Quality of life as a result of multiple injury in the aspect of limitations of handicaps--social roles.

Aim of the study was the comparison of quality of life after multiple injury using limitations of handicaps--social roles, ICIDH (World Health Organization). The study group comprised 1259 patients in the years 1989-2003 whose degree of injuries amounted to at least 18 scores in the Injury Severity Scores. Patients were evaluated during a 5 year period. The prospective study in the period to three years (to the end of 2006 year) included 827 (65.9%) patients. The results were compared and statistically analyzed. In the first 5 years--72.5% persons presented limitations on handicaps. In the second 5-years period--48.8% were found to have limitation on social roles and in the third 5-years period 50.3% of people. The most common limitations referred to physical activity--50.5% patients, economic self dependence--49.3% and carrying out of everyday routine--45.7% patients. The highest quality of life improvement and the decrease in the amount of people with limitations on social roles was noted in the second 5-year period and was statistically significant related to the first 5 years. The improvement of quality of life was not significant in the third 5-year period related to second 5-year period. The increase of injuries severity and age was one of the reasons of reduction of positive changes in the last 5-year period.

[Underfoot pressure distribution of female patients with obesity and plantar fasciitis]. / Rozklad nacisków na podeszwowej stronie stóp u kobiet z otyloscia i zapaleniem rozciegna podeszwowego.

OBJECTIVE: Estimation of underfoot pressure distribution of female patients with obesity and bilateral plantar fasciitis. MATERIAL: 45 women aged 58 (SD +/- 9.0) with obesity confirmed by BMI (BMI = 38.2, SD +/- 5.1) and hindfoot-related bilateral pain complaints typical for plantar fasciitis. The control group consisted of 50 women with no obesity and pathologies of motor apparatus found. METHODS: Clinical and radiological examination and postural pedobarography. The underfoot pressure was determined at defined foot regions according to modified Blomgren classification. RESULTS: When compared with the control group, patients with obesity had increased pressure within metatarsus, mainly in its lateral part and within anterior part of hindfoot (MT5, MM, LM, T zone). The maximal value of underfoot pressure was 1052 g/cm2 in patients with obesity and 784 g/cm2 in the control group. There were no statistically significant differences found between underfoot pressures and stronger and lesser pain complaints occurring in one patient. CONCLUSIONS: 1) In obese women with bilateral plantar fasciitis increased underfoot pressure mainly in the lateral part of metatarsus and anterior part of hindfoot was revealed. 2) The above changes correlate with feet dysfunction confirmed during the interview and through the physical examination.

[Results of autogenous bone marrow grafting in disorders of bone healing and bone defectives]. / Wyniki leczenia pourazowych zaburzen zrostu kostnego i ubytków kostnych autogennym przeszczepem szpiku kostnego.

The aim of the study constituted a prospective assessment of efficacy of autogenous bone marrow grafting for the treatment of defective bone healing in patients with isolated and multiple injuries. Material comprised 3367 patients that were operated since June 1st 2004 to October 31st 2007 due to long bone fractures. Disorders of bone healing were diagnosed in 32 (0.95%) patients. 9 (28.1%) patients from the study group were treated due to multiple injuries (with severity of injuries assessed to be 33 points according to ISS; on the average 2.9 injured body regions). Multifragmental and comminutive fractures were note in 12 (37.5%), in this group 3 open fractures. The average time interval to achieve bone healing was 4.5 months, but was about twice longer in cases of pseudoarthrosis. The method was not effective in 7 (21.8%) patients. Defective bone healing was predominantly noted in cases of femoral, tibia and radial fractures. Bone marrow grafting proved the most effective in cases of delayed unions and non-infected pseudoarthrosis and non-union.

[Hand injuries caused by circular saw]. / Obrazenia rak spowodowane pila tarczowa.

The investigation was carried out on 1199 patients treated for hand injuries in the II Department of Surgery of the Jagiellonian University between years 1987-2000. There were 225 patients injured while working with circular saw. These injuries were much more severe than others (p < 0.001) and patients with these injuries were more often (p < 0.001) admitted to the clinic. The length of total treatment was considerably longer (p < 0.001) and final results--worse than in other patients (p < 0.001)--permanent hand disability was almost three times larger. Disability pension was given to these patients much more frequently than to others (p < 0.001). The main reason of these injuries seems to be the common use of home-made circular saws without any protection devices and non-conformity to fundamental rules of work security. Patients with extensive multitissular hand injuries should be treated in specialistic centers of hand surgery, where the final results can be improved and the total costs of treatment considerably reduced.

[Major hand injuries--their causes and consequences]. / Ciezkie urazy rak--przyczyny i skutki.

To our study we included 1199 patients with hand injuries treated between 1987 and 2000 in II Dept. of Surgery of the Jagiellonian University in Cracow. The severity of the injury was estimated using our four-level, descriptive scale that was convergent to the HISS Campbell's and Kay's score. The most severe injuries (IVO) were found in 95 patients (7.92%) and 74 of them were professionally active. The injuries frequently occurred during operating the mechanical equipment (90%). In most cases these injuries required the stationary treatment after the primary emergency operation and the duration of the hospitalization period was av. 12.6 days. Our results were evaluated in respect to a patient's return to the previous performed profession and also taking into account the permanent hand function impairment basing on Swanson's study. 37 (50%) patients returned to previous professional activity and 37 (50%) patients received the disability pension. The hand function impairment in all patients with the most severe hand injuries was av. 42.9%). We also were taking into account the huge costs of the severe hand injury treatment. Concluding, the severe hand injuries should be treated in the specialist hand surgery centers. Such proceedings allow to minimize the extent of permanent post-injury disability and decrease total costs of treatment.

[Underfoot pressure distribution of a patient with unilateral ankylosis of talonavicular joint during rheumatoid arthritis--case report]. / Rozklad nacisków na podeszwowej stronie stóp u chorej z jednostronnym skostnieniem stawu skokowo-lódkowego w przebiegu reumatoidalnego zapalenia stawów--opis przypadku.

The aim of our study was to estimate underfoot pressure distribution of a patient with unilateral ankylosis of talonavicular joint during rheumatoid arthritis. The pedobarographic examination during bipedal standing revealed localisation of maximal pressure at the H region on the side opposite of ankylosis and increased underfoot pressure on the T region and decreased on GT, MT1-MT3 and H foot regions on the pathology side. After the end of orthopaedic treatment underfoot, pressure distribution changes persist in spite of pain regression.

[Estimation of foot crush injury treatment results--case report]. / Ocena rezultatów leczenia zmiazdzeniowego urazu stopy--opis przypadku.

The aim of the study was to estimate results of a 37-year-old man after foot crush injury treatment. Clinical, radiological and pedobarographic examinations were used in the patient's analysis. The result of therapy was successful.

Causes and consequences of hand injuries.

BACKGROUND: Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment. METHODS: Between 1987 and 2000, 1199 patients (average age 37.0 years (+/- 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs. RESULTS: Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (+/- 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%). CONCLUSIONS: The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses.

[Injuries in the elderly patients]. / Obrazenia ciala u osób w wieku podeszlym.

More and more higher development of civilisation causes constant lengthening of life in humans. Changes, which occur during growing old of organism predispose to increased risk of trauma. Financial cost of medical treatment of injuries in elderly are higher and higher. Degenerative disease of joints, osteoporosis, earlier body injuries and co-existing other diseases are important risk factors of trauma. Deficiencies of eyesight, hearing and prolonged time reaction are other strengthening risk of trauma. Falls and motor-vehicle accidents are the most frequent causes of trauma in elderly. Distal radius fracture, fracture of the proximal femur bone and compressive vertebral fracture of spine are typical fractures in the skeletal system. Head injuries are the most frequent cause of death in this group of patients. Limited functional reserves, especially in the respiratory and circulatory system brings difficulties in the treatment of even not dangerous injuries of chest and increases risks of infectious complications in respiratory system and finally may lead to organ failure. Elderly patients need more precise physical examination and diagnostics because essential information from the patient's history are often difficult to obtain. Indications to hospitalisation should be often widened even at not dangerous injuries, because the patients may demand intensive analgesic treatment and nursing. Necessity of care provided by other persons, poor care in household conditions, and inadequate social circumstances extend also indications to hospitalisation. There is a need to creation of nursing care departments for considerable group of injured persons who finished proper hospital-treatment, but because of the above-mentioned reasons cannot exist at home.

[Mass casualty events]. / Zdarzenia masowe.

Authors present problems concerning mass--casualty accidents, specificity of action rescue-system on different levels of co-operation, kind of segregation of victims and efficiency of the medical rescue system in Poland. Attention has been paid to the continuous instructions and education of life-saving services, preferably by simulation of events without earlier information of the interested. It is necessary to establish and abide official dependence by the rules of co-operation of components of life-saving system. A separate problem is the implementation of rescue--activities in special situations: nuclear, biological and chemical contamination, and with very important safety measures for people taking part in rescue action.

[Bone and joint decade--"mile step" in diagnostics and treatment of movement system diseases?]. / Dekada Kosci i Stawów--"krok milowy" w diagnostyce i leczeniu schorzen narzadu ruchu?

Musculoskeletal disorders affect hundreds of millions of people across the world and are the most common causes of severe long-term pain and physical disability. The impact from such disorders on the individual and on society let to propose by WHO for the Decade of the Bone and Joint from 2000 to 2010. The goal of the Decade is to improve the health-related quality of life for people with musculoskeletal disorders throughout the world and this could be achieved by raising awareness of the growing burden of bone and joint diseases on society, promoting prevention and treatment and advancing understanding of musculoskeletal disorders through research. The main fields of interest during the Decade are joint diseases, spinal disorders and low back pain, osteoporosis and severe trauma of the extremities. In our Department we study problems concerning on traumatology of old patients, multitrauma injury, biomechanics in spinal disorders, in degenerative joint disease and foot diseases. Apart from contemporary imaging methods like US or CT we use pedobarographic diagnostics and fotogrammetric examination. In this study we present strategic goals and the summary of our ongoing projects in our Department related to the goals of the Bone and Joint Decade.

[Developments of the bone and joint decade in the area of emergency medicine activity]. / Osiagniecia Dekady Kosci i Stawów w obszarze dzialania medycyny ratunkowej.

Emergency medicine in our country is still a new medical discipline, which is develope in spite of objective connected difficulties with generally well-known problems of medical service in Poland. Essential part of patients treated on the field of activity of rescue--medicine are victims with injuries of osteoarticular system. According to many authors determine they to 40% patients provided in pre-hospital care time. Development of Polish emergency medicine happens on period of Decade of the Bone and Joint, declared by the World Health Organization on years 2000-2010. Consequences of bones and joints injuries are the reason protracted pain complaints and physical disability of gigantic number of patients. The goal of the Decade are among other things, activities aiming to improvement of efficiency of osteoarticular system injuries on place of event and in emergency medicine departments, in accordance to accepted procedures. It is an extremely essential meaning for patient's future and of final results of treatment, and a quality of life of these people. In Clinic of Emergency Medicine and Multiple Injuries in relationship to Decade of the Bone and Joint we investigate problems concerning diagnostics procedures and initial medical management of isolated osteoarticular injuries, and coexisted with injuries of other body regions. In this study we present management strategy of osteoarticular injuries in emergency medicine in aspect of goals realization of the Decade of the Bone and Joint.

[Underfoot pressure distribution of a patient after fracture of the calcaneal bone and bilateral hallux amputation--case report]. / Rozklad nacisków na podeszwowej stronie stóp u pacjenta po zlamaniu kosci pietowej i obustronnej amputacji paluchów--opis przypadku.

The aim of our study was to estimate underfoot pressure distribution of a patient after bilateral hallux amputation and the unilateral calcaneal bone fracture on the left side at the end of orthopaedic end rehabilitation treatment. The pedobarographic examination during bipedal standing revealed localisation of maximal pressure at H region on the side of fracture and on MT1 and H foot regions on the other side. After the and of orthopaedic treatment underfoot pressure distribution changes persists in spite of pain regression.

[Evaluation of life quality in patients after surgical treatment due to neoplasmatic matastases in bones]. / Ocena jakosci zycia chorych leczonych operacyjnie z powodu przerzutów nowotworowych do kosci.

The aim of this study was to evaluate life quality in patients with disseminated neoplasmatic process after surgical treatment of pathological fracture due to metastasis to long bones. The examination group consisted of 33 patients (25 women, 8 men) treated surgically (av. age 67 years). Pathological fracture was revealed in femoral bone in 28 patients (bilateral in one patient) and in humeral bone in 5 patients. In case of femoral bone fracture unipolar arthroplastic of hip joint was used or stable osteosynthesis with the use of intramedullar nail or AO plate; while in case of humeral bone fracture elastic osteosynthesis with Rush nail was used. Survival period in patients after surgical treatment of pathological fracture was 6 months. Life quality in patients after surgical treatment was estimated on the basis of clinical scale. All the patients considered surgical treatment to be the purposeful improvement of the standard of the last months of life. The result of treatment presented in the scale of clinical assessment, turned out satisfactory in the examined grouped; the result was considered satisfactory in movement range of the operated limb, muscular strength and capacity of walking. The result of the evaluation of self-service capacity was estimated as more than satisfactory. In conclusion, the main advantage of surgical therapy in patients with neoplasmatic metastases into long bones is the decrease of pain and the improvement of self-service, even in the cases of serious degree of neoplasmatic process. Surgical treatment in those patients should ensure a fast comeback to possibly maximal functionality of the limb.

[Posttraumatic hand impairment]. / Kalectwo pourazowe rak.

1287 patients were treated due to hand injuries from 1987 to 2001 in the 2nd Department of Surgery in Cracow. Long-term follow-up was performed in 1071 patients (83.22%). Objective assessment of function was evaluated on the basis of Swansons examination protocol. Long-term follow-up examinations of 626 patients (58.45%) demonstrates different level of persistent hand disability. The level of hand impairment ranged between 1-100% with the average of 13.6%. This study demonstrates a statistically significant correlation (p < 0.001) between severity of injuries, place of accident, mechanism of injuries and severity of hand impairment. The most severe injuries and disability were caused by mechanical equipment and were incurred by farmers and workers in the place of employment. The level of hand impairment were determined on the basis of the patient's ability to return to previous work. This study demonstrated a statistically significant association (p < 0.001) between the increasing posttraumatic hand impairment and decreasing probability of returning to pre-injury profession. Concluding, severe hand injuries should be treated in the specialist hand surgery centers. Such proceedings allow to minimize the extend of the permanent post-injury disability and increase of better results of the treatment.

[Evaluation of posttraumatic hand impairment]. / Ocena pourazowego ograniczenia funkcji rak.

Long-term follow-up was performed in 1071 patients treated due to hand injuries. Those patients consisted 83.22% of patients treated because of hand injuries from 1987 to 2001 in the 2nd Department of Surgery in Cracow. Objective assessment of posttraumatic hand impairment function was evaluated on the basis of Swansons examination protocol and protocol of identification of persistent posttraumatic hand impairment. A statistically significant correlation in evaluation of hand disability of Swansons examination protocol and protocol of identify persistent posttraumatic hand impairment was found. The protocol of Ministry of Health is a simple and useful method for elevation of the level of hand impairment in epidemiological examination of large populations.

[Application of descriptive scale to the assessment of post-traumatic hand function limitation]. / Zastosowanie skali opisowej do oceny pourazowego ograniczenia funkcji rak.

Hand Injury Impairment Scale (HIIS) serving to assess hand post-traumatic limitation was described on the basis of Injury Impairment Scale (IIS). HIIS was used to estimate long-term follow-up of 1073 patients treated in the II Department of Surgery of the Jagiellonian University between 1987-2001. Correlation (p < 0.001) was proved between hand injury severity, value of HIIS, grade of persistent disability and the assessment of hands' usefulness in performing daily activities on the basis of Hand Disability Score (HDS) questionnaire described above. The HIIS can be used for general estimation of hand post-traumatic impairment.

[Therapy of consequences of ankle joint injury in patient with hypermobility--case report]. / Leczenie skutków urazu stawu skokowo-goleniowego u chorej hipermobilnoscia--opis przypadku.

The aim of the study was to estimate therapy, anatomy and biomechanics of ballet dancer feet. Physical, ultrasonographic and pedobarographic examinations were used for monitoring of the therapy. The complete efficiency of foot biomechanics was received.

[Hand injuries in adolescents]. / Obrazenia rak u dorastajacej mlodziezy.

MATERIAL AND METHODS: Based on the materials of 134 adolescent patients (age 15-19) with hand injuries treated in the II Department of Surgery of the Jagiellonian University between 1987-2000 results of treatment were described. The adolescents constituted 11.8% of all patients treated due to hand injuries. RESULTS: Home was the most common place of the accident (59 patients - 44.01%), and the most common mechanism of injury was cutting by the glass or another sharp tool (61 patients - 45.52%). The mild and moderate injuries predominated (112 patients - 83.58%). 39 patients (29.10%) were treated after alcohol abuse; unfortunately. 35 patients (26.12%) were hospitalized from 1 to 24 days (av. 7.14 days). Time to obtain complete recovery reached max. 270 days but av. 55.56 days. Various degree of the persistent limitation of the hand function were observed in 65 patients (48.5%). Two of them (1.49%) got the disability pension and 8 (5.77%) had to change former job and activities. CONCLUSION: The time of the complete cure could be shorter and the extent of persistent post-traumatic impairment of the patients with the heavy hand injuries could be limited if they would be treated in the specialized centers for hand surgery.

[Pelvic fractures coexistent with multiple trauma--own diagnostic and therapeutic algorithm]. / Zlamania miednicy skojarzone z mnogimi obrazeniami ciala--wlasny algorytm diagnostyczno leczniczy.

Pelvic fractures determine one from greatest diagnostic and therapeutic problems in complex of multiple injures. Pelvic fractures observes one-self at 20-30% patients with multiple injures of the body. These injuries are attended for prognostic factor of severity status in this to group of patients. Using at presence diagnostic and therapeutic methods appear continually insufficient. Testifies about this high mortality in these patients. Aim of study was presentation of own manner of diagnostic and therapeutic treatment at patients with pelvic fractures coexisting with multiple injuries, and confirmation of legitimacy early reposition of pelvic fracture and external stabilisation. Investigated group of patients embraced 201 ill with multiple injuries of the body attended in years 1999-2003. Pelvic fractures were recognised at 42 (20.9%) patients. Severity of injury according to Injury Severity Score carried out 54 points. Immediate closed reposition under X-ray inspection and anterior external stabilisation executed at 12 (28.5%) most heavy patients. In this group 5 (41.6%) of the patients survived. Diagnostics and treatment one passed according to settled by authors of algorithms in which one important criterium of conduct was state stability of the circulatory system. One turned also attention on necessity wider usages of angiographic investigations of pelvic blood vessels and their immobilisation. One acknowledged that conduct according to worked out algorithms arranges and makes easy process of diagnosis and treatments. One confirmed advantages early closed reposition of pelvic fractures and their external stabilisation at unstable patients, as intervention saving life.