Possible causes of failure in treatment of forearm bone shaft fractures - own experience.

BACKGROUND: Non-surgical treatment of forearm shaft fractures in adults is associated with a high incidence of non-union. Operator errors during surgery also often result in bone union complications. We attempted to identify the errors made during the treatment or other factors that might influence the development of forearm shaft union complications. MATERIALS AND METHODS: We have analysed the causes of 67 cases of non-union in 53 patients (17 women and 36 men), aged 18 to 85 years. Thirty-five patients were treated by open repositioning and fixation with plates and screws, 11 patients were treated by closed or open reposition and stabilization with Kirschner wires, and 4 patients had closed reposition and immobilization in a plaster cast. Other methods were used in 3 patients. RESULTS: In the group treated by open reposition and plate fixation, we found the following complications that might impede bone union: plate fracture, technical errors, screw loosening, bone inflammation, and other complications. In the group treated by closed or open repositioning and stabilization with Kirschner wires, we found the following factors that might impede bone union: open fractures, inaccurate fracture repositioning and inappropriately inserted Kirschner wires. CONCLUSIONS: Using rigid fixation, for example with a plate and screws, and avoidance of technical errors seem to be the most appropriate measures helping to decrease the risk of non-union during treatment of a fracture of both forearm shafts.

[The comparison of the use of cages with the use of autogenous bone grafts in the operative treatment of the isthmic spondylolisthesis by the posterior stabilisation and ALIF]. / Porównanie uzycia klatek miedzytrzonowych z uzyciem autogennych przeszczepów kostnych w operacyjnym leczeniu kregozmyku ciesniowego metoda tylnej stabilizacji i przedniego miedzytrzonowego usztywnienia kregoslupa.

In the following study the use of cages and autogenous bone grafts were comparised in the operative treatment of isthmic spondylolisthesis by the posterior stabilization and anterior lumbosacral interbody fusion. 55 patients were divided into two groups. Patients underwent ALIF with the use of autogenous bone grafts in the first group (34) and with the use of titanium interbody implants (cages) in the second group (21). The mean follow up period in the first group was 8.6 years and in the second group was 3.4 years. The objective clinical outcome assessment was based on Oswestry disability questionnaire. Subjective clinical evaluation was conducted with the use of visual analog pain score and two questions concerning the evaluation of success of the operative treatment and a possible agreement to the following operation if necessary. The radiological results were based upon the evaluation of the degree of spondylolisthesis, the angle of the lumbar lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The usage of autogenous bone grafts alone in ALIF was related to the significant loss of achieved segmental spine anatomy restoration. The implantation of the cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment.

[The influence of segmental lumbosacral anatomy restoration on clinical outomes in the operative treatment of the isthmic spondylolisthesis]. / Wplyw odtworzenia segmentarnej anatomii kregoslupa ledzwiowo-krzyzowego na wynik operacyjnego leczenia kregozmyku ciesniowego.

The influence of lumbosacral spine segmental anatomy restoration on the outcome of the operative treatment of isthmic spondylolisthesis was taken into evaluation. A series of 55 patients (29 males and 26 females) was examined. The long-term follow up period exceeded 3 years. The Oswestry Disability Questionaire was used to evaluate the objective clinical condition of the patients, while for the subjective assessment an analog pain score and the two questions survey concerning the evaluation of success of the operative treatment and a possible agreement to a following operation if necessary were used. The presence of neurological radical symptoms was evaluated. The radiological assessment was consisted of the evaluation of the degree of spondylolisthesis, the angle of lumbosacral lordosis, the height of the interbody space and intervertebral foramen. In conclusions, the proper spine anatomy restoration had the influence on the improvement of the outcome of operative treatment of isthmic spondylolisthesis. A metal cage usage for the anterior interbody fusion of lumbar spine in the operative treatment of isthmic spondylolisthesis enables long-lasting proper anatomical relations of the fused segment.

Outcome in corrective osteotomy for malunited distal radius fractures.

BACKGROUND: This article reports outcome in osteotomy for malunion of distal radius fractures. MATERIAL AND METHODS: We evaluated 12 patients with distal radius malunion (mean age 54), who were treated with corrective osteotomy. Wrist motion and grip strength were evaluated, along with examination of pre and post osteotomy radiographs. The indications for corrections were degree of deformity, limitation of function, pain, and the appearance of the wrist. RESULTS: The radiographic evaluation proved that the restoration of the normal anatomic relationship between the distal radius and ulna leads to significant improvement of the function of the hand, as measured by range of motion and grip strength. CONCLUSION: Osteotomy of the distal radius in cases of malunion gives favorable outcomes.

Outcome in the arthroscopic treatment of synovial chondromatosis of the knee.

Background. Synovial osteochondromatosis is a disease in which loose cartilaginous bodies develop around large joints, usually the knee. It is caused by synovial metaplasia of unknown etiology. Symptoms are due either to mechanical problems caused by the loose bodies or to the degenerative arthritis that follows after several years. Surgical or arthroscopic removal of the loose bodies appears to be the only effective treatment. This article reports treatment outcome in synovial chondromatosis of the knee. Material and methods. We treated 13 patients: 11 by arthroscopy and 2 by arthrotomy. The follow-up examination was performed at least two years after after surgery. Results. There were 6 good and very good outcomes, while 2 patients required arthroscopic re-operation. Conclusions. Arthroscopy seems to be the treatment of choice in synovial chondromatosis of the knee.