BPC 157, at all investigated intervals, given locally or intraperitoneally, accelerated post-injury muscle healing and also helped to restore the full function.

Purpose Anterior knee pain (AKP) is a common complication following intramedullary nailing of tibial shaft fractures. Our aim was, by analysing the postoperative lateral knee X-rays and clinical status (VAS score), to find the best intramedullary tip position of a non protruded nail that will provide the best postoperative outcome avoiding AKP. Methods We evaluated the postoperative outcome of 221 patients, from the last four years, with healed fractures initially treated with intramedullary reamed nails with two or three interlocking screws proximally and distally through a medial paratendinous incision for nail entry portal. Our aim was to analyse a possible relationship between AKP according to the VAS scale, and nail position marked as a distance from tip of nail to tibial plateau (NP) and to tibial tuberosity (NT), measured postoperatively on lateral knee X-rays. Results Two groups of patients were formed on the basis of presence of pain related to AKP (the level of pain was neglected): group A were patients with pain and group B without pain. The difference between the two groups concerning NP and NT measurements appeared to be statistically significant concerning NT measurement (p<0.05), with high accuracy according to the classification tree. Conclusions We presume that the position of the proximal tip of the nail and its negative influence on the innervation pattern of the area dorsal to patellar tendon could be the key factor of AKP. We conclude that the symptoms of AKP will not appear if the tip of the nail position is more than 5.5 mm from the tibial plateau (NP) and more than 2.5 mm from the tibial tuberosity (NT).

Introduction The case report evaluates the clinical and radiological success of early reposition, posterior decompression, posterolateral fusion and stabilization by titanium pedicle screws and rods, performed within six hours after injury in young patient with C-type second lumbar vertebrae (L2) fracture. Material and Methods 22 years old male patient presented in our Clinic with C-type L2 fracture after accident on work site when a part of truck engine felt on his back. The severity of injury was determined using the ASIA (American Spinal Injury Association) scale. Preoperative ASIA impairment scale was evaluated as grade C, with L2 as the most caudal segment with normal motor function. ASIA muscle grading was grade ⅖ evaluated bilaterally on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. Patient had voluntary anal contraction and normal anal sensation. ASIA sensory pin prick and light touch scores were in the normal range. Concomitant injuries included transverse process fractures of first, third and fourth lumbar vertebrae (L1, L3, L4) with dislocation, bilateral pneumothorax, fracture of eighth rib on right side and right-sided pulmonary contusion. MSCT showed multifragmentary fracture of anterior and posterior elements of L2 with dislocation and luxation. Preoperative treatment included corticosteroid therapy according to NASCIS III protocol and was continued 3 days postoperatively. Surgery was performed within 6 hours after injury. Reposition of lumbar luxation, posterior decompression, stabilization by titanium pedicle screws and rods and posterolateral fusion with autologous bone graft was done. Postoperatively patient wore a thoracolumbar orthosis for 12 weeks. Physical therapy started second day after surgery and was continued for 12 weeks. Results Patient underwent neurological and radiological evaluation 3 days and 12 weeks postoperatively. MSCT and MR imaging were performed. 3 days postoperatively ASIA impairment scale was grade D, showing neurological recovery on lower limbs with muscle grading ⅘ on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. 12 weeks postoperatively ASIA impairment scale remained D but complete motor recovery was noticed on knee extensors and long toe extensors bilaterally. Radiological examinations showed residual dislocation in L1/L2 segment with faset joints subluxation and right-sided foraminal stenosis. 12 weeks postoperatively patient was walking independently with residual motor deficit seen on ankle dorsiflexors and ankle plantar flexors on both legs. Conclusion In young patient with C-type lumbar fracture and incomplete neurological deficit open reposition, posterior decompression, posterolateral fusion and instrumented stabilization is a safe and effective procedure. It is important to involve corticosteroid therapy and to perform a surgery in early phase after traumatic incident. Our results showed that there is a great possibility of neurological recovery if the surgery is performed within ...