Activity of Dr Józef Aleksiewicz, PhD, Towards the Development of Orthopedics and Rehabilitation in Lviv in the Years 1912-1930.

The article describes the work of Dr Aleksiewicz towards the development of orthopedics and rehabilitation in Lviv in the years 1912-1930 based on source materials belonging to his family and articles published in medical journals and daily press. In 1919, Dr Aleksiewicz established a Surgical and Orthopedic Department and a factory of prostheses at the Disabled House in Lviv. He also formed a 200-bed division for the visually impaired with basket- and comb-making workshops as well as massage and typing courses. It was an innovative undertaking aiming to provide surgical treatment, orthopaedic aids and rehabilitation for victims of World War I. From 1919, Dr Aleksiewicz ran his Private Orthopedic Clinic with Factory of orthopaedic aids and pro-stheses" at 2 Friedrichów St. in Lviv. He specialised in therapy of surgical tuberculosis, fractures, dislocations and abnormal spinal curvatures. His work in Lviv in the period 1912-1930 undeniably contributed to the development of orthopaedics and rehabilitation, which were new medical specialties at the time.

Dr. Józef Aleksiewicz Activity in Support of the Development of Orthopedics and Rehabilitation in Iwonicz-Zdrój (1921-1957).

Based on source materials in the possession of Józef Aleksiewicz family (typescripts, manuscripts, photographs, other documents) and articles published in professional medical journals and newspapers, the authors present the contribution of Dr. J. Aleksiewicz to the development of orthopedics and rehabilitation in Iwonicz-Zdrój. In May 1921, he was appointed Surgeon General of the Spa Commission in Iwonicz-Zdrój. After holding several scholarly trips abroad in 1925 to sanatoriums treating cases of osteo-articular tuberculosis, he commenced the construction of "Sanato", a modern sanatorium. Opened in 1930, it was the only center in Poland treating osteo-articular tuberculosis in a spa setting. It was the first orthopedic rehabilitation center in what is now Podkarpackie Voivodship offering diagnostic work-up, surgery and conservative treatment of osteo-articular tuberculosis in children. Modelled on the best Western centers, Dr. Aleksiewicz widely employed physical methods, such as Swedish therapeutic gymnastics, mechanotherapy, massage, physical therapy and hydrotherapy.

[Functional outcome of tuberculous arthiritis of the knee in a male Moroccan patient]. / Regard fonctionnel sur l'arthrite tuberculeuse de genou, chez un homme d'origine marocaine.

PURPOSE: The purpose of this article is to present a case of tuberculous arthritis of the knee and discuss the importance of early diagnosis and rehabilitatin in management outcome. CASE REPORT: A 57-year-old Moroccan man with no medical history presented with a mass in the left knee associated with pain and fever. Analysis of aspirated fluid demonstrated sterile inflammatory liquid. Presumptive antibiotic therapy was ineffective. Diagnosis of tuberculous arthritis was made based on positive tuberculin skin test and interferon-release assays. Diagnosis was confirmed by arthroscopic biopsy. Physiotherapy allowed improvement in both function and analytical test findings. DISCUSSION: Tuberculous arthritis is rare occurring in only 2 to 5% of people with tuberculosis. It can be very destructive. Diagnosis is often delayed leading to joint pain, tissue damage, and functional disability (e.g. inability to walk). Since prompt treatment (antibiotics then physiotherapy) can limit complications, early diagnosis is necessary and often requires deep biopsy, except endemic zones. In the acute phase, immobilization of the extremity in a functional position is necessary. When inflammatory signs subside, physiotherapy can be undertaken in short but frequent sessions without excessive weight or resistance. CONCLUSION: The functional outcome of tuberculous arthritis depends on early multidisciplinary care involving the rheumatologist, infectious disease specialist, orthopedic surgeon and attending physician.

Descripción de un caso de neuroartropatía de Charcot y tuberculosis de tobillo / Description of a case of Charcot's neuroarthropathy and ankle tuberculosis

Presentamos a un varón de 68 años con dolor y deformidad progresiva en pie derecho, de evolución tórpida, secundario a un traumatismo. Dos años después del traumatismo presenta tumefacción dolorosa en región periaquílea externa que desemboca en fístula y precisa limpieza quirúrgica. A los 6 meses de la cirugía se obtiene cultivo positivo para M. tuberculosis y el cuadro se considera una neuroartropatía de Charcot (NC). Las causas más frecuentes de NC son diabetes, tuberculosis (TBC) y sífilis. La TBC articular es rara en los países desarrollados; es frecuente un retraso en su diagnóstico (12–18m). Cualquier articulación se puede afectar, en tobillo es infrecuente (7,4%). Puede estar precedida de un traumatismo articular (37%). El mecanismo fisiopatológico de la NC es independiente de la causa. Existen múltiples causas de NC, incluso un traumatismo menor puede desencadenar una cascada inflamatoria, que estaría iniciada por citoquinas proinflamatorias relacionadas con el sistema RANKL/OPG, que es el sistema enzimático responsable del metabolismo óseo. De diagnóstico diferencial difícil, se puede confundir con otras entidades y hay que sospecharla siempre que aparezca un cuadro inflamatorio. El tratamiento es fundamentalmente médico, en algunos casos se emplean bifosfonatos, aunque puede requerir cirugía. La rehabilitación debe ir orientada a minimizar secuelas y a la optimización funcional (AU)

A 68 years old man is presented. The patient complained of long term pain and progressive deformity of his right foot, attributed to a traumatism. Two years after the traumatism a painful inflammation was developed at the lateral region of the ankle, whith a fistulae and then surgery was needed. 6 month after surgery a positive culture for M. tuberculosis is obtained and finally a Charcot neuroarthropaty (CN) was considered. The more frequent causes of CN are diabetes, tuberculosis and syphilis. Articular tuberculosis is not common in developed countries and a delay on diagnosis is usual (12–18mo). Any articulation can be affected, but ankle is infrequent (7.4). In 37% of cases it is preceded by a traumatism. The physiopatological mechanism of CN is independent of the cause. There are multiple situations causing CN and a minor traumatism can trigger an inflammatory cascade, iniciated by proimmflamtory cytoquines related to the RNKL/OPG system, involved in the bone metabolism. The differential diagnosis is difficult because CN is similar to other conditions, but it should be suspected if an inflammatory reaction is present. Treatment is basically pharmacological, sometimes biphosphonates are used but surgery may be required. Rehabilitation is oriented to avoid sequelae and to optimize functionality (AU)

[Sociomedical efficiency of reparative operations in progressive tuberculosis of the hip joint].

The disability rates and life quality indices were analyzed in 69 patients operated on for active tuberculous coxitis revealed a clear-cut advantage of early radical operations in their complex treatment. Prolongation of the time of surgical interventions results in progression of destructive processes in the affected joint, shows a 2.5-fold increase in the disability rates and drastically reduces the quality of their life.

[Postoperative rehabilitation in patients with sequels of tuberculous and nonspecific gonitis after total endoprosthetic repair of the knee joint].

To evaluate the effectiveness of rehabilitative measures, comprehensive studies have been conducted in 37 patients with sequels of tuberculous and nonspecific gonitis, who underwent primary total endoprosthetic repair of the knee joint with an Osteonics-7000 cement fixation prosthesis (USA) in 1996 to 2002. After discharge from hospital, 18 patients received a complete course of rehabilitation, 19 patients refused it for different reasons. The results were assessed just after completion of the course of rehabilitation (3 months after surgery), following 1 year and on the last examination (on the average 45.2 months later). Statistically significant advantages in the function of the knee joint and in the force of its extensors were observed in the group of patients undergoing a complete course of postoperative rehabilitation just after completion of the course and a year after surgery. The last examination revealed a great difference between the patients who had undergone a complete course of rehabilitation and those who had refused it.

Physical therapist management of tuberculous arthritis of the elbow.

BACKGROUND AND PURPOSE: Tuberculous arthritis is not commonly seen by physical therapists in the United States. The purpose of this case report is to describe a case of tuberculous arthritis of the elbow. CASE DESCRIPTION: The patient was a 36-year-old man referred for physical therapy evaluation and intervention for chronic elbow pain. After an evaluation and a trial of physical therapy, the patient was referred back to a primary care provider for additional tests to rule out systemic pathology. An open debridement of synovium and biopsy of the capitellum and radial head was positive for acid-fast bacilli, which was later identified as Mycobacterium tuberculosis. OUTCOMES: The patient was placed on a 4-drug antituberculosis regimen that resolved all patient complaints and restored full elbow function. DISCUSSION: Tuberculous arthritis has characteristic findings during examination and in diagnostic tests. Although tuberculous arthritis is uncommon, it should be considered when patients have chronic or vague musculoskeletal complaints.

Infectious disease of the spine: outcome of rehabilitation.

Infectious disease of the spine is infrequently seen in the rehabilitation setting. We examined retrospectively 26 patients with spinal infections admitted to the rehabilitation centre over a 6-year period to determine the demographic characteristics, clinical features and outcome after rehabilitation. Their ages ranged from 24 to 83 years (mean = 56.4); 65.4% were males. The infection was due to pyogenic bacteria in 14 patients (53.8%) and Mycobacterium tuberculosis in 12 (46.2%). Staphylococcus aureus was the causative agent in 69% of those with pyogenic infections. A history of diabetes mellitus was present in 35.7% of the pyogenic group but in only 8.3% of the tuberculous group. Localised back pain, fever and neurological deficits were the typical clinical manifestations. The most common site of infection was the thoracic region. Surgery was performed on 24 patients and all received prolonged courses of antibiotics. All but three patients completed the rehabilitation programme. The motor score for the lower limbs and the modified Barthel scores for activities of daily living (ADL) and mobility improved significantly (P < 0.05) for both pyogenic and tuberculous groups. The amounts of improvement achieved were not significantly different between the pyogenic and tuberculous groups except for ADL. Age, gender and the presence of diabetes mellitus did not appear to significantly affect the neurological or functional outcome in our study population. The majority of patients (87.5%) were discharged to their own homes.

[Primary disability due to tuberculosis]. / Pervichnaia invalidnost' vsledstvie tuberkuleza.

The social and clinical background of 1,043 tuberculosis patients newly recognized as disabled was studied. A complex study of the interrelation between tuberculosis-induced disability and medical and social factors was undertaken. Ineffective treatment proved to be the leading cause of disability, associating with untimely detection of the disease in 19.4% of the cases, irregular chemotherapy in 51.2%, concurrent chronic alcohol abuse in 31.4% as well as with insufficient use of surgical interventions and disruptions in the treatment continuity at its different stages. An important role in establishing the disability belongs to a low qualification level of the patients, their ++counter-indicated occupational conditions and the associated difficulties in their employment. A possible drop in the disability extent depends upon a number of issues dealing with preventive, diagnostic, therapeutic and social activities.

[The results of radical-rehabilitative surgical treatment in tuberculous osteitis of the hip joint in children]. / Rezul'taty radikal'no-vosstanovitel'nogo khirurgicheskogo lecheniia tuberkuleznogo ostita tazobedrennogo sustava u detei.

Radical restorative surgery is an operation of choice in treatment of tuberculous osteitis of the hip joint in children of all age groups irrespective of the destructive process localization and duration. The early surgical treatment provided recovery from tuberculous osteitis in 100 per cent of the patients and proper development of the operated hip joint in 90 per cent of the patients.

Results of conservative treatment in tuberculosis of the elbow.

The authors have used conservative treatment in 29 cases of tuberculosis of the elbow with 12 months of specific chemotherapy regim and 1--2 months of plaster immobilisation followed by rehabilitation. Seven elbows were ankylosed at the end of the period of treatment, 20 elbows had a useful range of joint movement, and 14 had more than 70 degrees of free movement. The results were not so satisfactory regarding pronation and supination. The authors believe that conservative management gives better results than classical arthrodesis or excision of the elbow joint.

["Example of clinic rehabilitation" (author's transl)]. / Beispiel "einer klinischen Rehabilitation" (Arbeitskreis für Rehabilitation im Krankenhaus Seepark in Langen/Debstedt).

After ten years' activities of a working group for rehabilitation in an orthopedic clinic, the actual success as reported by the rehabilitated persons, is checked and evaluated in a questionnaire operation. The aim of this inquiry was to assess the work done by such a group within the general framework of clinical activities. Particular emphasis was places on the results in respect of rehabilitation, i.e., the extent to which the patient was able to resume his normal professional or employment activities.