Introduction Cerebral palsy (CP) is the most common neurological disorder in children, associated with movement disorders. The maximum age for reconstructive surgery is twelve years, but the optimal age for maintaining the results of multi-level orthopedic interventions is considered to be the second half of the adolescence period. Analysis of established orthopedic impairments and their impact on gait, as well as their characteristics depending on previous interventions, is of interest for determining the optimal conditions for reconstructive surgery on the lower extremities in adolescents. The purpose of this study was to evaluate the kinematic and kinetic gait parameters of adolescents with cerebral palsy (GMFCS I–III) before orthopedic surgery using a cross-sectional comparative analysis. The null hypothesis was the absence of differences in gait parameters between patients with previous orthopedic surgery and those who did not undergo it. Materials and methods This retrospective study included 102 adolescents aged 13–17 years with cerebral palsy, divided into two groups: Group A (GMFCS I–II, n = 63) and Group B (GMFCS III, n = 39). Three subgroups were identified in each group based on surgical history. All patients underwent computer video gait analysis. The gait analysis presents the parameters as medians with a percentile distribution level of 25 %–75 %. The unpaired Wilcoxon test (p ≤ 0.05) was used for comparison. The relationship between the parameters was assessed using Spearman's rank correlation. The chi-square test for binary samples was used to compare the incidence of the crouch gait pattern. Results Gait characteristics revealed a predominance of horizontal movement disorders (due to torsional deformities) in previously unoperated GMFCS I–II patients, while the prevalence of crouch gait increased in the remaining subgroups. An increase in decompensated crouch gait patterns was observed in the subgroups of patients who underwent early triceps surae interventions. A significant difference was found between groups 1A and 2A in the incidence of decompensated crouch gait (chi-square test, p = 0.002). No significant differences were found between the other subgroups. Discussion The systemic nature of motor impairments in children with cerebral palsy and the resulting orthopedic disorders, necessitate not only the assessment and monitoring of individual orthopedic impairments of the lower extremity locomotor chains but also the consideration of integrated movement indices (GPS), as well as kinematic and kinetic data in their interrelationships. Conclusion In patients with GMFCS levels I–II and no previous orthopedic interventions, indications for surgical treatment are determined by joint contractures and torsional deformities of the lower extremity segments. In patients with GMFCS level III, the crouch gait pattern, which remains compensated, predominates in adolescence. In the group of patients with triceps surae lengthening performed at an early age, the development of compensated and decompensated types of crouch gait with high-energy movements was observed. This should be taken into account both when choosing a surgical treatment strategy and during subsequent rehabilitation measures and orthotics. In adolescents with previous multilevel interventions, torsional deformities, recurrent contractures, and the development of knee flexion remained indications for surgical treatment. However, the spatiotemporal and strength characteristics of movements remained relatively high.
Introduction Treatment of patients with post-osteomyelitic defects is one of the most challenging areas in traumatology and orthopedics. Purpose To substantiate, on an experimental model, the potential of a partially bioresorbable material Rekost used to compensate for osteomyelitic cavities in combination with an antibiotic. Materials and methods The study was performed on nine male Soviet Chinchilla rabbits (16–18 months old, 4.3–4.5 kg of weight), in which osteomyelitis was modeled in the proximal metaphysis of the tibia by producing a trepanation hole and installing an Osteolite™ containing a Staphylococcus aureus culture. The animals were divided into three groups. Animals in group 1 were withdrawn from the experiment after 21 days of osteomyelitis modeling. In groups 2 and 3, the second stage included sequestronecrectomy and substitution of the bone defect thus formed with Rekost material (OOO AikonLabGmbh, Nizhny Novgorod, RZN 2014/1646 dated 03.07.2014, for indefinite) impregnated with an antibiotic in group 3. After 21 days of implantation, the animals were withdrawn from the experiment. Clinical, radiological, biochemical and histological methods were used. Results In Group 1, signs of osteomyelitis were recorded: necrotic fragments of bone trabeculae, inflammatory infiltrate, osteoclastic resorption and osteogenesis, bone marrow fibrosis, and pronounced CD15 expression. In groups 2 and 3, three weeks after implantation, a network of newly formed bone trabeculae at the bone-material interface was noted, and bone trabeculae were observed in the implant cavities. In the epiphysis of group 2, a HOES score of ≥ 6 points corresponded to active chronic osteomyelitis. In group 3, a median HOES score of 2 points indicated a remission of chronic osteomyelitis, and CD15 marker expression was less pronounced than in group 2. C-reactive protein levels continued to increase in Group 2 and significantly decreased in Group 3. Discussion Bioresorbable implants, impregnated with antibiotics, provide gradual replacement of the material with bone tissue, eliminate the need for repeated surgeries, reduce the risk of chronic infection, and are biocompatible. Conclusion In an in vivo experimental model, minimal degradation of the Rekost material was observed three weeks after implantation, manifested by highly frequent foreign-body-type giant multinucleated cells. Early data on the osteoplastic properties of the Rekost material and its ability to suppress infection and inflammation in combination with an antibiotic suggest the potential for further experimental studies of this product to be used in the treatment of patients with chronic osteomyelitis.
Introduction Histological data on the effect of intramuscular administration of branched-chain amino acids (BCAA) on muscle recovery are lacking. The purpose of the work was a histomorphometric assessment of the effect of intramuscular administration of BCAA in a dosage for injections on the regeneration of the anterior tibial muscle (ATM) after its closed partial crushing in rats. Materials and methods Compression of the ATM was performed for one minute in 48 male Wistar rats. After 24 hours, animals of series 1 received a single injection of saline into the ATM, while animals of series 2 received BCAA. Euthanasia was performed after 7, 14, 28, and 42 days. In paraffin section images, the volumetric densities of muscle fibers (MF) ( V Vm ), microvessels ( V Vmv ), and endomysium ( V V е ) were determined; MF diameters were measured, the numerical densities of MF ( Na m ), microvessels ( Na mv ), and intramuscular nuclei ( Na n ) were determined, and the vascularization ( kv as Na mv / Na m ) and nucleation ( kn as Na n / Na m ) coefficients were calculated. Ten intact rats were a control group. Results After seven days, VVm in both series decreased by 36–37 %; in the rest of the periods, the indicator was significantly higher in series 2, but remained below normal in both groups. Within 28 days, the MF diameter was higher in series 2. After seven, 14 and 28 days, the indicator exceeded the values of series 1 by 17 % ( p = 0.026), 11 % ( p = 0.012) and 5 % ( p = 0.048); after 28 days in series 1 and 2 it was 79 % and 84 % of the norm. The kn indicator in series 2 was lower than normal only after seven days of experiment, and in series 1 after seven, 14 and 42 days by 24 % ( p = 0.002), 24 % ( p = 0.004) and 10 % ( p = 0.034), that indicates less active myogenesis. The kv indicator after 14 and 28 days was higher in series 2 by 10 % ( p = 0.045) and 32 % ( p = 0.014). On the 42 nd day in series 2, the MF diameter decreased against the increase in their Nam and was 47 % lower than the norm ( p = 0.0006) and 30 % lower than in series 1 ( p = 0.0023). Discussion The findings obtained suggest that a BCAA injection has a positive effect on the MF regeneration and microvessels, and was more active than in series 1. Conclusion A single BCAA injection has a myogenic stimulating effect. Further studies on side effects and long-term outcomes are needed.
Introduction Special questionnaires recommended by SOSORT are used to study the quality of life (QoL) of children and adolescents undergoing brace treatment for scoliosis. One of them is the Brace Questionnaire (BrQ) which has undergone the stage of linguistic and cultural adaptation and validation in the Russian language. Aim To reveal groups of patients with scoliosis requiring special attention during brace treatment using the BrQ which was validated in Russia. Methods 405 patients that wore braces were surveyed with the automated BrQ. Changes in the domains and the overall quality of life score were statistically analyzed based on gender, age, duration of brace wear, and daily brace wear time. In 325 individuals, changes were tracked based on the magnitude of the main scoliotic curve. Results Boys showed statistically significantly higher scores in the "Vitality" (p = 0.05) and "Bodily Pain" (p = 0.03) domains. A main trend was identified: a decrease in domain scores and the overall QoL score with increasing age, duration of brace wear, and magnitude of the main curve. Statistically significant differences in various domains were found between the study groups for these parameters. The dependence of scores on the daily brace wear time was their growth. Discussion The identified trends in changes of domain scores and the overall QoL score in regard to increase in age, duration of brace wear, daily wear time, and the magnitude of the main curve are consistent with scientific literature data. Conclusion Determination of the significance of differences revealed groups of patients requiring special attention during brace treatment for scoliosis. These are girls who have a lower QoL level in the "Emotional Functioning" and "Social Functioning" domains; middle and senior school-age children who show a decrease in the "General Health Perception", "Bodily Pain", "Self-Esteem and Esthetics", and "Social Functioning" domains. These are patients who wore a brace for 4 years or more: the "General Health Perception", "Emotional Functioning", and "Self-Esteem and Esthetics" domains decrease; and for the "Bodily Pain" domain, pain increased already after 2–3 years of brace use. A special group of patients are those who at the initial stage of brace wear had the lowest Quality of Life (QoL) scores. High grades of scoliosis significantly reduce the scores in the domains such as "General Health Perception", "Vitality", and "School Activity", while the "Social Activity" domain score is reduced with a curve more than 50º.
Introduction Three-phalanx finger flexor tendon injuries in the fibrous-osseous canals of the fingers represent a complex orthopedic problem requiring multifaceted treatment. The functional outcome of flexor tendon reconstruction depends on the surgical strategy, timely provision of necessary rehabilitation support, and patient compliance. Failure to adopt a comprehensive approach to treating patients with this injury often leads to poor clinical and functional outcomes. The purpose was to determine key surgical and rehabilitation factors that have impact on the outcomes of primary reconstruction of the flexor tendons of the three-phalangeal fingers in the second zone. Materials and Methods We analyzed the postoperative results of 100 patients who underwent primary reconstruction of the deep flexor tendon of one three-phalangeal finger after damage to both flexor tendons in zone 2 according to the Verdan classification. These included finger function using the Strickland criteria and the Boyes – Lister scale, and clinical and functional assessment of the limb using the validated DASH and MHQ scales. The impact of patient morphological characteristics, anatomical topography of the injury, surgical strategy, and rehabilitation protocol on postoperative outcome was assessed. Results A statistically significant improvement in function was found according to the Strickland criterion with a surgical incision size not exceeding 1.5 phalanx lengths (p < 0.05). Functional results with the use of a four-thread 3/0 intrasegmental suture and a six-thread 3/0 suture according to the Strickland criterion and the Boyes Lister scale were statistically significantly better (p < 0.05). Poor results according to the Strickland criterion were observed statistically significantly more often in the absence of rehabilitation than with any type of rehabilitation (p < 0.05). Suture ruptured more frequently without rehabilitation (p < 0.001) than if rehabilitation with a hand therapist was provided. Discussion The obtained results both differ from the published ones in the literature and confirm some parameters. The use of fouror six-thread 3/0 tendon suture configurations and a rehabilitation protocol with a specialist improves functional outcomes in the treatment of flexor tendon injuries of the triphalangeal fingers and reduces the risk of suture rupture. Combined flexor tendon and digital nerve injuries do not show functionally significant differences compared to isolated tendon injuries. Conclusion A retrospective cohort analysis identified key surgical and rehabilitation factors that influence the outcomes of primary zone 2 flexor tendon reconstruction of the three-phalangeal fingers: the configuration and caliber of the intra-articular suture, the size of the surgical incision, and the availability and type of rehabilitation provided. These factors significantly had a significant impact on the clinical and functional outcomes of treatment.
