BACKGROUND: Congenital posterior elbow dislocation in children is a rare and scarcely reported condition. Owing to the difficulties of an early primary diagnosis and the lack of a standardized management, we present a clinical case of an analysis of surgical treatment according to literature and based on our experience. CLINICAL CASE: We present a case of congenital posterior elbow dislocation in a 7-year-old child. In the absence of a universal algorithm for surgical treatment, we performed an arthrotomy for visual assessment of articular surfaces, intervention on the capsule and tendons of m. brachialis, m. biceps brachii, m. brachioradialis, and modeling of the proximal epiphysis of the right radius. DISCUSSION: We analyzed surgical treatment options and made an overview of the main stabilizers of the elbow joint that prevent elbow dislocations. There are few publications on this condition; to our knowledge, over the past 10 years, only two clinical cases of a similar pathology in children had been published. Not a single case of congenital elbow dislocation in the neonatal period has been described. We analyzed early clinical manifestations and possible causes of delayed primary diagnosis. CONCLUSIONS: Recurrent posterior elbow dislocation of the congenital origin is associated with a functional deficiency of elbow joint stabilizers. In the neonatal period, these abnormalities are usually not detected. The first episode of dislocation may be triggered by a minor trauma without damaging the bone structures. Delayed primary diagnosis may be associated with the paucity of clinical symptoms and compensatory functionality in children. The decision on surgical correction should be based on the analysis of structural anatomical changes in the assessment, of which magnetic resonance imaging plays an important role.
Background. Chest deformities occur in 7% of the population, of them funnel deformation of the thorax constitutes more than 80%. Surgical correction appears to be the only way to change the configuration of the chest. The Nuss procedure is the "gold standard" to correct this deformity. This technique was modified in the clinic of the Department of Pediatric Surgical Diseases, Siberian State Medical University, Tomsk. The necessity to compare the Nuss procedure and its modified option has arisen due to accumulated experience in surgical interventions performed.The aim of the study was to describe a modified technique of the funnel deformation of the thorax and assess its effectiveness compared to the classical Nuss procedure.Material and methods. The study included results of surgical treatment of 94 children, both sexes, aged 10 to 17 years, who had the funnel deformation of the thorax. All patients were divided into two groups: the main group (45 patients), where a modified technique of surgical correction was applied, and the comparison group (49 patients), where the classical Nuss procedure was applied for the deformity correction. For the surgical correction of the funnel deformity of the thorax, improved plates made of smooth titanium nickelide were used to fix the sternocostal complex in children of the main group. The following criteria were selected to compare the effectiveness of two surgical options of the funnel deformation correction: intraoperative parameters, Gizycka index, the scale of role functioning SF-36, VAS of pain and the number of complications. The arithmetic mean number was derived based on the above criteria - the total efficiency coefficient; clinical results were defined depending on this coefficient - good, satisfactory and unsatisfactory.Results. The number of good results in patients of the main group, where modified surgery technique was applied, was 62.3% compared to 38.8% in patients who were exposed to the Nuss procedure. The number of satisfactory results in patients of the main group was 35.5% compared to 34.7% in patients of the comparison group. It should be noted that the use of the modified technique had unsatisfactory results in 2.2% of cases (in 1 patient), while the use of the conventional Nuss procedure resulted in unsatisfactory outcomes in 26.5% of cases.Conclusions. Clinical outcomes of surgical correction performed using modified technique of the Nuss procedure are more beneficial in terms of the duration of intervention, the volume of blood loss, and the number of postoperative complications. This technique allows minimizing invasiveness of the procedure and starting early rehabilitation.
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