Musculoskeletal System In Children Research Articles

Comparative analysis of the detection of diseases of the muscular system in minors of Saint Petersburg

BACKGROUND: Diseases of the musculoskeletal system in children and their dynamics and structure are urgent health problems and have important scientific and practical significance. The epidemiological features of the detectability of pathology in different regions are of interest for detailed consideration. AIM: This study aimed to conduct a comparative characterization of the primary morbidity of children with diseases of the musculoskeletal system in St. Petersburg in the 2017–2022 period. MATERIALS AND METHODS: Official collections of statistical reports of the Central Research Institute of Organization and Informatization of Healthcare from 2017 to 2022 were analyzed. Indicators of diseases of the musculoskeletal system and connective tissue in children were analyzed, and a comparative assessment of the ratio of the probabilities of detecting pathologies in general and for individual nosologies presented in the collections in St. Petersburg and the Russian Federation was performed. Digital analysis was performed in Microsoft Office 2010 programs (Word and Excel). RESULTS: The indicators of primary morbidity in St. Petersburg from 2017 to 2022 exceeded the national and regional averages and had a negative upward trend. In all age groups, over 6 years, the odds ratio in favor of St. Petersburg increased with arthropathies in general and deforming dorsopathies and decreased with spondylopathies and systemic connective tissue lesions. Moreover, in children aged 0–14 years, the chances of detection in St. Petersburg increased with respect to reactive arthropathies and fell with juvenile arthritis, whereas in adolescents the increase concerned juvenile arthritis and the decrease in reactive arthropathies. In rheumatoid arthritis, a transition was noted – the probabilities of detection have become lower in favor of the regions in Russia. CONCLUSIONS: In St. Petersburg, an unfavorable trend in the probabilities of detecting diseases of the musculoskeletal system and connective tissue was registered among children. A two-stage increase in indicators was found in 2017–2019 and 2020–2022, and the rate of increase in the detectability of most nosologies during the COVID-19 pandemic exceeded the prepandemic values, indicating the conjugacy of the studied group of diseases with organizational limitations in the outpatient unit, quality and specificity of differential diagnosis, and viral component. The identified features indicate the need for a reassessment of organizational measures and management decisions.

Патогенетические аспекты лечения болезни Шинца

Today, osteochondropathy is one of the most common pathologies of the musculoskeletal system in children, leading to persistent loss of function of the lower limbs. Osteochondropathies are one of the main causes of disability due to diseases of the musculoskeletal system, accounting for 31.4%. Osteochondropathies are combined with each other in 21% and are detected with other skeletal pathologies in 63% of cases. To date, there are no effective methods for treating this disease. The article lecture covers issues of epidemiology, modern theories of development, pathogenetic and clinical aspects, diagnostic criteria, and modern principles of treatment of Schinz disease, as well as an analysis of the causes of its prevalence in the child population.

Imaging Findings in Pediatric Musculoskeletal Infection and Inflammation

Infections and inflammatory conditions of immature musculoskeletal systems in pediatric patients also affect the adjacent muscles, connective tissues, and joints. Rapid diagnosis leading to appropriate treatment can significantly impact the occurrence of complications and mortality rates due to these conditions. When a radiologist becomes familiar with the imaging findings of pediatric musculoskeletal infections and inflammatory diseases, rapid differential diagnoses and more timely and appropirate treatment could be possible. In this paper, we introduce the imaging findings of infectious and inflammatory diseases affecting the immature musculoskeletal system, such as osteomyelitis, pyogenic arthritis, juvenile idiopathic arthritis, and hemophilic arthritis, based on the anatomical and pathophysiological characteristics of the immature musculoskeletal system in children.

Prevention of ankle joint deformities in children on the side of fibular graft intake for microsurgical transposition

BACKGROUND: Reconstructive operations of the musculoskeletal system in children may require the removal of a massive autograft for microsurgical bone grafting. The traditional donor site is the diaphyseal part of the fibula. In the late postoperative period, these patients may develop complications such as a valgus deformity of the ankle joint on the side of the donor fibular defect.
 AIM: To analyze the effectiveness of surgical methods for the prevention of hallux valgus of the ankle joint after free transplantation of a fragment of the fibula to replace limb-bone defects in children.
 MATERIALS AND METHODS: The treatment results of 11 patients aged 11–16 years (6 girls and 5 boys), in whom an autograft from the fibular diaphysis was used to replace defects in long tubular bones were analyzed. Two patients had a femoral defect as a result of previously transferred hematogenous osteomyelitis. A congenital false joint of the femur was found in 2 patients, bones of the lower leg in 6, and the ulna in 1. The distal fragment of the resected fibula was stabilized by an autograft from the iliac bone, in eight and three cases at the level of the diaphysis and metaphysis of the specified fragment, respectively. The size of the resected fragment in % of the total length of the fibula and the level of distal osteotomy were considered. The presence and magnitude of the proximal displacement of the fragment and the position of the ankle joint gap were evaluated at least 5 years after surgery.
 RESULTS: In this study, ≥5 years after the intervention, proximal displacement of the distal fragment of the fibula was absent in only one patient. In the remaining 10, the displacement value did not exceed 3.5 mm. Valgus deformity in the ankle joint of 5° from the initial position developed in two patients. Its progression was prevented by temporary hemiepiphysis of the distal epiphysis of the tibia using a 4.0-mm diameter spongiose screw, whereas in up to 16 months, the valgus deformity progression stopped and decreased to initial values.
 CONCLUSIONS: Fibular resection in the optimal variant should preserve the distal part of the bone as much as possible, and the stability of the ankle joint increases with synostosis of the shin bones in the distal diaphyseal section without bringing the bones closer together. When a clinically significant valgus deformity appears (5° from the initial position) with the preservation of the function of the distal growth zone of the tibia, the use of temporary transphyseal hemiepiphysiodesis of the tibia for correction is optimal.

Prevalence of temporomandibular disorders in juvenile idiopathic arthritis evaluated with diagnostic criteria for temporomandibular disorders: A systematic review with meta-analysis.

Juvenile idiopathic arthritis (JIA) is a very common systemic inflammatory rheumatic disorder affecting the musculoskeletal system in children below 16 years of age. Joint inflammation and tissue destruction is the prime characteristic of the disease. Along with the systemic involvement in the long joints, several studies are mentioning the increased association of temporomandibular disorders (TMDs) in JIA. This current systematic review intends to find the prevalence rate of TMD in JIA-affected individuals as compared to healthy controls. We have searched in PubMed, Scopus and Ovid SP for articles published between the timeframe 1 January 1990 and 1 June 2023. All the searched articles were subjected to the Population, Exposure, Comparison, and Outcome model (PECO) based on which inclusion or exclusion is carried out. Participants (P) are children below 18 years of age, Exposure (E) is children or adolescents with a diagnosis of JIA, Comparator is age and gender-matched healthy controls who has no JIA or any systemic disorder, Outcome (O) is the prevalence of TMD. Only the studies that evaluated TMD using diagnostic criteria for evaluation of TMD (DC/TMD) were included in the analysis. We have set the exclusion to the following reasons- diagnostic sensitivity studies, case reports, and systematic reviews. The software Review Manager Version 5.4 (Cochrane Collaboration) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two groups (JIA and no JIA) for the outcome TMD. The pooled total included subjects were 366 in this review with an established diagnosis of JIA as evaluated by DC/TMD. The overall effect of the pooled data suggests that there is a significant difference in the TMD prevalence in the JIA group when compared to the control, results suggest that TMD is more prevalent in the JIA group RR 3.86; 95% CI [2.59, 5.76]. Overall, based on the data we can suggest a positive relationship between JIA and TMD, hence presence of JIA can be a risk factor for the development of TMD. The sensitivity of DC/TMD is low when compared to magnetic resonance imaging.

The Effect of Additional Whole-Body Vibration on Musculoskeletal System in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Nowadays, whole-body vibration (WBV) has become increasingly popular as an additional therapy in the intervention of patients with cerebral palsy (CP). However, the impact of WBV remains a subject of debate. Consequently, a systematic review and meta-analysis were undertaken to evaluate the effects of WBV on the musculoskeletal system in children with CP. Randomized controlled trials (RCTs) were sought in the most frequent databases. The intervention studied was WBV combined with conventional physiotherapy (PT) compared with conventional PT as the control; the main outcomes were changes in the musculoskeletal system. Weighted mean differences with 95%CIs were calculated. A random-effects model was applied, and the publication bias was checked using funnel plots. On the basis of the inclusion and exclusion criteria, 16 articles, including 414 patients, were considered in the final analysis. The improvement in walking performance (speed and step length) was statistically significant (p < 0.05), and although there were no significant differences in the further outcomes, a clear positive tendency was visible in the case of improved muscle strength, decreased spasticity, enhanced gross motor functions, and overall stability. Based on the findings, a clear assessment of the usefulness of this intervention cannot be made; nonetheless, due to the promising results, it would be worthwhile to conduct additional RCTs to enhance the available evidence in this field. Due to the wide range of vibration configurations, including varying durations and intensities, it is suggested to establish guidelines and a strategy for the incorporation of this additional treatment.

БІОМЕХАНІЧНА ОЦІНКА ПОСТАВИ ДІТЕЙ 6-8 РОКІВ

The current state of health of the population of Ukraine as a whole, children and youth in particular, is a significant challenge to society and the state and, without exaggeration, poses a real threat to humanitarian security. Numerous studies conducted in recent years testify: the mass nature of functional disorders of the musculoskeletal system is one of the most urgent problems of modern society. Functional posture disorders are among the most common abnormalities in the musculoskeletal system in children and young people.

The Musculoskeletal System in Children with Cerebral Palsy.

Martin Gough and Adam Shortland. The Musculoskeletal System in Children with Cerebral Palsy: A Philosophical Approach to Management. London: Mac Keith Press; 2022 (174 pages) ISBN 978–1-911612–53–7 (£ 75.00)

Determinants for Predicting Polyorganic Functional Changes of the Musculoskeletal System in Children with Various Degrees of Joints Hypermobility

Aim: The aim of the work was to study the presence of determinants for predicting the local structures involvement of the musculoskeletal system against the background of joint hypermobility in children. Materials and Methods: The study involved 446 children aged from four to six years. The study plan includes: copying the data of a comprehensive medical examination; determination of joint hypermobility by goniometry and evaluation according to the criteria of presence and degree of joint hypermobility by the method of C. Carter, J. Wilkinson – in the modification of P. Beighton; application of clinical and physiological methods (functional testing, genealogical analysis) and methods of mathematical data processing. Results: The significance hierarchy of morpho-functional features in relation to the further development of the pathological process in children with one of the main manifestations of undifferentiated connective tissue dysplasia – joint hypermobility – is predicted. Determinants of predicting local involvement of musculoskeletal structures (mobility of the spine in the sagittal plane, muscles endurance of the dorsal torso surface) were determined. Conclusions: Against the background of the study of a wide range of clinical features of several generations’ orthopaedic lesions, the fact of highly-progressing risk of scoliotic disease and flat foot was established.

Differential diagnosis in children with musculoskeletal pain in Emergency Department

Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare system, we also evaluated the impact of pandemic on type of musculoskeletal symptoms.&#x0D; Study design: A retrospective cross-sectional study was conducted by statistical analysis of data of patients with non-traumatic musculoskeletal pain registered in HED between January 2018 and December 2020. Data of patients referred and not referred to hospital ward and admitted to HED before and during COVID-19 pandemic have been compared.&#x0D; Results: Majority of patients presented acute, non-trauma related, single-site pain, usually localized in the hip, the knee and the spine. 21,49% of patients were referred to a hospital ward, usually rheumatological, neurological or orthopedic. Final diagnoses in almost ¾ patients belong to the group of musculoskeletal system and connective tissue disorders. During the pandemic significantly less patients with musculoskeletal pain reported to our HED. The duration of symptoms before admission was not significantly longer than in previous years, but the problem in children and the impact of the pandemic on the musculoskeletal system in children is complex.&#x0D; Conclusions: Our study provides detailed information on patterns of pediatric musculoskeletal consultations in HED. A positive history of trauma preceding musculoskeletal pain in a child may only be accidentally related to the final cause. Musculoskeletal pain can be also a symptom of a lot of various systemic conditions, not only diseases of the musculoskeletal system. The still ongoing COVID-19 pandemic may require changes in the organization of the HED. We believe that the presented results can help in organizing and planning care in pediatric HEDs, develop diagnostic algorithms and training for HED staff.

Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review.

We present basic differences in the musculoskeletal ultrasound examinations between adults and children. Examiners who deal with adults on a daily basis have shared concerns about examining children. Such concerns may arise from the different approach to child ultrasounds, but they also come from differences in anatomical characteristics according to developmental age. We discuss the presence of growth plates, as well as non-mineralized parts of the bones. We also refer to the pathologies most often found in ultrasounds in early developmental stages. In the PubMed database, the set of keywords: “msk ultrasound in children”, “pediatric msk sonoanatomy”, “coxitis fugax”, “pediatric Baker’s cyst”, “Baker’s cyst ultrasonography”, “bone septic necrosis in ultrasonography”, “ultrasonography in juvenile idiopathic arthritis”, and “ultrasonography in juvenile spondyloarthropathies”, was used to identify a total of 1657 results, from which 54 was selected to be included in the article. We discuss the problem of osteochondritis dissecans, Osgood-Schlatter disease, examples of ligament injuries (especially in relation to the knee and ankle joints), exfoliation of growth cartilages, osteochondroma, exudates and inflammations affecting joints, and Baker’s cysts. In this way, we have collected useful information about the most common diseases of the musculoskeletal system in children.

Congenital dislocation of the hip – theories, etiological and predisposing factors (risk factors)

According to current statistics worldwide, congenital orthopedic pathologies rank second quantitatively after congenital diseases of the nervous system. Congenital dislocation of the hip is one of the most common and severe pathologies of the musculoskeletal system in children and adolescents. The theories of its development and etiological factors are not only of historical interest but also create prerequisites for determining the true cause of this complex process. The problem of predicting the development of hip dysplasia remains relevant. The practical significance lies in determining the etiological factor (predisposing or risk factors) of the disease onset or manifestation. Analysis of the literature suggests that hip dysplasia is based on a genetic substrate as an etiological factor. Predisposing factors only increase the risk of pathology manifestation. Further studies to determine the etiological factor will make it possible to formulate more specific recommendations for the management of patients with hip dysplasia and possibly expand the methods of prevention and conservative treatment.

Comparative assessment of the state of the musculoskeletal system in children with different types of environmental pollution

In areas with three types of environmental pollution, the state of the musculoskeletal system was studied in 22,710 children aged from the first days of life to 17 years. In general, an increase in the incidence of diseases and injuries of the osteoarticular system was noted, which was most pronounced in areas with aluminum production, which indicates a direct dependence of the pathology of the musculoskeletal system on microelement disorders. In the zone of consequences of the Chernobyl accident with a period of radiation contamination calculated from 1986, static skeletal disorders are most frequent, in Kazakhstan, where the mixed type of contamination has been active for 30 years, the frequency of congenital deformities is increased, and in the zone of aluminum complexes, acquired diseases of the skeleton.

THE INFLUENCE OF VITAMIN D DEFICIENCY ON THE DEVELOPMENT OF THE MUSCULOSKELETAL SYSTEM PATHOLOGY IN CHILDREN AND ADOLESCENTS

The aim of the study was to investigate the influence of vitamin D deficiency on the development of various diseases of the musculoskeletal system in children and adolescents. 120 patients were examined from 1.5 months (6 weeks) to 15 years from 2018 to 2020 years. They had different orthopedic disorders. There were 69 girls and 51 boys. 4 subgroups were divided according to the clinic: A. Hip joint dysplasia (25 pat.), B. Disorder of body constitution, posture (35 pat.), scoliosis (15 pat.), C. Bone deformation of the lower extremities (21 pat.), D. Delay in growth rate (24 pat). The results of this research look like: We found no difference between vitamin D levels in healthy (control group) and group A. Although the bone deformation of the lower extremities up to two years is considered physiological, we have found low levels of vitamin D without rickety changes in the bones on a radiograph. There is a discussion about the importance of vitamin D and Ca in the development of scoliosis. We found a correlation between low levels of vitamin D and clinical deterioration and negative dynamics on vertebral radiographs (group B1). Ca levels remained in normal range.

FEATURES OF INCIDENCE IN CADETS ASTRAKHAN REGION

Morbidity is one of the indicators of population health. In recent years, there has been an increase in the incidence of children, an increase in chronic diseases. The article analyzes the dynamics of the incidence of cadets in the Astrakhan region. As a result of the study, a persistent trend was revealed to increase the number of children included in the first health group. The number of children included in the third health group has decreased. In the structure of the incidence of ophthalmic pathology, the dominant place is occupied by myopia and spasm of accommodation. There is also a low prevalence of gastrointestinal tract morbidity among cadets. The results obtained point to the positive impact of sports and drill load on the development of the musculoskeletal system of children. Sports combat training contributes to the adequate development of the muscular system, which, of course, is the prevention of posture disorders and harmonious development.

MORPHOLOGICAL STRUCTURE OF THE FEMUR IN WHITE RATS WITH HYPOPARATHYROIDISM

The disease of the musculoskeletal system in children of the first months of life is quite a lot, deformities of the lower extremities are most common. The reason for the observed deformities of the lower extremities is the delay in the development of the bone skeleton during fetal life, due to heredity, infectious diseases of the mother during pregnancy, endocrine pathologies, toxicosis (especially the first half of pregnancy). Many authors, studying the endocrine status of patients with deformities of the lower extremities, came to the conclusion that this pathology is hormonal and mainly develops in the late period of the child's intrauterine life [1, 2, 4, 5 ].

The state of the feet in younger schoolchildren in the conditions of an innovative form of education

Introduction. The foot is the foundation of health, performing essential functions for ensuring human life. The foot’s disorders and deformities significantly limit the body’s capabilities and reduce the quality of life, starting from childhood. A necessary condition for prevention is the assessment and control of the feet, including educational activities. The importance of such studies increases with hygienic studies of innovative forms of education. Materials and methods. The study involved 220 7-9 year children (104 boys and 116 girls), studying in an innovative form of education that implements the mode of dynamic postures sitting at a table and standing at a desk. Plantographic studies were carried out using a copy print of the trace “Bauerfiend” (Germany). For the analysis of plantograms, the Striter method was used. Various symmetrical (two-sided) and asymmetric (one-sided) combinations of right and left foot states were evaluated (11 variants in total). Results. The features of the prevalence of symmetrical and asymmetric forms of states of the longitudinal arch of the foot in students aged 7-9 years are determined. Symmetrical forms of foot conditions were found in 64.1% of children, asymmetric-in 35.9 %. The prevalence of normal bilateral arch of the foot was observed in only 28.6 % of children, flat feet-in 13.2 %, flattening-in 17.3%, elevated arch-in 4.1 %, hollow foot-in 0.9 % of children. In the course of training from the 1st to the 3rd grade in dynamic poses, positive dynamics of the feet states was noted 1.8 times more often than unfavourable. The features of the dynamics of the state of the feet were revealed: the frequency of flat feet did not change, the increased arch of the right foot decreased by 3.5 times, the left - by 11 times; the flattening of the right foot increased by 1.6 times, the left foot - by 1.8 times. It is pointed out that it is necessary to identify asymmetric states of the feet that have a prognostic value in the formation of disorders of the musculoskeletal system in children, including in educational activities. Limitations. The criteria for inclusion of children in the study were the age from 7 to 9 years and the absence of acute diseases at the examination. Conclusion. The obtained data should be considered when conducting and analyzing the results of foot examinations in the process of preventive medical examinations of the child population.

Лучевые методы диагностики остеохондропатий

Osteochondropathies are degenerative and dystrophic diseases affecting various parts of the spongy bones. They are one of the most common diseases of the musculoskeletal system in children and adolescents, leading to disability in the absence of early diagnosis and timely treatment. Despite the fact that the etiology is currently insufficiently studied, there are many modern methods of diagnosing this pathology. Diagnostic radiology techniques are successfully used in modern medicine, but have both advantages and disadvantages. We review literature on radiology techniques for osteochondropathies diagnostic, such as radiography, ultrasound diagnostics, magnetic resonance imaging, computed tomography and some others. We analyze the results of the study of various researchers in this field and make the relevant conclusions. According to most researchers, the examination of patients with suspected osteochondropathy should begin with ultrasound examination. Osteodensitometry, perfusion magnetic resonance imaging, and pneumoarthrography can be used as auxiliary research methods in case of difficulties in making a diagnosis.

Investigation of the possible effectiveness of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia

Introduction. Congenital dysplasia of the hip joints is one of the main among congenital diseases of the musculoskeletal system in children and requires a long period of treatment, including in a hospital settings. Standard methods of treatment contain the orthopedic and rehabilitation measures: the use of abduction splints, a complex of physiotherapy exercises, general massage, the use of various physiotherapeutic procedures. Osteopathic correction is not included in the standards of care for this category of patients. At the same time, these standard treatment methods do not always give a desired result, and sometimes even lead to the development of complications. All this facts determines the need to search for additional therapeutic techniques.The aim of the study is to research the possible effectiveness of osteopathic correction as part of the complex treatment of children in the first year of life with hip dysplasia.Materials and methods. The study included 34 children with a diagnosis of hip dysplasia (ICD code-10 — Q65.8). The patients were randomly divided into 2 equivalent groups: study and control. Participants in both groups received standard treatment; the participants of the main group additionally underwent osteopathic correction of the revealed somatic dysfunctions. Before and after the course of treatment, the patients' osteopathic status, the disease clinical manifestations, and the X-ray data of the hip joints were assessed.Results. The inclusion of osteopathic correction in the complex with standard treatment procedures for children of the first year of life with hip dysplasia is accompanied by a statistically significant decrease in the detection frequency of the somatic dysfunctions at the regional and local levels. The median duration of standard orthopedic treatment also decreases (p&lt;0,05).Conclusion. The obtained results demonstrate that the inclusion of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia shortens the treatment time for patients. It is recommended to continue research in this direction with a larger sample size.

Роль плантарного апоневроза в формировании кавусного компонента при рецидивах врожденной эквино-поло-варусной косолапости

Актуальность. Врожденная эквино-поло-варусная косолапость (ВЭПВК) является второй по частоте среди всех врожденных аномалий костно-мышечной системы у детей и одной из самых распространенных причин детской инвалидности в Украине. Частота ВЭПВК достигает 1–3 случая на 1000 новорожденных (35–40 % от всех деформаций стоп). По данным ряда авторов, выполнение плантарной фасциотомии позволяет улучшить форму и функцию опоры и ходьбы у пациентов. Цель: определить роль плантарного апоневроза в формировании кавусного компонента в случаях рецидива ВЭПВК у детей. Материалы и методы. Проведены математические исследования с использованием графоаналитического метода. Результаты. Для снижения высоты свода стопы при коррекции ее полой деформации необходимо увеличить длину апоневроза на значительную величину (до 25 % его начальной длины). Для выполнения такой задачи к апоневрозу необходимо приложить значительную растягивающую силу, величина которой зависит от величины снижения высоты свода стопы. Так, для снижения высоты свода на 10 мм нужно удлинить апоневроз на 12 мм, для чего к нему нужно применить постоянно действующую силу величиной 932 Н. Для снижения высоты свода стопы на 20 мм величину растягивающей силы, приложенной к апоневрозу, необходимо увеличить до 1438 Н, что осуществить практически невозможно. Поэтому наличие сокращенного апоневроза является значительным препятствием для эффективного устранения полой деформации стопы. Выводы. Коррекция полой деформации стопы требует значительного уменьшения высоты ее продольного свода, что приводит к значительному удлинению апоневроза — до 25 % от его первоначальной длины. Для обеспечения увеличения длины апоневроза необходимо наличие постоянно действующей растягивающей силы значительной величины, превышающей значение 1000 Н. Плантарный апоневроз играет непосредственную роль в поддержке продольного свода стопы и является одной из причин устойчивости кавусной деформации у пациентов с рецидивом ВЭПВК, что не поддается консервативному лечению. Для устранения кавусной деформации стопы при отсутствии эффекта от консервативного лечения необходимо удлинение апоневроза путем хирургического вмешательства (пересечения). Величину угла продольного свода стопы в 110° можно выбрать в качестве критерия принятия решения в пользу сохранения или отсечения апоневроза.