Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

BACKGROUND: In recent years, the concept of sagittal balance has become increasingly important in the treatment of spinal deformities of various etiologies. However, the number of studies analyzing sagittal balance parameters in patients with idiopathic scoliosis is limited, especially those involving individuals with severe deformities.

AIM: This study aimed to evaluate global and regional sagittal balance parameters in adolescents with severe thoracic idiopathic scoliosis.

METHODS: The study included 45 patients aged 12–17 years diagnosed with thoracic idiopathic scoliosis (Lenke types 1, 2, and 3), presenting with a primary curve magnitude ranging from 80° to 150°, according to the Cobb method. Radiographic examinations were performed to assess both regional and global sagittal balance parameters, as well as characteristics of frontal plane spinal deformity. The patients were divided into two groups based on the global sagittal balance values. Descriptive, correlation, regression, and comparative statistical analyses of the data were conducted.

RESULTS: A positive correlation was observed between the magnitude of frontal plane spinal deformity and thoracic kyphosis values. The regression analysis indicated that when the primary curve exceeded approximately 100°, thoracic kyphosis values tended to rise above 60°. Thoracic hyperkyphosis was the predominant sagittal deformity in these patients; however, neither thoracic kyphosis nor the primary curve magnitude in the frontal plane showed statistically significant correlation with any of the global sagittal balance indicators. These indicators correlated more strongly with spinopelvic parameters (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI–LL).

CONCLUSION: Surgical treatment of severe idiopathic scoliosis should obligatorily consider correction methods that produce a corrective effect on the kyphotic component of the deformity. The development of pronounced anterior imbalance has been proven to be uncharacteristic for patients with thoracic idiopathic scoliosis, even with the largest primary curve magnitudes. The primary risk factors for its development were reduced PI and LL values. The development mechanism of the observed association in these patients remains unclear.

BACKGROUND: Patellar instability refers to recurrent dislocations and subluxations of the patella relative to the femoral trochlear groove. This condition is one of the most common disorders of the knee joint in pediatric patients. Both bone and soft tissue structures act as stabilizers of the patella, and alterations in any of these components may contribute to patella instability. Magnetic resonance imaging (MRI) findings related to the osteochondral and soft tissue structures of the patellofemoral joint in children with patellar instability, as well as their correlation with clinical presentation, are of practical interest.

AIM: This study aimed to assess the key MRI features of the patellofemoral joint zone in pediatric patients with patellar instability and evaluate their clinical manifestations.

METHODS: Epidemiological, clinical, and MRI data were analyzed for patients with patellar instability and anterior cruciate ligament injury. The study included 52 patients in the main group and 44 patients in the comparison group with anterior cruciate ligament injury. No statistically significant differences in age distribution were observed.

RESULTS: Significant differences were identified between the groups in terms of Wiberg patellar type, presence of a patellar apprehension sign, and patellar hypermobility. Differences were also noted in the lateral inclination and depth of the trochlear groove, as well as in the frequency of clinical signs such as patellar apprehension and patellar hypermobility (p < 0.001).

CONCLUSION: Trochlear dysplasia is a key predisposing factor for the development of patellar instability in pediatric patients. This study confirmed statistically significant differences in the parameters characterizing trochlear dysplasia, as well as the influence of this factor on patellar instability in children, including its correlation with clinical manifestations.

BACKGROUND: Most musculoskeletal diseases are diagnosed in childhood, allowing for the prevention of chronic progression and subsequent disability in adulthood. In recent years, monitoring pediatric morbidity has gained increasing scientific and practical importance, leading to the reassessment of key organizational strategies.

AIM: This study aimed to conduct a comparative analysis of the overall morbidity of musculoskeletal and connective tissue diseases among children in Saint Petersburg from 2017 to 2023.

METHODS: Based on official statistical reports from 2017 to 2023, the prevalence of musculoskeletal and connective tissue diseases among children aged 0–14 years and adolescents aged 15–17 years in Saint Petersburg was compared with national averages in Russia. Morbidity trends were analyzed per 1,000 of the respective pediatric population. The analysis was carried out using a quantitative assessment of the odds ratio for the occurrence of musculoskeletal conditions, overall and by individual disease forms, as presented in the statistical bulletins. Statistical significance was inferred when the 95% confidence interval for the odds ratio did not include 1 (p < 0.05). Data analysis was performed using Microsoft Office 2010 (Word and Excel).

RESULTS: The prevalence of musculoskeletal and connective tissue disorders among children in Saint Petersburg was extremely high, showing an upward trend and a widening gap compared with the national average in Russia. During the COVID-19 pandemic, the growth rates of most disease categories outpaced those of the preceding period. Among children aged 0–14 years in Saint Petersburg, the odds ratio showed an increase for reactive arthropathies (by 23.6%), deforming dorsopathies (by 27.4%), and other musculoskeletal conditions (by 23.0%). Among adolescents, increased odds were observed for juvenile arthritis (7.9%), arthropathies overall (13.3%), deforming dorsopathies (15.5%), and other disorders (22.7%). In contrast, both age groups showed a decreased likelihood of being diagnosed with spondylopathies. When assessing the significance of odds ratios and the validity of conclusions, preference should be given to the use of the smallest measurement units.

CONCLUSION: An increase in the prevalence and odds of musculoskeletal and connective tissue disorders among children in Saint Petersburg was observed. This underscores the need to improve care pathways and adopt modern approaches to the prevention and treatment of these conditions in the region, as well as to strengthen the availability and quality of medical resources in other Russian regions.

BACKGROUND: The development of instrument-based methods for the functional diagnostics of adaptive body changes in children engaged in sports activities is a currently relevant area of research.

AIM: This work examined the amplitude characteristics of postural sway at the pressure centers of the contralateral lower limbs in young athletes in motionless standing positions across a frequency range.

METHODS: Amplitude-frequency characteristics were analyzed during motionless standing in 18 children aged 7–10 years, of both sexes, who regularly participated in track and field. The postural sway parameters of the pressure centers under both feet were recorded using two stabilometric platforms. Measurements were collected in the low-frequency range (up to 1.0 Hz) for 20 seconds and the high-frequency range (1.0–6.0 Hz) for 1 second. The deviation angle α (°) of the sway axis of the lower limbs from the midline axis was determined. The first peak amplitudes and frequencies of sway were measured: а₁, а₂, and а₃ (mm) and f₁, f₂, and f₃ (Hz) in the low-frequency range, respectively; and А₁, А₂, and А₃ (mm) and F₁, F₂, and F₃ (Hz) in the high-frequency range. The control group comprised 18 children with typical daily physical activity levels.

RESULTS: In young athletes, more favorable amplitude-frequency characteristics of postural sway at the low- and high-frequency ranges were identified compared with age-matched peers not engaged in sports and leading sedentary lifestyles. This effect was manifested by a frequency shift in sway, a reduction in all peak sway amplitudes at both the low- and high-frequency ranges, lower asymmetry of sway amplitudes, and the stable synchronization of pressure center oscillations across the entire frequency spectrum.

CONCLUSION: Amplitude-frequency parameters of postural sway at the pressure centers of the contralateral lower limbs should be considered while training younger school-aged children for sports to prevent neuromuscular imbalance due to fatigue, and injuries.

BACKGROUND: Ischemic spinal cord stroke is a rare condition, accounting for approximately 1% of all spinal cord strokes. The relevance of this publication is determined by the rarity of the condition, the complexity of differential diagnosis with other acute onset myelopathic syndromes, the severity of spinal stroke outcomes, and insufficient awareness among physicians regarding this condition in children.

CASE DESCRIPTION: We present a clinical case of acute myelopathic syndrome in an 8-year-old child. Magnetic resonance imaging of the cervical spinal cord correlated with the clinical findings and indicated impaired circulation in anterior spinal artery at the cervical spinal level.

DISCUSSION: Acute impairment of spinal cord circulation may be caused by systemic hypotension; occlusion of spinal cord-supplying vessels (traumatic, iatrogenic, thrombotic, or embolic); arterial dissection; arteriovenous malformations and fistulas; or hypercoagulable states.

CONCLUSION: In pediatric patients presenting with acute myelopathic syndrome, ischemic stroke of the spinal cord should be considered in the differential diagnosis alongside inflammatory and infectious conditions, particularly in children with significant risk factors. Early recognition of acute impairment of spinal cord circulation is particularly important for timely neuroimaging, consultations with related specialists, and initiating etiotropic or symptomatic treatment upon identification of the underlying cause of acute spinal cord ischemia, as well as early rehabilitation.

The prevalence of benign bone tumors among pediatric patients highlights the relevance of such investigations for orthopedic practice. This article focuses on hand enchondromas in children. Despite the relative frequency of this condition, the lack of clinical guidelines for this disease area underscores the relevance of the publication. A total of 69 full-text articles were selected from 387 sources identified through searches in CyberLeninka, eLibrary, PubMed, and Scopus from 1990 to 2023. This review presents current views on the etiopathogenesis, diagnostic and therapeutic challenges, and prognosis of hand enchondromas in children. Radiography and computed tomography are the primary diagnostic methods for hand enchondromas. Histological verification of diagnosis is mandatory. Particular attention should be given to surgical treatment strategies, including the optimal timing and extent of intervention, selection of grafting material, risk factors, and frequency of recurrence. The scientific data analysis enabled the systematization of data on the etiopathogenesis of hand enchondromas, identification of diagnostic priorities, clarification of diagnostic and differential diagnostic criteria, and refinement of approaches to treatment strategy and methods. The choice of treatment strategy, including the method and timing of intervention, should be individualized, taking into account tumor localization and histogenesis, as well as any additional diagnostic findings and the risk of complications. In recent years, specialists have tended to favor early surgical intervention over wait-and-see approaches, with the choice between autograft and allograft being determined by the clinical context. Autografts are considered the gold standard; however, the use of allografts for restoring the structural and functional integrity of bone in cases of injury is a reasonable and well-substantiated alternative, even in the light of the high risks of donor site morbidity. Such decisions should be made collaboratively, considering the opinions of the involved specialists, including orthopedic oncologists, radiologists, pathologists, and rehabilitation physicians.

Stress (overuse) fractures of the upper extremities are a relatively uncommon condition typically observed in athletes. Due to their gradual onset, typically mild clinical symptoms, and sometimes unremarkable imaging findings, such injuries are frequently overlooked. The article aims to present data on the pathogenesis, clinical presentation, diagnostics, and treatment strategies of COVID-19. A scientific data search was conducted in the PubMed (MEDLINE) database and via the Google search engine from 1975 to 2024 using combinations of the operators OR and the following keywords: стрессовые переломы (stress fractures), нагрузочные переломы (overuse fractures), верхние конечности (upper extremities), and спортсмены (athletes). A total of 70 sources were selected, including 22 published within the past decade. Stress (overuse) fractures are reported in approximately 40% of athletes, with 80%–95% occurring in the lower extremities and only 5%–20% occurring in the upper extremities. Stress fractures result from repetitive mechanical loading of the bone and are compounded by fatigue of the surrounding muscles, leading to an increase in the rate of bone resorption by osteoclasts to exceed the rate of new bone formation by osteoblasts. Magnetic resonance imaging is the primary diagnostic modality. In most cases, bone healing occurs with load restriction and activity modification (avoidance of repetitive trauma-inducing movements). Surgical intervention is often required in stage III gymnast wrist fractures, avulsion fractures of the medial epicondyle with displacement ≥10 mm, complete or partial tears of the ulnar collateral ligament of the elbow, olecranon fractures, and carpal bone fractures. Although relatively rare, upper extremity stress fractures can cause significant problems and hinder athletic progression. A thorough medical history, physical examination, and analysis of the mechanism of injury will allow clinicians to raise suspicion of this condition. Load restriction, elimination of provoking factors, gradual increase in training intensity, and improvement of sports technique, in most cases, allowed the patient to avoid surgical treatment and return to sports activities.