Ortopedia, traumatologia, rehabilitacja
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Ortop Traumatol Rehabil · Aug 2017
Posterior Branches of Lumbar Spinal Nerves - Part III: Spinal Dorsal Ramus Mediated Back Pain - Pathomechanism, Symptomatology and Diagnostic Work-up.
Spinal Dorsal Ramus Mediated Back Pain is the second most frequently described condition (the first one being Lumbar Facet Syndrome) originating from pathology involving posterior branches of lumbar spinal nerves. Spinal Dorsal Ramus Mediated Back Pain was described as "thoracolumbar junction syndrome" by Maigne in 1989. As a rule, Spinal Dorsal Ramus Mediated Back Pain presents unilaterally within posterior branches at the levels Th11-12 and L1-2. ⋯ Diagnostic work-up may benefit from performance of the Kibler Fold Test to determine sensitivity of the tissues surrounding the iliac crest. Patients with Spinal Dorsal Ramus Mediated Back Pain respond well to manual manipulative techniques if these are delivered in a technically correct manner and address the appropriate segment. A recommended approach for patients with absolute contraindications to manipulation, i.e. advanced osteoporosis or osteogenesis imperfecta, is a block of the po-sterior branch of the spinal nerve involved.
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Ortop Traumatol Rehabil · Aug 2017
Review Case ReportsThe Challenges of Monoaxial Bone Transport in Orthopedics and Traumatology.
Bone defects represent the main challenging problem for the orthopedic surgeon and, consequently, they increase the duration of hospitalization, risk of complications and health expenditures. The aim of our observational, descriptive and retrospective study is to evaluate the outcomes of patients treated with a mo-nolateral external fixator for bone defects greater than 3 cm. ⋯ 1. A review of the literature related to our experience shows that bone transport is an effective tech-nique to repair loss of bone in the lower limbs. The use of a system of external fixation enables corrective actions throughout the treatment that can be in-dividualized on a case-by-case basis. In our experience, the LRS fixator (Orthofix) is a sta-ble, easy-to-use and very handy device. 2. In situations where soft tissue reconstruction procedures are needed, the size and shape of the splint should be such as not to constitute an obstacle. Fur-thermore, the use of pins rather than transfixation wires eliminates the risk of neuro / vascu-lar injury such as may occur during the application of a circular fixator. 3. The analysis of the cases presented here indicates that where possible the technique of bone transport produces good results and can often salvage the limb. Amputation should be reserved only for cases where the general and / or local preoperative status indicate that the surgeon can expect a poor result or when the compliance of the patient is determined to be inadequate.
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Ortop Traumatol Rehabil · Aug 2017
Case ReportsEvaluation of Strength Recovery after Traumatic Acute Compartment Syndrome of the Thigh. A Case Study.
Acute compartment syndrome of the thigh is an underestimated serious pathology which can cause long term morbidities. The management, recovery and follow-up of the case of a 20-year-old Caucasian man, who presented an acute compartment syndrome of the thigh, are described. After femoral fracture reduction and fixation by nail, intramuscular pressure measurements confirmed the diagnosis before treatment by fasciotomies. 12-months' follow-up showed the presence of neurological femoral complications and physical impairment in spite of rehabilitation care. Because compartment syndrome of the thigh after a trauma is rare but potentially devastating, prompt diagnosis is required for performing early fasciotomies.
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Ortop Traumatol Rehabil · Aug 2017
Predicting Functional Outcomes in Patients with Femoral Neck Fractures Treated by Hemiarthroplasty.
A femoral neck fracture leads to serious health-related, social and economic consequences and, according to the con-temporary 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. ⋯ 1. Evaluation of the quality of life of patients who underwent surgery after femoral neck fractures utilising the Harris Hip Score (HHS) in one-fac-tor correlations (age, sex, type of endoprosthesis, general condition) revealed significantly superior results for men who received the bipolar endo-prosthesis. 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 Ortho-paedic 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.