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Journal: Polish orthopedics & traumatology

163

A variety of patient-related outcome questionnaires have been used for the assessment of results of total hip replacement. Generic core scales (SF-12, SF-36) and disease-specific scales like: Harris Hip Score, Western Ontario and McMaster University Osteoarthritis Index, Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, American Academy of Orthopedic Surgeons hip and knee Questionnaire, Lower Extremity Functional Scale are used most frequently. Even though all of them were assessed in terms of construct and content validity, reproducibility and sensitivity, there are still some problems related to bias when total hip replacement evaluation is performed in the presence of comorbidities, contralateral hip disease and ceiling effect influencing the final score. As a result, there is a need for development of a new PRO questionnaire in order to improve total hip replacement assessment, enable early detection of postoperative complications or to evaluate the results of surgery in both hips separately. It is crucial that such measuring device has to be deprived of the influence of irrelevant factors on the final score.

Concepts: Assessment, Psychometrics, Hip replacement, Hip, Pelvis, Orthopedic surgery, Joint replacement, John Charnley

26

Abstract Systemic and chronic diseases frequently affect function of many organs and systems, not only those from which they derive. The hand is a very complicated structure in the human body and its normal activity is related to undisturbed function of many factors. Therefore, the hand is frequently exposed to harmful effects of systemic diseases. The article reports on disorders and functional disturbances of the hand that, more frequently than in an average population, accompany selected systemic diseases: rheumatoid arthritis, gout, and scleroderma. Hand diseases related to diabetes are a subject of a separate paper. This study reviews typical disorders involving hand structures: joints, tendons and nerves. Their prevention and management is described.

Concepts: Osteoporosis, Rheumatoid arthritis, Rheumatology, Osteoarthritis, Human body, Arthritis, Human anatomy, Course

0

Abstract We present a review of the current literature and the author’s opinion regarding Septic arthritis in the pediatric age group. The etiopathogenesis, clinical features, the laboratory parameters for diagnosis and monitoring of treatment, radiological features, are discussed along-with the debatable issues pertaining to the choice of antibiotics, their duration, and the need and mode of surgical drainage and mobilization of the joint.

Concepts: Medicine, Physician, The Current, Septic arthritis

0

Background We present a case series of 3 patients who underwent a novel technique of tight rope fixation for Neer type II distal clavicle fracture. Material and Methods 2-3 cm incision was made lateral to the fracture site moving inferomedially. Part of the distal end of clavicle was exposed close to fracture site and further dissection was carried out to reveal the coracoid process. Tight rope fixation of the distal ends of clavicle and coracoid was performed to achieve satisfactory fracture reduction on x-ray. Results 4 weeks of sling with gentle pendulum movement were followed by active shoulder movement exercises. Radiographic union was reached at 6 weeks' time, while the patients achieved proper shoulder functionality 3 months following the operation. Conclusions Neer type II distal clavicle fractures are characterized by disruption of the coracoclavicular ligament with wide proximal fragment displacement. Overall, type II distal clavicle fractures have a 20-30% nonunion rate if treated non-surgically. Various techniques have been described for the treatment of these fractures, including hook plate and nailing. Tight rope fixation provides proper apposition of the fracture fragments for union by maintaining a reduced coracoclavicular interval.

Concepts: Bone, Materials science, Clavicle fracture, Clavicle, Coracoid process, Coracoclavicular ligament, Scapula, Acromion

0

Background Many various surveys are used to assess quality of life of patients with hip osteoarthritis, but none of them evaluates quality of life dependent on a single joint in bilateral disease. Aim. Development and preliminary validation of hip-specific quality of life survey (HSS) of patients with hip osteoarthritis.  Material and Methods A group of experts developed the final version of HSS questionnaire in 4 stages. Statistical analysis was conducted on 181 preoperative and postoperative HSS questionnaires completed by patients undergoing hip replacement surgery due to hip osteoarthritis. Discrimination index for each item, questionnaire internal consistency, proportion and dispersion of unanswered items, questionnaire filling time, ceiling effect and floor effect values as well as correlation between each item and subscale score were subject to statistical analysis.  Results Final version of the questionnaire is characterized by good discriminant power (CR >3 for each item except for one). Cronbach alpha coefficient for each subscale of preoperative as well as postoperative questionnaire reached a value over 0.8 and point value for each item correlated significantly with the sum of points in each HSS subscale. Conclusions No floor effect was observed in any of the cases, while ceiling effect was demonstrated in 1.1% of preoperative HSS questionnaires.

Concepts: Quality, Assessment, Psychometrics, Hip replacement, Hip, Reliability, Cronbach's alpha, Internal consistency

0

Abstract Background: Galeazzi fractures are a rare injury to occur in adults, which are typically associated with high energy trauma. To our knowledge, the reported cases in the literature have only been associated with motor vehicle accidents, falls from a height, or athletic endeavors. The application of the force in the setting of a Galeazzi fracture has been disputed, but it is believed to occur with the wrist in hyperextension and pronation. Case Report: We describe a 27-year-old male who presented with multiple gunshot wounds that included his right forearm. The injury sustained to his right forearm resulted in a Galeazzi fracture, which after open reduction and internal fixation, demonstrated subluxation of the distal radioulnar joint in pronation. Conclusions: We provide a novel mechanism of a Galeazzi fracture that demonstrates a method for sustaining the fracture pattern without the wrist in the typical position of hyperextension and pronation.

Concepts: Injuries, Injury, Wound, Orthopedic surgery, Forearm, Distal radioulnar articulation

0

Background: Male breast cancer (MBC) represents a rare cause of vertebral body compression fractures along with severe pain restricting the patient’s daily functioning. Limited number of cases, lack of awareness among patients and physicians leading to delayed management, further increase the average age and disease progression at presentation, resulting in a poor prognosis. Additionally, studies on MBC treatment protocols and the use of female algorithms are unavailable. The implementation of vertebroplasty or kyphoplasty often results in unsatisfactory outcome due to recurrent pain and loss of vertebral height. Stentoplasty could become an alternative procedure, as described in the following case study. Case Report: 54-yr-old male patient with history of breast carcinoma presented with pain in the vertebral column. Baseline X-ray and CT scan revealed multiple osteosclerotic and osteolytic metastatic lesions in the thoracic vertebrae along with a compression fracture at T9. Stentoplasty was performed to limit fracture progression. Intraoperative scan revealed restoration of the vertebral body shape. Following surgery, direct reduction in pain was obtained. Postoperative 1-year follow-up did not show any loss in height of the operated vertebra. Results of adjuvant chemotherapy administration and a new method of treatment of compression fractures caused by metastatic lesions were compared with previously published studies. Conclusions: Stentoplasty with Vertebral Body Stenting-System is an innovative method that can be applied in kyphoplasty for compression fractures caused by metastatic lesions. Nevertheless, further research on the systemic treatment of MBC is needed.

Concepts: Cancer, Breast cancer, Metastasis, Chemotherapy, Vertebral column, Pleural effusion, Chemotherapy regimens, Vertebra

0

The usual causes of injury to sciatic nerve during total hip replacement are intraoperative direct nerve injury, significant leg lengthening, improper retractor placement, cement extravasation, cement-related thermal damage, patient positioning, manipulation and postoperative hematoma. We present a case of early sciatic nerve injury with entrapment of sciatic nerve around the prosthetic femoral neck following repeated manipulation of dislocated total hip replacement. This case emphasises the importance of soft tissue in dealing with orthopedic problem. Limited number of attempts at closed reduction should be made as prolonged manipulation may place surrounding soft-tissue structures particularly nerve at risk of injury. If a closed reduction with the patient under general anesthesia is difficult, there should be a low threshold for open exploration and reduction. Documentation of neurovascular status before and after manipulation is essential.

Concepts: Sciatica, Hip replacement, Hip, Orthopedic surgery, Prosthetics, Soft tissue, Amputation, Distraction osteogenesis

0

Background Medical literature suggest that Hip and Knee replacement surgery takes far more time to conduct in overweight and obese patients than in general population. Reasons for increase in operating time in obese patient are difficult positioning, more bleeding from fatty tissue and difficult retraction. One very interesting and to our knowledge never reported cause of increased operating time in obese patients undergoing hip and knee arthroplasty is accidental dropping of instruments onto the floor by operating team. We looked into the relationship between patient’s size and dropping of instruments during hip and knee arthroplasty. Material and Methods A prospective cohort study was done were we included twenty five patients with BMI <30 and 25 patients with BMI ≥30 undergoing hip and knee arthroplasty. Results Instruments were dropped in 31 out of a total of 50 operations giving a dropping rate of 62%, out of these 19 were in patients with BMI >30 and 12 were in patients with BMI <30, inferential analysis gave a p value of 0.04997 which is statistically significant. Conclusions Operative time in obese patients may be indirectly affected by time take to replace dropped instruments. We recommend that there should be a backup of instruments in centres where obese patients are undergoing arthroplasty.

Concepts: Cancer, Statistics, Obesity, Statistical significance, Overweight, Orthopedic surgery, Knee replacement, Autologous chondrocyte implantation

0

Algodystrophy occurs in children significantly less frequently than in adults. Symptomatology, course, responsiveness to treatment and prognosis of the pediatric disease is also different from the “adult” form. This paper presents substantial peculiarities of pediatric algodystrophy: it occurs after relatively minor trauma, involves lower limb more frequently than upper limb and presents with pain, paleness and coldness of the skin in the affected part, as well as with serious functional impairment. Diagnosis of the condition is based on clinical grounds and no imaging is necessary to confirm the diagnosis. Psychological distress is suspected in the development of the disease in children and adolescents, but there is no definitive evidence supporting this view. Treatment of pediatric algodystrophy should be complex and consist of physical therapy, psychotherapy, pain therapy and, in selected cases, sympathetic and somatic blocks. The literature emphasizes very poor knowledge of algodystrophy in the pediatric community.

Concepts: Medicine, Medical terms, Medical diagnosis, Pain, Clinical psychology, Upper limb, Limb, Adult