Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA) is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractures. Joint replacement operations for JIA are best performed by experienced teams, where pre-operative and peri-operative care, and post-operative rehabilitation can be optimized in a collaborative, patient-centered environment.

Tarsal coalition is a congenital anomaly of the foot, characterized by later appearance of the clinical and radiological signs, which become obvious in adolescents. Tarsal coalitions in children with cerebral palsy can lead to diagnostic confusion, as well as to complicate natural course of foot deformity and surgical treatment. The paper presents first experience with the systematized data for tarsal coalitions in children with cerebral palsy. Among 157 children operated for foot deformities this anomaly was identified in 4 patients (incidence - 2,5 % in our series). Clinical and radiological descriptions, surgical management, including complications, are presented for these cases, which demonstrate significance of tarsal coalitions for diagnostics, surgical management and prognosis. Information and caution, regarding tarsal coalitions in children with cerebral palsy, who undergo surgical treatment for foot deformities, as well as advanced methods of diagnostics (magnetic resonance and computed tomography), are required in order to avoid preventable complications.

The article describes the development terms of scar deformities of the foot and secondary changes in the tendon-muscular and osteoarticular systems depending on the child’s age and localization of scars. It is shown that the most common type of the secondary deformation is extensive contracture in metatarsophalangeal joints. In almost half of the patients (46.1 %) contractures lead to dislocations in metatarsophalangeal joints. It is noted that in younger children (1-3 years old) secondary deformations developed in the earliest time, after only 8 months after burn injury. It is shown that scars located on the lateral surface of the foot with the transition to the ankle cause an increased risk of multiplanar foot deformity. Prolonged existence of multiplanar deformation leads to the changes of the shape of the articular surfaces and requires a multi-stage surgical treatment.

The frequency of recurrent contractures of the joints of the lower limb after their correction by means of tendon-muscle plasty remains significant. Therefore, the search for effective ways to correct contractures with the most resistant long-term result is relevant. The objective of the study is to improve treatment outcomes of equinus contracture in children with spastic paralysis. Materials and methods. We analyzed the results of correction of contractures in joints of lower limbs in 40 patients with cerebral palsy and the influence of spasticity of patognomonic muscles on them. The mean age was 6 years 7 months. In addition, for the correction of hypertonus of triceps muscle of tibia, the 330 lower limb segments were performed selective neurotomy of appropriate motor branches of the general tibial nerve. This operation in 304 cases was combined with achilloplastics or Strayer operation. Results. A mean degree of correlation between the degree of contracture in the ankle and increased tone of triceps tibia was determined (r value ranged from 0.451 to 0.487). Short-term results of the combined neuroorthopedic method for correction of contractures were good in estimating within 1 year post surgery, but a study of its short-run effect requires long-term follow-up.

Introduction. The obstetrical upper limb paralysis and its sequelae are an actual problem of pediatric orthopedics and traumatology. Relevance of the problem is due to high incidence of this disease and increase of child disability. Purpose. To present the method of treating patients with a dislocated radius head and forearm rotation contracture in birth paralysis of the upper extremity. ^Materials and Methods. This article presents the clinical material on the survey in the Institute and the surgical treatment of 12 patients aged from three to 15 years with the pathology of the elbow and forearm, developed after the obstetrical upper limb paralysis. Results. We present the clinical picture, diagnostic methods, indications to surgical treatment, as well as new and effective methods of performing the proximal radioulnar joint arthrodesis in young children with obstetrical paralysis of the upper extremity. The use of surgical methods of treatment in such patients has improved the function of the arm and self-care in 95 per cent of cases, reduced their disability and increased their choice for occupation activities.

The objective of the work was to evaluate the efficiency of the existing methods of surgical treatment of pronation contracture of the forearm, the modification of the existing methods of treatment, the development of the indications for each specific method of treatment. Materials and methods. This study is based on a survey of children suffering from infantile cerebral palsy affecting the upper limbs. The main criterion for the patient selection was the presence of a fixed pronation contracture of the forearm, both isolated and combined with other contractures of the joints of the upper limb. Total 42 patients with spastic forms of cerebral palsy were examined. Results and conclusions. With age of the patient, the pronation contracture is usually increased, the contractures of the elbow and wrist joints may develop, which leads to the necessity for more and more radical operative techniques. Therefore, the early surgical treatment allows obtaining optimal results with its minimum scope. The investigation data gave an option to simplify, but to increase the efficiency of surgical treatment methods of pronation contractures in children with infantile cerebral palsy.

This article deals with the actual problem of present-day traumotology - improvement of rendering of medical care for patients with polytrauma. The new technology “Pansonoscopy” is presented, which is the minimally invasive and widely available method of fast imaging of the “whole body” of the patient in any medical situations. It permits to detect the most frequent and dangerous traumatic injuries (cranial, thoracal, abdominal, skeletal, etc.) applying portable ultrasound scanners in real-time mode. The guarantee of imaging of the intracranial injuries, pos sibility realization of ultrasound examination by clinician on his own, and possibility of online medical consultations to experts (sonologist) - are fundamently new. This technology is destined for the large sections of practitioners, what render medical care for patients with polytrauma.

The article presents a review of the literature, visited various forms of dislocations of the shoulder joint in children, the methods of diagnostics and treatment.

The article highlights the literature devoted to the problem of torsional deformities of the lower limbs in patients with infantile cerebral palsy. It also describes biomechanical features peculiar to the patients with infantile cerebral palsy, as well as long-term results of performed surgical interventions.

The approach to the healing process of idiopathic scoliosis in terms of the biopsychosocial model of disease, which involves consideration of factors of biological, social, psychological nature, is reviewed. Factors of a psychological nature provide adaptive behavior of the patient in the hospital, and coordinated participation of various specialists in the treatment and rehabilitation of the patient in a situation of complicated treatment. Idiopathic scoliosis is a disease that is accompanied with physical and moral suffering and defines the conditions of mental development and functioning of sick children and their parents in a situation of progressive disease. Under these conditions, an important factor in coping with the situation of the disease and the successful rehabilitation treatment is harmonious attitude of the sick child to the disease. Personal problems of parents of sick children, manifested in their disharmonious attitude to the disease, reduce the adaptive capacity of children in hospital. In this connection, it is necessary to perform participation of clinical psychologists who provide the necessary information concerning the interactions of medical staff with patients and their parents on the stages of orthopedic treatment by doctors and other staff, as well as to provide the necessary psychological support for sick children and their parents.