X-ray features to predict ankle fracture mechanism.

INTRODUCTION: The genetic Lauge-Hansen classification has been traditionally used for reconstruction of the mechanism of ankle injury. The ability of the Lauge-Hansen classification to predict actual mechanism of the injury has been questioned in recent studies, leaving a void in medicolegal reasoning. The aim of this study is to identify morphologic features of malleolar fractures on plain X-rays that may be used to reveal the fracture mechanism. MATERIAL AND METHODS: Radiographs of 78 patients with acute malleolar fractures were analyzed and compared with fracture mechanisms reported by these patients. RESULTS: A modified Pankovich classification of medial malleolus fractures and the presence of a posterior malleolus fracture were able to significantly predict the mechanism of fracture reported by the patient (p<0.05). Lateral fracture morphology was not useful for predicting the fracture mechanism except for infrasyndesmotic fractures pointing to a supination mechanism. CONCLUSION: A supination mechanism of the fracture can be predicted by observing pure ligamentous or chip-avulsion deltoid injury. The presence of an anterior colliculus fracture of the medial malleolus is correlated with a pronation mechanism. A fracture of the posterior malleolus correlates with pronation while an intact posterior malleolus correlateds with supination as a fracture mechanism. Absolute determination of fracture mechanism from the X-ray morphology of the fracture is impossible in the majority of cases.

Usefulness and diagnostic value of the NEMA parameter combined with other selected bedside tests for prediction of difficult intubation.

STUDY OBJECTIVE: To assess the usefulness of the new NEMA (Neck Circumference Minus Acromion-Acromion Distance) parameter, in preoperative identification of patients' difficult intubation and compare it with other commonly used scales and tests. DESIGN: Prospective study. SETTING: District Specialist Hospital of Lublin, Poland. PATIENTS: Six hundreds twenty-nine patients underwent nonemergency surgical interventions. MEASUREMENTS: The NEMA parameter was confronted with: Modified Mallampati classification, TMD, RHTMD, NC, MPND, SMD, I-I D, A-AD, and medical history of difficult intubation and diagnosed obstructive sleep apnea syndrome or snoring. MAIN RESULTS: Higher medians of NEMA and Mallampati parameters were reported in patients with difficult intubation. AUC for Mallampati parameter was 0.733 while the NEMA parameter's AUC was 0.625. Sensitivity and specificity for Mallampati and NEMA parameter were respectively 0.79; 0.55 and 0.42; 0.75. Significantly higher MPN, RHTMD, Mallampati, and NEMA parameter were observed in patients in whom the BURP was used. Easy intubation occurs more frequently in patients with a history of OSAS or snoring than in those with difficult intubation. CONCLUSION: It seems that none of the known bedside tests for predicting difficult intubation have a discriminating power sufficient for clinicians. Our study draws attention to a novel parameter, called NEMA, which appears to be a strong predictor of DEI, especially in combination with the Mallampati scale.

Aseptic Destruction of the Elbow Joint after Radial Head Replacement. Case Study.

Radial head replacement should be a routine treatment in cases of non-reconstructable radial head fractures. With the growing number of radial head arthroplasties, we are going to see more complications related to this procedure. We describe a case of aseptic destruction of the elbow joint, probably related to the release of polyethylene particles from the prosthetic head. Removal of the implant and extensive synovectomy was performed, leading to an excellent clinical outcome with reduction of pain and increase in the range of motion. The clinical improvement was not accompanied by radiographic change.

Translation, Cultural Adaptation and Validation of Polish Version of Foot and Ankle Outcomes Questionnaire.

BACKGROUND: The Polish orthopaedic literature lacks a tool to measure patient reported treatment outcomes in the foot and ankle. MATERIAL AND METHODS: The translation and cultural adaptation of the Foot and Ankle Outcomes Questionnaire was performed in accordance with relevant guidelines. The Polish version of the questionnaire was tested to check its test retest reliability, internal consistency and construct validity. RESULT: The Polish version of the questionnaire was prepared. Testing of the questionnaire revealed acceptable test retest reliability, internal consistency and construct validity. CONCLUSION: The translation, cultural adaptation and testing of the Polish version of patient related outcome measuring tool for the foot and ankle is described.

Surgical management of congenital radial head dislocation: a case report.

Congenital radial head dislocation is a rare condition which is, however, the most common of all congenital pathologies of the elbow joint. This paper is a case report on a patient presenting with moderate pain and discomfort in one of his elbow joints, both of which were found to be affected by this condition. He was treated by surgery which consisted of resection of the proximal radius and partial anterior capsulectomy of the elbow joint. This treatment led to a significant improvement in pain and elbow function compared to the preoperative status.