Vol 5, No 1 (2017)


The gene polymorphisms of COL1A1 and VDR in children with scoliosis

Vissarionov S.V., Larionova V.I., Kazarian I.V., Filippova A.N., Kostik M.M., Voitovich A.N., Rotchev E.V.


Background. Identification of the genetic prerequisites for development of spinal deformity.

Aim. The aim of the study was to assess the frequency of distribution of alleles and genotypes for polymorphisms −3731A/G (Cdx2) and +61968T/C (TaqI) of the VDR gene and −1997G/T and +1245G/T (Sp1) of the COL1A1 gene in children with scoliosis of various etiologies and in healthy children.

Materials and methods. Clinical genetic testing was performed in 154 children with congenital scoliosis, 145 children with idiopathic scoliosis, and 278 children without an orthopedic pathology. The molecular genetic testing was performed by PCR.

Results. Genotype tt/GG VDR gene incidence is twice as high in children with congenital scoliosis than in children who do not have scoliosis (11% and 5.2% of cases, respectively; χ² = 4.17; df = 1; p = 0.04).

Conclusion. We have found that children with the allele carriers t(C) and genotype tt(CC) in patients with congenital scoliosis were significantly more likely than children without scoliosis spinal deformity.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):5-12
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Total hip arthroplasty in children who have undergone arthroplasty with demineralized bone-cartilage allocups

Baskov V.E., Neverov V.A., Bortulev P.I., Krasnov A.I., Barsukov D.B., Pozdnikin I.Y., Krasnogorskiy I.N., Bortuleva O.V.


Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA) in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA.

Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA.

Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100%) aged between 15 and 16 years [8 girls (61.5%) and 5 boys (38.5%)]. The medical histories of all 13 children (100%) showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100%) underwent a total hip replacement. Upon hip replacement, all 13 patients (100%) showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%).

Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100%) showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100%) during the period from 6 to 9 months following total hip replacement surgery.

Conclusions. The main feature of the implementation of total hip replacement, following a previous intervention involving arthroplasty with DBCA, was a pronounced deficit of the pelvic bone in the joint component. This significantly complicated the subsequent implantation of the acetabular prosthesis component, and in some cases required the use of a cemented acetabular component. Our experience suggests that patients under 11 years of age who show clinical and radiological signs of coxarthrosis can be treated with arthroplasty with DBCA in order to save the lost function of the hip joint and maintain the function of the periarticular muscles.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):13-20
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Bilateral pathological hip dislocation in children

Garkavenko Y.E.


Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results.

Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78) who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used.

Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19) and open hip reduction with hip arthroplasty with one (6) or two (5) demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8%) children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint.

Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both sides (27 joints). The preservation of up to 80º or more of motion amplitude was noted in 17 (62.9%) of 27 operated hip joints. When assisting patients with pathological hip dislocation, it is necessary to understand that it is practically impossible to restore the affected joint to the anatomical state of the opposite unaffected joint. As for the bilateral lesion, this is most certainly impossible, and the development of arthrosis is inevitable. Therefore, the most important factor reflecting the degree of well-being and stability of the affected joint is the amplitude of active movements. Preserving this amplitude in the affected joints with a careful and attentive attitude is a fundamental and feasible task.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):21-27
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Growth changes of the femur and tibia after fractures in children

Timofeev V.V., Bondarenko A.V., Grigoryeva L.G.


Introduction. In contrast to adults, the reparative process in children with fractures has one essential feature: the consolidation of bones tissue runs parallel to further growth and bone formation.

The aim of the study. To determine the frequency of growth changes of different segments of the lower extremities in children, to determine the association of these types of fractures with age and/or method of treatment; to clarify the indications for orthopedic correction or surgical treatment of these deformities in long-term perspective.

Material and methods. Between 2001 and 2014, 306 children with multiple fractures of the lower limbs were treated in the Regional Clinical Emergency Hospital, Barnaul. Fifty six with femoral and tibial fractures of 306 children were re-evaluated in 3−10 years for the long-term results of treatment.

Results and discussion. In the long-term follow-up period, the measuring of the contralateral lower limb segments (tibia and femur) showed that 27 (44.3%) children had marked differences in their length. Three of them had shortening of limb segment and 24 children had lengthening shortening of limb segment. Changes in the growth rate were observed in fractures of the femur in 22 cases and in fractures of the tibia in 5 cases.

Conclusion. The frequency of limb segment elongation after surgical and conservative treatment was approximately the same.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):28-33
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Errors and complications in surgical treatment of non-stable equino-plano-valgus foot deformity in patients with cerebral palsy, with use of the calcaneus correcting osteotomy technique

Umnov V.V., Umnov D.V.


Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique.

Materials and methods. From 2006 to 2014, 64 patients (103 feet) aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve.

Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed.

Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):34-38
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Free skin grafting in reconstructive surgery of burns in children

Afonichev K.A., Nikitin M.S., Proshchenko Y.N.


When performing reconstructive surgery in children suffering from extensive post-burn hypertrophic scars, the main problem is deficiency of donor intact skin.

Aim. This study aimed to determine the possibility of using the expander skin balloon expansion method for obtaining free, large area split-thickness skin autografts.

Materials and methods. A comparative analysis of treatment for 39 children with extensive post-burn hypertrophic scars was performed. In 16 children (experimental group), balloon skin expansion of a donor site for obtaining large area split-thickness skin grafts (more than 100 cm²) was performed. In 23 children (control group), the large area grafts were cut off without prior balloon skin expansion of the donor site.

Results. In cases where it is necessary to close a wound defect over 100 cm², it is advisable to perform prior balloon skin expansion of the donor site. This technique enables attainment of an injury-resistant free implant full grafting material and also provides multiple uses of a donor site without disturbing the esthetics.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):39-44
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Video-analysis of the effect of different types of adapted shoes on knee adduction moment

Aksenov A.Y., Klishkovskaya T.A.


Background. The effect of different footwear profiles on knee adduction moment have not been fully studied.

Methods. Fifteen healthy volunteer subjects, age 25.3 (±2.73), undertook a series of gait laboratory trials with adapted shoes. Kinematic and kinetic data were collect using 16 Oqus 3+ cameras and the walking speed was controlled using timing gates. High street shoes were adapted to include five different heel heights (varying from a 1.5 cm to 5.5 cm heels), two heel profile conditions (curved and semi-curved heels), three varying apex angles (10, 15, and 20 degrees), and barefoot and 3CR footwear conditions. The baseline shoe had no heel curve, a heel height of 3.5cm, an apex position of 62.5% of the shoe length, an apex angle of 15 deg, and a rigid forepart of the shoe.

Results. The shoe with 5.5 cm heel height significantly increased the mean knee adduction moment during 50%–100% of the stance phase compared to the 1.5 cm heel (p = 0.008). The high heel shoe also significantly increased knee adduction impulse (area under the curve) versus the 1.5, 2.5, and 3.5 cm heels, and the 10° toe angle and barefoot condition. Ten degrees of toe angle reduced mean knee adduction moment during 0%–50% of the stance phase versus 20° and significantly reduced mean knee adduction moment during the late stance phase versus 15° and 20° toe angle footwear conditions. Walking with the curved heel for the healthy subjects increased mean knee adduction moment during 0%–50% of the stance phase compared to the heel without curvature (p < 0.0009).

Conclusion. Further study is required to investigate those changes in patients with high risk of knee osteoarthritis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):45-52
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Arthroscopic treatement of patella fractures in children

Timofeev I.V., Dyakonova E.Y., Gusev A.A., Romanova E.A., Khrolenko P.V.


Introduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2–3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment.

Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14–17). These were 3 males and 1 female. All patients had sport-related injuries.

Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing.

Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective method of surgical treatment for patellar fractures.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):53-57
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GENU RECURVATUM as a late complication of femoral fracture in children

Kuzmin V.P., Tarasov S.O.


Genu recurvatum is an uncommon condition in children. Occasionally, it may occur as a late complication of femoral shaft fracture. There are studies that describe the possibility of genu recurvatum occurrence due to the tibial pin traction and without tibial tuberosity pinning. The primary traumatic reasons are Salter – Harris V-type fractures of the tibial tuberosity and tuberosity avulsion. Our case of genu recurvatum occurrence in an 8-year-old girl with femoral shaft fracture 3 years after trauma confirms the importance of this complication. We believe that the etiology of tibial physeal closure and genu recurvatum after femoral fracture in children is unclear. It seems that identifying one cause for this serious complication in all cases is not possible. However, for complete elimination of iatrogenic factors, we recommend not to put the wire through tibial tuberosity in cases where traction is necessary.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):58-62
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Poland’s syndrome

Agranovich O.E., Komolkin I.A., Dimitrieva A.J.


Poland’s syndrome is a rare congenital condition classically characterized by partial or complete absence of chest muscles on one side of the body and usually webbing of the fingers of the hand on the same side. There may also be rib (aplasia or hypoplasia) and chest bone abnormalities, which may be noticeable due to less fat under the skin. Breast and nipple abnormalities may also occur, and underarm hair is sometimes sparse or abnormally placed. In most cases, the abnormalities in the chest area do not cause health problems or affect movement. Poland’s syndrome most often affects the right side of the body and occurs more frequently in males than in females. The etiology is unknown; however, interruption of the embryonic blood supply to the arteries that lie under the collarbone (subclavian arteries) is the prevailing theory. There are many methods of operative correction because of the polymorphic clinical features of this syndrome. We gathered data on the etiology, pathogenesis, and clinical presentation of Poland’s syndrome and reviewed the existing surgical treatment options.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):63-70
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Scientific events of the Turner Scientific And Research Institute for children’s orthopedics as a form of continuous medical education for pediatric traumatologists

Solovyova K.S., Zaletina A.V., Kuptsova O.A.


The experience of the Turner Scientific and Research Institute for Children's Orthopedics in educational activities for improvement of the professional knowledge of pediatric physicians was represented. The target audience of the continuous medical education include traumatologists, pediatric surgeons, and doctors of related specialties of Russia that are involved in diagnosis, treatment, and rehabilitation of children with injuries, congenital and acquired diseases of the musculoskeletal system. Since 1986, the Institute has organized 28 all-Russian scientific and practical conferences on topical issues of traumatology and orthopedics of pediatric age in 22 different cities across the country. In the interest of the institute, the school of pediatric orthopedists is constantly working for district orthopedists of children's polyclinics of St. Petersburg, and regular monothematic seminars are performed with the participation of leading Russian experts and visiting lecturers from abroad. These scientific and practical activities improve the professional skills of doctors and help them improve the provision of specialized care to children.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(1):71-74
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