Introduction. Management of pediatric long bones fractures is a complex and rapidly evolving field. Traditionally, casting and conservative techniques played a key-role in the management of fractures in skeletally immature patients. However, the surgical approach has evolved steadily over the past four decades or so and increasing evidence has been published supporting the advantages of fixation techniques over conservative methods.

The purpose of this narrative review is to outline how innovations in orthopedic surgery have changed the rationale of treating long bones fractures in children and adolescents with focus on surgical techniques, particularly elastic stable intramedullary nailing (ESIN).

Material and methods We aimed to describe the main trends in pediatric long bones fractures management and to identify its specificities and difficulties as well as the best standard of care.

Results. The introduction of ESIN has profoundly influenced the management of pediatric upper and lower extremity fractures. Overall, in comparison to conservative techniques, advantages of ESIN include minimally invasiveness, short hospital stay, primary bone union, early mobilization and progressive weight bearing, and good outcome with low complication rate. Moreover, the flexible nail can be used as a closed reduction tool itself.

Conclusions. Irrespective of the technique performed, the key-concepts remain 1) the proper understanding of the injury to treat; 2) the identification the main characteristics of the patient; 3) the pros and cons of each technique; and 4) the potential complications.

Introduction. More than 40 years after the launch of elastic stable intramedullary nailing (ESIN) as a golden standard of the treatment of some fractures in children and adolescents.

Material and methods. This review is based on answers to five essential questions: The position of ESIN compared with other methods of treatment; The choice of the implants; The indications for ESIN today; How to avoid complications as much as possible? Do we remove the implants or not?

Results. The aspects of biomechanics, design, indications for ESIN in comparison to other treatment, surgical techniques depending on fractured bones, complications are presented in the article.

Conclusion. ESIN is an excellent method to fix long bone fractures in children and adolescents. Top one is definitively the fractures of both bones of the forearm, then the diaphyseal fractures of the femur and the tibia before the age to be eligible for a locking nail. However, some unstable fractures cannot be treated conservatively or with a locking nail, and an ESIN remains unstable. In these cases, we are allowed to propose to add an external fixator for 4 to 6 weeks, waiting for a good stabilisation of the fracture.

Introduction. Periarticular injuries in children include types I and II fractures according to the Salter-Harris classification and metaphyseal fractures. In most cases, conservative treatment is an effective method, but in some cases, surgical treatment, including external fixation, is the method of choice.

Purpose. Discussion of the principles of using the Ilizarov apparatus in the treatment of children with periarticular fractures of various locations, its advantages and disadvantages.

Materials and methods. We present the principles and features of the Ilizarov surgical techniques for treatment of children with periarticular fractures of the distal humerus, femur, radius and tibia.

Discussion. The methods of osteosynthesis for pediatric periarticular fractures imply transphyseal introduction of fixators that have a potential threat of iatrogenic damage to the growth plate in contrast to external fixation which performance implies that transosseous elements do not injure the growth zone, providing stable fixation of bone fragments in combination with early functional recovery of the damaged segment which is a key advantage over other methods.

Conclusion. The use of the Ilizarov apparatus enables to achieve the desired result in the treatment of pediatric periarticular fractures and has a number of advantages over other methods of surgical treatment.

Relevance. The problem of meniscus injuries in children has acquired a particular relevance. The growth in their incidence has been caused not only by an active sports- and lifestyle of pediatric patients but also by improved diagnosis due to magnetic resonance and arthroscopic techniques.

Aim. To formulate indications for the use of various methods of meniscus suturing in children and to evaluate the results of treatment of meniscus injuries in children, depending on the location of the tears.

Materials and methods. Our study included 74 patients who underwent meniscus suturing from March 2018 to December 2020. The age of the children ranged from 10 to 17 years. Time since the injury ranged from one day to 3 years. Before surgery, they underwent instrumental examination; knee joint radiography was performed in all patients, knee MRI was performed in 66 patients.

Results. Meniscus sutures were evaluated clinically and instrumentally at 6 months after the operation (MRI). One year after the meniscus repair, X-rays of the knee were taken to assess osteoarthritis. There was no pain after surgery in 68 children (91.9 %). There were no blocks of the knee joint after surgery in all children. Full recovery of the range of motion in the knee joint was observed in 69 children (93.2 %). Complications were noted in five children.

Conclusion. Poor results after meniscectomy has led to the emergence of several methods that allow meniscus repair and avoid meniscectomy that impairs knee functions. In children, the potential for restoration of menisci after their reconstruction is higher than in adults. It is possible to repair lesions not only in the white zone but after periods of more than three months since the injury. The choice of the meniscus suture technique used is determined by the location of the tear, taking into account possible complications. The use of a combination of methods allows reconstruction of the damaged meniscus regardless of the location of the tear and the complexity of the injury. Good clinical results, absence of complaints and return to usual physical activities in the immediate postoperative period should be regarded as positive outcomes subjected to further study.

Introduction. Idiopathic clubfoot (IC), also referred to as congenital talipes equinovarus, is one of the most common lower limb deformities observed in newborns, leading to significant functional impairment when left untreated. Early minimally invasive treatment has been praised as one of the most successful practice of modern pediatric orthopedics. This review aims to report current knowledge and controversies about clubfoot treatment.

Material and methods. We describe the main trends in clubfoot managing, identifying peculiarities, difficulties and prognostic factors related to the treatment.

Results. Many treatment techniques either conservative, surgical or hybrid have been used over the past decades. Based on good and excellent results during long-term follow-up, Ponseti method has been globally accepted by paediatric orthopaedic surgeons as standard method of treatment. However, some other conservative methods are still widely applied in the clinical setting, such as the French Physical Therapy method. Adherence to the bracing protocol is critical for the long-term success of the treatment, being a better predictor for relapse than severity of the deformity at birth.

Conclusions. Taking care of the manipulation and casting details by trained professionals, together with enhancing the child and patents’ adherence to the brace, are essential for the success of conservative treatment. Surgery should be performed only when strictly needed, preferably on a “a la carte” approach.

Introduction. Recurrent clubfoot deformity may be due to either an imperfect initial correction, or a natural history of a severe disease. In the later, idiopathic clubfoot is uncommon. In the review we describe reconstructive surgery in recurrent deformity of idiopathic clubfoot.

Material and methods. Surgery may be justified at different age and according to the type of deformity. Different surgical approaches and their indications are exposed in the article.

Results. After Ponseti’s method application additional surgeries may be considered in recurrent clubfoot deformity which may represent 10 to 20 % of cases: second Achilles tenotomy, postero-lateral relapse, complete antero-medial and postero-lateral relapse, transfer of the anterior tibial tendon, correction of sequelae: metatarsus varus, residual equinus, residual rotation of the calcaneopedal unit.

Conclusion. Idiopathic equine varus clubfoot is a frequent condition. Well-codified management should lead to extremely favorable functional results. Unfortunately, some cases lead to a recurrence of the deformity. Surgical procedures are sometimes required. The goal is to avoid as much as possible arthrodesis and secondary degenerative arthritis.

Introduction The chondromas are a cartilaginous proliferation of mature appearance and moderate size, reason why these tumors are regarded more like hamartomas than real benign tumor. Chondromas represent 10 to 12 % of benign bone tumors. Any bone of an enchondral ossification may be involved. Several bones can be involved, and the disease is called “chondromatosis”. In the review we describe clinical and radiological findings of this pathology as well as indications for reconstructive surgery. Material and methods The review is dedicated to isolated chondromas, periosteal and extraskeletal chondromas, chondromatosis. Results The aspects of epidemiology, clinical presentation, radiology, MRI, prognosis, indications and methods of surgical treatment have been described in the article for each types of chondroma and enchondromatosis. Conclusion Chondromas are benign bone tumors which may be responsible of pathologic fractures. Their surgical treatment consists in curettage and bone grafting or bone-cement filling with or without osteosynthesis. Multiple enchondromatosis should be considered as an osteochondrodysplasia. Its treatment is not the treatment of the multiple chondromas themselves, but of the bone deformities and length discrepancy induced by the disorder. The transformation of some tumors in chondrosarcomas in adolescence or adulthood needs a strict follow up of these patients.

Introduction. The accumulation of glycosaminoglycan (GAGs) in the tissues in Mucopolysaccharidoses (MPS) can lead to skeletal anomalies (DYSOSTOSIS MULTIPLEX) and to soft tissue impairments (neural or medullar compression, joint stiffness, tenosynovitis). Here is a review of orthopedic issues frequently encountered in patients with MPS.

Material and methods. Surgery may be justified at different age and according to the type of MPS. Different surgical approaches and their indications are exposed in the article.

Results. The article exposes indications and techniques for orthopedic issues in MPS children: cervical stenosis, cervical instability, kyphosis, hip dysplasia and hip dislocation, genu valgum.

Conclusion. Various musculoskeletal anomalies can be found in patients with mucopolysaccharidoses. Neurological impairments are frequently seen due to cervical stenosis or instability and should be early detected with regular MRI of the cervical spine. Well-codified management should lead to favorable functional results and maintain functional and walking abilities.

Rotational problems of the lower extremities affect a vast number of infants and children, whereas increased femoral anteversion (inward rotation) is the most frequent cause of intoeing in school-aged children. Femoral anteversion is defined by the angle of the femoral neck in relation to the femoral shaft in the coronal plane, whereas the degree of anteversion is greatest in infancy and gradually decreases towards skeletal maturity in most children. In about 15 % of all children increased femoral anteversion persists into adulthood. In cases of excessive anteversion gait problems, hip and/or knee pain are common. Derotational osteotomy of the femur is an established treatment for the condition. However, there is a lack of knowledge and clear evidence when to perform surgery and how this affects function and pain in these patients. The current paper is not based on a complete literature review and, therefore, does not fulfill the criteria of a review article. However, the article is based on the authors’ in-depth knowledge and a rapid review of the literature, and it can be defined as a scholarly article providing a perspective on the condition.

The constantly changing information about the genetic nature of osteogenesis imperfecta (OI), new approaches to classification and diagnosis, and the growing interest in this pathology require careful analysis and generalization of the available data in the recent literature.

Purpose. Analysis of recent literature on epidemiology, pathogenesis, etiology, classification of osteogenesis imperfecta.

Materials and methods. The literature search was carried out in the scientific literature databases of PubMed, Web of Science, Scopus, eLIBRARY, RSCI, and references of the key works. The following inclusion criteria were used: literature reviews, review articles, multicenter studies, cohort studies of patients with osteogenesis imperfecta.

Results. This systematic review included 18 publications that met the inclusion criteria. All selected publications were published within the period from 2012 to 2020. The study designs were review articles or literature reviews. Discussion Osteogenesis imperfecta is one of the most common types of skeletal dysplasia, a phenotypically and genetically heterogeneous group of hereditary bone diseases. OI is characterized by high variability of manifestations, even within the same type and one family. The results of the analysis of the prevalence of this disease in different population groups remain not fully covered. The degree of genetic heterogeneity of the disease has not yet been determined. Research is ongoing to identify new genes involved in the pathogenesis of OI. The introduction of modern methods for determining mutations in genes contributed to the progress of research into the molecular pathogenesis of osteogenesis imperfecta, and identification of new genes, mutations in which lead to OI. The large number of causative genes complicates the process of creating an optimal classification of OI. The difficulty of creating a comprehensive classification of OI subtypes is the fact that there is no clear phenotype-genotype relationship; based on the mutation, conclusions about its clinical severity cannot be drawn.

Conclusion. The classification of various types of osteogenesis imperfecta is still the subject of ongoing debate and research.

Introduction. Surgical correction of orthopedic problems in children and adults with severe osteogenesis imperfecta is of interest to the medical community.

The aim of this study was to review the current relevant literature on the role of orthopedic surgery in the treatment of children and adults with osteogenesis imperfecta and the integration of surgery into a multidisciplinary approach to the treatment of patients with osteogenesis imperfecta. The review is based on the material of the report presented at the first educational conference of the European Pediatric Orthopedic Society which was held in Russia at the Ilizarov Center in 2021.

Material and methods. To prepare the review, we searched for information sources at the scientific platforms such as PubMed, Scopus, ResearchGate, RSCI, as well as published products (Elsevier, Springer).

Results and discussion. The review includes a discussion of the classification, indications, features of the surgical technique and the early postoperative period, the role of early functional loading, the features of long-term treatment results of using telescopic transphyseal constructs in the correction of deformities of lower limb long bones as well as issues of the combination of orthopedic surgery and bisphosphonate therapy.

Conclusion. Orthopedic support of children and adults with severe and moderate types of osteogenesis imperfecta requires construction of a multifactorial strategy that takes into account the requirements of physical therapy and medication treatment, as well as the use of specialized implants, instrumentation and methods of surgical intervention, while an optimal solution has been still sought.

Introduction. Spinal deformity is one of major orthopaedic manifestations of cerebral palsy (CP). Despite the prevalence of the nosologic condition there is a deficiency in the availability of criteria for screening and management of the spinal pathology in CP patients, difficulties in interdisciplinary logistics, lack of registry and restraints in the continuity of the rehabilitation system.

The purpose of the work was to focus the attention of mainstream audience of dedicated experts on the aspects of the course and correction techniques of spinal deformities in CP patients. Evidence level 5 (UK Oxford, version 2011).

Results. The type of spinal deformity depends on the functional level classified with the GMFCS. Vertebral evaluation included identification of the leading component of the deformity, apex location, mobility, trunk balance, chest deformity, type of pelvic obliquity, the way contractures and dislocation of the femoral heads affected the lumbar spine mobility. The goal of spinal deformity correction in CP patients is to maintain or improve the functionality of the patients, improve the quality of life for the patient and the family. The use of transpedicular multi-support fixation systems and bone allografts can be recommended for bone fusion in the patients. Spinal fixation can be extended from the upper thoracic vertebrae down to the pelvis. Dynamic fixation systems, multilevel or multi-rod fixation can be an option depending on the age, extent of the maturity of the axial skeleton and size of the curve.

Conclusion. The severity of manifestations of spinal deformity increases in CP patients with greater level of global motor functions and does not depend on the skeletal maturity. Conservative treatment is ineffective at a long term. Correction and instrumentation transpedicular fixation allows for threedimensional correction without the need for anterior fusion. Surgical treatment significantly improves body balance, functional level and quality of life.

Introduction. The purpose of the article was to review the modern literature on the role of multilevel single-stage interventions in the surgery of secondary orthopaedic complications in children with cerebral palsy.

Material and methods. The review was done using the databases of the current sources of scientific information including PubMed, Scopus, ResearchGate, RSCI and Elsevier, Springer publishing products. A report made for the first educational meeting of the European Pediatric Orthopaedic Society held in Russia at the Ilizarov Center in 2021 was used for the contribution.

Results and discussion. The article discusses terminology, indications, particular techniques and early postoperative period, long-term outcomes of multilevel orthopaedic interventions and aspects of iatrogenic orthopaedic conditions in children with cerebral palsy.

Conclusion. Multilevel intervention is the surgical procedure of choice for the correction of secondary orthopaedic complications in patients with cerebral palsy. The success of the surgery would depend on adequately identified indications and quantitative values of the correction to be performed on the basis of 3D gait analysis, the compliance with specific technical requirements for the procedure and an early rehabilitation program. The strategy of multilevel interventions suggests the greatest possible reduction in the number of orthopaedic surgeries and can be considered successful if the patient undergoes a maximum of two multilevel reconstructive interventions in the childhood.

Introduction. The article is a literature review focusing on reconstruction surgery for dislocated hips in children with cerebral palsy (CP).

Material and methods. Publications in Scopus, PubMed, RSCI indexed journals over the past 20 years were reviewed for hip dislocation in children with CP.

Results and discussion. The article discusses the prevalence of the orthopaedic complication of cerebral palsy, pathogenesis, diagnosis, indications to surgery, choice of surgical technique, early rehabilitation and long-term outcomes. A report made for the first educational meeting of the European Pediatric Orthopaedic Society held in Russia at the Ilizarov Center in 2021 was used for the contribution.

Conclusion. Surgical treatment is indicated for hip dislocation in children with CP using holistic approach and principles of single-event multilevel surgery that suggest hip reconstruction, addressing contractures and deformities of the subjacent segments and creating conditions for postoperative postural management. Standardized indications, patient selection and optimal time for intervention are to be carefully considered for the procedure with the use of customized orthopaedic implants and techniques.

Introduction. Achondroplasia (ACP) is a common skeletal dysplasia. Vozoritide is the first drug that has an effect on the pathogenesis of impaired enchondral growth in achondroplasia. Clinical trials of the second and third phases have shown its effectiveness according to the latest literature data presented. After providing scientifically grounded information, a questionnaire was completed by parents of children with ACP to have their opinion before the introduction of the drug into medical practice.

Materials and methods. The survey was conducted on June 21-24, 2021 at the Ilizarov Center supported by the patient’s organization Small People Support Center for Patients with Achondroplasia and Other Bone Dysplasias and Their Families. The questionnaire included 5 questions, compiled by the first author of this study. 65 completed questionnaires were received for the analysis.

Results and discussion. The overwhelming majority of parents have confidence in the use of vozoritide as a means of achieving targeted growth which may allow to avoid surgical treatment. However, the parallel use of this drug and surgical treatment for incomplete growth of a child is not excluded if the growth graphs show that the required parameters have not been achieved by the time the growth zones are closed. Despite the fact that at present only the influence of vozoritide on the growth of a child with ACP has been reliably proven, parents feel confident with the information about the possible effect of the drug on other problems associated with impaired enchondral growth, and are ready to start therapy at an earlier age and for a longer period. Parents do not oppose the pharmacological treatment to surgical treatment. Vozoritide is seen as the main component of treatment, and surgery as a complementary one that follows (if necessary). This reasonable combination increases the parents' confidence in the predicted favorable treatment outcome.