Ortopedia, traumatologia, rehabilitacja最新文献

{"title":"Morphology and Morphometry of the Connection Between the Gluteus Medius and the Midportion of the Iliotibial Band.","authors":"Kajetan Szymański, Dawid Dziedzic, Weronika Woźniak-Czekierda","doi":"10.5604/01.3001.0055.8582","DOIUrl":"10.5604/01.3001.0055.8582","url":null,"abstract":"<p><p>Background. The gluteus medius is a broad, thick, fan-shaped muscle located between the gluteus maximus and the gluteus minimus. It originates on the gluteal surface on the iliac ala, between the anterior and posterior gluteal lines, and inserts on the greater trochanter of the femur. It is the strongest hip abductor, playing a crucial role in ensuring appropriate stability of the pelvis and lower limb joints during activities such as walking and running. The main aim of this study was to examine the morphology and morphometry of the gluteus medius muscle and its connection to the iliotibial band.\u0000Material and methods: The study was conducted on 10 human lower limbs fixed in a formaldehyde solution. \u0000Results. The research conducted confirms the existence of adhesion between the gluteus medius and the iliotibial band. This adhesion was located on the outer surface of the gluteus medius muscle, within its free part that was not covered by the gluteus maximus and the tensor fasciae latae. \u0000Conclusion. The existence of adhesion existence of adhesion between the gluteus medius and the iliotibial band may suggest a crucial role in the control of iliotibial band tension, which is additionally influenced by the action of the gluteus maximus and the tensor fasciae latae.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 2","pages":"99-112"},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663322","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}

{"title":"Delayed Onset of Acute Compartment Syndrome of Lower Leg and Foot after Crush Injury. Case Report.","authors":"Jan Józef Majchrzak, Paweł Rzyczniok, Bogdan Dugiełło, Jacob Sobolewski, Damian Mazur, Wojciech Wawrzynek, Tomasz Stołtny","doi":"10.5604/01.3001.0055.8584","DOIUrl":"10.5604/01.3001.0055.8584","url":null,"abstract":"<p><p>This case report presents a 25-year-old man who sustained a crush injury to the right lower limb at the workplace due to compression by a car wheel hub. Initial examination revealed marked swelling of the lower leg and midfoot with preserved sensation and peripheral perfusion. Radiographs demonstrated a bimalleolar ankle fracture and multiple foot fractures. Approximately 5 hours after admission, the patient developed rapidly increasing pain, pallor and cooling of the foot, absence of the dorsalis pedis pulse, decreased toe sensation, and oxygen saturation of 80%. CT angiography showed absent flow in the distal segments of the anterior tibial and fibular arteries. An urgent fasciotomy of the lower leg and dorsal foot compartments was performed ten hours after injury using the shoelace technique, resulting in immediate restoration of perfusion and foot warmth. Sixteen days later, necrotic tissue was debrided, the defect was covered with a split-thickness skin graft (Thiersch technique), and the medial malleolus was stabilized with Kirschner wires. Wound healing was uneventful, with no signs of infection. This case highlights the dynamic and potentially misleading course of acute compartment syndrome and underscores the need for frequent clinical reassessment despite an initially reassuring presentation. Prompt diagnosis and immediate complete fasciotomy prevented irreversible complications.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 2","pages":"119-129"},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664294","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}

{"title":"Predictors of Long-Term Outcomes after Endoscopic Spinal Decompression in Patients with Lumbar Spinal Stenosis.","authors":"Nurbyek Baban, Gonchigsuren Dagvasumberel, Shiirevnyamba Avirmed","doi":"10.5604/01.3001.0055.8581","DOIUrl":"10.5604/01.3001.0055.8581","url":null,"abstract":"<p><p>Background. ESD is a minimally invasive procedure to alleviate disability in LSS patients. However, long-term predictors of suboptimal surgical outcomes remain unclear. We aimed to investigate the predictors of long-term outcomes in patients with lumbar spinal stenosis (LSS) treated with endoscopic spinal decompression (ESD) surgery. \u0000Material and methods. Patients with LSS unresponsive to conservative treatment underwent ESD surgery. Disability was assessed using the Oswestry Low Back Pain (LBP) Disability Questionnaire, reported as the Oswestry Disability Index (ODI), at pre-surgery, post-surgery, and 1-year follow-up. Patients were grouped ba­sed on the presence or absence of spinal instability.\u0000Results. 93 patients (mean age 55±14, 55% female) with LSS who underwent ESD due to persistent LBP were included. Pre-surgical ODI significantly decreased post-surgery in both groups (spinal instability: 25 [IQR 19-33] vs. 3 [IQR 1-7], p<0.001; no spinal instability: 30 [IQR 24-35] vs. 2 [IQR 1-4], p<0.001). However, the spinal instability group had higher post-surgical ODI (3 [IQR 1-7] vs. 2 [IQR 1-4], p=0.018) and 1-year ODI (14 [IQR 2-24] vs. 3 [IQR 1-7], p=0.013) compared to the no spinal instability group, where ODI remained stable (2 [IQR 1-4] vs. 2 [IQR 1-4], p=0.785). Multivariable linear regression identified multilevel degenerative disc disease (β=3.357, 95% CI 0.610-6.105, p=0.017) and spinal instability (β=7.368, 95% CI 3.370-11.365, p<0.001) as independent predictors of 1-year ODI.\u0000Conclusions. 1. ESD surgery significantly improves disability, as measured by ODI, in patients with LSS, regardless of spinal instability. 2. Multilevel degenerative disc disease and spinal instability are long-term predictors of outcomes following ESD surgery.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 2","pages":"91-97"},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663306","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}

{"title":"Clinical Outcomes of Arthroscopic Bankart Repair with Soft-Tissue Augmentation in Patients with Significant Glenoid Bone Loss: Is Non-Bony Reconstruction Sufficient?","authors":"Suthee Tharakulphan, Chayanin Angthong","doi":"10.5604/01.3001.0055.8583","DOIUrl":"10.5604/01.3001.0055.8583","url":null,"abstract":"<p><p>Background. To evaluate the clinical and functional outcomes of arthroscopic Bankart repair (ABR) sup­ple­mented with soft-tissue augmentation in patients stratified by varying severities of glenoid bone loss (GBL).\u0000Material and methods. A retrospective cohort study was conducted on 37 patients undergoing ABR for recurrent traumatic anterior shoulder instability. GBL was quantified via preoperative CT using the best-fit circle method. Patients were stratified into three groups: Mild (<13.5%, n=15), Subcritical (13.5%–20%, n=8), and Critical (>20%, n=14). All “off-track” lesions received a concomitant remplissage procedure. Primary out­comes included the Western Ontario Shoulder Instability (WOSI) Index, Rowe scores, and recurrence of in­stability at a minimum 6-month follow-up.\u0000Results. Baseline demographics and instability chronicity were comparable across all groups. Critical GBL (>20%) was significantly associated with off-track lesions and the performance of a remplissage procedure \u0000(p = 0.025). Despite the higher magnitude of osseous deficiency, there were no significant differences in recur­rence rates (p = 0.875) or postoperative functional outcomes (WOSI, p = 0.700; Rowe, p = 0.856) among the three cohorts. High rates of “Good-to-Excellent” outcomes were maintained across the spectrum, with 64.2% of the critical bone loss group achieving excellent postoperative WOSI scores.\u0000Conclusions. 1. Arthroscopic Bankart repair supplemented with selective remplissage for off-track lesions was associated with satisfactory short- to mid-term stability and functional outcomes in this small cohort, in­cluding selected patients with >20% glenoid bone loss. 2. However, given the limited sample size in the critical bone-loss group and the small number of remplissage cases, these findings should be interpreted cautiously and should not be taken to conclude that bony augmentation procedures are unnecessary. 3. Larger comparative stu­dies with longer follow-up are required.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 2","pages":"113-118"},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664271","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}

{"title":"Machine Learning - Powered Assessment of Plain Radiographs for Detecting Bony Bankart Lesions and Guiding CT Decision-Making.","authors":"Suthee Tharakulphan, Chayanin Angthong, Pawin Rattanasumrit","doi":"10.5604/01.3001.0055.8580","DOIUrl":"10.5604/01.3001.0055.8580","url":null,"abstract":"<p><p>Background. To evaluate the diagnostic accuracy of plain radiography in detecting bony Bankart lesions compared to computed tomography (CT) and to identify clinical factors that delineate the necessity for CT investigation using machine learning-powered analysis.\u0000Material and methods. A retrospective analysis of 69 cases of traumatic anterior glenohumeral dislocation was performed. Two blinded observers evaluated plain radiographs for bony Bankart lesions. Inter-observer reliability was assessed using Cohen’s kappa (κ). Diagnostic metrics (sensitivity, specificity, PPV, NPV) were calculated using CT as the gold standard. Multivariate logistic regression and machine learning (decision tree) models were utilized to identify predictors for ‘hidden’ lesions (X-ray negative, CT positive).\u0000Results. Inter-observer agreement for X-ray was fair (κ = 0.272). Observer 1 demonstrated 100% specificity but low sensitivity (27.27%). Multivariate analysis identified ‘Time from first dislocation’ as a significant predictor for CT-detected lesions (p = 0.019). ROC and machine learning models identified a critical cut-off of 36–42 weeks; patients presenting within this window had a 55.6-70% probability of a hidden lesion, compared to 16.7% for chronic cases.\u0000Conclusions. 1. Conventional radiographs demonstrated high specificity but limited sensitivity and only fair in­terobserver reliability for detecting bony Bankart lesions compared with CT. 2. A negative radiographic result does not reliably exclude a bony Bankart lesion in patients with traumatic anterior shoulder instability. 3. CT examination should be performed in patients presenting within 42 weeks after their first anterior shoulder dislocation, particularly when radiographs are negative but clinical suspicion persists. 4. CT should also be strongly considered in patients with recurrent instability, especially those with ≥3 dislocation episodes, to facilitate early identification of occult osseous pathology and guide appropriate surgical planning.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 2","pages":"83-89"},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663293","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}

{"title":"Relationship of Retropatellar Knee Cartilage and Subchondral Patellar Bone During the Course of Osteoarthritis.","authors":"Andreas Lahm, Richard Kasch, Heiko Spank, Christoph Zilkens","doi":"10.5604/01.3001.0055.8579","DOIUrl":"10.5604/01.3001.0055.8579","url":null,"abstract":"<p><p>Background. Rotational and shearing forces/stress as well as varying relationships between subchondral\u0000bone and retropatellar cartilage result in specific dysregulated bone remodeling of this joint section.\u0000Material and methods. Using immunohistochemistry and real-time polymerase chain reaction (RT-PCR)\u0000human retropatellar cartilage was investigated for expression of key molecules of the extracellular matrix and\u0000cartilage composition. Results were correlated with 3D microcomputed tomography of underlying subchondral\u0000bone. 129 serial medial and lateral patella facet samples of patients undergoing implantation of total knee endoprosthesis of areas showing mild (Group A, ICRS 1b) respectively advanced (Group B, ICRS 3a/3b) (43 each)\u0000osteoarthritis according to the histological-histochemical grading system (HHGS) were compared with 23\u0000healthy biopsies. \u0000Results. Periarticular subchondral bone analysis of OA samples showed sclerosis, altered trabecular structures and inflammatory-like infiltration. A decrease of trabecular number but increase of the bone volume fraction was observed in group B accompanied by subchondral bone resorption pits and enchondral ossification.\u0000Greater differences were found within the first mm of subchondral bone. Trabecular Thickness grew slightly in\u0000group A to increase most pronounced at the medial facet in group B representing cartilage graded ICRS 3a/3b\u0000(HHGS 11.7 points). The medial patella site in group B showed the highest increase in the ratio between expression values for the genes Col1A1 and the reference gene. The medial facet presented higher amounts and\u0000increased magnitude of variance in facet shape and size.\u0000Conclusions. 1. Comparable OA prevalence on the medial compared to the lateral patellar facet was shown.\u00002. Cartilage degeneration severity is correlated with bone volume fraction (BV/TV). 3. In total knee arthropla -\u0000sty and TKA revision surgery subchondral bone adressing techniques such as micro-fracturing and Bone-Grafting\u0000should be considered in non-resurfacing techniques. 4. Reconstructive techniques such as Matrix-induced ACI\u0000(MACI) or Osteochondral autograft transplantation must address state of subchondral patellar bone.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 2","pages":"73-82"},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663868","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}

{"title":"Risk Factors for Recurrence and Reoperation after Surgical Treatment of Cubital Tunnel Syndrome: A Narrative Review.","authors":"Andrzej Zyluk","doi":"10.5604/01.3001.0055.7769","DOIUrl":"10.5604/01.3001.0055.7769","url":null,"abstract":"<p><p>Background. Cubital tunnel syndrome is the second most common compression neuropathy in the upper limb. The outcomes of operative treatment of cubital tunnel syndrome are predictable to some extent. Ap­proximately 70-80% of patients are satisfied with the good long-term outcomes, but the remaining 20-30% benefits less or even are dissatisfied with the treatment. Moreover, in 7-24% recurrence occurs, or necessity of revision surgery due to lack of improvement after primary operation. The objective of this study was review of the literature identifying factors that affect the risk of recurrence and reoperation after cubital tunnel release.\u0000Material and methods. Articles form PubMed and Medline databases were extracted. A total of 8 papers were found meeting the assumed goals of the study. Several other papers were included that examined the impact of single parameters and their results were cited in the descriptive form.\u0000Results. The factor that most influenced the increased risk of recurrence and reoperation was younger age of patients at the time of surgery. The effect of other factors such presence of comorbidities, clinical severity and smoking was weaker and less important. Revision rates were low overall across the studies, with few rates of complications.\u0000Conclusions. 1. Outcomes of surgery for cubital tunnel syndrome are predictable to some extent, and overall worse than, i.e. after carpal tunnel release. 2. Further investigations of risk factors of suboptimal outcomes or recurrences are important for improvement of treatment outcomes of this condition.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205731","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}

{"title":"Expanding the Role of Tibial Tuberosity Osteotomy with Distalization and Medialization - a Retrospective Case Series Study.","authors":"Mikolaj Podsiadlo, Wojciech Solecki, Paweł Pruś, Andrzej Solecki, Leszek Borkowski, Adrian Blasiak","doi":"10.5604/01.3001.0055.7772","DOIUrl":"10.5604/01.3001.0055.7772","url":null,"abstract":"<p><p>Background. Patellofemoral instability is a multifactorial condition influenced by anatomical abnormalities as well as soft tissue dysfunction. Distalization of the tibial tuberosity is classically reserved for patients with patella alta, typically defined by a Caton–Deschamps (CD) index >1.2. However, clinical experience suggests that certain patients with lower CD indices but distally deepening trochlear morphology may also benefit. This study aimed to evaluate the long-term outcomes of tibial tuberosity osteotomy with distalization and medialization (TTO-DM) in patients with recurrent lateral patellar instability, regardless of patellar height.\u0000Materials and methods. This retrospective single-center study included 26 patients (17 females, 9 males) with recurrent patellar instability and Dejour type A, B, or C trochlear dysplasia. All demonstrated a distally deepened trochlear groove on MRI and underwent TTO-DM along with MPFL reconstruction. Patients were followed up for a minimum of 4 years (mean, 8.6 years). Outcome measures included the Kujala and Lysholm scores, radiographic assessment of the CD index and Kellgren–Lawrence grade, complications, range of motion, and pain during squatting.\u0000Results. Kujala scores improved from 60.1 ± 18.7 to 93.8 ± 7.1 (p < 0.0001), and Lysholm scores increased from 59.5 ± 20.7 to 93.8 ± 7.9 (p < 0.0001). The mean CD index decreased from 1.2 (range 1.0–1.56) to 0.88 (range 0.6–1.0) postoperatively. No patellar redislocations or progression of patellofemoral osteoarthritis were observed. One superficial infection resolved with oral antibiotics, and one tibial tubercle fracture was successfully managed with plate fixation. Four patients had delayed recovery but recovered full function without long-term sequelae.\u0000Conclusion. 1. TTO-DM led to excellent functional outcomes and complete prevention of redislocation, even in patients with CD indices ≤1.2. 2. These findings suggest that surgical indications for distalization may be expanded based on trochlear morphology rather than the CD index alone. 3. Although limited by its retrospective design and small sample size, this study provides one of the longest follow-up durations, supporting this approach in patellofemoral instability management.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 1","pages":"31-43"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205684","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}

{"title":"Total Joint Arthroplasty in Rural Trinidad and Tobago: A Pilot Study on Feasibility, Outcomes, and Access.","authors":"Marlon Mencia, Cara Mohammed, Laeshelle Basanoo, Raakesh Goalan, Shamir Cawich","doi":"10.5604/01.3001.0055.7771","DOIUrl":"10.5604/01.3001.0055.7771","url":null,"abstract":"<p><p>Background. Total joint arthroplasty (TJA) significantly improves quality of life for patients with advanced arthritis, yet access in rural and low-resource settings remains limited. The aim of this study was to describe our initial experience with TJA performed at a rural hospital, to evaluate its feasibility, outcomes and the lessons learned as a first step for developing arthroplasty services in low-resource environments.\u0000Materials and methods. A two-year retrospective cohort review was conducted of all patients who underwent primary total hip or knee arthroplasty at a rural hospital. Data including demographics, diagnosis, type and duration of surgery, length of hospital stay, complications, and postoperative outcomes were collected. Descriptive statistics and comparative analyses were performed with significance set at p < 0.05.\u0000Results. Ninety-three patients underwent TJA (71 total knee arthroplasties, 22 total hip arthroplasties). The mean age was 62.4 years, with 76% female. Mean operating time was 155.4 minutes (THA 169.5 vs TKA 145.0; p < 0.0014), and mean hospital stay was 5.8 days (THA 7.1 vs TKA 5.5; p = 0.0205). Eleven patients (11.8%) developed surgical site infections, including three deep prosthetic joint infections (3.2%). No perioperative deaths, dislocations, or thromboembolic events were recorded.\u0000Conclusions. 1. The findings confirm that TJA can be safely delivered in a low-volume rural hospital, though infection rates remain higher than those reported from high-resource settings. 2. Despite infrastructural and resource limitations, early outcomes demonstrated feasibility and acceptable safety. 3. The study serves as a model for decentralizing surgical services, promoting equitable access, and building sustainable orthopaedic capacity in resource-limited regions.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 1","pages":"23-30"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205672","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}

{"title":"Reconstruction of the Thumb After Failed Replantation Using Part of the Amputated Thumb and a Pedicled Flap - Report of Two Cases.","authors":"Marek Bielecki, Wiktoria Piórkowska, Marcin Kobyliński, Thomas Wenta, Marta Karpik, Jan Kiryluk, Paweł Bielecki, Piotr Piterow","doi":"10.5604/01.3001.0055.7773","DOIUrl":"10.5604/01.3001.0055.7773","url":null,"abstract":"<p><p>The thumb is the most important digit of the hand, and thumb amputation results in a 40% loss of hand function. The gold standard of management in thumb amputation is replantation. Late reconstruction methods of a lost thumb include wrap‑around great toe flap, deepening of the first web space, osteoplastic procedures, and others. The aim of this article is to pre­sent a rarely used method of thumb reconstruction after a failed replantation using non‑vascularized bone from the previously replanted thumb and a pedicled flap from the body wall (abdominal flap).\u0000We present the treatment outcomes of two patients after a failed thumb replantation in whom the thumb was reconstructed using non‑vascularized bone from the previously replanted thumb covered with a pedicled abdominal flap. The functional outcome was assessed using the QuickDASH questionnaire and the Kapandji opposition score. \u0000Elongation of the thumb relative to the initial amputation level was achieved in both patients. One patient scored 6.82 points on the QuickDASH scale, indicating a very low level of upper limb disability. The Kapandji score in that patient was 7–9 points, corresponding to good-to-excellent thumb opposition function. In the second patient, the QuickDASH score was 9.09 points, also indicating minimal functional limitations, and the Kapandji score was 4–6 points, corresponding to moderate opposition function. Comparatively, the first patient achieved better function of the reconstructed thumb.\u0000A failed thumb replantation does not necessarily lead to amputation of the entire necrotic replanted thumb segment. In selected clinical cases, the non‑vascularized bony part of the thumb can be used for early reconstruction with a pedicled body‑wall flap even several weeks after the primary replantation. This method has not been previously described in the domestic literature.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"28 1","pages":"45-55"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205726","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}