THE SURGICAL TREATMENT OF HEAD RADIAL BONE FRACTURE IV TYPE BY MASON-HOTCHKISS FOR THE IMPLEMENTATION OF THE CEMENTLESS BIPOLAR MODULAR ENDOPROSTHESIS OF THE HEAD RADIAL BONE

Aim. The author of the article shows the features of the surgical technique of implantation of the developed cementless modular bipolar endoprosthesis of the head of the radial bone with a pair of metal-metal friction. Materials and methods. The developed cementless modular bipolar endoprosthesis of the radial head with a pair of metal-metal friction. Indications for endoprosthetic of the head of the radial were the fracture of the head IV, according to Mason-Hotchkiss. The result of the treatment was assessed by the Mayo Elbow Performance Score evaluation system. Results and discussion. At fractures on Mason-Hotchkiss IV type, the endoprosthetic of the head of a radial bone is applied. The use of the developed modular endoprosthesis of the head of the radial made it possible to restore the stability of the elbow joint, to resume rotational movements of the head radial, while maintaining the functional volume of flexion-extensor movements, and also to restore the length of the radial bone. Conclusions. The use of the developed advanced cementless bipolar modular endoprosthesis of radial head fracture-dislocation type IV by Mason-Hotchkiss allowed obtaining a good result, according to the assessment of the MEPS clinic (88.5 scores) in 6 months after surgery.

Predicting Functional Outcomes in Patients with Femoral Neck Fractures Treated by Hemiarthroplasty

Background. A femoral neck fracture leads to serious health-related, social and economic consequences and, according to the con­temporary doctrine of medical management, should be treated surgically. Data provided by the Agency for Health Technology Assessment and Tariff System indicate that there were 1534 patients with femoral neck fractures treated by arthroplasty with a Moore’s endoprosthesis and 4744 with a bipolar endoprosthesis in Poland in 2014. Since the risk of femoral neck fracture increases exponentially with the patient’s age, and population aging is undoubtedly a real demographic trend, we believe that there is a need to develop criteria for taking treatment decisions to ensure the best possible outcomes. The aim of this paper is to identify factors influencing the functional outcomes of hemiarthroplasty measured with the Harris Hip Score (HHS) in patients with femoral neck fractures. Material and methods. The first part of study data consisted of clinical data derived from the medical treatment records of 161 patients with femoral neck fractures who were treated by hemiarthroplasty in the Orthopaedic Department of the Regional Hospital in Sieradz in 2009-2011. The age, sex, overall health status of the patients qualified for surgical treatment, time between injury and surgery, type of endoprosthesis, and length of stay at the department were determined. The second part was data from an outcome assessment using the Harris Hip Score (HHS) at two-year follow-up visits of 90 patients of the original group. Results. The mean outcome of all the patients was defined as satisfactory (HHS score of 73.37 points). Examination of one-factor correlations between the outcome and the patient’s sex and the type of endoprosthesis revealed significantly superior outcomes in men and patients who received the bipolar endoprosthesis. A multiple factor statistical analysis, which additionally included the variables of patient age and baseline overall health status, demonstrated that only overall health status (ASA score) had a statistically significant effect on the functional outcome of arthroplasty among all factors examined. Conclusions. 1. Evaluation of the quality of life of patients who underwent surgery after femoral neck fractures utilising the Harris Hip Score (HHS) in one-fac­tor correlations (age, sex, type of endoprosthesis, general condition) revealed significantly superior results for men who received the bipolar endo­prosthesis. There was also a moderately strong and negative correlation with the patients’ age. 2. The functional outcomes in patients with low energy femoral neck fractures treated with two types of partial hip endoprosthesis at the Ortho­paedic Department of the Regional Hospital in Sieradz, assessed by multiple factor analysis, showed a significant correlation only with the patient’s baseline overall health status.

Does the Self-Centering Mechanism of Bipolar Hip Endoprosthesis Really Work in vivo?

Purposes. To examine radiographically the component motion in a bipolar prosthesis and to determine whether the self-centering mechanism really works in vivo. Methods. 38 patients with 41 bipolar hip endoprostheses (30 for coxarthrosis and 11 for osteonecrosis of femoral head) were included in this study. Two radiographs of each case were taken to evaluate the self-centering mechanism. The first anteroposterior radiograph of both hip joints was taken at the maximum abduction while the patient standing on the endoprosthetic leg. The second radiograph was taken after the patient returned to neutral position while standing on 2 legs. In the present study, the order in which the radiographs were taken differed from previously reported studies. The radiographs were analysed using the method similar to that of Drinker and Murray. The adductive motion from abduction to a neutral position is within the range of inner bearing oscillation. Results. The outer head alignment changed from 23 degrees to 12 degrees in the patients with osteonecrosis. However, the valgus position of the outer head (36 degrees) remained unchanged in the patients with coxarthrosis standing on 2 legs in the neutral position. Conclusion. The self-centering mechanism of the bipolar endoprosthesis functioned in the patients with osteonecrosis, but did not work in the coxarthrosis group.