Ortopedia, traumatologia, rehabilitacja最新文献

Background: Humerus shaft fractures are common in orthopaedic practice. The emphasis in treatment has shifted from prolonged immobilisation to early mobilisation and internal fixation when needed for a quicker return to normal function. Internal fixation methods include plate osteosynthesis and intramedullary nailing. This study specifically evaluated the effectiveness of flexible intramedullary nails in treating diaphyseal humeral fractures.

Material and methods: Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) with diaphyseal humeral fractures. Treatment involved closed reduction and percutaneous fixation using two flexible nails. Patients, aged 17 to 65 with a mean age of 32, were included if they did not have pathological fractures, were above 16 years old, and were medically suitable. Causes included pedestrian vehicle accidents (17 cases) and falls or sports-related activities (12 cases). Surgical intervention occurred 1 to 8 days after the injury.

Results: Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) for diaphyseal humeral fractures using closed reduction and percutaneous fixation with two flexible nails. Patients, aged 17 to 65, were monitored for an average of 18 months. Radiographic assessments showed complete union in nineteen fractures within 13 to 21 weeks. One patient experienced non-union but was successfully treated with bone grafting and plating. There were no significant intraoperative complications. Notably, four patients with preoperative radial nerve injuries recovered within 6 to 8 weeks. Evaluation using the Stewart and Hundley Scoring technique showed excellent outcomes for 60% of patients, good outcomes for 30%, fair outcomes for 5%, and poor outcomes for 5%.

Conclusions: 1.The Elastic Stable Intramedullary Nailing (ESIN) technique shows promise in the treatment of humeral shaft fractures. 2. However, the success of treatment may depend on various factors, including patient age, fracture characteristics, and the presence of complications such as open fractures and radial nerve palsy. 3. Careful consideration of these factors is necessary when selecting a treatment approach for humeral shaft fractures.

Delayed union of fractures is one of the most frequent complications in orthopedic practice, especially in polytrauma patients. With the development of new methods of regenerative medicine, including the use of adipose derived stromal cells as a component of the stromal-vascular fraction (SVF), new possibilities for conservative treatment of this problem have emerged. This article presents a clinical case of conservative treatment of delayed union of a radial bone fracture using local SVF injections. In the fracture space, SVF with PRP creates a pool of cells that could differentiate towards surrounding tissue, releases various inducers of tissue growth and, via an indirect chemotactic effect on receptors, mobilizes the body's own resources and creates conditions for angiogenesis and trophism in the injured segment. In the patient with delayed consolidation after SFV-therapy, progress in clinical and radiological dynamics was noted with complete healing within 7 months. The positive clinical result provides a basis for further study and implementation in practice.

Background: Radial neck fractures account for 5-17% of elbow fractures and about 1% of all fractures in children. The subject of the presented research is assesment of clinical and radiological outcomes of the Metaizeau technique for treatment of isolated radial neck fractures in children.

Material and methods: Retrospective analysis of clinical and radiological data of patients treated with the Metaizeau technique in our Department between 2015 and 2020. Twenty children with isolated radial neck fracture met the inclusion criteria.

Results: Excellent outcomes of operative treatment were achieved in 95% of children. None of the complications described in the literature (e.g. avascular necrosis of radial head (AVN), malunion, nonunion) were observed in our case series.

Conlcusions: 1. The Metaizeau technique for reduction and stabilisation of the radial neck fracture using a TEN is a safe and effective method in the paediatric population and produces good clinical and radiological results. 2.Furthermore, the minimal demands it places on surgical equipment make it possible for this technique to be recommended to orthopaedic surgeons managing paediatric trauma patients.

Background: Peri-incisional numbness occurs frequently after Total Knee Arthroplasty (TKA), yet its impact on clinical outcomes remains controversial. With some studies reporting 100% incidence and patients often perceiving it as a minor inconvenience, its categorisation as a complication is controversial. This study investigates the prevalence and temporal changes of numbness post-TKA to refine the informed consent process and improve patient satisfaction.

Material and methods: A convenience sample of patients who underwent primary cemented TKA was studied. Demographic data, scar length, tourniquet time, and WOMAC scores were collected. Patients were grouped based on time from surgery, and areas of numbness for light touch and pinprick sensations measured.

Results: The study included 49 patients with a mean age of 68.9 years. While all patients reported numbness, the area decreased for both pinprick and light touch sensations over time. No significant correlation was found between WOMAC scores and the area of numbness.

Discussion: Numbness post-TKA is common, and the affected area contracts over time, implying a natural healing process. The study's findings challenge the perception of numbness as a complication and emphasise the importance of informed consent in managing patient expectations.

Conclusions: 1. Postoperative numbness around the incision site following TKA is a common occurrence with minimal clinical impact on patients. 2. It is important to inform patients that this numbness will improve, although some residual numbness may remain.

Background: Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10.

Material and methods: Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures.

Results: Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed.

Conclusions: 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

Background: The use of online learning methods has expanded considerably in many countries since the declaration of COVID-19 as a global pandemic by the World Health Organization. Smartphones are widely used for voice and text messaging, checking emails, and distance learning. The aim of this study was to investigate the relationship between using smartphones and text neck syndrome.

Material and methods: A cross-sectional study was conducted among university students in Jordan between February and March 2023. All undergraduate students were invited to participate. A self-administered online (Google forms) questionnaire was distributed by posting the link to the questionnaire on students' groups through social media websites such as Facebook, Twitter, and WhatsApp.

Results: A total of 171 students responded to the survey. The participants included 103 (60%) females and 68 (40%) males. Approximately 79% of the participants were less than 22 years old. Almost half of the participants reported pain at neck (54%) and shoulder (51%), while about 61% of participants suffered from upper back pain.

Conclusions: 1. Smartphones are widely becoming essential in educational technology, and more concern should be expended to increase the awareness about optimal and healthy usage of smartphones by restricting usage duration in order to reduce neck and shoulder pain and associated poor functioning in daily living activities. 2. Poor patterns of smartphone use increase the likelihood of neck pain. 3. Neck movement limitations are not associated with age or gender. 4. Students who did not report limitation in neck movement were less likely to have difficulty with reading.

Background: Patients with Type 2 Diabetes Mellitus (T2DM) constitute 20% of patients qualified for Total Hip Arthroplasty (THA). Poor glycemic control may result in a worse prognosis after THA. The aim of the study was to evaluate the effect of T2DM-induced inflammation on changes in bone density around the endoprosthesis stem in female patients.

Material and methods: The investigational group consisted of female patients with T2DM and HbA1c> 6.5% who underwent THA. A control group consisted of female patients with T2DM and HbA1c≤6.5% who underwent THA. Anthropometric measurements, laboratory testing and functional status assessment according to the Harris Hip Score (HSS) were performed. A DXA bone density scan was performed within the first day after THA. The measurements and assessments were repeated after one year.

Results: The Body Mass Index (BMI) was higher in the investigational group (33.802.93) than in the control group (31.223.40). Patients in the investigational group had higher CRP (4.661.59) as well as Bone Mineral Density (BMD) values in the operated (1.280.22) and opposite limb (0.940.14) on initial testing. After one year, there was a statistically significantly higher CRP in the investigational group (3.441.74) than in the control group (1.921.51).

Conclusions: 1. The level of HbA1c in patients with T2DM is not associated with periprosthetic changes in BMD. 2. BMD changes may be associated with chronic inflammation and may mask severe abnormalities in bone microarchitecture. 3. Patients with T2DM after THA should undergo long-term clinical follow-up.

Background: cartilage layer thickness, composition of the extracellular matrix (ECM), geometry and configuration of retropatellar cartilage partially differ significantly from those found at other locations and are essential for patellofemoral biomechanics.

Material and methods: 119 serial medial and lateral patella facet samples of patients undergoing implantation of a total knee endoprosthesis of areas showing mild (Group A, macroscopically ICRS Grade 1b) respectively advanced (Group B, macroscopically ICRS Grade 3a/3b) (38 each) osteoarthritis according to the histological-histochemical grading system (HHGS) were compared with 22 healthy biopsies by means of immunohistochemistry and histology investigations. We quantified our results on the gene expression of collagen type I and II and aggrecan with real-time (RT)-PCR rsp using colourimetry for proteoglycan content. The digitized images of histology and immunohistochemistry staining with Safranin O, Alcian blue, PAS, Masson Goldner, immunostaining, e.g. for collagen I and II were also analyzed with Photoshop software.

Results: The most significant decrease in staining intensity was revealed for Safranin-O staining in Group B at the lateral patellar facet, and the most relevant increase was for Col I staining at the same site. The lateral patella site in Group B also showed the highest increase in the ratio of expression indices for the genes Col1A1 and the reference gene following the equation 2-ΔCt with a quotient of 29.6.

Conclusions: 1. Comparisons of our retropatellar cartilage analysis with femoral and tibial studies utilizing similar techniques show significant differences. 2. Cartilage layer thickness, ECM composition, geometry and configuration are essential for patellofemoral biomechanics. 3. Consequently, there is a need for diversified approaches towards retropatellar surface during TKA as well as for advanced cartilage restoration techniques.

Background: The aim of the work was to investigate the influence of the position of a fractured greater tubercle of the humerus on stress distribution in the glenohumeral joint (GHJ) at shoulder abduction by performing stress-strain analysis (SSA).

Material and methods: A simulated 3D model of the shoulder was constructed on the basis of anatomical and anthropometric data as close as possible to real ones using the SolidWorks software package.

Results: A finite-element model (FEM) was generated in a semi-automatic mode composed mostly of tetrahedral and hexagonal elements < 1 mm in dimensions.

Conclusion: The simulated 3D model of the shoulder, based on anatomical and anthropometric data as close as possible to the real ones, makes possible highly accurate determination of the optimal mutual position of the movable elements of the real joint individually for each specific patient, and makes it possible to accurately perform a minimally invasive surgical operation.

Background: Total knee arthroplasty (TKA) is the standard treatment for terminal knee osteoarthritis. Simultaneous bilateral total knee arthroplasty (STKA) can be a cost-effective and practical option for patients with degenerative joint disease affecting both knees. The purpose of this study was to assess complication rates and functional outcomes following simultaneous versus staged bilateral total knee replacement.

Material and methods: Approximately 60 individuals who experienced debilitating knee osteoarthritis were enrolled in a prospective study with a randomized comparative design. Out of these, 30 patients underwent simultaneous total knee arthroplasty (STKA), while the remaining 30 individuals underwent two separate surgeries with a gap of 3-6 months between each procedure for both knees. After excluding 7 patients from both groups, a total of 53 patients were included in the study and followed up for at least 12 months.

Results: Pre-operative demographic parameters were equated between both groups. The overall number of systemic complications was higher in the simultaneous group compared with the stagedone. Systemic complications were correlated with the elderly and high-risk populations. However, simultaneous procedures were safe in a low-risk group with shorter hospitalization and operative times.

Conclusions: 1. Simultaneous bilateral total knee arthroplasty (TKA) is considered safe and feasible mainly for younger individuals with ASA 1 or 2 health status. 2. Patients undergoing simultaneous bilateral TKA experience significantly reduced hospital stays. 3. The procedure may not be advisable for elderly patients at a higher risk of systemic complications.