Effect of low-magnitude, variable-frequency vibration therapy on pain threshold levels and mobility in adults with moderate knee osteoarthritis-randomized controlled trial.

BACKGROUND: Osteoarthritis (OA) is one of the most commonly recorded diseases in clinical practice. Vibration therapy has been suggested for the treatment of knee OA. The purpose of the study was to determine the impact of vibrations of variable frequency and low amplitude on pain perception and mobility in patients suffering from knee OA. METHODS: Thirty-two participants were allocated into two groups - Group 1 (oscillatory cycloidal vibrotherapy-OCV) and Group 2-control (sham therapy). The participants were diagnosed with moderate degenerative changes in the knee (grade II based on the Kellgren-Lawrence (KL) Grading Scale). Subjects received 15 sessions of vibration therapy and sham therapy respectively. Pain, range of motion, and functional disability were assessed through Visual Analog Scale (VAS), Laitinen questionnaire, goniometer (ROM - range of motion), timed up and go test (TUG) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Measurements were taken at baseline, after the last session and four weeks after the last session (follow up). T-test and U-Mann Whitney test compare baseline characteristics. The Wilcoxon and ANOVA tests compared mean VAS, Laitinen, ROM, TUG and KOOS. The significant P-value was less than 0.05. RESULTS: After 3 weeks (15 sessions) of vibration therapy, reduced the sensation of pain and improved mobility was recorded. There was a more significant improvement in the vibration therapy group than the control group in pain alleviation on VAS scale (p < 0.001), on Laitinen scale (p < 0.001), knee ROMs flexions (p < 0.001) and TUG (p < 0.001) at the last session. KOOS score with pain indicator, symptoms, activities of daily living, function in sport and recreation and knee related quality of life improved more in the vibration therapy group than the control group. Effects maintained up to 4 weeks in vibration group. No adverse events were reported. CONCLUSIONS: Our data demonstrated that the use of vibrations of variable frequency and low amplitude in patients with the knee OA is a safe and effective therapy. It is recommended to increase the number of treatments performed, primarily in patients with degeneration II° according to the KL classification. TRIAL REGISTRATION: Prospectively registered on ANZCTR ( ACTRN12619000832178 ). Registered on 11 June 2019.

Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery.

Introduction: The method to prevent progression of symptoms in tethered cord syndrome (TCS) is neurosurgery. However, postoperative wound healing is a lengthy process and is hindered by the release of cerebrospinal fluid (CSF) through the wound. To the best of the authors' knowledge, there is no study evaluating the changes in the expression of factors involved in the wound healing process after neurosurgery for TCS. Aim: To clinically analyse 2 cases of TCS and evaluate the change in expression of selected genes during the postoperative wound healing process. Material and methods: Determination of TCS in two adult patients (woman, aged 26 years; man, aged 53 years) was based on magnetic resonance imaging (MRI). After confirming the initial diagnosis, a neurosurgical procedure was performed to remove the intrathecal spreading adipoma and transect the medullary terminal thread in patients. In the postoperative period, impaired wound healing was noted as a result of CSF secretion through the surgical wound. Results: Molecularly, there was an increase in expression of all genes assessed in skin biopsy specimens compared to skin samples. Impaired postoperative wound healing after neurosurgery for TCS is expected due to CSF leakage through the surgical wound. The greatest changes were noted for metalloproteinases (MMPs) and four isoforms (A-D) of vascular endothelial growth factor A-D (VEGF-A-D; p < 0.05). Conclusions: Changes in the expression of our selected genes can be used to monitor and predict the process of wound healing and scar formation, which occurred in our cases at 19 and 20 days after surgery.

Long-term outcomes and complications associated with operative and nonoperative treatment of distal radius fractures. Do we need to restore anatomy to have satisfactory clinical outcome?

A i m: The aim of this study was to assess long-term outcomes and complications associated with conservative and operative treatment of distal radius fractures and to determine if restoration of radio- graphic parameters influences functional outcomes. I n t r o d u c t i o n: Distal radius fractures (DRFs) are common injuries associated with many complications. Numerous studies suggest that operative treatment with anatomic reduction and restoration of radiographic parameters leads to better functional outcomes than nonsurgical treatment.Materials and Methods: We enrolled 207 patients with isolated DRF (mean age 64 ± 17.9 years, women 150 (72.5%)) to our retrospective, single-center study (101 treated operatively, 106 treated non-operatively). There were no significant differences in sex, age, AO type fracture between study groups. After 3.9 ± 1.6 years (mean ± SD) clinical, functional and radiological assessment was conducted using Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), 9-Hole Peg Test (9-HPT), grip and pinch strength tools. R e s u l t s: We found higher rates of malunion in nonoperative group (p <0.0001) and worse radiologic parameters such as volar tilt (p <0.0001), teardrop angle (p <0.0001) versus operative cohort. Nevertheless radiological parameters were not correlated with DASH and PRWE results. Moreover, patients aged 50 years and above treated operatively had similar functional outcomes (DASH, PRWE) to those treated nonoperatively. C o n c l u s i o n s: Restoration of anatomic and thus radiologic parameters of radius may not be obligatory to achieve satisfactory functional outcome in patients with DRF aged 50 years or above. Patient is the most important 'factor' in determining appropriate and successful treatment method of distal radius fractures.

Radiological results and clinical complications after calcaneal articular fracture surgical treatment using minimally invasive percutaneous fixation.

The choice of method for surgical treatment of articular calcaneal fractures remains problematic due to the potential complications and difficulty in restoring loss of functional status, anatomical geometry and congruence of joint surfaces. The preferred method of surgical treatment for these injuries, among others, is still minimally invasive percutaneous fixation. The aim of this study was to evaluate the radiological results of articular calcaneal fractures surgical treatment using a minimally invasive percutaneous fixation and to determine the prevalence of complications in early and long-term observation. Radiological results of surgical treatment of 82 patients operated using minimally invasive percutaneous fixation were analyzed. The radiological results were based on Bohler angle and varus angle using criteria according to Harnroongroj and Golec. Postoperative complications were registered in a 3 months follow-up (early observation) and after 6 months (long-term observation). Patients with tongue-type fractures had significantly better surgical outcomes than patients with depression-type fractures. Displacements of bone fragments in articular calcaneal fractures visualized radiographically by the changes of Harnroongroj et al. angle do not constitute a serious surgical problem and are easily repositioned and stabilized, as opposed to displacements resulting in changes in the value of the Böhler angle. The most common postoperative complications were local inflammatory reactions at the point of entry of fixation material and thromboembolic complications. Results of surgical treatment of articular fractures of the calcaneus using a minimally invasive percutaneous fixation are good and satisfactory in majority of patients suggesting that this method constitutes proper choice of treatment.

Health-Related Quality-of-Life and Functional Outcomes in Short-Stem Versus Standard-Stem Total Hip Arthroplasty: An 18-Month Follow-Up Cohort Study.

BACKGROUND Osteoarthritis (OA) progressively produces symptoms and disability that may significantly reduce health-related quality of life (HRQoL). Total hip arthroplasty (THA) is an important treatment for symptomatic OA. An alternative to standard-stem THA for younger patients is short-stem THA. The aim of this study was to investigate potential HRQoL and functional outcome differences between these patient groups to provide additional data that will be clinically useful in the decision making between the types of prosthesis. MATERIAL AND METHODS In an 18-month follow-up longitudinal cohort study, we conducted Harris Hip Score (HHS) evaluations and SF-36 questionnaires in a study group and a control group undergoing short-stem and standard-stem THA preoperatively and during follow-up at 1, 3, 6, 12, and 18 months. Effect size was calculated to estimate the size of changes in scores during follow-up between chosen time intervals. RESULTS A total of 168 patients were included in the study. The total HHS score was significantly increased postoperatively from 46.9 to 87.0 in the standard-stem group, and from 42.7 to 85.1 in the short-stem group. All SF-36 scores improved after THA in both groups. No HRQoL or functional differences were found in the use of either surgical option in the HHS or SF-36 score results (all p>0.05). CONCLUSIONS As there were no differences in HRQoL in the two groups, we strongly recommend considering short-stem THA, especially in younger patients, due to the benefit of future revision options and a minimally invasive approach.

"Pros and cons" of total hip arthroplasty with metaphyseal Proxima endoprosthesis.

The authors present their own experience concerning total hip arthroplasty with the metaphyseal prosthesis Proxima. Proxima, a metaphyseal prosthesis, provides an innovative supplement to total hip arthroplasty. In this study, the authors present their own experience using Proxima in patients with hip osteoarthritis. This study was performed between 2008 to 2013 and comprised of 62 patients, of which 38 were male (61.3%) and 24 female (38.7%). All patients were operated on due to hip osteoarthritis using total hip arthroplasty with the metaphyseal prosthesis Proxima. The age of patients included into the study ranged from 23 years to 62 years with the mean age of 46 years. The authors paid close attention to the "pros and cons" of surgical techniques and assessed clinical and radiological results in both the short and long-term observation periods. The clinical evaluation was based on the Harris Hip Score and radiological assessment of fixation of the acetabular cup of the endoprosthesis was based on Pradhan's criteria. The endoprosthesis Proxima stem was positioned using the manufacturer's recommended method, evaluating the direction, scope and duration of the displacement in the marrow cavity of the proximal stump of the femur. According to the authors' analysis, the surgery gives good functional and radiological results both in the short- and long-term observation periods. The effectiveness depends on precise qualification for surgery, proper surgical techniques and specific anatomical conditions of the proximal femur stump. The most common reasons for primary and secondary dislocations of the metaphyseal endoprosthesis Proxima stem occur during the first three months post surgery. This is due to incorrect surgical techniques, which disregard the importance of specific anatomical conditions of the proximal femoral stump, which affects Proxima implantation, and cause deviations towards a varus or valgus orientation.

Validation of the Polish version of the EORTC QLQ-BM22 module for the assessment of health-related quality of life in patients with bone metastases.

PURPOSE: The aim of our study was to undertake a prospective validation study of the Polish version of the European Organization for Research and Treatment of Cancer (EORTC) bone metastases (QLQ-BM22) module used alongside the EORTC core measure. METHODS: The translated module was pilot-tested according to the established EORTC guidelines. Patients with histological confirmation of malignancy and bone metastases, diagnosed by imaging studies, were eligible for the study. All patients filled out the Polish version of the QLQ-BM22 module in addition to QLQ-C30 and a demographic questionnaire. Standard validity and reliability analyses were performed. RESULTS: One hundred and fifty-five patients were enrolled into the study, including 94 women (60.7 %) and 61 men (mean age ± SD; 59.1 ± 12.1). Cronbach's alpha coefficients, range 0.68-0.93, showed positive internal consistency. Re-test was undertaken with fifty patients (32.3 %). Interclass correlations for the EORTC QLQ-BM22 ranged from 0.91 to 0.93 and proved sufficient test-retest reliability. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. CONCLUSIONS: Our study provides new and robust evidence which shows that the Polish version of the QLQ-BM22 module is a valid and reliable instrument for measuring health-related quality of life in patients with bone metastases. It is suitable for use in clinical trials and in research.

Preliminary psychometric validation of the Polish version of the EORTC elderly module (QLQ-ELD14).

AIM: The aim of our study was to report preliminary validation data on the EORTC translated, Polish version of the EORTC QLQ-ELD14 questionnaire to show that this tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish elderly patients with cancer. MATERIALS AND METHODS: Patients with histological confirmation of primary cancer were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-ELD14 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardized validity and reliability analyses were performed. RESULTS: Sixty-five patients (41 females - 63.1%) were enrolled into the study, with a mean age of 76.4 ± 5.7 years. Cronbach alpha coefficients, range 0.70-0.84, showed positive internal consistency. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. Strong correlations were observed between the EORTC QLQ-ELD14 (especially mobility and burden of illness), and the EORTC QLQ-C30 (r = -0.30-(-0.83); p <0.001). CONCLUSIONS: Basing on the preliminary data from this study, the Polish version of the EORTC QLQ-ELD14 module is a reliable and valid tool for measuring HRQoL in elderly cancer patients. However further research is needed to establish the full psychometric properties of the described module, especially in regards to test-retest and responsiveness over time.

The Impacts of Intervertebral Disc Degeneration of the Spine, Alcohol Consumption, Smoking Tobacco Products, and Glycemic Disorders on the Expression Profiles of Neurotrophins-3 and -4.

In the etiology of discogenic pain, attention is paid to the role of neurotrophic factors, which include classic neurotrophins (NTs). This study aimed to assess changes in the concentrations of NT-3 and NT-4 in the intervertebral discs (IVDs) of the lumbosacral (L/S) spine depending on the advancement of degenerative changes, pain severity, habits, and comorbidities. The study group included 113 patients who underwent microdiscectomy due to degenerative IVD disease of the L/S spine. The severity of degenerative IVD changes was assessed using the five-point Pfirrmann scale, and the pain intensity was assessed according to the visual analog scale (VAS). In turn, the control group included 81 participants from whom IVDs of the L/S section of the spine were collected post-mortem during forensic autopsy or organ donation. At the mRNA level, we noted NT-3 overexpression in the test samples compared with the controls (fold change (FC) = 9.12 ± 0.56; p < 0.05), while NT-4 transcriptional activity was decreased in the test samples compared with the controls (FC = 0.33 ± 0.07; p < 0.05). However, at the protein level, the concentrations of NT-3 (134 ± 5.78 pg/mL vs. 6.78 ± 1.17 pg/mL; p < 0.05) and NT-4 (316.77 ± 8.19 pg/mL vs. 76.92 ± 4.82 pg/mL; p < 0.05) were significantly higher in the test samples compared with the control samples. Nevertheless, the concentration of both proteins did not statistically significantly change depending on the advancement of degenerative changes and the pain intensity (p > 0.05). In addition, higher levels of NT-3 and NT-4 were noted in IVD samples from patients who consumed alcohol, smoked tobacco, were overweight/obese, or had comorbid diabetes compared with patients without these risk factors (p < 0.05). Our analysis confirmed that differences in the degenerative process of IVD, energy metabolism, and lifestyle are related to changes in the concentration profiles of NT-3 and NT-4.

Evaluation of the concentration of selected elements in serum patients with intervertebral disc degeneration.

Quantitative analysis of the trace element content of human intervertebral discs (IVDs) is essential because it can identify specific enzymes or metabolites that may be related to human intervertebral disc degeneration (IVDD). The goal of this study was to assess the concentrations of copper (Cu), iron (Fe), manganese (Mn), lead (Pb), zinc (Zn), sodium (Na), magnesium (Mg), potassium (K), phosphorus (P), and calcium (Ca) in serum samples obtained from patients with IVDD in comparison to healthy volunteers (a control group). The study group consisted of 113 Caucasian patients qualified by a specialist neurosurgeon for microdiscectomy. The control group consisted of 113 healthy volunteers who met the eligibility criteria for blood donors. The examined clinical material was the serum samples obtained from both groups.Based on the quantitative analysis of selected elements, there were statistically significantly (p 0.05) higher concentrations of Cu (1180 µg/L±800 µg/L vs. 1230 µg/L±750 µg/L), Zn (790 µg/L±300 µg/L vs. 850 µg/L±200 µg/L), and Mg (21730 µg/L±4360 µg/L vs. 23820 µg/L±4990 µg/L) in the serum of healthy volunteers compared to those in the study group. In addition, statistically significant changes were not detected in the concentrations of any elements among either sex in either the study or control group or in their body mass index (BMI) values (p > 0.05). In the serum samples from the study group, the strongest relationships were noted between the concentrations of Zn and Pb (r = 0.61), Zn and P (r = 0.69), Zn and Ca (r = 0.84), Zn and Cu (r = 0.83), Mg and Ca (r = 0.74), and Ca and P (r = 0.98).It has been indicated that, above all, the concentrations of Cu, Zn, Ca, and Mg depend on the advancement of radiological changes, according to the Pfirrmann scale. However, no influence on pain intensity was found, depending on the concentration of the assessed elements.The analysis indicates that the determination of serum Cu, Zn, Ca, and Mg concentrations may have diagnostic significance in predicting the onset of lumbosacral IVDD. The predictive evaluation of changes in the concentrations of selected elements in patients with degenerative lumbar IVD lesions appears to be a promising, cost-effective strategy.

The effect of sulfur baths on hemorheological properties of blood in patients with osteoarthritis.

Balneotherapy is an effective treatment method in various diseases and commonly used treatment modality among patients with musculoskeletal disorders. Sulfur baths are known for healing properties however effect on rheological properties is unstudied. Thus the aim of our study was to determine the effect of sulfur balneotherapy on hemorheological blood indices. A total of 48 patients with osteoarthritis were enrolled to the study. Blood samples were collected twice, before and after 3-week time period. We evaluated complete blood count, fibrinogen, hs-CRP and blood rheology parameters such as elongation index (EI), half-time of total aggregation (T1/2) and aggregation index (AI) analyzed with the Lorrca Maxis. Mean age of studied cohort was 67 ± 5 years. After sulfur baths WBC count was significantly decreased is studied group (p = 0.021) as well as neutrophile count (p = 0.036). Red blood cell EIs were statistically higher after sulfur baths in shear stress ranging from 8.24 to 60.30 Pa. T1/2 was significantly higher (p = 0.031) and AI lower (p = 0.003) compared to baseline. No significant changes in fibrinogen and hs-CRP were observed. It is the first study that evaluate effect of sulfur balneotherapy on rheologic properties of blood. Sulfur water baths may improve erythrocyte deformability and aggregation parameters.

Prevalence of overweight and obesity in children aged 6-13 years-alarming increase in obesity in Cracow, Poland.

UNLABELLED: This study in children aged 6-13 years (n = 1,499) was performed between October 2008 and March 2009. Height and weight measurements were taken to calculate BMI. The prevalence of overweight and obesity was determined by means of IOTF cut-offs with respect to age. Alarming is the fact that the percentage of obese children in Cracow increased dramatically from 1.04% in boys and 0.20% in girls in 1971 to 7% in boys and 3.6% in girls in 2009. In this report, a higher percentage of overweight boys was observed in rural boys (28.14%) than in urban ones (27.31%). Obesity was identified in an almost twice as high percentage of urban boys (7.78%) as in rural ones (3.52%). A higher percentage of overweight girls was registered in rural areas (16.49%) than in urban ones (16.09%). Obesity was prevailing in rural girls (4.12%) relative to their urban counterparts (3.44%). The highest number of overweight urban boys was diagnosed in the group of 12-year-olds (n = 48) and rural boys in the group of 10-year-olds (n = 39), as well as in urban girls aged 11 (n = 17) and rural girls aged 9 (n = 9). The highest number of obesity was observed in rural boys aged 12 (n = 3) and in urban boys aged 9 and 10 (n = 9 in both groups). In the group of girls, obesity prevailed in urban 9-year-olds (n = 5) and in rural 7-year-olds (n = 5). CONCLUSIONS: Overweight and obesity affect boys almost twice as frequently as girls. Obesity is twice as frequent in urban boys as in their rural peers.

The impact of the position of the head on the functioning of the human body: a systematic review.

The head is an important element of the biokinetic chain. Under physiological conditions, it should extend along the midline of the body. Due to its location and the fact that it constitutes approx. 6% of the total body weight, many authors believe it has a significant impact on its functioning. The aim of this study was to conduct a systematic literature search and to synthesize the evidence of the impact of the head posture on the functioning of the human body. A systematic review was conducted within 3 databases: PubMed, Medline OVID, and EBSCO, using the following terms: "forward head," "posture," "position," and "neck." For the analysis, scientific articles published after 2013 were selected. A total of 16 studies matched the inclusion criteria of this systematic review. Their results have proven that the position of the head has a significant effect on the human body. Research findings show that abnormal head position changes affect muscle activity, proprioception, the pattern of breathing and neck pain. This is the first systematic review of the relationship between the head posture, and the functioning of the human body. The results of this study seem to be promising if used in therapeutic practice. Int J Occup Med Environ Health. 2020;33(5):559-68.

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.

Higher Mortality in Men Compared with Women following Distal Radius Fracture in Population Aged 50 Years or Above: Are Common Distal Radius Fracture Classifications Useful in Predicting Mortality?

INTRODUCTION: Distal radius fractures (DRF) are one of the most common fractures with growing incidence in developed countries and are a reliable predictor of another osteoporotic fracture. Data concerning DRF mortality are conflicting and vague. Usefulness of common DRF classification systems in predicting mortality is unexplored. METHODS: We identified all patients hospitalized between January 1st 2008 and May 30th 2015 with isolated distal radius fracture, aged 50 y/o or above, in a 1st level trauma center in Poland. Fractures were evaluated according to AO, Frykman, and Fernandez classifications. Mortality ratios and long-term survival analysis with Kaplan-Meier estimator and log-rank tests with univariate and multivariate Cox proportional hazards model were used. RESULTS: We enrolled 1308 consecutive patients. The average age of the entire cohort was 72.5 ± 12 years. The study group consisted of 256 men (19.6%) with mean age 66 ± 12 y/o and 1052 women (80.4%) with mean age 74 ± 12 y/o. Men were statistically younger at the time of the fracture than women (p<0.0001). After 1-year follow-up the overall study group mortality ratio was 4.5%, being 2.2-fold higher in men compared to women. In long-term survival analysis, excess men mortality remained significant. Factors associated with higher mortality at any point of the study were age (HR: 1.08, 95%CI: 1.07-1.10, p<0.000001), male sex (HR: 1.92, 95%CI: 1.34-2.77; p<0.001), AO type A (HR: 1.64 95%CI 1.19-2.25, p<0.01), and Frykman type I (HR: 2.12 95%CI: 1.36-3.29, p<0.001). CONCLUSION: Distal radius fractures are connected with premature mortality. Men have higher mortality compared with women following distal radius fracture in population aged 50 years or above. Simple extra articular fractures classified as AO type A or Frykman type I may be predictors of higher mortality in DRF cohort.

Assessing the impact of certain exercises on the spatial head posture.

OBJECTIVES: The head constitutes 6% of the total body weight, which is linked to the cervical spine and all other joints through the kinematic chain by various muscles. The forward head posture is one of the most common postural disorders and seems to be especially dangerous. The goal of the work was to assess the impact of 4 weeks of training neck and nape muscles on the head posture. MATERIAL AND METHODS: The subjects were 20 participants, who performed neck exercises for 20 days. The head posture in a sagittal and frontal plane was assessed photogrammetrically twice: before and after the exercises. The following have been used for the assessment: craniovertebral (CV) angle, head tilt angle (HT), and frontal head tilt angle (FHT). RESULTS: After a 20-day program of neck and nape exercises the values of specific angles were compared. The results indicated significant changes in the head posture. In the sagittal plane: the average value of the CV angle before the training was 47.17°, and 50.82° after the training; the average value of the HT angle before the exercises was at 20.99°, and 24.31° after. In the frontal plane the average value of the FHT angle before the exercises was at 2.71°, and after 20 days of training the average value of this angle decreased to 2°. CONCLUSIONS: The results demonstrate that a short, home-based targeted exercise program can improve head posture. Int J Occup Med Environ Health. 2019;32(1):43-51.

[The results of the treatment of tibia shaft fractures in relation to the method of intramedullary nailing]. / Wyniki leczenia zlaman trzonu kosci piszczelowej w zaleznosci od metody sródszpikowego zespolenia.

The paper presents the results of treatment of tibial shaft fracture related to the method of intramedullary union with or without reaming of the marrow cavity. The clinical material was obtained from the traumatic-orthopaedic surgery department and rehabilitation department of the County Hospital in Dabrowa Tarnowska. A group of 128 patients treated with intramedullary blocking stabilization was evaluated. The clinical, radiological and functional indicators were assessed. The results of the study showed that the method of surgical union of tibial shaft fracture with the reaming of the marrow cavity was more favourable with regard to the assessed clinical and radiological parameters, complications concerning synostosis, infections and deviations of the long axis. The functional results were dependent, to a large degree, on the patients' age, and to some degree on the adopted operational technique.

[Comparative analysis of distribution on the sole surface of arched feet and flat feet]. / Analiza porównawcza dystrybucji nacisków na powierzchni podeszwowej stóp prawidlowo wysklepionych, oraz stóp plaskich.

The authors of this paper have carried out a hypothetical assessment of the difference in the distribution of pressure on the surface of the sole of correctly arched feet, and also of flat feet. They aimed to find out if there are significant differences in the spread of the pressure, and also at which levels of incidence they are highest. The authors carried out the research based on clinical material comprising 133 subjects (266 feet), including 75 females (56.4%) and 58 males (43.6%). The age of the subjects ranged from 10 to 83 years old, with the average age being 41.8 years old. The subjects were divided into three age groups. There were 22 subjects (16.5%) in the first group, aged from 10 to 20 years of age, 37 subjects (27.8%) aged 21 to 40 in the second group, and 74 subjects (55.6%), aged over 40 in the third group. All those included in the research underwent graphic contour testing in accordance with the Clarke method, and pedobarographic testing based on PEL 38. Results obtained suggest that the graphic contour testing is an important element of flat foot diagnosis, and that increased levels of pressure on the soles of flat feet are concentrated in the middle of the foot and below the first bone in the centre of the foot.

[Femur periprosthetic fracture complicating revision hip arthroplasty-outcomes of treatment and rehabilitation]. / Alloplastyki rewizyjne stawu biodrowego powiklane zlamaniami kosci udowej--wyniki leczenia i rehabilitacji.

Authors have done evaluation of treatment outcomes of femur periprosthetic fractures complicating cemented revision hip arthroplasty. It was done based on clinical material aged from 1996 to 2006. 16 patients with femur intraoperative peri-prosthetic fractures complicating cemented revision hip arthroplasty were included to the study. 5 male (31.25%) and 11 females (68.75%) were included in this group. Type of femur periprosthetic fracture was established according to Vancouver classification. Follow up evaluation was done 12 months after revision operation according to modified criterions announced by Golec and all. Authors obtained very good and good results in type B2, B3 and C fracture, but bad results in type B2 fracture. They pointed simultaneously on importance of use crumbled auto or allogenic bone grafts to perform revision operation.

[Long-term functional outcomes of periprosthetic ossification post-total primary and revision hip arthroplasty]. / Skostnienia okoloprotezowe, a odlegle wyniki czynnosciowe alloplastyki pierwotnej i rewizyjnej stawu biodrowego.

Authors present long-term functional outcomes of acquired peri-prosthetic ossifications complicating primary and revision hip arthroplasty. Aim of the paper was realized based on clinical material of 1995-2005, 142 patients was included to the study, 64 (45.1%) men and 78 (54.9%) women aged between 44-75 years (average 62 years) with periprosthetic ossifications after primary and revision hip arthroplasty done through the posterolateral surgical approach. Observation period was between 1-6 years (average 3 years). Study group of 142 patients made up 67.3% of all periprosthetic ossification diagnosed in during the analyzed period. Pharmacological and radiological pre and postoperative prophylaxis of periprosthetic ossifications was not done in this group. Clinical material was divided into three age groups and according to type of implants creating the study group. Diagnosed ossifications were classified according to Brooker classes. Evaluation of obtained outcomes was done basing on Harris criterions and compared to outcomes obtained in control group, which was separated from existeding Clinic data base. Control group made up 142 patients without periprosthetic ossifications, 64 (45.1%) men and 78 (54.9%) women aged between 37-78 years (average 66 years), observation period between 1-3 years (average 2 years).