Long-Term Results of Neurectomy Through a Dorsal Approach in the Treatment of Morton's Neuroma.

BACKGROUND: Morton's neuroma, a painful enlargement of the plantar digital nerve between the metatarsal heads, is a common cause of metatarsalgia. The etiology and treatment are still a controversial matter. OBJECTIVES: The objective of this study was to evaluate the long-term follow-up results of neurectomy through a dorsal approach and to identify prognostic factors that can affect the final outcome. MATERIAL AND METHODS: The study included 41 patients who were treated for Morton's neuroma. Their average age was 44 years (range: 25-69 years). The average follow-up time was 7.4 years (range: 5-12 years). Surgery was performed through a dorsal approach. The clinical evaluations, visual analog scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were assessed. RESULTS: The mean preoperative AOFAS score was 39.4 ± 7.84 and the mean postoperative AOFAS score was 83.4 ± 12.1. The mean preoperative VAS scale was 7.04 ± 1.4 and the mean postoperative VAS scale was 1.4 ± 0.8. There were 31 patients (76%) with very good results in the subjective and objective patient assessments; six (15%) had good results; one (2%) had satisfactory results and three (7%) had poor results. Statistically significant differences in the results between single and multiple neuromas were found, depending on the size of the neuromas and the duration of the symptoms. There were no statistically significant differences depending on the time between surgery and assessment, on steroid injections before operation or on the duration of preoperative conservative treatment. CONCLUSIONS: Despite the development of less invasive techniques and very good outcomes in a short period of time, long-term results have shown that neurectomy is still useful in the treatment of Morton's neuroma. The results of the study show that the outcome does not change during the postoperative follow-up period. The best results were achieved in the case of single neuromas larger than 3 mm that were resected within 12 months of the onset of symptoms.

Causes of Secondary Radial Nerve Palsy and Results of Treatment.

BACKGROUND The aim of this study was to analyze the causes that lead to secondary damage of the radial nerve and to discuss the results of reconstructive treatment. MATERIAL AND METHODS The study group consisted of 33 patients treated for radial nerve palsy after humeral fractures. Patients were diagnosed based on clinical examinations, ultrasonography, electromyography, or nerve conduction velocity. During each operation, the location and type of nerve damage were analyzed. During the reconstructive treatment, neurolysis, direct neurorrhaphy, or reconstruction with a sural nerve graft was used. The outcomes were evaluated using the Medical Research Council (MRC) scales and the quick DASH score. RESULTS Secondary radial nerve palsy occurs after open reduction and internal fixation (ORIF) by plate, as well as by closed reduction and internal fixation (CRIF) by nail. In the case of ORIF, it most often occurs when the lateral approach is used, as in the case of CRIF with an insertion interlocking screws. The results of the surgical treatment were statistically significant and depended on the time between nerve injury and revision (reconstruction) surgery, type of damage to the radial nerve, surgery treatment, and type of fixation. Treatment results were not statistically significant, depending on the type of fracture or location of the nerve injury. CONCLUSIONS The potential risk of radial nerve neurotmesis justifies an operative intervention to treat neurological complications after a humeral fracture. Adequate surgical treatment in many of these cases allows for functional recovery of the radial nerve.

Results of surgical treatment of tarsal tunnel syndrome.

BACKGROUND: The aim of our study is to evaluate retrospectively the prognostic factors affecting the final outcome of surgical treatment of tarsal tunnel syndrome. MATERIAL AND METHODS: Surgical decompression were performed on 31 patients. All patients had EMG and anesthetic test confirmation. The results were evaluated according to VAS scale and modified AOFAS score. Follow-up was after 12 months. RESULTS: 22 patients received very good or good (71%), 7 satisfactory (22%), 2 poor (7%) results in the subjective and objective patient's assessment. The outcomes decreased from 5.19 (SD 1.01) points to 1.19 (SD 0.83) points according to VAS scale, and modified AOFAS increased from 31.77 (SD 9.08) points to 57.58 (SD 9.90). Patients with diagnosed cause, short period of time between onset of disease till surgery, and positive Tinel's sign achieved the best results. CONCLUSION: Etiology of the tarsal tunnel syndrome has influence on the results. Immediate diagnosis and short period between occurrences of symptoms in surgical treatment improves the outcomes. Tinel's sign may be used as a prognostic factor.

[Outcome treatment of pseudoarthrosis of long bones with decortication method depends on osteosynthesis]. / Wyniki leczenia stawów rzekomych kosci dlugich konczyny górnej metoda dekortykacji w zaleznosci od rodzaju osteosyntezy.

Purpose of work was estimation of the results of treatment of pseudoarthrosis of the long bone with the method of decortication, with use of autogenic bone depends on kind of pseudoarthrosis and kind of osteosynthesis. In the years 1995-2005 56 patients were treated because of pseudoarthrosis of long bone in our Clinic. Pseudoarthrosis is classified according to Weber-Cech classification. In the methodology of clinical estimation and subjective estimation of the patient Stewart and Hundley and Anderson classification were used. Union was achieved in 51 cases. Time of bone union achievement was 5 months. The results of treatment are depends on morfology of pseudoartrosis and are independs of kind of osteosynthesis.

[Application of gentamycini impregnated polymethylmethacrylate (PMMA) (Septopal) in treatment of infected nonunion. Own experiments]. / Wykorzystanie implantów z polimetylmetakrylanu (PMMA) jako nosnika gentamycyny (Septopal) w leczeniu zakazonych stawów rzekomych. Badania wlasne.

INTRODUCTION: Treatment techniques of osteomyelitis and infected nonunion require local antibiotic-therapy in the infection places because of the necessity of achievement of a very high concentration of antibiotic. Among the methods of local application of antibiotic we have the possibility of non-absorbale carriers application where polymethylmethacrylate (PMMA) is the carrier. Aminoglycosides are the most commonly employed antibiotics for use with PMMA. PURPOSE OF THE WORK: Estimation of the possibility of use gentamycini-impregnated polymethylmethacrylate (PMMA) (Septopal) in treatment of infected nonunion. MATERIAL AND METHODS: In the years 2001-2006 in Clinic of Traumatology and Hand Surgery in Wroclaw Medical University, 16 patients were treated because of osteomyelitis and infected nonunion of the long bone. Osteomeylitis, according to the Cierny-Mader's classification, was determined as type IVA in 8 patients, as type IIIA in 4 patients, as type IVB in 4 patients. In stage I surgical cleaning focus of the infected nonunion, external stabilization and implantation of PMMA with gentamycyni were performed, in stage II bone graft with length from 2 to 5 cm was applied. RESULTS: Eradication of the inflammatory process was achieved 13 patients, bone union-in 12 patients. The mean time of bone union achievement was 9 months. The failures concerned mainly patients with type IVB of osteomyelitis according to Cierny-Mader's classification. CONCLUSIONS: Application of PMMA with gentamycini is an efficient method in the treatment of traumatic osteomyelitis. The reults of osteomyelitis treatment correspond to the osteomyelitis classification according to Cierny-Mader. Application of PMMA with gentamycyni in connection with surgery of nonunion prevents possible infection and creates the space for bone grafts.

Outcome treatment of pseudoarthrosis of long bones with decortication method depends on morfology of pseudoartrosis.

Introduction. Purpose of work was estimation of the results of treatment of pseudoarthrosis of the long bone with the method of decortication, with use of autogenic bone depends of kind of pseudoartrosis.. Material and methods. In the years 1995 2004 77 patients were treated because of 83 pseudoarthrosis of long bone in our Clinic. Pseudoarthrosis of humeral bones were the treated most often, next femoral bone , radial bone , ulnar bone . The time from the fracture to decortication was from 6 to 48 months. Pseudoarthrosis is classified according to Weber Cech division. In the methodology of clinical estimation and subjective estimation of the patient Stewart and Hundley classification, and Keating classification were used. For estimation of control roentgenogram radiological estimation of union according to the division of Hammer was used. Results. Union was achieved in 77 cases of 83 pseudoartrosis. Time of bone union achievement was: for hypertophic pseudoartrosis -4,75 months, oligotrophic pseudoartrosis-6,48 months, for dysplastic pseudoarthrosis 7,47 months, for aplastic pseudoartrosis 9,63 months. Conslusions. Surgery with decortication method gives very good results in case of treatment of long bone hypertophic, oligotrophic and dysplastic pseudoarthrosis. Failures are usually with atrophic pseudoartrosis. The results of treatment are depends on morfology of pseudoartrosis.

Treatment of delayed union and nonunion of the scaphoid.

Background. Lack of proper union in scaphoid fractures - particularly in the form of pseudarthrosis - is a complication that continues to be an object of concern for orthopedic surgeons. Treatment failures result from non-union or osteoarthritis. Material and methods. In the years 1998-2005 we treated 31 patients in our clinic for delayed union or non-union of the scaphoid. Corticocancellous bone graft (the Matti-Russe method) was performed in 23 cases, the Beck operation in 4 cases, and proximal resection in another 4. Results. We achieved union in every case of delayed union, in 19 cases after the first operation, and in 2 cases after revision procedures. Conclusions. Treatment by corticocancellous bone graft gives good results in the medium and distal part of the scaphiod. In the proximal part it is better to treat by revascularization.

Brachial plexus tumours--own experience in diagnostics and surgical treatment.

Brachial plexus tumours are rather rare peripheral nerve tumours. In this study, we have presented the results of surgical treatment of cases with neoplasmatic process in the brachial plexus structures. Clinical material consisted of 9 patients (8 women, 34-72 years old; and 1 boy, 7 years old) on which the following procedures were performed: a) excision of the tumour with immediate nerve grafting of the sural nerve, b) extirpation of the tumour, c) excision of the tumour and direct suture reconstruction, d) brachial plexus neurolysis, e) tumour biopsy. We evaluated the pre- and post-operative motor and sensory deficit and established the three point scale of deficit intensity from + to +++. We diagnosed the following tumours in the clinical material: neurofibroma (diagnosed in 4 cases), plexiform neurofibroma (diagnosed in 2 cases), neurilemmoma (diagnosed in 1 case), and malignant tumours (diagnosed in 2 cases), which were found at the plexus area; they were metastatic or spreading continuously from the surrounding tissue. After surgical treatment, the sensory and motor function improved significantly in 4 cases (44,4%). The surgical treatment results depended on the size, localization and histological pattern of the tumour.

Peripheral nerve tumours--diagnostic and therapeutical basics.

In this review of international literature, we have described recent opinions on diagnostics and therapy of peripheral nerve tumours. We have emphasised the use of differential diagnostics on certain stages of therapeutic procedures. The importance of proper surgical technique choice and its influence on final results have been especially underlined. Other important factors influencing final therapeutical results have also been considered and discussed.