Chirurgia narzadow ruchu i ortopedia polska最新文献

Total knee arthroplasty (TKA) is widely accepted method for treatment of severe osteoarthritis. The aim of this paper was to retrospectively review patients operated in our institution with total condylar knee arthroplasty due to osteoarthritis and assess clinical and radiological results of this procedure. All patients treated with TKA between 1998 and 2001 were reviewed, those with diagnosis of rheumatoid arthritis were excluded from the study. One hundred and one TKA in 68 patients were studied. WOMAC protocol and KSS (Knee Society Score) were used to evaluate patients clinically, and KSS alone for radiological analysis. Bone-implant interface has been studied, position of the implants and mechanical axis of the limb both pre- and postoperatively. Excellent and good results were achieved in 89% of TKA. Subjective self-assessment was usually worse than objective one. Radiolucency was found in 16 cases (more often around tibial component than the femoral one), usually without clinical symptoms of the loosening. An accurate alignment within the range of 3 to 9 degrees valgus has been found in 68% of the knees. Subjective scores were worse than objective clinical assessment. The clinical score was higher than radiological one. The tendency to varus tibial implant fixation was observed. Suboptimal implantation has not led to implant loosening in mid-term results.

The skeletal system is the third most frequent (after lungs and liver) seat of metastases, and metastatic tumours are the most common bone malignancies. The diagnostic work-up of spinal metastases begins with the identification of the primary neoplastic site. Histological analysis confirms the final diagnosis. The work-up of bony metastases poses considerable difficulty and requires the collaboration of a number of specialists. Historical paraffin-embedded tissue samples were subjected to a routine procedure for the preparation of histology specimens. All specimens were independently reassessed by two diagnosticians. The samples of metastatic tumours of 57 patients whose primary tumour sites had not been identified were subjected to an immunohistochemical analysis based on monoclonal antibodies and assays for antigens associated with tumours most often producing bony metastases, i.e.:: PSA, thyreoglobulin, villin, cytokeratin 7, cytokeratin 8, cytokeratin 17, cytokeratin 18, cytokeratin 19, cytokeratin 20, CD 38, oestrogen and progesterone and Vimentin, LCA, HMB-45 and S-100. The monoclonal antibodies and assays were shown to be useful aids for the identification of the histology and location of the primary tumour in patients in whom routine histological assessments had failed to determine the histological type of tumour. In many cases, effective immunohistochemical work-up can contribute to halting the progression of the tumour by enabling qualification for appropriate surgical and oncological treatment.

In 1997 World Health Organization regarded obesity as an illness caused by modern civilization. Elevated values of BMI index over 30 kg/m2 increase the risk of movement organ diseases. Growing ailment pains in lumbar part of vertebral column and disfunction of its joints leads to severe disability. Many studies revealed, that BMI > 30 kg/m2 increased the risk of joints injuries up to 4-5 times. Most common cause of back pain and knee pains, amount obese patients, seems to be a degenerative disease. Finn studies prove correlation between visceral obesity index (waist/hip ratio) and intensification of pain in lower part of vertebral column. Women were suffering more often than men, 39.5% vs 31.2%. Amount causes of individual degeneration changes the most common is "overloaded mechanism". Nowadays, scientists claim, that subclinical inflammatory process might be connected with obesity. Fat tissue is a source of many adipocytokines. Such adipocytokines as leptin, resistin, adiponectin and proinflammatory cytokines such as IL-6, IL-1, IL-8, TNF-alpha, IL-18 and hsCRP modulate inflammatory process and lead to damage of joint cartilage. Other cytokine, like osteoprotegrin, exerts osteo-protection impact. The reduction of body mass index seems to be necessary as far as patients with joints and vertebrae bone illnesses are concerned. That aim might be achieved by excessive physical activity and proper diet. Physical training should be fitted individually to every patient. Static and endurance training are not recommended. Proper weight loss should be more less 1 kg per week, and general physical ability improves. Cooperation between obesitologists and orthopedists seems to be necessary.

The review of the literature on the natural history of the carpal tunnel syndrome is presented. It is shown that the condition is characterised by non-uniform and unpredictable clinical course, in which besides the progressive type of evolution, a regressive one (characterised by spontaneous resolution of symptoms) and type of stable clinical picture (with episodes of exacerbation and resolution of symptoms) exist. Proportion of prevalence of particular types of clinical courses is not precisely estimated, but it appears that at least a half of the cases is of non-progressive type. Non-operative treatment of the condition may be effective in those particular cases, without risk of the development of severe neurological complications as a consequence of impairment of the median nerve. The evidence form analysed studies shows that in carpal tunnel syndrome, the clinical symptoms and signs and nerve conduction disturbances have different natural histories. Clinical features are subjected to greater temporal fluctuations than electrophysiological findings, and they frequently do not correlate one with another. There is not common opinion about efficacy of intervention in extreme carpal tunnel syndrome, characterised by severe conduction disturbances in electrophysiological tests and fixed neurological deficits, however surgical decompression of the carpal tunnel appears to be more promising than decline of the treatment. The natural history of the syndrome occurred in the course of other diseases (or conditions, e.g. pregnancy) is different, depending on the type of the disease itself. In the commonest systemic diseases associated with carpal tunnel syndrome, such as diabetes, hypothyroidism and rheumatoid arthritis, there is not common opinion about their prognostic effect on the natural course of the syndrome.

Introduction: Iliac spine fractures in children are a form of avulsion fractures at mechanically weak spot caused by the presence of the growth plate.

Objective: Presentation of observations concerning treatment and results of iliac spine fractures in children.

Material and methods: 49 children (1 girl and 48 boys). Age, at the time of injury, average 15.1 years (10.6-18 years). We analyzed medical and radiological documentation of patients.

Results: 17 patients sustained anterior superior iliac spine fractures (ASIS), 32 fracture of the inferior iliac spine (AIIS). Most of injuries happened during sport activities--27 patients suffered fracture while playing football. 37 patients asked for medical advice immediately after the injury. Rest of patients, who came late--sustained AIIS fracture. We hospitalized 26 patients (53%), all of them suffered significant pain. The average length of stay in hospital was 8 days. All patients were treated conservatively. All of the fractures healed without complications.

Discussion: Larger study than ours group, concerning 84 patients with iliac spine fractures, was presented only by Italian authors who analyzed injures of professional athletes. In literature reviewed conservative treatment strongly predominates. Only a small group of patients were treated surgically (including athletes treated by Croatian surgeons).

Conclusions: The treatment of iliac spines in children should be conservative, consisting of a couple days of bed rest and then for 2-3 weeks walking on crutches with only toe touching until the pain resolves. We recommend return to full activities after 2 months.

The main aim of the research was to define the degree of independence among patients after operative treatment femoral neck fractures in the first day after the operation and on day previous to the release from hospital. Attempt was made to determine the degree of independence in the ten activities of life, functional status and emotional state of patients. Efforts have also tried to assess the impact of functional status and emotional autonomy to the degree subjects. The study was conducted in Hospital in Poznan and Hospital in Chodziez, in the period from August 2006 March 2007. The research concerned 30 patients after operative treatment femoral neck fractures. To assess functional status, 100-point scale Barthel, to assess the emotional state HADS scale was used. Degree of independence was assessed Scale of Deficit Self-Care. The lack of independence was bigger among older patients in life activities like: moving, feed, drinking, expelling, personal sanitation and dressing. These patients required increasingly bigger medical care. Functional condition introduces considerably worst in older patients equal in research I and research II. Emotional status does not affect the degree of independence of patients, but in the first day after surgery, patients showing symptoms of depression had demanded a bigger range of assistance from medical personnel. Hip fracture have a negative impact on many areas of life activity of the patient, therefore, these patients require particularly caring therapeutic and rehabilitation activities.

Introduction: Ankle fractures are among the most common musculoskeletal injures. These fractures occur with an overall age- and sex-adjusted incidence rate around 180 per 100 000 person-years. The most frequent mechanism is considered to be supination-external rotation (60 to 80% of all ankle fractures) consisting of pathologic external rotation of the foot initially placed in some degree of supination. According to Lauge-Hansen classification, ankle joint structures are damaged in a sequence where the final, stage IV injuries, represents transverse fracture of the medial malleolus or its equivalent-rupture of the deltoid ligament.

Aim of the work: The aim of this study is to compare the results of two subtypes of supination-external rotation stage IV fractures.

Material and methods: 43 patients treated surgically in 2006 to 2007 at Authors institution because of stage IV supination-external rotation ankle fracture were submitted to retrospective analysis. There were 25 patients with bimalleolar fracture (type 1) and in 18 patients with lateral malleolar fracture with accompanying rupture of the deltoid ligament (type 2). The mean age was 46 years (from 20 to 82 years). Average follow up period was 37 months (from 24 to 46 months). For the evaluation of treatment AOFAS hind-foot score (American Orthopedic Foot and Ankle Society) was used.

Results: The mean AOFAS score scale for Type 1 fractures was 85 points and for type 2 was significantly higher and amounted to 91 points (p < 0.05).

Conclusions: Supination-external rotation stage IV ankle fractures with medial malleolar fracture, requires the implementation of additional diagnostic and therapeutic strategies and procedures in order to improve the outcome of results.

Hip arthroplasty is of particular great risk of venous thromboembolism (VTE). The objective of this study was to identify the risk factors of VTE and the analysis of their influence on VTE appear. There were 213 patients after hip arthroplasty in the investigation group. VTE occurred in 15 patients (7.04%).We found Deep Venous Thrombosis (DVT) in eight patients (3.75%) and Pulmonary Embolism (PE) in seven (3.3%). The analysis showed statistically real dependence on patient age, obesity, veins varicoses of lower extremity and VTE occur. We also showed the significant influence of the time of the leg ultraposition time during the surgery on the frequency of VTE episodes, which hasn't been described jet in accessible literature. It is the only risk factor which may be limited by simply modification of surgery technique.

In the past, the procedure for rehabilitation after hip surgery, related to the long immobilization of the operated joint, was often delayed and limited in time. Today's surgical procedures and rehabilitation allows for a quicker return to full physical fitness. Postoperative physiotherapy is mainly focused on regaining full joint function (range of motion--ROM, strength, stability). The rehabilitation program must be a dynamic process, dosed up to the possibility of the patient, depending on the type of procedure performed. Rehabilitation must take into account not only the type of procedure performed intraarticular, but also surgical approach. Rehabilitation after surgery requiring dislocation of the hip by osteotomy with simultaneous artrotomii trochanter must take into account the time required for the stable union. Range of motion exercises begin in the first days after surgery using a continous passive movement (CPM) and passive exercises, and later a stationary bicycle. Menaging patients after treatment of CAM type femoroacetabular impingement is dependent on the degree of bone resection performed within the femur. In the treatment of Pincer-type f emoroacetabular impingement, as well as injuries of the hip labrum rehabilitation proceedings must take into account the location and the area of pathology. Rehabilitation after surgery for articular cartilage (chondroplasty or osteoplasty) in the first period is mainly focused on the avoidance of intraarticular conflicts in the reconstruction of the full ROM.

Unlabelled: The aim our study was retrospective analysis of distal radius fracture treatment. We compared conservative treatment (closed reduction, cast immobilization) with operative treatment--percutaneous K-wire pinning.

Material and methods: 52 patients--39 female (75%) and 13 male (25%), with mean age of 58 years (range 25-77 years), that underwent displaced distal radius fracture in years 2002-2008. The number of evaluated groups is equal--26 patients, mean follow-up time is 40 months (range 4-79 months). Type of fracture has been evaluated on the X-ray film according to Frykman classification. The final X-ray film was estimated according to Lidström classification (based on radial inclination, volar angulation, radial shortening). Both groups of patient were statistically equal by means of sex, age and initial type of fracture according to Frykman classification. Range of motion of affected and contralateral radio-carpal joint after treatment has been evaluated using goniometer. Results were analyzed with statistical methods.

Results: Group of patients that underwent non-operative treatment had better range of motion only by means of ulnar deviation (statistical significance, p < 0.05). There were no statistical differences between patients who underwent operative and non-operative treatment in radiological evaluation using Lidström classification.

Summary: Our study has not proved statistically significant differences between patient treated non-operatively and operatively (functional and radiological evaluation), except for one radio-carpal joint range of motion parameter.