Definitive fixation of pelvic and acetabular fractures – current concepts

Introduction. The most challenging injury in orthopedic surgery is pelvic trauma. There are different concepts of treatment strategies, specially in final treatment of pelvic ring and acetabular fractures. Objectives. Analysis of recent studies and evaluation of treatment methods. Materials and Methods. Analysis of 22 recent studies. Five papers met our inclusion criteria, that equated 745 patients. Results. Patients hemodynamically unstable need to be resuscitated and „damage control” orthopedics is widely accepted method. Definitive treatment after fourth day should be performed. Some papers show that early, within 48 hours, definitive treatment of pelvic ring and acetabular fractures give similar or better results. Conclusions. Tendency to early definitive treatment is widely observed and decreases mortality rates and complications.

Reversed shoulder arthroplasty in treatment of proximal humeral fractures – early results in Department of Orthopaedics, Traumatology and Oncology, Regional Hospital in Torun, Poland

Introduction. Proximal humeral fractures (PHF) are a frequent finding, and still growing part of it needs to be treated operatively. Extending life expectancy, increasing percentage of osteoporotic fractures and progressive patients’ demand force surgeons to seek the best solutions of treating complex fractures. Just some teen years ago older patients who suffered a severe PHF were doomed to shoulder dysfunction. Today we can offer them a reversed shoulder arthroplasty (RSA) Purpose. The aim of the paper was a clinical evaluation of the patients who were treated with RSA in a Regional Hospital. Material and Methods. In years 2017-2021 in our department there were performed 41 RSAs and 5 TSAa (total anatomic shoulder arthroplasty). Earlier in 2010-2017 we performed 26 hemiarthroplasties. The procedures were done via delto-pectoral approach. The implant used were Aequalis Reversed Fracture (Tornier) and SMR (Lima). Results. The patients were evaluated in a simplified manner after 6 months postop. Functional active range of motion and VAS score were noted. Conclusions. In our department RSA is a well adopted method of treating complex PHFs, especially in elderly patients, and it yields overall good results and great percentage of satisfied patients.

Accidents in agriculture involving muscle skeletal system in children. Analysis based on hospitalization in the Paediatric Orthopaedics and Rehabilitation Department University Children’s Hospital in 2010-2019

Introduction. Accidents in agriculture involving children happen every year. They are attributable to a lack of safety and low awareness of caretakers, who oftentimes don’t pay enough attention to the little ones. Injuries in agriculture involve mainly falls from great heights: ladders, trailers, tractors; crushing by various types of agricultural machinery; partial or complete amputations within the regions of upper and lower limbs: amputations of feet or fingers. Those cases often include multi-tissue damages, which means that in addition to bone fractures, there might also occur other concurrent injuries like interstitial infections, crushing, neurovascular damages, or soft tissue damage. Material and Methods. In the years 2010-2019 there were 207 patients hospitalized in the Paediatric Orthopaedics and Rehabilitation Department of University Children’s Hospital in Lublin due to accidents in agriculture. Patients who suffered bone injuries, either caused by falling from heights or falling from agricultural machines, constitute the majority of the total 207 cases. The second case in terms of frequency, were the children whose limbs got stuck, or struck, by moving parts of agricultural machines and devices, which resulted in amputations at different levels. The third group consisted of patients crushed by agricultural machines or livestock. Results. The following data indicate a gradual decrease in the number of children requiring hospitalization. Between 2010 and 2019 there was a year-onyear decrease of 38.4%. Conclusions. After the analysis of causes and mechanisms of the injuries mentioned before, we conclude that the vast of these accidents could have been avoided if the caretakers looked after children with due attention, and the children were not allowed in the vicinity of currently functioning agricultural machines.

Dr. Kazimierz Grzebień – Wiktor Dega’s Poznań school of orthopedic in Toruń

Dr Kazimierz Grzebień was born in November26, 1928 in Kościerzyna. He received his medical degree at the Faculty of Medicine at the Medical Academy of Poznań on November 11, 1953 and started to work at the Orthopedic Clinic in Poznań, headed by prof. Wiktor Dega. He worked at the clinic until October 30, 1971. From April, 1972 to November 30, 1994 , he was the Head of the Orthopedic and Trauma Department at the Provincial Hospital in Toruń. On every occasion he made note of the brilliant and innovative method of treatments and rehabilitation applied by Prof. Wiktor Dega. He died on December 14, 2003, on the day of the opening of the symposium in Warsaw celebrating the 75th anniversary of Polish orthopedics, of which he was a great luminary.

Scaffolds for knee chondral lesions – indications and technical tips

Chondral lesions following an injury to the knee joint have poor healing potential and may lead to osteoarthritis. Nowadays, more and more research is focused on tissue regeneration and the prevention of osteoarthritis development. Efforts to restore the articular cartilage using advanced procedures like autologous chondrocyte implantation led to the development of scaffolds. Although the use of a scaffold-based technique is a reliable and effective method of cartilage repair, only the appropriate qualification can lead to good clinical outcomes.

Aseptic necrosis of the femoral head in the course of haemophilia; a different clinical and radiological course compared to typical Legg-Calve-Perthes disease (twenty years of follow-up) – case report

The authors analyse the course of aseptic necrosis of the femoral head in a 7-year-old boy with haemophilia A (factor VIII level - 0%) caused by massive haemarthrosis into the hip joint (joint tamponade). The patient’s clinical and radiological symptoms differed from those in classic LCP disease, and now, after 20 years, the consequences of necrosis do not confirm typical Perthes disease (LCP). Significant shortening (about 5 cm) of the limb and the X-ray image of the proximal end of the femur resemble the consequences of severe necrosis of the femoral head in the treatment of an infant with developmental dysplasia of the hip (DDH). The study presents necrosis of the femoral head in the course of haemophilia due to its extremely rare occurrence as opposed to haemophilic arthropathy typical for this disease. This description may also contribute to considerations on the etiopathology of LCP disease.

Non-microsurgical replantation (composite graft with palmar pocketing) – a case report of successful reintegration of distal finger amputation

Microvascular replantation in not always feasible for distal finger amputations. Our work presents a case of 23-year-old woman who suffered an amputation of index finger at the level of nail base. She was disqualified from microvascular replantation, however, the cooperation with Replantation Service resulted in an uncommon method of treatment, which resulted in excellent functional and aesthetic outcome. Composite grafting for fingertip amputations is a unique procedure which enables preserving original tissue with its function. We consider composite grafting to be a valuable adjunct to the wide range of methods for treating distal finger amputiations.

The comparison of results in treating primary degenerative lesions of the hip joint using the cementless total hip arthroplasty method with the Corail and Fitmore stems

The aim of this study is to clinically assess the results of a total hip arthroplasty surgery among patients with idiopathic hip degenerative lesions. These patients were treated using endoprosthesis with the standard Corail stem and the short Fitmore stem. The scope of this assessment includes surgeries carried out in the Provincial Hospital Complex in Kalisz in the Department of Orthopedics and Traumatology during years 2012-2015. In total, 64 patients with 70 endoprosthetics were analyzed (including 6 bilateral hip replacements). To assess the results before and after the treatment, both HHS and WOMAC scales were applied. The results achieved after the hip arthroplasty with both stem types were very similar and both produce good results for the patients. These results that are close to both Polish and international statistics.

Management of hipovascular non-union of ulna with implant destabilization in patient treated due to both forearm bone shafts fracture – a case report

A clinical case report of a 26-year-old patient with an open fracture of both forearm shafts without known comorbidities, who, during treatment, developed a non-union of the ulna with destabilization of the implants. After another fracture stabilization procedure, debridgement of the fracture ends and filling the bone gap with frozen allogenic bone grafts, union was obtained. In this paper, the authors consider possible causes of fracture healing problems in this patient based on the available literature.

Periprosthetic fractures in the hip joint – own study by the Department of Orthopedics and Traumatology in Kalisz

Every year, the number of total hip replacement treatments increases and along with it, so does the number of local and systemic complications, including periprosthetic fractures. These fractures usually occur among elderly people with deteriorated bone quality and other general and neurological disorders. Treatment of periprosthetic femoral fractures imposes a difficult and complex medical problem, which requires adequate experience and a rational combination of traumatological and orthopedical knowledge from the surgeon. In this article we review management of periprosthetic femoral fractures in the Department of Orthopedics and Traumatology in Kalisz.