Chirurgia narzadow ruchu i ortopedia polska最新文献

Introduction: Disclosure of the tumor area intertrochanteric femur occurs mostly at the time of pathological fracture. Detection of changes can also be made in conjunction with x-ray of the hip joint such as the hip injury. The purpose of this study was to present the treatment of benign tumors of the intertrochanteric area in children and adolescents.

Materials and methods: From 1. 01. 2002 to 31. 12. 2009 13 patients were treated with benign tumors of the femur intertrochanteric area, including 10 with pathological fractures in the background. Average age was 9.8 years (5-13 years). There were 11 boys and 2 girls. The procedure was performed with resection of the tumor,histopathology, allogenic bone grafting, the femur was fixed using locked plate (10 patients) or angular plate (3 patients).

Results: The mean observation time was 62 months (24-94 months). Histopathology examination showed a simple cyst in 7 patients, aneurysmal cyst in 2 patients, and fibrous dysplasia of bone in 4 patients. Bone consolidation was achieved in 10 patients after an average of 4 months (3-5 months) after surgery, as determined by X-ray examination and clinical examination. In 3 cases there was a recurrence of the tumor, 2 patients with fibrous dysplasia after 4 months and 6 months after surgery were found in X-ray partial resorption of bone graft >25%, and 1 patient after 4 months presented fatigue fracture at Adams angle. After re-treatment complete bone consolidation was achieved in this group after an average of 4 months (2.5-5 months) from the second surgery. 1 patient with aneurysmal cyst in 11 month after surgery, presented femoral infection, sequestrum and plate were surgically removed, antibiotic therapy was used and the inflammatory process was stopped.

Conclusion: Surgical treatment of benign tumors of the intertrochanteric area of the femur gives good results if it is carried out by a complex surgery (resection of the tumor - bone graft - osteosynthesis).

Background: The aim of our study was the assessment the final results of the operative treatment of the luxated neurogenic hips at patients with severe form of CP.

Materials and methods: Analysis was performed on 13 CP patients with hemiplegia bilateralis treated in our department because of the neurogenic hip dislocation. At 5 patients (7 hips) was performed resection of femoral head according to Castle. At 9 patients (13 hips) the femoral osteotomy according to Schanz were done. The follow up ranged from 1 to 3 years. The early and late complications such as pain before and after surgery and nursing possibilities were analysed. The 4 questions concerned on the status before and after surgery. They assessed the pain, possibilities of crotch nursing and rehabilitation as well as total opinion about the final result of surgery.

Results: At the group of patients after the resection of the femoral head two of them had no pain, one patients complained on the decreasing pain, and two hadn't any changes. Only three parents assessed the surgery as satisfactory. At the group after osteotomy according to Schanz six patients observed no pain, two complained on the decreasing pain and one didn't observe any changes. The possibilities of nursing improved at all patients in this group. Eight parents were satisfied and one dissatisfied after surgery. As late complications we have classified the following: ossification around the hip joint in one case and destabilization of the plate in one another.

Conclusions: The Schanz osteotomy permitted us to achieve the improvement in abduction of the hips at majority of the patients, the reduction of the pain and improvement in rehabilitation's possibilities. In our experience this method was more effective in the treatment of the luxated hips at patients with severe form of CP.

Leg length discrepancy is a common and not appreciated complication after THR. Unequal leg length may cause earlier implant wear, patient's dissatisfaction, impair patient's function or even some legal consequences for the surgeon. To achieve the final equal leg length after surgery one must comply with some rules: proper patient's examination, informing patient about possible leg length discrepancy, proper length measurement- both clinical and radiological after antero-posterior pelvis x-ray; proper radiological length measurements especially when some hip contractures are observed, appropriate implant selection, proper prosthesis templating. The intraoperative leg length measurement with some surgical or radiological devices is essential for leg equalization. Special operative techniques are necessary for leg lengthening or shortening without hip instability. Final leg length measurement after surgery is necessary to determine a rehabilitation program.

Background: Ischial tuberosity fractures in children are a form of avulsion fractures caused by the strong thigh muscles of the back group (ischiotibial muscles).

Objective: Presentation of observations covering the diagnostic difficulties, treatment and follow-up of ischial tuberosity fractures in children.

Material and methods: 6 children (one girl and five boys), average age at the time of injury - 13.6 years (12-15.5 years). An analysis of medical and radiological documentation of patients.

Results: Two patients with chronic pain were suspected of ischial bone tumor, one was suspected of Perthes disease, and only 3 were sent to the Traumatology Department immediately after the football injury. All patients were treated conservatively. Complete healing of fractures was finally achieved in all patients - (fibrous union in two cases) and finally, after an average period of 9 months, the pain subsided.

Conclusions: There is a discussion in medical literature about the difficulties in the diagnosis of ischial tuberosity fractures, which were primarily unrecognized. Radiological picture of significant bone rebuilding may suggest neoplastic lesions. In the literature dominates the attitude of conservative treatment. Only in cases of large displacement of fracture and chronic ailments caused by pressure on the sciatic nerve, surgery should be considered.

Aim of this study is to assess the causes of mechanical loosening of revision Recon Ring baskets (Aesculap / BBrown, Germany). This analysis was done by assessing the circumstances of baskets loosening of revision in 3 patients. Intraoperative images and radiographs of patients with these clinical complications were analyzed, and removed damaged bins and bolts of revision metallographic expertise. It was found that the most likely cause mechanical damage to the implant was originally unstable or re-fixing their ischial part, causing movable canopy closer to the basket is balanced by the screws and in turn causing fracture or bending arms, and follow-up baskets of hip bone loss. Our observations suggest that the most important is proper attachment of acetabular basket, especially his arm sciatic.

Introduction: The most common cause of spinal pain syndromes (SPS) is overload of the spine. It damages the function of the spine and the morphology of the spine's tissues. The literature suggests that a generalized insufficiency of connective tissue, which manifests itself as a hypermobility of joints (JHM), might be one of the causes of overload. The authors decided to evaluate, whether a frequency of the prevalence of JHM is greater within the population of patients treated because of spinal pain syndromes, and whether JHM might be a pathogenetical factor in sps.

Material and method: The material consisted of 8014 case records of patients treated in Rehabilitation Clinic because of dysfunctions and diseases of locomotoric system during 7 years. 7061 of those patients were treated for sps. The control group consisted of 953 patients without SPS, treated because of other reasons. All patients underwent an examination to screen for hypermobility. Four simple maneuvers of the peripheral joints and joints of the spine were performed. If hypermobility of joints was detected during testing, the patient underwent a complete examination of 13 tests using the Sasche criteria modified by Kapandij and was interviewed to screen for accompanying symptoms of hypermobility.

Results and conclusions: Hypermobility syndrome is recognized much more often in patients with spinal pain syndromes, than in patients treated because of other diseases (7.9% i 0.7%) and twice more often in females than in males (69.7% i 30.3%). Among young people, under 30 years of age hypermobility occurs in 55% of population with SPS. In the youngest patients HMS may be the cause of overload spinal pain syndromes, and a predisposition factor towards spinal pain syndromes in older patients.

Background: Total hip replacement (THR) is at present an accepted treatment in patients with severe osteoarthritis of the hip after Perthes disease. The aim of this paper is to evaluate the results of THR in patients suffering from secondary osteoarthritis, operated from 1990 to 2000 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences.

Material: Material included 9 patients, 3 females and 6 males, on whom 9 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 41 to 69 years (mean 56). Follow-up ranged from 11 to 21 years (mean 15 years). Cemented total hip arthroplasty was used during 3 of the THR, 6 of them were cementless.

Method: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system.

Results: The average preoperative Harris score for the group of patients was 34, WOMAC score 77. After an average of 15-years follow-up all hips were considered excellent, with average Harris score of 93, WOMAC Score of 6. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 22-45 degrees (mean: 33 degrees) and the acetabular opening angle was 0-15 degrees (mean: 3 degrees). The stem was neutral-oriented in all hips. No ectopic ossification concentrations were found.

Conclusion: Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of osteoarthritis secondary to Perthes disease allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Importantly, THR was carried out after a quite long time after Perthes disease in the childhood.

The subject of this information is the case of 33-year old male patient with tumefactive lesions of knee joint. It became an inspiration for this study due to diagnostic difficulties. The article covers the differential diagnosis of such pathologies as: synovial sarcoma, chondromatosis, tuberculosis and knee joint synovitis.

Injury to the scapholunate ligament is considered the most common and burdened with the most negative squeals cause of the carpal instability. The article provides information on the functional anatomy of the scapholunate complex and the consequences of the tear of the ligament that joints these bones. Rupture of this ligament, associated with tear of extrinsic (secondary) stabilizers of the wrist leads on to dislocation of the carpal bones one against another and, finally, results in carpal instability. Classifications of the severity of the instability based on radiological and arthroscopic grounds were presented. Clinical symptoms and signs of the condition were described as well as imaging techniques helpful in its diagnosing. The usefulness of arthroscopy was emphasised in diagnosing of scapholunate complex disturbances, particularly those which are negative radiologically and present with no typical symptoms.

Patients with high-grade open tibia fractures and massive soft tissue damage pose a demanding clinical challenge, requiring a complex inter-disciplinary approach and multiple orthopedic, vascular and plastic-reconstructive procedures. These types of fractures still have a 50% risk of loss, although amputation remains a treatment method of last resort. In our experience negative-pressure wound therapy (NPWT), used in the form of the vacuum assisted closure - VAC System (KCI, USA) improves healing of excessive soft tissue damage with exposure of the bone accompanying open fracture of the tibia. VAC seals the wound with a foam dressing and applies negative pressure to the wound bed. The removal of exudate and infectious material supports the cleaning of the wound. Together with the reduction of oedema and the increase in blood flow, this promotes formation of granulation tissue and eventually wound closure by split skin graft. Utilizing this method as part of a multi directional approach VAC System not only helps the patient to recover faster but also in some cases can replace microsurgical soft-tissue transfer and thus allows salvage of the leg in orthopaedic teams lacking advanced reconstructive experience.