Is acetabular dysplasia and pelvic deformity properly interpreted in patients with congenital femoral deficiency? A 3D analysis of pelvic computed tomography.

PURPOSE: The aim of this study is to assess the pelvis's morphology and spatial orientation of the acetabulum, and their relation to the severity of Congenital Femoral Deficiency (CFD) using 3D imaging. Defining these pathologies is crucial for adequate surgical correction. METHODS: The shape and structure of the acetabulum and pelvis were evaluated in 14 children with unilateral CFD via 3D computed tomography (CT) scans, and then analysed with geometric morphometrics (Procrustes ANOVA). The association between pelvic directional asymmetry and CFD classifications (Aitken, Paley) was assessed. The affected acetabulum's orientation was compared to the non-affected side, and the variability of orientation in different CFD types was evaluated (bivariate correlation). RESULTS: The hemipelvis with CFD is characterized by a smaller acetabulum, a laterally curved ischium and a less upright ilium (p < 0.001). Multivariate regressions revealed a greater level of pelvis asymmetry in more severe types of CFD (p < 0.001). The acetabulum orientation assessment showed a significant decrease in mean anteversion (1.3°) and inclination (9.6°) angle, when compared to the non-affected side (26°and 17.1° respectively; p < 0.001). CONCLUSIONS: The affected side of the pelvis is considerably smaller and more deformed, and this should be considered during limb lengthening. The acetabulum presents with significant dysplasia due to its severe retroversion and steepness (superoposterior distortion). This should not be interpreted as a simple wall deficit, but as a complete acetabular misalignment (often misinterpreted in 2D imagery). Using transiliac osteotomies (e.g. Dega, Salter) is debatable due to abnormal acetabular orientation (superoposterior malalignment). Therefore, alternative options, e.g. San Diego or triple pelvic osteotomy, should be considered.

Prophylaxis of medial compartment gonarthrosis in varus knee - current state of knowledge.

The progression of gonarthrosis results in reduction of physical activity. One of the factors that increase the risk of osteoarthrosis may be joint overload related to the malalignment of the mechanical axis of the lower extremity. The medial compartment (MC) of the knee is particularly susceptible to overload due to the external knee adduction moment (EKAM). Varus knee malalignment contributes to increased EKAM and thus results in increased MC loading. The purpose of this study is to present methods described in current literature aimed at reducing the disproportion in the distribution of loads on articular surfaces of medial and lateral knee compartments in people with varus knee malalignment. Methods have been divided into non-surgical (gait training, physiotherapy, and orthopedic supplies such as valgus braces, lateral wedge insoles, walking poles) and surgical ones (corrective osteotomy).

Humeral lengthening in patients with achondroplasia and in patients with post-septic shortening: comparison of procedure efficiency and safety.

PURPOSE: Although humeral lengthening in patients with achondroplasia is an accepted procedure for improving functional status, there is still a paucity of information about the effectiveness of the method. Therefore, the aim of this study was to evaluate the efficacy and safety of humeral lengthening using monolateral fixators in patients with achondroplasia and unilateral shortening. METHODS: Twenty-one patients (31 humeri) were included in this study. The study group consisted of eight patients with achondroplasia (16 segments). The control group consisted of 13 patients with post-septic shortening of the humerus (15 segments). All subjects underwent distraction osteogenesis with the use of a monolateral fixator. RESULTS: The mean lengthening in the patients with achondroplasia was 8.29 cm, whereas in the control group it was 7.34 cm (p = 0.1677). The mean lengthening percentage in the patients with achondroplasia (50% of the initial length of the humerus) was significantly greater than in the control group (33% of the initial length of the humerus) (p = 0.0007). The mean healing index was 24.8 days/cm in the patients with achondroplasia and 28.56 days/cm in the control group (p = 0.1832). The overall complication rates for the achondroplastic and post-septic patients were, respectively, 175% and 160% (p = 0.1420). CONCLUSIONS: Humeral lengthening with use of monolateral fixators in patients with achondroplasia is an efficient method. Although the segment lengthening percentage is significantly greater in patients with achondroplasia than in patients with post-septic shortening of the humerus, the safety of this procedure is comparable.

Does structural leg-length discrepancy affect postural control? Preliminary study.

BACKGROUND: Leg-length inequality results in an altered position of the spine and pelvis. Previous studies on the influence of leg asymmetry on postural control have been inconclusive. The purpose of this paper was to investigate the effect of structural leg-length discrepancy (LLD) on the control of posture. METHODS: We studied 38 individuals (19 patients with structural LLD, 19 healthy subjects). The examination included measurement of the length of the lower limbs and weight distribution as well as a static posturography. All statistical analyses were performed with Statistica software version 10.0. Non-parametrical Kruskal-Wallis with Dunn's post test and Spearman test were used. Differences between the groups and correlation between mean COP sway velocity and the value of LLD as well as the value of LLD and weight distribution were assumed as statistically significant at p < 0.05. RESULTS: There was a significant difference in the asymmetry of weight distribution between the group of patients and the healthy subjects (p = 0.0005). Differences in a posturographic examination between the groups were not statistically significant (p > 0.05). Meaningful differences in mean COP velocity in mediolateral direction between tandem stance with eyes open and closed were detected in both groups (in controls p = 0.000134, in patients both with the shorter leg in a front and rear position, p = 0.029, p = 0.026 respectively). There was a positive moderate correlation between the value of LLD and the value of mean COP velocity in normal standing in mediolateral direction with eyes open (r = 0.47) and closed (r = 0.54) and in anterioposterior plane with eyes closed (r = 0.05). CONCLUSIONS: The fact that there were no significant differences in posturography between the groups might indicate compensations to the altered posture and neuromuscular adaptations in patients with structural leg-length inequality. LLD causes an increased asymmetry of weight distribution. This study confirmed a fundamental role of the sight in postural control, especially in unstable conditions. The analysis of mean COP sway velocity may suggest a proportional deterioration of postural control with the increase of the value of leg-length asymmetry. TRIAL REGISTRATION NUMBER: Trial registry: ClinicalTrials.gov NCT03048656 , 8 February 2017 (retrospectively registered).

Isolated internal carotid artery dissection in a long-distance runner.

We present a case of internal carotid artery dissection (ICAD) in the precranial segment, which caused binocular visual impairment in a 49-year-old man during a marathon race. The incident lasted 3 h, after which the symptoms resolved. Imaging tests showed internal carotid artery dissection. No ophthalmologic changes were identified. After 6 weeks of ineffective non-invasive treatment the patient underwent vascular surgery - stent implantation into the damaged artery. Detailed diagnostic tests and adequate treatment allowed us to achieve a good clinical result. Upon the suspicion of ICAD it is recommended to extend standard Doppler ultrasound performed with a linear transducer and evaluate the proximal segment of the internal carotid artery with a curved transducer as well.

Leg length discrepancy treatment with subtrochanteric shortening osteotomy and blade plate fixation.

BACKGROUND: Subtrochanteric femoral shortening osteotomy is a method of surgical treatment of lower limb discrepancy (LLD). It is less commonly used due to numerous limitations and the resulting decrease in height, which is an undesirable effect for most patients. The aim of this study was to analyze the results and complications of treatment of leg length discrepancy (LLD) by femoral shortening osteotomy fixed with a blade plate and screws. MATERIAL AND METHODS: The study group comprised 18 patients treated by subtrochanteric shortening osteotomy fixed with a blade or straight plate and screws. The age of patients at the time of the operation ranged from 12 years and two months to 24 years and 3 months (mean 17 years and 8 months). Before the operation, the mean LLD amounted to 4.1cm (from 2,5 to 7,0). The size of the same-time resection of the femur at the level of the subtrochanteric osteotomy ranged from 2.5 cm to 5.0 cm (mean 3.7). The follow-up period ranged from 6 months to 15 years and 9 months (mean 3 years and 6 months). The analysis of the results was based on the following criteria. A good result was defined as obtaining an equal length of both legs or achieving the intended amount of shortening. A fair result was defined as a post-operative LLD from 0.5 cm to 1 cm. A poor result comprised patients with post-operative LLD greater than 1 cm or with complications that leave a lasting impact or complications requiring revision surgery. RESULTS: A good result was obtained in 15 patients and a fair one in 3 patients. Complications appeared in 5 (28%) patients. The most common complication was delayed bone healing. Full weight -bearing of the operated limb was allowed between 12 and 32 weeks post-surgery (mean 19 weeks). The final LLD ranged from 0 cm to 3 cm (mean 0.6 cm). Equal limb length was obtained in 13 (72%) patients. CONCLUSIONS: 1. Subtrochanteric femoral shortening osteotomy fixed with a plate and screws, taking into consideration the limitation of possible correction to 5-6 cm, is an effective method of treatment of lower limb discrepancy with a relatively low complication rate. 2. The most common complications of subtrochanteric shortening osteotomy are disorders of bone union. 3. The use of lag screws for stabilisation of the osteotomy with an angle plate may reduce the risk of complications.

Valgus slipped capital femoral epiphysis: subcapital growth plate orientation analysis.

The aim of the study was to determine the risk factors of unusual, lateral direction of epiphyseal displacement in primarily unilateral slipped capital femoral epiphysis (SCFE) patients with a special focus on radiological parameters of an unaffected hip. A total of 115 patients (75 boys, 40 girls), mean age 13.2 years (8.4-18.6), were analyzed. The mean follow-up time was 11 years (2-29). The proportion of valgus slip among SCFE patients was 11 of 115 cases (9.6%). The patients with valgus slip compared with the classic ones were predominantly females (55 vs. 33%), were younger (11.1 vs. 13.4 years), had a greater epiphyseal-shaft angle (67.4 vs. 59.1°), smaller displacement in the frontal plane (absolute value 6.7 vs. 15°), and a lower risk of contralateral slip (27 vs. 65%). There was no difference in the neck-shaft angle and epiphyseal-neck angle value. A more horizontal orientation of the subcapital growth plate, assessed by epiphyseal-shaft angle, can be considered a conducive factor in the valgus direction of epiphyseal slip in SCFE. In valgus SCFE cases, there is a smaller degree of epiphyseal displacement in both the sagittal and the coronal plane and a lower risk of consecutive contralateral slip.

Intermediate ray deficiency--a new type of lower limb hypoplasia.

OBJECTIVE: Diagnosis of fibular hemimelia is based on the identification of absence or shortening of the fibula in relation to the tibia. Despite the existence of different classifications of this congenital deficiency, certain morphological forms defy proper classification. One such form is absence of foot rays with leg shortening in the presence of an entire fibula. In these cases, foot morphology suggests that central foot rays, not lateral ones, are affected by the deficiency; thus justifying the hypothesis concerning the existence of a separate type of hypoplasia, which may be named "intermediate ray deficiency" (IRD). MATERIALS AND METHODS: Nine patients with IRD, with an average age of 9.4 years at diagnosis (2.9-15), were analyzed. Clinical and radiographic parameters of the leg and foot were recorded according to the Stanitski classification of fibular hemimelia. The position of the lateral and medial malleoli was assessed. Axial alignment was analyzed according to the Paley method. RESULTS: The number of foot rays in eight cases was 4, while in one case, it was 3. Talocalcaneal synostosis was observed in seven cases. The shape of the ankle joint was spherical in six cases, horizontal in two cases and valgus in one case. The position of the lateral malleolus was slightly higher compared to normal. An average functional leg length discrepancy was 4.4 cm. The average percentage of fibular shortening was 9.5 %, tibial shortening 8.7 % and femoral shortening 3.3 %. In all of the cases, slight knee valgus was observed on the femoral level (average 3.3°) and tibial level (average 2.0°). As a result, criteria for IRD diagnosis were proposed. CONCLUSION: "Intermediate ray deficiency" might be defined as a separate type of lower limb hypoplasia.

Phemister epiphysiodesis in leg length inequality treatment--evaluative outcome analysis.

BACKGROUND: The aim of this study was to evaluate the efficacy of Phemister epiphysiodesis for leg length inequality (LLI) treatment in comparison with epiphysiodesis techniques currently in use and to determine factors that may influence outcomes. MATERIALS AND METHODS: Nineteen girls and sixteen boys with a mean skeletal age of 12.2 years and a mean functional LLI of 3.8 cm at the time of surgery were enrolled. Data were retrieved from hospital records and bone ages were determined using standard atlases. Mean follow-up duration was 7 years. RESULTS: Good results (final LLI < 1.5 cm) were obtained in 74.3% of patients, fair results (final LLI 1.6-2.0 cm.) were seen in 5.7% and poor results (final LLI > 2 cm) were seen in 20%. A mean clinical LLI of 1.7 cm was the treatment outcome for the entire group. Valgus deformity of 7°, 10° and 13° occurred in three patients. CONCLUSIONS: 1. Phemister epiphysiodesis performed for LLI produced the desired correction but was associated with a risk of over- or undercorrection and frontal plane deformity due to inadequate physeal closure. 2. These complications are typical for any kind of epiphysiodesis.

Factors influencing bone regenerate healing in distraction osteogenesis.

BACKGROUND: The dynamics and effectiveness of new bone formation in the Ilizarov method varies according to different factors. Some of them may result in substantial prolongation of treatment time. The lengthening index (LI), defined as the number of months in a frame necessary to achieve 1 cm lengthening, is the main indicator of bone healing potential. The purpose of the study was to assess the effectiveness of distraction osteogenesis by analysing the lengthening index (LI) in relation to: age, limb length discrepancy, aetiology, bone segment involved, axial correction and lengthening achieved. We studied 251 patients between the ages of 3 to 50 years (mean 15.3) treated with the Ilizarov method because of lower limb inequality. A total of 319 lengthening procedures were analyzed (tibia--155, femur--164). MATERIAL AND METHODS: Total treatment time (time in a frame) and magnitude of lengthening were recorded in all patients to calculate LI (months per 1cm of lengthening). Patients were divided into several groups according to these factors. RESULTS: Mean LI in the entire sample was 1.6 months/cm (from 0.7 to 5.9). The lowest LI (1.4) was recorded in the youngest patients (from 3 to 9 years) and increased with age, amounting to 1.6 in the 10-17 years' age group, 1.7 in the 18-21 years' age group and 2.4 in the 22-50 years' age group. The mean LI for femoral lengthening was lower (1.5) than for the tibias (1.8). In a group of 63 cases of lengthening up to 4 cm, LI was 2.3; in another group (from 4 to 7 cm - 189 procedures) LI was lower (1.6), and in the last group (more than 7 cm) it was 1.2. There was no significant difference in mean LI between the groups with and without axial correction. However, differences between aetiology groups were statistically significant, with a mean LI of 1.2 in achondroplasia patients, 1.4 in post-septic patients and patients with and Ollier disease, 1.6 in patients with congenital deformities, 1.8 in post-traumatic patients and 2.0 in neurogenic and clubfoot patients. CONCLUSION: According to the lengthening index analysis, the effectiveness of distraction osteogenesis is related to age, aetiology, bone segment involved and the magnitude of lengthening, while it is not related to axial correction.

Lower limb inequality treatment with subtrochanteric femoral shortening osteotomy fixed with intramedullary nail.

BACKGROUND: The aim of the study is to analyze the results of treating the lower limb inequality with subtrochanteric femoral shortening osteotomy fixed with interlocking intramedullary nail. The analyzed material includes 14 patients aged 16 to 36 (mean 25), in whom femoral shortening osteotomy fixed with interlocking nail was performed. In all patients the indication for this therapeutic method was lower limb inequality caused by femur shortening and accompanied by contraindication for femoral lengthening procedure. Limb length inequality ranged from 1.5 to 6.0 cm (mean 3.8). The follow-up period was between 2 and 6 years (mean 3.8). MATERIAL/METHODS: All patients underwent open subtrochanteric femoral osteotomy with interlocking intramedullary nail fixation. The amount of bone resected from the femoral subtrochanteric area ranged from 1.5 to 4.5 cm (mean 3.3). Dynamization of the nail (removal of one or two peripheral interlocking screws) was performed in 11 patients. RESULTS: In all patients the expected limb shortening was achieved. Osteotomy site union was observed in 8 out of 14 patients 3.5 to 6 months (mean 4.8) after the surgery. In 3 patients delayed union was observed after 10-12 months (mean 11). In other 3 patients the lack of union did not cause any major problems, but it required additional surgical intervention (Judet-Forbes procedure, PRP administration). Following the procedure the union was observed after 30, 31 and 60 months respectively. CONCLUSIONS: Subtrochanteric femoral shortening osteotomy fixed with interlocking intramedullary nail is a good alternative method in lower limb inequality treatment in the adult patients in whom the Ilizarov method is contraindicated. Few complications such as delayed union are well tolerated due to intramedullary fixation, and only some of them may require secondary surgical intervention.

[Pain intensity in patients treated by the external fixation]. / Dolegliwosci bólowe u chorych leczonych metoda stabilizacji zewnetrznej.

One of the inherent features of the external fixation is pain occurring during the whole treatment process. The aim of this paper is evaluation of the level of pain intensity during particular stages of treatment and defining the correlation between pain intensity and type and also localization of fixator, etiology, type of treatment and patient's life activity. We analyzed 64 patients treated by external fixation of the lower limb in the age between 13 to 72 (mean 23.7). The pain intensity was evaluated four times by the NRS protocol (Numeric Rating Scale) in active and passive situation. It is stated that there is a different pain pattern in time depending on the type of treatment and personal life activity. Lengthened and patients in full time education are characterized by rapid increase in pain level in the first period of treatment. Patients with stabilization of non-union or fracture and professionally inactive had lower fluctuations of pain intensity. Localization of apparatus has influence on pain intensity level- greater pain was noted in the tibial group. Etiology influences on pain intensity. Increase of pain intensity in patients with non-union is lower in comparison to patients treated for the other indications.

[Humeral lengthening with a monolateral external fixator in achondroplasia]. / Wydluzenie kosci ramiennej z zastosowaniem dystraktorów monolateralnych u chorych z achondroplazja.

INTRODUCTION: In achondroplasia patients the shortening of upper limb (mainly the arms) is an important part of pathology in addition to low stature. Not all patients who are treated for increasing their height decided to have humeral lengthening and the indication for treatment is not only for cosmetic, psychological aspects but also limitation of upper limb function like self-services and personal hygiene. MATERIAL AND METHODS: 5 patients were evaluated (4 girls and 1 boy) at age of 14 to 18 years (mean 15.7) in whom 10 humeral lengthening were do-ne using monolateral external fixator "Pumed". All patients have lower limb lengthening with the Ilizarov method 4-5 years before humeral lengthening. Observation time was 6 to 34 months (mean 20). In all cases the Pumed external fixator was fixed to humerus by 4 Schanz screws, open humeral distraction osteotomy was done below the insertion of deltoid muscle. In one case 15 degrees anteflexion correction was done intraoperatively. Distraction began at 5-6th day postoperatively with rate of 1 mm/day. Because of hypertrophic bone regenerate the distraction rate was often increased up to 1.5 mm/day. RESULTS: 8 to 9 cm lengthening was achieved (mean 8.5) which represents more than 50% of the primary segmental length. The average time of fixator application was 7 months and the lengthening index ranged from 0.8 to 1.1 months/cm (average 0.85). No shoulder and elbow joint range of motion deterioration was observed. At the follow-up transient radial nerve palsy was observed in one case after acute limb axis correction. CONCLUSIONS: Humerus lengthening, in achondroplasia patients with the use of monolateral external fixator is an effective and reliable method of treatment, with relatively low lengthening index. Monolateral External Fixator are well tolerated by patients.

[Surgical treatment of short stature of different etiology by the Ilizarov method]. / Chirurgiczne leczenie niedoboru wzrostu o róznej etiologii metoda Ilizarowa.

THE AIM OF THE STUDY: To evaluate the results of surgical short stature treatment with distraction osteogenesis using Ilizarov apparatus. MATERIAL AND METHODS: Since 1996 sixteen patients were treated surgically because of short stature (11 male and 5 female) at the age of 9 to 29 years (mean 15.2). The cause of short stature in 6 patients was achondroplasia, 2 - Ellis van Creveld, 2 - Ollier disease, 1 - spondylometaphyseal dysplasia, 1 - hypothyroidism, 1 - pseudoachondroplasia and constitutional short stature - in other 3 patients. The pre-operative height ranged between 103 cm to 155 cm (mean 125). 12 patients were treated by the crossing method, means in one stage lengthening of the femur and the tibia of the contralateral limb. In 4 cases lengthening and improvement of body proportion was achieved by lower leg lengthening only (one of them lengthened twice). In 9 cases treated with the crossing method complete procedure was finished, in other 3 - only the first stage. Results In all patients the planed segmental lengthening was achieved except one tibial segment in the most older patient. Achieved height increase ranged from 8 to 20 cm (mean 13.8), on femur level 6 to 10 cm (mean 8.3) while on tibia level 2 to 10.5 cm (mean 7.3). The lengthening index for the single segment ranged from 0.6 to 4.7 months/cm (mean 1.5). COMPLICATIONS: Severe limitation of knee joint range of motion (up to 50 degrees) needs quadriceps plasty in one case. Residual valgus deformity of the tibia in one case with Ellis van Creveld needs corrective osteotomy. Abnormal bony re-generate of the tibia in the oldest patient did not allows achieving the planed lengthening and leads to increasing the lengthening index up to 3 times. CONCLUSION: Increasing the height with Ilizarov method is effective however the treatment time is long, requiring strict patients cooperation. The risk of complications should makes the qualification to this treatment careful and precise.

[Repair of the knee extension apparatus in the treatment of "extension contracture" after femoral lengthening]. / Przykurcz wyprostny stawu kolanowego jako powiklanie wydluzania uda-- analiza przyczyn i ocena wyników leczenia operacyjna plastyka aparatu wyprostnego kolana.

UNLABELLED: Restriction of the knee flexion is one of the most frequent complications during femoral lengthening with Ilizarov method. In most severe cases the knee flexion reaches less than 90 degrees, which leads to impairment of patient's activity ("extension knee contracture") and represents difficult clinical problem to manage. MATERIAL: We reviewed 4 patients at the age of 14 to 22 years (mean 19), treated surgically because of severe knee flexion limitation as a complication of femoral lengthening with the Ilizarov method. The mean age at femoral lengthening was 17 years (12 to 20). The indication for lengthening was femoral shortening from 5 to 12 cm (mean 7.5) because of myelodysplasia with club foot deformity (1 case), fibular hemimelia (1 case), sequelae of septic arthritis (1 case) and Ollier disease (1 case). Lengthening with Italian modification of Ilizarov device was used in all cases. In two patients with knee instability the apparatus was extended to stabilize the knee joint (in one case tibial and femoral lengthening was made simultaneously). Femoral lengthening of 5 to 12 cm (mean 7.5) was achieved. Knee flexion before lengthening varied from 90 degrees to 150 degrees (mean 135 degrees) and after femoral lengthening decreased to 41 degrees (20 to 75 degrees). METHOD: Plasty of knee extension apparatus was done 16 months after removal of the Ilizarov device. The procedure includes extensive release of subcutaneous and fascial adhesions around the knee joint (4 patient), patellar retinaculum and ilio-tibial tract release (4 patient), lengthening of vastus lateralis muscle (4 patients), vastus medialis (2 patients) and vastus intermedius (1 patient), mobilization of patello-femoral joint (3 patients), fractional, intramuscular lengthening of rectus femoris 15 cm above the knee joint (2 patients). Intraoperatively 90 degrees flexion was achieved (80 degrees to 100 degrees). In after treatment plaster cast with knee flexion 45 degrees was used. After 4-5 days passive exercises were started using K2 apparatus (continuous passive knee motion) and posterior slabs: one with knee extension for walking and second with knee flexion at the night were used. Active exercises began at the 10th day after surgery. RESULTS: At follow up 10 to 47 months (mean 36) after surgery 105 degrees to 120 degrees of knee flexion (mean 114 degrees) was achieved with full passive and active knee extension at good muscle power. All joints were evaluated as stable in sagittal and coronal planes (including 2 joints with mild instability in coronal plane before surgery). CONCLUSIONS: 1. Femoral lengthening procedure should be realized with proper attention to prophylaxis of knee extension contracture. 2. Knee extension apparatus plasty is effective and save procedure for treatment of so called "extension knee contracture" as a complication of femoral lengthening.

[Reduction of epiphyseal displacement and fixation in the treatment of unstable slipped capital femoral epiphysis]. / Repozycja przemieszczonej nasady w leczeniu niestabilnego mlodzienczego zluszczenia glowy kosci udowej.

UNLABELLED: Reduction of epiphyseal displacement by manipulation in the treatment of unstable slipped capital femoral epiphysis (scfe) can lead to very severe complications as avascular necrosis or acute necrosis of cartilage. The aim of this study is to analyze the results of treatment of unstable scfe with open reduction and fixation. Material consists of 14 patients (10 boys and 4 girls) with 15 hips treated surgically because of unstable scfe with an average follow up of 10 years and 6 months (ranged from 2 to 26 yrs). The age of the patients ranged from 9 to 17 yrs (mean 13). There was 14 cases of acute-on-chronic slips and 1 acute slip. The slip angle measured on anteroposterior radiographs ranged from 27 degrees to 57 degrees (mean 39 degrees) and on frog lateral radiographs ranged from 52 degrees to 81 degrees (mean 67 degrees). In all of the cases manipulated reduction and internal fixation was done. The mean amount of correction was 30 degrees measured on anteroposterior radiographs (from 7 degrees to 55 degrees) and 37 degrees on frog lateral radiographs (from 8 degrees to 82 degrees). An end results were classified according to Hall and Southwick classification with Szypryt modification. RESULTS: Excellent result was achieved in 6 hips (40%), good in 4 hips (27%), fair in 3 (20%) and poor in 2 (13%). Avascular necrosis developed in 2 hips. There was no cases with acute necrosis of cartilage. CONCLUSION: Reduction of epiphyseal displacement and fixation is a save procedure in the treatment of unstable slipped capital femoral epiphysis. Severe under-correction as well as over-reduction can lead to unsatisfactory results.

[Chronic exertional anterior compartment syndrome of the leg with fascial hernia--case report and review of the literature]. / Przewlekly, przeciazeniowy zespól ciasnoty przedzialów powieziowych goleni z przepuklina powieziowa--opis przypadku i omówienie pismiennictwa.

18-year-old female with chronic exertional anterior compartment syndrome was described. Pain was localized on the anterior part of the leg after long distance walking or another physical activity. Disorder was confirmed by electromyography and using Compartmental Pressure Monitor System (Stryker, USA). Intracompartmental pressure was measured three times--after rest, immediately after exercises and again after 30 min. rest. During measurement each compartment was injected by 0.2 ml 0.9% NaCl. The pressure value was noted 10 seconds later. The following values were noted: resting pressure--9 mmHg (normal 0-5 mm), immediately after exercises (active dorsal flexion of the foot)--99 mmHg (normal < 30 mm), after 30 minutes rest--29 mmHg. The patient was treated operatively by subcutaneous fasciotomy of the anterior and lateral compartment of the leg. This procedure was combined with neurolysis of the neural branches within a hernia. 6 months later at follow-up examination complete disappearing of the pain was confirmed. Chronic exertional anterior compartment syndrome should be consider in diagnostics of the lower extremity pain unknown origin in young adults (sportsmen).

[Analysis of some gait parameters at different stages of leg lengthening using the Ilizarov technique]. / Analiza wybranych parametrów chodu na róznych etapach leczenia metoda Ilizarowa u chorych z nierównoscia konczyn dolnych.

Summary Limping as the most frequent sign causing treatment decisions in patients with leg-length discrepancy, has become possible to measure using gait analysis. Consequently, observation of its changes may be a valuable guide in limb-lengthening treatment using Ilizarov technique. In this paper, we present results of repeated laboratory gait analysis in 23 patient with limb-length discrepancy treated with use of Ilizarov external fixation technique. We analyzed time, dimensional and kinetic gait parameters. The evaluation of vertical ground reaction force elements values was conducted twice--during standing (static phase) and walking (dynamic phase). Each examination was performed before treatment, during distraction, consolidation and after frame removal. Observed values of chosen gait parameters revealed substantial changes during initial treatment period comparing to those before treatment. In the course of time they normalized. Kinetic examinations proved also the initial reduction of ground reaction forces. Relations between vertical pressure forces were also disturbed in both static and dynamic gait phases. This determines the future course of search for optimal treatment solutions in patients treated by distraction with Ilizarov frame. Observed change regularities allow to control the course of treatment and determine indications for further distraction.

[Radiological risk factors of bilaterality in unilateral slipped capital femoral epiphysis]. / Radiologiczne czynniki ryzyka drugostronnego zluszczenia u chorych z jednostronnym mlodzienczym zluszczeniem glowy kosci udowej.

The aim of the study was to determine radiological risk factors of development of secondary contralateral slip in patients with primary unilateral slipped capital femoral epiphysis (scfe). The material consisted of 115 patients operated because of scfe in the Institute of Orthopaedics and Rehabilitation at the University of Medical Sciences of Poznan in 1968-1991. There were 75 boys (65%) and 40 girls (35%) at the mean age 12.8 years. The retrospective analysis showed that contralateral slip developed more often in patients with more vertical orientation of subcapital growth plate (with Alsberg angle less than 60 degrees). The neck-shaft angle, slip angle, slip direction and negative Klein's sign has no prognostic value according to development of secondary contralateral slip. More than 1/3 of the patients with unilateral scfe developed silent, subclinical contralateral slip. In most of that patients radiological signs of preslip stage of contralateral slip can be observed (positive Klein's sign, pathological neck-epiphyseal angle).

[Protocol of lower limb lengthening with the Ilizarov method]. / Monitorowanie wydluzania konczyn dolnych metoda Ilizarowa--Karta Chorego.

The aim of this study is simplification of treatment monitoring, along with assessment of the passed and present state of the therapeutic process. Strategy of treatment with Ilizarov technique is presented. It is based on a short stay on the ward after performing the Ilizarov procedure (about 2 weeks), with most of the therapeutic process realised at home with support from the outpatient clinic. During the distraction phase patients are checked up at the outpatient clinic once a week, while during the consolidation phase once every 3-6 weeks. An original patient monitoring technique is presented. The protocol allows collecting the most important information in a comprehensive way for fast clinical evaluation and research.