Validation of the Polish versions of the Lower Limb Task Questionnaire, Lower Limb Functional Index, and Lower Limb Functional Index-10.

BACKGROUND: Physicians who treat patients with lower limb diseases should pay attention not only to the patients' clinical condition but also to their individual needs and expectations. For this purpose, many different questionnaires can be employed. This study aimed to validate the Lower Limb Task Questionnaire (LLTQ), Lower Limb Functional Index (LLFI), and Lower Limb Functional Index-10 (LLFI-10) for their use in Polish conditions and to perform a mutual comparison and analysis of differences in subjective assessments by patients who undergo hip or knee arthroplasty. METHODS: The LLTQ, LLFI, and LLFI-10 were translated into Polish. A total of 103 patients who qualified for hip or knee arthroplasty at a University Hospital in from 2019 to 2021 were included in this study. The patients were asked to complete the Polish versions of the LLTQ, LLFI, LLFI-10, Lower Extremity Functional Scale (LEFS), and Short Form-36 four times - twice before and twice after their surgeries. RESULTS: The Polish versions of the LLTQ, LLFI, and LLFI-10 had good psychometric properties. One year after surgery, the Cohen's standard response mean revealed high improvement of limb functionality and thus quality of life among all patients. We observed better treatment outcomes among patients who had hip osteoarthritis. CONCLUSIONS: The questionnaires were validated and can be used both in everyday health practice and in further research in Poland.

The Influence of Single Whole-Body Cryostimulation on Cytokine Status and Oxidative Stress Biomarkers during Exhaustive Physical Effort: A Crossover Study.

The purpose of the study was to assess the impact of single whole-body cryostimulation (WBC) preceding submaximal exercise on oxidative stress and inflammatory biomarkers in professional, male athletes. The subjects (n = 32, age 25.2 ± 37) were exposed to low temperatures (-130 °C) in a cryochamber and then participated in 40 min of exercise (85% HRmax). Two weeks afterwards, the control exercise (without WBC) was performed. Blood samples were taken before the start of the study, immediately after the WBC procedure, after exercise preceded by WBC (WBC exercise) and after exercise without WBC. It has been shown that catalase activity after WBC exercise is lower in comparison with activity after control exercise. The interleukin 1ß (IL-1-1ß) level was higher after control exercise than after WBC exercise, after the WBC procedure and before the start of the study (p < 0.01). The WBC procedure interleukin 6 (IL-6) level was compared with the baseline level (p < 0.01). The level of Il-6 was higher both after WBC exercise and after control exercise compared with the level recorded after the WBC procedure (p < 0.05). Several significant correlations between the studied parameters were shown. In conclusion, the changes in the cytokine concentration in the athletes' blood confirm that body exposition to extremely low temperatures before exercise could regulate the inflammatory reaction course and secretion of cytokines during exercise. A single session of WBC in the case of well-trained, male athletes does not significantly affect the level of oxidative stress indicators.

Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial.

BACKGROUND: There are no scientific reports clearly describing the effectiveness of the High Tone Power Therapy in patients after ACL reconstruction. This caused that in own research an attempt was made to present the possibilities of using the selected method of electrical stimulation in the treatment of an orthopaedic patient. The aim was to assess the effectiveness of electro stimulation of the quadriceps muscle in patients after ACL reconstruction, with the use of High Tone Power Therapy. METHODS: In randomized controlled trial took part thirty-five men, aged 21-50, after ACL reconstruction. The tests were carried prior to and 6 months following the ACL reconstruction. After the surgery, the patients were randomly divided into experimental group (17 patients) with the High Tone Power Therapy in rehabilitation and control group (18 patients) without the High Tone Power Therapy. Patients were subjected to 6-month rehabilitation. Research tools included the measurement of muscle strength torque, ROM, knee and thigh circumference measurements, the Lysholm and the VAS scale. RESULTS: After applying HiToP, the analysis showed a statistically significant improvement of muscle torque (p = 0.041, Es = 3.71), knee circumference (p = 0.039, Es = 1.65), thigh circumference (p = 0.049, Es = 1.26), knee extension (p < 0.001, Es = 2.20) in Experimental group compared to the control group. Only the results of the VAS scale did not differ statistically significantly both within a given group and between groups. CONCLUSIONS: The results confirm the hypothesis that the use of HiToP in patients after ACLr have a beneficial effect on muscle strength, reduction of joint effusion, muscle mass gain and joint function. The assumption that HiToP significantly reduces pain levels is not supported - the results in both groups are statistically insignificant. TRIAL REGISTRATION: The research project was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of first registration 11.10.2016. Registration number: ACTRN12616001416482 .

The effect of pre-operative high doses of methylprednisolone on pain management and convalescence after total hip replacement in elderly: a double-blind randomized study.

PURPOSE: The aim of the study was to assess whether administration of a single dose of methylprednisolone in the group patients above 65 years of age will be effective in complex analgesic management after total hip arthroplasty (THA). METHODS: Seventy-seven patients above 65 years old were double-blind randomized into two: the study and controls groups. Pre-operatively, the study group received as a single dose of 125 mg intravenous methylprednisolone, while the others saline solution as placebo. Peri-operatively, all the patients were administered opioid and nonopioid analgesic agents. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein-CRP), pain intensity level (visual analog scale-VAS; numerical rating scale-NRS), the life parameters, and noted complications. RESULTS: Following administration of methylprednisolone were significantly lower levels of CRP on all the four post-operative days; leukocytosis on the second day; the VAS/NRS score at rest after six, 12, and 18 hours post-operatively, diminished the dose of parenteral opioid preparations (oxycodone hydrochloride), the duration of analgesia by peripheral nerve block was significantly higher as compared with the placebo group (p < 0.000001). No infectious complications were noted; there was one patient who developed post-operative delirium. CONCLUSION: A single dose of methylprednisolone significantly reduces the level of post-operative pain at rest on the day of THA in the group patients above 65 years of age, decreases the dose of opioid analgesic agents, and significantly decreases the level of inflammatory markers, without infectious processes.

Intra-articular pathologies associated with chronic ankle instability.

Chronic ankle instability causes intra-articular lesions, which may lead to secondary degenerative changes. The aim of this study was to evaluate the usefulness of the ankle arthroscopy for the evaluation and treatment of intra-articular pathologies associated with chronic ankle instability. Between January 2013 and March 2016, 25 anterior ankle arthroscopies with modi ed anatomic Broström-Duquennoy-Tourne lateral ankle ligaments reconstructions were performed. In arthroscopy all patients (100%) had some intra-articular pathologies: 75% synovitis or so tissue scarring, 19% - deep chondral defect, 56% - superficial chondral lesion, 52% - osteophytes, 24% - bony or avulsion fragments, 20% - loose bodies. All intra-articular pathologies were treated during procedure. In conclusion, it is recommended to perform anterior ankle arthroscopy in addition to lateral ankle ligament reconstruction to diagnose and treat intra-articular lesions.

[The impact of the type of anesthesia on postoperative pain after surgical correction of hallux valgus deformity]. / Oddzialywanie rodzaju znieczulenia na stopien nasilenia bólu pooperacyjnego po korekcji operacyjnej deformacji koslawej palucha.

BACKGROUND: Different kind of anesthesia are used in hallux valgus surgery e.g general and spinal anesthesia, peripheral blocks (sciatic, femoral, ankle), patient controlled analgesia (PCA), multimodal anesthesia and preemptive local anesthesia. The type of anesthesia can play a key role in postoperative pain control. The aim of the study was to compare the effectiveness of different types of anesthesia in reduction of postoperative pain. MATERIAL AND METHODS: In the years 2009-2015,260 hallux valgus surgeries were performed using chevron, scarf, Mitchell-Kramer or Kramer method. Depending on the kind of anesthesia, patients were assigned to one of the five groups: group A--general, group B--spinal, group C--general with local preemptive, group D--spinal with local preemptive, group E--sciatic (popliteal) block. The level of postoperative pain intensity was measured using a visual analogue scale (VAS) in 2, 4, 8, 12, 16, 24, 48 and 72 hours after surgery. Regardless of the type of anesthesia each patient received three doses of 1000 mg paracetamol, two doses of 100 mg ketoprofen and at the request 7.5 mg morphine sulphate intravenously. During discharge from the hospital followed a day after surgery each patient received a prescription for 325 mg paracetamol + 37.5 mg tramadol hydrochloride . All adverse effects of anesthesia and drugs were reported. RESULTS: During the first 24 hours average pain intensity measured by VAS was increased in group A compared to others (p < 0.05). Between 8 and 24 hours, a similar relationship was observed in group B compared to C, D and E (p < 0.05). At the second and third day after surgery the differences in VAS were not statistically significant. In groups C, D and E we observed decreased use of 7.5 mg morphine sulphate on demand and 325 mg paracetamol + 37.5 mg tramadol hydrochloride. In two patients of group A and one in group B dizziness and nausea after use of 325 mg paracetamol + 37.5 mg of tramadol hydrochloride were noted. Two patients in group B and one of group D had incident of bradycardia. Three patients of group A and C had nausea and vomiting. We did not observe side effects of injected solution of local anesthetics. CONCLUSIONS: Preemptive local anesthetic infiltration combined with general or spinal anesthesia and sciatic (popliteal) block are more effective than isolated general and spinal anesthesia in reducing the level of postoperative pain after hallux valgus surgery. They are also associated with decreased number of complications and reduction of applied analgesics.

[The influence of the local preemptive anesthesia on postoperative pain after open reduction and internal fixation of distal radius fractures].

Background: Severe postoperative pain is one of the causes of prolonged hospitalization, rehabilitation and complications after surgical treatment of distal radius fractures. Preemptive local anesthesia is effective in reduction of postoperative pain in general surgery, neurosurgery, gynecology and orthopedic surgery. The aim of the study was to assess the role and effectiveness of preoperative local anesthetic infiltration of the surgical site in open reduction and internal fixation (ORIF) of distal radius fractures under general anesthesia. Material and Methods: 88 patients with acute distal radius intra-articular and unstable fractures were randomly assigned to receive preoperative infiltration of the surgical site with a mixture of local anesthetic agents or with saline. We measured the time from the fracture to surgery and intensity of pain at 4, 8, 12, 16, 24, 48 and 72 hours after the release of the tourniquet using a visual analogue scale (VAS). We noted all the side effects and the requirement for intravenous (IV) rescue analgesia. From analysis of chart review of their follow up visits at 2, 6 and 12 weeks we obtained DASH (Disabilities of the Arm, Shoulder and Hand) score, ROM (Range of Motion) of the wrist and grip strength of the hand. Results: The level of postoperative pain measured by the VAS scale decreased significantly during first 24 hours after surgery in the study group in comparison to the placebo group (p<0.05). We observed a positive correlation between the time elapsed between the fracture and surgery and the average VAS score in the study group. Chart review of follow up visits at 2, 6 and 12 weeks revealed significant decreased DASH score at 2 weeks and significant increased wrist flexion and extension at 2 and 6 weeks postoperatively. Six patients from the control and three subjects from the experimental group used rescue analgesia. We did not observe any side effects of the drugs. In one patient from the control group, we noted complex regional pain syndrome in late follow-up. Conclusion: Preemptive local anesthesia is effective in reduction of postoperative pain after ORIF of distal radius fractures within first 24 hours. The effectiveness of preemptive local anesthesia decreases with the time elapsed between the fracture and operation. It is safe and reduces the use of rescue analgesia.

[Effectiveness and safety of intra-articular use of hyaluronic acid (Suplasyn I-Shot) in the treatment of knee osteoarthritis]. / Skutecznosc dzialania i bezpieczenstwo preparatu Suplasyn 1-Shot w leczeniu choroby zwyrodnieniowej stawów kolanowych.

Osteoarthritis (OA) is one of the leading causes of disability in the elderly. The changes in the lubricating properties of synovial fluid lead to significant pain and loss of function. Viscosupplementation, in which hyaluronic acid (HA) is injected into the knee joint, has evolved into an important part of our current therapeutic regimen in addressing the patient with knee pain due to OA. Intra-articular HA has proven to be an effective, safe, and tolerable treatment for symptomatic knee OA. In an effort to limit cardiovascular, gastrointestinal and renal safety concerns with COX-2 selective and nonselective NSAIDs and maximize HA efficacy, it is even proposed using HA earlier in the treatment paradigm for knee OA and also as part of a comprehensive treatment strategy. Our study reconfirmed effectiveness and safety of intra-articular use of hyaluronic acid (Suplasyn) in the treatment of knee osteoarthritis.

[Preemptive local anesthetic infiltration in hallux valgus one-day surgery]. / Wyprzedzajace znieczulenie miejscowe w operacjach palucha koslawego w trybie ambulatoryjnym.

BACKGROUND: The surgical treatment of hallux valgus deformity is connected with significant postoperative pain. Spinal and general anesthesia as well as peripheral blocks are successfully used in foot surgery. The purpose of this study was to evaluate the influence of local anesthetic infiltration before hallux valgus one-day surgery on postoperative pain and the need for analgesics. MATERIAL AND METHODS: 134 patients underwent chevron or miniinvasive Mitchell-Kramer osteotomy of the first distal metatarsal. After general anesthesia each patient randomly received an infiltration of 7ml of local anesthetic (4 ml of 0.25% bupivacaine and 3 ml of 2% lidocaine) or the same amount of normal saline 15 minutes before the skin incision. Both the patient and the surgeon were blinded. The patient was discharged after approximately 2 hours of observation. 2, 4, 8, 12, 16, 24 and 72 hours after the release of the tourniquet the level of pain was assessed by the visual analogue scale (VAS). Rescue analgesia, side effects and the use of painkillers were noted. RESULTS: Preemptive local anesthetic infiltration significantly decreased pain during the first 24 hours after the surgery. None of the patients from the injected group and 38 from the placebo group received 100 mg of ketoprofen intravenously for rescue analgesia in the first 2 hours after the release of the tourniquet. During the first 24 hours we noted significantly decreased use of 1000 mg of paracetamol and 100 mg mg of ketoprofen orally in the injected group. No systemic adverse effects were noted. One patient from placebo group had allergic rush after use of 100 mg ketoprofen. CONCLUSIONS: Preemptive local anesthetic infiltration in one-day hallux valgus surgery significantly decreases postoperative pain. It is safe, efficient and allows fast discharge.

[Chondrocytes application in regenerative medicine]. / Zastosowanie chondrocytów w medycynie regeneracyjnej.

Cartilage reconstruction is a crucial issue for tissue engineering because of high damage frequency in connection with low regenerative capacity. Microfractures and shaving are the oldest and most commonly used practices. The newest techniques are: Autologous Chondrocyte Implantation, Matrix Associated Chondrocytes Implantation and their derivatives. Dedifferentiation of chondrocytes due to low proliferation rate and phenotype loss makes isolation and in vitro culture of normal human chondrocytes very complex. Therefore, obtaining mesenchymal stem cells from various sources and differentiating them into chondrocytes is another interesting approach.

Mini-invasive mitchell-kramer method in the operative treatment of hallux valgus deformity.

BACKGROUND: The mini-invasive Mitchell-Kramer procedure is a new method of operative correction of mild to moderate hallux valgus deformity. The aim of this study was to describe the technique and evaluate the results of the procedure. METHODS: We evaluated 54 patients who underwent mini-invasive distal metatarsal osteotomy of the first metatarsal with preservation of the lateral cortex of the distal fragment. We did percutaneous 2-mm K-wire stabilization of the osteotomy and did not use cast immobilization with postoperative offloading of the forefoot. We used anteroposterior and lateral foot standing X-rays, visual analog scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment at 18 months' follow-up. RESULTS: Preoperatively, mean hallux valgus angle was 33.9 degrees; intermetatarsal angle, 14.8 degrees; VAS, 8.9; and AOFAS, 37.0. At follow-up period, hallux valgus angle was 14.2; intermetatarsal angle, 9.7; VAS, 2.6; and AOFAS, 90.7. The average first metatarsal shortening was 2.7 mm. No transfer metatarsalgia was noted at 18 months' follow-up. We found 1 superficial infection, but all patients were satisfied. CONCLUSIONS: The mini-invasive Mitchell-Kramer method was indicated in mild to moderate hallux valgus deformity. Cast immobilization was unnecessary, and full weightbearing was allowed early. Using the minioscillating saw allowed for reduced surgical exposure. The technique of the osteotomy also allowed for rotational stability of the osteotomy. LEVEL OF EVIDENCE: Level IV, retrospective case series.

[Modern methods of surgical treatment of hallux valgus deformity]. / Wspólczesne metody leczenia operacyjnego deformacji koslawej palucha.

Hallux valgus is the most common deformity of the foot, affecting 2-4% of the population. The disease is mostly genetic, but there are also exogenous factors. Conservative treatment for the use of orthotics is usually ineffective and only surgery leads to a complete cure. The indications for surgery are pain and/or problems with shoe choosing. AP and lateral foot standing X-ray film is necessary for the proper qualifications. Depending on the size of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) deformations are divided into mild, moderate, advanced and severe. In addition, we assess congruency of the first metatarsophalangeal joint (MTP I). Depending on the degree of deformation and the ascertained pathology we combine different procedures, such as: bunionectomy with medial capsulorrhaphy, osteotomy of basal phalanx of the great toe, distal, midshaft or proximal osteotomy of the first metatarsal, double osteotomy of the first metatarsal, MTP I joint arthrodesis and arthrodesis of medial cuneiform-first metatarsal I joint. In non-congruent MTP I joint we usually perform lateral release. In some indications we also use arthroplasty and minimally invasive techniques. Only the proper qualification for surgery provides a good clinical effect.

[Early results after surgical treatment of femoral neck fractures with total cementless hip arthroplasty]. / Wczesne wyniki leczenia operacyjnego zlaman szyjki kosci udowej calkowita alloplastyka bezcementowa stawu biodrowego.

UNLABELLED: The aim of the study was to assess early results after the treatment of femoral neck fractures with the cementless hip arthroplasty as well as complications after the earlier fixation of these fractures in patients aged 55-70 years. MATERIAL AND METHODS: 40 cementless hip arthroplasty procedures with the use of Bicontact S endoprosthesis were performed, including 33 due to the femoral neck Garden III and IV type fractures, 7 due to the destabilization of the earlier performed bone fixation with DHS (Dynamic Hip Screw) or the nonunion after the fracture fixation. Postoperative complications as well as early clinical and radiological results were assessed. Outpatient follow-up examinations assessed patients using Harris Hip Score (HHS) and Visual Analogue Scale (VAS), to estimate their quality of life and the level of contentment. RESULTS: The total cementless hip arthroplasty with the use of Bicontact endoprosthesis allows to achieve very good early clinical results in patients who have undergone the surgical procedure due to the femoral neck fracture and good clinical results in patients who have undergone this surgery because of complications after the fixation of fractures. In the examined group of patients early radiological results were good. CONCLUSIONS: Based on the very good and good early results of clinical trials can be assumed that the total cementless hip arthroplasty will be an effective and recommended method of treatment of femoral neck fractures and complications after the earlier fixation of these fractures in patients aged 55 to 70 years, but this requires further, long-term observation. Total hip arthroplasty, not the fixation, should be more often considered as a primary care management of fractures of this type because it allows for a pain-free walking faster and faster return to pre-injury functioning.

[Evaluation of trigger finger operative treatment and quality of life improvement with PEM (Patient Evaluation Measure) questionnaire]. / Ocena wyników leczenia operacyjnego palców trzaskajacych (przeskakujacych) i poprawy jakosci zycia w oparciu o kwestionariusz PEM (Patient Evaluation Measure).

UNLABELLED: One of the most frequent couse of pain and function impairment of the hand is trigger finger. The treatment of this desease can be conservative or operative. The aim of this study was the evaluation of operative treatment and improvement of the quality of life after the procedure with PEM questionnaire. There were 50 patient included into evaluation, all of them were treated in Second Department of Surgery of the Jagiellonian University Medical College between 2008 and 2010. Patients evaluated the function of their hand before surgery and then 3 months and a year after the procedure. There were also the assessment of treatment satisfaction. We analised the results and observed significant improvement of hand function after the surgery and very high satisfaction with the treatment. CONCLUSIONS: 1. Surgery is a very effective treatment method of trigger finger. 2. It is quite simple procedure and followed by very few complications. 3. It allows to significantly improve hand function and early return to work. 4. It can be performed in the outpatient clinic, which considerably reduces the costs of treatment.

Automated decision support for Hallux Valgus treatment options using anteroposterior foot radiographs.

BACKGROUND: Assessment of the potential utility of deep learning with subsequent image analysis to automate the measurement of hallux valgus and intermetatarsal angles from radiographs to serve as a preoperative aid in establishing hallux valgus severity for clinical decision-making. AIM: To investigate the accuracy of automated measurements of angles of hallux valgus from radiographs for further integration with the preoperative planning process. METHODS: The data comprises 265 consecutive digital anteroposterior weightbearing foot radiographs. 181 radiographs were utilized for training (161) and validating (20) a U-Net neural network to achieve a mean Sørensen-Dice index > 97% on bone segmentation. 84 test radiographs were used for manual (computer assisted) and automated measurements of hallux valgus severity determined by hallux valgus (HVA) and intermetatarsal angles (IMA). The reliability of manual and computer-based measurements was calculated using the interclass correlation coefficient (ICC) and standard error of measurement (SEM). Inter- and intraobserver reliability coefficients were also compared. An operative treatment recommendation was then applied to compare results between automated and manual angle measurements. RESULTS: Very high reliability was achieved for HVA and IMA between the manual measurements of three independent clinicians. For HVA, the ICC between manual measurements was 0.96-0.99. For IMA, ICC was 0.78-0.95. Comparing manual against automated computer measurement, the reliability was high as well. For HVA, absolute agreement ICC and consistency ICC were 0.97, and SEM was 0.32. For IMA, absolute agreement ICC was 0.75, consistency ICC was 0.89, and SEM was 0.21. Additionally, a strong correlation (0.80) was observed between our approach and traditional clinical adjudication for preoperative planning of hallux valgus, according to an operative treatment algorithm proposed by EFORT. CONCLUSION: The proposed automated, artificial intelligence assisted determination of hallux valgus angles based on deep learning holds great potential as an accurate and efficient tool, with comparable accuracy to manual measurements by expert clinicians. Our approach can be effectively implemented in clinical practice to determine the angles of hallux valgus from radiographs, classify the deformity severity, streamline preoperative decision-making prior to corrective surgery.

Relationship between Optimism, Self-Efficacy and Quality of Life: A Cross-Sectional Study in Elderly People with Knee Osteoarthritis.

BACKGROUND: Due to the presence of numerous problems in osteoarthritis, e.g., the presence of one or more chronic diseases, reduced self-esteem and reduced ability to cope, patients must undertake readaptation activities. In such circumstances, resources that are necessary for optimal adaptation become of particular importance. This cross-sectional study aimed to assess the impact of behavioral resources, namely self-efficacy and optimism, on quality of life perception in early-old-age patients with knee osteoarthritis. METHODS: An anonymous survey was conducted using recognized research tools: the Index of Severity for Knee Disease, Life Orientation Test, General Self-Efficacy Scale and World Health Organization Quality of Life BEFF. The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without diagnosed joint and muscular diseases of the lower limbs. Non-parametric tests (e.g., Mann-Whitney U test, Kruskal-Wallis test, Spearman's correlation coefficient) were used for the statistical analysis of the results, assuming a significance level of p < 0.05. RESULTS: The level of the examined personal resources was significantly lower in the group of people with gonarthrosis (p < 0.001), among whom low self-efficacy and a tendency toward pessimism prevailed. The results in terms of the level of lower limb joints impairment among the respondents correlated significantly and negatively with self-efficacy (r = -0.239; p = 0.003) and dispositional optimism (r = -0.318; p < 0.001). A higher level of the studied psychosocial resources led to a more favorable assessment of quality of life (p < 0.001) and own health (p < 0.001). In addition, a higher sense of self-competence was associated with better quality of life in the psychological (p = 0.044), social (p < 0.001) and environmental (p < 0.001) domains, while a tendency toward optimism was associated with higher quality of life perception in the social domain (p < 0.001). CONCLUSIONS: It would seem to be reasonable to introduce a routine diagnosis, assessing the level of personal capabilities of elderly people with knee osteoarthritis, which may have a beneficial effect on their perception of their quality of life and their own health.

Automated correction angle calculation in high tibial osteotomy planning.

High tibial osteotomy correction angle calculation is a process that is usually performed manually or in a semi-automated way. The process, according to the Miniaci method, is divided into several stages to find specific points: the center of the femoral head, the edges of the tibial plateau, the Fujisawa point, the center of the ankle joint, and the Hinge point. In this paper, we proposed an end-to-end approach that consists of different techniques for finding each point. We used YOLOv4 to detect regions of interest. To identify the center of the femoral head, we used the YOLOv4 and the Hough transform. For the other points, we used a combined method of YOLOv4 with the ASM/AAM algorithm and YOLOv4 with image processing algorithms. Our fully-automated method achieved a mean error rate of 0.5[Formula: see text] (0[Formula: see text]-2.76[Formula: see text]) ICC 0.99 (0.98-0.99) 95% CI on our own dataset of standing long-leg Anterior Posterior view X-rays. This might be the first method that automatically calculates the correction angle of high tibial osteotomy.

[Isolated bilateral medial cuneiform fracture: a case report]. / Izolowane i obustronne zlamanie kosci klinowatych przysrodkowych: opis przypadku.

UNLABELLED: Midfoot bones fractures are usually unisolated and associated with a high-energy trauma. Unfortunately a such fracture it is often missed or delayed in primary diagnosis. Isolated medial cuneiform fracture is a very rare injury. A review of the literature reveals only few cases and none of bilateral. CASE REPORT: We report of undisplaced isolated bilateral medial cuneiform fracture in 26-year-old woman after dancing trauma. Because of unclear physical examination and plain x-rays film, computed tomography was necessary. Early correct diagnosis allowed appropriate conservative treatment with good result. CONCLUSIONS: Cuneiform bones fractures are much more common than previously reported. Computed tomography should be considered even in cases of low energy trauma.

[The modified Elmslie-Trillat procedure for the treatment of recurrent patellar dislocation and instability]. / Korekcja nawykowych zwichniec i niestabilnosci rzepki zmodyfikowana metoda Elmslie-Trillat.

UNLABELLED: Habitual patella dislocation and instability in the absence of effective conservative treatment requires surgery. Surgical procedures can be divided into bone, soft tissue and mixed methods. In many studies the authors emphasize the good results of Elmslie-Trillat procedure. METHODS: In 2005-2008, we operated 20 patients by modified Elmslie-Trillat procedure but 2 patients were excluded from the study because of lack of control after surgery. We modified surgical technique by type of tibial tuberosity osteotomy and reconstruction of soft tissues. RESULTS: We used a subjective clinical evaluation (evaluation of Q angle, patella traction in the dynamic tests) and the Tegner and Lysholm scale. In the Tegner scale, we obtained an average improvement of 3.4 points (from 0 to 8), and in Lysholm scale average of 46.7 points (from 14 points to 65 points). CONCLUSIONS: Correction of recurrent patellar dislocation and instability by a modified Elmslie-Trillat method is effective and good results are obtained. Only the appropriate selection of surgical procedure depending on the cause of disease provides a permanent cure.