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.

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.

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 Impact of Chronic Pain, Stiffness and Difficulties in Performing Daily Activities on the Quality of Life of Older Patients with Knee Osteoarthritis.

Osteoarthritis causes a number of physical ailments, which result in the deterioration of a persons' general health and reduction of their ability to move freely. This cross-sectional study was designed to assess the impact of physical ailments in the course of knee osteoarthritis (KOA) on the quality of life (QoL) of patients in early old age. An anonymous survey was conducted by the use of the recognized research tools: Western Ontario scale and McMaster Osteoarthritis Index (WOMAC), The Index of Severity for Knee Disease (ISK) and World Health Organization Quality of Life-BEFF (WHOQOL-BREF). The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without lower limb complaints. The significant intensification of the symptoms of knee osteoarthritis was associated with a worse assessment of health (p < 0.001), overall quality of life (p < 0.001) and in the following domains: physical (p < 0.001), mental (p < 0.001) and environmental (p < 0.001) in a group of patients with KOA. These findings suggest that taking measures to reduce knee pain and improve function may have an impact on improving the overall quality of the life of people in their early old age.

Pre-emptive analgesia with methylprednisolone and gabapentin in total knee arthroplasty in the elderly.

The aim of this study is to assess whether administration of gabapentin and methylprednisolone as "pre-emptive analgesia" in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). One hundred seventy patients above 65 years were qualified for the study, with exclusion of 10 patients due to clinical circumstances. One hundred sixty patients were randomly double-blinded into two groups: the study group (80 patients) and the control group (80 patients). The study group received as "pre-emptive" analgesia a single dose of 300 mg oral (PO) gabapentin and 125 mg intravenous (IV) methylprednisolone, while the control received a placebo. All patients received opioid and non-opioid analgesic agents perioperatively calculated for 1 kg of total body weight. We measured (1) pain intensity level at rest (numerical rating scale, NRS), (2) life parameters, (3) levels of inflammatory markers (leukocytosis, C reactive protein CRP), and (4) all complications. Following administration of gabapentin and methylprednisolone as "pre-emptive" analgesia, the NRS score at rest was calculated at 6, 12 (p < 0.000001), 18 (p < 0.00004) and 24 (p = 0.005569) h postoperatively. Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p = 0.000006). The duration time of analgesia was significantly longer in study group (p < 0.000001), with CRP values lower on all postoperative days (1, 2 days-p < 0.00001, 3 days-p = 0.00538), and leukocytosis on day 2 (p < 0.0086) and 3 (p < 0.00042). No infectious complications were observed in the first postoperative days; in the control group, one patient manifested transient ischemic attack (TIA). The use of gabapentin and methylprednisolone as a single dose decreased the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, and the level of inflammatory parameters without infectious processes.

The effect of cervical spine rotation on electromyographic activity of the trapezius and serratus anterior during selected shoulder complex movements.

PURPOSE: The purpose of the study was the assessment of the effect of cervical spine rotation on the activity of the upper (UT) and lower (LT) trapezius and serratus anterior (SA) muscles during selected shoulder movements. METHODS: The investigation included 33 healthy individuals (mean age ± SD: 22 ± 1.73 years). Bioelectrical activity of the right (R) and left (L) UT, LT, SA muscles was assessed during the following movements: elevation, flexion, abduction in the scapular and right coronal planes of the dominant (right) arm accompanied by three cervical spine positions (neutral, right rotation, left rotation). RESULTS: RLT EMG activity was higher during right shoulder abduction with right spine rotation vs. that registered during abduction without cervical spine rotation ( p < 0.001). RUT EMG activity during right shoulder abduction was higher when abduction was associated with left cervical spine rotation ( p < 0.01) and lower during right shoulder flexing with right cervical spine rotation, compared to shoulder movements with neutral spine position ( p < 0.001). A higher RSA EMG activity was seen during shoulder flexing ( p < 0.001) and abducting ( p < 0.05) (both in the frontal and scapular plane) when the movement was performed with right cervical spine rotation, compared to RSA activity during shoulder movements without spinal rotation. CONCLUSIONS: The present results suggest that inclusion of appropriate cervical spine rotation during shoulder movements may result in improved activity of the trapezius and serratus anterior.

Evaluating the Effectiveness of Soft Tissue Therapy in the Treatment of Disorders and Postoperative Conditions of the Knee Joint-A Systematic Review.

The term "soft tissue therapy" (STT) refers to mechanical methods of treatment involving passive kneading, pressing and stretching of pathologically tense tissues in supporting the process of recovery after surgery or trauma to the musculoskeletal system. The objective of this study was to review current scientific reports evaluating the effectiveness of the use of STT in patients with diseases or after surgical procedures of the knee joint. A systematic search of the popular scientific databases PubMed, Scopus and Embase was performed from inception to 15 October 2021. Eight articles met eligibility criteria and were included in the review. Six papers were related to disorders of the knee joint, while the remaining two studies were related to dysfunctions associated with the conditions after surgical intervention. The findings presented confirmed the effectiveness of STT in orthopaedic patients who showed an increase in lower limb functional parameters. The research has shown that the use of various methods of STT has a significant impact on increasing muscle activity and flexibility as well as increasing the range of motion in the knee joint. The physiotherapeutic methods used had a significant impact on reducing pain and increasing physical function and quality of life. The techniques used reduced the time to descend stairs in patients with knee osteoarthritis. This review summarises the effectiveness of STT as an important form of treatment for orthopaedic patients with various knee joint dysfunctions.

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 .

Impact of the SARS-CoV-2 Coronavirus Pandemic on Physical Activity, Mental Health and Quality of Life in Professional Athletes-A Systematic Review.

Due to the rapid rate of spread of the SARS-CoV-2 coronavirus, a number of restrictions have been introduced into public spaces, including those related to the operation of sports facilities, compounding the difficulty for athletes to conduct appropriate forms of training. The aim of this study was to review current scientific reports assessing the impact of the pandemic on the physical activity, mental state, and quality of life of professional athletes. Popular scientific databases-PubMed, Scopus, and Embase-were systematically searched from the beginning of the pandemic until 12 July 2021. According to the adopted criteria, 14 articles were included in the review. Ten of the qualified studies determined the impact of the pandemic on the physical activity of athletes. The authors of 11 papers assessed the mental state and quality of life of athletes during the pandemic. The studies showed negative effects of the pandemic: a decrease in overall physical fitness and number of days and hours of training, as well as an increase in the occurrence of negative emotions (stress, fatigue, and depression) and a decrease in sleep quality. Changes in physical activity had an impact on overall well-being ratings, which depended on the sex of the subjects. Women were more likely to experience negative emotions compared to men. The mental state of the athletes affected the quality of sleep. This review summarises the negative effects of the SARS-CoV-2 coronavirus pandemic on the physical and mental health of professional athletes.

The use of an alternating magnetic field in the resorption of postoperative joint effusion following anterior cruciate ligament reconstruction: A randomized double-blind controlled trial.

CONTEXT: There are no scientific reports unambiguously describing the efficacy of alternating magnetic field therapy in patients after anterior cruciate ligament (ACL) reconstruction in the early postoperative period. OBJECTIVE: This study aims to evaluate the efficacy of using an alternating magnetic field in the resorption of postoperative joint effusion in patients after ACL reconstruction. STUDY DESIGN: A randomized, double-blind placebo-controlled study. SETTING: Inpatients. PARTICIPANTS: Forty patients were enrolled in the trial. However, the final study group consisted of 38 patients (28 men and 10 women) after ACL reconstruction who were randomly divided into an experimental group (19 patients) and a control group (19 patients). INTERVENTION: Each group received magnetic field therapy in the postoperative period, but only 1 apparatus emitted a magnetic field (the experimental group). Patients used the apparatus every day for 30 minutes for the next 11 days. The parameters in both devices were the same-3 mT and 10 Hz. MAIN OUTCOME MEASURES: The measurement of the knee circumference and range of motion were made. The knee circumference measurement was performed before magnetic field therapy began and for 11 days after magnetic field treatment. The active knee range of motion was evaluated before and after magnetic field therapy was completed. RESULTS: There were no statistically significant differences between the groups in the reduction of post-operative joint effusion or knee joint function. CONCLUSION: In patients after ACL reconstruction, in whom an alternating magnetic field was used to treat postoperative joint effusion, there were no beneficial effects on the analyzed variables compared to the control group.

Association between cardiovascular disease, cardiovascular drug therapy, and in-hospital outcomes in patients with COVID-19: data from a large single-center registry in Poland.

BACKGROUND: The coronavirus disease 19 (COVID-19) recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19. AIMS: We analyzed the impact of CVD and the use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19. METHODS: We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020. RESULTS: 1729 patients (median interquartile range age 63 [50-75] years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, ß-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR], 6.4; 95% CI, 4.3-9.6), male sex (OR, 1.4; 95% CI, 1.1-2.0), pre-existing DM (OR, 1.5; 95% CI, 1.1-2.1), and HF (OR, 2.3; 95% CI, 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR, 0.4; 95% CI, 0.3-0.6), ß-blockers (OR, 0.6; 95% CI, 0.4-0.9), statins (OR, 0.5; 95% CI, 0.3-0.8), or antiplatelet therapy (OR, 0.6; 95% CI: 0.4-0.9) was associated with lower risk of death. CONCLUSIONS: Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.

Does kinesiotaping can improve static stability of the knee after anterior cruciate ligament rupture? A randomized single-blind, placebo-controlled trial.

BACKGROUND: The aim of the study was the assessment of the early impact of the selected kinesiotaping technique on the static stability of the knee joint in patients with ACL rupture on the basis of stabilographic parameters. METHODS: Sixty-two patients with a complete ACL rupture (32 patients in experimental group and 30 patients in placebo group) took part in the randomized single-blind, placebo-controlled trial. The ligament technique of KT was taken into consideration. Application of a KT tape only on the injured knee was to stabilize the knee joint. Experimental group had application of KT on the injured knee and the placebo group had a KT placebo application (with no tension on KT). Intervention and stabilographic test in both groups was the same. Research tools included measurements of static stabilographic parameters on stabilometric platform CQStab2P®. Outcome measures were assessed before intervention and after KT application. The analysis included evaluation of outcome variables - total path length, (SP), statokinesiogram path length in the XY axes (SPML, SPAP), and mean velocities in the XY axes (MV, MVML, MVAP). RESULTS: The results show a statistically significant shortening of the SP, SPAP and SPML variables only in experimental group. In the placebo group the results were not significant. The analysis also showed a significant improvement in all analyzed variables in the experimental group compared to the healthy side. In the placebo group, the results did not improve significantly after KT application compared to the healthy side. CONCLUSIONS: Application o f KT in patients after ACL rupture shortened the total path length and improved the value of parameters in the frontal and sagittal planes in experimental group, which may suggest the potentially greater improvement in these parameters. By improving the values of the analyzed variables, the KT application is able to compensate for the loss of static stability of the knee. TRIAL REGISTRATION: This study was registered retrospectively in the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number: ACTRN12616001407482 .

Changes in postural stability on balance platform in patients after meniscal repair - two years follow up.

PURPOSE: The aim of this work was to evaluate postural stability on the balance platform averagely 2 years following meniscal repair. METHODS: This is a retrospective, case-control comparative analysis of patients who underwent surgical repair for the isolated longitudinal traumatic meniscal tear versus matched healthy controls. The study group consisted of 30 patients (mean age 29.93 years; averagely 2.3 years after surgery) and the control group - of 30 people. Following physical examination and completion of the IKDC, and the Lysholm questionnaires, the evaluation of the postural stability using two single-leg stabilometry tests was performed. In the static test, the analyzed variables included deviations from the horizontal, vertical axes and the length of the balance path travelled. In the dynamic test, the length of the path travelled and the time to complete task were recorded. Between-limb and between-groups comparison of collected stabilometry tests were performed. Additionally, the IKDC and the Lysholm questionnaires scores were compared between the study and heathy groups. RESULTS: No abnormalities were found on clinical examination in the study group nor any differences between the operated and contralateral knee ( p > 0.05). In stabilometry: (1) in the study group, the operated extremity scored worse than the contralateral limb (length of path traveled in: A) static test x = 56.7 cm SD = 37.91 cm vs. x = 21.6 cm SD = 9.06 cm; p = 0.002 and B) dynamic test x = 82.57 cm, SD = 50.43 cm vs. x = 53.32 cm, SD = 13.82 cm; p = 0.003); (2) In the control group, no leg-related differences were noted ( p > 0.05); (3) Between-group comparison revealed that the study group scored worse than the control group (length of path traveled in: A) static test x = 56.7 cm, SD = 37.91 cm vs. x = 17.23 cm, SD = 3.39 cm; p = 0.001 and B) dynamic test x = 82.57 cm, SD = 50.43 cm vs. x = 32.13 cm, SD = 9.41 cm; p < 0.001). Study group scored worse on IKDC scores ( p < 0.001) but not on Lysholm score ( p > 0.05). CONCLUSIONS: Postural stability deficit persists despite a successful meniscal repair.

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.

Multiple Glomus Tumors in the Left Foot of 41-year-old Woman. A Case Report.

Glomus tumors are very uncommon neoplasms arising from glomus bodies. They differ in the proportion of components, i.e. smooth muscle tissue, vessels and glomus cells. The most common location of this kind of tumor is the subungual area of digits. In other locations, glomus tumors are very rare but have been reported, among others, in bone, lungs, trachea and stomach. Glomus tumors are often misdiagnosed because of diverse clinical presentations. They can be asymptomatic, may lead to cosmetic discomfort, but clinical presentation often involves pain, tenderness and cold hypersensitivity. We present a case of multiple glomus tumor in the foot of a 41-year-old woman. After several surgical consultations, she had been referred for further surgery including possible ampu-tation, which she declined. Simultaneous multiple excisions of the tumors resulted in complete symptomatic relief. This case confirms that glomus tumors should be considered in a patient with multiple lesions producing ex-cruciating pain.

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus.

BACKGROUND: The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. METHODS: Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. RESULTS: Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. CONCLUSION: The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. LEVEL OF EVIDENCE: Level III, retrospective comparative study.