Vol 7, No 1 (2019)

Original papers

Vertebrogenic back pain syndrome in children 9–17 years with spinal deformities

Vetrile M.S., Kuleshov A.A., Eskin N.A., Tsykunov M.B., Kokorev A.I., Pyzhevskaya O.P.


Aim. We defined the prevalence of back pain in children and adolescents aged 9–17 years with spinal deformities.

Material and methods. The cross-sectional study included 230 students with different spinal deformities aged 9–17 years. The prevalence of back pain, intensity, location, and situations in which it occurred were assessed via questionnaire.

Results. Among 230 respondents, 186 (80.9%) admitted that they had experienced back pain (mainly in the lumbar spine) at various frequencies within the year preceding the study. Mild pain was prevalent (71% of respondents). Girls experienced back pain significantly more frequently than boys.

Conclusions. Back pain in children and adolescents requires clinical and instrumental examination, including X-ray. Back pain is a frequent phenomenon in children with different spinal deformities. Тhe incidence of pain in children and adolescents with spinal deformities in our study is statistically higher than that of “healthy” individuals of the same age group.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):5-14
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Lengthening of radius in patients with congenital radial club hand, type II

Avdeychik N.V., Golyana S.I., Safonov A.V., Grankin D.Y., Zakharyan E.A.


Background. Congenital radial club hand (CRCH) is characterized by longitudinal underdevelopment of the forearm and hand on the radial surface. Underdevelopment can range from hypoplasia to aplasia of the radius. More than 50 methods to correct the forearm deformities, depending on the degree of radius underdevelopment, have been proposed.

Aim. We evaluated the results of CRCH treatment using microsurgical technique and external fixation.

Methods. We analyzed 16 patients (age, 4.6 ± 0.9 years) with CRCH type II, according to the classification of Bayne and Klug, treated between 1994 and 2017. The patients were divided into two groups: Group 1 were patients undergoing microsurgical autotransplants of the epimetaphyseal second metatarsal bone with growth plate to the position of the radius defect and group 2 were patients treated by lengthening of the radius with external fixation. We analyzed the types of deformities, size of the radius defects, and range of motion in upper limb joints before the stage of the lengthening. External fixation index and number of complications also were determined. The type and number of recurrent deformities and timing of their detection were analyzed.

Results. The observation period ranged from 12 months to 10 years (average, 3.8 years). In group 1, good results were obtained in 62.5% of cases. After transplantation of the metatarsal bone growth plate, the work of the growth plate continued, characterized by increasing radius length in the later observation period. In group 2, good results were obtained in 50% of cases. Clinical and X-ray examinations showed recurrent hand deviation and radius shortening, which required repeated radius lengthening.

Conclusion. Microsurgical transplantation of the second metatarsal bone with growth plate is accepted more in reconstruction of the radial bone in patients with CRCH type II due to creation of a growth zone in the distal part of the radius. Radius lengthening via external fixation is applicable while maintaining the distal epimetaphysis and normal transverse dimensions of the radial bone.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):15-24
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Surgical treatment of children with hip dysplasia complicated with avascular necrosis of the femoral head

Teplenky M.P., Oleinikov E.V., Bunov V.S.


Introduction. Avascular necrosis of the femoral head complicates the surgical treatment of hip dysplasia and aggravates the prognosis.

Aim. We studied the immediate and medium-term results of reconstructive treatment in 18 children with hip dysplasia complicated by avascular femoral head necrosis, which developed after closed repositioning of a congenitally dislocated femur.

Material and methods. Average age at the time of operation was 4.2 ± 0.2 years. The patients were divided into two groups. Group 1 included 12 children with hip subluxation who underwent extra-articular reconstructions on articular components, spinal tunneling of the neck and head, and hardware unloading of the joint and group 2 included six patients with hip dislocation in whom an additional open reduction was performed. Functional results were estimated using D’Aubigne-Postel classification, whereas X-ray results were evaluated using Kruczynski classification.

Results. Duration of observation was 3–7 years (average, 4.2 ± 0.3 years). Functional results were good (15–18 points) in nine joints in group 1, satisfactory (12–14 points) in three joints in group 1 and five in group 2, and unsatisfactory (11 points) in one joint in group 2. X-ray results were good in six joints in group 1, satisfactory in six joints in group 1 and five in group 2, and unsatisfactory in one joint in group 2.

Conclusions. Extra-articular reconstructive and stimulatory interventions combined with hardware decompression helps improve the shape and structure of the femoral head, and formation of congruent articular surfaces in children with subluxation of the thigh complicated by avascular necrosis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):25-34
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Kinematic instrumental analysis of the shoulder and elbow joint in normal conditions and with hypermobility of the joint in the gait cycle

Vorontcova O.I., Udochkina L.A., Baranec M.S., Grechitaeva M.V., Goncharova L.A.


Background. There is evidence for violation or a complete change in the arm swing cycle during walking in a number of pathologic conditions.

Aim. We assess the functional state of the shoulder and elbow joints in normal conditions and with joint hypermobility syndrome (JHS) using the kinematic instrumental method of analyzing gait.

Material and methods. We studied 27 adolescent girls 12–15 years old with JHS and healthy subjects. A Vicon motion capture analysis system (Vicon, Oxford, Great Britain) was used to record biomechanical parameters.

Results. A decrease in limb movement amplitudes was noted in the shoulder joint around the frontal and sagittal axes in patients with JHS compared to the norm. During the arm swing cycle in the normal state, the shoulder is in a state of internal rotation, whereas in the girls with JHS, the shoulder is in a state of external rotation for most of the arm swing cycle. The elbow joint in the JHS subjects showed a significant increase in flexion angle of the forearm in the swing phase of 41.5° ± 0.90° and a decrease in this angle in the stance phase. The JHS group also showed a decrease in power of the muscles acting on the shoulder joint.

Conclusions. A common sign of changes in the range of motion of the links of the upper limb in the shoulder and elbow joints in subjects with JHS was decreased amplitude of their flexion and decreased power of the joints. In the adolescents with JHS in the shoulder joint, a significant decrease in the internal rotation angles and reduction of the limb was found.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):35-42
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Restoration of the support function of the lower limbs in children with coxarthrosis after bilateral total hip arthroplasty (Biomechanical research)

Nikityuk I.E., Kononova E.L., Baskov V.E., Imomov K.D.


Background. Deforming arthrosis of the hip joint in children leads to serious disorders of the walking biomechanics due to a decrease in the support and motor functions of the lower limbs. In patients with stage III coxarthrosis, when the potential of reconstructive surgeries has been exhausted, a total hip arthroplasty is performed.

Objective. To study the biomechanical parameters of support ability of the lower limbs in children with bilateral coxarthrosis before and after bilateral total hip arthroplasty.

Material and methods. Stabilometric and plantographic studies were conducted in 12 patients with bilateral coxarthrosis, aged from 13 to 17 years old, before and after hip arthroplasty. The time interval between operations on the contralateral joints ranged from 6 to 12 months. The control group consisted of 15 children of the same age, with no signs of orthopedic disorders.

Results. Before carrying out hip arthroplasty in patients, the tension of the statokinetic system was revealed during the implementation of support for the vertical balance of the body. The plantography method made it possible to diagnose disorders of the support function of the feet in the form of supination rigidity of the anterior section, a tendency toward rigidity of the internal longitudinal arch. After bilateral total hip arthroplasty in patients, the stability of the vertical posture improved, the support ability of the heads of the 1st metatarsal bones was significantly restored, and the weight-bearing distribution across the foot sections was normalized.

Conclusion. After bilateral hip arthroplasty in patients with coxarthrosis, stabilization of the support function of the postoperative lower limbs was achieved.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):43-50
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Assessment of the trace element blood condition in children with congenital deformities of the thoracic and lumbar spine (Preliminary report)

Lobachevskaya T.V., Talova D.M., Sogoyan M.V., Ovechkina A.V.


Introduction. Since the end of the last century, dysfunction of the trace element composition of blood in various forms of scoliosis has been an urgent problem in several studies. Hidden deficiency of trace elements, associated with insufficient food consumption or low absorption in the body, can cause progressive bone deformities. In this context, special importance is attached to trace elements, such as copper, selenium, zinc, boron, manganese, and others. The study of the trace element concentrations in patients with congenital spinal deformities currently is an important and significant task.

Aim. We assess the trace element composition of whole blood in children with congenital deformities of the thoracic and lumbar vertebral columns.

Materials and methods. We analyzed the trace element status of blood in 108 patients (aged 2–16 years) with congenital deformities of the thoracic and lumbar spine (CSD). The congenital vertebral anomalies included disorders of formation, fusion, and/or segmentation of the vertebrae. The control group consisted of 35 healthy children of identical age. Blood ethylenediaminetetraacetic acid (EDTA) was examined using mass spectrometry with inductively coupled plasma (ICP-MS ThermoScientific, iCAP RQ).

Results and discussion. The content of 33 essential and conditionally essential trace elements in the whole blood of patients with CSD was determined. In 37% of patients the zinc, copper, selenium, and chromium levels were decreased compared with the controls. In 7% and 89% of patients the selenium and of chromium levels, respectively, were especially low, below the sensitivity of the device.

Conclusion. The statistically significantly low content of zinc, copper, selenium, and chromium in the whole blood of patients with CSD may have a role in the pathogenesis of the disorders. Further investigations are needed to evaluate their importance as a marker of disease progression.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):51-56
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Musculoskeletal sequelae of childhood bone sarcoma survivors

Petrichenko A.V., Bukreeva E.A., Romanov P.A., Tiganova O.A., Ivanova N.M., Ochkurenko A.A., Snetkov A.I., Kozhevnikov O.V., Morozov A.K.


Background. Childhood solid tumor survivors are known to be at risk for serious musculoskeletal late effects that may result in disability, associated with multicomponent antitumor treatment.

Aims. To improve the quality of life of childhood bone sarcoma survivors.

Materials and methods. Forty-six children and adolescents (22 males, 24 females) were treated for primary bone sarcomas (follow-up, 22–216 months). Mean age at orthopedic diagnosis was 15.09 years (range, 6–23 years). Treatment consisted of neoadjuvant chemotherapy and radiotherapy of the initial tumor and metastasis left after induction and/or oncologic surgery and adjuvant chemotherapy. We used the NCI Common Terminology Criteria for Adverse Events for reporting.

Results. The most common grade of late effects observed was grade 2 (91 cases). We observed serious adverse events, that is, grade 4 (life-threatening consequences) in five cases and grade 5 (death related to adverse events) in one. A total of 32 orthopedic patients had fewer than six late effects, while 14 had more than six late effects.

Conclusions. The development of musculoskeletal sequelae is unavoidable in the majority of the survivors due to the need to use them in very aggressive treatment strategies leading to a significant increase in survival. Early diagnosis and orthopedic correction of adverse effects are necessary to ensure an acceptable quality of life and good social adaptation of patients.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):57-70
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Criteria of psychological health of adolescents with orthopedic diseases

Pyatakova G.V., Okoneshnikova O.V., Kudryavtseva S.V., Vissarionov S.V., Cerfus D.N.


Introduction. The task of preserving the psychological health of children and adolescents is recognized as most important in the complex conditions of the modern world. Interdisciplinary research addresses the psychological aspects of mental health. For psychological health, understanding the highest level of mental health is an integral characteristic of the well-being of the individual, and the prerequisites for the development of personal maturity. Among the adverse factors in relation to mental and psychological health is what is known as somatic suffering, which occurs in orthopedic diseases. Cognitive, emotional, and behavioral responses to orthopedic disease, eliminating maladaptive manifestations in difficult life situations due to the disease, can be important indicators of psychological health of adolescents.

Aim. We identify specific indicators of psychological health in adolescents with various orthopedic diseases.

Materials and methods. The study involved 90 adolescents: 60 aged 12–17 years with orthopedic diseases (30 with articular juvenile chronic arthritis and 30 with long-term consequences of mechanical trauma of the upper and lower limbs, resulting from an accident due to negligence) and a control group consisting of healthy adolescents of the same age. The characteristics of the self-esteem personality component (satisfaction with various aspects of their own lives) in adolescents with orthopedic diseases and their healthy peers were considered traditional indicators of psychological health. We used Piers–Harris scale modified by V.I. Gordeev Y.S. Aleksandrovich and test of attitude to disease.

Results. In adolescents with various forms of orthopedic disorders, the formation of stable variants of the attitude to the disease with a violation of adaptation of inter- and intrapsychic types is accompanied by the experience of discomfort, difficulties of self-regulation during treatment, and signs of a negative attitude. Formation of stable variants of emotional, cognitive, and behavioral responses without expressed disorders of mental and social adaptation is accompanied by a feeling of comfort and self-satisfaction. The prevailing reaction at harmonic, allopathic, and anosognosic types of mogutt act as a sanogenic effect. Emerging resistant variants of the attitude to the disease with a violation of adaptation of inter- and intrapsychic types can represent risk factors for breach of psychological health in adolescents with orthopedic diseases.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):71-80
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Сase report

Unilateral lytic changes over the weight-bearing joint causing severe destruction of ankle joint (atypical Charcot joint) in a girl with congenital insensitivity to pain without anhidrosis (hereditary sensory and autonomic neuropathy type V): Case report and literature review

Al Kaissi A., Grill F., Ganger R.


Background. The presence of Charcot arthropathies, joint dislocations, infections and fractures in a child without evidence of neurological abnormality should give rise to a suspicion of congenital insensitivity to pain (hereditary sensory and autonomic neuropathy). Hereditary sensory and autonomic neuropathy (HSAN) is a rare syndrome characterized by congenital insensitivity to pain, temperature changes and by autonomic nerve formation disorders. HSAN is classified into five types: sensory radicular neuropathy (HSAN I), congenital sensory neuropathy (HSAN II), familial dysautonomia or Riley Day Syndrome (HSAN III), congenital insensitivity to pain with anhidrosis (HSAN IV) and congenital indifference to pain (HSAN V).

Case presentation. A 13-year old girl first product of a non-consanguineous marriage, presented with malunion of successive fractures or Charcot’s ankle joint destruction on top of significant lytic changes/osteonecrosis. The patient had sustained many painless injuries resulting in fractures with subsequent disfiguremnt of her ankle joint. Arthropathy of the knees, ankles, tarsal bones and feet without pain associated with obvious changes in the shape of the ankle joint were present. Despite a normal sense of touch in our patient the indifference to pain made her extremely susceptible to breakdown of the skin over the ankle osseous prominences.

Conclusion. Generally speaking, the orthopaedic management of such patients is extremely difficult since these patients do not restrict the movements of the involved extremity as they lack the inhibitory pain reflex. Interestingly, our attempts for surgical stabilisation of the ankle joints were succsessfull and eventually the girl became able to walk. It is important to anticipate patient and parent education in joint protection and surveillance for injury as the most important component of the treatment plan for these children. We might postulate that the degree of osteolysis of the ankle joint in our present child might be a form of secondary osteolysis.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):81-86
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Surgical treatment of comminuted intraarticular distal femur fracture in patient with osteogenesis imperfecta type I

Burtsev M.E., Frolov A.V., Logvinov A.N., Ilyin D.O., Korolev A.V.


Aim. Osteogenesis imperfecta (OI) is characterized by bone fragility and long bones deformities. Most studies are dedicated to surgical treatment of diaphyseal fractures. To our knowledge, there are no reports giving recommendations about surgical treatment of distal femur intraarticular fractures.

Clinical case. We describe the surgical treatment of a 14-year-old girl with OI who had intraarticular fracture of the left distal femur and fracture of a right femur diaphysis. Surgical treatment was complicated by migration of a titanium elastic nail and impaired consolidation, which had to be fixed with a plate and led to peri-implant fracture. Results were assessed before trauma and at 1 and 2 years after trauma with Gillette Functional Assessment Questionnaire (GFAQ) and Bleck score.

Discussion. During surgical treatment of comminuted intraarticular distal femur fractures in patients with OI, we had to use big cancellous screw that made implantation in an intramedullary fixator more difficult. Internal fixation with a plate in patients with OI is associated with high risks of peri-implant fracture.

Conclusion. For treatment of comminuted intraarticular fracture of the distal femur, it is necessary to have large variety of internal fixators, follow the principles of absolute and relative stability, and be familiar with minimally-invasive techniques.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(1):87-96
pages 87-96 views

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