Benefit of percutaneous injection of autologous platelet-leukocyte-rich gel in patients with delayed union and nonunion.

This article reports the efficacy of percutaneous autologous platelet-leukocyte-rich gel (PLRG) injection as a minimally invasive method alternative to open grafting techniques. Each of 32 participants was followed on a regular basis with clinical examinations, roentgenograms, dual-energy X-ray absorptiometry examinations. In the delayed union group, the average time to union was 9.3 weeks after PLRG injection and the union was achieved in all cases. In the nonunion group, the union was observed in 13 of 20 cases and the average time to union was 10.3 weeks after PLRG injection. Interestingly, in patients in whom union was not achieved, the average time from the fracture and/or from the last operation was >11 months. This is our initial experience with the use of PLRG as biologic treatment for delayed union or nonunion. Our investigation showed that percutaneous PLRG injection in delayed union is a sufficient method to obtain union, which is less invasive procedure than bone marrow injection. Percutaneous PLRG grafting can be also an effective method for the treatment of selected cases of nonunion. The essential factor is the average time from the initial surgery to PLRG injection for nonunion; <11 months seems to be critical for good outcomes.

Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: an in vitro study.

Platelet-rich plasma is a new inductive therapy which is being increasingly used for the treatment of the complications of bone healing, such as infection and nonunion. The activator for platelet-rich plasma is a mixture of thrombin and calcium chloride which produces a platelet-rich gel. We analysed the antibacterial effect of platelet-rich gel in vitro by using the platelet-rich plasma samples of 20 volunteers. In vitro laboratory susceptibility to platelet-rich gel was determined by the Kirby-Bauer disc-diffusion method. Baseline antimicrobial activity was assessed by measuring the zones of inhibition on agar plates coated with selected bacterial strains. Zones of inhibition produced by platelet-rich gel ranged between 6 mm and 24 mm (mean 9.83 mm) in diameter. Platelet-rich gel inhibited the growth of Staphylococcus aureus and was also active against Escherichia coli. There was no activity against Klebsiella pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa. Moreover, platelet-rich gel seemed to induce the in vitro growth of Ps. aeruginosa, suggesting that it may cause an exacerbation of infections with this organism. We believe that a combination of the inductive and antimicrobial properties of platelet-rich gel can improve the treatment of infected delayed healing and nonunion.

[Intertrochanteric fractures of the hip treated with dynamic hip screws (DHS)]. / Leczenie zlaman przezkretarzowych kosci udowej z uzyciem sruboplytki zeslizgowej (DHS).

The history and concept of sliding fixation is presented. Treatment results of 72 cases with 76 intertrochanteric fractures treated with DHS were analysed. Fractures were classified according to the Kyle scale into 4 different types. 61 males and 11 women age ranging from 46 to 72 years (average age: 65 years) were treated surgically. In 48 cases good results were achieved, in 22 cases results were satisfactory and in 6 cases results were poor. The use of DHS screws is an effective way of treating intertrochanteric fractures among patients with osteoporosis, as well as young patients requiring anatomic reduction of bone fragments. This technique allows early mobilization and weight bearing.

Local experience in the diagnosis of avascular necrosis of the femoral head in adults using magnetic resonance.

We analyzed MRI results from 36 patients referred for testing to assess the degree of advancement of non-traumatic avascular necrosis (AVN) of the femoral head in adults (24 cases) or for diagnosis in difficult cases (12 cases). 32 patients were found to have AVN of the femoral head with various degree of advancement, mostly stages III and IV. In three cases the MRI did not show any pathology within the hip joint, and in one case the MRI picture was consistent with a metastatic lesion. This suggests that the value of the MRI as a sensitive diagnostic tool in the early diagnosis of AVN in adults is underestimated.

The value of clinical examination in the diagnosis of carpal tunnel syndrome.

Carpal tunnel syndrome is the most common neuropathy of the peripheral nerves. In diagnosing carpal tunnel syndrome, the case history and physical examination are of primary importance. The goal of our research was to examine the dependencies between particular clinical parameters in the diagnosis of carpal tunnel syndrome. For this purpose 80 cases of carpal tunnel syndrome were analyzed, involving 51 patients ranging in age to 81 (average 50). When the patient history was taken, the major complaints were noted: numbness, swelling, stiffness of the fingers, pain in the region of the wrist and fingers. As part of the clinical testing Lovett's method was used to evaluate muscle strength in the short abductor muscles of the thumb and the antagonist muscle of the thumb in both hands; surface and bifocal sensation were tested on the tips of the first, second, and third fingers; and the Tinel and Phalen Tests performed. In the clinical interviews most often complained of nocturnal pain in the wrist region (98,75%). On the Lovett scale the muscle strength of the short abductor muscle of the thumb was 5 in 85% of the cases, and 4 in the other 15%. Similarly, when the antagonist muscle of the thumb was tested, the result was 5 in 77,5% of the cases, 4 in 17,5% and 3 in 5%. Reduced surface sensation within the innervation zone of the medial nerve was found in 70% of the examined cases. Weakened bifocal sensation occurred in the first finger of the affected hand in 21,25% of the cases, in the second finger in 20% and in the third finger in 22,5% of the cases. On physical examination 54% of the cases showed a positive Tinel symptom, and 87,5% a Phalen symptom. The Tinel test results showed positive correlation with weakened bifocal sensation in the first and second fingers, which was confirmed statistically. The lack of statistical correlation between the results of case history and physical examination render it impossible to diagnosis carpal tunnel syndrome exclusively on the basis of either case history or physical examination.

Our experiences in total condylar knee replacement.

The purpose of this study was to evaluate the outcomes of total knee replacement using endoprostheses. The material consisted of 78 knee endoprostheses in 68 patients operated in our Clinic over a 3-and-a-half-year period beginning in March 1995. Outcome assessment was based on clinical and radiological examinations before and after surgery, with due regard for the patient's subjective evaluation. The average follow-up period was 13 months. The majority of the patients were found to have improved walk efficiency, eliminated or reduced pain, improved mobility, corrected limb axis, and excellent subjective evaluation.

The application of screws covered with a layer of nanocrystaline diamond in tibia fractures treated with a Polfix fixator: further observations.

This article presents further results in the treatment of tibial shaft fractures using a Polfix fixator with screws covered with a layer of nanocrystaline diamond. The advantages of this new protective layer are presented in 16 additional patients. Research to date indicates that nanocrystaline diamond can be used successfully to cover the surface of surgical screws and plates.

[Characteristics of intra-articular injuries of the knee joint in coal miners]. / Charakterystyka uszkodzen wewnatrzstawowych powstalych w nastepstwie przewleklych urazów stawu kolanowego u górników.

This study presents an analysis of chronic knee injuries among coalminers. The aim of this paper was to individuate a relationship between the work conditions in coal mines and the observed pathological changes in the knee joint, as well as to assess the results of treatment. A population of 120 coal miners age ranging from 20 to 46 years (mean age 33.4 years) working in conditions continuously stressing the knee joints was evaluated. It was found that the lower the seam where the miners worked, the greater was the damage to the cartilage. Meniscus injuries were found mainly in miners working in higher seams with smaller load on the knew. It was also found that in this population multiple structures of the knee were injured simultaneously.

Further observations regarding the treatment of the radio-ulnar joint in patients with rheumatoid arthritis.

The aim of this study was to evaluate the late outcome of synovectomy with different resections of the caput of the ulnar bone. Resection of the ulnar caput causes considerable displacement of the ulna in the radial direction. The degree of ulnar displacement and reduced height of the carpus depends more on the rheumatoid process than on surgical procedure. After 10 years or more, degenerative changes begin to develop in most cases more intensively in the distal radio-ulnar region.

Locking intramedullary nailing in failure of bone union.

Treatment of long bone fractures carries a high risk of complications. Among them slow union, nonunion and implant breakage are most often. It is very important to choose a proper method of treatment of these patients. In 15 such cases we performed locked intramedullary nailing. In most cases patients with femur and tibia nonunion after Zespol, Polfix or plate osteosynthesis were operated on. One patients with open tibia fracture treated by Ilizarov method, one with plate breakage after humerus shaft osteosynthesis and one with nonunion which followed closed treatment of tibia fracture were treated. It is very important to pay attention to technical elements of the procedure as well as a traumatic operative technic.

[Low back pain syndrome in coal miners: preliminary results of an epidemiological study]. / Bóle krzyza u górników kopaln wegla kamiennego--wstepne wyniki badan.

The objective of the study was to determine the occurrence of low-back-pain syndrome in coal-miners and to compare the results obtained in the study and control groups. In two groups of subjects (624 employees of the 'Staszic' and 598 employees of the 'Sosnica' mines) the survey and medical assessment were performed and available medical records reviewed. Two groups were similar in terms of age and employment duration, however, working conditions in the 'Sosnica' mine were more difficult, and associated with a larger physical burden. All workers were divided into three groups according to the workload: workers with 'heavy workload' (35.9%), 'medium workload' (37.6%), and 'light workload'. The control group consisted of 449 policemen matched by age and the number of years preceding their retirement. The study revealed that low-back-pain syndrome occurred in 66.4% and 62.2% of the 'Sosnica' and 'Staszic' miners, respectively, while in policemen this figure accounted for only 7.5%. Among miners and policemen, a group with the employment ranging from 10 to 20 years was identified. The group comprised 730 miners, including 179 persons with light workload, and 142 policemen. Law-back-pain occurred in 61.6% of miners and in 14.1% of policemen. In miners the syndrome was associated mainly with lifting heavy objects or with an inappropriate forced position of the body at work. The preliminary results of the epidemiological study indicated that low-back-pain syndrome occurred more frequently in coal-miners than in policemen.

[Gigantic liposarcoma of the lower extremity--case report]. / Olbrzymi tluszczakomiesak konczyny dolnej--opis przypadku.

A case of gigantic liposarcoma of the lower extremity in 42 years old female is presented. The tumor grew extremely fast and reached gigantic size. Over one year follow-up did not reveal any local recurrence or metastases.

[Back pain in coal miners of anthracite coal--pilot study results]. / Bóle krzyza u górników kopaln wegla kamiennego--wyniki badania pilotowego.

The objective of the study was to determine the occurrence of a low-back-pain syndrome in coalminers. The pilot study also aimed at the evaluation of the study design and methods, prior to planned full-scale epidemiological assessment of the syndrome in this workforce. In two groups of subjects (204 persons employed in the "Staszic" mine and 200 in the "Sosnica" mine) a questionnaire survey and medical assessment were carried out, and available medical records were reviewed. Two groups were similar in terms of age and duration of work, but workers of the "Sosnica" mine have worked in more difficult conditions, associated with a larger physical burden. The overall frequency of a low-back-pain syndrome was 73.2% in the "Sosnica" miners and 65.2% in the other group. The syndrome occurrence seemed to depend on the age and occupational history. However, conclusions regarding work-relatedness of the symptoms are not warranted in the light of the pilot study results. The study yielded background data which will contribute to the improvement of the study protocol, being prepared for the major epidemiological assessment of a low-back-pain syndrome in coalminers.

[Results of surgical treatment for tennis elbow]. / Wyniki leczenia operacyjnego "lokcia tenisisty".

This paper presented results after operative treatment of tennis elbow in 32 patients. I have done such types of operations; Froimson (14), Spencer and Herndon (8), Bosworth-Boyd (7) and Froimson with elbow joint synovectomy and radial head resection (3). In young people best results I obtained after Froimson operation. Results of operative treatment of the tennis elbow are dependent on systemic disease. The worst results I obtained in rheumatoid arthritis.

[Case of coexistence of meningiomas and malignant astrocytoma]. / Przypadek wspólistnienia oponiaków i glejaka zlosliwego.

The authors report coexistence of two meningiomas (meningioma psammomatodes) and malignant astrocytoma in a woman aged 58.