The influence of gender and sport on popliteal angle and dorsiflexion in junior high school students.

BACKGROUND: The aim of the study was to assess factors affecting the popliteal angle and foot dorsiflexion, in particular gender. The subjects were 142 students from the 2nd and 3rd year of Poznan junior high schools. METHODS: The participants included 57 girls and 87 boys. Three raters examined each subject: a specialist in orthopaedics, a resident doctor and a physical therapy student. Foot dorsal flexion was tested in a supine position with lower limbs extended. Next, dorsal flexion was evaluated with the knee and hip in 90 degrees of flexion. Finally, a passive knee extension (PKE) test was carried out. The significance of the PKE test is that the lower the angle the more flexible the hamstrings. This is because the PKE measurement is the distance to the right angle, that is a full knee extension with the hip flexed. RESULTS: The non-parametric test (Mann-Whitney) and the Student's t-test showed differences between the female and male gender in the measurements of the popliteal angle (p < .05000). The correlation was negative, which means that the hamstrings are more flexible in girls. No differences were found between gender and passive foot dorsiflexion and dorsiflexion with a flexed hip and knee. No differences were found between the group with the extended PE curriculum and the group with the standard number of PE classes in the range of motion of foot dorsiflexion and the value of the popliteal angle. CONCLUSIONS: Girls between 13 and 15 years old have a significantly larger hamstring flexibility, which is confirmed by the tests of the popliteal angle. No differences were found in dorsiflexion between girls and boys who have not been trained using a training model.

Flexibility does not affect the dorsiflexion of foot and the popliteal angle in young adults.

BACKGROUND: The aim of the study was to assess how flexibility affects the dorsiflexion of foot and the popliteal angle test results in junior high school students. METHODS: The subjects were 142 students from the 2nd, and 3rd year of Poznan junior high schools (age between 13 and 15). Each subject was examined 6 times: there were 3 raters, a specialist in orthopaedics, a resident doctor and a physical therapy student, and each of them performed 2 measurements. Flexibility was also measured using the Beighton scale (score from 0 to 9). RESULTS: Since the Beighton scale is ordinal in order to evaluate the relationship between flexibility and the range of motion Spearman's rank correlation coefficient was calculated. The statistical analysis showed no correlation between flexibility measured on the Beighton scale and the range of passive foot dorsiflexion and the popliteal angle. CONCLUSIONS: The degree of flexibility does not affect the dorsiflexion of the foot and the popliteal angle in junior high students. At this age the range of dorsiflexion is determined by the length of the triceps surae muscle while the popliteal angle depends on the length of the muscles on the back of the thigh.

Józef Brudzinski (1874-1917).

Józef Brudzinski's (1874-1917) contribution to the field of neurology is noteworthy and undeniable. His organizational efforts and research activity have earned him the name of the "father of the Polish paediatrics". He described the Brudzinski reflex and Brudzinski neck sign. He proved that the symptoms of these conditions were caused by nerve root irritation and elevated CSF pressure. He also described cheek phenomenon and symphyseal sign.

Joint preserving surgery versus arthrodesis in operative treatment of patients with neuromuscular polyneuropathy: questionnaire assessment.

The purpose of the paper was to present the results of surgical treatment of foot deformities in peripheral neuropathies using bone procedures: both joint preserving and with joint arthrodesis. The study included 26 patients, 14 males and 12 females (43 feet). The age of the patients at surgery ranged from 5 to 55 years (average 23 years). The follow-up ranged from 0.5 to 15 years (average 4.3 years). Seventeen patients presented Charcot-Marie-Tooth disease, three Friedreich's ataxia and six peripheral motor and sensory neuropathies of undetermined nature. Sixteen patients had bilateral procedures. Four patients had to be re-operated during the follow-up. The patients were divided into four groups depending on the age and the surgical technique applied. The groups I and II (9 children, 17 feet) included patients with growth plate still present in the foot just before surgery. In the groups III and IV (17 adults, 26 feet), bone growth was completed. The assessment of all patients based on a modified AOFAS scale ranged from 44 to 105 points (mean 83.7; SD 17.5). The assessment on the subjective scale ranged from 3 to 10 points (mean 7.4; SD 2.1). The assessment of quality of life on the WOMAC scale ranged from 0 to 41 points (mean 15.7; SD 13.2). All patients stated that they would decide to undergo the treatment again. For groups I and II, joint preserving surgeries gave better results; however, the results could not be statistically confirmed. The results for the groups III and IV were inconclusive as to which surgical techniques should be preferred, arthrodesis or joint preserving. The results show that none of the surgical techniques used for correction of foot deformities in motor-sensory polyneuropathies seems to be preferable.

Evaluation of PHASES Score for Predicting Rupture of Intracranial Aneurysms: Significance of Aneurysm Size.

BACKGROUND: Recent data have identified that certain risk factors for rupture differ between small and larger intracranial aneurysms (IAs). Such differing risk factors make up 5 out of the 6 predictor variables used in the PHASES score, which raises the question on whether IA size has a significant effect on the score's performance. METHODS: Patients who were diagnosed with an IA incidentally or due to a subarachnoid hemorrhage between 2015 and 2023 were selected for potential inclusion. The median IA size of the cohort was chosen as the cutoff point to categorize small and large (6 mm). The PHASES score was calculated for all patients, and a receiver operating characteristic curve analysis was performed to evaluate the classification accuracy of PHASES in predicting rupture for small and large IAs. RESULTS: A total of 677 IAs were included. Among the IAs, 400 (58.9%) presented as UIAs and 279 (41.0%) as subarachnoid hemorrhage. The average PHASES score was 2.9 and 6.5 for small (n = 322) and large (n = 355) IAs, respectively. The PHASES score performed significantly lower for predicting rupture in smaller IAs (area under the curve: 0.634) compared with the larger (area under the curve: 0.741) (P = 0.00083). CONCLUSIONS: PHASES was shown to underperform on small IAs. The decision to treat small unruptured IAs remains highly controversial, and the development of a new score to estimate the annual rupture rate while accounting for IA morphology is of great need. Our findings can help encourage future researchers to develop such a score.

Impact of athletic activity on the stability of the lower limb joint prosthesis.

This publication analyses the impact of athletic activity on the stability of lower leg implant. Analysis of literature does not allow for a clear answer whether such activity is an independent predictor of early loosening. Number of publications warning patients against excessive sports activities, equals the number of reassuring reports.

Patient-related outcome questionnaires in the assessment of the results of total hip replacement.

A variety of patient-related outcome questionnaires have been used for the assessment of results of total hip replacement. Generic core scales (SF-12, SF-36) and disease-specific scales like: Harris Hip Score, Western Ontario and McMaster University Osteoarthritis Index, Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, American Academy of Orthopedic Surgeons hip and knee Questionnaire, Lower Extremity Functional Scale are used most frequently. Even though all of them were assessed in terms of construct and content validity, reproducibility and sensitivity, there are still some problems related to bias when total hip replacement evaluation is performed in the presence of comorbidities, contralateral hip disease and ceiling effect influencing the final score. As a result, there is a need for development of a new PRO questionnaire in order to improve total hip replacement assessment, enable early detection of postoperative complications or to evaluate the results of surgery in both hips separately. It is crucial that such measuring device has to be deprived of the influence of irrelevant factors on the final score.

Influence of age on the outcome of rehabilitation after total hip replacement.

BACKGROUND: This publication compares the results of physiotherapy after total hip replacement in two groups, each consisting of 50 subjects, differing in age by 10 years. MATERIAL AND METHODS: A group of 100 patients after total hip replacement was divided into two subgroups consisting of 50 subjects each, with mean age difference of 10 years. The first group included patients aged 47-60 years, the other 61-69 years. Patients were assessed at 6 weeks and reevaluated at 10 weeks after surgery during a 4-week in-hospital rehabilitation program. The study was based on a questionnaire, physical examination, 6-minute walking test and a test on stabilometric platform. RESULTS: In the younger group we observed easier and faster resolution of pain in the operated joint. In group II, which included patients aged 61 to 69 years, improvement in hip joint mobility was less pronounced than in the younger group. Six-minute walking test showed less improvement in walking distance in group II than group I. Among group II patients we noted less pronounced increase in weight bearing on the operated limb (by 2%, while 4% improvement was noted in group I), while final degree of weight-bearing was greater in group II than in group I and amounted to 48%. CONCLUSIONS: Younger patients recover faster, hip pain subsides easier, hip function returns more readily and to a greater extent. During a 4-week course of in-hospital rehabilitation older patients may regain hip function in a manner that brings them closer to the younger group.

The agreement and repeatability of measurements of ankle joint dorsiflexion and poplietal angle in healthy adolescents.

BACKGROUND: The intra-rater repeatability and inter-rater agreement of orthopaedics measurements are important for estimating injury risk and appropriate treatment. In clinical practice, it is often unavoidable to trust the measurements of other health professionals. METHODS: This study tested the agreement and repeatability of measurements of the dorsiflexion of the foot, dorsiflexion with 90-degrees knee flexion, and popliteal angle test in healthy adolescents performed twice by three raters differing in clinical experience. Three raters, i.e., an orthopaedics specialist (16 years of experience), a resident medical doctor in orthopaedics (4 years of experience), and a physiotherapy student (1 year of experience) measured the ankle joint dorsiflexion and the popliteal angle in 142 healthy adolescent subjects. RESULTS: The student outperformed more experienced raters by displaying good repeatability for all the evaluated parameters. The orthopaedics specialist failed to replicate the measurements of the left ankle joint passive dorsiflexion and the left popliteal angle. The medical resident in orthopaedics displayed a lack of repeatability in evaluating the right ankle joint dorsiflexion with the knee joint bent. Kendall's W value for all parameters ranged 0.66-0.78, indicating a good inter-rater agreement. CONCLUSIONS: The study highlights that measurements of the ankle joint dorsiflexion and popliteal angle test by different health professionals can generally be trusted. It indicates that novice health professionals could potentially evaluate such parameters in healthy subjects without a quality loss.

Triple arthrodesis of the foot after calcaneal fractures. Twelve patients treated using K wires stabilization.

The most frequent problem following intra-articular calcaneal fracture is pain from the subtalar joint. Subtalar arthrodesis is not considered to be an optimal solution because it can lead to degenerative changes in the ankle joint. The aim of this study was to evaluate patients with such fractures treated by triple arthrodesis. The treated group consisted of 12 patients (5 female, 7 male) with no bilateral fractures. The mean age at injury was 36 years (22-54). The patients had surgery 2 years on average after injury. In all cases the arthrodesis was stabilized with Kirschner wires. The follow-up ranged from 1 to 5 years (average 2.9 ± 1.4). In 2 feet the calcaneal fracture was associated with a fracture of the talus. At clinical evaluation the Ankle-Hindfoot Scale (AOFAS) was applied. From the 100 point scale the question concerning movement in the subtalar joint was removed which made the scale range from 0 to 94 points. Postoperative scoring ranged from 19 to 92 points (mean 57.3 ± 25.1). The patients also evaluated the result of treatment on a visual analogue scale from 0 to 10 points which gave a mean score of 7.7 ± 2.2. Early results of the treatment of calcaneal fractures by triple arthrodesis show that this is valuable method for the prevention of significant foot pain.

Corrective arthrodesis to treat sequelae of compartment syndrome and ischaemic syndromes of lower leg and foot.

BACKGROUND: There is a scarcity of studies concerning the treatment of foot and talocrural deformities secondary to a compartment syndrome or ischaemia. MATERIAL AND METHODS: Five patients (4 males and 1 female) were treated by talocrural arthrodesis (1 foot) and triple tarsal arthrodesis (4 feet) due to equinovarus foot deformity secondary to compartment syndrome or ischaemia. The age at surgery ranged 28 to 50 years (mean 39 years). The deformity was a sequela to compartment syndrome due to an injury in 3 patients, popliteal artery damage in one male patient, and an embolism in the femoral artery during hip arthroplasty in one female patient. The evaluation of the results was based on the AOFAS Ankle-Hindfoot Scale functional scoring system and a subjective assessment of treatment outcomes according to a 10-grade scale (from 0 [worst] to 10 [best], no visualization). RESULTS: A complete correction of the deformity was achieved in 4 patients. A superficial infection and a prolonged healing process of the post-operative wound after the surgery occurred only in one (female) patient. The same patient had a slight persistent varus deformity in the rigid talocrural joint. The mean post-operative AOFAS score was 66.4 (35-86) and 8.4 (5-10) in the subjective scale. CONCLUSIONS: Corrective arthrodesis is an effective method of correction of foot deformities secondary to compartment syndrome and ischaemic syndromes. No significant post-operative complications were noted.

Radiographic evaluation of the results of total hip arthroplasty with the cementless Zweymüller endoprosthesis.

BACKGROUND: Cementless endoprostheses include the Zweymüller endoprosthesis. Extensive clinical and radiological investigations were carried out in the Department of Orthopaedics and Traumatology of the University of Medical Sciences in Poznan in 180 patients who had received this endoprosthesis between 1995 and 2004. MATERIAL AND METHODS: The study group was composed of 180 patients (252 hips), out of whom 138 patients (193 hips) had been operated on due to primary (idiopathic) degenerative changes and 42 patients (59 hips) had needed treatment on account of degenerative changes secondary to developmental hip dysplasia and hip joint dislocation. The mean duration of post-operative follow-up was 6 years in patients with primary degenerative changes and 7 years in patients with secondary degenerative changes. The patients were also divided into two groups according to the length of post-operative follow-up. The first group, evaluated after a follow-up of more than 10 years, was composed of 31 hips, whereas the second group, with a follow-up of up to 10 years after the surgery, comprised of 221 hips. We evaluated anteroposterior hip joint radiographs taken before the surgery, during the follow-up and at the final examination and, additionally, axial hip radiographs taken on the first post-operative day and lateral radiographs of the femur and the hip joint taken at the final examination. The radiographic evaluation was carried out according to the recommendations of the Hip Society. RESULTS: There was no radiographic evidence of implant loosening among the 180 patients. In the group of post-dysplastic hips, the inclination angle of the acetabular component was 29-52 ° (mean: 40.2 °) and the acetabular opening angle was 0-21 ° (mean: 7.9 °). The stem was valgus-oriented in 9 hips, varus-oriented in 11 hips and neutral-oriented in 39 hips. In the group of patients with primary degenerative changes the inclination angle of the acetabular component was 29-65 ° (mean: 42.5 °) and the opening angle was 0-32 ° (mean: 8.9 °). The stem was valgus-oriented in 12 cases (6.3 %), varus-oriented in 43 cases (22.6%) and neutral-oriented in 138 cases (71%).There were no statistically significant differences between the group of patients treated due to idiopathic degenerative changes and those treated on account of post-dysplastic patients as well as between the groups divided according to the length of the follow-up as regards the position, the inclination and opening angle of the acetabular component, and the position of the stem. CONCLUSIONS: The Zweymüller Alloclassic endoprosthesis provides good stability of the acetabular component and the stem in the treatment of both primary and post-dysplastic degenerative changes. The Zweymüller stem provides good conditions for the integration of bone surface with the endoprosthesis, while the acetabular component facilitates the remodelling of the bone surrounding the implant.

Short-term results of total hip replacement in patients under thirty years of age.

BACKGROUND: Total hip replacement is a commonly accepted treatment for disorders of the hip. The paper reviews the clinical and radiological outcomes of total hip arthroplasties performed in young patients. MATERIAL AND METHODS: Twenty-eight total hip arthroplasties were performed in twenty-one young patients between 1996 and 2005. The mean age of the patient at the time of the operation was 25.8 years (range 17 to 30 years). The mean follow-up was 6 years (range 3 to 12 years). RESULTS: The average preoperative Harris score for this group of patients was 35.82 (range 11.75 to 51.45). After 6 years of follow-up all hips were rated excellent, with an average Harris score of 99.13 (range 95.6 to 100). Radiographs revealed that the acetabular and femoral components were correctly positioned in all patients. CONCLUSIONS: 1. Total hip arthroplasty is an effective treatment in young patients who suffer from bilateral hip disease. 2. Using bone grafts around the acetabulum and inside the femoral canal is recommended especially in post-dysplastic hips and in rheumatoid patients.

Jan Evangelista Purkynje (1787-1869): first to describe fingerprints.

Fingerprints have been used for years as the accepted tool in criminology and for identification. The first system of classification of fingerprints was introduced by Jan Evangelista Purkynje (1787-1869), a Czech physiologist, in 1823. He divided the papillary lines into nine types, based on their geometric arrangement. This work, however, was not recognized internationally for many years. In 1858, Sir William Herschel (1833-1917) registered fingerprints for those signing documents at the Indian magistrate's office in Jungipoor. Henry Faulds (1843-1930) in 1880 proposed using ink for fingerprint determination and people identification, and Francis Galton (1822-1911) collected 8000 fingerprints and developed their classification based on the spirals, loops, and arches. In 1892, Juan Vucetich (1858-1925) created his own fingerprint identification system and proved that a woman was responsible for killing two of her sons. In 1896, a London police officer Edward Henry (1850-1931) expanded on earlier systems of classification and used papillary lines to identify criminals; it was his system that was adopted by the forensic world. The work of Jan Evangelista Purkynje (1787-1869) (Figure 1), who in 1823 was the first to describe in detail fingerprints, is almost forgotten. He also established their classification. The year 2013 marked the 190th anniversary of the publication of his work on this topic. Our contribution is an attempt to introduce the reader to this scientist and his discoveries in the field of fingerprint identification.

Robert Koch (1843-1910) and dermatology on his 171st birthday.

Robert Koch (1843-1910) received the Nobel Prize in Medicine in 1905 for his studies of tuberculosis. He contributed significantly to microbiology, isolating also cholera and anthrax pathogens, and introducing several postulates in this field. In addition, he developed staining methods, as well as culturing and microscopic techniques. Many of his achievements have also influenced dermatology. This contribution reviews his life and major achievements on the occasion of the 171st anniversary of his birth.

Maria Goeppert-Mayer (1906­1972): two-photon effect on dermatology.

Maria Goeppert-Mayer (1906­1972) created the theoretic basis for investigations using the double-photon effect. She was also involved in work on the Manhattan Project for the development of the atomic bomb. In 1963, she received the Nobel Prize in physics for her discoveries concerning nuclear shell structure. Her theoretic results on double-photon absorption are directly used today in dermatology in nonlinear microscopy, multiphoton tomography, and photodynamic therapy.