Introduction: Total or partial upper limb amputation significantly reduces ability of normal functioning in the society. Development of microsurgical skills enabled to replantation of the amputated limb (or part) and to regain its partial or sometimes full function.Material and methods: The study analyses the causes of refusal of admission to 55 of 141 patients referred to the replantation service of the Department of General and Hand Surgery PUM, over the period 2012–2013.Results: The causes of denied admission included: injury without compromise of blood supply to the limb (35%), distal amputations (27%), crush injuries (11%), single finger amputation (9%), severe damage of the amputated part (9%) and lower limb amputations (5%). The age of the patient had no significant influence on the decision to refuse admission. The distance between the referring hospital and the replantation centre was statistically significantly shorter in accepted cases (252 km vs 496 km, p < 0.05).Conclusion: Our outcomes show a variety of causes of refusal of admission to patients with severe trauma and amputation of the hand. The main factors influencing decision making regarding admission or denial were associated with the actual danger to the survival of the involved limb, and estimation/calculation of the chance for limb saving.

Abstract Background: Hip arthroplasty is increasingly performed in young people actively playing sports, professionally active, or treated with steroid drugs in the course of autoimmune diseases. Significantly more often in this group of patients the cause of osteoarthritis is sterile femoral head necrosis. Femoral neck endoprosthesis can be an alternative to pituitary or classical cementlessarthroplastyin the surgical treatment of osteoarthritis.Material and methods: The study group consisted of 27 men aged 32 to 65 years (average 46 years) in whom femoral neck endoprosthesis was implanted (16 on the left side, 11 on the right side).The most common indications for surgical treatment were idiopathic osteoarthritis of the hip (19 patients) and arthrosis due to sterile femoral osteonecrosis (8 patients).Operational access according to Hardinge in the patient's position on the back by embedding a uncemented femoral neck endoprosthesis in ceramic articulation was applied.In the studied group of patients, clinical condition was assessed using the HHS, WOMAC-HIP classification. An assessment of the quality of life was also carried out on the SF-12 scale and pain assessment on the VAS scale.Analyzes were performed before surgery, while the control test was carried out on average over a 5-year observation period.Results: The clinical condition of the examined men on the HHS (49.81 vs 84.05) and WOMAC-HIP (40.59 vs 13.5) scale significantly improved (p <0.05) in relation to the value before surgery.Similar results were obtained in the assessment of quality of life on the SF-12 scale (9.89 points vs. 32 points); (p <0.05) and pain on the VAS scale (6.74 vs 0.58); (p <0.05) during follow-up.Conclusions: The use of femoral neck endoprosthesis in men with hip arthrosis in the mean follow-up of 5 years improved both the clinical condition and the quality of life of the operated patients while reducing the pain.

BackgroundTibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. Material and methodsThe study group consisted of 19 men who were subjected to intramedullary and intra-osseous arthrodesis using an intramedullary nail. The average age of patients was 46 years (19-68). The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group of patients, clinical condition was assessed using the AOFAS classi cation, quality of life using the SF-12 scale, and assessment of pain intensity using the VAS scale. The above parameters were evaluated before surgery in the early (under 2 years), intermediate (from 2-5 years) and late (over 5 years) postoperative period. ResultsAnalysis of the results showed that the assessed clinical condition on the AOFAS scale improved from an average of 20.6 points before TTCA to 63.5 points after the procedure. The result was statistically signi cant (p < 0.0001). Analyzing the results obtained using the SF-12 quality of life scale, a statistically signi cant increase was found. In the physical sphere of quality of life PCS-12 increased from 26.5 points to 44.2 points (p = 0.0004) and in the mental sphere of quality of life MCS-12 from 46.1 points to 52.6 points (p = 0.030). The intensity of pain ailments, assessed in the VAS scale, decreased in all three periods of postoperative observation (in the early period p < 0.05, in the intermediate period p = 0.23, and in the late period p < 0.05), with the strongest analgesic effect (reduction of pain intensity by 4.3 points on the VAS scale) was observed in the early post-operative follow-up period. ConclusionsTibiotalocalcaneal arthrodesis using an intramedullary nail causes a signi cant improvement in the clinical condition according to the AOFAS classi cation, enabling most patients to move independently, a signi cant improvement in the physical and mental quality of life assessed in the SF-12 scale and a signi cant reduction in the intensity of pain ailments assessed in the VAS scale, especially in the early postoperative period.

Background We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis. Methods The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up. Results The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p < 0.001). The median WOMAC HIP score was pre-operatively 57 and post-operatively 0 (p < 0.001). The median SF-12 score was pre-operatively 4 and post-operatively 33 (p < 0.001). The median pain assessment in VAS scale was 7 pre-operatively and 0 post-operatively (p < 0.001). Conclusions The results of all examined patients have changed significantly in every category showing that SPIRON endoprosthesis improved their quality of life and statistically reduced pain ailments. Moreover we have proved that higher BMI (> 30) is associated with worse operation outcomes.