Pub Date : 2018-10-30DOI: 10.31139/chnriop.2018.83.5.39
Paweł Łęgosz, Sylwia Sarzyńska, B. Maciąg, Łukasz Pulik, D. Kotrych, P. Małdyk
Heterotopic ossification (HO) is the abnormal formation of mature bone in extraskeletal soft tissues, which may commonly occur after Total Hip Arthroplasty (THA). Despite the high incidence of HO and multiple clinical studies examining the phenomenon, the pathophysiology and etiology of HO remain unclear. In advanced cases, HO may significantly decrease results of surgery by impairing range of motion in joint and induce pain. For now, no prophylaxes protocol for prevention of HO in patients after THA exists. Nonsteroidal anti-inflammatory drug (NSAID) treatment and localized low-dose irradiation are currently available only as prophylaxis of HO formation. The authors, con-ducted a review summering present state of view in case of diagnosis and prophylaxis of HO occur-rence in different clinical cases of patients qualified for Total Hip Arthroplasty.
{"title":"Prophylaxis and treatment of heterotopic ossifications after total hip arthroplasty – contemporary view and proposition of the algorithm","authors":"Paweł Łęgosz, Sylwia Sarzyńska, B. Maciąg, Łukasz Pulik, D. Kotrych, P. Małdyk","doi":"10.31139/chnriop.2018.83.5.39","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.5.39","url":null,"abstract":"Heterotopic ossification (HO) is the abnormal formation of mature bone in extraskeletal soft tissues, which may commonly occur after Total Hip Arthroplasty (THA). Despite the high incidence of HO and multiple clinical studies examining the phenomenon, the pathophysiology and etiology of HO remain unclear. In advanced cases, HO may significantly decrease results of surgery by impairing range of motion in joint and induce pain. For now, no prophylaxes protocol for prevention of HO in patients after THA exists. Nonsteroidal anti-inflammatory drug (NSAID) treatment and localized low-dose irradiation are currently available only as prophylaxis of HO formation. The authors, con-ducted a review summering present state of view in case of diagnosis and prophylaxis of HO occur-rence in different clinical cases of patients qualified for Total Hip Arthroplasty.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48578272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-30DOI: 10.31139/CHNRIOP.2018.83.5.34
P. Szczerba
Introduction. Constantly increasing number of patients with cancer. The significant development of oncology and the introduction of new treatments al- lowed explicitly extend the life expectancy of cancer patients at the cost of increasingly revealing the late complications. Aim. Presentation of methods, problems and early results of multi-site treatment of spinal metastases in the Department of Orthopaedic Oncology Hospital in Brzozow. Materials and methods. In the Department from 2010 to 2016 due to spinal metastases were treated 541 patients. Preoperative planning included quality of life in Karnofsky scale assesment, pain VAS scale and the presence of neurological deficits in Frankel scale. Morphology metastases of all 541 were classified due to numbers of lesions and location. Surgical treatment was rated due to chosen approach. Results. In 411 patients who underwent surgery, a reduction of pain VAS scale was obtained. From the 91 patients with paresis in 23 patients achieved clinical improvement. Quality of life assessed on a scale Karnofskyego increased in 305 patients. In the group of 80 non-ambulatory patients 18 patients improvement of neurological re-enabled vertical position and walking. Among the complications dominated by superficial and deep infections, which involved 28 patients, of which required surgical intervention in 21 patients. Further re-operated due to disease progression were 23 patients. Marked increase in pain and progression of neurological deficits were observed in 9 patients. In the postoperative period 2 patients died. 14 patients had heavy bleeding during the operation. Implants destabilization involved 2 patients. Conclusions. Metastasis in the spine are mostly multifocal. Surgical treatment of metastases to the spine is a valuable method of treatment, clearly improves the quality of life of patients. Complications of surgery are common and due to the clearly increased risk of surgery in all patients with cancer.
{"title":"Multifocal spine methastasis – early surgical treatment results","authors":"P. Szczerba","doi":"10.31139/CHNRIOP.2018.83.5.34","DOIUrl":"https://doi.org/10.31139/CHNRIOP.2018.83.5.34","url":null,"abstract":"Introduction. Constantly increasing number of patients with cancer. The significant development of oncology and the introduction of new treatments al- lowed explicitly extend the life expectancy of cancer patients at the cost of increasingly revealing the late complications. Aim. Presentation of methods, problems and early results of multi-site treatment of spinal metastases in the Department of Orthopaedic Oncology Hospital in Brzozow. Materials and methods. In the Department from 2010 to 2016 due to spinal metastases were treated 541 patients. Preoperative planning included quality of life in Karnofsky scale assesment, pain VAS scale and the presence of neurological deficits in Frankel scale. Morphology metastases of all 541 were classified due to numbers of lesions and location. Surgical treatment was rated due to chosen approach. Results. In 411 patients who underwent surgery, a reduction of pain VAS scale was obtained. From the 91 patients with paresis in 23 patients achieved clinical improvement. Quality of life assessed on a scale Karnofskyego increased in 305 patients. In the group of 80 non-ambulatory patients 18 patients improvement of neurological re-enabled vertical position and walking. Among the complications dominated by superficial and deep infections, which involved 28 patients, of which required surgical intervention in 21 patients. Further re-operated due to disease progression were 23 patients. Marked increase in pain and progression of neurological deficits were observed in 9 patients. In the postoperative period 2 patients died. 14 patients had heavy bleeding during the operation. Implants destabilization involved 2 patients. Conclusions. Metastasis in the spine are mostly multifocal. Surgical treatment of metastases to the spine is a valuable method of treatment, clearly improves the quality of life of patients. Complications of surgery are common and due to the clearly increased risk of surgery in all patients with cancer.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69597357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-30DOI: 10.31139/chnriop.2018.83.5.36
I. Babiak
Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a serious complication of both total hip replacement (THR) and total knee artthoplasty (TKA). Materials and methods. Results were evaluated in 16 patients (17 prostheses) aged 35-82 years, operated due to infection and fracture after THR (8) and TKA (9). Observation period 3-13 years (average 6.5 years). Etiology of infection: S. aureus (11), Staph. epidermidis (3), VRE (1), Pseudomonas aeruginosa (1), E. Coli (1). Fractures have been stabilised with: cerclage, Partridge tapes, Bridgeplate system with acrylic cement with antibiotic (ALAC), 1-2 plates with screws, cerclage and nail with ALAC (2), Integracja plate, femoro-tibial nail with ALAC spacer as knee arthrodesis, intramedullary ALAC spacer constructed on a nail. There have been performed THR and TKA revisions: 2-stage (8), 1-stage (1), definitive removal of prosthesis (5), spacer without reaimplantation (1), debridement (1), conversion of the total femoral prosthesis into a permanent total femoral ALAC spacer (1). Results. Cure of infection in 12 and fracture healing was achieved in 9 patients. There were performed 2 amputations. 10 prostheses were preserved and 5 were removed. Limb function after treatment: very good (1), good (7), sufficient (6), bad - after amputation (2). Conclusions. In each case of fracture and infection, apart from the fixation of the fracture, revision of the endoprosthesis should be performed, using a spacer or local carriers of antibiotics near the endoprosthesis and fracture ostheosynthesis. A stable fixation of fracture with plate, intramedullary nail or spacer with stem is necessary to get union and cure the infection. In infected periprosthetic fractures with unstable endoprosthesis, good conditions for fracture healing and cure of infection can be obtained by using a spacer extended with a long intramedullary stem covered with ALAC with a 5% addition of a targeted antibiotic.
{"title":"Management and results in 16 cases of periprosthetic fracture and infection after hip and knee arthroplasty. Experience in 2005-2015","authors":"I. Babiak","doi":"10.31139/chnriop.2018.83.5.36","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.5.36","url":null,"abstract":"Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a serious complication of both total hip replacement (THR) and total knee artthoplasty (TKA). Materials and methods. Results were evaluated in 16 patients (17 prostheses) aged 35-82 years, operated due to infection and fracture after THR (8) and TKA (9). Observation period 3-13 years (average 6.5 years). Etiology of infection: S. aureus (11), Staph. epidermidis (3), VRE (1), Pseudomonas aeruginosa (1), E. Coli (1). Fractures have been stabilised with: cerclage, Partridge tapes, Bridgeplate system with acrylic cement with antibiotic (ALAC), 1-2 plates with screws, cerclage and nail with ALAC (2), Integracja plate, femoro-tibial nail with ALAC spacer as knee arthrodesis, intramedullary ALAC spacer constructed on a nail. There have been performed THR and TKA revisions: 2-stage (8), 1-stage (1), definitive removal of prosthesis (5), spacer without reaimplantation (1), debridement (1), conversion of the total femoral prosthesis into a permanent total femoral ALAC spacer (1). Results. Cure of infection in 12 and fracture healing was achieved in 9 patients. There were performed 2 amputations. 10 prostheses were preserved and 5 were removed. Limb function after treatment: very good (1), good (7), sufficient (6), bad - after amputation (2). Conclusions. In each case of fracture and infection, apart from the fixation of the fracture, revision of the endoprosthesis should be performed, using a spacer or local carriers of antibiotics near the endoprosthesis and fracture ostheosynthesis. A stable fixation of fracture with plate, intramedullary nail or spacer with stem is necessary to get union and cure the infection. In infected periprosthetic fractures with unstable endoprosthesis, good conditions for fracture healing and cure of infection can be obtained by using a spacer extended with a long intramedullary stem covered with ALAC with a 5% addition of a targeted antibiotic.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69597436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-30DOI: 10.31139/chnriop.2018.83.5.33
Karolina Adamkiewicz
Introduction. A number of diseases, including coronary artery disease are now considered as chronic low-grade inflammatory conditions. Their progres- sion is accelerated by other underlying infectious conditions, including periodontal disease. The aim of the study was to assess if periodontal disease is associated with an increased concentration of inflammatory biomarkers in patients scheduled for joint replacement, who represent a group at elevated cardiovascular risk. Materials and methods. The study included patients scheduled for an elective hip and/or knee replacement surgery, who had pre-operative workup made for the assessment of cardiovascular risk factors. All patients were evaluated by an experienced medical professional in order to assess the periodontal disease status. Patient had their blood taken for the assessment of laboratory parameters, including inflammation biomarkers. Results. Among 257 randomized patients (mean age, 67.1 years; women, 63.0%), 154 (59.9%) were scheduled for hip surgery and 103 (40.1%) for knee surgery. Groups divided by the type of procedure did not significantly differ in terms of age, sex distribution or the prevalence of diabetes. There were no differences in baseline laboratory parameters between the groups. When we compared patients with and without periodontal disease, we saw that the disease was present in 94 (36.6%) of patients. Patients with periodontal disease were significantly younger (66.6 ± 13.2 vs. 67.3 ± 11.3 years; p = 0.04) than patients without the disease. Patients with periodontal disease also had a higher average C-reactive protein (CRP) concentration (6.0 ± 10.6 vs. 4.1 ± 6.2 mg/ dL; p <0.001 No difference was found in terms of other laboratory parameters. More details about the study population can be found in table 1. Conclusions. Patients with periodontal disease have significantly higher CRP levels, which represents an underlying inflammatory process. The inflammatory process can be responsible not only for elevated cardiovascular risk but also for impaired joint healing.
{"title":"C-reactive protein levels as a cardiovascular risk factor in patients with and without periodontal disease who are undergoing hip and/or knee arthroplasty","authors":"Karolina Adamkiewicz","doi":"10.31139/chnriop.2018.83.5.33","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.5.33","url":null,"abstract":"Introduction. A number of diseases, including coronary artery disease are now considered as chronic low-grade inflammatory conditions. Their progres- sion is accelerated by other underlying infectious conditions, including periodontal disease. The aim of the study was to assess if periodontal disease is associated with an increased concentration of inflammatory biomarkers in patients scheduled for joint replacement, who represent a group at elevated cardiovascular risk. Materials and methods. The study included patients scheduled for an elective hip and/or knee replacement surgery, who had pre-operative workup made for the assessment of cardiovascular risk factors. All patients were evaluated by an experienced medical professional in order to assess the periodontal disease status. Patient had their blood taken for the assessment of laboratory parameters, including inflammation biomarkers. Results. Among 257 randomized patients (mean age, 67.1 years; women, 63.0%), 154 (59.9%) were scheduled for hip surgery and 103 (40.1%) for knee surgery. Groups divided by the type of procedure did not significantly differ in terms of age, sex distribution or the prevalence of diabetes. There were no differences in baseline laboratory parameters between the groups. When we compared patients with and without periodontal disease, we saw that the disease was present in 94 (36.6%) of patients. Patients with periodontal disease were significantly younger (66.6 ± 13.2 vs. 67.3 ± 11.3 years; p = 0.04) than patients without the disease. Patients with periodontal disease also had a higher average C-reactive protein (CRP) concentration (6.0 ± 10.6 vs. 4.1 ± 6.2 mg/ dL; p <0.001 No difference was found in terms of other laboratory parameters. More details about the study population can be found in table 1. Conclusions. Patients with periodontal disease have significantly higher CRP levels, which represents an underlying inflammatory process. The inflammatory process can be responsible not only for elevated cardiovascular risk but also for impaired joint healing.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48061898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-30DOI: 10.31139/CHNRIOP.2018.83.5.37
J. Zabrzyński
Locked bucket-handle tears of both medial and lateral menisci, called in the literature “Jack and Jill lesion”, with simultaneous anterior cruciate ligament (ACL) injury are an extremely rare phenomenon. It is highly differentiated in the field of trauma mechanism, treatment options and postoperative care. This is the first described case when a bicompartmental locked bucket-handle tears of menisci masked a torn ACL and imitated the stabile knee joint for 2 years. Complex trauma needs a complex treatment, and a single-stage or multi-stage surgical approach is performed. Authors chose a two-steps surgical procedure with primary meniscal repair and secondary, early ACL reconstruction.
{"title":"Bicompartmental locked bucket-handle tears of menisci concealing the concomitant anterior cruciate ligament injury for 2 years – case report","authors":"J. Zabrzyński","doi":"10.31139/CHNRIOP.2018.83.5.37","DOIUrl":"https://doi.org/10.31139/CHNRIOP.2018.83.5.37","url":null,"abstract":"Locked bucket-handle tears of both medial and lateral menisci, called in the literature “Jack and Jill lesion”, with simultaneous anterior cruciate ligament (ACL) injury are an extremely rare phenomenon. It is highly differentiated in the field of trauma mechanism, treatment options and postoperative care. This is the first described case when a bicompartmental locked bucket-handle tears of menisci masked a torn ACL and imitated the stabile knee joint for 2 years. Complex trauma needs a complex treatment, and a single-stage or multi-stage surgical approach is performed. Authors chose a two-steps surgical procedure with primary meniscal repair and secondary, early ACL reconstruction.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"193 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69597459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-30DOI: 10.31139/chnriop.2018.83.4.27
Dawid Lisowski
Introduction. Since the introduction of the Calcanail® in 2011 more and more surgeons have been treating calcaneal fractures with use of this method. It is mainly because of its safety concerning wound healing and final outcomes comparable to ORIF. This paper is to show the intraoperative problems the surgeon may encounter beginning with this method as well as final results in comparison to more experienced operators and other methods. Material and methods. Study of eleven displaced intra-articular calcaneal fractures operated between November 2015 and April 2018 with the use of the Calcanail®. All patients were evaluated with use of the AOFAS Hindfoot score. Pain, shoe fit and look of the foot were evaluated in 11 pointVAS scale. Böhler’s angle was measured before, after operation and in 3 and 6 month-time. All intra and post-operative complications were carefully noted. Results. Average AOFAS Hindfoot score was 79.75. VAS pain 2.0, shoe fit 1.5, look of the foot 1.25. Average Böhler’s angle restoration was 17.77 with no significant decrease with time. No intraor post-operative complications were observed. Patients with less comminuted fractures and better reduction got better final results. Conclusions. Treatment of displaced calcaneal fractures with the Calcanail® is a safe and good alternative for other procedures. Restoration of articular surface is on one hand the most difficult stage of the procedure and on the other a key to a good final outcome.
{"title":"Results and observations in operative treatment of displaced intra- articular calcaneal fractures with use of Calcanail®","authors":"Dawid Lisowski","doi":"10.31139/chnriop.2018.83.4.27","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.4.27","url":null,"abstract":"Introduction. Since the introduction of the Calcanail® in 2011 more and more surgeons have been treating calcaneal fractures with use of this method. It is mainly because of its safety concerning wound healing and final outcomes comparable to ORIF. This paper is to show the intraoperative problems the surgeon may encounter beginning with this method as well as final results in comparison to more experienced operators and other methods. Material and methods. Study of eleven displaced intra-articular calcaneal fractures operated between November 2015 and April 2018 with the use of the Calcanail®. All patients were evaluated with use of the AOFAS Hindfoot score. Pain, shoe fit and look of the foot were evaluated in 11 pointVAS scale. Böhler’s angle was measured before, after operation and in 3 and 6 month-time. All intra and post-operative complications were carefully noted. Results. Average AOFAS Hindfoot score was 79.75. VAS pain 2.0, shoe fit 1.5, look of the foot 1.25. Average Böhler’s angle restoration was 17.77 with no significant decrease with time. No intraor post-operative complications were observed. Patients with less comminuted fractures and better reduction got better final results. Conclusions. Treatment of displaced calcaneal fractures with the Calcanail® is a safe and good alternative for other procedures. Restoration of articular surface is on one hand the most difficult stage of the procedure and on the other a key to a good final outcome.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69597137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-30DOI: 10.31139/chnriop.2018.83.4.28
Urszula Moskała, M. Bierut, T. Sorysz
Fractures of the distal radius are one of the most common fractures among adults. Despite, there still ongoing discussions on the choice of method of surgical treatment. Recently also emphasizes the increasing role of bone grafts in the reconstruction of the articular surface especially in compression fractures and osteoporotic fractures. The study conducted in our hospital evaluated 127 patients with the fracture of the distal radius operated between 2016-2017. Various-age-population was taken into account. Using the questionnaire developed on the basis of the Mayo scale and X-rays, the results of three treatment methods of the fractures were compared. Percutaneous fixation with K wires with plate osteosynthesis and plate osteosynthesis with the use of bone grafts was compared. The significant effect of bone quality has on the success of the treatment method has been emphasized. We drew attention to the critical meaning of the Reconstruction of the middle column for the functional outcomes. We rated the correlation of the range of motion from loss of the volar tilt and radial inclination. The frequency of neurological complications for each treatment methods was assessed. The final outcomes of different treatment methods allowed to create the algorithm for proceedings of patient’s qualification for the optimal treatment method.
{"title":"Operative treatment of distal radius fractures: stabilization with Kirschner wires or plate fixation? Comparison of treatment methods based on own observations","authors":"Urszula Moskała, M. Bierut, T. Sorysz","doi":"10.31139/chnriop.2018.83.4.28","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.4.28","url":null,"abstract":"Fractures of the distal radius are one of the most common fractures among adults. Despite, there still ongoing discussions on the choice of method of surgical treatment. Recently also emphasizes the increasing role of bone grafts in the reconstruction of the articular surface especially in compression fractures and osteoporotic fractures. The study conducted in our hospital evaluated 127 patients with the fracture of the distal radius operated between 2016-2017. Various-age-population was taken into account. Using the questionnaire developed on the basis of the Mayo scale and X-rays, the results of three treatment methods of the fractures were compared. Percutaneous fixation with K wires with plate osteosynthesis and plate osteosynthesis with the use of bone grafts was compared. The significant effect of bone quality has on the success of the treatment method has been emphasized. We drew attention to the critical meaning of the Reconstruction of the middle column for the functional outcomes. We rated the correlation of the range of motion from loss of the volar tilt and radial inclination. The frequency of neurological complications for each treatment methods was assessed. The final outcomes of different treatment methods allowed to create the algorithm for proceedings of patient’s qualification for the optimal treatment method.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47259004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-30DOI: 10.31139/chnriop.2018.83.4.31
Przemysław Koszyk, T. Potaczek, B. Jasiewicz, P. Radło
Introduction. Degenerative spine disease (DSD) with spinal stenosis disturbs sagittal profile of the spine, by reducing lumbar lordosis which may alter normal gait leading to neurogenic claudication. On the other hand, Parkinson’s disease (PD), a progressive neurodegenerative process also largely alters spinal sagittal balance and influences physiological gait. A coexistence of these two morbidities raises a particular challenge for the spine surgeon. Aim. The aim of the study is to present the results of surgical treatment of patients with lumbar spinal stenosis with concomitant Parkinson’s disease. Material and methods. We analysed the course of treatment of 7 patients with DSD and symptomatic lumbar spinal stenosis with concomitant PD. The course of surgery was analysed, presence of all complications was noted. Clinical evaluation based on assessing pain intensity levels and pain-free walking distance prior and after surgical treatment. Besides that, radiographic evaluation was performed and consisted of lumbo-sacral sagittal balance parameters (lordosis angle between L1 and L5 (LL), thoraco-lumbar junction angle measured between Th11 and L2 (TL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT). Results. Mean age at surgery was 65.4 years (56-74), the duration of PD prior to surgery was 5 years (1-11). Only in two patients one surgery was sufficient to decrease the symptoms. The remaining 5 patients required revision surgery in all, but one cases due to instrumentation failure. A total of 13 revision surgeries were performed. Primary surgical treatment in all cases consisted of decompression of neural structures with instrumented fusion in 6 cases, and without instrumentation in one case. The level of back pain according to VAS before surgery averaged 5.3 and decreased during the last follow-up to 2.6. The severity of leg pain before surgery averaged 3.6 and decreased to 2.1 during last follow-up. Preoperatively all patients presented a mismatch between LL and PI, which increased after surgery due to a postoperative LL reduction. Conclusions. Surgical treatment of lumbar stenosis in patients with Parkinson’s disease is burdened with a significant risk of complications. The most common cause of reoperation in these patients is destabilization of instrumentation and progression of sagittal balance malalignment.
{"title":"Operative treatment of degenerative spinal disease with concomitant Parkinson’s disease – cases report","authors":"Przemysław Koszyk, T. Potaczek, B. Jasiewicz, P. Radło","doi":"10.31139/chnriop.2018.83.4.31","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.4.31","url":null,"abstract":"Introduction. Degenerative spine disease (DSD) with spinal stenosis disturbs sagittal profile of the spine, by reducing lumbar lordosis which may alter normal gait leading to neurogenic claudication. On the other hand, Parkinson’s disease (PD), a progressive neurodegenerative process also largely alters spinal sagittal balance and influences physiological gait. A coexistence of these two morbidities raises a particular challenge for the spine surgeon. Aim. The aim of the study is to present the results of surgical treatment of patients with lumbar spinal stenosis with concomitant Parkinson’s disease. Material and methods. We analysed the course of treatment of 7 patients with DSD and symptomatic lumbar spinal stenosis with concomitant PD. The course of surgery was analysed, presence of all complications was noted. Clinical evaluation based on assessing pain intensity levels and pain-free walking distance prior and after surgical treatment. Besides that, radiographic evaluation was performed and consisted of lumbo-sacral sagittal balance parameters (lordosis angle between L1 and L5 (LL), thoraco-lumbar junction angle measured between Th11 and L2 (TL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT). Results. Mean age at surgery was 65.4 years (56-74), the duration of PD prior to surgery was 5 years (1-11). Only in two patients one surgery was sufficient to decrease the symptoms. The remaining 5 patients required revision surgery in all, but one cases due to instrumentation failure. A total of 13 revision surgeries were performed. Primary surgical treatment in all cases consisted of decompression of neural structures with instrumented fusion in 6 cases, and without instrumentation in one case. The level of back pain according to VAS before surgery averaged 5.3 and decreased during the last follow-up to 2.6. The severity of leg pain before surgery averaged 3.6 and decreased to 2.1 during last follow-up. Preoperatively all patients presented a mismatch between LL and PI, which increased after surgery due to a postoperative LL reduction. Conclusions. Surgical treatment of lumbar stenosis in patients with Parkinson’s disease is burdened with a significant risk of complications. The most common cause of reoperation in these patients is destabilization of instrumentation and progression of sagittal balance malalignment.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69596873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-30DOI: 10.31139/CHNRIOP.2018.83.4.29
M. Gruca, Zakopane Poland Rehabilitation, B. Jasiewicz, T. Potaczek
Prune belly syndrome is a rare congenital syndrome of unknown etiology. It consists of three symptoms: total or partial absence of abdominal muscles, cryptorchismus, and genitourinary malformations. The goal of this study is an analysis of prune belly syndrome patients treated in one hospital. Material: between 2008 and 2017 authors treated 3 patients with prune belly syndrome. A retrospective analysis of medical history of these patients was performed, basing on patients’ data and images available in hospital archive. One patient was treated due to club-foot deformity and lower limb length inequality. Other two were treated for scoliosis, of which one received growth sparing technique, and the other posterior spinal fusion. In all cases the goals of treatment were achieved, no serious complications were noted. Conclusion: patients with prune-belly syndrome may also require orthopedic treatment. Multiple congenital anomalies, eg foot, spine or rib cage deformities may necessitate surgical treatment. Despite of higher risk of pulmonary complications, surgery might be uneventful.
{"title":"Orthopedic problems in prune belly syndrome – case report","authors":"M. Gruca, Zakopane Poland Rehabilitation, B. Jasiewicz, T. Potaczek","doi":"10.31139/CHNRIOP.2018.83.4.29","DOIUrl":"https://doi.org/10.31139/CHNRIOP.2018.83.4.29","url":null,"abstract":"Prune belly syndrome is a rare congenital syndrome of unknown etiology. It consists of three symptoms: total or partial absence of abdominal muscles, cryptorchismus, and genitourinary malformations. The goal of this study is an analysis of prune belly syndrome patients treated in one hospital. Material: between 2008 and 2017 authors treated 3 patients with prune belly syndrome. A retrospective analysis of medical history of these patients was performed, basing on patients’ data and images available in hospital archive. One patient was treated due to club-foot deformity and lower limb length inequality. Other two were treated for scoliosis, of which one received growth sparing technique, and the other posterior spinal fusion. In all cases the goals of treatment were achieved, no serious complications were noted. Conclusion: patients with prune-belly syndrome may also require orthopedic treatment. Multiple congenital anomalies, eg foot, spine or rib cage deformities may necessitate surgical treatment. Despite of higher risk of pulmonary complications, surgery might be uneventful.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69597161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-30DOI: 10.31139/chnriop.2018.83.4.32
Marcin Niedźwiecki, A. Makowski, T. Niedźwiecki, Damian Deresiewicz, R. Grzybowski, Kajetan Łątka
Ankylosing spondylitis (AS, Bechterew’s Disease) is a chronic inflammatory disease of the spine of unknown etiology. One of its consequences is the progressive deformity of the spine. The resulting spinal imbalance results in falls and fractures. Surgical treatment of fixed deformities consists in reconstructing the spine balance through osteotomies of the spine with its stiffening in a corrective position. The following paper presents the case of a patient with total hyperkyphosis in the course of AS, traumatic PTK, and global sagittal imbalance, subjected to two-stage surgical treatment of spinal deformities with the use of three-column osteotomies in the cervical and lumbar spine sections.
{"title":"Multilevel spinal osteotomy in ankylosing spondylitis – case report","authors":"Marcin Niedźwiecki, A. Makowski, T. Niedźwiecki, Damian Deresiewicz, R. Grzybowski, Kajetan Łątka","doi":"10.31139/chnriop.2018.83.4.32","DOIUrl":"https://doi.org/10.31139/chnriop.2018.83.4.32","url":null,"abstract":"Ankylosing spondylitis (AS, Bechterew’s Disease) is a chronic inflammatory disease of the spine of unknown etiology. One of its consequences is the progressive deformity of the spine. The resulting spinal imbalance results in falls and fractures. Surgical treatment of fixed deformities consists in reconstructing the spine balance through osteotomies of the spine with its stiffening in a corrective position. The following paper presents the case of a patient with total hyperkyphosis in the course of AS, traumatic PTK, and global sagittal imbalance, subjected to two-stage surgical treatment of spinal deformities with the use of three-column osteotomies in the cervical and lumbar spine sections.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69596995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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