Congenital pseudarthrosis of the tibia (CPT) is a rare disease that is detected with a frequency of 1 in 140–250,000 newborns. The disease is characterized by a wide range of clinical and radiological signs from progressive antecurvature deformation of the tibia to nonunion with a significant bone defect. Changes in the CPT area are caused by the influence of pathologically altered periosteum, which forms a fibrous hamartoma and is responsible for the deformityof the biomechanical properties of bone tissue. CPT can be formed at the moment of birth or developed spontaneously or as a result of minimal trauma in the early years. The main method of treatment of CPT is a surgery. Nowadays a number of surgical techniques, which are actively used and improved by specialists in the world, has been developed, The most used methods are the Ilizarovʼs method, application of intramedullary fixators, techniques with the use of vascularized tibial autograft, «induced membrane» technique. However, there are a few studies on comparing the effectiveness of different techniques or metal fixatives, most of them are presented in the format of a retrospective analysis of clinical cases series. This is due to the rarity of the disease and the lack of unified approaches on the choice of surgical treatment techniques. The main aim of surgical treatment of CPT is to achieveconsolidation in the area of pseudoarthrosis, which may restore the limb resistance. The part of primary consolidation of CPT after using the surgical treatment various techniques varies very much, range from 60 to 100 %. The percentage of children with CPT tibial amputations has decreased significantly over the past 30 years, which generally indicates an improvement of the results of surgical treatment of the mentioned pathology. However, CPT still remains one of the most difficult diseases of pediatric orthopedics due to the large number of unsatisfactory results and complications after surgery.
There are no questionnaires available in Ukrainian that can be used to objectify the results of treatment of orthopaedic and traumatological pathology of the knee joint in children. In world practice, subjective Pedi-IKDC and KOOS-Child scales are used for this purpose. Objective. Validation, intercultural adaptation and translation of the Pedi-IKDS scale in English (original) into Ukrainian for paediatric patients. Methods. Translation and adaptation agreed with the copyright holder of the AOSSM test and performed according to the requirements of the Recommendations for the Cross-Cultural Adaptation of Health Status Measures of the American Academy of Orthopaedic Surgeons Institute for Work & Health. The translated and adapted questionnaire has been tested on a heterogeneous group of 10 children treated for knee pathology. The questionnaire has been adjusted. The participants (both sexes, aged 10–18 years) have been divided into two groups for validation: I — without knee pathology, tested once; II — with knee injuries and physical limitations, tested before and after treatment. Results. We obtained 50 questionnaires in group I (50 children). Student's t-test has been chosen for the analysis of results. To compare the accuracy of the translation, a comparison has been made with the results of A.Y. Nasreddine's study (unpaired Student's t-test). The resulting differences between the original questionnaire and its translation have not been statistically significant (p = 0.966). Group II received 200 questionnaires. A paired Student's t-test has been chosen for analysis. Test results before and after treatment have been significantly different (t2 > tcrit, p < 0.001). The appropriateness and objectivity of the Pedi-IKDC questionnaire have been confirmed. Conclusions. The Pedi-IKDC test has been successfully translated into Ukrainian and adapted for use. The quality of adaptation has been confirmed and no statistically significant difference has been found compared to the results of the world studies. Pedi-IKDC is recommended to be used in children with knee pathology for clinical and scientific purposes.
It is impossible to find out the number of patients with knee joint instability (KJI) in case of congenital malformations of the lower extremities (CMLE). Children, adolescents and young people usually adapt well to this abnormality, so they rarely present with symptoms of instability, even with positive tests. The main reasons for the manifestation of KJI in CMLE are inadequate loading, injuries of the lower extremity and surgical correction. Objective. Based on the assessment of the scientific literature to define the KJI terminology, to identify the main causes of its development and clinical manifestations in conditions of CMLE, to identify trends in the treatment tactics. Methods. More than 500 articles from international libraries PubMed, NCBI, Google Scholar, Medscape, MedlinePlus were searched and analyzed. Taken into account the rarity of the abnormality and the small amount of research in recent years, the depth of the search was 25 years. Results. KJI in children with CMLE may be a consequence of congenital structural features of the lower extremity (isolated malformation in the form of agenesis of the cruciate ligaments or inferiority of the ligament of the knee joint in complex abnormality) and complication of surgical correction of longitudinal defects of the extremities. As the abnormality is not well studied, the tactics for such patients still remain the topic of discussion. The expediency of surgical stabilization of the knee joint has not been conclusively proven due to the fact that in the case of its anomalies certain adaptive mechanisms are formed, which on the one hand are not appropriate to violate, and on the other hand, the current level of medicine allows to promote patients’ functional capabilities, inducing KJI progressing. Conclusions. Children with CMLE adapt well to the concomitant KJI, so in everyday life and prior to surgical correction of CMLE, it does not bother patients. Particular attention should be paid to the stability of the knee joint both before and during prolongation and correction of deformity. The variability and severity of CMLE determines the implementation of multi-stage surgical treatment and surgical stabilization of the knee joint to improve extremity function may be one of them. Key words. Children, knee joint instability, congenital malformations, lower extremities, surgical treatment.
Congenital pseudarthrosis of the leg bones is accompanied by its shortening and deformation. It’s still unclear what is an optimal method of surgical treatment. Objective. Using a mathematical model, to study the relative deformations of the regenerate (RDR) in the zone of pseudarthrosis bones of the lower leg under different options of osteosynthesis. Methods. The zone of nonunion was modeled of the bones of the lower leg third of tibia and 4 variants of osteosynthesis on were analysed: intramedullary rod and needle (1); rod, spoke and bone graft in the form of a block on the tibia (2) or on both (3) bones; rod, spoke and bone with a graft on both bones of the leg with wrapping titanium mesh (4). A rotationally stable and unstable rod was used. Under the influence of the load on compression and torsion determined the values of RDR in the zone of pseudarthrosis. Results. In the case of osteosynthesis of option 1, intramedullary rods of both types (due to axial mobility of their elements) do not provide minimal deformation regenerates of both bones, so there is a possibility of their growth during the growth of the patient. Bone blocks grafts (options 2 and 3) take over part of the compressive load and the level of the RDR of the bones decreases up to 20 times. Rotationally stable rod is better under conditions of torsional loads, since RDR of the tibia is reduced by 20 times. However, bone graft blocks negate this advantage, providing rotational stability of bone fragments lower legs. The use of titanium mesh provides an additional strength of fixation of fragments of both tibia bones and level RDR of bones is reduced by 10 % compared to models of osteosynthesis with a block of grafts for both loading options. Conclusions. The use of only intramedullary rods that «grow» leads to the greatest deformations of regenerates. A rod with rotational stability is better under torsional loading conditions. Blocks from bone grafts reduce the level of RDR of bones tibia to a level of less than 0.1 % for both loading options, and the titanium mesh to an additional 10 %.
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