A Review of Total Hip Arthroplasty Comparison in FNF and OA Patients.

BACKGROUND: Worldwide, total hip arthroplasty (THA) has become one of the most commonly performed surgical procedures. Femoral neck fracture (FNF) and osteoarthritis (OA) are two of the medical conditions necessitating a hip replacement, most frequently carried out. The preoperative and postoperative pathways for patients suffering from these two diseases differ, yet worldwide, many national healthcare systems underestimate or misinterpret the (more than nuanced) care plan differences of the two. Factors and Criteria. Analyzed material was gathered from studies published between 2013 and 2019. Various strands of data demographics, comorbidities, and complications, as well as treatment outcomes, were tabulated to compare and contrast THA patients suffering from FNF and OA to collate their findings. Outcomes were cross-checked and validated for reliability and then were presented in a table format. RESULTS: All five retrospective cohort studies fitted the required criteria for inclusion in this work, four US-based study groups and one European-based study group. Data were gathered from three separate databases. The "average" FNF patient is 76.8 years old. There was a 68.96% female probability. The "average" OA patient is 69.15 years old. There was a 5.24% female probability. 59.57% operated for athrosis, and only 34.63% operated for fracture which received grade lower than the third in the American Society of Anaesthesiologist (ASA) classification. There was more than 3 times higher prevalence of complications in the trauma group. FNF patients' hospitalization was approximately 3 days longer. On average, 3.7% of patients operated for trauma and 1.5% of patients with elective THA required a second surgery. 6.57% FNF and 2.93% OA patients had unplanned readmission. CONCLUSIONS: In general, patients who suffer a femoral neck fracture are an extremely fragile group. They require additional perioperative and postoperative care. To meet these desired expectations, more FNF cost-comprehensive systems need to be initiated.

Assessment of Lacrimal Duct Patency in Patients Undergoing Endoscopic Medial Maxillectomy.

PURPOSE: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. MATERIALS AND METHODS: 21 patients who underwent medial maxillectomy in the years 2016-2019 were assessed for discomfort and epiphora based on patients' own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. RESULTS: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. CONCLUSIONS: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used.

Increased expression of the TNF superfamily member LIGHT/TNFSF14 and its receptors (HVEM and LTßR) in patients with systemic sclerosis.

OBJECTIVES: This study aimed to assess the potential role of the TNF superfamily member lymphocyte T-related inducible ligand that competes for glycoprotein D binding to herpesvirus entry mediator on T cells (LIGHT) in SSc through evaluation of: skin expression of LIGHT and its receptors, herpesvirus entry mediator and lymphotoxin ß-related receptor, and serum concentration of LIGHT in SSc patients. METHODS: Expression of LIGHT and its receptors was investigated by immunohistochemistry and evaluated semi-quantitatively in skin biopsies from 19 SSc patients and 9 healthy controls. Serum levels of LIGHT were measured using ELISA in 329 patients with SSc and 50 control subjects. RESULTS: Expression of LIGHT and both receptors was higher in SSc patients compared with controls (P < 0.05 for all comparisons). Patients with early SSc (⩽ 3 years from the first non-Raynaud's phenomenon symptom) showed higher expression of LIGHT and herpesvirus entry mediator compared with patients with longer disease duration (P < 0.05 for both comparisons). The mean serum concentration of LIGHT was significantly higher in SSc patients compared with the controls (P < 0.05). High serum concentration of LIGHT was associated with male sex, presence of digital ulcers, muscle involvement (defined by elevated serum creatine kinase levels), steroid treatment and lack of ACA. However, in multivariate regression analysis only presence of digital ulcers and creatine kinase elevation were independently associated with serum concentration of LIGHT. CONCLUSION: These data provide the first evidence of overexpression of LIGHT and its receptors in SSc and suggest that the LIGHT axis might contribute to the pathogenesis of SSc. Increased serum concentrations of LIGHT seem to reflect vascular injury in SSc.

The arachidonate 5-lipoxygenase activating protein gene polymorphism is associated with the risk of scleroderma-related interstitial lung disease: a multicentre European Scleroderma Trials and Research group (EUSTAR) study.

Objectives: The arachidonate 5-lipoxygenase activating protein (ALOX5AP) regulates synthesis of leukotrienes (LTs), which are important mediators of inflammation and connective tissue remodelling. The aim of this study was to evaluate if single nucleotide polymorphisms (SNPs) of ALOX5AP confer risk of SSc and/or SSc-related organ involvement. Methods: Seven SNPs of ALOX5AP (rs17222814, rs17216473, rs10507391, rs4769874, rs9551963, rs9315050 and rs7222842) were genotyped in a cohort of 977 patients with SSc and 558 healthy controls from centres collaborating within the European Scleroderma Trials and Research group. In 22 SSc patients, concentrations of cysteinyl LTs and LT B4 (LTB4) were measured in the supernatants of ionophore-stimulated peripheral blood mononuclear cells (PBMCs) by means of commercially available enzyme immunoassay kits. Results: Significant association was found between rs10507391 polymorphism (T/A) of ALOX5AP and the risk of SSc [odds ratio (OR) 1.27 (95% CI 1.07, 1.50), P < 0.05 vs controls], the presence of SSc-related interstitial lung disease on high-resolution CT of the lungs [OR 1.45 (95% CI 1.17, 1.79), P < 0.05 vs patients without SSc-related interstitial lung disease] as well as with restrictive ventilatory defect [forced vital capacity <70% of predicted; OR 1.51 (95% CI 1.16, 1.97), P < 0.05 vs SSc patients without pulmonary restriction]. PBMCs from SSc carriers of rs10507391 allele A synthesized greater amounts of cysteinyl LTs as compared with SSc patients with rs10507391 TT genotype ( P < 0.05). Synthesis of LTB4 did not differ significantly between the two groups. Conclusion: The results of our study indicate that the genetic variants of ALOX5AP might play a role in the development of SSc-related pulmonary fibrosis.

High serum sCD163/sTWEAK ratio is associated with lower risk of digital ulcers but more severe skin disease in patients with systemic sclerosis.

INTRODUCTION: Systemic sclerosis (SSc) is an autoimmune disease characterized by chronic inflammation, vascular injury and excessive fibrosis. CD163 is a scavenger receptor which affects inflammatory response and may contribute to connective tissue remodelling. It has recently been demonstrated that CD163 can bind and neutralize the TNF-like weak inducer of apoptosis (TWEAK), a multifunctional cytokine which regulates inflammation, angiogenesis and tissue remodelling. We aimed to investigate the relationships between serum levels of soluble CD163 (sCD163) and soluble TWEAK (sTWEAK) in relation to disease manifestations in SSc patients. METHODS: This study included 89 patients with SSc who had not received immunosuppressive drugs or steroids for at least 6 months and 48 age- and sex-matched healthy controls (HC) from four European centres. Serum concentrations of sTWEAK and sCD163 were measured using commercially available ELISA kits. RESULTS: The mean serum concentrations of sTWEAK were comparable between SSc patients (mean +/- SD: 270 +/- 171 pg/mL) and HC (294 +/- 147pg/mL, P >0.05). Concentration of sCD163 and sCD163/sTWEAK ratio were significantly greater in SSc patients (984 +/- 420 ng/mL and 4837 +/- 3103, respectively) as compared to HC (823 +/- 331 ng/mL and 3115 +/- 1346 respectively, P <0.05 for both). High sCD163 levels and a high sCD163/sTWEAK ratio (defined as > mean +2SD of HC) were both associated with a lower risk of digital ulcers in SSc patients (OR, 95%CI: 0.09; 0.01, 0.71, and 0.17; 0.06, 0.51, respectively). Accordingly, patients without digital ulcers had a significantly higher sCD163 concentration and sCD163/sTWEAK ratio as compared to SSc patients with digital ulcers (P <0.01 for both) and HC (P <0.05 for both). A high sCD163/sTWEAK ratio, but not high sCD163 levels, was associated with greater skin involvement. CONCLUSIONS: The results of our study indicate that CD163-TWEAK interactions might play a role in the pathogenesis of SSc and that CD163 may protect against the development of digital ulcers in SSc. Further studies are required to reveal whether targeting of the CD163-TWEAK pathway might be a potential strategy for treating vascular disease and/or skin fibrosis in SSc.

Recent advances in the diagnosis and treatment of systemic sclerosis.

Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by widespread vascular injury and progressive fibrosis of the skin and internal organs. The involvement of internal organs results in significant morbidity and mortality of SSc patients with cardiopulmonary involvement being the leading cause of SSc­related deaths. The management of SSc patients remains a challenge because therapeutic options are rather limited and no therapy has definitively shown a disease­modifying effect. A significant progress that has recently been made in the understanding of the SSc pathogenesis contributed to the introduction of new therapeutic options. Preliminary clinical studies have yielded promising results for mycophenolate mofetil, anti­CD20 antibodies, and stem­cell in the treatment of SSc. Multicenter cohort studies help understand the natural history of SSc, which leads to improvement in the care of SSc patients. The major objective of those studies is to establish the screening strategies for early diagnosis and, subsequently, to introduce appropriate management concerning specific organ involvement in SSc as well as to formulate specific treatment recommendations.

The role of leukotrienes in the pathogenesis of systemic sclerosis.

Systemic sclerosis (SSc, scleroderma) is an autoimmune disease characterized by widespread vascular injury and progressive fibrosis of the skin and internal organs. SSc-related involvement of the lungs, heart, kidneys and/or the gastrointestinal system accounts for the increased mortality of scleroderma patients. Despite the progress which has recently been made in this field, the treatment of SSc is still unsatisfactory due to the low efficacy and/or high toxicity of available therapies. Leukotrienes are a family of lipid mediators synthesized from arachidonic acid in a process mediated by 5-lipoxygenase; they include leukotriene B4 and a group of cysteinyl leukotrienes: C4, D4, and E4. Leukotrienes play an important role in the regulation of all the processes vital to the pathogenesis of SSc, namely inflammation, vascular function and connective tissue remodeling. The available data suggests that an excessive synthesis of leukotrienes may contribute to the development and progression of SSc. Accordingly, blockade of leukotriene pathways appears to be a new, promising target for the treatment of SSc.

[Treatment of foot drop in orthopaedic practice]. / Leczenie stopy opadajacej w praktyce ortopedycznej.

Foot drop is a symptom of many diseases and leads to an unaesthetic limping gait, falls and injuries. The most common cause of foot drop is injury to the common peroneal nerve, which innervates ankle joint and foot extensors. Other causes of foot drop include: sciatic nerve injury, lumbar plexopathies, L4/L5 radiculopathy, central nervous system related neuropathies (anterior horn cell disease, brain tumor). Also compartment syndromes of the lower leg can lead to foot drop deformity. Ankle-foot orthoses (AFO) are helpful in the treatment of paralyzed extensor muscles of the foot. The surgical treatment should be connected with the etiology of the foot drop and can include: neurolysis of the nerve, "end to end" repair, autogenous nerve graft procedures, nerve transfers, direct neuromuscular neurotization and tendon transfers. In proximal sciatic nerve lesions, nerve transfers and one-stage nerve repair with concomitant tendon transfer are valuable methods of the treatment of drop foot. The aim of the paper is to present pathogenesis and modes of treatment of foot drop deformity encountered in any orthopedic unit.

CD163 and its role in inflammation.

Mononuclear phagocytes represent a heterogeneous population of cells with individual subpopulations exerting different pro- or anti-inflammatory functions. CD163 is a monocyte/macrophage specific marker expressed predominantly on cells which possess strong anti-inflammatory potential. The expression of CD163 is strongly induced by anti-inflammatory mediators such as glucocorticoids and interleukin-10, while being inhibited by pro-inflammatory mediators such as interferon-gamma. CD163-expressing mononuclear phagocytes, as well as soluble CD163, may both take part in downregulating an inflammatory response. It seems, therefore, that CD163 may be an interesting target for therapeutic modulation of the inflammatory response.

[The importance of rehabilitation after operative treatment of Dupuytren's disease]. / Rola rehabilitacji po operacyjnym leczeniu choroby Dupuytrena.

Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common in medical practice. Through an effective splinting and exercise program, the surgical outcome can be enhanced. The treatment plan must take into account the wide range of reactions to surgery. The management plan must be flexible, more than in most areas of hand surgery. The most important points in hand therapy after surgery for Dupuytren's disease include: 1) early detection of potential postoperative complications--including disturbances in wound healing; 2) edema control; 3) scar management; 4) maintenance of surgical correction; 5) restoration of finger flexion to the degree of preoperative range of motion. The postoperative program of hand rehabilitation depends on type of surgery, and therapist's education. The hand therapist should see all patients initially on removal of the operative dressing and provide advice on a program of active mobilization. Thereafter, patients should be seen routinely at weekly intervals to ensure that recovery of motion is progressing.

Angiopoietins-1 and -2 are differentially expressed in the sera of patients with systemic sclerosis: high angiopoietin-2 levels are associated with greater severity and higher activity of the disease.

OBJECTIVES: The aim of the study was to investigate serum concentration of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) in SSc patients and to correlate Ang-1 and -2 levels with clinical manifestations. METHODS: Serum levels of Ang-1 and -2 were determined by ELISA in 47 SSc patients and 27 healthy controls matched for age and sex. RESULTS: In SSc patients, Ang-1 was significantly lower [mean (s.d.): 21,666.09 (11,516.06) pg/ml], while Ang-2 was significantly increased [2739.60 (1009.25) pg/ml] when compared with the control group [Ang-1: 28607.13 (10,506.93) pg/ml; Ang-2: 1706.28 (556.28) pg/ml, P < 0.01, for both comparisons]. No correlation was observed between Ang-1 and -2 levels. Serum concentrations of Ang-2 correlated with the modified Rodnan skin score (P < 0.01, r =0.422), the European Scleroderma Study Group (EScSG) disease activity index score (P < 0.001, r =0.403), ESR (P < 0.05, r = 0.366) and CRP concentration (P < 0.05, r =0.292), and showed inverse correlation with diffusing capacity for carbon monoxide (DL(CO)) (P < 0.01, r = -0.281). Ang-2 was significantly increased in SSc patients with more advanced capillary damage, as indicated by the presence of late capillaroscopic pattern, than in those with less severe microangiopathy (active pattern), and in SSc patients with intermediate/late stage of disease than in SSc subjects with early disease. In multivariate regression analysis, Ang-2 was independently associated with the EScSG activity index [ß-coefficient (ß = 0.305, P= 0.038], ESR (ß= 0.390, P =0.006) and, inversely, with the presence of digital ulcers (ß =-0.426, P = 0.003). CONCLUSIONS: Differential expression of Ang-1/Ang-2 might contribute to the pathogenesis of SSc. Ang-2 might be a new biomarker of disease activity in SSc.

Increased production of a proliferation-inducing ligand (APRIL) by peripheral blood mononuclear cells is associated with antitopoisomerase I antibody and more severe disease in systemic sclerosis.

OBJECTIVE: A proliferation-inducing ligand (APRIL), a member of the tumor necrosis factor (TNF) family, plays a crucial role in the survival of peripheral B cells, and may contribute to the pathogenesis of systemic sclerosis (SSc) through upregulation of autoantibody production and maintenance of autoimmune phenomena. We evaluated the capacity of peripheral blood mononuclear cells from patients with SSc (SSc-PBMC) to produce APRIL; and investigated correlations between production of APRIL by SSc-PBMC and clinical and laboratory features of the disease. METHODS: PBMC from 20 patients with SSc and 14 healthy subjects were incubated in fetal calf serum-supplemented RPMI medium. APRIL levels were determined in cell culture supernatants by ELISA. RESULTS: PBMC from patients with SSc produced significantly more APRIL (961 ± 151 pg/ml/105 cells) than control PBMC (798 ± 219 pg/ml/105 cells; p < 0.01). In patients with SSc, increased production of APRIL was associated with the presence of diffuse skin involvement, scleroderma lung disease, peripheral vasculopathy, greater capillary damage on capillaroscopy, and presence of anti-topoisomerase I (anti-topo I) antibodies. Multivariate regression analysis revealed anti-topo I antibodies as the only independent predictor of high production of APRIL by PBMC. CONCLUSION: Production of APRIL is increased in SSc-PBMC and is associated with the presence of anti-topo I antibodies and more severe disease. Targeting the APRIL pathway might represent a therapeutic possibility for treatment of patients with SSc, in particular those with anti-topo I antibodies.

Diminished production of TWEAK by the peripheral blood mononuclear cells is associated with vascular involvement in patients with systemic sclerosis.

Widespread vasculopathy and profound fibrosis are key features of the pathogenesis of systemic sclerosis (SSc). We hypothesized that the TNF-like weak inducer of apoptosis (TWEAK), a recently recognized multifunctional cytokine which regulates angiogenesis and tissue remodeling, may play a role in the development of SSc. The production of TWEAK by the peripheral blood mononuclear cells (PBMC) was investigated, by means of ELISA, in 24 SSc patients and 14 healthy subjects. Moreover, production of TWEAK was correlated with clinical features of SSc. PBMC were isolated using density gradient centrifugation on Histopaque and were cultured in FCS supplemented RPMI medium at 37 degrees C under 5% CO2. Production of TWEAK by PBMC was significantly diminished in patients with more severe microvascular damage, as indicated by the presence of "active" capillaroscopic pattern, compared with SSc patients with less pronounced microangiopathy ("slow" pattern), and healthy subjects. Moreover production of TWEAK correlated inversely with duration of Raynaud's phenomenon. PBMC from patients with scleroderma-related interstitial lung disease tended to produce lower amounts of TWEAK compared with SSc patients without lung involvement but the difference was not significant. The results of our study suggest that diminished production of TWEAK might play a role in the pathogenesis of vascular injury in SSc patients. Whether TWEAK may represent a new therapeutic target in SSc requires further studies.

The effect of prophylactic doses of nadroparin and therapeutic doses of betamethasone on skin flap survival in rats.

Application of pedicle flaps is of great importance in orthopaedics and reconstructive surgery. It has been postulated that anticoagulants or anti-inflammatory treatments may have advantageous effect on pedicle flap survival. The aim of this study was to investigate whether: 1. low-molecular-weight heparin given at prophylactic doses or 2. steroids given at therapeutic doses improve survival of dorsal pedicle flap in rats. Thirty four animals divided into three groups were used for the experiments: Group I (N=12) was treated with low-molecular-weight heparin (nadroparin, 40 IU per kilogram of body mass/day). Group II (N=12) received single injection of betamethasone (intramuscularly, 0.1 mg per kilogram of body mass). Group III (N=10) received sterile saline (0.9% NaCl) subcutaneously as placebo. All animals were housed individually in an environmentally controlled room. After seven days from the operation, 51.7% of the dorsal flaps survived in group I and 48.3% in the group II. These results were comparable to those in the control animals. Our results indicate that neither low dose heparin (nadroparin) used at prophylactic doses nor steroids used at therapeutic doses had any effect on dorsal pedicle flap survival in rats.

[Applying the posterior fasciocutaneous thigh flap in bed sores treatment]. / Zastosowanie uszypulowanego powieziowo-skórnego plata tylnego uda w leczeniu odlezyn.

The paper presents the possibilities of applying the posterior thigh flap in the treatment of ischial pressure sores. Between 2000 and 2004 the flap was used in three cases treated in the Orthopaedics and Traumatology Department of the Medical Universtity in Bialystok. The indications, contraindications, operative technique and advantages of the posterior thigh flap are described. In all three cases the ischial bed sores healed well without recurrences. The posterior fasciocutaneous pedicled flap is a good method of treatment for not too extensive bed sores in the ischial region. This flap can be applied in recurrences found after primary bed sore treatment with another method. However the fasciocutaneous flap has a limited range of transposition as compared with cutaneous flaps.

Interbody fusion and transpedicular fixation in the treatment of spondylolisthesis.

BACKGROUND: This is a retrospective analysis of long-term results of treatment of dysplastic, isthmic and degenerative spondylolisthesis with interbody fusion and transpedicular screw fixation. MATERIAL AND METHODS: Twenty-one patients underwent interbody fusion with the "Bialstab" transpedicular system. Anterior lumbar interbody fusion (ALIF) was subsequently performed in 2 patients. In the remaining patients, posterior lumbar interbody fusion (PLIF) was performed following interbody fusion in the same session. Mean follow up was 22.4 months. Results were evaluated on the basis of a physical examination, the Oswestry questionnaire and the VAS back pain score. Radiologic assessment was based on targeted lateral radiographs to the stabilized segment. RESULTS: The post-operative wound healed without complications in all patients. Clinical outcomes at follow-up were rated as good (10), quite good (9) and poor (2). The average Oswestry score was 14 (range 0-30). The mean VAS score at follow-up was 2.9 (range 0-8). Anatomical slip reposition was performed in 2 patients, partial reposition in 11 patients, and 8 patients were treated with in situ fusion. Radiological evaluation revealed fusion in 17 patients. CONCLUSIONS: 1. Transpedicular fixation with interbody fusion is an effective technique for the treatment of spondylolisthesis. 2. Partial reposition of spondylolisthesis with neural decompression makes it possible to avoid neurological complications. 3. The "Bialstab" fixation system fulfills the criteria for good transpedicular stabilization.

[New methods of hand mobilization after operative treatment of flexor tendon injuries]. / Nowoczesne metody usprawniania reki po operacyjnym leczeniu uszkodzen sciegien zginaczy.

The paper presents various methods of physiotherapy after operative treatment of lacerated flexor tendons of the hand. Early physiotherapy is a very important factor in the essential treatment of a patient after tendon injury. The goal of treatment is to restore an optimal range of motion of the injured finger which enables the patient to have unrestricted finger motion. There are various rehabilitation programs. They are based on passive, active or both of these kinds of finger movements. Each of these methods requires a different position of the hand. The choice of physiotherapy method depends on: type of surgical treatment of the lacerated tendon, the presence of other hand injuries, the level of education of the surgeon and physiotherapist, the patient's age and the possibility of cooperation with the patient.

[Sacral pressure sores and their treatment]. / Odlezyny okolicy krzyzowej i ich leczenie.

INTRODUCTION: Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over long periods of time and therefore involves considerable costs. MATERIAL AND METHODS: The material consisted of 11 sacral pressure ulcers treated surgically. The sores occurred in 4 severely disabled patients suffering from proximal third femur fractures, 4 patients with traumatic brain injury (treated in the Intensive Care Unit), and 3 patients suffering from bed sores after spinal cord injury. In 6 patients a fasciocutaneous flap was applied to the sores and in 5 cases a pedicled musculocutaneous gluteus maximus flap. The end results were assessed using Seiler's criteria. RESULTS: Complications of the "seroma" type were observed in 3 patients, and in 2 marginal necrosis. In all our patients complete healing was achieved within 2-4 weeks. CONCLUSIONS: On analysing our experience to date in surgical treatment of bed sores we are of the opinion that even extensive sacral sores can be covered with unilateral pedicled flaps provided that they are appropriately planned. Deep sores of the 4th degree sometimes with concomitant osteomyelitis require pedicled muscle flaps or in some cases musculocutaneous flaps to improve local circulation. The preparation of the patient for reconstruction surgery is just as important as the operation itself and therefore such preparation should never be neglected.

Distally based sural artery flap in soft tissue defects of the heel region.

Background. The coverage of tissue defects caused by decubitus ulcers in the remains a challenge for reconstructive surgery. In this article we describe our own experience with the use of the distally-based superficial sural artery flap. Material and methods. Between 1997 and 2004 we used distally-based superficial sural artery island flaps in 8 patients. In all cases the tissue was prepared as a fasciocutaneous flap. Results. All the flaps have survived. The advantages offered by this flap include constant and reliable blood supply, easy dissection, minimal morbidity of donor site, and preservation of the major arteries in the leg. We observed venous congestion and edema in three flaps, and marginal necrosis in one flap. Conclusions. The distally based sural artery flap is a good method for the treatment of soft tissue defects in the heel region. The procedure is short and can be performed in a single stage without microsurgery. This flap has the potential for reinnervation in demanding patients.

The radiological outcomes of total knee arthroplasty using computer assisted navigation ORTHOPILOT.

Comprehensive radiographic analysis of total knee arthroplasty performed traditionally and with the use of Computer Assisted Navigation (CAN) is presented. The aim of this study was to compare the precision of implant alignment considering two operating techniques. The analyzed material consisted of 100 radiograms of patients operated on traditional way and 100 knee joint radiograms of patients operated on with a use of CAN. Assessment of postoperative radiograms was carried out in order to analyze coronal mechanical axis and sagittal orientation of both femoral and tibial components. Measurements were taken precisely up to 1 degrees and therefore results were classified as good (0-2 degrees deviation due to mechanical axis), satisfactory (2-4 degrees) and poor (over 4 degrees). The radiological outcome allows to present the following conclusions: CAN allows to minimize the risk of incorrect prosthesis alignment and therefore significantly improves the radiological outcome of total knee arthroplasty. This improvement can lead to better long time "survival" of implant components. The only price one pays for this improvement is 15-20 minute surgery delay, however it needs further studies to determine other possible disadvantages.