Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients.

Background: Pulmonary embolism (PE) poses a significant challenge in diagnosis and treatment, particularly in high-risk patient populations such as those hospitalized for orthopedic reasons. This study explores the predictive and diagnostic potential of laboratory parameters in identifying PE among orthopedic patients. Objectives: The purpose of this study was to determine whether selected (inexpensive and readily available) laboratory parameters and their coefficients can be used to diagnose pulmonary embolism and whether they are applicable in predicting its occurrence. Material and methods: Selected laboratory parameters were determined twice in 276 hospitalized orthopedic patients with suspected PE: PLT, MPV, NEU, LYM, D-dimer, troponin I, age-adjusted D-dimer and their coefficients. Depending on the angio-CT results, patients were divided into groups. Selected popular laboratory coefficients were calculated and statistically analyzed. Optimal cutoff points were determined for the above laboratory tests and ROC curves were plotted. Results: D-dimer/troponin I [p = 0.008], D-dimer [p = 0.001], age-adjusted D-dimer [p = 0.007], NLR/D-dimer [p = 0.005] and PLR [p = 0.021] are statistically significant predictors of PE. D-dimer/troponin I [p < 0.001], troponin I [p = 0.005] and age-adjusted D-dimer [p = 0.001] correlated with the diagnosis of PE after the onset of clinical symptoms. Conclusions: In the context of orthopedic patients, cost-effective laboratory parameters, particularly the D-dimer/troponin I ratio and age-adjusted D-dimer, exhibit considerable potential in predicting and diagnosing PE. These findings suggest that combining readily available laboratory tests with clinical observation can offer a viable and cost-effective diagnostic alternative, especially in resource-constrained settings. Further studies with larger and diverse patient populations are recommended to validate these results.

Comparative analysis of venous thromboembolic complications in diverse groups of orthopaedic patients.

INTRODUCTION AND OBJECTIVE: Venous thromboembolism (VTE) is one of the most important and life-threatening complications in orthopaedic surgery. According to current scientific reports, there are several variables that can affect the severity of CVD, including the site of the pathology or the type of treatment implemented. The aim of the study was to analyze the risk of VTE depending on the location of the pathology, as well as to evaluate the impact of surgical treatment compared to conservative management. MATERIAL AND METHODS: Analysis of laboratory results and clinical picture of 276 patients hospitalized for orthopaedic reasons, admitted between January 2008 - December 2019, with suspected pulmonary embolism (PE). RESULTS: Among patients diagnosed with PE, the most common location of the disease was in the lower limb 59/116 (50.9%), followed by the pelvis location - 22/116 (19.0%), the spine - 19/116 (16.4%), disseminated lesions in oncological patients - 12/116 (10.3%), and a group of pathologies in the upper limb - 4/116 (3.5%). Significant statistical differences were found between the incidence of PE and the diagnosis of pathology in the lower limb and the pelvis. In the group of patients, there was no statistically significant relationship between the incidence of PE associated with surgical treatment, compared to conservative management. CONCLUSIONS: The group with the highest risk of VTE were lower limb and pelvic pathologies. The results are largely consistent with numerous reports treating the risk of CVD among orthopaedic patient populations.

Evaluation of long-term surgical treatment outcomes of thoraco-lumbar spinal fractures - follow-up period of over 10 years.

INTRODUCTION AND OBJECTIVE: Agricultural accidents often result in spinal injuries, particularly in fractures of the thoraco-lumbar spine. Surgical treatment of thoraco-lumbar fractures continues to comprise a major medical problem. The aim of this study was to assess and compare the long-term effects of surgical treatments of thoracic and lumbar spinal fractures treated with transpedicular stabilization, combined with posterior interbody spinal fusion (PLIF, also known as spondylodesis) or Daniaux reconstruction. MATERIAL AND METHODS: A retrospective analysis was conducted on 66 patients with a thoracic or lumbar spinal fracture (Th10-L3) type A in the AO classification system, operated in 2000-2005. All patients underwent a short segment transpedicular stabilization, which in 36 patients was combined with posterior interbody spinal fusion, and in 30 other patients combined with Daniaux reconstruction. Radiological assessment was performed based on X-ray imaging. A lateral X-ray image of the spine was used to measure the vertebral wedging angle of the fractured vertebrae, the height ratio of the anterior to posterior vertebral body, and the angle of segmental kyphotic deformation. Subjective long-term assessment of the patient was conducted using the Oswestry Instability Score. The results were analyzed for statistical significance. RESULTS: In both groups, similar improvements in all measured parameters were observed. Despite all patients losing some of the correction in the long-term, this loss was significantly smaller following Daniaux reconstruction. CONCLUSIONS: Spinal stabilization combined with vertebral reconstruction allows for long-term and improved treatment results for thoraco-lumbar fracture than posterior interbody spinal fusion (spondylodesis).

Dysphagia as a symptom of anterior cervical hyperostosis - Case report.

Degenerative lesions with hyperostosis on the anterior surface of cervical spine are common in clinical practice. In addition to pain being an effect of spinal dysfunction, they sometimes cause difficulties in swallowing or speaking as well as breathing disorders. A 52-year-old farmer with 4-year history of gradually intensifying dysphagia was admitted to hospital due to inability to intake a solid food, significant weight loss, and because of the appearance of a new symptom - dysphonia. Previous conservative treatment for swallow difficulties was ineffective. CT revealed a bone excrescence on the anterior surface of two cervical vertebrae which caused an oesophageal obstruction and compression of the vocal folds. Structural abnormalities of cervical spine should be considered in differential diagnosis of symptoms from the oesophagus and upper respiratory tract, especially when a first-line conservative treatment is not effective. In these cases, surgical removal of the osteophyte is an effective way of treatment.

[Results of operative treatment thoraco-lumbar fractures by posterior lumbar interbody fusion, Daniaux reconstruction or combination of both methods]. / Wyniki operacyjnego leczenia zlaman kregoslupa piersiowego i ledzwiowego tylna spondylodeza miedzytrzonowa, rekonstrukcja trzonu wedlug Daniaux oraz obiema metodami równoczesnie.

The aim of the study was to compare clinical and radiological results of treatment thoraco-lumbar spine fractures by short segment transpedicular stabilization accompanied by three techniques of reconstruction: posterior lumbar interbody fusion, vertebral body Daniaux reconstruction and combination of both methods. AO system was used to classify the fractures. Frankel's grade system was used for assessment of neurological deficit on admission and subsequently in the postoperative and follow-up period. The height of the fractured vertebral body and angle of segmental kyphotic deformation was measured on lateral X-ray pre- and post-operatively and at last follow-up. To the retrospective analysis we included 167 patients operated in the Orthopaedic and Traumatology Department, Medical University of Lublin in years 1998-2007. Posterior lumbar interbody fusion was performed in 69 patients (41%), isolated vertebral body Daniaux reconstruction in 82 patients (49%) and combination of both methods was performed in 16 patients (10%). The follow-up period has ranged from 3 to 13 years (mean 6.9 years). The most common type of the fracture was a B type (104 patients -62%), followed by type A (43 patients--26%), and type C (20--patients 12%). The neurological deficit was present in 80 patients. The postoperative neurological improvement was noticed in 37 patients (46%), whereas in 46 patients (54%) neurological status has not changed after the treatment. From 87 patients without neurological symptoms, we observed postoperatively contemporary neurological complications in 11 (12.6%) cases. The biggest correction of fractured vertebral height (mean 0.15) and correction of segmental kyphotic deformity (mean 6.3 degrees) we have noticed in the group of isolated vertebralbody Daniaux reconstruction with use of bone grafts. However in every group of patients we observed significant loss of correction during follow-up period. At the latest follow-up assessment there were no differences in vertebral body height of segmental kyphotic deformation between the analyzed groups of patients. None of analyzed methods of treatment: posterior lumbar interbody fusion, vertebral body Daniaux reconstruction or combination of these methods did not protect from recurrence of kyphotic deformity.

Comparison of bioabsorbable interference screws and posts for distal fixation in anterior cruciate ligament reconstruction.

Comparison of the results of bioabsorbable interference screws and posts for hamstring graft distal fixation in ACL reconstructions are presented. The results of 20 patients with bioabsorbable screws were compared to 22 patients with posts. The assessement was based on Lysholm-Gillquist and Marshall scores and the KT-1000 device. In the study group the points gained were 38.9 in the Lysholm-Gillquist and 12.89 in the Marshall scale. The average KT-1000 difference was 2.46 mm. In the control group the points gained were 32.93 in the Lysholm-Gillquist and 11.47 in the Marshall scale. The average KT-1000 difference was 2.5 mm. There were 14 patients in the study group with interference screw problems; in 2 the implants were removed. (1) There are no differences in outcome using bioabsorbable interference screws and posts for distal fixation of hamstring ACL grafts. (2) The lack of bioabsorbtion with poly L-lactide interference screws is frequent and causes problems.

Rehabilitation after one-stage anterior cruciate reconstruction and osteochondral grafting.

At least 10-20% of all ACL reconstructions require additional cartilage repair. The aim of this study was to compare the activity recovered by patients after one-stage open ACL reconstruction and osteochondral autologous grafting of articular cartilage lesions and after isolated open ACL reconstruction. The study group included 21 patients with chronic ACL deficiency and grade III or IV cartilage lesion according to the ICRS scale who were treated with combined ACL reconstruction and osteochondral grafting in one step. The control group included 32 patients with chronic ACL insufficiency and no chondral deficit higher than grade I on the ICRS scale who underwent isolated reconstruction of the ligament. For the assessment, the Lysholm and Gillquist (L&G) score and the functional Marshall score were used. Both groups displayed a statistically significant improvement in the L&G score and the Marshall score between the preoperative and 12-month assessments. The mean gain in L&G score over this period was 30.66+/-7.79 in the study group and 31.65+/-6.96 in the control group. The difference between the control group and the study group was not significant. The difference between 12 months and initial assessment was counted. The mean gain in Marshall score was 9.05+/-3.81 in the study group and 10.71+/-3.43 in the control group. The difference between the initial and the 12-month evaluation was statistically significant (p=0.49). Return to normal activity was slower and patient satisfaction was lower during the first year after operation in the study group than in the control group, however the overall advantage of the one-step operation outweighs the slightly inferior functional results at 12 months.

Treatment outcome after one-stage reconstruction of the anterior cruciate ligament and mosaicplasty of the articular cartilage of the knee.

Background. Chronic rotational instability of the knee after damage to the anterior cruciate ligament (ACL) fairly quickly produces undesirable secondary changes in the joint. Concomitant damage may affect the meniscus or the articular cartilage of the femoral condyle. The purpose of our study was to compare outcome in patients who had undergone one-stage surgical repair of damage to the ACL and articular cartilage. Material and methods. We studied 17 patients with associated cartilage and ligament damage. The control group consisted of 36 patients with isolated ACL damage. Joint function was assessed according to the Marshall Scale and the Lysholm and Gilquist Scale. Examinations were performed before treatment, 2 and 6 weeks post-operatively, and again 3, 6 and 12 months after surgery. Results. In the course of rehabilitation we observed a slightly slower recovery in the patients with combined damage up to 6 months after surgery. There were no statistically significant differences in rehabilitation outcome at the end of the observation period Conclusions. This treatment method has the potential to permanently remedy knee slippage and cancel its early effects. The surgical outcome in repair of damage to the patellofemoral joint, combined with centralization of the knee's extension apparatus, are comparable at 2 years to centralization of the patella alone when the normal structure of the articular cartilage has been perserved.

[Transpedicular reconstruction of vertebral body height with simultaneous interbody spondylodesis]. / Transpedikularna rekonstrukcja wysokosci zlamanych trzonów kregowych z równoczesna spondylodeza miedzytrzonowa

BACKGROUND AND PURPOSE: Surgical treatment of traumatic spinal injury should include fast and complete decompression of spinal cord and radices wits reduction of broken vertebral body, restoration of physiological spinal curvatures and spondylodesis of injured segments. Restoration of natural spinal curvatures is only possible when the height of broken vertebral body is reconstructed. MATERIAL AND METHODS: Between 1992 and 2001, 75 patients were operated on because of traumatic injuries of thoracolumbar spine in the Ortopaedic and Traumatology Department Skubiszewski Medical University of Lublin. 48 patients had broken vertebral body reduction with simultaneous filling of bone loss with autogenic bone grafts inserted through pediculum. Only in 4 cases posterior spondylodesis was carried out on arches and spinous processes. Transpedicular plasty of 44 broken vertebral bodies was connected with posterior interbody fusion with PLIF technique using graft application to interbody space. RESULTS: The operative protocol presented above allowed for the height of the anterior vertebral wall to be restored on average to 81.5% of the original height. We did not observe either fatigue breakage of the screws or screws loosening with kyphosis recurrence. We did not note serious postoperative complications, including neurological compromise. The operative procedure did not significantly change the neurological status of the patients. In 9 cases we noted neurological improvement: usually by 1 or 2 grades in Frankel's score. CONCLUSIONS: Restoration of the fractured vertebral body with bone grafts combined with posterior interbody spondylodesis effectively prevents the recurrence of the kyphotic deformation.

Posterior interbody fusion in the treatment of diseases and injuries of the thoraco-lumbar spine.

Background. The aim of our study was to evaluate the effectiveness of posterior interbody spondylodesis with autogenous bone grafts in the treatment of diseases and injuries of the thoraco-lumbar spine. Material and methods. In the period 1994-2003 122 patients were treated in the Orthopedics and Traumatology Department of the Skubiszewski Medical University of Lublin with posterior interbody fusion. The indications for surgery were spondylolisthesis in 24 patients, and injuries to the thoraco-lumbar spine in 98 patients. Results. Intraoperative injury of the spinal dura occurred in 4 patients. Graft migration to the vertebral canal with radicular pain occurred in one patient 4 weeks after surgery. Bone graft incorporation was observed in all patients. There was no breakage of instrumentation or loss of spondylolisthesis reduction. Conclusions. Posterior interbody fusion is an effective method of treatment to achieve durable stability of injured segments of the thoraco-lumbar spine.

Treatment outcome after patellar re-alignment by one-stage correction of the axis of the knee extensor and mosaicplasty of the patellofemoral joint.

Background. Patellar misalignment is often accompanied by damage to the chondral surface of the patello-femoral joint. The goal of surgical treatment is to address the primary cause by correcting the axis of knee flexion. In the Orthopedics and Traumatology Clinic in Lublin, Poland, we repair damaged cartilage and align the knee extensor in a one-stage operation. The goal of the present study is to compare the course of recovery and outcome in patients operated for recurrent patellar dislocation, in whom chondral damage in the patello-femoral joint is discovered intraoperatively. Material and methods. In a prospective experiment, 14 patients treated in our clinic from 2001 to 2003 were evaluated. The axis of the knee extensor was corrected both proximally and peripherally. Third- or fourth-degree chondral damage according to the ICRS scale was repaired by mosaicplasty. Outcome was evaluated by systematic assessment using the Marshall scale. The control group consisted of patients in whom only realignment was performed due to the absence of chondral damage. Results. Recovery was slower after combined treatment than in the control group. Two years post-operatively the functional outcomes in both groups were comparable, with no statistically significant differences. Conclusions. The treatment method described here gives reason to hope for long-term remediation of patellar misalignment, and removes the effects of earlier abnormalities. After 2 years, the functional outcome after repair to patello-femoral articular cartilage combined with patellar realignment are comparable to those achieved in patients not requiring repair of articular cartilage during patellar realignment.