The Effectiveness of Physical Therapy in Patients with Generalized Joint Hypermobility and Concurrent Temporomandibular Disorders-A Cross-Sectional Study.

Temporomandibular disorders (TMD) consist of a group of symptoms such as: pain of temporomandibular joints, masticatory muscles or surrounding tissues, dysfunctions of TMJs' mobility, and crepitation. The Hypermobility Joint Syndrome (HJS) manifests in the flaccidity of joint structures, an increase in the range of joint motion, and occurs more often in the young and women. The aim of this study was to present the occurrence of HJS among patients with myogenic TMD and disc displacement with reduction. The secondary goal was to assess the effectiveness of physiotherapy directed to TMD with coexisting HJS. The study involved 322 patients with symptoms of TMD. HJS was diagnosed using the Beighton Scale, which confirmed its occurrence in 26 cases. 79 subjects (7 males and 72 females; mean age, 33.9 ± 10.4 years) were selected and divided into two groups: HJS + TMD (n = 26; 2 males and 24 females; mean age, 27.1 ± 9.4 years) and TMD (n = 53; 5 males and 48 females; mean age, 37.4 ± 9.2 years). These patients completed 3-week physiotherapy management. Before and after physiotherapy, the myofascial pain severity on Numeric Pain Rating Scale, linear measurement of maximum mouth opening, and opening pattern, were assessed. To demonstrate differences between the results, the level of significance for statistical analysis was set at α = 0.05. A statistically significant improvement was obtained in decreasing myofascial pain in both groups. Coordination of mandibular movements was achieved in both groups. Generalized joint hypermobility occurred among patients with TMD. Physiotherapy directed to TMD was effective in reducing myofascial pain and restoring TMJ's coordination also in patients with HJS.

A double-blind, randomized, multicenter study of MP4OX for treatment of perioperative hypotension in patients undergoing primary hip arthroplasty under spinal anesthesia.

BACKGROUND: MP4OX (oxygenated polyethylene glycol-modified hemoglobin) is a novel oxygen therapeutic agent specifically developed to perfuse and oxygenate tissue at risk for ischemia and hypoxia. In this study, we investigated the ability of MP4OX to treat hypotensive episodes. In addition, the tolerability profile of MP4OX in a large surgical population was established. METHODS: Patients from 21 study sites in 5 countries, scheduled to undergo primary hip arthroplasty under spinal anesthesia, were randomized in a double-blind manner to receive MP4OX or hydroxyethyl starch (HES) solution (Voluven®; HES 130/0.4). Patients received the first 250-mL dose of investigational product when systolic blood pressure decreased to the predefined dosing trigger. A second 250-mL dose was given only if the systolic blood pressure decreased to the same trigger level after administration of the first dose. The primary efficacy outcome was total duration of all hypotensive episodes during surgery and the first 6 hours after skin closure. RESULTS: Of the 474 patients randomized, 405 reached the dosing trigger and received at least 1 dose. The mean total duration of all hypotensive episodes was significantly shorter (P < 0.0001) in the MP4OX group (52.4 ± 71.50 minutes; range, 3-442 minutes) compared with the HES group (137.6 ± 120.21 minutes; range, 5-435 minutes). The overall incidence of adverse events (AEs) in the intent-to-treat population was similar between the MP4OX and HES groups (75.2% vs 73.4%; P = 0.733). Transient increases in laboratory values were reported in more patients in the MP4OX group versus HES controls for aspartate aminotransferase (13.4% vs 7.4%; P = 0.052), alanine aminotransferase (6.9% vs 4.9%; P = 0.409), lipase (9.7% vs 3.6%; P = 0.015), and troponin (8.1% vs 2.0%; P = 0.006). There was no significant difference in the incidence of serious AEs reported (6.4% in MP4OX group vs 3.0% in HES controls; P = 0.106). Certain AEs did occur more frequently in the MP4OX group, including nausea (23.8% vs 14.3%; P = 0.016), bradycardia (14.9% vs 5.9%; P = 0.003), hypertension (8.4% vs 2.5%; P = 0.009), and oliguria (5.9% vs 1.5%; P = 0.019). The composite morbidity and ischemia end points did not reveal any differences between the 2 treatment groups. CONCLUSIONS: Administration of MP4OX achieved the end point of treating perioperative hypotension in patients undergoing primary hip arthroplasty under spinal anesthesia. The study was not powered to demonstrate clinical benefit based on the composite morbidity or ischemia outcomes. Although efficacy end points with sufficient power were met, MP4OX is not being proposed for use in routine surgery where the risk-benefit profile would not be favorable based on the safety profile demonstrated in this study.

Chondrocyte suspension in fibrin glue.

Autologous chondrocyte implantation has been shown to be a promising method for treatment of deep articular cartilage defects. The hyaline cartilage formed by implanted autologous chondrocytes has biomechanical properties similar to those of natural articular cartilage. Between June 2006 and September 2008 we performed Autologous chondrocyte implantation (ACI) in 50 patients and the chondrocytes were supported in fibrin glue. The cartilage biopsy samples were taken from the nonweight bearing area of the patient's femoral condyle and the samples were transferred to the cell culture laboratory. Chondrocyte were kept in culture about 20 days. Fibrin glue was used as a three dimensional carrier for chondrocyte implantation. A 450 ml of patient's own blood was collected prior to transplantation to produce autologous fibrinogen. Alternatively the allogenic fibrinogen was prepared from Regional Blood Center voluntary donors. Before surgery the chondrocyte suspension was mixed with fibrin glue and gel - like fibrograft was prepared. The total number of cells and the size of fibrograft depended on the defect size in the knee. Our results suggest that ACI technique with fibrin glue is a promising method for treatment of cartilage defect.

Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury.

Despite advances in surgical techniques and pharmacology, healing of injury-associated soft tissue defects is frequently complicated by infections, which often requires a secondary intervention. Cytokines are important mediators of healing. Application of autologous platelet-rich plasma enriched in growth factors and antimicrobial proteins, known also as platelet-leukocyte rich plasma (PLRP), represents a novel approach to the treatment of soft tissue and bone healing disturbances. This case is the first report on the application of PLRP in an infected high-energy soft tissue injury and shows that the volume and concentration of platelets and leukocytes is adequate to induce healing processes despite concurrent infection.

Bone mineral density changes after total knee arthroplasty: one-year follow-up.

The study involved analysis of differences in bone mineral density (BMD) in the region of knee arthroplasty in 106 female patients. BMD was assessed using dual-energy X-ray absorptiometry in a follow-up time schedule: before surgery and 2 weeks postoperatively (baseline), 5, 12, 24, and 48 weeks after knee joint arthroplasty. Four assessment regions A, B, C, and D were determined in immediate proximity to the arthroplasty site. A year after surgery, a decrease in BMD was observed in all determined regions-(9.9%, 13.8%, 9.9%, and 7.6% respectively) in comparison with the baseline value. The most significant BMD decrease was observed in the period between 5 and 12 weeks after the knee joint arthroplasty. In our opinion, the decrease in BMD at the knee joint arthroplasty site is a result of the postoperative increased bone resorption and decreased patient motor activity.

Improved treatment of mandibular odontogenic cysts with platelet-rich gel.

BACKGROUND: Platelets play a central role in hemostasis and healing processes. By concentrating platelets, platelet-rich plasma (PRP) with higher levels of growth factors can be obtained, which might stimulate healing processes. After platelet degranulation, massive release of growth factors and active substances occurs and gelatinous matrix-platelet-rich gel (PRG) is formed. OBJECTIVE: In this double-blind study, we report the influence of PRG on healing of mandibular odontogenic cysts. STUDY DESIGN: We examined 23 cases divided into control (no PRG treatment) and experimental (PRG-treated) groups. Each participant was followed on a regular basis with clinical examinations, roentgenograms, and dual-energy x-ray absorptiometry (DEXA) examinations. RESULTS: Clinical observations showed that oral mucosa healed faster in patients treated with PRG compared with cases where gel was not added. Roentgenograms and DEXA examinations showed considerable enhancement of bone regeneration beginning from the 5th week and continuing during subsequent periods after implantation of PRG in the experimental group compared with the control group. CONCLUSIONS: In our opinion, PRG possesses inductive properties that could stimulate the healing processes. The use of autologous growth factors from platelet gel seems to be one of the most promising methods of treatment of bone, cartilage, and soft tissue defects.

Use of densitometric examination after cemented total knee arthroplasty.

Background. Dual energy X-ray absorptiometry (DXA, DEXA) is one of many ways of measuring bone mineral density (BMD). Considering the fact that it is possible using DXA analysis to distinguish metal elements from bone, this method seems to be optimal in the assessment of bone mineral density in the area of an inserted implant. The aim of our study was to examine the usefulness of DXA examination of the knee joint area after cement arthroplasty. Material and methods. A BMD analysis of four areas surrounding the knee prosthesis was performed using the author's own method. Results. After a series of densitometry analyses, the coefficient of variation (CV) and the least significant difference (LSD) were determined. Conclusions. DXA analysis of the knee joint after arthroplasty using the method described here shows high repeatability. Periodic DXA analysis of the vicinity of the knee prosthesis may be useful in assessing the dynamics of change occurring around the implant.

The impact of selected metallic elements in the environment on the occurrence of osteoporosis in the voivodeship of Silesia.

Background. The existence of toxic metallic elements in the environment is one of the most important factors influencing the metabolism of calcium. The aim of our study was to compare the incidence of osteoporosis in Upper Silesia to the level of environmental pollution with lead, cadmium, zinc, and copper. Material and methods. An epidemiological data base gathered by the Silesian Branch of the National Health Fund was used to gather data concerning the incidence and treatment of osteoporosis in Silesia, with and without pathological fractures. Results. The results of our analysis suggest that the frequency of osteoporosis, with or without pathological fractures both, correlates with increased concentrations of lead, cadmium, copper and zinc in the environment. This relation can be noticed especially in the Upper Silesian Industrial District. Conclusions. In regions with increased risk due to the occurrence of significant amounts of heavy, osteotropic elements, programs should be implemented to intensify screening for osteoporosis.

An integrated system for the management of decubitus ulcers.

Background. The purpose of this article is to draw closer attention to a particularly important orthopedic problem: the prevention and early treatment of decubitus ulcers (bedsores). Material and methods. We retrospectively analyzed medical documentation for all orthopedic patients seen in our clinic during the period 1997-2003 (a total of 13,710 patients), and treated in accordance with an in-house protocol. Results. There were 3,061 patients (22.3% of all hospitalized) classified as high risk for decubitus ulcers. During the 7-year observation period, decubitus ulcers began to form in 103 patients, which comes to 0.42-1.49% of all orthopedic patients hospitalized each year. We observed a decreased incidence during the period in question; in the last year, 2003, 4.7% of the high-risk patients developed decubitus ulcers. Conclusions. Therapeutic success depends on effective cooperation between physicians and nurses.

External fixation in the treatment of severe tibial fractures complicated by soft tissue injury.

Background. In recent years multiple injuries to the tibial shaft have become increasingly common. High-energy impacts cause comminuted fractures, often accompanied by damage to neural and vascular structures, muscle, and surface layers. The key to good healing is preserving normal blood supply. Serious damage to the tibia should be treated by external stabilization. Material and methods. A group of 23 patients with severe tibial fractures accompanied by soft-tissue injures were treated surgically, using Polfix, Ilizarov and Dynastab external stabilizers. Open fractures were classified according to the Gustillo-Anderson scale. Internal bone transport and the Ilizarov apparatus were used for the treatment of fractures with bone defect. Bone infections were treated with targeted antibiotic therapy and flush drainage. In cases with staphylococcus infection anti-vaccination was used. Plastic surgery was performed to cover soft tissue defects. Polfix stabilizers were removed after 35 weeks, Ilizarov after 45 weeks, and Dynastab after 18 weeks. The Sarmiento cast was applied in 6 cases. Results. In all patients treated with external fixation good results we observed. Conclusions. In the treatment of open tibial fractures complicated by significant bone defects and soft-tissue defects (type IIIB/C), the methods of choice are Ilizarov or Dynastab stabilizers. Polfix or Dynastab stabilizers are suitable for open fractures of types I-IIIA. Serious tibial injury necessitates the use of various kinds of skin grafts, so the best solution is regular cooperation with a plastic surgeon. Treatment with Sarmiento's functional plaster cast is a valuable supplement to external fixation.

Atypical course of hematogenous osteomyelitis of the hip: a case report and clinical considerations.

The hematogenous osteomyelitis of the hip in infants include diverse destructions of the muskulo-skeletal system. This pathology requires lasting treatment and frequently is cause of the invalidity. A case report is presented of 13-year old boy with subcapital femoral neck fracture after hematogenous osteomyelitis of the hip. We introduce pathology and management of patients with acute hematogenous osteomyelitis and him sequelae.

[Revision arthroplasty in aseptic loosening of cemented sockets of hip prosthesis]. / Wymiana aseptycznie obluzowanych panewek cementowych stawu biodrowego.

The aim of this paper was to assess early results of revision arthroplasty in aseptic loosening of cemented sockets. A group of 67 patients (53 females and 14 males) age ranging from 47 to 78 years (average: 72 years) who underwent revision arthroplasty because of aseptic loosening of cemented sockets. Early surgical treatment can spare the patient from a risky procedure and lead to better end results. In cases with massive bone destruction of the pelvis good results can be achieved by using bone grafts and anti-protrusion cages.

[PSO modular hip endoprosthesis--personal experiences]. / Endoprotezoplastyka modularna PSO w materiale wlasnym.

Hip prosthesis reimplantation, particularly with concomitant bone destruction around the stem, leading to a total loss of mechanical properties of the joint, is a major concern of modern orthopedics. Between may 1998 and August 2000 nine reimplantation procedures were performed in our Department. All were performed with the use of the Biomet PSO system. In four cases reimplantation was performed because of aseptic loosening of the prosthesis, with massive bone destruction around the stem. In three cases surgery was necessary because of loosening of reimplanted prosthesis. In two cases PSO prosthesis was used because of intertrochanteric fracture instability concomitant with massive femoral head and intertrochanteric bone destruction. Functional assessment was based on the Merle d'Aubigne classification. On 6 points were attained before surgery and 10 points--6 months post-up, the difference resulting from a decrease of pain. Luxation of the prosthesis was noted in two cases one 15 days after surgery and the other one 6 months post-up. In our opinion use of PSO endoprosthesis is a very valuable method of treating cases with bone destruction of the femur following loosening of hip prosthesis.

Evaluation a range of the motion of knee during femoral lengthening by Ilizarov method.

Background. Extensory contracture of the knee joint is a constant problem during thigh lengthening procedures. Its occurrence is dependent on such factors as rehabilitation, the construction of the Ilizarov apparatus, the extent of the lengthening, and the etiology of the shortening.
Material and methods. Between 1998 and 2001, 34 children were treated for thigh shortening. Contracture occurred in all cases.
Results. The dynamics of the lengthening process were strictly associated with the development and elimination of any contracture that appeared. If the indicated rules are followed, extensory contracture of the knee joints always resolved within several months after removal of the Ilizarov apparatus.
Conclusions. The importance of the proper rehabilitation program is equal to that of the surgical procedure. Limiting the number of impulses and localizing them is helpful in later rehabilitation.

Differences in lower limb bone mineral density in children with anisomelia.

Background. Lower limb discrepancy (anisomelia) can be caused by many different factors leading to shortening (90% of cases) or lengthening of a limb (10% cases). This article present the results of densitometric tests performed on patients treated for lower limb discrepancy in the Department of Orthopedic of the Silesian Academy of Medicine in the years 1997-1998.
Material and methods. Our research involved 57 patients, 31 girls and 26 boys. The Ilizarov technique was used to lengthen 33 femurs and 24 tibias. The average discrepancy was 45 mm (48 mm in the femurs and 42 mm in the tibias), and the patients average age was 13,8 years (range 7-26). The test were performed with a DPX apparatus by the Lumar Corporation. The bone mineral density (BMD) was measured in the area of the shortened limb segment and compared to the results of the analogous measurement of the opposite limb. The height of the measurement frame was 50 mm, and the width was equal to the width of the bone. The measurement field was located in each case at a distance of 3-4 cm (on the respective bone) from the line of the knee joint, in order to eliminate additional density caused by growth cartilage and the imposition of the patella. The repeatability of the tests was assured by a support maintaining constant internal limb rotation of 400.
Results. A difference in BMD between the shorter limb and the opposite limb was found in 47 children (82,5%). The average was 16,5%, whereas it was higher in the shorter femurs (19,1%, range 4,5 - 68,5%) than in the tibia (14%, 5,2 - 59,8%). A greater degree of demineralization was found in the girls (23,5%) than in the boys (20%). No correlation was found between the etiology of the shortening and the degree of calcification.
Conclusions. The results of these tests may have great significance in the case of densitometric monitoring of regenerated bone being formed in the course of lower limb by the Ilizarow method.

Femoral lengthening over intramedullary nail: the theoretical basis.

The paper presents the currently available possibilities for using a locked intramedullary nail in femoral lengthening. Additional fixation of the bone lengthened over an intramedullary nail permits earlier removal of the external distracter, as soon as the planned bone lengthening is obtained. Even though the necessary surgery is more extensive, the proposed procedure reduces the risk of fracture in the lengthened femur and entail less restriction of knee joint mobility.

Hospital infections in the Orthopedics and Traumatology Department of a large multi-department specialized hospital.

Background. Hospital infections continue to be one of the most important medical problems, especially in departments where surgical operations are performed. Materials and methods. In the year 1996, 173 microbiological tests were performed in the Orthopedic Clinic, while 1,114 tests were performed in the year 2000. Results. The most commonly isolated microorganism from hospital infections in our Orthopedic Clinic is Staphylococcus aureus, which in the year 2000 accounted for 23.13% of all positive results. Infections were most commonly incurred at or around the point of operation or in the urinary tract. During the period in question the co-efficient of hospital infections was 6.32% in 1996, 8.27% in 1997, 5.48% in 1998, 8.28% in 1999, and 7.23% in 2000. Conclusions. Reducing this coefficient, despite the increased number of hospitalizations and operations, was made possible by a number of factors, including constant monitoring and registration of hospital infections.

Management of foot deformity in cerebral palsy.

Treatment of patients with cerebral palsy need particular management: diagnostics, early interventions, programme of functional estimations, rehabilitation, therapy with conservative methods (injections of botulin toxin, immobilizing cast) and surgical methods. Correction of foot deformations is only one part of general process of treatment, which target is usually equalization strength between antagonistic muscle groups, what influences on improvement of locomotion, enlargement of range joint mobility, diminution of pain and making possible orthopedic supplies. In 1997-2001 we treated 58 children with foot deformation in cerebral palsy. One talk overed mechanism of deformation and management in dependences from type, degree of deformation, and age of patient.