Vol 5, No 2 (2017)

Analysis of results of treatment without-of-spine-based implants in patients with multiple congenital anomalies of the spine and thorax
Vissarionov S.V., Husainov N.O., Kokushin D.N.

Aim. Treatment of patients with multiple congenital anomalies of the spine is a complex problem, demanding both correction and stabilization to be performed as early as possible without disturbing the growth of the spinal column. To achieve the latter, different instrumentation, such as rib-based distractors, may be useful. Little is known this treatment of congenital spine deformities. We aimed to investigate the results of treatment in our patients with the use of out-of-spine-based metal implants.

Material and methods. During 2012–2016, there were 44 procedures performed in 20 patients at an age of 2 years to 12 years. In 13 cases, the deformity was located in the thoracic spine and in the thoracolumbar regions in 7 cases. We used bifocal rib-rib connections in 18 procedures, and a rib-spine connection in 26 cases. Results were evaluated based upon the amount of achieved correction after each procedure, amount of stages of treatment, and complication rates.

Results. The mean curve magnitude was 68.7°. The mount of staged procedures varied from 3 to 7. The mean amount of achieved correction was 15.1°. In all cases, deformity was lower than at the beginning of the treatment. The complication rate was 15.9%.

Conclusion. We assume that out-of-spine-based metal implants may be used in treatment of patients with multiple congenital spine and thorax anomalies, as this technique allows effective correction and stabilization of the deformity, as well as increases the volume of the hemithorax.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):5-12
TENS for the surgical management of femoral shaft fractures in 6-14 years age group children
Khanna M., Wadhwani J., Batra A., Yadav S., Iman S., Vashishth S.

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children.

Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures.

Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks).

Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):13-21
Feet injuries in children with tarsal coalitions
Sapogovskiy A.V.

Introduction. Tarsal coalition is a foot bone malformation, characterized by bony, cartilaginous or fibrosis fusion between the tarsal bones. It clinically appears as decreased mobility of the tarsal joints. This feature can be predicting factor for feet injuries.

Aim: This study analyzed the frequency and nature of the injuries of the feet in patients with tarsal coalitions.

Materials and methods. TThe article presents data on the frequency and nature of feet injuries in patients with tarsal coalitions (22 patients (30 feet) with talocalcaneal coalitions and 28 patients (45 feet) with calcaneonavicular coalitions) aged 12 to 18 years. The control group included 50 patients (80 feet) with flatfeet without tarsal coalitions, aged 12 to 15 years. The study was a retrospective analysis of anamnestic data of feet injuries.

Results. The study found patients with tarsal coalitions had a significantly higher incidence of ankle sprains (the general group – 26 patients (52%) versus the control group – 12 (24%).

Conclusion. Tarsal coalition can be predicting factor to feet injuries. Patients with tarsal coalitions should consider this concern for sports activities. They can use different orthoses, tape, or choose not to engage in traumatic sports to avoid ankle sprains.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):22-25
Congenital dislocation of the knee: prenatal diagnostics and treatment at an early age
Rumyantsev N.Y., Kruglov I.Y., Omarov G.G., Voronin D.V., Rumiantceva N.N.

Background. Congenital dislocation of the knee (CDK) is a rare abnormality of the musculoskeletal system, with an incidence of 1 per 100,000 liveborn infants. Timely prenatal diagnostics and treatment during the initial days of life can help avoid the development of disabilities in a child.

Aim of the study. We aimed to study the possible prenatal ultrasound diagnostics and to assess the efficacy of early orthopedic alignment using conservative methods of treatment.

Materials and methods. From January 1988 to February 2016, 37 newborns (50 lower limbs) with CDK were treated. The initial assessment of the affected limbs was performed immediately after birth. To determine the severity of dislocation, the Seringe and Tarek classifications were used. Conservative treatment was performed for all the patients. The age of pediatric patients at the time of treatment onset ranged from 2 hours to 5 days. Various methods were used, such as stage plaster bandages (10 lower limbs) and correction using the von Rosen splint (8 lower limbs). Since 2003, a single treatment protocol, developed by the authors of this study, has been applied.

Results. The prenatal ultrasound screening enabled the detection of CDK before birth in 21% of cases. Long-term results (catamnesis from 3 to 28 years) were evaluated by the Seringe scale and were excellent in 60%, good in 32%, and satisfactory in 8% of cases. Bad results were not registered. All the pediatric patients included in the study began to walk independently at the age of 9–18 months.

Conclusion. Prenatal ultrasound diagnosis enables the detection of CDK. Treatment of newborns, started in the first hours of life, according to the protocol developed by the authors, enables the alignment of the dislocated lower leg in a short time, without using prolonged stage plaster bandages. Long-term results demonstrate the efficiency of the proposed methodology.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):26-35
Comparative analysis of the effectiveness of the incision designs by Bayne and Evans in the correction of congenital radial clubhand in children
Govorov A.V., Avdeychik N.V., Safonov A.V.

Introduction. In 1733, Petit first described the deformation of the forearm, congenital radial clubhand. A large number of modifications in the surgical treatment of this deformation have been developed. In the available literature, there is no comparative analysis of the applied designs of the sections.

Aim. The goal is a comparative analysis of the effectiveness of the use of dorsal rotation flap by Evans, and incision designs by Bayne, in the correction of congenital radial clubhand in children.

Material and methods. Between 2013 and 2016, block randomization of 40 children with congenital radial clubhand was used and grouped by procedures. Surgical correction was performed using two different incision designs (the first group by Bayne and the second by Evans). The analysis of the early postoperative complications was performed. The evaluation in the late postoperative period of soft tissue condition of the forearm using a pinch test, Vancouver scale, and a visual analog scale was carried out.

Results. Based upon gender, patients were divided with male predominance in both groups with 7 girls and 13 boys in the first group, and 8 girls and 12 boys in the second group. In the immediate postoperative period, marginal necrosis was observed in the first group (35%). In the late postoperative period, the study showed an advantage of using dorsal rotation flap by Evans versus the incision designs by Bayne.

Conclusion. Using incision designs by Evans with the formation of a dorsal rotation flap provided a more aesthetic and functional result.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):36-41
Errors of diagnosis and the initiation of conservative treatment in children with congenital hip dislocation
Pozdnikin I.Y., Baskov V.E., Voloshin S.Y., Barsukov D.B., Krasnov A.I., Poznovich M.S., Bortulev P.I., Baskaeva T.V., Bortuleva O.V.

Background. Dysplasia of hip joints and congenital hip dislocation are common impaired developments in newborns. Currently, there are common cases of late detection of the disease, failure in treatment, and development of complications, which is not adequately reflected in the modern literature.

Aim of the study. This study aimed to identify the most common errors during diagnosis and treatment onset in children with congenital hip dislocation during the first year of life.

Materials and methods. This study is based on a retrospective analysis of the anamnesis history, which is the history of diagnosis and previous treatment, as well as on clinical, sonographic, radiation, and magnetic resonance examinations of 250 patients aged 5 months to 2 years. The patients were admitted to the specialized Department of Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics with a diagnosis of congenital hip dislocation between 2005 and 2015.

Results and Conclusion. The most common causes of errors during diagnosis of congenital hip dislocation in children are the lack of examination of the newborn by an orthopedist in the maternity hospital and sonographic screening as well as an error in its implementation. At the onset of treatment, the use of structures that did not provide the optimal position for repositioning the femoral head was noted as well as late indications for primary surgical treatment in cases of unreducible hips.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):42-51
Clinical case for the use of intramedullary osteosynthesis in the treatment of pathological fractures of the femur in 6-day newborn girls with a high partial intestinal obstruction
Skryabin E.G., Sorokin M.A., Akselrov M.A., Emelyanova V.A., Naumov S.V., Bukseev A.N., Chuprov A.Y.

Abstract. Skeletal bone fractures in newborns present a problem of modern traumatology.

Aim. The goal is to present the use of the method of intramedullary osteosynthesis in the treatment of a pathological fracture of the right femur in a newborn girl to a wide audience of pediatric orthopedic traumatologists.

Material and methods. We have experience in the treatment of a 6-day-old girl, who was born with intrauterine growth retardation and bowel disease. On the second day of stay in the intensive care unit, she had a pathological fracture of the right femur. Diagnosis of the pathological fracture was established based upon the results of clinical examination and radiography of the injured limb segment.

Results. Immediately after the diagnosis, the right lower limb of the child was fixed with a plaster bandage. On the control radiographs, the standing of the bone fragments were unsatisfactory, and a decision was made to use the intramedullary osteosynthesis method with a knitting needle on the 6th day after birth of the child. The need for surgical treatment of a fracture of the femur was due to a congenital abnormality of the intestine in the child, and a need to perform surgery on the abdominal organs.

Discussion. Spontaneous fracture of the right femur occurred in the child in treatment in the intensive care unit. The cause of the fracture was osteopenic syndrome, which developed as a result of vitamin D deficiency. During the first 12 days of her life, the newborn had two laparoscopic operations to address the intestinal pathology.

Four weeks after the operation using osteosynthesis, the metal from the bone marrow channel of the right femur was removed. After the removal of the needle, the correct axis of the operated segment was fixed to the same length of the lower extremities. The patient had absence of pathological mobility in the fracture region, and full amplitude of movements in the knee and hip joints.

Conclusion. When receiving fractures of the femur, both traditionally used conservative methods of treatment, as well as surgical methods can be used on newborn children. This is especially true, when a newborn has an accompanying congenital pathology of the internal organs requiring immediate treatment.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):52-58
Methods of diagnosis of acute epiphyseal osteomyelitis in children
Labuzov D.S., Salopenkova A.B., Proshchenko Y.N.

Summary. The article presents the analysis of different method for diagnosis of epiphyseal osteomyelitis, including radiography, ultrasonography, computed tomography, magnetic resonance tomography, and radioisotope bone scans. We address the advantages, disadvantages, and possibilities of each method from the standpoint of early diagnosis of osteomyelitis in children.

Based upon the literature, the most effective and reliable methods for early diagnosis of epiphyseal osteomyelitis in pediatric patients are magnetic resonance and ultrasound. The present diagnostic methods involve no radiation exposure. Using an ultrasonic diagnostic method does not require complete immobility of the patient, can be used from the moment of birth, has widespread availability, and has a relative low cost to allow its use in any medical institution.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):59-64
Solitary bone cysts in children
Pozdeev A.P., Belousova E.A.

Summary. Solitary bone cyst (SBC) is one of the most common childhood pathologies of the skeleton. According to different authors, SBC represents 21 % to 57 % of the benign tumors and tumor processes in the bones of children. SBC usually consists of a single chamber cavitary formation filled with a transparent liquid with a straw colored lining of varying thickness, which consists of connective tissue and single giant cells. There is no consensus on the etiopathogenesis of SBC, and the choice of treatment. There are no clear indications for conservative and surgical treatment of SBC. Some authors are inclined to use puncture (minimally invasive) treatments, while others choose more radical surgical methods. Both methods have the same relapse rate at up to 27 %. In this article, we analyzed the published data on the etiology, pathogenesis, diagnosis, and methods of treatment of SBCs in children.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):65-74
Rate and structure of complications in spine surgery
Fadeev E.M., Haydarov V.M., Vissarionov S.V., Linnik S.A., Tkachenko A.N., Usikov V.V., Mansurov D.S., Nur О.F.

The risk of intraoperative and postoperative complications after spinal surgery still remains in the hospital-acquired conditions of any hospital. The methods for performing spinal surgery in children and adults are developing and constantly improving. A significant number of constructions for performing spinal surgery are created by leading manufacturers. The frequency of local and systemic surgical complications has not decreased. Knowing the rate and structure spinal surgery complications can expand the ability to predict and prevent them, which is important for medical science and practice. The presented review of literature addressed the current state of knowledge on spinal surgery complications.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):75-83

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