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Background: The aim of the study was to assess the outcomes of surgical treatment of complex knee injuries with a posterior inverted-L approach to the knee joint., Material and Methods: The study retrospectively enrolled 13 patients who underwent surgical treatment due to knee injuries with posterior tibial plateau fractures in 2015-2017. Pre-operative planning was based on antero-po-sterior and lateral X-rays and CT images. The fracture was assessed according to Luo's three-column classification. Radiographic postoperative assessment was based on lower limb (standing) X-rays and measurements of the MPTA, aPPTA, JLCA, and aFaT angles in the operated and healthy limbs. Clinical assessment was based on the IKDC, KOOS, and Tegner-Lysholm Knee Scoring Scale., Results: Mean follow-up duration was 11.5 months (4-25 months). Anatomical joint surface reduction was achiev-ed in 12 patients and bone union was present in all patients. A posterior inverted-L approach was used in 9 pa-tients and combined approaches in 8 patients. According to the three-column classification, single-column fractures were found in 3 patients, two-column fractures in 4, and three-column fractures in 6 patients. The KOOS was 82%, the IKDC score was 80%, and the Tegner-Lysholm score was 82 points. Radiographic assessments of the operated knee joints showed an MPTA of 88.64 degrees, aPPTA of 79.78 degrees, JLCA of 0.8 degrees, and aFaT of 7.9 degrees., Conclusions: 1. Anatomical reduction and stable fixation of posterior plateau fractures of the proximal tibia are crucial in fracture management. 2. A posterior inverted-L approach is very useful when treating posterior tibial plateau fractures.

Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been ob-tained, this procedure, like any other surgical procedures, may be associated with severe complications, includ-ing contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has al-ways been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.

We present a case of a neglected dislocation of the elbow joint. A 28-year-old patient suffered elbow joint dislocation with fracture of the radial head after a fall from a considerable height. Following a failed attempt at manual repositioning, the dislocation was reduced surgically and free fragments of the radial head were removed without stabilisation with a Kirschner wire. The joint was immobilised for 6 weeks in an arm-to-hand plaster cast, followed by two weeks during which an elbow joint orthosis with adjustable flexion was worn. The patient then attended rehabilitation. The first follow-up radiograph was obtained as late as 5 months following the operation and revealed a neglected dislocation and periarticular ossifications. Subsequent procedures did not improve limb function and the course was also complicated by a joint infection. The ultimate functional outcome is unsatisfactory. According to the principles of trauma care, all repositioning procedures need to be confirmed with a follow-up radiograph.

Mechanical injury to soft tissues and bones of the lower limbs may be complicated by thrombosis and oedema. Treatment of posttraumatic oedema in the lower limbs can be difficult and protracted and rarely leads to complete recovery. The pathogenesis of posttraumatic oedema has not been fully elucidated. This paper presents the aetiopathogenesis of posttraumatic oedema in the lower limbs and a review of relevant literature in English and Polish of the last 5 years, describing therapy outcomes and potential perspectives for develop ment.

Radial head replacement should be a routine treatment in cases of non-reconstructable radial head fractures. With the growing number of radial head arthroplasties, we are going to see more complications related to this procedure. We describe a case of aseptic destruction of the elbow joint, probably related to the release of polyethylene particles from the prosthetic head. Removal of the implant and extensive synovectomy was performed, leading to an excellent clinical outcome with reduction of pain and increase in the range of motion. The clinical improvement was not accompanied by radiographic change.

Background: The Polish orthopaedic literature lacks a tool to measure patient reported treatment outcomes in the foot and ankle., Material and Methods: The translation and cultural adaptation of the Foot and Ankle Outcomes Questionnaire was performed in accordance with relevant guidelines. The Polish version of the questionnaire was tested to check its test retest reliability, internal consistency and construct validity., Result: The Polish version of the questionnaire was prepared. Testing of the questionnaire revealed acceptable test retest reliability, internal consistency and construct validity., Conclusion: The translation, cultural adaptation and testing of the Polish version of patient related outcome measuring tool for the foot and ankle is described.

A case of posttraumatic checkrein deformity of the hallux is presented. This deformity is most often caused by scarring of the muscle belly or tethering of the tendon. A 22-year old woman developed a hallux checkrein deformity after a bimaleolar fracture. Intraoperatively, a linear scar tethering the muscle belly to the posterior tibia was observed. Resection of the scar allowed for full flexor hallucis longus mobility. Full hallux range of motion as well as foot function was restored. The cause of the checkrein deformity in our patient was a scar tethering the flexor hallucis belly to the posterior tibia.

Background: Chronically unreduced posterior dislocation of the elbow is a complex and difficult problem for the surgeon and its treatment significantly influences future functional performance of the patient. There are few reports in the literature regarding chronically unreduced dislocations, and most of them are based on observations of individual patients., Material and Methods: A total of 9 patients with chronically unreduced posterior dislocations of the elbow were treated in the Department of Orthopaedics and Traumatology between 2004 and 2012. The mean time between injury and reduction was 5.6 weeks. Eight of the patients had a concomitant fracture of the radial head, 5 had a fracture of the coronoid process, and 8 demonstrated significant damage to the lateral collateral ligament complex. All patients were qualified for surgical reduction of the dislocation, and then, after a maximum of 2 weeks of immobilization in a plaster cast, the patients were referred for intensive physiotherapy. Stability, range of motion and elbow function according to the MEPI score were evaluated during follow-up visits., Results: Elbow instability did not occur in any of the patients during the follow-up. Complications in our patients included a posttraumatic contracture of the elbow, periarticular ossifications and loosening of the radial head endoprosthesis., Conclusions: Recommendations for the management of these difficult cases are formulated.

The article presents a case of an adolescent patient suffering from osteochondritis of the humeral capitellum. Early symptoms of this disease appeared at an age typically associated with the onset of both Panner's disease and Osteochondritis Dissecans (OCD) of the humeral capitellum. About two years after the onset of the early symptoms, the patient reported to a specialised clinic. He was followed up for almost two years and was hospitalised and underwent surgical treatment during that period. Both diseases bear multiple similarities, which may entail diagnostic errors. The paper presents differences between these two similar clinical entities, in particular in terms of treatment and prognosis. Essential details potentially allowing for early diagnosis and classification of both conditions are described and discussed. Resolving the discussion may significantly contribute to improving performance and quality of life of patients suffering from necrosis of the humeral capitellum.

Background: Posterior ankle arthroscopy is considered to pose a risk of neurological and vascular complications. Some authors consider the postero-medial portal to be risky and recommend using only the postero-lateral portal. The aim of this study was to analyze the margin of error offered by posterior ankle arthroscopy portals., Material and Methods: Twenty MRI studies of the ankle joint were analyzed. The paths of the postero-medial and postero-lateral portals were drawn. Next, the path of the probe was diverged to aim at the neurovascular bundle and the angle of deviation was measured. We analyzed the distance between the probe located directly laterally to the flexor hallucis longus tendon and the neurovascular bundle., Results: The mean angle of deviation leading to collision with neurovascular bundle structures was 53.3° (range 37-70°) and 30.75° (range 22-41°) for the postero-medial and postero-lateral portals, respectively, p<0.05. The mean minimal distance between and the probe and the bundle was 12 mm (range 5-15 mm) and 13 mm (range 8-18 mm) for the postero-medial and postero-lateral portals, respectively, p>0.05., Conclusions: 1. The postero-medial arthroscopic portal is at least as safe as the postero-lateral one in posterior ankle arthroscopy. 2. Keeping instruments strictly laterally to the flexor hallucis longus tendon leaves at least 5 mm distance from the neurovascular bundle.

Congenital radial head dislocation is a rare condition which is, however, the most common of all congenital pathologies of the elbow joint. This paper is a case report on a patient presenting with moderate pain and discomfort in one of his elbow joints, both of which were found to be affected by this condition. He was treated by surgery which consisted of resection of the proximal radius and partial anterior capsulectomy of the elbow joint. This treatment led to a significant improvement in pain and elbow function compared to the preoperative status.

Introduction: Elbow joint stability is provided by the medial and lateral collateral ligaments, joint surface alignment, and the joint capsule. The contribution of the joint capsule is relatively minor and varies with the position of the joint. The normal range of forearm abduction and adduction in the elbow joint is estimated to be between 5 and 10°. The aim of the paper was to determine precisely the physiological range of elbow joint motion in the frontal plane (laxity), which, apart from the knowledge gained, will provide a means to assess the effect of the surgical treatment of elbow joint contractures by comparing the stability of operated and healthy joints., Material and Methods: The measurements were carried out using UB-01, a prototype device produced by ANT Polska, in a group of 52 healthy volunteers., Results: The mean valgus and varus deviation of the elbow joint was 11.2° (6.4° 16.1°) and 6.6° (3° 10.7°), respectively. The mean degree of elbow joint laxity was 17.8° (10.6° 26.5°). The difference in laxity between two opposite elbow joints in the same person was, on average, 1.2° (0.1° 3.8°). In healthy persons, the amplitude of deviation for both elbows is significantly smaller than 2°., Conclusions: 1. There are major differences in elbow joint laxity between individuals. 2. Nevertheless, laxity values of two elbow joints in the same individual are very similar. This observation allows for the healthy elbow to be treated as a reference while assessing the affected joint's stability in a patient following conventional surgery for elbow joint contracture.

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.

Background. Intraarticular distal radius fractures are marked by a significant amount of soft tissue damage, which is not always noticed on routine X-rays. The lack of early diagnosis and treatment of these lesions can lead to the development of carpal instability, and subsequently to limited range of motion or wrist pain syndrome. The purpose of this article is to show how these lesions can be diagnosed arthroscopically, and at the same time to compare arthroscopic evaluation to standard X-rays. Material and methods. In the period from August 2004 to April 2005 we performed 21 wrist arthroscopies in 20 patients with intraarticular distal radius fractures (7 women and 13 men, ranging in age from 20 to 63 years, average age 38). Results. In all these patients, numerous soft tissue lesions were found during arthroscopic examination: TFCC lesions in 13 patients, SL ligament lesions in 7 patients, and an LT ligament lesion in 1 case. None of these lesions were visible in X-rays. An ulnar styloid fracture was found in 9 cases, in 4 cases associated with TFCC lesions. Loose bodies, not seen in previous X-rays, were detected in 8 patients. Conclusions. Arthroscopy in intraarticular distal radius fractures facilitates the diagnosis and treatment of soft tissue lesions, which are numerous and usually not detected on standard X-rays.

Background. In patients older than 65 with osteoporosis, fractures of the proximal end of the humeral bone pose a difficult clinical problem. There is a larger body of opinion, however, favoring conservative treatment, while surgical intervention is most often reserved for complicated fractures., Material and methods. We studied 186 patients treated in the Traumatology Clinic at the Center for Post-Graduate Medical Education over the last 5 years., Conclusions. Our analysis showed that in osteoporotic fractures of the proximal epiphysis of the humeral bone there are very limited indications. As a general rule the best effects are achieved by the shortest possible duration of immobilization and early intervention.