KPS Bipolar Radial Head Arthroplasty - Polyethylene Head Replacement with a Metal-covered Head. Case Study.

Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been ob-tained, this procedure, like any other surgical procedures, may be associated with severe complications, includ-ing contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has al-ways been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.

Abdominal tuberculosis after removal of an adjustable gastric band - report of an unusual case.

Laparoscopic adjustable gastric banding (LAGB) is the third most popular bariatric procedure. Despite its reversibility and minimal invasiveness, band infection affects 1.2% of patients. We present a case of a 25-year-old, obese woman who was experiencing malaise and feverishness 3 years after gastric band placement. Due to port site infection the port was removed, which did not improve the patient's condition. After 2 years the band was removed via laparotomy with a minor surgical site infection reported. The patient returned 2 weeks after discharge with signs of sepsis. After ruling out pulmonary causes, an exploratory laparotomy was performed, revealing granulomatous peritonitis. Standard histopathological examinations, broncho-alveolar lavage culture and DNA tests along with microbiological cultures were inconclusive. Broad-spectrum antibiotics and antifungal and antiparasitic agents did not improve the patient's condition. Mycobacterium tuberculosis DNA was discovered in a greater omentum specimen. The patient was treated with isoniazid, rifampicin, pyrazinamide and streptomycin for four months.

Landscape of oncoplastic breast surgery across Poland.

Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast-conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two-stage expander followed by implant-based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement.

Osteochondrosis of the capitellum of the humerus (Panner's disease, Osteochondritis Dissecans). Case study.

The article presents a case of an adolescent patient suffering from osteochondritis of the humeral capitellum. Early symptoms of this disease appeared at an age typically associated with the onset of both Panner's disease and Osteochondritis Dissecans (OCD) of the humeral capitellum. About two years after the onset of the early symptoms, the patient reported to a specialised clinic. He was followed up for almost two years and was hospitalised and underwent surgical treatment during that period. Both diseases bear multiple similarities, which may entail diagnostic errors. The paper presents differences between these two similar clinical entities, in particular in terms of treatment and prognosis. Essential details potentially allowing for early diagnosis and classification of both conditions are described and discussed. Resolving the discussion may significantly contribute to improving performance and quality of life of patients suffering from necrosis of the humeral capitellum.

Biomechanical assessment of varus-valgus range of motion of normal elbow joint using prototype measuring device.

INTRODUCTION: Elbow joint stability is provided by the medial and lateral collateral ligaments, joint surface alignment, and the joint capsule. The contribution of the joint capsule is relatively minor and varies with the position of the joint. The normal range of forearm abduction and adduction in the elbow joint is estimated to be between 5 and 10°. The aim of the paper was to determine precisely the physiological range of elbow joint motion in the frontal plane (laxity), which, apart from the knowledge gained, will provide a means to assess the effect of the surgical treatment of elbow joint contractures by comparing the stability of operated and healthy joints. MATERIAL AND METHODS: The measurements were carried out using UB-01, a prototype device produced by ANT Polska, in a group of 52 healthy volunteers. RESULTS: The mean valgus and varus deviation of the elbow joint was 11.2° (6.4° 16.1°) and 6.6° (3° 10.7°), respectively. The mean degree of elbow joint laxity was 17.8° (10.6° 26.5°). The difference in laxity between two opposite elbow joints in the same person was, on average, 1.2° (0.1° 3.8°). In healthy persons, the amplitude of deviation for both elbows is significantly smaller than 2°. CONCLUSIONS: 1. There are major differences in elbow joint laxity between individuals. 2. Nevertheless, laxity values of two elbow joints in the same individual are very similar. This observation allows for the healthy elbow to be treated as a reference while assessing the affected joint's stability in a patient following conventional surgery for elbow joint contracture.

Arthroscopic assessment of intraarticular distal radius fractures--results of minimally invasive fixation.

BACKGROUND: For many years, wrist arthroscopy has been used to diagnose and treat soft tissue lesions and to restore anatomic articular surface alignment in intraarticular fractures. However, there are no publications providing clear and precise indications for wrist arthroscopy in distal radius fractures. The aim of the study was to analyse factors influencing the outcomes of intraarticular distal radius fracture treatment with K-wire fixation under arthroscopic guidance in AO B1 and C1 type fractures. MATERIAL AND METHOD: A group of 26 patients (27 wrists) following an arthroscopic procedure (ARTR group) was the prospective component and 27 patients (27 wrists) following a non-arthroscopic procedure (OP group) constituted the retrospective part of the trial. Both groups consisted only of patients with B1 and C1 type fractures (10 and 17, respectively) according to the AO classification. RESULTS: In the ARTR group, there was a marked (statistically significant) difference between radiologically and arthroscopically assessed displacement. This underestimation of displacement was higher in B1 than C1 type fractures (statistically significant difference). Numerous associated injuries were identified, such as carpal bone cartilage injuries (85.19%), TFCC injury (59.26%) and SL ligament injuries (40.74%). Loose bodies were detected in 66.7% of the patients. In B1 type fractures, the most common ligamentous injury was a SL ligament lesion (50%), while in C1 fractures it was a TFCC lesion (70.59%). Comparing both groups (ARTR and OP), better clinical outcomes were observed in the ARTR group (though not statistically significant), with the most marked differences noted with regard to B1 type fractures. CONCLUSIONS: In B1 and C1 type intraarticular distal radius fractures, displacement visible during arthroscopy was greater than that seen on primary radiological assessment. In B1 type fractures, the difference between radiological and arthroscopic evaluation of displacement was more marked than in C1 fractures. It means that B1 type fractures can be highly "misleading", because their radiological pattern suggested little displacement, while actual displacement was more pronounced. On the basis of our results, it might be concluded that wrist arthroscopy could become a standard, routine procedure in B1 type fractures. In C1 type fractures, the method of treatment would depend on the surgeon's preferences.