Effects of subtalar arthroereisis in children, assessed on the basis of quality-of-life questionnaires.

INTRODUCTION AND OBJECTIVE: Subtalar arthroereisis is a procedure commonly performed in children with flat feet. The procedure is performed when conservative treatment did not have the desired effect,or when the patient's abnormal symptoms are very severe and make it difficult for them to function normally in daily life. The aim of this study was to assess whether subtalar arthroereisis and physiotherapy improve the quality of life among children with flat feet. MATERIAL AND METHODS: The study comprised 79 patients (140 operated feet) diagnosed with a flat foot defect who underwent a subtalar arthroereisis procedure. A self-administered questionnaire and a shortened version of the standardised WHOQOL-BREF questionnaire were used in the research. RESULTS: The study confirmed that the patients' quality of life after surgery was high in all the areas regarding the somatic, psychological, social and environmental domains. In the group of children assessed 13-24 months after surgery. it was also found that rapid fatigue after exercise (30% ± 9%) and Achilles tendon contracture (7% ± 4%) were significantly reduced. The results of the study confirmed that subtalar arthroereisis contributes to a decreased demand for orthoses in children (9% ± 6%) and for orthopaedic footwear (11% ± 5%) than before surgery. CONCLUSIONS: The employment of subtalars arthroereisis has a positive effect on the quality of life of children with flat feet. The surgery contributes to a reduction in pain and other abnormal symptoms that are associated with flat feet. In addition, physiotherapy performed after the procedure had a positive effect on the healing process and contributed to the improvement of the children's quality of life.

Standards of perioperative management in total knee and hip arthroplasty procedures. A survey-based study. Part I: Preoperative management.

INTRODUCTION: Recent years have seen an increasing number of elective total knee (TKA) and hip arthroplasty (THA) procedures. Since a wide variety of methods and procedures are used in perioperative management, a survey-based study was carried out to identify the patterns of practice in Polish hospitals. MATERIAL AND METHODS: With the help of the LimeSurvey application, questionnaires for anaesthesio-logists and orthopaedists were prepared to gain insight into the preparation of patients for TKA and THA procedures and perioperative care. Questionnaires included both single and multiple-choice questions concerning among other things type of laboratory tests, additional examinations and consultations performed on a routine basis before elective TKA and THA procedures. RESULTS: A total of 162 medical centres took part in the study. Questionnaire responses were obtained from 93 (57%) orthopaedics teams and 112 (69%) anaesthesiology teams. A mean (standard deviation, SD) of 7.2 (3.5) laboratory tests are routinely ordered before surgery. For example, 47% of orthopaedists and 20% of anaesthesiologists order urinalysis, while 53% of orthopaedists and 26% of anaesthesiologists order a CRP test. Seventy-nine per cent of orthopaedists refer patients for at least one specialist consultation before the procedure. Dental consultation is requested by 40%, gynaecological consultation by 27%. Patient preoperative education is provided by 85% of orthopaedists and preoperative rehabilitation is prescribed by 46% of them. A total of 56% surveyed anaesthesiologists perform pre-anaesthetic evaluation upon patients' hospital admission. CONCLUSIONS: The study found that the number of examinations and specialist consultations conducted in Polish hospitals exceeded the scope of recommendations of scientific societies. Furthermore, the authors identified a need to standardise perioperative management in the form of Polish guidelines or recommendations, with the intention to improve patient safety and optimize health care expenses.

Effect of Nitrided and Nitrocarburised Austenite on Pitting and Crevice Corrosion Resistance of 316LVM Steel Implants.

Harmful lesions occur in the body around multielement stabilisers made of AISI 316 LVM (Low Vacuum Melted) steel, caused by products of pitting, fretting or crevice corrosion. Preventing the effect is possible by modifying the surface of the steel implants. Therefore, the goal of the paper is the comparison of the mechanical and physiochemical properties of plates for treating deformations of the anterior chest wall made of AISI 316 LVM steel, subjected to diffusion and sterilisation processes and exposed to Ringer's solution. The surface of the implants was subjected to electrochemical polishing, chemical passivation and, in order to modify their properties, nitrocarburised and nitrided diffusion layers were created on selected stabilisers under glow discharge conditions with the use of an active screen at a temperature of 420 °C, over 60 min. The conducted studies involved the examination of the microstructure of the formed layers, surface roughness testing, analysis of contact angles and surface free energy, examination of resistance to pitting and crevice corrosion and examination of nanohardness. On the basis of the results of the conducted studies, it was established that the most advantageous set of properties after sterilisation and exposure to Ringer's solution was displayed by implants with a formed diffusion nitrocarburised layer.

Time from admission to surgery in Polish patients with hip fractures: temporal trends in the last decade and association with duration of hospitalization and in-hospital mortality.

INTRODUCTION: Hip fracture is an important cause of morbidity and mortality among elderly patients worldwide. It poses a particular challenge for healthcare systems with limited financial and human resources. OBJECTIVES: The aim of the study was to assess factors associated with the length of hospital stay and in­hospital mortality, focusing on the time from admission to surgery. The secondary goal was to assess temporal trends in the intervals of admission to surgery between 2010 and 2011 and in 2019. PATIENTS AND METHODS: This was a cross­sectional study enrolling patients aged 65 years or older who underwent surgery for hip fracture between January 2010 and October 2011 in 12 Polish hospitals. Demographic and clinical data, dates of hospital admission and surgery as well as information about in­hospital death were gathered. We additionally searched the databases of the same 12 hospitals for patients hospitalized due to hip fracture between January and June 2019 and recorded the dates of admission and surgery. RESULTS: We included 381 patients who underwent surgery in 2010 and 2011 and 761 patients hospitalized in 2019. In a multivariable analysis, including age, sex, and diagnosis of dementia, we observed association between time from admission to surgery and higher in­hospital mortality and longer hospital stay. There was a decrease in proportion of patients undergoing surgery within 2 days from admission (52.8% vs 44.3%; P = 0.007) between 2010 to 2011 and in 2019. CONCLUSIONS: In­hospital mortality and length of hospitalization were associated with time from admission to surgery in patients undergoing surgery for hip fracture. We observed an alarming trend towards an increase in the admission-surgery interval.

Basic dissecting techniques in ultrasound-guided surgery.

Ultrasound-guided surgery is an area of minimally-invasive surgery where surgical procedures are performed with the aid of ultrasound imaging throghout the operation. This requires the operator to posses a certain degree of experience in endoscopic procedures, and to be adeptly skillfull in conducting US examinations. It is combining and finely tuning together these two elements that allows to perform efficiently an ultrasound-guided surgical procedure. Accessing an affected site correctly is of utmost importance in surgery, being oftentimes decisive in terms of the procedure's final outcome. In ultrasound-guided procedures, the operative site is accessed percutaneously, with a single point incision, yet tissues situated deeper within are dissected with dissecting techniques in a fluid evironment, typical for this area of surgery. Dissecting techniques in ultrasound-guided surgery are currently divided into basic ones which employ either a hydrodissection needle, surgical instruments, electrosurgical instruments, a thread, or a combination thereof, and advanced ones where either a balloon, a hook dissection technique, or a hybrid one is used. Hydrodissection with a needle was devised based on the rule of complementarity, and is the most frequently applied technique in ultrasound-guided surgery. The immense possibilities that go along with this modality will be of huge benefit to any surgeon, regardless of their field. Dissection with a variety of surgical instruments and electrosurgery instruments is a standard practice in all surgery areas, yet the method of imaging we employ in ultrasound-guided surgery results in certain modifications of these techniques. It is, however, learning the thread technique that facilitates a precise and oftentimes extensive dissection. This technique is successfully applied for dissecting muscle, ligament, tendon, vascular and other structures. Having mastered dissecting techniques allows to perform any minimally-invasive procedure efficiently, be they ultrasound-guided, artroscopic, or endoscopic ones. Various surgical techniques are bridged, resulting in applying the so-called hybrid ones. Their strength lies in excellent imaging results allowing to conduct a surgical procedure both in a body cavity and within a parenchymal organ.

The assessment of usefulness of the qualification card and ultrasonographic consultation.

The result of therapeutic success is always the effect of medical professionals cooperation. The creation of adequate mechanisms of cooperation of these teams demands time and appropriate examples. In the understanding of differentiated behaviors in the line patient - diagnostician - surgeon, particularly the mechanism of the cascade of errors formation, giving simple examples may help - their awareness will facilitate the formation of an adequate pattern of diagnostic-therapeutic chain. The therapeutic team formed in this way provides optimal forms of cooperation and positive result. One of the elements of the cooperation is the surgical procedure qualification card which is an example of the communication between surgeon and diagnostician. The propagation of proven examples seems to be justified by practical reasons. The introduction of the surgical procedure qualification card enabled maintaining of the preoperative and postoperative diagnoses in the range from 88.4% to 89.29%, the barrier of 90% however is still not achieved. The diagnoses discrepancy is still the most often occurring patient safety incident and our results should head towards its mineralization. In particularly complicated cases we come back to a well-known form of medical consultation, that is the form of examination and treatment establishment basing on simultaneous physical and ultrasound examination - hence the colloquial name of ultrasound consultation. The universality of medical consultation makes out of it an excellent tool, particularly in cases of significant discrepancy between physical and ultrasound examination. This is excellent form of the experience exchange and learning about mutual possibilities. We believe that the mechanisms presented will influence the improvement of patient security.

The advantages of combining sonotopogram with indication and fixation in invasive ultrasound.

The usefulness of sonotopogram, that is mapping of the operated area basing on ultrasound, is obvious and currently unquestionable. It is performed in order to improve safety level of a patient treated by means of invasive techniques. It constitutes an excellent complement of the Perioperative Control Card. At the beginning it was used in sonosurgical procedures, with time it has become an element of all surgical techniques. It undergoes multiple changes depending on the surgeon's needs. A particularly interesting phenomenon is the combination of the invasive techniques in order to facilitate the performance of medical procedures. Because of some relationship we are going to present the combination of sonotopogram with fixation and indication techniques. They are puncture techniques which are relatively rarely used in invasive ultrasound and surgical procedures. It seems that this results from the ignorance of their potential and the technique of their performance. Great simplicity makes them universal and allows to combine them freely. This simple combinations can be extended practically endlessly - similarly to domino bricks. For example, the next element of the technique combining can be the removal of an indicated and fixated element or a nailing. It is an excellent example of the complementarity rule - it should facilitate the understanding of Allin1 techniques and sonosurgery and also help in everyday practice of doctors performing invasive procedures. The use of these methods should be propagated not only in ultrasound but also in everyday medical practice in all the specialties. The presentation of the examples of particular techniques and their combination enables to bring closer their practical use.