Developmental dysplasia of the hip (DDH) is a vital and most frequently diagnosed disorder in pediatricrequiring developement and implementation of new diagnostic methods because of failure in detection of early dysplastic changes. Limitation in applying the diagnostic instrumental methods in infants and lack of uniform standards of clinical practice and management results in the increase in treatment cost and duration of rehabilitation. The purpose of this study was the search for new sensitive methods of diagnostics and treatment of DDH and profound study of pathogenic mechanisms. Despite the great attention of international pediatric specialists to the problem of DDH in children, the methods for early diagnostics, prevention of severe forms and complications are not still developed. The current study identifies the molecular mechanisms of DDH pathology and analyses the opportunities of instrumental and non-instrumental methods for its diagnosis. The authors presented the promising biomarkers and cytokines for the diagnosis and prediction of DDH.
The objective was to analyze experimental animal models of osteonecrosis (ON) using the femoral head, show advantages and disadvantages, capacity to translate the findings for adult and pediatric orthopaedics, potential model modifications for orthopaedic and rheumatology research. Material and methods The original literature search was conducted on key resources including PubMed, Web of Science, Cochrane Library, E-library, and the Springer databank. Literature searches included Russian, English, and Italian studies. The research covered studies of 1980 to 2021 and included important landmarks of laboratory experiments with animal models. Results and discussion Although there was no ON model with ideal conditions found for it, the choice of a model could be based on the researcher’s goal reproducing ON as a type of “osteochondropathy” to explore the results applicable to pediatric orthopaedics or classical ON in adults. Animals with long-term open growth plates, intensive blood circulation in the bone and rapid regeneration being characteristic of juvenile models of rats, rabbits and pigs could be appropriate for the experiment. Dogs, sheep, pigs and emus, in particular, were practical for reproducing ON in adults. Non-traumatic models of ON in adults were reversible and consistent with early stages of the condition. Conclusion The need for ON simulation increased due to progressing orthobiological techniques (PRP‑therapy, BMCs technologies, etc.) in the treatment of ON. Application of orthobiological treatment resulted in heterogeneous, scattered outcomes being statistically unreliable and necessitating the search for optimal animal models and assessment of treatment methods for ON in modern orthopaedics.
We analyzed foot functions in the late postoperative period in 41 patients with post-traumatic arthrosis of their ankle joints. The study involved clinical and surgical techniques as well as the Foot Function Index (FFI) measuring and statistical methods. No significant differences in FFI scores were revealed in 6 months after ankle arthrodesis surgeries with plates or intramedullary nails. However, in 3 months after their surgeries the patients with intramedullary nails featured lower FFI scores suggesting earlier satisfactory outcomes in this cohort.
From the point of view of the characteristics of childhood and clinical and pathophysiological features of diseases in children, the injections of platelet-rich plasma (PRP) are an advantageous manipulation procedures characterized by minimal invasiveness, minimal risk of side effects, ease of obtaining material and manipulation technique, as well as the uselessness of anesthesia. The purpose of this research was to analyze the use and possible effectiveness of PRP therapy in pediatric practice and its application, in particular, in traumatology and orthopedics. The bibliographical search for the 2015 to 2022 sources was carried out using the electronic databases of scientific data in both Russian and English languages. In general, the PRP has a complex biological effect on regeneration, repair, and positive remodeling of connective tissue. Unfortunately, there is no sufficient experience worldwide in the use of PRP therapy in pediatrics, which makes it difficult to interpret the method, evaluate its effectiveness and indications for the use. In the authors’ opinion, the PRP therapy is very promising and of a great potential in pediatric traumatology and orthopedics, where it is important to combine it with additive technologies (kinesio taping, post-isometric relaxation etc.). The unresolved aspects of the pediatric PRP therapy call for pediatric practitioners of different schools to build an evidence database using both clinical observations and biological models.
A group of degenerative hip disorders in children is discussed in the current review. The key pathogenic focus of these disturbances is an initial hyaline cartilage alteration or subchondral bone, which provokes damage of the epiphyseal hip zone. Eventually, such events lead to a local inflammatory reaction in the hip joint, cytokine cascade with hypoxia and ischemia, and apoptosis and necrosis in the hip. Developmental hip dysplasia, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis are analyzed in this review as the spreading forms of degenerative hip disorders in children. The key points of etiology, pathogenesis, diagnostics, and treatment of each disease are characterized. A group of degenerative hip joint diseases remains under the close supervision of pediatric orthopedists and traumatologists because of their high prevalence, severity of clinical manifestations, damage of life quality, and development of complications in the form of arthritis. In addition, the lack of unified approaches to the application of treatment methods for degenerative hip joint diseases is the subject of discussion among surgeons and often causes a decrease in the quality of care in terms of time and volume.
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