UNLABELLED:Shoulder arthroscopy used since sixties of the XXth century, becomes now dominating operative technique. Surgeon's skills are most important that's why perfect training model is still needed. Ideal training model for shoulder arthroscopy should combine best possible image of human anatomical structures, good accessibility and low price. Despite of great similarity, animal shoulder joint differs from human one. More spherical shape of animal glenoid gives better support for humeral head. As a result of different shape of glenoid, labrum is significantly less developed, and can actually be clearly seen on dorsal part of the glenoid rim. Glenohumeral ligaments are visible but not as well developed as in human joint.METHODS:We have used pig shoulder joints, all of the muscles externally surrounding joint capsulewere resected. Classical 30 degrees optical equipment and standard arthroscopy tools were used. Labrum stabilization was achieved using anchors and screws. Cannulas were used only in a few cases, in others, joint access was very easy and did not require one.RESULTS:Animal shoulder model is useful only in case of arthroscopic practice of instability treatment. Implants can be snapped back after practice.
On 15th May 2010 in Poland first computer planned total knee arthroplasty Vanguard Signature was performed and until now, including Orthopedic Traumatology Department of Central Clinical Hospital Ministry of Interior and Administration in Warsaw and Orthopedic Surgery Department of Promienista Clinic in Poznan, 65 patients have been operated with this method. The new system includes programming technical parameters of operation on the basis of diagnostic analysis of lower extremity using CT or MRI scans. Data are transmitted on Signature Positioning Guides (SPG) which implements function of navigation during surgery. Minimal bone resection, implants sizing and placement with reconstruction of mechanical axis of the limb provides proper functioning of the knee joint and reduces the risk of implants loosening. Further benefits include: instrument reduction, lower degree of femur trauma and reduction of average postoperative blood transfusion volume. The operator using Signature technology is required to have advanced knowledge in the conventional method TKR and medium level computer skills. Access to the program and materials and online communication with the Signature team in the USA allows the surgeon to modify the parameters of the operation and the necessary expert feedback. The rapid increase in the number of registered surgeons in Signature system shows a considerable interest in this technology.
UNLABELLED:As distal end of the radius is anatomically localised close to the carpal tunnel, fractures of this part of the bone is fairly commonly associated with symptoms typical for median nerve compression. The objective of the study was to assess frequency of the occurrence of these symptoms in patients after operative treatment of the fractures of the distal radius, and, additionally to evaluate the validity and specificity of the Levine questionnaire in the detection of symptoms of median nerve compression.PATIENTS AND METHODS:In 101 patients, at a mean of 9 weeks after surgery for fracture of the distal radius, the following variables were assessed: 1) pain intensity in visual analogue scale as well as 2) complaints and functional impairment of the hand typical for carpal tunnel syndrome with the Levine questionnaire.RESULTS:Pain intensity in the affected hand averaged 2.8 points in 0-10 scale, the Levine symptom score amounted a mean of 2.1 (range 1.0-3.7) and the Levine function score amounted a mean of 2.1 (range 1.0-5.0). Nine patients had score at least 3 in both symptom and function sub-scales of the Levine form, suggesting carpal tunnel syndrome. However, at the assessment at a mean of 15 months thereafter, none of these patients were treated for carpal tunnel syndrome, although, five of them still suffered from similar symptoms. The results of this study show transient character of compressions symptoms on the median nerve In patients after fractures of the distal radius, and, moreover, suggest poor validity and specificity of the Levine questionnaire as the diagnostic tool in suspicion of carpal tunnel syndrome associated with other diseases and injuries of the hand.
THE AIM:Evaluation of children with intervertebral disc calcification (IDC) and own experience.MATERIALS AND METHODS:A retrospective analysis of 7 patients (2 girls and 5 boys) with detected, in the years 1990-2009, IDC. Age at the onset of symptoms (neck pain in 6 patients, torticollis in 4, hip pain in one) was on average 8.7 years (5-13 years). The diagnosis was based on review of radiographs of the spine, which revealed the presence of calcifications within the intervertebral discs in the cervical (4 patients), cervical and thoracic (2 patients) and thoracic spine (1 patient). The mean level of IDC on average was 3.3 spaces (1-6).RESULTS:After conservative treatment, including use of nonsteroidal anti-inflammatory drugs and rest, the symptoms subsided within 1-2 weeks. 4 patients had a return of pain in the neck, in one year, but the symptoms were milder and resolved within a few days. The mean observation period was 9 years (3.5-16 years). In 4 patients, changes disappeared completely, while in the remaining three there was a very discrete calcifications. One patient, after 6 years, had a pain in the neck, and CT showed minor lytic changes on the surface of the vertebral bodies between which calcification occurred.DISCUSSION:ś IDC is a rare disease of the spine in children, but should be taken into account in cases of vertebral pain. Usually the disease affects children before the age of 10 and locates in the cervical spine. But it can be located in every segment of the spine. Most patients have multilevel location. Acute phase of the disease requires conservative treatment. Rarely used surgical treatment should be considered only in patients with persistant neurological symptoms. The natural course of the disease is mild, and over the years calcification gradually disappear spontaneously.
Continuous passive motion (CPM) is frequently used method in the early post-operative rehabilitation in patients after knee surgery. Aim of this study was to evaluate the effectiveness of CPM after primary total knee arthroplasty. Efficacy was assesed in terms of clinical score and functional recovery. 93 patients (101 knee joints) undergoing total knee replacement were assigned into two groups. The experimental group received continuous passive motion and active exercises. A control group received conventional physical therapy only. CPM was initiated in the first day after surgery, for 120 minutes, starting with 0-40 degrees range of motion, increased as tolerated (mean 10 degrees per day) and maintained during the hospital stay. Outcome measures were those included in Knee Society Score (KSS). Functional recovery was evaluated using WOMAC. All subjects were evaluated once before the surgery and on 10th day postoperatively. Mean clinical score (KSS) at the day 10 was 70 +/- 15 points in the experimental group and 74 +/- 12 in a control group. There were no statistical difference between the two groups for any outcome measures. CPM group mean range of motion was 83 degrees +/- 14 degrees and a group without CPM 77 degrees +/- 21 degrees. KSS functional score was 66 +/- 9 points in the experimental group compared to 62 +/- 7 points in a control group. Subjective estimation of pain level, joint stiffness and function showed no statistical difference between the two groups regarding total and subscale scores. Mean total score was 24 +/- 19 points in the CPM group and 22 +/- 17 in a group without CPM. These findings show that CPM had no significant advantage in terms of improving clinical measurements. However, there was beneficial effect on subjective assessment of pain level, joint stiffness and functional ability.
Since November 1989 till the end of 2007 year we have been operatively treating 752 of acetabular hip fractures. We have analised 750 operated patients, two patients bilateral fractures. The follow up span lasts from 2 till 20 years. The age of treated patients is from 14 till 79 years old. These fractures were divided into those operated to 21 days after trauma--569 operated acetabulum. And those operated after 21 days after trauma--183 patients with the delayed reconstruction of acetabular fractures from 22 till 229 days. Both groups were provided detailed assesement. And next we compared fracture reduction of broken acetabulum and assesement of clinical treatment. The types of fractures were defined according to classification of Judet-Letournel. The criteria of fracture reduction due to Letournel. The clinical result was based on Merle d'Aubigne-Matta scale. In the group of treated patients till 3 weeks after trauma, we have received 83.8% of very good and good results, 6.9% fair results and 9.3% poor results. During fracture reduction: 75% very good, 4% in secondary joint congruence, 17.8% fair and 3.2% poor. After fair reduction there was always the right congrugence between the head and acetabulum. The displacements to 3 mm were left in more cases as a part after weight-bearing area. In trauma fracture trated after 3 weeks, the result was very good and good 66.1%, fair 14.8% and poor 19.1%. During fracture reduction: 49.7% very good, 4.4% secondary joint congruence, 32.8% fair and 13.1% poor. We have noticed the crucial corelation between fracture reduction and the final result of treatment. Additional traumae, especially head with long time loss of consciousness and the traumae of chest with insufficient breathing have indirect infulence on treatment results causing the longer operation waiting. The complexity fractures also indirectly influence on the result of treatment decreasing the chances on anathomical fracture reduction.
INTRODUCTION:The most common cause of spinal pain syndromes (SPS) is overload of the spine. It damages the function of the spine and the morphology of the spine's tissues. The literature suggests that a generalized insufficiency of connective tissue, which manifests itself as a hypermobility of joints (JHM), might be one of the causes of overload. The authors decided to evaluate, whether a frequency of the prevalence of JHM is greater within the population of patients treated because of spinal pain syndromes, and whether JHM might be a pathogenetical factor in sps.MATERIAL AND METHOD:The material consisted of 8014 case records of patients treated in Rehabilitation Clinic because of dysfunctions and diseases of locomotoric system during 7 years. 7061 of those patients were treated for sps. The control group consisted of 953 patients without SPS, treated because of other reasons. All patients underwent an examination to screen for hypermobility. Four simple maneuvers of the peripheral joints and joints of the spine were performed. If hypermobility of joints was detected during testing, the patient underwent a complete examination of 13 tests using the Sasche criteria modified by Kapandij and was interviewed to screen for accompanying symptoms of hypermobility.RESULTS AND CONCLUSIONS:Hypermobility syndrome is recognized much more often in patients with spinal pain syndromes, than in patients treated because of other diseases (7.9% i 0.7%) and twice more often in females than in males (69.7% i 30.3%). Among young people, under 30 years of age hypermobility occurs in 55% of population with SPS. In the youngest patients HMS may be the cause of overload spinal pain syndromes, and a predisposition factor towards spinal pain syndromes in older patients.
Although congenital talipes equinovarus (CTEV) is one of the most frequently occurring congenital defects of locomotor organs, its ethiopathogenesis is still not fully known. Amongst the others, the inheritance patterns of that defect are not fully known, and that restricts genetic therapeutics and development of new treatment technologies. The aim of this study was analysis of family lineages of 205 children with CTEV (298 feet) treated at our centre in the years 1998-2008. The family occurrence of CTEV was found in 16 cases (8% of analysed group). 6 lineages, in which CTEV occurred in successive generations, were analysed in detail. Particularly interesting is the lineage of the family 1, in which the defect occurred in three successive generations. In case of that family, an autosomal dominant inheritance pattern is possible. Previously that pattern of CTEV inheritance was described only for isolated populations of Polynesians. In own material the family occurrence of CTEV was found to be less frequent than in bibliographic references. The defect occurred twice as often in boys, while the severe form was more frequently observed in girls, and that is consisted with data in the available bibliography. The analysis of presented lineages of families with CTEV did not allow unambiguous defining of the inheritance pattern for that defect. To confirm the autosomal dominant pattern of CTEV inheritance in the family in which the defect occurred in three successive generations, genetic tests would be necessary.
BACKGROUND:Ischial tuberosity fractures in children are a form of avulsion fractures caused by the strong thigh muscles of the back group (ischiotibial muscles).OBJECTIVE:Presentation of observations covering the diagnostic difficulties, treatment and follow-up of ischial tuberosity fractures in children.MATERIAL AND METHODS:6 children (one girl and five boys), average age at the time of injury - 13.6 years (12-15.5 years). An analysis of medical and radiological documentation of patients.RESULTS:Two patients with chronic pain were suspected of ischial bone tumor, one was suspected of Perthes disease, and only 3 were sent to the Traumatology Department immediately after the football injury. All patients were treated conservatively. Complete healing of fractures was finally achieved in all patients - (fibrous union in two cases) and finally, after an average period of 9 months, the pain subsided.CONCLUSIONS:There is a discussion in medical literature about the difficulties in the diagnosis of ischial tuberosity fractures, which were primarily unrecognized. Radiological picture of significant bone rebuilding may suggest neoplastic lesions. In the literature dominates the attitude of conservative treatment. Only in cases of large displacement of fracture and chronic ailments caused by pressure on the sciatic nerve, surgery should be considered.
BACKGROUND:It is unusual for the hips to be affected by psoriatic arthritis. But in that rare cases, totalhip replacement (THR) is at present an accepted treatment in patients with severe and painfull deformity. The aim of this paper is to evaluate the results of THR in patients suffering from psoriatic arthritis of the hip, operated from 2000 to 2008 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences.MATERIAL:Material included 4 patients, 2 females and 2 males, on whom 5 THRs were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 48 to 61 years (mean 53). Follow-up ranged from 2 to 10 years (mean 6 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cementeless total hip arthroplasty was used during all of the THRs.METHOD:The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system.RESULTS:The average preoperative Harris score for the group of patients was 31, WOMAC score 77. After an average of 6 years follow-up all hips were considered excellent, with average Harris score of 90, WOMAC Score of 5. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 30-48 (mean: 39 degrees) and the acetabular opening angle was 3-20 degrees (mean: 4 degrees). The stem was neutral-oriented in all hips. No ectopic ossification concentrations were found.CONCLUSION:The hip may be involved by the psoriatic arthritis. Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of psoriatic arthritis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. Ectopic ossification is not the clinical problem during THR in patients who suffer from psoriatic arthritis.
BACKGROUND:Total hip replacement (THR) is at present an accepted treatment in patients with severe osteoarthritis of the hip after slipped capital femoral epiphysis. The aim of this paper is to evaluate the results of THR in patients suffering from secondary osteoarthritis, operated from 1987 to 2004 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences.MATERIAL:Material included 16 patients, 9 females and 7 males, on whom 18 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 32 to 70 years (mean 50). THR was carried out after 33 years afterwards slippage of capital femoral epiphysis. Follow-up ranged from 6 to 23 years (mean 11 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented total hip arthroplasty was used during 5 of the THR, 13 of them were cementless.METHOD:The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system.RESULTS:The average preoperative Harris score for the group of patients was 32, WOMAC score 74. After an average of 11-years follow-up all hips were considered excellent, with average Harris score of 91, WOMAC Score of 6. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 22-49 degrees (mean: 36 degrees) and the acetabular opening angle was 0-10 degrees (mean: 4 degrees). The stem was valgus-oriented in 1 hip, and neutral-oriented in 17 hips. No ectopic ossification concentrations were found.CONCLUSION:. Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of osteoarthritis secondary to slipped capital femoral epiphysis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Importantly, THR was carried out after a quite long time after slippage of capital femoral epiphysis.
Injury to the scapholunate ligament is considered the most common and burdened with the most negative squeals cause of the carpal instability. The article provides information on the functional anatomy of the scapholunate complex and the consequences of the tear of the ligament that joints these bones. Rupture of this ligament, associated with tear of extrinsic (secondary) stabilizers of the wrist leads on to dislocation of the carpal bones one against another and, finally, results in carpal instability. Classifications of the severity of the instability based on radiological and arthroscopic grounds were presented. Clinical symptoms and signs of the condition were described as well as imaging techniques helpful in its diagnosing. The usefulness of arthroscopy was emphasised in diagnosing of scapholunate complex disturbances, particularly those which are negative radiologically and present with no typical symptoms.
INTRODUCTION:The aim of the study is assessment of ambulatory status in skeletally mature patients with myelomeningocele and scoliosis, as well as analysis of walking abilities on general physical function, quality of life, self-perception and motivation.MATERIAL AND METHODS:Prospective study was done on 19 patients in the mean age of 21.4 years. Those treated operatively for spinal deformity were excluded from the study. Several questioners were used for assessment of: dysfunction related to spinal deformity, general physical function, quality of life, self-perception and motivation. To describe ambulatory status Hoffer classification was used. Motor neuron level was assessed according to International Myelodysplasia Study Protocol.RESULTS:There was no correlation between walking abilities and Cobb angle, general physical function, quality of life, self-perception and motivation. Older patients and those with higher spine dysfunction had less chances for independent ambulation. Odds ratio shows, that independent walkers have 2.5 less chances for skin problems than sitters.CONCLUSIONS:The most important factor that determines walking ability is level of spine dysfunction. Walking ability may deteriorate with age. Patients general physical function, quality of life, self-perception and motivation in not related to ambulatory status.
Pelvic and acetabular fractures are common injuries in the time of rising traffic level and often affect young people, that's why this kind of injury during pregnancy must be considered. Despite lapse of years this subject is seldom raised in literature. Conservative treatment was usually recommended. We came across a single case report of surgical treatment of acetabular fracture during pregnancy, it was 18th week of pregnancy at the moment of accident. The aim of this study is detailed description of surgical treatment of hip joint acetabular fracture with fragment dislocation of 29 years old female at 27th week of pregnancy. Patient was involved in road accident, car passenger, she suffered: transverse fracture of the hip acetabulum with central dislocation of the femoral head, left distal radius fracture, head injury with concussion, numerous face injuries. Patient was treated surgically in 15 day after accident: open reposition and synthesis of a fracture. Course of operation as planed. Patient was discharged and advised to walk with crutches. Patient delivered healthy child by caesarean section at full-term afterwards. The outcome of acetabular fracture treatment was very good (18 points on a scale Merle d'Aubigne-Matta).
On the basis of 60 cases authors analyze treatment results of the humeral lateral condyle fractures in children. This type of fracture is a second most common elbow fracture in children after supracondylar fracture of the humerus. Authors consider this fracture to be the most difficult to diagnose among all elbow injuries. Analyzed cohort of patients consists of 54 at age between 1.5 to 10 years and 6 patients between 12 to 17 years of age. In 75% of cases operative treatment was delayed due to late referral from other hospitals. According to appearance of the fracture line on X-rays there were 53 cases of type II and 7 cases of type 1 according to Milch classification system. The amount of displacement was evaluated according to Jakob scale and there were 35 cases of III degree, 17 cases of II degree and 8 cases of I degree of displacement. All patients were evaluated with antero-posterior and lateral distal humerus x-rays. In some cases other diagnostic techniques were used. In older children computerized tomography and in younger children ultrasound examination was performed. The treatment results were evaluated according to Hardacre scale. Follow-up time was 1 to 13 years. There were 27 very good and 27 good results in a 54 cases group of patients who underwent surgery within 15 days since injury. In other group which consists of 6 patients who underwent surgery more than 5 weeks after injury there were 2 cases of very good, 2 cases of good; and 2 cases of bad results. Authors believe that putting a proper diagnosis of humeral lateral condyle fracture in children and performing an operative treatment results in a good and a very good outcomes. Basing on the analysis of treatment results of authors cohort of patients, they claim that precise diagnosis and proper determining of degree of displacement increases the number of patients qualified to operative treatment.
INTRODUCTION:Metal-on-metal bearings characterize lower wear than metal-poly, lower fracture risk than ceramics and they allow for the manufacturing of large diameter heads. The metal ion release from the bearings is the the major concern of these articulations.MATERIAL:The study group consisted of 16 patients who underwent hip resurfacing with Durom implant and had minimum 1 year follow-up period. Blood from the patients was collected 4 times: before the surgery, 2, 6 and 12 months postoperatively.METHODS:Clinical examination was done according to HHS, Radiographic image was used to measure the cup inclination, evaluation of chromium and cobalt ion blood levels was performed using graphite furnace atomic absorbtion spectrometry (GFAAS).RESULTS:The levels of cobalt and chromium increased postoperatively significantly to decrease slightly at 6 months. At 1 year cobalt levels increased to the similar level like at at 2 months. The chromium level decresed to the values as low as preoperatively. The mean cup inclination angle measured on X-rays was 48 degrees(range 39 degrees - 56 degrees). The mean HHS result was 89.86 (range 64.43 to 98.73). The mean activity level measured with UCLA scale was 6 (range 3-9).CONCLUSIONS:The metal ion blond levels increase sigficantly in the period 2-6 months following hip replacement with large diameter metal-on-metal articulation. In further examinations at 1 year post-op ion levels decrease.
We present the case of spontaneous damage to the patellar tendon in a patient with pathologic obesity (BMI = 41), without comorbid conditions. Damage occurred during normal load combined with the movement of the knee extension when inserting a foot in flip-flops. Surgical treatment was performed in a matter of urgency and the patellar tendon was sutured in half the length of. Six weeks of immobilization was used and then rehabilitation. After four months efficient gait and a good range of motion was achieved. Please note that obesity is a disease of civilization and cause further disease. These include acute injuries resulting from a sudden overload.
This paper presents a method for determining the proper diagnostic techniques and the respective therapy in patients affected with nerve root compression in the lumbar region of the spine based on developing an algorithm that attempts to assess the level of compression and determine the afflicted nerve root. The clinical picture of degenerative disease of the lumbar spine is characterized by symptoms related to the affected nerve root. The diagnosis and respective therapy benefits from the use of minimally invasive techniques, such as selective root blocks or use of the radiofrequency. For instance, with changes on many levels it is necessary to comply with the rules for the selection of the correct nerve roots so there can be referral for proper treatment. The method of selection is dependent on the correlation of the results of the clinical examination, as well as secondary diagnostic studies, of which the gold standard is the MRI. In clinical practice we rely on the results of magnetic resonance imaging to determine the nerve root level in the lumbar spine. This allows the classification of the roots in relation to the frequency of compression occurrence along its course. The morphologic changes resulting in a similar clinical picture may indirectly suggest a degree of exacerbated risk. In addition, we suggest a system of describing the MRI scans, which allows us to retrospectively obtain information on the locations of potential compression of nerve roots.
The study characterizes the idea behind the research project which consists in biomechanical and kinesiological analysis of three point crutch gait. The structure of the study is in part similar to an earlier publication of the authors [1], which discussed swing through gait. By defining the three point crutch gait and describing its general kinematic structure as well as synthetically analyzing the state of knowledge, the authors formulated the purpose of the study, the adopted research model - including the description of the modern and integrated measurement systems that were used and which consisted of: 2 AMTI force plates integrated into a measurement walkway, a set of 6 optoelectronic cameras of the BTS System as well as a multichannel kinesiological electromyography performed with the use of the NORAXON System. All phases of the research were characterized, presenting the adopted research protocol in its entirety.
There is an increasing number of hip joint arthroplasty procedures all over the world which are followed by revision surgery. The cases of severe bone loss and periprosthetic fractures revision of a stem can constitue a serious challenge even for an experienced orthopedic surgeon.In the research material there are 18 patients 6-50 months after the stem of the hip prosthesis revision with Stryker Restoration modular stem.Clinical evaluation according to HHS protocol, the quality of life measured with SF-36 form, and physical activity evaluated using UCLA score. The methods are also AP and X-Ray of both hips and lateral X-ray of revised hip with osteolysis around stem, stem subsidence, and difference in leg length evaluation, as well as the comparison of hip offsets.Mean HHS score was 78.6 pts, mean SF-36 based quality of life 50.5 pts, and the mean UCLA 4.72. Radiolucent zones around the stem were observed in several cases which were correlated with the stem subsidence.The clinical results in this study are similar to those from the literature, and slightly lower than of the patients after primary hip arthroplasty, particularly in function measuring subscales. The quality of life scores of our patients was significantly lower than reported by other authors in cases of hip revision arthroplasty. There was no case of aseptic loosening. Further observation of the patients considering osteolysis and its relation to stem subsidence is needed.
