An analysis of pathomorphic forms and diagnostic difficulties in tarso-metatarsal joint injuries.

Tarso-metatarsal injuries are rare but frequently missed. Due to the large variation in pathomorphic forms of these injuries, great precision is required when carrying out clinical and X-ray diagnostic procedures. The aim of the study was to describe the different forms of Lisfranc joint injuries and analyse the causes of delayed treatment. The treatment results of acute and chronic injuries were compared in 41 patients, with an average follow-up period of 16 years. Statistically significant poorer results were obtained in the group of chronic cases, based on two functional scores - the AOFAS evaluation questionnaire and the Lublin functional questionnaire. The main factor delaying the start of the proper treatment was diagnostic error during initial admission. The best results were achieved after closed reduction and percutaneous Kirschner wire fixation in acute cases.

[Long-term results comparison of simultaneous open reduction and subtalar arthrodesis with the efficacy of closed reduction in the treatment of fresh fractures of calcaneus]. / Porównanie odleglych wyników repozycji swiezych zlaman kosci pietowych polhczonych z równoczesna artrodeza skokowo-pietowa ze skutecznoscia zamknietej repozycji.

AIM: The aim of the study was the retrospective comparison of results of treatment of fresh fractures of calcaneus with open reduction and simultaneous subtalar arthrodesis performed at Orthopaedic and Traumatology Department in Lublin with closed reduction according to Westhues in Traumatology and Orthopaedic Department in Krosno. MATERIAL AND METHODS: In the years 1994-2001 in Orthopaedics and Traumatology Department in Lublin 33 patients were treated because of 35 fractures of calcaneus (2 bilateral fractures). The comparative material consists of 31 patients treated because of 38 fractures of calcaneus (7 bilateral fractures) in Traumatology and Orthopaedic Department in Krosno in the years 1994-2004. In retrospective study preoperative and postoperative Böhler's angle was measured, as wellas type of fracture was defined according to Essex-Lopresti classification. The clinical results of treatmentwas evaluated with Rowe's classification. RESULTS: Long-term evaluation was made to all of the patients treated at Orthopaedic and Traumatology Department in Lublin. The follow up is from 5 to 12 years (average 8 years). Clinical results according to Rowe's classification is from 15 to 100 points (average 84.4 pts.). 17 patients treated in Traumatology and Orthopaedic Department in Krosno with closed reduction according to Westhues were evaluated. The follow up is from 2 to 12 years (average 7 years) with the average 52.35 pts in Rowe's classification. The lack of healing of subtalar arthrodesis was observed in one patient, meanwhile osteoarthritis of subtalar joint was observed at 14 patients after closed reduction according to Westhues. CONCLUSIONS: Closed reduction according to Westhues gives possibility for Böhler's angle restoration, but it does not create the chance for anatomical reduction of articular surface. The considerable percentage of patients suffering pain after Westhues's method testifies about incomplete reduction of articular surface. Open reduction of fracture of calcaneus, combined with simultaneous subtalar arthrodesis restores the correct Böhler's angle and prevents from pain during walking.

[Intramedullary interlocking of humeral fractures and nonunions with Seidel nail]. / Sródszpikowe zespolenia zlaman i stawów rzekomych kosci ramiennych ryglowanymi pretami Seidela.

The advantages and disadvantages of interlocking Seidel's nails determined by their construction and the way of insertion were presented on the basis of own experience and literature. The advantages are strength and shape of the nails which are conductive to fragments stability and make insertion into humerus medullar canal easier. The tools set for insertion and locking of distal part. It doesn't truly protect from torsion displacements. Locking takes place by draw for a few weeks by external immobilization. The Seidel's nail has also disadvantages associated with proximal insertion. Unavoidable injury of supraspinatus tendon insertion can be the reason of loss of shoulder function. The antegrade fixation can cause pushing distal fragment downward by tip of the nail. It is necessary to control it's insertion under image intensifier. Presented disadvantages of Seidel's nail fixation didn't result in any problems in humerus fractures or pseudoarthroses healing. In one case it was necessary to perform additional decortication and space of fracture fulfillment with bone grafts.

Causes and effects of delayed treatment of spine deformation in children and youth.

Background. Delays and negligence in the treatment of spinal deformations have both objective and subjective causes and often occur simultaneously. The aim of our study was to evaluate and analyze the pathomorphological features of spine deformation in young patients following the program suggested by Karski, especially flexion-rotations exercises. Material and methods. We analyzed 36 post-surgical patients who performed flexion-rotation exercises for varying lengths of time. In additional to information regarding the course and manner of treatment with flexion-rotation exercises obtained from anamnesis, clinical and X-ray examinations were carried out. Results. Upon analysis of the progress of treatment with flexion-rotation exercises, correction of deformityof presumed abduction contracture of the right hip, and forced positions, we observed exceptionally rapid progression of scoliosis. Conclusions. Flexion-rotation exercises do not reduce the extent of spinal deformities, and may even accelerate the process of scoliosis. Unexpectedly rapid progress of sciolosis was confirmed in 3 patients treated by this method using complete radiological examination. Prolonging flexion-rotation exercises in progressive scoliosis is harmful, since it contributes to postponing the proper surgical treatment and reduces its effectiveness by giving the changes a permanent character.

Deceptive low back pain and pseudoradicular signs in avascular necrosis of the femoral head.

Background. Deceptive low back and buttock pain, especially at night, is often the main subjective symptom in necrosis of the femoral head. During this period, limitations of the final phase of the range of hip movement (especially inward rotation and abduction) constitute an objective symptom. Careful examination of both hip joints typically reveals asymmetry in the range of movement. Scintigraphy is decisive for the diagnosis. The real source of the pain is in the hip, but their common location in the lumbosacral area and the buttocks often leads to mistaken diagnosis. Material and methods. In the Orthopedics, Traumatology and Rehabilitation Clinic in Lublin 86 patients (41 women, 45 men), ranging in age from 19 to 69 years (mean age 42) were treated for necrosis of the femoral head (116 hips). Disturbances of blood supply to both femoral heads were found in 30 cases. Results. Ineffective treatment of 18 patients (20.9%) by neurologists and neurosurgeons, who performed unnecessary discectomies in 4 patients, delayed diagnosis of necrosis in 26 femoral heads (22%). The errors were discovered only in the third or fourth phases of the disease, when the only effective remaining treatment is hip arthroplasty. Conclusions. In patients with low back and buttock pain, examination of the range of hip movement is indispensable. If even a slight limitation of the range of movement is detection, hip x-rays should be made in two projections. If there is suspicion of early radionegative disturbances of the blood supply to the femoral head, scintigraphy is decisive.

Orthopedics in the greater lublin area, 1954-2004.

This article presents the history of the Orthopedics and Traumatology Clinic in the Greater Lublin Area in the fifty-year period from 1954 to 2004. The creation and development of comprehensive diagnostic and therapeutical centers for patients with musculo-skeletal disorder is described, as well as the development of the Clinic's scientific activity.

[Treatment methods for complications of forearm diaphyses fractures, first stabilized with plates]. / Leczenie niepowodzen i powiklan zrostu zlaman trzonów kosci przedramienia zespolonych plykami metalowymi.

A short series 8 patients with complications and failures of forearm shafts fractures treated with screws and plates was analysed. There were 2 pseudoarthroses of ulna, delayed union of radial shafts in 4 cases in which 2 had plates loosening. The additional 2 patients had the refractures of radius shortly after metal removal. The intraoperative investigation presented that main cause of delayed unions and pseudoarthroses was insufficient blood supply to the bony ends due to circulation destruction during plates implantation. All 8 patients had finally obtained union after second stage procedure. It was consisted of plates and screws removal, refreshing of fragments ends, cancerous auto grafts implantation and plaster cast immobilization. Intramedullary stabilization with Rush pins was performed in 6 patients. The additional 2 had such wide bone destruction after primary plates stabilization that intramedullary fixation was risky.

[Repair of focal chondral lesions of femoral condyles treated with osteochondral autografts]. / Naprawy ogniskowych uszkodzen chrzastki stawowej klykci kosci udowych autogennymi przeszczepami chrzestno-kostnymi.

A series of 15 patients with focal chondral lesions of the femoral condyles were treated at the Orthopaedics Department of the University of Medical Sciences of Lublin between 1998-2000. The patients' age varied from 20 to 72 years and the follow-up period from 6 months to 2.5 years. Osteochondritis dissecans was observed in 9 patients. Articular cartilage defects associated with chronic ligament instability was noted in 5 cases and 1 patient suffered from a chondral fracture of the lateral femoral condyle during a traumatic luxation of the patella. The depth of the lesions was graded according to ICRS scale. Grade IV was found in 11 cases and the remaining 4 cases had grade III lesions. The defects were treated with osteochondral autografts using OATS instrumentation set. Results were prospectively evaluated according to the HSS score. The preoperative value of HSS score ranged from 28 to 51 points (average 40.3). During follow-up the score values ranged from 76 to 91 points (average 84.7 points). All patients regained full range of motion in the knee, although in one case arthroscopic release of intraarticular adhesions was performed 6 months after chondroplasty. The lowest HSS values at follow-up were found in elderly patients with concomitant mild degenerative changes in the lateral knee compartment and in the patello-femoral joint. All patients had MRI examination early post-op, then after 6, 12 and 24 months from the procedure. MRI confirmed proper structure of the grafted cartilage but bony parts of the graft did not integrate with the surroundings.