Lower extremity deformities of patients with arthrogryposis multiplex congenita present a wide spectrum of severity and deformity combinations. Treatment goals range from merely ensuring comfortable seating and shoe wear, to fully independent and active ambulation, but the overarching intention is to help realize the patient's greatest potential for independence and function. Treatment of hip and knee contractures and dislocations has become more interventional, whereas treatment of foot deformities has paradoxically become much less surgical. This article synopsizes the treatment strategies presented in September 2014 in Saint Petersburg, Russia at the second international symposium on arthrogryposis.

Background. The relative overgrowth of the greater trochanter is one of the most common deformities of the proximal femur in association with several disorders of the hip joint. Aim. To analyze the dynamics of proximal femoral growth after trochanteric epiphysiodesis as well as to determine the options for using this method in the complex treatment of children with hip pathology. Materials and methods. We analyzed the data of clinical and radiological examinations and surgical treatment (permanent trochanteric epiphysiodesis with metal fixation) outcomes for 43 (52 joints) patients aged 412 years with a developing high position of the greater trochanter. Results. The surgery enabled slowing down of the growth of the greater trochanter on the side of intervention by (average) 50% (p 0.05), although the values of the neck-shaft angle both on the affected side and the side opposite to it did not change (p 0.05). Conclusion. In moderate disorders of the growth plate of the femoral head epiphysis, trochanteric epiphysiodesis can prevent the progression and, in some cases, correct disturbed ratios of the hip joint, thereby avoiding the need for larger surgical interventions.

In the present article, the crucial and specific aims of teaching that provide an ample staff competence for digital economics are introduced. We investigate contemporary teaching and training approaches, trends in staff quality requirements. The article highlights new employment trends and values that have been formed recently in environmental, technological and consumer services as a result of digital, creativity and virtual processes in business increased. We used comparison methods, analysis, observations with consequential conclusions for this survey. It should be noted that information literacy, attentional and emotional control skills, creativeness, ecological and intercultural mindedness, ability to be re-educated are clues for each career. We suppose that the implementation of best international and European teaching methods and standards and prompt introduction of new educational programmes into Russian educational system are key solutions that could provide graduates with expected competencies.

Introduction. In standard planning for corrective hip osteotomy, a surgical intervention scheme is created on a uniplanar paper medium on the basis of X-ray images. However, uniplanar skiagrams are unable to render real spatial configuration of the femoral bone. When combining three-dimensional and uniplanar models of bone, human errors inevitably occur, causing the distortion of preset parameters, which may lead to glaring errors and, as a result, to repeated operations.Aims. To develop a new three-dimensional method for planning and performing corrective osteotomy of the femoral bone, using visualizing computer technologies.Materials and methods. A new method of planning for corrective hip osteotomy in children with various hip joint pathologies was developed. We examined the method using 27 patients [aged 5–18 years (32 hip joints)] with congenital and acquired femoral bone deformation. The efficiency of the proposed method was assessed in comparison with uniplanar planning using roentgenograms.Conclusions. Computerized operation planning using three-dimensional modeling improves treatment results by minimizing the likelihood of human errors and increasing planning and surgical intervention  accuracy.

Актуальность. Дисплазия тазобедренных суставов и врожденный вывих бедра -часто встречающаяся ано-малия развития у новорожденных. По-прежнему не редки случаи позднего выявления заболевания, неудачи в лечении и развитие осложнений, что не находит должного отражения в современной литературе. Цель исследования -выявить наиболее распространенные ошибки на этапах диагностики и начала лечения детей первого года жизни с врожденным вывихом бедра. Материалы и методы. Работа основана на ретроспективном анализе данных анамнеза: истории диагности-ки и предшествующего лечения, а также клинического, сонографического, лучевого, магнитно-резонансно-го методов обследования 250 пациентов от 5 мес. до 2 лет, поступивших в специализированное отделение патологии тазобедренного сустава ФГБУ «НИДОИ им. Г.И. Турнера» с диагнозом «врожденный вывих бедра» в 2005-2015 гг. Результаты. Наиболее распространенными причинами ошибок на этапе диагностики врожденного вывиха бедра у детей являются отсутствие осмотра новорожденного ортопедом в роддоме и проведения сонографи-ческого скрининга, а также погрешности в его выполнении. При начале лечения отмечалось использование конструкций, не обеспечивающих оптимальное положение для вправления головки бедра, а также поздняя установка показаний к первичному хирургическому лечению в случаях невправимых вывихов бедра.Ключевые слова: врожденный вывих бедра, дисплазия тазобедренных суставов, диагностика, лечение.