This book is concerned with a trend of reconstructive surgical orthopedics using reparative potential of the organism. It presents a detailed description of combined surgical treatment methods of orthopedic pathologies in children as well as experimental substantiation. The first part of the monograph presents experimental studies concerning the combination of external fixation (Ilizarov method) and flexible intramedullary nailing (inert and bioactive) in limb lengthening. A separate chapter deals with a study of peculiarities in the influence of intramedullary transphyseal nailing on the longitudinal growth in tibia. In the clinical part of the monograph, a detailed description of combined surgical treatments (external fixation and flexible intramedullary nailing) in children of length discrepancy and deformities of limbs is presented. One can find results and peculiarities of management of deformities and shortenings in various etiologies, including congenital malformation, osteogenesis imperfection, and orthopedic complications in calcium and phosphor metabolic imbalance. This catalog also contains a review of conventional bioactive implants used in orthopedic practice. Also, new data of flexible intramedullary nailing application with bioactive coating in different adolescent orthopedic pathologies is presented. Variants and advantages of combined techniques using external and internal fixation in spine surgery are depicted. According to nosological groups, indications and methods of correction are defined. Along with a detailed description of new methods of combined surgical treatment, vast materials illustrating short and long term results are demonstrated.

Cerebral palsy presents stable encephalopathy that systemically influences on the child's and adult's organism. Orthopedic complications of cerebral palsy possess on the contrary progressive features and those complications cause gradual failure of motor ability of a person: impaired walking, loss of postural ability, reduced self-care and inclusion, finally quality of life becoming much worse. That is why orthopedic aspects are of great importance in children with cerebral palsy. This volume presents a collection of chapters covering a wide range of problems, from a system of universal classification of dysfunctions in Cerebral Palsy and practical issues of prevention of orthopedic complications orthopedic to surgery (diagnostics and quantitative interpretation of gait disorders in such patients, optimal methods of surgical intervention, hip surgery, spinal surgery) and aspects of nutritive status of this specific category of patients, associated comorbidities and their influence and connection with orthopedic problems. Furthermore, three chapters are dedicated to the anesthetic aspects of orthopedic surgery. The substantiation is given to the methods of combined anesthesia and sedation during surgery, as well as in the immediate postoperative period, taking into account concomitant epilepsy, increased intracranial pressure and spasticity in such children. Single-event multilevel orthopedic surgery is a recognized gold standard in ambulatory patients, though it varies according to gait patterns and associated orthopedic problems causing motor disorders. The book contains explanations and methodology of surgeries for conventional gait patterns, as well as in iatrogenic disorders caused by previous unreasonable interventions. The chapter on the correction of deformities and dysfunctions of the upper limb shows the first applied transfer of m.flexor cubitus ulnaris to the radius, which gave extremely positive results both in terms of function and aesthetics. Unfortunately, in Russia the number of CP patients with iatrogenic orthopedic disorders is high. Extremely negative consequences in the form of weakness of the triceps muscles after percutaneous fibromyotomies (so-called "Ulzibat method") or lengthening of the Achilles tendon in diplegia performed before the age of five years and before the development of muscle retraction lead to the development of crouch gait even in patients with high motor potential (GMFCS I, II). This complication of unreasonable surgical interventions develops in 5-7 years after primary surgery and in the opinion of doctors and parents is not related to previous procedures. This book, based on 3D-instrumented gait analysis, shows the features of iatrogenic crouch gait, as well as methods of surgical correction of this difficult situation. The data presented in this book are based, on the one hand, on the personal practical and scientific experience of each author, and on the other hand, the entire team of authors works in collaboration with each other, coordinating their decisions and interventions with colleagues, thus ensuring continuity in treatment of children and adults suffering from cerebral palsy.