Ortopedia, traumatologia, rehabilitacja最新文献

Total knee replacement surgery (TKA) ranks among the most commonly performed orthopedic procedures nowadays. Many surgeons perform TKA with the use of tourniquet. It is also possible to carry out a tourniquet-less TKA. As with every surgery, TKA comes with the possibility of postoperative complications. The aim of this paper is to review the available scientific literature in order to systematize current knowledge and compare the pros and cons of tourniquet-based and tourniquet-less methods of total knee arthroplasty. This objective will serve to enhance patient awareness regarding the methods of total knee arthroplasty and provide reliable information to surgeons performing this procedure. The use of a tourniquet in total knee arthroplasty reduces intraoperative blood loss and operation time but may increase postoperative blood loss. It is associated with a higher risk of infection. Patients without a tourniquet experience less postoperative pain, shorter hospital stays, and comparable muscle function recovery over time. Tourniquet use increases the risk of deep vein thrombosis, influenced by tightening time. The choice between these methods involves balancing advantages and drawbacks in blood loss, infection risk, pain, and muscle recovery. Each method presents its own set of advantages and potential drawbacks, and the choice between the two methods requires a careful consideration of these factors.

Background: Hallux rigidus is found in more than 2% of individuals aged 50 and above. As this condition progresses, mobility in the first metatarsophalangeal (MTP-1) joint decreases, leading practically to rigid fixation of the toe in the plantar flexion position, while pain and joint deformity caused by osteophytes intensify over time. Surgical approaches for hallux rigidus include joint arthroplasty of the first metatarsophalangeal joint, which is commonly employed. This study aimed to assess selected radiographic parameters of the foot before and after MTP-1 joint arthroplasty.

Material and methods: The study involved 15 patients (15 feet), comprising 11 women and 4 men, at an average age of 54.7 years (range: 43 to 70). All participants underwent arthroplasty of MTP-1 using the Tornier FGT endoprosthesis. Various radiologic parameters were examined, including the hallux valgus angle, intermetatarsal angle, Horton's index, Meary's angle, Nikolaev's angle, and hallux angle in a lateral view.

Results: Radiological measurements were analysed using the R3.6.2 statistical package (R Core Team, 2019). After surgery, Horton's index showed a significant increase, rising from 7.2 to 8. Additionally, the HVA-L angle increased from 11.26 to 14.4.

Conclusion: Arthroplasty of MTP-1 produces significant changes in radiographic parameters of foot statics.

Background: Tibial fractures, particularly diaphyseal fractures, are common and can result in prolonged non-weight-bearing periods, especially in older adults. Intramedullary nailing has become the standard treatment, offering early weight-bearing and improved functional outcomes. This study aims to compare the efficacy and safety of two knee flexion methods - Method A (using an adjustable triangular frame) and Method B (Seyhan method) - in tibial nailing procedures.

Material and methods: A prospective randomized controlled trial was conducted with 90 adult patients aged 18-70 requiring intramedullary nailing for isolated closed tibial fractures. Method A utilized an adjustable triangular frame, allowing various degrees of knee flexion. In Method B (Seyhan method), knee flexion was achieved by leg sloping on the operation table with a cushion pillow under the distal thigh.

Results: In terms of complication rates, a key finding was a significantly higher incidence of edema in Method B compared to Method A. The results indicated minor differences in satisfaction levels, with a slightly higher percentage of 'Well Satisfied' and a higher dissatisfaction rate in Method B. However, these variations in surgeon satisfaction did not reach statistical significance.

Conclusions: 1. The Seyhan method and the adjustable triangular frame were compared in our study, with the latter showing advantages in terms of ease of use and reduced complications. 2. While complications like knee pain were observed in some cases, the triangular frame showed superior results in surgical efficiency and patient outcomes. 3. Further research is needed to confirm these findings and explore specific scenarios where each method may excel.

Background: Non-specific LBP refers to back pain which arises from the spine, intervertebral discs and surrounding soft tissues in the absence of pathologic lesions. Most cases of non-specific LBP are not the result of a single injury from a high load, but the result of repetitive, cumulative micro-injuries. The aim of the study was to assess the effectiveness of strengthening, stretching and mixed exercises in patients with non-specific LBP and their impact on pain intensity.

Material and methods: We analysed 90 patients with non-specific LBP who performed prolonged sedentary work. Patients were qualified following history-taking, a physical examination and radiological evaluation if no pathology had been revealed on examination or on the available diagnostic imaging scans. The participants were randomly divided into 3 groups of 30 individuals each. The patients in each group performed one type of exercise (strengthening, stretching, mixed) for a period of 3 months. Both before starting and on completion of the exercise period, the patients were assessed with an original questionnaire as well as the Rolland-Morris, Oswestry and SF-12 scoring systems.

Results: Strengthening exercises were the most effective in reducing pain; on completion of the exercise period, pain assessed with the NRS scale was 2 points in the strengthening exercise group, 3 points, in the mixed group, and 4 points in the stretching group. The SF-12 questionnaire showed an improvement in the patients' health (increase in "excellent" and "very good" scores from 7% to 60%). According to the Oswestry disability questionnaire, strengthening exercises were the most effective (mean disability score of 4).

Conclusions: 1. The use of strengthening exercises in patients with non-specific LBP most effectively improves function and reduces back pain. 2. The use of stretching and mixed exercises in patients with non-specific LBP improves function and reduces back pain, but to a lesser extent than strengthening exercises.

Osteomyelitis of the symphysis pubis is a rarely described bone infection. The main strain of bacteria causing this infection is Staphylococcus aureus, while Pseudomonas aeruginosa is seen most commonly in intravenous drug users. Symmetrical involvement of both pubic bones is usually present. Osteomyelitis of the pubic bones following genital infections in females without a history of previous surgery is very unusual. We present a 47-year-old female patient who, to our best knowledge, is the first case in the literature to develop osteomyelitis of the pubic symphysis after adnexitis caused by Pseudomonas aeruginosa without having had previous surgery in that region.

Background: Distal radial fractures are common injuries, accounting for approximately 25% of fractures in the paediatric population and up to 18% of all fractures in the elderly age group. Assessment of treatment outcomes of these fractures includes objective measurements of wrist joint range of motion and grip strength as well as subjective parameters such as the intensity of perceived pain, hand function and quality of life. The recent years have ushered in a trend towards using several outcome measures for a more comprehensive evaluation of the results of the treatment. The objective of this study was to investigate whether the assessment of pain severity and grip strength is sufficiently accurate for correct assessment of the outcome of the treatment of distal radial fractures.

Materials and methods: One hundred and two patients, 79 women (77%) and 23 men (23%), at a mean age of 54 years with distal radial fractures were treated operatively. Treatment outcomes were assessed at 3 and 6 months by measurements of intensity of pain (according to a numerical rating scale, NRS), grip strength (with a dynamometer) and hand function with the DASH questionnaire. The results of these measurements were compared in order to investigate the strength of the possible correlation between variables.

Results: An analysis of the correlation between the variables of interest at 3 and 6 months' assessment showed statistically significant correlations (Spearman rank test, R=0,26-0,41; p<0,01). The NRS correlated negatively with grip strength (less pain - greater strength) and positively with DASH scores (less pain - better hand function). The correlation between grip strength and the DASH was the strongest (Spearman rank test R=0,61; p<0,001, showing that greater power of the hand indicated better function, whereas weaker grip indicated worse function.

Conclusions: 1. The severity of pain and the degree of weakness of the hand show (independently of each other) a very good correlation with the comprehensive assessment of hand function using the DASH questionnaire. 2. It follows that pain severity and hand weakness are sufficient to reliably assess the outcome of the treatment of a distal radius fracture.

Background: Whole-body vibration is commonly used in physiotherapy. The vibration platform generates mechanical stimuli that primarily influence the neuromuscular system. Vibration can improve proprioception and balance. The aim of the study was to assess the impact of whole-body vibration on foot position and postural stability.

Material and methods: A group of 31 participants took part in 6 vibration sessions at 15Hz and 30Hz over 2 weeks. Foot position parameters (angle and distance) and postural stability indicators before and after vibration were assessed on the Biodex Balance System. Vibration was performed on the Galileo Med35 platform (3x3 min). A control group consisted of 26 people who were only assessed on the Biodex platform.

Results: There was no change in the angle of both feet (p>0.05) after vibration at the frequency of 15 Hz. The angle of the right foot increased (p=0.013) after vibration at 30 Hz. Vibration increased the distance between the feet for both 15Hz (p=0.000) and 30Hz (p=0.000) sessions. There was no correlation between the change in feet spacing and the change in the overall stability index, anteroposterior stability index and mediolateral stability index (p>0.05). In the control group, no changes (p>0.05) in the angle and foot spacing were noted between consecutive measurements.

Conclusions: 1. Whole body vibration can increase the width of quadrilateral of support in static conditions but has a minimal effect on changing the angle of the feet. 2. The width of the quadrilateral of support after whole-body vibration does not appear to affect postural stability under static conditions. 3. It is recommended that postural stability is assessed before and after whole body vibration while the initial position of the feet is maintained.

Background: Total hip arthroplasty in patients with rheumatoid arthritis is difficult and leads to worse implant survival and higher risk for complications compared to osteoarthritis. Poor periacetabular bone quality might challenge the stability of the acetabular cup. Contemporary 3D-printed highly-porous titanium cup designs have become the benchmark for cementless implants; however, their usefulness in rheumatoid arthritis is still unclear. The purpose of this study was to assess the short-term results of the use of a highly-porous 3D-printed acetabular titanium cup in patients with rheumatoid arthritis.

Material and methods: We studied a consecutive series of RA patients who underwent cementless THA between 2019 and 2020 in our center with the same 3D-printed highly-porous titanium acetabular cup. All patients were evaluated prospectively for a minimum 3-year follow-up with the Harris hip score, VAS and Roles and Maudsley score. Radiographic assessment focused on evidence of cup osseointegration.

Results: 37 RA patients, mean age at surgery of 51.3 years, were included. Mean follow-up was 3.2 years (3 to 4 years). By the last follow-up visit, the Harris hip score had increased significantly from 37.8 to 88.5, VAS had decreased from 6.1 to 1.0 and excellent satisfaction for 31 patients. All 5 Moore's radiographic signs were present in 35 hips, with only 4 signs present in the remaining 2 hips, thus indicating complete osseointegration of all cups. There were no complications on the acetabular side but one intraoperative proximal calcar fracture.

Conclusion: 3D-printed highly porous implants used in primary THA worked well in patients with rheumatoid arthritis, showing excellent osseointegration and good clinical results in the short term.

Shoulder dislocation is undoubtedly one of the most common injuries in traumatology. Posterior dislocation of the shoulder is regarded as comparatively rare compared to anterior dislocation, whilst it is strikingly extraordinary for this type of injury to be accompanied by a concomitant fracture. Accurate diagnosis and appropriate treatment can be considerably demanding, while being vitally important in this exceedingly rare condition. These injuries are broadly considered to be under-reported in the existing literature, especially among high-demand athletes. We present a rare case of a high-demand athlete sustaining a traumatic locked posterior shoulder dislocation with an accompanying fracture treated in our Institution. A detailed clinical examination and plain radiography revealed the peculiar condition, and a CT scan was subsequently performed for more thorough evaluation of the injury. The patient underwent surgery on the day following admission for repair of the extensive shoulder damage, and a deltopectoral approach was utilized. Reduction of the metaphyseal fracture and the dislocation was accomplished with gentle manipulations, and stabilization was obtained with an anatomic plate. A modified McLaughlin procedure was carried out to address the reverse Hill-Sachs lesion. The postoperative period was uneventful, followed by a painstaking physical rehabilitation program, and the patient returned successfully to his sporting activities 6 months postoperatively. By presenting this thought-provoking case, we stress the challenging nature of these immensely infrequent injuries while also highlighting the requirement for more sensitive factor-specific studies regarding their optimal treatment.

Background: First tarsometatarsal arthrodesis is an effective procedure for the correction of hallux valgus deformities. Traditionally, first to third tarsometatarsal and Lisfranc arthrodesis is performed via an open approach. Little is known about the role of combined arthroscopic and minimally invasive techniques.

Material and methods: We present a case series of complicated hallux valgus deformities and other conditions managed using arthroscopically assisted minimally invasive arthrodesis. We first performed a minimally invasive surgical procedure that allowed easy and unhindered access for the introduction of an arthroscopic instrument over the joint surface.

Results: The mean Visual Analogue Score - Foot and Ankle and Short Form-36 scores indicated satisfactory and acceptable postoperative outcomes, respectively. The mean patient satisfaction score was 94.44 and the mean follow-up duration was approximately 17.7 months.

Conclusion: The described procedure has been preliminarily shown to be useful in terms of its minimal invasiveness, reproducibility, safety, and effectiveness.