Andrzej Żyluk and Bernard Piotuch
Treatment of Mallet Finger - A Review
Andrzej Żyluk and Tomasz Budzyński
Conservative vs Operative (Fixation with K-wires) Treatment of Isolated Fractures of Metacarpal Bones — Results of the Prospective, Randomized Study
Hand fractures (phalanges and metacarpals) are very common and they constitute a cause of considerable ambulatory and surgical departments workload. Isolated, undisplaced and displaced but stable fractures are usually treated non-operatively, and classical indication to surgery are unstable, oblique, spiral, intra-articular, open and complex fractures. Results of some studies suggest that oblique, spiral and apparently unstable fractures can be successfully treated conservatively, questioning afore-mentioned indications to surgery
The aim of this prospective and randomized study was to compare the results of conservative versus operative (by fixation with K-wires) treatment of isolated, displaced and extra-articular metacarpal fractures.
Material and methods. Forty-seven patients, 36 male (77%) and 11 female (23%) with a mean age of 34 years (range 16-75), with isolated metacarpal fractures, were randomly allocated to operative, by intramedullary fixation with K-wires (24 patients), or conservative, by reduction and immobilization (23 patients) treatment. Patients were followed-up at 2 and 6 months, and the assessments included measurements of active range of motion of fingers, total grip and pinch strengths, angular deformity on X-rays and subjective hand function with DASH questionnaire.
Results. In one patient (4%) treated conservatively, an unacceptable secondary displacement occurred, and he was withdrawn from the study. and given surgical treatment. All fractures consolidated. At 2 months assessment, no statistically significant differences between the variables in the operative and conservative treatment groups were noted, except of the angular deformity on X-rays, which was significantly greater after conservative than operative treatment (median 31° vs 9°). At 6 months assessment, an active range of motion of involved fingers was statistically significantly greater in operative, than in conservative treatment group (median 269° vs 250°) and the angular deformity was significantly lesser after operative than conservative treatment (median 24° vs 12°). There were no statistically significant differences between the groups with regard other analysed parameters. None healing disturbances and malrotations were noted.
Conclusions. The results of this study indicate the equal effectiveness of both the operative by K-wiring, and conservative treatment of fractures of the metacarpals. The better anatomical outcomes in terms of the degree of angular deformity did not translate directly into the better function of the hand.
Andrzej Żyluk and Grzegorz Jagielski
Results of the Treatment of Trigger Finger - A Review
Andrzej Żyluk and Paweł Ostrowski
An Analysis of Factors Influencing Accuracy of the Diagnosis of Acute Appendicitis
The aim of the study was to "refresh" the knowledge about the course of acute appendicitis, to confront the classical clinical picture with the practice, analyze its fluctuations and identify factors influencing these.
Material and methods. All patients admitted to the Department of General Surgery in Grudziądz District Hospital with the suspicion of acute appendicitis, who underwent appendectomy and in whom the appendicitis was confirmed in pathologic examination were included in the study. There were 85 patients, 49 men (58%) and 36 women (42%) in a mean age of 30 years (range 10-75). Symptoms, signs and results of biochemical tests (leukocyte rate and CRP) were considered in the analysis.
Results. The commonest constellation of symptoms and signs, occurring in at least of 3/4 patients consisted of pain and tenderness localized in right lower quadrant (100%), which exacerbates at movements (98%), felling unwell (93%), loss of appetite (88%), and rebound tenderness in right lower quadrant (74%).
Conclusions. No particular fluctuation of clinical features in relation to gender, age, duration of symptoms, biochemical parameters and morphological severity of the inflammation was observed. Relevant findings included relatively fast development (<12 hrs) of advanced appendicitis in 18% of adult patients and more than a half patients with normal body temperature, regardless true appendicitis.
Andrzej Żyluk and Paweł Ostrowski
Diagnosing of Acute Appendicitis - A Review
Leszek Loroch and Andrzej Żyluk
New Technologies for Air Traffic Security
Security of increasing intensity of air traffic requires significant technological support. In Europe, the dynamics of this phenomenon will be additionally stimulated by implementation of unmanned aerial vehicles (UAVs) into the air traffic. For effective operation of aircraft fleet it is necessary to employ new on-board diagnostic devices and flight recorders in order to evaluate technical condition of aircraft's instrumentation. Reducing the pilots' workload requires the development of new integrated digital avionics. On the other hand, in order to make the air traffic more secure, it is necessary to develop "sense and avoid" systems not only for UAVs, but for piloted aircraft, as well. On-ground support requires the effective airport/airfield protection and keeping airfield pavements well-maintained and safe.
Andrzej Żyluk and Ireneusz Walaszek
Traumatic Rupture of Massively Enlarged Spleen in Patient with Malignant Lymphoma and Thrombocytopenia - A Case Report
Traumatic ruptures of enlarged spleen in the course of haematological conditions are very rare. A case of 51-years old male suffering from a low-grade malignancy non-Hodgin lymphoma, who sustained a rupture of his massively enlarged spleen as a result of blunt trauma of the left side of abdomen and chest is reported. The patient attended to the hospital three days after trauma because of abdominal pain and weakness. Investigations revealed parenchymal laceration of massively enlarged spleen, heamoperitoneum, moderate anaemia and thrombocytopenia 48 G/l. Laparotomy was performed the next day after admission, after preparing packed red blood cells and packed platelets. Massively enlarged, 2.6 kg weight, ruptured spleen was removed and post-operative course was uneventful. Authors consider a reasonable the decision on delayed operation, when no signs of active intra-abdominal bleeding were observed. It allowed to prepare optimal conditions for potentially difficult splenectomy.
Andrzej Żyluk and Ireneusz Walaszek
Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius
Misdiagnosis or failed treatment of scaphoid fractures are frequently (25-45%) followed by disrupted healing and nonunion. This may reduce the wrist's capacity for occupational and daily use and, over time, lead to wrist arthrosis. Therefore, surgery is recommended even in asymptomatic nonunions of the scaphoid; the goal of this treatment is to achieve bone union and stability of the wrist.
The aim of the study was to evaluate the results of operative management of scaphoid nonunion by vascularized bone grafting from the distal radius.
Material and methods. Eleven patients, nine men and two women of a mean age of 29 (range 19-45 years) with scaphoid nonunion lasting a mean of 10 months (range 8-20) were recruited. The nonunion was localized in the waist of the scaphoid in seven patients and in proximal 1/3 in four patients. Operations were performed using cancellous bone grafts taken from the distal radius and supplied by the intercompartmental branch of the radial artery. Fracture fixation was accomplished with K-wires or headless canullated screws. The follow-up assessment at a mean of 10 months included measurements of wrist range of motion, grip strength and Mayo wrist score.
Results. All patients achieved bone union. The mean Mayo wrist score increased from 25 points preoperatively to 75 points at the final assessment, which suggested significant improvement of the hand functions. In a qualitative evaluation, two patients had an excellent result, four had a good result, four had a fair result and one had a poor result. Surgery resulted in significant pain relief and increase in hand strength, but failed to improve wrist range of motion. The modest clinical outcomes do not allow a definitive conclusion to be reached, but the fact that bone union was achieved in all patients with no complications justifies continued use of this technique for the management of scaphoid nonunion.
Bernard Piotuch and Andrzej Żyluk
An Assessment of the Usefulness of Patient Evaluation Measure Questionnaire as an Outcome Measure after Carpal Tunnel Surgery
Outcome assessment of carpal tunnel release has relied upon objective measurements including grip strength and sensory testing as well as subjective parameters such as relief from pain and improvement of hand function. The latter can be obtained by the use of standardized questionnaires.
The aim of the study was to assess the usefulness of Patient Evaluation Measure (PEM) questionnaire as an outcome measure after carpal tunnel surgery.
Material and methods. Fifty patients, 43 women and 7 men with an average age of 55 years with carpal tunnel syndrome received mini-invasive carpal tunnel release. Patients were examined before the operation, and at 1 and 6 months after, according the same protocol. They had measured a total grip and key-pinch strengths and sensation by the filament test. They completed also the PEM questionnaire. The following parameters of the questionnaire were determined: responsiveness, concurrent validity and internal consistency.
Results. Over a half-year follow-up, the sensation improved statistically significantly during the first month after operation. Power of the hand decreased initially comparing to baseline values, following by further gradual increasing throughout the follow-up. PEM scores showed continuous improvement of the hand status at each assessment. The PEM questionnaire showed excellent responsiveness to change of considered parameters, comparing to baseline values. The PEM showed also high concurrent validity with total grip and pinch strengths, as well as with Sensory Index, but only at 6 months assessment. However, the PEM showed a discordance with total grip and key-pinch strength at 1 month assessment. The instrument showed excellent internal consistency.
Conclusion. The PEM questionnaire is, with some exceptions, a good and useful instrument for outcome measurement after carpal tunnel treatment surgery.