Vol 13, No 4 (2025)

BACKGROUND: Surgical correction of scoliotic spinal deformities involving long-segment spinal fusion inevitably leads to changes in sagittal balance parameters, which may affect treatment outcomes in patients with scoliosis. This issue has been addressed only sporadically in the scientific data and requires further investigation.

AIM: This study aimed to analyze the impact of spinal deformity surgical correction on sagittal balance parameters in adolescents with severe thoracic idiopathic scoliosis in the early postoperative period.

METHODS: The study included 38 patients who underwent surgery between 2021 and 2025, which consisted of discectomy–apophysectomy at the apex of the main scoliotic curve, intraoperative halo traction, and correction and stabilization of the deformity using a posterior multisegmental pedicle screw instrumentation in a single surgical session. The inclusion criteria were as follows: idiopathic scoliosis with a primary thoracic curve; age 12–17 years; availability of standing full-spine radiographs in two projections obtained before and after surgery; and main scoliotic curve with a Cobb angle of more than 80°. The non-inclusion criteria included: congenital spinal, spinal canal, or spinal cord abnormalities; systemic musculoskeletal disorders; lower limb orthopedic condition; previous surgery on the spine, pelvic ring, or chest; poor-quality radiographs precluding reliable sagittal balance assessment; and refusal to participate in the study. Radiographic examination was performed preoperatively and 10–14 days after surgery. The regional and global sagittal balance parameters and frontal plane deformity characteristics were assessed.

RESULTS: Deviations in global sagittal balance parameters (SSA, TPA, and SVA) were observed preoperatively in 11 of 38 patients (28.9%). After surgery, such deviations were observed in 2 patients (5.3%). Insufficient correction of the kyphotic component of the deformity was identified as a significant risk factor for the persistence of anterior sagittal imbalance after surgery in patients with severe idiopathic scoliosis.

CONCLUSION: Surgery using the described approach achieves optimal global and regional sagittal balance parameters in most adolescents with severe idiopathic scoliosis. However, in cases of extremely severe deformities (Cobb angle >120–130°), which are characterized by a pronounced kyphotic component, techniques enabling greater correction of thoracic kyphosis should be considered.

BACKGROUND: The functional method is currently considered an effective treatment approach for children with developmental hip dislocation. This method involves the gradual centering of the femoral head within the acetabulum and fixation of the lower extremities using an orthosis with preserving motion in the hip and knee joints. However, complications may occur, including postreduction avascular necrosis of the femoral head and joint instability. These complications contribute to severe irreversible changes, early development of dysplastic coxarthrosis, and patient disability. The analysis of the factors leading to these adverse outcomes may improve treatment effectiveness; however, these issues remain understudied.

AIM: This study aimed to identify and analyze the main causes of unfavorable outcomes of functional treatment for dislocated developmental dysplasia of the hip in infants.

METHODS: The study was based on the examination of 56 children aged 1 to 3 years with a history of developmental hip dislocation who had received outpatient functional treatment at their place of residence, as well as a questionnaire survey of their parents. Exclusion criteria were neurological disorders and teratogenic or pathological hip dislocations. The main group comprised 26 children with unfavorable treatment outcomes, whereas the control group comprised 30 children without complications. The survey was conducted using a specially developed questionnaire designed to assess the timeliness of diagnosis and quality of outpatient orthopedic care provided to the children. Statistical analysis of the collected data was performed.

RESULTS: The main causes of treatment failure at the outpatient stage of orthopedic care were noncompliance with orthosis use by parents, prolonged disregard of the child’s anxiety during treatment, incomplete adherence to medical recommendations, and delayed attendance at scheduled follow-up visits with an orthopedic specialist.

CONCLUSION: The development of complications during functional treatment of children with developmental hip dislocation largely depends on social factors. These factors may be considered by outpatient orthopedic specialists to reduce the incidence of complications and, in most cases, help prevent the need for surgery.

BACKGROUND: Despite the high prevalence of flatfoot in children, the development of surgical techniques for its treatment has significantly outpaced their biomechanical justification. Cadaveric studies in traumatology and orthopedics have traditionally served as a primary method for gaining deeper insight into the biomechanics of deformities. Preoperative planning of osteotomy gap parameters remains a relevant issue when correcting various clinical forms of pediatric flatfoot.

AIM: This study aimed to evaluate the effect of the shape and size of the osteotomy gap, specifically its angular and linear parameters, on the correction of different clinical forms of flatfoot during calcaneal lengthening osteotomy under controlled conditions (in a cadaveric study).

METHODS: An experimental cadaveric study was conducted using a vertical load simulation device with radiographic control. The study was performed on 8 anatomical specimens of the lower leg and foot. The study consisted of two stages. During the first stage, anatomical specimens were prepared for placement in the vertical load simulation device, followed by radiographic examination under unloaded conditions and a simulated load of 750 N. During the second stage, a cadaveric flatfoot model was created with the possibility of simulating two clinical forms (abducted planovalgus deformity and flatfoot deformity), followed by calcaneal osteotomy and sequential implantation of specially designed implants of various shapes under radiographic control. Radiographic parameters were assessed at each stage of the study, including the Kite angle, talonavicular coverage angle (according to V. Mosca), cuboid abduction angle, longitudinal arch angle, calcaneal inclination angle, and Meary angle.

RESULTS: At the first stage of the study with anatomical specimens, reproducible cadaveric flatfoot models were successfully obtained using the proposed method, allowing the simulation of two clinical forms: abducted planovalgus deformity and flatfoot deformity. At the second stage, calcaneal lengthening osteotomy performed with different implant shapes demonstrated distinct patterns of change in radiographic parameters depending on the clinical form of flatfoot, which reflects differences in correction biomechanics.

CONCLUSION: The study demonstrated that the shape of the osteotomy gap, when selected in accordance with the clinical form of flatfoot, may play a key role in restoring the proper foot configuration.

The management of pediatric patients with gunshot-related polytrauma remains a major challenge, both in the acute phase due to the combined nature of injuries, and during reconstructive surgery. Treatment outcomes depend on an appropriately selected management strategy from the moment of first aid through specialized surgical rehabilitation at a tertiary care center. This clinical case report presents the management of a 7-year-old girl with combined blast injuries to the left shoulder and left gluteal region. During the clinical course, a foreign body migrated from the gluteal region into the abdominal cavity. The injury resulted from an explosive device detonating in proximity to the child. The patient was initially admitted to a primary care hospital in Krasnyi Lyman due to a combined blast injury. Primary surgical debridement of the left shoulder wound was performed with primary wound closure and immobilization using a plaster splint. After stabilization, the child was transferred to the Central District Multidisciplinary Hospital in Svatove, where revision and gauze tamponade of the left gluteal wound were performed. Later that day, the patient was transferred to the Republican Children’s Clinical Hospital in Luhansk, where repeated surgical debridement of the left shoulder wound was carried out with removal of primary sutures and application of external fixation using a wire–rod external fixation device for an open fracture of the left humerus. An additional diagnostic evaluation revealed a foreign body in the soft tissues of the gluteal region. The child was transported by air medical service to the Research Institute of Emergency Pediatric Surgery and Traumatology (Dr. Roshal Clinic) in Moscow for further specialized treatment. The diagnosis of blast injury to the left shoulder and left gluteal region was confirmed in the Clinic, and the foreign body migration into the abdominal cavity was identified. An individualized, staged surgical treatment strategy was developed during the inpatient stay. The appropriately selected treatment strategy resulted in survival and function restoration of the injured organs and limb segments. Modern adjunctive physical wound treatment modalities ensured rapid wound preparation for closure without infectious complications.

Idiopathic scoliosis remains one of the most common and complex orthopedic disorders in children and adolescents. Despite recognition of the role of genetic, hormonal, and environmental factors, the initial trigger initiating spinal deformity at an early age remains a subject of debate. This review analyzes the international scientific data addressing intranatal cervical spine injury as a potential provoking factor in the development of idiopathic scoliosis in genetically predisposed individuals. A systematic analysis of publications indexed in PubMed, Google Scholar, eLibrary, and CyberLeninka from 2010 to 2024 was conducted, addressing the etiology of idiopathic scoliosis, with an emphasis on studies examining the association between complicated childbirth, cervical spine biomechanics, and the subsequent development of spinal deformity. This review summarizes and analyzes current evidence on the potential role of intranatal injury to the craniovertebral junction in the pathogenesis of idiopathic scoliosis, integrating neurological, biomechanical, and genetic aspects. It has been demonstrated that mechanical stress applied to the cervical spine during childbirth (including breech presentation, precipitous or prolonged labor, and the use of obstetric maneuvers) may result in microinjury to dural structures, brainstem ischemia, and dysfunction of reticulospinal pathways. These alterations may lead to asymmetrical muscle tone, which, in pubertal growth acceleration and genetic susceptibility, manifests as a persistent three-dimensional spinal deformity. An integrative model of the pathogenetic cascade is proposed to explain the latent period and subsequent progression of idiopathic scoliosis. Intranatal cervical spine injury represents a considerable, although not exclusive, trigger in the development of idiopathic scoliosis. A comprehensive approach incorporating perinatal history assessment, early genetic screening, and ultrasound monitoring of the craniovertebral region in at-risk children may serve as a basis for developing primary prevention strategies for idiopathic scoliosis.

Nikolai G. Zhila, a pediatric surgeon, traumatologist-orthopedist, and professor, passed away on December 13, 2025, after a prolonged illness. Dr. Zhila led an active professional life as a physician, surgeon, scientist, educator, and healthcare administrator. His career was closely associated with two regions at the eastern and western borders of Russia: the Far East, Khabarovsk Krai, and Saint Petersburg. Through all challenges of time, geography, and health, Dr. Zhila remained devoted to his life’s work until his final days.