[Management of a fracture in a previously shortened extremity]. / Postepowanie w przypadku zlamania pierwotnie skróconej konczyny.

The management of fracture within previously shortened extremity is presented. Three patients with femoral fracture and one with crural fracture were treated. All fractures were displaced. Modified Ilizarov ring distractor was used to stabilize the fracture within 3 days from injury. Distraction was commenced on third postoperative day at speed of 0.75-2 mm/h with progressive reduction of fragments and alignment of mechanical axis of the limb. Lengthening required to equalize extremities was achieved in all cases. The author claims fracture within previously shortened extremity to be one more indication for external osteosynthesis as a method of choice.

[The author's own method of local anesthesia for skin incision around implants during limb lengthening]. / Wlasna metoda miejscowego znieczulenia umozliwiajaca wykonanie odbarczajacych naciec skóry w otoczeniu implantów wydluzanej konczyny.

Infection around implants is the most frequently described problem during limb lengthening. Fast elimination of the inflammatory response is crucial for intensive mobilization and weight bearing of the extremity being elongated. Prior to the unloading incision of the skin stretched around the implant EMLA ointment was used repeatedly in 12 children. EMLA was applied 1-2 hours prior to the procedure and covered with an occlusive dressing. All skin incisions, also within inflamed areas were painless. The management described eliminates the need for general anesthesia and thus for hospitalization, lowers treatment costs and limits child's anxiety.

[Principles of correct distraction device placement at lengthening of the femur to provide mechanical alignment of the extremity]. / Zasady prawidlowego mocowania dystraktora podczas wydluzania kosci udowej zapewniajace zachowanie prawidlowej osi mechanicznej konczyny.

The authors has lengthened 16 femoral bones with good mechanical alignment. To maintain it through the lengthening process the distraction devise must be parallel to the mechanical axis of the limb. This can be accomplished if the axis is marked on the skin prior to surgery. The above mentioned rule should be observed, particularly in bone lengthening with semi-frame distraction device with no feature of progressive correction.

[The possibility of growth plate protection in extensive bone lengthening]. / Mozliwosc ochrony chrzastki nasadowej w znacznych wydluzeniach kosci.

Lower extremity lengthening by 14 to 16 cm (70-100%) was done in 10 children aged 8-10 years. Growth plate protection was secured by including it in distractor or performing arthrodiatasis. No physeal fusion was observed during 2-3 years follow-up. No valgus deformity of the tibia in fibular aplasia was noted either. The authors conclude that the management protects growth plate in extensive limb lengthening.

[The value of computed tomography in evaluation of newly formed bone remodeling after lengthening]. / Wartosci komputerowej tomografii w ocenie przebudowy nowo powstalej kosci po wydluzeniu.

The paper presents evaluation of the newly formed bone remodeling and measurement of its density with the use of computed tomography in 7 children who underwent bone lengthening. The author concludes that CT is a precise tool in determination of cortical bone quantity, generation of medullar cavity and degree of regenerate mineralization.

[Use of the Ilizarov method in treatment of forearm deformity due to multiple exostoses]. / Zastosowanie sposobu Ilizarowa w leczeniu deformacji przedramienia w przebiegu mnogich wyrosli kostnych.

The use of Ilizarov distraction device in complete treatment of the forearm deformity due to multiple exostoses is presented. The method allowed for one stage correction of all components of the deformity.

[Treatment of lateral knee instability during lengthening of the leg by the Ilizarov method]. / Leczenie niestabilnosci bocznej stawu kolanowego podczas wydluzania goleni sposobem Ilizarowa.

The leg lengthening by the Ilizarov method has been performed concurrently with treatment for lateral instability of the knee in three children. The treatment included lowering of the fibular head along with distal fibular collateral ligament attachment.

[Combined treatment of crural shortening and calcaneus-malleolar conflict using the Ilizarov distractor]. / Skojarzone leczenie skrócenia goleni i konfliktu kostkowo-pietowego za pomoca dystraktora Ilizarowa.

The complex mode of treatment for crural shortening and calcaneus-malleolar conflict with Ilizarov distractor in 3 children is presented. The management resulted in fast ossification of the distal tibial epiphysis, adequate position of displaced lateral malleolus and correction of the tarsal varus as well as angular deformity of the tibia. The importance of timing for this kind of treatment is emphasized by the author.

[Differentiation of new bone formation at the site of limb lengthening procedures in ultrasonographic examination]. / Róznicowanie postaci nowo powstajacej kosci w wydluzanych segmentach konczyn w oparciu o badanie ultrasonograficzne.

Three different types of newly produced bone were found in 2500 ultrasound appearances of 79 bony segments submitted to the elongation. Their classification as normotrophic, hypertrophic and hypotrophic type has been proposed. Every type requires different management during distraction in order to achieve elongation planned and avoid complications.

[Chondrodiastasis in treatment of leg length inequality--preliminary report]. / Chondrodiastaza w leczeniu nierównosci konczyn--doniesienie wstepne.

A case of 13 years old female with femur shortening who underwent equalization by means of chondrodiastasis with simultaneous axial correction was presented. It was concluded that accurately performed chondrodiastasis is a painless, little traumatic method of bony fragments lengthening, perfectly tolerated by the patient.

[The value of ultrasound in monitoring of chondrodiatasis]. / Wartosc ultrasonografii w monitorowaniu chondrodiastazy.

The value of ultrasound in monitoring chondrodiatasis in 3 children between 12 and 13 years of age is presented. An ultrasound allows early estimation of chondral reaction to distraction, monitoring symmetry of chondrodiatasis and corticalization and yet reducing the need for the X-ray.

Use of Ilizarov distraction modified by Cattaneo and Catagni for femoral lengthening. / Zastosowanie dystraktora Ilizarova w modyfikacji Cattaneo i Catagniego do wydluzenia kosci udowej.

Ilizarov distraction device with proximal fixation by Cattaneo and Catagni has been used for femoral lengthening in 13 patients. Planned femoral elongation, fast remodeling of the newly formed bone and intended correction of the anatomical and mechanical axis of the limb have been achieved in all cases independently of the level of corticotomy. Full weight bearing was maintained during entire period of treatment.

[Use of Dynasplint in prevention of muscular contractures in limbs undergoing lengthening]. / Zastosowanie szyny Dynasplint w zapobieganiu przykurczom miesniowym wydluzanej konczyny.

Dynamic splinting with Dynasplint for prevention of muscular contractures and subluxations in the joints during lower limb lengthening in 10 children has been used. In all cases the splint successfully prevented subluxation in the knee and the foot deformity. Ability to move splinted joints allowed effective rehabilitation. The splint was well tolerated by all the patients during whole period of distraction.

[Use of magnetotherapy for treatment of bone malunion in limb lengthening. Preliminary report]. / Zastosowanie magnetoterapii w leczeniu powiklan zrostu w wydluzaniu kosci. Doniesienie wstepne.

Two children with bone malunion after lengthening of congenitally shortened lower leg have been presented. The crus has been elongation 8 cm by Ilizarov method in 9 years old boy and 5 cm elongation of the tibia has been achieved with the use of Bastiani method in 8 years old girl. In both cases malunion has occurred. The radiographs revealed pseudoarthrosis (the girl, 6 month after operation) and centrally located bony defect (the boy, 2 months postoperatively). In both cases pulse sinusoidal magnetic field was applied successfully with cortical bone and marrow cavity restored in 2 months.

[The value of ultrasonography in monitoring limb lengthening]. / Wartosc ultrasonografii w monitorowaniu wydluzania kosci konczyn.

The authors attempted to assess the value of ultrasound for monitoring of the new bone formation at the site of distraction in patients undergoing limb lengthening after Bastiani. Twenty patients were assessed; 12 cases of femur lengthening and 8 cases of tibia lengthening. It was found, that ultrasound allowed to detect the new bone formation visible as hyperechogenic foci as soon as 4 to 14 days postoperatively, while regular radiology showed this only 4 to 8 weeks after operation. Detection of the new bone formation at the site of lengthening permits, in authors opinion, to choose an optimal onset of distraction and its pace according to the speed of bone formation. Regular ultrasound monitoring prevents premature bone union or disintegration of the newly generated bone in case of to slow or to fast distraction respectively. In two cases sonography early demonstrated cystic changes at the location of distraction. It also permits detection of an axial displacement of the fragments of bone in every case.

[Van Neck disease or a variation of ischio-pubic synchondrosis development?]. / Choroba Van Necka czy wariant zarastania chrzastkozrostu kulszowo--lonowego.

Diagnostic problems in the case of 9 years old boy with flared ischio-pubic synchondrosis are presented. The condition is differentiated between Van Neck disease and variation od ischio-pubic synchondrosis development.