Polish Orthopedics and Traumatology
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Open Access journal
ISSN (Print) 0009-479X
This journal is no longer being updated because:
The journal ceased publication in 2014
- Pol Orthop Traumatol 2013; 78:139-150 "Injuries of the distal
Authors: Adrian Błasiak; Bogusław Sadlik, Roman Brzóska
Abstract: Background: Inuries to distal tibiofibular syndesmosis are common in clinical practice in traumatology and are particularly frequently associated with ankle or high fibular fracture (Maisonneuve fracture). Isolated syndesmotic injuries are less frequently observed – more often among athletes. Although injuries to ankle syndesmosis are numerous, methods of diagnosis and treatment remain controversial, and present diagnostic and therapeutic challenges.Material/Methods: Medical databases PUBMED, MEDLINE EMBASE and OVID were searched by entering the key words such as tibio-fibular syndesmosis, ankle ligaments, ankle injuries, ankle fracture, ankle instability.Results: Almost 200 publications regarding the topic were chosen. Important information on anatomy, causes and mechanisms of injury, diagnostics and current concepts of treatment of the distal tibiotibular syndesmosis were selected.Conclusions: Proper and early diagnosis and appropriate treatment, either conservative or surgical, is essential for full recovery. Due to numerous controversies regarding diagnosis and treatment of syndesmosis injuries more research is needed to establish strong recommendations for management of such injuries.
- Pol Orthop Traumatol 2013; 78:121-126 "Is carpal tunnel syndrome an
occupational disease' A review "
Authors: Andrzej Żyluk
Abstract: In many countries, including Poland, carpal tunnel syndrome is considered to be a disease of possible occupational etiology. This review presents information about work-related risk-factors which comprise the use of handheld vibrating machinery, forceful gripping of objects with hands, repetitive and frequent manual tasks and forced postures of the wrist (flexion/extension). However, the character of the job is only one of possible several factors leading to the development of the disease, as its etiology is multifactorial. Conditions to be taken into consideration when recognizing a case as occupational carpal tunnel syndrome were shown to include: coexistence of predisposing diseases (diabetes), constitutional factors (obesity), character, level and duration of the exposure to harmful stimuli during the workday as well as total duration of work upon exposure. Consideration of these circumstances provides adequate ground for recognizing a particular case as occupational. Nonetheless, even accepting the disease as occupational should be temporary, as surgical carpal tunnel release is an effective method of treatment and should allow the patient to return to previously performed work
- Pol Orthop Traumatol 2013; 78:109-113 "Influence of age on the
outcome of rehabilitation after total hip replacement"
Authors: Joanna Dolata ; Krzysztof Pietrzak , Wojciech Manikowski , Jacek Kaczmarczyk , Ewa Gajewska , Wiesław Kaczmarek
Abstract: [b]Background[/b]This publication compares the results of physiotherapy after total hip replacement in two groups, each consisting of 50 subjects, differing in age by 10 years[b]Material and Methods[/b]A group of 100 patients after total hip replacement was divided into two subgroups consisting of 50 subjects each, with mean age difference of 10 years. The first group included patients aged 47–60 years, the other 61–69 years. Patients were assessed at 6 weeks and reevaluated at 10 weeks after surgery during a 4-week in-hospital rehabilitation program. The study was based on a questionnaire, physical examination, 6-minute walking test and a test on stabilometric platform. [b]Results[/b]In the younger group we observed easier and faster resolution of pain in the operated joint. In group II, which included patients aged 61 to 69 years, improvement in hip joint mobility was less pronounced than in the younger group. Six-minute walking test showed less improvement in walking distance in group II than group I. Among group II patients we noted less pronounced increase in weight bearing on the operated limb (by 2%, while 4% improvement was noted in group I), while final degree of weight-bearing was greater in group II than in group I and amounted to 48%.[b]Conclusions[/b]Younger patients recover faster, hip pain subsides easier, hip function returns more readily and to a greater extent. During a 4-week course of in-hospital rehabilitation older patients may regain hip function in a manner that brings them closer to the younger group.
- Pol Orthop Traumatol 2013; 78:101-104 "A modified technique of
placing transpedicular screws into the S1 vertebrae - surgical technique
Authors: Łukasz Kubaszewski ; Jacek Kaczmarczyk , Andrzej Nowakowski
Abstract: Anatomical variability of sacral bone as well as its diverse interpretations a surgical field prompted the authors to modify surgical technique in such manner to allow unequivocal identification of a starting point for introduction of transpedicular screws into the first sacral vertebra.The starting point is not located, as described in previous publications, inferiorly and laterally to the S1 articular process, but goes through a precisely defined place in the dorsal ridge of superior articular process following its partial resection.
- Pol Orthop Traumatol 2013; 78:105-107 "The use of flexor digitorum
superficialis tendon in anterior cruciate ligament reconstruction.
Authors: Leszek Romanowski; Klaudiusz Kosowski , Wiesław Wiśniewski
Abstract: This paper presents the technique used in anterior cruciate ligament(ACL) reconstruction using the ring finger flexor digitorum superficialis tendon (FDS IV). The biologic material used in autografts and allografts is subject of controversy. Due to this some authors suggest using synthetic materials. All the authors agree that the use of biological material harvested from the vicinity of the knee joint can cause further dysfunction of this joint(weakening) It would seem that use of a biological material harvested from another part of body would be the optimal solution for ACL reconstruction. In our opinion the ring finger flexor digitorum superficialis tendon meets this criteria. Its parameters (length, strength, shape) are comparable to currently used biological materials. From experience in hand surgery we know that the harvesting of FDS IV(loss of FDS IV function) does not cause significant loss of function in the hand. It seems that the FDS IV is very well suited for ACL reconstruction. This paper presents the technique used in ACL reconstruction using FDS IV augmented with a synthetic material.
- Pol Orthop Traumatol 2013; 78:97-100 "Długotrwałe zachowanie
aktywności białek morfogenetycznych kości (BMP) w demineralizowanych
Authors: Krzysztof H Włodarski; Grzegorz Szczęsny, Bolesław Kuzaka, Paweł K Włodarski
Abstract: Demineralizowana macierz kości lub zębiny, wszczepione domięśniowo wywołują powstawanie kości w miejscu implantacji. Zjawisko to, zwane „indukcją osteogenezy” wywołane jest uwalnianiem z nich niekolagenowych białek, zwanych Białkami Morfogenetycznymi Kości (BMP). Demineralizacja ułatwia ich uwalnianie z macierzy a osiągnąwszy odpowiednie stężenie, te sygnałowe białka pobudzają różnicowanie się komórek mezenchymatycznych biorcy w kierunku osteo- i/lub chondrogennym. Macierze zmineralizowane w podobnych warunkach przeszczepiania uwalniają białka BMP zbyt wolno, by osiągnęły stężenie progowe, wyzwalające różnicowanie, przeto nie indukują osteogenezy. Na rynku dostępne są czyste postacie białek morfogenetycznych, lecz w wielu przypadkach stosowanie kości demineralizowanych ma przewagę nad izolowanymi białkami BMP, gdyż łączą w sobie własności osteoindukcyjne z walorami mechanicznymi, tak pożądanymi w osteosyntezach i wypełnianiu ubytków kostnych. W niniejszej pracy wykazano, że przechowywanie dmineralizowanych i liofilizowanych siekaczy myszy przez okres co najmniej 30 miesięcy nie zmienia ich potencjału kościotwórczego i zdolności do kolonizowania indukowanej kości szpikiem. Liofilizowaną zębinę, przechowywaną przez 0–30 miesięcy w temperaturze lodówki przeszczepiano do mięśni udowych myszy i miejsce implantacji oceniano histologicznie po 10–450 dniach. Tkankę kostną, ściśle połączona z implantowaną zębiną stwierdzono w ok. 87% przypadków a czas przechowywania matryc w przedziale czasowym 0–30 miesięcy nie wpływał na ich zdolności osteoindukcyjne.
- Pol Orthop Traumatol 2013; 78:91-96 "
Total elbow arthroplasty in
complicated distal humerus fracture – a case report "
Authors: Maciej Kaźmierczak; Krystian Stanisław Pyszel, Paweł Henryk Surdziel
Abstract: Background:Total elbow arthroplasty is still a rarely performed surgical procedure in distal humerus fractures. Reconstruction and osteosynthesis using Locking Compression Plates remains the gold standard for treatment of such types of fractures.Case Report: We report a case of 51-year-old man with distal humerus fracture and early destabilization of primary osteosynthesis, successfully treated with total elbow arthroplasty, resulting in excellent physical function of the operated elbow.Results: Several studies performed over the last decades demonstrated that total elbow arthroplasty in many cases may be a beneficial method of treatment. Osteoporosis, comminuted fractures, older age and early destabilization of primary osteosynthesis are the most common indications for considering elbow arthroplasty.
- Pol Orthop Traumatol 2013; 78:85-89 "Clinical assessment of the
efficacy of SpineCor brace in the correction of postural deformities in
the course of idiopathic scoliosis"
Authors: Barbara Plewka; Marcin Sibiński, Marek Synder, Dariusz Witoński, Katarzyna Kołodziejczyk- Klimek, Michał Plewka
Abstract: [b]Background[/b]The objective of the study was to perform a clinical, comparative assessment of the degree of postural deformities before and after the treatment of idiopathic scoliosis in patients treated with SpineCor brace compared to the control group.[b]Material and Methods[/b]A group of 90 children with idiopathic scoliosis (including 74 girls) at the average age of 12.2 was subject to prospective observation. Average pre-treatment Cobb angle was 24.9° in the thoracic spine and 25.8° in the lumbar spine. The group actively treated with the SpineCor brace consisted of 45 children, while the control group consisted of the remaining 45 children with the natural course of the disease.[b]Results[/b]Both groups did not differ significantly in terms of age, gender, height, body weight, Risser sign of skeletal maturity and baseline clinical and radiological parameters of scoliosis. Significant reduction of rib hump was observed upon 2-year SpineCor brace treatment (P=0.04) compared to the group treated by physiotherapy only (P=0.91). Similarly, improvement in lumbar prominence was observed in the actively treated group (P=0.009), with a trend towards worse results in the control group (P=0.07) In the group treated with the SpineCor brace, significant reduction in pectoral and hamstring muscle contractures as well as reduction in shoulder asymmetry and reduction in anterior and posterior vertical deviation were observed. [b]Conclusions[/b]Treatment using the SpineCor dynamic brace leads to a clinical improvement in posture, particularly to reduction in rib hump, lumbar prominence and muscular contractures.
- Pol Orthop Traumatol 2013; 78:29-31 "Impact of athletic activity on
the stability of the lower limb joint prosthesis"
Authors: Krzysztof Pietrzak; Jacek Kaczmarczyk, Wiesław Kaczmarek, Jacek Markuszewski
Abstract: This publication analyses the impact of athletic activity on the stability of lower leg implant. Analysis of literature does not allow for a clear answer whether such activity is an independent predictor of early loosening. Number of publications warning patients against excessive sports activities, equals the number of reassuring reports.
- Pol Orthop Traumatol 2013; 78:1-3 "Vitamin D concentration in
patients with normal and impaired bone union."
Authors: Andrzej M. Boszczyk; Piotr Zakrzewski, Stanisław Pomianowski
Abstract: Background: The aim of the study was to compare vitamin D concentration in patients treated due to delayed bone union and non-union (pseudoarthrosis) and patients with normal fracture healing.Material/Methods: A retrospective case-control study was conducted. We enrolled 35 patients with inexplicable (standard and correct surgery, closed fracture, no comorbid metabolic diseases) fracture healing impairment, and 35 patients assigned by age and measurement season. Vitamin D (as 25OHD) concentration was measured in all patients.Results: Vitamin D deficiency was reported in 86% of examined patients. No difference was shown between groups in deficiency prevalence.Conclusions: Previous studies indicated decreased vitamin D concentration in patients with impaired fracture healing. However, these studies did not include control groups. No difference was demonstrated between patients with normal fracture healing and those with impaired bone union in terms of vitamin D deficiency prevalence.
- Pol Orthop Traumatol 2013; 78:5-27 "Proprioception exercises in
Authors: Wanda Stryła; Adam M. Pogorzała, Justyna Stępień
Abstract: Proprioception, or kinesthesia, is the sense of orientation responsible for perception of body and relative position of its parts. Kinaesthesia is received by receptors located in muscles and tendons. In this study a set of proprioception developing exercises was presented. Proprioception should be restored in case of musculoskeletal and neurological disorders. Proprioception training can also be used as a prophylaxis before starting various sporting activities. Proprioception developing exercises have significant meaning for the elderly, who are at risk of balance disorders. These exercises help developing motor memory and at the same time protect from falls
- Pol Orthop Traumatol 2013; 78:33-39 "
Algorithm of physical therapy
exercises following total hip arthroplasty "
Authors: Wanda Stryła; Adam M. Pogorzała, Piotr Rogala, Andrzej Nowakowski
Authors present a set of exercises for patients after total hip replacement (THR) treated due to idiopathic hip joint osteoarthritis. Outcome of surgical treatment depends largely on physical therapy conducted after the procedure. Physical therapy following total hip arthroplasty involves restoration of proper physical function. Exercises increase the strength of hip girdle muscles and stabilize the involved hip joint. Total postoperative rehabilitation improves the gait esthetics. Restoring patient’s full independence in everyday and professional life after total hip arthroplasty is the best test for properly conducted rehabilitation. A rehabilitation algorithm following hip arthroplasty was established based on the data acquired from literature and authors’ own studies. Methods of rehabilitation following total arthroplasty was unified with regard to the type of endoprosthesis (cemented and non-cemented). Rehabilitation after revision and cancer arthroplasties were not taken into consideration. Exercises were divided into those performed in supine and standing positions as well as resistance training (using an elastic TheraBand® tape). At a later stage of rehabilitation, marching and walking as well as cycloergometer training were included. Patient’s position during the day and in the sleep for two months following THR was taken into account, including some types of exercises that are contraindicated and pose a threat of endoprosthesis luxation.
- Pol Orthop Traumatol 2013; 78:41-45 "Outcome of treatment of complex,
perilunate fracture-dislocation of the wrist: A case report"
Authors: Andrzej Zyluk; Bernard Piotuch, Piotr Puchalski
Abstract: Complex, perilunate fracture-dislocations of the wrist comprise severe and challenging injuries, characterised by a total loss of contact between the lunate bone and the head of the capitate as well as fracture of one, or more bones surrounding lunate bone. The principle of treatment of such injuries involves stable fixation of fractures, anatomical reduction of the displaced carpal bones with temporary arthrodesis wit K-wires to maintain their position. We present a patient who sustained a complex, perilunate fracture-dislocation of the wrist with fractures of the scaphoid, hamate and base of the IV metacarpal bone, as a result of a blast. A ssessment at one year after the surgery showed satisfactory result: mean range of motion in the wrist was 50-60% of the healthy side, grip strength was 55%, DASH score of 36 and Mayo score of 65.
- Pol Orthop Traumatol 2013; 78:47-51 "The impact of aerobic exercises
on bone mineral density in breast cancer women during endocrine
Authors: Katarzyna Hojan; Piotr Milecki, Piotr Leszczyński
Abstract: Background: The assessment of the impact aerobic exercises on bone mineral density in breast cancer women during endocrine therapy (ET). Material/Methods: The study included 53 women (mean 44.3 ±SD 4.9) during breast cancer treatment. This was a nonrandomized, prospective clinical study. The following examinations of the assessment of bone in the DEXA were measured: the bone mineral density of the neck of a femur (FN), lumbar region L1-L4, and total body (TB) as well as defining of T-score and Z-score. The examinations were conducted for all the patients according to the schedule: before the beginning of ET, after 6 months of ET and after 12 months of ET (after 6 month aerobic training). Results: After the first 6 months of ET without regular physical exercise the following results were noted: the BMD mean value of FN, in the L1-L4 spine region and in TB were significant lower than the initial value. After 6 month aerobic training, in the 12th month of the follow up, the BMD mean value of FN was 1.1% (p>0.05) lower, while in the L1-L4 spine region it was 5.6% (p<0.05) lower, and in TB 2.7% (p<0.05) lower in comparison to the values in the sixth month of the observation. Conclusions: That even short course of ET is related to changes in bone mineral density. The introduction of aerobic exercises caused a slowdown in negative changes in bones.
- Pol Orthop Traumatol 2013; 78:53-58 "Clinical and functional
evaluation of patients after total elbow arthroplasty"
Authors: Przemysław Lubiatowski; Izabela Olczak, Ewa Lisiewicz, Maciej Bręborowicz, Jan Długosz, Marcin Redman, Piotr Ogrodowicz, Leszek Romanowski
Abstract: Background: The operation of the total elbow arthroplasty (TEA) is recommended in case of advanced joint destruction. At present both in our country and abroad, the number of elbow arthroplasties performed per year is increasing. Surgical procedures are difficult, and postoperative complications may arise. The aim of this study is to evaluate the function of the elbow and the clinical status of patients after having undergone TEA. Material/Methods: Our research is based on 18 patients who had undergone total elbow arthroplasty. The average patient age was 60. The follow-up time varied from 8–108 months. Postoperative assessment included the evaluation of the range of motion and grip strength using a dynamometer. Functional evaluation was carried out using Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) and the SECEC Elbow Score (SES). We had also assessed the pain level (VAS), postoperative complications and patient satisfaction. The study included X-rays of the elbow for the evaluation of prosthesis integrity and possible signs of implant loosening. Results: The increase of the range of motion was seen among all patients. The amplitude of flexion and extension increased by an average of 25.3° (p<0.02). The results of all questionnaires of functional assessment showed a significant improvement comparing to results before surgery: DASH – 82.6 (±24.6) vs. 116.7 (±24.2), SECEC – 39.3 (±8.5) vs. 27.9 (±9.2), MEPS – 65 (±23.3) vs. 35.8 (±16.9). The VAS pain decreased from 10.9 (±3) to 5.3 (±4). In the postoperative period, 4 patients experienced inflammation, 2 patients had a loosening of prosthesis, and 6 needed a revision of the prosthesis. 94.4% patients were satisfied with the treatment. Conclusions: Total elbow arthroplasty effectively improves the clinical status of the patient by reducing pain, increasing range of motion and improving many activities of daily life.
- Pol Orthop Traumatol 2013; 78:59-63 "Clinical examination vs. MRI:
Evaluation of diagnostic accuracy in detecting ACL and meniscal injuries
in comparison to arthroscopy."
Authors: Mohammed Azfar Siddiqui; Ibne Ahmad, Aamir bin Sabir, Ekram Ullah, Syed Amjad Ali Rizvi, Syed Wajahat Ali Rizvi
Abstract: Background: To compare the diagnostic accuracy of clinical examination and MRI in evaluation of meniscal and ACL injuries using arthroscopic findings as reference standard.Material/Methods: A total of 51 patients with traumatic knee injuries were identified and prospectively followed up with clinical examination, MRI and arthroscopy. Clinical examination and MRI findings were compared with arthroscopic findings. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated with statistical analysis.Results: Out of 24 patients with arthroscopic evidence of medial meniscal injury, clinical examination and MRI correctly identified 20 and 18 patients, respectively. Clinical examination was characterized by better sensitivity and specificity with regard to diagnosis of medial meniscal tear. On arthroscopy, lateral meniscal tear was present in 13 patients; clinical examination and MRI both identified 8 of them correctly. Similarly, out of 9 patients with arthroscopic evidence of ACL tear, clinical examination and MRI correctly identified 7 and 8 patients, respectively. There were only marginal differences in sensitivity and specificity of clinical examination and MRI in diagnosis of lateral meniscal and ACL injury.Conclusions: Careful clinical examination is much better than MRI with regard to the diagnosis of medial meniscus injury and is as reliable as MRI with regard to diagnosis of lateral meniscus injury and ACL tears. MRI should be used to rule out such injuries rather than to diagnose them.
- Pol Orthop Traumatol 2013; 78:65-69 "Mortality as an indicator of
treatment quality after pertrochanteric fractures in the elderly."
Authors: Bogdan Koczy ; Jacek Semenowicz , Jacek Majewski , Jakub Wąsik
Abstract: Background: Fractures in people over the age of 65, especially pertrochanteric fractures of the femur, present a growing medical problem. Surgical treatment of such fractures should be performed in the shortest possible time after the accident.Efforts were made to answer the question what contributes to the reduction in mortality after pertrochanteric fractures.Material/Methods: This work presents a comparative analysis of two populations treated surgically due to pertrochanteric fractures at the District Hospital of Orthopedic and Trauma Surgery in Piekary Slaskie during years 1988–1992 and 2005–2008. Patient mortality was used as an indicator of treatment quality. In the first group of 118 patients hospitalized in years 1988–1992, there were 48 deaths reported during 12 months after the surgery. In the second studied population of 244 patients (operated in years 2005–2008), 54 deaths were noted in the 12-month period after the surgery. There was a reduction in mortality from 40.6% to 22.3% over those 15 years.Conclusions: Introducing mortality as an indicator in the comprehensive assessment of treatment quality will intensify its monitoring in both the hospital as well as the out-of-hospital period of care. It will also reveal the individuality and social importance of geriatric fractures.
- Pol Orthop Traumatol 2013; 78:71-76 "Organization and activity of the
Replantation Service for amputated hands in Poland"
Authors: Andrzej Żyluk
Abstract: A permanent on-call service for hand amputations (Replantation Service) was established in 2010 of the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. Organization of this system, rules of activity and spectrum of cases admitted to replantation units was presented. A scheme of referral of amputations was shown and the main problems that appeared during almost three-year activity of the Service were discussed. Medico-legal and ethical implications arising from these problems were shown and organization of replantation service in other European countries was outlined. Establishing of the Replantation Service constituted a significant progress in the organization of the management of upper limb amputations. Thanks to that, over the period of three years, more than 200 patients were saved from severe disability, receiving a chance to regain an amputated limb.
- Pol Orthop Traumatol 2013; 78:77-84 "Distal radioulnar joint
instability: A review of literature"
Authors: Andrzej Żyluk; Bernard Piotuch
Abstract: Distal radioulnar joint instability most commonly accompanies fractures of the distal radius and is directly caused by lesion of the triangular fibrocartilage complex, which is the major structure responsible for congruity of the distal radioulnar joint. Acute instability accompanying fractures of the distal radius usually does not require separate management, if the fracture itself is firmly fixated. Chronic instabilites causing persistent pain and wrist dysfunction are treated by arthroscopic reinsertion of the torn attachments of the triangular fibrocartilage. If not possible, radioulnar functional tenodesis is performed using palmaris longus tendon graft, thus restoring joint stability.