Judet type-IV fracture of the proximal end of the radius in a 7-year-old child. A surgical case report of open reduction and percutaneous pinning.

INTRODUCTION: Fractures of the proximal end of the radius are rare and account for 1 % of all childhood fractures. The treatment of the proximal end of the radius in children depends on age, the degree of angular displacement, and the presence of additional injuries. CASE PRESENTATION: This is a case of a 7-year-old child with a 90-degree angular displaced radial neck Judet type-IV fracture treated with open reduction and intramedullary stabilization with Kirschner wire. Follow-up examinations performed 4 and 12 weeks after the operative treatment revealed very good functional and radiological results. DISCUSSION: In fractures of the radial neck with head displacement reaching 90an open reduction is the method of choice. An undoubted advantage of this method is the possibility of achieving a satisfactory reduction and fixation on the fragments. Although other operative treatment techniques including percutaneous K-wire leverage, Metaizeau technique, may be taken into consideration. CONCLUSION: The method of open reduction and pinning is safe and gives good early outcomes as well as long-term results without leading to impairment of function or deformation of the elbow joint.

Is analog preoperative planning still applicable?-comparison of accuracy of analog and computer preoperative planning methods in total hip arthroplasty.

BACKGROUND: Preoperative planning is an integral part of total hip arthroplasty and has a significant impact on surgical technique and clinical outcome. The variety of types and sizes of endoprosthesis components makes the procedure more demanding and generates a need for accurate preoperative planning. The objective of this study was to analyze an analog method of preoperative planning of primary total hip arthroplasty based on templates overlaying on preoperative radiograms and compare its accuracy for predicting the size, both the stem and cup, with computer planning methods. METHODS: A retrospective cohort study based on 360 X-ray images of hip joints in 348 patients qualified for total hip arthroplasty between 2018 and 2019. The study group consisted of 136 men and 212 women, with an average age of 65 years (56 to 85 years). Material included both cementless and cemented endoprostheses. RESULTS: In the analyzed material, the accuracy of cup planning using the analog method was 85% (P<0.001) and 77% (P<0.001) in the planning of stem size. However, using the computer method, planning accuracy was 82% (P<0.001) for the cup and 72% (P<0.001) for the stem. CONCLUSIONS: Both methods of preoperative planning remain effective. The analog method of preoperative planning is simple, precise, and repeatable in choosing the type and size of endoprosthesis components with an accuracy of 85% and 77% for the cup and stem respectively. The accuracy of planning depends on the type of endoprosthesis and in the case of the cemented endoprosthesis, it is lower than in cementless.

Treatment of Massive Giant Cell Tumor of Bone of the Proximal Radius. Case Study.

This paper presents a case of a massive giant cell tumor of bone (GCTB), Campanacci and Enneking type III, in an atypical location at the proximal end of the radius. In type I and II cases, surgical treatment is the treat-ment of choice: curettage of the lesion, replacement of bone defects with bone grafts or cement. Advanced type III changes frequently require segmental resection and joint reconstruction. In our patient, a segmental resection of the proximal third of the radius and infiltrated surrounding soft tissues was performed without reconstruction of the radius. A good clinical outcome without a relapse has been noted at one year post surgery.

Traumatic Injuries in Pediatric Surgery in the Medical-epidemiological-economic Aspect.

BACKGROUND: The aim of this study was to present the medical, epidemiological and economic aspects of traumatic injuries in children and adolescents. The literature on the subject is scarce. MATERIAL AND METHODS: A retrospective analysis was performed on the data of 1,138 children treated at the Department of Pediatric Surgery, Stefan Zeromski Specialized Hospital in Kraków between 2012 and 2016 on account of head, abdominal and pelvic, chest, testicular and musculoskeletal injuries. Age, sex, circumstances and type of the injury as well as concomitant damage were analyzed. RESULTS: Musculoskeletal injuries accounted for 68% of all the injuries analysed. The mean age of the patients was 6.3 years. The main causes of injury were same-level fall (30%), fall from a height (22.5%), road accidents (8%), and sports injuries (19%). 36% and 29% of the patients sustained injuries at home and at or near school, respectively. CONCLUSIONS: 1. Traumatic injuries in children and adolescents are the most common cause of admissions to pediatric surgery departments, with musculoskeletal injuries being the most frequent among them. 2. Injuries occur most frequently at or near home or school. 3. The cost of treatment and hospital stay of patients with musculoskeletal injuries accounted for 50% of the total cost of treatment in the Department of Pediatric Surgery. 4. There is a need to develop and implement preventive and educational programs for parents, guardians, teachers and children to prevent injuries.

Pseudotumour and Metallosis after Revision Total Hip Replacement. Case Study.

Metallosis is a complication of hip arthroplasty. This pathological process contributes to the loosening and dislocation of the prosthesis. This article discusses the case of a 61-year-old patient who reported pressure and pain as well as a palpable subcutaneous lump in the left lower abdomen and groin area. Medical history included total arthroplasty and repeat arthroplasty of the left hip joint, hysterectomy, appendectomy and a laparoscopic fundoplasty. A CT scan and ultrasound showed an unrecognised heterogeneous fluid area raising suspicions of a rumour mass or an old haematoma. After exclusion of gastrointestinal pathology, the patient was referred to the department of trauma and orthopaedic surgery, where a new x-ray of the hip, ultrasound and CT scan were performed and loosening of the prosthesis was ruled out. The pathological tissue was removed surgically through an incision in the groin area. On the basis of intraoperative changes, the pseudotumour was diagnosed as metallosis based. In con-clusion, any suspicion of a pseudotumour requires extensive and accurate evaluation, excluding general surgical causes. Complete surgical removal of the tumour is the only effective method of treatment.

Midterm Results of Cementless Total Knee Arthroplasty: A Retrospective Case Series.

BACKGROUND: There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA). OBJECTIVE: The study aimed to assess midterm survivorship of the Vanguard cementless system, and to demonstrate the utility of the Bone Hardness Test (BHT) for the selection of cementless fixation TKA. METHODS: From September 2009 through November 2014, 123 total knee arthroplasties were completed, with cementless Vanguard Cruciate Retaining TKA in 110 knees (102 patients) and cemented Vanguard in 13 cases (12 patients). Implant fixation was based on intraoperative assessment of posterior cruciate ligament stability, bone quality, and BHT. All patients with a cementless Vanguard implant were eligible for this retrospective study. Preoperative and postoperative Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were obtained. Standardized standing anteroposterior and lateral radiographs were taken. RESULTS: Three patients (4 TKAs) were lost to follow-up. The mean follow-up time was 5.5 ± 1.4 years. All scores significantly improved postoperatively. No radiographic failures were observed. Five-year implant survival, with revision of any component for any reason as an endpoint, was 97.2% (95% confidence interval, 91.7 - 99.1%). Five-year survival with revision for aseptic loosening was 100%. Only one knee required revision due to an isolated unrelated bearing exchange, and two additional knees required secondary resurfacing of the patella for retropatellar pain. CONCLUSION: Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis. The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA.

Midterm Results of Cementless and Cemented Unicondylar Knee Arthroplasty with Mobile Meniscal Bearing: A Prospective Cohort Study.

BACKGROUND: Cemented unicompartmental knee arthroplasty (UKA) yields good clinical outcome but common revision reasons are loosening and pain. Cementless UKA may reduce the revision rate. OBJECTIVE: The current study was designed to assess clinical and radiographic outcome of cemented and cementless UKA, using bone quality as determined by the Bone Hardness Test (BHT) as selection criterion for cementless implantation. METHODS: In this prospective comparative cohort study we analyzed 50 cementless and 29 Oxford consecutive UKA cases. Patients with sufficient bone quality were eligible for cementless UKA. Bone quality was assessed with the BHT, which consisted of exercising pressure with the thumb on the bone surface created after resection of the tibia. RESULTS: The average surgical times were 62.5 ± 12.6 and 78 ± 16 minutes in the cementless and the cemented group, respectively (p < 0.01). The average thickness of the polyethylene insert was 4.3 ± 1.2 (range, 3 - 9) and 3.7 ± 0.8 (range, 3 - 6) mm, respectively (p = 0.02). Both types of implants yielded excellent clinical and functional results. At an average follow-up time of seven years, we found non-significant differences between clinical results of cementless versus cemented implants. CONCLUSION: Shorter surgical time makes cementless implantation more attractive to surgeons when considering UKA options for their patients. The average thickness of the polyethylene insert in cementless group was 0.6 mm thinner than in the cemented group. The BHT is a simple and useful test to assess whether patients are eligible for cementless UKA.

Arthroscopic verification of objectivity of the orthopaedic examination and magnetic resonance imaging in intra-articular knee injury. Retrospective study.

INTRODUCTION: Arthroscopy of the knee joint is regarded as the most objective diagnostic method in intra-articular knee joint lesions. AIM: The purpose of this study was to assess the objectivity and diagnostic value of orthopaedic examination (OE) and magnetic resonance imaging (MRI) in reference to the arthroscopic result. MATERIAL AND METHODS: In a group of 113 patients treated by arthroscopic surgery for post-traumatic knee pathology between 2008 and 2010 in our department, accuracy of clinical and MRI findings that preceded surgery were studied retrospectively using a statistical method. Sensitivity, specificity, accuracy and predictive negative and positive values were the subject of analysis. RESULTS: In the presented trial, sensitivity values of the orthopaedic examination for injuries of the anterior cruciate ligament (ACL), meniscus medialis (MM), meniscus lateralis (ML) and chondral injuries (ChI) were 86%, 65%, 38% and 51%, respectively. Specificity values were 90%, 65%, 100% and 100%, respectively. The MR sensitivity and specificity values were 80%, 88%, 44% and 32%, and 86%, 64%, 93% and 97%, respectively. CONCLUSIONS: Assessment of intra-articular knee joint lesions is a difficult diagnostic problem. In making a decision about arthroscopy of the knee joint, an appropriate sequence of examinations should be carried out: OE, MRI and arthroscopy. The improvement in the effectiveness of the orthopaedic examination and MRI can limit the too high frequency of diagnostic arthroscopies, which generates the risk of operation treatment and costs.

Clinical and cost effectiveness-related aspects of retransfusion in total hip and knee arthroplasty.

BACKGROUND: An increasing demand for blood products forces the rationalisation of management and conservation of blood. The aim of the study is to evaluate the possibility of retransfusion of blood conservation and the cost-effectiveness of this procedure when employed in Total Hip Replacement and Total Knee Arthroplasty. MATERIAL AND METHODS: This prospective cohort study involved two groups of patients. Group I comprised 50 patients who underwent blood retransfusion and in several cases had supplementary allogeneic transfusion. Group II, a control group, consisted of 50 patients who did not receive retransfusion. RESULTS: The retransfusion in Group I enabled the recovery of a mean amount of 364.5 ml (± 52.7) of blood in THR patients and 403.8 ml (± 110.7) in TKA patients. Demand for allogeneic blood transfusions in Group I versus Group II was 46% lower in THR patients and 42% lower in TKA patients. The blood recovered for retransfusion is biologically valuable with regard to cellular elements and plasma chemistries. In the costs evaluation, the total savings in Group I were 5,000 PLN. CONCLUSION: Retransfusion of recuperated blood from postoperative drainage tubing is a simple and safe method that provides clinical and cost-effectiveness advantages.

Total knee arthroplasty with application of anatomic endoprosthesis journey. Clinical and radiological assessment in a 2-year follow-up.

BACKGROUND: Growing expectations regarding TKA inspire the researchers to look for a perfect endoprosthesis. One of the new-generation prostheses is Journey BCS (Smith&Nephew), introduced in 2004, which, according to its inventors, completely restores anatomy and kinematics of the knee. The aim of this study was to evaluate TKA with Journey endoprosthesis in a two-year follow-up. MATERIAL/METHODS: The study was a prospective analysis. It included 61 patients aged 52-87 years, with primary OA and axial deformity under 15°, and without a significant instability in the frontal plain. A total of 61 TKAs were assessed with the use of WOMAC OI, KSS clinical and radiological scales. The group was evaluated after 6, 12, 24 weeks, 1 and 2 years postoperatively. RESULTS: At the end point of observation, 97% of the patients obtained good and very good clinical and radiological results. Mean knee flexion in the study group increased until 24 week and reached 121.8°. These results are comparable with the results described in the literature, but do not differ significantly from the outcomes of conventional endoprostheses. CONCLUSIONS: In the presented material, TKA with the application of anatomic endoprosthesis Journey allowed to obtain in the majority of patients very good and good early clinical and radiological results.

[Joint arthroplasty in patients on long-term renal dialysis. Qualification, risks and benefits]. / Endoprotezoplastyka stawów u pacjentów przewlekle dializowanych. Kwalifikacja, czynniki ryzyka i korzysci.

UNLABELLED: The aim of this study is to evaluate the qualifications, risks and benefits associated with the arthroplasty of the: hip, knee and elbow in patients on long term renal dialysis. MATERIAL AND METHODS: The study was retrospective and 11 patients were included who underwent 10 hip replacements, 4 knee and one elbow joint. RESULTS: In seven cases the outcome was excellent, six good and two satisfactory. CONCLUSIONS: Classification of patients with end-stage renal disease to joint arthroplasty is a difficult problem and requires an interdisciplinary experience in conducting intra and postoperative period which allows to avoid many complications. The benefits of improving the quality of life exceeds the operative risk and cost of treatment. Obtained good clinical results encourage to extend indications for surgical treatment.

Total hip arthroplasty with bone grafts for protrusio acetabuli.

BACKGROUND: This retrospective cohort study analyses the long-term outcomes of total hip arthroplasty (THA) in arthritis patients with various forms of acetabular protrusion. MATERIAL: We analyse 135 consecutive cemented total hip arthroplasties in 127 patients. Mean age of the patients was 55.2 years (range: 30-72 years). The study group consisted of 119 women and 16 men who were followed up for a mean of 12.7 years. Mean preoperative function was poor, with a Harris score of 28.0 points. METHODS: Clinical evaluation utilized the Harris hip score, and radiographic assessment relied on the criteria of the Joint Committee of the Hip Society, AAOS and SICOT. RESULTS: Clinical outcomes of the study group were as follows: excellent in 35 (25.9%), good in 78 (57.8%), fair in 17 (12.6%), and poor in 5 (3.7%). The mean postoperative Harris score was 86.6 points. The radiographic outcomes were excellent in 47 (34.8%), good in 60 (44.5%), fair in 18 (13.3%), and poor in 10 hips (7.4%). Loosening of both components was observed in 6 hips and of the acetabular component in 4 hips. Complications other than aseptic loosening were observed in 25 (18.5%) hips. CONCLUSIONS: Implant survival following THA in arthritis with acetabular protrusion depends mainly on proper bone stock reconstruction. 80-85% patients after THA with acetabular bone stock reconstruction achieved very good and good results following an average of 12 years of follow-up. Patients with autogenic bone grafts achieved better outcomes. There was no substantial effect of aetiology, type of endoprosthesis, grade of acetabulum migration on the final outcome.

Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation--incidence, risk factors and results of surgical treatment.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. MATERIAL/METHODS: The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken. RESULTS: Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20-30 years), 100% required surgical release procedures, while 66.66% of those treated for 15-19 years, 42.1% of those treated for 10-14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula. CONCLUSIONS: Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS.

Subvastus and medial parapatellar approaches in TKA: comparison of functional results.

The purpose of this study was to compare the clinical results of total knee arthroplasty (TKA) in the early and late postoperative period using subvastus and medial parapatellar approach. A prospective randomized controlled study was conducted in a group of 169 patients (180 TKAs) with 2-year follow-up. Patients were divided into a study group (97 TKAs) with a subvastus approach and a control group (83 TKAs) with a parapatellar approach. Assessment of the results of both operating approaches was based on functional, clinical Knee Society Score, and pain (visual analog scale). Patients in the subvastus group achieved full active extension, better range of motion, and better Knee Society Score results at 12 days, 6 weeks, and 12 weeks earlier than patients in the medial parapatellar group. They also had less pain at 12 days. No statistically significant differences existed between assessed end points in both groups at 24- and 52-weeks, and 24-months postoperatively. The subvastus approach has given patients better early clinical results; however, at longer follow-up, both groups had similar outcomes. The potential benefits of the subvastus approach are: protection of the extensor mechanism from damage, less risk of damaging the blood supply to the patella, earlier clinical recovery, and less pain in the early postoperative period. The subvastus approach is an alternative to the standard medial parapatellar approach in TKA. It can be used with equally good results, especially taking into consideration positive clinical aspects in the early postoperative period.

[Treatment of open femur fracture with critical bone loss of femoral shaft in politrauma patient--case report]. / Zaopatrzenie otwartego wieloodlamowego zlamania trzonu kosci udowej z krytycznym ubytkiem kosci w urazie wielomiejscowym--opis przypadku.

UNLABELLED: The authors describe the case of a 21 year old patient who suffered an politrauma injury in a traffic accident (motorcyclist). OBJECTIVES: Presentation of possiblities of treatment femur bone fracture with critical bone loss using intramedullary nail. METHODS: Patients's Injury included: fractures of the femur, temporal bone, and ulna. The patient's Severity Score (ISS) was 24. The dominant trauma fracture was open, comminuted fracture of femur shaft (AO 32-C2, Anderson-Gustilo IIIa) with bone loss stated as critical (loss of femoral shaft over 10 cm, including the loss of more than 50% of the circumference was about 8 cm length, and the loss of the full circumference of more than two branches of the missing bone). Osteosynthesisnad bone length reconstruction of the femur was with use of intramedullary locking nail. RESULTS: Full reconstruction was regenerated after 12 months. Although there was extensive injury no local and general complications appeared. CONCLUSION: Early definitive fracture stabilization and secondary dynamisation possible to obtain the bone regeneration at the defect site.

[Possibilities of orthopaedic treatment of patients with renal failure and its meaning in the continuation of haemodialysis and quality of life improvement]. / Mozliwosci leczenia ortopedycznego w skrajnej niewydolnosci nerek i jego znaczenie w kontynuacji dializoterapii oraz poprawie jakosci zycia.

Good cooperation between the fields of orthopaedic surgery and nephrology creates a possibility of multidirectional surgical treatment of the patients with terminal renal failure despite massive general burden and existing risk. Taking a very difficult decision concerning the multidirectional surgical treatment of these patients may to a very great extent improve their locomotor functions and their life comfort. An example of such a situation is the described case of elbow replacement, vascular surgery procedure, total hip replacement and carpal tunnel release surgery.

[Total hip arthroplasty in rheumatoid arthritis: results of 12-years follow-up]. / Specyfika calkowitej alloplastyki stawu biodrowego w reumatoidalnym zapaleniu stawów--wyniki 12-letniej obserwacji.

UNLABELLED: The aims of retrospective cohort study were: analysis of general and local factors, evaluation of clinical and radiographic results and presentation of authors' experience in total hip arthroplasty in rheumatoid arthritis. Study group consists of 222 consecutive total hip arthroplasties (205 cemented and 17 cementless) made in 216 patients. Mean patients' age was 58.4 y.o (range: 34-77 y.o.). In study group were 192 women and 24 men. Mean preoperative function was poor: 28.4 points (range: 24-32 p.). Clinical evaluation was made with Harris hip score, and radiographic one with criteria of Joined Committee of Hip Society, AAOS and SICOT. Clinical results of the study group were as follow: excellent--53 (23.9%), good--128 (57.6%), fair--34 (15.3%) and poor--7 (3.2%). Mean postoperative function was good: 86.8 points (range: 28-94 p.). There were following radiographic results of study group: good--176 (79.3%), fair--28 (12.6%) and poor--18 (8.1%). Complications another than aseptic loosening were observed in 56 (25.2%) hips. CONCLUSIONS: 1) general and local factors make total hip arthroplasty in rheumatoid arthritis more difficult procedure than the same one in osteoarthritis, 2) log-term survival rate of hip replacement in rheumatoid arthritis mainly depends on proper bone stock reconstruction, 3) 80-85% of excellent and good clinical and radiographic results are achieved at 12-year follow-up, 4) incidence of local and systemic postoperative complications are similar to osteoarthritis population, 5) preoperative autologous blood donation does not decrease demand of postoperative blood transfusion.

Cost analysis and sociomedical aspects of the conservative and surgical treatment of hip osteoarthritis.

INTRODUCTION: Hip osteoarthritis (OA) is one of the most common causes of pain, physical disability and marked impairment of patients' physical fitness and mobility. Insufficient funding for health care contributes to prolonged waiting times for total hip replacement (THR) surgery, which has been proven to be the only effective treatment for OA. Average waiting time in Poland is estimated at 2-2.5 years. Objective. To carry out a retrospective comparative analysis of the cost of THR surgery vs. conservative treatment for OA in a variety of sociomedical aspects while patients are awaiting THR. MATERIAL AND METHODS: Two groups of patients were compared. Group I consisted of 77 patients awaiting THR and treated with physical therapy and drugs. Group II consisted of 91 patients who underwent THR. Evaluations and comparisons were based on a modified WOMAC index, the SF-8 survey and estimates of pharmacological, procedural and orthopaedic equipment expenditures. RESULTS: Prolonged waiting times and the associated conservative treatment costs, including drugs, physical therapy, sanatorium, orthopaedic equipment, transport, sickness benefits and costs of pharmacological treatment of complications, were shown to be approximately twice higher compared to the cost of surgical treatment. Apart from financial costs, other significant aspects should also be noted, such as deterioration of the patient's life quality and psychosocial health, and prolonged anguish. CONCLUSIONS: Pharmacological treatment, rehabilitation, physical therapy and other methods appear to be inefficient in patients with hip OA awaiting THR and their costs are twice as high. Additionally, NSAID drugs produce GI ulcers in 25% of the patients. Psychosocial problems are also common for these patients. Surgical treatment produces a radical improvement of the quality of life and ameliorates psychosocial problems. Therefore, hip OA costs can only be reduced by shorter waiting times, which can be accomplished through an increase in funding resulting in wider access to the procedure.

[Appliance of the authors' own concept of the leg support device in the pelvic, hip, thigh operation]. / Zastosowanie podpórki wllasnego pomyslu do uloienia konczyny dolnej podczas zabiegów operacyjnych na miednicy, stawie biodrowym i udzie.

The aim of this study is to present the authors' own concept of the leg support device which facilitates stable positioning in a lateral position with the possibility of a controlled leg abduction in the pelvic, hip and thigh operation. The appliance of this device is a very good and cheap alternative of positioning patients in the hip operation in comparison with the improvised lateral position. As far as the operated leg is concerned the advantages of this device include: stable leg positioning, possibility of controlling the length of the leg, possibility of changing the leg position. The use of this device also reduces the number of medical staff assisting during the operation. Furthermore, this device prevents putting physical pressure on the leg that is not being operated. The experience of using this device for the last few years has proved its numerous advantages.