[Analysis of plantar pressure patterns among obese population]. / Elhízott populációra jellemzo talpnyomásminták vizsgálata.

INTRODUCTION: Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known. AIM: The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population. METHOD: 180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure. RESULTS: Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001). CONCLUSIONS: Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919-1925.

[Utilization of physiotherapy services for traumatic disorders of the lower extremity in ambulatory care]. / A fizioterápiás jellegu tevékenységek igénybevételi mutatói a járóbeteg-szakellátásban az alsó végtag traumatológiai kórképei esetében.

INTRODUCTION: Limited information is available on physiotherapy treatment of lower extremity injuries. AIM: The purpose of this study included analysis of the utilization of outpatient physiotherapy services in case of injuries of the lower extremity. METHOD: Data derived from the database of the National Health Insurance Fund Administration, Hungary. The number of cases undergoing physiotherapy activities after lower extremity injuries were determined. RESULTS: In 2009 the average number of cases undergoing physiotherapy activities following lower extremity injuries per 10,000 persons were the following: "hip and thigh injuries" 249.75 male cases and 443.7 female cases; "knee and leg injuries" 927.64 male cases and 668.25 female cases, and "ankle and foot injuries" 307.58 male cases and 245.75 female cases. CONCLUSIONS: According to this study, the number of physiotherapy activities for patients with injuries of the lower extremity showed significant differences between genders.

Osteoscopy for assessment of blood supply to the femoral head: a preliminary study.

OBJECTIVES: The aim of our study was to develop a minimally invasive endoscopic procedure (osteoscopy), which is capable of visualizing blood supply and quantitatively assessing circulation to the femoral head at the time of definitive surgery. METHODS: The new diagnostic technique was developed in animal experiments (four piglets) and was subsequently tested in nine consecutive patients requiring surgery for a femoral neck fracture. The direct visualization of the femoral head circulation was performed in the mortise prepared for the implant. The osteoscope optic fiber was placed at the orifice of the cavity created by the custom-made drill bit. The "mortise-sleeve-optic" system was connected to a manometer and a saline reservoir. The bleeding from the wall of bony cavity was observed, meanwhile the inner pressure of the "mortise-sleeve-optic" system was changed gradually. The pressure measurement at the first appearance of bleeding and the intraosseal pressure was recorded. RESULTS: The animal investigations demonstrated that the osteoscopy readily distinguished among diffuse bleeding, pulsatile bleeding, and the absence of bleeding in the femoral head. The human experiments proved that a different quality of the femoral head circulation can be observed during osteoscopy. CONCLUSIONS: Preliminary findings indicate that clinical osteoscopy may be a useful tool in the assessment of blood circulation to the femoral head.

[Correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up]. / Idôskori combnyaktöréseket követô halálozás és kockázati tényezôik kapcsolatának értékelése 5 éves utánkövetéssel.

UNLABELLED: Hip fractures are associated with increased mortality in the elderly. There are only a few studies based on large patient number covering a nationwide health care system. AIM: The aim of this study was to investigate the mortality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. METHODS: Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trends according to risk factors were calculated. Logistic and Cox regression analysis was performed to evaluate the correlation between risk factors and mortality. RESULTS: 3783 patients were involved in the study with a mean age of 77,97 years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year. CONCLUSIONS: In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropriate selection of methods corresponding to fracture type, providing the same conditions for primary treatment during all days of the week, to organize the treatment to special centres, appropriate acute care and follow-up corresponding to the general health status and co-morbidities of patients.

Effect of surgical delay on early mortality in patients with femoral neck fracture.

The aim of this study was to investigate the relationship between the delay between surgical treatment and mortality occurring within 30 days post-injury in patients aged 60 or older with femoral neck fracture. Data derive from the nationwide database of the National Health Insurance Fund Administration. Logistic regression analysis was performed to analyse the relationship between 30-day mortality and surgical delay in four groups of patients operated on within 12 h, between 12-24 h, 24-48 h or over 48 h post-injury. There were 3,777 patients involved in the study. Mortality rates in the four groups were 7.7%, 10.5%, 10.5% and 9.4%, respectively. Univariate logistic regression analysis revealed a statistically significant increase in the mortality risk in the 12-24-h treatment group compared to the group treated within 12 h (odds ratio, OR(12-24h)=1.413, confidence interval, CI(12-24h): 1.032-1.935; p=0.031). According to multiple regression analysis, all three groups (12-24 h, 24-48 h and over 48 h) showed a trend to increased mortality risks, but this was not statistically significant (OR(12-24h)=1.301, CI(12-24h): 0.945-1.791, p=0.106; OR(24-48 h)=1.384, CI(24-48 h): 0.932-2.056, p=0.108; OR(>48 h)=1.246, CI(>48 h): 0.950-1.635, p=0.113). We can conclude that sex, age and accompanying diseases significantly influenced early mortality, while early post-operative complications did not have a significant impact on the mortality risks.

Positioning of the wrist for scaphoid radiography.

PURPOSE: The purpose of this cadaver study was to determine the ideal position of the wrist for scaphoid radiography. MATERIALS AND METHODS: Four cadaver wrists were rotated around their longitudinal axis in 15 degrees increments and exposures were taken. Seven postero-anterior images were taken as well. Thus, 18 images of each wrist were available for assessment. Views were determined in which the main anatomic regions of the scaphoid were visualized undistorted. The size and localization of the overlap of other carpal bones were also evaluated. Finally, views with the best visualization of anatomic landmarks were selected. The results of these three investigations were compared to literature data. RESULTS: We consider the following four images the most valuable in the diagnostic imaging of scaphoid bone: (1) Postero-anterior view in ulnar deviation of wrist and fist position of the hand; (2) oblique view in 60 degrees of pronation; (3) oblique view in 60 degrees of supination; (4) lateral view. CONCLUSION: We concluded that our four views are sufficient for proper radiographic evaluation of the scaphoid.

[Analysis of health insurance costs in cases of patients under 60 years old with medial femoral neck fracture treated primarily with screw fixation or hip replacement]. / Az egészségbiztosítási költségek elemzése az elsodlegesen csavaros osteosynthesissel, illetve protézisbeültetéssel kezelt, 60 evesnél fiatalabb medialis combnyaktörést szenvedett betegek eseteiben.

AIM: The aim of the study is to analyse the cost of patients under the age of 60 with medial femoral neck fracture up to 2 years follow up after the primary treatment including cost of acute and chronic inpatient care, outpatient care, sickness pay and changes in ability to work according to the most frequently used surgical methods and Garden classification. PATIENTS AND METHODS: Patients were identified from the financial database of the National Health Insurance Fund Administration and a questionnaire was used for further analysis. The costs of patients were analysed in three groups I) all patients, (II.) patients with further treatment because of complications, and (III.) patients cured by one primary treatment. RESULTS: Altogether 518 patients were included into the study: 413 (79.7%) with primary screw fixation and 48 (9.3%) with hip replacement. The average cost for all patients (I) for the 2 years follow up was 582.181 Hungarian Forint (HUF) with screw fixation and 545.300 HUF with hip replacement. The average cost per patients in the group with one primary surgical treatment (II) was (N = 337, 81.6%) 441.466 HUF with screw fixation and (N = 44, 91.6%) 561.027 HUF with hip replacement. The average cost per patients in the subgroup with further hospitalization because of complications (II) was (N = 76, 18.4%) 1.005.578 HUF with screw fixation and (N = 4, 8.4%) 775.640 HUF with hip replacement. The costs according to Garden classification (I-IV.) were as follows: patients without complications from 436.681 HUF to 659.160 HUF and patients with complications from 628.323 HUF to 1.192.564 HUF. CONCLUSION: The results suggest that patients (N = 76, 18.4%) having displaced fractures with screw fixation receiving further treatment should be treated - knowing the vitality of femoral head - with stable osteosynthesis or hip replacement in order to reduce further reoperations and finally, health insurance expenditures and patients' burden.

Submental endotracheal intubation in concurrent orthognathic surgery: a technical note.

INTRODUCTION: Achieving the necessary occlusion for orthognathic surgery is not possible with conventional oral intubation since the tube interferes with the occluding teeth. Sometimes nasotracheal intubation is impossible due to developmental malformations requiring repair. Also, the oral or nasotracheal tube may interfere with the operation or may be damaged during the procedure. In 1986, Hernandez Altemir described a method of submental endotracheal intubation. His intentions were to avoid tracheostomy in maxillofacial trauma cases where short-term intermaxillary fixation was required. PATIENTS: Between January 2000 and May 2003, 13 patients were operated on, using submental intubation. Eight of these (three females and five males) had surgery for orthognathic malformations. METHODS: The Hernandez Altemir technique was modified to ease the procedure: a sterile nylon guiding tube and the '222 rule' incision were introduced. Eight cases with concurrent complex orthognathic surgery, using this modified technique are reported in this paper. RESULTS: There were no operative or postoperative complications related to the procedure. CONCLUSION: The technique is easy to use, rapid and free of complications compared to 'alternative' intubation methods (tracheostomy, retromolar location of tube, etc.). Submental scarring is acceptable. It is recommended for orthognathic procedures in selected cases.

A randomized study to assess the effectiveness of orally administered pilocarpine during and after radiotherapy of head and neck cancer.

BACKGROUND: This prospective randomized study was undertaken to assess the effectiveness of oral pilocarpine chloratum (Salagen) during and after radiotherapy. PATIENTS AND METHODS: Between October 1999 and December 2003, 66 patients received 60 Gy of irradiation to their head and neck cancer. Half of the patients received 5 mg oral pilocarpine 3 times a day from the beginning of radiotherapy over a period of 12 weeks. The control group received similar doses of pilocarpine only in the second 6 weeks following irradiation. Patient saliva secretion was recorded, and a visual analog scale measuring overall and daily xerostomia, difficulty in sleeping, speaking, eating and wearing dentures was employed. RESULTS: Pilocarpine, given concomitantly with radiotherapy, statistically improved the salivary flow and induced better patient comfort by the end of radiotherapy. Patient comfort and symptoms related to xerostomia greatly decreased compared to patients receiving pilocarpine after irradiation in the second 6-week period of therapy. The patients' quality of life, saliva production and symptoms related to xerostomia showed significant progress by the end of the 12 weeks. CONCLUSION: The results suggest that stimulated salivary glands suffer less decrease in saliva production during radiotherapy. The stimulated saliva flow reduced the side-effects of irradiation.

Examination of a novel, specified local antibiotic therapy through polymethylmethacrylate capsules in a rabbit osteomyelitis model.

Chronic bone and soft tissue suppurations have become more frequent recently due to the increasing number of high-energy injuries. There are certain antibiotic beads available for local administration, but they cannot always be applied specifically against the pyogenic microorganisms. In the present study, a new technique of local antibiotic therapy for the treatment of infections is described. Polymethylmethacrylate (PMMA) capsules were produced and filled with 0.1 ml Tazocin (0.02 g piperacillin sodium + 0.005 g tazobactam). The efficacy of these Tazocin-filled capsules was examined in vivo using a rabbit osteomyelitis model. Chronic osteomyelitis was induced in rabbit tibia by local injection of Staphylococcus aureus. The treatment included surgical debridement and implantation of Tazocin-containing PMMA capsules into the medullar cavity (n = 12). Simple surgical debridement with no antibiotic implantation was performed in control animals (n = 7). Results were evaluated using microbiological, radiological and histological methods 14 weeks after induction of osteomyelitis. Eight weeks after the implantation of PMMA capsules, complete physical, radiological and histological healing was achieved in 7 animals, initiation of the reparative phase was observed histologically in 3 cases and no reparative signs were detected in 2 rabbits. In the control group, no significant sign of reparation could be seen in any of the cases.

Biomechanics of the membranous flexor tendon sheath: the role of Grayson's ligaments.

BACKGROUND: The biomechanical integrity of the tendon sheath of the fingers has a significant effect on the success of flexor tendon surgery. As nonweightbearing elements, the membranous parts of the sheath have received little attention, and their contribution to sheath movement is still obscure. The authors presumed that Grayson's ligaments, which have been described as force-transmitting elements, might play a role in the biomechanics of the membranous flexor tendon sheath. METHODS: Twenty-two long fingers of cadaver hands were examined. The authors studied the movements of the inner aspect of the tendon sheath and the positions and patterns of the septa of the palmar soft tissues on picrosirius red-enhanced sagittal and transverse sections and hematoxylin and eosin-stained light microscopy specimens. RESULTS: The movements of the membranous flexor tendon sheath are controlled by subcutaneous structures. The septal patterns of the palmar fat pads indicate the existence of a highly flexible subcutaneous fibrous system in which the deformable fat pad keeps the force-transmitting elements tight. Collagen bundles in the microscopy specimens, which frequently form layers within the septa, are thought to correspond to Grayson's ligaments. The subcutaneous fibrous system adheres predominantly to the membranous parts of the flexor tendon sheath. CONCLUSIONS: Folding of the membranous flexor tendon sheath is guided by the subcutaneous fibrous system, of which the macroscopically dissectible elements are Grayson's ligaments. The current surgical approaches might have a deteriorating effect on the biomechanics of the flexor tendon sheath.

Comparative study of antibiotic-containing polymethylmetacrylate capsules and beads.

BACKGROUND: This study aimed at making local antibiotic therapy wider in cases of chronic suppurations by administering antibiotics which previously could not be given in this way through the conventional polymethylmetacrylate (PMMA) carrier techniques. Capsules from this material were produced with a pressing machine designed and laid out by us. The characteristics of antibiotic penetration from this novel carrier were compared to those of PMMA beads. METHODS: The time-dependent outflow of amikacin, clindamycin, pefloxacin, piperacillin + tazobactam, amoxicillin + clavulanic acid and cefotaxime was examined from the capsules and the beads with standard microbiological techniques using the Micrococcus luteus ATCC9341 test strain. The diameter of the inhibitory zones was measured after 24 h incubation at 37 degrees C and converted to mug/ml antibiotic concentrations. RESULTS AND CONCLUSIONS: Our results revealed that all antibiotics showed longer-lasting and higher concentration outflow from the PMMA capsules than from the beads. Therefore, these capsules can provide a more promising new opportunity for specific local antimicrobial treatment in cases of chronic suppurative bone and soft tissue injuries. In these cases the polymerization has already been completed and the heat does not influence the structure of the antibiotics; therefore, it can be inserted into the capsules in powder or solution form.

[Cost analysis of peritrochanteric fractures according to types of surgical treatment and progressive care from the viewpoint of financial providers]. / Trochantertáji törések ellátásának költségvizsgálata a mútéti eljárások és a progresszív ellátási szintek szerint finanszírozói szemszögból.

AIM: The aim of this study to calculate the health insurance cost of treatment of patients with pertrochanter fracture of femur from the first hospital admission for 18 months follow up period according to different surgical methods and progressivity levels. DATA AND METHODS: Recruitment criteria were: 1) all patients with a hip fracture in 2000 defined by the International Classification of Disease (ICD) as "S7210"; 2) working age between 18-60 and 3) first admission to surgical unit, and had an operation. The cost analyses include the cost of acute and chronic in-patient care, outpatient care and sick pay. RESULTS: The total costs were the highest in case of those types of operations with lower cost of prothesis device and lower load stability (Ender 588.000 Ft, fix angled plate 534.000 Ft) because of the higher sick-pay costs. The total costs were the lowest in case of those types of operations with higher cost of prothesis device and higher load stability (Gamma 512.000 Ft, DHS 465.000 Ft) because of the lower sick-pay costs. The gain in recovery time with the 3-4 months shorter disability period can be seen in case of operations with higher load stability. The average length of stay decreases from 15-17 days to 9-11 along progressivity levels. CONCLUSION: With the application of load stable prothesis device the total health insurance costs were the lowest at the universities and national institute while these costs proved to be higher.