An atypical surgical solution in a hangman's fracture: case report.

Anyone who is familiar with the pathomechanism of hangman's fractures will surely think twice before considering this type of injury to be relatively safe, on the grounds that a fracture of the C2 arches creates the conditions for decompressing the spinal cord, while the fact that the entire posterior complex is maintaining the ligament connection means that the fracture is relatively stable. Doe to the complexity of the pathomechanism involved in fractures, it is difficult to set the displacement non-surgically, and it may be dangerous to do so in the event of uncontrolled spine distraction. This article describes the surgical solution used to treat patient with a hangman's fracture using the anterior and posterior approaches simultaneously. The surgical procedure described here made it possible to decompress the spinal cord, perform a solid fixation, mobilize the patient quickly after surgery, and initiate effective rehabilitation.

[Sequelae of traumatic injury to the cervical spine treated conservatively]. / Nastepstwa urazowego uszkodzenia kregoslupa szyjnego leczonego zachowawczo.

A series of 37 patients with traumatic cervical spine injury has been examined 2 years after the accident on the average. Clinical assessment was followed by taking stress radiographs in functional positions. Redislocations, axial deformities and instability at the site of the injury have been found in 21 patients. Instability was caused by scarification and destruction of the injured disc. Secondary displacements occurred after vertebral dislocation or subluxation and axial deformities usually after crush fracture. Instability due to the ligamentous injury within rear column of the spine and partial disc injury was most frequently observed in young patients with general joint laxity.

[Failure of functional treatment for humerus fracture in adults]. / Niepowodzenia w leczeniu czynnosciowym zlamania kosci ramiennej u doroslych.

Results of functional hanging cast treatment for humeral fracture in 48 patients have been presented. Mean follow-up was 4 years. Good results were achieved in 35 cases, fair in 10 and poor in 3 cases. The study confirmed, that the method leads to the fast fracture union and restoring function of the extremity. The failures were caused by insufficient patient's alertness. They also may occur in alcoholics and patients with generalized joint laxity if excessive distraction of fragments takes place.

[Use of bone cements with added methotrexate for stabilization of pathologic fractures and filling of long bone defects in cases of neoplasm metastasis]. / Zastosowanie cementu kostnego z dodatkiem metotrexatu do stabilizacji zlaman patologicznych i wypelnienia ubytków kosci dlugich w przypadku przerzutów nowotworowych.

Preliminary results of surgical treatment in 24 patients with pathologic fractures or metastatic long bone defects impending fracture are presented. Fourteen females and 10 males aged 36-72 years with femoral (18 cases), tibial (4 cases) or humeral (2 cases) involvement were followed-up for 6-48 months. In 12 patients the pain ceased or decreased, 3 patients occasionally required non narcotic analgesics, in 9 cases the pain continued. All patients with lower extremity involvement were able to ambulate with an aid of walking sticks, 2 patients with humeral fracture resumed activities of daily living. Nine patients with multiple metastases to the lungs and spine died on average 15 months after surgery. The longest survival rate was found in patients with kidney cancer-19 months, ovary cancer-17 months and breast cancer 15 months. No postoperative complications were found. In 2 patients fracture fixation lost their stability after 8 and 10 weeks due to excessive weight bearing.

[Treatment of compression fractures of the spine by repositioning and immobilization in hyperextensive plaster casts]. / Leczenie kompresyjnych zlaman kregoslupa nastawieniem i unieruchomieniem w hiperekstenzyjnym opatrunku gipsowym.

The treatment results of 57 patients were evaluated clinically and radiologically according to Daniaux. A comparison of the X-ray pictures taken immediately after injury and after reposition of displacement with those after removal of a plaster cast and at a follow-up examination revealed in all the patients improvement of various degree of the wedge-shaped deformation after reposition and application of a plaster cast. Loss of correction after removal of a plaster cast was found in 11 patients, mainly with the wedge shaped deformation and lowering also of the posterior part of the vertebral body. On final follow-up examination, loss of correction was found in further 12 patients. They were mainly patients aged over 50 years, most of them women, and patients with primary vertebral body deformation of over 1/3 of the height. The best results were obtained in young persons with the wedge-shaped deformation of the vertebral body of less than 1/3 of the original vertebral body height.

[Pathomechanisms of injuries of the spinal cord and spinal nerve roots in trauma of the thoracic and lumbar segments of the spine]. / Patomechanizmy uszkodzenia rdzenia i korzeni nerwowych w urazach czesci piersiowej i ledzwiowej kregoslupa.

Apart from clinical examination, X-ray pictures after administration of contrastive medium to the subarachnoid space and axial computerized tomography were performed in 95 patients with traumatic damage of the spinal cord and the nervous roots. It was found that spinal cord lesion in 46.3 per cent of the patients was caused by the injury acting according to the shearing mechanism with the components of the torsional forces leading to dislocation of the vertebra. As a consequence of the crushing mechanism in the injuries of all three spinal columns, the spinal cord and the nervous roots were injured in 30.5 per cent of the patients. The neurological changes were caused by injury of the anterior and the medial spinal columns in 15.8 per cent of the patients, fracture according to the extension mechanism--4.2 per cent, compression of the spinal cord by the mass of nucleus pulposus--3.2 per cent of the patients. The risk of spinal cord injury increases in the patients with accompanying degenerative changes of the spine, growth disorders, the symptoms of local stenosis of the spinal canal.

[Pathomechanisms of spinal cord injuries caused by injuries of the cervical spine]. / Patomechanizmy uszkodzen rdzenia kregowego w nastepstwie urazów kregoslupa szyjnego.

The pathomechanism of injuries of the spinal cord due to injuries of the cervical spine in 158 patients treated during the last ten years has been presented. It has been determined that total and irreversible injuries of the spine occurred most often after fractures of the spine with displacement from hyperflexion (29.7 per cent) crushed fractures (24.7 per cent), and dislocation of the spine (24.7 per cent). In the majority of the patients, the spinal cord was irreversibly damaged already at injury, and in 29.2 per cent, the symptoms of deformity of the lumen of the vertebral canal and compression of the spinal cord remained. In about 24 per cent of the patients, the symptoms of congenital or habitual relative stenosis of the vertebral canal occurred. The performed examination has shown that knowledge of the pathomechanism of injury of the spine may facilitate determination of the degree of injury of the spinal cord as early as immediately after trauma.

[Densitometric evaluation of the proximal femur after cemented hip prosthesis]. / Ocena densytometryczna blizszej czesci kosci udowej po wszczepieniu protezy cementowej stawu biodrowego.

Results of DEXA densitometry evaluation of the proximal femur in 12 patients after cemented total hip replacement are demonstrated. Bone mineral density of the femur was measured using the dual energy absorptiometry Lunar DPX. Assessment was performed in the 3rd or 4th postoperative day, after 3rd, 5th and 12th week, after 6 and 9 months following surgery. A decrease in bone density around prosthetic stem ranging from 15% to 30% of the primary level was observed already in the third month after operation. The process continued and the values after 9 months were significantly lower then initial ones.

[The influence of the traction on the wrist in the course of healing of the radius distal part comminuted fractures]. / Znaczenie i wplyw sil rozciagajacych na nadgarstek w leczeniu przezstawowych i wieloodlamowych zlaman dalszej czesci kosci promieniowej dystraktorem zewnetrznym.

Traction and external fixation are the methods of choice by treating the comminuted fractures of the distal part of the radius. Bringing in two screws into the second metacarpal bone and the radius proximity from the fracture makes possible the traction and fixate the fractured bone splinters. The reposition of the comminuted fractures needs a very strong traction and provides to expand the ligaments and the wrist articular capsula. The aim of our study is to explain the mechanical influence of the external stabilization on the wrist and the wrist function after the immobilisation with the distraction. In 15 patients the examination was performed. The wrist was estimated on the base of clinical examination and rentgenography. Those examinations were performed within the moment of reduction of the dislocation, than 6 weeks and after next 6 weeks. All results are illustrated on graphics and x-ray pictures. The results of our study prove the profitable influence of the traction on the healing of the damaged articular surface in good clinical and functional position. Even a strong traction has in comparison to the control group (healing conservatively or by using various methods of the internal fixation) no influence on the wrist function.

[Pitfalls and failures in open reduction and stabilization of thoracolumbar fracture using Harrington rods]. / Przyczyny niepowodzen w nastawieniu przemieszczen i stabilizacji zlamanego kregoslupa pretami Harringtona.

A series of 26 patients with severe thoracolumbar burst fracture was treated with Harrington instrumentation. Pitfalls and failures in adequate stabilization are presented. In 2 cases vertebral arch supporting the hook was damaged. These patients required restabilization combined with anterior fusion. In another case sublaminar wire loop pulled by the hook compressed the dural sac. Long rods (over more then five segments) were usually applied for stabilization of several arches damage, most often cranially from the fracture site or developmental defects within L5 and S1. The best stabilization with short rods has been achieved within lumbar spine or in cases supplemented with anterior fusion with the use of bone graft.

[Surgical stabilization of fractures and dislocations of the spine]. / Operacyjna stabilizacja kregoslupa w leczeniu zlaman i zwichniec.

Observing the results of surgical treatment in 84 patients (64 males and 20 females) it was noted that stability of the cervical spine with a damaged posterior column could be achieved by using a coticospongious graft wedged in between the vertebral bodies. Unstable fractures of the thoracaic, thoracolumbar, and lumbar spine are best treated with a transpedicular stabilization system, involving application of either rods or plates onto the vertebral bodies. When using transpedicular screws, stability is achieved when screws are of the right size, are properly implanted into the pedicles and the rods are linked by transverse connectors (forming a 3D construction). Reconstruction of the anterior column by using bone graft or titanium baskets is of crucial importance.

[Current methods of thromboprophylaxis in total hip arthroplasty]. / Wspólczesne metody profilaktyki przeciwzakrzepowej w alloplastykach calkowitych stawów biodrowych.

The paper presents a review of methods of thromboprophylaxis, with regard given to both pharmacological and physiotherapeutic means in patients who underwent a total hip replacement procedure. Routine procedure should involve proper assertion of indications for surgical treatment, appropriate preoperative planning, surgery carried out in conduction anaesthesia, in the shortest possible time and as atraumatically as possible. Several weeks' of pharmacological treatment involving use of low molecular weight heparins in unison with mechanical means e.g. elastic stockings should follow surgical intervention. Quick mobilization of the patient following the surgical procedure along with intensive physiotherapy results in a decrease of the risk of thrombosis. In order to increase the efficiency of thromboprophylaxis different preventive methods should be applied simultaneously.

[Factors influencing bone mineral density around the femoral stem after cementless total hip arthroplasty]. / Wybrane czynniki wplywajace na gestosc mineralna kosci wokól trzpienia endoprotezy po bezcementowej alloplastyce stawu biodrowego.

Factors influencing bone mineral density around the femoral stem after PM cementless total hip arthroplasty were evaluated in longitudinal study of 18 hips in 18 patients who had undergone surgery due to unilateral hip osteoarthritis. Bone mineral density in the femoral neck was determined by dualenergy X-ray absorptiometry measurement performed preoperatively and in periprosthetic femoral Gruen's zones prospectively 2 weeks, 3, 6, 12 and 24 months after surgery. The concentrations of calcium, magnesium and fluoride were measured in cortical and trabecular bone samples taken from resected femoral head and neck. At 12 and 24 months after the operation the regional bone mineral density measurement showed significant, maximum decrease but after 12 months bone mineral density appeared to be stabilized. The analysis of preoperative femoral neck density and fluoride content in trabecular bone proved that osteopenia and lower fluoride concentrations correlated significantly with greater bone density decrease after total hip arthroplasty. No other factors (age, sex, weight, calcium and magnesium concentrations in bone and fluoride concentration in cortical bone) showed significant associations.