Vol 3, No 4 (2015)

Articles
Functional state of blood circulation and neuromuscular system of the lower limb of patients with congenital pseudarthrosis of the tibia after consolidation of the nonunion
Pozdeev A.P., Zakharyan E.A., Zubairov T.F., Nikityuk I.E.
Abstract
The aim of this study was to evaluate the clinical and functional state of the neuromuscular system and the blood supply to the lower limbs of children with congenital pseudarthrosis of the tibia (CPT) after consolidation. Material and Methods. A total of 100 patients with CPT were analyzed. We performed a clinical examination of patients, panoramic X-ray of the lower extremities, electroneuromyogram, and reovasography. Results and Conclusions. The primary complaints of patients with CPT after the consolidation of the non-union were lameness, deformations of lower extremities, and pain in the local joints. The electromyoneuromyogram data of the lower limbs of patients with CPT exhibited a decrease of the contractility of the muscles of the lower limbs, and neuropathy of the peroneal nerves of both lower limbs. The reovasography data of the lower limbs of patients with CPT displayed improvement in blood circulation in the lower extremities after the consolidation of the tibia. These data promote the current methods of treatment of patients with CPT; however, the temperature, degree of limb lengthening, and deformity correction should be considered in the future.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):6-11
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Analysis of the influence of various factors on the course of neurological disorders in children with spinal cord injury
Baindurashvili A.G., Solokhina I.Y., Kokushin D.N., Belyanchikov S.M.
Abstract
Background. The study of the influence of various factors on the course of recovery of neurological disorders in children with spinal cord injuries is an important and relevant problem. The main causes of thoracic and lumbar injuries of the spine in children are road accidents and catatraumas. Anatomical and physiological features of the spine and spinal cord in children have a significant influence on the nature of spinal cord injury, clinical manifestations of the injury, and method of treatment. The degree of spinal canal deformity at the level of the damaged segment is directly proportional to the severity of the neurological disorder. The time between injury to when surgery is performed will strongly influence the nature and course of recovery of motor functions. Aim. To assess the influence of different factors in pediatric patients with complicated injuries of the spine at the thoracic and thoracolumbar levels on the recovery of neurological disorders. Materials and methods. The analysis of results of the surgical treatment of 36 children (24 boys and 12 girls) aged 3-17 years with damage to the spine and spinal cord in the thoracic spine and thoracolumbar junction, accompanied with neurological deficit in the form of central or peripheral paresis and paralysis, was performed. All patients underwent surgical intervention depending on the type and extent of damage. Clinical methods (i.e., detailed neurological examination) as well as X-ray, CT, and MRI were used as diagnostic methods. Results. The study revealed that the most severe damage concerning neurological disorders in children with spinal cord injury occurs in the thoracic spine. The extent of neurological changes depends not only on the level of damage to the spinal column but also on the magnitude of spinal canal stenosis. Surgery performed in the first hours of the injury leads to a more rapid and full recovery of the neurological deficit. Conclusion. Therefore, this study found that several factors influence the recovery of neurological disorders in children with spinal cord injury: timing of surgery, localization of the injury, spinal stenosis, the nature of lesions of the spinal cord, and the elements involved.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):12-21
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Large and giant melanocytic nevi of the maxillofacial area in children: features of the morphological structure and surgical treatment
Usoltseva A.S., Stepanova Y.V., Krasnogorskiy I.N., Tsyplakova M.S.
Abstract
Background. Congenital melanocytic nevus is a benign pigmented neoplasm composed of nevus cells that clinically manifest at birth. When choosing a treatment for nevi, the possibility of recurrence as well as the threat of tumor malignancy should be considered. The aim of this work is to justify the surgical removal of a large and giant nevi of the face as a method of treatment justified by the pathomorphological structure. Materials and Methods. In 40 children of different ages born with large and giant nevi of the face, we used various types of plastic surgery to eliminate any defects formed after the excised nevi. We accounted for the features of the maxillofacial area: local plasty, expander dermotension, and transplantation of free skin grafts. We performed a total of 68 surgical interventions. Sixteen patients underwent the surgery once and 24 patients underwent secondary surgery (from 2 to 4). We also developed a scheme of the staged surgical treatments and conservative methods. Results. All patients had stable positive results that were studied by comparing the outcomes of different surgical treatment options and accounting for various morphological characteristics of the removed nevi.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):22-28
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Occurrence of radial club hand in children with different syndromes
Avdeichik N.V., Govorov A.V., Golyana S.I., Safonov A.V.
Abstract
Aim. Clinical analysis of congenital radial club hand as part of some genetic syndromes as well as the optimization of methods of non-surgical and surgical treatment of patients with this pathology. Material and Methods. From 2007 to 2014, we conducted a survey of 170 children with congenital radial club hand. Among them, 32 patients were diagnosed (18.8%) with different syndromes. We assessed the degree to which the radius was underdeveloped among this group of patients as well as the management features of patients according to various comorbidities. Results. The assessment identified Holt-Oram syndrome in 17 children (nine boys and eight girls; 53.1%) and TAR-syndrome in nine children (four boys and five girls; 28.1%). VACTERL syndrome was detected in four male patients (12.5%) and Nagera syndrome was observed in two children (one boy and one girl; 6.25%). Surgical treatment of radial club hand in patients with genetic syndromes is the same as that of the patients with isolated congenital radial club hand: a single- or two-stage correction of the hand relative to the ulna with subsequent reconstruction of the rays of the hand. The duration of treatment of such patients did not significantly differ compared to the patients with isolated congenital radial club hand. Conclusion. Congenital radial club hand, identified as part of genetic syndromes, requires a comprehensive examination to diagnose comorbidities, observation, and treatment by specialists to determine the optimal age for surgical correction of the existing strain of the upper limb.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):29-36
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Surgical correction of joint deformities and hyaline cartilage regeneration
Vinokurov V.A., Norkin I.A.
Abstract
Aim. To determine a method of extra-articular osteochondral fragment formation for the improvement of surgical correction results of joint deformities and optimization of regenerative conditions for hyaline cartilage. Materials and Methods. The method of formation of an articular osteochondral fragment without penetration into the joint cavity was devised experimentally. More than 30 patients with joint deformities underwent the surgery. Results. During the experiments, we postulated that there may potentially be a complete recovery of joint defects because of hyaline cartilage regeneration. By destructing the osteochondral fragment and reforming it extra-articularally, joint defects were recovered in all patients. The results were evaluated as excellent and good in majority of the patients. Conclusion. These findings indicate a novel method in which the complete recovery of joint defects due to dysplastic genesis or osteochondral defects as a result of injuries can be obtained. The devised method can be used in future experiments for objectification and regenerative potential of hyaline cartilage (e.g., rate and volume of the reformed joints that regenerate, detection of cartilage elements, and the regeneration process).
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):37-43
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Result of bilateral total hip replacement in the treatment of a child with cerebral palsy
Baskov V.E., Neverov V.A.
Abstract
Total hip replacement in children is performed according to very limited and compelling indications. The principal of such a treatment is the complete and irreversible destruction of the hip joint accompanied by a permanent loss of function of the lower limb. Hip replacement in children with cerebral palsy is a very rare method of treatment. According to observations from the Turner Institute, it was performed in only 2% of all replacement cases. After the placement of an artificial joint, the atherogenic component of the contractures disappears and improves the motor activity of patients. In this paper, a 3-year follow-up of the bilateral total hip replacement in a child with cerebral palsy and bilateral secondary stage III coxarthrosis is presented.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):44-47
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Minimally invasive technologies in the treatment of closed fractures of the intercondylar elevation of the knee: a clinical case
Voronchikhin E.V., Kozhevnikov V.V., Grigoricheva L.G., Naidanov V.F.
Abstract
Тhis article presents a clinical case of the surgical treatment of a fracture in the intercondylar eminences of the knee joint in a 7-year-old child. Closed fractures of the intercondylar exaltation are mainly a characteristic of childhood. This type of damage occurs by dysfunction of the knee resulting from instability. Because the fracture of the intercondylar eminences of the knee joint in children is similar to the damage of the anterior cruciate ligament in adults, the current course of knee surgery is a minimally invasive technique. These include fixation of the intercondylar exaltation using video stroboscopy as well as the assistance of various implants (e.g., screw, wire, and Dacron). In the children's Department of Traumatology and Orthopedics of the Federal Center of Traumatology, Orthopedics and Endoprosthesis Replacement in Barnaul, various surgeries are performed, including arthroscopy of the right knee joint, intercondylar exaltation reposition, and fixation of the intercondylar exaltation latch Lupine (De PuyMitek).
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):48-50
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Dystrophic epidermolysis bullosa associated with congenital contractures of the upper and lower limbs: literature review
Agranovich O.E., Buklaev D.S., Tikhonenko T.I.
Abstract
Epidermolysis bullosa (EB) is a rare hereditary disease. Its main feature is vesication and weeping sores (erosions) of the skin and mucous membranes, resulting from a minor injury. Clinical manifestations of the disease may vary from localized vesicles on the hands and feet to a generalized rash of the skin as well as lesions of the mucosa of the inner organs. At present, there are four main groups of EB: simple, intermediate, dystrophic, and Kindler syndrome. Mutations cause changes in the structure of the proteins responsible for the adhesion between layers of the dermis, leading to vesication. Treatment of EB is a challenge because of the lack of opportunities for the direct influence on the disease process, and its main purpose is to correct the existing cutaneous manifestations and prevent the occurrence of new elements. This article describes the main types of EB, methods of current diagnosis, and treatment of the disease as well as a clinical case of a rare combination of two severe disorders: 1) dystrophic EB and 2) arthrogryposis with upper and lower limb involvement.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):51-59
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Effect of vitamin D on the health status in the perinatal period
Vereschakina O.A., Zaletina A.V., Kenis V.M.
Abstract
Существуют данные, согласно которым дефицит витамина D может являться фактором риска в развитии многих хронических заболеваний, таких как остеомаляция, рахит, рассеянный склероз, шизофрения, сердечно-сосудистые заболевания, диабет I типа и рак. Повышенная подверженность подобным заболеваниям может брать начало на ранних этапах жизни в ходе развития структуры и функции тканей. Недостаточное содержание витамина D в период перинатального развития может заложить основу, которая в течение длительного времени будет представлять угрозу для здоровья человека. В данной статье говорится о рисках дефицита витамина D для здоровья человека и предлагаются современные рекомендации по использованию витамина D у матерей и их новорожденных детей.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(4):60-65
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