Spontaneous rupture of extensor pollicis longus tendon: demonstration of extensor indices proprius transfer technique

СУХОЖИЛИЯ ТРАВМЫ /ХИРРАЗРЫВ СУХОЖИЛИЯ /ХИРРАЗГИБАТЕЛЬ БОЛЬШОГО ПАЛЬЦАТКАНИ ТРАНСПЛАНТАЦИЯПЕРЕСАДКА ТКАНИВОССТАНОВЛЕНИЕ ФУНКЦИЙКЛИНИЧЕСКИЕ СЛУЧАИВ настоящее время при разрыве сухожилия длинного разгибателя большого пальца кисти нет единой схемы хирургического лечения. В статье представлен результат лечения пациента со спонтанным разрывом сухожилия длинного разгибателя большого пальца кисти в IV зоне по Б. Бойчеву, с подтверждением нарушения по данным ультразвукового исследования. В оперативном лечении нами был использован метод Pulvertaft (пересадка сухожилия собственного разгибателя указательного пальца на сухожилие длинного разгибателя большого пальца кисти). Через 3 месяца после операции пациент достиг полного объема движений большим пальцем и показал полное функциональное восстановление. Ультразвуковое исследование может рассматриваться как достаточно точное и экономически выгодное диагностическое обследование при оценке случаев с подозрением на разрыв сухожилия длинного разгибателя большого пальца кисти и тендинозом. Этот случай показывает, что метод пересадки сухожилия собственного разгибателя указательного пальца на сухожилие длинного разгибателя большого пальца кисти является эффективным и надежным хирургическим пособием.Till now no single scheme of surgical treatment has gained wide acceptance in rupture of extensor pollicis longus tendon (EPL). The result of treatment of a patient with spontaneous rupture of EPL in IV zone by B. Boichev with ultrasonographic examination is presented in the paper. In surgical treatment we used Pulvertaft technique in transfer of tendon of m. extensor indicis proprius (EIP) to EPL. After 3 months of surgery the patient showed a full range of motions of the thumb joints and functional restoring. Ultrasonography can be considered as an accurate and cost effective diagnostic investigation in evaluation of cases with the suspected extensor pollicis longus tendon rupture and tendinosis. This case report shows that technique of EIP to EPL transfer is effective and reliable surgical option

Successful Early Non-Operative Management of Congenital Knee Dislocation: Demonstration via a Case Report

Congenital knee dislocation (CKD) is a deformity in which unnatural hyperextension is possible at the knee much beyond the normal 0° full extension while the flexion is severely restricted. Incidence of this rare congenital malformation is 1/100,000 live births. We present a clinical case of unilateral CKD in a 2-week-old female child and our approach of treatment using serial casting. We have been able to demonstrate that if initiated early, within first few weeks of life, the congenital deformity of knee can be managed conservatively without any surgical intervention even in higher grades

Operative treatment of orthopedic complications in upper limb in children and adults with cerebral palsy

Introduction The benefits of surgical treatment of orthopaedic complications in the upper limb caused by cerebral palsy have been debated by some researchers. Secondary complications developed due to muscle spasticity and retraction are a serious obstacle to a significant improvement in healthrelated quality of life of CP patients. Objective To explore outcomes of CP patients who underwent surgical treatment at the Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics” between 2014 and 2016. Material and methods Total 23 operative interventions were produced for 21 patients aged from 11 to 36 years (mean age of 16.6 years) using an authors’ technique. We used integral scales of the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Classification systems intended for differential evaluation of upper extremity motor and functional impairment included Van Heest’s deformity assessment test, the House upper extremity assessment test and Gshwind and Tonkin classification. Results Spastic diplegia was diagnosed in 6 cases including 4 GMFCS III and 2 GMFCS IV. Manual ability was assessed as MACS IV in 3 cases and MACS V in 3. Fifteen patients with hemiparethic spastic CP underwent surgical treatment of upper limbs. Manual ability was assessed as MACS III in 4 cases, MACS IV in 8 and MACS V in 3. The use of the limb by the House’s scale showed level 1 in 2, level 2 in 5, level 3 in 10 and level 4 in 6 cases. The Gschwind and Tonkin classification for pronated forearm revealed level 1 in1, level 2 in 8, level 3 in 10 and level 4 in 4 cases. There was correlation between an extent of pronation contracture and impaired function of the thumb. Improved functional abilities of the upper limb, the cosmetic appearance and comfort with the use were recorded in all the cases. Conclusion Results of multilevel interventions on upper limbs in CP patients allow us to conclude that differential approach to the choice of technique and extent of surgery to ensure efficacious surgical treatment

THE ERRORS, COMPLICATIONS AND MEASURES FOR ITS PREVENTION IN THE TREATMENT OF SCHOOL AGE CHILDREN WITH CONGENITAL RECURRENT CLUBFOOT BY ILIZAROV METHOD

Objective. To analyze the errors and complications of treatment of school age children with congenital recurrent clubfoot, treated in RISC «RTO» by transosseous osteosyntesis. Material and methods. Within the period of 1999-2010 119 patients (148 feet) between the ages of 7 to 18 years with congenital recurrent clubfoot were treated by the Ilizarovs method. Patients of this group, along with holding the wires on the shin and foot, corresponding to the Ilizarov fixator assembly, received surgical procedures on soft tissue, osteotomy and stabilizing operations. Results. In the course of treatment complications were observed in 22 patients, accounted for 18.5% of the total number of patients. All complications were typical for transosseous osteosynthesis, eliminated during a course of treatment and did not affect his final result. Conclusion. Adherence to the methodical principles of transosseous osteosynthesis by Ilizarov in the surgical treatment of patients of school age with recurrent congenital clubfoot and rational management of patients in the postoperative period is the prevention of complications and contributes to achieving good results

Limb lengthening and deformity correction in patients with severe fibular hemimelia: experience of the children's university hospital in Belgrade

Background Fibular hemimelia (FH) is a congenital disease manifested by valgus deformity and instability of the knee joint, shortening and deformity of the tibia, hypoplasia and deformities of the foot and ankle. The aim of this paper was to determine the efficacy of the strategy of separate reconstruction of the foot along with correction of tibia deformity, and then tibial lengthening in patients with FH of types 3 and 4 according to Paley. Methods This retrospective study is based on an analysis of the treatment of 12 children with severe FH. The patients, aged no older than 24 months, were treated for foot reconstruction along with correction of tibial deformity followed by a separate stage of tibial lengthening. Tibial lengthening was performed in the age 4.6 ± 1.2 years. The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire. Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. The results of lengthening were classified by Lascombes as IA in 7 cases, IB in four cases, 2B in one case. Discussion In severe FH, the question of reconstruction or early amputation remains open. There are two opinions on the staging of reconstructive orthopedic surgery and tibial lengthening in young children with severe FH. Conclusion The strategy of reconstruction of the foot and ankle joint at an early age (16-24 months) in children with severe FH followed by lengthening of the lower leg (at the age of 4-6 years) proved to be effective and can be used when it is chosen by the patient's parents. In 3C type cases, the use of external fixation to correct the deformity and simultaneously lengthen the tibia at the first stage is an alternative reasonable strategy option

CELL-MEDIATED IMMUNITY IN PATIENTS WITH POSTTRAUMATIC LONG BONE OSTEOMYELITIS IN THE COURSE OF MANAGEMENT WITH THE ILIZAROV METHOD

Cell-mediated immunity parameters were studied in 26 patients (13 males, 13 females) aged 46 years (range: 39-51 years) with fistular type of chronic posttraumatic osteomyelitis of the humerus during the course of surgical treatment with the Ilizarov monofocal transosseous osteosynthesis. The study time-points were pre-surgery period and the following treatment stages: days 3, 7, 21 after osteosynthesis and day 1 after removal of the device. An obligatory criterion of inclusion was absence of postoperative complications and infection recurrence at least a year after removal of the apparatus. Control group were 30 healthy volunteers in the similar age (15 males, 15 females). Carriers of HCV, HIV, HBsAg and persons with concomitant somatic pathology that could affect the results of immunological study were not included. The study of subpopulation composition of the peripheral blood lymphocytes was carried out using laser flow cytometry. The parameters of cell-mediated immunity in patients with a fistular type of chronic posttraumatic osteomyelitis of the humerus were characterized by mild lymphopenia, increase in the number of cells of early and late activation of T lymphocytes (CD3+CD25+, CD3+HLA-DR+). Physiological response of the immune system to debridement of the purulent foci and transosseous osteosynthesis was normalization of the number of activated T-lymphocytes at the final stage of surgical treatment. In general, the dynamic changes of immunological indices were in favor of persistent arrest of the infection process and were confirmed by clinical observations

Chirurgie du pied bot varus équin idiopathique

La prise en charge actuelle d’un pied bot varus équin idiopathique est essentiellement conservatrice : succession de plâtres correcteurs suivis d’attelles selon Ponseti, ou physiothérapie intense et attelles appropriées. Dans la première méthode, qui est largement utilisée dans le monde, une ténotomie d’Achille est proposée vers l’âge de 6 semaines lorsque la dorsiflexion de la cheville ne dépasse pas 10◦. Les autres traitements chirurgicaux trouvent une place lors des cas initialement très sévères, des insuffisances de correction, des récidives et des pieds dits négligés qui n’ont pas eu la chance, dans certains pays, d’être traités précocement. De moins en moins fréquents, ils doivent être assurés par des équipes hyperspécialisées. Les principales techniques et indications sont les suivantes. La libération des parties molles postérolatérale de cheville et antéromédiale médiotarsienne consiste principalement à effectuer des capsulotomies, des sections de retinaculum et des allongements tendineux, dont celui d’Achille, ainsi que des tendons tibiaux postérieur et antérieur. Réalisée « à la carte » en fonction des déformations, elle est justifiée autour de l’âge de la marche en cas d’équin persistant. Le transfert du tendon tibial antérieur, le plus souvent sur le cunéiforme latéral (troisième), trouve son indication vers l’âge de 5 ans en cas de persistance de la marche en supination du pied. Les pieds bots négligés et récidivés peuvent être traités selon un protocole « Ponseti » ou, lorsqu’ils sont extrêmement enraidis, par des corrections progressives à l’aide de fixateurs externes et d’ostéotomies du tarse et/ou des métatarsiens. Enfin, les séquelles sont améliorées par diverses ostéotomies. Avant toute intervention, la décision doit s’appuyer sur une analyse soigneuse de la marche en laboratoire de cinésiologie. Ainsi, la bonne connaissance des déformations et des techniques thérapeutiques conduit à faire diminuer le nombre des chirurgies tout en assurant une excellente fonction locomotrice

Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

The aim of the study is to evaluate the efficiency of triple arthrodesis of foot and its effect on soft tissues blood supply at the surgical site during simultaneous correction of segment deformity in patients with cerebral palsy.Material and Methods. The present study reflects the authors’ experience of triple arthrodesis for correction and stabilization of foot multicomponent deformities of varying severity in 75 patients (136 feet) with cerebral palsy (IIIV level by Gross Motor Function Classification System (GMFCS)) treated in the Ilizarov center in the period from April 2012 to December 2016. The average age of the patients was 16.4±4.3 years (from 11 years 8 months to 43 years 3 months). All patients included into the study had severe arthrosis of hind and midfoot. The main option of foot fixation in this group of patients was internal fixation (elastic threaded wires, compression screws) together with plaster cast immobilization for 6–8 weeks. All patients underwent average of 4.59 surgical elements during a procedure as part of simultaneous multilevel interventions. The blood supply at the surgical site was evaluated by laser and high-frequency Doppler flowmetry before and after all stages of the surgery.Results. Long-term outcomes were evaluated at the average of 19 months after the surgery in 56 (74.7%) patients. 37 patients (66.1%) demonstrated good treatment outcomes and 19 patients (33.9%) — satisfactory outcomes. No unsatisfactory outcomes were observed. The clinical outcome of foot surgery was evaluated using the Angus-Cowell criteria. The obtained significant x-ray enhancement was maintained at the control stages of the follow up. Despite large simultaneous correction of foot deformity, there was no decrease in the parameters of microcirculatory blood supply of the skin, muscles and subcutaneous fat of the foot. The authors observed a stabilized or an increased perfusion of soft tissues.Conclusion. Triple arthrodesis for correction of foot deformities in patients with cerebral palsy and severe arthrosis in hind and midfoot is an efficient method which allows to correct and stabilize gained position of segments. The data of physiological research testify the sparing approach of such procedure and a possibility of an earlier weight-bearing on operated limb