Natalia N. Rumiantceva

BACKGROUND: Congenital knee dislocation is a very rare musculoskeletal disease, and it occurs in approximately 1 per 100,000 live births. Many researchers note that the treatment of congenital knee dislocation should begin with conservative methods, during which various complications arise. AIM: This study aimed to compare the clinical and radiological classifications of congenital knee dislocation and show the results of the treatment of this deformation using a Von Rosen splint and plaster corrections. MATERIALS AND METHODS: The study included 58 patients (34 boys and 24 girls) with congenital knee dislocation (83 knee joints). Congenital knee dislocation with arthrogryposis and other systemic pathologies were not included in the study. Before treatment, all patients were assessed for the severity of congenital knee dislocation according to the Tarek and J. Leveuf system. To evaluate the obtained results, nonparametric statistics were used. To search for differences between groups, the KruskalWallis test and the median test were used. To search for correlations, Spearman coefficients were used. Statistica v10 was used for statistical analysis. RESULTS: Clinical and radiological data were compared. In both groups, after conservative treatment, excellent and good results were obtained in nearly 98% and satisfactory in 2%. After conservative therapy, surgical treatment was required in 2 of 37 knee joints with the initial severity of Tarek III deformity. CONCLUSIONS: The severity of the deformity according to the Tarek system makes it possible to predict the effectiveness of the conservative treatment of congenital knee dislocation at a statistically significant level.

Congenital knee dislocation is relatively rare pathology of the musculoskeletal system. Timely diagnosis and treatment onset allow us to achieve full range of motion in the knee joint. However, low awareness of physicians in these topics and, as a result, diagnostic errors lead to pseudo-correction and motor deficit in the knee joint. This article describes correct examination of a child with congenital knee dislocation directly in the delivery room, management after discharge, and subsequent patient's routing with the assistance of orthopedic traumatologist.

BACKGROUND: Meyer-Gorlin syndrome is a rare genetic and autosomal recessive disease that is characterized by the classical triad, including, microtia, very small size or complete patellar absence, and nanism. CLINICAL CASE: Herein, presented the first clinical case description of a Russian patient with Meyer-Gorlin syndrome in combination with congenital anterior shin dislocation. The main clinical disease manifestations are characterized by a combination of microtia, patellar pathology, and dwarfism. DISCUSSION: In the practice of pediatric orthopedic surgeons, cases of congenital knee dislocations are extremely rare, especially as part of any syndromes, which cause interest in the presented clinical case publication. Our patient analysis, as well as the patients described in the literature, showed the presence of typical clinical manifestations, which allowed us to suspect the presence of Meyer-Gorlin syndrome during a clinical examination. CONCLUSIONS: This report is the first case of combined congenital knee dislocation and Meyer-Gorlin syndrome with a diagnostic triad (short stature, microtia, and patellar aplasia) in the Russian Federation. Conservative treatment with constant traction and flexion must be carefully performed to avoid complications. Without the effect of conservative therapy, surgical treatment is indicated.

Despite the rapid progress in medicine, today there is no clear protocol for the management of patients with such a rare disease as congenital dislocation of the knee (CDK). Analysis of the data shows that in the main percentage of cases, after ineffective conservative treatment, patients undergo late surgical intervention, which entails great number of complications and does not improve outcomes. This trend is associated with the lack of strict time limits for the start of medical care due to the lack of guidelines regulating the work. Aim of the study was study modern approaches to conservative and surgical treatment of patients with congenital dislocation of the knee based on a systematic analysis of the literature. Systematic analysis of literature sources on databases PubMed, Scopus, eLibrary, CyberLeninka, bibliography of key articles. Preparing the preliminary plan of correction and early initiation of treatment of congenital dislocation of the knee significantly increases the rate of positive outcomes of this disease. It is worth noting that using a less invasive approach to initiating treatment of congenital dislocation of the knee avoids a number of complications. Based not only on the classification of the stage of the severity, but also on the degree of contracture of the quadriceps muscle, it is possible to determine the possibilities of restoring the work of the joint, which proves the need to improve the knowledge gained. There is a need to organize the provision of medical care to patients with congenital dislocation of the knee on the basis of improved classifications that correspond to modern ideas about the outcomes of orthopedic treatment in patients with CDK.

Background. Congenital knee dislocation is a rare disease of the musculoskeletal system (1 in 100,000 live births). In the literature, few studies have described the anatomical changes characteristic of this pathology, which are only revealed during surgical treatment. Aim. This study aimed to evaluate the pathomorphological features of the ligamentousarticular apparatus and thigh muscles with congenital knee dislocation on autopsy material. Materials and methods. The study included two fetuses with bilateral congenital knee dislocation after spontaneous miscarriage at 18 and 20 weeks of gestation and one stillborn fetus with bilateral congenital knee dislocation at 29 weeks of gestation. The comparison group was composed of two fetuses after spontaneous miscarriages at 18 and 20 weeks of gestation and one stillborn fetus at 25 weeks of gestation without anomalies of the lower extremities. Results. Various abnormalities and displacements of the anatomical structures, as well as degenerative dystrophic changes in the soft tissues during histological examination, were found. Pathomorphological changes in the control group were not detected. Conclusion. Pathomorphological changes are the main manifestations of congenital knee dislocation in the studied fetuses.

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction. Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment. Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores. Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth. Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.

Introduction. Jacobsen syndrome, characterized by multiple developmental anomalies, is a rare genetic syndrome caused by a partial deletion of the long arm of the 11th chromosome. The incidence is 1 : 100,000 live births. Patients of this group have malformations of the heart, kidneys, gastrointestinal tract, central nervous system, and skeleton. The severity of clinical features is diverse. Jacobsen syndrome rarely combines with a congenital clubfoot. Case report. The clinical case of using the Ponseti method for the treatment of congenital clubfoot in combination with Jacobsen syndrome is presented. As a result, a complete primary correction of the foot was obtained, which did not relapse within 2 years. Discussion. Only brief references to this pathology were found in the literature. In the case of our patient, a greater number of gypsum dressings were required to complete the primary correction of the foot. Conclusion. Painless foot has been achieved, which has a full range of motion, which confirms the success of the application of the Ponseti method for the treatment of non-idiopathic congenital clubfoot and the need for using it as a starting method.