The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic.

The study analyzes whether the COVID-19 pandemic affects the incidence of arm, forearm, and hip fractures. Additionally, the change in the overall cost of those fractures treatment was estimated. During the COVID-19 pandemic, the incidence of arm, forearm, and hip fractures and the cost of fracture management are decreased. INTRODUCTION: Purposes of the study were to analyze if COVID-19 pandemic influences the incidence of arm, forearm, and hip osteoporotic fractures and to estimate the changes in costs of their management. METHODS: Data on arm, forearm, and hip fracture incidence were collected for inhabitants aged over 50 years in the district of Tarnowskie Góry and the city of Piekary Slaskie, South Poland, in the early stage of COVID-19 pandemic (77 days, from March 16th to May 31st 2020). These results were compared with the number of fractures noted in years 2015-2019 in the same period of the year. The ratio of analyzed fractures per 100,000 inhabitants was calculated. RESULTS: The recorded numbers of fractures of arm, forearm, and hip were 13, 43, and 29, respectively. The respective mean number for fractures reported in corresponding period in 2015-2019 years was 23.6, 52, and 33. The year fracture incidence calculated per 100,000 inhabitants decreased by 45.8%, 18.4%, and 13.4%, respectively. The estimated numbers of avoided fractures extrapolated for the whole country for arm, forearm, and hip were 1722, 1548, and 947, respectively. The total number of avoided fractures was 4217. The expected nationwide cost reduction for the arm, forearm, and hip fracture management was estimated at € 568,260, € 332,820, and € 1,628,840, respectively. The total cost reduction was € 2,529,920 over the period of observation. CONCLUSION: During COVID-19 pandemic, a decrease of arm, forearm, and hip fracture incidence was observed which may result in decrease of total costs for Polish healthcare system.

Evaluation of platelet function using PFA-100® in patients treated with Acetylsalicylic acid and qualified for Trauma and Orthopedic surgery procedures.

The phenomenon of high on-acetylsalicylic acid (ASA) treatment platelet (PLT) reactivity - HATPR - and its clinical implications have not been fully understood. Little data is available on assessing PLT activity based on the severity of intra- and postoperative bleeding in a population of orthopedic patients with normal closure time (CT) measured by a PLT function analyzer PFA-100®, despite being given long-term ASA therapy. The aim is to assess PLT function using PFA-100® in patients with ASA therapy and qualified for trauma and orthopedic surgery procedures. The retrospective analysis covered 384 patients whose PLT reactivity was assessed using PFA-100®. Out of those, 198 had been taking ASA with a 75 mg dose until hospital admission. In addition, a group of 70 patients with a proximal femoral fracture surgically treated using the dynamic hip screw (DHS) was selected, in whom severity of bleeding was assessed by HIP ASA (+). The reference group comprised 52 patients (without ASA therapy) who were operated on due to the same indications. Normal CT was found in 37% of ASA-receiving patients. Patients with normal CT, despite ASA therapy, exhibited significantly more intense bleeding after DHS surgery. A similar number of patients required red blood cells (RBCs) transfusion in HIP ASA (+) and HIP ASA (-). Increased risk of complications in HIP ASA (+) group was not found. CONCLUSIONS: Normal PLT function assessed using PFA-100® is a common phenomenon in patients with long-term ASA treatment and who are qualified for trauma and orthopedic surgery procedures. In many cases, it seems that inadequate response to ASA is only a laboratory phenomenon.

Long-term clinical and radiological assessment of untreated severe cartilage damage in the knee: a natural history study.

We aimed to evaluate whether and to what extent an isolated deep cartilage lesion localized within the tibiofemoral and the patellofemoral joint has an impact on the clinical outcomes and osteoarthritis (OA) progression when it is left untreated. From 1991 to 1994, 4121 consecutive knee arthroscopies were performed, and 37 of them in patients with a single isolated chondral lesion of Outerbridge grade 4 located within weight-bearing areas of the femoral and tibial condyles (FT group) and patella (P group). The lesion size ranged from 2 to 4 cm(2) . Outcomes were reported at a mean 15.3-year follow-up using the Lysholm score, the Tegner activity scale and the Womac score. The mean Lysholm, Tegner and Womac score in the FT group was 87.7, 5.6 and 88.7, respectively. In the P group, it was 83.8, 4.8 and 84.6, respectively (P<0.0.5). Osteoarthritic changes were found in 39% of the patients. There was no difference in OA severity between an injured and an uninjured knee. In patients of the FT group, there was a relationship between the incidence of tibiofemoral OA and patellofemoral OA (P=0.00075). Severe isolated single chondral damage left with no treatment has a limited influence on clinical outcomes and the development of OA.

Isolated full thickness chondral injuries. Prevalance and outcome of treatment. A retrospective study of 5233 knee arthroscopies.

PURPOSE OF THE STUDY The aim of this study was to provide data on the prevalence and epidemiology of isolated deep chondral lesions of the knee, diagnosed in arthroscopy. The study was also aimed to analyse subjective treatment results of localized deep isolated cartilage lesions and to determine how the different factors might affect the final outcome. MATERIAL AND METHODS From 1997 to 2002, 5233 knee arthroscopies were performed. The first part of the study is an epidemiological and statistical analysis of the isolated articular cartilage lesions in which we used the questionnaire based on the International Knee Documentation Committee (IKDC) Questionnaire. The second part is the analysis of subjective treatment evaluation. For this purpose the IKDC criteria were used. Following aspects were taken into account: lesion location and size, time after surgery, patients' age, performed surgical cartilage procedure. The follow-up period ranged from 1 to 7 years. The statistical analysis was performed with the use of the Pearson correlation coefficient and t-test. Significance was set at p<0.05. RESULTS In the analyzed material cartilage lesion was diagnosed in 2931 patients (57.3%). Isolated localized chondral Outerbridge grade 3 and 4 lesions were documented in 5.2% of all patients with diagnosed cartilage lesion. The patellar articular surface (37.5%) and the medial femoral condyle (32.2%) were the most frequent localizations of these lesions. There was no correlation between the results and the period of time after arthroscopy. The best results were obtained in cases of loose body removal, debridement, mosaicplasty and also in cases where the lesion was left untreated. DISCUSSION The management of full-thickness cartilage injury remains one of the most difficult problems in the orthopedic surgery, particularly isolated and symptomatic. In 7 years of follow-up we found good and satisfactory results when debridement and loose body removal was performed and when the lesions was left untreated. Significantly the worst results in subjective evaluation we observed in marrow-stimulating procedures. This study confirms that the appropriate qualification for treatment plays the most important role in successive management of cartilage injuries. CONCLUSIONS Treatment of isolated deep chondral lesions of the knee remains a questionable issue. Little invasive arthroscopic methods as well as using no surgical treatment in grade 3 and 4 isolated cartilage lesions may be effective and improve symptoms and knee function at mid-term follow-up.Our data support also the contention that the natural history of cartilage lesions still remains unpredictable and not well understood.

[Closed intramedullary stabilization of femoral shaft fractures with Eder's nails]. / Zamknieta, sródszpikowa stabilizacja zlaman trzonu kosci udowej pretami Endera.

Forty-one femoral shaft fractures were treated with flexible Ender nails which were introduced through the great trochanter without reaming of the medullary canal. There was one case of intraoperative femoral neck fracture. No wound infection or osteomyelitis occurred. Axial and rotational malalignment was always due to technical errors. All fractures united at an average of 12 weeks. Transverse fractures, short oblique and those with "unicortical" comminution proved to be stable after Ender nailing, while cases with "bicortical" comminution had tendency for bone shortening and often required additional procedures.

[Treatment of tibial shaft fracture by Ender's closed intramedullary nailing]. / Leczenie zlaman trzonu kosci piszczelowej zamknieta, sródszpikowa stabilizacja pretami Endera.

Operative technique and results of treatment of tibial shaft fracture using Ender nails in 46 patients are presented. In all cases tibial shaft fracture was concomitant with massive soft tissue injury and in 18 cases the fracture was open. The fracture healed in all cases, bone infection occurred in one patient.

[Surgical treatment of instability of the ankle joint caused by inveterate injuries of the ligaments of the lateral malleolus]. / Leczenie operacyjne niestabilnosci stawu skokowogoleniowego na tle zadawnionych wiezadel kostki bocznej.

The results of surgical Chrisman-Snook reconstruction of the lateral malleolus ligaments in 9 patients, aged 19-37 years, have been discussed. The follow-up ranged from 2 to 4 years. In all the patients, good functional results were obtained. Among many methods of reconstruction of the lateral malleolus ligaments, the Chrisman-Snook method distinguishes itself because of simplicity of procedure and furthermore, it can be used for reconstruction of injuries of the tarsus ligaments in the region of the malleolus. It can be recommended in the treatment of patients with the symptoms of instability of the talocrural joint.