Background. Posterior correction of pediatric spinal deformities using multisegmental pedicle screw fixation is the gold standard for surgical treatment of scoliosis. However, placement accuracy with the «free-hand» technique varies, and the risk of screw malposition depends on anatomical complexity and deformity parameters, creating the need for a simple preoperative planning tool for risk stratification. Aim. To develop a preoperative planning tool based on radiographic deformity parameters to predict the risk of pedicle screw malposition with the «free-hand» technique. Materials and methods. A single-center retrospective study was performed. Forty-five patients who underwent posterior spinal deformity correction with «free-hand» pedicle screw insertion were included; a total of 696 screws were analyzed. Females accounted for 73.3% (n=33) and males for 26.7% (n=12), median age was 14.0 [12.0; 16.0] years. Idiopathic scoliosis predominated (71.1%, n=32). Screw position was assessed on postoperative CT with multiplanar reconstructions, recording malposition and breach direction (medial, lateral, anterior). Preoperatively, vertebral frontal tilt, sagittal tilt, and vertebral rotation were measured at each instrumented level. A predictive model was built using binary logistic regression with Nagelkerke’s R²; discriminative performance was evaluated by ROC analysis (AUC) and the optimal cut-off was determined using the Youden index. Results. The median preoperative Cobb angle was 69° [61°; 93°]; the postoperative mean Cobb angle was 28±12°, corresponding to a 59% mean correction (p0.001). CT identified 148 malpositions (21.3% of screws). Malposition rates increased significantly with increasing frontal tilt and vertebral rotation (p0.001). Lateral malpositions were significantly more frequent with greater frontal tilt (p0.001), whereas medial malpositions increased with higher rotation compared with anterior and lateral breaches (p0.001). In the binary logistic model, both coronal tilt and rotation were significant predictors; the model differed from the null model (p0.001) with a Nagelkerke pseudo-R² of 10.3%. Each 1° increase in coronal tilt increased the odds of malposition by 2.7% (OR 1.027; 95% CI 1.013–1.042), and each 1° increase in rotation increased the odds by 5.0% (OR 1.050, 95% CI 1.030–1.070). The AUC was 0.682 (95% CI 0.631–0.733; p0.001). The optimal probability threshold was P=0.212, yielding 70.5% sensitivity and 62.0% specificity; P≥0.212 corresponded to a combination of coronal tilt and rotation of approximately 20° or more at the same instrumented level. Conclusion. The risk of pedicle screw malposition with the «free-hand» technique is significantly associated with vertebral coronal tilt and rotation at the instrumented level, with rotation exerting a stronger effect. When coronal tilt and rotation are approximately 20° or greater, the use of CT-based navigation or additive manufacturing (3D-printing) technologies should be considered, as well as modification of the fixation strategy (e.g., use of hook constructs or omission of screw placement at that level) to improve the safety of pediatric scoliosis correction.

Introduction. Multiple hereditary exostoses (MHE) is a disease that progresses as a child grows, which leads to severe deformities of the skeleton. In 30–60% of MHE cases, the bones of the forearms are affected with the development of radius deformity. In addition to resection of bone and cartilage formations, surgical treatment may include various types of osteotomies using submersible metal fixators and external fixation devices. The development of guided-growth technology dictates the need to expand the scope of minimally invasive surgery. The possibilities of using this technology for deformities of the upper extremities have not yet been sufficiently studied. Objective. To evaluate the effectiveness of the method of controlled bone growth in the surgical treatment of ulnar deformity against the background of multiple hereditary exostoses. Materials and methods. In the period from 2021–2024, thirty three 5 to 17 years children (55 segments/forearms) were hospitalized at the National Medical Research Center for Children’s Health. The study group consisted of 13 children (15 segments) diagnosed with: Distal radius deformiry on the background of multiple hereditary exostoses. A control group of 20 (40 segments) children were diagnosed with juvenile idiopathic arthritis. Patients from the study group underwent surgical treatment of radius deformity using temporary arrest of the growth zone (hemiepiphysiodesis) of the radius. All the studied patients were assessed the angle of the ulnar tilt (UT) and of the lunate subsidence (LS) on X-rays of the forearm in direct projection, patients from the study group were radiographed in the preoperative period and 12–20 months after surgery. The statistical analysis of the studied parameters is based on the search for statistical differences in groups and was performed in the Stattech program. Results. The preoperative value of the elbow angle UT was 35° (33.40), after surgical treatment, UT was 27° (24.32) at p = 0.0002. The value of the LS before surgery was 8.73 ± 3.33 mm, after surgical correction LS was 7.48 ± 3.36 mm at p = 0.005. The achieved level of correction of UT and LS in the study group did not statistically differ from that of the control group, which indicates that the target values were achieved. The average angle of correction of the UT parameter was 8°/year, the trend in postoperative LS values was 1.25 mm/year. Conclusion. The technology of guided-growth effectively corrects the axis of the radius deformity in MHE children during growth. The timely application of this technology makes it possible to prevent the development of severe deformity of the radius and to abandon the performance of corrective osteotomies in the future

Introduction. Idiopathic scoliosis (IS) is a common form of spinal curvature that occurs in children and adolescents. The analysis of the quality of life in such patients is an urgent topic. The PedsQL 4.0 questionnaire is widely used to determine changes in quality of life (QOL). The aim of the study was to determine changes in the quality of life in children with idiopathic scoliosis, depending on the used tactics of surgical treatment. Materials and methods. There were examined 88 patients aged 13–18 years, the average age was 15.1 ± 0.61 years, including 20 boys and 68 girls who underwent surgery from 2017 to 2024 for idiopathic scoliosis types I–IV according to L. Lenke score. The patients were divided into 3 groups. The 1st (control) group consisted of 29 children who underwent a single-stage dorsal correction of scoliosis, supplemented by G1 osteotomy according to F. Schwab. Group 2 consisted of 29 patients who underwent two-stage surgical treatment: at the first stage, preliminary mobilization of the anterior support column of the spine was performed, followed by pelvic traction; at the second stage, dorsal correction of spinal deformity was performed. Group 3 consisted of 30 patients who underwent surgery using a single-stage dorsal correction supplemented by an apical multilevel G2 osteotomy according to F. Schwab. The minimum follow-up period after surgery was 12 months. Results. The patients of group 1 initially showed high QOL scores on all scales of the questionnaire, while the children of group 2 had low QOL scores in the field of physical and role functioning. The parameters of social and emotional functioning in patients of groups 2 and 3 were similar. Changes in QOL in patients 12 months after surgical treatment turned out to be almost the same. At the same time, a significant improvement in QOL was revealed in patients of groups 2 and 3 compared with children of the control group. An analysis of patients based on baseline values of thoracic kyphosis revealed an improvement in QOL in patients of group 2 with hypokyphosis, which is associated with improved physical health and overall psychosocial functioning (p < 0.05). Patients in group 2 with normokyphosis showed marked improvement in the physical and psychosocial spheres, in contrast to children in group 3. In hyperkyphosis children, the improvement in QOL was more significant in patients of group 3 compared with patients of group 2, especially in the field of general psychosocial functioning (p < 0.02). Conclusion. The choice of surgical intervention tactics based on the severity of thoracic kyphosis has significantly improved the quality of life in patients after surgical treatment of idiopathic scoliosis. There was a significant increase in scores on the scales of emotional, social, and role functioning. The established patterns can be applied by orthopedists to optimize the choice of tactics for surgical treatment of idiopathic scoliosis in children.

Introduction. As a rule, the presence of an additional cervical rib is not accompanied by clinical manifestations, especially in childhood. However, in rare cases, when compression of large vessels by an additional rib occurs, the symptoms can seriously affect the patient’s quality of life. A thorough history collection, clarification of details and an individual approach to each patient with this pathology is extremely important. Goal. To present a description of the surgical treatment of a patient with an additional cervical rib and clinical manifestations associated with compression of the vertebral and subclavian arteries.Materials and methods. This scientific publication includes clinical experience in the observation and treatment of a boy patient who had compression of two arteries, subclavian and vertebral, due to the presence of a cervical rib. A 16-year patient was comprehensively examined, the following diagnostic methods were investigated: magnetic resonance imaging of the brain and spinal cord, chest X-ray, computed tomography of the neck and chest, ultrasound examination of the vessels of the neck and left upper limb, 3-D modeling of pathology.Results. According to the results of surgical treatment, it was possible to achieve a satisfactory clinical effect, confirmed by the absence of symptoms and an improvement in the patient’s quality of life in follow-up.Conclusion. Patients with an additional cervical rib should cause increased alertness, regardless of age and the presence of clinical manifestations. In the described case, it was the integrated approach that made it possible to achieve a clinical effect.Contribution: Chelpachenko O.B., Alkhasov A.B. — concept, definition of surgical treatment tactics and operation, writing the text; Portugal P.M., Strakhov D.A., Ratnikov S.A., Shmykova A.O., Zherdev K.V., Butenko A.S., Abdullayeva L.M. — collecting and processing material, writing the text, editing the text. All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.Acknowledgment. The study had no sponsorship.Conflict of interest. The authors declare no conflict of interest.Received: September 08, 2025Accepted: October 02, 2025Published: October 30, 2025

Introduction. Equino-plano-valgus deformity (EPVD) is one of the most common orthopedic pathologies in children with cerebral palsy. During surgical correction of such deformities, supination of the anterior section (elevation of the first metatarsal bone) may occur, which contributes to the loss of support of the head of the first metatarsal bone. Aim: to analyze the effectiveness of osteotomy modeling the forefoot in surgical treatment of EPVD in children with spastic diplegia associated with cerebral palsy.Materials and methods. There were examined thirty two 8 to 18 years children (64 feet) with the diagnosis of EPVD against the background of cerebral palsy, spastic diplegia, II-III level according to GMFCS, surgically treated at the National Medical Research Center of Children’s Health. The study group consisted of 15 children (30 feet) who underwent surgical treatment of EPVD using techniques that lower the first metatarsal bone. The control group consisted of 17 children (34 feet) who underwent surgical treatment of EPVD using standard techniques without intervention on the forefoot. Statistical analysis of the studied indices was based on the search for statistical differences in the groups and was performed in the STATTECH software (Stattech, Russia).Results. After surgical correction of foot deformities, the degree of elevation of the first metatarsal bone decreased by 30.6 ± 6.2%, and the intermetatarsal angle decreased by 5 ± 2° (p = 0.003), indicating the effectiveness of wedge-shaped bone osteotomy in correcting these parameters in patients with cerebral palsy.Conclusion. Osteotomy of the medial cuneiform bone is an effective way to eliminate the elevation of the first metatarsal bone after correction of EPVDS in children with cerebral palsy.Contribution: Zubkov P.A., Zherdev K.V. — research concept and design of the study; Zubkov P.A., Petel’guzov A.A. — collection and processing of material; Zubkov P.A. — statistical processing; Zubkov P.A., Petel’guzov A.A., Chelpachenko O.B. — writing the text; Zherdev K.V., Butenko A.S., Pimburskiy I.P., Timofeev I.V. — editing the text. All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.Acknowledgment. The study had no sponsorship.Conflict of interest. The authors declare no conflict of interest.Received: September 10, 2025Accepted: October 02, 2025Published: October 30, 2025

Introduction: Recently, the use of thoracoscopic methods in spinal deformity surgery has increased, however, the issue of the effectiveness of combining anterior release with posterior spinal fusion compared to single-stage posterior instrumentation remains controversial, which raises the issue of the effectiveness and feasibility of their use. Purpose: To evaluate the effectiveness of endoscopic anterior release for thoracic scoliosis in children. Material and method: A retrospective analysis of the results of surgical treatment of 48 patients with idiopathic scoliosis of the thoracic spine aged 12-17 years, with a thoracic curve of more than 60 degrees, was carried out. To determine the stability of deformity, the stability index according to A.I. Kazmin was used. (SI) defined as the ratio of the angle of deformity in the supine position to the angle of deformity in the standing position. Indications for anterior release were incomplete skeletal growth and relatively stable deformities (SI 0.75-0.85). Group 1 included 27 patients operated on in one stage without anterior release, and group 2 included 21 patients in two stages, with preliminary anterior release using video-assisted thoracoscopy. Results: In group 1, the average Cobb angle of deformity was 71.8 degrees with an average stability index of 0.8. In the second group, the average cobb angle of deformity was 69.7 degrees, the average stability index was 0.82. In group 1 after surgery, the average Cobb angle was 27.8 degrees, with an average correction of 63.39%. In the second group, the postoperative deformity angle was 17.4 degrees, the average correction was 76.26%. Thus, we found a statistically significant increase in postoperative correction when using a combined anterior/posterior approach (p < 0.05). Conclusion: In the study, in patients with relatively stable deformities, a statistically significant increase in the degree of postoperative correction was revealed (p < 0.05) when using a combined anterior/ posterior approach. Performing an anterior thoracoscopic release for thoracic deformities can improve long-term results due to the formation of 360 degrees spinal fusion at the apex of the deformity, as well as turning off the pathogenetic links in the progression of the deformity. Level of Evidence: III. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Severe multiplanar spinal deformities of various etiologies are accompanied by disorders of the organ systems, causing early disability and reduced life expectancy of patients, which, in turn, dictates the need for surgical correction. The method of choice for the surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Despite the advantages of this spinal stabilization technology, it has its own specific difficulties and risks of various complications, most often associated with malposition of the supporting elements. To reduce the number of complications associated with the surgical correction of scoliosis, methods have been developed, including intraoperative neuromonitoring and O-arm navigation, the effectiveness of which will be discussed in this article.

Introduction. The correction potential of modern systems is limited by the natural mobility of scoliotic deformities, which sometimes require multiple discectomy and osteotomy. Choosing the optimal method of treatment for scoliosis in the thoracic and lumbar regions is difficult due to the variety of approaches and options available for osteotomies. There is no single algorithm for the treatment of idiopathic scoliosis, making it necessary to develop a differentiated approach and treatment strategies. Purpose of the study. To optimize the choice of surgical treatment tactics for children with idiopathic scoliosis based on a compa­rative analysis of the use of one-stage and two-stage surgical treatment. Materials and methods. The study subjects were ninety four patients with idiopathic scoliosis (Lenke type 1–4), operated on between 2017 and 2023. They were divided into three groups: group I (control) — 30 patients underwent one-stage dorsal correction with G1 osteotomy, group II — 31 patients who received two-stage treatment, and group III — 33 patients who underwent a one-stage correction with apical G2 osteotomy. Depending on the initial thoracic kyphotic angle, subgroups were defined as A (hypokyphosis), B (normokyphosis) and C (hyperkyphosis). The minimum follow-up period was 12 months. Results. The frontal balance in all examined patients was in a state of relative compensation, both before surgical treatment and in the postoperative period. When comparing the results in patients from the second and third groups, we found no significant differences (p > 0.05). The second group showed a higher degree of correction of the main arch of spinal deformity (p < 0.05) in the frontal plane compared to the control and third group patients. When analyzing the results of thoracic kyphosis formation, we obtained reliable results in formation more significant indices in patients after surgery in Group II (subgroups A and B), for whom a two-stage applied surgical method was supplemented with anterior release and halo pelvic traction. In Group III (subgroup C), we obtained significant results in thoracic kyphosis indices when using single-stage surgery performed from the dorsal approach supplemented with G2 osteotomy. Conclusion. The condition of the sagittal profile, including the severity of thoracic kyphosis, is an important criterion for choosing the tactics of surgical treatment of scoliotic deformities of the thoracic and lumbar spine. Two-stage treatment, including ventral release and halo-pelvic traction, is recommended for rigid deformities of the thoracic or thoracolumbar spine, under conditions of initial normal kyphosis or hypokyphosis. Severe deformities with initial hyperkyphosis should be corrected preferably in a single stage using posterior surgery, supplemented by G2-osteotomy. The use of G2-osteotomies in patients with initial normal- or hypokyphoses is impractical due to the risk of neurological complications, development of pseudoarthroses, and increase in volume of perioperative bleeding.

Relevance. According to the results of surgical treatment, the sagittal imbalance of the spine was eliminated, the pain syndrome was stopped, and the patient’s independent movement was restored without the use of auxiliary devices (walkers). Results. In patients with combined pathology of the spine and hip joints, violations of the X-ray anatomical indices of the trunk balance lead to the development of severe pain syndrome, reduces exercise tolerance, and the quality of life. Correction of sagittal imbalance of the trunk becomes particularly relevant in this group of patients. Conclusion. If it is impossible to perform hip replacement to correct sagittal imbalance of the trunk in patients with combined pathology of the hip joint and spine corrective osteotomy of the lumbar spine is a non-standard treatment method, is potent of improving prognosis and quality of life in patients.

Introduction. In cases of osteoid osteoma (OO) of small sizes, visualization of tumor is difficult. In Russia, surgical removal under the control of an electron-optical converter (EOP) is often chosen for the treatment of OO, and only a few centers use CT control. The aim of this work is to identify the advantages and disadvantages of intraoperative imaging for surgical removal of OO in children using EOP and CT with navigation. Materials and methods. Sixteen 5 to 18 years patients with a diagnosis of OO were treated. The patients were divided into 2 groups depending on the method of intraoperative imaging: group 1 — surgical removal of OO under the EOP control (n = 7), group 2 — removal under the control of CT with a navigation system (n = 6). Exclusion criterion: tumor location outside the upper third of the femur (n = 3). The following indicators were evaluated: radiation load over the entire treatment period, the volume of resection, and the presence of X-ray symptoms. Results. In patients from group 2 with removal under the control of CT with navigation for the entire period of treatment, the radia­tion load was 5.24 ± 1.19 mSv, while in children from group 1 — 3.69 ± 1.28 mSv. In 4 patients, the diagnosis was not made. In 13 patients, CT revealed a focus of lytic destruction with a peripheral rim of sclerosis. The volume of postoperative defect of the bone defect in patients of group 1 was 5548 ± 1694.2 mm3, and in patients of group 2 — 2131.57 ± 290.301 mm3. It is obvious CT with a navigation system to be a highly sensitive method of detecting a tumor, allows minimizing the volume of bone tissue to be removed and instrumentally confirming the removal of OO. Conclusion. Intraoperative CT with navigation has a number of advantages over EOP control due to the less volume of resection of healthy bone tissue, it becomes possible to obtain intraoperative confirmation of OO removal, without need for immobilization during the postoperative period.

This study is aimed at investigating the clinical and genetic characteristics of 244 unrelated probands diagnosed with multiple osteochondromas (MO). The diagnosis of MO typically involves identifying multiple benign bone tumors known as osteochondromas (OCs) through imaging studies and physical examinations. However, cases with both OCs and enchondromas (ECs) may indicate the more rare condition metachondromatosis (MC), which is assumed to be distinct disease. Previous cohort studies of MO found heterozygous loss-of-function (LoF) variants only in the EXT1 or EXT2 genes, with DNA diagnostic yield ranging from 78 to 95%. The PTPN11 gene, which is causative for MC, was not previously investigated as a gene candidate for MO. In this study, we detected a total of 177 unique single nucleotide and copy number variants in three genes across 220 probands, consisting of 80 previously reported and 97 novel variants. Specifically, we identified five cases with OCs and no ECs as well as four cases with MC carrying LoF variants in the PTPN11 gene and two additional cases with ECs harboring variants in the EXT1/2 genes. These findings suggest a potential overlap between the MO and MC both phenotypically and genetically. These findings highlight the importance of expanding genetic testing beyond the EXT1 and EXT2 genes in MO cases, as other genes such as PTPN11 may also be causative. This can improve the accuracy of diagnosis and treatment for individuals with MO and MC. It is essential to determine whether MO and MC represent distinct diseases or if they encompass a broader clinical spectrum.

Background. The method of choice for surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Its use is associated with inherent difficulties and risks, often associated with malposition of supporting elements, as well as the risk of complications. The incidence of neurological complications during surgical correction of scoliosis can reach 7%. High risks, including irreversible complications, of surgical correction of scoliosis dictate the need to introduce modern safety methods, including O-arm navigation and intraoperative neuromonitoring (IONM). Aim. Increasing the effectiveness and safety of surgical correction of scoliosis in children using O-arm navigation and IONM. Materials and methods. 136 patients operated on for scoliosis were observed. The patients were divided into 2 groups: group 1 included patients operated on using the “free-hand” technology (a total of 609 screws were analyzed in 30 patients); group 2 included patients operated on using O-arm navigation and IONM (524 screws in 25 patients). The average Cobb angle of deformation was 66.9±28.1° in group I and 82.4±25.8° in group 2. Malpositions were assessed using the classification of G. Rao et al. (2002), and an analysis of neurological complications was also carried out in 69 patients in group 1, and in 67 patients in group 2. Results. In group 1, the overall incidence of malpositions was 27.3% (166 out of 609 screws). In group 2, it was 10.5% (55 out of 524 screws). In group 1, the frequency of grade 1 malpositions was 3.9% (24 out of 609), grade 2 – 11.8% (72 out of 609), grade 3 – 11.5% (70 out of 609). In 2: grade 1 occurred in 4.2% of cases (22 out of 524), grade 2 – 3.4% (18 out of 524), and grade 3 – 2.9% (15 out of 524). The frequency of medial malpositions in the first group was 7.6% (46 out of 609), in the second group – 2.7% (14 out of 524). Lateral malpositions in the group 1 were 11.7% (71 out of 609), in the group 2 – 4.4% (24 out of 524). Anterior malpositions in group 1 – 8.05% (49 out of 609), in group 2 – 3.2% (17 out of 524). In group 1 there were 3 cases of neurological complications – 4.3%, in group 2 – in 1 case – 1.4%. Conclusion. O-arm navigation and IONM made it possible to reduce the frequency of malpositions, and there was also a tendency to reduce the number of neurological complications in the group of patients where IONM and O-arm navigation were used.

Multiple osteochondromas (MO) is a rare autosomal dominant skeletal disorder characterized by the development of multiple benign tumors known as osteochondromas. The condition is predominantly caused by loss-of-function variants in the EXT1 or EXT2 genes, facilitating relatively precise clinical diagnosis through established diagnostic criteria. Despite this, a notable percentage of MO cases (10%–20%) remains unresolved after sequencing coding regions and copy number analysis of both genes. In our study, we identified mosaic structural variants in two patients who initially yielded negative results on standard genetic analysis for MO. Specifically, mosaic deletions affecting exons 8–11 and exons 2–11 in the EXT1 gene were detected. RNA analysis was performed in one case, while both cases underwent genome sequencing. To date, only six mosaic copy number variations have been reported in association with MO, representing a minority among known variants in both genes. Our report provides a detailed analysis of these findings, highlighting the significance of advanced genetic testing techniques in detecting mosaic variants in the EXT1/2 genes.

Background. The main orthopedic manifestation of osteogenesis imperfecta is multiple fractures. In severe disease, frequent fractures lead to malunion and deformity, which increases the risk of refracture. Surgical treatment of children with osteogenesis imperfecta is aimed at reducing the risk of complications and improving the quality of life of the child. The Fassier-Duval telescopic intramedullary system has taken the leading place among the growing metal fixators. In this study, we conduct a comparative analysis of the results of a longitudinal study between patients with osteogenesis imperfecta types I and III, as well as an assessment of motor activity. Aim. To evaluate the efficiency of using the telescopic intramedullary system depending on the type of osteogenesis imperfecta. Materials and methods. A prospective analysis of surgical treatment of 20 children with types I and III was carried out. Group I included 8 patients with type I NO, group II included 12 with type III. The average age of patients was 8.2 years. Surgical treatment was carried out on the basis of the neuroorthopedic department with orthopedics of the National Medical Research Center for Children's Health. A total of 48 intramedullary telescopic pins were installed. The average period of postoperative dynamic follow-up was 42 months. The analysis of the results of surgical treatment was carried out according to the following criteria: the frequency of migrations of metal structures, the formation of bone deformities, the number of revisions, as well as the number of bone fractures with an installed metal fixator. Evaluation of the results of motor activity was carried out using two scales: Gillette Functional Assesment Questionnaire (Gillette FAQ) and HofferBullock. Results. There were no statistical differences in the number of complications in the two groups. Fractures among patients with type I occurred more often than in patients with type III by 19.3%. The frequency of migrations in the I study group was 7.1% (1 segment), in the II group 35.3% (12 segments). The formation of deformation was the main factor in the revision intervention, which in our case amounted to 83.3%. In the group of patients with type I, the number of repeated operations was 7.1% (1 segment in 1 patient), in the group of patients with type III 17.6% (6 segments in 4 patients). All patients in the postoperative period had II or I level of motor capabilities on the HofferBullock scale. According to the Gillette FAQ scale in the postoperative period, the subjects showed a result above 4 points. Conclusion. The Fassier-Duval telescopic rod is a modern and reliable metal fixator. Despite the absence of statistical differences in the two study groups (p-value20.005), there was an increase in the tendency to complications in severe course with NO. Correction of varus deformation when restoring normal values of DN125 and HEA within 2538 is the prevention of the re-formation of the truth of Coxa Vara. The motor activity of children with severe course did not statistically differ from children with mild course (p-value20.005) in the postoperative period with an average follow-up period of 42 months, regardless of the initial low motor capabilities in children with type III.

Osteogenesis imperfecta (OI) is a rare disease characterized by frequent fractures and deformities of the bone skeleton due to collagen abnormalities. Clinically, OI is heterogeneous in its features and varies in severity. Frequent fractures as a result of brittle bones lead to malunion and deformity, which increases the risk of refraction. Surgical treatment of children with imperfect osteogenesis is aimed at reducing the number of fractures, the formation of deformities and improving the quality of life of the child. According to the literature, two main methods of intramedullary osteosynthesis in the surgical treatment of children with OI can be distinguished: static rods and a growing metal structure. Aim. To compare the frequency of revisions and complications when using titanium elastic rods (TEN) and the Fassier-Duval telescopic system (FD) in the treatment of fractures and deformities of long bones in children with OI type I (mild disease) and type III (severe disease). Materials and methods. A retrospective and prospective analysis of the results of surgical treatment in 38 children with OI using two different methods of intramedullary osteosynthesis was carried out. Among them, 26 children (68% of all studied patients) were of type III and 12 (32%) children of type I. The mean age of the patients was 7.8 years [5.2, 10.8]. The 1st study group (retrospective) included 17 patients (45% of all patients) who underwent surgical treatment with the installation of titanium elastic rods (TEN). A total of 46 surgical interventions were performed. Surgical treatment with the installation of titanium elastic rods (TEN) for patients was carried out in other medical institutions before hospitalization at the National Medical Research Center for Children's Health. The 2nd study group (prospective) included 21 patients (55% of the total number of patients in the study), who were implanted with FD telescopic rods, 53 surgical interventions were performed. Patients of the prospective group received surgical treatment on the basis of the neuroorthopedic department of the National Research Center for Children's Health. The study groups were structured as follows: Study Group 1 consisted of 2 subgroups. Subgroup A included 6 patients with OI type I, subgroup B included 11 patients with OI type III; The 2nd study group was represented by two subgroups. Subgroup C included 6 patients with OI type I, and subgroup D included 15 patients with OI type III. A total of 228 segments of the upper and lower extremities (humerus, femur and tibia) were examined. Surgical treatment using intramedullary osteosynthesis was performed on 99 segments. The average period of postoperative follow-up was 20 months (from 16.5 to 24.5 months), the data collection of the retrospective group was carried out in the period from 20152022, the prospective group from 20172022. Analysis of the results of surgical treatment according to the following criteria: the frequency of migration of metal structures, the formation of bone deformities, the number of bone fractures with an installed metal fixator in two different methods of osteosynthesis, as well as the number of revisions in OI types I and III. The results of motor activity in the retrospective and prospective groups were assessed using two scales (the HofferBullock scale, the Gillette Functional Assessment Questionnaire score scale), before the start of surgical treatment and after 20 months. The statistical analysis was performed using the Matplotlib, SciPy, Pandas и NumPy modules in Python 3.8. In all cases, the distribution was different from normal. The comparison of the independent groups was carried out using the MannWhitney test (in the case of comparing two samples), while the comparison of the dependent groups was carried out using the Wilcoxon test. To compare the distribution of the categorical features, the Pearson chi-square test and Fisher's exact test (with the number of observations in one of the cells in the table 225) for the independent groups, and McNemars test for the dependent groups were used. In all cases, when the multiple comparisons were made, the level of the significance of p was recalculated using the Bonferroni correction. Hypothesis testing was two-sided; the values of p0.05 were considered statistically significant. Results. According to the comparison of two subgroups of the 1st study group, it was noted that fractures in two subgroups after the installation of static intramedullary nails occurred with an equal frequency (p-value0.999). Among patients with OI type I, migration was observed in 13% of cases (2 segments), with OI type III in 48%. Deformity in type I OI was formed in 13% of cases, in type III in 39%. Revisions in children with type I OI were required in 13% of cases, in children with type III in 32%. According to the comparison of two subgroups of the 2nd study group, it was noted that fractures and migrations in two subgroups after the installation of a telescopic metal structure occurred with equal frequency (p-value0.999). Deformity in type I OI was not formed, in type III it was 18%. Revisions in children with type I OI were required in 7.7% of cases, in children with type III in 15%. A comparative analysis of the results of surgical treatment of children with type I OI who underwent TEN osteosynthesis and children with type III OI who used a telescopic metal fixator demonstrates the absence of statistically significant differences in deformities, migrations, and revisions (p-value0.999). Also, in the group of children with OI type III, osteosynthesis of which was performed by FD, there is a decrease in the risk of re-fracture by 10%, in comparison with the group of children with OI type I, osteosynthesis of which was performed by TEN. Also, according to the data of statistical processing, surgical treatment of children with OI type III using an intramedullary telescopic system makes it possible to achieve a level of motor activity comparable to the group of patients with OI type I (p-value=0.344), where osteosynthesis was performed using TEN. Conclusion. The TEN method is a reliable method of treatment in children with OI type I, it is comparable to the method of telescopic metal construction in children with OI type I in terms of the frequency of migrations (p-value0.999). However, the risk of repeated surgical interventions is increased by 5.3% compared with FD, the frequency of fractures is higher by 12.3%, the formation of deformities by 13%. The use of growing hardware in children with type III reduces the risk of possible refracture by 9%, migration by 36%, deformity by 21% and the number of revisions by 17% compared with static rods. Patients who underwent FD osteosynthesis showed higher results of motor activity than patients who underwent TEN osteosynthesis. The results of the frequency of complications and revisions in the group of patients with OI type III, in which osteosynthesis was performed by the telescopic FD system, are comparable with the group of patients with OI type I, in which osteosynthesis was performed with TEN static rods. The quality of life and motor activity of children in the group with a severe course, whose osteosynthesis was carried out with a growing metal structure, reaches the level of patients with a mild course of the disease, whose osteosynthesis was performed using TEN (p-value=0.344). The method of choice in the surgical treatment of children with OI, both in type I and type III, is a growing intramedullary metal structure. The use of static rods is acceptable in OI type I, however, it should be taken into account that this metal structure is effective for the first 12 months, later, due to the inability to reinforce the bone throughout its entire length, the risk of possible complications increases.

Objective of the study: to evaluate the effectiveness of layered alloplasty in the surgical treatment of active aneurysmal bone cysts (ABCs) in children. Materials and methods of research: from 2007 to 2020 56 patients with ABCs were treated in the Neuroortopedic Department with orthopedics of the National Medical Research Center for Children’s Health (Moscow, Russia). All patients have underwent a comprehensive clinical and radiological examination, including the determination of intraosseous pressure (IOP) to determine the activity of the pathological process. Surgical treatment of 19 patients with ABCs was performed through layered alloplastic method of the cyst cavity with the enhancing of the bone growth zone with alloimplants based on sea coral. Results: the results of treatment were evaluated on the basis of an analysis of the radiographic picture of reconstruction of bone implants and restoration of bone tissue structure, as well as analysis of the quality of life of patients in the 1st and 2nd module of the PedsQL Generic Core scale questionnaire before and after surgical treatment. Conclusion: the use of layered plasticity of a bone defect in the surgical treatment of ABCs can be considered as effective method for preventing recurrence of the disease.

Introduction. Bone cysts are one of the most common tumor-like bone diseases of childhood, most often occurring in the 1st and 2nd decade of life. According to the world medical literature, there is still no consensus on the best methods of treating bone cysts.Aim – to evaluate the effectiveness of surgical treatment of aneurysmal bone cysts (ABC) in children with the use of allografts of biological (animal and human) origin.Materials and methods. This study included 56 pediatric patients with ABC treated at The National Medical Research Center for Children’s Health, Russia, Moscow. 37 patients with aneurysmal bone cysts (29 active ABC, 8 inactive ABC) underwent surgical treatment. Our follow-up period ranged from 12 months to 80 months. In the postoperative period, the examination was carried out at a period of 3, 6, 12, 18, 24 months and then once a year, while assessing: the presence/absence of the recurrence (radiologically), the timing of functional recovery of the operated segment, the timing of X-ray reconstruction of the graft, the assessment of physical and emotional components of the patients’ quality of life were evaluated using the PedsQL questionnaire at admission and within 12 months from the date of surgery.Results and discussion. In 37 cases of surgical treatment of ABC with the use of allografts of biological origin, the recurrence presented in 7 patients (19%) – these patients, who had an active ABC, required repeated surgical interventions. The average time of complete bone repair in the lesion site ranged from 9 months to 22 months (14 months on average). Functional recovery of the operated segments was on average 10 months for the upper extremities and 12 months for the lower extremities.Conclusion. The use of allografts of biological origin is effective in the case of inactive aneurysmal bone cysts. In case of active ABC the effectiveness of bone grafting with allografts of biological origin is reduced.

Osteogenesis imperfecta (OI) is a heterogeneous group of diseases with different types of inheritance, characterized by frequent fractures and deformities of the bone skeleton. Conservative and surgical treatment of children with this pathology is an integral part of a multidisciplinary approach. In the surgical treatment of bone deformities in children with OI, the method of choice is corrective osteotomies, and an effective method of fixation is intramedullary osteosynthesis. Surgical treatment of children with OI is aimed at reducing the number of fractures, correcting deformities and increasing motor activity. Aim of the study to determine the indications for intramedullary osteosynthesis of long tubular bones in children with the disease. To review the studies concerning treatment of children with OI. Consider the different types of metal fixers, their advantages and disadvantages. Today the technique of intramedullary fixation is the "gold" standard in the surgical treatment of children with OI. There is a clear advantage of telescopic rods in terms of the frequency of reoperations, but their use does not exclude the presence of postoperative complications.

Purpose. to analyze the effectiveness of soft tissue surgical correction of equine-flat-valgus-feet deformity in children with cerebral palsy. Material and methods. A retrospective analysis of clinical and X-ray findings of 47 patients (86 feet) with equino-flat-valgus deformity was performed. All patients were treated surgically. They were divided into two groups by age: Group I - 23 children (4-7 y.o.); Group II - 24 children (8-11 y.o.). The neurological status was examined in patients with the motor development of level I - III (by GMFCS classification) who had hemiparesis, diplegia and tetroparesis. A comparative analysis was made with a reference group which consisted of 30 children (56 feet), aged 4-11, who had exostotic chondrodysplasia or trauma of the ligamentous apparatus in one foot without neurological pathology and feet deformities. Results. One year after surgery, a significant improvement in clinical and radiological parameters comparing to preoperative findings was registered in patients of both studied groups. Most parameters were close to the established reference intervals. In Group I, three years later at the follow-up examination no significant difference was revealed in similar parameters obtained three years later and one year later after the surgery. However, in Group II three years later a negative dynamics was seen in most of studied parameters when compared with reference values and with results of the first postoperative year. Such outcomes demonstrate high efficiency of soft foot tissue surgery in children under 8. A significant decrease in clinical and radiological parameters after similar amount of surgical correction in children of primary school age (8-11 y.o.), which were under the long-term observation, may indicate the ineffectiveness of such techniques at this age. Evaluation of the functional status by the Gillette functional assessment scale three years after the surgery revealed the increased functional status in 78.26% of patients from Group I and in 41.66% from Group II. In some children from Group II (primary school age), there was a negative dynamics in their functional status. Conclusion. In generally, the obtained data indicate good prospects for improving the functional status in the postoperative period in children of both groups. However, the existing negative dynamics in children from Group II (8-11 y.o.) indicates a weak prospective for a long-term surgical deformity correction of the foot ligamentous apparatus because the coming period is a period of rapid growth and increased loading on the musculoskeletal system of a child with cerebral palsy.

Introduction. Cerebral palsy (CP) is the main cause of childhood neurological disability in the world. Due to the fact that the prevalence of knee contractures in children with cerebral palsy occupies the 3rd place in the structure of orthopedic pathology of the lower extremities, this topic is least covered in the scientific periodicals. Material and methods. Findings from 40 patients of the main group, aged 7-12 and having cerebral palsy (CP), were studied retrospectively. They had knee flexion contractures with patella alta. Findings of goniometry and of Gillette FAQ were analyzed before and after surgery. The Spearman coefficient was used for the correlation analysis of goniometry parameters and surgical intervention effectiveness before surgery. 35 patients having no bilateral CP damage and other diseases leading to lower limb deformities were included into the reference group. X-ray examination and goniometry assessment of a healthy limb were made in patient’s lying position on his back with passive extension; plus goniometry in a standing position with shin active extension. Results. The median of deformation angles before and after surgery was 20° and 5°, respectively (p