Ortopedia, traumatologia, rehabilitacja最新文献

Ceramic materials produced by various methods from calcium phosphates have long been used in orthopaedic and dental surgery. Until recently, it was generally believed that at least some of them faithfully reproduce bone minerals. Newer studies, however, have shown that hydroxyapatite in bone is closely associated with citrate molecules. This raises the yet unanswered question whether the materials used in clinical practice are optimal in relation to the tasks which they are supposed to fulfil. The description of the function of citrate in bone mineralization requires appropriate background information, which is presented in this review.

Regeneration of bone and cartilage tissues is a key area of research and practice in sports medicine and orthopedics. Modern technologies, integrating traditional methods with innovative solutions, open new perspectives in therapy and improvement of patients' quality of life. Examples of such methods and their clinical applications confirm the dynamic development of this field of medicine, which gives hope for achieving more satisfactory therapeutic outcomes in the future.Nuclear Magnetic Resonance Therapy (NMRT), also known as MBST, is an innovative therapeutic method that is gaining popularity in the treatment of musculoskeletal disorders, including bone and cartilage regeneration. This method is an answer to the growing demand for effective and non-invasive methods of treating musculoskeletal conditions. Clinical trials conducted over the last 10 years provide ample evidence for the effectiveness of NMRT in the treatment of musculoskeletal conditions. NMRT is used to treat both chronic and acute diseases such as arthrosis and osteoporosis. Thanks to its properties, it focuses on the source of the problem, and not only on relieving the symptoms. An additional advantage is that no side effects have been demonstrated to date. Magnetic resonance therapy can be used as an adjunct to traditional treatments. Thanks to the ability to stimulate regenerative processes at the cellular level, it significantly accelerates the process of returning to full fitness.This article aims to discuss the processes of bone and cartilage tissue regeneration in response to nuclear magnetic resonance therapy (NMRT), present the results of clinical trials and therapeutic guidelines against the background of other treatment methods.

Multiligamentous knee injuries occur as a result of both high- and low-energy trauma to the knee, most commonly due to motor vehicle accidents and sports-related injuries. Commonly reported complications after multi-ligament knee reconstruction include wound infection, deep venous thrombosis (DVT), and arthrofibrosis. A 42-year-old female was struck by a motor vehicle and suffered pain and swelling in her left knee. The patient was ambulated using a wheelchair. She underwent debridement and a synovial fluid evacuation procedure. An MRI examination and arthroscopy revealed arthrofibrosis and multi-ligamentous injury in her left knee. Arthroscopic debridement was performed, and the evaluation of the knee showed a multi-ligamentous injury. Ligament reconstruction was performed and produced a favorable outcome in terms of range of motion.Arthrofibrosis causes knee symptoms during walking and standing, and the condition is frequently more debilitating than the original injury or degenerative condition. Even a small loss of knee extension of 5 results in difficulty walking, while a loss of flexion creates problems with stair climbing, sitting, getting in and out of chairs and cars, and driving. Post-operative fibrosis of the knee is defined as a limited ROM in extension and/or flexion. Arthrofibrosis is classified as mild, moderate, and severe. Staged surgery consists of acute primary repair of collateral ligaments with cruciate reconstruction once improved range of motion has been obtained, and good outcomes have been reported for range of motion and stability. Conditions that play a role in the development of arthrofibrosis include acute ACL reconstruction, late rehabilitation, and meniscus injury. Arthroscopic debridement plays a pivotal role in the management of arthrofibrosis.

Background: Carpometacarpal (CMC) joint dislocations are rare, accounting for less than 1% of all hand injuries. They result from direct high-energy blows to the hand, i.e. falls on the outstretched hand, falls from bicycles or punching one's fist against an object. The objective of this case-series study was to analyse the results of treatment of these injuries in 6 patients who presented to the author's institution.

Material and methods: In the 3-year period between 2021 and 2023, a total of 6 male patients, mean age of 39 years, with CMC joints dislocations were treated. Three patients had single CMC joint dislocation and the other three had 2 or 3 CMC joints dislocated. Three patients had concomitant fractures of metacarpals or the hamate. Four patients were treated operatively, one conservatively, and one patient with a neglected injury was given physiotherapy. Results were assessed at an average of 16 months post-treatment by a telephone interview in 5 patients.

Results: None of the patients reported pain at rest in his hand and 4 reported mild pain after major loading of the hand. Two patients reported minor pain when the weather changed. Function of the hand as assessed with the quickDASH form was normal. All patients believed that they had fully recovered and all had resumed their pre-injury jobs.

Conclusions: 1. Presented case-series shows satisfactory outcomes of the treatment of CMC joint dislocations, both in isolated injuries and in complex cases. 2. Early diagnosis and rapid reduction of joint dislocations are crucial to regaining proper hand function.

Background: Tibiotalocalcaneal arthrodesis (TTCA) has been an effective surgical treatment for ankle and hindfoot deformity correction and pain relief. This paper presents the results of tibiotalocalcaneal arthrodesis using a hindfoot nail and bone grafting.

Material and methods: From November 2016 to December 2019, 15 patients underwent tibiotalocalcaneal arthrodesis with a hindfoot nail for treatment of advanced ankle and hindfoot disease. Included cases were 10 instances of end-stage arthritis characterized by severe pain, instability, and challenges in weight-bearing, 4 cases of hindfoot pain with hindfoot fusion non-union (failed arthrodesis fixation), and 1 case of Charcot arthropathy. Unilateral procedures were conducted in all instances, comprising 9 male and 6 female participants. The average age at the surgery date was 56.25 years, ranging from 45 to 63 years. The follow-up duration averaged 16 months, falling within a range of 12 to 18 months.

Results: Successful fusion was observed in all 15 cases. The average AOFAS score, with a maximum of 73 points, increased from an initial mean of 18 points (ranging from 5 to 31) to a mean of 57 points (ranging from 41 to 73), excluding stability and range of motion scores. Patient satisfaction on a scale of 10 points rose from 3 to 7 for both pain and function.

Conclusions: 1. The results of the present study suggest that TTCA using a short, retrograde intramedullary nail is a worldwide accepted technique for achieving fusion with minimal complications. However, long-term follow-up is necessary to provide definitive information about topics such as adjacent degenerative arthritis. 2. Tibiotalocalcaneal fusion with intramedullary nail (Hindfoot Nail) resulted in a higher fusion rate, no/minimal infections, lower pain levels, higher quality of life, and quicker return to work. 3. Retrograde intramedullary nailing offers a safe and reliable salvage option and a very viable alternative to amputation in patients with severe ankle and hindfoot pathologies.

Background: Since over century it has been known that hand to arm transmitted vibrations (HAV) can affect health and quality of life. Exposure over certain level and intensity over time are risk causes of Hand Arm Vibration Syndrome (HAVS). Symptoms varies from the damaged structures which most commonly are secondary Raynaud Phenomenon known as Vibration Induced White Finger (VWF), carpal tunnel syndrome, tingling, loss of manual dexterity, osteoarthritis or even Dupuytren's contracture. The usage of pneumatic vibrating tools among physical workers and specialists like dentists, without any doubt has grown significantly since the start of previous technological era. Unfortunately, development of medicine is not sufficient to reverse harmful effects of vibrations on human body but is able to diagnose and treat symptoms faster and with better efficiency than it used to in the past. Brief update and awareness booster of occupational disease which is silently present in our society, giving more insight and knowledge about current possibilities of treatment and diagnosis for medical personnel and everyone interested.

Material and methods: The article presents actual state of knowledge and scientific discoveries collected and researched via databases of platforms: Journal of Education Health and Sport, PubMed, Google Scholar, National Library of Medicine, Elsevier. Used keywords in research: Vibration induced White Finger, HAVS, Hand Arm Vibration Syndrome.

Conclusion: While full protection from occupational vibrations is not possible, we should advance in spreading knowledge of occupational hazards, updating and regulating work standards policies, as continue research in new aimed therapies and effects of vibrations on human body.

Background: Musculoskeletal injuries in children and adolescents have rarely been investigated in the recent literature. This study aimed to perform a comparative medical and economic analysis of the cost of treatment of musculoskeletal injuries and that of selected pediatric surgical procedures in children and adolescents.Material and methods, We performed a retrospective analysis of data of children treated in a pediatric surgery department for musculoskeletal injuries and selected general surgical conditions in 2021-2023. The number of hospitalizations, procedures, the number of NHF credits awarded, and the monetary value (PLN) of procedures performed were assessedResults. There were a total of 3,809 children hospitalized in 2021-2023, of whom 1,933 received surgical treatment (51%). In this group, 529 children (28%) were treated due to musculoskeletal injuries (Group I), and 402 (20%), due to general surgical conditions (Group II). The average monetary value of the procedures performed was 949,238.2 PLN / year for Group I and 740,583.6 PLN / year for Group II.

Conclusions: 1. In the pediatric population, musculoskeletal injuries account for the highest percentage of injuries associated with serious sequelae. 2. The monetary value of procedures for treating musculoskeletal injuries is higher compared to selected general surgical procedures according to DRGs. 3. The cost of performing trauma procedures constitutes 56% of the NHF contract value and has been gradually increasing. 4. The significant and increasing incidence of traumatic injuries and the high cost of their treatment require an increase in the overall contract value for centers treating injuries in children and adolescents.

Background: Cervical spine injuries in children are relatively uncommon and account for approximately 1.5% of trauma admissions. The aim of our study was to determine the incidence and patterns of pediatric cervical spine fractures in a single Trauma Center over the last decade.

Material and methods: The hospital's medical database was queried for data from the period between January 2014 and December 2023. An initial search revealed that 511 patients had been hospitalized with neck injuries in that time frame. Among these records, we identified 24 patients with a fracture of the cervical spine. The inclusion criteria were: (1) age under 18 yo, (2) fracture of the cervical spine (3) follow-up of at least 6 months. A thorough analysis was performed, including injury mechanism, diagnosis, medical procedures and final outcome., A Neck Disability Index (NDI) was assessed for all patients at the six months' follow-up visit to evaluate treatment outcomes.

Results: The study group consisted of 14 boys and 10 girls aged 4.6 to 18 years (average age 14.2). We diagnosed one case of an isolated C1 fracture, six C2 fractures, two C4 fractures, two C5 fractures, two C7 fractures, and nine cases of multiple spinal fractures. Additionally, we diagnosed two cases of cervical spine dislocation: one of right-sided rotational dislocation of C6/C7 and one of complete dislocation of C2/C3. Eight patients were treated surgically by open reduction combined with anterior plate fixation. Four patients were treated using a halo vest. Eleven patients were treated conservatively: six using a Minerva orthosis, four with a cervical-thoracic orthosis, and one with a rigid cervical collar. The highest NDI values were encountered in the group of patients with concomitant intracerebral injury, where the mean value was 18.6/45 (12-26/45). The mean NDI score for the remaining patients was 4/45 (0 - 9/45).

Conclusions: 1. The incidence of cervical spine fractures in children is low. 2. Most cervical spine injuries in children are treated conservatively with good outcomes. 3. Both conservative and surgical treatment of cervical spine fractures in children produces good results 4. Computed Tomography remains the gold standard for diagnosing cervical spine fractures in children. 5. The halo-vest in pediatric patients suffering from C2 fractures was well tolerated and provided good outcomes. 6. Surgical treatment of lower cervical fractures by open reduction with anterior fusion is efficient in terms of fusion status and patient satisfaction. 7. Prospective, randomized, multicenter studies are required to assess the epidemiology, methodology, and treatment effects of cervical spine fractures in children.

Background: Unstable distal end intra-articular fractures of the radius pose a greater risk of reduction loss, potentially resulting in malunion and poor functional outcomes. Therefore, the amount of reduction and the technique of fracture fixation play a crucial role in achieving improved functional outcomes and ensuring patient satisfaction.

Material and methods: This is a study of prospectively enrolled 27 patients with displaced intra-articular distal end radius fractures treated surgically by volar locking plate through modified Henry's approach in the department of orthopedics at a tertiary care center. Patients were post-operatively evaluated for functional outcome and complications.

Results: Out of the 27 patients 26 came for regular follow up, ranging from 3 months to 18 months and one patient was lost to follow-up. The functional outcome was investigated with the Mayo wrist score. Excellent scores were noted in 34.6%, good in 53.8% and satisfactory in 11.5% of the patients.

Conclusion: Irrespective of the direction and degree of displacement, the volar locking plate as a treatment for an intraarticular distal end radius fracture is a good option as it provides stable fixation, and good to excellent outcomes with less complications.

Backgrounds: Ankle fractures of Danis-Weber type B represent common lower limb injuries. The aim of the study was to compare the effectiveness of standard physical therapy and proprioception training during the acute rehabilitation period.

Materials and methods: The study group comprised 38 patients with Danis-Weber type B ankle fractures during the acute rehabilitation period in 2022-2023. All patients underwent surgery and were randomized into: Group I (18 patients), who received a rehabilitation program that included standard physiotherapy and proprioceptive exercises, and Group II (20 patients), who received a rehabilitation program of standard physiotherapy only.

Results: Before the start of rehabilitation, AOFAS scores were 33.910.4 in Group I and 21.38.9 in Group II. At the end of the study, scores were 67.626.1 and 38.57.8, respectively. In contrast, the FADI scores were almost identical at beginning (11.62.4 vs. 11.452.4). At the end of the study, there was a small but significant improvement in Group II, with scores of 37.05.4 compared to 32.55.4 in Group I. The barotensometric indicators at the beginning of the intervention were not significantly different between the groups.

Conclusions: 1. Incorporating proprioception stimulation training during the acute rehabilitation period may offer some advantages in enhancing ankle and foot function following a Danis-Weber type B ankle fracture. 2. It may be beneficial to perform prolonged monitoring to develop an evidence-based approach to rehabilitation strategy after ankle fractures.