Polish orthopedics and traumatology最新文献

{"title":"The application of intramedullary nails and transmedullary support screws in surgical treatment of distal tibia fracture","authors":"Marcin Bęcki, M. Falis, M. Synder, Łukasz Lipiński","doi":"10.31139/chnriop.2023.88.1.1","DOIUrl":"https://doi.org/10.31139/chnriop.2023.88.1.1","url":null,"abstract":"Introduction. Fractures of the distal tibia are a difficult treatment problem due to the specific anatomy of this area and the soft tissue injuries resulting from trauma. A distal fracture is short, has a wide marrow cavity, and the asymmetric muscle forces acting on it can cause secondary displacements despite the originally correct positioning. Against the background of the problems presented above, the fixation with an intramedullary nail (IMN) with the use of TMS (trans medullary support) screws directional screws seems to be the best alternative for treatment. Aim. The aim of this study was to evaluate the bone fracture repositioning after surgical treatment of tibia fracture, the time of bone healing and the function of the upper ankle joint. Materials and methods. Forty patients treated surgically due to a fracture of the distal tibia with the use of an intramedullary nail and TMS screws were included in this study. The mean follow-up time was 25.3 months. The function of the ankle joint of the injured limb was evaluated using the AOFAS, VAS and SF-36 questionnaires. Radiological documentation was assessed in terms of correct bone fragment repositioning, placement of directional screws and correct union of the fibula. Post-operative X-rays as well as X-rays taken at the end of treatment in AP and lateral projection were also assessed, evaluating LDTA (lateral distal tibial angle) and ADTA (anterior distal tibial angle). Results. The function of the ankle joint after surgical treatment of a distal tibia fracture using the IMN + TMS method is as follows: AOFAS score 91.5, VAS 2.2 / 10 points. The range of motion of the ankle joint: the angles of ankle movement were significantly greater in the case of the uninjured limb compared to the injured one. Bone union was obtained in all patients. In 80% of patients, it was achieved in less than 6 months. Assessment of repositioning after surgery – mean LDTA angle after surgery was 89 and mean ADTA angle after surgery was 86 (standard LDTA 90, ADTA 85). Conclusions. The function of the ankle joint after treatment of a distal tibial fracture with an intramedullary nail and TMS screws according to the AOFAS and VAS scale was very good and allowed for the anatomical bone fragment fixation. The bone healing after fixation of the distal tibial fracture with an intramedullary nail and TMS screws was shorter than 6 month in most cases.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69600450","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":"Classics. Transiliac osteotomy in the treatment of congenital dysplasia of the hip","authors":"W. Dega","doi":"10.31139/chnriop.2022.87.4.1","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.4.1","url":null,"abstract":"The author is presenting his experience in surgical reconstruction of the dysplastic acetabular roof. The reconstruction is combined with a simultaneous reduction of the subluxed hip. This method was under the author’s elaboration since 1927 and it was named by him as transiliac osteotomy in 1958. Detailed surgical technique is described.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47762190","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":"Pre-operative spirometry evaluation in adolescent girls with severe idiopathic scoliosis","authors":"K. Politarczyk, Wiktoria Popowicz-Mieloch, T. Kotwicki","doi":"10.31139/chnriop.2022.87.4.3","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.4.3","url":null,"abstract":"Introduction. Pulmonary impairment may be observed in patients with severe idiopathic scoliosis (IS). The aim of the study was to analyze spirometry parameters and identify the pulmonary status of patients prior to scoliosis surgery. Materials and methods. Ninety-two adolescent girls with IS, aged 10-18 underwent a spirometry examination and radiographic evaluation. The body height loss was calculated from Stokes’ formula. The values of the pulmonary parameters were interpreted against the measured versus the corrected body height. Results. The mean thoracic Cobb angle was 68.3°, range 50°-89°. A restrictive pattern was observed in over 40% of patients. The use of reference values calculated for corrected body height decreased the number of patients presenting pulmonary parameters within the normal range (48.9% versus 56.5%) and increased the number of patients with a possible restrictive pattern (42.4% versus 32.6%). Airway obstruction was observed in 10.9% of patients when measured body height was used versus 8.7% of patients while corrected body height was used. Conclusions. More than half of patients with severe thoracic idiopathic scoliosis present pulmonary impairment, mainly of a restrictive pattern. The calculations of reference values from the corrected body height as a substitute for the measured one may influence the interpretation of the spirometry examination results.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48834805","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":"Severe insertional Achilles tendinopathy. Our experience with two different surgical techniques: surgical debridement and dorsal closing wedge calcaneal osteotomy according to modified Zadek’s technique","authors":"R. Kucharski, Z. Abiddin, Kashif Ahmad, A. Munoruth, R. Maheshwari","doi":"10.31139/chnriop.2022.87.4.2","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.4.2","url":null,"abstract":"Introduction. This study is a retrospective analysis of two cohorts of patients treated for severe insertional Achilles tendinopathy (IAT) with two different surgical methods: surgical debridement and dorsal closing wedge calcaneal osteotomy according to modified Zadek’s technique. Materials and methods. We treated a total of 36 feet in 35 patients. Twenty five patients had surgical excision of intra-tendinous calcification with excision of posterior calcaneal prominence and reinforcement of insertion with either suture anchors or fibre tape. Ten patients (11 feet) had modified Zadek’s calcaneal osteotomy as an isolated intervention, without any other procedure to the Achilles tendon insertion or to the posterior part of the calcaneus. The mean age at operation was 52.6 years. (Range: 31 to 68 years in the debridement group and 18 to 64 years in the osteotomy group). There were 17 males and 18 females. 20 were right-sided procedures. Mean follow-up in the outpatient clinic for a clinical examination was 20 weeks. We expanded observation period with an up-to-date score based on Victoria Institute of Sport Assessment-Achilles Tendon (VISA-A) questionnaire and Manchester Oxford Foot Questionnaire (MOXFQ) making the maximum follow up in the debridement group up to 8 years and the osteotomy group of 4 years. Results. The open debridement group showed 76% (19 patients) to have a good to excellent outcome. The calcaneal osteotomy group showed 82% (9 patients) to have a good to excellent outcome. Osteotomies were united in all patients. We had no complications in either group until discharge. Conclusions. Both methods showed to be safe and efficient in bringing symptomatic relief to patients in short, medium and long-term observation.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69600317","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":"Posture stability and risk of fall test in the objective assessment of balance in patients with ectopic bone tissue after total hip replacement","authors":"B. Maciąg, Krystian Żarnovsky, Olga Adamska, G. Maciąg, Paweł Czuchaj, M. Łapiński, Maciej Świercz, Hanna Tsitko, A. Stolarczyk","doi":"10.31139/chnriop.2022.87.4.4","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.4.4","url":null,"abstract":"Introduction. Total hip replacement is an operative treatment method for end-stage osteoarthritis, considered the most effective nowadays. One of the typical complications after the procedure is heterotopic ossification which may influence patient posture stability and increase the risk of falls. Aim. The study aimed to assess whether patients developing heterotopic ossifications after total hip replacement have a higher risk of falls in comparison to the matched-cohort group without them. Materials and methods. 46 out of 312 patients undergoing a total hip replacement in 2020 who developed heterotopic ossifications were observed. For these patients, a propensity score based on age, sex, and BMI was generated, and a matched-cohort control group consisting of 39 patients was selected. Each patient was operated on via an anterolateral approach, and an uncemented total hip prosthesis was implanted. Patients from both cohorts underwent postoperative radiological and biomechanical assessment and fulfilled WOMA C and Oxford questionnaires pre-and postoperatively. Statistical analyses of the results were performed. Results. There were statistically significant differences between cohorts in the postural stability test (4.9±1.1 vs 2.0±1.0 p<0.05), antero-posterior stability index (3.6±1.2 vs 1.6±0.9, p<0.05), medio-lateral stability index (3.0±1.3 vs 1.0±0.7, p<0.05) and risk of fall test (9.8±1.0 vs 7.8±1.0, p<0.05). No statistically significant differences were observed in the WOMA C and Oxford questionnaires. Conclusions. Our study proved that heterotopic ossifications, which appear in hip abductor muscles, could have an impact on balance and the risk of falls in patients after total hip replacement. In the elderly population, this can result in serious consequences such as a periprosthetic fracture or head trauma after total hip replacement.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47467107","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":"The local application of a calcium sulfate bone graft substitute with antibiotics for the treatment of infection after anterior cruciate ligament reconstruction. The results of 3 cases and a literature review","authors":"I. Babiak, J. Banasiewicz","doi":"10.31139/chnriop.2022.87.4.5","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.4.5","url":null,"abstract":"Introduction. We report the results of revision surgery in recurrent infection after anterior cruciate ligament reconstruction (ACLR) consisting of graft canal debridement and the local application of a calcium sulfate bone substitute (CSBS) with the addition of gentamicin and vancomycin in graft canal and infected foci. Materials and methods. Three patients (3 knees) were operated due to a chronic and unsuccessfully treated knee infection after ACLR. Two patients underwent multiple previous revisions (4 and 9, respectively). In all cases, the tibial ACL graft canal and adjacent bone foci were debrided. Post debridement defects in the femur and tibia and the graft tunnel in the tibia were filled with CSBS with an addition of gentamicin and vancomycin. If the absence of the ACL graft was stated, the tibial canal was closed from the joint side with a collagen sponge with gentamicin. Results. After a follow-up of 20 to 26 months, all patients obtained a complete resolution of inflammation and CRP normalization. No side effects related to CSBS were observed. There was no deterioration in the knee function and stability compared to the pre-revision status. Conclusions. CSBS with the addition of gentamicin and vancomycin applied in the graft canal and inflammatory foci in the surrounding cancellous bone proved to be effective and unrelated to complications in chronic infection after ACLR. Level of Evidence: IV (case series).","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69600371","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":"Pain management in total knee arthroplasty. A comprehensive review","authors":"M. Domagalska, Tomasz Reysner","doi":"10.31139/chnriop.2022.87.4.6","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.4.6","url":null,"abstract":"Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end-stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for the perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and urine retention, which limit their application in daily clinical practice. This review aimed to discuss the current postoperative pain management regimens for TKA. Our review of literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications, including preemptive analgesia, especially local infiltration analgesia and peripheral nerve blockade. Multimodal analgesia provides superior pain relief, promotes knee recovery, and reduces opioid consumption and related adverse effects in patients undergoing TKA.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69600379","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":"The impact of preoperative cardiology consultation on the surgical treatment of patients with proximal femur fractures","authors":"D. Ciechanowicz, M. Wójtowicz, Barbara Ufnalska, P. Głodek, Hanna Ruszkowska, Ł. Kołodziej","doi":"10.31139/chnriop.2022.87.3.2","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.3.2","url":null,"abstract":"Introduction. Proximal femur fractures are a common problem in the geriatric population. Moreover, due to numerous comorbidities, the choice of the appropriate form of treatment requires a cardiology consultation. Aim. Therefore, the aim of this study is to analyze whether these consultations have a significant impact on the treatment of patients with proximal femoral fractures. Materials and methods. A total number of 158 patients with a mean age of 81.3 (range, 56-98), treated for femoral neck and trochanteric fractures were enrolled in a retrospective study. Data from the patient’s treatment history were used for the study, such as: age, hospital admission date, cardiological consultation date, surgery date, discharge date or date of death. Results. Patients without cardiology consultation stayed in hospital on average 3.97 days shorter (p = 0.0011) and had surgery on average 2.89 days earlier (p = 0.000001) than patients with an arranged consultation. The percentage of deaths in both groups was similar: 6.1% and 7.1% (p = 0.70068). Spinal anesthesia was mainly performed by anesthesiologists in the group with consultation (64.3%) and without consultation (83.8%) (p = 0.442). More cases with a consultation were disqualified from surgery: 18.8% vs. 2.9% (p = 0.00357). Among the patients with an ordered cardiological consultation, 53.6% had surgery > 48 hours after admission compared to 26.2% patients without consultation (p = 0.0002). Conclusions. Cardiological consultations extend the length of stay in hospital and delay surgical treatment, but do not affect the choice of anesthesia. However, consultation in some cases may help in the proper qualification and disqualification from surgery.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69600269","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":"Avulsion fractures of the pelvis in the pediatric population. A review of the literature and case report","authors":"Szymon Urban, Justyna Napora, Szymon Wałejko, T. Mazurek","doi":"10.31139/chnriop.2022.87.3.3","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.3.3","url":null,"abstract":"Avulsion fractures of the pelvis usually occur in young athletes and are the most common type of avulsion fractures in the pediatric population. The most frequent fractures of this group are fractures of the anterior superior and anterior inferior iliac spine and fractures of the ischial tuberosity. The diagnosis of this type of fracture requires awareness, because their symptoms may suggest muscular injuries. There have not been found clear-cut guidelines for the treatment of pelvic avulsion fractures in the currently available literature. Most of these fractures can be successfully treated conservatively. Operative treatment should be considered first in professional athletes, and significant displacements fragments of the fracture, amount to more than 1-3 cm depending on the source. Patients who undergo surgical treat-ment have a faster recovery, however, surgery is associated with several possible complica-tions, including this contingent on implant presence. There are several surgical treatment techniques, all of which are described as giving good results with few complications.","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69600276","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":"The Sanders Maturity Scale for skeletal maturity assessment in idiopathic scoliosis","authors":"J. Tschurl, Wojciech Napiontek, Łukasz Żytka, Karolina Sławatycka, T. Kotwicki","doi":"10.31139/chnriop.2022.87.3.1","DOIUrl":"https://doi.org/10.31139/chnriop.2022.87.3.1","url":null,"abstract":"Introduction. Skeletal maturity assessment in Idiopathic Scoliosis (IS) is used for the evaluation of deformation progression risk, as well as selecting a method of treatment. The Sanders Maturity Scale (SMS) is based on the ossification of phalanges, metacarpal bones and radius rated on AP radiograms of the left hand. Aim. This retrospective study aimed to compare SMS to other skeletal maturity assessment methods used in daily practice. Materials and methods. We included 39 female patients with IS (50 series of radiograms) with a mean age of 13.4, ranging from 10.3 to 17.3. Each series of radiograms was evaluated by three observers with different experience. Skeletal maturity was assessed using the Sanders Maturity Scale (SMS), Risser sign, Greulich and Pyle (GP) atlas, as well as the closure of the triradiate cartilage. Results. The majority of patients, 17 out of 50 (34 %) were classified as type 3 (adolescent rapid – early). Intra-observer and inter-observer reliability for the SMS was very good (Krippendorff’s alpha >0.95). The GP and Risser method showed good reliability, whereas the triradiate cartilage closure assessment showed lower reliability. The Risser 0 grade corresponded with as many as four Sanders stages, 16 out of 20 (80 %) were rated Sanders 3. All radiograms with open triradiate cartilage (7/50, 14 %) were rated Sanders 2 or 3; they all received a Risser 0 grading. Conclusions. The SMS proved to have a very good intra-observer and inter-observer reliability, it is easy to be used by physicians and does not require an atlas. The SMS enhances the assessment of skeletal maturity of IS patients by providing additional stages in the early phase of growth (Risser 0).","PeriodicalId":89713,"journal":{"name":"Polish orthopedics and traumatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49543812","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}