Showing papers in "Ortopedia, traumatologia, rehabilitacja in 2007"

Effect of Kinesio Taping on bioelectrical activity of vastus medialis muscle. Preliminary report.

Abstract: BACKGROUND: Kinesio Taping is currently regarded by physiotherapists as a method supporting rehabilitation and modulating some physiological processes. It is employed e.g. in orthopaedics and sport medicine. This sensory method supports joint function by exerting an effect on muscle function, enhancing activity of the lymphatic system and endogenous analgesic mechanisms as well as improving microcirculation. The aim of the study was to determine the effect of Kinesio Taping on changes in the tone of the vastus medialis muscle during isometric contractions. MATERIAL AND METHOD: The study group included 27 healthy persons. A Kinesio Tape was placed to support the function of the medial head of the quadriceps muscle of thigh. Transdermal EMG was used to assess bioelectrical activity of the muscle. A standardised protocol was employed for measurement of muscle tone, recorded as the peak torque of the muscle. RESULTS: An examination performed 24 hours after the placement of the Kinesio Tape revealed significantly increased recruitment of the muscle's motor units, as expressed by peak torque. An examination performed after 72 hours of kinesio taping showed a statistically significant increase in bioelectrical activity of the muscle. However, this was lower than the effect at 24 hours. In the group where the tapes were removed after 24 hours, high torque was still maintained. CONCLUSIONS: 1. Clinically significant effects of Kinesio Taping in this study included an increase in the bioelectrical activity of the muscle after 24 hours of kinesio taping and the maintenance of this effect for another 48 hours following removal of the tape. 2. The decrease in muscle tone to the baseline value, which was observed during the fourth day of Kinesio Taping use, may have resulted from the time of effective use of the KT tape being shorter than previously believed and may restrict Kinesio Taping use. 3. Kinesio Taping used shortly before the motor activity it is supposed to support may fail to fulfil its function.

Current opinion about using the platelet-rich gel in orthopaedics and trauma surgery.

Abstract: The use of growth factors in combination with tissue engineering seems to be the most promising method in the future for the treatment of tissue, bone and cartilage defect. Growth factors are cytokines with regulatory functions for healing in tissues of the musculoskeletal system. These small peptides are synthesised by resident cells at the site of injury such as mesenchymal stem cells and chondrocytes, or by the infiltrating inflammatory process. Platelet-rich plasma (PRP) is a novel osteoinductive therapeutic approach that is increasingly used in treatment of such complications of bone healing processes. The activator for PRP is a mixture of thrombin and calcium chloride. After connecting these substances platelet-rich gel (PRG) is formed and numerous regulatory molecules to the injury site such as PDGF, TGF-, VEGF, IGF, EGF and antimicrobial proteins are released. The aim of this article is presentation of present knowledge about properties and possibilities of using platelet-rich plasma in the treatment of soft tissue and bone healing disturbances.

Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation.

Abstract: The study documents a general change of position on osteoporosis (definition, diagnosis, aim of treatment) Taking into consideration a multifactorial nature of bone fragility in osteoporosis we do not diagnose "osteoporosis" but a total, individual 10-year fracture risk (AR-10) on the basis of independent and self-sufficient risk factors These are: advanced age, prior fragility fracture, parental history of proximal femur fracture, low BMI, low bone mass, glicocortycosteroids treatment, rheumatoid arthritis, smoking, overuse of alcohol The treatment should be implemented in persons burdened with a fracture risk higher than a population risk The intervention threshold is a result of an agreement and a result of work of various working groups of experts According to Johnell AR-10 below 8% does not require a therapeutical intervention; above 14% justifies the treatment independently of BMD measurement AR-10 between 8% and 14% is an indication for BMD measurement precising fracture risk The aim of the treatment is to decrease fracture risk It combines a limitation of fracture risk factors effects including fall prevention and improvement of bone quality with applying pharmacotherapy This study highlights that a bone mineral measurement, so far accepted as a criteria for diagnosis of osteoporosis or its exclusion should not be made in aim of diagnosis but to evaluate an absolute fracture risk Spinal X-rays are performed in aim to diagnose vertebral fractures, which mean a multiple increase of risk of further fractures The principles of low bone mass differential diagnosis and current possibility of pharmacological treatment are also described Guidelines for fall avoidance in fracture prevention are described

Walking index for spinal cord injury.

Abstract: This review reports on the contemporary possibilities of objective evaluation of walking ability in patients with paraplegia following a spinal cord injury Current methods of evaluation of walking function, ie the ASIA Classification, Functional Independence Measure (FIM), Barthel Index and Spinal Cord Independence Measure (SCIM) are described The latest classification, known as the WISCI (Walking Index for Spinal Cord Injury) is described in detail WISCI is the most detailed scale that is also the most sensitive to changes in the patient's walking ability compared to the other scales

MicroHip: a minimally invasive procedure for total hip replacement surgery using a modified Smith-Peterson approach.

Abstract: This article presents an anterior, minimally invasive surgical approach to the hip joint, aligned along an inter-nervous plane. Positioning in lateral decubitus position on a regular operation table obviates the need for a special orthopedic or fracture table. Traction is not applied. Most of the instruments used for this procedure are standard instruments for reaming of the acetabulum and positioning of the cup; specific, angulated instruments are recommended at least for obese patients. Using an incision of < 6-8 cm, this MI approach provides a perfect view of the acetabulum and proximal femur,including natural landmarks for proper implant positioning. The approach follows the gap between the tensor muscle and the gluteus medius muscle, using part of the anterior ilo-femoral Smith-Peterson approach. No tendons or muscles are cut or detached. The joint capsule is split and left in place. The hip joint is not dislocated; we perform the osteotomy of the femoral neck in situ. To date we have performed several hundred MicroHip operations, with no nerve lesions or trochanter fractures. Definitive results are not yet available, but our experience to date shows that this method can be used with virtually any patient, while such factors as hospitalization time, pain, blood loss and work incapacity can be cut almost in half. The MicroHip technique, used by an increasing number of clinics around the world, can be successfully applied by good surgeons after suitable training.

Current trends in total hip arthroplasty.

Abstract: After 20 years of application, with excellent short-term and long-term results, uncemented total hip arthroplasty (THA) is now generally regarded as the standard procedure for younger patients undergoing THA. However, expectations regarding hip replacement are continuously rising, along with the increasing number of young and active patients undergoing hip arthroplasty: a complication rate, including postoperative dislocation, close to zero, faster postoperative rehabilitation, low wear even in active patients, high durability and long term survival, etc. Demographic changes in aging societies are also leading to an increased need for cost-effective THA for the low-demand trauma patient. For high-demand patients, modern THA bearings, such as ceramic-ceramic articulations and other improved PE and metal materials, provide high durability and low wear, if the components are properly aligned. Navigation technology has been introduced in THA to ensure perfect component positioning without outliers and concomitant risk of increased wear and implant failure. Minimally and less invasive approaches are becoming increasingly popular in order to facilitate rehabilitation and fast-track surgery in younger patients. Navigation provides assistance for implant positioning in procedures with limited surgical exposure and visibility. New bone-preserving implants, such as surface replacement or short-stemmed femoral shaft prostheses, have been introduced especially for younger patients. Some of these new procedures are still under development,and the long-term results of new implant concepts have to be evaluated over the next decades. Not every modern concept will likely stand the test of time, but some will be beneficial for patients undergoing total hip arthroplasty in the future.

Entrapment of the suprascapular nerve: anatomy, etiology, diagnosis, treatment.

Abstract: Entrapment of the suprascapular nerve is a rare peripheral neuropathy, which can be easily overlooked in the differential diagnosis of shoulder pain and dysfunction. Entrapment of the suprascapular nerve can occur at different locations along the pathway of the nerve. The primary symptoms are pain, weakness, and atrophy of the supraspinate and infraspinate muscles. Differential diagnosis should include brachial plexopathy, disorders of the cervical spine, cervical discopathy, glenohumeral pathology, tendonitis, and rotator cuff tear. Accurate diagnosis facilitates appropriate and timely treatment.

Nine-years experience with the use of shock waves for treatment of bone union disturbances.

Abstract: Background Stimulation of bony union by means of various physical modalities has not been widely used in clinical practice. Extracorporeal shock wave therapy (ESWT) offers the most promise. ESWT was first used to crush kidney stones (lithotripsy) in 1980. It is based on a sound rationale. Shock waves penetrate soft tissues and to release mechanical energy at the surface of bone, producing microfractures in sclerotic bone ends and triggering physiologic fracture healing, or "healing of fracture without a fracture". Material and methods Since 1998 we have treated more than 150 patients with delayed and non-unions of fractures using a standard lithotripter. Between 1,500 and 3,000 pulses were generated during one procedure depending on fracture size. Treatment effects were typically seen in the first follow-up radiographs at 6-12 weeks. Results Fracture union was achieved in 83% of the patients after 3-6 months. No complications were noted. The method arguably represents a useful adjunct to the treatment of bone union disturbances. It is a method of choice for patients with non-dislocated bony fragments. It can be used with metal implants or immobilisation in a cast or brace. In patients with dislocated bony fragments, we used the Ilizarov apparatus for correction and compression and shock waves for stimulation of healing. The best results were observed in delayed unions and vital nonunions. Atrophic nonunions did not respond well. Large bone defects did not fill. Conclusions Shock wave therapy is a very effective treatment for delayed union or non-union of bone. It is a safe and complication-free method. ESWT should be considered in every case of delayed union. It may help avoid surgery under favourable conditions.

Penetration of a selected antibiotic and antiseptic into a biofilm formed on orthopedic steel implants.

Abstract: BACKGROUND The aim of the study was to determine the impact of octenidine hydrochloride and gentamicin on bacterial survival and reduction of biofilms formed on orthopaedic metal implants. MATERIAL AND METHODS We studied metal orthopaedic components (screws, nails, fragments of wires used in Ilizarov devices) and a bone sequester. The presence and intensity of biofilm formation on the medical biomaterials was determined using the method of Richards et al. by visual evaluation of 2,3,5-triphenyl tetrazolium chloride (TTC) reduction by viable bacteria. The presence and structure of the biofilm on the components of the Ilizarov device, screws and bone sequester was also studied by electron microscopy. Bacterial survival in the biofilm following exposure to the antibiotic and antiseptic was studied by CLSI microdilution method in microtitre plates using TTC. Results. Most of the 16 strains (S. aureus, S. epidermidis, E. coli, Enterobacter) isolated from orthopaedic implants were able to form a biofilm. Established biofilms were resistant to gentamicin and octenidine hydrochloride but demonstrated greater susceptibility to octenidine. CONCLUSIONS The results of the study indicate that octenidine hydrochloride is more effective than gentamicin in the treatment of infections associated with the formation of a biofilm on orthopaedic implants.

Zone 1 extensor tendon lesions: current treatment methods and a review of literature.

Abstract: The treatment options for the soft-tissue mallet finger, both acute and chronic, continue to generate a certain degree of controversy. Priority should always be given to conservative management of these injuries. This translates into a 6-to-8-week period of uninterrupted immobilization of the DIP joint with an external splint. Splinting has been shown to be highly effective and safe for both acute and chronic lesions. Even in the presence of an open injury, the value of splinting should be appreciated by the practitioner. The conversion of an acute closed, soft-tissue injury to an open one is to be discouraged,due to unacceptable complication rates. When surgery is contemplated, in a selected group of patients, the first option advocated by most authors is the placement of a trans-articular Kirschner wire at the DIP joint and/or conjoint tendon advancement. If external splinting fails in an acute injury, an argument can certainly be made for a second trial of conservative management. It has been found that some patients will not tolerate a second period of immobilization, and in most such cases surgery is offered. In summary, mallet injuries are best treated using closed, nonoperative techniques. The period of time after injury for which this conservative treatment can be prolonged and still be effective is being extended, and the absolute outside time limit remains unknown. Surgical treatment should be reserved for mallet fractures, and in such cases Bunnel's pull-out suture is recommended. Finger rehabilitation is an indispensable part of any method of treatment.

Heterotopic ossification in patients after total hip replacement.

Abstract: Heterotopic ossification (HO) is defined as pathological bone formation in soft tissues, for example in muscles, where physiologically there is no osseous tissue present. It is one of the most common complications of total hip joint replacement surgery. A wide variety of risk factors for heterotopic ossification have been identified to date. Almost 90% of total hip arthroplasty patients are at high risk for HO. There are two primary methods of preventing heterotopic ossification: pharmacotherapy with NSAIDs (non steroid anti-inflammatory drugs) and radiotherapy. Symptomatic heterotopic ossifications are treated by extracorporeal shock wave therapy (ESWT) and surgery, followed by NSAID pharmacotherapy or radiotherapy. The arterioles adjacent to areas of heterotopic ossification are usually embolized prior to the operation. This article describes the state of the art in the prevention and treatment of heterotopic ossifications based on the available literature.

New technique of surgical treatment of malignant calcaneal tumours. Preliminary report.

Abstract: BACKGROUND Malignant tumours of the calcaneus are very rare among children, constituting up to 3% of all bone tumours. This paper presents the outcome of a new technique of surgical treatment of malignant calcaneal tumours in the paediatric population involving the use of a large frozen allogeneic graft of the head of femur with a fragment of the femoral neck. MATERIAL AND METHODS Three patients were treated for primary malignant tumours of bone at our Department. The surgery was preceded by induction chemotherapy. A skin incision was made on the medial aspect of the foot. After the dissection of the calcaneus together with the tumour (Ennecking's wide resection), the defect was reconstructed with a frozen allogeneic bone graft. The graft was modelled and attached to the tarsal bone using metal clasps (arthrodesis). The Achilles tendon was also attached to the graft with metal clasps. A Redon suture was left in the floor of the wound. Single-layer sutures were placed in subcutaneous tissue and skin. The limb was immobilized in thigh plaster with the foot in 900 dorsiflexion. RESULTS The wound healed by first intention. Early post-operative complications were not observed, except for transient oedema of the surrounding tissues. The flexion and dorsiflexion movements were partially preserved. Local radical excision of the tumour was achieved in all the children. The graft healed into place. The patients are able to move without aid. CONCLUSIONS The use of a large allogeneic bone graft of the head of femur after excision of the calcaneus can assure very good long-term functional outcomes.

Reliability of clinical spasticity measurements in patients with cervical spinal cord injury.

Abstract: BACKGROUND The Modified Ashworth Scale (MAS) is the most popular clinical measure of spasticity. Other clinical signs of spasticity include hyperactive tendon reflexes, myoclonus and Babinski sign. PURPOSE To assess reliability of the MAS with myoclonic and tendon reflex examination (MTR) in patients with spinal cord injury (SCI). MATERIAL AND METHODS 30 patients (16 with complete and 14 with incomplete neural deficit) who sustained cervical SCI 4-66 months prior to the study. Mean age 33,9 years (SD=14,7). 6 independent observers rated MAS and MTR in each patient. RESULTS Poor interrater reliability of MAS (ICC=0.56) and good reliability of MTR (ICC=0.81) were demonstrated. There was satisfactory to good correlation between averaged MAS rates (Pearson coefficient 0.67-0.9). MAS reliability was lower in the lower limbs and when joint contractures were present. Significantly (p<0.01) lower MAS repeatability was noted in subjects below 30 years of age. There was a positive correlation between patient functional status and MAS repeatability. MAS reliability did not depend on mean muscle tone, sex, or time since injury. CONCLUSIONS Although MAS does not reliably assess the tone of individual muscle groups in patients with SCI, it may be helpful in assessing overall muscular tone. MAS repeatability is lower in younger patients. MAS is inappropriate for the assessment of patients with joint contractures. An examination of tendon reflexes, myoclonus and the Babinski sign is reliable in SCI patients

Obstetric brachial plexus palsy--risk factors and predictors.

Abstract: Background Obstetric brachial plexus palsy is a rare condition occurring in about 1 per thousand of live births It is caused most often by traction during delivery, although in some cases clear evidence of direct injury to the nerves is not present The aim of the study was to define risk factors for obstetric brachial plexus palsy and relate the chances of recovery to the severity of the injury Material and methods Two prospective databases of patient information and clinical assessment data were used for the study The first database contained information about pregnancy, labour, severity of injury, operative procedures and coexisting disorders of 162 children The second comprised information about clinical assessment of the affected limb in 76 patients The mean age of patients at last follow-up was 6 years and 9 months Results and conclusion High birth weight, shoulder dystocia, forceps delivery and clavicle fracture were important risk factors in obstetric brachial plexus injury Breech delivery was not associated with a higher incidence of nerve injuries despite literature data pointing to the contrary A Caesarean incision reduced the risk of plexus palsy but did not eliminate it completely In Narakas group 1 patients, recovery of biceps function occurred before the age of 4 months The vast majority of the children will have complete recovery of the affected limb In group III and IV, return to full function is very unlikely Our results confirm that Narakas' classification, apart from being very popular for classifying severity of the pathology, is a strong predictor of outcome

Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results.

Abstract: BACKGROUND AIMS Evaluation of: 1. early clinical and radiographic results of total hip arthroplasty (THA) through a standard lateral direct approach, 2. early clinical and radiographic results of THA through a minimal lateral approach, 3. comparison of the results of THA in these two groups. MATERIAL AND METHODS 120 THAs (60 cementless and 60 cemented) done in 120 patients due to degenerative changes were evaluated prospectively. 60 THAs were done through a minimal lateral approach and constituted a study group. 60 THAs were done through a direct lateral approach and constituted a control group. The mean age of the 120 patients (98 women and 22 men) was 45 y.o. (range: 32-67 y.o.). The duration of follow-up in the study group was from 6 to 12 months (mean: 8.5 months). The duration of follow-up in the control group was from 10 to 16 months (mean: 10.5 months). Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score. Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society, AAOS and SICOT. RESULTS 6 months after THA, clinical results were 92 pts in the study group and 88 pts in the control group. Radiographic outcomes were very good in all 120 patients from both arms: there were no differences between the control and study group. The incidence of complications was similar in both groups. CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of degenerative changes of the hip joint with regard to short-term outcomes. The clinical and radiographic outcomes were comparable between the standard and minimally invasive approaches. Success with THA using a minimally invasive approach depends on excellent operative technique and experience with standard hip approaches rather than on the use of special instruments.

Minimally invasive approaches in total hip arthroplasty.

Abstract: The success of operative treatment depends on a quick recovery of limb function. Every injury to a muscle or its attachment is associated with decreased muscle strength and disturbed proprioception, which impedes functional recovery. Minimally Invasive Surgery (MIS) is defined as a surgical technique performed through a short skin incision to avoid injury to muscles and tendons. The advantages of MIS over the classic technique in Total Hip Arthroplasty include: faster recovery, shorter rehabilitation and hospital stay, decreased blood loss, less pain and a shorter scar. The anterior approach to the hip, first described by Robert Judet in 1947 as a modified Smith-Petersen approach, follows the principles of MIS. Other approaches advertised as minimally invasive (posterior, lateral, or double incision approach) are associated with muscle and/or tendon injury. Therefore, they should be referred to as Less Invasive Surgery (LIS). Complications of THA performed with the MIS technique occur most often in women with osteoporosis, above 65 years of age, or with a BMI of more than 32. The rate of complications doubles with surgeons performing less than 50 THAs per year. A special set of instruments facilitates implantation of the endoprosthesis and reduces the number of complications. The anterior approach allows for implantation of an endoprosthesis without damage to muscles and their insertions, reduces tissue damage and, more importantly, decreases the intensity of postoperative pain. Should complications occur, the anterior approach has the advantage of allowing simple access to the proximal femur by extending the approach distally, as in the Smith-Petersen technique. However, the technical challenges of MIS and the risk of complications warrant caution.

Effectiveness of botulinum toxin A in the treatment of spasticity of the lower extremities in adults - preliminary report.

Abstract: Background Botulinum toxin (BTX is currently a recognised treatment for local spasticity, especially in children with cerebral palsy. The following paper presents the early result of BTX treatment for adult patients with spastic paresis of the lower limbs. Material and methods Twenty adult paraplegic patients (mean age 42 years) following cervical or thoracic SCI or suffering from MS, with moderate-to-severe spasticity in the lower extremities received BTX for the first time in life into the thigh adductor, knee flexor and foot flexor muscle groups. Results were evaluated using Modified Ashworth's Scale, Visual (Analogue) Scale for Pain Assessment, Modified Rivermead Mobility Index and Repty Functional Index prior to and three weeks after the administration of the toxin. Results Improvement was observed in most patients, usually manifesting as reductions or resolution of pain. Mild side effects (low-grade fever and flu-like symptoms) occurred in only one patient. Conclusions Our study confirmed the efficacy and safety of BTX for focal lower limb spasticity in adults.

Experience with surgery for entrapment syndrome of the suprascapular nerve.

Abstract: Background The suprascapular nerve entrapment syndrome accounts for about 1-2% of all causes of shoulder pain and dysfunction Entrapment may occur at different levels and a frequent site of compression is the suprascapular notch, the upper border of which is the superior transverse scapular ligament Material and methods We studied 5 patients with entrapment of the suprascapular nerve at the suprascapular notch, analyzing the pathomechanism of the compression syndrome The outcome of the surgical treatment was evaluated by examining the improvement in strength of the supraspinatus and infraspinatus muscles based on the Narakas method The degree of recovery of atrophy of the muscles and pain was also evaluated Results Following surgical treatment, pain subsided in 4 patients (80%), muscle strength improved in three (60%) and in 1 patients (20%) there was recovery of muscle mass Conclusions The outcomes of surgery for suprascapular entrapment depend on appropriate differential diagnosis, early detection and prompt referral for operative treatment whenever such is necessary

Comparative analysis of clinical usefulness of the Staffelstein Score and the Hospital for Special Surgery Knee Score (HSS) for evaluation of early results of total knee arthroplasties. Preliminary report.

Abstract: BACKGROUND Introduced and developed in the second half of the last century, joint arthroplasty has become a method of choice in the treatment of advanced degenerative knee joint disease. The aim of study was to compare the usefulness of the Hospital for Special Surgery Knee Score and the Staffelstein Score in the assessment of early treatment outcome, including rehabilitation, in patients who underwent knee arthroplasty due to gonarthrosis. MATERIAL AND METHODS A total of 24 patients who had undergone an arthroplasty procedure for degenerative changes in knee joints were examined in the study. The analysis included forty-four sets of results from examinations performed on average 13 days (SD 7) after knee arthroplasty. Treatment results were evaluated using the Hospital for Special Surgery Knee Score (HSS) and the Staffelstein Score (ST Score). RESULTS The HSS Knee Score averaged 59.5 points (SD 19.8). The mean ST score was 82.0 points (SD 22.5). There was a strong correlation (p< 0.005) between the results obtained using both scores and their subscales (activities of daily living, clinical examination, and pain evaluation). CONCLUSIONS 1. The analyzed scores seem to be a reliable source of information on the functional status of patients after knee arthroplasty and may be helpful tools in clinical evaluation also at an early postoperative stage. 2. Introducing a two-dimensional pain evaluation component, modeled on the HSS Knee Score, into the Staffelstein Score might improve its reliability. 3. A lower sensitivity of the HSS score in comparison with the ST Score that was revealed in the study requires further investigations in order to develop a questionnaire in the future that will combine the advantages of both scores.

Epidemiology and cost of conservative treatment of patients with degenerative joint disease of the hip and knee.

Abstract: BACKGROUND Degenerative joint disease most often affects middle-aged and elderly people. Patients over 65 years of age are frequently afflicted. The pain and limitation of mobility in joints are the cause of disability and reduced quality of life and lead to a decision to carry out total replacement surgery of the affected joint. Conservative treatment is often a palliative modality that generates high treatment costs. This study presents the results of an analysis of the cost of conservative treatment in patients with degenerative disease of the hip and knee joints in the Podkarpacie Province undergoing treatment between January 2004 and October 2005. MATERIAL AND METHOD Data were obtained from reports submitted by medical care centers contracted by the Podkarpacie Regional Branch of the National Health Fund concerning the number of patients hospitalized at rehabilitation, rheumatology and orthopedic departments, the number of physiotherapeutic treatments carried out at physiotherapy centers and the cost of treatment of patients with degenerative disease of the hip and knee joints. RESULTS Between January 2004 and October 2005, patients with degenerative joint disease of the hip and knee constituted approximately 10% of patients hospitalized at rehabilitation, rheumatology and orthopedic departments or receiving care at physiotherapy centers. CONCLUSIONS 1. The cost of treatment of degenerative joint disease is high and tends to increase both in Poland and in the world. 2. Treatment costs and incidence can be reduced through the use of established standards of conservative treatment and comprehensive prevention programs.

The vertical expandable prosthetic titanium rib (VEPTR) in the treatment of scoliosis and thoracic deformities. Preliminary report.

Abstract: Background Severe deformities of the chest, early-onset progressive scoliosis, congenital defects of the ribs and the vertebral column may all give rise to the thoracic insufficiency syndrome (TIS), when the chest capacity is too low to fully support basic vital functions, leading to gradually progressive cardiopulmonary failure. Aim of study. This paper presents new possibilities for sequential correction of progressive deformities of the thorax and spinal column in skeletally immature children using a vertical expandable prosthetic titanium rib (VEPTR) system. Material and methods At the Department of Pediatric Orthopedics of the Medical University in Lublin, three children were treated surgically with VEPTR, a low-profile modular system allowing simultaneous correction of scoliosis and chest deformities. Two children (aged 8 and 9 years) required treatment for multiple congenital spinal deformities, while one (aged 7) had early progressive neuromuscular scoliosis. Discussion Existing surgical approaches based on the Harrington method do not prevent further progression of chest deformity. The ongoing sequential VEPTR treatment of our patients resulted in significant correction of thoracic and spinal deformities already in the first phase of the treatment, with considerably improved respiratory capacity. Conclusion The vertical expandable prosthetic titanium rib appears to be the best alternative to other approaches to sequential treatment of chest and spine deformities currently in use.

Treatment of non-union of the forearm using distraction-compression osteogenesis.

Abstract: Background The goal of the study is presentation broad abilities like gives Ilizarov method in the treatment of posttraumatic nonunion the of forearm with concomitant shortening and axis deformity, in minimally invasive technique, with contemporary axis correction and lengthening . Material and methods . Authors present 6 patient operated on with the use of Ilizarov method, in years 2001-2005 , suffer from vital nonunion of the forearm - 6 cases radius; 1 case ulna and radius. In all cases with nonunion concomitant shortening of the radius from 2 to 3 cm and valgosity of radius with deformity in sagittal plane in 4 patients (2antecurvation, 2 retrocurvation). All patients had restricted rotation ROM of forearm and restriction of wrist motion . Author's modification of Ilizarov apparatus (with mini-Schanz's half-pins, which permitted rotation of forearm) was used in most of patients. In 3 cases monofocal slow correction with lengthening within nonunion was performed. In 2 cases bifocal, one-step slow correction of deformity and compression within nonunion with lengthening was performed. In 1 remaining case compression of ulna nonunion and compression with deformity correction of radius nonunion were performed. Distraction and correction start in 7 postoperative day in rate from 0,25 to 1 mm/day and correspondingly from1 to 2o/day. Results Time of correction and distraction was average 63,3 days (40 - 90 days) . Total time of stabilization was average 25,4 weeks (20 - 35 weeks). Bone union was obtained in all patients. In all cases considerable recovery of limb function was achieved. All patients had superficial pin-tract infection . One patient had staphylococcal pin-tract infection of soft tissues, which retreat after 3-weeks guided antibiotic therapy. Conclusion The Ilizarov method permit for contemporary axis correction and/or distraction or compression. There is the method of choice in the treatment of nonunion of forearm with concomitant shortening and axis deformity.

Upper limb joint mobility ranges during activities of daily living determined by three-dimensional motion analysis--preliminary report.

Abstract: Background Analysis of hand therapy programmes used in various hand therapy centres shows that the programmes primarily aim to restore a maximum range of motion, although basic activities of daily living do not often require full joint mobility. This report of our investigations, which commenced in 2003, presents the results of an evaluation of the range of motion in the joints of the upper limb, including both proximal and hand joints, during selected daily activities. Material and method Right-handed students of physical therapy were examined using a three-dimensional motion analysis system in the Biokinetics Laboratory of the Division of Biomechanics at the University of Physical Education in Krakow. Spatial registration of movement focused on three daily activities that primarily involve the upper limb, namely, natural movements associated with combing, closing a zip fastener and answering a telephone call. Angular changes in the joints recorded in three movement planes were used as analysis inputs. Results The range of motion in the analysed joints during daily activities never reached the respective maximal values, usually centering around the middle point of the ranges. Conclusions Daily activities require only limited mobility in the upper limb joints. Three-dimensional motion analysis is a useful tool to monitor and assess this phenomenon. The results of such assessments should be taken into account by hand therapists designing and implementing rehabilitation programmes.

The results of treatment of bone defects and non-union within the femoral shaft with shortening of femur using Ilizarov method.

Abstract: Background The non-union within the femur with shortening of the limb as a consequence of trauma is an indication to choose external stabilisation as a method of treatment for that reason, that healing of the bone and surrounded soft tissues is disordered. Materials and methods Authors discuss the results of treatment of 16 patients with post-traumatic bone defect and pseudarthroses with femur shortening. The injury was located in femur shaft in 8 cases, distal epiphysis in 5 cases and proximal epiphysis in 3 cases. 11 patients were treated in one stage, 4 patients were treated in two stages and 1 was held in three stages. First operation was made for achievement of union in place of bone loss or pseudarthrosis- the second and third- for elongation and correction of the axis of the femur. The follow-up consisted of 10 patients. In most cases subjective and objective improvement was achieved. Results The bone union was reached in 15 patients and in 1 case pseudarthrosis was observed. Patients who were considered to have next procedures due to remaining femur shortening or other limb deformity didn't see necessity of following treatment. Conclusion The results of the current study indicated that Ilizarov's method can be successfully used in most patients with post-traumatic bone defect and pseudarthrosis with femur shortening. The method allows to reach the bone union, correct the deformity and lengthen the limb as well, what need mostly multi-stage treatment.

Evaluation of factors influencing the quality and efficacy of ultrasound and phonophoresis treatment

Abstract: The first attempts at using ultrasound acoustic waves to aid the penetration of drugs into the skin tissue were made in the 1950's. Despite a wide usage of phonophoresis in physical therapy cabinets, doubts persist as to the relevance and efficacy of this method. Despite its popularity, the issue of conditions underlying the efficacy of phonophoresis treatment has still not been adequately addressed. Particular areas of interest include:1. treatment parameters to be followed in physical therapy. 2. appropriate dosage forms of drugs to ensure propagation of ultrasound waves 3. principles of omoeostasis and other physiological processes which play a decisive role in achieving the biological and therapeutic effects of ultrasound therapy.4. indications and contraindications to this kind of treatment The dearth of objective research methods and reliable scientific verification does not allow unambiguous determination of the efficacy of phonophoresis.

Evaluation of treatment results of patients with Dupuytren's contracture--our clinical experience.

Abstract: Dupuytren's contracture is a common condition leading to impairment of the function of the hand which affects from 2 to 12 % of the population, mainly males, and presents as progressive contracture of fingers caused by shortening of the palmar aponeurosis. The objective of the work was to present our own approach to managing Dupuytren's disease and evaluate treatment results in patients with hypertrophy of the palmar aponeurosis. Material and method 288 patients with Dupuytren's disease were treated at the Plastic Surgery Hospital in Polanica Zdroj over a period of 25 years (1977-2002). The present paper is a retrospective analysis of treatment results in 253 patients for whom complete medical documentation was available. All patients were operated in local anaesthesia in ischemia. A Bunnell flap skin incision was followed by a fasciectomy of the hypertrophied segment of the palmar aponeurosis. The skin wound was closed using V-Y plasty. Postoperative management involved hand elevation and early rehabilitation. Results Restoration of the full range of motion and total extension in the MP joint and the interphalangeal joints were achieved in 70% and 68% of patients, respectively. Of 145 patients who were professionally active, 132 were able to return to work. Finger amputation was necessary in 2 patients, one patient suffered from arthrodesis and two other developed skin necrosis which was removed with the wound closed by skin grafts. A follow-up examination 6 months after the operation revealed a recurrence in 8 patients and deterioration of hand dexterity with finger stiffness in 4. Conclusions A low complication rate and good treatment results are arguments in favour of the approach adopted at our hospital, i.e. surgery in local anaesthesia in ischemia with compressive bandaging, using a Bunnell flap skin incision followed by radical fasciectomy and V-Y plasty.

Treatment of femoral shaft union disturbances with intramedullary nailing. Treatment failure.

Abstract: Background The paper contains an analysis of the treatment outcomes of intramedullary nailing for femoral shaft non-union. Materials and methods Twenty-two patients were treated between 1999 and 2005 with locked intramedullary nailing for femoral shaft non-union. The average age was 38.2 years (range 17-79). The study group comprised 20 males and 2 females. The right femur was affected in 12 patients, and the left in 10 patients. All patients had undergone multiple operations to treat the non-union. At the time of the study, non-union had been present for a period ranging from 9 months to as much as 10 years. Stabilisation with an intramedullary nail was preceded by reaming of the medullary cavity. Nails of different diameter were used (11-16 mm, usually 11 or 13 mm). Both static and dynamic locking was used. Surgery was confined to stabilization with an intramedullary nail in 13 patients, and 9 patients additionally underwent the Judet-Forbes decortication procedure, bone grafting or internal plate fixation and osteomuscular decortication. Results The non-union healed in 19 patients and was not achieved in the remaining 3. A detailed analysis was performed in 9 cases in which the bone union was not achieved despite reaming the medullary cavity, nailing and additional procedures, which did not lead to bone healing in 3 patients. Conclusions Despite being an acknowledged method of treatment for delayed union of long-bone shafts, intramedullary nailing following reaming of the medullary cavity did not result in bone healing in all of our patients and additional procedures were often required. Therefore, the use of this procedure for femoral shaft pseudoarthroses should be decided on a case-by-case basis.

Assessment of muscle strength of hip joints in children with idiopathic scoliosis.

Abstract: Background The choice of an appropriate approach to the treatment of idiopathic scoliosis is considerably complicated owing to the lack of a clear-cut aetiology of this condition. Idiopathic scoliosis impairs the body's biomechanical balance and adversely affects body statics. Material and methods The muscle torques of the flexor and extensor muscles of the hip joints were assessed in 123 children (96 girls and 27 boys) aged from 8 to 16 with the I degrees scoliosis. Statistically significant differences (p>0.05) were revealed. Results The primary lumbar scoliosis was to the left in 109 patients (Group 1) and to the right in 14 patients (Group 2). All children participated in a 6-month exercise programme to strengthen the weakened muscle groups. Torque measurements were performed twice: immediately after the child joined the rehabilitation programme and on completion of the programme. The strength of the weakened muscles was seen to increase to a statistically non-significant level (p>0.05). Conclusions 1. Exercises strengthening weakened muscles of the hip joint improve the posture of scoliotic children and can be helpful in treating idiopathic scoliosis. 2. Differences in the strength of the flexors and extensors of the hop joint impair body statics and may constitute one of the causes of idiopathic scoliosis in children.

Efficacy of closed reduction and maintenance of surgical outcome in plaster cast immobilization in different types of distal radius fractures.

Abstract: BACKGROUND The aim of this paper is to evaluate the results maintaining after closed reduction of distal radius fracture and to assess difficulties in restoration of the articular surface continuity with reference to the type of fracture according to the AO classification. MATERIAL AND METHODS 65 patients were included in the study (40 female, 25 male), mean age of 59 years (19-84), diagnosed with the distal radius fracture, treated by closed reduction and a plaster cast immobilization. The mean immobilization period was 40 days (25-50). Secondary dislocations were assessed since closed reduction until follow-up in respective AO groups. Mean follow-up was 624 days ( 374-1210). For the evaluation of secondary dislocations we have applied radiographic parameters defining the distal radius morphology: RIA, RL, UV, RW, PI. In assessment of the articular surface restoration, the articular surface step-off and gap were measured following closed reduction in relevant AO groups. RESULTS The most significant secondary dislocations occurred in group C3 then A3 and C2. Statistically significant differences in secondary dislocations within respective types of fractures were observed between groups A2 and A3 ( p<0.05). Type C fractures presented statistically significant differences between groups: C1 and C3; C2 and C3 as to chances of restoring the articular surface continuity by closed reduction (p<0.05), whereas no such a difference was observed between group C1 and C2. CONCLUSIONS The AO classification is a tool which with accuracy characterizes the complex pathomorphology of distal radius fractures and includes essential elements differentiating respective fracture groups. We conclude that in group A3, C2 ,C3 the result of closed reduction is difficult to maintain with a plaster cast immobilization. Additionally, the restoration of articular surface continuity in type C3 fractures can hardly be achieved by closed reduction.

Posture in people with shoulder impingement syndrome.

Abstract: Background The posture of people with shoulder impingement syndrome (SIS) is a result of adaptive defensive posturing to decrease the intensity of pain in the affected joint. The aim of this work is to characterise trunk and shoulder girdle positioning in patients with SIS. Material and method The study involved 58 patients treated for SIS in the years 2004-2006. Symptoms had been present for 40 months on average. A photogrammetric study was performed with the use of a MORA 4G system. It consisted in measuring lordosis and kyphosis, as well as the symmetry of some selected anthropometric points in the frontal plane. Results Changes in posture presenting as an increased angle of trunk inclination in the sagittal plane and in the frontal plane were observed in all patients. There was asymmetry of bony points as regards the position of the scapula and the waist triangles. Conclusions The impingement syndrome is associated with displacement of all bony points analysed. Changes in posture are a result of adaptive mechanisms. Trunk asymmetry is secondary to changes in the spatial position of the scapula.