Biomedical subjects

Marek Synder

Publications and source records attributed to Marek Synder.

At least 19 recordsLinked to original sources

PubMed2006

The value of preliminary overhead traction in the closed management of DDH.

We aimed to discover whether there is a difference in incidence of growth disturbances of the proximal femoral epiphysis and final results in two similar groups of children with developmental dislocation of the hip (DDH) treated with (107 hips) and without (48 hips) overhead traction. The only variable between the groups was the use of preliminary traction. All children were followed up until at least the age of 14 years. Pre-reduction traction should be used among children treated non-operatively for DDH who are older than one year of age and/or have high-dislocated hips. In cases that are diagnosed late, this treatment would reduce the risk of severe growth disturbances and increase the probability of a favourable long-term outcome.

Child, Preschool↗

PubMed2006

Role of ultrasound in the diagnosis and management of developmental dysplasia of the hip: an international perspective.

Early diagnosis of developmental dysplasia of the hip is very important for proper treatment. Different ultrasound techniques have been used for early diagnosis of developmental dysplasia of the hip, but two of them are widely used in orthopedic practice: Graf's technique in Europe and Harcke's method in the United States. Our experience has led us to use an ultrasound technique that combines the two methods. Use of ultrasound has reduced the number of late-presenting cases, shortened treatment time, and decreased the number of surgical procedures of the hip joint in Poland.

Hip Dislocation, Congenital↗

PubMed2006

[The prevalence of intraarticular lesions in patients with active growth plate].

UNLABELLED: Anterior cruciate ligament (ACL) injuries are becoming increasingly prevalent in children and adolescents. In those who had undergone ligament injuries progressive meniscal damage is frequently observed. This, in turn, can lead to osteoarthritis in older age. The aim of the study was to assess the prevalence of ACL injury and/or other intraarticular lesions in patients with active growth plate. MATERIALS AND METHODS: 59 patients (30 girls and 29 boys) with an average age of 15.5 years (range 7-16 years) were included in the study. Thirty-nine injuries occurred during sports activities. Average time between knee trauma and surgery was 7,3 months (range 1 week-3 years). The relationships between meniscal and ligament injuries were analyzed by means of logistic regression. RESULTS: Of all 50 patients had meniscal tears (36 localized in the medial side) and 35 ACL tears. Both type of injuries occurred together in 26 patients. Three patients had undergone additional cartilage injury. We observed that in patients with ACL injury medial meniscus tear was found with higher frequency (20 knees, 57%) than lateral one (6 knees, 17%). Although meniscal tear was slightly higher distributed in boys (27/29) than in girls (23/30), sex appeared not to be the risk factor to knee injury. CONCLUSIONS: Anterior cruciate injuries are common in adolescents and have similar character to those observed in adults. Higher incidence of medial meniscus tear may be related to chronic anterolateral knee instability caused by delay in surgical treatment.

Adolescent↗

PubMed2006

[Hip joint development after closed reduction, complicated by growth disturbance of the capital femoral epiphysis].

The purpose of the study was to assess hip joint development after the treatment of DDH with overhead traction and closed reduction complicated by growth disturbances of the proximal femoral epiphysis. Comparison was also made between joints affected by AVN and other treated joints. Antero-posterior radiographs of 107 hip joints (81 children) done during treatment and follow-up were retrospectively reviewed. The average age was 14.2 months (from 5 to 33 months) and age at the final follow up 20.7 years (minimum 14 years). AVN was detected in 31 (29%) of the hip joints. Type II necrosis according to Bucholz and Ogden classification system was the most common one. In the hips affected by growth disturbances of proximal femoral epiphysis there were worse final clinical and radiological results, osteoarthrosis and elongation of acetabulum were more often seen in comparison to other treated joints. There was no difference in terms of other parameters describing acetabulum. In 19 out of 31 cases deformity of femoral head was noted. AVN may present as a wide spectrum of pathology from mild, probably not significant growth disturbances of physis to severe deformity and lateralisation of femoral head. Statistically hips with AVN had worse final results and in cases with good congruity prognosis is often uncertain due to aspherical femoral head and secondary osteoarthrosis. Acetabular development is most often unaffected by AVN.

Adolescent↗

PubMed2006

[The prognostic factors in perthes disease].

The purpose of this study was to evaluate the role of selected factors which may play role in the estimation of late result during Perthes disease and which one can be eliminated during treatment period. The study population consisted of 311 patients (50 patients with bilateral disease, 361 hips joint) who had reached skeletal maturity at last follow up. All hips were treated by containment methods (bed rest and traction in abduction, Petri cast, brace, varus osteotomy, Salter osteotomy and shelf acetabuloplasty). Both clinical and radiological parameters (taken during fragmentation stage) were included in our study: gender, age at the onset, hip joint abduction, type of treatment, extend of the femoral head necrosis according to the Herring and Catterall classification, LLD, premature growth plate arrest, ATD and ATD index, lateral acetabulum shape - type I - normal, concave lateral acetabulum margin, type II--flat, horizontal and type III--convex, sloping, femoral head subluxation, femoral head sphericity disturbance according to the Mose, risk factors according to the Catterall, Wiberg angle, Eyre-Brook index. Long-term results were evaluated according to the Stulberg classification and were divided into two groups: good result--Stulberg group 1 or 2 and poor and bad result--Stulberg group 3, 4 or 5. The unilateral and bilateral Perthes disease was estimated separately. The statistical analysis revealed in unilateral Perthes disease that next risk factors may lead to poor or bad late result: age at the onset 9 and more years, group 3 or 4 according to Catterall and group C according to Herring classification, type III lateral acetabulum shape, hip joint abduction less than 10 degrees, premature growth plate arrest, ATD index less than 0.8, femoral head subluxation more than 20%, femoral head sphericity disturbance more than 5mm, Gage sign, calcification laterally to the femoral head (sensitivity 85.0%, specificity 98.7%). Bilateral Perthes disease: age at the onset over 6 years, group 3 or 4 according to Catterall and group C according to Herring classification, hip joint abduction less than 10 degrees and calcification laterally to the femoral head (sensitivity 81.8%, specificity 92.3%). The statistical analysis showed which clinical and radiological factors may play an important role in estimation of late results during Perthes disease. Additionally during fragmentation stage of Perthes disease we have possibility to correct or eliminate some of the risk factors - femoral head subluxation, lateral acetabulum shape and hip joint abduction and improve the late result.

Adolescent↗

PubMed2006

[Hip joint development after treatment the developmental dislocation with overhead traction].

Despite the fact that ultrasound of children's hips is widely used for screening, late diagnosed cases of developmental dislocation of the hip are still a common problem in the orthopaedic practice. The aim of the study is to review final clinical and radiological outcomes of treatment of DDH with overhead traction and closed reduction after skeletal growth. Clinical records and radiograms of 107 hips (81 children) were retrospectively reviewed. All of them were treated according to the same program: overhead traction (about 2 weeks), followed by closed reduction, modified Lorenz cast (2 months) and finally cast in Lange position (3 months). Average age of children was 14.2 months at the beginning of treatment and 20.7 years at last visit. Good and very good results were found in 80% of cases according to final radiological assessment of Severin and in 91% according functional classification of Harris. Avascular necrosis of femoral head according to Bucholz-Ogden classification system was identified in one third of patients. Functional results are better than radiological, but deteriorated with time especially in hips with residual dysplasia and AVN due to development of early, secondary degenerative changes.

Adolescent↗

PubMed2005

RANTES and chemotactic activity in synovial fluids from patients with rheumatoid arthritis and osteoarthritis.

A massive accumulation of inflammatory cells in synovial tissues is a major pathological feature of rheumatoid arthritis (RA). Neutrophiles dominate synovial fluid while rheumatoid synovium is infiltrated with mononuclear cells. Mechanisms regulating influx of particular subpopulations of leukocytes into articular cavity and synovium compartment are not completely defined. An increasing amount of data supports a crucial role of a C-C chemokine RANTES in the RA pathogenesis. Our objective is to evaluate chemotactic activity for neutrophils (NCA), lymphocytes (LCA), and monocytes (MoCA) in SFs obtained from patients with RA and osteoarthritis (OA). We also aimed to characterise the relation between chemotactic activity, RANTES, and percentage distribution of leukocytes in SF. SFs from 11 patients with RA and 6 with OA were included in the study. Modified microchamber Boyden method was employed to assess chemotactic activity. Cytological and biochemical analysis of SF was performed. RANTES was measured with ELISA. Rheumatoid SFs were rich in cells with predominance of neutrophiles while osteoarthritic fluids were lymphocytic. RA SFs were also characterised by increased lactoferrin level. Both NCA and LCA were higher in SF from patients with RA (62 +/- 12 and 24 +/- 6 cells/HPF, resp) as compared to patients with OA (23 +/- 6; P < .05 and 6 +/- 2 cells/HPF; P < 0.05). The chemoattractive effect of RA SF was more pronounced on neutrophiles than on lymphocytes. RA SF expressed high RANTES levels (145+/- 36 pg/mL), while OA SF was characterised by only trace amount of this chemokine (2 +/- 1 pg/mL). We found positive correlation of RANTES with chemotactic activity for mononuclear cells (LCA + MoCA; R = 0.61; P < .05). Surprisingly, RANTES correlated also positively with neutrophiles number (R = 0.77; P < 0.001). Rheumatoid SF possesses strong chemotactic potency for leukocytes. RANTES is overexpressed in RA SF and is a potential mediator influencing intensity and composition of cellular infiltration in joints affected with inflammatory arthritis.

Aged↗

PubMed2005

[Long-term results of uncemented hip arthroplasty for dysplastic coxarthrosis].

UNLABELLED: The purpose of the study was to evaluate the long-term results of uncemented total hip arthroplasty (THA) in young patients (below 50 years of age) with dysplastic coxarthrosis. In the last 20 years, 862 primary uncemented THA, were implanted in our Institution. This surgery was performed in 459 patients. From this group 220 hips in 177 patients (167 women and 10 men), who had dysplastic coxarthrosis, were included in our study. The left hip was operated in 66 and the right one in 68 patients. Bilateral surgery was performed in 43 cases. The means age at the time of hip surgery was 38.3 years (range from 18 to 49 years). The mean follow-up was 9.3 years (range from 2 years to 18.6 years). In 167 (75.8%) patients the operative treatment of DDH was performed during the early childhood (Colonna-Zahradnicek procedures, Dega, Pemberton and Salter pelvic osteotomies). Only 39 (17.7%) patients were treated in the childhood conservatively by means of overhead extension, Frejka pillow or Pavlik harness. All patients were evaluated clinically and radiological. For clinical evaluation the classification system proposed by Merle d'Aubigne and Postel with Chamley modification was used. For radiological evaluation of the steam implantation the classification system proposed by De Lee and Chamley was used and for the cup implantation the system by Gruen and Moreland. The femoral head displacement prior to THA surgery was classified according to Crowe at all. classification. Based on above mentioned criteria in 26 hips (11.8%) the final result was graded as very good, in 61 cases (27.7%) as good, in 94 hips (42.7%) as satisfactory and in the remaining 39 cases (17.8%) the final result was poor. We observed a very strong correlation between clinical and radiological results. According to Crowe and all. classification, in class I we noted 19 (61.3%) very good, 11 (35.5%) good, 1 (3.2%) satisfactory results. In class II in 5 cases (6.6%) the results was very good, 25 (32.9%) good and in 39 (51.3%) satisfactory results. In class III only in 2 cases the final result was graded as very good, and good in 23 hips (25.8%). In class IV there was no very good result, and we observed 19 (21.4%) poor results. In analyzed group in 37 (16.8%) patients the revision hip surgery was necessary because of aseptic prosthesis loosening. CONCLUSIONS: The treatment of dysplastic coxarthrosis by means of THA is difficult. The high level of experience is necessary to perform this type of surgery. This type of THA should be performed only in selected orthopaedic centers. Starting the surgery one has to think about complications.

Adult↗

PubMed2005

[Ceramic-ceramic articulation in uncemented total hip arthroplasty].

UNLABELLED: The main problem in total hip arthroplasty (THA) surgery is aseptic loosening of prosthesis components. In most cases the phagocytes reaction against the wear particle during the hip movement is responsible for aseptic prosthesis loosening. To prevent this reaction different hip articulation are invented to reduce this reaction. One of these solutions is ceramic-ceramic hip prosthesis articulation. The aim of this study was to evaluate the long-term results in patients who were treated because of coxarthrosis by means of ceramic-ceramic hip prosthesis. We analyzed 258 primary THA (222 patients, 116 women and 106 men) who were treated because of advanced coxarthrosis by Mittelmeier type hip endoprosthesis (ceramic-ceramic articulation). The mean age of patients at the surgery was 45.6 years and a mean follow-up 10.2 years. In most of our cases the idiopathic, traumatic and dysplastic coxarthrosis was noted. For clinical evaluation the classification system proposed by Merle d'Aubigne and Postel with Charnley modification was used. For radiological evaluation of the steam implantation the classification system proposed by De Lee and Charnley was used and for the cup implantation the system by Gruen and Moreland. In 87 patients (33.7%) the final results was graded as very good, in 96 (37.2%) as good, in 47 (18.2%) as satisfactory and in 28 patients (10.9%) the final results was poor. In analyzed group in 13 patients (5.0%) the revision surgery was necessary. CONCLUSIONS: The long-term results of THA with the use of Mittelmeier type of hip prosthesis presented a very low percentage of aseptic loosening. This type of prosthesis gives very high patients satisfaction.

Adult↗

PubMed2005

[The teardrop development after conservative treatment of developmental dysplasia of the hip].

The purpose of the study was to evaluate the development of the teardrop in children from the time of the initial diagnosis of DDH to skeletal maturity and asses if width, shape and type of teardrop were associated with final results. Anteroposterior pelvis radiographs of sixty eight patients (64 girls and 4 boys) with unilateral dislocation of the hip treated with closed reduction were reviewed retrospectively. The average age of children at the time of initial diagnosis was 13,4 months (range from 5 to 32 months), and at final follow-up minimum 14 years (average 23 years). At the time of initial diagnosis teardrop was seen in 66% normal and 21% dislocated hips. The width of acetabular floor and superior width of teardrop were greater in dislocated hips. Five months after the reduction and at the age of 6 to 8 years teardrop was observed with similar frequency in both groups. In treated hips widening of acetabular floor and superior part of teardrop was still present. The V shape was detected more often in primary dislocated hips at the age of 6 to 8 years and these hips were usually classified as fair or poor according to Severin class at skeletal maturity. There was no relationship between the type of teardrop and the final results. The continued presence of V shaped teardrop, widening of superior width of the teardrop and thickening of the acetabular floor are suggestive of residual dysplasia.

Acetabulum↗

PubMed2004

Avascular necrosis after surgical treatment for development dysplasia of the hip.

We reviewed the medical records of 101 patients with developmental dysplasia of the hip who were treated with Dega's (102 hips), or Salter's (42 hips)osteotomy preceded by open reduction and femoral intertrochanteric osteotomy. The minimal follow-up was 17 years. At the last follow-up, there were proximal fem-oral growth disturbances in 52 hips (36%). In 20 hips, the disturbances were graded as mild and in six as severe. We found significantly better clinical and radiological results in hips without avascular changes. Risk factors for the development of avascular necrosis were: involvement of the left side and surgical treatment initiated after 2 years of age without pre-operative traction and without femoral shaft shortening. We found that the incidence of avascular necrosis increased with the length of follow-up. The avascular necrosis influenced both clinical and radiological results.

Chi-Square Distribution↗

PubMed2004

[Premature femoral head growth plate closure in Perthes' disease].

The study population consisted of 311 patients (50 female and 261 male) who had reached skeletal maturity at last follow up (361 hips). The mean age at the onset of symptoms was 6 years and 10 months (range: 2.5-13 years). All patients were treated by containment methods (bed rest and traction in abduction, brace, Petri cast, varus osteotomy, Salter osteotomy and shelf operation). Premature growth plate closure was estimated according to Bowen (central and lateral). Necrosis of the femoral head was classified according to Herring and Catterall, late results according to Stulberg and Mose and leg length discrepancy on scanograms. Article-trochanter distance (ATD) was estimated according to the Edgren methods. Premature femoral head growth plate closure was found in 61 hips (central--41 and lateral--20). Statistical analysis did not reveal any correlation between the gender and type of treatment and premature growth plate closure. The central pattern of growth plate closure was more often seen to 6 years of age at the onset and the lateral over 9 years of age at the onset (p = 0.0176). Premature growth plate closure was observed more often in Herring group C and Catterall group 4 (p = 0.0001). Disturbances in femoral head sphericity according to Mose increased (except with bilateral Perthes' disease) and ATD decreased in patients with premature growth plate closure. Also premature growth plate closure increased the leg length discrepancy in Perthes' disease. Thirty two (52.5%) hips with abnormal physeal growth were classified into type I or II according to Stulberg classification, 16 (26.2%) into type III and 13 (21.3%) into type IV or V. Premature growth plate closure in Perthes' disease is more common in huge necrosis of the femoral head. The central pattern of growth plate closure is more often in younger children (to 6 years of age) and the lateral in older (over 9 years of age). With abnormal physeal growth the greater trochanter overgrow and ATD decreased, the leg length discrepancy and disturbances in sphericity of the femoral head increased. Premature growth plate closure increased satisfactory and poor results according to Stulberg classification.

Adolescent↗

PubMed2004

[Remodeling after in situ pinning for slipped capital femoral epiphysis].

We reviewed 61 hips in 50 children (33 boys and 17 girls) with slipped capital femoral epiphysis (SCFE), all treated by in situ pinning. Average age of our patients was 11.8 years (range, from 8 to 15 years). The average clinical and radiographic follow-up was 7.4 years. By studying the changes in physeal-shalt angle on radiographs in Lauenstein (frog) position, we found evidence of physeal remodeling in three (8%) of 38 mild and seven (30%) of 23 moderate slips. Remodeling of the proximal femoral metaphysis occurred in 92% of hips with a head-shaft angle less than 30 degrees and in 52% of hips between 30 degrees and 60 degrees. A process of local resorption and apposition of bone seems to be essential to final remodeling. The probability of remodeling was significantly less the greater the degree of slip, but was significantly increased among children 11 years old or younger and if the triradiate cartilage was open at the time of presentation. The range of internal rotation was significantly greater in those hips that remodeled. Pinning in situ of a slipped capital femoral epiphysis represents a simple, quick and effective method of treatment, allowing remodeling in mild and moderate slips.

Adolescent↗

PubMed2003

Magnetic resonance imaging of the growth plate in late-onset tibia vara.

We used Magnetic resonance imaging (MRI) in five patients (six knees), mean age 13.2 (12-15) years, with late-onset tibia vara (Blount's disease), to study the growth plate and its abnormalities. The MRI study was classified for severity of disease and compared with a radiographic classification. In severely involved knees, MRI indicated severe growth-plate changes on both sides of the knee joint. Widening in the entire proximal tibial growth plate, involvement of the distal femoral growth plate, as well as cartilage invaginations into the metaphyses, were constant findings. Three knees were treated operatively with oblique tibial osteotomy and three with lateral hemiepiphysiodesis. Two severely involved patients treated initially with hemiepiphysiodesis required additional surgery. The three patients with mild disease treated with tibial osteotomy had good clinical and functional results. This study suggests that extensive growth-plate changes in severe, late-onset tibia vara preclude successful treatment by tibial hemiepiphysiodesis. In addition, oblique osteotomy, which was successful in mild cases, was problematic in severe cases.

Adolescent↗

PubMed2003

[Closed reduction and pinning for acute slipped capital femoral epiphysis].

Acute slipped capital femoral epiphysis is a rare adolescent hip disorder, which may be a problem for orthopedic surgeon. No series to date has demonstrated the superiority of any treatment method. The purpose of the study was to evaluate the outcome of treatment and to assess the risk factors of avascular necrosis associated with this condition. Fourteen cases of acute slipped capital femoral epiphysis were treated with closed reduction and pinning. There were 9 boys and 5 girls. The average age at presentation was 11.8 years (range 9.1-15.3). Eight children were treated 4-10 days and six within 48 hours of the onset of their acute symptoms. The severity of the slip was classified according to the system of Southwick. Presence of chondrolysis and avascular necrosis was estimated. The clinical results were graded with the use of the criteria of Aadelen et al. Four slips were classified as mild, seven as moderate and three as severe. Average follow up was 5.2 years (range from 2.4 to 14.3). In two hips with severe slip AVN developed. One of these cases was treated within 48 hours and one after 7 days. Chondrolysis developed in one hip and was associated with presence of intra-articular fixation. Twelve of the fourteen hips had good and vary good results and remaining 2 with AVN had poor. Closed reduction and pinning in acute slipped capital femoral epiphysis is an effective and giving satisfactory outcome method of treatment. Early reduction is not associated with a high rate of AVN and should be performed as soon as possible. More severe slips were noted to have an increased risk of AVN.

Adolescent↗

PubMed2003

[Effect of femoral shaft fracture for growth of the lower extremity in children].

On the material of 15 children aged from 1.5 to 15 years (mean 6.6), who were treated conservatively the influence of fracture of the femoral shaft for growth of the lower extremity was assessed. In the follow-up from 1 to 14 years (mean 6.2) 2 patients had shortened of the fractured limb 5 mm, 5 patients had equal extremity and 8 had lengthened limb from 5 mm to 15 mm, at the same time 6 had overgrowth 10 mm and more. The overgrowth of the limb was observed only within of the femur, the legs were equal in every case. The overgrowth was remarked in the cases of spiral fracture with overriding, in fracture of the opposite site to dominant hand, in boys and in the cases which were treated by direct traction.

Case-Control Studies↗

PubMed2003

[ATD index in Perthes disease].

Authors present an estimation of articulo-trochanteric-distance (ATD) and ATD index in patients with Perthes disease and if there is any correlation between ATD and ATD index and age at the onset, gender, type of treatment, Herring and Stulberg classification. The study population consisted of 242 patients (35 female and 207 male) who had reached skeletal maturity at last follow up. The mean age at the onset of symptoms was 7 years and 4 months. All patients were treated by containment methods (bed rest and traction in abduction, brace, Petri cast, varus osteotomy, Salter osteotomy and shelf operation). ATD was estimated according to the Edgren methods and ATD index was calculated as relation ATD on Perthes site to ATD in normal joint. The late results were classified according to the Stulberg classification. Statistical analysis did not revealed any correlation between the age at the onset, gender and ATD index and ATD during last follow up. Both parameters decreased with poor results according to the Stulberg classifications. ATD index and ATD were statistically significant less after surgical treatment than after non-operative treatment. The same relations were seen between patients with leg length discrepancy (LLD) and without LLD. Patients in Herring group A had statistically significant bigger both parameters than patients in group B, C and patients in Herring group B than C. Articulo-trochanteric-distance and ATD index decreased during follow up and ATD decreased also in normal joint. In our opinion ATD index is a more reliable radiological parameter than ATD. ATD index decreases with bigger necrosis of the femoral head and poor result according to the Stulberg classification. This parameter is an evidence of the dysfunction proximal femoral growth plate in patients with LLD. The most decreased ATD index was observed after surgical treatment. There was no correlation between the age at the onset, gender and ATD index at last follow up.

Adult↗

PubMed2002

[Evaluation of carpal instability after distal radius fracture].

In this study carpal stability was assessed in a group of patients with distal fractures of the radius. The aim of this study was to: assess the frequency of carpal instability as a concomitant lesion to fractures of the distal radius, determine the type of instability and its correlation to fracture type and patient age, assess the influence of bone fragment dislocation on the type of instability. For a clinical evaluation of carpal instability results of physical examination and X-ray examination performed in both static and dynamic conditions were taken into account. In 33% of the examined cases different types of instability were noted. Carpal instability was found more often among younger patients, predominantly of the dorsal type. The type of observed instability depended mainly on the injury mechanism and fracture type of the distal radial epiphysis. Fracture type did not influence the frequency of carpal instability, whereas direction and degree of bone fragment displacement did correlate to the type of primary or secondary instability.

Adult↗