Search

The aim of this paper is to analyze on clinical cases specific features of femoral insufficiency fractures during bisphosphonates therapy. We are presenting two insufficiency femoral fractures (2 patients) in patients receiving bisphosphonate therapy. These two cases represent new type of femoral fractures. These are low energy or spontaneous fractures of diaphysis and subtrochanteric region. Prodromal pain is often observed. On x-rays thick lateral cortex, its ellipsoid thickening and transverse or oblique fracture line is observed. Many authors link such fractures to long-term bisphosphonate therapy. Patients on long term bisphosphonate therapy present with new and specific fracture pattern of femoral bone. Fractures of this pattern are extremely rare. The risk benefit ratio of bisphosphonates therapy is not changed.

Background: For many years, wrist arthroscopy has been used to diagnose and treat soft tissue lesions and to restore anatomic articular surface alignment in intraarticular fractures. However, there are no publications providing clear and precise indications for wrist arthroscopy in distal radius fractures. The aim of the study was to analyse factors influencing the outcomes of intraarticular distal radius fracture treatment with K-wire fixation under arthroscopic guidance in AO B1 and C1 type fractures., Material and Method: A group of 26 patients (27 wrists) following an arthroscopic procedure (ARTR group) was the prospective component and 27 patients (27 wrists) following a non-arthroscopic procedure (OP group) constituted the retrospective part of the trial. Both groups consisted only of patients with B1 and C1 type fractures (10 and 17, respectively) according to the AO classification., Results: In the ARTR group, there was a marked (statistically significant) difference between radiologically and arthroscopically assessed displacement. This underestimation of displacement was higher in B1 than C1 type fractures (statistically significant difference). Numerous associated injuries were identified, such as carpal bone cartilage injuries (85.19%), TFCC injury (59.26%) and SL ligament injuries (40.74%). Loose bodies were detected in 66.7% of the patients. In B1 type fractures, the most common ligamentous injury was a SL ligament lesion (50%), while in C1 fractures it was a TFCC lesion (70.59%). Comparing both groups (ARTR and OP), better clinical outcomes were observed in the ARTR group (though not statistically significant), with the most marked differences noted with regard to B1 type fractures., Conclusions: In B1 and C1 type intraarticular distal radius fractures, displacement visible during arthroscopy was greater than that seen on primary radiological assessment. In B1 type fractures, the difference between radiological and arthroscopic evaluation of displacement was more marked than in C1 fractures. It means that B1 type fractures can be highly "misleading", because their radiological pattern suggested little displacement, while actual displacement was more pronounced. On the basis of our results, it might be concluded that wrist arthroscopy could become a standard, routine procedure in B1 type fractures. In C1 type fractures, the method of treatment would depend on the surgeon's preferences.

In the years of 2003-2005 there was carried out an investigation on 24 patients (17 male and 7 female) based on measuring the pressure in the deep posterior compartment during tibial intramedullary nailing with reaming. The pressure was checked in each part of the operation. The mean increase of the pressure was 7% (+ 1.6 mmHg) and didn't cause any risk of compartment syndrome. In our opinion the intramedullary nailing might be consider as a safe procedure.

Intraarticular distal radius fractures affect predominantly young people by contrary to "loco typico" fractures concerning old patients with osteoporosis. They are usually caused by high energy trauma and their treatment needs anatomic reposition. Between August and December 2004 there were performed 10 wrist arthroscopies in distal intraarticular radius fractures: 3 women and 7 men, age from 20 to 63 years, average 41. In all cases arthroscopy revealed larger displacement than assessed by standard radiographs and multiple associated soft tissue injuries were detected: lesions of TFCC in 5 patients, cartilage lesions of carpal bones in 6 and I degree SL interosseous ligament lesion in 4 patients. Arthroscopy in distal radius fractures allows detailed articular surface displacement assessment and reposition under "eye control". Additionally associated soft tissue injuries, which are not visible in standard X-ray examination are detected and treated.

The authors describe rare phenomenon of the snapping of the medial head of the triceps muscle and recurrent dislocation of the ulnar nerve. The indications for operative treatment are established. The authors describe its own case making a conclusion that operative treatment is a good option in some cases.

From 1997 to 2002 in the Department of Traumatology there had been performed 488 total hip replacements: 334 in men and 454 in women at the age between 20 and 84 (average 63.6). The procedures were performed by 12 surgeons and postero-lateral approach was used. Dislocation was found in 22 patients (4.51%): 14 women and 8 men. Majority of dislocation occurred during first 8 weeks after an operation and 68% of them happened during first 6 weeks. The surgical treatment was necessary in 10 cases (45% of all dislocation): 3 patients had only a surgical reposition and 7 patients had a revision arthroplasty. There was found that most cases of dislocation took place at the age above 81 years. Dislocation occurred 5 times more frequently in patients operated on for a femoral neck fractures then for coxarthrosis. The prosthesis TT1 most often dislocated possibly due to its shape (low Head Neck Ratio). Based on our own experience we find dislocation is a multifactorial complication and precise description of causes is usually very difficult.

158 patients after the knee trauma and operational treatment were evaluated. Quadriceps and hamstring isometric strength and thigh circumference 10 cm above the patella were measured. Injured leg was compared to non-injured., Patient Groups: Group 1 - 43 patients with isolated ACL injury treated non-operatively. Group 2 - 29 patients after ACL reconstruction using Leeds-Keio prosthesis. Group 3 - 29 patients after subtotal arthroscopic meniscectomy. Group 4 - 13 patients with patellar fractures treated operatively and 6 weeks in long leg cast, Group 5 - 31 patients with proximal articular tibial fractures treated operatively and immobilized 6 weeks in long leg cast. Group 6 - 13 patients with distal femoral articular fractures treated operatively without immobilization. Group 7 - 10 patients with habitual dislocation of the patella after the Campbell-Goldwaith operation and 6 weeks in a long leg cast., Conclusions: 1) No significant correlation between the quadriceps and hamstring strength deficit and thigh atrophy was found. 2) Strength deficits concerns both quadriceps and hamstring muscles. 3) Strength deficits are higher in patients treated in the long leg casts than in non-immobilized.

The authors describe indications and contraindications for total elbow arthroplasty. The brief characteristic of total elbow replacement is done. The authors describe its own case of clinical use of the Coonrad-Morrey implant.

The authors describe its own design--bipolar radial head prosthesis. The value of this prosthesis is analyzed. The early results in 10 patients, age 20-69 (average 36 years), 7 male and 3 female have been reported. The results are excellent and good. The authors conclude that this prosthesis should be used as an alternative for radial head resection.

The fractures of the shaft of the tibia were analyzed in 120 cases. The level of the osteoporosis in the radiological examination was assessed in comparison to the healthy limb. Osteoporosis was recorded in 60.6% of the cases. The clinical symptoms of the Sudeck syndrome was recorded in 11.25% of the cases. The Laser-Doppler examination was carried out in 120 cases. A standard 3 points measurement was employed: the apex of the toe, the flexion-dorsal part of the foot, and the medial part of the mid tibia length. The examination was done comparatively on both limbs. The pressure used in the occlusion, was 100 mm Hg higher than the pressure on the humeral artery. A faster and higher amplitude post-occlusion circulation reaction in the affected limb, among the patients with an early stage of the clinically diagnosed Sudeck syndrome had been recorded. The outcome is significant statistically. The Laser-Doppler measurement of the microcirculation is a new method and definite conclusions must be draw with caution. However, these results encourage further research.

The authors present a case of radial head fracture with disruption of the lateral collateral ligament and elbow dislocation. Treatment gave a very good result. Elbow instability after reduction and radial head fixation is a strong indication for ligament repair.

69 patients with the ACL rupture: 40 non-operated, without functional knee instability, and 29 after the ACL reconstruction using Leeds-Keio prosthesis due to knee instability have been evaluated. Isometric dynamometric examination of the quadriceps and hamstring muscles was performed. The mean strength deficit in non-operated group was: quadriceps--18.48%, hamstring--7.19%, in operated group was: quadriceps--11.87%, hamstring--10.30%. The higher strength deficit of the quadriceps and lower of the hamstring in non-operated patients may be the sign of an adaptational mechanism to the ACL deficiency. No statistical correlation between the strength deficit and the deficit of the thigh circumference 10 cm above the patella was found.

The authors give indications for internal fixation of the radial head fractures. The results in 20 patients, age 18-69 (average 38 years), 12 male and 8 female have been reported. The authors conclude that fixation is a better method of treatment than resection of the radial head. The authors suggest that good fixation is also possible in the case of comminuted fracture. Fracture-dislocation of the elbow joint is not an indication for ligaments repair if the elbow is stable after radial head osteosynthesis.