Surgical treatment of metastatic tumors of the femur.

OBJECTIVE: To evaluate the patients functional outcome and pain control after resection of metastatic femoral tumors. MATERIAL AND METHODS: A prospective randomized clinical study was conducted, which included 26 cases of metastatic tumors of the femur with an associated pathologic fracture. These selected cases were randomly divided into two groups based upon the using of methylmethacrylate cement in fracture fixation. Group 1 (n=13) included all cases where the fractures were treated with bone cement augmentation. Group 2 (n=13) included all cases where the fractures were treated without bone cement augmentation. Functional outcome was evaluated according the American Musculoskeletal Tumor Society system. RESULTS: Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (chi(2)=2.4762; P=0.115) of all cases in the Group 2. Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1. Total lower extremity function of full normal function was 67% in the Group 1 versus 49% in the Group 2 (P<0.05). We did not observe significant difference between patients' postoperative survival in the groups (P>0.05). The postoperative durability of stable pathologic fracture fixation was shorter in the Group 2 (273.9+/-51.7 vs. 358.9+/-116.8 days) comparing with Group 1 (P=0.03). CONCLUSIONS: The introduction of bone cement as the adjunct to the pathologic femoral fracture fixation significantly improved the clinical our study results: we achieved better functional outcome and better pain control.

Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial.

The results of minimally invasive techniques used for total knee replacement are controversial. Despite reported advantages such as faster recovery, there are some concerns regarding component positioning. We compared mini-midvastus versus medial parapatellar arthrotomy with respect to component position and functional results. We included 70 osteoarthritis total knee replacement patients in our study. Patients were randomised for the approach. We recorded Knee Society scores before and after the surgery and radiological component position. Patients were followed up to 12 weeks after the surgery. We found that the mini-midvastus approach was associated with better Knee Society scores six weeks after surgery; after 12 weeks the difference was not statistically significant. We found no difference related to the approach in radiological component position. The mini-midvastus approach is associated with faster recovery and reproduces the same accuracy in component positioning as the medial parapatellar approach.

[Surgical treatment of humeral metastatic tumors]. / Chirurginis zastikaulio metastaziniu naviku gydymas.

OBJECTIVE: To evaluate the functional outcome and pain control in patients after resection of humeral metastases. MATERIAL AND METHODS: A prospective randomized study of 24 cases of metastatic disease of the humerus with an associated pathologic fracture was carried out. The selected cases were divided into two groups based on the using methylmethacrylate cement for fracture fixation. Group 1 (n=12) included all cases in which the fracture was treated with bone cement augmentation. Group 2 (n=12) included all cases in which the fracture was treated without bone cement augmentation. Functional outcome was evaluated according to the American Musculoskeletal Tumor Society system. RESULTS: Good and excellent pain control was achieved in 95% of cases in both groups. Functional outcome after resection of humeral metastases and pathological fracture fixation was significantly better in Group 1. Total function in five patients (45%) accounted for 86% and in three patients (25%) for 83% of full normal upper extremity function, whereas in Group 2, total function in six patients (50%) accounted for 70% and in three patients (25%) for 83% of full normal upper extremity function. The rate of fixation failure was significantly greater in Group 2, where fixation instability was observed in 50% (n=6) of cases (P=0.03). There were no significant differences in complication rate (in 50% of cases, mechanical instability occurred after fixation with intramedullary nail and in 50% of cases after fixation with plates). CONCLUSIONS: The introduction of bone cement as an adjunct to fixation of pathologic fracture improved clinical results and reduced the rate of fixation failure.

Effect of femoral head size on polyethylene wear and synovitis after total hip arthroplasty: a sonographic and radiographic study of 39 patients.

BACKGROUND AND PURPOSE: The role of synovitis and high fluid pressure in the loosening process after total hip arthroplasty has gained increasing attention. We investigated the correlation between head size, polyethylene wear, and capsular distention. PATIENTS AND METHODS: We analyzed 39 unrevised, radiographically stable hips that had been operated with 28 or 32 mm femoral heads 10 years earlier because of osteoarthritis. We evaluated radiographic signs of loosening, linear and volumetric polyethylene wear, body mass index, activity level, and age. Sonographic examination was performed to measure capsular distance i.e. the distance between the prosthetic femoral neck and the anterior capsule. RESULTS: Linear wear was 0.09 mm/year and 0.18 mm/year in the 28 mm and 32 mm groups, respectively (p < 0.001). The volumetric wear was 51 mm(3)/year and 136 mm(3)/year (p < 0.001) and the capsular distance was 13 mm and 17 mm, respectively (p < 0.001). There was a correlation between linear wear (r = 0.54), volumetric wear (r = 0.62), and capsular distance (p < 0.001). INTERPRETATION: Wear was greater for the larger femoral head and was correlated to capsular distension.

[A prospective comparison of double- and single-bundle anterior cruciate ligament reconstructions]. / Prospektyvusis dvieju ir vieno pluosto priekinio kryzminio raiscio rekonstrukcijos metodu palyginimas.

OBJECTIVE: A nonrandomized clinical study was performed to compare the clinical and radiological outcome between double-bundle and single-bundle anterior cruciate ligament (ACL) reconstructions with semitendinosus tendon in athletes. MATERIAL AND METHODS: We examined 70 patients with unilateral anterior cruciate ligament injury. They were followed up for a mean of 24 months. Each group of 35 patients underwent either double- or single-bundle ACL reconstruction. The mean age of the patients was 24.7 years (range, 18-35 years). There were no differences between two groups regarding age at surgery, sex, follow-up period, period before surgery, combined meniscus injuries, athletic activity level, and International Knee Documentation Committee (IKDC) and Tegner scores. All patients followed the same postoperative program. They were evaluated using manual knee laxity tests, knee extension and flexion strength testing. General knee condition was evaluated by the IKDC and Tegner scores. RESULTS: The results were excellent and good in 32 (91.4%) patients after double-bundle ACL reconstruction and in 30 (85.7%) patients after single-bundle ACL reconstruction, evaluating by IKDC system. However, statistical analysis showed no significant difference between the two groups regarding all IKDC-categorized data (P=0.87). The average scores of Tegner activity in double-bundle and single-bundle groups were 8.0 and 8.1, respectively. CONCLUSIONS: This trial showed no significant difference between the double and single-bundle ACL repairs.

Exeter total hip arthroplasty with matte or polished stems.

OBJECTIVE: To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stem type. MATERIAL AND METHODS: The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991-1995. Two different designs of Exeter stems were used: matte surface stems during 1991-1995 (matte surface group--47 cases), and polished stems during 1992-1995 (polished stem group--71 cases). During the second part of the study, 24 patients (11 in polished stem group and 13 in matte stem group) were prospectively examined with radiography and sonography. Sonography was performed in order to evaluate capsular distension, i.e. the distance between prosthetic femoral neck and anterior capsule. Capsular distension depends on synovitis and/or synovia in prosthetic hip. The relationship between capsular distension, stem type, and radiographic signs of loosening was assessed. RESULTS: For the first part of our study, total implant survival was 78% with matte stems and 61% with polished stems 13 years postoperatively (P=0.27). Stem survival was 82% for matte stems, and 88% for polished stems (P=0.54). In the second part of study, a significant relationship between increased capsular distension and cup loosening was determined (P=0.04). We did not find significant difference in capsular distension when compared matte and polished stems. CONCLUSION: Implant survival rates did not differ between the groups. The relationship between capsular distension and cup loosening was statistically significant.

The treatment of odontoid fractures with a significant displacement.

OBJECTIVE: The purpose of this study was to determine the treatment features of odontoid fractures with a significant displacement. MATERIAL AND METHODS: Thirty-seven patients with acute odontoid fractures were treated in Kaunas University of Medicine Hospital between 1998 and 2003. Seventeen persons with displacement of fragments less than 5 mm or 5 mm (according to E. A. Seybold and J. C. Bayley method) were in the first group. Twenty patients with displacement of fragments more than 5 mm were in the second group. The attempt of closed reduction of the cervical spine axis was performed for all patients. If successful closed reduction was achieved, patients were placed in halo-vest device for 8 weeks. If closed reduction failed, patient was operated according to W. E. Gallie. Postoperatively, all patients wore a halo-vest device during the first 8 weeks. RESULTS: Demographics including age, sex, neurological condition, and associated spinal fractures were similar in patients from these groups (p>0.05). Successful closed reduction of the cervical spine axis was achieved in 11 (64.7%) patients from the first group and in 13 (65%) patients from the second group (p>0.05). Six (35.3%) patients from the first group and seven (35%) from the second group were treated with immediate C1-C2 posterior fusion (p>0.05). Two (16.7%) from twelve patients from the second group were treated by external immobilization by halo-vest device and had nonunion of fracture 8 weeks after the treatment. All operated patients had a solid fusion. CONCLUSIONS: If closed reduction of the odontoid fracture with a significant displacement was achieved then external immobilization by halo-vest device can be used. Posterior fusion is the treatment of choice for irreducible odontoid fractures.

Metal type of the femoral stem in total hip arthroplasty.

OBJECTIVE: To compare the influence of two different cemented stems each made of different alloys on survival and outcome. MATERIAL AND METHODS: We analyzed 341 total hip replacements performed in 1998-2001. Two types of prostheses were implanted. Biomet Bi-Metric titanium stem, cobalt-chrome head and ultra high molecular weight all poly cup were implanted in 102 cases. Aesculap Centrament cobalt-chrome stem, head and ultra high molecular weight all poly cup were implanted in 239 cases. All prostheses were cemented; Palacos bone cement with gentamycin was used in all cases. Cementing technique was consistent in all cases. All data were collected prospectively. For every total hip replacement the form was filled in. The documental patients' data, implant type, cement type, cementing technique, intraoperative and postoperative complications were registered. All revision surgeries were registered; the patients' death dates were recorded from national register database up to December 31, 2004. Kaplan-Meier curves were used to calculate implant survival rates. RESULTS: The total implant survival for Biomet Bi-metric prostheses was 98%, 7 years postoperatively. The total implant survival as Aesculap Centrament prostheses were used was 98%, 6 years postoperatively. CONCLUSION: The mid-term implant survival of Biomet Bi-Metric titanium stems was the same as survival of Aesculap Centrament cobalt-chromium stems.

Total hip replacement for the treatment of femoral neck fractures. Long-term results.

OBJECTIVE: To evaluate the outcome of total hip replacement after femoral neck fractures and analyze implant survival rates, complication rates, and mortality after surgery. MATERIAL AND METHODS: We analyzed 135 primary hip replacements and 8 revision hip replacements performed in 1991-2003 years. Femoral neck fracture was the diagnosis for all primary hip replacements. All patients we analyzed prospectively: special form was filled in for every patient participating in the study. Personal data, operation data, revision date, diagnosis and complications were recorded. Personal patient's identification number was used to determine the death date if it was present, and it was checked if the patient was operated on in other orthopedic centers. Study ended up on 31st of December, 2003. RESULTS: Total cumulative implant survival rate was 92% and 94% for revision because of aseptic loosening 10 years postoperatively. Stem survival was 95% for revision because of aseptic loosening. Cup survival was 94% for revision because of aseptic loosening. Implant type had no influence on survival rates. Dislocation rate after hip replacement was 10%. Mortality was 25% at the end of the follow-up. CONCLUSIONS: Total hip replacement after femoral neck fracture showed high implant survival and low additional surgery rate. Total hip replacement after femoral neck fracture was associated with high dislocation rate. Low patient's mortality rate was associated with relatively lower mean patient's age.

[Evaluation of combined menisci repair results]. / Kompleksines menisku susiuvimo metodikos rezultatu ivertinimas.

Between 2001 and 2003 sixteen patients underwent repair of the menisci with combined "outside-inside", "all-inside" and reabsorbable arrow techniques. This prospective study compared two patient groups: combined fixation group (16 patients) and "outside-inside" fixation group (16 patients). Patients were evaluated using Lysholm and Tegner activity scales. Results of 12 (87.5%) patients in combined fixation group were excellent and good at the time of last follow-up. Results of 10 (62.5%) patients in "outside-inside" fixation group were excellent and good 10 months post operations. There was statistically significant difference between the groups (p<0.05).

[Early results of total ankle arthroplasty]. / Ciurnos sanario endoprotezavimo ankstyvieji rezultatai.

UNLABELLED: Objective of the study was to evaluate total ankle arthroplasty as the treatment of choice for ankle arthritis; to analyze variables' influence upon early results after total ankle arthroplasty; and to determine early and late postoperative complications and the ways to avoid them. MATERIAL AND METHODS: We evaluated clinical results of 18 patients (out of 23 operated patients), for whom total ankle replacement was performed in 1998-2003. Uncemented Scandinavian Total Ankle Replacement (WLink, Germany) endoprosthesis was used in all cases. The patients were examined, questioned and evaluated according to modified rating system recommended by American Orthopedic Foot and Ankle Society. We observed early and late postoperative complications. RESULTS: Excellent and good results were observed in 9 cases (50%); fair results were in 6 cases (33%), poor in 2 cases (12%), and failure in 1 case (5%). Complications occurred in 11 cases (61%): 4 patients had neurological complaints in operated foot, delayed wound healing was observed in 2 cases, 3 patients had plantar flexion contracture, for 1 patient arthrodesis was done because of dislocation of meniscus component. CONCLUSIONS: Total ankle replacement is an alternative treatment to arthrodesis after posttraumatic ankle arthritis. Results after total ankle arthroplasty are worse than after total hip or knee replacement. Operative technique has great influence on total ankle replacement results. Accurately selected indications for surgery decrease complication rate.

[Hip revision arthroplasty (long-term results)]. / Revizinis klubo sanario endoprotezavimas (velyvieji pooperaciniai rezultatai).

OBJECTIVE: To evaluate the risk factors after total hip replacement arthroplasty for rerevision and to analyze complications after hip revision surgery. MATERIAL AND METHODS: We obtained data from 117 hip revisions and 12 hip rerevision arthroplasties performed in 1992-2001 in the Department of Orthopedics of Klaipeda Hospital. Special forms were filled in for every patient who participated in the study. Name, operation date, type of implants, operative technique, revision diagnosis, intraoperative and postoperative complications were recorded. All patients were checked for death until 2003. RESULTS: Hip revisions were performed for 77 (66%) women and 50 (44%) men in 1992-2001. We revised 22 (19%) cups, 6 (5%) stems, 86 (74%) total hip revisions; femoral head was exchanged for 3 patients. Revision diagnoses were: aseptic loosening in 106 (90%) cases, recurrent dislocations in 7 (6%) cases, and periprosthetic fractures in 4 (4%) cases. Patients' age varied from 26-82 years, average 63.5 years. In revision group only 8% of patients were less than 50 years old, compared to 33% in rerevision group. Morselized allografts and bone impaction technique for reconstruction of bone defects were used in 70 (60%) of cases. We rerevised one cup only for which revision morselized allografts were used. Eight (67%) rerevisions were performed after first 28 (24%) hip revisions. CONCLUSIONS: Patients, who underwent revision surgery being younger than 50 years old, were at higher risk for rerevision surgery. Revision with morselized bone allografts and bone impaction technique decreases number of rerevisions. Learning curve was steep and had great influence to our results.

[Treatment of early and late obstetric brachial plexus palsy]. / Vaiku peties nervinio rezginio pazeidimo ir jo sukeltu padariniu gydymas.

The aim of this study was to review and to analyze treatment patterns of early and late obstetric brachial plexus palsy. Eighty-one children with early and late obstetric brachial plexus palsy were treated in the Department of Pediatric Orthopedics and in the Postintensive Care Unit within the period 1988-2002. Children were classified into 2 groups according to age: Ist group (67 newborns) was treated conservatively, and IInd group (14 children with late obstetric brachial plexus palsy with deformity) underwent operative treatment. Active hand movements and innervation were evaluated before and after treatment. Thirty newborns had full recovery, 32 newborns had incomplete recovery, and in 5 cases no improvement was seen. Fourteen children with late obstetric brachial plexus palsy underwent the following operations: rotation osteotomy of the humerus was performed in 10 cases, lengthening of biceps and brachialis muscle tendons--in 6 cases, transposition of triceps muscle tendon--in 1 case, transposition of pectoralis major tendon--in 3 cases and flexor carpi transposition--in 1 case. There was an improvement in active hand movements after operative treatment and rehabilitation. According to our experience, in most cases newborns recover spontaneously or after conservative treatment. Secondary reconstructive surgery of late brachial plexus palsy can improve the condition of these patients.

[Features of the spinal cord injury in distractive flexion and compressive extension cervical spine trauma]. / Nugaros smegenu pazeidimo ypatybes esant stuburo kaklines dalies distrakciniams lenkimo ir kompresiniams tiesimo suzalojimams.

OBJECTIVES: 1) to assess neurological status in patients with distractive flexion and compressive extension cervical spine injuries; 2) to determine the relationship between neurological recovery and the patterns of cervical spine injuries. MATERIAL AND METHODS: Prospectively collected data on 78 persons with traumatic distractive flexion and compressive extension cervical spine injuries. These patients were treated in Kaunas University of Medicine Hospital between 1998 and 2000. The study included 18 (23.1%) females and 60 (76.9%) males. The age range was 16-80 years, mean age was 46.6 years. Cervical spine injuries in all patients were visualized at using Computed tomography and radiography. The cervical spine injury patterns were recognized by the Ferguson-Allen's classification. We divided these patients into two groups: the first group included patients who had sustained distractive flexion cervical spine injuries; the second group included patients who had sustained compressive extension cervical spine trauma. We assessed neurological status of these patients after admission to hospital in the average of four hours after an accident. Motor and sensory evaluation was conducted using the guidelines established by the American Spinal Cord Injury Association. Forty-nine patients were investigated in the average of four years after trauma and treatment. We assessed their neurological status and determined the relationship between neurological recovery and the patterns of cervical spine injury. RESULTS: Forty-eight (61.5%) patients had distractive flexion cervical spine injuries (the first group) and 30 (38.5%) had compressive extension trauma (the second group). We compared patients from the first and the second groups and did not find any difference among an accident circumstances (p>0.05), the level of the cervical spine injury (p>0.05) and neurological status at the early period after a trauma (p>0.05). Eight (16.7%) patients died from the first group, 5 (16.7%) from the second group due to severe spinal cord injury (p>0.05). Thirty patients from the first group, and 19 patients from the second group were investigated in the late posttraumatic period (average four years). We performed statistical analysis of these patients and did not find any difference between the accident circumstance (p>0.05), the level of the cervical spine injury (p>0.05), displacement of the vertebra body (p>0.05), neurological status and did not determine the relationship between neurological recovery and the patterns of cervical spine injuries. CONCLUSIONS: Neurological status of the patients with distractive flexion and compressive extension cervical spine injuries did not differ. The relationship between neurological recovery and the patterns of cervical spine injuries did not exist.

[Cervical spine trauma and spinal cord injury: the deaths caused by spinal cord swelling]. / Stuburo kaklines dalies trauma ir nugaros smegenu pazeidimas: mirstamumas nuo nugaros ir pailguju smegenu edemos.

OBJECTIVE: To investigate clinical status features of the patient's who died from spinal cord and brain swelling. MATERIAL AND METHODS: Retrospectively collected data on 67 persons with severe spinal cord injury. These patients were treated and died in Kaunas University of Medicine Hospital between 1995 and 2003. The death reasons were determined after autopsy. The study included 2 (3%) females and 65 (97%) males. The age range was 16-82 years, mean age was 49.6 years. Cervical spine injuries in all patients were visualized at computed tomography and radiography. The cervical spine injury patterns were determined using Ferguson-Allen's classification. Motor and sensory evaluation after admission to hospital was conducted using the guidelines established by the American Spinal Cord Injury Association. From this group of patients, 48 cases were selected with spinal cord swelling as the reason of death. We divided these patients into two groups; 21 patients with C4-C5 neurological level were in the first group and 27 persons with C6-Th1 neurological level were in the second group. RESULT: . We compared the patients from the first and the second groups and did not find any difference between their age, the patterns of the accidents, the patterns of the cervical spine injuries (p>0.05), clinical status after admission to hospital and six hours before patient's death (p>0.05). Patients, who died from spinal cord swelling, had alterations in cardiopulmonary function before their death. The patients from the first group died on average in 80 hours after the accident; the patients from the second group died on average in 146 hours after the trauma (p<0.05). CONCLUSIONS: Patients, who died from spinal cord swelling, had distinct respiratory failure before their death. Alterations of the clinical status of patients with C4-C5 neurological level were faster.

Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty.

Dislocation after total hip replacement is more common in the early, postoperative period. Postoperative intraarticular haematoma and remaining seroma fluid and/or weakened posterior soft tissue wall may be contributing factors. Our purpose was to compare and follow with sonography the resorption of the postoperative volume of intraarticular fluid/synovial oedema after total hip arthroplasty (THA) with or without posterior soft tissue repair. Thirty-three consecutive patients with hip osteoarthritis were admitted for THA. All of them received the same type of cemented implant. Patients were randomised for posterior soft tissue repair or not. Sonography, measuring the anterior capsular distension, indicating the volume of intraarticular fluid/synovial oedema in the prosthetic hip joints, was performed after six and 12 months in all patients. At six months postoperatively greater capsular distension, i.e., remaining volume of intraarticular fluid/synovial oedema, was observed in the group with posterior soft tissue repair than in the group without. After one year the capsular distension had decreased in both groups and there was no significant difference between the groups. Our results show that posterior soft tissue repair after THA is associated with increased capsular distension during the first six months. After 12 months the volume of intraarticular fluid/synovial oedema is the same with or without posterior soft tissue repair.

Management of acute traumatic atlas fractures.

OBJECTIVE: A prospective review of a clinical series was performed. The treatment features of atlas fractures with and without associated axis injuries were investigated. METHODS: Twenty-nine patients were investigated. RESULTS: No displaced fractures were treated with a cervical orthosis. Patients with displaced fractures were managed with a halo vest immobilization; 96.4% patients had a solid fusion at their last follow-up evaluations. CONCLUSIONS: Isolated not displaced or combined with not displaced axis fractures atlas fractures can be treated effectively with a rigid cervical collar alone. Isolated displaced fractures or not displaced but with concurrent displaced axis fractures require immobilization by the halo vest.

[Treatment of supracondylar humerus fractures in children, according to Gartland classification]. / Virsgumburiniu zastikaulio luziu gydymas vaikams remiantis Gartlando klasifikacija.

Supracondylar fractures are the most common fractures in the area of elbow in children. The purpose of this study was to review and analyze the treatment patterns of supracondylar humerus fractures in childhood. There were 93 children with supracondylar humerus fractures treated in the Department of Pediatric Orthopedics within the period from March 2000 till November 2002. Ninety fractures were extension-type injuries, 3 were flexion injuries, these were not included in our study. Supracondylar humerus fractures were classified according to Gartland classification. Type III fractures were found in 63 patients, type II fractures were seen in 23 patients and 4 patients had type I fractures. Indications for treatment were determined according to fracture type. Four children were treated with external immobilization alone. Twenty-three patients underwent closed reduction and percutaneous pinning by K-wires. Sixty-two patients were treated with closed reduction and external immobilization such as a plaster cast or according to Blount. Eleven of these 62 children (type III) underwent close or open reduction and internal fixation in follow-up. In 1 case of comminutive fracture a patient underwent immediate operation. There were no early or late complications. All operated patients healed without sequela and had excellent or good results. We had noticed that all manipulations should be performed immediately in order to avoid severe swelling and neurological or vascular complications. In type I fractures we performed the external immobilization only. Type II displaced fractures can be treated satisfactorily with closed reduction and external immobilization. Type III displaced fractures should be treated with closed reduction and percutaneous pinning with K-wires under the fluoroscope guidance. It is believed to be a safe, reliable and efficient method for treatment of this difficult fracture. Indications for open reduction and internal fixation includes open fractures, fractures complicated by vascular injury, unsatisfactory closed reduction due to unstable fracture.

[The treatment and complications of intraarticular fractures of the distal radius]. / Stipinkaulio distalinio galo intrasanariniu luziu gydymas ir komplikacijos.

UNLABELLED: The purpose of this trial was to determine the rate of complications and the cause of complications after intraarticular fractures of the distal radius. We examined those patients, who had intraarticular fractures of the distal radius and who were treated in Kaunas University of Medicine Hospital and Kaunas Red Cross hospital in 1998-2000. The evaluation of results was made by movement of the joint and pain in the wrist, which was evaluated by pain scale and McGill pain questionnaire. Palmar slope, radial inclination and radial length were evaluated rentgenologically. Distal radioulnar joint was evaluated as well (with evaluation of scapholunate ligament condition). Patients were investigated 1.5 and 2 years after fracture. RESULTS: There are more secondary dislocations and the shortening of radius in group that was treated by gypsum bandage. Good distraction of fracture ends is seen using external fixation, but strain of soft tissue gives complications: contraction of fingers, and instability of wrist. The incongruence of joint surface causes early arthrosis and pain. The injury of ligaments in the wrist, which can be seen by X-ray examination, causes instability of wrist and chronic pain.

[Minimally invasive arthroscopic treatment of shoulder impingement]. / Peties sanario ankstumo sindromo minimaliai invazinis artroskopinis gydymas.

Between 2000 and 2002 thirty four patients were evaluated after arthroscopic acromionplasty procedures. Patients had different shoulder pathology and were evaluated 15+/-1.2 months post operations through Constant scale and with x-rays. The mean age of patients was 42+/-6.5 years during operations. Twenty eight (82.3%) arthroscopic assisted acromionplasties results were good at the time of last follow-up. Final evaluation showed statistically significantly improvement of the Constant results from 26+/-6.24 preoperatively to 60+/-7.56 postoperatively (p<0.05).