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Vol 9, No 1 (2021)

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Original studies

Trauma rates in children in the period of restrictive measures related to the spread of the new coronavirus infection (COVID-19)

Kuptsova O.A., Zaletina A.V., Vissarionov S.V., Baindurashvili A.G., Mikava A.G., Alexandrov S.V.

Abstract

BACKGROUND: Due to the spread of the novel coronavirus infection (COVID-19) and the introduction of restrictive measures to prevent its spread, there has been a change in the organization and work of medical institutions. New rules for admitting patients with injuries, limiting hospitalization of planned patients, examining patients for coronavirus infection, examining parents of children with injuries, conducting remote consultations, and identifying areas without COVID-19 for repeated outpatient care have been introduced in trauma centers and hospitals. New conditions for the organization and functioning of outpatient and inpatient departments have had an impact on the picture of child trauma.

AIM: This study aims to conduct a comparative analysis of the level and nature of musculoskeletal injuries in children who sought medical care during the COVID-19 pandemic and injuries that occurred during the same period of the previous year.

MATERIALS AND METHODS: The analysis of the medical history data of 3820 patients aged 0 to 17 years, who were admitted to the City Center for Outpatient Surgery and Trauma of St. Petersburg St. Mary Magdalene Children’s City Hospital No. 2 during the period from March 16, 2020, to May 31, 2020, and for the same period in 2019.

RESULTS: The number of initial visits with trauma in 2019 was 2851 patients, whereas during the same period in 2020, 969 patients came with trauma. In general, during the study period in 2020, the trauma rate decreased by 66% compared with the same period in 2019. Despite the general decrease in the level of injuries in the study period in 2020, in the injured structures of the musculoskeletal system, the proportion of limb fractures was 35% and exceeded the same indicator in 2019 (p = 0.004, ÷2 criterion). In 2020, the level of street injuries (p < 0.0001) decreased by 83%, while there was a 61% increase in domestic injuries (p < 0.0001) and a 47% increase in traffic injuries (p < 0.0001).

CONCLUSION: The relationship between the outbreak of a pandemic and a decrease in the number of visits to the trauma center of Children’s Hospital No. 2 was revealed and a change in the structure of injuries depending on their cause. This change may be associated with restrictive measures, the transfer to distance learning, the ban on organized sports events, and the reduced usage of playgrounds. This information can be useful for planning the work of health authorities and distributing resources during future pandemic situations.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):5-16
pages 5-16 views

Evaluation of the role of ventral interventions in the surgery of idiopathic scoliosis in patients with active bone growth

Chernyadjeva M.A., Vasyura A.S., Novikov V.V.

Abstract

BACKGROUND: Today, the question of the tactics of surgical treatment of patients with idiopathic scoliosis during active bone growth, namely, the need for ventral interventions due to the emergence of modern dorsal instruments, remains open.

AIM: This study aims to evaluate the role of ventral interventions in the surgical treatment of patients with progressive idiopathic scoliosis Lenke type 1, 2, 3 during the period of active bone growth.

MATERIALS AND METHODS: The long-term results of operational correction 352 patients with thoracic idiopathic scoliosis aged from 10 to 14 years old operated in Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan from 1998 to 2018 using various methods and different instrumentation types.

RESULTS: Among patients (352 people) aged 10 to 14 years with idiopathic thoracic scoliosis (Lenke type 1, 2, 3), statistically significant postoperative progression was observed in patients who underwent surgical deformity correction using laminar (hook) fixation. At the same time, additional ventral stage conduction could not prevent deformity progression in the postoperative period. In those groups where hybrid fixation was used combined with the ventral stage and total transpedicular fixation, no significant progression was observed in the postoperative period.

CONCLUSION: Modern dorsal systems for transpedicular fixation narrow the indications for using additional mobilizing and stabilizing ventral interventions in the surgical treatment of progressive idiopathic scoliosis in patients with active bone growth. Total transpedicular fixation provides excellent main curve and anti-curvature arch correction in the absence of scoliotic deformity progression in the postoperative long-term follow-up.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):17-28
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Role of ultrasound and electro-diagnostic studies in the diagnosis of carpal tunnel syndrome: A comparative study

Tungoe B.N., Chopra R.K., Agarwal Y., Jaiman A.

Abstract

BACKGROUND: The current gold standard for the diagnosis of Carpal tunnel syndrome (CTS) is a topic of debate. Nerve conduction studies (NCS) traditionally have been used as the confirmatory test; however, ultrasound (USG) has garnered interest as an alternative diagnostic test for CTS. Ultrasound measurement of the cross sectional area of the median nerve at the carpal tunnel has been proposed as an alternative for confirmation of CTS.

AIM: The aim of the study was to compare the sensitivity and specificity between Ultrasound and Electro-diagnostic Studies in the diagnosis of Carpal Tunnel Syndrome with reference to a validated clinical diagnostic tool i.e. CTS- 6; that combines findings from the history and physical examination.

MATERIALS AND METHODS: 40 (20 Cases and 20 controls) adult patients and adolescents of both sexes with complain of pain and paraesthesia in upper limb were included in this cross sectional study. All patients were evaluated using CTS-6 clinical diagnostic tool. Those patients with CTS score≥12 were considered as positive diagnosis for Carpal Tunnel Syndrome (cases) (Main group). Those patients with CTS Score<12 were taken as Controls. Ultrasound and Electro-diagnostic Studies were performed by individuals blinded to the results of the CTS-6 and ultrasound examination.

RESULTS: We found that USG have sensitivity of 90%, specificity of 85%, and positive predictive value of 85.71% and negative predictive value of 89.47%. Whereas NCS have sensitivity of 85%, specificity of 80%, positive predictive value of 80.95% and negative predictive value of 84.21%.

CONCLUSION: Using CTS-6 clinical tool as a standard reference, the sensitivity and specificity of USG is more than that of NCS.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):29-39
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Stage results of the use of orthoses in children after surgical treatment of congenital spine deformity (Preliminary report)

Redchenko I.А., Vissarionov S.V., Gusev M.G., Lein G.A., Pavlov I.V.

Abstract

BACKGROUND: After surgical treatment of congenital spinal deformities, we can see the progression of deformities of the spinal column segments free from metal structures, which leads to the need for reoperation. Without sufficient scientific evidence, several specialists after surgical treatment use various orthoses on the body to prevent scoliotic compensatory changes.

AIM: This study aims to assess the results of body orthosis after surgical treatment of children with congenital spinal deformity with the impaired formation of the vertebrae, using orthoses, compensatory deformity after one year of treatment.

MATERIALS AND METHODS: Twenty-five patients aged 2 to 12 years (10 boys and 15 girls) after surgical treatment of congenital deformity of the spine in the thoracic regions (13) and lumbar regions (12), wearing body orthoses. The results were assessed at 3, 6, and 12 months using thermal sensors for the orthosis wearing time by X-ray and statistical methods.

RESULTS: After three months of wearing the brace, we saw a correction of about 50% of the value of the initial compensatory deformity. After six months, both thoracic and lumbar, the correction was 60%. After one year, when performing an X-ray image without an orthosis, in thoracic deformities without a brace, the correction stabilized and remained at the level of 40%. In lumbar deformities without a brace, the original deformity returned, i.e., the correction occurred but was not fixed without the orthosis. Only one of 25 patients (4%) required a second operation to increase the fixation’s duration.

CONCLUSION: The results of observing a group of patients (25 children) for one year after surgical treatment of congenital spine deformity showed a positive effect of a functionally corrective orthosis on the body to correct secondary deformities.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):41-50
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Influence of orthopedic shoes on the indicators of the interzonal load distribution on the foot when walking patients with cerebral palsy

Smirnova L.M., Koltsov A.A., Dzhomardly E.I.

Abstract

BACKGROUND: Clinical observations of patients with spastic forms of cerebral palsy and surveys showed the most commonly used technical rehabilitative device of this patient contingent are orthopedic shoes. However, almost no clinical and instrumental studies examine the effect of such shoes on the walking characteristics of patients with cerebral palsy (CP).

AIM: This study aims to estimate the effect of orthopedic shoes on the interzonal load distribution on the plantar foot surface in children with CP and adolescents with different levels of gross motor function disorders (GMFCS).

MATERIALS AND METHODS: Biomechanical studies were conducted in 42 patients with CP 5-16 years old with GMFCS 1–3 level while wearing standard and orthopedic shoes. In 14 healthy children controls while wearing standard shoes (a total of 112 feet). Biomechanical examinations were performed on the software and hardware complex “DiaSled-M-Scan” with matrix plantar pressure meters in the form of insoles. Statistical data analysis was performed using nonparametric methods via SPSS software for Windows.

RESULTS: The use of complex orthopedic shoes in patients with level GMFCS 1 did not improve but worsened their foot loading parameters. The shoes reduced the loading of the heel, increased the toe-heel load ratio, and mediolateral load distribution in the fascicle area. In patients with GMFCS 2, the positive effect of orthopedic shoes was limited to improving the mediolateral load distribution in the fascicle area. In patients with GMFCS 3, the positive effect of orthopedic shoes was noted in the majority of the tested parameters.

CONCLUSION: Thus, the study showed that in children and adolescents with CP using complex orthopedic shoes led to the most significant normalization of interzonal load distribution under the foot in GMFCS 3 patients, less significant — in GMFCS 2 patients, and worsened the parameters in GMFCS 1 patients.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):51-61
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Differential diagnosis of bone cysts of long tubular bones of the extremities in children

Shpileuski I.E.

Abstract

BACKGROUND: Bone cysts are characteristic tumor-like bone lesions occurring in childhood. Overall, they represent 21% to 57% of all benign tumors and tumor-like bone lesions in children. Clinical and X-ray symptoms of aneurysmal and simple bone cysts are similar. Like some other, often occurring, benign bone lesions, such as enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects.

AIM: This study aims to identify the main clinical and instrumental characteristics of simple and aneurysmal bone cysts that allow us to differentiate them from some similar destructive bone neoplasms (enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects) and to develop indications for various diagnostic surgical interventions.

MATERIALS AND METHODS: A retrospective analysis of the results of the survey of 206 patients aged 3 to 18 years who were treated at our facility from 2000 to 2015 was performed. The features of the diagnostic tactics and their effectiveness were rated.

RESULTS: The main clinical and instrumental diagnostic criteria have been established. They enable the differentiation of bone cysts from some similar benign bone lesions at the pre-morphological stage. The indications for diagnostic surgical interventions have been formulated.

CONCLUSION: The main difficulties in the differential diagnosis of bone cysts and some similar benign bone lesions have been revealed. An algorithm for applying various diagnostic surgical interventions in patients with these diseases has been proposed.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):63-76
pages 63-76 views

Exchange of experience

Features of free skin grafting to correct post-burn neck deformities in children

Filippova O.V., Afonichev K.A.

Abstract

BACKGROUND: In the literature, various methods of reconstructive plastic surgery for neck cicatricial contractures, from free skin grafting to expander dermotension and microsurgical tissue complex autotransplantation, are widely covered. However, very little attention has been paid to conservative measures aimed at stabilizing surgical treatment results.

AIM: This study aims to evaluate the long-term results of free skin grafting of neck granulating wounds after burns and secondary relapsing scar contracture correction. The study also aims to analyze the causes of poor results and demonstrate the possibility of using free skin grafting to correct neck contractures with basic preventive measures.

MATERIALS AND METHODS: Forty-six patients with neck burn cicatricial sequelae were treated at the clinic of trauma sequelae in H. Turner National Medical Research Center from 2017 to 2019. The patients were divided into two groups: group 1 patients with neck contractures after plasty of granulating wounds with free skin autografts, and group 2 patients with a relapse of neck contracture after corrective reconstructive surgery.

Anamnestic data analysis enabled establishing the actual volume of preventive rehabilitation measures in both patient groups. The classification by N.E. Povstyany (1973) was used to determine the severity of contracture.

RESULTS: The most severe neck contractures, grade III and IV, developed in group 1 patients (grade III — 41.2%). In group 2 patients, there was a limitation of neck extension, corresponding to grades I (33.3%) and II (58.3%).

Conservative preventive measures as immobilization and compression therapy were absent in group 1 in 100% of cases. The most common preventive measure was the prescription of topical anti-scar drugs.

Two-stage skin grafting with full-thickness skin autografts combined with conservative measures made it possible to correct neck contractures of grade I-IV completely and obtain good aesthetic results.

CONCLUSION: The main reason for neck contractures development is the retraction of skin autografts, which inevitably develops in the absence of appropriate preventive measures.

Correction of neck contractures using free skin grafting combined with preventive immobilization using a Schantz collar and a compression half-mask allows obtaining good functional and aesthetic results.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):77-86
pages 77-86 views

Posttraumatic distal radius growth arrest as a cause of the development of distal radioulnar joint instability in children

Proshchenko Y.N., Semenov S.Y.

Abstract

BACKGROUND: The distal radial physis is involved in the injury process in approximately 15% of distal radius fractures. Distal radius physeal arrest and the normal functioning of the distal ulna growth lead to lengthening and dislocation of the head of the ulna in the distal radioulnar joint (DRUJ). These changes, in turn, lead to pain syndrome and forearm dysfunction, which is a manifestation of DRUJ instability.

AIM: This study aims to evaluate the results of a study of pediatric patients with traumatic DRUJ instability.

MATERIALS AND METHODS: An analysis of the results of the examination of 11 children aged from 13 to 17 years with traumatic type DRUJ instability due to the distal radius growth arrest.

RESULTS: According to the X-ray examination data, all children showed closure of the distal growth zone of the radius and ulnar positive variant (ulna +). The shortening of the radius was calculated. Also, the time interval between the injury and the discovery of the wrist joint pathology was estimated. All types of radius fractures with growth plate involvement can cause physeal arrest, leading to a DRUJ instability. The interval from the acute wrist injury with damage to the distal radius growth zone to develop clinical manifestations of a DRUJ instability is 2.4 years on average.

CONCLUSION: The development of this type of traumatic DRUJ instability is typical only in children since changes occur in the presence of an active growth zone and are associated with previous fractures of the distal radius. Therefore, a long-term dispensary observation by a traumatologist-orthopedist is necessary for patients with this pathology.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):87-94
pages 87-94 views

Clinical case report

Oral rehabilitation of a patient with hidrotic ectodermal dysplasia (Clouston syndrome)

Rozov R.A., Trezubov V.N., Gerasimov A.B., Emdin L.M.

Abstract

BACKGROUND: Ectodermal dysplasia is a rare genetic condition affecting the development and homeostasis of two or more ectodermal structures, including hairs, teeth, nails, and some glandular organs. The prevalence is 1.6–21.9 per 100000. The teeth are affected in 79% of cases. Patients with ectodermal dysplasia have a low level of quality of life affected by unemployment, utilization of removable dentures, and a constant dry mouth condition. The main rehabilitation method of the masticatory-phonic elements for the patient with ectodermal dysplasia is conventional removable prosthodontics. The main treatment objective for these patients is to restore the missing elements of the masticatory-phonic apparatus for normalizing mastication, speech, deglutition, and creating optimal aesthetics. This approach can lead to restoring social activity by the increase of a patient’s quality of life. A clinical case report of patient M., 20 years old, is presented in this article. Treatment was completed one year ago.

CLINICAL CASE: The rehabilitation strategy included producing screw-retained full ceramic opposing prostheses supported by six implants in the upper and lower jaws.

DISCUSSION: The choice restoration method of the masticatory-phonic elements for patients with ectodermal dysplasia is prosthodontic treatment with the fabrication of ordinary removable dentures. Early attempts of implant treatment of patients with such conditions led to a low percentage of implant survival. In most works dedicated to treating patients with ectodermal dysplasia, the fabrication of implants supported by a metal resin hybrid prosthesis with acrylic teeth sets is the final rehabilitation. We decided to produce an implant supported by a zirconia ceramic prosthesis with partial layering for patient M. It was feasible because, first of all, his growth was finished, and also this decision gives us the possibility to fabricate a high quality implant supported by a prosthesis enabling optimum function with an unlimited service period. After finishing treatment, 100% of implants and prostheses last one year.

CONCLUSION: It is necessary to engage all available clinic diagnostic, planning, therapeutic, and preventive resources to achieve a high aesthetic and functional result of the dental rehabilitation of patients with ectodermal dysplasia. Implementing implant supported prosthetic rehabilitation of such patients after reaching 17 years of age has to be the treatment of choice that could help achieve stable and reliable results. It might also foster social adaptation that would enable high quality of life.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):95-106
pages 95-106 views

Current aspects of medical care for children with extensive soft tissue injuries (Description of three clinical observations with an analysis of mistakes)

Bogdanov S.B., Blazhenko A.N., Kurinniy S.N., Mukhanov M.L., Boyko A.A., Karakulev A.V., Aladina V.A.

Abstract

BACKGROUND: Injury is an epidemic of the 21st century. It is associated with the increasing high-speed transportation, natural and man-made emergencies, and local wars. All this leads to the appearance of patients with complex, multiple, and not rarely combined injuries. Traumatic skin detachment is the result of high-energy trauma. The treatment of this patient group presents certain difficulties due to the provisional peculiarities of medical care because of the severity of these patients’ condition of such patients and the underlying muscle tissue destruction.

CLINICAL CASES: This paper presents several clinical examples of successfully treated patients with traumatic skin detachments as a part of polytrauma. The timely correction of the improper treatment procedures enabled avoiding unfavorable results.

DISCUSSION: Treatment of victims with traumatic skin detachment who are in a relatively stable state and the absence of destruction of the underlying muscle tissues should be performed using traditional full layer free skin grafting, according to Krasovitov. In contrast, the treatment of victims with traumatic full-thickness skin detachment in an unstable (decompensated) state and the destruction of the underlying muscle tissues, it is necessary to perform it using the technology of staged full layer free skin grafting with the possible use of a biological coating based on chitosan.

CONCLUSION: The presented clinical examples reflect the importance of developing a unified method of treating injuries at all stages of organizing medical assistance to the victim.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):107-114
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Review

Differential diagnosis of flaccid palsy of the upper extremities in children first months after birth (Literature review)

Agranovich O.E., Ikoeva G.A., Gabbasova E.L., Petrova E.V., Kenis V.M., Sapogovskiy A.V., Melchenko E.V.

Abstract

This article analyzes the literature related to flaccid paresis and paralysis of the upper extremities in children during the first months of life. This pathology is a heterogeneous group of diseases with different etiopathogenesis. There are various courses of flaccid paresis and paralysis of the upper extremities in children: damage to the spinal cord, brachial plexus, peripheral nervous system to the level of the brachial plexus, and isolated damage to peripheral nerves. According to the time of occurrence, flaccid paresis and paralysis can be divided into three groups: antenatal, intranatal, and postnatal pathology.

The main mechanism of occurrence of this pathology is intranatal trauma. More rare causes of flaccid paresis and paralysis of the upper extremities are antenatal conditions of dysplastic and traumatic origin, postnatal damage to the peripheral nervous system due to trauma or infection. Congenital contractures of the upper extremities combined with flaccid paralysis are connected with genetically determined diseases of the lower motor neurons and congenital myopathies, intrauterine injuries of the brachial plexus peripheral nerves. This article discusses the issues of topical and differential diagnosis of this pathology, the clinical picture suitable for each period of the child’s life, and the prognosis of the disease. This research will be useful not only for neurologists, but also for specialists of related specialties: orthopedists, physiotherapists, and neonatologists for making correct the diagnosis, providing adequate treatment, and predicting its results.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(1):115-126
pages 115-126 views

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