Ortopedia, traumatologia, rehabilitacja最新文献

{"title":"Early Weight-Bearing Following Open Ankle Arthrodesis: Radiographic and Clinical Outcomes.","authors":"Chatree Tangpatanasombat, Chayanin Angthong","doi":"10.5604/01.3001.0055.6927","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6927","url":null,"abstract":"<p><strong>Background: </strong>Ankle arthrodesis is a standard surgical treatment for end-stage ankle arthritis. The optimal timing of postoperative weight-bearing remains controversial, as traditional protocols recommend prolonged non-weight-bearing. Early weight-bearing may improve functional recovery without compromising fusion. This study aimed to evaluate radiographic union and clinical outcomes following early weight-bearing after open ankle arthrodesis.</p><p><strong>Material and methods: </strong>A retrospective study was conducted on 20 patients with end-stage ankle osteoarthritis who underwent open ankle arthrodesis between January 2024 and August 2025. All procedures were performed by a single surgeon using a standardized anterior approach and crossed screw fixation. Partial weight-bearing in a removable walking boot was initiated two weeks postoperatively, with progression to full weight-bearing at 12 weeks. Clinical and radiographic outcomes were assessed for up to one year. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used for clinical evaluation.</p><p><strong>Results: </strong>Radiographic union was achieved in 19 patients (95%). Partial union was most frequently observed at three months, and complete union was commonly achieved by one year postoperatively. One patient developed nonunion, and one minor wound complication was treated conservatively. The mean AOFAS score improved from 13.55 preoperatively to 90.1 at one year in the patients with successful fusion.</p><p><strong>Conclusions: </strong>1. Early weight-bearing following open ankle arthrodesis demonstrated high union rates, significant clinical improvement, and a low complication rate. 2. Early mobilization appears to be a safe and effective alternative to delayed weight-bearing when stable fixation is achieved.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 6","pages":"289-293"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691387","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":"Optimization of Treatment Costs in Diseases and Injuries of the Hand: a Narrative Review of the Literature and Presentation of Personal Experiences.","authors":"Andrzej Zyluk","doi":"10.5604/01.3001.0055.6924","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6924","url":null,"abstract":"<p><strong>Background: </strong>Expenditure on health care has been growing for many years at a constantly accelerating pace, especially in the last dozen or so years. The trend towards cost reduction and rationalized spending has become a challenge that health care providers and payers are trying to meet. The aim of this study was to identify and analyse the factors that affect the costs of treatment of diseases and injuries of the hand as well as finding effective methods of reducing them.</p><p><strong>Material and methods: </strong>An analysis identified seven elements driving the costs of treatment, from the diagnosis of an illness or injury to rehabilitation. The paper presents the author's own experiences and a review of the literature from the PubMed and Medline databases on the variables affecting the cost of treatment of common hand injuries and diseases.</p><p><strong>Results: </strong>The analysis showed that each of cost-driving elements can be reasonably reduced, without having a negative impact on the safety of the patient and the doctor. The greatest potential for cost reduction is related to the patient's anaesthesia and surgical treatment.</p><p><strong>Conclusion: </strong>The implementation of relatively simple changes in diagnostic and therapeutic procedures brings multiple benefits to all stakeholders, i.e., the patient, the doctor, the hospital and the overall health care budget. This approach is not only economically rational, but also ecological.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 6","pages":"247-267"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691397","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":"Unlocking the Future of Orthopaedic Imaging: A Comprehensive Update on the Role and Benefits of The Medical Open Network for AI (MONAI).","authors":"Chayanin Angthong, Wirana Angthong, Napat Pongsakonpruttikul","doi":"10.5604/01.3001.0055.6925","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6925","url":null,"abstract":"<p><strong>Background: </strong>Deep learning (DL) has revolutionized orthopaedic imaging, transitioning from traditional radiomics-based analysis to powerful, data-driven diagnostic and prognostic models. However, a persistent lack of methodological standardization has limited clinical translation. The Medical Open Network for AI (MONAI), an open-source PyTorch-based framework, addresses this gap by providing domain-specific tools optimized for medical imaging. This review evaluates MONAI's role and benefits in orthopaedics across diagnosis, treatment planning, and outcomes prediction.</p><p><strong>Material and methods: </strong>A comprehensive literature synthesis was conducted, examining studies utilizing MONAI for musculoskeletal imaging. We assessed technical attributes including architecture, data handling, loss functions, and multimodal integration and their applications in fracture detection, disease grading, surgical planning, and prognostic modeling.</p><p><strong>Results: </strong>MONAI demonstrated superior efficiency in handling 3D/4D orthopaedic imaging data and managing class imbalance using specialized medical loss functions (e.g., Dice and Tversky). Diagnostic models achieved near-expert accuracy in fracture detection and quantitative osteoarthritis grading, providing explainable, and reproducible outputs. MONAI enabled automated, high-fidelity 3D reconstruction for personalized implant design and 3D printing integration. Prognostically, it outperformed surgeons in predicting arthroplasty complications, revealing latent imaging biomarkers. The framework's evolution into MONAI Multimodal - with agentic AI and radiomics integration - enhanced personalized, multimodal risk assessment.</p><p><strong>Conclusions: </strong>1. MONAI establishes a standardized, transparent infrastructure that accelerates orthopaedic AI research and clinical translation. Its integration of domain-optimized architectures, multimodal data fusion, and explainable AI tools enables accurate diagnosis, individualized surgical planning, and reliable outcome prediction. 2. Adoption of MONAI-based pipelines is strongly recommended to promote reproducibility, regulatory readiness, and clinician trust in next generation of precision orthopaedic care.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 6","pages":"269-277"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691359","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":"Effect of Physical Therapy Program on Cervical Radiculopathy in Patients with a Reversed Cervical Curve: a Single-blind Randomized Controlled Trial.","authors":"Mahmoud Elshazly, Abdelrazak Abdelnaeim, Hassan Abdelnour, Mohamed Rafat Borham, Amany Abbas, Ali Rabee Hamdan","doi":"10.5604/01.3001.0055.6926","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6926","url":null,"abstract":"<p><strong>Background: </strong>Although many physical therapy modalities are used in treating the cervical spine, the efficacy of physical therapy as well as the selection of appropriate techniques, frequency, and duration of treatment have not been fully investigated. This study was designed to investigate the effect of physical therapy programs on cervical pain, range of motion, and cervical curve restoration.</p><p><strong>Material and methods: </strong>A total of sixty patients (20-45 years) who exhibited a reversed cervical curve combined with cervical radiculopathy were randomized into experimental (n=30) and control (n=30) groups. The control group received medical treatment and a collar orthosis, while the experimental group received medical treatment, a collar orthosis, and physical therapy. Cobb's angle, a visual analog scale (VAS), and ROM measurements were recorded before and after the treatment. Unpaired t-tests were used (p&lt;0.05).</p><p><strong>Results: </strong>Inter-group analysis demonstrated the statistical significance post-treatment of all study variables in the experimental group compared to the control group. Within-group analysis indicated substantial improvements in Cobb's angle, visual analog scale, and cervical flexion and extension range of motion in the experimental group.</p><p><strong>Conclusion: </strong>The physical therapy program effectively improved Cobb's angle, radiating pain, and cervical range of motion in the reversed cervical curve.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 6","pages":"279-287"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691345","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":"Comparative Analysis of Radiological and Biochemical Markers of Bone Healing in Patients with Concomitant Traumatic Brain Injury.","authors":"Roman Bihun, Vadym Sulyma, Andrii Sribniak, Taras Kovalyshyn","doi":"10.5604/01.3001.0055.6649","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6649","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the phenomenon of accelerated bone repair in patients with TBI-related trauma by comparing radiological and biochemical markers against isolated fracture cases.</p><p><strong>Material and methods: </strong>A cohort of 108 patients with femoral or tibial fractures was analyzed, divided into Group I (isolated fractures, n=82) and Group II (fractures with mild-to-moderate traumatic brain injury, n=26). Evaluation utilized the Radiographic Union Scale for Tibial Fractures (RUST) alongside serum levels of calcium and total protein.</p><p><strong>Results: </strong>TBI patients exhibited significantly higher RUST scores (mean increase of 1.3 points, p &lt; 0.001) compared to isolated trauma. The effect was most pronounced in young adults (18-44 years), with RUST scores 31.4% higher. This acceleration diminished with age, as shown by a negative correlation between age and RUST scores (r = -0.53, p = 0.005) Higher RUST scores in Group II corresponded to lower postoperative serum calcium levels despite identical baseline values (p=0.64) Initial total protein was 15% higher in TBI, likely reflecting early systemic immune activation and cytokine production.</p><p><strong>Conclusions: </strong>1. Traumatic brain injury significantly accelerates radiological bone repair, particularly in younger cohorts. 2. These findings suggest that systemic metabolic and immune shifts following TBI drive enhanced osteogenesis.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 5","pages":"207-213"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574974","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":"Proximal Femur Nail Antirotation-II: Complication of Protrusion of Proximal End of Nail Over Greater Trochanter in Indian Population.","authors":"Faisal Shah, Muzaffar Mushtaq, Wajahat Mir, Kafeel Khan, Aabid Rather","doi":"10.5604/01.3001.0055.6648","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6648","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary nails are increasingly being used for intertrochanteric fractures. PFNA-II has shown good outcomes; however, some characteristic complications are also reported due to mismatch between implant design and anatomy of the proximal femur in the Asian population. Our paper aims to study outcomes and complications of PFNA-II in a North Indian population.</p><p><strong>Material and methods: </strong>This single centre study was conducted at a teaching hospital in North India. 116 patients were recruited, of which 105 were included in the final analysis. The protrusion height of the nail tip in the early postoperative radiograph was used to divide the cohort into two groups: group A with nail protrusion and group B without nail protrusion. Clinical and radiographic outcomes were measured and compared between the two groups.</p><p><strong>Results: </strong>Nail protrusion was seen in 62% cases (Group A) while 38% did not have any nail protrusion over GT (Group B). Average protrusion in Group A was 12.6 mm. The average protrusion differed between males and females with doubtful statistical significance (6.7 versus 8.3, p=0.0537). At one-year follow-up, 40% experienced GT pain (52% in Group A and 20% in Group B) (p&lt;0.0021). Harris hip score was 78.6 and did not differ significantly between the groups.</p><p><strong>Conclusion: </strong>PFNA-II is an excellent implant for intertrochanteric fractures. However, implant-bone mismatch in some populations can lead to proximal nail protrusion, causing proximal thigh pain. We advocate modifying PFNA-II, shortening proximal nail end by 5-10 mm and introducing end-caps of varying heights for better adaptation, particularly in Indian/Asian populations.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 5","pages":"199-205"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575007","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":"Paradigm Shifts in Regenerative Medicine for Bone and Joint Surgery: From Mechanical Repair to Intelligent Biological Restoration.","authors":"Chayanin Angthong, Nuttapol Tanadchangsaeng, Akira Maeyama","doi":"10.5604/01.3001.0055.6647","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6647","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic surgery is transitioning from a mechanical repair paradigm to intelligent biological restoration driven by advances in regenerative medicine and artificial intelligence (AI). This review synthesizes the science and clinical translation of stem cell therapies, bioactive and 'smart' scaffolds, growth factor strategies, and AI-enabled planning and delivery systems.</p><p><strong>Material and methods: </strong>We conducted a narrative review of peer-reviewed literature (2013-2025) on regenerative orthopedics, including stem cells, platelet concentrates, tissue engineering, biofabrication/bioprinting, AI/robotics, and translational frameworks, with an emphasis on musculoskeletal applications and regional experiences.</p><p><strong>Results: </strong>Evidence supports mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC) for selected indications, augmented by biomimetic scaffolds and controlled growth factor delivery. Biofabrication enables defect-specific constructs including three-dimensional bioprinting sheet, while AI assists scaffold/matrix optimization through machine learning-based design algorithms, supports imaging-based healing prediction via deep learning models, and enhances precision in robotic-assisted biologic delivery. Regulatory hurdles such as variable stem cell approval pathways, ethical concerns over cell sourcing and patient data use, and high production costs remain major barriers to clinical adoption, alongside the need for surgeon training in biologic and AI-integrated systems.</p><p><strong>Conclusion: </strong>The convergence of biologics, smart materials, and AI is redefining bone and joint surgery from replacement to restoration. Future systems will pair digital twins and wearables with bioprinting, living implants and precision robotics for closed-loop, adaptive regenerative care.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 5","pages":"189-198"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575043","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":"Three-dimensional Printed Anatomical Models in Orthopedic Preoperative Planning.","authors":"Przemysław Czuma","doi":"10.5604/01.3001.0055.6650","DOIUrl":"https://doi.org/10.5604/01.3001.0055.6650","url":null,"abstract":"<p><p>Preoperative planning plays a crucial role in orthopedic surgery, especially in cases of complex and/or atypical anatomical abnormalities. This article discusses the role of 3D printed anatomical models, generated on the basis of imaging data, as a tool supporting surgeon preparation for orthopedic procedures. The aim of the paper is to identify and review the potential benefits of their use.This is an opinion paper based on current publications on the use of 3D printing in orthopedics, with particular emphasis on preoperative planning and the treatment of more complex cases. 3D printed models improve the surgeon's spatial orientation, make procedures more personalized, shorten surgical time and reduce blood loss. They also facilitate the correct placement of implants, improve functional outcomes, and serve as an educational tool. Additional advantages include potential cost savings and better patient understanding of the procedure. 3D anatomical models thus appear to be a valuable tool in orthopedic preoperative planning and can be particularly significant in difficult clinical cases. In the coming years, their use in daily orthopedic practice is likely to increase.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 5","pages":"115-121"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575003","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":"Comparison of Suture Configurations for Acromioclavicular Joint Synthetic Reconstruction in Acromioclavicular Joint Separation: Finite Element Analysis.","authors":"Chidchanok Sakdapanichkul, Chamaiporn Sukjamsri, Cholawish Chanlalit","doi":"10.5604/01.3001.0055.4446","DOIUrl":"10.5604/01.3001.0055.4446","url":null,"abstract":"<p><strong>Background: </strong>In acromioclavicular (AC) joint separation, the weight of the upper extremity and scapula causes the scapula to rotate downward and internally along the thoracic cage. This results in displacement of the AC joint along three axes: anteroposterior, mediolateral, and vertical. Finite element models can aid in directing future biomechanical studies on this concept, not just the vertical axis, as has mainly been the focus in the past. This study uses finite element models to evaluate the stress across six suture configurations which reflects the efficacy on restraining AC joint motion after ligament resection with the upper extremity at rest.</p><p><strong>Material and methods: </strong>Three finite element (FE) models were constructed to simulate AC joint stabilisation with six different suture configurations, which were anterior-, posterior-, O-, X-, O-plus-X-, and V-frames. Internal and downward rotations of scapula, along with upward rotation of clavicle were defined following a whole-cadaveric study where the AC and coracoclavicular (CC) ligaments were removed entirely. Stress magnitude and distribution across the strand of each suture configuration were evaluated.</p><p><strong>Results: </strong>There is high stress in sutures that cross posteriorly and insert at the posterior clavicle (171,877-219,489 MPa) and anterior limbs (162,512-177,021 MPa). Suture crossing from the posterolateral to anteromedial point showed 36,573-39,430 MPa of stress.</p><p><strong>Conclusion: </strong>1. There are significant loads on sutures crossing posteriorly across the AC joint and located at the posterior aspect of the distal clavicle, as well as the anterior limbs. 2. The sutures crossing from the posterolateral to anteromedial point experience minimal load. 3. Further biomechanic studies in cadavers and clinical studies are still necessary to strengthen the evidence base for these findings.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 3","pages":"115-123"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588458","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":"K-wire Migration Following Acromioclavicular Joint Fixation: A Case Report.","authors":"Vadym Sulyma, Andrii Sribniak, Roman Bihun, Yevhen Nychvyd, Liliia Lehun, Myroslav Lehun, Bohdan Divnych, Yuliia Divnych Filiak","doi":"10.5604/01.3001.0055.4447","DOIUrl":"10.5604/01.3001.0055.4447","url":null,"abstract":"<p><p>Kirschner wire (K-wire) is commonly used for temporary fixation of bone fractures, particularly in pediatric patients, but it poses risks such as breakage and migration. We present the case of a 67-year-old patient who underwent acromioclavicular joint fixation with K-wires after an injury. Nine months post-surgery, a wire fragment was found to have broken and migrated to the neck area. The migration led to the development of a pseudoaneurysm, which required surgical intervention for removal. The wire fragment was successfully removed, and the aneurysm was repaired after rupture. This case highlights the risks associated with wire migration and underscores the importance of strict adherence to the Tension Band Wiring (TBW) technique. Timely removal of fixation devices and regular radiographic monitoring during follow-up are essential to prevent potentially life-threatening complications.</p>","PeriodicalId":19622,"journal":{"name":"Ortopedia, traumatologia, rehabilitacja","volume":"27 3","pages":"125-129"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588512","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}