Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

Background. Treatment of severe spinal deformity remains a challenging surgical problem, with an iatrogenic injury to the spinal cord being a critical complication. There is a high risk of neurological deficit following surgical correction of a severe spinal deformity.

Aim. To determine the relationship between the extent of disturbed thermal and pain sensations at Th1-S2 dermatomas and the intensity of the spinal cord pathways’ responses to surgical correction of the severe spinal deformity.

Material and methods. We reviewed 58 patients with severe spinal deformities of different etiologies (mean age, 15.7±0.8 years). All patients underwent surgical deformity correction followed by thoracic/thoracolumbar spine fixation by using a variety of internal transpedicular fixations. Intraoperative neurophysiological monitoring (IONM) with transcranial motor-evoked potentials (MEPs) was used during operative interventions. Preoperative and postoperative thermal and pain sensations were assessed in Th1-S2 dermatomas to the right and left by using an electrical aesthesiometer.

Results. The extent of disturbed preoperative and postoperative thermal and pain sensations in Th1-S2 dermatomas before and after correction of spinal deformities correlated with the response type scale (I–V) of the spinal cord pathways to the surgical correction we offered. Correlation between the response type and characteristics of thermal and pain sensations was mostly revealed by the test results for the thermal pain threshold (thermal analgesia). The incidence of postoperative thermal analgesia increased monotonically from patients with response type I (persistent MEP form and amplitude-time parameters close to the baseline) to patients with response type V (higher risk of neurological complications). The overall rate of thermal analgesia increased after surgical correction of the spinal deformity relative to the baseline and was higher (≤8%) in patients with response type V.

Conclusions. Surgeons and neurophysiologists who perform IONM should give careful attention to patients with severe spinal deformity who exhibit marked postoperative thermal analgesia.

Background. Birth head trauma causing intracranial injury is one of the most common causes of neonatal mortality and morbidity. In case of suspected cranial fractures and intracranial hematomas, diagnostic methods involving radiation, such as x-ray radiography and computed tomography, are recommended. Recently, an increasing number of studies have highlighted the risk of cancer complications associated with computed tomography in infants. Therefore, diagnostic methods that reduce radiation exposure in neonates are important. One such method is ultrasonography (US).

Aim. We evaluated US as a non-ionizing radiation method for diagnosis of cranial bone fractures and epidural hematomas in newborns with cephalohematomas or other birth head traumas.

Material and methods. The study group included 449 newborns with the most common variant of birth head trauma: cephalohematomas. All newborns underwent transcranial-transfontanelle US for detection of intracranial changes and cranial US for visualization of bone structure in the cephalohematoma region. Children with ultrasonic signs of cranial fractures and epidural hematomas were further examined at a children’s hospital by x-ray radiography and/or computed tomography.

Results and discussion. We found that cranial US for diagnosis of cranial fractures and transcranial-transfontanelle US for diagnosis of epidural hematomas in newborns were highly effective. In newborns with parietal cephalohematomas (444 children), 17 (3.8%) had US signs of linear fracture of the parietal bone, and 5 (1.1%) had signs of ipsilateral epidural hematoma. Epidural hematomas were visualized only when US was performed through the temporal bone and not by using the transfontanelle approach. Sixteen cases of linear fractures and all epidural hematomas were confirmed by computed tomography.

Conclusion. The use of US diagnostic methods reduced radiation exposure in newborns with birth head trauma. US methods (transcranial-transfontanelle and cranial) can be used in screening for diagnosis and personalized monitoring of changes in birth head trauma as well as to reduce radiation exposure.

Aim. To retrospectively analyze the results of two treatment methods for lower leg deformities associated with partial growth arrest.

Materials and methods. Group I comprised 15 children who underwent osteotomy, acute overcorrection, and external fixation by Ilizarov with subsequent lengthening of the segment. Group II comprised 13 patients who underwent epiphysiodesis of the healthy part of the growth plate by drilling, osteotomy with external fixation by use of an Ortho-SUV Frame, and subsequent gradual deformity correction and lengthening.

Results. In group I, overcorrection of varus deformities by mechanical axis deviation (MAD) was 18.28 ± 5.25 mm, overcorrection by mechanical medial proximal tibial angle (mMPTA) was 14.86 ± 4.45°, and overcorrection by mechanical lateral distal tibial angle (mLDTA) was 12.85 ± 3.02°. Overcorrection of valgus deformities according to MAD was 15.12 ± 8.28 mm, overcorrection by mMPTA was 10.38 ± 2.77°, and overcorrection by mLDTA was 7.5 ± 3.9°. Recurrence of the deformity was observed in 11 (73%) cases (range, 5–16 months).

In group II, the accuracy of correction (AC) in varus deformities for MAD was 98% and 94% for mMPTA and mLDTA. For valgus deformities, AC for MAD was 90% and 96% for mMPTA and mLDTA. The AC for anatomical proximal posterior tibial angle and anatomical anterior distal tibial angle was 96% for procurvation deformities and that for recurvation deformities was 92%. Deformity recurrence was observed in only one case within 6 months after frame removal. In 2 cases, repeat limb length discrepancy correction surgeries were performed.

Conclusion. Use of epiphysiodesis of the healthy portion of the growth plate in combination with osteotomy, computer-assisted external fixation with subsequent gradual deformity correction, and lengthening in patients with deformities associated with partial physeal arrest significantly decreased the number of deformity recurrences.

Introduction. The modern approach to the treatment of unstable fractures of the thoracolumbar and lumbar spine in children is surgical stabilization at the early stages after trauma by using metal structures that quickly restore vertical functionality to the patient and shorten the period of inpatient treatment. However, the issues related to restorative treatment have not been sufficiently addressed.

Aim. To develop an algorithm for restorative treatment of children at the inpatient stage after surgical treatment of unstable uncomplicated fractures of the thoracolumbar and lumbar spine.

Material and methods. Based on the results of treatment of 73 patients aged 9 to 17 years with unstable uncomplicated vertebral fractures, an algorithm of stage-by-stage rehabilitation by means of therapeutic gymnastics depending on the severity of the injury, method of surgical stabilization of the spine, physical condition of the child, and time passed after the operation was developed.

Results and discussion. The use of differentiated groups of respiratory gymnastics and isometric and dynamic exercises for muscle groups restored vertical functionality to patients in 1–3 days after surgery, restored spine and motor functions, and shortened the duration of inpatient treatment to a range of 10–14 days.

Conclusion. The developed algorithm for physical rehabilitation of children after surgical treatment of unstable injuries of the thoracic and lumbar spine by using metal structures at the inpatient stage contributed to the selection of the most rational and effective program of restorative treatment.

In addition to the physical injury, deep burns of the face also can cause psychological injury. The purpose of this study was to develop new technical methods for improving engraftment of full-thickness autografts. Since 2017, autologous fibroblasts have been used for skin facioplasty of one full thickness autograft in Scientific Research Institue, Reginal Clinical Hospital No 1. Isolation of fibroblasts was performed by using an enzymatic method and a skin sample with an area of 10 cm2. Cultivation of autologous fibroblasts was performed for 22 days according to a standard procedure. The prepared culture of autologous fibroblasts was used together with a full-layer autologous transplant to close the wound on the face. We found that autologous fibroblasts provided faster adaptation of the autograft. There were no signs of fibrous tissue over the long term. We concluded that fibroblasts promoted rapid engraftment and adaptation of the full-thickness autograft. Improvement of facial plastic surgery methods can help achieve maximum cosmetic treatment results.