[Short stature treatment by lower limb lengthening--multicenter study from five centers]. / Leczenie niskiego wzrostu metoda Ilizarowa--zbiorcza analiza wyników z pieciu osrodków w Polsce.

MATERIAL: 26 patients (17 female, 9 male) from 5 centers were evaluated. The age at the beginning of treatment ranged from 6 to 29 years (mean 13.8). The cause of short stature in 19 patients was achondroplasia or pseudoachondroplasia, in next 2--other bone dysplasias. The other 5 patients had not bone pathology and were treated because of cosmetic indications. Preoperative body height ranged from 90 to 149 cm (mean 120). Axial deviations of the lower extremities were noted in 11 patients. Mean follow-up was 3.7 years. METHOD OF TREATMENT: Most of patients were treated with Ilizarov device using cross lengthening strategy (2 stages--opposite femur and tibia lengthening). Mean duration of treatment including interval between two stages (mean 12 months) was 29 months. Planned increase of body height ranged from 10 to 26 cm (mean 16.4). RESULTS: Planned or greater lengthening (mean 14.8 cm) was achieved in 14 patients. Partial planned lengthening (mean 65% of planned lengthening) was achieved in 8 patients (mean 11.8 cm) including two patients who resigned the second stage of treatment. In two patients lengthening was stopped during first month of treatment because of great complications. In 2 patients treatment was not completed (interval between first and second stage). Mean increase of body height of patients with complete treatment was 13.1 cm (from 2 to 28). Problems, obstacles and complications were analyzed according to Paley classification. PROBLEMS: There were 24 problems in 15 patient (inflammation process around K wires--15 patients, bone healing disturbances--3, regenerate fracture--2, transient foot equinus--2 and axial deviation of the lower extremity--1). OBSTACLES: There were 31 obstacles in 19 patients (regenerate's defect--7 patients, premature bone consolidation--6, foot equinus--4 and other--14). COMPLICATIONS: There were 26 complications in 18 patients (axial deviation of the lengthened segment--8, foot equinus--6, paresis of the peroneal nerve--3, fractures--2 and other--5). The most serious complication was hemiparesis after cerebral embolism (1 patient) and damaging of the femoral artery (1 patient) both disrupting bone lengthening. CONCLUSION: The risk of complication in surgical treatment of short stature patients is high. Qualification for short stature treatment because of cosmetic indication should be made very careful and after precise psychological and/or psychiatric investigation.

[The use of Bicontact hip prosthesis in treatment of coxarthrosis]. / Zastosowanie endoprotezy Bicontact w leczeniu zmian zwyrodnieniowych stawu biodrowego.

The issue of a stabile, long lasting bone-implant interface is still very valid. One of the new models of uncemented hip prosthesis is the Bicontact prosthesis made by Aesculap. This four-part endoprosthesis offers two types of cups: threaded München type and spherical Plasmacup type. The prosthesis stem is a wedged type stem, porous in the proximal type. The aim of this paper was to evaluate the value of Bicontact prosthesis in treatment of coxarthrosis. Our material consisted of 69 patients (38 female and 31 male) with 72 operated hips. Average age of the patients was 50.8 years. The mean follow-up was 24.5 months. Clinical and radiological evaluation according to Merle d'Aubine-Postel classification with Charnley's modification yielded 88% very good and good results. In 11 hips a similar complication was noted--fracture of the femur during final hammering of the prosthesis stem into the medullary canal. This was immediately repaired by circular wire fixation without any influence on the final result. This complication was observed during the first procedures. The learning curve of surgical technique allowed us to avoid this complication during subsequent procedures. We concluded that type of hip prosthesis was is very useful in in treatment of coxarthrosis.

[Heterotopic ossification as a complication of total hip replacement]. / Kostnienie pozaszkieletowe jako powiklanie calkowitej alloplastyki stawu biodrowego.

Heterotopic ossification is the most common complication after THR. The authors present the distribution of frequency of ectopic ossification after cementless THR using Mittelmeier and Parhofer-Mönch prosthesis and it's influence on THR outcome. 151 hip joints were evaluated with a follow-up period of more than 2 years. All procedures were performed by a lateral approach. The ectopic ossification was verified according to the Brooker classification. Clinical evaluation was performed according to the d'Aubigne-Postel method in Charnley's modification. The 3rd degree ectopic ossification was found in 14 hip joint and 4th degree ectopic ossification in 2 hip joints (together 10.6%). The positive correlation between the degree of ossification (3rd and 4th) and the decrease of range of motion of the hip joint along with an increase in pain after THR was found.

In situ posterolateral spine arthrodesis for grades III, IV, and V spondylolisthesis in children and adolescents.

The purpose of the study was to analyze the results after in situ posterolateral arthrodesis without reduction in children and adolescents with Meyerding grades III and IV spondylolisthesis and in patients with spondyloptosis who had an average follow-up of 12.8 years. The study population consisted of 21 patients who underwent an in situ posterolateral spinal fusion from L4 to S1 with autogenous iliac bone graft and were immobilized in a pantaloon cast for 4 months. All patients reported improvement after the operation and had no limitation in daily activities. Only four of 21 patients complained of occasional mild pain after physical activity, which resolved with rest and did not disturb their work. After surgery there were no motor deficits, incontinence of bowel or bladder, or sexual dysfunction. Roentgenographic findings showed progression of the slip in five patients and increase of the slip angle and the displacement index in two patients. These changes happened during the first year after the operation. Progression of the slip was not associated with symptoms. There was no pseudarthrosis. In situ posterolateral arthrodesis with a large amount of autogenous bone graft followed by immobilization in a pantaloon cast yields a solid arthrodesis and provides satisfactory results.

[Clinical evaluation of the hip joint after implantation of cementless Mittelmeier type and Parhofer-Mönch type hip prosthesis]. / Ocena kliniczna stawu biodrowego po implantacji endoprotezy bezcementowej typu Mittelmeiera i Parhofera-Möncha.

Total hip replacement is the most common procedure in the treatment of severe degenerative changes in the hip joint. The authors present clinical evaluation of 129 patients (151 hips) who underwent total hip replacement using either the Mittelmeier type or the Parhofer-Mönch type hip prothesis. The age of the patients ranged at the time of the operation between 17 and 74 years (average 44.9). The follow-up ranged from 24 to 143 months (average 61.2 months). The P-M prothesis was implanted in 53 hips, the P-M "Plasmapore" prothesis in 42 patients, Mittelmeier Autophor 900 prothesis in 49 patients and the Mittelmeier Autophor 900S prothesis in 7 patients. Clinical evaluation was performed according to the d'Aubigne-Postel method with the Charnley modification. The results were graded as very good in 17 cases, good in 64 cases, satisfactory in 53 cases and poor in 17 cases. Very good and good results were mainly observed after implantation of the P-M type prothesis and P-M "Plasmapore" type prothesis. Worse results were observed in patients, who at the time of the operation were aged 45 years or less and who had congenital hip dysplasia. P-M type prothesis gives better clinical results in the treatment of degenerative changes of the hip joint.

[The value of selected imaging techniques in evaluation of bone regeneration during limb lengthening]. / Wartosc wybranych metod obrazowych w ocenie regeneratu kostnego w procesie wydluzania konczyn dolnych.

The paper presents the value of different imaging techniques, including X-rays, ultrasonography, computed tomography and densitometry in the evaluation of bone regenerates during limb lengthening. Material consisted of 60 children, age ranging from 4 to 18 years who underwent surgery using the Ilizarov technique because of limb inequality. During of limb lengthening different imaging techniques were employed for monitoring regenerate growth and remodeling. The study showed that all the employed imaging techniques play an important role in monitoring bone regenerate remodeling at different stages of limb lengthening.

[Long term results of the treatment of clubfoot with postero-medial fibular graft]. / Odlegle wyniki leczenia wrodzonej stopy konsko-szpotawej metoda uwolnienia okoloskokowego.

The authors present long term results of treatment of congenital clubfoot by postero-medial release. Our material consisted of 82 patients, with 103 clubfeet, 5 months to 9 years old (mean age 22 months) at the time of surgery. The age at the time of the final follow-up ranged from 6.3 to 27 years. Final results were evaluated according to the Magone classification. Basing on this classification we achieved very good results in 9 feet, good results in 20, sufficient results in 28 and poor results in 46 feet. In the analyzed group most of the results were either sufficient or poor--71.84% of the cases. These feet required further surgical procedures. The authors stress that incorrect classification for this type of surgery and inadequate surgical technique caused a high percentage of poor and sufficient results.

[Long-term results of surgical treatment for clubfoot with the posterior release method]. / Odlegle wyniki leczenia operacyjnego wrodzonej stopy konsko-szpotawej metoda uwolnienia tylnego.

The authors present long term results of congenital clubfoot by posterior release. Our material consisted of 57 patients, with 57 clubfeet, 5 to 27 months old (mean age 9.5 months) at the time surgery. The age at the time of the final follow-up ranged from 8 to 20 years (mean age 14.7 years). The time of the observation ranged from 7 to 20 years (mean 13.9 years). Final results were evaluated according to the Magone classification. Basing on this classification we achieved very good results in 21.3%, good results in 29.3%, sufficient results in 26.7% and poor results in 22.6%. In the authors opinion posterior release and Achilles tendon elongation give the best possibility of correction of residual deformation. Varus deformity, abduction and equinal position should not be treated by posterior release.

[Surgical treatment of congenital clubfoot with constriction band syndrome]. / Leczenie operacyjne wrodzonej stopy konsko-szpotawej ze wspólistniejacymi przewezeniami amniotycznymi goleni.

Twelve feet in 11 patients with constriction band syndrome age ranging from 3 to 18 months (mean age 11 months) were evaluated in this study. The constriction band was located at the in the calf, at distal, media and proximal third levels. All these patients were treated surgically by a wide peritalar release using the Cincinnati incision, followed by a two-stage Z-skin plasty. Both clinical and radiological results were evaluated. In our material an excellent result was achieved in 1 case, good results in 3 cases, satisfactory in 4 cases and poor in the remaining four cases. Very good and good results were achieved in feet with shallow bands type II and III, while poor results were found in feet with deep constriction band type I. Early surgical treatment followed by serial casting leads to better functional results.

[Radiography assessment of the hip joint after the implantation of cementless ceramic cup and metal cup]. / Ocena radiologiczna stanu stawu biodrowego po implantacji bezcementowej panewki ceramicznej i metalowej.

Radiographic assessment of the hip joint and clinical results after implantation of cementless Mittelmeier ceramic cup and metal Parchofer-Munch cup are presented. Material included 151 hips (56 ceramic cups and 95 metal cups). A-P radiograph and Engh criteria served for radiological assessment of the cup. Vertical, horizontal and angular migration as well as radiolucency in three De Lee zones were evaluated on postoperative and follow-up radiographs. Vertical migration and increased radiolucency within III De Lee zone were the most frequent findings. All types of migration and increased radiolucency in De Lee zones were observed more often after ceramic cup implantation.

[The assessment of changes of the plate growth in Blount disease by MRI]. / Ocena zmian w obrebie chrzastek nasadowych kolana w chorobie Blounta w obrazie rezonansu magnetycznego.

The changes within growth plates around the knee in Blount disease have been analyzed with MRI in 4 patients with late onset tibia vara. Extensive changes were found in both tibial and femoral growth plate. General widening of the plate, invagination into metaphysis and high intensity irregularities of the shape were observed. Lateral aspect of both physes was involved to higher degree. Our study supports mechanical etiology of the late onset tibia vara. In our opinion long lasting distraction stress on the lateral aspect of the knee due to the varus deformity might be responsible for the changes observed in MRI.

[Radiological assessment of the hip after Mittelmeier and Parhofer- Mönch stem implantation]. / Ocena radiologiczna stawu biodrowego po implantacji trzpienia endoprotezy Mittelmeiera i Parhofera-Möncha.

Radiological assessment and results after cementless stems implantation at Mittelmeier (Autophor 900 and 900S) and Parhofer-Mönch total hip replacement are presented. Engh criteria were used to assess implantation of the stem on a-p radiograph. Vertical migration, presence of ossifications around the tip of the stem within medullar cavity and radiolucency in 7 Gruen zones were evaluated. The investigation revealed that vertical migration, presence of ossifications around the tip of the stem within medullar cavity and radiolucency around the stem were more frequent after implantation of stems with no microporous surface and Autophor 900 type stems. Radiolucency appeared mainly within IV and VII Gruen zone.

[Surgical treatment for cleft foot]. / Leczenie operacyjne rozszczepu stopy.

The methods and results of treatment of 13 cleft foot in 8 patients are presented. An approximating dexon-polyester suture has been used in Blauth I deformity. Joplin procedure (resection of the intermediate cuneiform) has been done in grade III deformities. If hallux valgus coexisted an arthrodesis of interphalangeal joint has been performed. Family history of hand and foot deformity in one case might prove genetic theory of autosomal dominant inheritance. At follow-up examination mean 11 years after surgery satisfactory cosmetics, efficient gait and standard shoes fitting were found.

[Surgical treatment for recurrent dislocation of the patella in children and adolescents]. / Leczenie operacyjne nawykowych zwichnec rzepki u dzieci i mlodziezy.

Over 100 surgical procedures for recurrent patellar dislocation is described in the literature. Soft tissue operations being less traumatic are specifically indicated in children and adolescents. This paper deals with three of them: Ali Krogius, Garlicki-Salamon and Blauth-Schwarz procedure. Material included 31 patients aged 8-21 years. Thirty-five operation were done: Ali Krogius procedure 14 times, Garlicki-Salamon 13 times and Blauth-Schwarz procedure in 8 cases. The four grade Hall and Michelli scale was used to assess the results. Excellent results were achieved in 12 cases, good in 19, fair in 4 and 2 were poor. Blauth-Schwarz procedure rendered the best results, the worst were accomplished with Ali Krogius operation.