Influence of Various Strontium Formulations (Ranelate, Citrate, and Chloride) on Bone Mineral Density, Morphology, and Microarchitecture: A Comparative Study in an Ovariectomized Female Mouse Model of Osteoporosis

Osteoporosis stands out as a prevalent skeletal ailment, prompting exploration into potential treatments, including dietary strontium ion supplements. This study assessed the efficacy of supplementation of three strontium forms-strontium citrate (SrC), strontium ranelate (SrR), and strontium chloride (SrCl)-for enhancing bone structure in 50 female SWISS mice, aged seven weeks. In total, 40 mice underwent ovariectomy, while 10 underwent sham ovariectomy. Ovariectomized (OVX) mice were randomly assigned to the following groups: OVX (no supplementation), OVX + SrR, OVX + SrC, and OVX + SrCl, at concentrations equivalent to the molar amount of strontium. After 16 weeks, micro-CT examined trabeculae and cortical bones, and whole-bone strontium content was determined. Results confirm strontium administration increased bone tissue mineral density (TMD) and Sr content, with SrC exhibiting the weakest effect. Femur morphometry showed limited Sr impact, especially in the OVX + SrC group. This research highlights strontium's potential in bone health, emphasizing variations in efficacy among its forms.

Complex Regional Pain Syndrome after Distal Radius Fracture-Case Report and Mini Literature Review

This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field.

THE EVOLUTION OF TREATMENT AT THE ORTHOPEDICS AND REHABILITATION CLINIC

OBJECTIVE

Introduction: The last 20 years have been a period of huge changes in Polish healthcare, both in terms of medical progress as well as organization and financing. These changes, and especially the newly introduced queuing systems significantly influenced the changes in the profile of hospital admission. The aim: To analyze changes in the patient profile, causes and time of hospitalization, as well as the waiting time for hospitalization, in 1996-2019 Lublin SPSK4 Orthopedics and Rehabilitation Clinic.

PATIENTS AND METHODS

Material and methods: Patients' medical records were analyzed, including qualification cards. The waiting time for admission to the hospital, the time of hospitalization, the cause of hospitalization, gender and the patient's place of residence were analyzed.

RESULTS

Results and conclusions: 1. During the 13 years analyzed, the number of hospitalizations increased from 452 to 1387 patients a year. 2. The waiting time for hospitalization increased from an average of 2 months in 1996 to even 2 years (in the case of patients with chronic category) in 2020. 3. The average length of hospitalization changed compared to the level of 1996 (8 weeks) in the case of patients with the early neurological category increased slightly (9 weeks), in the case of other patients - it decreased to 4 weeks, respectively - chronically ill patients, 3 weeks - patients from the systemic and weekly rehabilitation category - orthopedic patients. 4. The scope of the reasons for hospitalization, but also methods of treatment has expanded significantly. 5. Patient demographic profile in the examined aspects (origin, gender) - remained similar.

[Protein and physical activity in prevention and treatment of sarcopenia]

There is continuous ageing in world population. Although life expectancy still increases there is no similar trend in maintaining quality of life. The number of disabilities due to age is expected to double in 2060. Muscle mass is one of the most important factors of health and nutrition in old age and it constant loss is characteristic for process of ageing. Muscle mass is controlled by number of different factors. The most important of which is balance between muscle protein synthesis and degradation. Ageing has no influence on muscle protein degradation so for maintaining muscle mass it is better to target muscle protein synthesis. Optimal protein dose in the meal is the minimal amount of protein effecting in maximal anabolic response. Threshold for anabolic response increase with age. This process, named anabolic resistance can be overwhelmed with high amount of protein in diet. Experts in the field of ageing and nutrition recommend 1,2-1,5 g/kg/d protein for the maintaining of muscle mass, 1,2-1,5 g/kg/d for older with additional risk factors, 2,0 g/kg/d for seriously ill and malnourished. Physical training has synergistic influence with diet protein. Physical training improves muscle performance, muscle strength and prevents muscle wasting. Physical training combined with increased amount of protein in diet results with increased muscle mass.

[Peripheral nerves alcoholization in the spasticity managament]

INTRODUCTION

Spasticity is velocity dependent increased resistance to passive lengthening of the muscle. Mild spasticity doesn't require treatment, but severe impede with hygiene, constrict range of motion and mobility, interfere with gait pattern and can be the cause of pain and discomfort. Proper spasticity management is crucial for correct rehabilitation.

THE AIM OF THE STUDY

The assesment of chemodenervation with ethyl alcohol in spasticity treatment.

MATERIAL AND METHODS

13 patients (5 female, 8 male) age 18-68 yrs (mean 46,8±13,3). Qualification to the procedure requiered high level of spasticity (mean 3,4 ± 0,5 in Ashworth scale), no response for pharmacological treatment, low level in Bartel scale. Patients were evaluated with VAS pain scale, EQ-5D before, day after and 6 weeks after procedure.

RESULTS

Ashworth scale before procedure: 3-4 (mean 3.44±0.52), after procedure: 0-3 (mean 2.0±1.26), 6 weeks after procedure: 1-3 (mean 2.0±1.0). VAS before procedure: 0-4 (mean 1.49±1.9), after procedure: 0-2 (mean 1.33±1.0), 6 weeks after procedure (mean 1.0±1.0). Bartel scale before procedure: 0-16 (mean 9.25±6.7), after procedure: 0-16 (mean 6.0±8.71), 6 weeks after procedure: 0-16 (mean 9.25±6.7). EQ-5D results showed on Fig 5-19.

CONCLUSION

Results shows improvement in every examinated aspect (decrease in spasticity level, decrease in pain, increase in quality of life and disability scale).

Principles of social security and health insurance for farmers in Poland and Germany--a comparative assessment

INTRODUCTION AND OBJECTIVE

As landowners occupied with agricultural production comprise a sizeable part of the populations in mid- and western European countries, it seemed reasonable to assess the organization of health care systems concerning farmers and their families in Poland and Germany. Both countries have similar geographical conditions and rural environments. It so happens that in Poland the principles of the system of agricultural insurance (KRUS) is based on the experiences of Germany and France.

STATE OF KNOWLEDGE

Basically, both in Poland and Germany, the agricultural health insurance companies provide the same insurance cover as other health insurance companies. In both countries, under certain conditions, in the case of illness, the insured farmers receive instead of sickness benefit operational assistance and home help. In spite of the similarities that characterize both administrations, many particular differences are to be noted, e.g. the farmers' social insurance in Poland is subject to only one ministry, in contrast to Germany where two ministries are responsible for farmers' social insurance. In Poland, KRUS is a monopolistic organization, whereas in Germany, nine similar independent structures fulfil the task of a health insurance company. Needless to say, many more funds are available for prevention, treatment and rehabilitation in Germany than in Poland, due to obvious differences in the overall national income.

Postoperative limb lengthening following Total Hip Arthroplasty (THA) through a posterior approach--a challenge for the orthopaedist or physiotherapist?

BACKGROUND

As coxarthrosis progresses, pain and mobility limitation exacerbate, usually presenting as a progressive flexion-abduction contracture. This, combined with the degradation of articular ends of bones, is responsible for anatomical and functional shortening of the limb. The sensation of postoperative leg length difference is a significant problem both for the patient and the operator. A sense of the operated limb being longer may be due to excessive length of the femoral segment following total hip arthroplasty. It may also result from a postoperative abduction or flexion-abduction contracture. The aim of the study was to review the clinical course of total hip replacement surgeries. The focus was on complaints of leg length discrepancy persisting for more than two weeks after ambulation.

MATERIAL AND METHODS

We investigated a series of 210 unilateral THA procedures. Swanson's technique through a posterolateral approach was used in all cases. Twelve patients, including 8 women and 4 men (out of the total of 210 patients - 169 women and 41 men), reported a sensation of operated limb lengthening for more than two weeks after ambulation. We reviewed the process of rehabilitation in this group of patients.

RESULTS

The rehabilitation procedure presented in this paper eliminated the sensation of limb length discrepancy in all patients who had reported this problem.

CONCLUSIONS

1. Complaints of leg lengthening following total hip arthroplasty were reported by approx. 5% of the THA patients. 2. Consistent physiotherapy involving muscle energy techniques (MET) helped to eliminate the sensation of limb length inequality.

[Problem and tolerance of leg lengthening after total hip replacement]

Inevitable sequaelae of predominant number of hip arthritis is shortening of the upper end of the femur due to the destruction of the femoral cartilage and head which is usually accompanied by increasing flexion contracture. The main goal of hip replacement is to restore normal hip biomechanics and appropriate femoral neck lever. As the number of hip arthroplasties increases the patients dissatisfied with the early postoperative result related to the apparent lengthening of the operated limb are becoming more numerous. The authors retrospectively analyzed group of 10 patients complaining of postoperative lengthening limb derived from series of 210 hip replacements. In this group a rehabilitation programme comprising of repeated maneuvers of manipulation aiming at reduction of abduction contracture and obtaining adduction was performed. After a period of one week to six months in all the cases the perception of leg length discrepancy disappeared.

[Asymptomatic thrombo-embolic venous disease before total hip replacement--when the risk is important?]

In spite of widely applied prophylaxis against thrombo-embolic venous disease its future complications still present important clinical issue. According to rough statistics this disease occurs in 71/100 000 persons per year and reveals in 1/3 as pulmonary embolism and in 2/3 as a pure thrombotic venous disease. Massive pulmonary embolism is at present a major cause of death in hospitalized subjects. In the USA mortality due to diagnosed pulmonary embolism is reported as approximately 25 000 cases per year. The aim of this paper is to draw attention to the asymptomatic cases of the thrombotic venous disease in the patients before hip arthroplasty. A retrospective clinical analysis of 210 total hip replacements (years 2005-2008) was performed. Standard perioperative routine antithrombotic prophylaxis with low-molecule heparins was introduced in each case. Special attention was paid to the occurrence of the risk factors or the presence of venous thrombosis in the lower extremities perioperatively. In the analyzed group preoperative ultrasound revealed in 5 (2.38%) cases asymptomatic venous thrombi reaching above the knee region and this was the cause of postponing of the procedure. In the early postoperative period pulmonary embolism was evidenced in 4 cases (1.9%). The authors suggested that preoperative ultrasound investigation of lower extremities venous system is important issue together with the assessment of d-dimers in the blood in all patients admitted to total hip arthroplasty. In any suspicion of the pulmonary embolism in these patients an angio-CT should be performed as an emergency.