Validation of the Polish versions of the Lower Limb Task Questionnaire, Lower Limb Functional Index, and Lower Limb Functional Index-10

BACKGROUND

Physicians who treat patients with lower limb diseases should pay attention not only to the patients' clinical condition but also to their individual needs and expectations. For this purpose, many different questionnaires can be employed. This study aimed to validate the Lower Limb Task Questionnaire (LLTQ), Lower Limb Functional Index (LLFI), and Lower Limb Functional Index-10 (LLFI-10) for their use in Polish conditions and to perform a mutual comparison and analysis of differences in subjective assessments by patients who undergo hip or knee arthroplasty.

METHODS

The LLTQ, LLFI, and LLFI-10 were translated into Polish. A total of 103 patients who qualified for hip or knee arthroplasty at a University Hospital in from 2019 to 2021 were included in this study. The patients were asked to complete the Polish versions of the LLTQ, LLFI, LLFI-10, Lower Extremity Functional Scale (LEFS), and Short Form-36 four times - twice before and twice after their surgeries.

RESULTS

The Polish versions of the LLTQ, LLFI, and LLFI-10 had good psychometric properties. One year after surgery, the Cohen's standard response mean revealed high improvement of limb functionality and thus quality of life among all patients. We observed better treatment outcomes among patients who had hip osteoarthritis.

CONCLUSIONS

The questionnaires were validated and can be used both in everyday health practice and in further research in Poland.

The adaptation of Polish version of Six-Item Carpal Tunnel Syndrome Symptoms Scale

BACKGROUND

The Carpal Tunnel Syndrome is one of the most common peripheral neuropathy. The diagnosis could be made by taking the medical history from a patient or by physical examination or by performing electroneurography. The aims of the study were (1) to translate and adaptate the Polish version of the Six-Item Carpal Tunnel Syndrome Symptoms Scale (CTS-6 SS) and (2) to analyse the associations between different Patients-Reported Outcome Measures and nerve conduction studies (NCS).

METHODS

One-hundred and fifty patients consistent with inclusion criteria filled the CTS-6 SS, Boston Carpal Tunnel Questionnaire (BCTQ), Disabilities of the Arm, Shoulder and the Hand (DASH) and Michigan Hand Outcomes Questionnaire (MHQ) during their first visit to the clinic. Then, they had the NCS done. After two weeks, 99 patients filled the CTS-6 SS for the second time.

RESULTS

The Polish version of CTS-6 SS revealed good psychometric properties: high values of internal consistency, test-retest reliability and validity. The construct validity showed strong correlation with BCTQ - R = 0.87 (p < 0.05) for Symptoms Severity Scale (SSS) and R = 0.64 (p < 0.05) Functional Status Scale (FSS). Additionally CTS-6 SS has at least moderate correlation with DASH R = 0.53 (p < 0.05).

CONCLUSIONS

The Polish version of translated scale was adapted and used together with NCS complete the overall picture of patients suffering from CTS.

STUDY DESIGN

Prospective study.

BMPR1B gene in brachydactyly type 2-A family with de novo R486W mutation and a disease phenotype

Background

Brachydactylies are a group of inherited conditions, characterized mainly by the presence of shortened fingers and toes. Based on the patients’ phenotypes, brachydactylies have been subdivided into 10 subtypes. In this study, we have identified a family with two members affected by brachydactyly type A2 (BDA2). BDA2 is caused by mutations in three genes: BMPR1B, BMP2 or GDF5. So far only two studies have reported the BDA2 cases caused by mutations in the BMPR1B gene.

Methods

We employed next‐generation sequencing to identify mutations in culpable genes.

Results and Conclusion

In this paper, we report a case of BDA2 resulting from the presence of a heterozygous c.1456C>T, p.Arg486Trp variant in BMPR1B, which was previously associated with BDA2. The next generation sequencing analysis of the patients’ family revealed that the mutation occurred de novo in the proband and was transmitted to his 26‐month‐old son. Although the same variant was confirmed in both patients, their phenotypes were different with more severe manifestation of the disease in the adult.

The Arteries of the Central Forehead: Implications for Facial Plastic Surgery

BACKGROUND

The forehead has substantial importance as an aesthetic unit. The central and supraorbital parts of this area are supplied by the supratrochlear (ST) and supraorbital (SO) arteries as well as the recently defined paracentral (PA) and central arteries.

OBJECTIVES

The authors aimed to assess the morphometry of the vessels of the forehead in the context of plastic surgery and minimally invasive cosmetic procedures.

METHODS

This research included 40 cadavers directed for forensic autopsy and subjected to postmortem computed tomography angiography. In total, 75 hemifaces were examined for the course and location of arteries relative to the bones and surrounding structures.

RESULTS

The arteries were observed as follows: ST in 97.3%, SO in 89.3%, and PA in 44.0%. The PA can be expected in the 13-mm-wide zone starting 2 mm laterally from the midline. The ST should be expected in the 10-mm-wide area extended laterally from the tenth millimeter from the midline, and the SO should be expected in the slightly wider (11 mm) area extending laterally from the 20th millimeter from the midline. For the proximal main trunks of the ST and SO arteries, we observed no overlap between the zones of occurrence, whereas the zones for the PA and ST main proximal trunks did overlap. No distinctive central artery was observed in the midline region of the forehead, but instead a network of small vessels in the midline region was visible.

CONCLUSIONS

The ST is the main and most conservative artery of this region and the PA is the most variable. A unique and detailed anatomical map was created to better understand the vasculature of the forehead area.

Polish version of the Patient-Rated Ulnar Nerve Evaluation in preoperative patients: Translation and psychometric testing

STUDY DESIGN

Cross-sectional design.

INTRODUCTION

This study examined the translated English to Polish version of the Patient-Rated Ulnar Nerve Evaluation (PRUNE) for its internal consistency, test-retest reliability, and construct validity.

METHODS

During the first assessment validity testing, a total of 39 consecutive patients with cubital tunnel syndrome completed the PRUNE, Michigan Hand Outcome Questionnaire, Disabilities of the Arm, Shoulder, and Hand questionnaire, and Patient Evaluation Measure in conjunction with the grip and key pinch tests and pain score (by Visual Analogue Scale). Cronbach's alpha (CA), intraclass correlation coefficient (ICC), and the Bland-Altman plot were used to evaluate internal consistency, test-retest reliability, and agreement, respectively. Analysis of variance compared the PRUNE score with the McGowan clinical stages.

RESULTS

After a 1-day interval, 19 patients completed the PRUNE for the second time. The total PRUNE score was 44.4 ± 20.4, CA = 0.93, and ICC = 0.921. The total PRUNE score limits of agreement varied from -9.87 to 7.55 points. PRUNE subscale CA ranged from 0.79 to 092; the ICC varied from 0.738 to 0.911. The construct validity revealed a strong association with Michigan Hand Outcome Questionnaire (R = -0.83; P < .000), and moderate with Disabilities of the Arm, Shoulder, and Hand (R = 0.75; P < .000), Patient Evaluation Measure (R = 0.75; P < .000), and Visual Analogue Scale (R = 0.69; P < .000). The grip and pinch tests had low and no correlation with the total PRUNE score, respectively.

CONCLUSION

The Polish version of PRUNE showed good psychometric properties for use in both clinical and research practice in patients with cubital tunnel syndrome of varying intensity.

Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures

BACKGROUND

The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures.

OBJECTIVES

The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach.

METHODS

Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures.

RESULTS

In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively.

CONCLUSIONS

An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.

The Superficial Temporal Artery: Anatomical Map for Facial Reconstruction and Aesthetic Procedures

BACKGROUND

The superficial temporal artery (STA), a terminal branch of the external carotid artery, supplies multiple regions of the scalp and face. Knowledge of the STA is important for reconstructive and aesthetic procedures of the head and face.

OBJECTIVES

The aim of this study was to map the STA in relation to anatomical landmarks.

METHODS

Computed tomographic head angiographies of 215 patients were included in this study; the final analysis comprised 419 STAs. The STA's main branches and variants were identified. The diameters of the STA and its frontal and occipital branches were measured, and the distance between the STA tree and anatomical landmarks was delineated.

RESULTS

Frontal and parietal branches were recorded in 98.1% and 90.7% of patients, respectively. The mean diameters, measured 1 and 7 cm from the STA bifurcation for the frontal branch, were 0.97 ± 0.32 and 0.81 ± 0.26 mm, respectively, and for the parietal branch, the diameters were 0.96 ± 0.28 and 0.76 ± 0.23 mm, respectively. The STA bifurcation point was located above the zygomatic arch (ZA) in 75.6%, below in 14.7%, and on the ZA in 9.7% of patients. The mean distance from the ZA center to the STA bifurcation was 16.8 ± 16.0 mm.

CONCLUSIONS

The STA artery and its main branches follow a conservative course, and serious anatomical variations are relatively rare. The STA and its main branches may be localized using simple anatomical landmarks. An anatomical map showing artery-free zones in the lateral forehead region was presented, which may prove useful for plastic, reconstructive, and aesthetic surgeons.

Level of Evidence: 4.

Hand Function Deficiency in Patients with Dupuytren's Disease and Course of Recovery after Palmar Fasciectomy

PURPOSE OF THE STUDY To evaluate hand function deficiency in patients with Dupuytren's disease (DD) in addition to assessing the improvement of function after palmar fasciectomy by using different hand-related questionnaires. MATERIAL AND METHODS A total of 121 hands (95 patients) underwent surgery. Disease severity was designated using Tubiana's Staging System. The Tendency of changes of Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Patient Evaluation Measure (PEM), and Hand Function Score (HFS) scores of patients with DD undergoing palmar fasciectomy were assessed prior to, 3 months after, and 1 year after the operation. Moreover, total loss of extension (TLoE) was evaluated using a goniometer in the same time intervals. Repeated measure ANOVA Friedman's test were used. Responsiveness to clinical change was calculated by using standardized response means (SRMs). RESULTS The results showed statistically significant improvement of the originally obtained questionnaire results after 3 months for DASH and HFS and 12 months for all forms; only the PEM and DASH score significantly changed between 3 and 12 months. TLoE before surgery was 144.1 o ±99.6 o ; 3-month and 1-year after surgery: 14.3 o ±58.0 o and 19.3 o ±34.7 o respectively. SRMs for 1 year after surgery was large for PEM (1.11) and medium for DASH (0.7) and HFS (0.79). CONCLUSIONS DASH, PEM, and HFS are valuable tools to monitor the hand function of patients with DD after surgery. Key words:hand function, Dupuytren's disease, palmar fasciectomy.

Morphological variations of the interatrial septum in ovine heart

Smooth septum interatrial septum, patent foramen ovale (PFO) channel and atrial septal pouches (SPs) are commonly described variants in humans. Recent discoveries on the clinical significance of left-sided SP may encourage the creation of new strategies and devices for the management of SPs. However, these strategies may first be tested in the ovine model before implementation in humans. Unfortunately, little is known about the presence of SPs in ovine. In this study a total of 60 ovine (Ovis aries) hearts were examined. The interatrial septum morphology was assessed and the PFO channel and SPs were measured. The most commonly occurring variant were PFO channels (25.0%) with channel lengths of 5.4±2.3 mm. Smooth septums were observed in 18.3% of hearts. In the remaining cases, septums had a left septal ridge (15.0%), left SP (11.7%), left septal bridge (10.0%), right SP (10.0%), or had both a right SP and left septal ridge (10.0%). No double SPs were observed. The mean right SP depth was 3.4 ± 1.2 mm, and its mean ostium width and height were 7.9±1.8 mm and 2.8±1.0, respectively. For the left SP, the mean depth was 6.0±1.7mm, the ostium width was 7.9±2.4mm, and the ostium height was 4.1±1.6mm (range: 2.3-6.4mm). In conclusion the interatrial septum of ovine hearts exhibit morphologies that are more similar to humans than they are to swine, which should be taken into account during experimental studies. The presence of a left SP in sheep hearts make ovine models a promising alternative to the human heart for developing left-sided SP management devices and techniques.

Hand anthropometry in patients with carpal tunnel syndrome: a case-control study with a matched control group of healthy volunteers

BACKGROUND

The aim of this study was to perform anthropometrical measure- ments of patients' hands with carpal tunnel syndrome (CTS) in order to evaluate if there is a correlation between CTS occurrence and hand features regarding sexual dimorphism, age and physical activity.

MATERIALS AND METHODS

Study sample consisted of 48 patients (33 females) and control group included 80 healthy volunteers (58 females) with no history of CTS. The following measurements were performed: the wrist circumference, length of the hand, the hand's width, width of the wrist, thickness of the wrist, height of the hypothenar and thenar, length of the arm and forearm, circumference of the proximal phalanges and width of the digits; as well as several indexes were calculated i.e.: body mass index (BMI), shape index, digit index, wrist index, hand length/height ratio (HLH-ratio) and hand length/upper limb length ratio (HLULL-ratio).

RESULTS

Correlation coincidences were analysed between circumferences within the hand, palm and body weight. All parameters except fingers were correlated with body weight in either gender in both groups (p < 0.05; r = 0.40-0.80); Furthermore, width of the hand was correlated with body height (p < 0.001; r = 0.56-0.71). Mean values of wrist index for CTS patients were: males: 0.8, females: 0.74 (significantly higher than in healthy individuals and indicating square shape); shape index: males 76.5, females 75.8; digit index: males 55.7, females 56.5. The calculated HLH-ratio in CTS group was: males 10.6, females 10.9; HLULL-ratio: males 23.6, females 24.9 and they did not differ significantly from healthy volunteers. Almost 90.0% of females with diagnosed CTS have BMI > 25.0 kg/m2.

CONCLUSIONS

There are significant differences in morphometrical features of the upper limbs between CTS patients and healthy individuals. Hands of patients with CTS are more massive and with 'plumb' fingers and square shape of the wrist. Furthermore, higher BMI values were confirmed to be predisposing factors in CTS occurrence.

The Polish version of the Michigan Hand Outcomes Questionnaire: Cross-cultural adaptation, reliability, construct validity, and measurement error

The aims of this study were to translate the Michigan Hand Outcomes Questionnaire into the Polish language and to test the measurement properties of its quality criteria. A total of 120 patients with hand complaints completed the Polish Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire on the first assessment, along with the grip test, pinch test, and pain sore assessed using a visual analogue scale during activity. After 7 days, 76 patients completed the Michigan Hand Outcomes Questionnaire the second time. The Cronbach alpha of the Michigan Hand Outcomes Questionnaire subscales ranged from 0.79 to 0.96. The intraclass correlation coefficient varied from 0.82-0.97, and the Bland-Altman method indicated the Michigan Hand Outcomes Questionnaire total score limit of agreement was -13.2-12.3 and -9.18-9.62 for the right and left hand, respectively. The construct validity revealed a moderate to strong correlation between every subscale of the Polish Michigan Hand Outcomes Questionnaire and Disabilities of the Arm, Shoulder, and Hand, but they only correlated with the grip test and the visual analogue scale, and neither correlated with the pinch test. The study demonstrated properties similar to the original version, validating the belief that the use of this questionnaire in medical practice in Poland is justified.

[Evaluation of influence of Dupuytryen contracture's operative treatment on increase of quality of hand's function basing on research in use PEM (Patient Evaluation Measure) questionnaire]

INTRODUCTION

Dupuytren's contracture is a progressive fibrosis of facial structures of the palmar surface of the hand, gradually leading to a reduction of its functions by impaired range of motion of fingers.

MATERIALS AND METHODS

Clinical material consisted of 95 patients treated surgically in the Second Department of Surgery of the Jagiellonian University in 2006 - 2011 because of Dupuytren's contracture. Based on a study using PEM questionnaire (Patient Evaluation Measure) an assessment of the quality of life before and after surgery was made.

RESULTS

The average numeric value obtained in the PEM questionnaire before surgery was 30 points (SD ± 14.35). The postoperative controls were found of gradual decrease in the value and so after three months it was 22.39 points (SD ± 14.23), and after a year it reached the value of 18.12 points (SD ± 12.43). Statistically significant correlations (p < 0.001) were demonstrated between test results of PEM taken before and after 3 and 12 months after surgery.

CONCLUSIONS

It has been shown that Dupuytren's contracture has negative impact on quality of life but the quality of life improves after surgical treatment.

[Carpal tunnel syndrome- etiology and treatment]

The paper presents the etiology, diagnostics, management, treatment and prognosis of carpal tunnel syndrome. The mechanism of the median nerve compression as well as the predisposing factors that cause the syndrome are discussed, as well as the sequence of specific symptoms and the classification of the level of severity of disease. The diagnostic methods are presented with both the benefits and consequences of each method. The treatment of carpal tunnel syndrome is divided into conservative and surgical approaches. Conservative treatment consists of keeping the wrist immobile using wrist splints, physiotherapy, systemic and local pharmacotherapy, as well as local steroid injections into the carpal tunnel. The results of conservative treatment are often short-term. Operative treatment consists of cutting the flexor retinaculum tendon. This directly eliminates the cause of CTS, the increased pressure in the carpal tunnel of the wrist. A certain percentage of patients experience complications post treatment or disease recurrence.

[Evaluation of trigger finger operative treatment and quality of life improvement with PEM (Patient Evaluation Measure) questionnaire]

One of the most frequent couse of pain and function impairment of the hand is trigger finger. The treatment of this desease can be conservative or operative. The aim of this study was the evaluation of operative treatment and improvement of the quality of life after the procedure with PEM questionnaire. There were 50 patient included into evaluation, all of them were treated in Second Department of Surgery of the Jagiellonian University Medical College between 2008 and 2010. Patients evaluated the function of their hand before surgery and then 3 months and a year after the procedure. There were also the assessment of treatment satisfaction. We analised the results and observed significant improvement of hand function after the surgery and very high satisfaction with the treatment.

CONCLUSIONS

1. Surgery is a very effective treatment method of trigger finger. 2. It is quite simple procedure and followed by very few complications. 3. It allows to significantly improve hand function and early return to work. 4. It can be performed in the outpatient clinic, which considerably reduces the costs of treatment.

[Evaluation of influewnce of Dupuytryen contracture's operative treatment on increase of quality of hand's function basing on research in use DASH (disability of the arm, shoulder and hand) questionnaire - own experience]

The essence of Dupuytryen's contracture is progressive process of fibrous overgrow of the subfascial sturctures of hand volar's surface. This is the reason of impaired range of the finger movement's and subsequent limitations of their function.

MATERIAL AND METHODS

The study group consist of 95 patients treated because of Dupuytryen contracture in the 2nd Chair of Surgery, Medical College of JagielIonian University between 2006-2011. The subjective evalution of increase of hand's function quality was based on DASH (Disability of the Arm, Shoulder and Hand) questionnaire.

THE AIM OF THE STUDY

The aim of the study was to determinate an influence of Dupuytren contracture's operative treatment on increase of quality of hand's function using the DASH questionnaire.

RESULTS

Average value in DASH before operative treatment was 40.38 points (SD+/-12.53). In postoperative evaluation gradual increase was observed: after 3 month was 33.35 points (SD+/-16.39) and after one year - 32.57 points (SD+/-14.96). Statistically important differences between DASH test's results (P<0.01) were observed. Significantly superior results was before operation, results after 3 month and 1 year were nut statistically important.

CONCLUSIONS

The research with the use of DASH questionnaire revealed the influence of Dupuytren's contracture severity on subjection evaluation of hand's function.

[An attempt to objectify the assessment of extension or recurrence of Dupuytren's disease on the basis of ultrasound]

Dupuytren's contracture is a disease of unknown etiology, leading with time to decreased hand function caused by increasing contracture of fingers. Excision of contracted longitudinal palmar fascia constitutes the most important way of treatment. Due to fact that disease has progressive course in many patients recurrence (i.e. overgrowth of longitudinal palmar aponeurosis apart from the operated site) or extension (i.e. similar process affecting formerly operated site) occurs. An attempt to objectify the assessment of recurrence or extension of Dupuytren's disease on the basis of sonographic examination of palmar surface of the hand during distant (at least 24 months from surgery) followup constituted the aim of the study. 41 patients operated on from January 2000 to February 2009 in 2nd Department of General Surgery in Krakow due to Dupuytren's contracture constituted the study material. Mean age of the patients reached 62,78 years (SD +/- 9,32), and mean follow up time 5,74 years (SD +/- 2,90). Sonographic assessment was performed in 26 operated on left hands and 24 right hands. 9 patients had both hands operated on. In most of the patients during surgery the contralateral hand was also affected by the disease. Extension of Dupuytren's disease was found in 11 hands, recurrence--in 18 hands, while concurrent extension and recurrence was found in 17 hands. Extension usually was found on the radial side and affected mainly I interphalangeal space followed by disease affecting I and III ray of the hand. In one patient 2 independent foci of the disease were found within I interphalangeal space. Recurrences affected mainly ulnar side of the hand: V and IV rays of the hand. Concurrently found extension and recurrence affected 2 or 3 rays. In the cases of 3 rays affected extension dominated (2 rays vs. 1 ray of recurrence). On sonographic assessment mean diameters of lesions during distant follow- up were 12,69 x 4,62 x 3,95 [mm] with recurrent lesions being larger than mean values found in extensions. With partial fasciectomy being the most commonly performed operation in cases of Dupuytren's disease ultrasound can constitute very important technique of assessment of exacerbation of the lesions of palmar aponeurosis allowing for the choice of appropriate surgical technique for particular case, detection of postoperative extension and/or recurrence and for the cases clinically doubtful.

[Evaluation of hand injury severity]

Hand Trauma Severity Scale (HTSS) was created on the basis of our study on 1199 patients who were treated because of the hand injuries in the Second Chair of Surgery Jagiellonian University in Krakow in years 1987-2000. (last examination in 2010, follow-up: 11 to 23 years, mean follow-up: 16 years). Hand Trauma Severity Scale (HTSS) has been created based on We looked at the range of injury, likely total length of treatment, final functional result and possible amount of posttraumatic disability. Created HTSS scale was compared to Hand Injury Severity Score (HISS) and their statistically significant correlation (p < 0,001) was found. We have also found statistically significant correlation between the severity evaluated with HTSS and the circumstances of traumas, their direct cause, necessity of hospitalization after primary reconstructive treatment and total length of treatment. Distant results of treatment such as resuming of previously performed work and permanent posttraumatic disability also correlated with the severity of hand injuries measured with scale described in this study.

[Concomitance of Ledderhose's disease with Dupuytren's contracture. Own experience]

INTRODUCTION

Ledderhose's disease is a rare fibromatosis affecting plantar aponeurosis. Clinical picture and risk factors resemble the ones found in much more common cases of Dupuytren's disease.

MATERIAL AND METHODS

The group of 101 patients with Dupuytren's disease qualified for surgical treatment constituted material for the study. Within that group incidence of Ledderhose's disease was assessed on the basis of clinical and ultrasound examination. Estimation of the presence of risk factors common for both forms of fibromatosis was also evaluated.

RESULTS

Ledderhose's disease was found in 15 patients (14.85%) suffering from Dupuytren's contracture. Bilateral Ledderhose's disease was found in 10 of them. Established risk factors were similar to the ones found in Dupuytren's disease--tobacco and alcohol dominated. Indications for the surgical treatment were limited to the symptomatic cases of the disease. Two feet in 4 patients were operated on. Surgical technique was presented in broad outline. Pain relief on walking and normalization of feet pressure distribution were achieved in all cases.

[Metrological analysis of stabilization material damages in AO treatment method]

The aim of the study was the assessment of the material damages within the AO plates, used in fractures stabilization. Both the fixation material that became fractured and the fixation material removed without essential macroscopic damages were taken into consideration. There were 40 randomly chosen patients in the studied group (20 women and 20 men), who underwent stabilization of the fracture with the use of AO method in Second Department of Surgery of the Jagiellonian University Medical College between 2000-2009, followed by the removal of the fixation material and its metrological analysis. The mean age of patients in the studied group was 38 years. The mean follow-up was 4,3 years (2-11 y.). Complete bone union was achieved in 37 patients after the stabilization. Loosening and fracure of the fixation matierial was observed in 3 patients. Another stabilization surgery was necessary in these cases. After metrological analysis of the fixation material noticeable surface damages were found in 6 patients and damages within the holes in 20 plates, including 3 fractures. Damages of the fixation material were taking place mostly in patients with the femoral bone fractures.

CONCLUSIONS

1) There are two typical damages of the stabilization plates: the surface damage and the damage within the screw holes. 2) Damage and loosening of the plates are mainly caused by its re-modelling and traumatisation during the surgery. 3) No essential surface changes were observed within most of the AO plates and the changes within the screw holes are observed in half of the cases.

Psychologic aspects of Dupuytren's disease: a new scale of subjective well-being of patients

INTRODUCTION

Dupuytren's disease usually appears in middle-age patients and is more prevalent in men than women (2-10 times less often than in men). Dupuytren's disease may accompany diabetes, smoking, alcoholism, HIV, and epilepsy. There is no cure for this disease. The disease causes a remarkable worsening of the quality of life resulting mainly from two factors: reduced physical performance or disability, and disfigurement.

MATERIAL AND METHODS

We studied 38 patients suffering from Dupuytrens's disease. The study was done in 2007-2008 at the Second Department of Surgery of the Jagiellonian University. We used the Dupuytrens disease scale of subjective well being of patients (DDSP) questionnaire covering four areas of the quality of life.

RESULTS

Blue-collar workers experienced more severe problems at work than white-collar workers.

CONCLUSION

There were no differences between location of the disease in left- and right-handed patients.

[Clinical implication of residual mesoaxial polydactyly of the foot--case report]

The aim of our study was to estimate influence of anatomical malformations in foot (characterised by mesoaxial polydactyly) in 26-year old female patient on clinical condition and biomechanical motion. Clinical, radiological and pedobarographic examinations were used in the patient's analysis. The postural pedobarographics examinations revealed persistent disturbances in underfoot pressure distribution despite pain recovered, which has been achieved by discontinued of wearing tight shoes.

Quality of life as a result of multiple injury in the aspect of limitations of handicaps--social roles

Aim of the study was the comparison of quality of life after multiple injury using limitations of handicaps--social roles, ICIDH (World Health Organization). The study group comprised 1259 patients in the years 1989-2003 whose degree of injuries amounted to at least 18 scores in the Injury Severity Scores. Patients were evaluated during a 5 year period. The prospective study in the period to three years (to the end of 2006 year) included 827 (65.9%) patients. The results were compared and statistically analyzed. In the first 5 years--72.5% persons presented limitations on handicaps. In the second 5-years period--48.8% were found to have limitation on social roles and in the third 5-years period 50.3% of people. The most common limitations referred to physical activity--50.5% patients, economic self dependence--49.3% and carrying out of everyday routine--45.7% patients. The highest quality of life improvement and the decrease in the amount of people with limitations on social roles was noted in the second 5-year period and was statistically significant related to the first 5 years. The improvement of quality of life was not significant in the third 5-year period related to second 5-year period. The increase of injuries severity and age was one of the reasons of reduction of positive changes in the last 5-year period.

[Underfoot pressure distribution of female patients with obesity and plantar fasciitis]

OBJECTIVE

Estimation of underfoot pressure distribution of female patients with obesity and bilateral plantar fasciitis.

MATERIAL

45 women aged 58 (SD +/- 9.0) with obesity confirmed by BMI (BMI = 38.2, SD +/- 5.1) and hindfoot-related bilateral pain complaints typical for plantar fasciitis. The control group consisted of 50 women with no obesity and pathologies of motor apparatus found.

METHODS

Clinical and radiological examination and postural pedobarography. The underfoot pressure was determined at defined foot regions according to modified Blomgren classification.

RESULTS

When compared with the control group, patients with obesity had increased pressure within metatarsus, mainly in its lateral part and within anterior part of hindfoot (MT5, MM, LM, T zone). The maximal value of underfoot pressure was 1052 g/cm2 in patients with obesity and 784 g/cm2 in the control group. There were no statistically significant differences found between underfoot pressures and stronger and lesser pain complaints occurring in one patient.

CONCLUSIONS

1) In obese women with bilateral plantar fasciitis increased underfoot pressure mainly in the lateral part of metatarsus and anterior part of hindfoot was revealed. 2) The above changes correlate with feet dysfunction confirmed during the interview and through the physical examination.

[Underfoot pressure distribution of a patient with unilateral ankylosis of talonavicular joint during rheumatoid arthritis--case report]

The aim of our study was to estimate underfoot pressure distribution of a patient with unilateral ankylosis of talonavicular joint during rheumatoid arthritis. The pedobarographic examination during bipedal standing revealed localisation of maximal pressure at the H region on the side opposite of ankylosis and increased underfoot pressure on the T region and decreased on GT, MT1-MT3 and H foot regions on the pathology side. After the end of orthopaedic treatment underfoot, pressure distribution changes persist in spite of pain regression.

[Results of autogenous bone marrow grafting in disorders of bone healing and bone defectives]

The aim of the study constituted a prospective assessment of efficacy of autogenous bone marrow grafting for the treatment of defective bone healing in patients with isolated and multiple injuries. Material comprised 3367 patients that were operated since June 1st 2004 to October 31st 2007 due to long bone fractures. Disorders of bone healing were diagnosed in 32 (0.95%) patients. 9 (28.1%) patients from the study group were treated due to multiple injuries (with severity of injuries assessed to be 33 points according to ISS; on the average 2.9 injured body regions). Multifragmental and comminutive fractures were note in 12 (37.5%), in this group 3 open fractures. The average time interval to achieve bone healing was 4.5 months, but was about twice longer in cases of pseudoarthrosis. The method was not effective in 7 (21.8%) patients. Defective bone healing was predominantly noted in cases of femoral, tibia and radial fractures. Bone marrow grafting proved the most effective in cases of delayed unions and non-infected pseudoarthrosis and non-union.

[Computer simulation of the isolated lesion of tibiofibular an syndesmosis using the finite element method]

The aim of this study was to construct a computed simulation of an isolated lesion of tibiofibular syndesmosis on typical clinical range of value. The analysis was made using the method of finite elements with a simplified plain model of a bone and assuming material of bone and ankle joint as isotropic and homogeneous. The distraction processes were modelled by external generalized forces. The computed programme ANSYS was used. For evaluation obtained was the computed image of changes of anatomy in relation to forces.

[Hand injuries caused by circular saw]

The investigation was carried out on 1199 patients treated for hand injuries in the II Department of Surgery of the Jagiellonian University between years 1987-2000. There were 225 patients injured while working with circular saw. These injuries were much more severe than others (p < 0.001) and patients with these injuries were more often (p < 0.001) admitted to the clinic. The length of total treatment was considerably longer (p < 0.001) and final results--worse than in other patients (p < 0.001)--permanent hand disability was almost three times larger. Disability pension was given to these patients much more frequently than to others (p < 0.001). The main reason of these injuries seems to be the common use of home-made circular saws without any protection devices and non-conformity to fundamental rules of work security. Patients with extensive multitissular hand injuries should be treated in specialistic centers of hand surgery, where the final results can be improved and the total costs of treatment considerably reduced.

[Major hand injuries--their causes and consequences]

To our study we included 1199 patients with hand injuries treated between 1987 and 2000 in II Dept. of Surgery of the Jagiellonian University in Cracow. The severity of the injury was estimated using our four-level, descriptive scale that was convergent to the HISS Campbell's and Kay's score. The most severe injuries (IVO) were found in 95 patients (7.92%) and 74 of them were professionally active. The injuries frequently occurred during operating the mechanical equipment (90%). In most cases these injuries required the stationary treatment after the primary emergency operation and the duration of the hospitalization period was av. 12.6 days. Our results were evaluated in respect to a patient's return to the previous performed profession and also taking into account the permanent hand function impairment basing on Swanson's study. 37 (50%) patients returned to previous professional activity and 37 (50%) patients received the disability pension. The hand function impairment in all patients with the most severe hand injuries was av. 42.9%). We also were taking into account the huge costs of the severe hand injury treatment. Concluding, the severe hand injuries should be treated in the specialist hand surgery centers. Such proceedings allow to minimize the extent of permanent post-injury disability and decrease total costs of treatment.

[Estimation of foot crush injury treatment results--case report]

The aim of the study was to estimate results of a 37-year-old man after foot crush injury treatment. Clinical, radiological and pedobarographic examinations were used in the patient's analysis. The result of therapy was successful.

Emergency medicine in Poland

The article describes the feature of Poland's emergency medicine services system. Pre-hospital emergency medical service (EMS) access, regional differences and the main features of the system are described. EMS personal education and skill level are discussed. The authors offer a critical analysis of the current situation and proposal for the future development of emergency medicine in Poland based on changes in law, organization and education.

Causes and consequences of hand injuries

BACKGROUND

Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment.

METHODS

Between 1987 and 2000, 1199 patients (average age 37.0 years (+/- 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs.

RESULTS

Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (+/- 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%).

CONCLUSIONS

The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses.

[Evaluation of posttraumatic hand impairment]

Long-term follow-up was performed in 1071 patients treated due to hand injuries. Those patients consisted 83.22% of patients treated because of hand injuries from 1987 to 2001 in the 2nd Department of Surgery in Cracow. Objective assessment of posttraumatic hand impairment function was evaluated on the basis of Swansons examination protocol and protocol of identification of persistent posttraumatic hand impairment. A statistically significant correlation in evaluation of hand disability of Swansons examination protocol and protocol of identify persistent posttraumatic hand impairment was found. The protocol of Ministry of Health is a simple and useful method for elevation of the level of hand impairment in epidemiological examination of large populations.

[Therapy of consequences of ankle joint injury in patient with hypermobility--case report]

The aim of the study was to estimate therapy, anatomy and biomechanics of ballet dancer feet. Physical, ultrasonographic and pedobarographic examinations were used for monitoring of the therapy. The complete efficiency of foot biomechanics was received.

[Hand injuries in adolescents]

MATERIAL AND METHODS

Based on the materials of 134 adolescent patients (age 15-19) with hand injuries treated in the II Department of Surgery of the Jagiellonian University between 1987-2000 results of treatment were described. The adolescents constituted 11.8% of all patients treated due to hand injuries.

RESULTS

Home was the most common place of the accident (59 patients - 44.01%), and the most common mechanism of injury was cutting by the glass or another sharp tool (61 patients - 45.52%). The mild and moderate injuries predominated (112 patients - 83.58%). 39 patients (29.10%) were treated after alcohol abuse; unfortunately. 35 patients (26.12%) were hospitalized from 1 to 24 days (av. 7.14 days). Time to obtain complete recovery reached max. 270 days but av. 55.56 days. Various degree of the persistent limitation of the hand function were observed in 65 patients (48.5%). Two of them (1.49%) got the disability pension and 8 (5.77%) had to change former job and activities.

CONCLUSION

The time of the complete cure could be shorter and the extent of persistent post-traumatic impairment of the patients with the heavy hand injuries could be limited if they would be treated in the specialized centers for hand surgery.

[Evaluation of life quality in patients after surgical treatment due to neoplasmatic matastases in bones]

The aim of this study was to evaluate life quality in patients with disseminated neoplasmatic process after surgical treatment of pathological fracture due to metastasis to long bones. The examination group consisted of 33 patients (25 women, 8 men) treated surgically (av. age 67 years). Pathological fracture was revealed in femoral bone in 28 patients (bilateral in one patient) and in humeral bone in 5 patients. In case of femoral bone fracture unipolar arthroplastic of hip joint was used or stable osteosynthesis with the use of intramedullar nail or AO plate; while in case of humeral bone fracture elastic osteosynthesis with Rush nail was used. Survival period in patients after surgical treatment of pathological fracture was 6 months. Life quality in patients after surgical treatment was estimated on the basis of clinical scale. All the patients considered surgical treatment to be the purposeful improvement of the standard of the last months of life. The result of treatment presented in the scale of clinical assessment, turned out satisfactory in the examined grouped; the result was considered satisfactory in movement range of the operated limb, muscular strength and capacity of walking. The result of the evaluation of self-service capacity was estimated as more than satisfactory. In conclusion, the main advantage of surgical therapy in patients with neoplasmatic metastases into long bones is the decrease of pain and the improvement of self-service, even in the cases of serious degree of neoplasmatic process. Surgical treatment in those patients should ensure a fast comeback to possibly maximal functionality of the limb.

[Underfoot pressure distribution of a patient after fracture of the calcaneal bone and bilateral hallux amputation--case report]

The aim of our study was to estimate underfoot pressure distribution of a patient after bilateral hallux amputation and the unilateral calcaneal bone fracture on the left side at the end of orthopaedic end rehabilitation treatment. The pedobarographic examination during bipedal standing revealed localisation of maximal pressure at H region on the side of fracture and on MT1 and H foot regions on the other side. After the and of orthopaedic treatment underfoot pressure distribution changes persists in spite of pain regression.

[Posttraumatic hand impairment]

1287 patients were treated due to hand injuries from 1987 to 2001 in the 2nd Department of Surgery in Cracow. Long-term follow-up was performed in 1071 patients (83.22%). Objective assessment of function was evaluated on the basis of Swansons examination protocol. Long-term follow-up examinations of 626 patients (58.45%) demonstrates different level of persistent hand disability. The level of hand impairment ranged between 1-100% with the average of 13.6%. This study demonstrates a statistically significant correlation (p < 0.001) between severity of injuries, place of accident, mechanism of injuries and severity of hand impairment. The most severe injuries and disability were caused by mechanical equipment and were incurred by farmers and workers in the place of employment. The level of hand impairment were determined on the basis of the patient's ability to return to previous work. This study demonstrated a statistically significant association (p < 0.001) between the increasing posttraumatic hand impairment and decreasing probability of returning to pre-injury profession. Concluding, severe hand injuries should be treated in the specialist hand surgery centers. Such proceedings allow to minimize the extend of the permanent post-injury disability and increase of better results of the treatment.

[Bone and joint decade--"mile step" in diagnostics and treatment of movement system diseases?]

Musculoskeletal disorders affect hundreds of millions of people across the world and are the most common causes of severe long-term pain and physical disability. The impact from such disorders on the individual and on society let to propose by WHO for the Decade of the Bone and Joint from 2000 to 2010. The goal of the Decade is to improve the health-related quality of life for people with musculoskeletal disorders throughout the world and this could be achieved by raising awareness of the growing burden of bone and joint diseases on society, promoting prevention and treatment and advancing understanding of musculoskeletal disorders through research. The main fields of interest during the Decade are joint diseases, spinal disorders and low back pain, osteoporosis and severe trauma of the extremities. In our Department we study problems concerning on traumatology of old patients, multitrauma injury, biomechanics in spinal disorders, in degenerative joint disease and foot diseases. Apart from contemporary imaging methods like US or CT we use pedobarographic diagnostics and fotogrammetric examination. In this study we present strategic goals and the summary of our ongoing projects in our Department related to the goals of the Bone and Joint Decade.

[Developments of the bone and joint decade in the area of emergency medicine activity]

Emergency medicine in our country is still a new medical discipline, which is develope in spite of objective connected difficulties with generally well-known problems of medical service in Poland. Essential part of patients treated on the field of activity of rescue--medicine are victims with injuries of osteoarticular system. According to many authors determine they to 40% patients provided in pre-hospital care time. Development of Polish emergency medicine happens on period of Decade of the Bone and Joint, declared by the World Health Organization on years 2000-2010. Consequences of bones and joints injuries are the reason protracted pain complaints and physical disability of gigantic number of patients. The goal of the Decade are among other things, activities aiming to improvement of efficiency of osteoarticular system injuries on place of event and in emergency medicine departments, in accordance to accepted procedures. It is an extremely essential meaning for patient's future and of final results of treatment, and a quality of life of these people. In Clinic of Emergency Medicine and Multiple Injuries in relationship to Decade of the Bone and Joint we investigate problems concerning diagnostics procedures and initial medical management of isolated osteoarticular injuries, and coexisted with injuries of other body regions. In this study we present management strategy of osteoarticular injuries in emergency medicine in aspect of goals realization of the Decade of the Bone and Joint.

[Application of descriptive scale to the assessment of post-traumatic hand function limitation]

Hand Injury Impairment Scale (HIIS) serving to assess hand post-traumatic limitation was described on the basis of Injury Impairment Scale (IIS). HIIS was used to estimate long-term follow-up of 1073 patients treated in the II Department of Surgery of the Jagiellonian University between 1987-2001. Correlation (p < 0.001) was proved between hand injury severity, value of HIIS, grade of persistent disability and the assessment of hands' usefulness in performing daily activities on the basis of Hand Disability Score (HDS) questionnaire described above. The HIIS can be used for general estimation of hand post-traumatic impairment.

Alcohol-related hand injuries

The study was based on 1199 patients consecutively treated for hand injuries in the Second Department of Surgery of the Jagiellonian University in Krakow between the years 1987 and 2000. Three hundred and twenty of these patients (26.6%) had consumed alcohol several hours before an accident. Data collected from an interview with the patient and a doctor on duty were used in the study. Routine tests for blood alcohol concentration were not carried out. Young men (89.3%), mostly manual workers (74.3%) (p<0.001), constituted the majority of patients in the alcohol group. They were younger on average (p<0.001) than sober patients. In most cases, the accident had happened at home (65.9%) (p<0.001) and the main cause of injury was a cut with glass (p<0.001). Despite only minor injuries they were treated in hospital due to their state of intoxication. The degree of hand disability was higher (p<0.05) than with sober patients. The average cost of treatment in a state of intoxication was more than twice as high as the cost of treatment in sober patients. Alcohol-related hand injuries present a major medical and socioeconomic problem.

[Pelvic fractures coexistent with multiple trauma--own diagnostic and therapeutic algorithm]

Pelvic fractures determine one from greatest diagnostic and therapeutic problems in complex of multiple injures. Pelvic fractures observes one-self at 20-30% patients with multiple injures of the body. These injuries are attended for prognostic factor of severity status in this to group of patients. Using at presence diagnostic and therapeutic methods appear continually insufficient. Testifies about this high mortality in these patients. Aim of study was presentation of own manner of diagnostic and therapeutic treatment at patients with pelvic fractures coexisting with multiple injuries, and confirmation of legitimacy early reposition of pelvic fracture and external stabilisation. Investigated group of patients embraced 201 ill with multiple injuries of the body attended in years 1999-2003. Pelvic fractures were recognised at 42 (20.9%) patients. Severity of injury according to Injury Severity Score carried out 54 points. Immediate closed reposition under X-ray inspection and anterior external stabilisation executed at 12 (28.5%) most heavy patients. In this group 5 (41.6%) of the patients survived. Diagnostics and treatment one passed according to settled by authors of algorithms in which one important criterium of conduct was state stability of the circulatory system. One turned also attention on necessity wider usages of angiographic investigations of pelvic blood vessels and their immobilisation. One acknowledged that conduct according to worked out algorithms arranges and makes easy process of diagnosis and treatments. One confirmed advantages early closed reposition of pelvic fractures and their external stabilisation at unstable patients, as intervention saving life.

[Evaluation of posttraumatic hand function in everyday activities]

The original Hand Disability Score (HDS) questionnaire which subjectively evaluates the quality of hand function in 25 one- and two-handed daily living activities was developed. The strict correlation (p < 0.001) between HDS and both severity of injury and objectively measured hand impairment was confirmed. The HDS may be used as a single estimation of hand function after treatment or as an evaluation of the progress of rehabilitation procedures.

[Occupational hand injuries]

BACKGROUND

Hand injuries are the most frequent bodily traumas sustained at work. The aim of the study was to assess hand injuries and the results of their treatment in a group of our patients.

MATERIALS AND METHODS

The study covered 275 patients with occupational hand injuries treated in the II Department of Surgery, Collegium Medicum, Jagiellonian University, Kraków, during the years 1987-2000. The injury severity was estimated according to our own injury severity scale and the degree of hand disability according to the norms for certifying permanent posttraumatic disability issued by the Ministry of Health. The control group comprised 924 patients with non-occupational hand injuries treated in our Department in the same period.

RESULTS

The study revealed that occupational hand injuries were more severe than those sustained in other conditions, their treatment was longer and posttraumatic disability more severe.

CONCLUSIONS

More severe occupation-related injuries should be treated in hand surgery specialized centers.

[Hand injuries in elderly patients]

We studied 1199 patients treated in II Department of Surgery in Cracow between 1987 and 2000. In the studied group, 138 patients were aged over 60 years. In most cases the injury took place at home (43.68%) and more often than not they occurred during operating mechanical equipment (52.89%) among which circular saw predominated (35.51%). It was revealed that the hand injuries of senior patients were more severe compared with the other patients and the permanent post-injury disability was more intense. The elderly patients with multi-tissue hand injuries should be treated in specialist centers. It is also essential to start as soon as possible the therapeutic rehabilitation (even during surgical treatment). Only such proceedings enable better final results of treatment.