Functional Instability of the Second to Fifth Metacarpophalangeal Joints.

BACKGROUND: Clinically, functional instability (FI) of metacarpophalangeal joints (MCPJ) is not considered to represent a pathology. This excessive mobility can be detected by the application of external forces to a MCPJ at different angles. Our study aimed to measure the FI of 2nd to 5th MCPJ. MATERIALS AND METHODS: A group of 36 healthy right-handed individuals were enrolled. The value of FI was measured in millimeters and verified by a CT scan. Statistical calculations was made in Statistica v.10.0. RESULTS: The largest values of the right and left-hand finger posterior displacement (FI) in the second to fifth MCPJ were obtained in the neutral position 0° (p<0.05). Measurements of volar displacement of the proximal phalanx second to fifth MCPJs in both hands revealed higher values at position 0° (p<0.05). CONCLUSIONS: 1. FI of the second to fifth MCPJs is determined by anatomical configuration and dynamic stabilizers. 2. Instability measurements show that posterior displacement of the proximal phalanges is greater by at least 1 mm in the 0° neutral position.

Mathematical Modelling of Destabilization Stress Factors of Stable-Elastic Fixation of Distal Trans- and Suprasyndesmotic Fibular Fractures.

Introduction: Specification of possible stress factors destabilizing the fibula stable osteosynthesis by the intramedullary nail with distal blocking and elastic fixation of distal syndesmosis by the thread with endobuttons by mathematical modelling of distal unstable ankle injuries. Material and Methods. We studied the thread tension during the combined stable-elastic fixation of unstable injuries of the ankle joint in cross-syndesmosis fractures of the fibula (B, C Danis-Weber classification), which includes a one-time stable minimally invasive fixation with the intramedullary nail and elastic fixation by the thread with endobuttons. We used a titanium alloy for the intramedullary nail and polyester for the thread. The deformed state was studied using the methods of mechanics. Results: A model of a fractured fibula blocked with the intramedullary nail and fixed with the elastic thread was developed. A formulation to specify the rational tension forces of the elastic thread depending on the parameters of the fibula and intramedullary blocking nail and on the location of the bone injury was obtained. The effect of foot rotation on the thread tension was investigated. The results of theoretical research should be implemented in medical practice. Conclusions: A mathematical model of the damaged fibula blocked by the intramedullary nail and fixed with the elastic thread was developed. Dependences for calculation of tension of the fixing thread were obtained. A slight increase in thread tension during foot rotation was found.

Case Study of Emphysematous Osteomyelitis of Both Femoral Heads.

Early references of emphysematous osteomyelitis (EO) in the literature trace back to 1981, when the presence of intraosseous gas was mentioned in a paper of Ram et al.. Subsequently, 48 cases of EO were described. A significant underlying comorbidity was reported in most EO cases, especially diabetes and malignancy. This report presents a 37-year-old male with undiagnosed diabetes mellitus which was accompanied by emphysematous osteomyelitis of both femoral heads.

Emphysematous Osteomyelitis: Review of the Literature.

This article presents a detailed review of the 49 reported cases of emphysematous osteomyelitis. Infection of the bones and joints usually developed in various locations of patients with concomitant diseases. The treatment includes antibiotic therapy and minor surgery, usually drainage.

Choice of optimal time and type of orthopedic surgery in multiple injured patients with acute respiratory distress syndrome (ARDS) depending on age: retrospective study.

BACKGROUND: Multiple traumatic injuries are severe conditions with a high risk of complications. Hemorrhage, multiple organ failure syndrome (MOFS), systemic inflammatory response syndrome (SIRS) and sepsis are the most dangerous sequelae. ARDS (acute respiratory distress syndrome) is a part of MOFS. Despite new strategies of prevention and care, the mortality associated with these conditions still remains high. MATERIALS AND METHODS: We conducted a retrospective study of the surgical management tactic of 145 patients with multiple trauma complicated by ARDS. All patients were treated in Ivano-Frankivsk Regional Clinical Hospital between 2007 and 2012. There were 118 (81.4%) males and 27 (18.6%) females. Patients were divided into two age groups. Group I consisted of 113 (78%) patients aged 18-64 years, including 106 (94%) males and 7 (6%) females. Group II consisted of 32 (22%) patients over 65 years old, with 7 (21.8%) males and 25 (78.2%) females. AISS-NISS (Abbreviated Injury Severity Score - New Injury Severity Score) scores were 55.9±1.312 in Group I and 54.9±2.43 in Group II. RESULTS: The difference in emergency surgery timing between Group I and II was not significant (p>0.05). Age was an important criterion in defining optimal time of osteosynthesis (p<0.01). The choice of osteosynthesis type did not depend on patient age in the early period of trauma (1-3 days) (p>0.05), but the surgical tactic was significantly different in the late period (8 days and more) (p<0.01). Active fracture management with a stable osteosynthesis technique (intramedullary nailing, plating and external fixation) was preferred in the younger age group. CONCLUSIONS: 1. The age of the patient is quite an important factor defining the surgical tactic. 2. However, neither age nor severity of injury to the anatomical segments is a reliable criterion for assessing the severity of a patient's condition.