Spinal osteotomy for children with congenital scoliosis with unilateral unsegmented bar: Preliminary results

Introduction. Segmentation disorder of the lateral surfaces of the vertebral bodies leads to the development of progressive deformity of the spine. Surgical interventions in different variants are the only effective way of treatment. This study examines the use of corrective vertebrectomy in patients with congenital scoliosis with impaired segmentation of the lateral surfaces of the vertebral bodies. Objective of the study. To evaluate the results of surgical treatment of children with congenital scoliosis with impaired segmentation of the lateral surfaces of vertebral bodies. Materials and Methods. A single-center retrospective study on the basis of the Department of Spinal Pathology and Neurosurgery at the Turner Scientific and Research Center for Pediatric Traumatology and Orthopedics. G.I. Turner for the period from 2014 to 2020. Twenty-six patients were included in the study: 14 girls and 12 boys. The age range was 84 to 144 months. All patients underwent surgical intervention in the volume of a one-stage corrective wedge vertebrectomy. Statistical processing was performed by comparing the reliability of differences in distributions using Wilcoxon t-criterion. Results and discussion. The median Cobb preoperative scoliotic deformity was 31, interquartile interval (IQR) = 30.5. The median preoperative lordotic deformity was 29 Cobb, IQR = 29.5. The magnitude of correction of the scoliotic component of the deformity was 84%, (median value after intervention: 5 according to Cobb, IQR = 14.5). The magnitude of correction of pathological lordosis of the thoracic spine was 41%, (median value after intervention: 17 according to Cobb, IQR = 14.5). The obtained results were statistically significant (p 0.05). Conclusion. Corrective wedge vertebrectomy is an effective method for surgical treatment of children with congenital spinal deformity with impaired segmentation of the lateral surfaces of vertebral bodies. This method of treatment achieves an average of 84% correction of scoliotic deformity and 41% correction of pathological lordosis.

Andrey Ivanovich Krasnov. 29.04.1947–15.11.2021

On November 15, 2021, at the age of 75, an outstanding orthopedic traumatologist, Honored Doctor of the Russian Federation, Candidate of Medical Sciences, associate professor of the Educational and Methodological Department of the FSBI "NMIC of Pediatric Traumatology and Orthopedics named after G. I. Turner" of the Ministry of Health of Russia, associate Professor of the Department of Pediatric Traumatology and Orthopedics of the I. I. Mechnikov Northwestern State Medical University of the Ministry of Health of Russia Andrey Ivanovich Krasnov passed away.

DIAGNOSTIC TACTICS FOR TRANSCONDYLAR AND SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN

Transcondylar and supracondylar fractures of the humerus in children are one of the most relevant and still not completely solved problems of modern pediatric traumatology. In the problem of condylar and supraorbital fractures of the humerus, the issues of diagnosis, choice of indications for surgical revision of the vascular-nervous bundle of the elbow area in this pathology are insufficiently covered. To solve the problems of the study, we analyzed the treatment of 313 victims with transcondylar and supracondylar fractures of the humerus, which were treated at the City Children's Clinical Hospital in Lviv in the period from 2013 to 2018. The structure of the distribution of arrays on the basis of rotational displacement in condylar fractures of the humerus is dominated by displacement up to 30°, which in the first group was found in 61.8% of cases, and in the second group - 69.2% of cases. The share of severe rotational displacements in the structure of group arrays is almost the same in both observation groups: 29.1% in the first group and 29.5% in the second group. Analysis of the proportion of extremely severe rotational displacements up to 90° in the structure of group arrays revealed that such victims were 7 times more among the victims of the first group than among the victims of the second group, due to the use of the proposed unified protocol scheme for diagnosis and treatment humeral fractures in pediatric patients, which avoids or reduces the difference in the occurrence of secondary displacements.

Fingertip defects coverage using reverse-flow homodigital island flaps

BACKGROUND: The hand has always been a highly organized tool in humans daily and professional activity. Distal phalanges are most commonly exposed to trauma, which often cause defects that need to be covered through plastic surgery. One of the most reliable and universal methods for fingertip reconstruction is the reverse-flow homodigital island flap. CLINICAL CASES: This series of clinical cases describe three children aged 7, 8, and 11 years who underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In all cases, mechanisms of injury were associated with crushing and rupture of soft tissues. All children underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In the first case, evaluation results at 6 months after surgery revealed 4 mm in the Webers test and phalanx length deficit of 2 mm. In the second case, the assessment performed 1 month after surgery revealed 5 mm in the Webers test and the length of the operated phalanx corresponds to the contralateral one. In the third case, results of the 2-month observation period revealed 4 mm in the Webers test and lengths of the operated and contralateral phalanges were the same. DISCUSSION: The reverse-flow homodigital island flaps have irrefragable advantages among methods of surgical reconstruction of soft tissues of distal phalanges. These are single-stage reconstruction techniques that can possibly replenish sufficient amounts of soft tissues to the defect. A literature data analysis of the outcomes of the fingertip reconstruction through the reverse-flow homodigital island flaps revealed good and satisfactory results. CONCLUSIONS: The method of the reverse-flow homodigital island flap has potential to take a significant place in pediatric traumatology and reconstructive surgery.

The state of the problem of fractures of the distal metepiphysis of the humerus in children and adolescents

Annotation. One of the most frequent injuries of the distal end of the humerus is the trans-condylar and supracondylar fractures of the humerus, which make up 47.5-80% of all intraarticular fractures of the elbow joint in children. Among the injuries of the distal humerus, the supracondylar and supracondylar fractures occur with the greatest frequency and is one of the most common domestic injuries in children aged 3 to 12 years. Our work is based on a retrospective analysis of the treatment of 255 patients treated in the Lviv City Children's Hospital for the period 2013-2017. 83.1% of patients were diagnosed with flexion fracture, 16.9% – flexion fracture. Transvertebral fractures of the shoulder were diagnosed in 85.5% of cases of the study array, supragingival – in 14.5%. The treatment of patients with the consequences of injuries of the elbow joint presents great difficulties and remains one of the most difficult problems in pediatric traumatology. Depending on the presence of rotational displacement and the severity of the fracture, the following types of treatment are most often used: conservative, osteosynthesis with spokes or Ilizarov apparatus. An ideal reposition and stable fixation of fragments during these injuries is necessary not only to ensure timely consolidation of the fracture, restoration of the anatomical integrity and shape of the distal humerus, but also to prevent the development of deformation in the elbow joint. Deformations of the elbow joint during supracondylar and supracondylar fractures of the shoulder, unlike deformation of another localization, cannot be adjusted and subsequently only increase and as a result can lead to impaired function of the elbow joint, and often to disability already in childhood. Thus, complicated anatomical localization of supracondylar and supracondylar fractures of the humerus in children, great technical difficulties in comparing and fixing fragments, there is a high probability of neurological and vascular disorders, both at the time of injury and during the provision of medical care, impaired function of the elbow joint determine the need for further study of this problem.

Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

Purpose Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities. Methods The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases. Results In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome. Conclusion In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.

Prospects of hydroxyapatite-based nanomaterials application synthesized by layer-by-layer method for pediatric traumatology and orthopedics

The present brief review focuses on the features of the Layer-by-Layer (LbL) synthesis of coatings containing hydroxyapatite nanoparticles and assesses their use in solving several biomedical problems. This work provides the state-of-art of this field. This method is based on the sequential chemical adsorption of reagents on the substrate surface that makes it possible to apply nanolayers of the specified composition on the surface of a wide range of substrates of complex shape, to control the thickness of the synthesized layers accurately at the nanometer level. It also enables the modification of surface characteristics, including roughness, hydrophilicity, and surface charge, and allows artificially constructed multilayers consisting of hybrid organic and inorganic substances to be obtained. The experimental material presented in the review demonstrates the effectiveness of LbL synthesis for creating new 3D scaffolds as bone substitutes, coatings on the surface of metal implants, and drug delivery systems. A promising direction for the development of LbL synthesis is the creation of methods that involve ion-substituted hydroxyapatites as reagents. Success in this area can pave the way for significant advances in biomedicine and open new opportunities for creating a new generation of structures that mimic the structural, compositional, and mechanical properties of the bone mineral phase.

Surgical treatment of congenital pseudoarthrosis of the clavicle in children

Introduction. In the literature the issue of indications for surgical treatment of CPC (congenital pseudoarthrosis of the clavicle) is exposed to discussion. Also, there are no accurate age indications for surgery. The conducted research has shown that the course of CPC is accompanied by clavicle shortening as well as by bone fragments deformation in 60% of the cases, which has a significant effect on the planning of surgery. Purpose of study: to develop a differentiated approach to the treatment of congenital pseudoarthrosis of the clavicle in children, taking into account the clinical and radiological picture. Patients and methods. 27 patients with the congenital pseudoarthrosis of the clavicle (CPC) aged from 4 up to 16 years old were operated. In 6 observations bone fragments deformation of the clavicle was absent, and in 21 observations various deformations occurred. The surgery included restoration of clavicle axis, replacement of bone tissue defect with bone autograft, fixation of bone fragments with a needle. Results. After the first surgery, bone fragments consolidation of the false joint was reached in 82% of the cases (22 patients); the recurrence of the false joint was observed in 18% (5 patients). Repeated surgeries were successfully performed on four of them; one patient is being observed on an outpatient basis. Conclusion. The results of the surgical treatment have shown that for the union of a false joint it is necessary to use differentiated approach to the adoption of surgical technique with regard to bone fragments deformation. Partially eliminated deformation and clavicle sternal bone fragment high standing served as the main reason for the recurrence of pseudoarthrosis. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with financial support «Research Institute of pediatric traumatology and orthopedics G.I. Turner» Ministry of Health Russia