Lower Extremities In Children Research Articles

Effects of Acupuncture Combined with Biofeedback Therapy on Limb Motor Rehabilitation in Patients with Acute Stroke: Systematic Review and Meta-Analysis.

Objective The purpose of the systematic review is to verify the effect of biofeedback therapy on limb motor rehabilitation in patients with acute stroke and to provide evidence-based medicine for the promotion and use of biofeedback therapy. Methods The randomized controlled trials (RCT) of biofeedback therapy in the treatment of cerebral palsy were searched in PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang Database, and Chinese Biomedical Literature Database (CBM). The starting time and ending time of this study are from the time of building the database of the number of pieces to October 31, 2018. The data included in this study were extracted by two independent researchers and evaluated the bias risk of all the literature included in the study according to the Cochrane manual 5.1.0 criteria. RevMan5.4 statistical software was used to analyze the collected data by meta. Results This systematic review included 9 RCT studies with a total of 1410 patients. The results of meta-analysis showed that there were significant differences in the improvement of lower limb muscle tension, comprehensive spasm scale score, EMG score, and passive range of motion of ankle joint between biofeedback therapy and routine rehabilitation therapy. Conclusion Biofeedback therapy can improve lower limb muscle tension, spasticity, EMG integral value, and passive range of motion of ankle joint in children with cerebral palsy and provide better conditions for improving the motor ability of lower extremities in children with cerebral palsy. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.

Pathogenetic substantiation of methods for correcting disorders of the neuromuscular apparatus of the lower extremity in children with congenital clubfoot

Ensuring effective and stable correction of congenital clubfoot remains an urgent task of modern pediatric orthopedics (1, 4, 6, 9). The high frequency of unsatisfactory treatment results for this deformity, according to many researchers [1, 2, 4 - 6, 9], is due to neuromuscular disorders that persist in the outcome of traditional lower limb correction. Insufficient effectiveness of traditional rehabilitation of the neuromuscular apparatus in congenital clubfoot is associated with insufficient pathogenetic substantiation of treatment [1, 6].

More than 25 years after selective dorsal rhizotomy: physical status, quality of life, and levels of anxiety and depression in adults with cerebral palsy.

The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child's life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures. Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels. Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2-41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores. Normalized lower-extremity muscle tone was sustained 25-35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.

A pediatric patient with a femoral diaphysis fracture occurring after a motorcycle accident

Introduction: Femoral diaphysis fractures are the second most common fractures influencing the lower extremity in children. They occur after high-energy traumas. Surgical treatment has come into prominence over the last 10 years to enhance patient compliance and early mobilization. Objective: We prepared this study to present an example of trauma which may lead to serious permanent disability in pediatric patients and attract attention to the precautions to be taken on this issue. Case: A five (5)-year-old male patient was evaluated in the emergency department with his older brother after a motorcycle accident. The vital signs of the patient with an isolated femoral trauma were found stable. His hemogram and biochemical values were normal. Orthopedic consultation was requested for the patient with an isolated femoral distal diaphysis fracture. He was hospitalized by an orthopedic consultant physician. He was taken into surgery. Fixation was performed surgically with a plate-screw system. The patient was discharged without complications. Conclusion: Since large bone fractures may occur in pediatric patients after a high-energy trauma such as a motorcycle accident, pediatric patients should be legally prohibited from getting on a motorcycle or getting on a motorcycle without protective equipment.

Juvenile spondyloartropathies.

Juvenile spondyloarthropathies (JSpA) are defined as a heterogeneous group of diseases that start before the age of 16, which is associated with peripheral joint (especially large joints of the lower limbs) and axial skeletal (spine and sacroiliac joint) involvement, enthesitis, and human leukocyte antigen (HLA) B27 positivity. Juvenile spondyloarthropathies mainly cover juvenile ankylosing spondylitis (JAS), psoriatic arthritis, reactive arthritis, inflammatory bowel disease-associated arthritis, seronegative enthesopathy, arthropathy syndrome (SEA), and enthesitis-associated arthritis. Symptoms associated with spondyloarthropathies are enthesitis, inflammatory low back pain, dactylitis, nail changes, psoriasis, acute anterior uveitis, and inflammatory bowel disease-related symptoms. In JSpA, axial involvement is rarely seen in the early stages of the disease, in contrast to adult patients with ankylosing spondylitis (AS). The disease usually begins as asymmetric oligoarthritis of lower extremities in children, and axial skeletal involvement can occur in the course of the disease. Although the debate on the classification of juvenile spondyloarthropathies continues due to its initial nonspecific findings and the heterogeneity of the disease phenotype, the International League of Associations Rheumatology (ILAR) classification criteria are the most commonly used pediatric criteria. In that set of criteria, patients with JSpA are mainly classified under enthesitis-related arthritis or psoriatic arthritis group. Since juvenile spondyloarthropathies can cause severe loss of function and long-term sequelae, the main goal in treatment should be suppression of inflammation as early as possible and prevent sequelae.

The role of peripheral circulation disorders in the development of diabetic myopathy in children with diabetes mellitus

Abstract. The significance and role of peripheral blood circulation sufficiency in the formation of disorders of the muscular system in children with diabetes mellitus remain insufficiently studied. At the same time, the formation of some chronic complications of diabetes is associated with a deficient muscular system function. Aim of study. To discover the state of blood supply to the lower extremities in children with type 1 diabetes mellitus, according to the ankle-brachial index and to determine the value of deviations in the development of diabetic myopathy. Materials and methods. We examined 137 children with type 1 diabetes mellitus. The control group included 41 apparently healthy children. Assessment of the functional state of skeletal muscles, determination of the skeletal muscle index, hand force index and ankle-brachial index before and after exercise were studied in all patients. The ROC analysis was used to calculate cut-off points for the hand force index and the skeletal muscle index in order to determine the diagnostic criteria for dynapenia and diabetic myopathy. Results. We observed functional disorders of skeletal muscles and a decrease in the skeletal muscle index already in the first year of diabetes mellitus. In dynamics, the progression of violations was noted. Found a negative correlation between the level of glycated hemoglobin and the skeletal muscle index (r = -0.49, p <0.05), and muscle strength (r = -0.31, p <0.05), and a positive correlation with the index percentage of body fat (r = + 0.49, p <0.05). Dinapenia was diagnosed in 68 (49.6%) children with type 1 diabetes mellitus. Diabetic myopathy was established in 37 (27.0%) patients. Changes in skeletal muscles in children with diabetes mellitus were accompanied by a deterioration in peripheral blood supply. This was supported by a decrease in the ankle-brachial index at rest and more significantly after exercise. The worst results were obtained in the group of children with diabetic myopathy. Conclusions.1. We discovered impairment in the functional state of skeletal muscles and a decrease in muscle mass in the form of dynapenia (49.6% of cases) and diabetic myopathy (27.0% of cases) in children with diabetes mellitus, taking into account the increase in the duration of the course of the disease and the insufficient state of glycemic control. 2. Impairment of peripheral circulation is one of the factors in the development of diabetic myopathy in children with type 1 diabetes mellitus. 3. The study of the ankle-brachial index after dosed physical activity can be used to diagnose latent disorders of peripheral blood supply. We can use the definition of the ankle-brachial index as a screening for children with type 1 diabetes mellitus.

Foot Print Analysis and Prevalence of Flat Foot among Children of Rural India – A Study Protocol

Introduction: Foot shape and its proportions changes gradually during normal growth of human beings, but the mechanical stresses during bipedal locomotion are a key factor for development of foot. To sustain static position and to arrange for stable base while performing various functional activities, Foot plays major role in it. Deformities in lower extremities of children’s are being very common. As this conditions are physiological, that’s why most of the time this conditions do not require treatment. In an average 90% of patient who are visiting to clinic for foot problem are flat foot. Primary manifestation of flat foot is decreasing in longitudinal arch, which shows that while standing or walking, there is transmission of whole body weight towards the medial side of foot sole. This is the main reason for which flat foot is considered as problem of static alignment of foot and ankle structure.
 Objective: To analyze footprint of children and to determine prevalence of flat foot, their anthropometric measurement, Prevalence of structural pathologies of foot and correction of foot prints and radiological evaluation of 8 – 13 years age group of children.
 Methodology: All the visiting patients of orthopedic department of AVBRH of age group 8 – 13 year, with sample size. Examination will be done along with radiological examination, radiological assessment and different anthropometric will include Plain X-ray of both feet.
 Results: We expect that, anthropometric measurements of rural children may differ from other literatures.

Comparative analysis of weight-bearing function of lower extremities in children with recurrences of congenital equinovarus clubfoot after surgical treatment by «traditional» methods and Ponseti method

Congenital equinovarus clubfoot (EVC) is the second most common congenital anomaly of the musculoskeletal system in children and one of the most common causes of childhood disability in Ukraine. The frequency of EVC reaches 1–3 cases per 1 000 newborns (35–40 % of all foot deformities). Objective. To determine the features of the children ability with EVC recurrences, before and after surgical treatment by «traditional» methods and Ponseti method. Methods. Biomechanical examinations of 65 children with EVC recurrences were performed. They were divided into two groups: group I (33 patients) — treated by «traditional» methods, which provided initial surgery, in order to completely correct all components of the deformity; group II (32 patients) — treatment by Ponseti method. Weight-bearing function was studied for all patients, before treatment, after 6 and 12 months after surgery, with statography. Results. It was determined that the standing parameters in the groups were not statistically different. After 6 months after the treatment, according to the statograms, the weight-bearing displacement remained, under the conditions of two weight-bearing standing towards the contralateral limb, in both groups of patients. In group I, after treatment, this parameter did not change (p = 0.924), and in group II it decreased by (2.7 ± 4.7) % (p = 0.013). Weight-bearing on the operated limb in both groups, in 12 months from surgery increased by 45 %. Conclusions. In patients, after treatment of EVC recurrences by Ponseti method, the weight-bearing function indicators, in the case of two weight-bearing standing, changed statistically significant. During the recovery process, when patients began to load the operated foot, a slight deterioration of standing parameters was observed in patients of group I in 6 months from surgery. In patients of group II, a complete restoration of statographic parameters occurred earlier, in 6 months, a normalization of weight-bearing and stability was observed. Thus, it can be argued that the use of Ponseti method in the complex treatment of EVC allows to restore the ability of weight bearing much earlier than with the «traditional» method. Key words. Congenital talipes equinovarus, children, Ponseti method, statography.

High lower limb amputations in gangren. Russsian Consensus

The presented recommendations were developed by federal level experts, approved at the International Scientific and Practical Conference "High amputations of the lower extremities in children and adults" (Moscow, 2019) and published on the website www.woundsurgery.ru for use in work by general, purulent, cardiovascular surgeons, specialists in X-ray endovascular diagnostic and treatment methods, endocrinologists, combustiologists and general practitioners.

Determining the relationship between the impairment of selective voluntary motor control and gait deviations in children with cerebral palsy using simple video-based analyses.

The impairment of selective voluntary motor control (SVMC) in children with cerebral palsy (CP) has been shown to correlate with their gait characteristics using complex 3D gait analysis systems (3DGA); however, this relationship has not been investigated using simple video-based observational gait analysis (VBOGA). The aim of this study was to determine the relationship between VBOGA and SVMC of the lower extremities in children with CP. Forty-two CP children 10.9 ± 5.7 years old with Gross Motor Function Classification System (GMFCS) levels I-III participated in the study. Their gait characteristics were assessed using the Edinburgh Visual Gait Score (EVGS), and selective voluntary motor control was tested using the Selective Control Assessment of the Lower Extremity (SCALE). Spearman's rho correlation test with Cohen's classification were used in the statistical analyses. The GMFCS levels (r = 0.604, p < 0.001), foot clearance (r = -0.584. p < 0.001), and maximum ankle dorsiflexion (r =-0.567, p < 0.001) during the swing phase had strong correlations with total SCALE scores. There was also a moderate correlation between total SCALE scores and total EVGS (r =-0.494, p < 0.001), knee extension in the terminal swing phase (r = -0.353, p < 0.001), peak sagittal trunk position (r = -0.316, p < 0.005), and maximum lateral shift (r = -0.37, p < 0.001). Impaired lower extremity SVMC was noticeably related to the foot and ankle movements in the swing phase and initial stance during walking as well as the total EVGS scores and sagittal and frontal trunk movements. The SCALE correlations with VBOGA were similar those observed in the complex 3DGA in the literature; therefore, we suggest that SVMC impairment of gait could be evaluated using simple VBOGA. These findings may help to tailor physical therapy programs for CP children to increase their motor control and walking quality.

Altered Somatosensory Cortical Activity Is Associated with Cortical Thickness in Adults with Cerebral Palsy: Multimodal Evidence from MEG/sMRI.

Somatosensory cortical activity is altered in individuals with cerebral palsy (CP). However, previous studies have focused on the lower extremities in children with CP and have given less attention to structural changes that may contribute to these alterations. We used a multimodal neuroimaging approach to investigate the relationship between somatosensory cortical activity and cortical thickness in 17 adults with CP (age = 32.8 ± 9.3years) and 18 healthy adult controls (age = 30.7 ± 9.8years). Participants performed a median nerve paired-pulse stimulation paradigm while undergoing magnetoencephalography (MEG) to investigate somatosensory cortical activity and sensory gating. Participants also underwent magnetic resonance imaging to evaluate cortical thickness within the area of the somatosensory cortex that generated the MEG response. We found that the somatosensory responses were attenuated in the adults with CP (P = 0.004). The adults with CP also hypergated the second stimulation (P = 0.030) and had decreased cortical thickness in the somatosensory cortex (P = 0.015). Finally, the strength of the somatosensory response was significantly correlated with the cortical thickness (P = 0.023). These findings demonstrate that the aberrant somatosensory cortical activity in adults with CP extends to the upper extremities and appears to be related to cortical thickness.

Дослідження нижніх кінцівок при вродженому артрогріпозі у дітей під впливом застосування реабілітаційних заходів

The article presents the etiology and pathogenesis of the disease according to ICD 10, determination of disorders according to IFF-DP, evaluation of the results of goniometry, VAS, muscle strength according to L.D. Potekhinim and Khabirov, manual testing of muscles by Lovett in congenital arthrogryposis of the lower extremities in children under the influence of the author's program of physical therapy: muscle-energy techniques, soft tissue techniques and articulation techniques.

Contact pressure distribution of the hip joint during closed reduction of developmental dysplasia of the hip: a patient-specific finite element analysis

BackgroundDevelopmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for the success of CR treatment sand complications by using finite element analysis (FEA) for the first time.MethodsFinite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR.ResultsA 3D reconstruction by the FEA method was performed on a 16 months of age girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and “flat-shaped” deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head.ConclusionsSevere dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to AVN, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

The scientific practical input of academician N. O. Milanov in development of national plastic surgery: To the Seventieth anniversary

Nikolai Olegovich Milanov, the academician of the Russian Academy of Medical Sciences, leading Russian surgeon, Merited Scientist of the Russian Federation, is one of the pioneers of development of reconstructive microsurgery in our country. He made immense contribution to development of modern plastic and reconstructive microsurgery. He is the author of unique developments that inputted significantly into successive achievements in treatment of traumatic and iatrogenic tissue defects and congenital pathology. The priority areas of his research were replantation of fingers, hands and larger segments of limbs in adults and lower extremities in children, abjuncted because of wheeled traumas, auto-transplantation of revasculized tissue complexes in post-traumatic, congenital and acquired pathologies in adults and children, in oncologic diseases, in extensive tracheal defects, reconstructive microsurgery of blood and lymph vessels and peripheral nerves, reconstructive microsurgery in male and female infertility. He introduced to clinical practice great number of new surgical interventions based on micro-surgical auto-transplantation of various tissue complexes. He achieved brilliant successes in scientific and practical activities during 39 years of work. He was the first in the world who underwent a successful re-implantation of lower limb, amputated at the level of upper third of leg by train wheel in 2.5-year-old child. He also was the first surgeon who performed unique operation of simultaneous replantation of two limbs, amputated at the level of middle third of leg in 7-year-old child. N. O. Milanov used the micro-surgical technique of applying direct lymphatic venous anastomoses in lymphatic edema. He developed innovative methods of multiple transplantation of toes to hand and transplantation of omentum, for example, to close defects of the scalp in basal cell carcinoma. This brilliant surgeon can be called the founder of clinical auto-transplantology. He actively participated in resolving problem of "prefabrication" of various tissue complexes with desired properties for their subsequent auto-transplantation. Under the direction of N. O. Milanov, the new scientific school was formed that included such well-known surgeons as R. T. Adamyan, A. I. Nerobeev, I. V. Reshetov and many others.

Does therapeutic yoga have an impact on flexibility of bi-articular muscles of lower extremities in children with spastic cerebral palsy?

Current diagnostic criteria for arthrofibrosis are limited. Since many patients will be aspirated during their clinical course, synovial fluid analysis may supplement current diagnostic criteria for arthrofibrosis. The goal of this study was to determine a unique synovial fluid and inflammatory marker profile for diagnosing arthrofibrosis.Patients with arthrofibrosis following total knee arthroplasty will have a unique synovial fluid aspirate profile compared to control patients to aid in diagnosis.Between 2013 and 2017, 32 patients (32 total knee arthroplasties [TKAs]) underwent revision TKAs for arthrofibrosis. Fourteen patients had pre-revision aspirations. They were 2:1 matched based on age, sex, body mass index (BMI), and year of revision to 28 patients who underwent aseptic revision TKAs for reasons other than arthrofibrosis (control group). Mean age at revision was 66 years, with 64% males.In TKAs revised for arthrofibrosis, mean total cell count was 828 cells/uL. These aspirates contained a mean distribution of 46% macrophages (range, 4–76%), 31% lymphocytes (range, 11–68%), 21% neutrophils (range, 0–75%), 1% other cells (mainly synovial cells; range, 0–11%), and 1% eosinophils (range, 0–7%). There was no significant difference in mean total cell count (p = 0.8) or mean distribution of macrophages (p = 0.6), lymphocytes (p = 0.1), neutrophils (p = 0.2), eosinophils (p > 0.9), or serum inflammatory markers (p > 0.7) when compared to controls. All aspirations were culture negative for infection.The profile of arthrofibrotic synovial fluid aspirates and serum inflammatory marker values were similar to patients revised for non-arthrofibrotic aseptic etiologies. This suggests synovial fluid and serum inflammatory markers in non-infected knees with arthrofibrosis should expect to have characteristics similar to synovial fluid and inflammatory marker profiles in other aseptic diagnoses.III; Retrospective case-control study.

Magnetic resonance imaging of a sports injury of the lower extremities in children

Introduction. The number of acute and stressful injuries has been increasing in recent years. Injuries of the musculoskeletal system in children seeking emergency care account for 41%, while children aged from 5 to 17 years with chronic sports injuries account for 53% who need medical attention. The lower extremity is the most frequently affected part of patients aged from 5 to 18 years, which is about 60% of all injuries. Aim of the study. To show the possibilities of magnetic resonance imaging in the diagnosis of sports injuries of lower extremities in children. Materials and methods. MRI was performed on a scanner with a magnetic field strength of 3 T to obtain multi-planar STIR, T1-, T2- and PD-weighted images (WI) SE and GE in axial, oblique frontal and sagittal projections with a slice thickness of 4 mm, as well as 2D and 3D isotropic images that were used to obtain images with contrast gain. Specialized coils were used for MRI. MRI was performed in case of damage to the hip (n = 19), knee (n = 329), and ankle joints (n = 32). Results. Studies of the hip were limited to sports muscle injury - muscle strain due to forced contractile load (75.8%) and muscle bruises (24.2%). According to the MRI results, 320 children with knee injury were diagnosed with ACL ruptures, in 67% - complete (n = 214), 33% (n = 106) - partial. Eight (3.7%) of 214 athletes had isolated full breaks in ACL; the remaining 206 were associated with damage to other structures of the knee joint. ACL ruptures were accompanied in all 320 cases of hemarthrosis. Of 30 patients with an ankle injury, 17 had an anterior talofibular ligament (56.7%), in 8 cases with an avulsion of bone fragments from the lateral ankle. Partial deltoid ligament injuries were detected in 9 patients (30.0%); complete ruptures were rare and were observed in only two patients (6.7%). Conclusion. Among imaging methods, MRI plays a decisive role in the diagnosis of sports injuries in children.

A transcranial magnetic stimulation study for the investigation of corticospinal motor pathways in children with cerebral palsy

The aim of this study is to perform transcranial magnetic stimulation (TMS)-based investigation of corticospinal motor pathways in children with cerebral palsy (CP) secondary to hypoxic-ischemic encephalopathy (HIE). TMS parameters including motor evoked potentials (MEPs) and central motor conduction time (CMCT) were recorded in 38 children with CP and 46 age-matched healthy controls. The z-score of MEPs were analyzed with respect to the types of MRI patterns of cortical involvement in children with CP. MEP latency values were correlated with the weight and height of children and to reflect the maturation of the corticospinal pathway. TMS evoked MEPs with prolonged onset latencies in 64% of children with CP while 10% of the CP group failed to elicit MEPs. Related with the MRI pattern, multicystic encephalomalacia (89%) was associated with the highest rates of abnormal cortical MEPs, as followed by periventricular leukomalacia (80%), basal ganglia involvement (66%) and focal cortical involvement (60%) patterns. Children with CP as compared with healthy controls had similar CMCT values on the upper and lower extremities in children with all cortical MR patterns. MEP abnormalities with TMS were consistent with the extent of motor cortex lesions on MRI patterns in CP children with HIE.

Combined Xenon and Epidural Anesthesia During Surgical Correction of Joint Deformities in the Lower Extremities of Children with Cerebral Palsy

Objectives. The objective of this study is to compare different methods of combination general and regional anesthesia based on xenon.Materials and methods. Xenon anesthesia combined with epidural block was performed in 50 children with cerebral palsy aged 3–17 years. In 30 patients xenon was used to maintain anesthesia, in 20 children xenon was combined with sevoflurane. We compared the process of anesthesia, the intraoperative hemodynamic parameters and cognitive status before surgery and after it.Results. The use of xenon in all studied anesthesia methods increased the cardiac performance and was associated with a stable hemodynamic profile at all stages of anesthesia despite the depressive effect of epidural blockade on hemodynamics. Psychological testing revealed that xenon anesthesia has no negative effect on cognitive functions in children with cerebral palsy.Conclusion. Xenon anesthesia is a promising trend in anesthesia care for children with cerebral palsy. Xenon can compensate the hemodynamic depression caused by epidural anesthesia due to its cardiac stimulant property, with no neurotoxicity being a significant benefit for children with initial damage of CNS. However, anesthesia with xenon turned out to have some disadvantages. In our study, xenon showed insufficient analgesic properties, had emetic properties and was associated with spirometric abnormalities. It was more difficult to maintain normal ventilation parameters in young children when using xenon. Several adverse events were noted in the recovery period. These disadvantages can be partially reduced by using a combination of xenon and sevoflurane.

Comparative Study between Nancy Nail and Conservative Treatment in Diaphyseal Fracture Tibia in Children

Abstract Background nonphyseal fractures of the tibia and fibula are among the most common injuries involving the lower extremities in children and adolescents; represent approximately 15% of all pediatric fractures. They occur more frequently in boys than girls. Aim of the Work assessing of efficacy and safety of treatment of diaphyseal fracture tibia in children by nancy nail versus conservative treatment. Patients and Methods this review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Results ESIN is an ideal device for treating pediatric tibial fractures allowing mobilization and maintenance of alignment until bridging callus forms. The device would exploit the rapid healing and ability to remodel without risking the physis or blood supply to the tibia. Conclusion the present study supports the treatment of tibial shaft fractures in children aged 8-13 years with ESIN, as it hastens fracture union, and allows earlier, weight bearing, rehabilitation and return to normal activity.

Comparative study of day 01 spica cast versus skin traction followed by spica cast for treatment of closed femoral shaft fracture in children

Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in followed by spica cast. Mean age in group A was 5.06 years and 5.12 years in group B (range 6 month – 10 years). Ratio of males and female in Group A and Group B was 19:13 and 20:12 respectively. Average duration of hospital stay was 1.65 days and 11.65 days in group A and group B respectively. Average total time of spica cast application was 45.13 days 49.41 days in group A and group B patients respectively. There were no significant differences between early and delayed spica regarding the complications of treatment and functional outcome. But immediate spica decreased the hospitalization time and the cost of treatment significantly with increased availability of beds while having similar result as achieved by delayed spica application.