Mid-term Functional Results and Failure Analysis after First Metatarsophalangeal Joint Arthrodesis.

BACKGROUND: First metatarsophalangeal joint arthrodesis is the gold standard in the treatment of arthritis of the first MTP joint as well as an effective salvage procedure after unsuccessful primary forefoot procedures. The paper aims to present an evaluation of mid-term functional results and specify the causes of low postoperative satisfaction among patients. MATERIAL AND METHODS: 44 patients who underwent operative treatment in the years 2012-2018 were assessed with the AOFAS-MTP, EFAS and VAS scores and a radiological evaluation after at least half a year of follow-up. Multiple factors were analysed with regard to their influence on functional results and overall patient satisfaction. Our results were then compared to those of the most recent meta-analysis. RESULTS: The mean follow-up time was 27.4 months (from 6 to 82 months). The mean AOFAS-MTP score increased from 30.5 (SD 15.6) to 67.16 (SD 18.68), the mean EFAS score increased from 8.2 (SD 5.2) to 17.2 (SD 6.7), and the mean VAS score decreased from 7.6 (SD 1.6) to 3.2 (SD 2.5). Additionally, 35 patients (79.5%) were satisfied or very satisfied with the surgery, 9 patients (20.5%) reported their satisfaction as low or very low, while 6 patients (13.6%) required a revision procedure. CONCLUSIONS: Despite using methods of treatment comparable to those found in the literature and achieving similarly comparable functional and radiological results, the finding that a significant proportion of patients were not satisfied with the surgery shows the need for further investigation and optimization of operative techniques.

Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries in the early period after trauma.

INTRODUCTION: Severe trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance. THE AIM OF THE STUDY: Severe trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient's immunological status before the decision to introduce elective procedures. MATERIAL AND METHODS: The study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdansk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score - RTS, Injury Severity Score - ISS, Glasgow Coma Scale - GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1ß, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury. RESULTS: Evaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including "timing" depending on the patient's biological status.

[The comparison of the use of cages with the use of autogenous bone grafts in the operative treatment of the isthmic spondylolisthesis by the posterior stabilisation and ALIF]. / Porównanie uzycia klatek miedzytrzonowych z uzyciem autogennych przeszczepów kostnych w operacyjnym leczeniu kregozmyku ciesniowego metoda tylnej stabilizacji i przedniego miedzytrzonowego usztywnienia kregoslupa.

In the following study the use of cages and autogenous bone grafts were comparised in the operative treatment of isthmic spondylolisthesis by the posterior stabilization and anterior lumbosacral interbody fusion. 55 patients were divided into two groups. Patients underwent ALIF with the use of autogenous bone grafts in the first group (34) and with the use of titanium interbody implants (cages) in the second group (21). The mean follow up period in the first group was 8.6 years and in the second group was 3.4 years. The objective clinical outcome assessment was based on Oswestry disability questionnaire. Subjective clinical evaluation was conducted with the use of visual analog pain score and two questions concerning the evaluation of success of the operative treatment and a possible agreement to the following operation if necessary. The radiological results were based upon the evaluation of the degree of spondylolisthesis, the angle of the lumbar lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The usage of autogenous bone grafts alone in ALIF was related to the significant loss of achieved segmental spine anatomy restoration. The implantation of the cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment.

[The influence of segmental lumbosacral anatomy restoration on clinical outomes in the operative treatment of the isthmic spondylolisthesis]. / Wplyw odtworzenia segmentarnej anatomii kregoslupa ledzwiowo-krzyzowego na wynik operacyjnego leczenia kregozmyku ciesniowego.

The influence of lumbosacral spine segmental anatomy restoration on the outcome of the operative treatment of isthmic spondylolisthesis was taken into evaluation. A series of 55 patients (29 males and 26 females) was examined. The long-term follow up period exceeded 3 years. The Oswestry Disability Questionaire was used to evaluate the objective clinical condition of the patients, while for the subjective assessment an analog pain score and the two questions survey concerning the evaluation of success of the operative treatment and a possible agreement to a following operation if necessary were used. The presence of neurological radical symptoms was evaluated. The radiological assessment was consisted of the evaluation of the degree of spondylolisthesis, the angle of lumbosacral lordosis, the height of the interbody space and intervertebral foramen. In conclusions, the proper spine anatomy restoration had the influence on the improvement of the outcome of operative treatment of isthmic spondylolisthesis. A metal cage usage for the anterior interbody fusion of lumbar spine in the operative treatment of isthmic spondylolisthesis enables long-lasting proper anatomical relations of the fused segment.