Subjective and Objective Outcomes of Ankle Joint Arthrodesis with Either Ilizarov or Internal Fixation.

After arthroplasty, arthrodesis of the ankle joint is the most common method to treat advanced ankle osteoarthritis. The goal of the study was to assess the subjective and objective outcomes in 2 different types of fixation for ankle joint arthrodesis. We retrospectively assessed 47 patients who had undergone ankle joint arthrodesis with fixation either via an Ilizarov apparatus (group 1) (n = 21) or cannulated screws (group 2) (n = 26). The outcomes were measured by: (1) the quantity of analgesics administered, (2) the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, (3) general patient satisfaction, (4) the patients' decision to undergo the same procedure given another chance, and (5) the necessity of blood transfusion during hospitalization. Data was collected at the last postoperative follow-up visit. The AOFAS scores in group 1 and group 2 patients were 73.9 ± 13 and 72.7 ± 14.3, respectively. In group 1, 17 patients (81%) were very satisfied with the results, while in group 2, 19 patients (73%) were very satisfied with the results (p = .043). Two group 1 patients (10%) and four group 2 patients (15.3%) reported that they were satisfied with the outcomes (p = .035). Two patients (10%) from group 1 and three patients (11%) from group 2 were fairly satisfied. Seventeen patients (81%) after arthrodesis with Ilizarov fixation and 21 patients (81%) after arthrodesis with internal fixation would choose the same procedure given the opportunity to choose again. In group 1 there were no patients who required blood transfusion; in group 2 one patient (4%) required blood transfusion; the difference was statistically significant (p = .039). Nineteen group 1 patients (90%) were administered an analgesic preoperatively, while postoperatively only 6 (29%) required analgesics. In group 2, 24 patients (92%) were administered analgesics preoperatively, with 8 (31%) of them still requiring analgesics postoperatively. Ankle arthrodesis patients from both group 1 and group 2 achieved good subjective and objective results of treatment. We noted slightly better results in the Ilizarov apparatus group.

Clinical evaluation of ankle arthrodesis with Ilizarov fixation and internal fixation.

BACKGROUND: Ankle arthrodesis may have internal or external stabilization. We assessed whether the type of stabilization after ankle arthrodesis will affect: (1) functional outcome in Foot and Ankle Ability Measure (FAAM) scale, (2) pain level, (3) period of hospitalization, (4) rate of complications. METHODS: We retrospectively studied 47 individuals after ankle arthrodesis with Ilizarov fixation (group 1, n = 21) and internal stabilization (group 2, n = 26) at our institution in years 2007-2015. Clinical outcomes were measure by: (1) functional outcome in FAAM scale, (2) pain level, (3) period of hospitalization, (4) rate of complications. RESULTS: Total number of complications in Ilizarov group was 13, which corresponded to 0.62 complications per patient on average. In group 2 there were 15 complications, which corresponded to 0.58 complications per patient on average. The intergroup difference in rate of complications was not statistically significant (p = 0.066). In group 1 the mean VAS pain level before treatment was 4.69 and after treatment was 1.5 (p = 0.037). In group with internal stabilization the mean VAS pain level before treatment was 4.71 and after treatment was 2.9 (p = 0.044). In group 1 the mean period of hospitalization was 5.29 days, in group 2 was 5.71 days (p = 0.517). In group 1 the mean functional outcome in FAAM scale was 79.38, in group 2 was 70.11 (p = 0.458). CONCLUSIONS: Ankle arthrodesis with Ilizarov stabilization is associated with lower prevalence of VAS pain level after surgery than after internal screws stabilization. Rate of complications, FAAM functional score and period of hospitalization were not statistically significant between group 1 and 2. Clinical outcome was satisfactory in group 1 and 2, but outcomes in Ilizarov group were slightly better than after internal stabilization.

Sport and physical activity after ankle arthrodesis with Ilizarov fixation and internal fixation.

BACKGROUND: Severe osteoarthritis (OA) of the ankle joint constitutes an important social problem. OBJECTIVES: We used (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA (University of California Los Angeles) activity scale, (4) the VAS (visual analogue scale) ACTIVITY scale, and (5) the FAAM (foot and ankle ability measure) SPORT scale to verify whether the type of ankle joint arthrodesis stabilization affected sports and physical activity levels. MATERIAL AND METHODS: We carried out a prospective clinical study of 47 patients who had undergone ankle arthrodesis with Ilizarov external fixator stabilization (Group 1, n = 21) or internal stabilization with screws (Group 2, n = 26) at Orthopaedic Clinic at the Wroclaw Medical University, Poland, from 2007 to 2015. Sports and physical activity levels were measured by (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA activity scale, (4) the VAS ACTIVITY scale, and (5) the FAAM SPORT scale. RESULTS: A comparison between the average results of Group 1 and Group 2 on the LOWER LIMB Activity scale and the GRIMBY scale before and after surgery revealed no significant differences. In Group 1, the mean scores on the VAS ACTIVITY scale and the UCLA activity scale after treatment were higher than in Group 2. In Group 1, the mean outcome in the SPORT FAAM scale after treatment was 40; in Group 2 it was 30.06. CONCLUSIONS: Ilizarov fixation of ankle arthrodesis is associated with better scores on the FAAM SPORT, UCLA activity and VAS ACTIVITY scales after treatment than internal fixation. The scores on the GRIMBY scale and the UCLA activity scale were significantly higher after treatment than before treatment in both groups. In this study, ankle fusion with Ilizarov fixation and internal fixation was found to be effective in the treatment of ankle arthritis. The levels of sport and physical activity were satisfactory in both groups, but the outcomes after fixation with the Ilizarov apparatus were better than after internal stabilization.

Three-dimensional printing as a technology supporting the treatment of lower limb deformity and shortening with the Ilizarov method.

BACKGROUND: Treatment of multiplanar deformities, especially in younger children, requires construction of a complex Ilizarov fixator, frequently with small dimensions. The aim of this study is to verify clinical application of a3D-printed bone model in treatment with the Ilizarov method. METHODS: The study involved a 6-year-old child in whom clinical and radiological examination revealed multiplanar deformity of the right leg. Then, 3D models of individual bones were printed by means of additive manufacturing and were used as a scaffold to install the Ilizarov apparatus. To compare the expected and factual axial correction and lengthening, we measured spatial orientation of bone fragments three times. The factual axial correction and lengthening were determined with a photometric technique. RESULTS: Ilizarov fixator with a configuration developed using a 3D model of the treated bone was mounted on the patient's leg. Corticotomy was carried out at the proximal metaphysis of the right tibia, along with osteotomy of the right talus. The treatment resulted in a 3.5-cm lengthening of the limb and a 7° correction of valgus angle. The values of actual lengthening and axial correction were 4.1% lower than the expected values of these parameters. INTERPRETATION: Orthopedists should consider differences between the expected and actual lengthening and axial correction in planning treatment with the Ilizarov method. Three-dimensional printing is a useful technology that can be used to support treatment with the Ilizarov method.

Results and biomechanical consideration of treatment of congenital lower limb shortening and deformity using the Ilizarov method.

One of the applications of the Ilizarov apparatus is the correction of congenital shortening and deformities. Ilizarov external fixator produces biomechanical structure with surrounding tissue, which is the reason why very important is correct stability of fixator. Large distraction in the case of high value of lengthening, and large deformity corection result in shear stresses that occur additionally in the regenerate, which can potentially lead to damage of the regenerating nutritive microcirculation of bone tissue and bone fragment displacements. Our objective was to assess the results of the Ilizarov method in the treatment of congenital shortening taking into account treatment strategy and the size of the axis of lengthening and correction. Our research problems include presenting the effects of biomechanics of musculoskeletal deformations on treatment results, presenting complications and their treatment. Between 1989 and 2009, 62 patients underwent surgery to correct congenital lower limb deficiencies at our Clinic; 33 patients were followed-up. In total, there were 70 surgeries (2.12/patient). Axial correction was performed in 26 patients (78.79%). Average age at the start of the treatment was 15.58 years. Mean follow-up was 8.58 years. Mean lengthening per surgery was 3.17 cm with the lengthening index of 50.7 day/cm. Results were very good for 23 patients, good for 7 patients, satisfactory for 3 patients. Complications appeared in 24 patients, problems occurred in 74.42% of the cases, obstacles in 4.65% of cases, and true complications in 20.93% of the cases. The best results were achieved in the treatment of patients with two-stage and two-segment lengthening with a total elongation of less than 7 cm, and without correction of the axis. Congenital shortening of the lower limb should be treated comprehensively because the shortening applies to all segments, and disturbs biomechanics of all lower limb. In the case of axial correction and large amount of elongation high soft tissue forces counteract the distraction forces. Hybrid construction may help to shorten treatment time, increase fixator stability and decrease rate of complications. We suggest use of hybrid Ilizarov fixator, especially when large elongation and axis corection are planned.

Epidemiology of distal radius fractures in own material--own experience.

BACKGROUND: Although distal radius fractures constitute 1/6 of all fractures in humans, epidemiology of the fracture has been a subject of limited number of publications in Polish medical literature. MATERIALS AND METHODS: Epidemiological data of 395 patients (277 females, 118 males) diagnosed with distal radius fracture and treated between January 2003 and May 2005 were collected. 81 patients were seen at 12-month and over follow-up and then categorized according to the AO classification system. They were also examined for subsequent osteoporotic fractures. BMD values were analysed in patients who had undergone bone density scans. RESULTS: Distal radius fractures constituted 18% of all fractures (77% of forearm fractures) treated during the study period. The mean age of patients was 58 years (females 63.5, males 44.8). Respective age groups presented significant gender-related differences in morbidity. The morbidity in women increased rapidly in the 6th decade of life, whereas was fairly stable in men. An analysis of fracture mechanism also pointed to osteoporotic changes as a pathogenic factor. CONCLUSION: Distal radius fractures are the most common fractures in humans. This type of fracture especially in women and older age groups is due to osteoporotic changes and constitutes a risk factor of subsequent osteoporotic fractures. Despite many morphological forms, distal radius fractures in almost 2/3 cases can be allocated into 4 main subgroups.

Elliptical head hemiarthroplasty in the treatment of femoral neck and head fractures--preliminary report.

BACKGROUND: The aim of his study is to evaluate efficacy of elliptical head hemiarthroplasty in treatment of femoral neck and head fractures and related complications in young patients under 55 years of age. MATERIAL AND METHODS: Uncemented elliptical head hemiarthroplasty was performed in 14 patients aged 28-55, mean age of 46,7 years, out of whom 12 diagnosed with a femoral neck fracture or related complications and 2 with a femoral head fracture. Mean follow-up period was 4,5 years, range from 10 months to 6 years. The Harris Hip Score was applied for evaluation of functional results. The radiographic analysis was based on standard anteroposterior and axial radiographic projections. Acetabular cartilage erosion was assessed according to the Wetherell et al radiographic method of measurement. RESULTS: The functional results ranged from 58 to 97 points, mean 85,28 points (according to the HHS). The radiographs revealed no signs of stem loosening. No cartilage erosion or migration of the prosthesis were observed in the study. CONCLUSION: An elliptical shape of the prosthetic head reflects the anatomy of the hip reducing the risk of acetabular cartilage erosion and migration of the prosthesis. We conclude that modular elliptical head hemiarthroplasty can be a useful method of management of femoral neck or head fractures and related complications in younger patients.

Use of thermography to monitor the bone regenerate during limb lengthening--preliminary communication.

BACKGROUND: Bone regenerate is routinely assessed on X-ray images obtained every 7 to 14 days in the distraction period and every 14 to 28 days during the stabilisation period. Tissue reconstruction during new bone formation and increased metabolism in the tissues being lengthened are associated with an increase in the temperature of the limb. The aim of this study was to establish a correlation between the bone regenerate, assessed on the basis of X-ray evidence, and thermographic images of the limb registered in a non-invasive manner with a thermographic camera. A positive correlation would enable a reduction in the number of X-ray studies in the future. MATERIALS AND METHODS: Bone lengthening using the Ilizarov technique of distraction osteogenesis was performed in 18 patients (9 men and 9 women) aged 12-74. The lengthened segments included the crus in 13 patients, the thigh in 4 patients and lower arm in 1 patient. Assessments of the bone regenerate were made during periodic follow-up visits on the basis of X-ray images and compared to thermographic images, on the basis of which thermal indices were established. The indices comprised the difference in the temperatures between the lengthened limb at the lengthening site and the contralateral limb at the same level, as well as the difference in the temperature of the lengthened limb at the lengthening site and at selected nearby points. RESULTS: A statistical analysis of the results of the monitoring of distraction osteogenesis established a statistically significant correlation between the regenerate status and thermal indices. The strongest correlation between X-ray and thermographic images was obtained in the frontal view for the crural bones. Mean values of Spearman's correlation coefficient for the tibia and femur were rS = 0.925 (p < 0.01) and 0.724 (p < 0.05), respectively. CONCLUSIONS: As a non-invasive method of measuring temperature thermography is a valuable adjunct to the traditional diagnostic methods and can be used successfully to monitor and evaluate the formation and remodelling of the regenerate at all stages of the treatment. It is particularly useful for the assessment of the bone regenerate in the tibia. The robust correlation between the regenerate and thermal indices measured with Spearman's correlation index enables a reduction in the number of radiographic studies of up to 50% in most cases. Moreover, thermography enables early detection of soft tissue inflammation around Kirschner wires.

Cementless stem stability in dysplastic osteoarthritis of the hip--12 years' experience.

BACKGROUND: The aim of this paper is a retrospective assessment of artificial hip joint function and stability of cementless stems of varied design used in the treatment of deformative and degenerative dysplastic changes in the hip. MATERIALS AND METHODS: The study enrolled 182 patients treated by cementless total hip arthroplasty. The average age of the patients was 44 years and the follow-up time ranged from 2 to 22 years (16.7 years on average). The following features were assessed: endoprosthesis survival judex according to Kaplan-Meier's criteria, functional outcome of the treatment on the Harris Hip Score (HHS) and endoprosthesis stability and changes in periprosthetic bone tissue over time, according to McGovern, Callaghan and Engh. RESULTS: The study revealed a considerable importance of the method chosen for matching the type of endoprosthesis to the anatomy of the dysplastic hip. The highest probability of long endoprosthesis survival time, correct implant placement and good stability in the femoral canal was obtained in the group with anatomical stem implants. The function of the operated hip in the study group had improved three times by the third year of follow-up. CONCLUSIONS: In dysplastic arthrosis, in which the proximal part of the femur has a narrow canal, the intertrochanteric area is often deformed and the angle of antetorsion greatly increased, better stability and osteointegration as well as a considerable functional improvement and extension of survival time can be obtained through using the so called anatomical stem, with anteflexion and antetorsion, fitted in the intertrochanteric area of the bone.

Evaluation of follow-up results of McBride operative treatment for hallux valgus deformity.

BACKGROUND: Hallux valgus still remains a problem in orthopaedic surgery, a fact attested to by over a hundred operating procedures for the correction of this deformity that have been elaborated until now. The aim of the study was to evaluate the results of the McBride procedure for surgical correction of the hallux valgus deformity using an anatomic & functional foot scoring system and roentgenometric assessment. MATERIAL AND METHODS: 121 feet in 65 women who underwent the McBride procedure for a hallux valgus deformity at the Orthopaedic Department of the Wroclaw University of Medicine in the years 1995-2001 were analysed. The follow-up period varied from 4 to 11 years, for an average of 6.5+4.2 years. Foot function was assessed with a scoring system developed by the author. The roentgenometric examination comprised the following parameters: hallux valgus angle, intermetatarsal angle 1-2, metatarsal I varus angle, and medial sesamoid displacement. RESULTS: After the operation the number of painless feet as well as walking ability increased. The number of bunions and the number of painful callosities beneath metatarsal heads also decreased in a statistically significant manner. The average hallux valgus angle on physical examination decreased by 17.2 o. The mean overall functional score increased from 31.2 to 74.1 points, i.e. it rose by two categories, from 'poor' to 'good'. The overall satisfaction rate (excellent and good results) was 76.9%. There were 4 cases (3.3%) of hypercorrection and 14% of the 121 patients experienced a recurrence of the valgus deformity. CONCLUSIONS: The McBride procedure is still useful in the treatment of hallux valgus for selected groups of patients, on condition that the qualification criteria are very strictly adhered to.

Treatment of non-union of the forearm using distraction-compression osteogenesis.

BACKGROUND: The goal of the study is presentation broad abilities like gives Ilizarov method in the treatment of posttraumatic nonunion the of forearm with concomitant shortening and axis deformity, in minimally invasive technique, with contemporary axis correction and lengthening . MATERIAL AND METHODS: . Authors present 6 patient operated on with the use of Ilizarov method, in years 2001-2005 , suffer from vital nonunion of the forearm - 6 cases radius; 1 case ulna and radius. In all cases with nonunion concomitant shortening of the radius from 2 to 3 cm and valgosity of radius with deformity in sagittal plane in 4 patients (2antecurvation, 2 retrocurvation). All patients had restricted rotation ROM of forearm and restriction of wrist motion . Author's modification of Ilizarov apparatus (with mini-Schanz's half-pins, which permitted rotation of forearm) was used in most of patients. In 3 cases monofocal slow correction with lengthening within nonunion was performed. In 2 cases bifocal, one-step slow correction of deformity and compression within nonunion with lengthening was performed. In 1 remaining case compression of ulna nonunion and compression with deformity correction of radius nonunion were performed. Distraction and correction start in 7 postoperative day in rate from 0,25 to 1 mm/day and correspondingly from1 to 2o/day. RESULTS: Time of correction and distraction was average 63,3 days (40 - 90 days) . Total time of stabilization was average 25,4 weeks (20 - 35 weeks). Bone union was obtained in all patients. In all cases considerable recovery of limb function was achieved. All patients had superficial pin-tract infection . One patient had staphylococcal pin-tract infection of soft tissues, which retreat after 3-weeks guided antibiotic therapy. CONCLUSION: The Ilizarov method permit for contemporary axis correction and/or distraction or compression. There is the method of choice in the treatment of nonunion of forearm with concomitant shortening and axis deformity.

The results of treatment of bone defects and non-union within the femoral shaft with shortening of femur using Ilizarov method.

BACKGROUND: The non-union within the femur with shortening of the limb as a consequence of trauma is an indication to choose external stabilisation as a method of treatment for that reason, that healing of the bone and surrounded soft tissues is disordered. MATERIALS AND METHODS: Authors discuss the results of treatment of 16 patients with post-traumatic bone defect and pseudarthroses with femur shortening. The injury was located in femur shaft in 8 cases, distal epiphysis in 5 cases and proximal epiphysis in 3 cases. 11 patients were treated in one stage, 4 patients were treated in two stages and 1 was held in three stages. First operation was made for achievement of union in place of bone loss or pseudarthrosis- the second and third- for elongation and correction of the axis of the femur. The follow-up consisted of 10 patients. In most cases subjective and objective improvement was achieved. RESULTS: The bone union was reached in 15 patients and in 1 case pseudarthrosis was observed. Patients who were considered to have next procedures due to remaining femur shortening or other limb deformity didn't see necessity of following treatment. CONCLUSION: The results of the current study indicated that Ilizarov's method can be successfully used in most patients with post-traumatic bone defect and pseudarthrosis with femur shortening. The method allows to reach the bone union, correct the deformity and lengthen the limb as well, what need mostly multi-stage treatment.

Efficacy of closed reduction and maintenance of surgical outcome in plaster cast immobilization in different types of distal radius fractures.

BACKGROUND: The aim of this paper is to evaluate the results maintaining after closed reduction of distal radius fracture and to assess difficulties in restoration of the articular surface continuity with reference to the type of fracture according to the AO classification. MATERIAL AND METHODS: 65 patients were included in the study (40 female, 25 male), mean age of 59 years (19-84), diagnosed with the distal radius fracture, treated by closed reduction and a plaster cast immobilization. The mean immobilization period was 40 days (25-50). Secondary dislocations were assessed since closed reduction until follow-up in respective AO groups. Mean follow-up was 624 days ( 374-1210). For the evaluation of secondary dislocations we have applied radiographic parameters defining the distal radius morphology: RIA, RL, UV, RW, PI. In assessment of the articular surface restoration, the articular surface step-off and gap were measured following closed reduction in relevant AO groups. RESULTS: The most significant secondary dislocations occurred in group C3 then A3 and C2. Statistically significant differences in secondary dislocations within respective types of fractures were observed between groups A2 and A3 ( p<0.05). Type C fractures presented statistically significant differences between groups: C1 and C3; C2 and C3 as to chances of restoring the articular surface continuity by closed reduction (p<0.05), whereas no such a difference was observed between group C1 and C2. CONCLUSIONS: The AO classification is a tool which with accuracy characterizes the complex pathomorphology of distal radius fractures and includes essential elements differentiating respective fracture groups. We conclude that in group A3, C2 ,C3 the result of closed reduction is difficult to maintain with a plaster cast immobilization. Additionally, the restoration of articular surface continuity in type C3 fractures can hardly be achieved by closed reduction.

Local experience in the surgical treatment of primary malignant and metastatic bone tumors of the proximal femur.

Background. The introduction of new techniques for fixation of long bones and postresectional prosthetic replacement, combined with chemotherapy and radiotherapy, have created new possibilities for the surgical treatment of primary and metastatic bone tumors. The main problem is still the time of diagnosis and the proper choice of operative treatment. Material and methods. We examined a group 67 patients operated for tumor of the proximal femur between 1985 and 2004, consisting of 48 females (average age 57) and 19 males (average age 46.8). The follow-up period ranged from 1 to 24 years (average 5.7 years). Metastatic bone tumors were found in 51 cases, as compared to 16 primary bone tumors. The clinical outcomes were evaluated by orthopedic and radiological examination, using Enneking's functional scale, depending on the treatment method applied. Results. Following surgical excision of the bone tumor, total postresectional arthroplasty was performed, or, in some patients, hip hemiarthroplasty. In some cases resection of the tumor was followed by plate fixation or the application of an intramedullary device after the resection bone defect had been filled with methylmethacrylate. Conclusions. Excellent or good postoperative outcomes were obtained by 76% of the patients. In 18% of the patients there was tumor recurrence. The most common complication was either surgical wound infection caused by lowered immunity after chemotherapy or breakage of the stabilizing plates.

[Rationalizing blood management in orthopedics and traumatology]. / Racjonalizacja zasad gospodarowania krwia w warunkach oddzialów ortopedycznourazowych.

In recent years there has been growing interest in blood conservation and avoidance of transfusion in patients undergoing orthopedic surgery. The benefits of blood transfusion must be considered and evaluated in terms of risk factors relating to the adverse effects of transfusion. A number of strategies are available to reduce the need for blood transfusion. These strategies are maximally effective if combined to span the pre-operative, intra-operative and post-operative periods. Surgical, anesthetic and pharmacological techniques can reduce blood loss during operation and the use of allogenic blood. This article presents current opinions, on the base of contemporary literature, regarding risks of transfusion and several simple techniques that will reduce the need for transfusion in orthopedic procedures.

The impact of selected biological factors on bone regeneration in distraction osteogenesis.

Background. Comparatively few reports have analyzed the biological factors influencing the course of distraction osteogenesis, such as the etiology and magnitude of shortening or the patient's age at surgery. The aim of our study was to assess the impact of selected biological factors on the course of bone regeneration in distraction osteogenesis of the lower leg. Material and method. We examined 126 patients, on whom 138 lower leg lengthening operations were performed. Congenital shortening was the most numerous cause (54.9%), followed by postinfectious (16.6%), posttraumatic (14.3%), neurogenic (7.9%), and achondroplastic (6.3%). The course of distraction osteogenesis was analyzed on the basis of duration of treatment, expressed by the lengthening index. Results. The highest lengthening index values were found in neurogenic patients, somewhat lower in congenital. The lowest lengthening index values were observed in postinfectious and posttraumatic shortenings, and in the group of bi-level lengthenings in achondroplastic patients. The lengthening index decreased along with increasing elongation. Lower lengthening index values were found in patients younger than 20 years, regardless of the method and number of osteotomy levels. Conclusions. There is clinical evidence for the impact of etiology, age, and magnitude of shortening on the course of distraction osteogenesis. The shortest treatment duration was found in shortening of acquired etiology and achondroplasia, and in patients older than 20 years. The values of the lengthening index were the lowest in lengthenings over 6 cm, whereas the greatest values were observed in lengthenings less than 4 cm.

[Usefulness of distraction osteogenesis in the treatment of knee arthrosis]. / Zastosowanie metody dystrakcyjnej osteogenezy w leczeniu operacyjnym artrozy stawu kolanowego.

AIMS: The purpose of this study is the assessment of efficiency of distraction osteogenesis (DO) as a method of operative treatment of knee arthrosis with co-existent varus deformity. MATERIAL AND METHODS: Authors undertook an attempt of evaluation of results of tibial corticotomy in 21 patients (25 operated knee joints) treated in Orthopaedic Clinic of Wroclaw Medical University in years 1995-2001, with the use of circular, external Ilizarov's fixator. All the operated patients underwent corticotomy of proximal tibial metaphysis followed by slow axis correction and bone regenerate formation started at 7th postoperative day. In orthopaedic examination functional evaluation of knee joint with modified point scale according to Ranawat (HSS-score) there were taken into account. In rentgenometric examination the limbs axis in the frontal plane and joint space morphology according to Ahlback were evaluated. RESULTS: The results in our group of patients were very encouraging. Accordingly to Ranawat scale, in majority of patients assessed before the treatment as poor and fair moved to group assessed as fair and good and even excellent. We observed decelerated regenerate formation and remodeling probably caused by advanced age of patients in 6 cases. In 3 cases persistent lose of entire correction was observed. CONCLUSIONS: In author's opinion DO as a method of operative treatment of unicompartmental knee arthrosis could be advocated as alternative method to traditional tibial osteotomy considering its biological effect stimulating regeneration of all tissues including cartilage even in advanced unicompartmental arthrosis.

Some aspects of treatment of metastatic bone tumors.

Background. Metastatic bone tumors are the most frequently met malignant musculoskeletal tumors. Asymptomatic and hidden onset of the primary stage of the illness may state very serious diagnostic and treatment problems for the orthopaedic surgeon, oncologist and radiotherapist.
The aim of this work is to evaluate clinical and radiological results of surgical treatment of metastatic bone tumors in long bones and pelvic ring considering localization and general condition of the patient.
Material and methods. There have been treated 57 patients with metastatic bone tumors in long bones and pelvic ring in our center in the years 1992-2003. Among them 38 women (average age 45.5) and 19 men (a.a. 42.7). 51 patients have been surgically treated with radical resection of the tumor and firm stabilization, 6 were treated with stabilization without radical resection of tumor tissue.
Results. Patients were evaluated clinically, radiologicaly and functionally with the use of Functional Evaluation System proposed by Enneking.
Conclusions. We conclude that early diagnosis and beginning of surgical treatment of metastatic bone tumors with radical resection and firm stabilization prolongs longevity, survival and life comfort of the patients.

The development of the distraction-compression osteogenesis method in orthopedic surgery in Poland.

The dynamic development of the Ilizarov method around the world and in Poland during the last decade has been made possible by the scientific of its application, based on universal laws of physiology and biomechanics. The Ilizarov method is beyond a doubt the treatment method of choice in many serious disorders of the locomotor apparatus, and is of extremely high value in the treatment of complicated open fractures with concomitant diffuse infuries of soft tissue, and not just in Poland's flagship orthopedic centers. Even though the complication rate is fairly high, the method is well tolerated by the patients, and the majority of failures can be effectively treated by the same method. This article outlines the history of limb lengthening in the worlds and the history of the development of the Ilizarov method in Poland.

Radiological imaging of the formation of regenerated bone in distraction osteogenesis: an experimental study.

Introduction. One of the biological factors affecting the formation of regenerated bone in distraction osteogenesis is the method used for osteotomy. The purpose of the present study was to evaluate the course of bone regeneration using various types of osteotomy in an experimental setting.
Material and method. Our research involved 35 Merynos sheep. Single-level tibia lengthening was performed in all these sheep in the proximal segment using an Ilizarov fixator. The material was divided into 5 groups depending on the osteotomy method used: closed corticotomy, open corticotomy, the Cattaneo method, osteotomy, and osteoclasia. The regenerating bone was evaluated by x-ray examinations performed in two standard projections.
Results. The x-ray images were evaluated based on a descriptive analysis of the features of the course of bone regeneration in all the experimental groups. The regenerating bone the osteoclasia group was most abundant and homogeneous in structure.
Conclusions. The formation of regenerated bone in distraction osteogenesis is dependent on the method of osteotomy. Radiological images of the course of regeneration in the various experimental groups showed differences in the intensity and rate of formation of new bone tissue. The formation and reconstruction of regenerated bone was faster in the osteoclasia group than in the other experimental groups.