Background: The need to minimize the immobilization of the elbow joint in multifragmental fractures of the distal metaepiphysis of the humerus is confirmed by a number of factors, including the complexity of its anatomical structure, the uniqueness of biomechanics, as well as the limited ability of hyaline cartilage to regenerate. The restoration of the motor potential of the limb in multifragmentary fractures of the distal metaepiphysis of the humerus determines the priority of the treatment technique, which allows the patient to return to his usual lifestyle in the near future.Objective: Demonstration of the effectiveness of percutaneous spinal osteosynthesis with wires in fractures of distal metaepiphysis of the humerus in adolescent children.Clinical cases: This paper describes two clinical cases in adolescent children with multifragmentary fractures (open and closed) of the distal part of humerus (12В and 13С according to the AO classification). In both cases, the treatment consisted of sequential application of skeletal traction, for fragments traction and their mobility increase, then closed reposition of fragments under the control of electron-optical converter with metal osteosynthesis with wires. Moreover, taking into consideration the U- and T-shape nature of the fractures, the first stage of reposition included stabilization and fixation of the distal fragments to each other and then to the proximal fragment.Conclusion: In our opinion, it is the combination of traditional methods of treatment (application of skeletal traction system), modern technologies (EOC control), alternative (atypical) options for using metal structures that allow achieving good functional treatment results in this category of patients.

Neonatal necrotic enterocolitis (NEC) is a nonspecific inflammatory disease of unknown etiology with multifactorial pathogenesis, which development is explained as a result of hypoperfusion of the immature intestinal mucosa of a newborn who has undergone perinatal hypoxia and, as a result, a change in blood flow in the mesenteral vascular system. This disease more often affects the intestinal wall of premature babies. In typical cases, mucosal necrosis develops in the terminal iliac and right parts of the colon, and when the process progresses, it can spread to the entire thickness of the intestinal wall, causing its perforation, so peritonitis is a frequent complication of NEC. But in addition, distant complications of NEC are distinguished, which include the development of intestinal obstruction in view of a decrease in the contractility of the intestinal wall section due to its fibrosis and, as a result, narrowing of the lumen.We report the clinical case of surgical treatment of the twisting of stenosed portion of the ileum in a child who underwent NEC in the early neonatal period. A mother sought assistance with a child of 3 months at the Reginal Children’s Hospital (born at 28 weeks of gestation). After birth, there was a violation of the absorption of enteral nutrition (periodic posseting, bloating), blood in the stool was determined. On the 14th day of life a pediatric surgeon examined the baby: necrotizing enterocolitis II A. After stabilizing the condition (2 months), the child was transferred from the perinatal center to a pediatric hospital with a diagnosis of bronchopulmonary dysplasia, a new form, a severe course, and a period of exacerbation. At the age of 2.5 months, he was discharged in a satisfactory condition to the outpatient stage. On the 15th day from the moment of discharge (3 months of life), the mother noted the expressed anxiety of the baby, bloating, stool retention. On the 16th day from the moment of discharge during feeding, the child began to suck sluggishly, did not absorb the age norm. He was examined by a pediatrician, the consultation of a pediatric surgeon was recommended. Due to the severity of the condition, the baby was hospitalized.In the initial examination, no data for intestinal obstruction were detected. The patient received parenteral nutrition, antibacterial therapy. Ultrasound and radiography of abdominal organs were performed daily. On the third day of observation, deterioration is noted (abdomen bloated mainly in the upper parts, soft upon with palpation, the baby was anxious, peristalsis was reduced), with ultrasound: between the loops of the enlarged intestine, an echogenic band of up to 18 mm (adhesion?) was determined, there was the liquid component between the loops. A laparotomy was performed, during the revision there was a displacement of the large intestine into the left parts of the abdominal cavity. Ten cm from the ileocecal angle, a section of the ileum with a length of up to 15 cm was found, which was like a “double trunk” wrapped at the base around its axis around a cord-like adhesive stretching to the posterior abdominal wall. Visually, the loop was dark bard in color, its walls were swollen, infiltrated, and their cartilaginous density was determined upon palpation in the contact area of the walls of the intestine. The resection of this loop was performed, end-to-end anastomosis was formed according to the method of J. Louw. After the operation, the baby received treatment in the intensive care unit, enteral feeding on day 5, on day 9, after expanding the volume of feeding, he was transferred to the department of pediatric surgery. Discharged in satisfactory condition on the 12th day after surgery.

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Currently, purulent-inflammatory diseases of the abdominal organs are the prevalent causes of complications and mortality. Treatment of these diseases complicated by peritonitis is one of the urgent problems in modern clinical medicine. Experiment is important for testing new treatment methods. This article provides a systematic analysis of the current in vivo models of the purulent peritonitis, which are used to test the options for surgical treatment and combinations of antibacterial drugs. We describe the most common models as well as rare simulations of specific peritonitis. It should be noted that despite the wide use of minimally invasive techniques, the literature has few reports on simulation of peritonitis through the laparoscopic approach.

To demonstrate an interesting and rare case in the clinical practice of testicular feminization syndrome in a child, as an accidental finding when performing a planned surgical intervention. A mother with a child E., born in 2010 (at the time the child was 4 years old) was hospitalized with the mothers complaints about the presence of protrusions in both inguinal areas from birth, the mother denied cases of infringement. The child was examined on an outpatient basis and the next day a scheduled surgical intervention was prescribed hernia repair on both sides. At the opening of the hernial sac on the right, the contents were the testicle, 1.6 1.6 1.0 cm in size, with an appendage and vas deferens. Then an opening of the hernial sac was performed on the left, the contents of the hernial sac was also a testicle measuring 1.8 1.2 1.0 cm with an appendage and d. deference. Examination was performed: on an ultrasound of the pelvic organs the bladder is full, the effusion in the pelvis is up to 1215 mm high, the uterus and ovaries are not located at the time of the examination. In the abdominal cavity (in the iliac regions), ovarian testicles with mediastinum are located on both sides 19 11 mm on the right, 16 10 mm on the left. The clinical case that we have provided will be of interest to pediatric surgeons and geneticists in view of the unusual and complex clinical diagnosis of this condition. In the presence of a female phenotype, the child completely lacked the organs of the female reproductive system, this disease was detected only due to the presence of a concomitant pathology in the child, a bilateral inguinal hernia. The early diagnosis of STF is especially important given the risk of malignancy of the gonads in the post-pubertal period.