Vol 11, No 1 (2023)

BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy.

AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique.

MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 2–4 years (3.1 ± 0.45) with grade II–IV hip dysplasia, according to the supplemented classification of Tönnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neck–shaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO).

RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation.

CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p > 0.05), and reduction of possible secondary deformities.

BACKGROUND: The absence of active elbow flexion is the most common problem in children with amyoplasia, leading to daily living difficulties. Many variants of muscle transfer are used for the restoration of active elbow flexion. The pectoralis major and latissimus dorsi muscles are the most used muscles for this purpose; however, the optimal age for these operations is not reported in the literature.

AIM: This study aimed to determine the optimal age of children with amyoplasia for the restoration of active elbow flexion.

MATERIALS AND METHODS: The retrospective study involved 61 patients (90 upper limbs) with amyoplasia (30 [49%] girls and 31 [51%] boys) who were examined and treated between 2011 and 2020. In 46 (51.1%) cases, we used major muscles, and in 44 (48.9%) cases, the latissimus dorsi muscle was used as a donor muscle. All patients were divided into four groups: group 1 included children aged 1–3 years (n = 17, 27.9%); group 2, 3–7 years (n = 30, 49.2%); group 3, 7–11 years (n = 8, 13.1%), and group 4, 12–18 years (n = 6, 9.8%). The clinical examination of the patients was conducted before and after the operation (≥6 months). Statistical data processing was performed using Statistica 10 and SAS JMP 11. To describe the numerical scales, the average value and standard deviation (M ± SD) were used.

RESULTS: The age of the patients at the time of surgery was 5.16 ± 3.72 years, and the postoperative follow-up period was 41.93 ± 30.13 months. Elbow flexion contractures were observed mainly in groups 1–3 (p < 0.05). The greatest changes in indicators such as the strength of forearm flexor muscles, active elbow flexion, and function of the elbow were noted in group 1 (p < 0.05). The same postoperative indicators were worse in group 4 than in younger patients (p < 0.05). Groups 3 and 4 had less strength of the donor muscles than groups 1 and 2 (p < 0.05).

CONCLUSIONS: The retrospective analysis of the results of the restoration of active elbow flexion in children with amyoplasia allowed us to recommend these operations in children aged 1–3 years. The prevention of elbow flexion contractures and the formation of a new stereotype of movement help improve the self-ability of these patients and the treatment results.

BACKGROUND: To date, there is no consensus regarding the diagnostics of flatfoot in children and approaches to its classification and treatment.

AIM: This study aimed to demonstrate the results of the first Russian consensus, performed according to the Delphi method, for the diagnostics and treatment of flatfoot in children.

MATERIALS AND METHODS: The study was conducted in accordance with the principles of the Delphi survey and the RAND/UCLA and participated by 22 experts in their field. The questionnaire consisted of four main sections, namely, general clinical assessment, flatfoot diagnosis, classification approach, and treatment, including 179 close-ended and 11 open-ended statements in both rounds. A 5-point Likert scale was used to rank responses. The level of agreement was determined as follows: ≥70% of the experts agrees, the statement is accepted; <55%, rejected; 55%–69%, reassessment by experts in subsequent rounds. To assess agreement among experts, parameters such as general agreement, agreement without doubt by experts, and percentage of doubting experts were calculated. Mean (M), standard deviation (SD), and Cronbach’s alpha were calculated.

RESULTS: The statement was accepted with an agreement without doubt by experts ≥ 70%, with Cronbach’s alpha of ≥ 0.8. According to the survey data, in the two rounds using 179 close-ended statements, 96 statements were accepted, 63 were rejected, and no consensus was reached on 20.

CONCLUSIONS: This scientific work presents the results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children with a unique number of experts (n = 22). The lack of agreement on some of the statements, even among experts, showed that consensus was a necessary first step toward standardizing the diagnosis and treatment of flatfoot in children.

BACKGROUND: Diabetes insipidus is characterized by the kidneys’ inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the disease’s clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period.

CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided.

DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the C_VI–C_VII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin.

CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.

BACKGROUNG: A situation in which despite an obvious ulnar fracture, radial head dislocation is not diagnosed, resulting in a missed Monteggia fracture is not uncommon. Unsatisfactory results of the treatment of this pathology have prompted several researchers to search for an optimal treatment strategy.

AIM: This study aimed to conduct a systematic review of literature data on missed Monteggia fractures and dislocations in children by studying the main therapeutic and tactical approaches to this problem.

MATERIALS AND METHODS: A literature search was conducted in the Cochrane Database, Science Direct, Google Scholar, PubMed, and eLibrary information bases, and the search depth was 10 years. Moreover, 46 sources were selected based on the criteria. The main characteristics revealing the problem were identified, divided into four semantic groups, according to which the literature was analyzed: initial data on the condition of patients at the time of seeking medical help, status before and after treatment, and treatment methods.

RESULTS: The average age of the children was 8.4 years. The average interval from injury to the surgical treatment of missed Monteggia fracture was 15.3 months, and 883 clinical cases presented in sources with known treatment techniques were analyzed. Thus, open reduction of the radial head in combination with the restoration or reconstruction of the annular ligament and ulnar osteotomy is one of the most common methods (n = 482, 54.6%). The second most frequent application was the above-described approach, but without manipulations on the annular ligament (n = 273, 30.9%). Bone osteosynthesis and external fixation apparatus were the most widely used stabilization methods in 350 (67.8%) and 149 (28.9%), respectively. The most common complications were associated with the deterioration of the functional status after surgery.

CONCLUSIONS: Accurate diagnosis of injury and early correction of existing disorders is the key to reducing the frequency of missed Monteggia fractures. Surgical treatment is the main method of treating children with this injury, in which the restoration of the ulnar anatomy and the ratios in the brachial and proximal radiocarpal joints are the most important, providing a more physiological development of the segment with the growth of the child.

BACKGROUND: Enthesitis-related arthritis is one of the subtypes of juvenile idiopathic arthritis and is characterized by the involvement of the joints, enthesitis, and axial skeleton (sacroiliitis and spondylitis). The clinical variability of enthesitis-related arthritis and similar manifestations with orthopedic diseases present difficulties in diagnosis.

AIM: To present the clinical features of enthesitis-related arthritis and issues of differential diagnosis based on literature analysis.

MATERIALS AND METHODS: A literature search was conducted in the open electronic databases of eLibrary, PubMed, and Cochrane Library. In total, 46 foreign and 4 Russian publications were analyzed, which were limited to 1981–2021. The keywords used in the literature search were as follows: enthesitis, enthesitis-related arthritis, juvenile spondyloarthritis, and SAPHO syndrome. Own archive data for instrumental investigations were used in the article.

RESULTS: The clinical manifestations can be variable, and laboratory tests do not always allow us to prove the inflammatory nature of the pain syndrome. The most priority diagnostic tests were imaging methods, namely, magnetic resonance imaging and ultrasonography. The greatest diagnostic difficulty was found in patients in whom enthesitis prevailed over arthritis, and in some cases, it was the only disease manifestation. The classification criteria used for the diagnosis of EAA were considered. The differential diagnosis of enthesitis included various orthopedic diseases. Ultrasound diagnostics of joints and enthesis should be performed in every patient with local pain musculoskeletal symptoms, which allows patients to be correctly routed.

CONCLUSIONS: The alertness of both orthopedists in relation to enthesitis-related arthritis and the awareness of rheumatologists of the most common orthopedic diseases that affect the entheses are necessary.