József Nyárády

Biomechanics of the Human Flexor Tendon Sheath Investigated by Tenography

Tenography has been performed on eight detached lingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.

Examination of a Novel, Specified Local Antibiotic Therapy through Polymethylmethacrylate Capsules in a Rabbit Osteomyelitis Model

Chronic bone and soft tissue suppurations have become more frequent recently due to the increasing number of high-energy injuries. There are certain antibiotic beads available for local administration, but they cannot always be applied specifically against the pyogenic microorganisms. In the present study, a new technique of local antibiotic therapy for the treatment of infections is described. Polymethylmethacrylate (PMMA) capsules were produced and filled with 0.1 ml Tazocin (0.02 g piperacillin sodium + 0.005 g tazobactam). The efficacy of these Tazocin-filled capsules was examined in vivo using a rabbit osteomyelitis model. Chronic osteomyelitis was induced in rabbit tibia by local injection of Staphylococcus aureus. The treatment included surgical debridement and implantation of Tazocin-containing PMMA capsules into the medullar cavity (n = 12). Simple surgical debridement with no antibiotic implantation was performed in control animals (n = 7). Results were evaluated using microbiological, radiological and histological methods 14 weeks after induction of osteomyelitis. Eight weeks after the implantation of PMMA capsules, complete physical, radiological and histological healing was achieved in 7 animals, initiation of the reparative phase was observed histologically in 3 cases and no reparative signs were detected in 2 rabbits. In the control group, no significant sign of reparation could be seen in any of the cases.

[Correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up].

UNLABELLED Hip fractures are associated with increased mortality in the elderly. There are only a few studies based on large patient number covering a nationwide health care system. AIM The aim of this study was to investigate the mortality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. METHODS Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trends according to risk factors were calculated. Logistic and Cox regression analysis was performed to evaluate the correlation between risk factors and mortality. RESULTS 3783 patients were involved in the study with a mean age of 77,97 years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year. CONCLUSIONS In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropriate selection of methods corresponding to fracture type, providing the same conditions for primary treatment during all days of the week, to organize the treatment to special centres, appropriate acute care and follow-up corresponding to the general health status and co-morbidities of patients.Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up. Hip fractures are associated with increased mortality in the elderly. There are only a few studies based onlargepatientnumbercoveringanationwidehealthcaresystem.Aim:Theaimofthisstudywastoinvestigatethemor tality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. Methods: Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trendsaccordingtoriskfactorswerecalculated.LogisticandCoxregressionanalysiswasperformedtoevaluatethecorre lationbetweenriskfactorsandmortality.Results:3783patientswereinvolvedinthestudywithameanageof77,97years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5 th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year.Conclusions:In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropri

Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up

UNLABELLED Hip fractures are associated with increased mortality in the elderly. There are only a few studies based on large patient number covering a nationwide health care system. AIM The aim of this study was to investigate the mortality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. METHODS Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trends according to risk factors were calculated. Logistic and Cox regression analysis was performed to evaluate the correlation between risk factors and mortality. RESULTS 3783 patients were involved in the study with a mean age of 77,97 years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year. CONCLUSIONS In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropriate selection of methods corresponding to fracture type, providing the same conditions for primary treatment during all days of the week, to organize the treatment to special centres, appropriate acute care and follow-up corresponding to the general health status and co-morbidities of patients.Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up. Hip fractures are associated with increased mortality in the elderly. There are only a few studies based onlargepatientnumbercoveringanationwidehealthcaresystem.Aim:Theaimofthisstudywastoinvestigatethemor tality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. Methods: Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trendsaccordingtoriskfactorswerecalculated.LogisticandCoxregressionanalysiswasperformedtoevaluatethecorre lationbetweenriskfactorsandmortality.Results:3783patientswereinvolvedinthestudywithameanageof77,97years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5 th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year.Conclusions:In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropri

Comparative Study of Antibiotic-Containing Polymethylmetacrylate Capsules and Beads

Background: This study aimed at making local antibiotic therapy wider in cases of chronic suppurations by administering antibiotics which previously could not be given in this way through the conventional polymethylmetacrylate (PMMA) carrier techniques. Capsules from this material were produced with a pressing machine designed and laid out by us. The characteristics of antibiotic penetration from this novel carrier were compared to those of PMMA beads. Methods: The time-dependent outflow of amikacin, clindamycin, pefloxacin, piperacillin + tazobactam, amoxicillin + clavulanic acid and cefotaxime was examined from the capsules and the beads with standard microbiological techniques using the Micrococcus luteus ATCC9341 test strain. The diameter of the inhibitory zones was measured after 24 h incubation at 37°C and converted to µg/ml antibiotic concentrations. Results and Conclusions: Our results revealed that all antibiotics showed longer-lasting and higher concentration outflow from the PMMA capsules than from the beads. Therefore, these capsules can provide a more promising new opportunity for specific local antimicrobial treatment in cases of chronic suppurative bone and soft tissue injuries. In these cases the polymerization has already been completed and the heat does not influence the structure of the antibiotics; therefore, it can be inserted into the capsules in powder or solution form.

Osteoscopy for assessment of blood supply to the femoral head: a preliminary study.

Objectives The aim of our study was to develop a minimally invasive endoscopic procedure (osteoscopy), which is capable of visualizing blood supply and quantitatively assessing circulation to the femoral head at the time of definitive surgery. Methods The new diagnostic technique was developed in animal experiments (four piglets) and was subsequently tested in nine consecutive patients requiring surgery for a femoral neck fracture. The direct visualization of the femoral head circulation was performed in the mortise prepared for the implant. The osteoscope optic fiber was placed at the orifice of the cavity created by the custom-made drill bit. The “mortise-sleeve-optic” system was connected to a manometer and a saline reservoir. The bleeding from the wall of bony cavity was observed, meanwhile the inner pressure of the “mortise-sleeve-optic” system was changed gradually. The pressure measurement at the first appearance of bleeding and the intraosseal pressure was recorded. Results The animal investigations demonstrated that the osteoscopy readily distinguished among diffuse bleeding, pulsatile bleeding, and the absence of bleeding in the femoral head. The human experiments proved that a different quality of the femoral head circulation can be observed during osteoscopy. Conclusions Preliminary findings indicate that clinical osteoscopy may be a useful tool in the assessment of blood circulation to the femoral head.

Utilization of physiotherapy services in case of trauma disorders of the lower extremity in the outpatient care

Bevezetes: Az also vegtagi serulesek ellatasanak orvosi aspektusai jol dokumentaltak, azonban keves informacioval rendelkezunk e korkepek fizioterapias ellatasarol. Celkitűzes: A szerzők az also vegtag seruleseihez kapcsolodo fizioterapias jellegű tevekenysegek igenybeveteli mutatoinak elemzeset tűztek ki celul eletkor es nemek szerinti bontasban a jarobeteg-szakellatasokban. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisabol a 2009-ben tortenő jarobeteg-ellatasokbol az alsovegtag-serulesekhez kapcsolodo fizioterapias tevekenysegek esetszamait elemeztek. Eredmenyek: 2009-ben az also vegtag seruleseit kovető fizioterapias tevekenysegek 10 000 főre juto atlagos esetszam a ferfi es a női nemnel „a csipő es a comb serulesei” csoportban 249,75 es 443,7, „a terd es a labszar serulesei” csoportban 927,64 es 668,25, „a boka es a lab serulesei” csoportban 307,58 es 245,75 volt. Az also vegtag seruleseinel mindharom regio vonatkozasaban megallapithato volt, hogy a 15–49 ev kozotti korosztalyban a ferfiak esetszamai, mig idősebb korban a nők ertekei voltak magasabbak. Kovetkeztetesek: A tanulmany alapjan az alsovegtag-serulesek kezeleseben a fizioterapias tevekenysegek szama jelentős, nemek kozotti eltereseket mutatott. Orv. Hetil., 2013, 154, 985–992. | Introduction: Limited information is available on physiotherapy treatment of lower extremity injuries. Aim: The purpose of this study included analysis of the utilization of outpatient physiotherapy services in case of injuries of the lower extremity. Method: Data derived from the database of the National Health Insurance Fund Administration, Hungary. The number of cases undergoing physiotherapy activities after lower extremity injuries were determined. Results: In 2009 the average number of cases undergoing physiotherapy activities following lower extremity injuries per 10,000 persons were the following: „hip and thigh injuries” 249.75 male cases and 443.7 female cases; „knee and leg injuries” 927.64 male cases and 668.25 female cases, and „ankle and foot injuries” 307.58 male cases and 245.75 female cases. Conclusions: According to this study, the number of physiotherapy activities for patients with injuries of the lower extremity showed significant differences between genders. Orv. Hetil., 2013, 154, 985–992.

Biomechanics of the membranous flexor tendon sheath : The role of Grayson's ligaments

Background: The biomechanical integrity of the tendon sheath of the fingers has a significant effect on the success of flexor tendon surgery. As nonweightbearing elements, the membranous parts of the sheath have received little attention, and their contribution to sheath movement is still obscure. The authors presumed that Graysons ligaments, which have been described as force-transmitting elements, might play a role in the biomechanics of the membranous flexor tendon sheath. Methods: Twenty-two long fingers of cadaver hands were examined. The authors studied the movements of the inner aspect of the tendon sheath and the positions and patterns of the septa of the palmar soft tissues on picrosirius red–enhanced sagittal and transverse sections and hematoxylin and eosin–stained light microscopy specimens. Results: The movements of the membranous flexor tendon sheath are controlled by subcutaneous structures. The septal patterns of the palmar fat pads indicate the existence of a highly flexible subcutaneous fibrous system in which the deformable fat pad keeps the force-transmitting elements tight. Collagen bundles in the microscopy specimens, which frequently form layers within the septa, are thought to correspond to Graysons ligaments. The subcutaneous fibrous system adheres predominantly to the membranous parts of the flexor tendon sheath. Conclusions: Folding of the membranous flexor tendon sheath is guided by the subcutaneous fibrous system, of which the macroscopically dissectible elements are Graysons ligaments. The current surgical approaches might have a deteriorating effect on the biomechanics of the flexor tendon sheath.

Utilization of physiotherapy services for traumatic disorders of the lower extremity in ambulatory care

Bevezetes: Az also vegtagi serulesek ellatasanak orvosi aspektusai jol dokumentaltak, azonban keves informacioval rendelkezunk e korkepek fizioterapias ellatasarol. Celkitűzes: A szerzők az also vegtag seruleseihez kapcsolodo fizioterapias jellegű tevekenysegek igenybeveteli mutatoinak elemzeset tűztek ki celul eletkor es nemek szerinti bontasban a jarobeteg-szakellatasokban. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisabol a 2009-ben tortenő jarobeteg-ellatasokbol az alsovegtag-serulesekhez kapcsolodo fizioterapias tevekenysegek esetszamait elemeztek. Eredmenyek: 2009-ben az also vegtag seruleseit kovető fizioterapias tevekenysegek 10 000 főre juto atlagos esetszam a ferfi es a női nemnel „a csipő es a comb serulesei” csoportban 249,75 es 443,7, „a terd es a labszar serulesei” csoportban 927,64 es 668,25, „a boka es a lab serulesei” csoportban 307,58 es 245,75 volt. Az also vegtag seruleseinel mindharom regio vonatkozasaban megallapithato volt, hogy a 15–49 ev kozotti korosztalyban a ferfiak esetszamai, mig idősebb korban a nők ertekei voltak magasabbak. Kovetkeztetesek: A tanulmany alapjan az alsovegtag-serulesek kezeleseben a fizioterapias tevekenysegek szama jelentős, nemek kozotti eltereseket mutatott. Orv. Hetil., 2013, 154, 985–992. | Introduction: Limited information is available on physiotherapy treatment of lower extremity injuries. Aim: The purpose of this study included analysis of the utilization of outpatient physiotherapy services in case of injuries of the lower extremity. Method: Data derived from the database of the National Health Insurance Fund Administration, Hungary. The number of cases undergoing physiotherapy activities after lower extremity injuries were determined. Results: In 2009 the average number of cases undergoing physiotherapy activities following lower extremity injuries per 10,000 persons were the following: „hip and thigh injuries” 249.75 male cases and 443.7 female cases; „knee and leg injuries” 927.64 male cases and 668.25 female cases, and „ankle and foot injuries” 307.58 male cases and 245.75 female cases. Conclusions: According to this study, the number of physiotherapy activities for patients with injuries of the lower extremity showed significant differences between genders. Orv. Hetil., 2013, 154, 985–992.

Elhízott populációra jellemző talpnyomásminták vizsgálata

Absztrakt Bevezetes: A testsulynak jelentős szerepe van a lab megnovekedett terheleseben es a nyomasmintak valtozasaiban, de a valtozasok eloszlasa pontosan nem ismert. Celkitűzes: Jelen kutatas celja volt normal es koros testtomegindexű egyenek talpnyomasmintainak vizsgalata, hogy kozelebbi kepet kapjunk a regionalis plantaris terheles valtozasairol. Modszer: A vizsgalatnak 180 alanya volt, a talpnyomas merese dinamikus pedobarograffal tortent. A talp 8 anatomiai regiojat vizsgaltuk, az alabbi parameterek fuggvenyeben: kontakt terulet, csucsnyomas, maximalis erő. Eredmenyek: A lab kozepső teruleten es metatarsusok alatt jelentősen nagyobb csucsnyomas jellemző az elhizott egyenekre (p<0,001). A maximalis erőertekek az ujjaknal alacsonyabb (p<0,001), a kontakt terulet adatai a totalis talpteruleten (p<0,001) es a kozepső talp teruleten szignifikansan nagyobb ertekeket mutatott az elhizottak csoportjaban (p<0,001). Kovetkeztetesek: Elhizas hatasara koros mertekű terhelesnovekedes kovetkezik be a lab kozepső...