Dose Escalation Can Enhance the Therapeutic Potential of Radial Extracorporeal Shock-Wave Therapy in the Treatment of Plantar Fasciitis in Runners.

Background and Objectives: Treatment of chronic plantar fasciitis is challenging given that there are various of available treatment options with no clear gold standard. The aim of the study was to examine the dose-escalation effect of rESWT on the biomechanical parameters of the plantar fascia and pain ailments. Materials and Methods: In the experimental group (n = 30), the intensity of the shock wave was increased every two subsequent treatment sessions. In the control group (n = 32), the treatment parameters were not changed. In both groups, six treatments were performed, with two treatment sessions a week. In order to assess the biomechanical parameters of the plantar fascia, myotonometric measurements were performed. The pain intensity was assessed using the Visual Analog Scale (VAS). Results: The tension of the plantar fascia attachment in the experimental group decreased from 27.69 ± 2.06 [Hz] before treatment to 26.29 ± 1.69 [Hz] after treatment (p = 0.009) and to 26.03 ± 2.15 [Hz] 1 month after the beginning of treatment (p = 0.003). In the control group, the frequency results did not change significantly (p > 0.05). Flexibility increased in both groups. The test results before treatment and 1 month after the beginning of the treatment showed statistical significance in the experimental group (p = 0.001) vs. (p = 0.002) in the control group. The differences were not statistically significant between groups (p > 0.05). The assessment of pain intensity carried out 1 month after the end of treatment in the experimental group amounted to 3.14 ± 2.28 points, which was statistically significantly lower compared to that in the control group, where it amounted to 5.14 ± 1.92 points. (p < 0.001). Conclusions: The use of rESWT performed with an increasing intensity of impact during subsequent treatment procedures demonstrated greater effectiveness in improving the biomechanical parameters of the plantar fascia and was also more effective in reducing the pain ailments. Our results are encouraging. The dose escalation in the treatment cycle is worth considering. To prove that this method of treatment is more effective, a randomized controlled trial should be carried out on a representative sample.

Comparison of the therapeutic efficacy of magneto-LED therapy and magnetostimulation applied as the adjuvant treatment of venous leg ulcers - preliminary study.

PURPOSE: Venous leg ulcers are chronic wounds that are difficult to cure. The aim of the study was to compare the therapeutic efficacy of two methods of physical medicine - magneto-LED therapy and magnetostimulation, applied as adjuvant treatment in the treatment of venous leg ulcers. METHODS: The study included 81 patients, 37 male (45.6%) and 44 female (54.3%) ones, age range between 45 and 90 years, with venous leg ulcers. The patients were assigned to two study groups: magneto-LED therapy (group 1) or magnetostimulation (group 2). In both groups, a total of 40 daily procedures were performed. Wound healing was evaluated using computerized planimetry and the pain intensity on numeric rating scale. RESULTS: After treatment, the decrease in healing rate in group 1 was statistically significantly higher in comparison to group 2 (p < 0.001), while a statistically significant reduction in the surface area of ulcers was obtained, amounting on the average from 6.34 ± 1.29 cm2 to 2.31 ± 1.25 cm2 in group 1 (p < 0.001), and from 6.52 ± 1.20 cm2 to 4.79 ± 1.17 cm2 in group 2 (p < 0.001). The percentage changes of ulcers area in group 1 (64.21 ± 17.94%) were statistically significantly greater as compared to group 2 (25.87 ± 14.07%) (p < 0.001). After treatment, the decrease in pain relief in group 1 was statistically significantly higher in comparison to group 2 (p = 0.006), while pain intensity after treatment decreased statistically significantly in both compared groups of patients (p < 0.001). CONCLUSIONS: Magneto-LED therapy and magnetostimulation caused significant reduction of surface area of the treated venous leg ulcers and pain intensity, yet magneto-LED therapy was more efficient. Both evaluated methods also significantly reduced pain intensity.

Chronic wounds are wounds, which despite ongoing treatment, do not heal within 6­8 weeks. A wound that occurs as a result of an ongoing disease process is called an ulcer. Leg ulcers are still a significant challenge for modern medicine because they are characterized by complex etiology, chronic pain and require specific diagnostic and therapeutic measures. In many cases, the inability to heal ulcers quickly is associated with social isolation, long-term suffering and deterioration of the quality of life of treated patients. In addition to standard treatment including surgery, pharmacotherapy and compression therapy, new more effective methods of ulcer therapy are still being sought. Nowadays, physical treatment methods are increasingly used as a supporting treatment the healing of chronic wounds. In the study, variable magnetic fields and low-energy light were used in the treatment of 81 patients (including 44 women and 37 men) in aged 45­90 years. All patients had chronic, non-healing of venous leg ulcers accompanied by severe pain. After completion of treatment, both groups of patients experienced a significant reduction of surface area of treated ulcers and a reduction in the intensity of pain ailments. According to our study results, the use of magnetic field and light therapy can be an important supportive treatment option in patients with venous leg ulcers.

Biomechanical properties of masseter muscle assessed through myotonometry in patients with temporomandibular disorder treated with ultrasound therapy: a randomized comparative study.

BACKGROUND: The aim of the study was to make an objective quantitative assessment of effectiveness of procedures with the use of a therapeutic dose of ultrasounds in this nosological entity, in connection with improved biomechanical properties and alleviation of pain experienced in masseter muscles. METHODS: The study included 40 patients with temporomandibular disorder. In group 1 (N.=20) ultrasound therapy (1.2 W/cm2) was carried out, while in group 2 (N.=20) sham therapy was applied. A total of 10 procedures were performed. Myotonometric measurements and assessment of pain intensity were carried out before treatment and after the completion of procedures. RESULTS: The analysis revealed a significant difference (P=0.011) between the values of decrement (D) measured on day 0 (2.08±0.45 [log]) and day 4 (1.80±0.55 [log]) in group 1. In group 2 no statistically significant differences were noted between the results obtained on consecutive days of the therapeutic cycle. A statistically significant difference in values of decrement (D) between group 1 (1.80±0.55 [log]) and group 2 (2.23±0.51 [log]) was noted on day 4 of the experiment (P=0.021). Both in group 1 and in group 2, a statistically significant reduction of pain intensity (VAS Scale) was obtained. CONCLUSIONS: The masseter muscle was more elastic during ultrasound therapy. However, the effect was transient. The analgesic effect was also observed in the control group; therefore, a placebo effect cannot be excluded.

Quality of Life in Patients with Venous Leg Ulcers Treated by Means of Local Hyperbaric Oxygen Therapy or Local Ozone Therapy-A Single Center Study.

Background and Objectives: Venous leg ulcers pose a significant medical problem worldwide. The complexity of the problem determines the need for further interdisciplinary activities that will improve the quality of life for treated patients. This study compared the quality of life of patients with venous leg ulcers who received local hyperbaric oxygen therapy or local ozone therapy procedures as part of comprehensive treatment. Materials and Methods: The study included 129 patients (62 men and 57 women) with venous leg ulcers. Group I underwent local hyperbaric oxygen therapy (HBOT), and Group II underwent local ozone therapy (OZONE). In both groups, the patients' quality of life was assessed before the start of the treatment cycle, as well as 10 weeks and 6 months after the completion of the treatment, by means of the EQ-5D-5L questionnaire and the Polish shortened version of the SF-36 scale. Results: After completing the respective therapeutic cycle, both groups showed statistically significant (p < 0.001) improvement in quality of life, according to the EQ-5D-5L questionnaire and the SF-36 scale. Differences were noted between the 1st examination (before treatment) and the 2nd examination (10 weeks after treatment), as well as the 3rd examination (6 months after treatment). In the EQ-5D-5L assessment of anxiety and depression, self-care, and activities of daily living 6 months after the end of treatment, better results were found in the group of patients treated with local hyperbaric oxygen therapy (p < 0.001). In this group, 6 months after the end of the treatment, a statistically significantly higher result on the EQ-VAS scale was also obtained (73.09 ± 19.8 points vs. 68.03 ± 17.37 points, p = 0.043). However, in the SF-36 assessment performed 6 months after the end of treatment, better results-a statistically significantly lower value of the quality of life index-were recorded in the group of patients treated with local ozone therapy (103.13 ± 15.76 points vs. 109.89 ± 15.42 points, p < 0.015). Conclusions: Hyperbaric oxygen therapy and local ozone therapy procedures have a beneficial effect on improving the quality of life of patients with venous leg ulcers.

Application of Topical Hyperbaric Oxygen Therapy and Medical Active Dressings in the Treatment of Arterial Leg Ulcers-A Pilot Study.

Leg ulcers are a very serious worldwide medical problem. When the ulcer is extensive and deep the prognosis is usually unfavorable. The treatment requires comprehensive solutions that take into account modern specialized medical dressings, and more and more often, selected methods in the field of physical medicine. The study included 30 patients (13 women-43.4% and 17 men-56.6%) with chronic arterial ulcers of the lower limbs. The mean age of the treated patients was 65.63 ± 8.77 years. Patients were randomly assigned to two study groups. In group 1 (16 patients), specialist ATRAUMAN Ag medical dressings and local hyperbaric oxygen therapy treatments were used. In group 2 (14 patients), only specialized ATRAUMAN Ag dressings were used. The treatment was carried out for 4 weeks. The progress of healing ulcers was assessed by using the planimetric method, while the intensity of pain ailments was assessed by the visual analog VAS scale. In both study groups, a statistically significant reduction in the mean surface area of the treated ulcers was obtained, respectively, from 8.53 ± 1.71 cm2 to 5.55 ± 1.11 cm2 in group 1 (p < 0.001) and 8.43 ± 1.51 cm2 to 6.28 ± 1.13 cm2 in group 2 (p < 0.001). There was also a statistically significant reduction in the intensity of pain ailments, respectively: 7.93 ± 0.68 points to 5.00 ± 0.63 points in group 1 (p < 0.001) and 8.00 ± 0.67 points to 5.64 ± 0.49 points in group 2 (p < 0.001). The percentage change in ulcer area from baseline in group 1 was 34.6 ± 8.47% and was statistically significantly greater than in group 2 (25.23 ± 6.01%) (p = 0.003). In turn, the percentage assessment of the pain intensity assessed in the VAS scale in group 1 was 36.97 ± 6.36% and was statistically significantly higher compared to group 2 (29.34 ± 4.77%) (p = 0.002). The addition of local hyperbaric oxygen therapy treatments as a supplement to the therapy with the use of specialized medical dressings improves the effectiveness the arterial ulcers treatment of the lower limbs in terms of reducing the ulceration area and reducing pain ailments.

Risk Factors for Injury in CrossFit®-A Retrospective Analysis.

CrossFit® is a physical activity program and sport which is based on functional movements performed at high intensity and with high variability of exercises. It develops all motor skills. The study included 424 athletes (266 men and 158 women) from twelve centers in Poland, actively practicing CrossFit® between 18 and 60 years of age. A questionnaire consisting of 25 questions was used, which was divided into four subsections concerning the characteristics of the sample, training routine, injuries, and information about environment. In total, 48% of respondents participating in the study suffered at least one injury during their entire training history. The injuries suffered most often involved shoulder joint and lumbar spine. Men were found to face a higher risk of injury than women, at 32.78% vs. 15.33% (p = 0.027). The shorter the training period, the smaller the number of injuries observed among the trainees. It was also noted that the shorter the training period, the lower the number of injuries that occurred (p = 0.041). An increase in the number of training sessions per week did not increase the incidence of injuries (p > 0.05). Performing isometric exercises during warm-up reduced the likelihood of injury during CrossFit® training itself (p = 0.012). Training despite of concomitant acute pain had a significant adverse effect on the incidence of injuries (p = 0.002). The most common risk factors for injury in the CrossFit® training process include, in particular: gender, training experience, and length of training sessions. Proper warm-up including isometric exercises and training conducted without accompanying pain symptoms reduces the risk of injury.

Topical Hyperbaric Oxygen Therapy Versus Local Ozone Therapy in Healing of Venous Leg Ulcers.

BACKGROUND: the treatment of venous leg ulcers still poses a difficult interdisciplinary medical problem. The aim of this study was to compare the therapeutic efficacy of local hyperbaric oxygen therapy with local ozone therapy in the treatment of venous leg ulcers. MATERIALS: this study included 114 patients; 60 males (52.63%) and 54 females (47.36%) of ages ranging between 39 and 88 years (mean age: 68.9 ± 9.8 years) with venous leg ulcers, who underwent topical hyperbaric oxygen therapy (group I) and local ozone therapy (group II). In each of the study groups, the patients underwent 30 therapeutic procedures lasting 30 min each. The progress in wound healing was evaluated by computerized planimetry, and the intensity of pain was assessed with the use of the Visual Analogue Scale (VAS). RESULTS: in both groups of treated patients, a statistically significant (p = 0.000001) reduction in the area of treated ulcers was achieved. In group I, the wound area decreased by an average of 69.67 ± 22.52%, from 7.55 ± 2.99 cm2 to 2.78 ± 2.43 cm2, and in group II, by an average of 41.33 ± 21.31%, from 7.36 ± 2.82 cm2 to 4.62 ± 2.76 cm2. In both groups of patients, a statistically significant (p = 0.000001) reduction in the intensity of pain ailments was observed: in group I, by an average of 0.55 ± 0.54 points, and in group II, by an average of 2.33 ± 0.82 points on the VAS scale. CONCLUSIONS: local hyperbaric oxygen therapy and local ozone therapy cause a statistically significant reduction in the surface area of venous leg ulcers as well as in the intensity of pain. Better results were observed after the application of local hyperbaric oxygen therapy procedures.

The Influence of Combined Physical Therapy Procedures on Oxygen Partial Pressure in Tissues Surrounding Ulcer in Patients With Venous Leg Ulcers.

Venous ulcers in lower legs remain a profound treatment problem in contemporary medicine. Proper healing requires, among other things, sufficient blood supply and provision of suitable amount of oxygen to the treated tissues. The aim of the study was to assess the influence of combined physical therapy applied in patients with chronic venous leg ulcers on the oxygen partial pressure values. Fifty-four patients (25 females and 29 males), in the age range of 38 to 89 years with chronic venous leg ulcers, underwent a cycle of 15 procedures with the use of Laserobaria-S device. During a procedure, the patient's lower limb was simultaneously exposed to oxygen having the pressure of 1.5 ATA, low-frequency magnetic field, and low-energy light radiation. Before procedures, directly after the first procedure, as well as on completion of the entire therapeutic cycle, the patients underwent oxygen partial pressure measurements in the tissues surrounding the ulceration area, by means of transcutaneous oximetry, with the use of Medicap Précise 8008s device. The combined physical therapy shows a statistically significant increase of oxygen partial pressure values in tissues surrounding the ulceration, from the average of 68.63 ± 17.04 mm Hg before commencing the therapeutic cycle, to the average of 74.20 ± 18.92 mm Hg after the first procedure (P < .001) and to the average value of 83.79 ± 20.74 mm Hg (P < .001) after completion of therapeutic cycle. Combined physical therapy procedures cause a statistically significant increase of oxygen partial pressure values in tissues surrounding the ulceration, assessed using the objective method of transcutaneous oximetry, both in women and men.

Are the mechanical properties of Achilles tendon altered in CrossFit athletes? Reliability and accuracy of myotonometry.

PURPOSE: Tendons adapt to loads affecting them by changing tendons' mechanical and morphological properties. The aim of the study was to investigate the influence of involvement in sport activities in the form of CrossFit training by individuals of different age upon the mechanical properties of Achilles tendon. METHODS: 231 people participated in the study. One group consisted of subjects who trained CrossFit as amateurs, the other group comprised subjects who were not physically active. Achilles tendon was studied for various positions of the ankle joint: 0° DF/PF, 10° DF, 20° DF, 20° PF and 40° PF. The following mechanical and viscoelastic tendon properties were measured using MyotonPRO: frequency [Hz], stiffness [N/m], decrement [log], relaxation time [ms] and creep [De]. The results have been compared in reference to physical activity, BMI, age and length of training history. RESULTS: Both the tension and stiffness increased with degree of Achilles tendon stretching and decreased as it contracted. Higher values have been noted in the group of people in training and with higher BMI values. The elasticity of Achilles tendon decreased with plantar flexion increase. Lower elasticity has been recorded in the group in training and with higher BMI. No significant influence of age and length of training history upon the parameters achieved has been noted. CONCLUSIONS: The specificity of CrossFit training and accompanying mechanical load result in development of adaptation changes in Achilles tendon, in the form of its higher tone/tension and stiffness, as well as lower elasticity.

The Impact of Coronavirus Infection on Health-Related Quality of Life in Amateur CrossFit Athletes.

BACKGROUND: The aim of this study was to assess how the disease, developing over the course of coronavirus infection, affects the quality of life of athletes practicing amateur sports who are not burdened with comorbidities. METHODS: The study included 102 amateur CrossFit athletes (54 (53%) women and 48 (47%) men) who had been infected with SARS-CoV-2, but were not hospitalized. The training experience of the respondents ranged from 1.5 to 15 years (average: 6.7 ± 3.8 years). The quality of life was assessed with EQ-5D-5L and Clinical COPD Questionnaire (CCQ), which was used to assess the quality of life specific to the respiratory system, and the severity of dyspnea was assessed using the MRC questionnaire. RESULTS: The training experience did not differ statistically significantly between men and women (p = 0.595). The quality of life in men according EQ-5D-5L was statistically significantly higher than in the case of women (0.979 ± 0.028 vs. 0.942 ± 0.073 (p < 0.001), respectively), and in EQ-VAS it was significantly higher in men than in women (85.64 ± 10.4 vs. 72.5 ± 19.36 points (p < 0.001)). The assessment of dyspnea by means of mMRC showed its higher intensity in women than in men. The differences were not statistically significant (p = 0.195). In men, a significantly lower result of the quality of life was noted in the CCQ questionnaire: 0.71 ± 0.57 vs. 1.14 ± 0.84 points (p = 0.009). CONCLUSIONS: The HRQOL, which surveyed amateur CrossFit after COVID-19, was higher in men than in women. People practicing strength- and strength-endurance-based sports rated their quality of life as the highest. Most of the subjects observed a slight intensification of dyspnea. The findings can be used for future healthcare measures to be applied in the population of CrossFit athletes.

Ozone Therapy in the Comprehensive Treatment of Leg Ulcers: Case Report.

ABSTRACT: Treatment with ozone therapy is of interest in many fields of medicine. In the field of angiology, ozone is used to treat infected wounds that are difficult to heal. In this case report, the authors report the introduction of innovative therapeutic equipment into clinical practice to accelerate the healing process of clinical wounds by the external application of ozone in various forms. They present positive results of the comprehensive treatment of a 52-year-old woman with an ulcer on her right lower leg, which formed after a previous orthopedic surgery. In addition to pharmacotherapy and compression therapy, local ozone therapy was applied. After 30 ozone therapy procedures, the ulcer healed completely, and the patient's pain was significantly alleviated, as assessed by a visual analog scale (9.0 points before therapy vs 0.5 point after therapy). As a result, the patient's quality of life improved, as assessed by the EuroQol scale (10 points before therapy vs 90 points after therapy).The use of local ozone therapy can be an appropriate complement in the comprehensive treatment of chronic wounds. In the presented case, ozone therapy helped complete healing of the ulcer and significantly reduced the intensity of pain experienced, thus improving the patient's quality of life.

Topical Ozone Therapy-A Novel Modality in the Treatment of a Complicated Wound after Knee Joint Ligament Operation as a Consequence of Traffic Accident-Case Report.

BACKGROUND AND OBJECTIVES: For many years, medicine has been looking for effective methods to be used in the treatment of chronic wounds. Pharmacological treatment is insufficient and does not give expected results of treatment. In the comprehensive treatment of wounds, physical medicine methods have been used, which are characterized by high efficiency and safety as well as relatively low costs of the therapy. Efficient application of a novel therapeutic modality in the form of topical ozone therapy in the treatment of a difficult-to-heal wound of the left knee joint after surgery due to the rupture of the anterior cruciate ligament and damage to the medial meniscus because of a previous road accident in a 61-year-old female patient is presented. METHODS: Topical ozone therapy treatment in the form of the "Ozone bag" with the use of an oxygen-ozone mixture (2.86% ozone and 97.14% of oxygen) with a concentration of 40 µg/mL was applied to the wound area. The therapeutic cycle consisted of two series of 10 treatment sessions lasting 20 min each, performed every day for 5 days a week, and carried out for 6 weeks. RESULTS: Topical ozone therapy caused complete healing of the complicated wound remaining after orthopaedic surgery, which allowed the patient to live independently without experiencing pain, to move without elbow crutches, and to perform daily activities independently and ultimately to return to work.

Local Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers.

Background: Diabetes mellitus is one of the most common metabolic diseases. The most serious complication of diabetes is diabetic foot ulcer, which affects several million people around the world each year. In recent years, increasingly modern methods of physical medicine including hyperbaric oxygen therapy have been used often in the complex therapy of this complication. Methods: This study included 45 patients, 24 male (53.3%) and 21 female (46.6%), whose age was between 49 and 83 years (mean age: 66.7 ± 8.8 years) with diabetes lasting for 1.5-18 years, who underwent local hyperbaric oxygen therapy at the pressure of 2.5 ATA (30 exposures for 30 min each) due to diabetic foot ulcers. The progress in wound healing before and after the end of therapy was evaluated by computerized planimetry, and the pain intensity was assessed with the use of a VAS. Results: The analysis of results showed a statistically significant reduction in the wound surface area after the treatment, from 8.54 ± 3.34 cm to 4.23 ± 3.23 cm² (p = 0.000001). In 5 patients (11.1%), the wounds were healed completely. In 25 patients (55.5%), the topical state of the wound surface was significantly decreased by 50% on average. There was also a significant reduction in the perceived pain on the VAS in all examined patients from 4.64 ± 1.68 points before treatment to 1.51 ± 0.92 points after treatment (p = 0.000001). Conclusions: The application of local HBO therapy in the treatment of diabetic foot ulcers accelerates the ulcer healing process, as judged in objective planimetric assessment, and reduces the intensity of perceived pain ailments.

Cementless femoral neck endoprosthesis SPIRON in men in aspects of clinical status and quality of life in an average 7-year follow-up.

BACKGROUND: We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis. METHODS: The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up. RESULTS: The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p < 0.001). The median WOMAC HIP score was pre-operatively 57 and post-operatively 0 (p < 0.001). The median SF-12 score was pre-operatively 4 and post-operatively 33 (p < 0.001). The median pain assessment in VAS scale was 7 pre-operatively and 0 post-operatively (p < 0.001). CONCLUSIONS: The results of all examined patients have changed significantly in every category showing that SPIRON endoprosthesis improved their quality of life and statistically reduced pain ailments. Moreover we have proved that higher BMI (> 30) is associated with worse operation outcomes.

Antioxidant System and Ions Concentrations After Femoral Neck and Resurfacing Hip Arthroplasty.

BACKGROUND Oxidative stress is a disruption of the pro-oxidative-antioxidant balance, caused by excessive production or ineffective removal of reactive oxygen species. MATERIAL AND METHODS The study included 42 male patients aged 38 to 69 years. The first group consisted of 21 men with osteoarthritis after primary hip arthroplasty using the Smith & Nephew Birmingham Hip Resurfacing implant. The second group included 21 men after hip arthroplasty using the femoral neck SPIRON K-implant. In both groups, concentrations of ions, the antioxidant system in the blood, and parameters of oxidative stress were evaluated twice. Clinical assessment using the Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score, and Short Form (12) Health Survey (SF-12) scales was performed. RESULTS Concentrations of metal ions in the blood and the level of oxidative stress were significantly higher in the resurfacing group than in the femoral neck arthroplasty group. The response of the antioxidant system was significantly greater in the femoral neck arthroplasty group. During clinical evaluation, groups did not show significant differences, with the exception of greater shortening of the operated limb and a lower score in the mental-sphere of the SF-12 scale in the resurfacing arthroplasty group. CONCLUSIONS Resurfacing hip arthroplasty increased oxidative stress, increased the concentration of metal ions, and did not affect alignment of the abbreviation of the operated limb. A significant improvement in the quality of life of patients in the mental sphere according to the SF-12 occurred after the application of resurfacing arthroplasty, in the first month after the procedure.

Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement.

Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.

Local Ozone Therapy in Complex Treatment of Venous Leg Ulcers: Ozone therapy for venous leg ulcers.

A significant health problem in many countries of the world is the occurrence of hard to heal leg ulcers. In recent years modern methods of physical medicine in comprehensive treatment have been used often including ozone therapy. The study included 54 patients, 25 male and 29 female in age between 39 and 87 years (mean age: 66.7 ± 11.9 years) with venous leg ulcers who underwent a cycle of local ozone therapy. The progress in wound healing was evaluated by computerized planimetry and pain intensity was assessed with use a visual analog scale (VAS) . As a result of the applied local ozone therapy a statistically significant reduction of the ulcer area was achieved from median 7.1 (5.6-9.4) cm2 to 4.4 (3-7) cm2 (P = .000001), which was on median 38.74 (27.27-51.42)% compared to the baseline values ​​before the start of the therapy. In 2 patients (3.7%) the ulcers were completely healed. 18 patients (33.3%) achieved a reduction in ulcer area of ​​more than 50% of the baseline value and the remaining 34 patients (63%) also achieved a reduction in ulcer area. A statistically significant in the percentage of surface area was observed in the group of 19 patients suffering from > 5 years of age compared to the group of 35 patients suffering from ≤5 years (median 50 (32.03-67.16)% versus 33.96 (23.71-45); P = .033178), while percentage changes in ulcer surface area did not differ significantly between all other subgroups of patients. There was also a statistically significant reduction in the intensity of pain in VAS scale in all patients, median 6 (5-7) points before treatment versus 4.4 (3-7) points after treatment, P = .000001). Local ozone therapy of venous leg ulcers accelerate the healing process of ulcers in objective planimetric assessment and reduce the intensity of pain ailments.

Tibiotalocalcaneal Arthrodesis in Osteoarthritis Deformation of Ankle and Subtalar Joint: Evaluation of Treatment Results.

Tibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. The study group consisted of 19 men who were subjected to intramedullary and intraosseous arthrodesis using an intramedullary nail. The average age of patients was 46 (range 19-68) years. The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group, clinical condition was assessed using the American Orthopedic Foot and Ankle Score (AOFAS) classification, quality of life using the SF-12 scale, and assessment of pain intensity using the visual-analog scale (VAS) scale. The above parameters were evaluated before surgery (under 2 years), intermediate (from 2 to 5 years), and late (over 5 years) postoperative period. The clinical condition on the AOFAS scale improved from an average of 20.6 points before tibiotalocalcaneal arthrodesis to 63.5 after the procedure. The result was statistically significant (p < .0001). Analyzing the results using the SF-12 scale, a statistically significant increase was found. In the physical sphere of Physical Health Component Score-12 (p = .0004) and in the mental sphere of Mental Health Component Score-12 (p = .030). The intensity of pain assessed in the VAS scale, decreased in all three periods-p < .05. The strongest analgesic effect was observed in the early postoperative follow-up period. Tibiotalocalcaneal arthrodesis using an intramedullary nail causes a significant improvement in the clinical condition according to the AOFAS classification, enabling most patients to move independently, a significant improvement quality of life assessed in the SF-12 scale and a significant reduction of pain ailments assessed in the VAS scale, especially in the early postoperative period.

Evaluation of the therapeutic efficacy of active specialistic medical dressings in the treatment of decubitus.

INTRODUCTION: Treatment of decubitus ulcers is a grave medical problem. In many cases, it is difficult to cure a pressure ulcer, especially when it is deep and extensive, and prognosis is usually unfavourable. Treatment of decubitus ulcers requires new specialist dressings, which play an important role in the healing process. AIM: To evaluate therapeutic efficacy of active specialist medical dressings in the treatment of decubitus. MATERIAL AND METHODS: Research involved 40 patients - 18 (45%) women and 22 (55%) men, suffering from decubitus ulcers of different size and depth, localized in the sacral region, lasting from 1.5 to 30 months. Patients were randomly assigned to two research groups (20 people each), were treated for 4 weeks with 2 different specialist dressings. ATRAUMAN Ag, which contains silver ions, was used in the first group, while paraffin gauze of BACTIGRAS type was used in the second group. An assessment of pressure ulcers' healing progress was done with a planimetric method, which evaluates the wound surface area. RESULTS: The analysis results showed a significant statistical decrease in an average decubitus ulcer surface area in both research groups: in the first group by 60.2% (p = 0.001), and in the second group by 32.95% (p < 0.001), which speaks in favour of dressings with silver ions as having better therapeutic effectiveness. CONCLUSIONS: Using specialist dressings results in a significant decrease in the decubitus ulcer surface area, depending on the type of dressing and active substances contained within, while silver ions support curative effectiveness of the dressing used.