Contrary to the conventional view of their functional autonomy, the skeletal and nervous systems exhibit unique molecular, physical, and ontogenetic similarities. This review considers selected aspects of the mechanisms of bidirectional regulation, within which the nervous system actively controls bone tissue metabolism and structural remodeling by regulating the differentiation of mesenchymal stem cells into osteoblasts, activation of osteoclasts, and the functional activity of skeletal system cells. In turn, bone tissue performs not only a supporting function but also acts as an endocrine organ capable of modulating the expression of neuronal genes and the synthesis of key neurotransmitters, thereby influencing cognitive functions, memory, and learning ability. Despite promising results, research into the bidirectional interaction between the skeletal and nervous systems remains at its conception stage. Further identification of shared biomarkers and signaling pathways will make it possible to develop fundamentally new approaches to the prevention and treatment of skeletal system disorders as well as neurodegenerative diseases. This perspective not only challenges classical concepts of physiology but also opens interdisciplinary avenues for biomedical research.

Swimming, both as a recreational and professional sport, is widely practiced in Russia and globally. This sport is unique in that it combines strength exercises for the upper and lower extremities with cardiovascular training without weight-bearing load. However, the high repetition of movements characteristic of the conventional freestyle stroke may predispose professional swimmers to musculoskeletal injuries, predominantly of the shoulder joint. The lack of comprehensive information in the Russian scientific data on swimmer’s shoulder determines the relevance of this review. For this scientific review, articles in Russian and English published between 1974 and 2025 were selected from PubMed, Google Scholar, CyberLeninka, and Google using the following keywords: плечо пловца (swimmer’s shoulder), плавание (swimming), ротаторная манжета плеча (rotator cuff), импинджмент-синдром плечевого сустава (shoulder impingement syndrome), спорт (sport). A total of 56 sources were included, 18 of which were published within the past 10 years. The incidence of musculoskeletal injuries of various localizations in swimmers ranges from 2.6 to 4.0 cases per 1000 hours of swimming, with shoulder injuries leading (23%–51% and 33%–41% in men and women, respectively). Despite advances in sports medicine and rehabilitation, a global trend toward an increase in shoulder injuries among swimmers has been observed. Swimmer’s shoulder is a collective term describing multiple conditions accompanied by pain in the shoulder joint in athletes engaged in swimming. The main etiologic factors in the development of swimmer’s shoulder are high training intensity and the lack of a well-designed and balanced training program, which affect overall muscle balance, the scapulothoracic articulation, the rotator cuff, and shoulder joint motion. The most common mechanisms of shoulder pain in swimmers are impingement syndrome, anteroinferior instability, scapular dyskinesis, and rotator cuff muscle imbalance. Shoulder pain persisting for 1 month during intensive training is experienced by 91% of junior athletes and is most often associated with impingement syndrome or supraspinatus tendinopathy. As a rule, active rest, temporary reduction or cessation of swimming, and the use of nonsteroidal anti-inflammatory drugs make it possible to relieve pain and allow the athlete to return to training shortly. In cases of labral tear, rotator cuff tear, or shoulder instability, surgical treatment is indicated. Timely and accurate diagnosis and treatment, together with a rational training regimen both in water and on land, allow the athlete to avoid severe shoulder injuries and resume training.

BACKGROUND: Coccydynia is characterized by intense and persistent pain in the coccygeal region and often presents challenges in diagnosis and treatment owing to its low prevalence and diverse etiology among children and adolescents. AIM: This study aimed to analyze the causes of coccydynia in children and adolescents participating and not participating in sports. METHODS: The outpatient records of 906 patients presenting with coccygeal pain to a consultative and diagnostic department between January 2010 and March 2025 were reviewed. Medical history, physical examination findings, and imaging data were analyzed. RESULTS: The study included patients aged 9–18 years. There were 5.5 times more girls than boys. Most of the patients did not participate in sports. Traumatic coccydynia was identified in 37% of patients. In most cases, the injury resulted from falls onto the buttocks, typically at school or outdoors. Among the patients with traumatic coccydynia, only 5.1% were participating in sports. The causes of nontraumatic coccydynia included coccygeal instability, coccygeal retroversion, coccygeal spicule, and weight loss. In 40.7% of cases, the cause was not identified. Among the patients participating in sports, 64% of the cases of coccygeal pain were associated with coccygeal instability, which presented under conditions of chronic static or repetitive coccyx overload during training. CONCLUSION: The most common types of coccydynia in children and adolescents are traumatic and idiopathic. Coccygeal injuries during sports training occur twice as rarely as household injuries. In young athletes, repetitive excessive loads during equestrian sports, cycling, choreography, and ballet are associated with the development of coccygeal instability. The prevention of coccydynia among children participating in sports may involve proper exercise technique, gradual increase of load, and use of protective equipment.

BACKGROUND: Ankle joint and foot injuries are the most common type of musculoskeletal trauma in children. Their mechanism of injury mainly determines the pattern of damage. AIM: To optimize the diagnosis and treatment of inversion injuries of the ankle joint and foot in children and assess their association with sports participation and comorbidities. METHODS: Outpatient medical records of patients treated at the consultative and diagnostic department between 2014 and 2023 were analyzed. Overall, 1518 cases involving ankle joint and foot injuries were determined, including 111 patients referred with a preliminary diagnosis of sprain and an inversion injury mechanism. RESULTS: The study included boys and girls aged 10–16 years, one-third of them participated in sports, primarily team and gymnastic disciplines. Recurrent inversion injuries occurred more often in children who participated in sports, which should be considered when planning training programs and return to sport. Analysis of the incidence of injuries associated with inversion trauma showed that ligament sprains were most common in nonathlete children (39%), whereas bone fractures predominated in children who participated in sports (38%). CONCLUSION: This study revealed a high incidence of bone and ligament injuries associated with inversion trauma in children and elucidated the contribution of sports participation to these injuries. The broader use of magnetic resonance imaging and ultrasound, along with the refinement and standardization of their protocols, improves the understanding of inversion injuries of the foot and facilitates development of more effective diagnostic and treatment algorithms.

BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited. AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening. MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test. RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period. CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.

BACKGROUND: Nail–patella syndrome is an autosomal dominant disease caused by LMX1B mutations, characterized by a combination of dermatological and musculoskeletal abnormalities. The classic tetrad of the nail–patella syndrome includes hypoplasia of the nail plates, absence or hypoplasia of the patella, elbow joint contractures, often accompanied by posterior subluxation of the radial head, presence of “iliac horns” on radiographs of the pelvic bones, and renal changes. However, its diagnosis and treatment are not described in sufficient detail in domestic and foreign literature. AIM: This study aimed to analyze the variability of clinical and radiological manifestations in children with nail–patella syndrome. MATERIALS AND METHODS: Nine patients with nail–patella syndrome were examined and treated (aged 4 months to 14 years). All children presented to the H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery with a diagnosis of congenital multiple arthrogryposis. The examination results excluded this diagnosis. The diagnosis of nail–patella syndrome has been verified. RESULTS: Various variants of the nail–patella syndrome have been identified, with lesions to only the elbow joints (n = 3), damage to the upper and lower extremities (n = 5), and damage to only the lower extremities (n = 1). All patients had hypoplasia of fingernail plates. However, the pathognomonic sign – “iliac horns” on radiographs of the pelvic bones – was noted only in 33% of cases. Regarding functional disorders of the kidneys, proteinuria was observed in one patient, which appeared at the age of 15 years. In two cases, the parents suffered from this disease. A genetic examination was performed in three patients: a pathogenic variant in LMX1B was detected in a heterozygous state. All patients underwent conservative treatment for knee and elbow joint contractures and foot deformities. When casting, the presence of dislocation of the radial head or patella was considered. Surgical treatment was performed on five patients. The results of surgery on the lower extremities (knee contractures, foot deformities, and hip dislocation) were good in 87% of the cases. Recurrence of flexion contractures in the elbow joints was observed both after conservative and after surgical treatment in all cases; however, their severity varied. CONCLUSIONS: Clinical observations were considered to attract the attention of doctors of different specialties to a rare pathology. Moreover, a molecular genetic study is recommended for the timely diagnosis of the nail–patella syndrome, determining the treatment techniques and disease prognosis.

BACKGROUND: Archery is one of the oldest human skills that survived to the present day. At first, it was used for hunting and war and later became a sport. The interest in archery has grown annually. Each type of sport has specific injuries. Information about archery-related injuries will allow us to develop preventive measures and help make this sport safer. The article will be useful for coaches, sports doctors, physiotherapists, and orthopedic surgeons. AIM: To present modern information about frequency, types of archery-related injuries, and preventive methods. MATERIALS AND METHODS: The publication search was performed in the PubMed/MEDLINE databases from 1978 to 2023 using combinations of OR, AND operators, and keywords: archery, archery injuries, rotator cuff injuries, arrow injuries, and overuse. Consequently, we extracted 49 foreign and domestic scientific sources. RESULTS: Archery injuries occur in 4.4 per 10,000 people involved in this sport. Acute injuries in archers are rare, mainly due to shooting errors and most often lead to soft tissue damage because of a fracture of a bow, arrow, or bowstring during a shot (83.3%) or as a result of touching the bowstring with a bow. Chronic injuries occur in 83.9% of archery athletes. The main risk factors for their occurrence include overuse, high repetitions during training, lack of strength of the athlete, and incorrect technique. Overuse (67.9%) is the most common cause of chronic tendon, ligament, and joint injuries. Injuries occurred in 30%–53% of cases in the shoulders (rotator cuff tear, scapular dyskinesia, and shoulder impingement syndrome), 12.8% in the elbow (medial and lateral epicondylitis and traumatic bursitis), 8.9%–19.9% in the spine and forearm (chronic tendovaginitis and tunnel syndromes). CONCLUSIONS: Proper training and safety measures help prevent acute injuries. Practicing archery techniques and strength training are the main measures of preventing muscle overuse and reducing the incidence of chronic injuries.

BACKGROUND: Transient brachial plexopathy such as burner or stinger syndrome is a mild injury of the brachial plexus caused by forced movements of the arm or cervical spine, less often by direct impact of a traumatic factor in the supraclavicular region. It occurs mainly in athletes involved in contact sports. Clinically, transient brachial plexopathy is characterized by a sudden, sharp, stabbing pain that spreads from the neck to the fingertips and usually lasts from a few seconds to several minutes. Considering the lack of Russian literature on this disease, this article will be useful for trauma orthopedists, neurologists, sports doctors, trainers and rehabilitation specialists. AIM: The aim of this paper was to review current data on the pathogenesis, diagnosis, and treatment of transient brachial plexopathy and ways to maintain the ability of patients to participate in sports. MATERIALS AND METHODS: Publications were searched in PubMed (MEDLINE) databases and Google from 1965 to 2024 using combinations of OR, AND operators and keywords such as “transient brachial plexopathy,” “stinger syndrome”, “burner syndrome”, “sports medicine”, “children.” A total of 49 papers were selected, 13 of which were published in the last 10 years. RESULTS: The disease is diagnosed in 18.8%–65.0% of American football and rugby players. Stinger syndrome is reported in children when they fall from a chair and hit their shoulder on a table, when they hit a wall while running, accompanied by a sharp tilt of the head to the opposite side of the shoulder lesion. It is also reported in patients with shoulder hypermobility. Transient brachial plexopathy is caused by damage to the C5–C6 roots of the spinal cord or upper trunk of the brachial plexus. The pain syndrome usually lasts from a few seconds to a few minutes. It may be accompanied by paresthesia, numbness, and weakness of the upper extremity. Most symptoms of stinger syndrome (55.5%) develop during competition and resolve less than 24 hours after the game (63.8%). If the stinger syndrome resolves quickly, the patient does not require further evaluation or treatment. Indications for imaging include attacks lasting more than one hour with associated neck pain, symptoms topically associated with local nerve root damage, and recurrent attacks. CONCLUSIONS: Early diagnosis and competent management of athletes with transient brachial plexopathy, as well as improved playing technique, may prevent or reduce recurrent attacks. It is important to remember that this disease can occur in both adults and children, even in everyday life.

BACKGROUND: The absence of active elbow flexion is the most common problem in children with amyoplasia, leading to daily living difficulties. Many variants of muscle transfer are used for the restoration of active elbow flexion. The pectoralis major and latissimus dorsi muscles are the most used muscles for this purpose; however, the optimal age for these operations is not reported in the literature. AIM: This study aimed to determine the optimal age of children with amyoplasia for the restoration of active elbow flexion. MATERIALS AND METHODS: The retrospective study involved 61 patients (90 upper limbs) with amyoplasia (30 [49%] girls and 31 [51%] boys) who were examined and treated between 2011 and 2020. In 46 (51.1%) cases, we used major muscles, and in 44 (48.9%) cases, the latissimus dorsi muscle was used as a donor muscle. All patients were divided into four groups: group 1 included children aged 13 years (n = 17, 27.9%); group 2, 37 years (n = 30, 49.2%); group 3, 711 years (n = 8, 13.1%), and group 4, 1218 years (n = 6, 9.8%). The clinical examination of the patients was conducted before and after the operation (6 months). Statistical data processing was performed using Statistica 10 and SAS JMP 11. To describe the numerical scales, the average value and standard deviation (M SD) were used. RESULTS: The age of the patients at the time of surgery was 5.16 3.72 years, and the postoperative follow-up period was 41.93 30.13 months. Elbow flexion contractures were observed mainly in groups 13 (p 0.05). The greatest changes in indicators such as the strength of forearm flexor muscles, active elbow flexion, and function of the elbow were noted in group 1 (p 0.05). The same postoperative indicators were worse in group 4 than in younger patients (p 0.05). Groups 3 and 4 had less strength of the donor muscles than groups 1 and 2 (p 0.05). CONCLUSIONS: The retrospective analysis of the results of the restoration of active elbow flexion in children with amyoplasia allowed us to recommend these operations in children aged 13 years. The prevention of elbow flexion contractures and the formation of a new stereotype of movement help improve the self-ability of these patients and the treatment results.

BACKGROUND:The pathology of upper limb deformities often leads not only to impaired self-ability but may be one of the factors that lead to the development of specific difficulties inachild at various stages of learning. Deficiency of visual-motor integration and/or its subcomponents (visual perception and motor coordination) are the risk factors for academic failure. Children aged 3 years with arthrogryposis multiplex congenita and obstetric palsy are have delayed speech development and behavioral disorders, which require correction, including speech therapy atanearly age. AIM:To examine the features of the organization of correctional and developmental education of children with arthrogryposis multiplex congenita and obstetric palsy, depending on their speech development and motor disorders, and assess the features of speech development of children with obstetric palsy. MATERIAL AND METHODS:From 2020 to 2022, we examined 46 children aged 615 (average age, 9.57 2.91) years with upper limb deformities caused by arthrogryposis multiplex congenita and obstetric palsy. Speech therapy and orthopedic and statistical methods were used. RESULTS:The study included 25 children (54.3%) with arthrogryposis multiplex congenita and 21 (45.7%) with obstetric palsy. In addition, 5.09 4.34 procedures were performed for the correction of orthopedic pathology. Most of the patients had mild (n= 17, 36.9%) and moderate (n= 20, 43.5%) functional disorders of the upper extremities, and 30 (65.2%) had problems with hand function. Moreover, 11 (23.9%) children had delayed speech development atanearly age. Speech pathology was detected in 41 (89.1%) children (general speech underdevelopment,n= 20, 43.9%; lexical-grammatical underdevelopment,n= 12, 26.1%; and phonetic-phonemic underdevelopment,n= 9, 19.8%. Dysarthria was the main speech pathology in 25 patients of different age groups (54.3%). Moreover, 18 (52.9%) schoolchildren had impaired writing ability. The speech pathology in patients with arthrogryposis multiplex congenita and obstetric palsy were the same. These groups differed from each other by the form of learning (p 0.05). CONCLUSIONS:Children and adolescents with arthrogryposis multiplex congenita and obstetric palsy have special educational needs and often need speech therapy assistance taking into account the specific orthopedic pathology.

BACKGROUND: Disorders of the maxillofacial region in children with аrthrogryposis multiplex congenita can be congenital or occur as secondary changes. The lower jaw and associated muscles play important roles in the functioning and development of the maxillofacial region. In children with аrthrogryposis multiplex congenita, the functional activity of the muscles of the maxillofacial region has not been studied. AIM: To estimate the functional activity of the muscles of the maxillofacial region in children with аrthrogryposis multiplex congenita. MATERIALS AND METHODS: Surface electromyography was used to examine the masticatory and facial muscles of 47 children aged 317 years with arthrogryposis (main group) and 20 healthy children with orthognathic bite (control group). The main and control groups were examined by a dentist and had not previously received orthodontic treatment. The bioelectric activities of the temporalis and masseter muscles on the right and left sides were simultaneously registered at rest and during functional tests (opening of the mouth, moving the lower jaw forward, jaw compression, and chewing). The average activity amplitudes were taken into account, and asymmetry coefficients were calculated. The obtained data are statistically processed. RESULTS: Electromyography results, according to different functional tests, revealed disorders in 65%88% of children with аrthrogryposis multiplex congenita. In all samples, the tonic activity of the masticatory muscles increased at rest, the amplitude of the activity of masseter and temporalis muscles decreased, signs of an imbalance of the masticatory muscles such as the hyperactivation of the temporalis muscle compared with the masseter muscle with jaw compression and chewing were noted, and muscle asymmetry indices increased. The frequency and degree of functional muscle disorders prevailed in children with deciduous and temporary occlusion. CONCLUSIONS: Arthrogryposis multiplex congenita in children is characterized by a high frequency of impaired functional activity of the muscles of the maxillofacial region, which can negatively affect bite formation, chewing function, and articulation.

BACKGROUND: The absence of active forearm flexion in children with amyoplasia leads to severe functional disorders. Muscle transfer can potentially restore active elbow flexion and the patients daily living. AIM: This study compares the results of the transposition of the latissimus dorsi and pectoralis major to the biceps brachii and identifies the optimal donor area for restoring active elbow flexion in children with amyoplasia. MATERIALS AND METHODS: The retrospective study involved 61 patients with amyoplasia (30 (49%) girls and 31 (51%) boys) who were examined and treated from 2011 to 2020. Restoration of elbow flexion was performed in 90 cases. In 46 cases (51.1%), we used the pectoralis major, and in 44 (48.9%), the latissimus dorsi as donor muscles. In both groups, we performed monopolar muscle transfers. The clinical examination of the patients was conducted before and after the operation. Statistical data processing was performed using Statistica 10 and SAS JMP 11. RESULTS: The age of patients at the time of surgery was from 1.5 to 15.5 years (6.24 4.24 years), the follow-up period after surgery was from 6 to 99 months (41.25 30.19 months). After surgery, all patients had elbow flexion contractures. However, when the latissimus dorsi was used as a donor muscle, the degree of contracture was less than after pectoralis major transfer (15.19 13.04 and 23.24 15.37, respectively, p = 0.0483). In addition, after the latissimus dorsi transfer, the strength of the forearm flexors was on average 1 point greater than after the pectoralis major transfer (2.85 1.08 and 4.00 0.62 points, respectively, p 0.0001). After the latissimus dorsi transfer, the active elbow amplitude flexion was bigger than that of the pectoralis major transfer (75.37 17.86 and 55.88 24.60, respectively, p = 0.0022). CONCLUSIONS: The study demonstrated the effectiveness of using the latissimus dorsi and the pectoralis major to restore elbow flexion in children with amyoplasia. However, if it is possible to choose a donor muscle, it should be the latissimus dorsi.

BACKGROUND: Obstetrics plexus occurs in 0.44 cases per 1000 newborns. Moreover, 70%92% of the patients have mild injuries that spontaneously recover within 2 months after delivery, and the remaining patients have secondary deformities of the limbs, leading to motor disorders of varying severities. Studies have reported that the limited or absence of hand motor functions can lead to cognitive deficits and speech underdevelopment. AIM: To study the features of speech development in children with obstetrics palsy. MATERIAL AND METHODS: From 2020 to 2021, we performed speech examination of 33 children with obstetrics palsy from the age of 315 (average age, 8.10 3.71) years. All patients were divided into four groups: group 1 (34 years, n = 6), group 2 (56 years, n = 10), group 3 (710 years, n = 9), and group 4 (1115 years, n = 8). Speech examination and orthopedic, neurological, and statistical tests were performed. The results of the examination were analyzed statistically. RESULTS: In this study, 78.8% of the patients with obstetric palsy had speech pathology. Children with speech disorders had more severe neurology and motor disturbance than children without speech pathology. In group 1, speech disorders were identified in 66.7%; group 2, 90.0%; group 3, 66.7%; group 4, 87.5%. Group 1 had speech development delay and phoneticphonemic underdevelopment. Group 2 had general speech underdevelopment and phoneticphonemic underdevelopment. Group 3 had general speech, lexicalgrammatical, and phoneticphonemic underdevelopment, Group 4 had general speech and lexicalgrammatical underdevelopment. Moreover, 73.1% of the children had minimal dysarthria (predominantly in children of groups 1 and 2). Groups 3 and 4 had written expression disorder. CONCLUSIONS: The study demonstrates a high incidence of speech disorders in children with obstetrics palsy. These children demand early speech examination and timely correction of existing disorders.

Introduction Amyoplasia is the most common type of arthrogryposis multiplex congenita. Some patients may lack active elbow flexion due to aplasia of the forearm flexor muscles. The objective was to identify the optimal age for pectoralis major muscle transfer to improve elbow flexion in children with amyoplasia and estimate outcomes of the procedure depending on the level of spinal cord injury. Material and methods Restoration of active elbow flexion was performed for 34 children with amyoplasia (39 upper limbs) between 2011 and 2020 using partial monopolar pectoralis major muscle transfer. The age of patients ranged between 1.5 and 15.5 years (6.24 ± 4.24 years). The patients were divided into 3 groups depending on the level of spinal cord injury: C6–C7 (n = 4; 11.8 %), C5–C7 (n = 24; 70.6 %), C5–Th1 (n = 6; 17.6 %). The outcomes were estimated at 6 to 99 months (44.53 ± 31.72 months). The patients underwent preoperative and postoperative clinical and neurological examination. The results were statistically analyzed. Results Active elbow flexion improved by 56.8 degrees (p < 0.0001), forearm flexor muscles strengthened by 2.0 points (p < 0.0001) and extension deficit improved by 14.5 degrees (p < 0.0001) were postoperatively statistically significant. Results were rated as good in 15 (38.5 %); as fair, in 8 (20.5 %) and poor in 16 (41 %) cases. Greater differences were found between the group of patients with the level of C6-C7 spinal cord injury in relation to the group of patients with the level of C5-Th1 (p < 0.05). There were no statistically significant differences between patients with C6–C7 and C5–C7 lesion levels (p > 0.05). Children of different age groups showed no differences in the results of treatment (p > 0.05). Conclusion Pectoralis major muscle could be used for active elbow flexion restoration in patients with amyoplasia. The best results were observed in patients with C6–C7, C5–C7 segmental lesions of the spinal cord. There was no correlation between age of patient at the time of surgery and the effectiveness of operation.

Background. Patients with amyoplasia-type arthrogryposis and hip dislocation have different variants of hip contractures and deformities, but there is no difference in the selection of the type of surgery. The study aimed to justify and evaluate the effectiveness of the original algorithm of the rational selection of surgical approaches in children aged 3 years with hip dislocation in amyoplasia. Material and Methods. Level of evidence II. Seventy patients were examined, including 21 children aged 1 year (main group) who underwent 25 hip open reductions; 19 children aged 1.53 years (main group) who underwent hip open reductions, Salter innominate osteotomy, and femoral osteotomy; and 30 patients aged 37 years (control group) who had not previously received conservative and surgical treatment. All patients were divided into two subgroups depending on the variant of hip contracture: flexionextensionabductionexternal rotation (frog-like) (subgroup 1) and flexionextensionadductionexternal rotation (subgroup 2). Clinical, radiological, and statistical methods were used. Results. In subgroup 1, after hip open reduction, good results were noted in 17% of cases, satisfactory in 50%, and unsatisfactory in 33%. Severe complications, i.e., classes III and IV according to the modified ClavienDindoSink classification, were noted in 83% of the cases. After hip open reduction, Salter innominate osteotomy, and femoral osteotomy in subgroup 1, good results were noted in 50% of cases and satisfactory and unsatisfactory each in 25%, and 50% had less severe complications (p = 0.041). In subgroup 2, after hip open reduction, good results were obtained in 90% of cases and satisfactory in 10%, and 10% had severe complications When this surgery was combined with Salter innominate osteotomy and femoral osteotomy, good results were noted in 75% of cases, satisfactory in 19%, and unsatisfactory in 6%, and 25% had severe complications (p = 0.05). Conclusion. A differentiated treatment approach of children with hip dislocation in amyoplasia-type arthrogryposis will increase the effectiveness of treatment methods, and its introduction into clinical practice will help to improve outcomes.

Background. Despite the success in the treatment of children with mucopolysaccharidoses (MPS) as a result of the widespread of enzyme replacement therapy and hematopoietic stem cells transplantation, orthopedic manifestations continue to be a significant problem, while the pathology of the upper limbs in children with MPS is not sufficiently represented in the literature. The aim of this studywas to analyze orthopedic and neurological manifestations in the upper extremities of children with mucopolysaccharidosis based on a sequential case series. Materials and Methods. We carried out a comprehensive analysis of clinical and radiological involvement of the upper extremities in 49 patients with MPS. Results. The most common complaints reated to the upper extremities were difficulties in the daily activities (dressing, self-care, playing), impairment of the fine motor skills, and muscle weakness. The most frequent clinical manifestations related to the upper extremities were limited active shoulder abduction, impaired hand grip, flexion contractures of the elbow joint, ulnar deviation of the hand. All patients with MPS types I, II, and VI had limited active and passive extension and flexion of the metacarpophalangeal and interphalangeal joints. In patients with MPS IV, hypermobility of the hand joints prevailed. We noticed minimal presence of typical clinical manifestations related to compression of the median nerve secific for carpal tunnel syndrome. The majority of patients showed a decrease in tendon and periosteal reflexes. The most pronounced decrease in muscle strength was observed in to extensors (elbow, fingers) and shoulder abductors, which may contribute to the predominant formation of a flexion pattern of contractures. On radiographs of the hand, the “melting sugar” symptom and shortening of the metacarpal bones were observed in most patients. Conclusion.Clinical and radiological manifestations related to the upper extremities take place in all types of the mPS, and lead to functional disorders that complicate daily life and self-care. Upper limb pathology in children with MPS requires earlier detection and more active treatment after comprehensive risk assessment.

Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.

This article analyzes the literature related to flaccid paresis and paralysis of the upper extremities in children during the first months of life. This pathology is a heterogeneous group of diseases with different etiopathogenesis. There are various courses of flaccid paresis and paralysis of the upper extremities in children: damage to the spinal cord, brachial plexus, peripheral nervous system to the level of the brachial plexus, and isolated damage to peripheral nerves. According to the time of occurrence, flaccid paresis and paralysis can be divided into three groups: antenatal, intranatal, and postnatal pathology. The main mechanism of occurrence of this pathology is intranatal trauma. More rare causes of flaccid paresis and paralysis of the upper extremities are antenatal conditions of dysplastic and traumatic origin, postnatal damage to the peripheral nervous system due to trauma or infection. Congenital contractures of the upper extremities combined with flaccid paralysis are connected with genetically determined diseases of the lower motor neurons and congenital myopathies, intrauterine injuries of the brachial plexus peripheral nerves. This article discusses the issues of topical and differential diagnosis of this pathology, the clinical picture suitable for each period of the childs life, and the prognosis of the disease. This research will be useful not only for neurologists, but also for specialists of related specialties: orthopedists, physiotherapists, and neonatologists for making correct the diagnosis, providing adequate treatment, and predicting its results.

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii. AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle. MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11. RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 31.72) postoperative. The mean age of patients was 6.24 4.24 years. The active postoperative elbow motion was 0120 (71.94 33.40). The passive postoperative elbow motion did not change and was 90130 (104.12 12.40). Muscles strength after the operation was grade 25. Elbow extension was limited in 30 cases (76.9%) from 0 to 40 (21.70 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%). CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.

The current study aimed to compare differences in the cognitive development of children with and without upper limb motor disorders. The study involved 89 children from 3 to 15 years old; 57 children with similar upper limb motor disorders and 32 healthy children. Our results showed that motor disorders could impair cognitive functions, especially memory. In particular, we found that children between 8 and 11 years old with upper limb disorders differed significantly from their healthy peers in both auditory and visual memory scales. These results can be explained by the fact that the development of cognitive functions depends on the normal development of motor skills, and the developmental delay of motor skills affects cognitive functions. Correlation analysis did not reveal any significant relationship between other cognitive functions (attention, thinking, intelligence) and motor function. Altogether, these findings point to the need to adapt general habilitation programs for children with motor disorders, considering the cognitive impairment during their development. The evaluation of children with motor impairment is often limited to their motor dysfunction, leaving their cognitive development neglected. The current study showed the importance of cognitive issues for these children. Moreover, early intervention, particularly focused on memory, can prevent some of the accompanying difficulties in learning and daily life functioning of children with movement disorders.