The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial.

OBJECTIVES: To estimate the usefulness of therapeutic ultrasound for healing of venous leg ulcers. METHODS: Eighty-one patients were included in this study. Patients in groups 1 and 2 were treated surgically. Patients in groups 3 and 4 were treated conservatively. Patients in groups 1 and 3 were additionally treated with the ultrasound (1 MHz, 0.5 W/cm(2)) once daily, six times a week for seven weeks. RESULTS: Comparison of the number of complete healed wounds indicated statistically significant differences between groups 1 and 4 (P = 0.03), 2 and 4 (P = 0.03), 3 and 4 (P = 0.03) in favour of groups 1, 2 and 3. Comparison of the other parameters also demonstrated more efficient therapy effects in groups 1, 2 and 3 than in group 4. There were no statistical differences in all examined parameters between groups 1, 2 and 3 (P > 0.05). CONCLUSIONS: The ultrasound is an efficient and useful method only in conservatively treated venous leg ulcers. There are no special reasons for application of the ultrasound in surgically treated patients. A well-conducted surgical operation is much more effective for a healing process than conservative pharmacological procedures.

Peripheral nerve compression neuropathy after fractures of the distal radius.

Sixty patients with unilateral distal radius fractures were managed conservatively. Clinical assessment included objective and subjective evaluations of the outcome of treatment. Radiographic evaluation included fracture classification using the AO/ASIF system and measurement of volar tilt, radial inclination and radial height shortening at the end of treatment. Clinical signs of carpal tunnel syndrome were confirmed electrodiagnostically in 12 patients (20%) during the recovery period. Each patient had electrodiagnostic studies of both upper limbs performed to confirm the diagnosis. The mean time between injury and the onset of symptoms was 10 months (range 6.5 weeks-27 months). A statistically significant correlation between the final clinical results of treatment and post-traumatic median nerve compression neuropathy was found, but the occurrence of the neuropathy correlated with neither fracture type nor with the final radiographic findings. No clinical signs of ulnar or radial nerve compression occurred in this study.

[Assessment of quadriceps muscle isometric strength following operative treatment of femoral shaft fractures]. / Ocena sily izometrycznej miesnia czworoglowego po leczeniu operacyjnym zlaman trzonu kosci udowej.

The authors investigated quadriceps muscle strength following operative treatment of femoral shaft fractures in 135 patients. Patients were categorized according to the kind of procedure performed: open Kuntscher intramedullary nailing--30 cases; Zespol--30 cases; AO plate osteosynthesis--47 cases and closed intramedullary nailing 28 cases. Two groups of patients were formed according to surgical technique: open method--107 cases and closed method--28 cases. 39 patients treated with an open method required re-operation. The best results were obtained in cases treated with closed technique--79.6%. The worst results were noted in the group requiring re-operation: 56.7%. The worst results were found in cases with comminuted fractures, and those located in the distal third of the femoral shaft.

[Computer stimulation of stress distribution in finite element models of the normal femur and after Weller, Centrament, Parhofer-Mönch type prosthesis implantation]. / Komputerowa symulacja rozkladów naprezen w modelach kosci udowej prawidlowej oraz po implantacji trzpieni typu Weller, Centrament i Parhofer-Mönch.

The paper presents an example of application of computerized analysis in the evaluation of the biomechanical reactions of the bone tissue after total hip replacement. Finite element models of the normal femur and femurs after Weller, Centrament and Parchofer-Monch type hip prosthesis implantation were constructed. Basing on these models, a comparative analysis of the stress patterns in all femurs was performed according to Pauwels' method. This study showed that total hip replacement leads to a redistribution and diminution of stress in the bone tissue, because of material disconformity of the prosthesis. The authors believe that the evolving virtual analytic tools used in simulations will in the future play a major role in reconstructive surgery.

[Comparative evaluation of stress patterns in models of the normal hip joint and after implantation of the Parhofer-Mönch type hip prosthesis]. / Porównawcza ocena rozkladów naprezen w modelach panewki stawu biodrowego prawidlowego i po endoprotezoplastyce Parhofera-Möncha.

The paper presents a comparative appraisal of stress patterns of the normal acetabulum of the hip joint and after implantation of a Parhofer-Monch type prosthesis based on a computer simulation analysis. Three-dimensional physical models were constructed basing on finite element methods and loaded according to Pauwels' scheme with a force R = 2878 N. Mathematical analysis was performed on a computer equipped with a Pentium II processor, using professional software written for theory of elasticity problem solving. Equipotential stress patterns were designated according to Hubers' hypothesis. A redistribution and decrease in stress values in the bone directly around the acetabular component of the prosthesis was noted.

[Comparative assessment of mineral changes in the femoral bone after the Weller and Centrament total hip replacement]. / Porównawcza ocena zmian mineralnych w kosci udowej po endoprotezoplastyce cementowej stawu biodrowego typu Weller i Centrament.

Mineral changes within femoral bone after Weller cemented stem implantation (31 females, 20 males, mean age 69.6 years) and cemented Centrament stem implantation (35 females, 16 males, mean age 65.3 years) were evaluated and compared. Densitometry with LUNAR DPX has been performed 4 times in every patient: 8-12 days after surgery and subsequently in 6-months time span. Orthopedic Auto Analysis software has been used to determine BMC and BMD. Decrease of both values was observed at every measurement and Gruen zones 7, 6 and 1 were affected most despite of the stem type.

[Densitometry for assessment of periacetabular bony changes after Parhofer-Mönch total hip replacement]. / Densytometryczna ocena kostnych zmian okolopanewkowych po endoprotezoplastyce stawu biodrowego typu Parhofera-Möncha.

Densitometry for assessment of mineral changes after Parhofer-Mönch total hip replacement 10 mm around the acetabular component has been done in 53 patients (31 females and 22 males, mean age 52.1 years) with unilateral hip arthritis. Lunar DPX apparatus has been used, "manual analysis" of "Orthopedic" software and modification of DeLee and Charnley zones for DEXA technique was employed. After 6 months follow-up BMC and BMD decreased in all zones analyzed, especially in zone 2. These values increased in next 6 and 12 months but did not compensate for the primary loss.

[Dual energy X-ray absorptiometry in Ilizarov lower extremity lengthening: preliminary study]. / Metodyka badania densytometrycznego w wydluzeniach konczyn dolnych sposobem Ilizarowa--doniesienie wstepne.

Ilizarov method for lower extremity lengthening has been employed in 107 patients. Some 25% of numerous complications are bony union disturbances. Dual energy X-ray absorptiometry (DEXA) for assessment of new bone formation was introduced to reduce these problems. Detailed densitometry methodology developed on the ground of 93 measurements in 11 patients is presented. Pre-operative measurement was followed by subsequent evaluations done every 3 weeks after the onset of distraction. DEXA was capable of showing the callus 3-4 weeks earlier than conventional radiography. DEXA allows for adjusting the pace of lengthening to the extent of new bone mineralization, evaluation of lengthening achieved, determining the timing for safe removal of the apparatus. The need for temporary rearranging of the apparatus and troublesome image analysis are among the drawbacks of the method.

[Ochronotic changes in alkaptonuria: a case report]. / Zmiany ochronotyczne w alkaptonurii--opis przypadku.

Alkaptonuria is a rare metabolic condition caused by congenital homogentisate oxidase deficiency of recessive autosomal inheritance. Homogentisate polymers are accumulated and cause urine darkening (alcaptonuria), brown/black pigmentation of connective tissue (ochronosis), articular cartilage pathology, osteoporosis and patomorphologic changes in internal organs. A case of 61 female with ochronotic polyarthropathy is presented. An early result of Weller THR is encouraging. Pathogenesis, clinical picture, diagnostics and treatment of alkaptonuria is presented on the ground of the literature.

[Early results of densitometry around the cementless stem of the Parhofer-Mönch hip endoprosthesis]. / Wczesne wyniki badania densytometrycznego tkanki kostnej wokól trzpieni endoprotez bezcementowych stawu biodrowego typu Parhofera-Möncha.

Fifty-three patients with unilateral hip arthritis (31 females, 22 males) aged from 29 to 66 years (mean 52.1 years) after total hip replacement with cementless Parhofer-Mönch endoprosthesis underwent densitometry. The content (BMC) and mineral density (BMD) of calcium within proximal end of the femur was evaluated at 8-12 days postoperatively and at 6, 12 and 18 months follow-up. Early results show various mineral changes in Gruen zones around the stem. The greatest BMC and BMD decrease was found at 6 months follow-up in zones 1 and 7 as well as 2 and 6. The BMC and BMD tendency to decrease gradually ceased and slightly positive values were found in zone 3, 4 and 5 at the final evaluation.

[Surgical treatment for Salter-Harris type II distal femoral epiphysis injury]. / Leczenie operacyjne urazowego uszkodzenia dalszej nasady kosci udowej typu II wg Saltera-Harrisa.

Results of surgical treatment for Salter-Harris type II distal femoral epiphysis injury in 4 boys aged 10-16 are presented. In 3 cases the epiphysis was fixed with two screws introduced above the growth plate. Kirschner wires inserted through epiphysis were used in one case. Healing occurred in all cases. Shortening of the femur due to the injury to the distal growth plate was observed in 2 patients. In these cases surgery was preceded by two attempts to reduce displacement conservatively. MRI and CT studies are useful in diagnostics for epiphyseal injuries and their consequences.

[Use of densitometry examinations for evaluation of proximal femur fracture risk in people over 50 years of age]. / Zastosowanie badania densytometrycznego w ocenie ryzyka zlaman blizszej nasady kosci udowej u osób powyzej 60 roku zycia.

The paper presents the use of dual energy X-ray absorptiometry for selecting patients with high risk of proximal femur fracture. A group of 63 patients with fracture has been compared with a group of 306 patients who fell down but did not sustain a fracture, all individuals aged over 60. Most significant bone density decrease (p < 0.001) presented as Z indices related to young population was found in all three examined areas of the proximal femur. The difference between the groups ranged between 1.62 to 2.19 SD depending on the area and the sex. Threshold values for ZYA have been established. For the femoral neck it was -1.3 SD, for Ward's triangle -1.5 SD and for trochanteric area -0.4 SD.

[An attempt to assess the effect of stress in the femoral bone after implantation of the Weller endoprosthesis on changes within bone tissue in correlation with densitometry examination]. / Próba oceny wplywu stanu wytezenia w kosci udowej po implantacji endoprotezy typu Weller na zmiany zachodzace w tkance kostnej w korelacji z badaniem densytometrycznym.

The paper presents comparative analysis of stress distribution, determined by finite elements method in normal femoral bone and one after Weller total hip replacement, with Gruen zones in consideration. An attempt to correlate an effort and bone tissue state has been made. The results of computer simulation have been compared with results of densitometry. It was found, that alloplasty unloads bone tissue along the stem and particularly around trochanteric area. Dual energy X-ray densitometry performed 7 days, 6 and 12 months after surgery revealed decreased BMC and BMD values in all analyzed zones. The greatest decrease was noted in zone 7.1 and 6.

[Results of treating forearm bone shaft fractures with a 3.5 mm self compressive plate]. / Wyniki leczenia zlaman trzonów kosci przedramienia plytka samodociskowa 3.5 mm.

Results of 29 forearm bones shaft fracture treatment with 3.5mm self compressive plate in 26 patients aged 18-64 (mean 33) are presented. Open reduction with 3.5mm self compressive plate fixation has been performed in all cases. Anderson et al criteria were used to assess functional and radiological outcome. Excellent and good functional results were achieved in 25 cases, one was rated fair, no poor results were observed.

[Growth disturbances after A-O cancellous screw head-neck transfixation for slipped femoral epiphysis]. / Zaburzenia wzrostowe po zespoleniu szyjkowo-glowowym sruba gabczasta AO w mlodzienczym zluszczeniu glowy kosci udowej.

The impact of head-neck A-O cancellous screw transfixation on subcapital growth plate in 20 children operated for slipped capital femoral epiphysis is presented. It was found, that early fusion of the growth plate may be attributed to the compression by A-O screw used for transfixation (p-0.0001). Resulting shortening of the femoral neck and relative overgrowth of the great trochanter did not influence the final outcome of treatment.

[Use of densitometric examination in evaluation of cementless hip endoprosthesis]. / Zastosowanie badania densytometrycznego w ocenie endoprotezoplastyki bezcementowej stawu biodrowego.

Five patients underwent densitometry in order to establish bone mineral content (BMC) and bone mineral density (BMD) around Parhofer-Mönch total hip components. The measurements were taken with LUNAR DPX unit twice: 11 days and 6 month postoperatively. "Orthopedic" software was employed to analyze them. Bone around the stem was evaluated with "auto analysis" option and relation to Gruen zones; "manual analysis" was used in modified DeLee and Charnley zones around the acetabulum. After six months BMC and BMD decrease in all Gruen zones was noted. In DeLee and Charnley zones BMC and BMD decreased in field 1 but slightly increased in field 2 and 3. The authors consider densitometry as important tool for monitoring and documentation of postoperative bone reaction to the implanted endoprosthesis.

[Reproducibility of densitometric examinations of the tibial shaft]. / Powtarzalnosc badania densytometrycznego trzonu kosci piszczelowej.

The aim of this paper is to evaluate the reproducibility of tibial shaft densitometry in own method under development. It will be expressed as percentage value of coefficient of variability (%CV). Bone mineral content (BMC) and bone mineral density (BMD) were measured with a dual energy X-ray densitometer Lunar DPX; the data were analyzed with a "Orthopedic" software. Three tibial bone scans were done in 10 males. High reproducibility was found, ranging from 0.98% to 1.45% and from 1.45% to 2.08% for BMC and BMD respectively. Reproducibility increases as the analyzed surface increases. Reproducibility so high allows for further investigations; it might be interesting to monitor BMC and BMD of the tibia in course of fracture treatment by Polfix or Zespol method.

[Measurement of lower extremity length using computed tomography]. / Pomiar dlugosci konczyn dolnych przy uzyciu tomografu komputerowego.

A new method for lower extremities length measurement in patients destined for surgical legalization is presented. It is based on a scan in investigational CT. Reference points are marked and the distance between them is calculated. The record is inclusive of synthetic, diminutive anterior-posterior image of the extremity along with the measurement. Since September 1990 to December 1993, 34 patient underwent this procedure. The advantage is sensitivity better than 1 mm, flexibility in choosing reference points, good reproducibility and little exposure to the radiation. The result is more precise and trustworthy then obtained with other radiological or clinical methods.

[Treatment outcome for forearm shaft fracture using AO plate stabilization]. / Wyniki leczenia zlaman trzonów kosci przedramienia sposobem stabilizacji plytkowej AO.

Results of treatment for 104 forearm shaft fractures in 70 patients have been presented. In all cases included in this study an open reduction of the fracture was followed by AO plate stabilization. Functional and radiological assessment was carried out according to the criteria of Anderson et al. Excellent and good functional results were achieved in 48 cases, fair in 10 and poor in 12 cases. The ulna united in 75%, the radius in 78% (delayed union included). Cross- union occurred in three patients, one case of destabilization at fracture site was observed, no infection has been noted. AO plate osteosynthesis proved to be still valuable mode of treatment for forearm shaft fracture.

[Treatment outcome of juvenile slipped capital femoral epiphysis with Imhauser osteotomy]. / Wyniki leczenia mlodzienczego zluszczenia glowy kosci udowej osteotomia Imhäusera.

Results of Imhauser osteotomy for treatment of slipped capital femoral epiphysis grade II and III performed in 32 patients (33 hips) are presented. The average correction of the slip angle was 39.7 +/- 14.9 degrees. Excellent results were found in 16 hips (48.5%), good in 10 (30.3%), fair in 5 hips (15.1%) and poor results in 2 hips (6.1%). No head-neck fixation after osteotomy did not lead to further slippage and decreased the risk of other complications. In 6 hips (18.2%) chondrolysis occurred. In one case prolonged immobilization of the hip was to blame, perforation of the femoral head in another, no cause has been identified in remaining cases. Avascular necrosis of the head was not observed.