Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

BACKGROUND: Juvenile idiopathic arthritis is the most common chronic inflammatory musculoskeletal disease in children. Its most prevalent clinical subtype is oligoarthritis. Pigmented villonodular synovitis, also known as tenosynovial giant cell tumor, is a rare benign synovial disorder, which may clinically resemble oligoarthritis. Differential diagnosis between juvenile idiopathic arthritis and pigmented villonodular synovitis is challenging. Intra-articular steroids used in juvenile idiopathic arthritis therapy may induce negative effects in patients with pigmented villonodular synovitis. Orthopedic and surgical procedures used to rule out pigmented villonodular synovitis are burdensome for children. Magnetic resonance imaging may yield similar findings for both conditions at early stages. Several studies revealed that serum calprotectin is a promising biomarker for juvenile idiopathic arthritis.

AIM: To assess synovial fluid calprotectin concentrations in children with oligoarthritis and pigmented villonodular synovitis.

METHODS: The synovial fluid concentrations of calprotectin, interleukin-6, and tumor necrosis factor-alpha in 42 children with oligoarthritis and 12 children with diffuse pigmented villonodular synovitis of the knee joint were obtained by enzyme-linked immunosorbent assay. In patients with juvenile idiopathic arthritis, cytokine levels were determined at disease onset, and prior to therapeutic and diagnostic arthroscopy in those with pigmented villonodular synovitis.

RESULTS: Synovial calprotectin significantly increased in children with oligoarthritis (108 [28.2; 237] μg/mL) compared to those with pigmented villonodular synovitis (1.53 [1.26; 1.69] μg/mL; p < 0.001). No statistically significant differences were found in synovial tumor necrosis factor-alpha and interleukin-6 concentrations between patients with juvenile idiopathic arthritis and those with pigmented villonodular synovitis. ROC analysis showed a synovial calprotectin threshold of >2.9 μg/mL for the diagnosis of juvenile idiopathic arthritis (AUC = 0.996 ± 0.00479; 95% CI: 0.926–1.000).

CONCLUSION: In children, the differential diagnosis of oligoarthritis is often complicated by clinically similar nonrheumatic joint disorders. The main synovial proinflammatory markers cannot be used for the differential diagnosis of juvenile idiopathic arthritis and pigmented villonodular synovitis. Synovial calprotectin concentration is a promising biomarker of juvenile idiopathic arthritis.

BACKGROUND: Avulsion fracture of the tibial intercondylar eminence is a rare injury, which commonly occurs in adolescents aged 8–14 years, and may result in disability caused by improper bone union. Several surgical techniques for the treatment of patients with such fractures have been developed, involving various methods of fixation for the avulsed fragment of the tibial intercondylar eminence.

AIM: To evaluate the effectiveness of the novel technique for the treatment of type III tibial intercondylar eminence avulsion fractures according to the Meyers–McKeever–Zariczny classification in children with open growth plates and compare its outcomes to those of arthroscopically assisted reduction and fixation of the avulsed fragment using a Herbert screw.

METHODS: Functional outcomes in 45 children aged 14–17 years with tibial intercondylar eminence fractures were analyzed at 3, 6, and 12 months after surgery. Group A included 22 children who underwent arthroscopic fixation with a Herbert screw. Group B comprised 23 children who underwent arthroscopic fixation using a self-tightening suture loop following the novel method.

RESULTS: Group B demonstrated better anteroposterior and rotational stability of the knee than group A. Postoperative functional assessment scores (IKDC 2000, Lysholm Knee Scoring Scale, and Tegner Activity Scale) were significantly better in group B than in group A (p = 0.00006). In group A, postoperative complications were observed in 18.1% of cases (p ≤ 0.05), including screw fracture (4.5%) and aseptic synovitis due to a foreign body reaction (13.6%). No postoperative complications were noted in group B (p < 0.05).

CONCLUSION: The proposed technique for treating tibial intercondylar eminence avulsion fractures in children with open growth plates is more reliable and safer compared with Herbert screw fixation and may be recommended for clinical practice.

BACKGROUND: Monitoring the functional parameters of the musculoskeletal system is crucial for evaluating children’s adaptive responses to physical activity. Such health monitoring of children participating in sports should be systematic. Stabilometry is a promising method for the functional assessment of the musculoskeletal system in young athletes.

AIM: To develop criteria for the differentiated assessment of postural control in children based on analysis of asymmetry in stabilometric parameters of the contralateral lower limbs centers of pressure and compare these findings with those obtained in young athletes.

METHODS: A two-stage study of postural balance in healthy children was conducted using dual stabilometric platforms. In stage 1, a control group including 59 children aged 5–16 years who were not involved in sports and whose physical activity did not exceed routine daily levels was investigated to determine the range of normal stabilometric parameters. The children were divided into four age subgroups: 16 children aged 5–6 years, 13 aged 7–10 years, and 15 each aged 11–13 years and 14–16 years. In stage 2, 15 boys and girls aged 7–10 years who regularly trained at sports schools in Saint Petersburg were examined.

RESULTS: In the control group, postural balance gradually improved with age starting from 5 to 6 years and reached its highest levels by age 14–16 years. In the main group, regular sports training with increased physical loads in children aged 7–10 years did not adversely affect postural balance or the balance between contralateral lower limbs. This may be associated with a gentle exercise methodology that provides balanced and age-appropriate training loads adjusted for the physiological characteristics of children. The quality of postural control was better in young athletes than in their nonathlete peers, with median stabilometric parameters of 80% and 72%, respectively (p < 0.05). Lower center of pressure velocities and smaller statokinesiogram areas were noted in athletes, showing more efficient postural balance. These findings indicate adaptive processes in the postural ontogenesis of children in the main group because of systematically graded physical loads on the musculoskeletal system.

CONCLUSION: The functional asymmetry between the contralateral lower limbs should be considered, which is a physiological characteristic of growing children, particularly young athletes. This asymmetry is linked to age-related physiological differences in the centers of pressure movements of the left and right lower limbs associated with cerebral lateralization. Considering motor asymmetry of the contralateral lower limbs in training programs is advisable to prevent sports-related injuries.

BACKGROUND: Accuracy and precision are crucial in pedicle screw implantation in children with congenital spinal deformities combined with thoracic cage anomalies. The use of patient-specific navigation templates supplemented with radiopaque markers significantly improves screw positioning accuracy and reduces the risk of complications.

AIM: To evaluate the effectiveness of a novel patient-specific surgical template with radiopaque markers and accuracy of pedicle screw placement in children with congenital spinal deformities combined with thoracic cage anomalies, compared with the freehand technique.

METHODS: The study included 26 patients (aged 4–9 years) who underwent surgery at a specialized center. The patients were grouped into two: group 1 (n = 13) underwent screw placement using the new template with radiopaque markers and group 2 (n = 13) underwent screw placement using the freehand technique. Screw placement accuracy was evaluated using the Gertzbein scale based on postoperative radiographs and computed tomography. Statistical analysis was performed using the Student’s t-test, with p < 0.05 indicating significance.

RESULTS: In the navigation template group, 100% of screws were placed correctly (grade 0). In the freehand group, 80.5% of screws were correctly positioned; 16.9% showed deviations up to 2 mm (grade 1), and 2.6% showed deviations >2 mm (grade 2). The use of the navigation template significantly reduced the time required for bone canal preparation compared with the freehand method.

CONCLUSION: Navigation templates with radiopaque markers demonstrate high accuracy and correctness in pedicle screw placement in children with congenital spinal deformities, reducing malposition risk and shortening operative time. Their widespread implementation may enhance the safety and effectiveness of surgical treatment in this patient population.

BACKGROUND: Pathologic hip dislocation is a severe complication of septic arthritis and hematogenous osteomyelitis of the proximal femoral metaphysis in young children. Bilateral involvement of the hip joints results in more severe anatomical and functional impairments, requiring greater treatment efforts. In such cases, rehabilitation may take years and involves staged surgical correction and continuous conservative management. Meeting these requirements is crucial, as insufficient or inadequate treatment may result in contractures, restricted hip mobility, and progression of secondary deformities.

AIM: To analyze the outcomes of surgical treatment in children with bilateral pathologic hip dislocations treated with hip arthroplasty using demineralized osteochondral allografts and highlight rehabilitation aspects required to achieve favorable short- and long-term postoperative outcomes.

METHODS: Surgical outcomes in 11 children (22 hip joints) aged 1.5–10 years with bilateral destructive pathologic hip dislocations who underwent hip arthroplasty using demineralized osteochondral allografts were analyzed.

RESULTS: Long-term follow-up (1–12 years) demonstrated radiologically confirmed joint stability in 86.4% of cases and preservation of at least 80 of hip flexion range.

CONCLUSION: Hip arthroplasty with demineralized osteochondral allografts in children with destructive pathologic hip dislocations is an effective method for restoring hip joint function, providing stability and preserving range of motion over the long term. A consistent, systematic, and comprehensive treatment approach is critical for successful rehabilitation and for restoration and long-term preservation of hip function in children with bilateral hip involvement.