Vol 11, No 2 (2023)

BACKGROUND: According to the literature, the Greek questionnaire on the study of the quality of life of children and adolescents undergoing brace treatment (BRACE questionnaire, abbreviated as BrQ) is informative and reliable, which is confirmed by its validation in different countries. This necessitates the creation of an adopted Russian version and its validation.

AIM: To perform Russian localization and validation of the Greek questionnaire on the study of the quality of life of children and adolescents undergoing brace treatment.

MATERIALS AND METHODS: Russian localization and validation of the Russian version of the questionnaire on braces (Ru-BrQ) was carried out in several stages: direct and reverse translations, examination of the questionnaire, formation of a preliminary version, pilot testing of 104 patients with idiopathic scoliosis on brace treatment, development of the final version, reliability study using the evaluation of Cronbach’s alpha criterion and intraclass correlation coefficient (ICC), and provision of the final version.

RESULTS: According to the indicators of the overall Ru-BrQ score, 0% of patients scored at the “floor” and “ceiling” levels. The average quality of life scores according to Ru-BrQ and in the retest were 72 ± 9.2 and 72.4 ± 9.0 points, respectively. According to the ICC indicator, domains such as “general health,” “self-esteem and aesthetics,” “vitality,” and “social functioning” showed excellent reliability (>0.9). “Physical functioning” and “school activity” demonstrated good reliability (0.75–0.9). “Emotional functioning” and “body pain” demonstrated moderate reliability (0.5–0.75). The Cronbach’s alpha coefficient showed that except for the domains “emotional functioning” and “body pain,” where good internal consistency was determined (≥0.8), all other domains confirmed excellent internal consistency (≥0.9). The Pearson correlation coefficient (index 0.67) revealed a noticeable correlation between Ru-BrQ and the Russian version of SRS-22.

CONCLUSIONS: The Russian version is a reliable questionnaire for the study of the quality of life of children and adolescents undergoing brace treatment, comparable with the original Greek version of BrQ, and can be recommended for use in practical and scientific activities to assess the effect of a torso brace on the quality of life in children and adolescents.

BACKGROUND: The pathology of upper limb deformities often leads not only to impaired self-ability but may be one of the factors that lead to the development of specific difficulties in a child at various stages of learning. Deficiency of visual-motor integration and/or its subcomponents (visual perception and motor coordination) are the risk factors for academic failure. Children aged <3 years with arthrogryposis multiplex congenita and obstetric palsy are have delayed speech development and behavioral disorders, which require correction, including speech therapy at an early age.

AIM: To examine the features of the organization of correctional and developmental education of children with arthrogryposis multiplex congenita and obstetric palsy, depending on their speech development and motor disorders, and assess the features of speech development of children with obstetric palsy.

MATERIAL AND METHODS: From 2020 to 2022, we examined 46 children aged 6–15 (average age, 9.57 ± 2.91) years with upper limb deformities caused by arthrogryposis multiplex congenita and obstetric palsy. Speech therapy and orthopedic and statistical methods were used.

RESULTS: The study included 25 children (54.3%) with arthrogryposis multiplex congenita and 21 (45.7%) with obstetric palsy. In addition, 5.09 ± 4.34 procedures were performed for the correction of orthopedic pathology. Most of the patients had mild (n = 17, 36.9%) and moderate (n = 20, 43.5%) functional disorders of the upper extremities, and 30 (65.2%) had problems with hand function. Moreover, 11 (23.9%) children had delayed speech development at an early age. Speech pathology was detected in 41 (89.1%) children (general speech underdevelopment, n = 20, 43.9%; lexical-grammatical underdevelopment, n = 12, 26.1%; and phonetic-phonemic underdevelopment, n = 9, 19.8%. Dysarthria was the main speech pathology in 25 patients of different age groups (54.3%). Moreover, 18 (52.9%) schoolchildren had impaired writing ability. The speech pathology in patients with arthrogryposis multiplex congenita and obstetric palsy were the same. These groups differed from each other by the form of learning (p < 0.05).

CONCLUSIONS: Children and adolescents with arthrogryposis multiplex congenita and obstetric palsy have special educational needs and often need speech therapy assistance taking into account the specific orthopedic pathology.

BACKGROUND: Increasing rates of childhood trauma, poisoning, and sequelae of environmental exposure not only reduce the quality of life of children and their families but also lead to disability and death. Statistical analysis of childhood trauma data makes it possible to define risk age groups among children and adolescents, identify the causes of the decrease or increase in the rates, estimate the level of medical care, and make necessary management decisions.

AIM: To assess the state of childhood trauma in St. Petersburg and its changes in 5 years (2016–2020) and the provision of inpatient trauma care.

MATERIALS AND METHODS: Data on childhood trauma in St. Petersburg were analyzed based on the analysis of Federal statistical observation forms submitted by the St. Petersburg State Budgetary Institution Medical Center for Information and Analysis, collections of N.N. Priorov National Medical Research Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation ‘Trauma, orthopedic morbidity, the state of trauma and orthopedic care for the population,’ edited by Acad. S.P. Mironov, RAS, and data from the Federal State Statistics Service.

RESULTS: From 2016 to 2019, the frequency of trauma, poisoning, and sequelae of environmental exposure in children of St. Petersburg slightly increased. In 2020, owing to the COVID-19 pandemic, childhood trauma rates decreased, and the most significant decrease in trauma rates was recorded at 32%–36% in adolescents aged 15–17 years. Despite the overall decrease in childhood trauma in 2020, the structure of trauma due to environmental exposure revealed an 81% increase in transport accidents, compared with previous years, and a 39% increase in trauma due to injuries with undetermined intentions. For 5 years, the number of beds was reduced, and by 2020, the provision of trauma, and orthopedic beds for children in St. Petersburg was 1.4 beds per 10 thousand children, which corresponds to the data for Russia.

CONCLUSIONS: The incidence of traumatic injuries slightly increased in children in St. Petersburg, mostly in children aged 0–4 years, and mortality from environmental exposure also increased in adolescence. A correlation was found between the COVID-19 pandemic and a decrease in the number of visits and hospital admissions of children with trauma to medical institutions. Moreover, the incidence of severe, high-energy injuries that require more serious treatment approaches also increased, as evidenced by the annual increase in the number of surgical interventions in children with traumatic injuries. The new form of statistical reporting does not allow us to determine all causes of trauma. The provision of trauma care for children in St. Petersburg remains at an appropriate level.

BACKGROUND: Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation of an osteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology.

AIM: To evaluate the efficacy of treatment in a small clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area.

MATERIALS AND METHODS: Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was 10 (6–11) months, with a maximum duration of 12 months.

RESULTS: The observation results demonstrate a high efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans.

CONCLUSIONS: The use of orthobiological technologies is an actively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.

BACKGROUND: Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Only a few publications explored this problem in children. In this study, we present a surgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the “antenna procedure” and the reverse-flow homodigital island flap.

CLINICAL CASES: A series of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, and an acceptable appearance, and function of the fingers were achieved.

DISCUSSION: Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases.

CONCLUSIONS: We consider the combination of the “antenna procedure” and reverse-flow homodigital island flap as a justified method. However, issues raised in this technique require further investigation.

BACKGROUND: Congenital cervical spinal deformities due to hemivertebrae are rare and serious entities that are difficult to solve because of anatomical obstacles in the cervical region and the lack of treatment experience of such patients.

AIM: To analyze current literature dedicated to the surgical treatment of patients with congenital scoliotic deformities.

MATERIALS AND METHODS: We searched for studies evaluating the results and surgical management of patients with cervical hemivertebrae. The literature search was performed using keywords and similar articles in PubMed, Science Direct, and Google Scholar. The depth of the search was 50 years.

RESULTS: No studies have explored the issue of the surgical management of patients with congenital cervical scoliotic deformities because of the rarity and complexity of treatment. Still, data are sufficient to develop an efficient and safe algorithm.

CONCLUSIONS: Despite the complexity and lack of treatment experience in such patients, modern technologies for perioperative planning and surgical management allow for remarkable improvement of patients’ quality of life without serious complications.

BACKGROUND: Patients with cervical spinal cord injury have the highest risk of developing respiratory dysfunction and associated complications such as pneumonia, atelectasis, and respiratory failure. Respiratory dysfunction is the leading cause of comorbid, somatic, and infectious pathology, and mortality following traumatic cervical spinal cord injuries. Mechanical ventilation of the lungs is the standard treatment for such patients; however, it is associated with atrophy and diaphragm dysfunction.

AIM: To analyze literature data on the use of electrical stimulation techniques of the spinal cord, nerves, and muscles for the correction of respiratory disorders in patients with cervical spinal cord trauma.

MATERIALS AND METHODS: This study presented the results of the search and analysis of peer-reviewed articles that examined the effects of various electrical stimulation techniques on respiratory function in patients with cervical spinal cord injury. ScienceDirect, Google Scholar, and PubMed were searched from 2000 to 2022.

RESULTS: Currently, new treatment options are available for patients with tetraplegia, with reduced ventilatory function. Many studies have shown the positive effect of electrostimulation techniques on ventilatory function such as reduced time spent on mechanical ventilation and reduced incidence of infections and other lung complications.

CONCLUSIONS: Electrical stimulation promotes neuromuscular plasticity and results in improved spontaneous activation of the diaphragm and respiratory muscles. Electrostimulation in a comprehensive rehabilitation program of patients with traumatic spinal cord injuries at the cervical level is currently employed to promote weaning from mechanical ventilation and prevent accompanying complications such as respiratory failure, pneumonia, and atelectasis. In addition to invasive electrical stimulation of the diaphragmatic nerve and/or spinal cord, existing less invasive electrostimulation techniques require further investigation in patients with spinal cord injury and respiratory dysfunction.

We performed a prospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for whom the radiographic findings met the criteria for flatfoot, were randomly assigned to one of four groups: Group I, controls; Group II, treatment with corrective orthopaedic shoes; Group III, treatment with a Helfet heel-cup; or Group IV, treatment with a custom-molded plastic insert. All of the patients in Groups II, III, and IV had a minimum of three years of treatment, and ninety-eight patients whose compliance with the protocol was documented completed the study. Analysis of radiographs before treatment and at the most recent follow-up demonstrated a significant improvement in all groups (p < 0.01), including the controls, and no significant difference between the controls and the treated patients (p > 0.4).

We concluded that wearing corrective shoes or inserts for three years does not influence the course of flexible flatfoot in children.

Taken from The Journal of Bone & Joint Surgery. 71(6):800-810, Jul 1989 with the approval of publisher and Dennis R. Wenger