Ortopedia, traumatologia, rehabilitacja最新文献

Background: In acromioclavicular (AC) joint separation, the weight of the upper extremity and scapula causes the scapula to rotate downward and internally along the thoracic cage. This results in displacement of the AC joint along three axes: anteroposterior, mediolateral, and vertical. Finite element models can aid in directing future biomechanical studies on this concept, not just the vertical axis, as has mainly been the focus in the past. This study uses finite element models to evaluate the stress across six suture configurations which reflects the efficacy on restraining AC joint motion after ligament resection with the upper extremity at rest.

Material and methods: Three finite element (FE) models were constructed to simulate AC joint stabilisation with six different suture configurations, which were anterior-, posterior-, O-, X-, O-plus-X-, and V-frames. Internal and downward rotations of scapula, along with upward rotation of clavicle were defined following a whole-cadaveric study where the AC and coracoclavicular (CC) ligaments were removed entirely. Stress magnitude and distribution across the strand of each suture configuration were evaluated.

Results: There is high stress in sutures that cross posteriorly and insert at the posterior clavicle (171,877-219,489 MPa) and anterior limbs (162,512-177,021 MPa). Suture crossing from the posterolateral to anteromedial point showed 36,573-39,430 MPa of stress.

Conclusion: 1. There are significant loads on sutures crossing posteriorly across the AC joint and located at the posterior aspect of the distal clavicle, as well as the anterior limbs. 2. The sutures crossing from the posterolateral to anteromedial point experience minimal load. 3. Further biomechanic studies in cadavers and clinical studies are still necessary to strengthen the evidence base for these findings.

Kirschner wire (K-wire) is commonly used for temporary fixation of bone fractures, particularly in pediatric patients, but it poses risks such as breakage and migration. We present the case of a 67-year-old patient who underwent acromioclavicular joint fixation with K-wires after an injury. Nine months post-surgery, a wire fragment was found to have broken and migrated to the neck area. The migration led to the development of a pseudoaneurysm, which required surgical intervention for removal. The wire fragment was successfully removed, and the aneurysm was repaired after rupture. This case highlights the risks associated with wire migration and underscores the importance of strict adherence to the Tension Band Wiring (TBW) technique. Timely removal of fixation devices and regular radiographic monitoring during follow-up are essential to prevent potentially life-threatening complications.

Background: Knee sprains are a relatively frequent reason for hospitalisation in the paediatric population, with most patients needing a specialized surgical intervention. This article presents the epidemiology of internal torsional injuries to the knee joint among paediatric patients.

Material and methods: We analysed data on paediatric patients hospitalised at the Department of Orthopaedics and Paediatric Orthopaedics of the Central Teaching Hospital in Łódź in the years 2018-2023 assigned the ICD codes M23 or S83.

Results: We identified a group of 324 patients (163 boys, 161 girls) aged 8-18 years, with most of this group falling into the 14-18 age bracket (85%). 290 of the patients reported first-time injuries, and 34 had recurrent injuries. Among the 414 first-time injuries, the most common types were as follows: meniscal injuries (212), mostly of the medial meniscus (128), anterior cruciate ligament ruptures (125), lateral meniscus injuries (84) and medial patellofemoral ligament ruptures (77).

Conclusions: 1. Most torsional injuries tot he knee joint in the paediatric population involves multiple knee structures, thus requiring compreensive diagnostic work-up and individualised treatment. 2. In view of the high treatment cost and considerable burden on the health care system, future research should focus on optimising treatment strategies according to patient age, type of injury, risk of complications and cost-effectiveness of techniques used.

Background: Injuries to the Achilles tendon in men aged 20-40 years are most commonly caused by intensified physical activity leading to prolonged overload of the tendon. Most injuries affect the tendon's proximal third, which is less vascularised. Surgery for Achilles tendon injuries aims to obtain the best possible gait biomechanics and quickly restore the patient's functional performance. Clinical outcomes vary with the surgical technique used. This article presents the results of a study comparing the minimally invasive technique and the classical technique for primary repair of the Achilles tendon in men aged 20-40 years.

Material and methods: A prospective clinical analysis was performed to investigate the treatment outcomes of 10 male patients aged 20-40 years and free from chronic medical conditions. The experimental group consisted of 5 men operated on using a minimally invasive technique in the form of a modified Webb-Bannister technique where the tendon is not sutured, but the tendon stumps are brought close together, resulting in better healing without the tendon being compressed. A control group consisted of 5 men who were subjected to conventional tendon repair.

Results: A follow-up of one year found that both techniques of Achilles tendon repair produced positive clinical outcomes, with better effectiveness of the minimally invasive technique noted in the early phase of treatment.

Conclusion: Men undergoing surgery for complete rupture of the Achilles tendon experience fewer complications related to surgical wound healing and achieve good mobility in the talocrural joint earlier when minimally invasive surgery is used as compared with conventional (classical) repair.

For more than five decades, anterior cervical discectomy and fusion has been the mainstay of surgical management of symptomatic cervical disc disease. Nonetheless, worries regarding adjacent segment degeneration (ASD) have prompted research into alternative techniques. Cervical disc arthroplasty (CDA), by preserving motion and restoring near-normal spinal biomechanics, seemed to be a promising solution. This review explores normal intervertebral disc (IVD) biomechanics and biomechanical changes following CDA. Evidence from current literature indicates that CDA generally maintains physiological spinal motion, though inevitably, there are changes. The range of motion (ROM) at treated levels approximates normal values. Although complications such as wear and heterotrophic ossification are relatively common, device stability remains satisfactory, and biomechanical comparisons between semi-constrained and unconstrained designs have shown negligible differences. CDA offers a compelling alternative to ACDF in appropriately selected patients. Nevertheless, long-term studies are essential to assess its outcomes comprehensively.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has significantly affected healthcare systems, raising concerns about patient outcomes, particularly for those with coexisting conditions. Despite various studies on orthopedic injuries during the COVID-19 pandemic, differences in treatment outcomes remain insufficiently known. This retrospective cohort study investigated the effects of SARS-CoV-2 infection on patients with major extremity fractures requiring surgery. We hypothesized that patients with COVID-19 would experience longer hospital stays (LOS) and higher mortality rates.

Material and methods: Data from 500 patients (mean age 47.1 years; 69.8% male) admitted to our hospital between March 2020 and July 2022 were analyzed. We collected demographic data, COVID-19 test results, fracture-related data, LOS, and mortality-related data.

Results: Of the patients, 23 (4.6%) had COVID-19. While overall LOS showed no significant prolongation in patients with COVID-19, a significantly longer LOS was observed for patients with COVID-19 and lower extremity fractures (14.62 vs. 11.39 days, p<0.00001) and upper extremity fractures (11.90 vs. 5.73 days, p=0.0271).

Conclusions: 1. Patients with COVID-19 exhibited a markedly longer LOS than those without COVID-19, with this effect being more pronounced in patients with lower extremity fractures. 2. When all patients had major extremity fractures, patients with COVID-19 had a significantly higher mortality rate than those with out COVID-19.

Avascular necrosis (AVN) of the femoral head is a recognized complication of steroid and cytostatic treatment commonly used for leukemia, lymphoma and other cancers. It is often linked to high doses of oral and intravenous corticosteroids and extended therapy duration. AVN occurs due to a temporary or permanent loss of blood supply to the bone, leading to bone necrosis. The femoral head is the most frequently affected site. Patients with AVN typically experience pain and restricted joint motion. The primary goal of treatment is to improve joint function and prevent further bone damage. Modern therapeutic approaches include physical therapy and surgical interventions such a core decompression with bone substitute filling or total hip replacement. In this article, we present two cases of AVN in pediatric oncology patients treated with the former surgical approach - core decompression and bone substitute filling.

Background: The talus is a peculiar bone in the human body that plays a key role in load transfer due to its unique shape and characteristics. Fractures involve challenging treatment and potential complications. We aimed to simulate the talus using real-world data and analyze its biomechanical responses to potential forces that might cause its fracture.

Material and methods: We retrieved a three-dimensional (3D) file of the intact talus, submitted it to a 3D finite element analysis (FEA) using software (ANSYS Mechanical V2023R2), and then set the elastic modulus or Young's modulus values of the talus based on a previous study. To analyze talar fractures, we employed both positive and negative force directions to examine fracture behavior. The talar configurations were 0 , 15, 30, and 45 cases. Force applied in the y-direction compressed the top of the talus. The bottom surface of the talus, subjected to compression, supports the boundary conditions that mimic realistic talus motion mechanics.

Results: FEA demonstrated that the neck of the talus exhibited the highest magnitude of total deformation, suggesting susceptibility to crack initiation. A sudden increase in force in the positive direction increased the likelihood of a talar fracture. Stress analysis depicted the maximum equivalent (von Mises) stress on the talus, indicating that the highest stress occurred when the force was applied in the positive direction, particularly at 15 (posterosuperior to the anteroinferior direction). Our analysis underscores that the angle of force is the primary contributor to talar fractures.

Conclusion: Our 3D FEA study concluded that the talar neck area was the most vulnerable to fracture in the axial force simulation, especially in the 15 force direction. Safety measures should be implemented for people performing risky activities related to axial force injuries.

Background: Global postural reeducation (GPR) has been developed over recent decades and has shown success in the treatment of chronic low back pain (LBP). The aim of this study was to compare the effectiveness of GPR associated with a conventional reeducation protocol to that of the conventional reeducation protocol alone on pain, mobility, function and psychological symptoms in patients with non-specific LBP.

Material and methods: This randomized controlled trial enrolled patients diagnosed with chronic LBP. The patients were randomized into two groups: a GPR group who received GPR associated with a conventional reeducation protocol and a control group who received conventional reeducation alone. Two evaluations were performed for both groups: at baseline (T0) and at the end of the 4-week session period (T1). The parameters evaluated comprised pain (measured using the Visual Analog Scale, VAS), mobility (by the Fingertip-to-floor test (FFT) and the Schober index), muscle endurance (by the Shirado and the Sorensen tests), function (by the Oswestry Disability index (ODI)) and anxiety-depressive symptoms (by the Hospital Anxiety and Depression scale (HADs)).

Results: A total of 26 patients were enrolled, with 13 in the GPR group and 13 in the control group. At the 4 weeks' evaluation, the GPR group showed significantly greater improvements in pain (p=0.04), lumbar mobility (p=0.007) and functional disability (p=0.02) compared to the control group. No differences between the two groups were found regarding muscular endurance and anxiety-depressive symptoms at the 4-weeks evaluation.

Conclusion: Our findings suggested that GPR combined with conventional reeducation methods holds promise as an effective treatment approach for common LBP, particularly in improving pain levels, lumbar mobility and functional disability.

Background: Degenerative lumbar spinal stenosis (LSS) is a common cause of chronic low back pain (LBP) and is often associated with various degrees of disability. Endoscopic spinal decompression (ESD) is a minimally invasive surgical approach for treating degenerative LSS. However, the impact of ESD on the rehabilitation of disability in patients with LSS remains unclear.

Material and methods: Patients with LSS who underwent ESD surgery were selected prospectively. The disability status was evaluated as the Oswestry Disability Index (ODI) using a standard Oswestry LBP disability questionnaire pre- and post-surgery and at 1-year follow-up. Based on pre-surgical ODI, patients were classified into mild and moderate-to-severe disability groups.

Results: A total of 93 patients with LSS who underwent ESD surgery (mean age5514 and female 55%) were included. Fourteen patients were classified into a mild disability group, while 79 patients were placed in a moderate-to-severe disability group. Pre-surgical ODI scores were significantly lower in the mild disability group compared to the moderate-to-severe disability group (17, IQR 13-19 vs. 31, IQR 25-35, p<0.001). After ESD surgery, ODI was significantly reduced in both mild (17, IQR 13-19 vs. 3, IQR 0-4, p=0.016) and moderate-to-severe disability groups (3, IQR 0-4 vs. 2, IQR 1-5, p<0.001). Post-surgical ODI scores were similar between the study groups (3, IQR 0-4 vs. 2, IQR 1-5, p=0.656). These improvements in ODI were maintained at the 1-year follow-up in the mild (3, IQR 0-4 vs. 2, IQR 0-8, p=0.766) and moderate-to-severe disability groups (2, IQR 1-5 vs. 3, IQR 1-5, p=0.078). The 1-year ODI scores remained comparable between the mild and moderate-to-severe disability groups (2, IQR 0-8 vs. 3, IQR 1-5, p=0.581) Conclusions. 1. Endoscopic spinal decompression surgery is associated with significant improvements in disability, as measured by the Oswestry Disability Index, in both mild and moderate-to-severe disability patients. 2. Post-surgical amelioration of disability is sustained for at least one year following the surgery. 3. These findings support the use of early intervention with minimally invasive endoscopic spinal decompression in mild disability patients with degenerative lumbar spinal stenosis.