Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

BACKGROUND: Fractures of elbow joint bones are the most common type of fracture in children. Despite methodological advances in managing these injuries, adverse anatomic and functional outcomes are still common in clinical practice.

AIM: The aim was to evaluate the structure of primary injuries and primary treatment strategies to evaluate the sequelae of elbow bone fractures in children.

MATERIALS AND METHODS: Based on inclusion criteria, a retrospective cohort (n = 115) was formed. Clinical, historical and radiological data were evaluated in patients with sequelae of elbow fracture, admitted for surgical treatment in the clinic of the H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery of Russia in 2022–2023. The Shapiro–Wilk test (for less than 50 subjects) or the Kolmogorov–Smirnov test (for more than 50 subjects) were used to test the normality of quantitative parameters. The Pearson’s chi-squared test was used to compare percentages in the contingency table analysis.

RESULTS: The mean age of patients in the study population was 11 years (ranging from 4 to 17 years). The duration of injury is 15.6 ± 1.0 months (min = 3; max = 65). Based on the structure of the sequelae, three groups were identified: patients with contracture (42 cases; 36.5%), patients with deformity (31 cases; 27%), and patients with both contracture and deformity (42 cases; 36.5%). Supracondylar fractures of the humerus (40%) and apophyseal fracture of the medial epicondyle (31%) were the most common primary injuries. Primary conservative treatment of the fracture was performed in 82 (71%) patients, primary surgery was performed in 33 (29%) children, and 17 patients were switched from conservative to surgical treatment. A total of 31 (27%) children had repeated procedures.

CONCLUSIONS: Contractures are the most common adverse outcome of elbow fractures in children. Characteristics of conservative treatment and repeated procedures indicate a need for better training of pediatric trauma surgeons. Even today, despite the development of advanced algorithms, the main causes of adverse outcomes are still errors in diagnosis, care strategies, and intervention techniques.

BACKGROUND: The reason for conducting this study was the lack of Russian literature on the relationship between visual foot assessment using the Foot Posture Index (FPI)-6 and foot dorsiflexion in preschool children.

AIM: The aim was to evaluate the relationship between visual foot assessment, FPI-6 and dorsiflexion in healthy preschool children.

MATERIALS AND METHODS: The study included 81 children aged 5–7 years (162 feet). All children were examined using visual foot assessment, FPI-6, assessment of passive dorsiflexion, Beighton hypermobility score, and anthropometric measurements (height/weight). Dorsiflexion was assessed with posterior segment stabilization and the knee joint in flexion and extension. The Kolmogorov–Smirnov test was used to assess the normality of the data distribution, followed by the use of parametric and non-parametric statistical tests. The analysis of variance (ANOVA) was used to compare the means of three groups. The Pearson’s test was used to assess correlations.

RESULTS: Flat feet was diagnosed in 41.0% of children. There were 2 times more boys than girls in the group with flat feet and 1.5 times more girls in the group without flat feet. The FPI-6 scores of the same feet were at least 8 in children with flat feet and 0 to 4 in children without flat feet. Moderate to medium correlations were found between the clinical diagnosis of flat feet and FPI-6 scores. In 95% of the children aged 5–7 years, dorsiflexion with the knee joint in extension was 11.4°–34.2°. Mean dorsiflexion difference between flexed and extended knees was 24.1° ± 9.5°. ANOVA showed no significant difference in dorsiflexion between children with and without flat feet.

CONCLUSIONS: The mean dorsiflexion in preschool children was 22.8° ± 5.7°. No reliable difference in dorsiflexion between children with and without flat feet was demonstrated. Gastrocnemius muscle retraction was evaluated quantitatively.

BACKGROUND: Triceps surae retraction plays a key role in the pathogenesis of flat feet in children. This is a pennate muscle. The pennation angle is defined as the angle between triceps surae fascicles and aponeurosis.

AIM: The aim of the study was to evaluate the effect of a long-term triceps surae stretching program on the pennation angle of the triceps surae head in children with flat feet and Achilles tendon shortening.

MATERIALS AND METHODS: The study included a total of 82 children with hypermobile flat feet and Achilles tendon shortening. The pennation angle was measured by ultrasound. Triceps surae stretching was recommended for 6 months as a basic exercise. SPSS v.26.0 was used for statistical analysis of data.

RESULTS: The study group included 63 children who performed stretching exercises and the control group included 19 children who did not perform stretching exercises at the required intensity. The study group showed a significant improvement in the Foot Posture Index (FPI)-6, while the control group showed no change. The baseline foot dorsiflexion was 4.84° ± 0.10° in the study group and 4.81° ± 0.17° in the control group. After 6 months of stretching, dorsiflexion was 11.34° ± 0.24° in the study group and 4.85° ± 0.19° in the control group (p < 0.01). The pennation angle of the triceps surae heads showed a significant increase in the medial head of the gastrocnemius and soleus muscles.

CONCLUSIONS: A long-term stretching program in children with flat feet resulted in a significant increase in foot dorsiflexion. These changes were associated with morphological and functional muscle restructuring, manifested by a significant increase in the pennation angle of the medial head of the gastrocnemius and soleus muscles. Further research will identify the mechanisms underlying anatomical and functional muscle restructuring and their effects on anatomical foot parameters in flat feet.

BACKGROUND: Legg–Calvé–Perthes disease is a multifactorial disease with a non-inflammatory and avascular mechanism of necrotic lesions. In some cases, children may have more aggressive disease with signs of osteoarthritis. This variant of Legg–Calvé–Perthes disease is characterized by active inflammation of the bone tissue and arthritis, often leading to severe deformity of the femoral head and early coxarthrosis. The problem of treating osteoarthritis in children with Legg–Calvé–Perthe disease is not solved due to the low effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs). Osteoclast inhibition therapy with bisphosphonates in adults with idiopathic aseptic necrosis of the femoral head has been pathogenetically accepted. The use of bisphosphonates in children with Legg–Calvé–Perthe disease and osteoarthritis has not been evaluated.

AIM: The aim of the study was to evaluate the efficacy and safety of bisphosphonates in children with Legg–Calvé–Perthes disease who presented with signs of osteoarthritis.

MATERIALS AND METHODS: The study used data on the treatment of 14 children (mean age 7.5 ± 2.4 years, 71.4% girls) with Legg–Calvé–Perthe disease (at the impression fracture stage) and active hip osteoarthritis. All children had torpid arthritis refractory to NSAID therapy and present for at least 3 months. Treatment included ibandronic acid at 1.0 mg and 1.5 mg per infusion every 3 months in children younger than 7 years old and older than 7 years old, respectively. Five consecutive infusions were performed in the study. Treatment outcomes were assessed at 6, 12, and 18 months based on combined clinical, imaging, and laboratory changes. A modified SCORING OF HIP MRI FOR JIA score was used to assess osteoarthritis activity.

RESULTS: All children showed a decrease in hip pain after the first infusion of ibandronic acid. The inactive phase of osteoarthritis during bisphosphonate treatment was achieved in 78.5% (11) of children after three consecutive infusions and in 21.5% (3) of children after four infusions. Post-infusion reactions were reported in 85.7% (12) of children during the initial phase of bisphosphonate treatment and were transient. Serum erythrocyte sedimentation rate, C-reactive protein, interleukin-6, and tumor necrosis factor-alpha levels were within reference ranges in children with osteoarthritis. Only 28.5% (4) of patients were found to have 25(OH)Vitamin D deficiency at the time of osteoarthritis diagnosis.

CONCLUSIONS: The use of bisphosphonates in children with Legg–Calvé–Perthes disease and osteoarthritis can be considered an innovative pathogenetic treatment option. The data obtained suggest the potential for the use of bisphosphonates in children with Legg–Calvé–Perthes disease. Further follow-up of children in the study group is needed to assess long-term outcomes.

BACKGROUND: Despite the availability of many surgical treatment options, the surgical management of congenital spinal deformities in preschool children remains a significant and pressing problem. Current techniques for transpedicular screw placement have some limitations.

AIM: The aim of the study was to evaluate the results of surgical treatment of children with congenital thoracic and lumbar deformities with impaired vertebral development based on literature data.

MATERIALS AND METHODS: This article reviews the literature on surgical techniques for congenital spinal deformities using additive technologies. Data searches were performed using keywords in the PubMed and eLibrary databases. A total of 396 papers were selected for 2000–2023, of which 51 were thematically relevant.

RESULTS: It is too early to draw conclusions about the positive results of using additive techniques, especially in the surgical treatment of congenital deformities in preschool children with hemivertebrae, due to the small number of patients described in the literature by different authors.

CONCLUSIONS: After reviewing several articles on the use of guides for transpedicular screw placement in congenital thoracic and lumbar anomalies in early preschool children with impaired vertebral development, it is concluded that this promising technique provides high accuracy of screw placement, reduces the number of complications, but further research is needed.

BACKGROUND: Degenerative/dystrophic cartilage diseases are an epidemiologically important challenge in modern traumatology and orthopedics. The use of autologous mesenchymal stem cells to repair cartilage defects is currently the most promising treatment option.

AIM: The aim of this paper was to review the literature on the use of adipose tissue-derived mesenchymal stem cells to repair articular cartilage defects in laboratory animals.

MATERIALS AND METHODS: Recent and historical Russian and English literature was searched in Google Scholar, Cyberleninka, PubMed, eLibrary, Mendeley, Science Direct databases for over 20 years. A total of 113 papers were selected, and 25 papers that met the inclusion criteria were selected based on full-text materials and abstracts.

RESULTS: Literature shows that autologous adipose-derived mesenchymal stem cells stimulate hyaline cartilage regeneration. The vast majority of studies show that the addition of both differentiated and undifferentiated cells accelerates cartilage repair, regardless of the composition of the vehicle matrix or gel. Adipose-derived mesenchymal stem cells can also be used as a stand-alone technology without any vehicles.

CONCLUSIONS: There is still no ideal graft to restore cartilage tissue, despite a wide range of technologies, surgical techniques and materials for repairing cartilage defects. However, mesenchymal stem cells improve the rate of defect repair and may become a new therapeutic strategy for degenerative/dystrophic cartilage diseases.