ABSTRACT
Early attempts at surgical management of cartilage lesions date back to the 1950s. Since then, various reconstructive techniques have been developed; unfortunately, none of the methods used has been able to produce a regenerate formed solely of hyaline cartilage. This paper summarizes the most popular techniques for chondral and osteochondral reconstructions of knee joint tissues.The techniques differ in their indications, which depend primarily on the location of the injury, the extent of the damage and the patient's overall health. In cases of deep damage, osteochondral reconstruction is indicated, which involves both repairing the bone defect and creating favorable conditions for the formation of regenerative tissue cartilage.The use of an appropriate repair technique increases the chances of a good therapeutic effect, which is understood as a reduction in pain, resumption of previous activities and slowing down the progression of osteoarthritis.
Subject(s)
Cartilage, Articular , Humans , Cartilage, Articular/surgery , Cartilage, Articular/injuries , Knee Joint/surgery , Transplantation, AutologousABSTRACT
Articular cartilage lesions negatively affect patients' well-being, causing severe pain and significantly limiting functioning. The purpose of this study was to evaluate the effectiveness of a one-stage reconstruction, performed arthroscopically using a hyaluronate-based scaffold. Pain reduction and functional improvement were assessed. The study also evaluated if postoperative vitamin D supplementation and rehabilitation protocol impact obtained outcomes. A group of 29 patients was included in a retrospective study. All the participants underwent arthroscopic reconstruction of osteochondral lesions using hyaluronate-based scaffolds. The study group used standard questionnaires to self-assess their condition before surgery and at the time of completion. Despite the aforementioned, all the participants fulfilled two original questionnaires on postoperative rehabilitation and vitamin D supplementation. Significant pain reduction (mean NRS 1.83 vs. 7.21, p < 0.0001) and functional improvement (mean Lysholm score 82.38 vs. 40.38, p < 0.0001; mean OKS 40.2 vs. 23.1, p < 0.0001) were found. No differences in pain reduction and functional improvement were seen between genders. The impact of post-operative rehabilitation and vitamin D supplementation on clinical outcomes was found to be statistically nonsignificant. The results obtained in this study clearly confirm the effectiveness of osteochondral reconstruction using hyaluronate-based scaffolds. The outcomes were equally favorable, regardless of postoperative rehabilitation and vitamin D supplementation.
ABSTRACT
Osteoarthritis, which is the most common joint disorder, is one of major reasons for hospitalizations and one of the greatest burdens to health care systems. Osteoarthritis has a complex etiology, but lesions of articular cartilage are a major risk factor. These lesions are often encountered in young active people and usually remain asymptomatic for a long time. Depending on the extent of injury, chondral lesions can be managed conservatively or surgically. An important factor influencing the effectiveness of conservative treatment is the morphology and location of injury. Conservative treatment should be based on patient education and rehabilitation, and supported by pharmacotherapy.
Subject(s)
Cartilage, Articular , Osteoarthritis, Knee , Osteoarthritis , Humans , Cartilage, Articular/injuries , Hyaluronic Acid/therapeutic use , Conservative Treatment , Osteoarthritis/diagnosis , Osteoarthritis/epidemiology , Osteoarthritis/therapy , Osteoarthritis, Knee/drug therapy , Knee Joint/pathologyABSTRACT
The aim of this study in anterior cruciate ligament reconstruction (ACLR) patients was to assess the effect of six months of supervised physiotherapy with a higher number of visits (SPHNV) compared to supervised physiotherapy with a lower number of visits (SPLNV) on the maximal peak torque (PT) and isometric torque (IT) of values obtained for hamstring (H) and quadriceps (Q) muscles of the knee joints under isokinetic and isometric conditions. Hypothesis: SPHNV improves IT and PT more than SPLNV. Group I had ACLR with a higher number of visits (n = 20), Group II had ACLR with a lower number of visits (n = 20), and Group III served as the control (n = 20). In Groups I and II, IT values were measured for quadriceps and hamstring muscles of the knee joints in the 13th and 24th weeks and for PT in the 18th and 24th weeks after ACLR (60 and 180 °/s). In group III, the measurements were taken once. The isometric torque and isokinetic peak torque values were measured in N*m and they were normalized to body mass as relative IT (RIT) and relative PT (RPT) were expressed in N*m/kg. Results: In both ACLR groups, the RIT and RPT values obtained from the operated knee joints significantly increased in the 24 weeks following ACLR compared to the uninvolved side. Group II had significantly lower RIT and RPT values for quadriceps and hamstring muscles of the operated limbs compared with the uninvolved limbs (p = 0.008, p = 0.001). In group I, the larger number of visits positively correlated with the higher PT for quadriceps and hamstring muscles of the operated and uninvolved knees (from r = 0.506; p = 0.023 too r = 0.566; p = 0.009), respectively. Six months of SPHNV positively correlated with and improved the IT and PT values in patients after ACLR much more significantly than six months of SPLNV.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries/surgery , Humans , Knee Joint/surgery , Muscle Strength , Physical Therapy ModalitiesABSTRACT
Blood coagulation disorders in patients with intracranial bleeding as a result of head injuries or ruptured aneurysms are a diagnostic and therapeutic problem and appropriate assessments are needed to limit CNS damage and to implement preventive measures. The aim of the study was to monitor changes in platelet aggregation and to assess the importance of platelet dysfunction for predicting survival. Platelet receptor function analysis was performed using the agonists arachidonic acid (ASPI), adenosine diphosphate (ADP), collagen (COL), thrombin receptor activating protein (TRAP), ristocetin (RISTO) upon admission to the ICU and on days 2, 3, and 5. On admission, the ASPI, ADP, COL, TRAP, and RISTO tests indicated there was reduced platelet aggregation, despite there being a normal platelet count. In 'Non-survivors', the platelet response to all agonists was suppressed throughout the study period, while in 'Survivors' it improved. Measuring platelet function in ICU patients with intracranial bleeding is a strong predictor related to outcome: patients with impaired platelet aggregation had a lower 28-day survival rate compared to patients with normal platelet aggregation (log-rank test p = 0.014). The results indicated that measuring platelet aggregation can be helpful in the early detection, diagnosis, and treatment of bleeding disorders.
ABSTRACT
BACKGROUND: The reorganization of bone tissue is closely associated with its metabolism and changes in its internal structure. Metabolism of the bone, which results from the simultaneous processes of resorption and formation of new bone tissue, may depend on the presence and type of arthritis. OBJECTIVES: The objective of the study was to assess, based on the morphological features and mineral composition of bone tissue, changes in the femoral head in various types of hip joint degeneration. MATERIAL AND METHODS: The study group consisted of 21 patients surgically treated for hip joint degeneration. They included 17 women, aged 30-70 years (mean age 52.5 years), and 4 men, aged 38-51 (mean age 48.5 years). The assessment of the morphological condition of the bone and the mineral composition of bone tissue took into account quantitative and qualitative relationships among the mineral components and bone matrix. The structure of spongious bone tissue was analyzed in histological studies, with special attention paid to osteogenesis and osteoclastic processes and the advancement of degeneration. RESULTS: Three main types of degenerative changes in bone tissue of the examined femoral head were recognized: osteoporosis with a prevalence of coarse-fiber bone tissue and decreased osteogenic activity; osteolysis with few osteogenesis centers; and intensified reorganization of bone tissue. In more than half of the examined samples, coarse-fiber bone tissue was replaced by newly formed bone tissue. We observed bone resorption and osteogenesis, which indicate normal homeostasis of the bone tissue. Uneven saturation of spongious bone with mineral components was found. The content of organic and inorganic bone components measured with Ca : P and C : Ca + P ratios had similar values in all types of changes. Only the bone with intense osteolysis contained a smaller quantity of carbon (4.96-8.13%). CONCLUSIONS: Our observations indicate an intense adaptive reorganization of bone tissue depending on external and internal factors, including biomechanical condition.
Subject(s)
Bone Remodeling , Bone Resorption , Hip , Osteogenesis , Osteolysis , Osteoporosis , Adult , Aged , Bone Density , Bone and Bones , Female , Hip/pathology , Humans , Male , Middle Aged , Osteoclasts , Osteolysis/pathology , Osteoporosis/pathologyABSTRACT
BACKGROUND: Ankle arthrodesis may have internal or external stabilization. We assessed whether the type of stabilization after ankle arthrodesis will affect: (1) functional outcome in Foot and Ankle Ability Measure (FAAM) scale, (2) pain level, (3) period of hospitalization, (4) rate of complications. METHODS: We retrospectively studied 47 individuals after ankle arthrodesis with Ilizarov fixation (group 1, n = 21) and internal stabilization (group 2, n = 26) at our institution in years 2007-2015. Clinical outcomes were measure by: (1) functional outcome in FAAM scale, (2) pain level, (3) period of hospitalization, (4) rate of complications. RESULTS: Total number of complications in Ilizarov group was 13, which corresponded to 0.62 complications per patient on average. In group 2 there were 15 complications, which corresponded to 0.58 complications per patient on average. The intergroup difference in rate of complications was not statistically significant (p = 0.066). In group 1 the mean VAS pain level before treatment was 4.69 and after treatment was 1.5 (p = 0.037). In group with internal stabilization the mean VAS pain level before treatment was 4.71 and after treatment was 2.9 (p = 0.044). In group 1 the mean period of hospitalization was 5.29 days, in group 2 was 5.71 days (p = 0.517). In group 1 the mean functional outcome in FAAM scale was 79.38, in group 2 was 70.11 (p = 0.458). CONCLUSIONS: Ankle arthrodesis with Ilizarov stabilization is associated with lower prevalence of VAS pain level after surgery than after internal screws stabilization. Rate of complications, FAAM functional score and period of hospitalization were not statistically significant between group 1 and 2. Clinical outcome was satisfactory in group 1 and 2, but outcomes in Ilizarov group were slightly better than after internal stabilization.
Subject(s)
Arthrodesis/methods , Fracture Fixation, Internal/adverse effects , Ilizarov Technique/adverse effects , Osteoarthritis/surgery , Pain, Postoperative/epidemiology , Adolescent , Adult , Aged , Ankle Joint/physiology , Ankle Joint/surgery , Arthrodesis/adverse effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Range of Motion, Articular/physiology , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: A number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads. METHODS: Retrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. RESULTS: In group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant. CONCLUSIONS: Balance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients' balance.
Subject(s)
Ankle/surgery , Arthrodesis/methods , Lower Extremity/physiology , Postural Balance , Adolescent , Adult , Body Weight , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Ankle arthrodesis with the Ilizarov method is an accepted form of treatment of advanced degenerative changes of the ankle joint. Incorrect balance and load distribution on the lower limbs may result in pain and dysfunction. The aim of the study was to assess the change of balance and load distribution in lower extremities in patients before and after ankle arthrodesis with the Ilizarov method. Between 2013 and 2016, ankle arthrodesis using the Ilizarov method was performed on 21 patients. The evaluation of balance and percentage of load in each lower limb was performed before the surgery and during the follow-ups. The evaluation was performed using a Zebris pedobarographic platform. Before the surgery, the patients exhibited an average load of 41.9% of body weight in the affected limb, whereas the load in the healthy limb was 58.1%. The difference was statistically significant (p = 0,000031). In two years follow-up, the average load in the treated limbs was 48.19%, whereas the healthy limbs were subjected to an average load of 51.81%. In preoperative tests, the average path length of the center of gravity was 161.55 cm; postoperatively, the average path length of the center of gravity was 129.7 cm (p = 0.00003206). Preoperatively, the average area of the center of gravity was 18.85 cm2; it decreased to 6.19 cm2 (p = 0.000032) postoperatively. Arthrodesis of the ankle with the Ilizarov method improved the statics of the musculoskeletal system by improving the distribution of loads in the lower limbs as well as balance. However, it failed to restore the parameters of a healthy person. Advanced degenerative changes of the ankle disturb the biomechanics of the entire lower limb.
Subject(s)
Ankle Joint/surgery , Arthrodesis/methods , Ilizarov Technique , Lower Extremity/physiology , Osteoarthritis/surgery , Postural Balance/physiology , Adolescent , Adult , Aged , Ankle Joint/pathology , Biomechanical Phenomena , Body Weight/physiology , Female , Follow-Up Studies , Gravitation , Humans , Male , Middle Aged , Pain Measurement , Statistics, Nonparametric , Treatment Outcome , Walking Speed , Young AdultABSTRACT
BACKGROUND: Treatment of multiplanar deformities, especially in younger children, requires construction of a complex Ilizarov fixator, frequently with small dimensions. The aim of this study is to verify clinical application of a3D-printed bone model in treatment with the Ilizarov method. METHODS: The study involved a 6-year-old child in whom clinical and radiological examination revealed multiplanar deformity of the right leg. Then, 3D models of individual bones were printed by means of additive manufacturing and were used as a scaffold to install the Ilizarov apparatus. To compare the expected and factual axial correction and lengthening, we measured spatial orientation of bone fragments three times. The factual axial correction and lengthening were determined with a photometric technique. RESULTS: Ilizarov fixator with a configuration developed using a 3D model of the treated bone was mounted on the patient's leg. Corticotomy was carried out at the proximal metaphysis of the right tibia, along with osteotomy of the right talus. The treatment resulted in a 3.5-cm lengthening of the limb and a 7° correction of valgus angle. The values of actual lengthening and axial correction were 4.1% lower than the expected values of these parameters. INTERPRETATION: Orthopedists should consider differences between the expected and actual lengthening and axial correction in planning treatment with the Ilizarov method. Three-dimensional printing is a useful technology that can be used to support treatment with the Ilizarov method.
Subject(s)
Ilizarov Technique , Lower Extremity/surgery , Printing, Three-Dimensional , Child , Humans , Lower Extremity/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Normal balance and symmetric distribution of lower limb loads are associated with adequate muscle strength, joint mobility and proprioception. The aim of this study was to analyze the distribution of lower limb loads and balance prior to and after axis correction and lengthening with Ilizarov method. MATERIALS AND METHODS: The prospective analysis included 20 patients from our clinic, who have been subjected to distraction-corrective lower limb corticotomies with the Ilizarov method in 2014-2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. RESULTS: Prior to the surgery, mean loads on affected and non-affected limbs corresponded to42%and58%of body weight, respectively. Mean loads on affected and non-affected limbs during the postoperative examination did not differ significantly. Mean path length of the center of gravity prior to and after the surgery amounted to143.27â¯cm and 125.11â¯cm, respectively. Mean area of the center of gravity was 7.81â¯cm2prior to the surgery and 5.81â¯cm2after the procedure. DISCUSSION: Our present study showed that distraction-corrective Ilizarov corticotomy may provide more symmetric distribution of lower limb loads and improvement of balance. This outcome should be considered satisfactory from the perspective of the locomotor system statics. Corticotomies with Ilizarov method provide symmetric distribution of loads between non-affected and operated limb.
Subject(s)
Body Weight/physiology , Ilizarov Technique , Leg Length Inequality/surgery , Lower Extremity/surgery , Postural Balance/physiology , Weight-Bearing/physiology , Adult , Female , Humans , Leg Length Inequality/diagnostic imaging , Leg Length Inequality/physiopathology , Lower Extremity/diagnostic imaging , Lower Extremity/physiopathology , Male , Muscle Strength , Muscle Strength Dynamometer , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: The clinical value of pedicle screws in spinal deformity surgery is well known; however, screw insertion is demanding and sometimes associated with complications. Navigation systems based on intraoperatively obtained three-dimensional (3-D) images were developed to minimize pedicle screw misplacements. However, there is a lack of data confirming superiority of navigation above other techniques. There are also concerns regarding increased radiation used during the procedure. QUESTIONS/PURPOSES: The purposes of this study were (1) to compare accuracy of the two methods of pedicle screws placement: intraoperative 3-D image navigation versus a freehand technique in patients with idiopathic scoliosis; and (2) to assess the radiation dose received by patients with both methods. METHODS: Between 2014 and 2016, 49 patients underwent posterior spinal fusion with all pedicle screw constructs for idiopathic scoliosis performed by two surgeons. The study design involved alternating the use of the freehand technique and navigation to position pedicle screws in consecutive patients, forming groups of 27 patients with 451 navigated screws and 22 patients with 384 screws positioned freehand. The two groups did not differ in age, sex, or magnitude of deformity. Two observers not involved in the treatment evaluated the position of the screws. The pedicle breach was assessed on intraoperatively obtained 3-D O-arm® scans according to a grading system: Grade 0 = no pedicle wall violation; Grade 1 = perforation ≤ 2 mm; Grade 2 = 2 to 4 mm; and Grade 3 = perforation > 4 mm. Grades 0 and 1 were considered properly positioned and Grades 2 and 3 represented malposition. RESULTS: In terms of accuracy, we found no differences, with the numbers available, between the freehand and navigated groups in terms of the proportion of screws that were properly positioned (96% freehand and 96% in the navigation group, respectively; p = 0.518). Grade 3 pedicle screws were observed only in the freehand group and were all located in the upper thoracic spine. Patients undergoing navigated pedicle screw placement received a greater mean radiation dose than those whose screws were placed freehand (1071 ± 447 mGy-cm versus 391 ± 53 mGy-cm; mean difference, 680 mGy-cm; 95% confidence interval, 217-2053 mGy-cm; p < 0.001). CONCLUSIONS: In patients with moderate idiopathic scoliosis undergoing primary surgery, we did not observe benefits of pedicle screw placement with CT-based navigation, but the patients experienced greater exposure to radiation. LEVEL OF EVIDENCE: Level III, therapeutic study.
Subject(s)
Pedicle Screws , Radiation Dosage , Radiation Exposure , Radiography, Interventional/methods , Scoliosis/surgery , Spinal Fusion/instrumentation , Tomography, X-Ray Computed/methods , Adolescent , Adult , Child , Female , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Radiation Exposure/adverse effects , Radiographic Image Interpretation, Computer-Assisted , Radiography, Interventional/adverse effects , Risk Factors , Scoliosis/diagnostic imaging , Spinal Fusion/adverse effects , Spinal Fusion/methods , Time Factors , Tomography, X-Ray Computed/adverse effects , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: We asked whether the type of ankle joint arthrodesis stabilization will affect: (1) rate of union, (2) rate of adjacted-joint arthritis, (3) malalignment of the ankle joint. MATERIAL AND METHODS: We retrospectively radiological studied 62 patients who underwent ankle arthrodesis with Ilizarov external fixator stabilization (group 1,n=29) or internal stabilization (group 2,n=33) from 2006 to 2015. Radiologic outcomes were mesure by: (1) rate of union, (2) rate of adjacent-joint arthritis, (3) malalignment of the ankle joint. The Levene's test,Mann-Whitney U test and Students t-test were used to the statistical analyses. RESULTS: Ankle fusion was achieved in 100% of patients treated with external fixation and in 88% with internal stabilization. Desired frontal plane alignment was achieved in 100% of patients with external fixation and 76% with internal stabilization. Desired sagittal plane alignment was achieved in 100% of external fixation and 85% of internal stabilization. A total of 14 (48.3%) patients from group 1 showed a radiographic evidence of pre-existing adjacent-joint OA. The radiographic evidence of pre-existing adjacent-joint OA was also found in 27(81.8%) subjects from group 2. Alterations of adjacent joints were also found on postoperative radiograms of 19 (65.5%) patients subjected to Ilizarov fixation and in all 33 patients from group 2. DISCUSION: Ilizarov fixation of ankle arthrodesis is associated with lower prevalence of adjacent-joint OA and ankle joint misalignment,and with higher fusion rates than after internal fixation.Although achieving a complex ankle fusion is generally challenging,radiological outcomes after fixation with the Ilizarov apparatus are better than after internal stabilization.
Subject(s)
Ankle Joint/diagnostic imaging , Ankle Joint/surgery , Arthrodesis , Foot Deformities, Acquired/surgery , Fracture Fixation, Internal/methods , Osteoarthritis/surgery , Radiography , Adolescent , Adult , Aged , Ankle Joint/physiopathology , Female , Follow-Up Studies , Foot Deformities, Acquired/diagnostic imaging , Foot Deformities, Acquired/physiopathology , Humans , Ilizarov Technique , Male , Middle Aged , Osteoarthritis/diagnostic imaging , Osteoarthritis/physiopathology , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Recent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment. MATERIALS AND METHODS: Thirty-six consecutive patients who underwent posterior spinal fusion with pedicle screws only constructs for idiopathic scoliosis. Fifteen patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and postoperatively-coronal curves, kyphosis (T2-T12, T5-T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn. RESULTS: We observed reduction of RAsag in all patients; however, in DVR group, decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p = 0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p = 0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2-T12 kyphosis has increased in 28 (65%) patients whereas in non-DVR group in 31 (69%) cases. Mean value of T2-T12 kyphosis growth was 16.7% in DVR and 22.1% in non-DVR group. These differences however did not occur statistically significant. CONCLUSIONS: Direct vertebral rotation (DVR) maneuver reduces significantly apical rotation of the spine, enhances ability of coronal correction, and it does not reduce thoracic kyphosis.
Subject(s)
Scoliosis/surgery , Thoracic Vertebrae/surgery , Adolescent , Adult , Child , Female , Humans , Male , Pedicle Screws , Rotation , Scoliosis/diagnostic imaging , Spinal Fusion/methods , Thoracic Vertebrae/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Symmetrical distribution of the load of the lower limbs and balance are among the determinants of proper biomechanics of the musculoskeletal system. So far, it has not been elucidated whether the correction of the axis and the equalization of the length of the lower limbs allow for achieving proper balance and load distribution. The aim of the present study was to compare load distribution and balance of patients who underwent Ilizarov method corticotomies with healthy controls. METHODS: The clinical studies evaluated 57 patients, who underwent corticotomy with the Ilizarov method. The control group consisted of 59 healthy volunteers. The evaluation assessed the distribution of the load of the lower limbs and balance using pedobarographic platform. FINDINGS: In the study group operated limb bore 48.02% of the load on average, while the healthy limb 51.98%. These differences were not statistically significant. The average percentage of load in limbs in treated and control groups did not differ significantly. In the study group, the average length of path of the center of gravity was 145.47cm. In the control group, the average length of path of the center of gravity was 112.69cm. In the study group, the average area of the center of gravity was 7.54cm(2), while in the control group it was 5.19cm(2). INTERPRETATION: Ilizarov method corticotomy allows for the obtainment value of the load distribution of the lower limbs in the study group not significantly different from those in a control group, but does not ensure the achievement of completely normal balance.
Subject(s)
Body Weight , Ilizarov Technique , Lower Extremity/physiology , Orthopedics/methods , Postural Balance , Adult , Case-Control Studies , Female , Humans , Male , Middle Aged , Weight-Bearing/physiology , Young AdultABSTRACT
BACKGROUND: The aim of this paper is to evalute perioperative blood loss associated with total cemented knee joint alloplasty, with special regard to specific factors that may influence this loss. Additionally, the significance of postoperative autotransfusion in these procedures is assessed. MATERIALS AND METHODS: The study group consisted of 85 patients (61 females and 24 males); in 32 cases a postoperative autotransfusion system was used (CBCII ConstaVac, Stryker). Factors analysed comprised pre- and postoperative hemoglobin levels, drain blood loss, heterologous blood transfusion volume and reasons for the transfusion, including co-morbidities. RESULTS: Allogeneic blood transfusion was necessary in 54.72% of the patients who did not have autotransfusion and in 34.38% of the patients who received autotransfusion. The mean volume of blood collected in the drains was 882 ml, while the mean volume of reinfused blood amounted to 524.2 ml. Hypertensive patients experienced greater postoperative blood loss. The average drop in hemoglobin levels was 3.6 g/dl and was smaller by 0.6 g/dl in patients who received autotransfusion. The lowest preoperative hemoglobin values occurred in patients who required heterologous blood transfusion despite autotransfusion. Heterologous blood transfusion was performed at a hemoglobin level of 8.4 g/dl; in patients with a concomitant ischemic heart disease the cut-off value was 9.6 g/dl. CONCLUSIONS: 1. The average drop in hemoglobin levels associated with knee alloplasty was 3.5 g/dl. The volume of recovered blood used for post-operative autotransfusion was approx. 500 ml. 2. A low preoperative hemoglobin level is the most significant risk factor for heterologous blood transfusion. 3. Co-mordibities need to be taken into consideration when determining the amount of blood required.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Blood Loss, Surgical/statistics & numerical data , Blood Transfusion, Autologous/methods , Blood Transfusion, Autologous/statistics & numerical data , Aged , Aged, 80 and over , Comorbidity , Female , Hemoglobins/analysis , Humans , Hypertension/blood , Hypertension/epidemiology , Male , Middle Aged , Myocardial Ischemia/blood , Myocardial Ischemia/epidemiology , Retrospective Studies , Risk FactorsABSTRACT
The purpose of this study was to evaluate cervical spine function, based on our own functional method of roentgenometric analysis in patients who suffered from cervical spine sprain injury. Study involved 72 patients who suffered from cervical spine whiplash injury. Conventional plain radiographs in all patients included three lateral views: maximum flexion, neutral (resting) and maximum extension. All views allowed roentgenometric evaluation of ligament instability of the lower cervical spine C5-C7 according to the White and Panjabi criteria. Furthermore, based on literature analysis and their own clinical observations, the authors proposed new classification of dynamic formation of cervical spine column. The dynamic formation of cervical column is evaluated based on pathomechanical chain of being between normal and unstable. Authors' own evaluation system in flexion views can be useful in diagnosis and treatment of this type of injury.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/physiopathology , Spinal Injuries/diagnostic imaging , Spinal Injuries/physiopathology , Adult , Aged , Female , Humans , Male , Middle Aged , Radiography , Range of Motion, Articular/physiology , Surveys and Questionnaires , Young AdultABSTRACT
The aim of this study was to define the influence of whiplash injury on cervical spine stability. The study involved 72 patients who had suffered from sprain injury to cervical spine of 0°-III° according to QTF. To verify the results the authors examined the control group whose representatives have never suffered from any cervical spine injury and met all the exclusion criteria. Conventional plain radiographs in both groups showed three lateral views: maximum flexion, neutral (resting) position and maximum extension view. The results of image studies were subjected to roentgenometric analysis to find mechanical symptoms of instability according to radiological criteria: AADI, anterior translation and regional angulation. The authors demonstrated that there was no influence of whiplash injury on mechanical stability of cervical spine measured on radiograms in static-functional lateral views.
Subject(s)
Cervical Vertebrae/pathology , Spinal Injuries/pathology , Whiplash Injuries/pathology , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/physiopathology , Female , Humans , Male , Middle Aged , Radiography , Range of Motion, Articular , Spinal Injuries/diagnostic imaging , Spinal Injuries/physiopathology , Whiplash Injuries/diagnostic imaging , Whiplash Injuries/physiopathology , Young AdultABSTRACT
INTRODUCTION: Femoral neck fractures are among the most frequent and the most dangerous types of musculoskeletal injuries in the elderly population. There is general agreement that because of the morphology of the fracture, internal fixation is the treatment of choice irrespective of the degree of displacement. The optimal surgical treatment of femoral neck fractures remains controversial despite constant progress in the surgical management of such fractures and still remains a serious therapeutic problem. The goal of the present study was to compare the outcome in patients who underwent surgery of femoral neck fractures with AO screws; a compression screw and a side-plate; and a compression screw and a side-plate with an additional AO screw. MATERIAL AND METHODS: The study group included 112 patients who underwent surgery for femoral neck fracture with the use of AO screws; a compression screw and a side-plate; and compression screw and a side-plate with an additional AO screw, at the Orthopaedic Department at Vendsyssel Hospital, Hjörring, Northern Orthopaedic Division, Denmark, between 1 January 2004 and 31 December 2005. Garden's classification was used to classify femoral neck fractures. Implant position and fracture reduction were categorised according to recommendations by Tornkvist and Lindequist. RESULTS AND CONCLUSIONS: Irrespective of fracture morphology, compression screw and side-plate fixation provides better stabilisation to the bony fragments and improves early mobilisation in comparison with AO screws.
Subject(s)
Bone Plates , Bone Screws , Femoral Neck Fractures/surgery , Fracture Fixation, Internal/instrumentation , Internal Fixators , Adult , Aged , Aged, 80 and over , Biomechanical Phenomena , Denmark , Female , Fracture Fixation, Internal/methods , Humans , Male , Middle Aged , Osteotomy , Range of Motion, Articular , Retrospective Studies , Treatment Outcome , Weight-BearingABSTRACT
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.