Nonunion of ulnar diaphysis after Monteggia fracture of a right forearm in a 55-year-old patient - Are all methods effective? Case report

Fractures of the forearm make up about 10-14% of all fractures. Monteggia lesions account for 1-6% of the forearm fractures. The eponym “Monteggia fracture” is a term used for fracture of ulnar proximal shaft with concomitant dislocation of the radial head in the proximal radioulnar joint [1]. Its clinical symptoms are: pain, edema, local sensitivity, friction between bone fragments, deformation of the limb, loss of function in elbow joint and the forearm. Radiographs in AP and lateral views of the entire forearm, with wrist and elbow joint, are mandatory for successful diagnosis [2]. There are four types of fractures in the Bado classification system of the Monteggia lesion [3]. All Monteggia fractures in adults require surgical procedure of open reduction and internal fixation as a method of choice [4]. Delayed bone adhesion, nonunion, synostosis, instability of the radial head, nerve damage and restriction of movement are main complications of surgical intervention. We present a case of a 55-year-old patient with Monteggia fracture of a right forearm with a complication of a nonunion of the ulnar shaft, despite undergoing surgical procedure of open reduction and internal fixation. We describe consecutive methods of treatment that resulted in complete bone adhesion. Nonunion typically occurs due to technical mistakes in initial surgical intervention. Application of the correct reparative technique with autogenous bone graft and compression plates allows to fully heal nonunion of the bone

Early, posttraumatic, frontal instability of the knee joint deriving from injured medial collateral ligament, after total knee arthroplasty, complicated by wound dehiscence and Clostridium difficile infection in a 70-year-old patient

Gonarthrosis is a joint disease in which a balance between regenerative and degenerative processes of articular cartilage is impaired. Its main symptoms are: pain, swelling, rigidity, function restraint as well as articular deformation [1]. It is estimated that about 40% of the knee joint degeneration is a consequence of ageing of the body. 60% of remaining cases of gonarthrosis is a result of excessive strain, contusion and injury. Patients with advanced arthrosis are qualified for total arthroplasty of the knee. Medial collateral ligament (MCL) is responsible for the medial stability of the knee joint, it prevents from valgus deformity and restraints external rotation of tibia relative to the femur. Injury, most often distorting the knee, may lead to straining as well as complete rupture of the MCL [2,3]. We present a case of a 70-year-old patient with MCL injury that happened three weeks after total knee arthroplasty, complicated by wound dehiscence. Insufficiency of the medial collateral ligament in our patient had an effect in longer healing process and rehabilitation. Main treatment options are: revision surgery with use of constrained implants and injured medial collateral ligament reconstruction. Constrained implants may have reduced longevity in some patients through aseptic loosening. Our patient underwent a MCL reconstruction. Reconstruction of MCL without revision arthroplasty has good results for injured MCL after total arthroplasty of the knee

Pilon fracture of the tibia with severe complications in a 42-year-old patient – case report.

Pilon type fractures of the distal tibia are among the most difficult injuries of the lower extremity. They occur due to the axial loading injury which drives the talus into the tibial plafond, mainly because of high energy traumas such as car accidents and falls, but may arise from low energy traumas also. Due to specific conditions in the area of the injury: where skin and subcutaneous tissue is delicate, soft tissues are usually severely damaged, it is crucial to choose the correct timing for surgical intervention. There are several surgical options regarding treatment of the pilon fractures, however treatment plan of pilon fractures has not yet been unified. Surgical methods include open reduction with internal fixation and external fixation. Main purpose of the treatment of pilon fractures are the preservation of length and restoration of the joint surfaces. Great risks for the successful treatment are skin and soft tissue infections, that occur quite commonly due to specific anatomy of the fractured area. Wound infection may have potentially catastrophic consequences. Here we present a case of our 42-year-old patient, with a pilon fracture of the tibia who suffered multiple complications due to obtained tauma as well as his concurrent diseases: diabetes, alcohol and nicotine abuse, also as a result of his lack of compliance with medical advice. Despite the complications that occurred, outcome of the overall treatment was satisfactory both to the patient as well as orthopedic team. This example shows that treatment method should be chosen wisely not only on the type of the fracture, but also with patient’s ability to comply with doctors’ recommendation

Assessment of the Impact of Physical Activity on the Musculoskeletal System in Early Degenerative Knee Joint Lesions in an Animal Model

Osteoarthritis (OA) is one of the most prevalent diseases of the osteoarticular system. Progressive destruction of joints is accompanied by development of pathological changes in the muscle tissue, i.e., weakening, atrophy, and remodelling (sarcopenia). The aim of the present study is to assess the impact of physical activity on the musculoskeletal system in an animal model of early degenerative lesions in the knee joint. The study involved 30 male Wistar rats. The animals were allocated to three subgroups of 10 animals each. Each animal from the three subgroups received sodium iodoacetate by injection into the patellar ligament of the right knee joint, whereas saline was administered through the patellar ligament in the left knee joint. The rats in the first group were stimulated to exercise on a treadmill. The animals in the second group were allowed to lead a natural lifestyle (no treadmill stimulation). In the third group, all parts of the right hind limb muscle were injected with Clostridium botulinum toxin type A. The study demonstrated that, compared to the active rats, bone density in the immobilised rats decreased, as indicated by the densitometric assessment of the whole body and the examination of rats’ hind limbs and knee joints alone. This clearly evidenced the impact of physical activity on bone mineralisation. The weight of both fat and muscle tissues in the physically inactive rats was reduced. Additionally, the adipose tissue had higher weight in the entire right hind limbs, where monoiodoacetic acid was administered to the knee joint. The animal model clearly showed the importance of physical activity in the early stages of OA, as it slows down the process of joint destruction, bone atrophy, and muscle wasting, whereas physical inactivity contributes to progression of generalised changes in the musculoskeletal system

The effect of maternal HMB supplementation on bone mechanical and geometrical properties, as well as histomorphometry and immunolocalization of VEGF, TIMP2, MMP13, BMP2 in the bone and cartilage tissue of the humerus of their newborn piglets.

The presented experiment focuses on assessing the impact of HMB (hydroxy-β-methobutyrate) supplementation of mothers during pregnancy on the development of the skeletal system of their offspring. For this purpose, an experiment was carried out on 12 clinically healthy sows of the Great White Poland breed, which were divided randomly into two groups the control and the HMB group. All animals were kept under standard conditions and received the same feed for pregnant females. In contrast, females from the HMB group between 70 and 90 days were supplemented with 3-hydroxy-3-methylbutyle in the amount of 0.2g/kg b.w/day. Immediately after birth, the piglets were also divided into groups based on: sex, and presence or lack HMB supplementation, and subsequently were euthanized and humerus bones from all piglets were collected. Mother's HMB supplementation during pregnancy affected the multiple index of their offspring. The higher humerus mass and length was observed with the greater effect in males. Maternal supplementation also influenced on the geometrical and mechanical properties of the humerus as in the case of mass, this effect was higher in males. Also, the collagen structure of the compacted and trabecular bone changed under the HMB addition. Maternal supplementation also affected the expression of selected proteins in growth cartilage and trabecular bone. The obtained results show that the administration to the mother during pregnancy by the HMB significantly affects the development of the humerus in many ways. The obtained results also confirm the utility of such experiments in understanding of the importance of the pregnancy diet as an develop and adaptable factor of offspring organisms and are the base for further research in that area as well as in the protein markers expression area

Structural Changes in Trabecular Bone, Cortical Bone and Hyaline Cartilage as Well as Disturbances in Bone Metabolism and Mineralization in an Animal Model of Secondary Osteoporosis in Clostridium perfringens Infection

There is no information regarding whether changes in the microbiological balance of the gastrointestinal tract as a result of an infection with Clostridium perfringens influence the development of metabolic bone disorders. The experiment was carried out on male broiler chickens divided into two groups: control (n = 10) and experimental (n = 10). The experimental animals were infected with Clostridium perfringens between 17 and 20 days of age. The animals were euthanized at 42 days of age. The structural parameters of the trabecular bone, cortical bone, and hyaline cartilage as well as the mineralization of the bone were determined. The metabolism of the skeletal system was assessed by determining the levels of bone turnover markers, hormones, and minerals in the blood serum. The results confirm that the disturbed composition of the gastrointestinal microflora has an impact on the mineralization and metabolism of bone tissue, leading to the structural changes in cortical bone, trabecular bone, and hyaline cartilage. On the basis of the obtained results, it can be concluded that changes in the microenvironment of the gastrointestinal tract by infection with C. perfringens may have an impact on the earlier development of osteoporosis

Impact of the Body Composition on Knee Osteoarthritis Assessed Using Bioimpedance Analysis

Osteoarthritis (OA) ranks among the most prevalent inflammatory diseases affecting the musculoskeletal system and is a leading cause of disability globally, impacting approximately 250 million individuals. This study aimed to assess the relationship between the severity of knee osteoarthritis (KOA) and body composition in postmenopausal women using bioimpedance analysis (BIA). The study included 58 postmenopausal females who were candidates for total knee arthroplasty. The control group consisted of 25 postmenopausal individuals with no degenerative knee joint changes. The anthropometric analysis encompassed the body mass index (BMI), mid-arm and mid-thigh circumferences (MAC and MTC), and triceps skinfold thickness (TSF). Functional performance was evaluated using the 30 s sit-to-stand test. During the BIA test, electrical parameters such as membrane potential, electrical resistance, capacitive reactance, impedance, and phase angle were measured. Additionally, body composition parameters, including Total Body Water (TBW), Extracellular Water (ECW), Intracellular Water (ICW), Body Cellular Mass (BCM), Extracellular Mass (ECM), Fat-Free Mass (FFM), and Fat Mass (FM), were examined. The study did not find any statistically significant differences in the electrical parameters between the control (0–1 grade on the K–L scale) and study groups (3–4 grade on the K–L scale). However, statistically significant differences were observed in BMI, fat mass (FM), arm circumference, triceps skinfold thickness, and sit-to-stand test results between the analyzed groups. In conclusion, the association between overweight and obesity with KOA in postmenopausal women appears to be primarily related to the level of adipose tissue and its metabolic activity