Ortopedia, traumatologia, rehabilitacja最新文献

Background: Various arthroscopic stabilization procedures are associated with recurrence rates ranging from 10.8% to 21.1%. Recurrences occur especially in young male patients participating in contact sport activities. Bony defects of the humeral head and the glenoid predispose not only to subsequent dislocations but also to failure of surgical treatment. This is the group where "bony" procedures such as arthroscopic Latarjet are recommended to provide better stability as the primary treatment.

Material and methods: Patients with traumatic unidirectional anterior shoulder instability treated from 2009 to 2016 with an arthroscopic Latarjet procedure operated on in two centres. Clinical results, including range of motion, Subjective Shoulder Value and Walch-Duplay score, and postpoperative complications were evaluated.

Results: 156 patients were available for follow-up at a minimum of 2 years after surgery. The mean follow-up was 4318 months. Mean age at the time of surgery was 27.9 (16-53) years. At final follow-up, 8 cases of recurrent instability were identified, including 6 cases of recurrent dislocation and two cases of recurrent subluxation. Mean Walch-Duplay score increased from 3019 preoperatively to 8316 (p<0.05) at the last follow-up. An average loss of external rotation of 11.8 (0-70) (p<0.05) when compared with the contralateral shoulder was observed at the last follow-up. Mean Subjective Shoulder Value score was 92.89.4%. 8 (5%) patients presented with loss of shoulder stability. 25 (15.8%) patients reported subjective return to sport anxiety. Eleven (7%) patients complained of anterior compartment pain. The total number of revision surgeries was 14 (8.9%).

Conclusions: 1. The arthroscopic Latarjet procedure can achieve satisfactory clinical outcomes for the treatment of anterior shoulder instability 2. The rate of complications and recurrence does not increase with time and is comparable at a minimum of 2 years follow-up to early results described in literature.

Background: The aging structure of society results in a growing need for treatment of shoulder osteoarthritis. Reverse shoulder arthroplasty (RSA) has been developed to improve the motor function and strength of the shoulder joint without increasing the risk of dislocation. The aim of the study was to assess the change in quality of life and functional assessment of the shoulder joint after RSA in patients with osteoarthritis, based on the Oxford Shoulder Score (OSS) and an assessment of joint mobility parameters.

Material and methods: A total of 10 patients were admitted to our centre for shoulder arthroplasty between August 2020 and October 2021. The assessment of the degenerative changes was based on the Walch classification and the Samelson & Prieto classification. The OSS questionnaire was used to assess function of the affected shoulder joint and pain in each patient. The range of motion in the shoulder joint was assessed in the pre- and postoperative period. A follow-up examination was performed approximately 6 months after surgery.

Results: Analysis of the OSS scores revealed a mean value of 46 points preoperatively and 25 points postoperatively. The OSS scores six months after the procedure were an average of 20.5 points lower. A statistically significant improvement was noted in shoulder flexion (mean 37), abduction (42), external rotation (34), and internal rotation (5)(p<0.05).

Conclusion: Each patient reported reduced pain and demonstrated an increased range of motion in the affected shoulder joint and functional improvement.

Background: Two-stage revision arthroplasty remains the main surgical strategy for the treatment of prosthetic joint infections (PJI). Sonicate fluid culture has improved sensitivity compared to standard periprosthetic tissue culture, but its usefulness is questionable during the second stage of revision arthroplasty.

Material and methods: Twenty-seven patients with prosthetic joint infection were investigated. Tissue and sonicate fluid cultures were examined to detect bacteria on the removed spacer during the second stage of exchange arthroplasty. Microbiological findings were analyzed and patients were assessed within an average of 5 years follow up.

Results: Tissue cultures in second-stage revision arthroplasties were positive in 6/27 cases (22.2%) growing CNS in 4 cases (14.8%), Staphylococcus aureus in 1 case (3.7%), and Enterococcus faecalis in 1 case (3.7%). In 3 cases (11.1%) infection was identified as a result of a sonication procedure. Clinical failures at final follow-up were recorded in 4 (14.8%) patients, with reinfection noted in 3 of them. Arthrodesis and spacer exchange followed by suppressive antibiotic therapy were performed in 2 cases.

Conclusions: 1. Tissue cultures remain the gold standard in diagnosis of PIJ although a negative culture does not rule out the presence of bacteria on spacers removed during second stage revision for PJI. 2. Sonication appears to have limited ability to detect persistent infection before reimplantation and was not associated with recurrent infection; however, it can be considered a complementary method that could make it possible to identify new microorganisms and facilitate the selection of appropriate treatment options. 3. The positive results of sonication should be interpreted as the detection of actual pathogens in the light of the clinical, microbiological and histopathological data, especially for patients with immunodeficiency.

Background: Total cementless hip joint arthroplasty is a method commonly used in the treatment of advanced hip osteoarthritis. The aim of this paper is to present the early results of hip joint arthroplasty with the straight Zweymller stem.

Materials and methods: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the straight Zweymller stem. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years).

Results: Pre-operative Merle dAubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 95.1% for the stem alone.

Conclusions: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the straight Zweymller stem affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, indicating a need of regular long-term follow-up.

Background: Humeral shaft fractures are relatively rare in the paediatric population. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at a children's trauma centre and assess cases involving radial nerve injury.

Material and methods: We retrospectively evaluated a group of 5 skeletally immature patients with radial nerve palsy out of a total of 104 patients with humeral shaft fractures treated in our hospital between January 2011 and December 2021.

Results: The study group consisted of four boys and one girl aged 8.6 to 17.2 years (average age 13.6). Mean follow-up duration was 18.4 months. We diagnosed two open and three closed fractures. There were two cases of neurotmesis, two cases of nerve entrapment within the fracture site and one case of neuropraxia. Bone union and functional recovery was achieved in all five patients.

Conclusions: 1. Humeral shaft fractures complicated with radial nerve palsy are a challenging medical problem; 2. The incidence of radial nerve injury in the paediatric population is significantly lower than in adults; in our study, it accounted for 4.8% of all humeral shaft fractures; 3. Expectant observation without nerve exploration is reasonable in fractures caused by a low-energy trauma; 4. Early surgical nerve exploration combined with fracture stabilisation is highly recommended in fractures due to a high-energy trauma.

Background: To evaluate the outcomes of transiliac cerclage with Dall-Miles cable in the internal fixation of the posterior complex in unstable pelvic ring fractures between January 1995 and December 2014.

Material and methods: A study of 42 men injured at work with an average age of 35.2 years (range, 23 to 61) was conducted. The mechanisms of injury were traffic accidents in 25 cases (59.5%), crushing accidents in 12 cases (28.6%), and fall from height in 5 cases (11.9%). Thirty-six cases were polytraumatized patients (85.7%). The patients were evaluated using Majeeds functional score and Mattas radiological criteria.

Results: The average follow-up time was 135.8 45.6 months. The clinical outcomes were excellent in 17 cases (40.5%), good in 19 cases (45.2%), fair in 5 cases (11.9%), and poor in 1 case (2.4%). The radiological outcomes were satisfactory in 32 cases (76.2%) and unsatisfactory in 10 cases (23.8%). All fractures were healed. The sequelae were 3 cases (7.2%) of lower limb dysmetria and 3 cases (7.2%) of chronic neuropathic pain.

Conclusion: The internal fixation of the sacroiliac complex by Dall-Miles cable cerclage reinforced with small fragment plates should be considered as an alternative method for minimally invasive osteosynthesis in selected cases of unstable pelvic ring fractures.

Based on an analysis of archival materials from the private collections of Janina Sikorska-Tomaszewskas family, the Document Repository of Wiktor Dega Memorial Orthopedics and Rehabilitation Hospital in Pozna, articles from daily press and some publications, the authors present the work of Janina Sikorska-Tomaszewska (19111998), Associate Professor of Medical Sciences, towards the development of rehabilitation in Poland in the years 19481978. Her organizational, educational and scientific activity in the early years of the development of rehabilitation medicine in our country contributed significantly to the establishment of the Polish school of rehabilitation. The 30 years of her activity allow Janina Sikorska-Tomaszewska to be counted among the pantheon of founders of rehabilitation in Poland.

Background: Periprosthetic distal femur fractures following total knee arthroplasty (PDFFTKA) are increasingly common [1], mainly in elderly patients with significant co-morbidities [2]. Surgical management usually requires balancing prompt fixation for early mobilization with the need to consider the least physiologically demanding option [3].The aim of this study was to assess predictors of clinical and radiological outcome in patients with PDFFTKA treated with open reduction and internal fixation (ORIF).

Materials and methods: A retrospective cohort study of patients managed for PDFFTKA over the last 21 years in the Trauma & Orthopaedics Department of the Royal Shrewsbury Hospital (RSH) was carried out. Radiological images, pre- and post-operatively, were assessed for fracture related parameters. Last known functional status was evaluated using the most recent outpatient review letters. After assessment of normality of data, evaluation of predictors of clinical and radiological outcome was made using correlation analyses.

Results: There was no statistically significant correlation between age, primary TKA to fracture interval, and length of intact medial cortex vs clinical outcome for the parametric variables evaluated. For non-parametric variables assessed, there was a statistically significant correlation between clinical outcome and evidence of callus formation (Spearman rho value -0.476; p=0.022). In stratifying the patients with poor and good outcome, there was no difference noted in primary TKA to fracture interval, or length of intact medial cortex (mm) between both groups. In terms of the number of comminuted fragments and anterior flange to fracture distance (mm), there was also no difference noted between the poor and good functional groups.

Conclusions: 1. There was no observed correlation in pre-operative patient and fracture related variables with outcome in this population of patients with PDFFTKA. 2. Post-operative evidence of callus formation appears to be directly related to better clinical outcomes.

Background: Pelvic asymmetry and accompanying postural defects tend to become more common with age. The school period, which is associated with spending more time in a sitting position and daily activities performed with the dominant limb, may contribute to this.

Material and methods: We examined 22 children (12 girls, 10 boys) aged 7 years. The same group was re-examined two years later. Pelvic asymmetry was identified by assessing the position of the iliac spines. The indicator of trunk asymmetry was the trunk rotation angle (TRA) measured with a Bunnel scoliometer within the spinous processes on the upper thoracic vertebra, apex of thoracic kyphosis, thoracolumbar junction, lumbar spine, and (if present in patients) the greatest deformity (rib hump, hump in the lumbar region).

Results: Pelvic asymmetry was detected in 14 children at the age of 7 years compared to 16 in the same group of patients aged 9 years. During these two years, the prevalence of trunk asymmetry in children with an oblique/rotated pelvis had increased. The progression of trunk asymmetry with an oblique position of the pelvis was most marked in the lumbar region. In children with symmetrical pelvis, the most marked increase in TRA was recorded in the thoracic segment.

Conclusions: 1. The development of pelvic girdle asymmetry is influenced by the increasing number of asymmetrically performed movements and asymmetric body positions assumed, which increase in number with age. 2. The most marked increase in asymmetry of the spine in subjects with an oblique/rotated pelvis was seen in the lumbar spine, which proves an association of the former with tilting of the pelvic girdle. 3. Asymmetry is a dynamic process. When ignored, this postural defect progresses significantly and there may be compensatory changes in neighbouring systems.