Chronic, Neglected Medial Subtalar Dislocation with Associated Talar and Calcaneal Fractures. A Case Report.

Subtalar dislocation is a very rare injury that accounts for just approximately 1% of traumatic dislocations. Stan-dard treatment in acute subtalar dislocations is immediate closed reduction and cast immobilization. Early reduction is of key importance and allows avoiding further damage to soft tissues, nerves and blood vessels. Neglected, chronic subtalar dislocations are seen extremely rarely and only a few cases have been reported in the literature to date. Considering the lack of guidelines and very few literature reports relating to the treatment of such injuries, we have decided to present the case of a male patient with a chronic, neglected, closed medial subtalar dislocation of the right foot with associated fractures of the talar and calcaneal bones. The patient was admitted 4 months post trauma to his right ankle joint caused by a fall from a ladder. An open subtalar reduction was performed with arthrodesis of the talocalcaneal joint and the talonavicular joint of the right foot. The treatment was effective and recreated the me-chanical axis of the limb. One year after the surgery, the patient reported no pain and no limitations in everyday functioning, work and activities. At the one-year follow-up, his AOFAS score was 88/100.

Pseudotumor as a Complication of Total Hip Replacement.

Total hip arthroplasty with metal-on-metal bearing is associated with specific complications: local delayed hypersensitivity reaction (ALVAL) to metal particles, osteolysis and the development of pseudotumors. This process results from the low resistance of the metal bearing to abrasion and corrosion, which causes the release of metal ions into the surrounding tissues. This paper presents the case of a 54-year-old man who required revision surgery due to aseptic loosening of the endoprosthesis with a ceramic (TiN)-on-metal bearing. The removed implants were subjected to material analysis. Mean chemical analysis revealed that the main component of the residue samples was titanium, which constituted 65% of the sample weight, followed by calcium (16%), phosphorus (11%) and aluminum (3.8%). The fissures on the insert were a result of trauma caused by the head, with both elements matching in terms of visible damage. More than 50% of the surface of the head had been damaged due to abrasive wear. The transitional area between the normal and completely delaminated TiN coating shows uneven abrasion, a gradual decrease in coating thickness. In conclusion, the use of endoprosthesis heads with TiN ceramic coating involves very low polyethylene wear. The low resistance of TiN ceramic coating to trauma and the fragility of this coating prevent the use of TiN-coated heads in combination with any non-polyethylene hip endoprosthesis inserts.

Factors Influencing Treatment of Proximal Femoral Fractures.

BACKGROUND: Orthopaedics and traumatology departments are dominated by patients with proximal femoral fractures, who represent 20-30% of all patients treated there. The aim of this study was identification and evaluation of factors influencing treatment of proximal femoral fractures. MATERIAL AND METHODS: Between 2008 and 2015, we treated 424 femoral neck fractures and 442 trochanteric fractures in patients over 40 y/o. The impact of fracture location (femoral neck/trochanteric), character (non-displaced/displaced) and the patient's general condition (metrical/biological age, health condition) on qualification and treatment used (fixations/hip pro-sthesis/non-operative) was analyzed. RESULTS: The results show a significant impact of factors such as type of fracture and general health condition on treatment method selection (mainly in femoral neck fractures). The distinction between non-displaced and displaced fractures is significant in preoperative qualification. For displaced femoral neck fractures, total hip replacement (non-cemented) was performed in patients between 55 and 65 y/o, while total hip replacement (cemented) and hemiarthroplasty (bipolar/Austin Moore's) in patients between 75 and 90 y/o. In lateral fractures of the femoral neck, mostly total hip replacement and occasionally proximal femoral nail fixation was performed. The importance of qualification factors was much lower in preoperative qualification of trochanteric fractures, where internal fixation remains the primary method of treatment and total hip replacement was only used in patients with co-existing coxarthrosis. CONCLUSIONS: 1. The biggest impact on selection of femoral neck fractures treatment method was exerted by the degree of displacement of bone fragments, age and the patient's pre-injury walking status. 2. Besides general condition, the presence of coxarthrosis was the most important factor influencing trochanteric fracture treatment method.

Laceration of abdominal aorta by a fragment of fractured L2 vertebral body after a low-energy injury: a case report and review of literature.

STUDY DESIGN: A rare case of direct injury to the wall of abdominal aorta caused by a displaced fracture of the L2 vertebral body resulting from a low-energy injury. Potential injury mechanism and predisposing factors are discussed along with a review of literature pertaining to the subject. OBJECTIVE: To describe a unique case of direct aortic wall injury caused by a displaced vertebral body fracture. SUMMARY OF BACKGROUND DATA: The literature on aortic wall injuries after vertebral fractures is reviewed. So far, only the injuries of the thoracic aorta were extensively described. Injuries of the abdominal aorta are much less frequent and usually associated with high-energy trauma. However, coexisting disorders, predisposing the patient to thoracolumbar vertebral body fractures (e.g., osteoporosis, chronic alcoholism) and aortic wall injuries (atherosclerosis) make aforementioned complication possible, despite the low-energy mechanism of injury. METHODS: A clinical and radiographical interpretation of the reported case is presented. RESULTS: Laceration of abdominal aorta was caused by a sharp, anteriorly displaced bone fragment of the fractured L2 vertebral body. CONCLUSION: The reported case adds to the literature on vertebral fractures by describing another mechanism leading to aortic wall disruption. Similar vascular complications may be identified more frequently in the future given the high prevalence of osteoporosis and atherosclerosis in the general population.

Neglected, developmental hip dislocation treated with external iliofemoral distraction, open reduction, and pelvic osteotomy.

Between 1995 and 2003, we operated upon 18 children with 20 hips involved, aged 5-11 years (average: 7.5 years) suffering from an inveterate high developmental dislocation of the hip joint. An average follow-up period of our middle-term study was 51 months (range: 34-96 months). A two-staged management was applied. First, femoral head was lowered back to the level of acetabulum with an external fixator or a distractor device. The second stage involved open reduction combined with pelvic osteotomy and, in four cases with femoral derotation osteotomy. We noted two cases of avascular necrosis. Equal limb length was achieved in 15 cases. There were two cases of 0.5-cm length discrepancy, two cases of 1-cm length inequalities, and one case of 5-cm limb shortening. We endorse this method in neglected cases of previously untreated unilateral high developmental hip dislocations in children aged 8-10 years. It results in a usable hip joint without the need of femoral shaft shortening and facilitates future joint replacement.

[Solid focal lesions in the lungs as first sign of hypereosinophilic syndrome]. / Lite zmiany naciekowe w miazszu pluc jako pierwszy objaw zespolu hipereozynofilowego--opis przypadku.

The paper introduces a case of 50 years old women who was diagnosed because of solid focal lesions in the lungs with coexist hypereosinophilia in blood smear. During diagnostics neoplastic and infectious diseases were excluded. In the meanwhile secondary causes of hypereosinophilia was not found. The diagnosis of the hypereosinophilic syndrome was diagnosed and atypical (solid) character of focal lesions in the lungs was underlined.

Selected problems in the bone union of complicated diaphyseal fractures treated with interlocking nail.

Background. This article discusses the effectiveness and technical problems encountered in the union of complications of diaphyseal fractures treated with interlocking nail. Material and methods. Between 2000-2003 we operated 35 patients for pseudoarthrosis (humerus - 6, femur - 13, tibia - 16). In a one-step procedure a plate was removed from the humerus (3 patients) or femur (4 patients), a retrograde interlocking nail was introduced, and spongy grafts were applied. In the remaining patients an external stabilizer or ZESPOL outer plate were first removed; then, after soft tissue healing, an anterograde nail was introduced sequentially using a closed technique. This method of nailing was also used in patients with plates that had previously been removed. The Dencker classification was used to evaluate outcome. Results. We achieved bone union in all cases. We observed intra- and post operative complications in 5 cases: breakage of distal locking screws in 4 patients, and breakage of 1 tibial nail. In closed nailing we encountered major difficulties in passing through the sclerotic edges of pseudoarthrosis, and it also proved extremely difficult to maintain the right direction of the reamer without a guiding wire, which was crucial for a successful operation. Conclusions. Interlocking nailing is an efficacious method of treatment of complications in fracture healing, but in some cases closed nailing of pseudoarthrosis is difficult.

The application of bone cement to fill the surgical defect after resection of a giant-cell tumor: A case report.

Background. A case of a large bone defect treated with bone cement filler is discussed, and the usefulness and advantages of this treatment method are assessed. Case report. A 25-year-old male was admitted to our hospital with an intra-articular pathological fracture of the lateral femoral condyle due to an underlying giant cell tumor (stage I according to the Enneking classification). The tumor was surgically resected, and the walls of the post-operative bone defect were treated with a burr. The defect was then filled with bone cement (PMMA). The tumor was found to be histologically benign. Post-surgical treatment included immobilization in a cylinder cast and no weight bearing for a period of 8 weeks. The follow-up included frequent check-ups and repeated radiographs and CT scans. The follow-up period was 7 years, during which time no clinical or radiological signs of tumor recurrence were found. There was visible osteosclerosis surrounding the bone cement filler, which is believed to be a prognostically favorable finding, associated with a low risk of recurrence. The functional outcome of treatment was assessed with the Knee Rating Score. The patient gained a knee score of 100 points and a functional score of 100 points. Conclusions. The use of bone cement in order to fill a bone defect after tumor excision proved to be an effective and safe method to manage a giant-cell tumor of the bone. This method provided good biomechanical circumstances and allowed for good follow-up, as it enabled easy detection of possible tumor recurrence.

[Inferior subluxation of humerus after surgery of fractures of proximal humerus]. / Dolne podwichniecie stawu ramiennego po operacyjnym leczeniu zlaman blizszego konca kosci ramiennej.

Posttraumatic inferior subluxation of the humerus can be a possible cause of nerve injury and is therefore an alarming symptom. Etiology and frequency of subluxation after surgery of fractures of proximal humerus in group of 53 patients, including 4 cases of nerve injuries were studied. X-rays performed during treatment of this patients were analyzed. We confirmed high rate (41.5%) of this subluxation in our patients, 4 times more often in comminuted fractures, as result of deltoid atony, impaction of bony fragments and distention of the joint by hematoma. Surgical trauma and heavy cast immobilization were additional factors. We remarked after bone plating subluxation more frequent (62.5-75%) and duration longer than after nailing (13.6-34%). We concluded subluxation is secondary to many factors, needs meticulous evaluation for excluding injury of nerves, and for avoiding surgical trauma and cast immobilization should be minimized.

[Chlamydia pneumoniae antibodies and other atherosclerosis risk factors in haemodialysed patients. Preliminary report]. / Przeciwciala przeciwko chlamydia pneumoniae a inne czynniki ryzyka miazdzycy u chorych przewlekle hemodializowanych. Doniesienie wstepne.

Nowadays, it is considered that viral or bacterial infections can influence atherosclerosis development rate. One of them is infection by Chlamydia pneumoniae. The aim of the study was to assess the occurrence of anti-Chlamydia pneumoniae antibodies (AChPA) and their relationship with biochemical and clinical atherosclerosis risk factors in haemodialysed patients. There were 38 patients (24M, 14F) at the mean age 63.3 +/- 14.5 years, haemodialysed for 30.9 +/- 26.1 months. Previous Ch. Pneumoniae infection was assessed based on AchPA IgA and IgG concentrations determined using SIMPLE INDEX. The following risk factors for atherosclerosis were checked in the study group: total cholesterol. CRP and iPTH. AChPA indicative for Ch. pneumoniae infection in the past were detected in 28 patients (74%). The study group was divided into two subgroups; A- (n = 28 patients) with serological features of previous Ch. pneumoniae infection and B- (n = 10 patients) without serological features of Ch. pneumoniae infection. We found no statistical difference between the groups in the studied biochemical factors. We found no correlation between AChPA and other atherosclerosis risk factors. Our preliminary report does not confirm the prognostic value of AChPA presence as an atherosclerosis risk factor in haemodialysed patients.