Subjective assessment of rehabilitation protocol by patients after ACL reconstruction - preliminary report.

BACKGROUND: Subjective evaluation by patients has recently become an important adjunct to postoperative clinical assessment. Apart from standard physical examination, scales demonstrating patients' subjective outcome measures are used for assessing the efficacy of the treatment and rehabilitation of knee ligamentous injuries. The present work presents patients' subjective assessment of rehabilitation protocols after ACL reconstruction. MATERIAL AND METHODS: Forty individuals who had undergone ACL reconstruction were randomised into two groups (G1, G2) and followed one of two rehabilitation protocols (A or B). The subjects assessed their knee function at baseline and after physical therapy using the Lysholm score and the IKDC form. The results were analysed with the Mann-Whitney U test. The subjects also completed a questionnaire at discharge. RESULTS: Analysis of Lysholm and IKDC scores revealed significant differences between the mean pre- and postrehabilitation results in the groups (p<0.05). The greatest improvement was seen in G2 patients rehabilitated with protocol B, with significant mean improvements of 56.3% and 46.7% for the Lysholm and IKDC scores, respectively. Group G1 registered only half of this magnitude of change. Protocol B was also highly rated in the questionnaires. CONCLUSION: According the patients opinion a rehabilitation protocol involving a larger number of open kinetic chain exercises may prove more effective in the rehabilitation of patients after ACL reconstruction compared to a programme basing mainly on closed kinetic chains.

[The results of the treatment of tibia shaft fractures in relation to the method of intramedullary nailing]. / Wyniki leczenia zlaman trzonu kosci piszczelowej w zaleznosci od metody sródszpikowego zespolenia.

The paper presents the results of treatment of tibial shaft fracture related to the method of intramedullary union with or without reaming of the marrow cavity. The clinical material was obtained from the traumatic-orthopaedic surgery department and rehabilitation department of the County Hospital in Dabrowa Tarnowska. A group of 128 patients treated with intramedullary blocking stabilization was evaluated. The clinical, radiological and functional indicators were assessed. The results of the study showed that the method of surgical union of tibial shaft fracture with the reaming of the marrow cavity was more favourable with regard to the assessed clinical and radiological parameters, complications concerning synostosis, infections and deviations of the long axis. The functional results were dependent, to a large degree, on the patients' age, and to some degree on the adopted operational technique.

Management of open fractures of the tibial shaft in multiple trauma.

BACKGROUND: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. MATERIALS AND METHODS: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years). The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8-10 days after the trauma. RESULTS: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8%) males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. CONCLUSION: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8-10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture.

[A comparative analysis of results of operative treatment of olecranon fracture utilizing Gruca screw and Weber girth]. / Analiza porównawcza wyników operacyjnego leczenia zlaman wyrostków lokciowych sruba Grucy i popregiem Webera.

An injury to the elbow constitutes 3.5% of all injuries of the movement system and of these 31% concern olecranon fractures. In the majority of cases they are intra-articular fractures, unstable because of the action of the triceps muscle of the arm. Most of the patients require operative treatment. In the years 1984-2001 in the Traumatic and Orthopedic Ward we treated 49 patients with olecranon fractures. In 30 patient we utilized Gruca screw and in 10 of them Weber girth. 3 fractures were fixed with a wire loop and the remaining 6 did not require operative but only conservative treatment. The results were estimated according to the Hofbauer's scale in 37 patients among whom 27 were treated making a fixation with a Gruca screw and 10 by using Weber girth. Altogether, we achieved good and satisfactory results in 33 cases and bad results in 4 cases. Based on these results there is no evident superiority of one method over the other. The study emphasizes the importance of the correct qualification to either therapeutic method.

[Disorders considering concrescence of os longums in plurilocular injuries]. / Zaburzenia zrostu kosci dlugich w urazach wielomiejscowych.

The work describes the influence of plurilocular trauma on complications of concrescence in comparison with single trauma of the motion organ. It has been show that disorders of fractures healing had appeared in 13% of plurilocular trauma with accompanying fractures of the bone and in 4% in isolated trauma. Manner of stabilization and the kind of fracture also influences concrescence disorders.

[The pathogenesis of chrono osseous necrosis of the knee joint]. / Oddzielajaca martwica chrzestno-kostna stawu kolanowego.

The research presents pathogenesis of the chrono osseous necrosis of the knee joint with accompanying clinical, histological and radiological symptoms; as well as its treatment. The results of treatment have been analyzed. The method - site of bone abrasion and stabilization of parted fragment with a metal screw; as well as rebuilding of the stabilized part. Ten results were very positive and two were satisfying. No poor results have been noticed. The conclusion from the above work - the stabilization of a free fragment by a screw is an advisable and preferable method. The present methods of filling the chrono osseous defects have been revised.

[The use of the gamma nail in fractures of the nearer end of femur]. / Zastosowanie gwozdzia gamma w zlamaniach blitszego konca kosci udowej.

The elaboration presents the operating indications in treatment of fractures of the nearer end of the femur using the Gamma nail. In comminuted fractures, the Kyle partition was used. The operating- techniques, difficulties and complications appeared after treatment with this method have been presented. Among 42 patients operated with the Gamma nail, 39 good and satisfactory results have been obtained. The stable intramedullary osteosynthesis ought to be recommended in fractures of the nearer end of femur having in mind characterised by the closed operating techniques, little loss of blood, stability of the junction and early mobilization of the patient.

[The operative treatment of habitual humeral abarticulation using the Bankart method]. / Leczenie operacyjne nawykowego zwichniecia stawu ramiennego metoda Bankarta.

The elaboration presents the results of the operating- treatment of the habitual humeral abarticulation using the intervention according to Bankart. In spite of more and more widely introduced arthroscopic treatment techniques of these dislocations, in cases when the copular and capsular structures which stabilize a joint are damaged, it is still a good method to be recommended. The recurrences of the habitual humeral abarticulation have not been observed.

[An operative treatment of subcutaneous injuries of the achilles tendon using a reversed flap]. / Operacyjne leczenie podskórnych uszkodzen sciegna pietowego platem odwróconym.

In this study we present a method of an operative treatment of Achilles tendon injuries using reconstruction surgery with a reversed flap from the tendinous part of the triceps muscle of the calf. The method improves blood supply to the injured tendon, as well as its endurance by using a flap with good blood supply. The treatment outcome being very good in over 90% of cases justifies the method as the first choice of treatment.

[Management of multiple open fractures of long bones in multiple trauma]. / Taktyka postepowania w zlamaniach otwartych kosci dlugich w mnogich obrazeniach ciala.

Management of multiple injuries is presented in the following article. 14 patients with open fractures during multiple trauma were assessed taking into consideration: time of post trauma stabilization and such complications as osteitis and growth impairment. Patients' clinical status with specific aspects were assessed (stride, muscle atrophy, edema, limaxis). Infected tibia false joints were diagnosed in 3 patients. 2 cases concerned open fractures of the II degree and III degree degree of the tibia according to Gustilo. They were patients operated during the first 24 houre in the year 2000. No such complications as infected false joints were diagnosed in patients operated between the 8th-10th day post trauma. All patients achieved bone growth and normal waound post traumatic bone healing.

[Diagnostic difficulties of popliteal fossa tumors basing on material presented by the traumatic and Orthopedic Surgery unit in Dabrowa Tarnowska]. / Trudnosci diagnostyczne guzów dolu podkolanowego w oparciu o material Oddzialu Chirurgii Urazowo-Ortopedycznej w Dabrowie Tarnowskiej.

The elaboration presents cases of popliteal fossa tumors basing on the material presented by The Traumatic and Orthopedic Surgery Unit in Dabrowa Tarnowska. Special attention was given to numerous difficulties connected with the univocal diagnosis. It was based on accessible research methods and the need to extend diagnostic procedure to highly specialized procedures in justified cases.

[Operating treatment results of acromioclavicular (joint) abarticulations in materials of the Traumatic and Orthopedic Surgery unit and Rehabilitation Unit in Dabrowa Tarnowska]. / Wyniki leczenia operacyjnego zwichniec stawu barkowo-obojczykowego w materiale Oddzialu Chirurgii Urazowo-Ortopedycznej i Rehabilitacji w Dabrowie Tarnowskiej.

The work presents results of operative treatment of acromioclavicular (joint) abarticulations using two different materials during syndesmoplasty of the coracoclavicular ligament, the steel loop of wire and the coal fibre (fabrics). Examining the patients, all the advantages and disadvantages of the treatment have been pointed out. In the reconstruction of coracoclavicular ligament, better results were obtained when using the steel loop.

[An inveterate fracture of the barton type of the distal radius with dislocation in the radiocarpal joint--case history]. / Zastarzale zlamanie dalszej nasady kosci promieniowej typu Bartona ze zwichnieciem w stawie promieniowo-nadgarstkowym--opis przypadku.

Barton's fracture was first described and isolated as a disease entity in 1839. It is a quite rare fracture constituting, according to various authors 1.5-2.3% of the distal radius fractures. It is usually accompanied with subluxation or luxation in the radiocarpal joint. In the study we present treatment, dealing with operative difficulties and rehabilitation in a 52-year-old patient with an inveterate fracture of the Barton type of the distal radius with dislocation in the radiocarpal joint. He was previously treated by a local quack. The patient underwent an operative treatment; fragments were anatomically repositioned and a stable fixation was applied. As a result of treatment and intensive rehabilitation, we achieved synostosis and functionality of the wrist and left hand.