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Purpose and Hypothesis: The aim of this study was to compare early clinical results after open and arthroscopic Latarjet stabilisation in anterior shoulder instability. Our hypothesis was the results of arthroscopic stabilisation were comparable with the results of open procedure.Material and Methods: The clinical results of the patients after primary Latarjet procedure were analysed. Patients operated on between 2006 and 2011 using an open technique composed the OPEN group and patients operated on arthroscopically between 2011 and 2013 composed the ARTHRO group; 48 out of 55 shoulders (87%) in OPEN and 62 out of 64 shoulders (97%) in ARTHRO were available to follow-up. The average age at surgery was 28 years in OPEN and 26 years in ARTHRO. The mean follow-up was 54.2 months in OPEN and 23.4 months in ARTHRO. Intra-operative data were analysed regarding time of surgery, concomitant lesions and complications. Patient results were assessed with Walch-Duplay, Rowe, VAS scores and subjective self-evaluation of satisfaction and shoulder function. Computed tomography scan evaluation was used to assess the graft healing.Results: Average time of surgery was significantly shorter in ARTHRO than OPEN: respectively 110 and 120 minutes. The number of intra-operative complications was six (12.5%) in OPEN and five (8.1%) in ARTHRO. The results were comparable in both groups, with no significant difference between OPEN and ARTHRO group: satisfaction rate - 96.8% and 91.9%, shoulder function - 92.2% and 90%, Walch-Duplay score - 83.9 and 76.7 respecively. A significant difference was reported in Rowe score: 87.8 in OPEN and 78.9 in ARTHRO. Another significant difference was found in the presence of "subjective apprehension"-a term referring to the subjective perception of instability with no signs of instability at clinical examination - 28.7% in OPEN and 50% in ARTHRO. Range of motion in both groups were comparable, however patients in OPEN had significantly lower loss of external rotation in adduction to the side comparing to the contralateral shoulder: 7° versus 14° in ARTHRO. Recurrence was reported in three cases in each group: 6.2% in OPEN and 4.8% in ARTHRO. A revision surgery was performed in four patients (9.3%) in OPEN and six (9.7%) in ARTHRO. Radiographic evaluation showed a significantly lower rate (5%) of graft healing problems (fracture, non-union and osteolysis) after arthroscopic stabilisation, however a partial osteolysis of the proximal part of the bone block was significantly more frequent (53.5%).Conclusions: The arthroscopic Latarjet stabilisation showed satisfactory and comparable results to open procedure. We recommend further investigation and development of arthroscopic technique.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

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.

Background: Calcaneal fracture is a most common bony injury of the hindfoot. In constitutes 60% of foot fractures and 1-2% of all fractures. According to current literature 75% of these fractures involve articular surfaces, which makes them especially difficult to treat. Intraarticular fractures often result in permanent disability impairing foot function and ambulation, sometimes due to inadequate treatment method. According to literature, in developed countries open reduction and internal plate fixation is standard treatment of intraarticular calcaneal fractures. This treatment poses a risk of impaired wound healing and is appropriate for selected group of patients without additional risk factors. Other patients are treated with minimally invasive methods. Proponents of minimally invasive techniques apply distraction, which makes most intraarticular calcaneal fractures amenable to this method., Case Report: This paper presents a minimally invasive treatment technique for intraarticular (depression type according to Essex-Lopresti, IIA accordind to Sanders) calcaneal fracture in 63-years old man. External fixator (Monotube) is used for intraoperative distraction. Posterior facet is reduced with additional maneuvers., Results: With this technique we were able to reduce posterior faced, correct varus alignment and restore Böhler's angle. With restoration of shape of calcaneal bone optimal functional result can be expected. At six moths follow-up very good result was observed.

Background: The aim of the study was to compare vitamin D concentration in patients treated due to delayed bone union and non-union (pseudoarthrosis) and patients with normal fracture healing., Material/methods: A retrospective case-control study was conducted. We enrolled 35 patients with inexplicable (standard and correct surgery, closed fracture, no comorbid metabolic diseases) fracture healing impairment, and 35 patients assigned by age and measurement season. Vitamin D (as 25OHD) concentration was measured in all patients., Results: Vitamin D deficiency was reported in 86% of examined patients. No difference was shown between groups in deficiency prevalence., Conclusions: Previous studies indicated decreased vitamin D concentration in patients with impaired fracture healing. However, these studies did not include control groups. No difference was demonstrated between patients with normal fracture healing and those with impaired bone union in terms of vitamin D deficiency prevalence.

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.

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.

Radial head fractures constitute 33% of all elbow fractures. In cases of unreconstructible fractures, the resection of the head was advocated. Radial head arthroplasty is an alternative way of the treatment. As the implantation could end up with complications, thus new and better designs are constantly looked for. One of such designs is modal/bipolar radial head endoprosthesis. The aim of this paper is to assess the functional outcome following the implantation of this endoprosthesis using movement analysis system. Seven patients participated in the study: 5 after implantation of endoprosthesis and 2 after surgical reconstruction of the radial head. The upper extremity movements with EMG were assessed during gait and pronation/supination movements with and without the external load. The functional abilities of patients with radial head endoprosthesis do not differ from those of the patients after the elbow reconstruction. This allows the patients normal, daily activity, with no restrictions and pain.

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.

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.

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.