Traumatology Department Research Articles

Evaluation of Gastrocnemius Spasticity With Shear-Wave Elastography in Children with Cerebral Palsy after Botulinum Toxin Injection: Defining A Proper Position for Measurement

Aim: Cerebral Palsy (CP) is the most common neuromuscular disorder in children and it is characterized by a dysfunction in movement and posture. Botulinum toxin injection is a treatment method used for muscle spasticity in patients with CP. Elastography is a new method which is used for measuring muscle stiffness. This study aims to evaluate the gastrocnemius muscle stiffness in cerebral palsy patients before and after botulinum toxin injection by using the elastography method and contribute to the establishment of a treatment algorithm with a proper position for measurement.Materials and Method: The participants of this study were chosen from the patients of our hospital’s orthopaedics and traumatology department. Among the patients on whom botulinum injection to gastrocnemius muscle was planned, 30 patients were randomly selected. Elastography of both gastrocnemius muscles were taken before the injection of botulinum toxin, in the third week and third month after the injection. Simultaneously with the elastography, Modified Ashworth Scale (MAS) values were noted. In hemiparetic patients, contralateral legs were taken as the control group.Results: The elastographic values of the medial head of gastrocnemius when the knee is in extension and ankle in passive dorsiflexion, were found to be statistically significantly related (p<0.05) to the MAS values before botulinum toxin injection, third week and third month post-injection.Conclusion: Stiffness due to spasticity in gastrocnemius muscle in CP patients was demonstrated through elastographic evaluation. A correlation was found between clinical MAS values. The most proper position was in which the knee is fully extended and the ankle is passively dorsiflexed. Elastographic measurements may be able to be used in these patients as a method of diagnosis in the future and it will help to assess the effectiveness of the treatment after the injection of botulinum toxin.

Лечение диафизарных переломов костей голени у детей и подростков

The report is based on the study of the results of treatment of 102 patients with diaphyseal fractures of shin bones [DFSB], aged 4–17 y. o., treated in the children’s Department of Traumatology and Orthopedics of Children’s Republic Clinical Hospital of the Republic of Tatarstan. In 18 patients with stable fractures of shin bones, the fracture was repositioned and fixed with a plaster cast. 31 patients with unstable fractures underwent bypass polysynostosis after a closed manual reposition of a fracture of shin bones with a plaster cast. Osteosynthesis with elastic nails (TEN) was performed in 32 patients after closed reposition. 21 patients were treated with extra-focal transosseous osteosynthesis. The authors developed an algorithm for the treatment of patients with shin bones fractures in children and adolescents.

Manažment ošetrovateľskej starostlivosti o pacienta po endoprotézach

Introduction: We present a comprehensive view of the nursing management of patients after endoprostheses. The paper also discusses the information given on compensatory devices and their use in practice by patients after implanted endoprostheses. Attention is focused on exploring the subjective perception of the patient’s health status after endoprosthesis and the provision of information prior to elective surgery. In the last area examined, the thesis investigates the relationship between gender, occupation and associated diseases, which as external factors may influence the implantation of an endoprosthesis. In the empirical part of the thesis, the research problem was set to find out “How the implantation of an endoprosthesis can affect the perceptibility of the patient’s health status.” In order to achieve the main objective, we set individual sub-objectives: - To find out the difference in patient’s perceptibility before and after total knee/hip arthroplasty implantation. - To determine whether patients are provided with sufficient information about treatment options, risks of surgery, medical, diagnostic and therapeutic procedures as well as potential risks and consequences associated with healthcare prior to elective hip/knee replacement surgery. - Determine whether, when receiving healthcare, the healthcare facility informed the patient about the possibilities of providing and how to use compensatory devices that affect the patient‘s health after the surgery. - Determine whether gender, comorbidities, and occupation are factors that may affect the implantation of an endoprosthesis. Methodology: In order to verify the hypotheses and fulfil the main objective, we used quantitative research methods (questionnaire). On the basis of the collected information, we have underlined the context of the analyzed areas, to obtain a comprehensive picture of the studied topic. In order to achieve the aim of the work, working hypotheses were established, for the processing of which chi-square test of goodness of fit was used to evaluate the statistical data. The result is a set of hypotheses, which are subsequently formulated into concrete suggestions and recommendations. The respondent pool consisted of patients after hip/knee implantation, of different ages and gender. A total of 120 questionnaires were distributed during the research, namely 60 questionnaires at the Department of Trauma Surgery at Rastislavova No. 43 in Košice and 60 questionnaires at theDepartment of Orthopaedics and Traumatology of the Musculoskeletal System at the SNP Class 1 of the UNLP in Košice. The total number of respondentswho participated in our research was 112 (93.33%) respondents, while the return rate of questionnaires at the Department of Trauma Surgery was 58 respondents (52%) and at the Department of Orthopaedics and Traumatology of the Musculoskeletal System was 54 respondents (48%). Conclusion: Following the set objectives, the paper brings answers to the issue of patient awareness and the connection between the above mentioned external factors in relation to the implantation of the endoprosthesis. The proposed recommendations for practice are intended to make the nursing care of the patient after joint arthroplasty more effective.

Our Clinical and Radiological Results in the Treatment of Bone Transport with Ilizarov External Fixator in Patients with Segmental Tibial Defects. Is Depression Associated with Poor Outcomes?

Abstract Objective: The aim of this study was to evaluate the clinical and radiological results of patients who underwent bone transport with Ilizarov external fixator in the treatment of tibial defects due to traumatic causes, and to investigate the factors that have a positive or negative effect on the results. Patients and Methods: From a total of 30 patients with tibial segment loss due to traumatic causes treated with bone transport with an Ilizarov external fixator between 2013 and 2020 in the Department of Orthopedics and Traumatology of the Faculty, 25 with adequate examinations and follow up were included in this study and were evaluated retrospectively. The patients were grouped according to the etiology of bone loss, demographic characteristics, Paley’s pseudoarthrosis classification and Solomin’s long bone defect classification. The results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) outcome criteria. Results: The 25 patients in the study comprised 20 males and 5 females with an average age of 44.80 ± 18.51 years. According to the Paley pseudoarthrosis classification, 16 (64%) patients were Type B1, 5 (20%) were Type B2, and 4 (16%) were Type B3. According to the Solomin long bone defect classification, 4 (16%) patients were Type B2, 14 (56%) were Type C1, and 7 (28%) were Type C2. In some patients, due to the fixation problem, early fixation was achieved with minimally invasive plate osteosynthesis or intramedullar nailing by removing the Ilizarov fixator after the necessary length and alignment was achieved for the purpose of early rehabilitation. Early fixation was achieved before consolidation was completed in 16 of 25 patients. Fixator duration was 360 ± 130.77 days in the group without additional fixation and external fixation index (EFI) was 61.63 ± 29.81 days/cm, while the fixator duration was 273.33 ± 116.82 days in the early fixation group, and EFI was 57.22 ± 29.05 day/cm. Complications were evaluated according to Paley’s criteria. A total of 39 complications were recorded, the most common being pin tract infection. The ASAMI bone results were found to be excellent in 7 patients, good in 9, moderate in 4, and poor in 5. The functional results were excellent in 5 patients, good in 11, moderate in 4, and poor in 5. In addition, 5 (20%) of 25 patients whose results were evaluated had depressive illness. Moreover, the results of these patients were found to be poor according to the ASAMI criteria. Conclusion: The Ilizarov method is a very safe and successful option in the treatment of open fractures with tibial segment loss resulting from high-energy traumas. Nevertheless, when making the decision for treatment with this method, the patient’s current depressive disorder should be taken into consideration in addition to the clinical problems of the patients.

Congenital Kyphosis with Rapid Progression In Adolescence: A Case Report

Congenital kyphosis deformity represents a relatively infrequent spinal disorder in comparison to other types of spinal deformities. However, when left untreated and neglected, it can result in significant morbidity and associated complications. The objective: To present a patient with congenital kyphosis who presented with severe hunchback and weakness in the lower extremities and to review the literature.Case presentation. A 15-year-old patient, accompanied by their parents, presented to our outpatient clinic with a chief complaint of a recent increase in severe kyphotic deformity of the back. Additionally, the patient reported experiencing lower limb weakness and difficulty walking long distances. Following a thorough examination and radiographic evaluation, no intraspinal pathology or comorbidities were identified. Consequently, surgical intervention was planned, and a Schwab 4 osteotomy procedure was performed. Substantial clinical and radiological improvements were observed in the postoperative period. The preoperative angular measurements of the spinal curvature were as follows: thoracic kyphosis (TK) measured at 136º, local kyphosis at 145º, lumbar lordosis (LL) at 109º, sacral slope (SS) at 18.5º, and pelvic tilt (PT) at 39.3º. Notably, a significant postoperative correction was observed, resulting in improved alignment: TK 64º, LL 66º, SS 34º and PT 24º. No intraoperative or postoperative complications were observed.Congenital kyphosis conditions have the potential to exhibit a rapid progression of deformity during adolescence. Therefore, timely surgical correction becomes crucial before the deformity attains advanced dimensions. Early-age surgical interventions for correcting the deformity hold significant importance in improving the overall quality of life for affected individuals.Keywords: Congenital kyphosis, posterior instrumentation, spinal osteotomy.Corresponding author: Alim Can Baymurat, Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey Address: Emniyet Mahallesi, Mevlana Bulvarı No:29Phone: 05455452589E-mail: alimcanbaymuratahoo.comJ Trauma Ortho Kaz 2023; 2 (67): 34-38Recieved: 15-06-2023Accepted: 24-06-2023 This work is licensed under a Creative Commons Attribution 4.0 International License

Outcome Analysis in Ipsilateral Proximal Femur and Shaft Fractures Treated by Intramedullary Nail and Plate Combinations: A Comparative Study

Abstract Introduction: Ipsilateral neck and shaft fractures of femur are not common. They result from high-energy trauma mechanisms, including motor vehicle traffic accidents and falls from heights. Surgical stabilization of such fractures remains a challenge. This study was planned to compare reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients with these fractures. Aim: The aim was to study and compare the clinical, radiological, and functional outcomes of ipsilateral proximal femur and femoral shaft fractures treated by two methods nailing/plating. Subjects and Methods: We included 20 patients admitted from March 2020 to September 2020 to assess the clinical, radiological, and functional outcomes of ipsilateral proximal femur fractures associated with femoral shaft fractures, treated either by intramedullary nailing or by various plate combinations at the Department of Orthopaedics and Traumatology, Thiruvarur Medical College and Hospital, Thiruvarur, Tamil Nadu. Statistical Analysis Used: Continuous variables were summarized as mean and standard deviation, and the significance between their mean variables was analyzed using t-test. Results: We found that ipsilateral proximal femur and femoral shaft fractures are common in the 3rd, 4th, and 5th decades of life. There was a statistical significance in mean duration of surgery in nailing group 140.00 ± 24 compared with plating group 158.00 ± 18.7. In terms of average union time for proximal femur and femoral shaft fractures, age of the patient, delay in duration of surgery, and outcome results of both groups were similar and showed no statistical significance. Conclusion: Both treatment methods achieve satisfactory functional outcomes in patients with ipsilateral proximal femur and shaft fractures.

Наиболее распространенные диагнозы в ортопедической онкологии: регион Юго-Восточной Анатолии, Турция

The purpose of this study: Musculoskeletal tumors are very rare, and their distribution varies regionally. We aim to share the musculoskeletal system tumors and tumor-like lesions that orthopedic surgeons in the region commonly encounter in their daily practice.Methods. In this retrospective study, 339 patients diagnosed with tumor and tumor-like lesions in the musculoskeletal system who consulted a single orthopedic surgeon between 2022 and 2023 in a tertiary hospital in the Southeast of the country were included. Age, gender, size, type of lesions, tumor diagnoses, and anatomical sites were examined.Results. Bone localization (62.8%) is more common than soft tissue. Benign lesions are most commonly seen in both bone and soft tissue. Osteochondroma (21.7%) and chondrosarcoma (54%) are the most common benign and malignant bone tumors, while osteomyelitis (47.6%) is the most common tumor-like lesion. Hemangioma (27%) and peripheral nerve sheath tumor (62.5%) are the most common benign and malignant soft tissue tumors, while ganglion cyst (63.8%) is the most common tumor-like lesion. Benign bone tumors are larger in males than females (p:0.008). Lower extremity located of musculoskeletal tumors and tumor-like lesions is more common than upper extremity.Conclusions. In the Southeastern Anatolia region, benign bone and soft tissue tumors (osteochondroma and hemangioma) are more likely. The most common malignant tumors are chondrosarcoma and peripheral nerve sheath tumors. Additionally, it should not be forgotten that musculoskeletal system tumors are often located in the lower extremities.Keywords: Benign tumors, bone tumors, malign tumors, musculoskeletal tumors, soft tissue tumors, tumor-like lesions.Corresponding author: Özlem Orhan, Assistant professor of the Department of Orthopedics and Traumatology, Medical Faculty, Harran University, Sanlıurfa, Turkey. Postal code: 63300Address: Turkey, Sanlıurfa, Osmanbey campusPhone: +905057475401Email: droorhan@gmail.comJ Trauma Ortho Kaz 2023; 3 (69): 12-18Recieved: 28-07-2023Accepted: 11-09-2023 This work is licensed under a Creative Commons Attribution 4.0 International License

Management of Loss of Skin Substance of the Hand: About A 12 Cases with Review of the Literature

Never has reconstructive surgery for loss of cutaneous substance of the hand made so much progress as over the last thirty years thanks to a better knowledge of the cutaneous vascularization, as well as to the possibilities of raising island flaps with reverse flow. We report 12 cases of coverage of loss of cutaneous substance of the hand collected within the Department of Orthopedic Surgery and Traumatology of the Ibn Sina Souissi Hospital in Rabat.

Giant Cell Tumor of the L1 Vertebra with a Large Soft Tissue Component: A Case Report

Giant cell tumor (GCT) is a locally aggressive benign tumor that most often appears on long bones. Less than 10% of GCT’s in the spine are occur above the sacrum, and cases involving the lumbar spine are relatively little reported in the literature. Soft tissue invasion of GCT is rare. We present a case of GCT in the L1 vertebra, a large soft tissue component, that occurred in a 24-year-old female patient with low back pain and right radiculopathic thigh pain for approximately 3 months. The patient had no neurological deficit. A lytic lesion involving the L1 vertebral body, more prominently in the right half, extending to the pedicle and transverse process on the right was detected in computed tomography (CT) and magnetic resonance imaging (MRI) sections. In the MR imaging taken 2 months later; It was noted that the mass increased in size and the soft tissue content extending to the right psoas muscle developed. Tru-cut biopsy was performed for the diagnosis and the pathology diagnosis was evaluated as consistent with GCT. The patient underwent L1 vertebral spondylectomy and T1–L3 instrumentation with pedicle screw/mesh cage. Denosumab treatment was started after surgery. The histopathology results of the excised bone and soft tissues were also evaluated as consistent with GCT. As a result, GCT should be considered in the differential diagnosis of destructive lesions with a soft tissue component in the lumbar vertebra.Key words: giant cell tumor, lumbar spine, soft tissue component, clinical case.Corresponding author: Alim Can Baymurat, Assistant Professor of the Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey Postal code: 06560Address: Turkey, Ankara, Polis Mah, Gazi University Rectorate, Bandırma Cad. No:6/1, YenimahallePhone: +903122022000Email: alimcanbaymurat@yahoo.com Gani.box.94@gmail.comJ Trauma Ortho Kaz 2023; 3 (69): 19-24Recieved: 18-05-2023Accepted: 04-06-2023 This work is licensed under a Creative Commons Attribution 4.0 International License

Investigating patient satisfaction in the orthopedic and traumatology departments of a public hospital: a study in Istanbul, Turkey

Patient satisfaction is a complex concept influenced by various factors and is one of the most important indicators of the quality of patient care. Patient satisfaction is generally focused on whether the healthcare service rendered meets the patient’s expectations or how the patient perceives the service delivered because theories are insufficient to explain patient satisfaction. This study aims to test and investigate patient satisfaction in the orthopedic and traumatology departments of a public hospital. The study was conducted with 140 patients who were hospitalized in the orthopedics and traumatology ward in Istanbul, Turkey, between April and June 2022. Data were collected using a five-point Likert scale. Patients’ data were selected randomly, and patients who had the time and consented to participate in the study were selected. The patients were frequently satisfied with the nurses’ respect for their privacy (76.2%), their helpfulness (58.7%), and individual behavior (54.3%). It was determined that the orthopedic and traumatology patients participating in the study were very satisfied with the care they received.

Evaluation of Intraoperative Iatrogenic Lesions and Postoperative Complications in 1140 Patients Treated for Carpal Tunnel Syndrome in the Orthopedic Surgery and Traumatology Department of the Moulins-Yzeure Hospital Center in France

Evaluation of Intraoperative Iatrogenic Lesions and Postoperative Complications in 1140 Patients Treated for Carpal Tunnel Syndrome in the Orthopedic Surgery and Traumatology Department of the Moulins-Yzeure Hospital Center in France

Опыт лечения перелома обеих костей нижней трети левого предплечья при помощи чрескостного компрессионно-дистракционного остеосинтеза

Fractures of the forearm bones are at one of the first places among all fractures in frequency and are considered as a violation of the integrity of the bone tissue structure. Causes can be a fall on the forearm as well as a blow from a heavy object. A fracture of one or both bones of the forearm is a difficult injury to treat and restore. Trauma is relevant among both children and adults. Limb function is significantly lost, and this worsens the quality of life. The diagnosis is established based on the collected medical history, visual examination and data from instrumental examination methods (radiography). For fractures of the forearm bones, treatment tactics are determined individually. It depends on the severity of the injury. The purpose of this research is to demonstrate successful experience in treating a closed fracture of both bones of the lower third of the left forearm with displacement of fragments using extrafocal transosseous compression-distraction osteosynthesis. Materials and methods – data from the medical documentation, results of instrumental research and dynamic observation of the hospitalized patient in Traumatology Department of City Clinical Hospital. Result. As a result of treatment, consolidation of the fracture was achieved and the function of the injured limb was restored. Conclusion. When using the Ilizarov apparatus for fractures, the degree of damage to soft tissues is reduced, and the need for repeated surgery to remove the metal structure is eliminated.

Isolation of Pyogenic Microorganisms from Infected Wounds in the General Surgery and Orthopedic & Traumatology Departments of the Near East University Hospital: A Retrospective Study

Isolation of Pyogenic Microorganisms from Infected Wounds in the General Surgery and Orthopedic & Traumatology Departments of the Near East University Hospital: A Retrospective Study

Functional and Radiological Outcome after Anatomic Coracoclavicular Ligament Reconstruction for Type III to Type V Acromioclavicular Joint Dislocation Using Semitendinous Autograft

INTRODUCTION: Acromioclavicular joint dislocation is a commonly encountered shoulder injury. Various surgical methods are available for the treatment of complete ACJ dislocation (type III to VI), however, optimal surgical treatment is still controversial. The purpose of this study was to evaluate the radiological and functional outcome of anatomic coracoclavicular reconstruction (ACCR) using semitendinosus autograft with suture augmentation for type III to V ACJ dislocation. MATERIALS AND METHODS: It was a single centered, cross sectional, observational study conducted at Department of Orthopedics and Traumatology, Dhulikhel Hospital. Twenty-three consecutive patients who underwent ACCR with semitendinosus autograft from Jan 2017 to Dec 2019 were included in the study. Patients below 18 years of age and patients with previous ipsilateral shoulder injury were excluded. The radiological outcome was assessed using coracoclavicular (CC) distance and functional outcome using DASH score and Constant score. Paired t-test and Pearson correlation were used for inferential analysis. RESULTS: Mean age of the patient was 33.83 ± 7.08 years. Mean duration of follow up was 28.17 ± 6.19 months. Mean CC distance at final follow up was 9.93 ± 1.12 mm. Mean DASH score was 5.60 ± 5.35 and mean Constant score was 88.04 ± 12.13. There were 12 (52.17%) excellent outcomes, 6 (26.08%) good outcomes, 2 (8.69%) fair outcomes and 3 (13.04%) poor outcomes based on Constant scores. CONCLUSIONS: ACCR with suture augmentation is an effective method for management of type III to V acromioclavicular joint dislocation.

Sensitivity of Strains of Meticillin Resistant Staphylococcus aureus (MRSA), Isolated from Bacterial Infections in the District of Abidjan

Staphylococcus aureus is one of the most prevalent human pathogens causing a wide range of bacterial infections. Since the introduction of methicillin as a treatment option, the emergence and subsequent spread of methicillin-resistant Staphylococcus aureus (MRSA) strains has become a global concern. The objective of this study is to determine the prevalence of MRSA isolated from bacterial infections in Abidjan as well as their resistance profile to certain antibiotics. One hundred and twenty-four (124) strains of Staphylococcus aureus from the University Hospital of Cocody and various clinics isolated from various biological products were included in our study. The antibiogram on Mueller-Hinton agar was repeated by testing cefoxitin for the revelation of MRSA. Several other families of antibiotics have also been tested with the aim of observing resistance associated with MRSA. Among the one hundred and twenty-four strains of Staphylococcus aureus analyzed, 75 present, after phenotypic interpretation, a profile of resistance to methicillin (MRSA strains), i.e. 60.48%. These MRSA were isolated from blood culture (26.67%), purulent secretions (44%), urine (14.67%), sperm culture (1.33%), wound (4%), pleural fluid (4%), stool (1.33%) and tip of urinary catheter (4%); and came from neonatology, surgery, pneumology, pediatrics, outpatient, medicine, emergency, rheumatology, ENT, neurology, traumatology and gastroenterology departments. A variable proportion of MRSA strains express resistance to other families of antibiotics including aminoglycosides (23.32%), fluoroquinolones (85.33%), erythromycin (27.64%), clindamycin (24.19%) and tetracycline (20.73%). The increasing prevalence of multidrug-resistant Staphylococcus aureus, limiting the therapeutic options available against this pathogen, has become an issue of concern worldwide. Thus, the establishment of a relevant resistance monitoring policy to better control the circulation of multi-resistant strains is necessary.

Comparison of the predictive power of the 2005 and 2010 Caprini risk assessment models for deep vein thrombosis in Chinese orthopedic patients at admission: A prospective cohort study

IntroductionSeveral DVT risk assessment tools have been developed and validated to stratify the patients. The 2005 and 2010 Caprini risk assessment models (RAMs) proved reliable in detecting deep vein thrombosis (DVT) and are widely used worldwide. Although the 2010 version was recently modified, the 2005 version is still more exact and popular in the surgical population. This study aimed to compare the predictive power of the 2005 and 2010 Caprini RAMs in Chinese orthopedic patients at admission and describe the incidence of DVT during hospitalization. Study designThis prospective cohort study involved 2733 patients from the Arthritis Clinic and Research Center, Orthopedics and Traumatology Department, Orthopedic Oncology Department, and Spinal Surgery Department of Peking University People's Hospital from September 2018 to January 2019. The DVT risk scores and levels were determined for all patients using the 2005 and 2010 Caprini RAMs at admission. The sensitivity and specificity of the two tools were calculated. The patients were divided into the screened and unscreened groups according to whether or not a Doppler ultrasound (DUS) was performed. Depending upon the DUS results, the patients were divided into the DVT and non-DVT groups. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. ResultsEighty-four patients had DVT in the four orthopedic departments, and the incidence of DVT was 3.1 %–17.2 %. The scores between the 2005 and 2010 Caprini RAMs differed (P < 0.001) among orthopedic patients at admission. Among DVT patients, the highest-risk patients accounted for 63.5 % and 52.9 % based on the 2005 and 2010 Caprini RAMs, respectively. The AUCs of the 2005 and 1020 Caprini RAMs were 0.669 ± 0.030 and 0.648 ± 0.032, respectively. There were no significant differences between the two ROC curves (P = 0.164). ConclusionThe 2005 and 2010 Caprini RAMs showed a similar predictive power in detecting DVT, but neither met the high sensitivity criteria for screening DVT in orthopedic patients. The incidence of DVT in orthopedic patients was relatively high during hospitalization.

A new method of distal blocking of intramedullary implants

Aim to assess the capabilities of the developed method and device for distal blocking of intramedullary implants.&#x0D; Material and methods. An experimental study on the tibia models was performed in the settings of the Department of Traumatology and orthopedics of the Voronezh State Medical University. The main group included 10 models on which the blocking was done using the developed method. In the control group (10 models) the "free hand" method was used. The study evaluated the following parameters: the duration of blocking, the time of X-ray exposure, the number of blocking attempts.&#x0D; Results. In the main group, the duration of distal blocking procedure was significantly shorter than in the control group (T-criterion = -36.0; p 0.05). The time of X-ray exposure in the main group was also less than in the control group (T-test = -30.2, p 0.05). The number of blocking attempts in the control group was higher than in the main group (U-criterion = 20, p = 0.02). In the main group, all screws were inserted at the first attempt. In the control group, drilling holes past the pin holes was noted.&#x0D; Conclusion. The developed method and the device for its implementation are universal. They can be used with most intramedullary pins and revision femoral components of a hip endoprosthesis, both cannulated and non-cannulated.

Traumatic Brain Injury during the SARS-CoV-2 Pandemics in Slovenia: A Single Center Study.

(1) Background: The SARS-CoV-2 pandemic had a significant impact on the management of traumatic brain injury (TBI). We aimed to compare the clinical characteristics and outcomes of TBI patients before and during the SARS-CoV-2 pandemic.; (2) Methods: We analyzed depicted data from existing medical records on sex, age, mechanism of injury, clinical performance at admission and discharge, neuroimaging, laboratory values at admission, mortality, duration of hospitalization, and referrals after discharge from the traumatology department for all adult patients during the SARS-CoV-2 pandemic and a year before. Variables were compared using the Chi-square or t-test between both groups.; (3) Results: Most patients had mild (n = 477), followed by moderate (11) and severe (11) TBI. Mild TBI was less frequent during the SARS-CoV-2 period (n = 174 vs. n = 303). The incidence of high falls increased during the SARS-CoV-2 period (14.5% vs. 24.7%; p < 0.05) in the group with mild TBI. Patients had similar mean Glasgow Coma Scales (GCS), Glasgow Outcome Scales-Extended (GOSE), and glucose levels at admission before and during the pandemic. Serum ethanol levels were significantly lower during the SARS-CoV-2 period (1.3 ± 0.7 mmol/L vs. 0.7 ± 1.2 mmol/L; p < 0.001). At discharge, the mean GCS was significantly lower (14.7 ± 1.8 vs. 14.1 ± 0.5; p < 0.05) for patients treated during the SARS-CoV-2 period than before the SARS-CoV-2 period. There were no differences in GOSE; (4) Conclusions: our results demonstrated a significant impact of SARS-CoV-2 pandemic on the frequency, mechanism, and consequences of TBI, and may help improve care for our patients.

Posterior femoral condylar separation: Is it a particular type of osteochondritis dissecans in adolescents?

Introduction. Dissecting osteochondritis (RO) is based on damage to the subchondral bone, leading to its detachment and sequestration separately or together with articular cartilage with the possible formation of a free bone-cartilage fragment. The disease occurs more often in adolescents, accompanied by an increased risk of early arthrosis of the knee joint. Chronic traumatization of the subchondral bone leads to insufficient blood supply to a certain area of the growth zone of the secondary point of ossification of the femoral epiphysis, to ischemia and subsequent necrosis of the subchondral bone, which, according to modern literature, is the leading cause of the formation of the lesion. The typical localization of the RO focus is the lateral part of the medial condyle of the femur along the supporting surface. The present clinical analysis presents cases of atypical localization of dissecting osteochondritis with clinical features, specific signs on MRI, as well as various tactical approaches to treatment.Material and methods. This clinical review presents 3 cases of sequestration of the posterior lateral condyle of the femur in adolescents. Despite the similarity of the clinical picture and the MRI data, the features of the foci of RO were found in all children, which determined the need for an individual approach to therapeutic tactics. All children required surgical treatment, which was performed in the Department of Traumatology and Orthopedics of the N.F. Filatov DGKB in different volumes in each case: from transchondral osteoperforations and fixation of an osteochondral fragment with a screw to debridement of a fragmented focus with removal of osteochondral fragments.Results. All 3 clinical cases are united by atypical localization of the focus in the posterior lateral condyles of the femurs, the clinical course of the disease in the form of a low-intensity long-term pain syndrome, as well as the results of MRI of the knee joint. Most researchers adhere to the classical multifactorial etiological theory of dissecting osteochondritis, according to which the main mechanism of the origin of the lesion is mechanical overload of the subchondral bone with subsequent disruption of blood supply in it at the border with the secondary point of ossification of the femoral epiphysis. However, there is also data in the literature on congenital ossification disorder in the cartilaginous part of the growth zone of the secondary ossification point as the morphological basis of dissecting osteochondritis. The presented clinical cases cast doubt on the generally accepted model of primary damage to the subchondral bone as the only possible cause of the formation of the focus of RO, since patients have, among other things, signs of impaired ossification of the secondary ossification point of the femoral condyle, in one of whom a violation of ossification of the secondary ossification center was also determined in the patella in the form of patella bipartita.Conclusion. Inspite of all similarities connecting these cases there is still lack of data to judge about separate type of the OCD because every separate type of disease usually have particular morphological basis. There is a need of partial biopsy of these lesions to confirm or refute our hypothesis of posterior condylar separation being separate type of OCD. However these cases undoubtedly require particular managementwith special attention to timing of appropriate diagnostic procedures and surgical management to perform in time prior to osteochondral fragment separation. In case of the absence of any complaintswith particular MRI appearance of fragmented bone in the lesion with impaired ossificationindividual treatment planneeds to be defined.

Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial

(1) Background: The management of postoperative pain after knee replacement is an important clinical problem. The best results in the treatment of postoperative pain are obtained using multimodal therapy principles. Intrathecal morphine (ITM) and single-shot femoral nerve block (SSFNB) are practiced in the treatment of postoperative pain after knee replacement, with the most optimal methods still under debate. The aim of this study was to compare the analgesic efficacy with special consideration of selected side effects of both methods. (2) Materials and methods: Fifty-two consecutive patients undergoing knee arthroplasty surgery at the Department of Orthopedics and Traumatology of the Medical University of Warsaw were included in the study. Patients were randomly allocated to one of two groups. In the ITM group, 100 micrograms of intrathecal morphine were used, and in the SSFNB group, a femoral nerve block in the distal femoral triangle was used as postoperative analgesia. The other elements of anesthesia and surgery did not differ between the groups. (3) Results: The total dose of morphine administered in the postoperative period and the effectiveness of pain management did not differ significantly between the groups (cumulative median morphine dose in 24 h in the ITM group 31 mg vs. SSFNB group 29 mg). The incidence of nausea and pruritus in the postoperative period differed significantly in favor of patients treated with a femoral nerve block. (4) Conclusions: Although intrathecal administration of morphine is similarly effective in the treatment of pain after knee replacement surgery as a single femoral triangle nerve block, it is associated with a higher incidence of cumbersome side effects, primarily nausea and pruritus.