Influence of Various Strontium Formulations (Ranelate, Citrate, and Chloride) on Bone Mineral Density, Morphology, and Microarchitecture: A Comparative Study in an Ovariectomized Female Mouse Model of Osteoporosis.

Osteoporosis stands out as a prevalent skeletal ailment, prompting exploration into potential treatments, including dietary strontium ion supplements. This study assessed the efficacy of supplementation of three strontium forms-strontium citrate (SrC), strontium ranelate (SrR), and strontium chloride (SrCl)-for enhancing bone structure in 50 female SWISS mice, aged seven weeks. In total, 40 mice underwent ovariectomy, while 10 underwent sham ovariectomy. Ovariectomized (OVX) mice were randomly assigned to the following groups: OVX (no supplementation), OVX + SrR, OVX + SrC, and OVX + SrCl, at concentrations equivalent to the molar amount of strontium. After 16 weeks, micro-CT examined trabeculae and cortical bones, and whole-bone strontium content was determined. Results confirm strontium administration increased bone tissue mineral density (TMD) and Sr content, with SrC exhibiting the weakest effect. Femur morphometry showed limited Sr impact, especially in the OVX + SrC group. This research highlights strontium's potential in bone health, emphasizing variations in efficacy among its forms.

Relationship between Upper Limb Functional Assessment and Clinical Tests of Shoulder Mobility and Posture in Individuals Participating in Recreational Strength Training.

BACKGROUND: The upper limb is crucial for functioning in everyday life, thus comprehensive assessment is crucial for physically active people to monitor the effect of exercise and prevent injuries. The aim of this study was to analyse the relationship between upper limb function, shoulder mobility, and posture in individuals who participate in recreational strength training. METHODS: Thirty-four subjects who engaged in strength training of the upper limbs were divided into two groups: Group 1 (exercise < 3 years) and Group 2 (exercise ≥ 3 years). Lateral scapular slide tests, head and clavicle posture evaluations, and shoulder mobility and closed kinetic chain tests were performed. RESULTS: Group 1 had a greater flexion deficit in both shoulders than Group 2. There was greater external rotation in the non-dominant shoulder and a greater score of the closed kinetic chain test in Group 2 compared to Group 1. There were no statistically significant differences between groups regarding scapula, clavicle, and head posture. The closed kinetic chain test was correlated with a scapula position and symmetry in shoulder flexion in Group 2. CONCLUSIONS: Long-term strength training of the upper limbs can be recommended to improve functional abilities in the closed kinetic chain, increase shoulder mobility, and reduce asymmetry.

Complex Regional Pain Syndrome after Distal Radius Fracture-Case Report and Mini Literature Review.

This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field.

Contribution to Knowledge on Bioapatites: Does Mg Level Reflect the Organic Matter and Water Contents of Enamel?

The matter constituting the enamels of four types of organisms was studied. The variability of the ions was presented in molar units. It was proven that the changes in water contents of the enamel are significantly positively related to changes in Mg; inversely, there is also a strong connection with changes in Ca and P, the main components of bioapatite. The variability in the organic matter has the same strong and positive characteristics and is also coupled with changes in Mg contents. Amelogenins in organic matter, which synthesize enamel rods, likely have a role in adjusting the amount of Mg, thus establishing the amount of organic matter and water in the whole enamel; this adjustment occurs through an unknown mechanism. Ca, P, Mg, and Cl ions, as well as organic matter and water, participate in the main circulation cycle of bioapatites. The selection of variations in the composition of bioapatite occurs only along particular trajectories, where the energy of transformation linearly depends on the following factors: changes in the crystallographic d parameter; the increase in the volume, V, of the crystallographic cell; the momentum transfer, which is indirectly expressed by ΔsinΘ value. To our knowledge, these findings are novel in the literature. The obtained results indicate the different chemical and crystallographic affinities of the enamels of selected animals to the human ones. This is essential when animal bioapatites are transformed into dentistic or medical substitutes for the hard tissues. Moreover, the role of Mg is shown to control the amount of water in the apatite and in detecting organic matter in the enamels.

Strontium Ranelate and Strontium Chloride Supplementation Influence on Bone Microarchitecture and Bone Turnover Markers-A Preliminary Study.

Despite strontium ranelate use in osteoporosis management being one of the promising concepts in disease treatment, there is no clear evidence that strontium organic compounds are more effective than inorganic ones. The aim of this study was to compare strontium chlorate and strontium ranelate influence on the mice bone microarchitecture. We investigated whether strontium chlorate (7.532 mmol/L) and strontium ranelate (7.78 mmol/L) solutions fed to healthy SWISS growing mice (n = 42) had an influence on the percent of bone volume (BV/TV), trabecular thickness (Tb.Th), number of trabeculae (Tb.N), and separation between each trabecula (Tb.Sp) in the chosen ROI (region of interest) in the distal metaphysis of the left femurs. The cortical bone surface was examined close to the ROI proximal scan. There was an increase in each examined parameter compared with the control group. There were no statistical differences between strontium ranelate and strontium chlorate parameters. Our study indicates that organic and inorganic strontium compounds similarly affect the bone microarchitecture and strength.

A Kinesio Taping Method Applied in the Treatment of Postsurgical Knee Swelling after Primary Total Knee Arthroplasty.

Background The knee is one of the joints in the human body that is most susceptible of osteoarthritis (OA). In the case of advanced-stage OA, total knee arthroplasty (TKA) is a treatment of choice. One modern physiotherapeutic method to support the treatment in the early postsurgical period is Kinesio Taping (KT). The aim of this study is to evaluate the efficacy of KT on swollen subcutaneous tissue after TKA. MATERIALS AND METHODS: The studied group consisted of 23 patients who had received TKA. The mean BMI was 30.60 ± 4.91, and KT was applied between the 3rd and 8th day of the early postoperative period. The control group was constituted by 22 patients who had received TKA. The mean BMI was 30.41 ± 6.00, and KT was not applied. On the 3rd and 8th day after TKA, in all patients, the swelling of the shin, range of motions (ROM), and pain were measured using ultrasound, a goniometer, and a VAS scale, respectively. RESULTS: In the KT group, the lateral measurement at the top of the head of the fibula significantly decreased between the 3rd and 8th day (11.47 ± 0.76 vs. 9.76 ± 0.77; p = 0.0004). The knee flexion angle on day 3 was statistically significantly different from that on day 8 (48.61 ± 3.08 vs. 72.74 ± 3.92; p = 0.00004). The evaluation results for severity of pain using the VAS scale on day 3 were statistically significantly higher than those on day 8 (5.74 ± 0.25 vs. 4.30 ± 0.25; p = 0.00006). In the group of patients to whom KT was not applied, the lateral measurement at the top of the head of the fibula on day 3 was not statistically significantly different from that on day 8 (10.323 ± 0.828 vs. 10.273 ± 0.995; p = 0.9227). The knee flexion angle in the group that did not receive KT on day 3 was statistically significantly different from that on day 8 (45.182 ± 3.654 vs. 59.909 ± 4.817; p = 0.0006). The severity of pain evaluated using the VAS scale on day 3 was statistically significantly different from that on day 8 (6.227 ± 0.146 vs. 4.864 ± 0.190; p = 0.0001). CONCLUSIONS: KT is an effective method for improving subcutaneous drainage and decreasing subcutaneous tissue. However, KT does not affect postoperative pain and ROM.

THE EVOLUTION OF TREATMENT AT THE ORTHOPEDICS AND REHABILITATION CLINIC.

OBJECTIVE: Introduction: The last 20 years have been a period of huge changes in Polish healthcare, both in terms of medical progress as well as organization and financing. These changes, and especially the newly introduced queuing systems significantly influenced the changes in the profile of hospital admission. The aim: To analyze changes in the patient profile, causes and time of hospitalization, as well as the waiting time for hospitalization, in 1996-2019 Lublin SPSK4 Orthopedics and Rehabilitation Clinic. PATIENTS AND METHODS: Material and methods: Patients' medical records were analyzed, including qualification cards. The waiting time for admission to the hospital, the time of hospitalization, the cause of hospitalization, gender and the patient's place of residence were analyzed. RESULTS: Results and conclusions: 1. During the 13 years analyzed, the number of hospitalizations increased from 452 to 1387 patients a year. 2. The waiting time for hospitalization increased from an average of 2 months in 1996 to even 2 years (in the case of patients with chronic category) in 2020. 3. The average length of hospitalization changed compared to the level of 1996 (8 weeks) in the case of patients with the early neurological category increased slightly (9 weeks), in the case of other patients - it decreased to 4 weeks, respectively - chronically ill patients, 3 weeks - patients from the systemic and weekly rehabilitation category - orthopedic patients. 4. The scope of the reasons for hospitalization, but also methods of treatment has expanded significantly. 5. Patient demographic profile in the examined aspects (origin, gender) - remained similar.

THE ROLE OF THE PERIOPERATIVE NURSING CARE IN THE SATISFACTION OF PATIENTS AFTER LARGE JOINT REPLACEMENTS.

The medical services market is inevitably changing. Competition among health care institutions is growing, patients' health awareness and expectations regarding the quality of health services are increasing. This translates directly into, among others, to the patient's choice of medical facility. "Satisfaction" defined as "general satisfaction accompanying the consumption of products or services" is an important aspect affecting the position of a healthcare institution on the health services market. While in the hospital, the patient carefully observes and remembers many details of behaviors and reactions he encounters. Opinions of patients about a medical facility are usually subjective and relate mainly to satisfaction with the treatment process, therefore the lack of proper care in terms of patients' needs may result in the loss of the hospital's reputation. A very important aspect of the assessment of any medical service is the direct relationship between the patient and medical staff, mainly nurse. Among the factors affecting the level of patient satisfaction during a hospital stay are, inter alia, the availability of a doctor, nursing care, conditions in the ward, the possibility of patient participation in the treatment process, providing the patient with information in a clear and reliable manner, and improved health. Factors related to nursing care that have the greatest impact on the patient's level of satisfaction comprise the nurse's individual approach to the patient, time devoted to him, providing professional information, patient education and scrupulous nursing activities. The aim: The aim of the paper was to assess the role of perioperative nursing care in the satisfaction of patients after hip and knee joint replacements.

HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN PREGNANT AND POSTPARTUM WOMEN.

OBJECTIVE: Introduction: Haemophagocytic lymphohistiocytosis (HLH) is an extremely rare, life-threatening disease, caused by uncontrolled activation of lymphocytes T and macrophages. This situation leads to cytokine storm, infiltration and internal organs failure. HLH can be categorised into either primary (familiar) or secondary which may be associated with infections, immunodeficiency syndromes, autoimmune diseases and malignancy. The secondary HLH is difficult to diagnose due to nonspecific symptoms and complicated differential diagnostics. The aim: To conduct a comparative analysis of pregnant and puerperal patients diagnosed with HLH. PATIENTS AND METHODS: Material and methods: Review of available literature on haemophagocytic lymphohistiocytosis during pregnancy and the puerperium. RESULTS: Results: Review of the latest literature shows that HLH can occur at any time during pregnancy and in the puerperium. Symptoms of the disease are non-specific: fever not responding to antibiotic therapy, sometimes hectic, hepatosplenomegaly, swelling, lymphadenopathy, disseminated intravascular coagulation, multi-organ failure and death. In laboratory tests, worsening bicytopenia or pancytopenia, increasing indicators of organ damage, hypertriglyceridemia, hypofibrinogenemia and abnormally high serumferritin levels are observed. CONCLUSION: Conclusions: HLH, due to non-specific symptoms and rarity, is often overlooked in the diagnostic process. Due to the high mortality and morbidity rates of HLH during pregnancy for mother and foetus, timely diagnosis and the inclusion of specialist treatment are particularly important. An interdisciplinary approach to the patient is necessary to make an accurate diagnosis. The assessment of serum ferritin concentrations facilitates diagnosis. The bone marrow is essential to diagnosis and should be performed as early as possible.

ISCHEMIC SPINAL CORD INJURY FOLLOWING AORTIC STENT GRAFT IMPLANTATION - CASE STUDY.

Morbidity and mortality associated with aortic aneurysm remains high. Aneurysms involving the thoracic and lumbar part of the aorta (TAAA) are particularly burdened with mortality. They are also one of the biggest challenges that vascular surgeons can face. Despite several dozen years of progress in surgical techniques, as well as the constant development of accompanying methods of spinal protection, ischemic spinal cord injury with subsequent paresis or pareresis is still one of the most serious complications of both open and closed surgical treatment of aortic aneurysms. Ischemic complications of the spinal cord occur immediately after the procedure, when the patient wakes up with a neurological deficit (according to some authors within the first day after the procedure) or in a deferred manner. In the case of open surgery, immediate damage is more common, in the case of endovascular surgery - deferred. Factors such as low blood pressure, arrhythmias, cardiovascular failure, sepsis and anemia due to anemia contribute to an increased risk of deferred complications. The rehabilitation of a patient with limb paralysis as a consequence of vascular spinal injury is laborious and requires a comprehensive approach. Proper treatment and prompt intervention in the form of rehabilitation is a great therapeutic challenge. The aim of the paper was to present the importance of the ischemic injuries of spinal cord following aortic stent graft implantation through a case report.

[Protein and physical activity in prevention and treatment of sarcopenia].

There is continuous ageing in world population. Although life expectancy still increases there is no similar trend in maintaining quality of life. The number of disabilities due to age is expected to double in 2060. Muscle mass is one of the most important factors of health and nutrition in old age and it constant loss is characteristic for process of ageing. Muscle mass is controlled by number of different factors. The most important of which is balance between muscle protein synthesis and degradation. Ageing has no influence on muscle protein degradation so for maintaining muscle mass it is better to target muscle protein synthesis. Optimal protein dose in the meal is the minimal amount of protein effecting in maximal anabolic response. Threshold for anabolic response increase with age. This process, named anabolic resistance can be overwhelmed with high amount of protein in diet. Experts in the field of ageing and nutrition recommend 1,2-1,5 g/kg/d protein for the maintaining of muscle mass, 1,2-1,5 g/kg/d for older with additional risk factors, 2,0 g/kg/d for seriously ill and malnourished. Physical training has synergistic influence with diet protein. Physical training improves muscle performance, muscle strength and prevents muscle wasting. Physical training combined with increased amount of protein in diet results with increased muscle mass.

[Peripheral nerves phenolisation in spasticity management - forgotten art or interesting perspective?]

INTRODUCTION: Spasticity is one of the most common obstacles in the process of rehabilitation after permanent central nervous system injury. Statistics show that the problem affects more than 12 billion people all over the world. Treatment of spasticity is necessary for proper rehabilitation, prevention of secondary disability, pain management and also strongly influences quality of life. Nowadays the most common formula used for the treatment of local spasticity is injection of botulinum toxin. Years ago and also nowadays physicians all over the world successfully used phenol as the chemodenervating factor. This technique today almost forgot in Poland but still used in other countries. MATERIALS AND METHODS: Peripheral nerves phenolisation had been used in STOCER (Konstancin) since 1965. The procedure was performed once in 59 patients, twice in 13 patients and three times in 7 patients. Evaluation was based on clinical presentation completed with patient self evaluation form. RESULTS: Good - 36 cases (45%), moderate - 34 cases (43%), bad - 9 cases (12%). CONCLUSION: Peripheral nerve phenolisation seems to be an interesting alternative to botulinum toxin in the management of spasticity.

[Peripheral nerves alcoholization in the spasticity managament].

INTRODUCTION: Spasticity is velocity dependent increased resistance to passive lengthening of the muscle. Mild spasticity doesn't require treatment, but severe impede with hygiene, constrict range of motion and mobility, interfere with gait pattern and can be the cause of pain and discomfort. Proper spasticity management is crucial for correct rehabilitation. THE AIM OF THE STUDY: The assesment of chemodenervation with ethyl alcohol in spasticity treatment. MATERIAL AND METHODS: 13 patients (5 female, 8 male) age 18-68 yrs (mean 46,8±13,3). Qualification to the procedure requiered high level of spasticity (mean 3,4 ± 0,5 in Ashworth scale), no response for pharmacological treatment, low level in Bartel scale. Patients were evaluated with VAS pain scale, EQ-5D before, day after and 6 weeks after procedure. RESULTS: Ashworth scale before procedure: 3-4 (mean 3.44±0.52), after procedure: 0-3 (mean 2.0±1.26), 6 weeks after procedure: 1-3 (mean 2.0±1.0). VAS before procedure: 0-4 (mean 1.49±1.9), after procedure: 0-2 (mean 1.33±1.0), 6 weeks after procedure (mean 1.0±1.0). Bartel scale before procedure: 0-16 (mean 9.25±6.7), after procedure: 0-16 (mean 6.0±8.71), 6 weeks after procedure: 0-16 (mean 9.25±6.7). EQ-5D results showed on Fig 5-19. CONCLUSION: Results shows improvement in every examinated aspect (decrease in spasticity level, decrease in pain, increase in quality of life and disability scale).

Effect of implanted bisphosphonate-enriched cement on the trabecular microarchitecture of bone in a rat model using micro-computed tomography.

PURPOSE: Bisphosphonates (BPs) are antiresorptive drugs typically used to inhibit bone resorption. The latest reports show that BPs play an important role in not only achieving better bone mineral density but also in improving bone microarchitecture. The mechanism of action of the BPs is complex and multifactorial. We tried to determine whether there are any changes in the microarchitectural bone structure during local use of BP (Pamifos 60). The aim of this study was to see if BP-enriched cement used in rat models had positive effects on bone formation. METHODS: Research was performed on 40 adult male Wistar rats that were divided into four groups: two control groups and two experimental groups. Rats in the experimental groups were implanted with BP-enriched cement into the bone, while the control group rats were implanted with clean bone cement (without BP). Micro-computed tomography was applied for the investigation of trabecular microarchitecture of the proximal physis of the tibial bone in all animals three and six weeks after surgery. In all microCT images variables such as bone volume density (BV/TV), trabecular thickness (TbTh), trabecular separation (TbSp) and trabecular number (TbN) were used to describe trabecular bone morphometry. RESULTS: The major finding of this study is that using BP-enriched cement results in distinct changes in bone microarchitecture. We showed that local use of pamidronate (Pamifos 60) in orthopaedic cement had a positive effect on bone formation. It significantly changed three variables. We noticed increasing bone volume fraction and trabecular thickness together with decreasing trabecular separation. CONCLUSION: In this paper we demonstrate the efficacy of using BP-enriched cement in vitro in the tibiae of rats. Our most significant finding based on micro-CT picture analysis allows us to start further work on more suitable applications of BP-enriched cement in humans. We believe that future successful experiments will facilitate potential use of BP-enriched cement in clinical applications.

Histological changes in the epiphyseal plate of growing young adult male rats after long-term hydrocortisone and salmon calcitonin administration.

INTRODUCTION: Glucocorticosteroids decrease the longitudinal growth of bones. It has been reported that skeletally immature rats on calcitonin treatment grow longer and slimmer. The aim of this study was to assess whether concomitant treatment with calcitonin would influence longitudinal growth and histology of epiphyseal plate in hydrocortisone-treated rats. MATERIAL AND METHODS: Fifty six growing male Wistar rats were randomly divided into two control and four experimental groups. Rats in the first two experimental groups were treated i.p. b.i.d. with hydrocortisone, while to the other experimental animals salmon calcitonin s.c. was administered concomitantly. The controls received appropriate vehicula. The rats were kept under standardised conditions. The first phase of the experiment was completed after 28 days and right femora and tibiae were harvested from groups and preserved in 4% buffered formalin. Lengths of the fresh femora were measured with an electronic caliper. After preservation, tibial bones were decalcified in 5% EDTA at room temperature. Paraffin-embedded coronal slices 10 µm thick from proximal tibia were taken and stained with hematoxylin/ eosin and alcian blue for histological assessment of the epiphyseal plate. A similar procedure was repeated after 56 days in the second phase of the experiment. RESULTS: The femora of hydrocortisone-treated rats were significantly shorter than those of controls, but after concomitant administration of salmon calcitonin the difference was insignificant. The histological assessment showed that depressed function of growth plate in hydrocortisone-treated animals after both phases of the experiment was partially reversed by salmon calcitonin treatment. CONCLUSIONS: Prolonged concomitant treatment with high-doses of salmon calcitonin partially reverses glucocorticoid-induced depression of rat growth plate.

Postoperative limb lengthening following Total Hip Arthroplasty (THA) through a posterior approach--a challenge for the orthopaedist or physiotherapist?

BACKGROUND: As coxarthrosis progresses, pain and mobility limitation exacerbate, usually presenting as a progressive flexion-abduction contracture. This, combined with the degradation of articular ends of bones, is responsible for anatomical and functional shortening of the limb. The sensation of postoperative leg length difference is a significant problem both for the patient and the operator. A sense of the operated limb being longer may be due to excessive length of the femoral segment following total hip arthroplasty. It may also result from a postoperative abduction or flexion-abduction contracture. The aim of the study was to review the clinical course of total hip replacement surgeries. The focus was on complaints of leg length discrepancy persisting for more than two weeks after ambulation. MATERIAL AND METHODS: We investigated a series of 210 unilateral THA procedures. Swanson's technique through a posterolateral approach was used in all cases. Twelve patients, including 8 women and 4 men (out of the total of 210 patients - 169 women and 41 men), reported a sensation of operated limb lengthening for more than two weeks after ambulation. We reviewed the process of rehabilitation in this group of patients. RESULTS: The rehabilitation procedure presented in this paper eliminated the sensation of limb length discrepancy in all patients who had reported this problem. CONCLUSIONS: 1. Complaints of leg lengthening following total hip arthroplasty were reported by approx. 5% of the THA patients. 2. Consistent physiotherapy involving muscle energy techniques (MET) helped to eliminate the sensation of limb length inequality.

[Modified Swanson's hip replacement--intraoperative complications and learning curve of the procedure]. / Modyfikowany dostep Swansona w protezoplastyce stawu biodrowego--powiklania sródoperacyjne jako ilustracja krzywej uczenia nowej techniki operacyjnej.

Our study aimed at analysis and presentation of intraoperative complications during total hip replacements with the use of limited posterior approach according to T.V. Swanson. Consecutive 210 hip arthroplasies (79 males, 131 females, aged 20-87 years, mean age 61 +/- 12,) were analyzed according to intraoperative complications. Left hip was operated in 117 cases, right in 93, bilateral procedure was performed in 27 cases (9 men, 18 women). Idiopathic disease occurred in 196 hips, 8 were result of rheumatoid arthritis, in 5 was of dysplastic origin and one occurred due to idiopathic necrosis of femoral head. In 120 cases concomitant arthrosis of the lumbosacral spine and the other joints of the lower limbs was recorded. Preoperative Harris Hip Score (HSS) was 30 +/- 5 points and Body Mass Index (BMI) ranged from 23 to 36. Our clinical material was divided into three equeal series of consecutive hip replacements (n = 70). Each of the series represented different intraoperative complications. In the first series five intraoperative notorious bleedings, four transient sciatic nerve palsies, two injuries to piriforimis muscle and one spiral fracture of the proximal femur were noted. In the second series no important adverse intraoperative findings occurred. In the third series two perforations of the acetabulum and one fracture of the femur were observed. Differences of frequencies of vascular and neural complications between these three series appeared statistically significant. The authors suggested that these observations represent the "learning curve" of the new surgical procedure--the first phase reflects difficulties and technical errors, the second without complications--maturity of the procedure and the third one carelessness due to having false sense of "perfection" by the operators.

An analysis of pathomorphic forms and diagnostic difficulties in tarso-metatarsal joint injuries.

Tarso-metatarsal injuries are rare but frequently missed. Due to the large variation in pathomorphic forms of these injuries, great precision is required when carrying out clinical and X-ray diagnostic procedures. The aim of the study was to describe the different forms of Lisfranc joint injuries and analyse the causes of delayed treatment. The treatment results of acute and chronic injuries were compared in 41 patients, with an average follow-up period of 16 years. Statistically significant poorer results were obtained in the group of chronic cases, based on two functional scores - the AOFAS evaluation questionnaire and the Lublin functional questionnaire. The main factor delaying the start of the proper treatment was diagnostic error during initial admission. The best results were achieved after closed reduction and percutaneous Kirschner wire fixation in acute cases.

[Problem and tolerance of leg lengthening after total hip replacement]. / Problem i granica tolerancji wydluzenia konczyn po protezoplastykach stawów biodrowych.

Inevitable sequaelae of predominant number of hip arthritis is shortening of the upper end of the femur due to the destruction of the femoral cartilage and head which is usually accompanied by increasing flexion contracture. The main goal of hip replacement is to restore normal hip biomechanics and appropriate femoral neck lever. As the number of hip arthroplasties increases the patients dissatisfied with the early postoperative result related to the apparent lengthening of the operated limb are becoming more numerous. The authors retrospectively analyzed group of 10 patients complaining of postoperative lengthening limb derived from series of 210 hip replacements. In this group a rehabilitation programme comprising of repeated maneuvers of manipulation aiming at reduction of abduction contracture and obtaining adduction was performed. After a period of one week to six months in all the cases the perception of leg length discrepancy disappeared.

[Asymptomatic thrombo-embolic venous disease before total hip replacement--when the risk is important?]. / Bezobjawowa zylna choroba zakrzepowa przed operacja protezoplastyki stawu biodrowego--kiedy ryzyko jest istotne?

In spite of widely applied prophylaxis against thrombo-embolic venous disease its future complications still present important clinical issue. According to rough statistics this disease occurs in 71/100 000 persons per year and reveals in 1/3 as pulmonary embolism and in 2/3 as a pure thrombotic venous disease. Massive pulmonary embolism is at present a major cause of death in hospitalized subjects. In the USA mortality due to diagnosed pulmonary embolism is reported as approximately 25 000 cases per year. The aim of this paper is to draw attention to the asymptomatic cases of the thrombotic venous disease in the patients before hip arthroplasty. A retrospective clinical analysis of 210 total hip replacements (years 2005-2008) was performed. Standard perioperative routine antithrombotic prophylaxis with low-molecule heparins was introduced in each case. Special attention was paid to the occurrence of the risk factors or the presence of venous thrombosis in the lower extremities perioperatively. In the analyzed group preoperative ultrasound revealed in 5 (2.38%) cases asymptomatic venous thrombi reaching above the knee region and this was the cause of postponing of the procedure. In the early postoperative period pulmonary embolism was evidenced in 4 cases (1.9%). The authors suggested that preoperative ultrasound investigation of lower extremities venous system is important issue together with the assessment of d-dimers in the blood in all patients admitted to total hip arthroplasty. In any suspicion of the pulmonary embolism in these patients an angio-CT should be performed as an emergency.