Clinical Consequences of Unreconstructed Pelvic Defect Caused by Osteosarcoma with Subsequent Progressive Scoliosis in a Pediatric Patient-Case Report.

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. The standard and most effective treatment is wide resection of the tumor combined with neoadjuvant chemotherapy. Adolescent idiopathic scoliosis (AIS) is a genetically determined three-dimensional spinal deformity, which occurs in teenage patients and is mostly progressive. The basic management strategy is surgical treatment when the curve exceeds 50 degrees. However, the indications are different in oncologic patients. The aim of this study was to describe a case of adolescent scoliosis with osteosarcoma of the pelvis. The authors conducted a scoping review using PubMed and Embase to analyze the state of knowledge. The presented paper is the first report of pelvis osteosarcoma coexisting with adolescent idiopathic scoliosis. Treatment for this complex case finished with very good results, with no recurrence observed during the nine-year follow-up.

Delay in Diagnosis and Treatment of Primary Bone Tumors.

BACKGROUND: Delay in the diagnosis and treatment of bone tumors continues to be a common problem. Prolonged diagnosis can significantly reduce the chances of successful treatment of the disease. Accordingly, the aim of this study was to assess the delay in the diagnosis of primary bone tumors, identify the most common symptoms and analyze the course of the diagnostic and therapeutic path. MATERIAL AND METHODS: Thirty-two (K=18; M=14) patients treated surgically for primary bone tumors were included in the retrospective study. Patient records were analyzed. Delay in diagnosis was defined as the time from the onset of symptoms to the initial diagnosis and referral to an orthopedic oncology center. RESULTS: The median delay in diagnosis was 7 (3-12) months. For tumors located in the pelvis, the delay was 10 months, compared to 5 months for the upper limb and 7 months for the lower limb (p=0.2312). The delay was 6 months In patients with osteosarcoma, and 8 months in chondrosarcoma patients (p=0.1786). At the first office visit, an x-ray was ordered in 19 cases (59.4%), of whom 9 patients (47.4%) were referred on to the oncology center. The most common symptoms were pain in the affected area (90.6%), limited mobility (28.1%) and pathological fracture (25%). After admission to an orthopedic department, a biopsy was performed after 5.5 (3-8.2) days. The histology results were ready after another 14 (8-18) days, and surgical treatment was performed after 95 (76-100) days. CONCLUSIONS: 1. Although patients show typical symptoms of bone tumors, only a small proportion are referred directly to an oncology center. After a primary bone tumor is suspected, further diagnostic and therapeutic activities proceed efficiently, in accordance with the current guidelines.

Prospective, Long-Term Functional Outcomes of Extra-Osseous Talotarsal Stabilization (EOTTS) Using HyProCure in Adult Patients with Talotarsal Joint Instability: Assessment of Physical Activity and Patient Satisfaction.

BACKGROUND: The partial dislocation of the talus from the calcaneus and navicular bones is a primary factor leading to a prolonged overpronation during weightbearing. This study aimed to assess the possibility of returning to physical activity and long-term patient satisfaction after an extra-osseous talotarsal stabilization (EOTTS) procedure with a HyProCure sinus tarsi implant for partial talotarsal joint dislocation (TTJ). METHODS: A total of 41 adult patients (61 feet), with an average age of 46.41, were included and treated surgically with EOTTS as a stand-alone surgery. Physical activity and functional scores were assessed pre- and post-operatively using questionnaires-the UCLA Activity Score, Symptom-Related Ankle Activity Scale (SAAS), Sports Frequency Score (SFS), Lower Extremity Functional Scale (LEFS), and VAS scale. Satisfaction was assessed on a ten-point scale. The follow-up period was on average 8.61 years (from 7.33 to 10.31). RESULTS: EOTTS had a positive impact on physical activity, and a high rate of patient satisfaction (8.95 ± 1.9) was noted. The treatment led to a reduction in foot pain, as well as an increase in SAAS and LEFS scores (15,6% and 19,3%, respectively, p <0.01). The VAS pain score decreased by 18,6% (p <0.001). SFS and UCLA scores showed a small increase, but it was not statistically significant. A positive correlation was noted between patient satisfaction and time of physical activity per week (R = 0.33, p =0.04), and also between patient satisfaction and SAAS scores (R = 0.43, p =0.005). Pain from other joints (knee, hip) was eliminated or reduced in 40% of patients after surgery. CONCLUSIONS: EOTTS with a HyProCure implant is an effective long-term treatment option for partial talotarsal joint dislocation, leading to a reduction in foot pain and increased patient satisfaction, and allowing for a return to physical activity.

Delay in Diagnosis and Treatment of Primary Bone Tumors during COVID-19 Pandemic in Poland.

BACKGROUND: The COVID-19 pandemic has affected all of the medical specialties, including orthopedic oncology. Therefore, the aim of the study was to assess how it influenced the diagnostic and therapeutic processes for patients with bone neoplasms. METHODS: We evaluated 87 patients treated due for bone neoplasms before (Group I, n = 36) and during the COVID-19 pandemic (Group II, n = 51). A delay in diagnosis was defined as the period between the initial clinical symptoms and the date of referral to an oncology center. The patients from Group II were asked to complete a short questionnaire regarding the COVID-19 pandemic. RESULTS: The median general delay in diagnosis before the pandemic was 7 months, while during the pandemic, it was 10 months (p = 0.728). The biopsy delay was lower in the pre-pandemic group: median-6.5 vs. 12 days (p = 0.025). The patients from Group II were diagnosed with larger tumors compared to those in Group I: the median values were 75 vs. 56 mm (p = 0.025), respectively. After an X-ray examination, the bone neoplasms were suspected more frequently in the Group II: 63% vs. 44% cases (p = 0.024), respectively. In Group II, 20 (60.8%) cases of SARS-CoV-2 infection were reported, however, no respiratory failure cases were noticed. CONCLUSION: The pandemic affected the diagnostic process of primary bone tumors, resulting in delays in performing biopsies. During the pandemic, the patients reported larger diameters of their bone lesions.

Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons.

BACKGROUND: The proper diagnosis and treatment of bone metastases are essential for patient survival. However, several strategies for the treatment are practiced. Therefore, the aim of the study was to analyze what factors influence the choice of a method of treatment. METHODS: An online survey was conducted within the Polish Society of Orthopedics and Traumatology. It consisted of 45 questions and was divided into four main parts: Participant Characteristics, Diagnosis and Qualification, Treatment, and Clinical Cases. RESULTS: A total number of 104 responses were collected. The most frequently chosen methods were: Intramedullary nail (IMN) + Resection + Polymethyl methacrylate (PMMA) (30.47%) and IMN without tumor resection (42.13%), and in third place, modular endoprosthesis (17.25%). The less experienced group of orthopedic surgeons more often (47.5% vs. 39.5%) decided to perform IMN without tumor resection than the more experienced group (p = 0.046). Surgeons from district hospitals less frequently (13.7% vs. 23.1%) would decide to use modular endoprosthesis than surgeons from university hospitals (p = 0.000076). Orthopedists who performed ≥ 11 bone metastases surgeries per year would more often use modular endoprosthesis (34.8% vs. 13.2%) than those who performed ≤ 10 operations per year (p = 0.000114). CONCLUSION: Experience, place of work, and the number of metastasis surgeries performed during a year may influence the choice of treatment method in patients with bone metastases.

Does the use of 3D-printed cones give a chance to postpone the use of megaprostheses in patients with large bone defects in the knee joint?

Revision procedures and the resulting bone loss are a big challenge for orthopedic surgeons. Therefore, we checked what functional outcomes that 3D-printed cone augments can offer to patients with bone defects (Anderson Orthopedic Research Institute [AORI] classification type 2B and 3) in the knee and whether the use of cones can delay the necessity to use a megaprotheses. Data from 64 patients (M = 22; W = 42) who underwent total knee arthroplasty (TKA) revision were included in the analysis. The Knee Society Clinical Rating System (KSS) and the range of motion in the knee joint were used for the functional assessment. The mean follow-up was 28 months (range: 18-44 months). The survival rate for aseptic loosening at follow-up was 100%. Infection occurred in two (3.1%) patients. The mean KSS score increased from 12.75 points preoperatively to 66.56 postoperatively (p < 0.001). The mean range of motion in the knee changed from 61.15° preoperatively to 115.93° postoperatively (p < 0.001). 3D-printed cone augments seem to be a good solution for patients requiring a TKA revision procedure. When used in patients with bone defects classified as 2B and 3 (AORI), they can be a good alternative, delaying the need for megaprotheses.

The impact of the COVID-19 pandemic on Polish orthopedics, in particular on the level of stress among orthopedic surgeons and the education process.

The Coronovirus Disease 2019 -(COVID-19) pandemic had a significant impact on the health care system and medical staff around the world. The orthopedic units were also subject to new restrictions and regulations. Therefore, the aim of our research was to assess how the COVID-19 pandemic affected orthopedic wards in the last year in Poland. We created an online survey, which was sent to 273 members of the Polish Society of Orthopedics and Traumatology. The survey contained 51 questions and was divided into main sections: Preparedness, Training, Stress, Reduction, Awareness. A total of 80 responses to the survey were obtained. In Preparedness section the vast majority of respondents (90%) replied, that they used personal protective equipment during the pandemic, however only 50% of the respondents indicated that their facility received a sufficient amount of personal protective equipment. Most of the respondents indicated that the pandemic negatively affected the quality of training of future orthopedists (69.4%) and that pandemic has had a negative impact on their operating skills (66,7%). In Reduction section most of the doctors indicated that the number of patients hospitalized in their departments decreased by 20-60% (61,2% respondents), while the number of operations performed decreased by 60-100% (60% respondents). The negative impact of pandemic on education was noticeable especially in the group of young orthopedic surgeons: 0-5 years of work experience (p = 0,029). Among the respondents, the level of stress increased over the last year from 4.8 to 6.9 (p <0.001). The greatest increase in the level of stress was observed among orthopedists working in country hospitals (p = 0,03). In section Awareness 36,3% of respondents feel well or very well informed about the latest Covid-19 regulations. In addition, most doctors (82.6%) believe that the Polish health care system was not well prepared to fight the pandemic and that the regulations applied so far are not sufficient to effectively fight the pandemic (66.2%). The COVID-19 pandemic has impact on orthopedics departments in Poland and negatively affected the quality of training of orthopedic surgeons and the level of stress.

Incidence and etiology of mortality in polytrauma patients: an analysis of material from Multitrauma Centre of the University Teaching Hospital no 1 in Szczecin, over a period of 3 years (2017-2019).

<b>Introduction:</b> The pattern of traumatic death is a subject of great interest in the worldwide literature. Most studies have aimed to improve trauma care and raise awareness of avoidable fatal complications. <br><b>Aim:</b> The objective of the present study was an epidemiological and clinical analysis of causes of traumatic death of patients treated at the Multitrauma Centre of the University Teaching Hospital No 1 in Szczecin, over a period of 3 years (2017-2019). <br><b>Material and methods:</b> The study material comprised medical data of 32 patients with a mean age of 63 years, who died due to polytrauma injury. The time of death form admission to the Multitrauma Centre, primary cause of death, spectrum and sites of injuries, as well as method of treatment (operative or conservative) were variables considered in the analysis. <br><b>Results:</b> The predominant mechanisms of injury were traffic accidents - 22 cases (69%) followed by falls from a height 8 (25%) and other mechanism - 2 cases (6%). The most common primary cause of death was brain injury - 17 patients (53%) followed by pelvic or spinal fractures - 5 (16%). The predominant constituents of polytrauma were bony injuries (pelvis, spine and limbs) - 28 cases (87%), followed by head injuries - 25 (78%), chest - 24 (75%) and abdominal injuries - 17 (53%). Eighteen patients (56%) required operative treatment; craniotomy for brain injuries was the most commonly performed - in 11 patients, followed by laparotomy - in 5. Five other patients underwent an endovascular procedure - pelvic artery embolization. Twelve patients (38%) died in the first two days from admission to the trauma center, 5 (16%) in the first week and 15 over one week form admission. <br><b>Conclusions:</b> Head injuries, pelvic fractures with associated retroperitoneal bleeding and severe injuries affecting several body parts were identified as the most dangerous for the survival of polytrauma patients. A trend to decrease mortality due to hemorrhagic shock was observed, but it remains unchanged for central nervous system injuries.

Return to Physical Activities after Scarf Osteotomy for Hallux Valgus.

BACKGROUND: Scarf osteotomy is an effective method of surgical treatment of hallux valgus. The final im-pact of the procedure on patients' physical activity has not been assessed so far. Our goals were to evaluate sports and physical activities in patients following the Scarf osteotomy and to compare these with clinical outcomes. MATERIAL AND METHODS: The study included 79 patients who were treated for hallux valgus with a Scarf osteotomy in 2015-2016. The average age in the examined group at the time of surgery was 55.43 (± 11.97) years, while the follow-up was on average 3.13 (± 0.42) years. Physical activity was measured using the UCLA - Activity Score and Author's Sport Specific Questionnaire. Clinical outcomes were evaluated with the Ame-rican Orthopedic Foot and Ankle Score (AOFAS HMI) and compared to sports outcomes. RESULTS: After the procedure, the frequency of undertaking physical activity increased by about 21% (p = 0.0005) and the time spent by patients during the week on sports (minutes per week) increase by about 19% (p = 0.005). The result of the UCLA - Activity Score after surgery increased by an average of about 4.7% (p = 0.016). The average satisfaction with the result of the surgery was 8.2 (1-10 scale). The majority of patients (67%) were able to maintain the amount of physical activity after the surgery and few patients (24%) were able to increase this amount. CONCLUSION: The study suggests that Scarf osteotomy has a positive effect on the ability of patients with hallux valgus to return to sport and physical activity.

An analysis of causes of trauma, spectrum of injuries and treatment outcomes in patients treated at Multitrauma Centre of the University Teaching Hospital No 1 in Szczecin in 2015. Comparison of results from years 2015 and 2007.

INTRODUCTION: Multitrauma is defined as injury involving two or more different body parts, with a condition that at least one of these injuries is life-threatening. They represent serious traumas, requiring treatment in the intensive care units and frequently surgical intervention. AIM: The objective of this study was epidemiological and clinical analysis of patients treated in 2015 year in Multitrauma Centre of the University Teaching Hospital no 1 in Szczecin, and comparison the results with outcomes of similar study conducted in the same Centre in 2007 year. MATERIAL: Clinical material comprised medical notes of 82 patients, 52 men (63%) and 30 women (37%), with a mean age of 44 years, who sustained multitrauma injuries. An analysis included causes of traumas, spectrum of injuries, involvement of body parts, methods and outcomes of the treatment. RESULTS: The most common cause of multitrauma was traffic accident - 45 cases (55%), followed by fall from height - 22 (27%) and other mechanism - 15 (18%). The most frequent component of multitrauma made bone fractures (spine, pelvis, limbs) - 64 cases (78%), followed by head traumas - 63 (77%), chest - 53 (65%) and abdominal 30 (36%) injuries. A total of 48 patients (58%) required surgical intervention, the most frequently fixation of bone fractures - 24 patients (29%), repair of abdominal and head injuries - 18 (22%) either. Of 82 treated patients 64 (78%) survived and 18 (22%) died. A mean period of stay in Multitrauma Centre was 23 days for survived patients and 17 days for those who died. Comparing to similar analysis conducted 8 years earlier, a change in involvement of particular body parts comprising multitrauma injury was observed: number of head injuries increased of 14%, number of chest traumas and bone fractures decreased of 21% and 11%, respectively. The survival rate improved of 10%.