Treatment results of adult patients with primary bone tumours of the humerus with the use of the oncological modular endoprosthesis.

AIM OF THE STUDY: Primary bone tumours are relatively rare, but their diagnosis and treatment is difficult and connected with a high risk of complications. The goal of this report is a retrospective evaluation of outcomes in patients with primary tumours of the humerus treated in our centre with the use of modular endoprosthetic reconstruction. MATERIAL AND METHODS: Currently, surgical treatment is a standard procedure for local therapy, with wide tumour-free margin resection after a planned multidisciplinary and individualised strategy of tumour management based on the diagnostic biopsy result. The best option for patients to avoid disability is simultaneous surgical reconstruction aiming to spare the limb and its functionality. RESULTS: In this report, we present the results of treatment of our 11 adult patients suffering from primary bone tumours of the humerus, who have undergone wide bone resection followed by reconstruction with the use of a modular MUTARS® endoprosthesis. CONCLUSIONS: The study showed that prosthetic reconstruction of the resected humerus due to a primary bone tumour is safe and acceptable for patients; despite the fact that limitation of active abduction of the shoulder is up to 20 grades, this surgical procedure provides satisfactory limb function.

Orthotic treatment in osteoporosis.

This article reviews the orthotic treatment of elderly patients with osteoporosis. Application of orthopaedics devices shorten the time of immobilization and reduce the risk of complications.

The application of spinal orthoses in the treatment of scoliosis.

This article presents the most commonly used types of spinal orthoses, their effectiveness in the prevention of progression of scoliosis, and the impact of various factors on treatment outcome in patients qualified for conservative treatment. Spinal orthoses achieved the apex of their popularity in the 1960s, but in later years their role in the treatment of scoliosis has diminished. Nevertheless, the results of long-range observation of the outcome of conservative treatment with spinal orthoses have shown that this is the only treatment method other than surgery that can stop the progression of curvature of the spine.

Orthotic treatment of developmental hip dysplasia.

Summary. Abduction orthoses are used in the treatment of hip dysplasia in newborns and infants. These devices force ca. 1000-1100 flexion of the hips and 30-600 abduction. In this position, the femoral head assumed a concentric position in relation to the acetabulum, which is a basic precondition for normal hip development. This article presents the orthoses most commonly used id Poland to treat development hip dysplasia. Flexion-abduction orthoses are an excellent replacement for the plaster casts formerly used in these cases. The selection of orthosis depends on the attendant physician's experience and the type of defect. The treatment of developmental hip dysplasia is charged with the risk of nutritional defects of the femoral head, and thus requires caution. Orthotic treatment is suitable only for children to age 6 months, since at a later age it can disturb hip development. Lack of parent cooperation can cause complications or lack of treatment effect.

Orthoses in pediatric spinal injures.

This article presents the possibilities of orthotic management in pediatric spinal injures. Orthoses play an important role in the acute and long-term treatment of spinal injures in children. Knowledge of specific indications, effectiveness and possible complications of orthotic use is essential for appropriate decision making.

Arthroscopic treatment of subacromial impingement syndrom.

Background. Subacromial impingement syndrome is a frequently seen disorder of the shoulder, however it is also often misdiagnosed. The aim of the study was the assessment of the clinical value of the arthroscopic subacromial decompression.
Material and methods. From January 1999 to December 2002 sixty five patients were included to our study. The main complaints of patients was severe, long-lasting and progressing pain of the shoulder. Sixty one patients had failed conservative treatment (physical therapy, NSAID's, multiple steriod injections). Average duration of pain before surgery was 20 months, ranged from 1 to 50 months. On examination, restricted range of abduction and narrowing of subacromial space to 5 mm (3-8 mm) on plain AP X-ray view were found. The patients were followed up after six and twelve months after surgery.
Results. Finally, we noted full range of movement and absence of pain in neutral shoulder position in 38 patients. Four patients presented persistent pain while moving their shoulders, but no resting pain. In two cases pain relief was achieved but shoulder joint ROM restriction by 20 degrees abduction and 10 degrees external rotation.
Conclusions. Based on performed study we conclude that treatment emploing arthroscopic subacromial decompression is a valuable method, allowing to achieve very good outcomes and to introduce early rehabilitation.

Functional bracing of the tibial diaphyseal fracture.

This article presents the possibilities of orthotic management of tibial diaphyseal fractures. Functional braces, prefabricated or custom-made allow early guarded weightbearing, mobilization of intact joints and shortening of treatment. Understanding of the philosophy, indications, clinical practise and possible complications of orthotic use is essential for appropriate decision making and good results in treatment.

Aesthetic partial hand prostheses.

This article discusses medical and technical problems involved in the proper fitting of aesthetic hand prostheses. The most important factors determining success include level of amputation, quality of the stump and experience of prosthetic technician. Restoration of almost-normal appearance of the hand and improving the patient's physical capability are an important bonus.