Evaluation of lateral epicondylopathy, posterior interosseous nerve compression, and plica syndrome as co-existing causes of chronic tennis elbow.

PURPOSE: A great number of patients that suffer from lateral epicondylitis, commonly called tennis elbow (TE), are not successfully treated, meaning, not getting adequate therapeutic effects and the main origin of the pain not being handled appropriately. The hypothesis of the present study is that the inefficiency of the treatment of the chronic TE may often be due to underdiagnosis of posterior interosseous nerve (PIN) entrapment or and plica syndrome, as the authors believe that those pathologies can often occur simultaneously. METHODS: A prospective cross sectional study was conducted. A total of 31 patients met the required criteria. RESULTS: Thirteen (40.7%) of the patients had more than one source of the lateral elbow pain. Five patients (15.6%) had all three examined pathologies. Six patients (18.8%) had TE and PIN syndrome. Two patients (6.3%) had TE and plica syndrome. CONCLUSION: The present study demonstrated concomitant potential sources of lateral elbow pain in patients diagnosed with chronic TE. Our analysis shows how important it is to systematically diagnose patients that present with lateral elbow pain. The clinical characteristics of the three most common causes of chronic lateral elbow pain, meaning, TE, PIN compression, and plicae syndrome were also analyzed. Having adequate knowledge about the clinical aspects of these pathologies can help with a more effective differentiation of the etiology of chronic lateral elbow pain, and with that, a more efficient and cost-effective treatment plan.

[Locked posterior shoulder dislocation]. / Tylne zastarzale zwichniecie stawu ramiennego.

Posterior shoulder dislocations are diagnosed rarely in every-day practice. Although the methods of radiological imaging have been developing and becoming commonly available, the cases of late diagnosis are still happening. Proper clinical examination and properly conducted and interpretated radiographs allow for identification and implementation of appropriate medical procedures. In spite of fact that such cases are identified expectionally rarely, a few types of procedural have been analised and numerous therapeutic methods have been described. The choice of an appropriate treatment is complicated and requires in-depth theoretical knowledge as well as the knowledge of specific conditions within the shoulder surgery. Based on an algorithm, proposed by Griggs, between 2000-2006 seven patients with locked posterior instability were treated, for all of them defect of the proximal humerus did not exceed 30%. In all these cases the goals of improving stability and range of motion were obtained.

Lengthening of congenital forearm stumps.

The Ilizarov device and distraction osteogenesis method became very useful in correction and elongation of forearm defects. Two cases of forearm elongation with congenital transverse defect are described. The construction of the device is provided. During follow-up examination, 2 and 7 years after the treatment, good clinical results were achieved in both patients with the use of upper limb prosthesis employing the patient's own elbow joint. Presented application of the Ilizarov method can significantly improve possibilities for the use of prosthesis in patients with congenital upper limb defects and result in better cosmetic and functional outcome.

Limb lengthening in fibular hemimelia type II: can it be an alternative to amputation?

The purpose of our study was to analyze limb lengthening in fibular hemimelia type II. Ten patients underwent 16 tibia lengthenings. The mean tibia shortening was 5.8 cm. We used the Ilizarov technique in all cases. The mean follow-up time was 7.2 years. The mean lengthening was 23% of the former length. The healing index was 50.8 days/cm. In the final examination six patients were skeletally mature, equal limb length and functional foot positioning were achieved in four of them. Complications were observed during 14 lengthenings (87.5%). Although lengthening in fibular hemimelia is difficult, elongation with axis and foot correction may offer an alternative to amputation.

[A comparison of radiological outcomes in the surgical treatment of thoraco-lumbar scoliosis by anterior "bone on bone" and posterior spondylodesis]. / Porownanie wynikow radiologicznych operacyjnego leczenia skrzywien piersiowoledzwiowych w skoliozach idiopatycznych metoda spondylodezy tylnej i przedniej "kosc na kosc"

Background. The goal of surgical treatment in idiopathic scoliosis is to assure maximal correction of the curvature with a minimal number of spine segments fused. There are two main methods of spondylodesis: anterior and posterior. Material and methods. We compared radiological outcomes after surgical treatment of idiopathic thoraco-lumbar scoliosis by the anterior method called "bone on bone" and the posterior method using derotating fusion. Group I consisted of patients operated by the posterior technique, while Group II consisted of patients operated by the anterior "bone on bone" technique. Results. In Group I, the mean range of fusion was 7 vertebrae. After surgery the mean curve was 23 degrees (61% correction), while at 1-year follow-up the mean angle was 26 degrees . In Group II, the mean range of fusion was 4 vertebrae. After surgery the mean angle was 15 degrees (78% correction), while at one-year follow-up the mean angle was 16 degrees . Conclusions. The "bone on bone" method of anterior fusion gave greater correction and a shorter range of fusion compared to the posterior approach. At one-year follow-up no major loss of correction was noticed in either group.

Leg lengthening in patients with congenital fibular hemimelia.

Background. Anisomelia in patients with congenital fibular deficiencies is a difficult orthopedic problem due to concomitant deformities of the angle and knee. The goal of the present study was to analyze outcomes of tibia lengthening in these patients. Material and methods. In the period 1989-2001 we performed lengthening of 26 limbs in 21 patients with congenital fibular deficiency (11 female, 10 male, average age 10.1 years). Under the Achterman-Kalamchi classification, 8 tibiae were Type 1, 3 were Type 1b, and 10 were Type 2 (including one case with bilateral defect). The average baseline shortening was 4.6 cm, i.e. 15.3%. The Ilizarov method was used in 24 cases, chondrial lengthening in the others. We measured time of lengthening, time of stabilization, total healing time, amount of lengthening, and the lengthening index, as well as the range of ankle and knee movement, the positioning of the foot, and the axis of the tibia at each stage. Problems and complications were classified according to Paley. The average follow-up was 4.9 years Results. The mean time of lengthening was 101 days, stabilization time 177 days, total healing time 269 days, mean lengthening 5.6 cm (22.9%). As of the last examination only 7 patients did not require follow-up surgery, 6 with Type 1a and 1 with Type 1b. Conclusions. Tibia lengthening with axis correction constitutes an alternative to amputation in congenital fibular deficiency. It is a difficult procedure, however, encumbered by a significant risk of complications.