[The possibilities of operative treatment of residual and recurrent congenital clubfoot]. / Mozliwosci leczenia operacyjnego resztkowej i nawrotowej, wrodzonej stopy konsko-szpotawej.

The paper presents 14 different surgical procedures recommended in literature for the correction of singular deformed elements of congenital clubfeet. Basing on clinical material collected from patients treated during the last five years, the authors introduce the application of the presented procedures for the correction of residual and recurrent deformities occurring in congenital clubfeet. Basing on their own experience, knowledge and available publications the authors attempt to assess the indications for each particular procedure and their mutual connections, which depend on: the kind and extend of the deformity, its location and the age of the child.

The value of radiological examination in the orthopedic management of children with cerebral palsy.

This article presents current views on the role of x-ray examinations in the assessment of spastic hip in children with cerebral palsy. The developmental character of spastic hip luxation is emphasized. The value of the x-ray examination of the hip and the necessity to repeat radiological assessment is describes. Checking the hip migration index is considered the most valuable method for evaluating spastic hip.

[Biomechanical studies of forces occurring in the Ilizarov and Orthofix apparatuses during limb lengthening by distractive osteogenesis]. / Biomechaniczne badania sil wystepujacych w ukladzie aparat Ilizarowa-konczyna i aparat Orthofix-konczyna podczas wydluzania metoda osteogenezy dystrakcyjnej.

The magnitude of the distractive forces occurring in the Ilizarov and Orthofix apparatuses during limb lengthening by distractive osteogenesis has been investigated. Eighteen patients treated between 1995 and 1998 were included in the study. The data obtained were computerized and related to clinical, radiographic and sonographic findings. Typical and repeatable graphs of forces were found during the process of lengthening as well as typical relationships between the callus and the values of distractive forces.

Follow-up study after treatment of knee flexion contractures in spina bifida patients.

Knee flexion contractures in spina bifida patients are seen in all levels of paralysis. The majority is encountered in children with thoracolumbar lesions. Positional deformation, spinal reflex activity, fractures around the knee joint and a weak quadriceps are the main causes of the flexion deformity of the knee. One hundred and forty-five knee flexion contractures in 80 children have been treated between 1980 and 1995; 15 with unilateral contracture, 65 with bilateral involvement. The age at the time of correction in 38 patients with thoracolumbar lesions was between 24 months and 11 years (average, 7.7 years). In 42 patients with sacral or lumbosacral lesions, the age at the time of correction was between 10 and 19 years (average, 16.3 years). Associated surgery was mainly carried out on hip flexors, adductors and triceps surae. Complete posterior release was practiced in thoracolumbar lesions including posterior capsulotomy and release of the posterior cruciate ligament. In lumbosacral lesions, the lengthened tendons are sutured to prevent flexor weakness in the postoperative course. Vascular and neurologic structures are spared. Postoperative serial casts are helpful to achieve full extension without vascular or skin troubles. The long-term results were very good in 59 patients with 106 knees, good in 16 patients with 29 knees, and unsatisfactory in 5 patients with 10 knees. Slow deterioration years after surgery can be anticipated. The main causes are lack of personal initiative to stand and to walk, and obesity.

[Biomechanical investigation of distraction forces appearing in the course of femoral lengthening in rabbits: radiological and histological study]. / Biomechaniczne badania sil dystrakcyjnych wystepujacych podczas wydluzania piszczeli u królików--obserwacje radiologiczne i histologiczne.

This study was conducted in order to determine the values of forces necessary to stretch bony fragments during tibia lengthening in rabbits. The aim of this study was to determine the conditions which lead to complications of the lengthening process related to the rate of distraction. The experiment was conducted on 16 rabbits of New Zealand breed. The construction of the apparatus eliminated tension resulting from the so-called "bending moment". In all rabbits distraction was began on the 5th day after fixing the apparatus. The standard rate of lengthening was 2 x 0.25 mm per day. In 8 rabbits the rate of distraction was regulated. The distraction forces were measured and electronically recorded during the distraction procedure, during the animal's movement and resting position at strictly monitored intervals. Radiological examination of the lengthened tibia was performed once a week. Histological examination was performed in three rabbits after completion of the experiment. We made 328 measurements of the involved distractive forces, collecting a total of 223 MB of data. Graphical representation of the lengthening force and it's performance turned out to be similar for various experimental animals and it's course was typical for every stage of the lengthening process. At the time of distraction of the apparatus the measured force increased on average by 0.87 N (minimum 0.61, maximum 1.1N). Abnormal rates of distraction resulted in a break of the callus continuity in 3 rabbits. Radiological and histological examinations were used to assess to confirm certain observations concerning the technique and rate of distraction.

[Surgical treatment of knee flexion contracture in children with flaccid limb paralysis using surgical procedures in soft tissues under the knee and serial casting]. / Operacyjne leczenie przykurczów zgieciowych kolana u dzieci z niedowladami wiotkimi konczyn przez zabiegi operacyjne a tkankach miekkich dolu podkolanowego i etapowe redresje gipsowe.

Surgical technique and results of surgical correction for substantial flexion contracture of the knee in 15 children with spina bifida or other spinal conditions with lower extremities paresis is presented. Extensive posterior capsulotomy, occasionally supplemented with posterior cruciate sectioning is necessary to correct considerable flexion contracture of the knee. The technique is also effective in congenital flexion contracture with no articular surfaces deformity. Serial redressing and casting are imperative in postoperative management.

[Outcome of surgical treatment for infant clubfoot with complete subtalar release according to McKay]. / Wyniki leczenia operacyjnego niemowlecych stóp konsko-szpotawych metoda calkowitego uwolnienia podskokowego wg Mc Kay'a.

Between 1992 and 1996 81 clubfeet in 69 children younger than 1 year of age were operated on with Mc Kay procedure at Pediatric Orthopedic Department in Lublin. Results of treatment after follow-up ranging from 6 months to 2.5 years are presented. Mc Kay procedure proved to give access to clubfoot morphology and allowed for complete correction of the deformity. The author recommend it for treatment of severe clubfoot, especially arthrogrypotic one.

[5-year experience with De Bastiani's method of extremity lengthening]. / 5 Jahre Erfahrungen mit der Extremitätenverlängerung nach De Bastiani.

From 1987-1991 19 patients had 20 lengthenings in 23 bones. The average hospitalisation time was 54 days. The time to lengthen one limb was 30 weeks on an average. In a retrospective study the cases were analysed according to Paley's criteria. Our complication rate is compared to that of other authors. We have to cope with a rather high rate of complications. 17 out of 19 patients showed good or very good final results.