[Contraction of the tensor fasciae latae muscle of the fascia of the broad thigh and flexion of the knee joint in the runners].

OBJECTIVE: Introduction: The illustration of the ranges of bending the limb during the outflow allowed to divide the study group into two parts. In the majority of respondents, the initial flexion prevailed over the final one. The researchers focused on finding the reasons for the advantage of the final bend over the initial one in 30% of the subjects. The aim: The analysis of the dynamic stride under the control of the MVN Biomech system in the bending of the knee joint of the lateral limb, comparing the preparation to the leg (initial bending) and its ending (final). PATIENTS AND METHODS: Materials and Methods: 18 right-handed 25 to 35 year old runners were selected after the following exclusion criteria were applied: polyarticular hypermobility, systemic diseases, Rheumatoid arthritis, osteoarthritis, post-traumatic instability. The MVN Biomech system assessed the three-dimensional movements of the joints of the free part of the lower limb and pelvis, and the flexibility of the muscles was subject to physiotherapeutic assessment. RESULTS: Results: In 55% of respondents dominated the pattern in which the initial flexion exceeded by min. 10° final bend in both limbs (decreasing type). The researchers focused on finding the reasons for the smaller difference or the advantage of the final bending on both sides in 30% of respondents (mixed type). The comparison of physiotherapeutic examination results and measurements of MVN Biomech showed functional contractures of the tensor fasciae latea muscles in 5 subjects with a mixed type (83% of subjects with a mixed type). CONCLUSION: Conclusions: Contraction of the tensor fasciae latae constrained the initial flexion of the knee joint of the lateral limb, and also increased bilateral visitation of the hip joints during the dynamic mixed-type twitch. The remaining muscles of the lower limbs show no statistically significant differences in elasticity compared to the type of the leg.

Lateral instability of the knee joint and disorder of the ankle joint extension disorder in men.

OBJECTIVE: Introducion: The flexion of the knee joints in the movement of the squat may be accompanied by physiological varus deformity that increases smoothly with the lowering of the center of gravity, followed by a return to the starting position. Observing the disturbances of the physiological movement of the knee joints in the frontal plane, the authors correlated them with the mobility of the ankles in the sagittal plane. The aim: To show the relationship of knee joint motion disorders in the frontal plane with the movement of the ankle joints in the sagittal plane in the movement of the squat. The authors asked themselves about the number of subjects with the physiological mobility of both joints in the given planes and in what part of the subjects there are disorders and whether they relate to the ipsi or the contralateral part of the body. There was also the question of whether and in which group there are deviations not meeting the above criteria. PATIENTS AND METHODS: Materials and methods: 20 healthy right-handed men aged 25-35 were examined with physiological mobility of lower limb joints, confirmed in a physiotherapeutic study. Exclusion criteria included: polyarticular laxity, systemic diseases, rheumatoid arthritis, osteoarthritis. The subjects performed a three-time squat after putting in the Biomech measuring system inertial sensors on the lower limbs and the pelvis. Assessment was related to the movement of the knee joint in the frontal plane with the movement of the ankle joint in the sagittal plane. RESULTS: Results: Alternating deformity with right knee valgus occurred in 16 people in the right knee joint (80% of subjects) and in 6 men in the left knee joint (30% of subjects). Three subjects (15%) had a degenerative disorder in both knee joints. The others presented physiological mobility or single (not correlating) disturbances in the mobility of selected joints. CONCLUSION: Conclusions: The tests confirmed that the ankle joint is functionally connected to the dysfunctional knee joint on the opposite side, despite various surfaces of mutual movement. Dysfunction of the knee joint is about 10 ° reduction of varus deformity during squat during maximum flexion of the knee joint and again varus deformation when lifting the center of gravity, which ends in distortion until the starting position. These deflections are accompanied by a decrease in the opposite ankle extension at the time of knee valgus deformity in the maximum flexion. The above dysfunctions occurred in 100% instability of the non-dominant knee joint, and on the dominant side in 63%.

Intramedullary nailing in treatment of complications of long bone union following fracture - case studies.

Open osteosynthesis of long bones fractures carries high risk of complications, the most common of which are plate breakage, slow union, delayed union and non-union. The paper analysis of 3 cases of bone union complications treated by locked intramedullary nailing. The aim was to show differences in the therapeutic management of different bones and non-unions following different types of osteosynthesis. Although bone union took longer to complete than in acute fractures, a good functional result was obtained in each case. Locked intramedullary nailing permits stable bone fixation. Intramedullary canal reaming stimulates bone consolidation since it is the source of autologous bone graft. Similar to its use in the treatment of acute fractures, the method permits early, active and efficient patient rehabilitation.

Current opinion about using the platelet-rich gel in orthopaedics and trauma surgery.

The use of growth factors in combination with tissue engineering seems to be the most promising method in the future for the treatment of tissue, bone and cartilage defect. Growth factors are cytokines with regulatory functions for healing in tissues of the musculoskeletal system. These small peptides are synthesised by resident cells at the site of injury such as mesenchymal stem cells and chondrocytes, or by the infiltrating inflammatory process. Platelet-rich plasma (PRP) is a novel osteoinductive therapeutic approach that is increasingly used in treatment of such complications of bone healing processes. The activator for PRP is a mixture of thrombin and calcium chloride. After connecting these substances platelet-rich gel (PRG) is formed and numerous regulatory molecules to the injury site such as PDGF, TGF-, VEGF, IGF, EGF and antimicrobial proteins are released. The aim of this article is presentation of present knowledge about properties and possibilities of using platelet-rich plasma in the treatment of soft tissue and bone healing disturbances.

Changes in bone mineral density around the femoral stem after total hip replacement: a preliminary report.

Background. Degenerative changes in the hip, accompanied by clinically significant pain, decrease the range of motion in physical examination and give characteristic changes in X-ray images. Total hip replacement is most often indicated. The most important factor affecting the usable life of implants is the adaptive rebuilding of osseous tissue in this region. A typical radiological examination showing the hip prosthesis and surrounding osseous tissue gives only late, qualitative indications of possible loosening of the prosthesis. Examination of bone mineral density (DEXA) gives quantitative data on changes occurring in the immediate region of the hip prosthesis, enabling early assessment of prothesis endurance. The aim of our study was to compare proportional changes in the BMD of the proximal femur after cemented and cementless total hip replacement. Material and methods. Densitometry of osseous tissue was done with a LUNAR device, using the Orthopedic computer program, in two groups of female patients after total hip replacement. BMD changes were analyzed occurring around the femoral stem 3 months after surgery using autoanalysis in the 7 Gruen zones. Examinations were done across different types of hip prosthesis. Results. In both groups our preliminary data point to a proportional decrease in BMD in all the analyzed zones. The greatest decreases occurred in zones 1 and 7, the least in zone 4. Conclusions. DEXA allows for quantitative monitoring of changes in osseous tissue in the region around the prosthesis.

[Revision hip arthroplasty management tactics--own experience]. / Taktyka postepowania w endoprotezoplastyce rewizyjnej stawu biodrowego--doswiadczenia wlasne.

INTRODUCTION: Aseptic loosening of hip prosthesis is one of the most serious complications after primary joint arthroplasty. Due to the aging of societies, lengthening of the average life span and increasing number of primary arthroplasty procedures, it can be assumed that the number of revision procedures will be continuously increasing by the year. THE AIM OF THE STUDY: presentation of own experience in operative management tactics and early results of treatment after the revision hip arthroplasty. MATERIALS AND THE METHOD: The analysis included 182 patients at the average age of 68, who underwent the revision hip arthroplasty procedure. The procedures of this type were performed most often after cement arthroplasty performed using the Weller's method (45%). The average observation period was 2.3 years. A clinical evaluation of the patients was performed using the Harris scale. A preoperative radiological evaluation was performed using Paprosky classification (for an acetabulum) and Mallory classification (for a femoral bone shaft). Bone defects were evaluated using AAOS classification. A postoperative radiological evaluation was performed on the basis of: radiolucent lines of the acetabulum area in DeLee-Charnley zones and in the area of the endoprosthesis stem in Gruen zones, acetabulum migration and settling of the endoprosthesis stem. RESULTS: During the 2-year observation there were 88.5% of good results reported. According to the Harris scale an improvement was achieved from the average of 46 points before the operation to 85 points after the procedure. 11.5% of bad radiological and functional results were reported including: 11 cases (6.0%) with bad radiological results, and 10 cases (5.5%) with bad clinical results. CONCLUSIONS: Revision hip arthroplasty procedures require individual planning, selection of implants and additional implants. Intraoperative evaluation is required due to lack of an objective image analysis of prosthesis element loosening and a level of bone stock damage determining the scope of the procedure, selection of implants and number of allogenic grafts. Our management tactics is an effective method of aseptic loosening of acetabulum and stem treatment after primary hip arthroplasty.

Local experience with total hip replacement in dysplastic coxarthrosis.

Background. The goal of our study was to assess the efficacy of total hip replacement in the treatment of dysplastic arthrosis of the hip. Material and methods. Between November 2001 and June 2003 we performed total hip replacement in 40 patients (46 hips). Arthritic deformations were classified according to Crowe's classification scheme and operated using a variety of techniques and prostheses. Outpatient examinations were performed every 6 weeks. Rehabilitation began 24 hours after surgery. Results. The average time of hospitalization was 14 days. According to Harris's scale, the average result was 35.4 before operation, 59.8 immediately after surgery, and 79.16 at 18 months post-operatively. The average difference between lower limbs was 3 cm before surgery and 1 cm post-operatively. The average range of flexion in the hip preoperatively was 36 degrees , 85 degrees post-operatively. All the patients suffered pain in the dysplastic hip before surgery; 4.4% patients still felt pain 12 months after surgery. In 2 cases there was loosening of the acetabular component of the prosthesis, which required revision surgery. In 3 cases there was dislocation of prosthesis. In 2 cases the implant was infected. In 1 case there was paresis of the femoral nerve. Thromboembolism occurred in 3 cases. Conclusions. In Crowe's first and second degree dysplastic arthrosis of the hip, a good outcome is obtained with standard stem prosthesis. A CDH stem should be used in stenosis of the intramedullary canal. Patients with dysplastic hips have better quality of life after total hip replacement.

[Locked intramedullary nailing in treatment of femur and tibia delayed union and pseudoarthrosis]. / Gwozdziowanie sródszpikowe z ryglowaniem w leczeniu zrostu opóznionego oraz stawów rzekomych kosci udowej i piszczelowej.

Five patients treated operatively on account of tibia and femur shaft delayed union and pseudoarthrosis were re-operated by locked intramedullary nailing. The method permits stable bone fixation. Intramedullary canal reaming stimulates bone union, as it refreshes fracture site and is a source of bone graft. Intramedullary nail covers anatomical axis of bone and, in the case of femur, is close to its mechanical axis. It diminishes the risk of implant breakage. The method permits active and efficient rehabilitation. Some fractures stabilised with external fixator or operated by Zespol or Polfix method can be re-operated by close technic. It shortens time of operation and diminishes its aggressiveness. In our opinion locked intramedullary nailing is an efficient method in treatment of tibia and femur shaft delayed union and pseudoarthrosis.

[Results of treatment of tibial spine fracture in children]. / Wyniki leczenia oderwania wynioslosci miedzyklykciowej u dzieci.

In this work there are presented the results of the treatment of 10 patients with avulsion fracture of tibial spine. In this group were 9 boys and 1 girl. The age range was from 9 to 14, and the median age was 11.5. In 6 cases the diagnosed injuries were of I and II degree according to the classification of Meyers and McKeever. These were treated conservatively. In 4 cases the results were very good, in other two there occurred the extension deficiency lower than 5 degrees. 4 patients with the III degree injury underwent operation which constituted in the fracture reposition and stabilization with wire suture. In all cases the clinical results were very good.

[Knee arthrodesis performed with intramedullary nailing technique in failed total knee replacement--a preliminary report]. / Usztywnienie stawu kolanowego technika gwozdziowania sródszpikowego jako metoda leczenia powiklan protezoplastyki stawu kolanowego--doniesienie wstepne.

Knee arthrodesis is the method of choice in treatment of failed total knee replacement. It is recommended when revisory total knee replacement is impossible. The authors present 2 cases of knee fusions using intramedullary nails after prosthesis loosening (1 aseptic, 1 septic). In both cases good results were achieved, with no complications observed during convalescence.

[The influence of body injuries on bone union of femoral shaft fractures treated by different operative methods]. / Wplyw dodatkowych obrazen ciala na gojenie sie zlaman trzonu kosci udowej leczonych róznymi metodami operacyjnymi.

Femoral shaft fracture is very often main musculo-skeletal injury in polytrauma patient. We analysed bone union of femoral shaft fractures treated by different operative open methods--AO plate osteosynthesis, Zespol method and open intramedullary nailing and by closed intramedullary nailing, in patients with concomitant body injuries. We compared patients operated by open methods without complications with the group demanding fracture reoperation. We found out no statistical correlation between the frequency of local complications demanding reoperation and the presence of associated injuries p = 0.209 or their severity expressed in ISS p = 0.202. The highest ISS 29.5 points occurred in the group operated on by closed intramedullary nailing. Lack of complications in this group gives evidence of efficiency of this method of treatment.

Current methods for monitoring the treatment of osteoporosis: increased bone mineral density or reduced fracture risk?

Bone fractures are the most serious complication of osteoporosis. Fractures occurring in vertebrae or the proximal epiphysis of the femur directly increase the risk of mortality. As a result of the aging of our society and the prolonged average life expectancy, it is becoming increasingly important to develop diagnostic methods that will enable the early and accurate diagnosis of osteoporosis, and testing methods to measure the factors that are decisive for the mechanical endurance of bones. The most important diagnostic test, despite certain defects and the danger of a false result, is still the densitometric measurement of bone tissue using the DEXA method. By contrast, the monitoring of treatment based on the testing of bone tissue density remains a dubious method. The new definition of osteoporosis introduced in 2001 has concentrated our attention on reducing the risk of fracture. Thanks to large, randomized epidemiological studies, we can identify those drugs which reduce the risk of first and subsequent osteoporotic bone fractures. Alendronian, rizedronian, and parathormon have been demonstrated to have effects that reduce the risk of fractures, both in vertebrae and in the proximal epiphysis of the femur. The overarching goal of our treatment is still avoiding osteoporotic fractures, and not merely trying to improve the results of densitometric tests.

Immunomodulatory medicine use in the bi-symptomatic neuro-vertebral conflict.

Background. The following study is an attempt to draw the readers' attention to the issue of the multifariousness of the intervertebral discs' destructive processes resulting in the neuro-vertebral syndrome. The professional literature mentioned here gives a prominence to the thread of immunological phenomena accompanying disc diseases and their treatment.
Material and methods. Selected groups of patients with a high probability of the coexistence of immunological processes were analyzed in terms of pain patterns and topographic cross-sections of the intervertebral discs. They were then treated transdermically with butapirazole and levamisole hydrochloride under the control of Lasegu's bioengineer test, electro-sensory tests and CIC level tests.
Results. A Lasegu's test, an electro-sensory (I) test and a survey showed that the groups of patients treated locally 15 times with Butapirazole showed an almost complete recovery of the symmetry with no effect on the CIC level and the localized pain intensity (II). The majority of the patients experienced a regression of ailments within 3 months. As far as the group of patients treated with Levamisole is concerned both root (I) and localized pains (II) subsided rapidly as confirmed by a survey and a Lasegu's test as well as the electro-sensory tests (I), (II). A high decrease of the level of immunological complexes was noticed after only 15 Levamisole infusions. This correct level was maintained 3 months later, which was shown by further tests.
Conclusions. This seems to be the premise confirming the effect of a localized inflammatory point on the level of immunological complexes present in blood (CIC).

Possibilities of surgical treatment of bone metastases to the proximal epiphysis of the femur: a review of the literature and own experience.

Background. The most common complication of bone metastases to the hip is pathological fracture of the proximal epiphysis. The present study presents the indications and contraindications for surgery and the choice of particular surgical techniques, based on the literature and the authors' own experience.
Material and methods. In the period 1992-2002 we treated 25 patients with bone metastases to the proximal epiphysis of the femur. All had suffered pathological fractures. Various surgical procedures were used, depending on the indications. In two cases we used pallative treatment.
Results. There were no intraoperative or immediate post-operative deaths. In all cases but one we observed reduced pain after surgery. 23 patients recovered hip mobility. 22 patients could walk with elbow crutches after surgery. A functional evaluation performed on day 14 post-surgery produced an average score of 13.2, which on Merle d'Aubigne's scale is a "good" outcome. The survival time ranged from 6 weeks to 4 years (average 13.5 months).
Conclusions. Surgical treatment is essential, both in existing and imminent pathological fractures of the proximal epiphysis of the femur, in order to provide relief from persistent pain and enable independent movement. A patient with advanced neoplastic disease and bone metastases to the hip should be operated even before a pathological fracture occurs, which enables the use of a less invasive surgical technique and prevents immobility and worsening of the patient's physical and mental status.