Segmental Humeral Head Reconstruction in Patients with Chronic Locked Posterior Shoulder Dislocation.

Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25-50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant's scoring scale was used. Results: The average value of Constant's point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant's point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25-50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods.

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis.

(1) Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth's method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: "Schroth exercise", "idiopathic scoliosis", "Cobb angle", "angle of trunk rotation", and "quality of life". Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. (3) Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = -0.492, p ˂ 0.005); ATR (ES = -0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). (4) Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis.

Anthropometric profile of leg length inequality and its impact on gait / Perfil antropométrico de la desigualdad en la longitud de las piernas y su impacto en la marcha

SUMMARY: Leg length inequality (LLI) affects gait - primarily pelvic and torso movements. LLI is present in around 40-70 % of the healthy population. Due to LLI's significant impact on the body, as well as the possible occurrence of a variety of associated health problems, the aim of this research is to determine whether there is a significant difference in pelvic movement in all three planes, depending on the degree of LLI. This study was conducted on a sample of 30 healthy subjects. The functional length of lower limbs was measured. When LLI was calculated, kinematic measures were taken of pelvic and lower limb movements during gait using 3D cameras and ©Vicon Motion Systems Ltd. UK. The obtained data on kinematic pelvic movement in all three planes during gait were compared with the reference values. The results show that there is no statistically significant difference in pelvic movement about the axes x, y, and z in cases of LLI of up to 18mm (p>0,05). There is a statistically highly significant positive correlation between the difference in functional leg length (r=0,575; p=0,008) and femur length (r=0,525; p=0,015) on one hand, and the difference in pelvic movement about the axis x on the other, compared to the reference values. In a healthy population with LLI from 0 to 18 mm, gait remains unaffected and an increase in LLI predominantly affects pelvic movement about the horizontal axis (x) - pelvic tilt, which exponentially increases with an increase in femur length discrepancy.

La diferencia en la longitud de las piernas (LLI, por sus siglas en inglés) afecta la marcha, principalmente los movimientos pélvicos y del dorso. La LLI está presente en alrededor del 40-70 % de la población sana. Debido al importante impacto de LLI en el cuerpo, así como a la posible aparición de una variedad de problemas de salud asociados, el objetivo de esta investigación fue determinar si existe una diferencia significativa en el movimiento pélvico en los tres planos, dependiendo del grado de LLI. Este estudio se realizó en una muestra de 30 sujetos sanos. Se midió la longitud funcional de los miembros inferiores. Cuando se calculó el LLI, se tomaron medidas cinemáticas de los movimientos pélvicos y de los miembros inferiores durante la marcha utilizando cámaras 3D y ©Vicon Motion Systems Ltd. UK. Los datos obtenidos sobre el movimiento pélvico cinemático en los tres planos durante la marcha se compararon con los valores de referencia. Los resultados mostraron que no existe diferencia estadísticamente significativa en el movimiento pélvico sobre los ejes x, y, y z en casos de LLI de hasta 18 mm (p>0,05). Existe una correlación positiva estadísticamente muy significativa entre la diferencia en la longitud funcional de la pierna (r=0,575; p=0,008) y la longitud del fémur (r=0,525; p=0,015), y la diferencia en el movimiento pélvico sobre el eje x por otro, en comparación con los valores de referencia. En una población sana con LLI de 0 a 18 mm, la marcha no se ve afectada y un aumento en LLI afecta predominantemente el movimiento pélvico sobre el eje horizontal (x) - inclinación pélvica, que aumenta exponencialmente con un aumento en la discrepancia de longitud del fémur.

Effects of Corrective Exercises on Lumbar Lordotic Angle Correction: A Systematic Review and Meta-Analysis.

Lumbar lordosis is one of the most important parts of the spine, which is of special importance due to its unique position and direct contact with the pelvis. The aim of this study was to combine the results of several studies and to evaluate the magnitude of the effect of different Lumbar lordotic angle correction programs through meta-analysis. This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Four databases were searched for articles collection: PubMed, Cochrane Library, Web of Science, and Google Scholar. The key search terms were: "Lumbar Lordotic angle", "Lordosis", "Hyperlordosis", "Corrective exercise", and "Low back pain. "The articles included in our study were limited to original articles written only in English that met the following inclusion criteria: (1) participants with lumbar lordosis or hyperlordosis or low back pain; (2) different programs of corrective exercises were applied; (3) Lumbar lordotic angle used as outcome measures. Ten studies are included in our systematic review and meta-analysis. The effect size for the Lumbar lordotic angle outcome was (SMD = 0.550, p ˂ 0.001, moderate effect size). Subgroup analysis for Lumbar lordotic angle: Subgroup Younger group (SMD = 0.640, p ˂ 0.001), Subgroup Older group, (SMD = 0.520, p ˂ 0.001). Subgroup Treatment (SMD = 0.527, p ˂ 0.001), Subgroup No treatment (SMD = 0.577, p = 0.002). This was the only outcome assessed in our analysis. The current meta-analysis indicates that different correction methods have a positive effect on subjects with lumbar lordosis or hyperlordosis. In the following research, we should try to determine which corrective methods have the best effects.

CONCOMITANT INJURIES OF ANTERIOR CRUCIATE LIGAMENT AND MENISCUS.

INTRODUCTION: The aim of this study was to determine the correlation between meniscal injuries with injuries of the anterior cruciate ligament, as well as risk factors for those associated injuries. MATERIAL AND METHODS: This study included 496 operated patients. Almost half of patients with meniscal injury were between the ages of 2l and 30 years. RESULTS: Meniscal injuries were diagnosed in 187 patients (38%). These patients were significantly older than the patients without meniscal injury. Meniscal injuries were significantly more frequent in patients who played sports recreationally than in professional athletes. The patients with meniscal injury underwent surgery almost four months later than the patients with preserved menisci. Meniscal injuries occurred significantly more frequently by non - contact mechanism, as a result of landing and sudden changes of direction and rhythm of running. CONCLUSION: Male patients hurt the medial meniscus more often, "bucket handle" type of lesion being much more frequent than on the lateral meniscus. The increase of body -mass index is exactly proportional to the increase in the incidence of meniscal injuries.

RISK FACTORS FOR BILATERAL ANTERIOR CRUCIATE LIGAMENT INJURIES.

INTRODUCTION: The aim of this study has been to identify which risk factors can influence bilateral anterior cruciate ligament injury. MATERIAL AND METHODS: Thirty-two operated patients took part in this survey during the period of ten years. There were 5 women and 27 men, with average age of 30.46 years (19-55). The respondents filled in the questionnaire by answering the questions regarding the time when getting injured and operated, mechanism of injuries, genetic and anthropometric data, characteristics of sports and every day activities. RESULTS: The incidence of reconstructed bilateral injuries in relation to unilateral ones was 2.3% (50/2168). The age of respondents and side of the injured knee did not correlate significantly with the achieved subjective physical activity level after the second knee surgery. The average time from the first injury to operation was 10 months and 4.3 years since that moment up to the injury of the other knee. It took more than 9 months on average until the reconstruction of contralateral anterior cruciate ligament. The most of athletes were injured in football matches. Three-quarters of athletes returned to competition activities after the first operation, which caused the same injury of the contralateral knee. DISCUSSION AND CONCLUSION: Anterior cruciate ligament rupture of the contralateral knee most often occurs in young active athletes within the first four years after the initial reconstruction. Its frequency is not affected by sex, side of extremity, genetic predisposition, type of sport, concomitant injuries and the choice of graft. Returning to the same or higher level of sports activities after the first reconstruction is one of the preconditions for injuring the other knee in the same way.

Solitary synovial chondromatosis as a cause of Hoffa's fat pad impingement.

INTRODUCTION: Synovial chondromatosis is a benign disease of synovial membrane usually affecting knee, elbow and shoulder joints. It rarely appears as a solitary formation and exceptionally within Hoffa's fat pad. CASE REPORT: We report a case of solitary synovial chondromatosis within Hoffa's fat pad as a cause of its impingement in a female patient aged 63. At first, the patient had anterior knee pain with limited extension of the knee. Standard radiogram showed only mild patellofemoral osteoarthritic changes. Magnetic resonance of the knee showed ovoid solitary formation within Hoffa's fat pad repressing its superior part between the kneecap and distal femur. Histopathological examination confirmed a case of extra-articular synovial chondromatosis. The tumorous mass was extracted surgically en bloc. CONCLUSIONS: Solitary synovial chondromatosis is an uncommon cause of Hoffa's fat pad impingement and anterior knee pain in elderly female patients and can easily be misinterpreted as a different diagnosis.

QUALITY OF LIFE AFTER BILATERAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONS.

INTRODUCTION: The aim of study was to analyze the influence of bilateral anterior cruciate ligament reconstructions on life quality of patients and their return to sports activities. MATERIAL AND METHODS: Thirty-two operated patients took part in this survey during the period of ten years. There were 5 women and 27 men, their average age being 30.46 years (19-55). The participants answered a modified Knee Injury and Osteoarthritis Outcome Score questionnaire set and gave data about preoperative and postoperative periods. RESULTS: The participants' age and parameters of Lysholm scale did not correlate significantly with the subjective level of physical activity after the second knee surgery. After the first anterior cruciate ligament reconstruction, 4 participants (12.5%) did not return to trainings, while 28 did (87.5%); 8 patients (25%) did not return to competitions and 24 of them (75%) achieved the competition level of sports activities. After the anterior cruciate ligament reconstruction of contralatera knee, 6 (18.8%) did not return to trainings, while 26 (81.3%) did; 15 patients (46.9%) did not return to competitions, while 17 (53.1% continued to compete without restrictions. The average values of questionnaire scores were between 95.1-98.2 points. Discussion and CONCLUSION: Resuming the same or higher level of sports activitie., after the first reconstruction is one of the preconditions for the same injury of another knee. An athlete looses more than two and a half years of competitions on average. Operations of additional meniscu ruptures do not play a crucial role in restitution of sports activities Although we achieved good operative results, only every seconc athlete with bilateral injury has returned to sports activities withou restrictions after the bilateral anterior cruciate reconstructions.

Scaphoid fractures in children.

INTRODUCTION: Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. OBJECTIVE: To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. METHODS: We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011).The outcome of the treatment of"acute"scaphoid fracture was evaluated using the Mayo Wrist Score. RESULTS: There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm--76% of patients. During the examined period 31 children with "acute" fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. CONCLUSION: Conservative therapy of "acute" scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

Quadriceps tendon injuries.

INTRODUCTION: The aim of study was to analyze risk factors, mechanisms of injury, symptoms and time that elapsed from injury until operation of complete quadriceps tendon ruptures. MATERIAL AND METHODS: This retrospective multicenter study included 30 patients operated for this injury, of whom 28 (93.3%) were men. The average age was 53.7 years (18-73). Twenty-six patients had reconstruction of unilateral rupture and four of bilateral one. RESULTS: Eighty percent of them had some risk factors for rupture of the tendon with degenerative changes. Eight patients had diabetes, seven patients were on renal dialysis, two patients had secondary hyperparathyroidism, five patients were obese and two patients had former knee operations. These injuries occurred in 80% following minor trauma caused by falls on stairs, on flat surfaces and squatting. The most frequent symptoms were: pain, swelling, lack of extension of knee and defect above patella, and three cases were initially misdiagnosed. During the first 10 days after injury, acute and chronic ruptures were reconstructed in 22 (73.3%) and 8 patients, respectively. CONCLUSION: Quadriceps tendon injuries most often happen to male patients with predisposing conditions in their fifth and sixth decade of life due to trivial trauma. Patients on renal dialysis are the most vulnerable population group.

Quadriceps tendon rupture - treatment results.

INTRODUCTION: Quadriceps tendon rupture is a rare but rather serious injury. If this injury is not promptly recognized and early operated, it may lead to disability. This research was aimed at pointing out the results and complications of the quadriceps tendon rupture surgical treatment. MATERIAL AND METHODS: This retrospective multicentric study was conducted in a group of 29 patients (mostly elderly men). Lysholm knee scoring scale was used to evaluate the surgical results. The post-operative results were compared in relation to the type of tendon rupture reconstructions (acute or chronic), various surgical techniques, type of injuries (unilateral or bilateral) as well as the presence or absence of comorbid risk factors in the patients. RESULTS: The average value of a Lysholm score was 87.6. Excellent and satisfactory Lysholm score results dominated in our sample of patients. Better post-operative results were recorded in the group of patients without risk factors, in case of a bilateral injury, and in case of an acute injury. The best result was obtained after performing the reconstruction using anchors, and the worst result came after using Codivilla technique. DISCUSSION AND CONCLUSION: Early diagnosis and surgical treatment are an absolute imperative in management of this injury. We have not proven that a certain surgical technique has an advantage over the others. A comorbid risk factor is related to a lower Lysholm score. Despite a few cases of complications, we can conclude that the surgical treatment yields satisfactory results.