Ortopedia, traumatologia, rehabilitacja最新文献

Background: Conservative treatment of lateral idiopathic curvatures of the spine is a difficult and complex therapeutic process that is not always successful. Repeated assessments of the patient's mastery of a given exercise may significantly increase the effectiveness of conservative treatment. The aim of the study was to assess the credibility of an original scale for evaluating DoboMed exercise proficiency in a group of people with adolescent idiopathic scoliosis.

Materials and methods: The study was conducted in a group of 41 patients with juvenile idiopathic scoliosis aged 10 to 16 years. In each patient, during a 3-week exercise period, the mastery of the Dobomed exercise method was assessed according to the authors original scale. Four physical therapists conducted this study.

Results: The Kendall-Smith concordance coefficient was used in the statistical analysis. On the basis of Kendalls W coefficient, Spearmans R coefficient of similarity was calculated to describe the correlation of all possible pairs of orderings. There was a high level of agreement between the therapists in the assessment of the key elements for mastering the method.

Conclusion: 1. The original method mastery evaluation scale has clinical value in monitoring the progress of exercises according to the Dobomed method. 2. A high level of agreement between the therapists was noted for those features that are important in mastering the method. 3. Standardisation of our scale for evaluating mastery of DoboMed exercises will allow patients to be monitored with regard to their performance of the exercises also by their parents.

Trapeziometacarpal osteoarthritis (carpometacarpal arthritis / CMC-1 arthritis) is a common cause of chronic thumb pain and may significantly worsen patients' quality of life. The thumb is the most important digit of the hand. A diagnostic-therapeutic algorithm for CMC-1 arthritis should be widely known and based on up-to-date evidence-based medical knowledge. The literature describes many medical and surgical treatment approaches. The methods used vary between hospitals and clinics. They also depend on patients' financial capabilities and many other factors.Medical (conservative) treatment appears to be effective in 60% of cases, in particular when the synergy of combining several treatment methods is taken advantage of. The most commonly performed surgical procedures in CMC-1 arthritis fall into two major groups, namely trapeziectomy or arthroplasty. However, there is no proof of superiority of one surgical treatment method over the others, and all of them have their advantages and disadvantages.This paper aims to present the most up-to-date knowledge about: (1) conservative and (2) surgical treatments for CMC-1 arthritis and (3) to propose a diagnostic-therapeutic algorithm for this condition. It is based on the latest literature (mainly works published in the last 5 years) acquired from databases such as PubMed, Clinical Key and Science Direct. The article is the second of a two-part series that presents a diagnostic-therapeutic algorithm for CMC-1 arthritis. The authors believe that it may contribute to broadening knowledge about CMC-1 arthritis, optimizing the therapeutic process and improving care for patients with CMC-1 arthritis in Poland.

Background: Delay in the diagnosis and treatment of bone tumors continues to be a common problem. Prolonged diagnosis can significantly reduce the chances of successful treatment of the disease. Accordingly, the aim of this study was to assess the delay in the diagnosis of primary bone tumors, identify the most common symptoms and analyze the course of the diagnostic and therapeutic path.

Material and methods: Thirty-two (K=18; M=14) patients treated surgically for primary bone tumors were included in the retrospective study. Patient records were analyzed. Delay in diagnosis was defined as the time from the onset of symptoms to the initial diagnosis and referral to an orthopedic oncology center.

Results: The median delay in diagnosis was 7 (3-12) months. For tumors located in the pelvis, the delay was 10 months, compared to 5 months for the upper limb and 7 months for the lower limb (p=0.2312). The delay was 6 months In patients with osteosarcoma, and 8 months in chondrosarcoma patients (p=0.1786). At the first office visit, an x-ray was ordered in 19 cases (59.4%), of whom 9 patients (47.4%) were referred on to the oncology center. The most common symptoms were pain in the affected area (90.6%), limited mobility (28.1%) and pathological fracture (25%). After admission to an orthopedic department, a biopsy was performed after 5.5 (3-8.2) days. The histology results were ready after another 14 (8-18) days, and surgical treatment was performed after 95 (76-100) days.

Conclusions: 1. Although patients show typical symptoms of bone tumors, only a small proportion are referred directly to an oncology center. After a primary bone tumor is suspected, further diagnostic and therapeutic activities proceed efficiently, in accordance with the current guidelines.

Background: The use of "SpineJack" implants in patients with stable spinal fractures and without neurological deficits enables restoration of the shape of the fractured vertebra and significantly accelerates restoration of normal function. In unstable spinal fractures, additional posterior fixation is recommended. This is not recommended in patients with traumatic spinal stenosis. The aim of the study was to evaluate the surgical and functional outcomes of treatment of patients with the SpineJack implant.

Material and methods: The objectives of this paper were accomplished on the basis of an evaluation of the outcomes of treatment of 39 patients operated on at the Orthopaedic Oncology Department in Brzozów and the Department of Orthopaedics and Traumatology in the District Hospital in Stalowa Wola in the years 2020-2021. 71% of patients were men; the mean age of women was 54 years and the mean age of men was 41 years. A total of 30 patients suffered traumatic fractures, while 9 patients suffered non-traumatic (pathological) fractures. Fractures were most often located in the lower parts of the thoracic and upper lumbar spine. Patient radiographs taken on the day before, the first day after and 3 months following the surgery were evaluated to assess the correction of vertebral wedging and cement leakage. Functional status was assessed using ODI, the quality of life was assessed with the EQ-VAS and the severity of pain was measured with a VAS.

Results: Pain intensity, measured with a VAS scale after the surgery, significantly decreased from the mean preoperative 6.9 to 2.4 three months post-op. The mean functional status of patients (ODI) before surgery was 74.4, compared to 14.8 at 3 months post-op. Mean Quality of life (EQ-VAS) was 56.4 before the surgery and 72.4 at 3 months post-op. The vertebral wedge angle decreased after surgical treatment, from a mean value of 15.8 degrees before surgery to 8.8 degrees after surgical treatment. At three months following the surgery, the mean loss of correction was 2.2 degrees and occurred in 4 patients. The most frequent complication was cement leakage into the disc and into the spinal canal, occurring in 4 and 2 patients, respectively.

Conclusions: 1. The use of "SpineJack" implants in the treatment of stable vertebral fractures enables the restoration of the shape and reduction of the vertebral wedge angle. 2. The quality of life of patients after vertebral fracture treatment with "SpineJack" implants assessed using the EQ-VAS improved significantly. The severity of pain assessed on a VAS scale decreased significantly and the patients' functional status improved according to the ODI. 3.Complications observed during treatment with "SpineJack" implants include fractures of the vertebral endplate and cement leakage, mostly asymptomatic.

An essential component of joint quality is cartilage. Therefore, the protection of this is a prerequisite for maintaining the condition of each joint. The assessment of the presence of articular cartilage is shown by X-ray of both joints in the standing position. Cartilage protection is possible for 1, 2 and 3 degree of cartilage damage according to the Kellgren and Lawrence scale.The challenge for the physician is to identify the cause of OA in accordance with the principles of Evidence Based Orthopedics/Traumatology, and not merely treat symptomatically, which is usually ineffective.In order to objectively present treatment methods, indications and the period of their implementation, it is biologically reasonable to refer to the needs of cartilage tissue resulting from the analysis of the causes of its damage and indications for justified methods of its protection.Biomechanical and biological elements are important in the process of implementing articular cartilage protection.The biomechanical elements are: limb axis disorders, differences in length, distortions at the level of the support quadrilateral, pelvic triangle and shoulder triangle, as well as balance disorders resulting from disturbances in the segmental proportion of the Fi number according to Leonardo da Vinci.There are many biological elements of the discussed disorder and they concern: the state of articular cartilage structure, matrix structure, matrix biophysical elements, molecular sponge mechanism, chondrocytes, cartilage nutrition and the severity of osteoarthritis (OA).The improvement of the conditions of the biological elements of damaged articular cartilage is considered fundamental and concerns the positive impact on numerous cartilage matrix proteins by chondroprotection. This element of treatment consists in the use of chondroitin sulphate and glucosamine as a drug, administered together in the appropriate dose and for a long time depending on the degree of degradation of the articular cartilage, usually from several to several months. The combination of chondroitin sulfate with glucosamine causes the activation of a much larger number of matrix proteins than each of the preparations separately.The pharmacokinetics of chondroitin sulfate and glucosamine are positive and favor their chondroprotective effect.The pharmacoproteomics of chondroitin sulfate and glucosamine administered together result from the activation of as many joint cartilage matrix proteins as possible. The development of proteomic techniques creates completely new therapeutic possibilities and is used to study the action of individual molecules.A clinically significant fact is that both chondroitin and glucosamine are natural, endogenous components of bone tissue and articular cartilage, so the use of both drugs is biologically compatible and results in numerous elements of cartilage protection.

Background: Ankle joint injuries are an important orthopedic issue due to their high incidence and the variety of treatment methods available. This study assessed the effect of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. There is lack of papers which address this problem.

Material and methods: This study compared epidemiological data on ankle joint injuries in adults and children collected during the period of the COVID-19 pandemic (2020) and a corresponding prepandemic period (2019). Epidemiological data, demographic data, treatment methods, hospital stay duration, and injury-to-surgery time were analyzed.

Results: The total number of patients hospitalized for ankle fractures in the evaluated pandemic period was lower by 34% than that in the corresponding prepandemic period in 2019. The pediatric patient subpopulation showed a 70% decline during the analyzed period of COVID-19 pandemic. The number of hospitalized females declined by 12%, and the number of hospitalized males dropped by 53%.

Conclusions: 1. Our study showed the impact of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. 2. The COVID-19 pandemic effected a decrease in the number of patients with ankle joint injuries, particularly pediatric and male patients with these injuries. 3. National lockdown measures had a considerable effect on lowering the numbers of pediatric patients with ankle joint injuries treated conservatively. 4. Importantly, the tendency can be noted among orthopedic surgeons and emergency room doctors to more readily qualify orthopedic patients for a trial of conservative treatment. This only prolongs the duration of treatment and time to the ultimate therapeutic surgery.

Background: To explore the impact of the ProFHER trial on initial decision making in the management of proximal humerus fractures at a district general hospital (DGH).

Material and methods: Retrospective review of all proximal humerus fractures at a single DGH during 1 year before ProFHER (2014) and 1 year following publication (2018). Data related to demographics, fracture pattern, and management was collected from electronic patient records and analysed.

Results: 52 patients in 2014 and 70 patients in 2018 met the inclusion criteria. There was no significant difference in demographics or fracture classification. Fewer patients were admitted from Accident and Emergency in 2018 (44% vs 55%). Of patients admitted, there was no significant difference between the proportion referred to a shoulder surgeon (SS) (27.5% vs 30%). In patients seen initially in fracture clinic by a non-shoulder surgeon (NSS), significantly fewer were referred for a SS opinion in 2018 (6.7%) vs 2014 (50%). Computed tomography was requested in 5/52 cases (9.6%) in 2014 and 8/70 cases (11.4%) in 2018, all cases involved an SS. Significantly more patients (14/52, 27%) were managed surgically in 2014 compared to 2018 (10/70, 14%). All patients were discharged with the exception of 1 patient in each group who required later surgical intervention.

Conclusions: 1. The widely disseminated ProFHER trial is likely to have influenced contemporary clinical practice. 2. This study shows non-shoulder specialists are more likely to manage these patients conservatively and without the involvement of shoulder surgeons post ProFHER. 3. This impact on clinical outcomes requires further research.

The aim of our study was to assess the clinical course, disease duration, functional status dynamics and prevalence of elevated blood sugar values in patients with frozen shoulder (FS). We also tested two other hypotheses: a) Duration of symptoms before the beginning of therapy affects rehabilitation outcome and duration of symptoms. b) Postponed initiation of therapy affects the duration of sick leave.Our prospective study took place at the University Rehabilitation Institute-Republic of Slovenia (URI-RS) between April 2017 and March 2021. The sample comprised 26 patients with FS. We evaluated patients every 3 months for consecutive 2 years with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Shoulder Pain and Disability Index (SPADI) and by measuring the shoulder range of motion (ROM).During the first year, there was a statistically significant change in passive ROM, against no improvement in the second year of follow-up. Only one of the patients was a known diabetic, the majority (77 %) of patients had normal blood sugar values, and in the remaining patients, elevated levels were incidental findings. Twelve patients were on sick leave for more than 12 weeks.The study showed that the duration of sick leave did not corelate with time to treatment initiation. It is advisable to perform a fasting blood sugar test in patients with FS.

Arthritis is the most common joint disease. It impairs patients quality of life on account of the associated chronic pain and loss of joint function. The thumb is the most important digit of the hand and trapeziometacarpal osteoarthritis (carpometacarpal arthritis / CMC-1 arthritis) may significantly compromise functions of the entire hand. CMC-1 arthritis produces several non-specific symptoms, affecting mainly postmenopausal women. The risk of developing CMC-1 arthritis increases with age.Considering these facts, knowledge about the etiopathogenesis and diagnosis of CMC-1 arthritis should be widely disseminated and based on evidence-based medicine. The first step in the diagnostic work-up is a detailed history and clinical examination where the use of more sensitive tests than the grind test, e.g. the pressure-shear test, is recommended. It is advisable to widen the classic radiographic views with additional thumb projections such as Roberts view. The use of magnetic resonance imaging or computed tomography is only advised in special individual cases.This paper aims to present the most up-to-date knowledge about: (1) the anatomy and biomechanics of the trapeziometacarpal joint, (2) the epidemiology of CMC-1 arthritis and (3) its diagnosis. It is based on the latest literature (mainly works published in the last 5 years) acquired from databases such as PubMed, Clinical Key and Science Direct. The article is the first of a two-part series that presents a diagnostic-therapeutic algorithm for CMC-1 arthritis. The authors believe that it may contribute to broadening knowledge about CMC-1 arthritis, optimizing the therapeutic process and improving care for patients with CMC-1 arthritis in Poland.