Blood serum levels of amino-terminal pro-C-type natriuretic peptide in patients with systemic sclerosis.

The aim of this pilot study was to examine the association of serum levels of amino-terminal fragment of pro-C-type natriuretic peptide (NT-proCNP), as a substitute measure of serum C-type natriuretic peptide (CNP), with clinical and laboratory findings in patients with systemic sclerosis (SSc). Serum NT-proCNP, soluble (s)E-and sP-selectin levels were examined using specific enzyme-linked immunosorbent assay in 30 patients with SSc and 30 healthy controls. We found no statistically significant difference in serum levels of NT-proCNP neither between patients with SSc and healthy controls nor between those treated with immunosuppressive agents and untreated patients. Nevertheless, in the investigated SSc group, serum NT-proCNP levels correlated with the concentrations of C-reactive protein (CRP) and the duration of the disease. Both sP- and sE-selectin levels were elevated in SSc patients when compared to healthy subjects. Also they did not correlate with the concentrations of NT-proCNP. The results of the study indicate that serum NT-proCNP level is likely secondary to existing inflammation. However, the magnitude of CNP action in SSc and its possible role in the pathogenesis of the disease remains to be elucidated.

Large bone distractor for open reconstruction of articular fractures of the calcaneus.

The results of operative treatment of two groups of patients with articular fractures of the calcaneus were evaluated. Twenty-three cases were treated surgically using a standard reconstruction procedure. In the second group of 19 patients a large bone distractor was used; it held the soft tissue flap retracted, while aiding in articular and tuberosity fragment reduction and increasing visualisation by distraction of the posterior talocalcaneal joint. After a year, the anatomical and functional results, together with the operative time, were evaluated. All fractures healed with good or very good anatomical results. All cases, except those with complications (n = 3), achieved good (n = 28) or very good (n = 11) functional scoring. The distractor group had significantly shorter operative times, and less manpower was needed during surgery. We conclude that the large bone distractor is a useful tool in open reconstruction of articular calcaneal fractures.

Compartment syndrome of the foot after calcaneal fractures.

BACKGROUND: A compartment syndrome is a condition in which high pressure within a closed fascial space causes reduced blood flow with nerve and muscle ischaemia. Untreated compartment syndrome leads to ischaemia with necrosis, contractures, myofibrosis and irreversible functional impairment in the involved part of the limb. Calcaneal fractures and other kinds of foot trauma may cause acute compartment syndrome of the foot. This condition may lead to foot deformities, including clawing of the toes, weakness of the foot muscles and, ultimately, a gait disorder. MATERIAL AND METHOD: We studied 13 patients with unilateral calcaneal bone fractures. The healthy feet were examined as a control group. Data were derived from histories, physical examinations and measurements of intracompartmental pressure in three muscle compartments of the foot. RESULTS: Pressure in the foot with a calcaneal fracture was significantly higher than that on the healthy side, with pressures of 68.6 mmHg vs. 18.8 mmHg (p=0.0002) in the calcaneal (central) compartment, 49.0 mmHg vs. 14.4 mmHg (p=0.0003) in the lateral compartment, and 45.9 mmHg vs. 11.8 mmHg (p=0.0003) in the medial compartment. The pressures correlated with pain intensity rated by patients on a 10-point scale. CONCLUSIONS: Calcaneal fractures are accompanied by elevated intracompartmental pressure and symptoms of compartment syndrome. Acute compartment syndrome of the foot is very rarely diagnosed in Poland and only exceptionally treated by compartmental decompression. If left untreated, combined with deformities directly related to the fracture, it may lead to disability.

Complications of dislocated calcaneal fractures.

BACKGROUND: Calcaneal fractures are the most common of all tarsal fractures, with the majority being the result of high energy injuries causing comminution of bone and lesions of the posterior articular surface. If the bone fragments are left dislocated or non-operative reduction is attempted, the outcome is poor, often with chronic disability. On the other hand, operative treatment does not always lead to a good result and there is an inherent risk of devastating complications. MATERIAL AND METHODS: During a 3-year period (2002-2005) the authors treated operatively (by open reduction and internal fixation) 23 dislocated calcaneal fractures involving the posterior calcaneotalar joint. A control group of 12 patients was treated non-operatively or using minimally invasive techniques. Medium-term results were compared by evaluating the Bohler and Gissane angles and the shape of the posterior calcaneal articular surface on radiographs (lateral and Broden views), while functional outcomes were rated according to the Creighton-Nebraska scale. Complications not included into this scheme were noted. RESULTS: Both anatomic and functional results were markedly better in the group treated with open reduction and internal fixation. In this group, there were three cases of infectious complications that were attributed to the surgical procedure, while in the other group, two such cases were associated with open fractures. Both groups developed clawing of the toes. The quality of reduction was always unsatisfactory in the non-operative group. CONCLUSIONS: 1. Complications of calcaneal fractures significantly worsen the therapeutic outcome. 2. Proper care based on meticulous evaluation of the foot in the early period is crucial for reducing the incidence of complications.

Surgical treatment of articular calcaneal fractures.

BACKGROUND: Although Leriche (in 1921) and Judet (in 1954) introduced screw or plate fixation of the broken calcaneus, surgical treatment using open anatomical reduction and stable internal osteosynthesis only appeared in the early 1980s. This was made possible by the introduction of imaging methods such as CT, which allowed for better detection of the fracture pathology and provided the basis for new surgical strategies, e.g. anatomically-shaped calcaneal plates, available since the early 1990s. MATERIAL AND METHODS: During a 3-year period (2002-2005) the authors operated 23 dislocated calcaneal fractures (19 men, 4 women, 19-57 years of age) involving the posterior calcaneo-talar joint (Sanders II and III according to CT-based classification). Treatment involved open reduction and internal fixation of the calcaneus through an extended lateral approach. Fixation was performed using lag screws and a reconstruction plate. We describe both the anatomic results (evaluation of the posterior articular surface of the calcaneus and the Bohler angle) and the functional outcome, using the Creighton-Nebraska system. RESULTS: In this prospectively evaluated group we achieved 12 good and 11 very good anatomical results, and 2 fair, 16 good and 5 very good functional outcomes at follow-up (at least one year after surgery). Infections occurred in 3 cases. CONCLUSIONS: The treatment option described here requires careful preoperative planning, with evaluation of the fracture pattern and patient condition, and good surgical expertise, but it provides good medium-term (1-3 years) outcome. The presence ofa good or very good reduction does not always correlate with the functional outcome.

Intraspinal migration of a Kirschner wire as a late complication of acromioclavicular joint repair: a case report.

BACKGROUND: Penetrating neck trauma involving foreign bodies is a rare event in European countries. Due to its relatively high mortality rate, the correct management strategy must be initiated from the beginning to prevent fatal complications. In the medical literature, there are only a few cases describing foreign bodies penetrating the cervical spine. Because of its rareness, many trauma centers lack the proper routine to adequately manage such injuries. CASE PRESENTATION: This case report describes a 34-year-old white man of Central European descent with Kirschner wire migration and perforation of his vertebral foramen. He underwent acromioclavicular joint repair surgery 7 years ago, presented with a painful sensation around the area of his left clavicle and left side of his neck after a motorcycle accident. No neurological deficit was detected. CONCLUSIONS: In such cases, a thorough radiological evaluation of the spinal cord and the surrounding vasculature is mandatory for a complete understanding of the extent of the injury and determining the proper surgical management. In cases of vertebral artery trauma both an endovascular and an open approach can be contemplated.

Functional bracing of humeral schaft fractures in osteoporotic patients.

Introduction. There are many treatment methods in use, both surgical and non-surgical, for fractures of the shaft of the humeral bone.
Material and methods. We did a prospective study of the effectiveness of functional bracing for humeral shaft fractures in 8 selected patients with osteoporosis, aged 56-78. Evaluation was based on radiographic signs of bone union, the quality of reduction, and the functioning of the ulnar and gleno-humeral joints and the upper extremity as a whole.
Results. In all the cases studied, good and fast bone union was achieved with varying degrees of residual deformation, without detectable influence of the latter on the functional result.
Conclusions. The method in use proved to be very effective, since early, good function of the injured extremity was restored and patient satisfaction was very high.

Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases.

Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.

Hybrid external fixation for neglected fractures of the distal radius: results after one year.

BACKGROUND: External fixation is a well-established procedure for the treatment of unstable fractures of the distal radius, but its use is beset with complications. A plethora of theoretical and experimental data suggests that nonbridging fixators are superior for this setting. A new concept for the use of hybrid external fixation seemed reasonable and was applied for this study. MATERIALS AND METHODS: We report on the first 14 cases of unstable, extraarticular fractures of the distal radius with a one-year follow-up and describe the operative technique. All were treated at 3-5 weeks after injury; nevertheless, closed reduction after the fixator elements were fixed to the bone was always possible. RESULTS: We had no intraoperative complications, but in the follow-up period three cases of algodystrophy and one transient irritation of the ulnar nerve ensued. One case developed superficial infection at the K-wire entry site that resolved with local care and systemic antibiotics. No redisplacements were observed. Early and late (at one year) evaluation of results revealed good and very good anatomic results (Lidström system) and two satisfactory (cases with algodystrophy), eight very good and four good functional outcomes (Gartland-Werley system). The patients' acceptance of the device was high. CONCLUSIONS: Hybrid external fixation of neglected distal radial fractures results in good outcomes if care is taken to prevent overdistraction of bone fragments.