Vol 5, No 3 (2017)

Articles
Finger reconstruction in children by the transfer of hand segments
Aleksandrov N.M., Petrov S.V., Uglev O.I.
Abstract

Aim. We aimed to evaluate the possibility of reconstruction of amputated fingers using various methods of hand segment transfer in children.

Materials and methods. A retrospective analysis of the reconstruction of the first and triphalangeal fingers of an injured hand using a segment transfer method in 31 children was performed. Eleven patients had a mechanical injury; 12, a gunshot injury; 7, a burn injury; and 1, a freezing injury. The reconstruction of 32 fingers was performed by the transfer of an intact triphalangeal finger (3), defective finger (3), finger stump (14), and a metacarpal (12). The surgery was performed using traditional (16) and original (16) methods. In 26 cases, skin grafting using donor resources from remote areas was required for segment transfer. Newly developed approaches enable the transfer of the defective finger and any stump of the main finger phalanges and metacarpals, irrespective of their location, amputation level, hand defect character, level of cicatrical changes of the soft tissues, and impaired circulation, while adequately preventing ischemic complications.

Results. Survival of all the transferred segments, including those with total cicatrical tissue changes and vascular disruptions, was achieved. The analysis of results showed that handgrip was restored in 31 hands. The best results were achieved in the transfer of intact fingers. Transfer of the utile segments enabled the reconstruction of the double-sided grip with minimum donor retrieval. Two-point discrimination was 2 mm for finger transfer, 4.5 mm for finger stump, and 6.5–7.4 mm for the metacarpal stump.

Conclusion. The transfer of injured hand segments in children for finger reconstruction provides acceptable functional and anatomical results. This method can be used in combination with other finger reconstruction methods. Advanced technical and tactical approaches have widened the criteria of segment suitability and indications for the use of this method.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):5-16
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Treatment of funnel chest in children
Stalmakhovich V.N., Dudenkov V.V., Dyukov A.A.
Abstract

Background. Funnel chest has a relatively high prevalence in the Russian population. Given the high percentage of the unsatisfactory results of thoracoplasty, further research for the development of new treatment methods is needed.

Aim. To improve the treatment results for funnel chest in children.

Materials and methods. We analyzed the treatment results of 230 children with funnel chest after thoracoplasty. We used 2 surgical techniques: classic thoracoplasty by Nuss (114 children) and its modified version by the authors (116 children). The modified technique included two-sided thoracoscopy, partial resection of the deformed rib cartilages, and endoscopic longitudinal transection of the sternal cortical plate, resulting in subcutaneous emphysema along the sternum.

Results. The comparison of the 2 surgical techniques showed no significant difference in terms of duration and invasiveness of the procedure. Recurrent episodes of funnel chest were observed in children who had undergone thoracoplasty before 7 years of age, regardless of the technique used.

Conclusion. This study revealed that the author’s modified thoracoplasty method was more effective in children > 14 years of age with rigid funnel chest because it allowed the surgeon to decrease the thoracic pressure on the plate and the plate itself on the ribs, facilitating the repositioning of the sternum and preventing the deformation and development of pressure sores on the ribs.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):17-24
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Clinical and morphological characteristics of the vascular bed of hypertrophic scar tissue in different periods of its formation
Filippova O.V., Afonichev K.A., Krasnogorskiy I.N., Vashetko R.V.
Abstract

Background. The state of the microcirculatory bed in the scar tissue is extremely important for determining the most appropriate methods of conservative and surgical treatments. Only few studies have assessed the vascular features of scar tissue.

The objective was to study and analyze the morphological features of the vascular bed of scar tissue and their clinical implications.

Materials and methods. Fifty-four patients with hypertrophic post-burn scars were examined. The study used a clinical method and performed histological analysis of the scars biopsy specimens, including a survey light microscopy, a morphometric assessment of the vascular bed as well as the verification of the collagen fibers of scar tissue with an immunohistochemical (IHC) analysis with specific monoclonal antibodies (AT) (Novocastra, Bond) to Type I and III collagens.

Results. A significant increase in the total area of the vessels of the rumen in the first 6 months of its formation was observed in comparison with intact skin and later maturation of the scar tissue (in % in 1 mm2 of intact skin – 8.50, in the rumen in terms of up to 6 months – 13.10). The average number of vessels in the scar tissue and the total area of their lumen in the maturing rumen from 2 to 5 years decreased in comparison with that in the intact skin. The nodes were detected in the scars by an early appearance of the clinical signs of vascular disorders including blisters and erosions on thickened and hyperemic scar tissues.

Discussion. In the developing hypertrophic rumen, the circulatory conditions gradually deteriorated due to the compression and obliteration of the vessels of the skin with collagen. The enhancement in perfusion recorded using laser Doppler fluorometry may be associated with a significant dilatation of the rumen vessels, rather than because of actual enhanced perfusion.

Conclusions. 1. The increase in the vascular cross sectional area in the early stages of scar formation is attributable to the expansion of their lumen vessels. In the ripened rumen, the number of vessels is 3 times less than that in intact skin. 2. Hyperemia of the hypertrophic scar is caused by a substantial widening of the vessels of the scar tissue, and not by an increase in their number. 3. The use of a hypertrophic scar for the creation of rotational and other flaps is associated with a high risk of trophic complications.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):25-35
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Clinical and ultrasonographic evaluation of the neurological status of children with mild brain injury in acute phase
Povzun A.A., Shchugareva L.M., Iova A.S., Kruchina M.K., Shulgina M.A.
Abstract

Background. The intracranial changes in children with mild traumatic brain injury in acute period are identified by a combination of clinical-neurological and ultrasonographic evaluations of the condition severity.

Aim. The aim of the study was to assess the possibility of performing comprehensive clinical and ultrasonographic evaluations in for determining the severity of the neurological condition of children with mild traumatic brain injury in an acute phase.

Materials and Methods. Clinical and ultrasonographic assessment of the severity of the neurological condition was performed on 256 patients with clinical criteria suggesting mild traumatic brain injury. Ultrasonography was used as the main neuroimaging.

Results. We found that the diagnostic sensitivity of clinical and ultrasonographic examination for detecting traumatic structural intracranial changes in children with mild traumatic brain injury was 90% (95% confidence interval [CI] 0.71–0.98), diagnostic specificity was 97% (95% CI 0.96–0.98), and diagnostic efficiency was 94.9% (95% CI 0.918–0.971).

Conclusions. A comprehensive clinical ultrasonographic approach can be effectively used to assess the severity of the neurological condition of children with mild traumatic brain injury in the acute phase.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):36-42
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Injury rate in the pediatric population of Saint Petersburg
Solovyova K.S., Zaletina A.V.
Abstract

Introduction. The injury rate in children remains an urgent and unresolved problem in the field of medicine. In recent years, the average injury rate in 0- to 17-year-old children is 116–118 injuries per 1000 children of the corresponding population in Russia.

Aim. The study aimed to analyze the injury rates in the children in St. Petersburg in 2016 and to compare them with the injury rates of previous years and those of children in Russia.

Material and methods. Based on state statistics, the indices of injury rate in the children in St. Petersburg in 2016 were evaluated. The disability in children as a result of external actions and the activities of medical and preventive institutions for providing specialized care to children with injuries were also investigated.

Results and discussion. A new form of reporting by Rosstat enabled the clarification of the data with respect to the nature of the injuries and the number of bone fractures in various locations of the body in accordance with the XIX class of the ICD-10, as well as with respect to the morbidity and mortality in children owing to external causes (class XX of the ICD) that include road-traffic accidents and physical abuse.

Conclusions. The rate of injury in children aged 0–14 years decreased when compared with that suggested by the previous year’s data. Further, in adolescents aged 15–17 years, the rate of injury was significantly higher than the average rate in Russia. The disability in children as a result of external actions has decreased. However, the prevention of child injuries in St. Petersburg, especially in adolescents, remains an urgent medical and social problem.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):43-48
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The vertical balance management system is more synchronized in children with cerebral paralysis than in healthy children
Nikityuk I.E., Ikoeva G.A., Kivoenko O.I.
Abstract

Introduction. All forms of infantile cerebral paralysis involve motor function defects. In clinical practice, the stabilometrics method is widely used due to its ability to perform detailed analyses of the mechanisms of disturbance and restoration of postural control in patients with various cerebral lesions.

Aim. The study aimed to analyze the parameters of orthostatic balance in practically healthy children and in children with motor disorders caused by infantile cerebral paralysis of various severities.

Material and methods. We examined 6- to 12-year-old children with mild and severe cerebral paralysis and impaired vertical postural control with a preserved ability to self-balance in the principal posture. Each group examined for comparison comprised 10 patients (children with infantile cerebral paralysis, and impaired vertical postural control) and 10 healthy children in the same age range. The stabilometrics method was used, and the statistical evaluation included correlation and regression analyses.

Results. The results revealed that in comparison with the healthy children, the patient group exhibited a decrease in the vertical postural stability, which manifested as pronounced deviations from the nominal values of the stabilometric parameters. However, a strong correlation between the parameters of S, LFS, and the amplitude A of the pressure center was revealed, which significantly exceeded that of the healthy children, being most pronounced in cases of severe infantile cerebral paralysis. This indicates a more ordered center of pressure trajectory and, consequently, a higher synchronization of the vertical balance management system in children with infantile cerebral paralysis compared with that in healthy children.

Conclusion. The use of correlation and regression analysis to study the vertical balance of patients provides a deeper understanding of the mechanisms used by the postural control system in patients with infantile cerebral paralysis to maintain a complex multilevel structure of the musculoskeletal system in equilibrium in the process of standing still. Increased ordering of the center of pressure trajectory of statokinesiograms of children with infantile cerebral paralysis can be considered as a dynamic indicator of postural control deficiency.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):49-57
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Psyсhologiсal defense mechanisms of children with cerebral palsy in the context of mothers attitude to a child’s disease
Pyatakova G.V., Mamajchuk I.I., Umnov V.V.
Abstract

Introduction. Cerebral palsy (CP) has a significant prevalence in industrialized countries and is characterized by a high level of disability. Children and adolescents with CP face challenging situations. Physical defects repeatedly manifest in the daily life of a child in the form of other extraordinary events such as hospitalization, surgery, prolonged immobilization, and separation from family. Such events can be accompanied by feelings of fear, anxiety, helplessness, and pronounced symptoms of maladjustment. Under these conditions, certain biological and social compensatory manifestations help to identify such complicated conditions and restore the normal functioning of the body. Compensatory manifestations are a type of compensatory defense mechanisms. The major role in establishing a system of protection is played by the relationship between a child and his or her parents. Defense mechanisms can be formed during the process of assimilation of protective parental behavior, or because of the inappropriate attitude of mothers to the child’s illness. The purpose of the research was to study the defense mechanisms in children with CP in the context of mothers’ relationship to her child’s illness.

Materials and methods. The research involved 120 people. The experimental group included 30 children with CP aged 5 to 11 years and their mothers. The control group consisted of relatively healthy children (30) and their mothers. The following was used to achieve the goal: the elements of clinical and biographical method, projective technique, the technique of diagnostics of attitude to the child’s illness.

Results and discussion. The repertoire of psychological defense mechanisms in children with CP is limited in comparison with those in healthy children. Children with CP are dominated by the defense mechanism of “denial” that can play a negative role in the process of adaptation of these children in a situation involving complex treatments. The mothers of children with CP share an emotionally intense relationship with their child’s disease. Excessively disturbing attitudes of the mother to the disease of her child can contribute to the formation of negative psychological defense mechanisms of negation type in the child, which reduces the child’s psychological compensatory capacity and capability of adaptation in conditions of complex treatment.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):58-65
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Disabled child and the society: Relationships and socialization
Khubulava G.G.
Abstract

Background. The problem of pediatric disability remains one of the most acute social challenges. Along with the question of the social status of a disabled person and the ambivalence of the term “disabled person” itself, whom the modern society prefers to refer to as “a person with limited abilities,” there is the unresolved issue pertaining to the method of socialization of disabled children.

Aim. We aimed to analyze the relationships of a disabled person and the society in the context of cultural history and consider the problem of the socialization of disabled children and the methods used for this form of socialization.

Method. The study involved the analysis of the relationships between disabled children and the society as well as the methods and ways of social and psychological rehabilitation of such children, undertaken in terms of philosophical anthropology.

Results and discussion. The purpose of encouraging the socialization of a disabled child in his family that actively interacts with a team of doctors is not only to teach him/her to adapt to societal conditions and be useful to the society but also to help him/her to integrate effectively in the society as a person who is aware of himself/herself, is equal to other members of the society, and is conscious of his/her dignity and undoubted value.

Conclusion. The family and the immediate environment of the child, apart the medical community, play an active role in his/her social and psychological rehabilitation. The success of rehabilitation depends largely on their interactions. Irrespective of the rehabilitation method we use, including gaming methods, para athletics, and the practice of integrated schools or home education, we must remember that we are working with an individual with his/her own personality, talents, problems, and needs.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):66-73
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Planning corrective osteotomy of the femoral bone using three-dimensional modeling. Part II
Baskov V.E., Baindurashvili A.G., Filippova A.V., Barsukov D.B., Krasnov A.I., Pozdnikin I.Y., Bortulev P.I.
Abstract

Introduction. Three-dimensional (3D) modeling and prototyping are increasingly being used in various branches of surgery for planning and performing surgical interventions. In orthopedics, this technology was first used in 1990 for performing knee-joint surgery. This was followed by the development of protocols for creating and applying individual patterns for navigation in the surgical interventions for various bones.

Aim. The study aimed to develop a new 3D method for planning and performing corrective osteotomy of the femoral bone using an individual pattern and to identify the advantages of the proposed method in comparison with the standard method of planning and performing surgical intervention.

Materials and methods. A new method for planning and performing corrective osteotomy of the femoral bone in children with various pathologies of the hip joint is presented. The outcomes of planning and performing corrective osteotomy of the femoral bone in 27 patients aged 5 to 18 years (32 hip joints) with congenital and acquired deformity of the femoral bone were analyzed.

Conclusion. The use of computer 3D modeling for planning and implementing corrective interventions on the femoral bone improves the treatment results owing to an almost perfect performance accuracy achieved by the minimization of possible human errors reduction in the surgery duration; and reduction in the radiation exposure for the patient.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):74-79
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Surgical treatment of gross posttraumatic deformations in thoracic spine
Shul’ga A.E., Zaretskov V.V., Korshunova G.A., Smol'kin A.A., Sumin D.Y.
Abstract

Rigid severe post-traumatic thoracic spine deformities result from frequent, recent high-energy trauma in children with an increasing frequency due to a variety of reasons. These types of injuries are commonly followed by spinal cord anatomic injury; therefore, the treatment of these patients warrants special attention from the ethical viewpoint. Generally, the only indication for surgical intervention is spinal dysfunction. Considering this and the patients’ ordinary severe somatic state, surgical trauma should be minimized as much as possible. However, for adequate deformity correction, effective spine stabilization and restoration of liquorodynamics is necessary. Recent studies have reported the successful use of different methods of dorsal interventions (P/VCR) in cases with unstable damages in children. Here, we present the case of a 15-year-old boy who underwent surgical treatment for coarse post-traumatic thoracic spine deformity with chronic fracture-dislocation of Th7 vertebra.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):80-86
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Malignant tumors of the sternum in pediatric patients: report of two cases and literature review
Maletin A.S., Zorin V.I., Gileva V.A., Novitsky T.A., Mushkin A.Y.
Abstract

Destructive changes in the bones are rarely observed in daily practice of pediatric orthopedic surgeons. Clinical and X-ray signs of destructive changes in the bone tissue are characteristic of tumoral, infectious, and inflammatory damages of bones. These signs do not always correspond to a specific disease, and differential diagnostics without histological evaluation is difficult. This is especially true for tumors of the sternum, 85% of which are malignant.

Two rare clinical cases of primary malignant sternal neoplastic lesions in pediatric patients, and a detailed analysis of their clinical, radiologic, and morphologic data are presented. The importance of early histological verification for determining the choice of treatment is demonstrated. A short literature review is also presented.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):87-92
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Scoliosis in patients with arthrogryposis: a literature review
Agranovich O.E., Komolkin I.A.
Abstract

The reported incidence of scoliosis in patients with arthrogryposis varies greatly between 2,5% and 69%. Curves can progress quickly. The most typical localizations of scoliosis are the thoracic and the thoracolumbar parts of the spine. In some cases, thoracolumbar scoliosis is combined with contractures in the hip and pelvis oblique. Scoliosis in children with arthrogryposis, as opposed to limb abnormalities, is generally rarely diagnosed at birth. The diagnosis is often established at the age of 5 years and can be explained by a period of rapid spine growth. The poor prognostic signs that determine the rapid development of scoliosis include progression at an early age, paralytic deformity, and pelvis oblique. Treatment options include spine casting, bracing, expandable implant surgery, and spinal fusion. The treatment goal is to allow optimal growth and development of the chest and a well-balanced spine. This article analyzes the modern approach to treatment scoliosis in patients with arthrogryposis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(3):93-98
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