Vol 4, No 1 (2016)

Introduction: Congenital clubfoot is a complex orthopedic problem, and the frequency of recurrence or secondary deformities may reach up to 60% in some cases.

Purpose: To determine indicators for the surgical treatment of recurrent foot deformity using the Ilizarov external fixator and to evaluate the effectiveness of this approach.

Materials and Methods: The feet of 78 children with recurrent congenital clubfoot were analyzed using X-ray and ultrasound to investigate their clinical and functional characteristics. According to the characteristics of the deformity, we performed tenoligamentocapsulotomy combined with tarsal osteotomies and tendon plastics. Furthermore, we determined the indicators for the surgical treatment of foot deformity using the Ilizarov external fixator.

Results: In total, 33 children (56 feet) were treated using a distraction external fixator combined with tenoligamentocapsulotomy. Following treatment, long term results were assessed using a three-point scale: good, satisfactory, and unsatisfactory. The number of children of 8 years of age whose treatment was graded as either good or satisfactory was higher than children who were over 9 years of age. Functional recovery was also better in the younger age group.

Conclusion: By determining specific indications for different treatment methods, physicians are able to apply an individual approach for diagnosing and treating recurrent congenital clubfoot. Good and satisfactory long term results were obtained in approximately 90 % of cases.

Aim: To improve treatment outcomes for children with combined craniofacial injuries

Materials and Methods: This study involved a retrospective analysis of treatment outcomes from 43 children with combined craniofacial trauma who were admitted to Rauhfus Children's City Hospital No. 19 from 2012 to 2015. Analysis involved the age and gender of patients along with the mechanism of injury, areas sustaining injury, and methods of examination and treatment.

Results: All patients underwent full surgical treatment in the early stages.

Conclusions: Managing patients with concomitant craniofacial trauma requires a multidisciplinary approach. Treatment inevitably requires surgery, which needs to be performed as early as possible to avoid posttraumatic deformities and optimize functional and esthetic outcome.

Aim: To evaluate the feasibility of an organizational model of specialized traumatological and orthopedic care for children using public–private partnership mechanisms in the Novosibirsk region.

Material and Methods: Data from patients visiting the Federal State Novosibirsk Research Institute of Traumatology and Orthopedics between 2011 and 2015 were acquired from “Medassist,” the local medical information system. Data were subsequently analyzed to identify the relative extent of medical care provided.

Results: This study included results from an organizational model of specialized traumatological and orthopedic care for children developed via public–private partnership mechanisms that have been implemented in the Novosibirsk region since 2011. A number of institutions were involved in this model of medical care for children with traumatological and orthopedic pathology, including the Federal State Novosibirsk Research Institute of Traumatology and Orthopedics, Clinic “NIITO” (a non-governmental medical organization), and various other primary health care organizations, including children’s polyclinics and hospital outpatient departments. This model allowed us to create a closed (full) cycle of provision for specialized traumatological and orthopedic care, from primary treatment to the completion of rehabilitation with dynamic supervision throughout. This was accomplished by combining various clinical stages, including the specialized clinic, hospital, rehabilitation organization, and outpatient clinic. The main areas of this model include timely and reliable detection; determination of treatment indicators; appropriate definition of treatment terms; and the provision of specialized medical care, including high technology input, rehabilitation, and dynamic monitoring.

Conclusions: Implementation of an organizational model of specialized traumatological and orthopedic care for children in the Novosibirsk region using mechanisms associated with public–private partnerships has proved to be very positive. Application of the model allowed improvements in the availability of specialized traumatological and orthopedic care for children to ensure succession in the stages of medical care and to increase the number of cases entering rehabilitation. Therefore, this model demonstrates the viability of providing medical care to the population through the mechanisms of public–private partnership.

Various options for medical treatment of children with compression fractures of the thoracic and lumbar spine include unloading of damaged segments by simultaneous or gradual reclination (e.g., functional traction and reclination of the spine); measures aimed at building and strengthening the muscular “corset” of the back; and the use of orthotic devices of various designs (e.g., fixating-discharging, fixating-correcting corsets, orthoses on a modular basis). Questions regarding the early and late use of orthotics in patients with compression fractures of the vertebral bodies are discussed. Literature analysis, considering different methods used in the treatment of these patients in terms of their effectiveness to restore the height and shape of the damaged spinal segment revealed the absence of a differentiated approach for choosing treatment and selection criteria for orthopedic management.

WHO experts recommend including quality of life measures when evaluating the results of surgical treatment in the postoperative period. Quality of life measures help to determine not only the quality of treatment but also the completeness of medical and social rehabilitation. We reviewed the research of international authors, who had used general questionnaires to study quality of life of children with long bones fractures of the lower extremities. We suggest using general questionnaires-PedsQLTM 4.0 (for children aged 2-18 years) and QUALIN (for children aged between 3 months and 3 years) as tools to evaluate treatment results in this population. Presentation of the results of studies using international efficiency indicators, in particular the assessment of quality of life, provides the basis for reliable summary of the international clinical experience.