Biomedical subjects

M Napiontek

Publications and source records attributed to M Napiontek.

At least 19 recordsLinked to original sources

PubMed2001

Perthes' disease or late avascular necrosis after developmental dislocation of the hip? 10 children followed for 6-35 years.

We studied 10 patients treated because of late avascular necrosis (AVN) mimicking Legg-Calvé-Perthes' disease (LCPD) after developmental dislocation of the hip (DDH). DDH was recognized late at an average age of 5.4 months and in all children it was treated without surgery. In 4 children, the treatment was complicated by mild AVN of the femoral head, which had disappeared before 3 years of age. The first clinical signs of LCPD were noted at a mean age of 5.8 years. They all had Catterall's type III or IV of LCPD. The course was typical of LCPD. 8 children were operated on at mean age of 7.4 (5-12) years. In 7 of them, subtrochanteric derotation-varisation osteotomy of the femur with shortening combined mainly with Dega's pelvic osteotomy was done. The operative treatment resulted in a concentric position of the femoral head and good coverage of the acetabulum. Follow-ups were done at 10 (6-35) years. Shortened femoral neck and trochanteric overgrowth occurred in 4 operated hips. According to the Stulberg classification, 2 hips were classified as type I, 1 as I/II, 5 as II/I as II/III and 1 as IV. We conclude that LCPD mimicking late AVN can occur in hips treated because of developmental dislocation.

Age Factors↗

PubMed2001

[Principles of choice of primary operative techniques for congenital clubfoot].

Review article. A definition of the congenital clubfoot as the rotational and torsional disorder in the sagittal, coronal and horizontal plane was described. The method of choice of the operative technique on the basis of clinical and radiographic parameters was presented. It was found that the primary technique used for surgical clubfoot correction is chosen from a set of different procedures, ranging from posterior release to complete subtalar release. The technique can be extended and modified during surgery.

Choice Behavior↗

PubMed2001

[Evaluation of treatment outcome in congenital clubfoot by subtalar release].

This paper presents an analysis of the results of congenital clubfoot treatment by partial or complete subtalar release performed through the Cincinnati approach. Of 116 patients (142 feet) who underwent surgery in the years 1995-1996, 33 (47 feet) came in for final follow-up. The type of primary deformity was defined in only in 36 feet. There were 25 type II deformity and 1 type III deformity. Total subtalar release was performed in 39 feet. Partial subtalar release was performed in 8 feet. During the release procedure, the calcaneo-cuboid joint was not opened, but stabilized with a K-wire. Clinical results were assessed according to the Magone classification. Radiological results were assessed according to the modified criteria of Scientific Committee of the XXI Meeting of the Polish Orthopedic Society held in 1976. Talo-navicular reposition was assessed according to Napiontek. Follow-up time ranged from 40 to 54 months (mean: 48 months). The clinical assessment revealed that the analyzed group as a whole gave 82.2 points (yielding a good result). Very good results were noted in 12 feet (25%), good results in 21 (45%), satisfactory results in 7 (15%) and poor results in 7 (15%). Analysis of radiological results yielded on average 2.5 points (0-7 points). Good results were noted in 45 feet (96%) and satisfactory in 2 feet. A talo-calcaneal index of less than 55 degrees was noted in 23 feet.

Child↗

PubMed2001

[Lengthening of the IV metatarsal in the treatment of the shortened toe of the foot].

The author presents the results of surgical treatment of congenital shortening of the IV metatarsal in 3 girls. In 2 cases the defect was bilateral. A total of 5 feet were operated on the age of the patients at time of operation ranged from 10 years and 1 months to 16 years and 11 months. A one-stage procedure with the use of a Pumed mini-distraction device was performed. The fissure between the bone fragments was augmented with a bone graft from the fibula. It was harvested in such a way as to maintain internal cortical integrity. K-wire fixation of the bony fragments was applied for 7 weeks. Immobilization by means of a plaster cast was applied for 6 to 8 weeks. Follow-up ranged from 7 months to 3 years. In all cases an improvement of the finger shape and it's lengthening was noted, although in 2 cases lengthening wasn't complete. In one case it resulted from an axial deformity of the IV metatarsal, a sequel of early (5 weeks) removal of the K-wire.

Adolescent↗

PubMed2000

Muscular strength after extensive operative treatment of congenital talipes equinovarus.

Maximum isometric voluntary contraction (MIVC) strength of muscles (extensors, plantar flexors, pronators and supinators of the foot) in children with congenital talipes equinovarus who underwent extensive operative treatment was evaluated. The first group consisted of 28 children (50 clubfeet) operated on with posteromedial-lateral release aged 7 months to 76 months (mean, 22 months), with mean follow-up period of 85 months. The second group consisted of 32 children (39 clubfeet) operated on with complete subtalar release from Cincinnati incision aged from 3 months to 50 months (mean, 11 months), with mean follow-up period of 51 months. In both groups, the muscles moving the foot in the sagittal and coronal plane showed a decreased MIVC. The greatest deficit was observed in the supinators and extensors, less in the pronators and plantar flexors. Better results were accompanied by greater MIVC, but significant relations existed in the first group between the strength of the extensors and the quality of results (better results correlated with better MIVC of the extensors). No significant differences between both patient groups were noted. For the plantar flexors, the difference of the MIVC strength between the normal and affected feet is stable; instead, for the extensors, supinators and pronators, it increases in the analyzed age interval.

Ankle Joint↗

PubMed2000

[Inter-observer variation of the Caterall and Herring classification in Perthes disease].

The reliability of the Caterall and the Herring classifications (inter-observer study) was compared using radiographs of 63 hips in 58 patients. The radiographs were reviewed by three independent observers with various clinical experience. The results were analyzed using kappa statistics and the percentage of inter-observer agreement. The less experienced observers seemed to be more prone to classify the hips as more affected than they actually were. They also seemed to produce a higher agreement rate. Disagreement was most common in the Caterall groups II and III. The Herring classification appears to be more reliable, also in children older than six, which perhaps makes it more useful in deciding between conservative or operative treatment.

Child↗

PubMed2000

[Problems, obstacles and complications of femoral lengthening with the use of the Italian modification of the Ilizarov device].

The results of femoral lengthening using the Italian modification of the Ilizarov are presented. Mean age of the patients was 14 years (ranging from 7 to 29). The most frequent etiology of limb shortening was femoral hypoplasia (7 patients) and sequelae of septic arthritis of the hip and/or the knee (6 patients). Indications for surgical treatment were limb shortening from 3 to 12 cm (mean 6.5 cm), along with axial deviation ranging from 10 degrees to 40 degrees in 6 patients. Mean follow-up time was 15 months (ranging from 6 to 35 months). The Ilizarov apparatus was based on two distal rings, stabilized by "K" wires, and proximally by a ring connected with an Italian femoral arch, stabilized by a Schanz screw. Planned lengthening (ranging from 3.5 cm to 12 cm) was achieved in all treated patients. The healing index ranged from 0.8 to 2.1 month/cm (mean 1.4). Problems, obstacles and complications were analyzed according to the Paley classification. In all 16 patients without primary knee stabilization, limited knee flexion ranging from 5 degrees to 90 degrees (mean 40 degrees) was noted during the distraction phase, which didn't improve significantly during the consolidation phase. Knee flexion improved to a mean 90 degrees after a 6 month follow-up. Bone regenerate defects (cysts, narrowing) were noted in 4 patients. Secondary knee stabilization was performed in 2 cases. In the first case because of knee pain and a severe limitation of knee motion. In the second, during a revision procedure because of distal femur angulation. Premature consolidation was noted in one patient and was treated by osteotomy. In one case axial deviation during the consolidation phase required osteotomy. In another case a fracture of the femur was treated by a plaster cast. In one case 1.5 years after the lengthening procedure subluxation of the hip was noted. Permanent knee flexion limitation to less than 90 degrees was noted in 6 patients. Femoral lengthening with the use of the Italian modification of the Ilizarov device give a high incidence of knee range of motion limitation, which can be decreased by preserving more than 30 degrees knee flexion during the distraction phase.

Adolescent↗

PubMed2000

[Rehabilitation principles following treatment with the Ilizarov method of the lower extremities].

The paper presents the rehabilitation principles of patients treated by the Ilizarov method. Based on different disease etiology, site and age of the patient, different rehabilitation algorithms are presented. A way of management and rehabilitation of patients treated with the Ilizarov method worked out at the Department of Pediatric Orthopedics at of the K. Marcinkowski University of Medical Sciences of Poznan is also described.

Adolescent↗

PubMed1998

Hamstring shortening: postural defect or congenital contracture.

The clinical appearance of hamstring shortening in 10 patients referred with diagnosis of asymmetry of the trunk, scoliosis, postural defect, strange gait, and back pain is reported. Additionally, an assessment of knee extension deficit (KED) angle in 575 healthy children (4-15 years of age) was performed. The mean KED angle in the group of healthy children was 35 degrees (SD = 14 degrees). The border between norm and disease was defined as a mean + 2 SD and equaled 63 degrees. A KED angle greater than 60 degrees occurred in 10% of normal children. There was no correlation between age and a value of KED angle. In the study group, KED angle greater than 40 degrees was more frequent in boys. A correlation between disorders within musculoskeletal system and greater KED angle was found. These disorders were more frequent in children with asymmetrical KED angle. In our opinion, the border value of the KED angle is not a good differentiating factor between hamstring shortening and contracture because it does not explain the cause of the disorder.

Adolescent↗

PubMed1996

Transposed skin graft for wound closure after Cincinnati incision. Experience in 7 patients with severe foot deformities.

I report a technique of wound closure by a transposed skin graft after operative treatment of foot deformities, using a Cincinnati incision. Three-dimensional correction of severe foot deformities (congenital talipes equinovarus, congenital vertical talus, etc.) results in skin excess on one side of the foot and lack of this on the opposite side. The skin excess can be cut out and used as a full-thickness skin graft for wound closure on the opposite side of the foot.

Child, Preschool↗

PubMed1996

[Treatment of slipped capital femoral epiphysis with one-time head-neck transfixation and subtrochanteric corrective osteotomy].

Results of treatment for slipped capital epiphysis with one-time head-neck transfiction and subtrochanteric corrective osteotomy in 21 patients (21 hips) operated at Institute of Orthopaedics and Rehabilitation in Poznań between 1973 and 1991 have been presented. Indication for this type of operation was acute-on-chronic slip and magnitude of epiphyseal slip not less than 1/3 of neck width. The follow-up ranged from 4 to 21 years (mean 11y). Using Hall and Southwick criteria modified by Szypryt results in 7 cases were rated excellent, good in 10, fair in 1 and poor in 3 cases. Radiologically 3 cases were excellent, 6 were good, 7 fair and 5 cases were rated poor. Aseptic necrosis of the femoral head occurred in 1 case, chondrolysis in 2 and superficial infection in 1 case. The method proved to be safe in treatment for slipped capital femoral epiphysis.

Adolescent↗

PubMed1995

Intraoperative ultrasound for evaluation of reduction in congenital talipes equinovarus.

A technique of intraoperative ultrasound for evaluation of reduction in congenital talipes equinovarus (CTEV) is reported. Ultrasound (US) scanning enables the surgeon to perform controlled reduction of both calcaneocuboid and talonavicular joint during the operation because visualization of the relation in the medial and lateral column of the foot is as precise as that obtained with radiographs. The relation between talus and calcaneus in the horizontal plane cannot be visualized. Examination is quick and simple but is more easily performed if the shape of the foot is near-normal; i.e., the foot has been well prepared for operation by nonoperative treatment.

Clubfoot↗

PubMed1995

Congenital vertical talus: a retrospective and critical review of 32 feet operated on by peritalar reduction.

Thirty-two feet in 23 children treated for congenital vertical talus by peritalar reduction have been evaluated. The age at operation ranged from 9 months to 8 years (mean 3.2 years). The follow-up ranged from 2.8 to 19.1 years (mean 9.2 years). In eight feet Green-Grice extraarticular subtalar arthrodesis was performed as part of a one-stage procedure. Eight of all operated feet required a second surgery 2.2 years after the first operation. In all the reoperated feet the Green-Grice arthrodesis was performed as well. Clinical examination found excellent results in five feet, good results in 12, fair results in nine, and poor results in six feet. The severe type of deformity, other abnormalities, and less extensive surgical procedures contributed to worse clinical results. Poor clinical results were associated with persistent equinus of the hindfoot, abduction of the forefoot, restriction of supination and eversion, and weakness of push-off power. X-ray examination showed excellent results in three feet, good in nine, fair in 13, and poor in seven feet. Poor radiological results were observed in children operated on after the fourth year of age. In most of the feet the navicular remained dislocated dorsally, dorsally and medially, and dorsally and laterally toward the head of the talus. A divergence between a relatively good appearance of the operated foot and a worse radiographic image has been observed. The Green-Grice extraarticular subtalar arthrodesis combined with the peritalar reduction method led to overcorrection in seven feet.

Child↗

PubMed1995

[Strength of leg and foot muscles after surgical treatment for clubfoot].

In 50 congenital clubfeet (in 28 children aged 62-126 months) operated on with subtalar release from dorsolateral and posteromedial approach isometric strength of flexors, extensors, pronators and supinators was assessed with tensometry. All the muscular groups showed decreased momentum if compared to normal foot. The smallest deficit was observed in plantar flexors. Better results were accompanied by greater muscular strength, but statistically significant relation existed between strength of dorsal flexors and the quality of result. Postoperative calcaneus position did not influence the strength of dorsal or plantar flexors of the foot. Additional lengthening of FHL and FDL decreased the strength of plantar flexion.

Biomechanical Phenomena↗

PubMed1994

[Multilevel osteotomy with Rush pin fixation in treatment of osteogenesis imperfecta].

Fourteen multilevel osteotomies with Rush pin fixation have been performed in 5 children with osteogenesis imperfecta. The age of patients at the operation ranged from 6.5 to 15.5 years. Plaster of Paris immobilization never exceeded 8 weeks. An axial correction, improved ambulating and equalization of the limbs have been achieved in all cases. Complications of the method included varus deformity of the proximal tibia (1 case), migration of the pin (1 case) and supracondylar fracture of the femur at the level of pin end (2 cases).

Adolescent↗

PubMed1994

[Skew foot--etiology, clinical appearance, management].

Thirty feet in 18 children diagnosed as skew foot (Z-foot, serpentine foot) have been assessed. Following types of deformity have been distinguished: 1. idiopathic congenital (21 feet), 2. congenital, associated with other defects or systemic disease (8 feet), 3. acquired (iatrogenic) after manipulations for club foot treatment (1 foot) and 4. neurogenic, not represented in this study. In the first group minor forefoot adduction that remained after cast treatment was generally accepted by the parents; 7 feet required surgical release. Eight feet were corrected operatively in group 2. In most of the cases palliative procedures were performed due to late turning for surgery of children with systemic disease. In case of type 3 deformity termination of manipulations spontaneously led to the restoration of anatomy in the Chopart joint. According to the authors, surgery, preferably in the first year of life, offers full possibility to regain anatomy and shape of the foot.

Adolescent↗

PubMed1994

[Osteotomy of the medial cuneiform in the treatment of the adducted forefoot].

A series of 20 feet in 17 children (12 females, 5 males) treated surgically with medial cuneiform osteotomy and bony bloc insertion to correct forefoot adduction has been assessed. Primary diagnosis were: congenital clubfoot (17 feet), skewfoot (2 feet) and congenital fibular aplasia (1 foot). The average age at the operation was 4.5 years (range from 23 months to 8 years 2 months). Five children (7 feet) were operated before 4 years of age. Medial cuneiform osteotomy has been combined with complete subtalar release from Cincinnati approach, wedge resection of the cuboid and Dwyer procedure. The follow-up was 18 months on an average (6-30 months). Correction of the deformity has been assessed clinically and radiologically (angles: tarsal-metatarsal I, tarsal-metatarsal V and first ray angle ray angle according to Barriolhet. In all cases accurate position of the forefoot has been achieved.

Child↗

PubMed1993

Paralytic drop foot and gluteal fibrosis after intramuscular injections.

Eight children with paralytic drop foot after intramuscular injections later developed gluteal fibrosis. Sciatic palsy, presenting as equinovarus or equinus deformity, was diagnosed on average 3.8 months after the intragluteal injections, but gluteal fibrosis was not diagnosed until 5.1 years after the injections. In three patients the equinovarus recurred after surgical correction due to persistent muscle imbalance and the effect of the external rotation contracture of the hip.

Buttocks↗