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.

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.

[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.

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.