Vol 7, No 2 (2019)

Original studies
The influence of triple pelvic osteotomy on the spine-pelvis ratios in children with dysplastic subluxation of the hip
Bortulev P.I., Vissarionov S.V., Baskov V.E., Barsukov D.B., Pozdnikin I.Y., Poznovich M.S.
Abstract

Introduction. Triple pelvic osteotomy is an effective surgical treatment for dysplastic subluxation of the hip in children aged above 12 years. However, modern studies did not assess the indicators of spine-pelvis ratios, sagittal profile of the spine in children with dysplastic subluxation of the hip following surgical treatment, and possibility of change on these values during the operation.

Aim. This study aimed to evaluate the effectiveness of the improved technique of performing triple pelvic osteotomy on children with dysplastic subluxation of the hip.

Materials and methods. We analyzed the x-ray images and surgical treatment of 35 female patients (44 hip joints) aged 13 to 18 years with dysplastic subluxation of the hip between 2016 and 2018. The patients were divided into two groups: the main group consisted of 20 patients (25 hip joints) who underwent surgical treatment that had taken into account the state of sagittal spine-pelvis ratios according to the improved method using personalized navigation templates, and the control group consisted of 15 patients (19 hip joints) who received surgical treatment according to the generally accepted method.

Results. In addition to the typical clinical and radiological abnormalities of the dysplastic subluxation of the hip in 90% of patients in both groups, there were changes in the sagittal balance in the form of excessive pelvic anteversion and lumbar hyperlordosis. One year postoperatively, patients in the main group showed significant changes (p < 0.05) in the state of sagittal spine-pelvis ratios in the form of a decrease in the pelvic base angle, which led to the achievement of the average values of the angle of inclination of the sacral slope (SS) and the value of global lumbar lordosis. On the other hand, these radiological parameters in patients in the control group remained within the preoperative values.

Conclusion. The improved technique of triple pelvic osteotomy provides conditions for the reduction of pelvic anteversion and restoration of the sagittal profile of the spine (p < 0.05). The use of personalized navigation templates allows for the most accurate multiplane correction of the acetabulum. It is necessary to include a specialized x-ray examination in the preoperative planning to assess the state of sagittal spine-pelvis ratios.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):5-16
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Effectiveness evaluation of translingual neurostimulation in motor rehabilitation in children with spastic diplegia
Ignatova T.S., Ikoeva G.A., Kolbin V.E., Sarana A.M., Shcherbak S.G., Volkov V.G., Kalinina L.P., Skoromets A.P., Danilov Y.P.
Abstract

Introduction. Cerebral palsy is one of the most common non-progressive neurological disorders caused by fetal or infant brain injury. Current rehabilitation for children with cerebral palsy involves a series of measures, including physical training, special massage techniques, physiotherapy, treatment by certain positions and postures, use of supporting orthoses and fixation devices for walking, and special orthopedic suits facilitating verticalization and motor activity of a child. Over the last few decades, computerized stimulators and robotics with virtual reality systems have been actively used in neurorehabilitation. However, most of these systems did not show significant efficiency in rehabilitation of children with cerebral palsy. In the last few years, different non-invasive electrostimulation techniques have been considered innovative and can be applied independently or in combination with existing procedures. One of such techniques is translingual neurostimulation.

Aim. This study aimed to evaluate the effectiveness of a combination of translingual neurostimulation and physical rehabilitation for children with cerebral palsy.

Materials and methods. In this study, we observed 134 children (63 girls and 71 boys) with spastic diplegia aged 2–17 years (mean age is 7.8 years old ± 0.3). Depending on the type of rehabilitation therapy, the patients were divided into two groups: active (main) and control. Active group consisted of 94 children who received standard restorative treatment in combination with translingual neurostimulation, whereas the control group consisted of 40 children who received only standard rehabilitation treatment without translingual neurostimulation.

Results. Both groups of patients showed positive dynamics; however, patients in the active group showed greater improvements as evidenced by all grading scales. Improvements were observed in children of all ages, and the results were mostly stable for 12 months.

Conclusion. Translingual neurostimulation is a novel approach to neurorehabilitation that shows promising results, in addition to its proven effectiveness and safety. As a result of neurostimulation, the patient’s brain becomes more susceptible to the applied therapeutic procedures aimed at restoring motor control and formation of new motor skills, thereby markedly increasing the effectiveness of neurorehabilitation. This study broadens the perspectives in the use and further development of translingual neurostimulation in rehabilitation of children with cerebral palsy.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):17-24
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Does the timing of surgery affect outcomes of Gartland type III supracondylar fractures in children?
Shon H., Kim J., Shin H., Kim E., Park S., Park J., Song S., Park J.
Abstract

Background. Gartland type III supracondylar fractures in children are treated as emergency. But there are few studies about surgical timing and clinical outcomes.

Aim. To evaluate whether the time interval from injury to surgical treatment affects the treatment outcomes of Gartland type III supracondylar fractures in children.

Methods. The study population comprised all children presenting to our hospital between April 2003 and December 2013, who had Gartland type III supracondylar humerus fracture. Patients were divided into three groups: those who were treated within less than six hours from injury, those who were treated between six and twelve hours, and those who were treated between twelve and twenty four hours after injury. In this retrospective study, we checked whether the timing of surgery affected clinical outcomes such as bone union, range of motion, peri-operative complications, and operation time.

Results. All patients were treated with closed reduction and percutaneous pin fixation within 24 hours. This study showed a trend that the delay in the timing of surgery after traumatic injury increases operation time, however with no statistical differences. The neurological complications were similar in the three groups. There were 11 cases (14.7%) of preoperative neurologic deficit, however every patient recovered postoperatively. There was no difference between the three groups in terms of clinical outcomes such as range of motion of the elbow and bone union.

Conclusion. For Gartland III pediatric supracondylar humerus fractures, operation can be delayed for up to 24 hours, which may allow time for operation during regular hours, rather than late at night, with thorough evaluation of circulation, nerve injury, and swelling.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):25-32
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Evaluation of the results of functional prosthetics in children with congenital defects of the hand and fingers
Kruglov A.V., Shvedovchenko I.V.
Abstract

Background. Evaluation of the result of functional prosthetics in patients with different upper limb defects is a topical problem of modern prosthetics. Providing patients with non-functional hand stumps with functional prostheses is not wide-scale and refers to atypical and experimental prosthetics. While new functional prosthetic hands appear, there is no algorithm for evaluating the results of prosthetics.

Aim. This study aimed to evaluate the result of functional prosthetics in children with congenital defects of the hand and fingers by active prostheses.

Materials and methods. We observed 67 children with congenital hand defects, of which 22 were included in the experimental prosthetics group. Bench test station was used for an objective assessment of the residual function of the hand. The booth imitated the tasks of an international competition for the users of Cybathlon rehabilitation equipment and allowed users to perform a series of tests, for each of which a certain number of evaluation points were awarded. Samples at the stand were supplemented with a subjective assessment of the function of the hand using the DASH questionnaire validated in Russia.

Results. The best subjective assessment of the supply of an active prosthetic hand was determined in the patients with underdeveloped hand similar to the truncation of the hand proximal to the metacarpophalangeal joints. The lowest functionality score of the active prosthetic hand was obtained in cases of ectrodactyly and hypoplasia of 1–5 fingers, which was associated with a high residual functionality of the hand.

Conclusions. In addition to training functions, the developed bench test station serves a diagnostic function as it evaluates the results of functional prosthetics in patients with upper limb defects in different levels, including defects on the hand and fingers. The results of the study on the station correlate with the results of the DASH questionnaire.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):33-40
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The variability of the flatfoot frequency depending on the diagnostic criteria and the method of statistical analysis
Kenis V.M., Dimitrieva A.J., Sapogovskiy A.V.
Abstract

Background. Flatfoot frequency in children varies from 0.6% to 77.9%. This wide-range data is associated with lack of uniform diagnostic criteria and method of statistical analysis.

Aim. This study aimed to demonstrate the variability in flatfoot frequency in the same population using different indices of footprint and methods of statistical analysis.

Material and methods. This study included 317 school-age children. Children with orthopedic and foot pathology were excluded. The main evaluation methods were clinical examination, computer plantography with footprint index calculation (Staheli index, Chippaux–Smirak index, Clarke’s angle, podometric index, arch height index), and statistical analysis (descriptive statistics methods with Kolmogorov–Smirnov and Shapiro–Wilk criteria, data definition according to the law of normal distribution with standard deviation and quartile assessment).

Results. According to the law of normal distribution (with a double standard deviation), our study demonstrated that the flatfoot frequency using the plantar footprint indices varies from 1.6% to 4.8% in 7–17-year-old children and using the medial footprint indices, from 1.28% to 2.8% in the same age. Quartile assessment method showed a flatfoot frequency of 5.85%–28.33% with plantar foot indices and 5.7%–15.43% with medial footprint indices.

Conclusion. The different plantographic indices and methods of statistical analysis demonstrated that the frequency of a flattened longitudinal arch of the feet in a population may differ significantly. Thus, the frequency of flatfoot determined on the basis of indices calculated on the medial footprint is 1.7–1.8 times lower than that determined on the plantar footprint. In addition, the frequency of flatfoot is 5.5–5.9 times lower than that determined by the quartile assessment.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):41-50
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Effectiveness of achillotomy in children with arthrogryposis
Trofimova S.I., Derevianko D.V., Kochenova E.A., Petrova E.V.
Abstract

Introduction. Ponseti method is a widespread treatment for clubfoot in children with arthrogryposis. Closed subcutaneous achillotomy in these patients could not completely rectify the equinus deformity due to tissue rigidity which often leads to reconsideration of the tenotomy principles.

Aim. This study aimed to formulate the anticipating criteria to assess the effectiveness of achillotomy in order to develop a different achillotomy approach for children with arthrogryposis.

Materials and methods. This study retrospectively analyzed closed subcutaneous achillotomy in 28 patients (56 feet) with arthrogryposis. The mean age of the patients was 5.4 months (range 2–8 months). The children were subdivided into two groups according to the residual equinus deformity after the completion of Ponseti serial casting. All patients were physically and radiographically examined.

Results and discussion. The first group included 12 patients (24 feet), which achieved foot neutral position or dorsiflexion ≥5° after achillotomy. The second group consisted of 16 patients (32 feet) with residual equinus after achillotomy who required surgery. X-ray images showed that the patients in the second group had significantly wider tibiocalcaneal angle and smaller talocalcaneal angle in lateral view (р < 0.01). The correction values of the equinus deformity after achillotomy in the children with arthrogryposis were greatly limited: 27° (20°–30°) and 19° (10°–30°) in the first and second groups, respectively.

Conclusion. Closed subcutaneous achillotomy for effective equinus elimination during clubfoot treatment by Ponseti method should be performed only after complete correction at the level of tarsal joints. X-ray examination of the feet is recommended for the children with arthrogryposis in order to evaluate the talocalcaneal divergence and heel position more comprehensively. Furthermore, the values of tibiocalcaneal and talocalcaneal angles in lateral view prior to achillotomy are essential prognostic factors of its effectiveness. Moreover, the severity of equinus contracture should be considered prior to achillotomy. Achilles tenotomy is inappropriate if equinus deformity exceeds 30°. In such cases, open surgery should be considered.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):51-60
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Abnormal hypersynchronization of body balance control system in children with post-burn foot deformity
Nikityuk I.E., Kononova E.L., Nikitin M.S., Afonichev K.A.
Abstract

Relevance. Treatment of children with post-burn foot deformities is an important task of reconstructive plastic surgery. The scars formed on the back surface of the feet, even with adequate surgical approach, in the acute period of thermal injury, further often lead to deformities of the entire foot, which leads to a derangement of its support function. The importance of the problem lies in the fact that with the growth of the child, secondary abnormal changes develop on the part of the joints of the lower extremities and the spine, leading to impaired locomotor function, including deviations in the body balance control system.

Purpose of the study. To study postural stability in children with post-burn foot deformities before and after surgical treatment.

Material and methods. The stabilometric study was conducted in 12 patients with post-burn cicatricial foot deformity, the average age of the patients was 9.8 ± 0.93 years old. The control group consisted of 12 children of the same age with no signs of orthopedic abnormality. To assess the results, the methods of descriptive statistics with the inclusion of correlation and regression analysis were used.

Results. In patients with post-burn cicatricial deformity of the foot at the pre-treatment stage, a compensatory redistribution of the static load towards the intact lower limb was revealed. Analysis of postural control indicators in patients of the main group showed an abnormal increase in the synchronization of the system of body balance control. After reconstructive operations on the affected foot, symmetry of the distribution of the load and restoration of the support of the limb of the affected side were noted. Correlation analysis revealed a pronounced decrease in abnormal hypersynchronization between stabilometric parameters, which may indicate a trend towards normalization of the postural control strategy in patients after treatment.

Conclusion. Elimination of post-burn foot deformity contributed to the restoration of its anatomical shape and was accompanied by pronounced positive dynamics in the state of the system of vertical balance of the patient’s body.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):61-68
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Exchange of experience
Pes calcaneus deformity in children and methods of surgical correction
Kozhevnikov O.V., Kralina S.E., Gribova I.V., Ivanov A.V.
Abstract

Introduction. Pes calcaneus deformity is a rare pathology in children, which is due to the defect of long flexors of the foot caused by various neurological diseases. The treatment choice is based on the patient’s age, parameters of neuromuscular disorders, and degree of foot deformation.

Aim. This study aimed to analyze the results of operative correction of рes calcaneus deformities in children.

Material and methods. This analysis of surgical treatment involved 13 patients (21 feet) aged 1.5 to 15 years with рes calcaneus deformities. The different approaches and methods of surgical treatment were described. Children up to 12 years old were released joints of the foot with the elimination of deformation and tendon-muscle transposition with the transfer of functionally preserved muscles in the position of fallen muscle antagonists. Children over 12 years old underwent surgery on the bone apparatus of foot: three-articular arthrodesis or corrective osteotomy of the calcaneus, some cases were supplemented with tendon-muscle transpositions.

Results. Treatment results were evaluated based on the radiometric parameters on the system of AOFAS. All treated patients showed improvement in foot stability with reduced deformation; АОFAS at an average of 91.14 points was observed.

Conclusion. A record of all causes and strain components with a graded approach eliminates the pes calcaneus deformity in the long-term, despite persistent violation of neuromuscular conduction.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):69-78
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Clinical cases
Surgical treatment of aggressive hemangiomas of the transitional cervical-thoracic spine in children (сlinical observations, preliminary results)
Zaretskov V.V., Arsenievich V.B., Likhachev S.V., Stepukhovich S.V., Mizyurov S.A.
Abstract

Introduction. Vertebral hemangioma is a common pathology, in which 3.7% cases are aggressive. One of the pathogenetic factors contributing to the growth of vertebral hemangioma is mechanical overload. The transitional parts of the spine are the most loaded. Lesions of the transitional cervical-thoracic spine by hemangioma are rare (2%–4% of all vertebral hemangiomas). A common treatment for aggressive hemangiomas is puncture vertebroplasty. Currently, the number of pediatric patients with vertebral hemangiomas has increased, with an incidence close to 8% for individuals aged below 18 years. Exaggeration of the possibilities of conservative treatment for hemangiomas in children often leads to unsatisfactory results. Clinical research on this problem is relevant due to the lack information about the surgical tactics in aggressive spinal hemangiomas in children.

Clinical observation. Two patients aged 15 and 17 years old with aggressive hemangiomas of the transitional cervical-thoracic spine underwent operation with the use of open-puncture vertebroplasty. There were no postoperative complications, and good preliminary results were obtained.

Discussion. Various approaches in the treatment of aggressive hemangiomas of the transitional cervical-thoracic spine in children, including open-puncture vertebroplasty, were presented and analyzed.

Conclusion. Due to the limited information about surgical treatment for pediatric vertebral hemangiomas, the presented clinical cases of surgical treatment for aggressive hemangiomas of the transitional cervical-thoracic spine may be of interest to a wide audience.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):79-86
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Review
Current approach to diagnosis and treatment of children with osteogenesis imperfecta
Burtsev M.E., Frolov A.V., Logvinov A.N., Ilyin D.O., Korolev A.V.
Abstract

Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. Approximately 85% of OI cases are caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2), which affect the quantity or structure of collagen. The remaining percentage of cases is caused by mutation in the proteins responsible for posttranslational modification, processing and crosslinking of collagen, bone mineralization, and osteoblast differentiation. In the past decade, new recessive, dominant, and X-linked inheritance. As a result, new types of OI were added to the Sillence classification, and a new genetic classification consisting of XVIII types is formed. Treatment of patients with OI is a complex task which requires a multidisciplinary care. Pharmacological treatment is based on bisphosphonate treatment, which increases the bone mineral density. In this article, we will describe other approaches in which the effectiveness is studied. Surgical treatment of the fractures and deformities of the extremities showed a positive effect on the patients’ quality of life, despite existing complications. There are a lot of debates about the choice between telescopic and non-telescopic fixators. Rehabilitation plays huge role in the recovery process after fracture and surgeries.

Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. Approximately 85% of OI cases are caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2), which affect the quantity or structure of collagen. The remaining percentage of cases is caused by mutation in the proteins responsible for posttranslational modification, processing and crosslinking of collagen, bone mineralization, and osteoblast differentiation. In the past decade, new recessive, dominant, and X-linked inheritance. As a result, new types of OI were added to the Sillence classification, and a new genetic classification consisting of XVIII types is formed. Treatment of patients with OI is a complex task which requires a multidisciplinary care. Pharmacological treatment is based on bisphosphonate treatment, which increases the bone mineral density. In this article, we will describe other approaches in which the effectiveness is studied. Surgical treatment of the fractures and deformities of the extremities showed a positive effect on the patients’ quality of life, despite existing complications. There are a lot of debates about the choice between telescopic and non-telescopic fixators. Rehabilitation plays huge role in the recovery process after fracture and surgeries.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):87-102
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Psychological aspects of treatment and rehabilitation of patients with adolescent idiopathic scoliosis: research analysis
Pyatakova G.V., Okoneshnikova O.V., Kozhevnikova A.O., Vissarionov S.V.
Abstract

Idiopathic scoliosis is a common orthopedic disease of unknown etiology in childhood that limits the patient’s activity for a lifetime. Treatment of idiopathic scoliosis includes both conservative and surgical methods and requires psychological consideration, which is important for the rehabilitation of patient with chronic disease.

Systematic research on the psychological aspects of the treatment and rehabilitation of patients with idiopathic scoliosis in the form of analysis allows us to evaluate the medical and psychological approaches to the problem and to identify the factors contributing to the successful adaptation of the patient to chronic disease situation.

Methodology. We selected the articles related to the psychological aspects of scoliosis and its treatment between 2017 and 2018. The primary selection included 16 publications, of which 2 were survey studies. Earlier foreign and domestic publications were also included in the analysis in order to compare the changes in treatment and rehabilitation approaches.

Literature analysis. Idiopathic scoliosis was considered as a risk factor for psychological discomfort in the forms of stress, negative emotions, anxiety, distortion of the image of “I,” reduced self-esteem, and communication problems. These increase the risk of mental disorders, such as depression, suicidal tendencies, and psychological disadaptation.

Discussion. Analysis allows us to highlight the most important topics in the studies of adolescent idiopathic scoliosis in recent years: topic on mental health/ill health in adolescent idiopathic scoliosis (AIS), theme of the psychological component of pain, topic on clinical psychological and social psychological factors that determine the course of the disease of the patients with AIS, quality of life of a child or adolescent with AIS, issues of psychological resources for adaptation to a chronic disease, topic on parents’ perception of their child’s illness, and topic on the psychological accompaniment of patients suffering from AIS.

Conclusions. A modern approach to the study of idiopathic scoliosis suggests a point of view from a biopsychosocial model of the disease; therefore, it is necessary to consider various factors affecting the patient’s quality of life, including the psychological component of the disease. Psychological support of the treatment should focus on the formation of the patient’s active position in relation to his or her own life and active coping strategies with chronic disease.

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(2):103-115
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