Grzegorz Szczęsny - Academia.edu (original) (raw)
Papers by Grzegorz Szczęsny
Journal of Trauma-injury Infection and Critical Care, Sep 1, 2001
Background: The aim of this study was to investigate changes in the blood microcirculation of ski... more Background: The aim of this study was to investigate changes in the blood microcirculation of skin, subcutaneous tissue, and striated muscle, and the venous and lymphatic outflow from hind limb, after a standardized mechanical trauma. Methods: Trauma, defined as 50% of the minimal energy needed for tibia fracture (3.7 J/g), was applied to the leg of hairless mice. Intravenously injected fluorescein isothiocyanate-dextran 150 kDa and Rhodamine-6G were used for intravital fluorescence microscopy of blood vessels. Lymphatics were stained with fluorescein isothiocyanate-dextran injected into the footpad. A computer-assisted analysis system allowed measurement of the functional capillary density (FCD), vessel diameters, velocity of blood flow, and edema value expressed as extravasation index (EV). The percentage of slowly rolling and sticking leukocytes in postcapillary venules was estimated. Results: At the site of injury, trauma resulted in significant reduction of FCD in skin, subcutaneous tissue, and striated muscle. There were no significant differences in the vessel diameter (skin subcutaneous and muscle arterioles and venules, and superficial saphenous artery and vein) or velocity of blood flow (subcutaneous tissue and muscle venules). The EV increased significantly in muscle venules and was higher in muscles, subcutaneous tissue, and superficial saphenous veins than in controls (nonsignificantly). An increased percentage of slowly rolling and sticking leukocytes was noted in the superficial saphenous vein at the site of injury and proximal to it. The lymphatics remained patent, with faster visualization and increased summarized cross-sectional areas in traumatized extremities. Conclusion: Early changes occurring in soft tissues in response to mechanical injury were characterized by reduction in FCD of skin and muscles, and less in subcutis; increased EV, reflecting leakage of macromolecules; increased percentage of slowly rolling and sticking leukocytes; maintenance of lymphatic vessel continuity; and increased lymph formation and flow rate.
PubMed, Nov 20, 2012
Background: In this publication, we present a technique for internal ankle fracture fixation thro... more Background: In this publication, we present a technique for internal ankle fracture fixation through minimally invasive surgical access. Material/method: Observations were carried out in a group of 17 patients (9 men and 8 women) treated due to closed injuries. Fractures were reduced under fluoroscopic guidance and stabilized percutaneously with 2 or 3 Kirschner wires (lateral malleole), 1-2 malleolar screws (medial malleole) and cortical screws (syndesmosis). If displaced or involving articular surfaces, posterior tibia was reduced and stabilized with cortical screws. Results: We compared the results from our group with those obtained in a group of 17 patients (13 men and 4 women) operated on using traditional technique. In all cases, satisfactory stabilizations with forthcoming healing process were achieved, but in 2 cases widening of approach to medial malleole was required to remove interposing soft tissues. The operation time of procedures performed via minimal approach was shorter (50.1±23.4 min vs. 77.8±12.0 min; p=0.002), as well as duration of hospital stay (7.8±3.6 days vs. 10.5±5.5 days, NS), but required longer exposition to fluoroscopy (271.2±137.8 vs. 96.1±103.7 sec.; p=0.0002). Conclusions: Minimally invasive technique is an alternative to traditional method. It allows for proper stabilization with minimal soft tissue traumatization, and thus could be recommended for patients with coexisting massive injuries affecting soft tissues and for those who, do not agree to open reductions for cosmetic reasons. It allows for reduction of operation time and hospital stay. Nevertheless, it involves higher exposition to fluoroscopy and, in some cases, widening of surgical approach.
Medycyna Sportowa, Aug 10, 2021
In clinical setting no spectacular treatment results confirmed using histological approaches were... more In clinical setting no spectacular treatment results confirmed using histological approaches were noted as compared with these obtained in laboratory research (finding the regeneration built of the hyaline cartilage in the damaged area in the treated patients is very rare since, as a rule the regeneration is built of the fibrous cartilage). Numerous and increasingly frequent procedures aimed at regeneration of the articular cartilage using platelet rich plasma (PRP), isolated autogenous chondrocytes or mesenchymal precursor cells in patients with osteoarthritis provide access to the vast research material for the analysis of the efficacy and safety of the treatment, based on which, no definitely adverse consequences of the applied methods were noted, such as life-threatening consequences due to new tissue formation. However, the knowledge of the underlying mechanisms indicates the necessity of exercising caution in qualifying patients for such procedures and many years long monitoring in order to the fastest possible diagnosing and successful treatment of the complications. Streszczenie W warunkach klinicznych nie odnotowano spektakularnych, potwierdzanych meto dami histologicznymi wyników leczenia jakie są uzyskiwane w badaniach laboratoryjnych (stwierdzenie u leczonych chorych wytworzenia w miejscu ubytku regeneratu zbudowanego z chrząstki szklistej jest rzadkością; regułą jest w zasadzie wytworzenie regeneratu chrząstki włóknistej). Olbrzymia i szybko rosnąca liczba wykonywanych zabiegów mających na celu regenerację chrząstek stawowych, w tym z użyciem osocza bogatopłytkowego, izolowa nych autogennych chondrocytów czy mezenchymalnych komórek prekursorowych u chorych leczonych z powodu choroby zwyrodnieniowej stawów, udostępnia olbrzymi materiał badawczy dla analizy skuteczności i bezpieczeństwa terapii, na podstawie którego, jak dotąd, nie stwierdzono jednoznacznie negatywnych skutków stosowa nych terapii w postaci groźnych dla życia powikłań wynikających choćby z nowotworzenia. Jednak znajomość mechanizmów ich działania zmusza do zachowania da leko idącej ostrożności w kwalifikowaniu chorych oraz ich stałego i wieloletniego mo nitorowania w celu jak najszybszego wykrycia i skutecznego wyleczenia powstałych powikłań.
Ortopedia, traumatologia, rehabilitacja, Feb 28, 2019
Osteoarthritis is the most common musculoskeletal disease worldwide, generating enormous social a... more Osteoarthritis is the most common musculoskeletal disease worldwide, generating enormous social and medical costs. In recent years, research shedding new light on the etiology and pathogenesis of osteoarthritis has been closely related to innovations in diagnostic imaging. Precise visualization of all joint structures affected by osteoarthritis is critical for early detection and assessment of the prognosis and response to treatment. The purpose of this paper is to present recent advances in the imaging of hip osteoarthritis.
Ortopedia, traumatologia, rehabilitacja, Dec 31, 2018
A high rate of humeral head “overscrewing” during stabilization of comminuted fractures of the p... more A high rate of humeral head “overscrewing” during stabilization of comminuted fractures of the proximal humerus, reaching 14-19% and, according to some reports, even more than 20% of all stabilizations, as reported by various surgeons around the world, suggests that this complication does not simply reflect the lack of surgical skills or inattention during the procedure.
InTech eBooks, Sep 19, 2018
Healing of the bone fracture is a biological process that is based on various cell lineages recru... more Healing of the bone fracture is a biological process that is based on various cell lineages recruited, activated and regulated by molecular mediators, namely chemokines, growth factors, and cytokines, cooperating in a cascade of events aimed to fill the fracture gap with callus. Remodeling of the callus rebuilds the microarchitecture to the mature bonecancellous or compact, depending on the type of the bone that was primarily at the fracture gap. Restitution of the bone continuity requires activation of mesenchymal stem cells that transform into osteoblasts and mature into osteocytes. It is activated and regulated by molecules released from blood platelets from posttraumatic hematoma, traumatized tissues, nerve endings, and inflowing inflammatory cells. The significance of the inflammatory cells in this process is inappreciable, as they eradicate pathogens, remove wound debris, and supply the fracture gap with molecules regulating forthcoming cellular events. They also provide immune regulation of the healing. To proceed uneventfully, healing requires an adequate bone contact and biomechanical environment, proper oxygenation, and nutrition. Unfortunately, up to 15% of bone fractures show some kinds of disturbances that may result in cessation of reparative processes leading to non-union. Factors, responsible for that, are brought to date based on current literature and clinical observations.
Ortopedia, traumatologia, rehabilitacja, Aug 30, 2018
Background. Fractures of the proximal humerus make up 4 to 10% of all fractures. Their incidence ... more Background. Fractures of the proximal humerus make up 4 to 10% of all fractures. Their incidence increaseswith age, usually affecting individuals over 40 years old, reflecting the mineral status of the bone, Material and methods. Out of a group of 131 patients operated on due to comminuted proximal humeral fractures, 25 cases presenting inappropriate postoperative results were selected for further analysis. Results. Failures were found in 16 cases, but affected the final outcome in seven cases only (lack of anatomical repositioning of bone fragments, including one that was stabilized at the fifth postfracture week, in whom a severe contracture of the supraspinatus muscle dislocated the major tubercle, or conflict of the implant with the acromion), and were negligible in the other nine. In two, properly stabilized major tubercles were dislocated due to their bearing the body weight immediately after the procedure. Another two developed necrosis of the humeral head, and in one the fracture was revealed to be pathological, requiring further oncological treatment. In four cases, ostensible false stabilizations were recorded as a consequence of inappropriate patient positioning for x-rays. Conclusions. 1. Our observations indicate that anatomical repositioning of bone fragments, especially those containing articular surface and muscle attachments, and their firm stabilization as well as proper implant positioning are crucial for the final result. 2. In some cases objective and unpredictable factors influencing the type and time of intervention affect the final results. 3. In those cases the decision to operate seems to be controversial. 4. The possibility of a pathological fracture should also be remembered, as such fractures require an appropriate oncological treatment.
PubMed, Dec 18, 2012
Background: The aim of the study was to validate the impact of angular and lateral displacements ... more Background: The aim of the study was to validate the impact of angular and lateral displacements of bone fragments on the interfragmentary contact surface. Mathematical analysis was performed in a model of transverse fracture of long bone shaft treated as a tubular structure with a diameter of 42 mm. We performed our calculations for cortical thickness of 4, 6 and 8 mm. Material/methods: Displacements to the side were analyzed within a range from 0 to a half of bone diameter (21 mm), and angular displacements within a 0-18 degree range. Acquired results were related to the contact area of a non-displaced fracture. Results: Lateral displacement of bone fragments equal to the width of bone's cortical layer (4, 6 and 8 mm) leads to a decrease in interfragmentary contact area to 48.6%, 51.3% and 54.6%, while displacement equal to a half of bone's diameter--to 7.9%, 20.1% and 28.4% of the contact area in an anatomically reduced fracture for cortical thickness values of 4, 6 and 8 mm respectively. Interfragmentary contact area equal to 80% of anatomically reduced fracture is achieved for displacements of 1.5 mm, 2.4 mm and 3.5 mm, corresponding to 3.6%, 5.7% and 8.3% of bone diameter, and to 37.5%, 40% and 42.5% of its cortical thickness (4, 6 and 8 mm, respectively). Angular displacement of less than 2.5 degrees did not affect the interfragmentary contact area, decreasing rapidly to reach values of 66.1%, 76.1% and 81.1% of anatomically reduced fractures at 3.3-degree angulation (values given for cortical thickness of 4, 6 and 8 mm, respectively). Conclusions: Obtained results indicate pronounced loss of contact surface between bone fragments during their displacement to the side and for angular displacements greater than 2.5 degrees. Moreover, bone fragments contact surface decreases with reduction of cortical thickness. In conclusion, it is necessary to reduce a fracture as precisely as possible, particularly in case of bone atrophy.
Ortopedia, traumatologia, rehabilitacja, Dec 29, 2015
Ortopedia, traumatologia, rehabilitacja, Jul 3, 2014
Wstęp. Wraz z ro sną cą licz bą wy ko ny wa nych alo pla styk sta wu bio dro we go, wzra sta licz... more Wstęp. Wraz z ro sną cą licz bą wy ko ny wa nych alo pla styk sta wu bio dro we go, wzra sta licz ba zła mań oko ło pro te zo wych ko ści udo wej. Ce lem pra cy by ła oce na wy ni ków le cze nia zła mań oko ło pro te zo wych przy uży ciu funk cjo nal nej ska li Harris Hip Sco re (HHS). W przed sta wio nym ba da niu do ko na no po rów na nia wy ni ków le cze nia zła mań oko ło pro te zo wych z wy ni ka mi le cze nia sprzed wy stą pie nia zła ma nia, uzy ski wa ny mi w trak cie kon tro li am bu la to ryj nych. Ma te riał i me to dy. Do ba da nia włą czo no 65 cho rych, któ rych po dzie lo no na czte ry gru py w za le żno ści od ty pu prze prowa dzo ne go za bie gu pier wot ne go: pierw szą gru pę sta no wi li cho rzy ze zła ma nia mi oko ło pro te zo wy mi ko ści udo wej po im planta cji pro te zy po ło wi czej, dru gą po alo pla sty ce cał ko wi tej ce men to wa nej, trze cią gru pę sta no wi li pa cjen ci po alo pla sty ce bezce men to wej, czwar tą po re alo pla sty ce sta wu bio dro we go. Do kla sy fi ka cji ty pu zła ma nia uży to ska li Van co uver. Wy ni ki. U wszyst kich cho rych, w czte rech ba da nych gru pach, stwier dzo no na pod sta wie kwe stio na riu sza HHS po gorsze nie wy ni ków le cze nia w po rów na niu z wy ni ka mi uzy ski wa ny mi przed wy stą pie niem zła ma nia. Naj więk sze po gor szenie funk cjo nal nych wy ni ków le cze nia ob ser wo wa no w gru pie cho rych po alo pla sty ce po ło wi czej i cementowej. Wnio ski. 1. Wy ni ki le cze nia zła mań oko ło pro te zo wych oce nia nych wg ska li HHS są gor sze w po rów na niu ze sta nem sprzed wy stą pie nia zła ma nia. 2. Do bre wy ni ki le cze nia zła mań oko ło pro te zo wych uzy ska no je dy nie w le cze niu zła mań typu B1 wg kla sy fi ka cji Van co uver. 3. Wy stę po wa nie cho rób współ ist nie ją cych u osób w po de szłym wie ku wpły wa na słab szy wy nik osta tecz ny le cze nia zła mań oko ło pro te zo wych Słowa kluczowe: złamanie okołoporotezowe, aloplastyka stawu biodrowego, zabiegi rewizyjne, kwestionariusz HHS, analiza funkcjonalna SUMMARY Background. As more and more hip replacement procedures are being performed, the incidence of periprosthetic femoral fractures is also growing. The aim of the study was to assess the outcomes of periprosthetic fracture treatment with the use of the functional Harris Hip Score (HHS). It compares the outcomes of periprosthetic fracture treatment and prefracture treatment results obtained during follow-up outpatient consultations. Material and methods. The study involved 65 patients divided into the following four groups, depending on the type of the primary procedure: patients with periprosthetic femoral fractures after hip hemiarthroplasty; patients after cemented total hip replacement; patients after cementless arthroplasty; and patients after revision hip arthroplasty. The types of fractures were classified according to the Vancouver scale. Results. The HHS questionnaires showed a deterioration of treatment outcomes in all patients from the four groups as compared with the outcomes obtained prior to the fracture. The most pronounced decrease in functional outcomes was observed in the group of patients after hemiarthroplasty and revision hip replacement. Conclusions. 1. The outcomes of periprosthetic fracture treatment, assessed with the HHS, are worse than the results obtained prior to the fracture. 2. Good results of periprosthetic fracture treatment were obtained only in patients with Vancouver Type B1 fractures. 3. The presence of co-morbidities in elderly patients contributes to a poorer final result of periprosthetic fracture treatment
Ortopedia, traumatologia, rehabilitacja, Jun 30, 2021
The discovery of unique properties of the hyaluronic acid and learning about the role of this aid... more The discovery of unique properties of the hyaluronic acid and learning about the role of this aid in pathophysiology of extracellular matrices resulted in using this substance in pharmacological support in cases of tissue dysfunction due to numerous disease units. Therefore, the products containing this substance are now widely used in medicine including dermatology and aesthetic medicine, ophthalmology, facial-mandibular surgery and orthopedics, being among the most effective products used in the treatment of numerous cases of function impairment and deformation of tissues and organs. There are applied in both post-traumatic and post-inflammatory conditions as well as in symptoms due to chronic conditions. Their therapeutic effects result from joint surface moisturizing, reduction of the coefficient of friction (COF) and good bio-tolerance and biocompatibility confirmed by a low percentage of side effects and biocompatibility. The introduction of hyaluronic acid hybrid complexes with high and low molecular mass (H/L-HA) has increased the clinical usefulness of hyaluronic acid products thanks to their increased viscoelasticity, increased anti-inflammatory and chondroprotective properties and thermodynamic stabilization of the product guaranteeing its half-life. Thanks to the above mentioned properties it becomes more effective in the non-surgical treatment of osteoarthritis.
Ortopedia, traumatologia, rehabilitacja, Dec 29, 2015
Ka te dra i Kli ni ka Or to pe dii, War szaw ski Uni wer sy tet Me dycz ny, Polska 2 Za kład Sto ... more Ka te dra i Kli ni ka Or to pe dii, War szaw ski Uni wer sy tet Me dycz ny, Polska 2 Za kład Sto ma to lo gii Za cho waw czej, War szaw ski Uni wer sy tet Me dycz ny, Polska 3 Ka te dra i Za kład Hi sto lo gii i Em brio lo gii, War szaw ski Uni wer sy tet Me dycz ny, Polska
PubMed, Apr 4, 2013
Demineralized bone or dentine implanted intramuscularly induce endochondral bone formation. This ... more Demineralized bone or dentine implanted intramuscularly induce endochondral bone formation. This phenomenon, termed "bone induction" is triggered by non-collagenous signal molecules, named "Bone Morphogenetic Proteins" (BMPs), released from bone or dentine. Demineralization of bone/dentine prior their implantation facilitates the release of BMPs from the extracellular matrix allowing to reach a BMP threshold level needed to initiate the process of differentiation of mesenchymal cells towards an osteogenic/chondrogenic lineage. Unprocessed, mineralized tissues usually fail to induce cartilage/bone. Isolated BMPs are commercially available, and in clinical practice are an alternative for demineralized tissues, however, in many cases demineralized bone has advantages over soluble BMPs, as it combines both bone inducing principles and mechanical properties, a feature important for bridging bone fracture and filling bone defects. Demineralized bones are an inexpensive source of bone forming agents for bone-fracture healing or filling bone defects. In this report we demonstrated that storage of lyophilized demineralized murine incisors for 30 months does not deteriorate its osteoinductive potency and colonizing induced bone by bone marrow. Lyophylized incisors, stored for 0-30 months at refrigator were implanted intramuscularly and recovered, together with surrounding tissues at various time intervals ranging 10-450 days. Bone closely associated with implant was observed in about 87% of cases, regardless the storage duration. It is concluded that storage of demineralized and lyophilized incisor matrices for at least 30 months does not change their osteoinductive potency.
Ortopedia, traumatologia, rehabilitacja, Apr 30, 2019
Comminuted fractures of the proximal humerus impair shoulder function, resulting in more or less ... more Comminuted fractures of the proximal humerus impair shoulder function, resulting in more or less severe disability. They rank among the most frequent fractures in adults, with incidence increasing with age and the degree of bone loss (osteoporosis). Among all currently used methods of stabilization of proximal humeral fractures, the best outcomes are afforded by angularly-stable plate fixation and interlocking or reconstructive intramedullary nailing. Both methods produce comparable results enabling bone union and restoration of limb functionality. Nevertheless, in elderly patients with advanced bone loss, in whom anatomical reduction of bone fragments is difficult or impossible, stabilization questionable and patient cooperation in the postoperative rehabilitation impossible to enforce, arthroplasty should be considered. Non-displaced or minimally displaced fractures may be treated conservatively by immobilizing the limb in an orthosis for three weeks. Nevertheless, the recommendations for operative interventions are being broadened, as stabilization eliminates the need to immobilize the limb, thus not affecting the patient’s professional and social activities, enabling immediate rehabilitation, reducing the risk of joint stiffness and shortening recovery time.
Laboratory Animals, 2004
The aim of this study was to establish a simple and safe method of anaesthesia for intravital mic... more The aim of this study was to establish a simple and safe method of anaesthesia for intravital microcirculatory observations in small laboratory animals. The usefulness of iso urane inhalation anaesthesia has been investigated in different strains of mice commonly used in experimental medicine. These were the hairless (hr=hr, nˆ12), the BALB=c (nˆ12) and the nude mouse (nu=nu, nˆ3). Anaesthesia was maintained by mask inhalation of iso urane vaporized at concentrations of up to 4% in the induction phase, at 1.5% during acute surgical procedures and at 0.8-1.3% during prolonged experimental observations. Iso urane was vapoured in a N 2 O=O 2 mixture and saturated with 32-36% F i O 2. During observations the body temperature was kept constant at 37¯C. The tail artery was cannulated for monitoring of mean arterial blood pressure (MAP) and heart rate (HR). To maintain the body uid balance, isotonic saline was administered at a constant rate of 0.2 ml=h. Arterial blood samples were drawn for blood-gas analysis at the end of the experiments. All animals survived the anaesthesia protocol lasting between 3 and 6.5 h. During iso urane inhalation, no breathing complications or changes in systemic circulatory parameters were observed. Mean values of MAP and HR were 79 § 3 mmHg and 486 § 13 min ¡ 1 , respectively, over the entire observation period. A moderate acidosis was recorded in animals under iso urane anaesthesia, with alterations of arterial blood pH, p a O 2 and pCO 2 values (7.29 § 0.06, 130 § 19 mmHg and 35.6 § 4.7 mmHg, respectively). In conclusion, inhalation anaesthesia with iso urane is useful for experimental studies in the mouse due to (1) the simplicity of administration of the anaesthetic, (2) the rapid induction of anaesthesia, (3) easy control of the depth of anaesthesia, (4) the low percentage of complications, and (5) stable MAP and HR during observations lasting several hours. The proposed technique is especially suitable for observations of the microcirculation under intravital uorescence microscopy.
PubMed, Aug 23, 2011
Summary We present two cases of successful microsurgical replantation and revascularization of th... more Summary We present two cases of successful microsurgical replantation and revascularization of the thumb of dominating extremity in young men performed in orthopedic department, to whom operative treatment in specialized replantation center could not be performed. Microvasculature of the finger was restored anastomosing microsurgically its artery and vein under operative microscope, and bone fracture was stabilized intramedullary with Kirschner wires. In both cases vitality of the finger was restored, which enabled proper healing of soft tissues and bone, leading to restoration of satisfactory function of the thumb. Due to high value for the function of the hand, thumb injuries threading with its loss should be managed primarily. Due to small vessel diameter those procedures require special instrumentation and trained personnel, and thus shouldbe done in replantation centers. Nevertheless, when treatment in an appropriate center is unavailable, those procedures could also be successfully performed by trained orthopedists.
Pomiary Automatyka Kontrola, 2012
PubMed, Jun 18, 2014
Background: Severe, multitissue hand injuries constitute a serious problem of the modern world. D... more Background: Severe, multitissue hand injuries constitute a serious problem of the modern world. Despite investing significant funds in their management these injuries often exclude young people from professional life. It is often due to improper management conducted by untrained personnel lacking appropriate instruments. The goal of this work is to review the literature on the problem and attempt to organize this information. Material/methods: A review of available literature on mutilating hand trauma, amputations in the hand region, replantation and scales used for assessment of the severity of injury and hand function, both in Poland and internationally. Results: Hand injuries may be managed through three approaches: concomitant definitive, delayed and secondary. The best results are achieved through the first approach. However sometimes, due to the character of injury or lack of trained personnel, the team is forced to apply temporary dressing and, subsequently, initiate complex further management. HISS scale is a useful tool allowing for precise determination of the severity of injury and, used together with DASH questionnaire, prediction of long-term treatment outcome. Conclusions: Necessary changes need to be implemented in the healthcare system in order to achieve better results of treatment of severe hand injuries. Proper guidelines for everyday practice should be also introduced. Changes should encompass precise determination of competences of individual centers as well as the mode and indications for patient transport between them. Training of doctors should be modified in such way to ensure that at least one person in each center would be capable of performing proper immediate management of such injuries, making further treatment possible. At the same time, financing, as a strong motivator, should promote appropriate management.
Chirurgia narzadów ruchu i ortopedia polska, Nov 1, 2009
Successful operative stabilization of the comminuted, trochanteric fractures in elderly patients ... more Successful operative stabilization of the comminuted, trochanteric fractures in elderly patients is problematic due to advanced osteoporosis and poor physical activity excluding the cooperation in the postoperative rehabilitation. Stable fixation with dynamic hip screw or gamma nail, or flexible Ender nailing requires relieve of load during forthcoming several postoperative weeks needed for bone union, that reduced their usefulness in elderly patients. The aim of study was to analyze the usefulness of the cemented hemiartrhoplasty for the treatment of patients with comminuted trochanteric fractures. We analyzed 18 patients (16 women and 2 men, aged 69- 93-years-old (mean 83.3 years) treated in our Department in 2007 with cemented hemiathroplasty due to comminuted trochanteric fractures. Patients were intensively rehabilitated bearing their body weights from 3rd-5th, and consequently discharged on 9th-12th postoperative day. Due to the possibility of almost immediate mobilization in the postoperative period, cemented hemiathroplasty could be a method of choice for the treatment of the comminuted trochanteric fractures in elderly patients.
Journal of Trauma-injury Infection and Critical Care, Sep 1, 2001
Background: The aim of this study was to investigate changes in the blood microcirculation of ski... more Background: The aim of this study was to investigate changes in the blood microcirculation of skin, subcutaneous tissue, and striated muscle, and the venous and lymphatic outflow from hind limb, after a standardized mechanical trauma. Methods: Trauma, defined as 50% of the minimal energy needed for tibia fracture (3.7 J/g), was applied to the leg of hairless mice. Intravenously injected fluorescein isothiocyanate-dextran 150 kDa and Rhodamine-6G were used for intravital fluorescence microscopy of blood vessels. Lymphatics were stained with fluorescein isothiocyanate-dextran injected into the footpad. A computer-assisted analysis system allowed measurement of the functional capillary density (FCD), vessel diameters, velocity of blood flow, and edema value expressed as extravasation index (EV). The percentage of slowly rolling and sticking leukocytes in postcapillary venules was estimated. Results: At the site of injury, trauma resulted in significant reduction of FCD in skin, subcutaneous tissue, and striated muscle. There were no significant differences in the vessel diameter (skin subcutaneous and muscle arterioles and venules, and superficial saphenous artery and vein) or velocity of blood flow (subcutaneous tissue and muscle venules). The EV increased significantly in muscle venules and was higher in muscles, subcutaneous tissue, and superficial saphenous veins than in controls (nonsignificantly). An increased percentage of slowly rolling and sticking leukocytes was noted in the superficial saphenous vein at the site of injury and proximal to it. The lymphatics remained patent, with faster visualization and increased summarized cross-sectional areas in traumatized extremities. Conclusion: Early changes occurring in soft tissues in response to mechanical injury were characterized by reduction in FCD of skin and muscles, and less in subcutis; increased EV, reflecting leakage of macromolecules; increased percentage of slowly rolling and sticking leukocytes; maintenance of lymphatic vessel continuity; and increased lymph formation and flow rate.
PubMed, Nov 20, 2012
Background: In this publication, we present a technique for internal ankle fracture fixation thro... more Background: In this publication, we present a technique for internal ankle fracture fixation through minimally invasive surgical access. Material/method: Observations were carried out in a group of 17 patients (9 men and 8 women) treated due to closed injuries. Fractures were reduced under fluoroscopic guidance and stabilized percutaneously with 2 or 3 Kirschner wires (lateral malleole), 1-2 malleolar screws (medial malleole) and cortical screws (syndesmosis). If displaced or involving articular surfaces, posterior tibia was reduced and stabilized with cortical screws. Results: We compared the results from our group with those obtained in a group of 17 patients (13 men and 4 women) operated on using traditional technique. In all cases, satisfactory stabilizations with forthcoming healing process were achieved, but in 2 cases widening of approach to medial malleole was required to remove interposing soft tissues. The operation time of procedures performed via minimal approach was shorter (50.1±23.4 min vs. 77.8±12.0 min; p=0.002), as well as duration of hospital stay (7.8±3.6 days vs. 10.5±5.5 days, NS), but required longer exposition to fluoroscopy (271.2±137.8 vs. 96.1±103.7 sec.; p=0.0002). Conclusions: Minimally invasive technique is an alternative to traditional method. It allows for proper stabilization with minimal soft tissue traumatization, and thus could be recommended for patients with coexisting massive injuries affecting soft tissues and for those who, do not agree to open reductions for cosmetic reasons. It allows for reduction of operation time and hospital stay. Nevertheless, it involves higher exposition to fluoroscopy and, in some cases, widening of surgical approach.
Medycyna Sportowa, Aug 10, 2021
In clinical setting no spectacular treatment results confirmed using histological approaches were... more In clinical setting no spectacular treatment results confirmed using histological approaches were noted as compared with these obtained in laboratory research (finding the regeneration built of the hyaline cartilage in the damaged area in the treated patients is very rare since, as a rule the regeneration is built of the fibrous cartilage). Numerous and increasingly frequent procedures aimed at regeneration of the articular cartilage using platelet rich plasma (PRP), isolated autogenous chondrocytes or mesenchymal precursor cells in patients with osteoarthritis provide access to the vast research material for the analysis of the efficacy and safety of the treatment, based on which, no definitely adverse consequences of the applied methods were noted, such as life-threatening consequences due to new tissue formation. However, the knowledge of the underlying mechanisms indicates the necessity of exercising caution in qualifying patients for such procedures and many years long monitoring in order to the fastest possible diagnosing and successful treatment of the complications. Streszczenie W warunkach klinicznych nie odnotowano spektakularnych, potwierdzanych meto dami histologicznymi wyników leczenia jakie są uzyskiwane w badaniach laboratoryjnych (stwierdzenie u leczonych chorych wytworzenia w miejscu ubytku regeneratu zbudowanego z chrząstki szklistej jest rzadkością; regułą jest w zasadzie wytworzenie regeneratu chrząstki włóknistej). Olbrzymia i szybko rosnąca liczba wykonywanych zabiegów mających na celu regenerację chrząstek stawowych, w tym z użyciem osocza bogatopłytkowego, izolowa nych autogennych chondrocytów czy mezenchymalnych komórek prekursorowych u chorych leczonych z powodu choroby zwyrodnieniowej stawów, udostępnia olbrzymi materiał badawczy dla analizy skuteczności i bezpieczeństwa terapii, na podstawie którego, jak dotąd, nie stwierdzono jednoznacznie negatywnych skutków stosowa nych terapii w postaci groźnych dla życia powikłań wynikających choćby z nowotworzenia. Jednak znajomość mechanizmów ich działania zmusza do zachowania da leko idącej ostrożności w kwalifikowaniu chorych oraz ich stałego i wieloletniego mo nitorowania w celu jak najszybszego wykrycia i skutecznego wyleczenia powstałych powikłań.
Ortopedia, traumatologia, rehabilitacja, Feb 28, 2019
Osteoarthritis is the most common musculoskeletal disease worldwide, generating enormous social a... more Osteoarthritis is the most common musculoskeletal disease worldwide, generating enormous social and medical costs. In recent years, research shedding new light on the etiology and pathogenesis of osteoarthritis has been closely related to innovations in diagnostic imaging. Precise visualization of all joint structures affected by osteoarthritis is critical for early detection and assessment of the prognosis and response to treatment. The purpose of this paper is to present recent advances in the imaging of hip osteoarthritis.
Ortopedia, traumatologia, rehabilitacja, Dec 31, 2018
A high rate of humeral head “overscrewing” during stabilization of comminuted fractures of the p... more A high rate of humeral head “overscrewing” during stabilization of comminuted fractures of the proximal humerus, reaching 14-19% and, according to some reports, even more than 20% of all stabilizations, as reported by various surgeons around the world, suggests that this complication does not simply reflect the lack of surgical skills or inattention during the procedure.
InTech eBooks, Sep 19, 2018
Healing of the bone fracture is a biological process that is based on various cell lineages recru... more Healing of the bone fracture is a biological process that is based on various cell lineages recruited, activated and regulated by molecular mediators, namely chemokines, growth factors, and cytokines, cooperating in a cascade of events aimed to fill the fracture gap with callus. Remodeling of the callus rebuilds the microarchitecture to the mature bonecancellous or compact, depending on the type of the bone that was primarily at the fracture gap. Restitution of the bone continuity requires activation of mesenchymal stem cells that transform into osteoblasts and mature into osteocytes. It is activated and regulated by molecules released from blood platelets from posttraumatic hematoma, traumatized tissues, nerve endings, and inflowing inflammatory cells. The significance of the inflammatory cells in this process is inappreciable, as they eradicate pathogens, remove wound debris, and supply the fracture gap with molecules regulating forthcoming cellular events. They also provide immune regulation of the healing. To proceed uneventfully, healing requires an adequate bone contact and biomechanical environment, proper oxygenation, and nutrition. Unfortunately, up to 15% of bone fractures show some kinds of disturbances that may result in cessation of reparative processes leading to non-union. Factors, responsible for that, are brought to date based on current literature and clinical observations.
Ortopedia, traumatologia, rehabilitacja, Aug 30, 2018
Background. Fractures of the proximal humerus make up 4 to 10% of all fractures. Their incidence ... more Background. Fractures of the proximal humerus make up 4 to 10% of all fractures. Their incidence increaseswith age, usually affecting individuals over 40 years old, reflecting the mineral status of the bone, Material and methods. Out of a group of 131 patients operated on due to comminuted proximal humeral fractures, 25 cases presenting inappropriate postoperative results were selected for further analysis. Results. Failures were found in 16 cases, but affected the final outcome in seven cases only (lack of anatomical repositioning of bone fragments, including one that was stabilized at the fifth postfracture week, in whom a severe contracture of the supraspinatus muscle dislocated the major tubercle, or conflict of the implant with the acromion), and were negligible in the other nine. In two, properly stabilized major tubercles were dislocated due to their bearing the body weight immediately after the procedure. Another two developed necrosis of the humeral head, and in one the fracture was revealed to be pathological, requiring further oncological treatment. In four cases, ostensible false stabilizations were recorded as a consequence of inappropriate patient positioning for x-rays. Conclusions. 1. Our observations indicate that anatomical repositioning of bone fragments, especially those containing articular surface and muscle attachments, and their firm stabilization as well as proper implant positioning are crucial for the final result. 2. In some cases objective and unpredictable factors influencing the type and time of intervention affect the final results. 3. In those cases the decision to operate seems to be controversial. 4. The possibility of a pathological fracture should also be remembered, as such fractures require an appropriate oncological treatment.
PubMed, Dec 18, 2012
Background: The aim of the study was to validate the impact of angular and lateral displacements ... more Background: The aim of the study was to validate the impact of angular and lateral displacements of bone fragments on the interfragmentary contact surface. Mathematical analysis was performed in a model of transverse fracture of long bone shaft treated as a tubular structure with a diameter of 42 mm. We performed our calculations for cortical thickness of 4, 6 and 8 mm. Material/methods: Displacements to the side were analyzed within a range from 0 to a half of bone diameter (21 mm), and angular displacements within a 0-18 degree range. Acquired results were related to the contact area of a non-displaced fracture. Results: Lateral displacement of bone fragments equal to the width of bone's cortical layer (4, 6 and 8 mm) leads to a decrease in interfragmentary contact area to 48.6%, 51.3% and 54.6%, while displacement equal to a half of bone's diameter--to 7.9%, 20.1% and 28.4% of the contact area in an anatomically reduced fracture for cortical thickness values of 4, 6 and 8 mm respectively. Interfragmentary contact area equal to 80% of anatomically reduced fracture is achieved for displacements of 1.5 mm, 2.4 mm and 3.5 mm, corresponding to 3.6%, 5.7% and 8.3% of bone diameter, and to 37.5%, 40% and 42.5% of its cortical thickness (4, 6 and 8 mm, respectively). Angular displacement of less than 2.5 degrees did not affect the interfragmentary contact area, decreasing rapidly to reach values of 66.1%, 76.1% and 81.1% of anatomically reduced fractures at 3.3-degree angulation (values given for cortical thickness of 4, 6 and 8 mm, respectively). Conclusions: Obtained results indicate pronounced loss of contact surface between bone fragments during their displacement to the side and for angular displacements greater than 2.5 degrees. Moreover, bone fragments contact surface decreases with reduction of cortical thickness. In conclusion, it is necessary to reduce a fracture as precisely as possible, particularly in case of bone atrophy.
Ortopedia, traumatologia, rehabilitacja, Dec 29, 2015
Ortopedia, traumatologia, rehabilitacja, Jul 3, 2014
Wstęp. Wraz z ro sną cą licz bą wy ko ny wa nych alo pla styk sta wu bio dro we go, wzra sta licz... more Wstęp. Wraz z ro sną cą licz bą wy ko ny wa nych alo pla styk sta wu bio dro we go, wzra sta licz ba zła mań oko ło pro te zo wych ko ści udo wej. Ce lem pra cy by ła oce na wy ni ków le cze nia zła mań oko ło pro te zo wych przy uży ciu funk cjo nal nej ska li Harris Hip Sco re (HHS). W przed sta wio nym ba da niu do ko na no po rów na nia wy ni ków le cze nia zła mań oko ło pro te zo wych z wy ni ka mi le cze nia sprzed wy stą pie nia zła ma nia, uzy ski wa ny mi w trak cie kon tro li am bu la to ryj nych. Ma te riał i me to dy. Do ba da nia włą czo no 65 cho rych, któ rych po dzie lo no na czte ry gru py w za le żno ści od ty pu prze prowa dzo ne go za bie gu pier wot ne go: pierw szą gru pę sta no wi li cho rzy ze zła ma nia mi oko ło pro te zo wy mi ko ści udo wej po im planta cji pro te zy po ło wi czej, dru gą po alo pla sty ce cał ko wi tej ce men to wa nej, trze cią gru pę sta no wi li pa cjen ci po alo pla sty ce bezce men to wej, czwar tą po re alo pla sty ce sta wu bio dro we go. Do kla sy fi ka cji ty pu zła ma nia uży to ska li Van co uver. Wy ni ki. U wszyst kich cho rych, w czte rech ba da nych gru pach, stwier dzo no na pod sta wie kwe stio na riu sza HHS po gorsze nie wy ni ków le cze nia w po rów na niu z wy ni ka mi uzy ski wa ny mi przed wy stą pie niem zła ma nia. Naj więk sze po gor szenie funk cjo nal nych wy ni ków le cze nia ob ser wo wa no w gru pie cho rych po alo pla sty ce po ło wi czej i cementowej. Wnio ski. 1. Wy ni ki le cze nia zła mań oko ło pro te zo wych oce nia nych wg ska li HHS są gor sze w po rów na niu ze sta nem sprzed wy stą pie nia zła ma nia. 2. Do bre wy ni ki le cze nia zła mań oko ło pro te zo wych uzy ska no je dy nie w le cze niu zła mań typu B1 wg kla sy fi ka cji Van co uver. 3. Wy stę po wa nie cho rób współ ist nie ją cych u osób w po de szłym wie ku wpły wa na słab szy wy nik osta tecz ny le cze nia zła mań oko ło pro te zo wych Słowa kluczowe: złamanie okołoporotezowe, aloplastyka stawu biodrowego, zabiegi rewizyjne, kwestionariusz HHS, analiza funkcjonalna SUMMARY Background. As more and more hip replacement procedures are being performed, the incidence of periprosthetic femoral fractures is also growing. The aim of the study was to assess the outcomes of periprosthetic fracture treatment with the use of the functional Harris Hip Score (HHS). It compares the outcomes of periprosthetic fracture treatment and prefracture treatment results obtained during follow-up outpatient consultations. Material and methods. The study involved 65 patients divided into the following four groups, depending on the type of the primary procedure: patients with periprosthetic femoral fractures after hip hemiarthroplasty; patients after cemented total hip replacement; patients after cementless arthroplasty; and patients after revision hip arthroplasty. The types of fractures were classified according to the Vancouver scale. Results. The HHS questionnaires showed a deterioration of treatment outcomes in all patients from the four groups as compared with the outcomes obtained prior to the fracture. The most pronounced decrease in functional outcomes was observed in the group of patients after hemiarthroplasty and revision hip replacement. Conclusions. 1. The outcomes of periprosthetic fracture treatment, assessed with the HHS, are worse than the results obtained prior to the fracture. 2. Good results of periprosthetic fracture treatment were obtained only in patients with Vancouver Type B1 fractures. 3. The presence of co-morbidities in elderly patients contributes to a poorer final result of periprosthetic fracture treatment
Ortopedia, traumatologia, rehabilitacja, Jun 30, 2021
The discovery of unique properties of the hyaluronic acid and learning about the role of this aid... more The discovery of unique properties of the hyaluronic acid and learning about the role of this aid in pathophysiology of extracellular matrices resulted in using this substance in pharmacological support in cases of tissue dysfunction due to numerous disease units. Therefore, the products containing this substance are now widely used in medicine including dermatology and aesthetic medicine, ophthalmology, facial-mandibular surgery and orthopedics, being among the most effective products used in the treatment of numerous cases of function impairment and deformation of tissues and organs. There are applied in both post-traumatic and post-inflammatory conditions as well as in symptoms due to chronic conditions. Their therapeutic effects result from joint surface moisturizing, reduction of the coefficient of friction (COF) and good bio-tolerance and biocompatibility confirmed by a low percentage of side effects and biocompatibility. The introduction of hyaluronic acid hybrid complexes with high and low molecular mass (H/L-HA) has increased the clinical usefulness of hyaluronic acid products thanks to their increased viscoelasticity, increased anti-inflammatory and chondroprotective properties and thermodynamic stabilization of the product guaranteeing its half-life. Thanks to the above mentioned properties it becomes more effective in the non-surgical treatment of osteoarthritis.
Ortopedia, traumatologia, rehabilitacja, Dec 29, 2015
Ka te dra i Kli ni ka Or to pe dii, War szaw ski Uni wer sy tet Me dycz ny, Polska 2 Za kład Sto ... more Ka te dra i Kli ni ka Or to pe dii, War szaw ski Uni wer sy tet Me dycz ny, Polska 2 Za kład Sto ma to lo gii Za cho waw czej, War szaw ski Uni wer sy tet Me dycz ny, Polska 3 Ka te dra i Za kład Hi sto lo gii i Em brio lo gii, War szaw ski Uni wer sy tet Me dycz ny, Polska
PubMed, Apr 4, 2013
Demineralized bone or dentine implanted intramuscularly induce endochondral bone formation. This ... more Demineralized bone or dentine implanted intramuscularly induce endochondral bone formation. This phenomenon, termed "bone induction" is triggered by non-collagenous signal molecules, named "Bone Morphogenetic Proteins" (BMPs), released from bone or dentine. Demineralization of bone/dentine prior their implantation facilitates the release of BMPs from the extracellular matrix allowing to reach a BMP threshold level needed to initiate the process of differentiation of mesenchymal cells towards an osteogenic/chondrogenic lineage. Unprocessed, mineralized tissues usually fail to induce cartilage/bone. Isolated BMPs are commercially available, and in clinical practice are an alternative for demineralized tissues, however, in many cases demineralized bone has advantages over soluble BMPs, as it combines both bone inducing principles and mechanical properties, a feature important for bridging bone fracture and filling bone defects. Demineralized bones are an inexpensive source of bone forming agents for bone-fracture healing or filling bone defects. In this report we demonstrated that storage of lyophilized demineralized murine incisors for 30 months does not deteriorate its osteoinductive potency and colonizing induced bone by bone marrow. Lyophylized incisors, stored for 0-30 months at refrigator were implanted intramuscularly and recovered, together with surrounding tissues at various time intervals ranging 10-450 days. Bone closely associated with implant was observed in about 87% of cases, regardless the storage duration. It is concluded that storage of demineralized and lyophilized incisor matrices for at least 30 months does not change their osteoinductive potency.
Ortopedia, traumatologia, rehabilitacja, Apr 30, 2019
Comminuted fractures of the proximal humerus impair shoulder function, resulting in more or less ... more Comminuted fractures of the proximal humerus impair shoulder function, resulting in more or less severe disability. They rank among the most frequent fractures in adults, with incidence increasing with age and the degree of bone loss (osteoporosis). Among all currently used methods of stabilization of proximal humeral fractures, the best outcomes are afforded by angularly-stable plate fixation and interlocking or reconstructive intramedullary nailing. Both methods produce comparable results enabling bone union and restoration of limb functionality. Nevertheless, in elderly patients with advanced bone loss, in whom anatomical reduction of bone fragments is difficult or impossible, stabilization questionable and patient cooperation in the postoperative rehabilitation impossible to enforce, arthroplasty should be considered. Non-displaced or minimally displaced fractures may be treated conservatively by immobilizing the limb in an orthosis for three weeks. Nevertheless, the recommendations for operative interventions are being broadened, as stabilization eliminates the need to immobilize the limb, thus not affecting the patient’s professional and social activities, enabling immediate rehabilitation, reducing the risk of joint stiffness and shortening recovery time.
Laboratory Animals, 2004
The aim of this study was to establish a simple and safe method of anaesthesia for intravital mic... more The aim of this study was to establish a simple and safe method of anaesthesia for intravital microcirculatory observations in small laboratory animals. The usefulness of iso urane inhalation anaesthesia has been investigated in different strains of mice commonly used in experimental medicine. These were the hairless (hr=hr, nˆ12), the BALB=c (nˆ12) and the nude mouse (nu=nu, nˆ3). Anaesthesia was maintained by mask inhalation of iso urane vaporized at concentrations of up to 4% in the induction phase, at 1.5% during acute surgical procedures and at 0.8-1.3% during prolonged experimental observations. Iso urane was vapoured in a N 2 O=O 2 mixture and saturated with 32-36% F i O 2. During observations the body temperature was kept constant at 37¯C. The tail artery was cannulated for monitoring of mean arterial blood pressure (MAP) and heart rate (HR). To maintain the body uid balance, isotonic saline was administered at a constant rate of 0.2 ml=h. Arterial blood samples were drawn for blood-gas analysis at the end of the experiments. All animals survived the anaesthesia protocol lasting between 3 and 6.5 h. During iso urane inhalation, no breathing complications or changes in systemic circulatory parameters were observed. Mean values of MAP and HR were 79 § 3 mmHg and 486 § 13 min ¡ 1 , respectively, over the entire observation period. A moderate acidosis was recorded in animals under iso urane anaesthesia, with alterations of arterial blood pH, p a O 2 and pCO 2 values (7.29 § 0.06, 130 § 19 mmHg and 35.6 § 4.7 mmHg, respectively). In conclusion, inhalation anaesthesia with iso urane is useful for experimental studies in the mouse due to (1) the simplicity of administration of the anaesthetic, (2) the rapid induction of anaesthesia, (3) easy control of the depth of anaesthesia, (4) the low percentage of complications, and (5) stable MAP and HR during observations lasting several hours. The proposed technique is especially suitable for observations of the microcirculation under intravital uorescence microscopy.
PubMed, Aug 23, 2011
Summary We present two cases of successful microsurgical replantation and revascularization of th... more Summary We present two cases of successful microsurgical replantation and revascularization of the thumb of dominating extremity in young men performed in orthopedic department, to whom operative treatment in specialized replantation center could not be performed. Microvasculature of the finger was restored anastomosing microsurgically its artery and vein under operative microscope, and bone fracture was stabilized intramedullary with Kirschner wires. In both cases vitality of the finger was restored, which enabled proper healing of soft tissues and bone, leading to restoration of satisfactory function of the thumb. Due to high value for the function of the hand, thumb injuries threading with its loss should be managed primarily. Due to small vessel diameter those procedures require special instrumentation and trained personnel, and thus shouldbe done in replantation centers. Nevertheless, when treatment in an appropriate center is unavailable, those procedures could also be successfully performed by trained orthopedists.
Pomiary Automatyka Kontrola, 2012
PubMed, Jun 18, 2014
Background: Severe, multitissue hand injuries constitute a serious problem of the modern world. D... more Background: Severe, multitissue hand injuries constitute a serious problem of the modern world. Despite investing significant funds in their management these injuries often exclude young people from professional life. It is often due to improper management conducted by untrained personnel lacking appropriate instruments. The goal of this work is to review the literature on the problem and attempt to organize this information. Material/methods: A review of available literature on mutilating hand trauma, amputations in the hand region, replantation and scales used for assessment of the severity of injury and hand function, both in Poland and internationally. Results: Hand injuries may be managed through three approaches: concomitant definitive, delayed and secondary. The best results are achieved through the first approach. However sometimes, due to the character of injury or lack of trained personnel, the team is forced to apply temporary dressing and, subsequently, initiate complex further management. HISS scale is a useful tool allowing for precise determination of the severity of injury and, used together with DASH questionnaire, prediction of long-term treatment outcome. Conclusions: Necessary changes need to be implemented in the healthcare system in order to achieve better results of treatment of severe hand injuries. Proper guidelines for everyday practice should be also introduced. Changes should encompass precise determination of competences of individual centers as well as the mode and indications for patient transport between them. Training of doctors should be modified in such way to ensure that at least one person in each center would be capable of performing proper immediate management of such injuries, making further treatment possible. At the same time, financing, as a strong motivator, should promote appropriate management.
Chirurgia narzadów ruchu i ortopedia polska, Nov 1, 2009
Successful operative stabilization of the comminuted, trochanteric fractures in elderly patients ... more Successful operative stabilization of the comminuted, trochanteric fractures in elderly patients is problematic due to advanced osteoporosis and poor physical activity excluding the cooperation in the postoperative rehabilitation. Stable fixation with dynamic hip screw or gamma nail, or flexible Ender nailing requires relieve of load during forthcoming several postoperative weeks needed for bone union, that reduced their usefulness in elderly patients. The aim of study was to analyze the usefulness of the cemented hemiartrhoplasty for the treatment of patients with comminuted trochanteric fractures. We analyzed 18 patients (16 women and 2 men, aged 69- 93-years-old (mean 83.3 years) treated in our Department in 2007 with cemented hemiathroplasty due to comminuted trochanteric fractures. Patients were intensively rehabilitated bearing their body weights from 3rd-5th, and consequently discharged on 9th-12th postoperative day. Due to the possibility of almost immediate mobilization in the postoperative period, cemented hemiathroplasty could be a method of choice for the treatment of the comminuted trochanteric fractures in elderly patients.