Establishing an optimal trajectory for calcaneotibial K-wire fixation in emergent treatment of unstable ankle fractures.

OBJECTIVE: In unstable ankle fractures the associated soft tissue damage can be a therapeutic challenge. The aim of this study was to optimize planning of minimally invasive stabilization of ankle fractures by calcaneotibial transfixation, which is a demanding technique due to the complex hind foot anatomy. METHODS: In a retrospective radiographic analysis the angles and dimensions of a safe drill tunnel for calcaneotibial K-wire insertion were defined on standard radiographs of the ankle joint. 165 lateral weight-bearing radiographs (77 right; 88 left) and 147 (80 right; 67 left) mortise views of 186 (90 right; 96 left) uninjured feet from 123 patients (74 women (114 feet); 49 men (72 feet)) were included in this study. The average patient age was 49 (range, 13-85) years. Inter- and intra-observer reliability was evaluated on 20 randomized radiographs that were analyzed in a default set, three times, by two different examiners on three different days. RESULTS: In the lateral view the drilling tunnel was orientated at 59.4° to the plantar plane with a maximum proximal variance of 7.1 image-mm. Distal variance cannot be tolerated since an ankle joint injury would ensue. In the mortise view the drill tunnel was directed with a mean angle of 18.4° to the distal tibial articular surface. At most a mean of 11° fibular- and 13.4° tibial- expansion can be tolerated. Intra- and inter-observer reliability was higher for the angles than for the drill corridors. CONCLUSION: The three-dimensional (3D) orientation for safe K-wire placement for calcaneotibial transfixation should adhere to the drill tunnels established in this study.

[Relationship between the iron status of the pregnant woman and her body size and body composition before and during pregnancy]. / Zaleznosc pomiedzy stopniem wysycenia zelazem organizmu kobiety ciezarnej a jej budowa i skladem ciala przed i w trakcie ciazy.

For the analysis the relationship of the iron status of 86 pregnant women and size and composition body factors before and during pregnancy were made anthropometric, hematological and iron status indices. There were significant relations between pregestational body weight, height, body mass index and body weight, body composition in pregnancy and the values of iron status indicators in blood throughout gestation.

[Estimation of iron status in women in the course of gestation and delivery]. / Oszacowanie stanu zelaza w organizmie ciezarnych.

The triple examinations have taken in the course of gestation on 86 pregnant women living in Lódz. The determinations of HGB, HCT, RBC, MCV, MCH, MCHC, RDW, SF, TIBC, SI, TS, ST, and EP in the venous blood were made between 8-14 hbt, 22-24 hbt, 32-35 hbt and at the first phase of the delivery. Among the examined women it was state the decrease of the value of hematological and iron indexes during the testified to the depletion of the reserved, transport and functional iron store in the organism of the pregnant women. The multiple criteria models were applied to diagnose the prevalence of different stages of iron deficiency with or without anemia in our pregnant women. For women in all trimesters of pregnancy the prevalence of iron deficiency and iron deficiency anemia was 38% in first and 54% in second half of pregnancy.

[Estimation of iron reserves in the body of pregnant women]. / Oszacowanie zapasów zelaza w organizmie kobiet ciezarnych.

The iron reserves were assessed using Cook's formulas in 86 women in following trimesters of pregnancy and in the course of labour. The range of obtained iron reserves' levels was wide and amounted from -570 mg to 874 mg. The iron reserves' levels differed statistically in the groups of women with normal iron amount, with hypoferraemia and with sideropenic anaemia diagnosed on the basis of haematologic and iron indexes. Iron reserves insufficient for the maintenance of iron positive balance in organism were found in about 30% of examined gravidae.