Vol 3, No 1 (2015)


Surgical treatment of kyphosis in children with scheuermann’s diseaseusing 3D-CT navigation

Vissarionov S.V., Kokushin D.N., Belyanchikov S.M., Murashko V.V.


The purpose of the study is to describe features of the surgical technique for correction of kyphotic deformity of the spine and to analyze the results of surgical treatment of juvenile kyphosis in children with the use of 3D-CT navigation.— Materials and methods. We observed 11 patientsaged 14-17 years old (2 girls and 9 boys) with kyphoticdeformity of the spine, developed on the backgroundof Scheuermann’s disease. The deformity amount aver-aged 73,9° (60 to 90°). Surgery was performed fromthe combined access, carring out discapophysectomyand corporodesis on top of kyphosis and fixing mul-tibasic corrective metal construction. For the insertionof pedicle screws we used 3D-CT navigation.— The results. After surgery kyphosis value decreasedto 32,6° (20 to 45°), the deformity correction averaged41,3° (30 to 50°). Hybrid systems were placed in 5 pa-tients, total transpedicular fixation - in 6 children.Number of fixed vertebrae with hybrid metal construc-tions averaged 14 (13 to 15), in patients with total pediclefixation - 13 (12 to 14). In all cases we observed the correct position of pedicle support elements. Postopera- tive follow-up period was from 1 year and 5 months to5 years and 4 months, on average - 3 years 5 months. The loss of the result achieved in the long-term follow- up period was observed in patients with hybrid metal constructions and averaged 7,2° (4 to 9°).— Conclusion. The use of pedicle screws for thecorrection of juvenile kyphosis in children allows forthe effective correction of the deformity, restoring thephysiological profiles of the spine, eliminating post-operative progression of curvature, and reducing thelength of metal fixation and save the result achievedin the long-term follow-up. The use of active optical3D-CT navigation allows carring out a correct inser-tion of pedicle screws in the vertebral bodies in chil-dren with juvenile kyphosis.— Keywords: Scheuermann’s disease, juvenile ky-phosis, transpedicular fixation, navigation, children,surgical treatment.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):5-14
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Restoration of active forearm flexion in children with arthrogryposis:results of transfer of long head of triceps

Trofimova S.I., Agranovich O.E.


The purpose of this study was to analyze resultsof the long head of triceps transfer for active elbowflexion restoration in children with arthrogryposis.— Materials and Methods. 29 patients with lack of active elbow flexion aged from 10 months to 15 years were examined and treated in Turner Scientific and Research Institute for Children’s Orthopedics from2008 to 2014. The relation between potential donormuscle condition and the level of segmental spinalcord lesions was determined on the basis of clinical,neurological, physiological and ultrasound examina-tions. 35 transpositions of long head of the triceps in29 children were performed (17 - with mobilizationand 18 - without mobilization of the elbow).— Results and Conclusion. Analysis of long-termresults of long head of triceps transposition as a ped-icle flap in patients with arthrogryposis has shown theeffectiveness of restoration of active forearm flexion.Good results were noted in 35 %, satisfactory in 35 %and pure in 30 % of cases in the series.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):15-21
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Selective dorsal rhizotomy opportunities with foot deformitiesin children with cerebral palsy

Kenis V.M., Ivanov S.V., Kiseleva T.I.


Foot deformities are the most common orthopedic condition in children with cerebral palsy. The aim of the study was to evaluate the influence of selective dorsal rhizotomy (SDR) on foot deformities in children with cerebral palsy. The results were assessed clinically by measurement of changes in muscle spaticity and foot posture. Percentage of resection of dorsal rootlets was from 40 to 90 % of total thickness. The degree of tone reduction had a tendency to be more pronounced in the more proximal muscles and was minimal in calf muscles. Nevertheless, foot posture improved more significantly. That can be explained by generalimprovement of pathological posture at the level of more proximal joints. Thus, SDR has insignificant direct effect on spastic foot deformity and can not be recommended as a basic method of treatment even in pure spasticity. However, SDR should be considered as a part of multidisciplinary management protocol if foot deformity reflects more complex postural disturbance due to generalized spasticity.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):22-26
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300 neonatal clubfeet evaluated at birth: statistical analysis

Omarov G.G., Rumyantsev N.Y., Kruglov I.Y.


Aim - to study the initial parameters of clubfeetbefore treatment, to analyze clubfoot population.— Materials and methods. The research includes196 neonates with a total of 300 clubfeet. All feetwere initially evaluated during the first day of life.Patients with myelomeningocele, arthrogr yposisand other syndromes were not included. The initialclubfoot severity was evaluated according to Piraniand Dimeglio scales. Patients with Dimeglio I and IItypes of clubfeet were excluded from the study. Thefollowing criteria were analyzed: gender, unilateralor bilateral involvement, family history and prenatalclubfoot visualization.— Results and conclusions. Female/male ratio was1 : 2,16. Unilateral/bilateral clubfoot ratio was 1 : 1,13.Left side/right side ratio in unilateral clubfoot groupwas 1 : 1,79. Family history was positive in 24 of196 patients (12,2 %). Clubfoot was prenatally detected in 98 patients (50 %). Most of clubfeet had Dimeglio III type (88 %) and only 12 % were Dimeglio IV. In bilateral cases the right foot was more severely affected than the left one in 64 % of the patients. 48 clubfeet in 34 patients were evaluated at birth and on 7th day of life provided no treatment was performed. The deformity increased significantly in 100 % of cases. Clubfoot was more often observed among boys. In cases of unilateral clubfoot it is the right foot that is involved more often than the left one. Most patients do not have any family history of clubfoot. The most severe clubfoot type (Dimeglio IV) was found much more rarely than Dimeglio III. The clubfoot severity progressed significantly in all the affected feet during the first week of life.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):27-31
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Follow-up care of children suffered from burns

Afonichev K.A., Filippova O.V.


Outcomes of III-VI AB degree burns in children,regardless of the nature of treatment in the acute andrecovery period, are the development of scar contractures and deformities of the joints. However, thecorrect organization of follow-up care and rehabilitation treatment can significantly reduce the severity and facilitates the full recovery of the affected segment. Based on the analysis of their own material, the author defines the early stage of rehabilitation in these patients before full maturation of scar tissue or before the formation of functionally significant joint contractures, and later period, when there are indications for surgical rehabilitation. In the early period, follow-up care is recommended in 1 month after discharge and then on a quarterly basis, and with the appearance of deformities - at least once in 2 months. At the2nd stage of rehabilitation, older children and children of secondary school age are subject to follow-up care at least 1 time per year of primary school age - atleast once in 6 months, preschool children - every3 months. The proposed assessment of scar tissuehelps to determine the terms of follow-up care. Usingthis scheme of follow-up care and appropriate treatment allowed the author to obtain excellent and goodresults in 87-90 % of cases at the stages of rehabilitaion.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):32-37
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3D Modeling and prototyping of jaw models as a stage of osteoreconstructive surgery on the facial part of the skull of children

Semyonov M.G., Mihailov V.V., Filippova A.V., Stetsenko A.G.


The article presents the results of surgical treatment of children with tumors, with postoperative facial deformities and defects of the skull secondary to tumors, using the technique of 3D modeling followed by prototyping of jaw models.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):38-45
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Possibilities of applying the method of radiofrequency (RF)thermal destruction to correct spasticity in childrenwith cerebral palsy

Zvozil A.V., Umnov V.V., Novikov V.A., Umnov D.V.


For the treatment of focal spasticity in the TurnerInstitute we developed and applied the approach toreduce spasticity in children with cerebral palsy byapplying the method of radiofrequency thermal de-struction of peripheral nerves and muscle motorpoints. This method is based on the effect of heatrelease during the passage through biological tissueof radiofrequency currents. The procedure was totally performed in 112 patients aged 1,2 to 14 yearsold with a level of spasticity over 3 points on a scaleAshworth. In order to reduce hypertonia of femuradductors, the target for RF ablation was obturatornerve; we targeted on the motor point of the gastrocnemius muscle in equinus, to reduce forearm flexorhypertonia we targeted on the musculo-cutaneousnerve, flexor muscles of the hand we intervened on their motor points. A positive result was maintained at follow-up of 6 months to one year in all patients, maximum - 2 years. The obtained results are preliminary and subject to further statistical processing, but they are quite comparable with the results of the use of type A botulinum toxin preparations. The proposed method of treatment is minimally invasive, virtually devoid of the risk of postoperative complications, can cut one stage spasticity in the muscles of various motor segments in children with cerebral palsy of great age range, including children up to 2 years old.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):46-49
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Holographic interferometry for early diagnosisof children flat foot

Bolshakov O.P., Kotov I.R., Polyakova E.L.


The article presents the first experience ofthe use of holographic interferometr y for earlydiagnosis of the flat foot in 4-5 years old children.13 patients were examined. The results of the clinicalexamination, plantography, and of the graphicalreconstruction of the form of the foot arch basedon the interferogramms of the prints on Pedilen areanalyzed. We revealed typical differences betweenthe form of the foot arches in children with flat foot and children with normal status. The use of the proposed method for early detection of congenital pes valgus and of the signs of “flexible flat” foot is being suggested.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):50-56
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Central polydactyly: an alternative method of treatment

Govorov A.V., Golyana S.I., Zavarukhin V.I., Safonov A.V.


Polydactyly is a rare congenital malformationcharacterized by an increase in the number of segments of hand ray. Central polydactyly is much rarerthan other types of polydactyly and is characterizedby a doubling of the segments of the second, thirdand fourth fingers. The main methods of surgicaltreatment of central polydactyly consist in the resection of additional segments and removal of the existing union. Often, the result of this treatment is the development of secondary deformities, leading to unsatisfactory results. The article describes the clinical example of microsurgical reconstruction of the patient’s hand with central polydactyly of both hands and presentation of long-term outcome.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):57-60
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Orthopedic hexapods: history, present and prospects

Vilensky V.A., Pozdeev A.P., Bukharev E.V., Pozdeev A.A., Zubairov T.F., Solomin L.N.


The article is dedicated to computer-assisted external fixation devices, so-called hexapods. The main advantage of these frames is capability to make mathematically precise correction of bone fragments in three planes and six degrees of freedom on the base of calculations made in special software application. Recently these devices are mostly applied in long bone deformity correction but the sphere of its effective useis not limited by only this direction. The article presents the history of investigation of these devices, their development, implemented comparative analysis of the basic hexapods: TSF (Taylor Spatial Frame), IHA (Ilizarov Hexapod Apparatus) and Ortho-SUV Frame.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):61-69
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Alla Vladimirovna Ovechkina

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Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):70-71
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Conclusion on the 2nd International symposium onartrogryposis

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Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):72-73
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North-western forum of pediatric anesthesiologistsand intensivists

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Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(1):74-75
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