Vol 8, No 1 (2020)

Background. Pathological vertebral fractures are rare and occur in inflammatory, tumor, and dystrophic lesions.

Aim. This study aimed to analyze clinical features and morphological structure of pathological fractures of the spine in children.

Materials and methods. The authors examined and operated 62 children aged 2–17 years for pathological vertebral fractures. We investigated the clinical, radiological, and morphological features.

Results. The average age of children at the time of hospitalization was 10 years. Lesions of thoracic vertebrae prevailed (78%) with the maximum frequency of occurrence at the apex of physiological kyphosis Th_7–8. In 10 cases, multiple lesions were noted, including the pathology of other parts of the skeleton. In 69% of observations, clinical symptoms were not dominated by mechanical back pain. Palpation pain (34%) and local spinal deformation (27%) were noted. On average, local kyphosis was 24°. Eleven patients (18%) manifested a neurological deficiency, of which nine fractures were a consequence of the tumor process. In 16% of observations, the fracture of the vertebra was detected to be an accidental Х-ray finding. Among the radiation manifestations, all cases (12 patients) registered the decrease in the height of the vertebral body in the form of collapse. Destruction was manifested by various options other than blastic. Therapeutic and diagnostic interventions were performed in 56 patients, and in six children, manipulation was limited to trepan biopsy. The pathological fracture was caused by an inflammatory process in 50% of observations and tumors in 42%, of which 31% is malignant.

Conclusions. Pathological spinal fracture in children should be considered as a syndrome, which in most cases is based on an inflammatory or tumor process. The high frequency of neoplastic, including malignant processes, requires active invasive diagnosis. Therapeutic tactics are determined by the clinical, radiation, and morphological characteristics of pathology.

Background. The frequency of deep cervical burns in children is four times higher than that of deep face burns. Currently, there is no consensus on the methods for surgical treatment of deep burns in cervical areas; meshed skin autografts continue to be used.

Aim. To evaluate the benefits of early surgical treatment of deep сervical burns in children between the third and fifth days from the moment of injury.

Materials and methods. Case-control study. Surgical treatment was performed in 81 children with deep cervical burns. The main group with early surgical treatment included 46 children and underwent surgical treatment at 3.37 ± 0.14 days from the moment of injury; the control group received autograft during stage treatment for 35 children at 27.17 ± 0.18 days. The treatment results were evaluated by the following indicators: the number of dressing changes, the period of skin restoration, and the area of graft success. In the long term, functional and cosmetic treatment results were evaluated.

Results. In the study and control groups, 7.93 ± 0.45 and 18.75 ± 0.61 dressings were required to complete the treatment, respectively (p < 0.001). The skin restoration periods were 16.54 ± 0.68 and 36.94 ± 0.89 days, respectively (p < 0.001). The graft success areas were 99.50% ± 0.13% in the main group and 93.91% ± 2.68% in the control (p < 0.001). During the staged surgical treatment, one patient showed a loss of 90% of the graft, which required regrafting. Other complications in the treatment process have not been noted. When assessing long-term cosmetic results using the Vancouver Scar Scale, the average score was 4.0 ± 0.26 points in the main group and 7 ± 0.28 points in the control (p < 0.001). The presence of post-burn cicatricial contracture in the main group was noted in 12 (26%) people and the absence in 34 (74%) children. In the control group, 20 (57%) patients required surgical removal of post-burn deformity, and 15 (43%) children did not need further surgical interventions.

Conclusions. Early surgical treatment of deep cervical burns in children on the third and fifth days from injury allows not only to accelerate the process of restoration of the skin but also to directly affect the cosmetic and functional results in a better way.

Background. Teenagers with orthopedic diseases are in a difficult life situation, accompanied by experiences of an extraordinary level. Adaptation mechanisms play an important role in overcoming emotional difficulties. An important component of the adaptation process is psychological defense mechanisms. The article discusses the structure and effectiveness of the protective disposition of personality in adolescents suffering from various forms of acquired orthopedic diseases.

Aim. This study aimed to determine the structure and effectiveness of the protective disposition of personality in adolescents suffering from various forms of acquired orthopedic diseases.

Materials and methods. The study involved adolescents suffering from acquired orthopedic diseases: juvenile chronic arthritis, idiopathic scoliosis, and adolescents with long-term consequences of physical trauma on the basis of voluntary informed consent. All teenagers received treatment in the children’s orthopedic clinic. The study involved 139 adolescents with acquired orthopedic diseases and 36 healthy adolescents aged 12–17 years. Clinical psychological and psychodiagnostic methods were used to survey the respondents.

Results. The general and specific features of the protective system of personality in adolescents with various forms of orthopedic diseases and their healthy peers were revealed. The role of mechanisms of psychological protection in the development of post-traumatic symptoms in adolescents with various forms of acquired orthopedic diseases in the situation of rehabilitation treatment is revealed.

Conclusions. Taking into account the features of the protective disposition of the personality of adolescents with orthopedic diseases allows a differentiated approach to psychological correction at the stages of rehabilitation treatment, to develop individual approaches to providing psychological assistance in a hospital.

Background. Despite the wide range of studies, the development of osteoplastic material, which has not only osteoconductive but also osteoinductive properties, remains an extremely topical issue in modern medical materials science. This work is devoted to experimental evaluation of the effectiveness of synthetic osteoplastic composite material based on chitosan and hydroxyapatite.

Aim. This study aimed to determine the effects of spongy implants based on chitosan and its composite with hydroxyapatite nanoparticles in an amount of 50 wt. % on early osteogenesis in the area of the through defect of the ileum.

Materials and methods. The studied materials were sponge implants based on chitosan and its composite with hydroxyapatite nanoparticles in an amount of 50 wt. %. Comparison groups include those without implant placement and those with replacement with commercial Reprobone osteoplastic material. Materials were implanted into the zone of the through defect of the ileum of rabbits for a period of 28 days.

Results. A high rate of resorption of materials based on chitosan in bone tissue and active growth of reticulofibrotic bone tissue along the edges of the defect was established, and the formation of cartilaginous islands and bone marrow was recorded in the group of chitosan implants with hydroxyapatite. The aseptic effect was observed with the use of implants made of chitosan and hydroxyapatite.

Conclusions. The data obtained allow us to argue about the osteoconductivity of the studied materials and the prospects for further development in this direction.

Background. Мeningococcal infection with damage to various organs and systems, including the musculoskeletal system, causes growth plate dysfunction, which usually leads to the formation of orthopedic consequences, including axis deviation and/or limb length discrepancy.

Aim. This study aimed to analyze the features of limb deformities and methods for their correction in children with consequences of meningococcemia.

Materials and methods. The retrospective analysis was performed on patients with consequences of meningococcemia who were examined and surgically treated in the clinic between 2012 and 2018. A total of 12 patients (six boys and six girls) were included, with an age range of 2–15 years. The examination included clinical, X-ray, and physiological methods. Treatment methods consisted of a combination of angular deformity correction and limb lengthening.

Results. In 12 patients, 76 growth plate arrests of long bones were found. Most frequently (17.1%), growth plate arrests of the distal femur and proximal tibia were observed, which resulted in limb shortening and/or axis deviation. For restoration of limb alignment in 10 (83.3%) patients, transosseous compression-distraction osteosynthesis was performed. For limb deformity correction, guided growth technique was applied by using eight-plate for temporary epiphysiodesis of active functioning part of the growth plate in four (33.3%) patients, whereas partial growth plate arrest resection with following epiphysiodesis was achieved in two (16.6%).

Conclusions. Meningococcal septicemia leads to long bone growth plate dysfunction. The main complaints in this patient are limb shortening and their deformity. Along with the transosseous compression-distraction osteosynthesis technique, using the guided growth method by carrying out temporary epiphysiodesis of the remaining functioning part of the growth plate of damaged bone was appropriate.

Background. The Loeys–Dietz syndrome is a rare autosomal dominant connective tissue disorder characterized by the pathology of the cardiovascular system in combination with various anomalies of the musculoskeletal system. In modern literature, there is neither any information about the frequency of pathology nor any algorithm of examination and treatment for patients with this syndrome.

Clinical case. The article presents a clinical observation of a 7-year-old patient with Loeys–Dietz syndrome with a genetically confirmed diagnosis.

Discussion. This article provided a literature review, examined diagnosis issues and differential diagnosis, and presented the clinical picture of the syndrome. The main symptoms of Loeys–Dietz syndrome are artery aneurysms (most often in the aortic root), arterial tortuosity (mainly the vessels of the neck), hypertelorism, and bifid (split) or broad uvula. However, the combination of these symptoms is not found in all patients with this disease.

Conclusions. The article emphasized the importance of a genetic verification of the disease, as well as a multidisciplinary approach to treatment with mandatory dynamic monitoring by specialists such as a cardiologist, neurologist, orthopedist, and pediatrician, which help prevent the development of complications and increase the life expectancy of this group of patients.