. Computerized operation planning using three-dimensional modeling improves treatment results by minimizing the likelihood of human errors and increasing planning and surgical intervention 
accuracy.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):52-58
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Clinical diagnosis of rigid forms of flatfeet in children
Sapogovskiy A.V.

Abstract

Introduction. Tarsal coalition is congenital bony, cartilaginous, or fibrous fusion between tarsal bones. The most specific clinical feature of these patients is limitation of tarsal joints mobility. Foot mobility is evaluated using a few clinical tests-tip-toe test, Jack test, and manual evaluation of passive foot inversion/eversion. However, these tests do not have high rates of sensitivity and specificity, and cannot be used to make differential diagnosis among the different types of coalitions.

Aims. To improve the clinical diagnosis of calcaneonavicular coalitions.

Materials and methods. We present a new clinical test-evaluation of calcaneonavicular segment mobility. To evaluate this test, we studied a group of 100 children (155 feet), which included those with talocalcaneal coalitions (22 patients/30 feet), calcaneonavicular coalitions (28 patients/45 feet), and those without tarsal coalitions (50 patients/80 feet).

Results. The sensitivity of the test was 95.6%, and specificity was 93.3%. This test had good reproducibility, as evidenced by the inter-rater reliability coefficient of 0.818.

Conclusions. The clinical test presented here can be used to identify patients with calcaneonavicular coalitions, which could not be identified using other clinical tests of foot mobility
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):59-62
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Experimental use of wound dressings with the properties of photonic crystals for restoring deep skin defects
Nikityuk I.E., Kubasov V.A., Petrash V.V., Afonichev K.A.

Abstract

The treatment of deep skin lesions is a pressing issue in modern medicine. Using chinchilla rabbits, we examined the effect of multilayer dressings with ordered periodic structure on the regeneration of skin covered with deep skin lesions. On the back of all animals, fascias (size up to 40 × 40 mm) were dissected. In rabbits (from experimental group I), the wound dressing was composed of a plate of fish (carp) scales (multilayer biogenic structure). In rabbits (from experimental group II), the wound dressing was composed of 50 lavsan films metallized by a nanodimensional layer of aluminum. In the control group, wound dressings were composed of a thin plate of Teflon or aluminum (one layer). In all rabbits of the control group, purulonecrotic processes were developed within 1–2 weeks. In all rabbits of the experimental groups, the repair of the wound proceeded without any clinical signs of inflammation during the whole period of observation. In the experimental animals, within 6 weeks, the deep skin lesions had fully healed, and the area of the skin defects had a thickness and structure characteristic of normal skin. The multilayer principle may be promising for the development of dressings for the treatment of deep but small skin wounds of different etiology in cases when high quality dermal regeneration is needed.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):63-70
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Craniocervical instability in children with Down’s syndrome
Khusainov N.O., Vissarionov S.V., Kokushin D.N.

Abstract

Introduction. Pathology of the craniovertebral zone in children with Down’s syndrome is a very important topic, because of the high risk for developing neurological complications in these patients, after even a minor trauma.

Material and methods. We performed a review of the literature highlighting the disorders of the cervical spine in children with Down’s syndrome.

Results. We gathered data on the etiology, pathogenesis, and clinical presentation of craniocervical instability in children with Down’s syndrome. We reviewed the existing surgical treatment options, and presented our own clinical cases. We also developed a protocol for the management of these patients.

Discussions. Understanding the several forms of craniocervical instability in children with Down’s syndrome is very important. As it is a very dangerous condition that can lead to devastating neurological deficits, all medical specialties working with these patients should be aware of them. There are clinical and radiological criteria for this condition that can help in the management of such patients. Surgical treatment is an effective option, but it has a high complication rate and rarely results in neurological improvement.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2016;4(3):71-77
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