http://www.ortopedia.com.plTable of contents Wolumin 12, 2010 Numer 3.en-usCopyright 2010 by the Ortopedia Traumatologia Rehabilitacjahttp://www.ortopedia.com.pl/rssIndexCopernicus Journal Management System RSS GENERATORwebmaster@www.ortopedia.com.pl (ADM)Wed, 30 Jun 2010 00:00:00 ESThttp://www.ortopedia.com.pl/abstracted.php?icid=914647&level=5Summary The author presents the epidemiology, classification, clinical features and strategies of treatment of Giant Cell Tumor. Giant Cell Tumor of Bone accounts for 4-8% of primary bone tumors. It is most commonly seen in women aged 20 to 40 years. The most common sites are the distal femur and proximal tibia, distal radius, and proximal humerus. Increasing pain at the tumor site is the most common presenting symptom. Three types of GCT can be distinguished radiographically according to the Cappanacci or Enneking classification. The mainstay of treatment is total mechanical removal with curettage. The recurrence rate is high (12-50%) during the first 2-3 years after surgery, regardless of pre-operative tumor stage. 5-7% cases of giant cell tumor produce malignant recurrences, usually after five to more than 10 years after surgery.Marta Karpik Review articlehttp://www.ortopedia.com.pl/abstracted.php?icid=914647&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914648&level=5Summary Introduction. The term frozen shoulder refers to an inflammatory condition characterized by pain and reduced range of passive and active motion of the shoulder. Initial management is mostly conservative. In some cases, however, invasive treatment is necessary. Given the dearth of available data on long-term operative outcomes, it appears interesting to present a comprehensive discussion of this issue. The aim of this study was to evaluate the improvement of range of motion and function  of the affected shoulder after a minimum of two-year follow-up following arthroscopic capsular release of idiopathic and posttraumatic frozen shoulder. Material and methods. The study enrolled 30 patients with frozen shoulder, including 16 patients with idiopathic FS and 14 patients with posttraumatic frozen shoulder. All patients had an anteroinferior capsular release and three additionally had a posterior capsulotomy. After a minimum of two-years of follow-up, the shoulder’s range of motion and limb function were evaluated according to a modified version of the Constant-Murley Score (0-75), the ASES (American Shoulder and Elbow Surgeons) score and a subjective scale designed by the authors. Results. The improvement in the range of motion after arthroscopic capsular release was considerable and statistically significant (p<0.05) compared to pre-operative values both intraoperatively and after a minimum of two years of follow-up in both groups and across all planes of movement tested. The improvement of function of the shoulder after a minimum two years following arthroscopic capsular release was significant (p<0.05) according to the Constant-Murley score (from 19.3 preoperatively to 65.9 postoperatively, 0-75) and the ASES score (from 22.8 preoperatively to 92.7 postoperatively, 0-100). Conclusions. Arthroscopic capsular release significantly improved the range of motion and function in idiopathic and posttraumatic frozen shoulder.Michał Waszczykowski , Jarosław Fabiś Original articlehttp://www.ortopedia.com.pl/abstracted.php?icid=914648&level=5http://www.ortopedia.com.pl/abstracted.php?icid=915745&level=5Summary: Introduction: Low back pain syndromes are one of the most frequent causes of movement limitation in populations of highly industrialized countries. They are listed as the main cause of inability to work among people of working age. Chronic pain and the associated limitation of movement underlie the quest for effective therapies. The use of ultrasound, LLLT, vacuum therapy with Ultra Reiz current in physical therapy of these patients prompts research over their effectiveness in the therapy of patients with low-back pain. Aim: The aim of the work was to evaluate the analgesic efficacy of LLLT, ultrasound, and vacuum therapy with Ultra Reiz current in patients with low back pain.Material and methods: The study involved 94 people divided into three groups (A,B,C). Group A (n=35) received a series of 10 low energy laser therapy sessions (wave length 808 nm, surface density of radiation 510 mW/cm², continuous wave form, scanning mode, a dose of 12 J/cm² on a surface of 100 cm² [10x10cm]). Patients in Group B (n=27) had ultrasound sessions with a wave intensity of 1W/cm2 for 3 minutes. Patients in Group C (n=32) underwent vacuum therapy (8 kPa) combined with Ultra Reiz current. Subjective pain assessment was carried out using a modified Latinen questionnaire and a visual analogue scale of pain intensity. Lumbosacral spine mobility was evaluated with the Schober test and the finger–to- floor test. Results: In Group A, following low energy laser therapy, a statistically significant decrease in pain intensity was observed, together with decreased analgesic consumption compared to the other groups. In Group C, following vacuum therapy combined with Ultra Reiz currents, a significant decrease in the frequency of pain was observed together with increased physical activity compared to both Groups A and B, assessed according to a modified Laitinen pain indicator questionnaire. The biggest improvement in global spine mobility and lumbosacral flexion was observed in Group C (vacuum therapy plus Ultra Reiz current) compared to the other groups. However, the most significant improvement in lower spine extension was noted in Group B (ultrasound). Conclusion 1. The study showed slightly higher analgesic efficacy of laser biostimulation in comparison to vacuum therapy combined with Ultra Reiz current in patients with low back pain.  2. A more prominent increase in lumbosacral spine mobility was observed after vacuum therapy combined with Ultra Reiz current and ultrasound therapy.Magdalena Charłusz , Jowita Gasztych, Robert Irzmański , Jolanta Kujawa Original articlehttp://www.ortopedia.com.pl/abstracted.php?icid=915745&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914649&level=5Abstract Introduction. The aim of the study was to analyse the outcomes of hip replacement complicated by intraoperative femoral fractures and to analyse their effective management. Materials and methods. The medical records of 43 cases of intraoperative femoral fractures (1.4% of all hip replacements) were retrospectively reviewed. The patient group included 29 females. Patients’ age ranged from 20 to 66 years (mean age: 48.4 years). Follow-up duration ranged from 8 to 89 months (mean duration: 44 months). Results. There were 13 fractures of the greater trochanter, 21 fractures of the lesser trochanter involving the calcar, 7 at the implant stem level, and two below the implant stem. In 3 cases, the fracture was treated with a revision stem, with cerclage used in 17 other cases. In the remaining cases, the fractures were stable and did not require any internal fixation. Eighteen patients had very good final results, 19 had good and 6, fair results, according to Merle D’Aubigne- Postel’s classification in Charnley’s modification. None of our patients demonstrated evidence of stem loosening at the final follow-up. Conclusions. Unstable intraoperative femoral fractures during a hip replacement procedure are rare and occur mostly in patients with post-dysplastic hips with a narrow intramedullary canal. In cases of stable fractures of the trochanter and calcar region, 12 weeks of partial weight bearing without additional immobilization is a sufficient approach. The final results are satisfactory in most cases of intraoperative femoral fractures. Tomasz Dorman, Marcin Sibiński, Krzysztof Kmieć, Mirosław Bira, Andrzej Borowski Original articlehttp://www.ortopedia.com.pl/abstracted.php?icid=914649&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914646&level=5Summary Background: The paper presents the results of tibio-talo-calcaneal fusions using Retrograde Nailing System and Bone Grafting. Material and methods: From May 2006 to January 2008, we performed 13 fusions in 11 consecutive patients with advanced ankle and hindfoot disease. Patients underwent 13 tibiotalocalcaneal fusions (2 patients had initial tibiotalocalcaneal fusion using screws and subsequently developed a non-union) and all 11 patients were available for follow up. The procedure was performed unilaterally in all cases; there were 4 males and 7 females. The average age at the time of surgery was 65.25 years (range 51-81 years). The average duration of follow-up was 8 months (range between 6-15 months). Results: Solid fusion was achieved in all 11 cases. The average AOFAS score (maximum 78 points) improved from a pre-operative mean of 16 points [range 3 to 29] to a mean of 54 points [range 42 to 70], excluding the scores for stability and range of motion. Patient satisfaction scale (maximum 10 points) improved from 3 to 7 in both pain and function. Conclusion: 1- Arthrodesis should be considered only after all conservative treatments fails; it is one of the most challenging surgical procedures that must be undertaken with care in order to provide the best possible outcome. 2- Thorough evaluation and examination will help the surgeon to find the correct indication and identify patients who are not suitable for the procedure. It is crucial to assess the vascular and neurological status and to obtain weight-bearing radiographs (possibly CT) of the ankle to evaluate the deformity. 3- The optimal position of the ankle is in neutral flexion, 0-5° valgus, and 10° external rotation, similar to the contralateral foot and posterior translation of the talus under the tibia (5mm). 4- Tibio-talo-calcaneal fusion with retrograde nailing and bone grafting is a successful salvage procedure in severe ankle and hind foot arthrosis with deformity.Rolf Haaker, E. Y. Kohja, Mariusz Wojciechowski, G. Gruber Original articlehttp://www.ortopedia.com.pl/abstracted.php?icid=914646&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914645&level=5A 15-year-old boy with neurofibromatosis type 1 developed habitual dislocation of the right hip. No intraarticular pathology could be found in imaging studies. The dislocation became fixed during the follow-up.Marcin Tyrakowski , Szymon Pietrzak , Waldemar Przybysz , Jarosław Czubak Case reporthttp://www.ortopedia.com.pl/abstracted.php?icid=914645&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914651&level=5Diastrophic dysplasia is a rare genetic disorder characterised by short limbs and deformities of several joints occurring in conjunction with abnormal spinal curvatures, impaired metacar pal modelling and socalled hitchhi ker thumbs. The condition is progressive and leads to considerable physical disability. It continu es to constitute a challenge for doctors as the outcomes of corrective or thopa edic surgery are limited. The aim of this paper is to present the course of diastrophic dysplasia in a 7-year-old girl who also experienced cervical spine luxation with signs of com pression of the spinal cord and carotid ar te ries. We describe deformities of the motor or gans present in the patient and characteristic of dia strophic dysplasia, and the findings of specialised acces sory investigations. The example of evaluation for bone disorders is used to draw attention to the principles of interpretation of densitometry measurements in a patient with im paired so mtic development.Anna Szczepaniak-Kubat, Maciej Tęsiorowski, Zofia Merc-Gołębiowska, Elżbieta Jakubowska-Pietkiewicz Case reporthttp://www.ortopedia.com.pl/abstracted.php?icid=914651&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914644&level=5Summary 1. Introduction. Diastematomyelia is a type of dysraphism with a double or bifid spinal cord divided by an osseous septum. This defect often co-occurs with other developmental disorders of the skull or the atlanto-occipital junction. The course may be benign or aggressive. 2. Case reports. We describe two female patients treated in the Rehabilitation Clinic and the Orthopaedic Department at the Medical University of Lublin in the years 2004 – 2009. The first patient was diagnosed at the age of 20 years to have diastematomyelia at the L3 level and spina bifida occulta at L1- S5 and at the C1 arch. In the other patient, diastematomyelia at the L3 level and spondylolisthesis at L5-S1 were found at the age of 14 years. Initially both patients were treated for lumbosacral radicular syn-dromes. Physiotherapy intensified the pain. The patient with diastematomyelia and L5-S1 spondylolisthesis had L5-S1 segment stabi-lization performed at the age of 16. The pain subsided after the surgery. The other patient was instructed to stop rehabilitation, follow a balanced lifestyle, and re-frain from physical work, which eliminated the pain. 3. Discussion Managing a patient with diastematomyelia demands caution. Diagnosis of this defect re-quires a thorough cause-and-effect analysis of the presenting signs and symptoms of spinal dysfunction. The treatment should be dependent on local pain intensity (which is often not directly associated with the disorder) and on the degree of neurological dysfunction. 5. Conclusions 1. A thorough clinical evaluation with spinal imaging prior to elective surgery for sco-liosis and other spine deformities should be a standard procedure undertaken in order to avoid complications. 2. The treatment for diastematomyelia should depend on the intensity of local pain and on the level of neurological dysfunction. 3. Broadly understood rehabilitation is not always effective, often increasing the pain and/or neurological complaints.Marek Fatyga , Michał Latalski , Tomasz Raganowicz , Andrzej Gregosiewicz Case reporthttp://www.ortopedia.com.pl/abstracted.php?icid=914644&level=5http://www.ortopedia.com.pl/abstracted.php?icid=914650&level=5One of the fundamental problem to solved, connected with a way of proceeding in hip osteoarthritis is appropriate selection of diagnosis methods. Various scores helps in assessment of functional efficiency of the hip. They are applied on variable stages of diagnosis process, assumed way of treatment included physiotherapy and to analysis achived results of treatment. Universal applied scores are: HHS, WOMAC, Merle D’Aubigne- Postel, Mayo. The purpose of this study was to compare methods mentioned above. The special attention was paid to an assessment of usefulness of scores in treatment process.Joanna Golec, Karina Rożek, Magdalena Kazana Otherhttp://www.ortopedia.com.pl/abstracted.php?icid=914650&level=5