RESUMEN

The purpose of this study was to assess whether the type and duration of screw fixation affects ankle joint functional scores and patient activity levels. We evaluated 55 patients who had undergone surgical treatment for ankle fracture with concomitant distal tibiofibular syndesmosis injury. The follow-up period ranged from 2 years to 4 years and 2 months (mean 36 months). Depending on the time of screw removal, patients were divided into 2 groups (the 8-15-week group-19 patients, and the 16-22-week group-36 patients). There were 17 patients with tricortical and 38 patients with quadricortical syndesmosis fixation. The following parameters were assessed: range of motion, rates of complications, level of pain in visual analogue scale (VAS), and function. In the quadricortical fixation group the range of plantar flexion p = .04 and adduction p = .043 were significantly lower in the operated than in the nonoperated limb. In the patients who had their syndesmotic screws removed after 16-22 weeks, the range of plantar flexion in the operated limb was significantly lower than that in the nonoperated limb. We observed no differences between the evaluated groups in terms of ankle joint mobility, VAS pain levels, functional outcomes, or complication rates. All the analyzed subgroups showed poorer ranges of some types of motion in the ankle and worse functional scale and VAS pain scores after treatment in comparison with those before the injury. We suggest removing the syndesmotic screws after 8-15 weeks, due to the possibility of earlier rehabilitation, faster return to work and physical activity and less burden on the health care system. Tricortical or quadricortical syndesmosis fixation is at the surgeon's discretion.

RESUMEN

Background: The biomechanical outcomes of intra-articular calcaneal fracture treatment have not been fully explored. The purpose of this study was to analyze pedobarographic assessments of balance and body weight distribution over the lower limbs in patients following calcaneal fracture treatment with the Ilizarov method and to compare the results with those of a control group. Materials and Methods: The data for our retrospective study came from cases of intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method in the period between 2021 and 2022. The experimental group (21 patients; 7 women, 14 men) included Sanders classification calcaneal fractures type 2 (n = 3), type 3 (n = 5), and type 4 (n = 13). The control group comprised 21 sex-matched healthy volunteers, with no significant differences from the experimental group in terms of age or BMI. The examination included an assessment of balance and weight distribution over the lower limbs. The device used was a FreeMED MAXI pedobarographic platform (SensorMedica). Results: The mean displacement of the center of gravity in the experimental group was significantly higher at 1307.31 mm than in the control group (896.34 mm; p = 0.038). The mean area of the center of gravity was not significantly different between the groups. An analysis of weight distribution over the operated and uninjured limb in the experimental group and the non-dominant and dominant limb, respectively, in the control group revealed no significant differences. We observed no significant differences in the percentage of weight distribution over the lower limbs between the operated limb in the experimental group and the non-dominant limb in the control group, or between the uninjured limb in the experimental group and the dominant limb in the control group. Conclusions: The use of the Ilizarov method in calcaneal fracture treatment helps normalize the percentage weight distribution in the lower limbs, with the results comparable with those obtained in the healthy control group. The mean displacement of the center of gravity was worse in the experimental group than in controls; whereas the mean area of the center of gravity was comparable between the two groups. Treatment of calcaneal fractures with the Ilizarov method does not help achieve completely normal static parameters of lower-limb biomechanics. Patients treated for calcaneal fractures with the Ilizarov method require longer and more intense rehabilitation and follow-up.

RESUMEN

INTRODUCTION: There is no consensus among orthopedic surgeons on the number of cortical layers (tricortical or quadricortical fixation) involved or the duration of syndesmotic fixation after a tibiofibular syndesmosis (TFSD)-injury treatment. The purpose of this study was to assess radiographic parameters following the treatment of TFSD injuries, with various time-windows of syndesmotic screw removal and numbers of cortical layers involved. MATERIALS AND METHODS: Fifty-five patients, aged from 25 to 75 years, were included in the study. The follow-up period ranged from 2 years to 4 years and 2 months. The patients were subdivided into groups based on the duration of the syndesmotic fixation (8-15 weeks-19 patients or 16-22 weeks-36 patients) and the number of cortices involved (tricortical-17 patients or quadricortical fixation-38 patients). RESULTS: The quadricortical fixation group showed a significant development of ankle joint arthritis and subtalar joint arthritis at the final follow-up. The mean medial clear space was 2.84 mm in the tricortical fixation group and 3.5 mm in the quadricortical fixation group (p = 0.005). Both groups, with different screw removal times showed significant development of posttraumatic arthritis. A comparison of the two groups (with different time-windows of the screw removal) revealed a significant difference only in terms of the postoperative tibiofibular (TF) overlap and the observed rates of talonavicular arthritis at the final follow-up. DISCUSSION: We found that the duration of the screw fixation had no effect on most of the evaluated radiographic parameters. Only the postoperative TF overlap was lower in the 8-15-week fixation group, and the proportion of patients with talonavicular joint arthritis at the final follow-up was higher in the 16-22-week fixation group. In addition, the number of cortices involved in the screw fixation had no effect on the radiographic outcomes in our patients, apart from the differences in one parameter-the medial clear space-at the final follow-up. CONCLUSION: We achieved similar radiographic results irrespective of the duration of the screw fixation and the number of cortices involved. All study subgroups showed the development of adjacent-joint arthritis following treatment. Considering the results of our study, the economic and medical aspects of treatment, and the possibility of a faster recovery, the most optimal solution seems to be the use of a tricortical fixation, with the screws being removed after 8-15 weeks.

RESUMEN

BACKGROUND: The optimal duration of cast immobilization following distal radius fractures (DRFs) in elderly patients has not been established. OBJECTIVES: To assess the functional and radiological parameters following DRF treatment in elderly patients using 2 different periods of cast immobilization. MATERIAL AND METHODS: We assessed 50 patients (33 women and 17 men). The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. One subgroup (n = 26) included patients treated with a cast for 4 weeks, whereas the other subgroup (n = 24) included patients treated with a cast for 6 weeks. The following measures were assessed: union rate, radial inclination, volar tilt, radial height, Visual Analogue Scale (VAS) pain score, Mayo Wrist Score, and VAS activity score. RESULTS: The mean volar tilt was 9.13° in the group treated with a cast for 4 weeks and 3.29° in the group treated with a cast for 6 weeks (p = 0.043). There were no differences between the groups in terms of any other functional or radiological parameters. CONCLUSION: The VAS pain score, Mayo Wrist Score and VAS activity score were similar between the 2 study groups. The greatest volar tilt angle was observed after 6 weeks of cast immobilization. The study groups showed no significant differences in terms of radial inclination, union rate, radial height, or bone union. A period of 4 weeks of cast treatment was sufficient for elderly patients with DRFs.

Asunto(s)

RESUMEN

BACKGROUND: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. METHODS: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: (1) muscle strength, (2) range of motion. RESULTS: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. CONCLUSION: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

RESUMEN

Diabetes mellitus (DM) is one of the major public health problems that account for morbidity, mortality, and disability worldwide. The presence of DM increases the risk of peripheral artery disease (PAD), as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status. Unfortunately, alternative treatments for vascular complications in diabetes are poorly researched. Physiotherapy (kinesitherapy combined with different physical therapy agents) in individuals with DM and coexisting PAD may offer an important complementary therapy alternative. Early therapeutic measures can significantly improve patient outcomes, reduce cardiovascular risk, and improve daily life quality. The article provides an update on the current state of knowledge on physiotherapy interventions in the course of DM in patients with coexisting PAD.

Asunto(s)

RESUMEN

PURPOSE: There is no consensus as to the number of bone cortices engaged in tibiofibular syndesmosis treatment. The purpose of our study was to assess the weight distribution on the lower limbs after tricortical or quadricortical syndesmosis fixation and different timing of screw removal. METHODS: A total of 55 patients who underwent treatment for acute tibiofibular syndesmosis injury were analyzed in this study. The Zebris pedobarographic platform was used to measure the distribution of body weight on the lower limbs. The study population was stratified by the time to syndesmotic screw removal (8-15 weeks versus 16-22 weeks) and the number of bone cortices involved in fixation (three [tricortical fixation] versus four [quadricortical fixation]). RESULTS: The weight distribution on the operated and healthy limbs in patients with tricortical syndesmosis fixation was asymmetrical, with the mean load on the operated and healthy limbs of 48.38% and 51.62%, respectively. The patients who underwent quadricortical syndesmosis fixation exhibited a symmetrical distribution of weight on the operated and healthy limb. There was a symmetrical distribution of the load of body weight on the operated and healthy limbs both in the group with different times to syndesmotic screw removal. CONCLUSION: Tricortical syndesmosis fixation is associated with an asymmetrical weight distribution on the operated and healthy limbs. In treating tibiofibular syndesmosis injuries, based on our pedobarographic research, quadricortical syndesmosis fixation and leaving the syndesmotic screw in place for up to 15 weeks, seems more beneficial to the patient.

RESUMEN

BACKGROUND: Severe osteoarthritis (OA) of the ankle joint constitutes an important social problem. OBJECTIVES: We used (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA (University of California Los Angeles) activity scale, (4) the VAS (visual analogue scale) ACTIVITY scale, and (5) the FAAM (foot and ankle ability measure) SPORT scale to verify whether the type of ankle joint arthrodesis stabilization affected sports and physical activity levels. MATERIAL AND METHODS: We carried out a prospective clinical study of 47 patients who had undergone ankle arthrodesis with Ilizarov external fixator stabilization (Group 1, n = 21) or internal stabilization with screws (Group 2, n = 26) at Orthopaedic Clinic at the Wroclaw Medical University, Poland, from 2007 to 2015. Sports and physical activity levels were measured by (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA activity scale, (4) the VAS ACTIVITY scale, and (5) the FAAM SPORT scale. RESULTS: A comparison between the average results of Group 1 and Group 2 on the LOWER LIMB Activity scale and the GRIMBY scale before and after surgery revealed no significant differences. In Group 1, the mean scores on the VAS ACTIVITY scale and the UCLA activity scale after treatment were higher than in Group 2. In Group 1, the mean outcome in the SPORT FAAM scale after treatment was 40; in Group 2 it was 30.06. CONCLUSIONS: Ilizarov fixation of ankle arthrodesis is associated with better scores on the FAAM SPORT, UCLA activity and VAS ACTIVITY scales after treatment than internal fixation. The scores on the GRIMBY scale and the UCLA activity scale were significantly higher after treatment than before treatment in both groups. In this study, ankle fusion with Ilizarov fixation and internal fixation was found to be effective in the treatment of ankle arthritis. The levels of sport and physical activity were satisfactory in both groups, but the outcomes after fixation with the Ilizarov apparatus were better than after internal stabilization.

Asunto(s)

RESUMEN

BACKGROUND: A number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads. METHODS: Retrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. RESULTS: In group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant. CONCLUSIONS: Balance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients' balance.

Asunto(s)

RESUMEN

Ankle arthrodesis with the Ilizarov method is an accepted form of treatment of advanced degenerative changes of the ankle joint. Incorrect balance and load distribution on the lower limbs may result in pain and dysfunction. The aim of the study was to assess the change of balance and load distribution in lower extremities in patients before and after ankle arthrodesis with the Ilizarov method. Between 2013 and 2016, ankle arthrodesis using the Ilizarov method was performed on 21 patients. The evaluation of balance and percentage of load in each lower limb was performed before the surgery and during the follow-ups. The evaluation was performed using a Zebris pedobarographic platform. Before the surgery, the patients exhibited an average load of 41.9% of body weight in the affected limb, whereas the load in the healthy limb was 58.1%. The difference was statistically significant (p = 0,000031). In two years follow-up, the average load in the treated limbs was 48.19%, whereas the healthy limbs were subjected to an average load of 51.81%. In preoperative tests, the average path length of the center of gravity was 161.55 cm; postoperatively, the average path length of the center of gravity was 129.7 cm (p = 0.00003206). Preoperatively, the average area of the center of gravity was 18.85 cm2; it decreased to 6.19 cm2 (p = 0.000032) postoperatively. Arthrodesis of the ankle with the Ilizarov method improved the statics of the musculoskeletal system by improving the distribution of loads in the lower limbs as well as balance. However, it failed to restore the parameters of a healthy person. Advanced degenerative changes of the ankle disturb the biomechanics of the entire lower limb.

Asunto(s)

RESUMEN

PURPOSE: Exerting axial pressure on the affected lower limb remains one of the most crucial elements of Ilizarov method. The objective was to determine the effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method. METHODS: The study included 15 patients who underwent lower limb lengthening. The patients were tested on the third day after surgery using the pedobarographic platform. The tests were performed four times in the standing position: twice with the support of forearm crutches and twice without crutches. Patients were asked to either remain in the relaxed standing position (two tests) or use the lower limb equipped with Ilizarov apparatus to support the body weight (two tests). RESULTS: In relaxed stance average pressure with forearm crutches was 24.1% for affected limb, as compared to 75.9% for the healthy limb. In test without forearm crutches average pressure for affected limb was 26.1%, as compared to 73.9% for the healthy limb. Patients shifted body weight to the affected limb with forearm crutches on average, at the rate of 53.6%. In test without forearm crutches the affected limb was supporting the body weight at the rate of 48.26%. None of the patients was able to fully support the body weight on the affected leg. CONCLUSIONS: In spite of strict physiotherapy regimen, patients are neither able to equally distribute their body weight between the two lower limbs nor to shift their body weight to the limb equipped with Ilizarov apparatus.

Asunto(s)

RESUMEN

The ability to reach a high running velocity over a short distance is essential to a high playing performance in team games. The aim of this study was to determine the relationship between running time over a 10-meter section of a 30-meter sprint along a straight line and changes in the angle and angular velocity that were observed in the ankle, knee, and hip joints. The possible presence may help to optimize motion efficiency during acceleration sprint phase. Eighteen girls involved in team sports were examined in the study. The Fusion Smart Speed System was employed for running time measurements. The kinematic data were recorded using the Noraxon MyoMotion system. Statistically significant relationships were found between running time over a 10-meter section and the kinematic variables of hip and ankle joints. An excessively large flexion in hip joints might have an unfavorable effect on running time during the acceleration phase. Furthermore, in order to minimize running time during the acceleration phase, stride should be maintained along a line (a straight line) rather than from side to side. It is also necessary to ensure an adequate range of motion in the hip and ankle joints with respect to the sagittal axis.

RESUMEN

There is very limited, evidenced data about movement possibilities in patients with high level of lower limb muscles atrophy and fatigue in patients suffering from Charcot-Marie-Tooth syndrome. Patient (age 46) suffering from Charcot-Marie-Tooth disease for 30 years with multiple movement restrictions and muscles atrophy above knees took part into the study. Tests were performed for 8 muscles of the lower limb and pelvis. Muscles electrical activity was tested in sitting and standing position (for knees extended and hyperextended). In the right leg rectus femoris, vastus lateralis obliquus, gluteus medius and semitendinosus muscles activated at first and were working the longest time. The highest activity was observed in standing position with knees extended. In the left leg rectus femoris and biceps femoris muscles activated at first and biceps femoris was working the longest time. Activity level in left lower limb is much lower than in the right one. Muscles weakness is asymmetric. Left leg is much weaker and engages antagonists and synergists muscles to compensate weaker rectus femoris, vastus medialis obliquus and vastus lateralis obliquus.

Asunto(s)

RESUMEN

BACKGROUND: The following article describes the concept of optical measurement of blood volume in ventricular assist devices (VAD's) of the pulsatile type. The paper presents the current state of art in blood volume measurements of such devices and introduces a newly developed solution in the optic domain. The objective of the research is to overcome the disadvantages of the previously developed acoustic method-the requirement of additional sensor chamber. METHODS: The idea of a compact measurement system has been introduced, followed by laboratory measurements. Static tests of the system have been presented, followed by dynamic measurements on a physical model of the human ventricular system. The results involving the measurements of blood chamber volume acquired by means of an optical system have been compared with the results acquired by means of the Transonic T410 ultrasound flow rate sensor (11PLX transducer, uncertainty ±5 %). RESULTS: Preliminary dynamic measurements conducted on the physical model of the human cardiovascular system show that the proposed optical measurement system may be used to measure the transient blood chamber volumes of pulsatile VAD's with the uncertainties (standard mean deviation) lower than 10 %. CONCLUSIONS: The results show that the noninvasive measurements of the temporary blood chamber volume in the POLVAD prosthesis with the use of the developed optical system allows us to carry out accurate static and dynamic measurements.

Asunto(s)

RESUMEN

BACKGROUND: Torsional distortion causes numerous musculoskeletal pathologies. Effective treatment allows restoring limb function and return to sport activity. Objectives was to assess the sport activity in patients with derotational corticotomies using the Ilizarov method. METHODS: It was case series retrospective study. The study examined 56 patients. The control group consisted of 54 patients. A mean follow-up time was 5 years and 6 months. A mean age at the start of treatment was 19 years and 10 months. Patients underwent derotational corticotomies of distal epiphysis of the femur or proximal epiphysis of the tibia using the Ilizarov method. The effect of etiology, type of treatment strategy, and rate, size, and level of derotation on the scores of four activity scales was evaluated; additionally, the activity was compared with the control group. RESULTS: There were no differences in the scales of activity before and after treatment in the study and control groups. In the study group, higher activity after treatment was reported in the level of GRIMBY activity. Patients with internal torsion had a higher VAS activity level after treatment as compared to patients with external torsion. CONCLUSIONS: Derotational corticotomies allow returning to or increasing physical and sport activity: they do not have a negative influence on physical activity after treatment as compared to the control group.

Asunto(s)

RESUMEN

PURPOSE: The aim of the study was to determine the relationships between time of running over a 15-25 m section of a 30-meter run along a straight line and changes in the angle and angular velocity observed in ankle, knee and hip joints. Therefore, the authors attempted to answer the question of whether a technique of lower limbs movement during the phase of sprint maximum velocity significantly correlates with the time of running over this section. METHODS: A group of 14 young people from the Lower Silesia Voivodeship Team participated in the experiment. A Fusion Smart Speed System was employed for running time measurements. The kinematic data were recorded using Noraxon MyoMotion system. RESULTS: There were observed statistically significant relationships between sprint time over a section from 15 to 25 m and left hip rotation (positive) and between this time and left and right ankle joint dorsi-plantar flexion (negative). CONCLUSIONS: During the maximum velocity phase of a 30 m sprint, the effect of dorsi-plantar flexion performed in the whole range of motion was found to be beneficial. This can be attributed to the use of elastic energy released in the stride cycle. Further, hip rotation should be minimized, which makes the stride aligned more along a line of running (a straight line) instead of from side to side.

Asunto(s)

RESUMEN

BACKGROUND: The paper presents a newly researched acoustic system for blood volume measurements for the developed family of Polish ventricular assist devices. The pneumatic heart-supporting devices are still the preferred solution in some cases, and monitoring of their operation, especially the temporary blood volume, is yet to be solved. METHODS: The prototype of the POLVAD-EXT prosthesis developed by the Foundation of Cardiac Surgery Development, Zabrze, Poland, is equipped with the newly researched acoustic blood volume measurement system based on the principle of Helmholtz's acoustic resonance. The results of static volume measurements acquired using the acoustic sensor were verified by measuring the volume of the liquid filling the prosthesis. Dynamic measurements were conducted on the hybrid model of the human cardiovascular system at the Foundation, with the Transonic T410 (11PLX transducer - 5% uncertainty) ultrasound flow rate sensor, used as the reference. RESULTS: The statistical analysis of a series of static tests have proved that the sensor solution provides blood volume measurement results with uncertainties (understood as a standard mean deviation) of less than 10%. Dynamic tests show a high correlation between the results of the acoustic system and those obtained by flow rate measurements using an ultrasound transit time type sensor. CONCLUSIONS: The results show that noninvasive, online temporary blood volume measurements in the POLVAD-EXT prosthesis, making use of the newly developed acoustic system, provides accurate static and dynamic measurements results. Conducted research provides the preliminary view on the possibility of reducing the additional sensor chamber volume in future.

Asunto(s)

RESUMEN

BACKGROUND: Major obstacles to operative treatment of elderly patients with femoral neck fractures frequently encountered in clinical practice include poor overall health, lack of consent to have an operation, and general medical or anaesthesiological contraindications. In such cases, conservative treatment is the only possibility. This aims at maximally improving the patient's functional status, an approach best termed "movement-oriented patient management". MATERIAL AND METHODS: The study population consisted of 51 patients (31 F, 20 M) with femoral neck fractures in whom surgery was contraindicated. The patients took part in a movement-oriented management programme. The study consisted in evaluating movement abilities, self-care and locomotion of the patients using the Harris and Lazansky scales. Patients were evaluated twice: at discharge from hospital and at three months after discharge. RESULTS: In patients assessed using the Lazansky score, Evaluation 1 revealed 88% poor results and 12% satisfactory results, compared to 63% poor results and 37% satisfactory results at evaluation 2. Harris scores did not differ between Evaluations 1 and 2, with 100% of the patients achieving the lowest scores. CONCLUSIONS: 1) The study population of patients with femoral neck fractures in whom surgery was contraindicated did not demonstrate a definite improvement or deterioration of their functional status following "movement-oriented management"; 2) "movement-oriented management" cannot be regarded as having any effect on change in functional status, which should therefore be improved using a more beneficial method of treatment.

Asunto(s)