Evaluation of comparative results of rehabilitation of patients with acromioclavicular dislocation of the third degree treated by surgical techniques by Phemister and Vukov.

INTRODUCTION: In terms of access to treatment of acromioclavicular joint injuries, there are many controversies, especially after the appearance of works that promote "neglecting of injury". GOAL: The aim of this paper is to give a comparative analysis of the results of rehabilitation of patients after acute injury of the acromioclavicular joint of the third degree, treated by two surgical techniques: by Phemister and Vukov. MATERIAL AND METHODS: In this study, we investigated a total of 60 operated patients: 30 patients were operated by Phemister techniq-ue, and 30 by Vukov technique. RESULTS: Postoperative follow-up lasted for one year. Between these two groups, the time when the rehabilitation process began is significantly different p < 0.01. With technique by Vukov, the rehabilitation begins on the first postoperative day and with technique by Phemister it begins later (after 7 weeks outpatient). With technique by Phemister, rehabilitation lasted on average 60 days, and with technique by Vukov on average 40 days. The duration of recovery is also significantly different p < 0.01, with technique by Vukov the duration time is shorter, and therefore the process of rehabilitation in days--is shorter than with the other technique. Both techniques gave good stability of the lateral end of clavicle. The difference was not statistically significant p > 0.05, which means that both techniques can be applied depending on the indication and the experience of the surgeon.

[Early rehabilitation after traumatic brain injury and cerebrovascular accident--functional tests database].

INTRODUCTION: This paper deals with implementation of functional tests used in early rehabilitation into medical record databases. A pilot-testing of certain measurement instruments was performed to establish if they can be used in short intervals as variables for traumatic brain injury patients and those with stroke in intensive care units. The steering group gave critera for inclusion/exclusion. MATERIAL AND METHODS: We followed up four groups of 15 patients. On admission, their Glasgow Coma Score (GCS) was 5-8, 9-12, 13-15. Patients with isolated traumatic brain injury (TBI) were examined using Disability Rating Score (DRS); patients with GCS 13-15 underwent Galveston Orientation and Amnesia Test (GOAT); stroke patients were tested using Motricity Index and the Canadian Stroke Scale. All test were performed for five days in a row. RESULTS: In the first group, DRS results were identical in all cases. Differences were found in patients with GCS higher than eight, while GOAT was positive in four patients that required neuropsychological testing. In stroke patients, Motricity Index was more discriminative than the Canadian Stroke Scale. CONCLUSION: In accordande with our results, the steering group accepted DRS as the variable for patients with GCS 9-12 and 13-15, GOAT for patients with GCS 13-15 and Motricity Index for stroke patients.

[Prognostic value of classical electrodiagnosis in patients with peripheral facial nerve paralysis].

INTRODUCTION: Electrodiagnostic tests are performed in order to obtain information on the severity of lesions and the possibility of functional recovery. Classic electrodiagnostics implies excitability testing by faradic and galvanic currents, and chronaximetry. This method has been pushed out by new diagnostic procedures, although it is a reliable method that can give data about the severity of lesions and precise data about the maximal possible function recovery and the time it takes. The aim of this study was to investigate the correlation between the results of classic electrodiagnosis and functional recovery in patients with facial paralysis. MATERIAL AND METHODS: The prospective study included 50 ambulatory patients treated at the Department of Physical Medicine and Rehabilitation. After the use of diagnostic procedures (otorhinolaryngological, neurological, radiological), all patients underwent physical therapy. Two weeks after the onset of paralysis, classic electrodiagnostics was performed. We compared the prognosed and achieved recovery in two ways: for each muscle separately and for gross function (the House-Brackmann scale). RESULTS: 32 patients (64%) had only changes in excitability, 7 patients (14%) showed partial electrodegenerative reactions, 4 patients (8%) had electrodegenerative reactions and preserved reactions to faradic currents, 4 patients (8%) showed electrodegenerative reactions and inexcitability to faradic currents, and 3 patients (6%) had disruption of conductivity. Comparison of prognosed and achieved marks for the frontal, orbicularis oris and mental muscle showed a highly significant agreement in 94%, 80% and 86% of patients, respectively. There is also a highly significant agreement between prognosed and achieved recovery, described according to the House-Brackmann scale. DISCUSSION: In this study, classic electrodiagnostics showed a highly significant correlation between the predicted and the achieved outcome. Correlation was more significant when the "marking method for individual muscles" was used. The authors think that the classic test, unjustly pushed out in favor of new methods, (electroneurography - ENG, nerve excitability test - NET), certainly has advantages (insignificant intertrial and side-to-side variations as well as the possibility to test each muscle separately). CONCLUSION: The classic electrodiagnostics is a century old technology that offers useful information on nerve lesions. In our opinion, it should be part of the physiatric examination of patients with peripheral facial nerve paralysis.