Papers by Grzegorz Szczesny
Medicina
Background and Objectives: Intramedullary nailing (IMN) and angularly stable plating (ASP) are th... more Background and Objectives: Intramedullary nailing (IMN) and angularly stable plating (ASP) are the most popular techniques for the stabilization of comminuted fractures of the proximal humerus, without either one being obviously superior. The aim of the study was to validate the functional outcomes of both stabilization techniques in the COVID-19 pandemic by comparing them with data obtained just before the pandemic, because the limitations of the COVID-19 pandemic are affecting several aspects of social and medical life—being afraid of the transmission of the infection, patients reduce their exposure to healthcare to absolutely essential emergencies. Moreover, working conditions in the operating theater have also become more restrictive. Materials and Methods: Investigations were performed on 112 adult patients with Neer’s three- and four-fragment fractures stabilized with IMN (64) and ASP (48). Treatment effects were validated six months after surgery based on radiographs for evid...
Joint Diseases and Related Surgery
Hospital-acquired infections (HAIs) complicate surgical procedures bringing the risk of severe di... more Hospital-acquired infections (HAIs) complicate surgical procedures bringing the risk of severe disturbances. They are among the most crucial factors determining patient safety in the peri-and postoperative period capable to squander the final treatment result. Susceptibility to HAI increases with prolonged hospitalization, invasive procedures, comorbid diseases and their medication, advanced age, malnutrition, obesity, and currently running infections. When caused by pathogens of high virulence, and previously treated with antibiotics, it increases their resistance. It is also well known that the number of HAI increases with poor compliance to antimicrobial procedures, overcrowding, poor hygiene, and sanitation, mainly when caused by pathogens of high virulence. Shortage or even lack Objectives: The purpose of the study was to validate the risk of patients' exposure to pathogenic flora carried on hands of students, visitors, and patients themselves, analyzing its density and genera and to compare them with the microflora of healthcare workers (HCWs). Patients and methods: Between May and June 2018, five groups of participants were included. Each group consisted of eight individuals. Palmar skin imprints were obtained from dominant hands of doctors, nurses, students, visitors, and patients in orthopedics ward. Imprints were incubated at 37°C under aerobic conditions, and colony-forming units (CFU) on each plate were counted after 24, 48, and 72 h. Microorganisms were identified. Results: Hands of doctors were colonized more often by Gram -positive non-spore-forming rods bacteria than hands of nurses (p<0.05). A higher number of Staphylococcus epidermidis CFUs was observed on doctors' than on nurses' hands (p<0.05), whereas Staphylococcus hominis was isolated from doctor's and patients' imprints, but was not from nurses' and students' imprints (p<0.05). Micrococcus luteus colonized patients' hands more often than students' (p<0.05), visitors' hands than doctors' (p<0.05), students' than nurses' (p<0.05), visitors' than nurses' (p<0.05) and patients' hands (p<0.05). Staphylococcus aureus (S. aureus) was isolated only from one doctor and one nurse (203 and 10 CFUs/25 cm 2 ). Imprints taken from the hands of patients, students and visitors were S. aureus-free. No methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, nor expanded spectrum betalactamase-positive or carbapenemase-positive rods were isolated. The number of Gram-negative rods was the highest on visitors' hands, significantly differing from the number on patient's, doctor's, nurse's, and student's hands. Spore-forming rods from genus of Bacillus were isolated from representatives of all tested groups. Bacillus cereus occurred more commonly on visitors' hands than doctors' hands (p<0.05). Patients, students, and visitors may play the causal role in the spread of pathogenic bacteria, particularly spore-forming rods. Our study results confirm the effectiveness of educational activities, that is the hospital's hand hygiene program among HCWs, patients, and visitors. Hand hygiene procedures should be reviewed to put much more effort into reducing the impact of all studied groups on the transmission of infectious diseases.
Diagnostics
The number of overweight and obese patients in developed countries is gradually increasing. It wa... more The number of overweight and obese patients in developed countries is gradually increasing. It was reported that 1287 (64%) out of 2007 adults operated on in 2017 had a body mass index (BMI) greater than 25 kg/m2, and 26.4% even greater than 30, while the BMI of the most obese patient was as high as 57.6 kg/m2. Such distressing statistics raised an issue related to the inadequate durability of implants used for the fixation of bone fractures. Implants for the lower-extremity fractures may not be durable enough to fit the requirements of overweight and obese patients. This case report presents the history of a 23-year-old obese male with a BMI of 38.7, who bent the angularly stabile titanium plate stabilizing his broken lateral ankle and torn distal tibiofibular syndesmosis. Biomechanical analysis showed that the maximal static bending moment registered during one-leg standing was equal to 1.55 Nm. This value was circa one-third of the maximally admissible bending moment for this par...
Krzysztof H. Włodarski, Grzegorz Szczęsny, Aniela Brodzikowska 1 Retired Professor in the Departm... more Krzysztof H. Włodarski, Grzegorz Szczęsny, Aniela Brodzikowska 1 Retired Professor in the Department and Institute of Histology and Embryology of the Medical University of Warsaw, Poland 2 Department of Orthopedis, Warszawa, Polska 3 Institute of Stomatology, Department of Conservative Dentistry of the Medical University of Warsaw,, Poland 1 Emerytowany Profesor w Katedrze i Zakładzie Histologii i Embriologii WUM, Warszawa, Polska 2 Klinika Ortopedii WUM, Warszawa, Polska 3 Instytut Stomatologii, Zakład Stomatologii Zachowawczej Warszawskiego Uniwersytetu Medycznego, Warszawa, Polska
Polish Journal of Sports Medicine, 2021
In clinical setting no spectacular treatment results confirmed using histological approaches wer... 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 monito...
Trauma Surgery, 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.
Materials, 2021
In this paper, fracture behavior of four types of implants with different geometries (pure titani... more In this paper, fracture behavior of four types of implants with different geometries (pure titanium locking plate, pure titanium femoral implant, Ti-6Al-4V titanium alloy pelvic implant, X2CrNiMo18 14-3 steel femoral implant) was studied in detail. Each implant fractured in the human body. The scanning electron microscopy (SEM) was used to determine the potential cause of implants fracture. It was found that the implants fracture mainly occurred in consequence of mechanical overloads resulting from repetitive, prohibited excessive limb loads or singular, un-intendent, secondary injures. Among many possible loading types, the implants were subjected to an excessive fatigue loads with additional interactions caused by screws that were mounted in their threaded holes. The results of this work enable to conclude that the design of orthopedic implants is not fully sufficient to transduce mechanical loads acting over them due to an increasing weight of treated patients and much higher the...
Ortopedia Traumatologia Rehabilitacja, 2015
Ortopedia Traumatologia Rehabilitacja, 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
Ortopedia Traumatologia Rehabilitacja, 2015
Go je nie zła mań jest pro ce sem bio lo gicz nym za le żnym od zdol no ści do ak ty wa cji, ku m... more Go je nie zła mań jest pro ce sem bio lo gicz nym za le żnym od zdol no ści do ak ty wa cji, ku mu la cji w szpa rze prze ło mu oraz pro li fe ra cji i ró żni co wa nia me zen chy mal nych ko mó rek pre kur so ro wych w kie run ku ko mó rek li nii oste obla stycz nej. Je go ce lem jest wy two rze nie kost ni ny i jej re mo de lo wa nie do tkan ki kost nej o bu do wie ana lo gicz nej do tej, któ ra wy stę po wa ła przed ura zem. Jej mi ne ra li za cja wa run ku je przy wró ce nie wła ści wo ści me cha nicz nych za pew nia jąc wa run ki dla speł nia nia funk cji pod po ro wej utra co nej w wy ni ku zła ma nia. Za bu rze nia zro stu kost ne go są re la tyw nie czę stym po wi kła niem, w znacz nym stop niu utrud nia ją cym po stępo wa nie te ra peu tycz ne i pod no szą cym kosz ty le cze nia. Po wo dem ich wy stą pie nia jest brak lub uszko dze nie ko mó rek pre kur so ro wych, za bu rze nia ich re gu la cji hu mo ral nej -za rów no wi kła ją ce ak ty wa cję, jak i na pły wanie do miejsc ura zu, pro li fe ra cję i ró żni co wa nie w kie run ku ko mó rek li nii oste obla stycz nej oraz brak za pewnie nia od po wied nie go śro do wi ska dla opty mal ne go, z punk tu wi dze nia pro ce su go je nia zła ma nia, prze bie gu pro ce sów re pa ra cyj nych. W ni niej szej pra cy przed sta wio no ro lę po szcze gól nych czyn ni ków w pro ce sie zro stu kost ne go oraz me cha ni zmy po wsta wa nia ich za bu rzeń. Słowa kluczowe: złamanie kości, zaburzenia zrostu kostnego, molekularna regulacja gojenia złamań, komórki prekursorowe osteoblastów, czynniki stymulujące zrost kostny The healing of a bone fracture is a biological process depending on the activation of mesenchymal progenitors, their accumulation in the fracture gap, proliferation and differentiation into the osteoblastic cell lineage. Its aim is to form a callus in the fracture gap which is later remodelled into mature bone, restoring the mechanical properties lost in consequence of the fracture. Disturbances in fracture repair occur relatively often, causing therapeutic problems and increasing costs of treatment. They are caused by the lack of or damage to progenitor cells, disturbances in molecular regulation of their activation, homing, proliferation and differentiation into the osteoblastic cell lineage, or lack of appropriate environment for their optimal metabolism for fracture repair. This paper discusses the roles of individual factors crucial for the reparative process as well as the mechanisms responsible for their disturbances.
Journal of Bone Joint Surgery British Volume, May 1, 2011
Infections regularly complicate orthopaedic procedures loosing implant stability and impairing bo... more Infections regularly complicate orthopaedic procedures loosing implant stability and impairing bone union. Nevertheless, the question whether infection is caused by pathogens transposed intraoperatively, infiltrating the implant with blood stream or lymph, or dwelling in clinically healthy tissues, remains unanswered. The AIM of our study was to validate the hypothesis that pathogens may residue deep tissue. Material and Methods: Skin, subcutaneous fat, muscle and fracture gap callus were obtained from 155 adult patients operated on due to closed comminuted fractures of tibia or femur, 75 because of non-alignment of bone axis and 80 due to delayed fracture healing. Results: Aerobic bacteria were isolated from gap callus of 12% healing and 31% non-healing fractures, but also from deep soft tissues. No anaerobic bacteria were detected. PCR amplifications of 16s rRNA were found positive in 40% of callus specimens proving presence of bacterial DNA even when no isolates were found. The 95% similarity of the genetic pattern of some strains from foot skin and callus, estimated with RAPD technique, suggested their foot skin origin. Conclusions: The colonizing bacteria and their DNA were detected in fracture callus and deep soft tissues. Contamination was precluded by lack of isolates in disinfected skin and materials used for sampling cultured after surgery. Our results point out that bacterial cells residing clinically non-infected deep tissues may be a source of infection, when activated by mechanical trauma and/or orthopaedic implant insertion.
From Department of Orthopaedics and Traumatology Medical University of Warsaw Head of the Departm... more From Department of Orthopaedics and Traumatology Medical University of Warsaw Head of the Department: Prof. A. Górecki M.D. Ph.D. Abstract Introduction: In calcaneal osteomyelitis there is no clear bone substance, which can be defined as sequestrum. Resection of whole calcaneus due to osteomyelitis is controversial and regarded as disabling because calcaneus plays important role for foot biomechanics. Material and method: They are presented 8 cases of bacterial calcaneal osteomyelitis. In 4 cases debridement of surrounding soft tissue and drilling of spongiotic bone was performed and application through these holes of collagen gentamicin sponge. In one case with cavitary defect of bone an antibiotic loaded acrylic cement spacer was used. In two cases partial resection and in one subtotal resection of calcaneus was performed. Results: In all cases treated with partial or total resection of calcaneus and 4 cases treated without resection but with drilling of bone and filling with gent...
Wound Repair and Regeneration
Chirurgia narzadow ruchu i ortopedia polska
Destabilizacja złamania okołoprotezowego po aloplastyce stawu biodrowego leczonego płytą kablową ... more Destabilizacja złamania okołoprotezowego po aloplastyce stawu biodrowego leczonego płytą kablową w przebiegu zaburzeń zrostu kostnego u chorej z niedoborem witaminy D Abstract Background: Number of periprosthetic fractures, which constitute the third most common complication of total hip replacement surgery, increases with the number of performed hip arthroplasties. Bone malunion is one of the complications of periprosthetic fractures. Although it occurs sporadically, treatment is difficult and associated with high failure rate. Case Study: We present a case of a 72-year-old woman treated for recurrent destabilization of periprosthetic Vancouver B1 femoral fracture accompanied by plate fracture due to a disorder of bone union. In the course of therapeutic process we took into consideration differential diagnosis of disorders of bone union, assessing bone turnover and vitamin D levels. Therapy included calcium and vitamin D supplementation, facilitating proper progression of bone hea...
Celem pracy było wyjaśnienie aktywacji procesów osteolizy zachodzących w błonie wokół implantów o... more Celem pracy było wyjaśnienie aktywacji procesów osteolizy zachodzących w błonie wokół implantów ortopedycznych. CEL i METODY: Badania przeprowadzono w grupie 22 church z aseptycznymi obluzowaniami protea stawów biodrowego i kolanowego. W trakcie zabiegów realoplastyki z ognisk osteolizy wokół implantów pobierano bioptaty i wykonywano z nich preparaty barwione HE i immunohistochemiczne przeciwaciałami przeciwko CD3,CD4, CD8, HLA-DR, CD14, CD22, CD68, TLR4, TLR9, oral poszukiwano pierwistaków metalicznych, z których wyprodukowano implants pray użyciu mikroskopu elektonowoego i mikroanalizatora rentegonwskiego, Wykonano również posiewy mikrobiologiczne. WYNIKI: W preparatach histologicznych stweirdzono nacieki komórkowe komórek HLA-DR (prezentujące antigen), CD68 (monocyty/makrofagi) i CD22 (limfocyty B). Komórki nacieków eskrymowały TLR-4 i TLR-9 (receptory type Toll). Na poziomie ultrastrukularnym w ziarnistiościach komórek odpowiadających morfologicznie osteoblastom stwierdzono gęst...
Ortopedia, traumatologia, rehabilitacja
Due to the unknown etiology, which prevents treatment of the causes, chronic post-traumatic edema... more Due to the unknown etiology, which prevents treatment of the causes, chronic post-traumatic edema of the lower limbs is a major clinical problem. The present article discusses the etiological factors that produce chronic post-traumatic edema, including traumatic and iatrogenic damage to lymph vessels and disturbances of venous outflow (including thrombosis of deep veins), as well as bacterial contamination of injured tissues, peripheral nerve involvement, and many other factors. Treatment methods for patients with chronic post-traumatic edema of the lower limbs are presented.
Ortopedia, traumatologia, rehabilitacja
As more and more hip replacement procedures are being performed, the incidence of periprosthetic ... more 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. 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. 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 p...
Polish orthopedics and traumatology, Jan 18, 2014
Severe, multitissue hand injuries constitute a serious problem of the modern world. Despite inves... more 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. 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. 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 use...
Polish orthopedics and traumatology, 2012
The aim of the study was to validate the impact of angular and lateral displacements of bone frag... more 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. 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. 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 cont...
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Papers by Grzegorz Szczesny