Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

BACKGROUND: The high frequency and recurrence of chronic patellar instability and the lack of unified treatment techniques indicate the need for a comprehensive individualized approach in the diagnosis and surgical treatment of patellar instability.

AIM: To develop an algorithm and compare the anatomical and functional results of its use with those of traditional surgical treatment of patients with patellar instability.

MATERIALS AND METHODS: The functional results of the treatment of 194 patients with patellar instability were compared. Two groups of patients were formed. The surgical treatment techniques of the main group (n = 93) were based on the results of the preoperative examination, considering risk factors of instability development, established as a result of retrospective analysis of the control group (n = 101). The effectiveness of the algorithm was compared with the techniques of patellar stabilization used from 2010 to 2015. The Kujala, IKDC 2000, and Lysholm scales were used to assess the functional results of treatment.

RESULTS: Surgical treatment of instability aims to eliminate risk factors such as anomalies of the extensor apparatus of the knee joint and to repair or reconstruct damaged structures. Plasty of the medial patellofemoral ligament is the method of choice for patellar stabilization. In the case of dysplastic changes in the patellofemoral joint, combinations of proximal and distal knee joint surgeries were performed. Rotational lower-limb deformities were treated by corrective derotational osteotomy of the femur. Trochleoplasty was performed in cases of type B or D femoral block dysplasia. Patients with stiff lateral patellar retention underwent lateral release or extension tenotomy. In both groups, the functional status of the patients significantly (p < 0.05) improved 12 months postoperatively. The mean values of the functional scales increased because of the increased number of patients with excellent and good scores in the group. Higher values were recorded in the main group (Kujala, p = 0.038; IKDC 2000, p = 0.021; Lysholm, p = 0.032). Patellar dislocation recurred in 2 (1.9%) patients in the control group (p = 0.172).

CONCLUSIONS: The proposed algorithm helped verify the degree, type, and etiology of patellar instability and helped obtain better anatomofunctional treatment results in patients.

BACKGROUND: Diastrophic dysplasia (OMIM #222600) is a rare congenital autosomal recessive skeletal dysplasia associated with homozygous or compound-heterozygous variants in the sulfate transporter gene SLC26A2. Clinical and radiological descriptions of diastrophic dysplasia in patients of different ages will help improve the diagnosis and orthopedic treatment.

AIM: To describe clinical and genetic characteristics of Russian patients with diastrophic dysplasia caused by previously described and newly identified pathogenic SLC26A2 variants.

MATERIALS AND METHODS: A comprehensive examination of 28 Russian patients from 28 unrelated families aged 3 months to 34 years with clinical and radiological signs of diastrophic dysplasia was performed. To confirm the diagnosis, genealogical analysis, clinical examination, radiography, and targeted research of SLC26A2 using direct Sanger sequencing were performed.

RESULTS: Typical clinical and radiological signs sufficient for diagnosing diastrophic dysplasia in newborns have been identified, which included rhizo/mesomelic shortening of the upper and lower extremities, congenital clubfoot, hand anomalies, multiple dislocations, and joint contractures. In our patients, 14 SLC26A2 variants were identified, 9 of which were first discovered. The most common variant identified in Russian patients with diastrophic dysplasia was c.1957T>A (p.Cys653Ser), which accounted for 50% of the alleles.

CONCLUSIONS: Clinical and genetic analyses of Russian patients with diastrophic dysplasia made it possible to identify the core clinical and radiological signs and evaluate the polymorphism of the clinical manifestations of the disease. In contrast to previously examined patients from European populations (including Finland with the largest number of patients with diastrophic dysplasia), 50% of the cases in the Russian population are caused by the c.1957T>A (p.Cys653Ser) homozygous or compound-heterozygous variant.

BACKGROUND: The high prevalence of musculoskeletal system and connective tissue diseases, effects on the quality of life of children, and disability level are among the main medical and social problems.

AIM: To assess the morbidity rates and provision of medical care to St. Petersburg children with musculoskeletal diseases between 2017 and 2021.

MATERIALS AND METHODS: Data on the incidence of musculoskeletal diseases in children of St. Petersburg were analyzed based on the 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: In Saint Petersburg, the morbidity rate of musculoskeletal and connective tissue diseases from 2017 to 2021 was 13%, excluding 2020, which was most likely due to the introduction of measures aimed at counteracting the spread of COVID-19 and the suspension of planned outpatient specialized care. The number of orthopedic beds for children decreased by 58, whereas the availability of beds for children remained at the same level and amounted to 4.3 beds per 10,000 children, which exceeded the indicator for the Russian Federation (1.0). The number of children with these disabilities increased 1.4-fold. Deaths of children due to musculoskeletal and connective tissue diseases were recorded in 2019 and 2020.

CONCLUSIONS: The results of the 5-year observation period of musculoskeletal and connective tissue diseases in children in St. Petersburg revealed increasing incidence because of the increase in the number of children newly diagnosed with these diseases.

BACKGROUND: Currently, the eponym “Poland syndrome” has become a universal term for clinicians for all pectoral muscle developmental disorders with symbrachydactyly and without. Misinterpretation of the diagnosis in patients with pectoral muscle underdevelopment can narrow the diagnostic search, making it difficult to genetically verify the diagnosis. Thus, this study was conducted.

CLINICAL CASE: We present the results of our clinical observation of a 17-year-old adolescent with complaints of restricted movement in the joints of the right hand, right shoulder joint, shortening of the right upper extremity, and chest wall deformity. Orthopedic examination and computed tomography indicated the presence of Poland syndrome, severe Sprengel’s deformity (soft tissue form), severe left-sided keel chest deformity, kyphoscoliosis of the thoracic spine, and Scheiermann–Mau disease. The focal neurological symptoms and associated structural and functional changes in the medulla oblongata were characteristic of the extended Mebius syndrome.

DISCUSSION: Modern hypotheses of pathogenesis, clinical features, and possibilities of diagnostics of this syndrome are considered.

CONCLUSIONS: The variety of clinical manifestations of the Poland–Mebius syndrome and the current lack of clear genetic markers for both the Mebius syndrome and Poland syndrome hindered the establishment of a consensus among researchers, that is, whether the Poland–Mebius syndrome is an independent disease or a group of individual phenotypic features that are components of previously known syndromes. Further molecular genetic studies may provide a basis for the designation of Poland–Mebius syndrome as a separate entity.

BACKGROUND: Despite expanding research, the development of materials for replacing bone defects remains an urgent problem in orthopedics and traumatology. Thus, one of the most important tasks is to create conditions for proper trophicity of the bone implant.

AIM: To analyze modern approaches to bone scaffold vascularization and evaluate their adequacy in in vivo models.

MATERIALS AND METHODS: The article presents a literature review dedicated to the methods of vascularization of bone scaffolds. A literature search was performed in PubMed, ScienceDirect, eLibrary, and Google Scholar databases from 2013 to 2023 using keywords, and 271 sources were identified. After exclusion, 95 articles were analyzed, and the results of 38 original studies and one literature review were presented.

RESULTS: Regardless of the initial vascularization method of scaffolds, bone implants show distinct osteoinductive features and promote advanced bone tissue regeneration. Constructs based on solid polymers and calcium–phosphate compositions also perform osteoconductive functions. Mesenchymal stem cells are used as the main cell type, as well as vessel-type cells, which in cooperation also have a positive effect on bone-defect remodeling. Bone morphogenetic proteins are used for directed differentiation in the osteogenic direction, and vascular endothelial growth factor is used for differentiation in the vascular pathway.

CONCLUSIONS: At present, no method for vascularization of scaffolds has been approved universally. In addition, no evidence supported the comparative effectiveness of vascularization methods, whereas animal model studies have demonstrated a positive effect of prevascularized patterns on the recovery rate of minor and critical defects.

BACKGROUND: The study comprehensively describes the issues of the normal biomechanics of the first toe, first metatarsophalangeal joint, and first ray when walking. Understanding the fundamental processes of the functioning of these structures is a leading aspect in the study of the etiopathogenesis of hallux valgus and is important in treatment planning.

AIM: To analyze the literature concerning the kinematic and kinetic indicators of the first toe, first metatarsophalangeal joint, and first ray of the foot when walking in the final support phase.

MATERIALS AND METHODS: The characteristics of periods, gait phases, kinetic and kinematic movements were analyzed.

RESULTS: To perform a “push-off” when walking, sufficient extension of the first toe in the first metatarsophalangeal joint is necessary, which is fully accomplished only in combination with flexion and eversion of the first ray of the foot. Muscular control of the position of the first toe in the first metatarsophalangeal joint is carried out by the short and long flexors of the first toe with the sesamoid apparatus of the first metatarsal bone, whereas functions of the first ray and midfoot joints are stabilized by the peroneus longus muscle.

CONCLUSIONS: The influence of kinematic and kinetic indicators of movements in the lower-limb joints in the horizontal plane on the flexion of the first ray and extension of the first toe in the metatarsophalangeal joint and the determination of the nature and volume of movements in midfoot joints in various phases of the gait cycle remains a pressing issue.

BACKGROUND: Archery is one of the oldest human skills that survived to the present day. At first, it was used for hunting and war and later became a sport. The interest in archery has grown annually. Each type of sport has specific injuries. Information about archery-related injuries will allow us to develop preventive measures and help make this sport safer. The article will be useful for coaches, sports doctors, physiotherapists, and orthopedic surgeons.

AIM: To present modern information about frequency, types of archery-related injuries, and preventive methods.

MATERIALS AND METHODS: The publication search was performed in the PubMed/MEDLINE databases from 1978 to 2023 using combinations of OR, AND operators, and keywords: archery, archery injuries, rotator cuff injuries, arrow injuries, and overuse. Consequently, we extracted 49 foreign and domestic scientific sources.

RESULTS: Archery injuries occur in 4.4 per 10,000 people involved in this sport. Acute injuries in archers are rare, mainly due to shooting errors and most often lead to soft tissue damage because of a fracture of a bow, arrow, or bowstring during a shot (83.3%) or as a result of touching the bowstring with a bow. Chronic injuries occur in 83.9% of archery athletes. The main risk factors for their occurrence include overuse, high repetitions during training, lack of strength of the athlete, and incorrect technique. Overuse (67.9%) is the most common cause of chronic tendon, ligament, and joint injuries. Injuries occurred in 30%–53% of cases in the shoulders (rotator cuff tear, scapular dyskinesia, and shoulder impingement syndrome), 12.8% in the elbow (medial and lateral epicondylitis and traumatic bursitis), 8.9%–19.9% in the spine and forearm (chronic tendovaginitis and tunnel syndromes).

CONCLUSIONS: Proper training and safety measures help prevent acute injuries. Practicing archery techniques and strength training are the main measures of preventing muscle overuse and reducing the incidence of chronic injuries.