Jacek Lorkowski

Nieleczone zniekształcenia narządu ruchu w przebiegu chorób systemowych – analiza przypadku

The synergy of two arthritides coexistence is very rare. In this paper we describe a 46 -year -old patient with psoriatic and gouty arthritis. The pathologies had been developing for a dozen or so years in the ulnar area of both upper limbs. The patient elected to undergo surgical treatment in a very advanced stage of the disease due to increasing psychological discomfort.

OCENA SPOSOBU POSTĘPOWANIA I WYNIKÓW LECZENIA U PACJENTÓW Z ODMĄ PRĘŻNĄ

Introduction: Tension pneumothorax is a directly critical illness condition. The aim of this study was to evaluate the outcome of tension pneumothorax treatment in trauma patients. Material and methods: We assessed the results of treatment of 22 patients hospitalized for trauma in 2000–2010, in whom at the time of admission tension pneumothorax symptoms were found. This constituted 18% of trauma patients who at the time of admission to the hospital, during the initial examination, were diagnosed with pneumothorax. In the study group there were 17 men and 5 women. The patients’ ages ranged from 21 to 85 years (mean 48.8). In 19 cases tension pneumothorax was associated with polytrauma. Traffic accidents were the cause of most cases. Injury to one or both lungs was observed in 16 patients. Typical paradoxical breathing occurred in 2 patients. The number of fractured ribs averaged 6.3 per patient. In each of the patients, immediately on admission, after diagnosis based on clinical symptoms, tension pneumothorax decompression was performed by pleural drainage. Lung decompression and improvement of the clinical condition of the patient were obtained in a few minutes after pleural drainage. Then, further diagnostic and therapeutic procedures were continued. Full time of hospitalization due to polytrauma injury was on average 58.6 days. Two patients died during treatment for polytrauma. Pneumothorax was not the cause of death in either of the patients. Conclusion: In summary, the therapeutic standard ordering of tension pneumothorax decompression, directly on admission to the hospital, allows the patient to survive in spite of the grave nature of the injury.

Analiza przyczyn uszkodzeń płytki blokowanej kompresyjnej stabilizującej złamanie końca dalszego i części dalszej trzonu kości piszczelowej

Introduction: Implant damage is one of the complications of fracture treatment. Case report: In this paper we present the case of a 59 -year -old patient after surgical treatment of the distal tibia and distal end of the tibia fracture with multiple bone fragmentation (AO 43C3). The implant damage was caused not only by the patient’s noncompliance, but also by the notch effect and fatigue fracture of the locking compression plate (medial distal tibial plate), most probably secondary to technological error (macroscopic and FEM analysis). Conclusion: The presented case shows that the patient’s compliance and elimination of construction and production errors are necessary to achieve satisfactory treatment effects.

Biomechanical Causes of Fracture Non-union after Diaphyseal Forearm Fracture Fixation: an in Silico Analysis. Case Study.

Non-union of forearm bone shaft fractures remains, in some cases, a major clinical problem. The aim of this study was to assess the biomechanical causes of non-union in a patient with diaphyseal forearm fractures fixated with LCP plates. The paper describes the case of a 35-year-old male who developed a non-union as a result of destabilisation of the fixation. The case was analysed with an in silico analysis of the removed fixation device. CONCLUSION To sum up, we believe that the case described in this paper confirms the limitations to the use of LCP reconstruction plates in patients with well-developed musculature, even in the case of repeat fixation, when good adjustment of the plate well to the axis of the bone appears necessary. It is possible to use an orthosis, first a locking one and then one that limits pronation during further treatment of a partially healed fracture, but, as this case shows, it is not a fully reliable method of preventing complications.

An in Silico Analysis of Ankle Joint Loads in Secondary Ankle Osteoarthritis. Case Study.

Secondary, post-traumatic, degenerative lesions of the ankle joint remain a serious clinical challenge. This paper presents the case of a 66-year-old patient with secondary, post-traumatic ankle osteoarthritis and subchondral cysts. The use of rapid computer modelling FEM 2D enabled optimization of surgical treatment. A FEM 2D model of biomechanical changes in bones may help in streamlining treatment as well as improve our understanding of the pathomechanism of osteoarthritis.

[The Use of Pedobarographic Examination to Biomechanical Evaluation of Foot and Ankle Joint in Adult - Own Experience].

A non-invasive method, that can be used to describe the underfoot pressure distribution during stance and gait, is pedobarography. This examination helps to describe biomechanics of foot and ankle. It has been used to diagnose foot disorders, assess the disease progression, monitor the progress of rehabilitation and also evaluate the effectivness of undergone surgical treatment. In this article we describe chosen issues of pedobarographic examination in diagnostics and treatment of foot and ankle in adults. We base on our own experience (about 10 thousand examinations) and review of literature. In our opinion, pedobarography should be used in diagnostics and treatment of foot and ankle more often and widely than now.

The outcomes of cementless total ankle arthroplasty - pilot study.

BACKGROUND Since new generation ankle endoprostheses came into common use, total ankle arthroplasty has become an alternative to arthrodesis in the treatment of advanced osteoarthritis. The aim of paper was present preliminary results of cementless total ankle arthroplasty in patients with osteoarthritis. MATERIAL AND METHODS In 2012-2014, 12 cementless total arthroplasties of the ankle joint with a Mobility implant were conducted at the Department of Orthopaedics and Traumatology of the Central Clinical Hospital of the Ministry of Interior in Warsaw. The patients were 7 women and 5 men aged 27-72 years. Nine of the patients had the arthroplasty procedure due to severe post-traumatic degenerative changes while 3 patients had haemophilic arthropathy. Clinical assessment was based on the AOFAS scale and the VAS pain scale. The patients were followed up for at least 6 months. RESULTS All patients improved considerably. After surgery, the AOFAS score improved by 43.0 (± 7.5) points against baseline while the VAS score improved by 5.2 (± 0.8) points. Imaging studies revealed an anatomical position of the endoprosthesis in all patients and no evidence of implant loosening. CONCLUSIONS 1. Cementless total ankle arthroplasty currently seems to be an optimal solution in the treatment of osteo arthritis of the ankle joint. 2. Correct qualification for surgery is a prerequisite for successful treatment.

Orthopedic procedures in patients with congenital coagulation disorders: single center experience.

BACKGROUND Spontaneous intraarticular bleeds in congenital coagulation disorders result in early and extensive damage to the joints and periarticular structures. Total arthroplasty is the only effective method of treating these defects. Interim surgical procedures (arthroscopy, osteotomy, etc.) exist that can postpone arthroplasty, especially considering the fact that the condition affects young people. The aim of this paper is to discuss the range of trauma care and orthopedic procedures performed in patients with congenital coagulation disorders. Also presented are early results of joint arthroplasty in these patients. MATERIAL AND METHODS A total of 168 trauma care and orthopedic procedures were performed in patients with congenital coagulation disorders at the Clinical Department of Orthopedics and Traumatology of the Central Clinical Hospital of the Ministry of Interior in Warsaw in the years 2010-2013. Among them were total arthroplasties (79 arthroplasties of the knee, 30 of the hip, 3 of the ankle and 1 of the elbow), arthroscopies, filling bone cysts with grafts and trauma procedures. The HHS, KSS, AOFAS and MEPS scales were used to evaluate the respective clinical results of hip, knee, ankle and elbow arthroplasty procedures. A VAS was used to evaluate pain intensity. In knee arthroplasty patients, quality of life parameters were evaluated with the WOMAC index. RESULTS In patients post hip arthroplasty, HHS scores increased by 50.22 points and VAS scores increased by 6.34 points. An increase of 116.41 points in KSS scores and 6.67 points in VAS scores was recorded in patients after knee arthroplasty. Also, WOMAC scores improved by 53.8 points after surgery. Evaluation of early results of ankle arthroplasty in the AOFAS scale showed a mean improvement of 35.5 points and a 5-point improvement in VAS scores. MEPS scores, used for evaluation of elbow arthroplasty results, improved from 15 to 70 points, with an improvement from 6 to 2 points in VAS scores. CONCLUSIONS 1. Orthopedic procedures in patients with congenital coagulation disorders require thorough preparation of the patient and close cooperation between the orthopedic and hematological teams. 2. Early clinical outcomes are promising. 3. Decreased pain intensity, increased joint range of motion and improved quality of life post-surgery are observed.