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Background. Patients with clubfoot can have pain and functional disorders that lead to disability. Familiarity of obstetrician-gynecologists, general practitioners, surgeons with its early diagnosis and timely management may prevent disablement.Objective. The aim of the study is to analyze the opinion from parents of children with clubfoot on medical care via Ponseti method in outpatient center of surgery, traumatology and orthopedics.Methods. Cross-sectional study in the form of sociological survey (questionnaire) was carried out in N.F. Filatov Children’s City Hospital from March to December 2021 among parents of children with the following diagnoses: congenital bilateral clubfoot, congenital right clubfoot, congenital left clubfoot.Results. Respondents rated the quality of provided medical care and its availability, the hospital stay conditions by 10.0 points on the scale from 0 to 10. Territorial accessibility of medical care was estimated by 9.0 (7.0; 10.0) points, 30 out of 99 respondents (30.3%) required improvement in territorial accessibility (7 points out of 10 and below). Only 36.4% (36 out of 99) of children were sent to N.F. Filatov Children’s City Hospital for treatment by doctor of out-patient clinic. Others learned about this variant from the Internet, from acquaintances, etc. 10 out of 15 (15.2%) children with disabilities included in the study had difficulties in learning socially necessary skills. None of 10 children who have been diagnosed antenatally had any difficulties in learning socially necessary skills or disabilities. Mean age of disability was 10.6 ± 7.3 months. Children with disease diagnosed since birth had difficulties in learning socially necessary skills in 7.1% (2 out of 28) cases, and in 13.3% (8 out of 60) cases if diagnosed after birth (p = 0.356). Disability did not affect conditions in which children received treatment (14.6% and 20.0% of children under outpatient and inpatient treatment, respectively, had disabilities; p = 0.646). 26.7% of children with disabilities and only 11.9% of children without disabilities received treatment in hospital before the treatment (p = 0.218). 5.9% of children treated on outpatient basis had difficulties with learning socially necessary skills. Children treated on inpatient basis had difficulties with learning socially necessary skills in 35.7% cases (p = 0.005). The choice of outpatient or inpatient treatment did not depend on the presence of spina bifida (p = 0.276), children age (2.1 (0.7; 3.6) months vs 3.65 (0.6; 4.975) months, respectively; p = 0.309).Conclusion. Treatment can be delayed statistically significantly in case of late diagnosis, which is associated with the observed low awareness of doctors (working by the district principle) about specialized medical care. Ratio of children with disabilities and difficulties in learning socially necessary skills or disabilities is lower among patients with antenatal diagnosis. However, further studies are required for evaluation of these factors’ association.

Osteochondritis dissecans (OCD) of the knee is a pathological condition of subchondral bone resembling focal osteolysis with subsequent bone resorption, which may lead to osteochondral fragment separation. Several etiological concepts reported for OCD development. The multifactorial theory is commonly adopted for days. Different investigators report OCD lesion healing while using conservative treatment or even “waitful watching” with a healing rate of up to 67%. In spite of these results, there are not any commonly adopted guidelines for conservative treatment. The last stage of OCD is a separation of osteochondral fragment leaving a full-thickness osteochondral defect, which is usually filled with low-quality fibrocartilaginous tissue. This tissue provides a lesser extent of resistance to peak loading forces, which poses at risk subchondral bone for further destruction and early osteoarthritis development. Appropriate treatment method should be chosen for each OCD stage in order to prevent early osteoarthritis development, increase return-to-sport rate, and decrease healing time for OCD lesions. This chapter provides short but comprehensive to date knowledge about OCD on the knee of adolescents and young adults.

Aim. The study aimed to improve the outcomes for surgical correction of talipes equinovarus in children using the Ponseti method, as well as vertical talus correction using the Dobbs method combined with massage, physiotherapy and therapeutic exercise. Material and methods. In the period from 2015 to 2020, 109 children were examined and treated at the Filatov City Children’s Hospital, Moscow. Results. The study has revealed that without timely correction the orthopedic foot pathology in children is often accompanied by pain, functional changes and a high risk of developing disability in a child, which determines a high social significance of this nosology. After a comprehensive assessment and a combination of conservative and surgical correction techniques, the congenital foot deformity in all children was completely eliminated. Conclusion. The Ponseti method is required to be carefully adhered to in order to achieve a complete pes equino-varus correction. Early start of correction of changes is effective.

Introduction. In the number of countries, the ambulatory direction in the domain of medical care has been created as an alternative one to hospitalization. This is a type of round-o’clock hospitalization which is a modern trend in medical care where a patient is in the center of progress and modernization of healthcare.Material and methods. The literature search was made in Scopus, MedLine, ELibrary, CyberLeninka, RSCI databases.Results. Over the past 30 years, the proportion of outpatient surgeries in children has significantly increased in developed countries. Such modality of medical care is provided in the overwhelming majority of cases. In Russia, in 2010-2018, the number of ambulatory surgical interventions increased by 15%, but this figure is still lower than in European countries. In pediatric surgical practice, there is no good evidence-based support yet for performing most of common surgical procedures outpatiently, due to the lack of well-planned randomized trials. However, the world’s widespread experience allows to suggest that routine surgical interventions could be recommended for outpatient care. Inpatient replacement technologies reduce health care costs because the inpatient care is a more expensive type of medical services.Conclusion. The outpatient medical care has to develop so as to transfer medical services from expensive hospital stay to much more economic and efficient one-day stay. At the same time, while developing the inpatient replacement technologies one must observe the basic principle – to ensure a high quality of medical care.