The Effect of Smoking on Posttraumatic Pseudoarthrosis Healing after Internal Stabilization, Treated with Platelet Rich Plasma (PRP).

Disturbed or delayed healing remains one of the most serious fracture-related complications, despite bone capacity for internal regeneration and reabsorption. Considerable progress in the understanding and treatment of fractures has been noted. The aim of our study was to evaluate treatment outcome in patients (smokers and non-smokers) with post-traumatic pseudoarthrosis. HYPOTHESIS: Determinate when administration of growth factors is most beneficial, and whether it accelerates bone union. MATERIAL AND METHODS: The study included patients treated for post-traumatic pseudoarthrosis resulting from multiple bone fractures. The study group and controls were further subdivided into: non-smokers, non-smokers >2 years after quitting, and smokers. Independent tests were performed for men and women. The study group, apart from other methods of treatment, received concentrated PRP (platelet-rich plasma) to aid the process of bone healing, or in cases of delayed healing confirmed by radiological assessment on follow-up visits. RESULTS: Mean time of fracture healing was 8 weeks for non-smokers and non-smokers >2 years after quitting, whereas in smokers the healing process was significantly prolonged (18 weeks in both, men and women). CONCLUSIONS: The risk for infection is smaller in non-smokers as compared to smokers, with the latter being at an elevated risk for bone inflammation and delayed union.

The concentration of manganese, iron, and strontium in hip joint bone obtained from patients undergoing hip replacement surgery.

The aim of this study was to determine the concentrations of manganese (Mn), iron (Fe) and strontium (Sr) in the cartilage with adjacent compact bone and spongy bone collected from patients after total hip replacement surgery. In addition, we examined relations between the concentrations of the metals in the bone and selected environmental factors. The concentration of Fe was the highest while Mn concentration was the lowest. The concentrations of Fe in the spongy bone in patients from larger cities were higher than in those living in smaller towns and villages. Significant correlations were found between Fe and Mn concentrations in the cartilage with adjacent compact bone and in the spongy bone, and between Mn and Sr in the spongy bone. In general, Mn, Fe and Sr concentrations in the bones of patients from NW Poland were lower than in other Polish regions and Europe, especially in industrialized countries. In conclusion, it seems that in addition to routine monitoring of the abiotic environment, it is essential to monitor concentrations of heavy metals having a long-term impact in humans.

Surgical treatment of advanced, stiff neurologic cavovarus foot in adults.

BACKGROUND: Cavovarus foot is a complex, three-dimensional deformity of neuromuscular origin. A rigid cavovarus deformity causes difficulty in walking, instability, fatigue fractures, calluses and trophic ulcers in the overloaded lateral part of the foot and requires wearing orthopaedic shoes. The aim of the study was to evaluate current surgical techniques in the treatment of rigid cavovarus foot in adults. MATERIAL AND METHODS: This paper is a retrospective analysis of 14 patients (15 feet) treated surgically at our centre who presented with advanced cavovarus foot caused by a spectrum of neuromuscular diseases such as Charcot-Marie-Tooth, poliomyelitis, cerebral palsy, myelomeningocele, diabetes (Charcot's neuroarthropathy), sequelae of strokes and CNS injuries, compartment syndrome and inveterate sciatic nerve injuries. Average patient age was 53 years. Average follow-up period was 24 months (range: 18-58). The AOFAS scoring system was used to assess treatment results. RESULTS: The mean AOFAS score before surgery was 24 (range: 8-35) points and increased to 60 (range: 40-76) points after surgery. A stable, plantigrade, painless foot was achieved in all treated patients. CONCLUSIONS: 1. Surgical treatment of advanced cavocarus foot of neuromuscular origin should be carried out in a staged process with reassessment and adaptation of subsequent stages rather than following a rigid scheme. 2. The surgeon must be familiar with a number of techniques and procedures in order to correct the bony deformity and achieve muscle imbalance correction in a single-stage surgery.

[The influence of hypersensitivity to nickel, chrome and cobalt on the process of fracture healing in patients treated operatively by stable osteosynthesis]. / Wplyw nadwrazliwosci na nikiel, kobalt i chrom na przebieg procesu gojenia sie zlaman u pacjentów leczonych operacyjnie technikami stabilnej osteosyntezy.

The aim of the study was to evaluate the frequency of occurrence of the hypersensitivity to nickel, chrome and cobalt in patients with longbone fractures. Two groups of patients were compared. The first group was composed of those treated operatively by stable osteosynthesis with the use of metal implants. The control group consisted of patients who have never been operated. Additionally, the influence of recognized hypersensitivity on the process of fracture healing was estimated. The study group consisted of 80 and the control group of 65 patients. All patients were patch tested with metal salts. The correlation was sought between hypersensitivity to metal in the study group, and incidence of complications relating to fracture healing. There was no significant difference observed both in frequency of occurrence of hypersensitivity to nickel, chrome and cobalt among patients treated operatively, and those treated conservatively, as well. There was no correlation between occurrence of hypersensitivity to the ions of metals, and complications in the process of fracture healing.

Penetration of screw into the wall of thoracic aorta after stabilization of thoracic spine--case report.

In our research we have discussed a rare case of penetration of screw into the thoracic aorta after stabilization of thoracic spine due to compressive fracture of IV thoracic vertebra. We have focused on existence of potential danger of damage of aorta during stabilization of the posterior part of thoracic spine. We have emphasized the meaning of prophylactic implantation of stent-graft into the site of potential damage of aorta before the restabilization of the vertebral column.

Limitations of bone harvesting from organ donors in Poland.

The demand for organ transplantations greatly exceeds the number of organ donors (OD) and it is likely that this discrepancy will continue. There is a continuously growing demand for biostatic allogenic bone transplantation mostly for orthopedic reconstructions. The bone material is predominantly harvested during postmortem examinations in forensic medicine departments. The collected amounts are not enough so the material need to be acquired from other sources. Bone collecting from OD seems to be the optimal solution. Between January 2000 and December 2005, 1,883 out of 2,601 organ donors fulfilled the criteria for bone donation, but only 42 bone harvesting (BH) were performed being only 2.22% of all suitable cases. The main reasons for so few bone procurements were: lack of acceptance of bone procurement by relevant part of donors' families, insufficient cooperation between tissue banks and transplantation teams, lack of equipment for BH, and no experience in bone procurement.

Surgical treatment of chondrosarcoma with massive bone destruction.

Background. The purpose of the study is to present the results of surgical treatment of chondrosarcoma in patients with massive bone destruction. Material and methods. Surgical treatment involved 10 male patients with chondrosarcoma of pelvis (4 cases), shoulder (4 cases), femur (1 case) and ankle (1 case). We performed the following surgical procedures: complete resection without reconstruction, resection with arthroplasty, resection with bonegraft, amputation or disarticulation. Results. Surgical resection without reconstruction was done in 6 patients. Cemented hip and shoulder arthroplasties were performedin 2 patients. Resection en bloc and bone graft was used in one patient. Amputation of the upper limb was performed in one case due to the enormous size of tumor. None of the patients had perioperative complications. Good outcome and no sign of recurrence was seen in 8 cases. One patient had local recurrence and had to be reoperated 6 months after surgery and another one died 12 months following surgery due to lung metastases. Conclusion. The surgical techniques we used allowed most patients to preserve the limb and its function. The apropriate surgical treatment may be one of the most important factors determining good prognosis in chondrosarcoma.