Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

Partial monopolar transfer of pectoralis major for elbow active flexion restoration in children with arthrogryposis

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii. AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle. MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11. RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 31.72) postoperative. The mean age of patients was 6.24 4.24 years. The active postoperative elbow motion was 0120 (71.94 33.40). The passive postoperative elbow motion did not change and was 90130 (104.12 12.40). Muscles strength after the operation was grade 25. Elbow extension was limited in 30 cases (76.9%) from 0 to 40 (21.70 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%). CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.

Prosthetic liner-socket design for children with long congenital and amputated shoulder

BACKGROUND: Traditional cosmetic prosthetic designs for a long shoulder stump in children have several disadvantages, such as a rigid uncomfortable receiving socket, the need to use a strap fastening, and the non-cosmetic product due to the disproportionate shoulder and forearm length compared with the preserved limb. AIM: This study aimed to design, manufacture, and test a prototype of the shoulder stump liner-socket. MATERIALS AND METHODS: A new liner-socket of a shoulder cosmetic prosthesis has been developed, confirmed by a Russian Federation patent for an invention, which for the first time, in the practice of domestic prosthetics, is made of two types of silicone and has been successfully used in cosmetic prosthetics for 17 children, of whom 10 previously used traditional long stump prosthesis. Satisfaction with new liner-socket prosthesis was analyzed using a psychometric scale compared with a conventional prosthesis. RESULTS: The developed design combines both the inner socket function, which allows the elbow hinge to be attached to it and the liner properties, which ensures a comfortable stay of the stump in the receiving socket due to the properties of silicone and excludes the use of traditional bandages. CONCLUSIONS: The presented medical and technical solution ensures the simplicity and reliability of fastening the cosmetic shoulder stump prosthesis, including on the long shoulder stump, without disturbing the relatively healthy limb proportions, as well as wearing comfort.

Lower jaw reconstruction using a vascularized bone graft is the main stage of complex rehabilitation of a child with lower jaw osteoblastoclastoma

BACKGROUND: Jaw bone benign tumors and dysplasia in childhood often have an aggressive growth pattern, which requires early radical operations. Uneven growth and changing morphological characteristics of the childs dentofacial apparatus imply stage-by-stage bone and plastic surgery in the maxillofacial region. CLINICAL CASE: The paper presents a clinical observation of the medical rehabilitation of a patient from 5 to 24 years old with lower jaw osteoblastoclastoma following our proposed algorithm. DISCUSSION: The presented clinical observation demonstrates all the main stages of medical rehabilitation of a child with a benign lower jaw neoplasm. Along with timely and fully operative neoplasm removal, rational dental prosthetics, and dispensary observation with X-ray diagnostics play an important role in the childs growth period. All these measures were important to prevent a possible neoplasm recurrence, partially maintain the masticatory function for the growth period, and avoid secondary postoperative dental apparatus deformities. The age of repeated surgery to replace the titanium structure with autosteal tissue depends on the individual characteristics of patients. The operation can be performed, in some cases, starting from age 1617 years. CONCLUSIONS: Successful treatment of children with benign neoplasms of the lower jaw after post-resection defects is a complex multi-stage process of medical rehabilitation, of which the completion, most often, passes into the adult period.

Congenital dislocation of the knee in combination with Meyer-Gorlin syndrome: A case report

BACKGROUND: Meyer-Gorlin syndrome is a rare genetic and autosomal recessive disease that is characterized by the classical triad, including, microtia, very small size or complete patellar absence, and nanism. CLINICAL CASE: Herein, presented the first clinical case description of a Russian patient with Meyer-Gorlin syndrome in combination with congenital anterior shin dislocation. The main clinical disease manifestations are characterized by a combination of microtia, patellar pathology, and dwarfism. DISCUSSION: In the practice of pediatric orthopedic surgeons, cases of congenital knee dislocations are extremely rare, especially as part of any syndromes, which cause interest in the presented clinical case publication. Our patient analysis, as well as the patients described in the literature, showed the presence of typical clinical manifestations, which allowed us to suspect the presence of Meyer-Gorlin syndrome during a clinical examination. CONCLUSIONS: This report is the first case of combined congenital knee dislocation and Meyer-Gorlin syndrome with a diagnostic triad (short stature, microtia, and patellar aplasia) in the Russian Federation. Conservative treatment with constant traction and flexion must be carefully performed to avoid complications. Without the effect of conservative therapy, surgical treatment is indicated.

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.

Speech development in children of preschool age with arthrogryposis multiplex congenital with upper limb deformities

BACKGROUND: The difficulties or gross disturbance in motor development, which are diagnosed in children at an early age, are one of the prognostic markers of further problems in their speech development. AIM: This study aimed to determine the speech development of children with arthrogryposis multiplex congenita with upper limb deformities. MATERIALS AND METHODS: Speech examination was conducted in 21 children with arthrogryposis multiplex congenita preschool age (average age: 5.16 1.49 years) from 2020 to 2021. Patients were divided into 2 groups: group 1 (10 people) with children of younger and middle preschool age (average age 3.81 0.63 years) and group 2 (11 people) with children of older and preparatory preschool age (average age 6.39 0.78 years). The speech examination results were exposed to statistical analysis. RESULTS: The majority of children with arthrogryposis multiplex congenita had speech pathology (90.5%), whereas general speech underdevelopment dominated over speech development delay (78.9% and 21.1%, respectively). A high frequency of perinatal hypoxic-ischemic encephalopathy in children with arthrogryposis multiplex congenita (80.9%), a complicated perinatal anamnesis (57.1%), and a delay in early motor or speech development (100% and 52.4%, respectively) links with speech disorder development in the future. Patients with arthrogryposis have a large percentage of congenital pathology of the articulatory apparatus structure (57.1%). Of the children, 76.2% were with a total form of arthrogryposis multiplex congenita, whereas 23.8% with an isolated upper extremity lesion. No statistically significant differences were determined in the form of speech pathology between patients with various forms of arthrogryposis multiplex congenita. Children of the first age group had speech disorders in 90% of cases, whereas 90.9% in group 2. Based on the form of speech pathology, patients with general speech underdevelopment and speech development delay were determined in group 1 (55.6% and 44.4%, respectively), whereas children with general speech underdevelopment in group 2 (100%). In the clinical form of speech pathology, dysarthria prevailed in children of both age groups (80%). CONCLUSIONS: Children with arthrogryposis multiplex congenita with upper limb deformities have a high incidence of speech disorders. Early speech examination and speech therapy eliminated all detected disturbances.

Algorithm for torticollis diagnosis in children of younger age groups

BACKGROUND: Torticollis is a common term for abnormal head or neck positions. Torticollis can be due to a wide variety of pathological processes, from relatively benign to life-threatening. This syndrome is of particular relevance in pediatric practice and is often underestimated at the primary care level. AIM: To analyze the data of domestic and foreign literature on the etiopathogenesis and clinical features of various types of torticollis in children and develop algorithms for the differential diagnosis of torticollis in children of younger age groups. MATERIALS AND METHODS: A literature search was conducted in the open information databases of eLIBRARY and Pubmed using the keywords and phrases: torticollis, congenital muscular torticollis, non-muscular torticollis, acquired torticollis, and neurogenic torticollis, without limiting the depth of retrospection. RESULTS: Based on the literature data generalization, the classification of torticollis and the key directions of its differential diagnosis are systematized in tabular form. The range of differential diagnosis of torticollis is quite wide and has its characteristics in newborns and children of the first years of life, contrary to older children. The most common is congenital muscular torticollis. Concurrently, non-muscular forms of torticollis in the aggregate are not uncommon, more often with a more serious etiology, and require careful examination. Based on the analyzed literature, differential algorithms for torticollis diagnosis in children of younger age groups have been compiled. CONCLUSIONS: Increasing the level of the knowledge of pediatric clinicians in the etiopathogenesis of torticollis syndrome will improve the efficiency of early diagnosis of dangerous diseases that lead to pathological head and neck positions in children.

Treatment outcomes of patients with knee hyaline cartilage damages using osteoperforative methods

BACKGROUND: The treatment of traumatic and degenerative cartilage damage is one of the largest areas in orthopedic practice, and the therapy success remains limited. AIM: To analyze the results of surgical treatment of patients with traumatic and degenerative injuries of the knee joint hyaline cartilage using debridement and osteoperforative techniques, taking into account the time from the surgical intervention. MATERIALS AND METHODS: A statistical analysis was conducted on the treatment outcomes of servicemen with traumatic and degenerative damage in the knee joint articular hyaline cartilage. Patients underwent surgical treatment using osteoperforative techniques (abrasive chondroplasty, tunneling, and microfracturing) at the Clinic of Military Traumatology and Orthopedics of the S.M. Kirov Military Medical Academy from 2009 to 2019. The study relied on the data obtained from questioning the patients using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and LKSS questionnaires. RESULTS: The result analyses using the KOOS and LKSS scales revealed significantly higher good results in the observed group in the postoperative period from 1 to 4 years than in the groups from 4 to 8 and more than 8 years (p = 0.004). No significant differences were determined in the treatment outcomes of the groups with resection and different osteoperforative methods. CONCLUSIONS: Treatment methods for hyaline cartilage defects, such as resection and osteoperforative, are technically simple with good treatment outcomes in patients with articular cartilage injuries from 1 to 4 years postoperative. Treatment outcome deterioration was noted in 48 years postoperative, regardless of the treatment method used, which is more significant in patients in 8 years postoperative.

Scaphocapitate fracture syndrome in a child

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.