2024, Bobiński, Andrzej, Tomczyk, Łukasz, Pelc, Marcin, Chruścicki, Damian, Śnietka, Bartosz, Wójcik, Jarosław, Morasiewicz, Piotr

2025, Kowal, Igor, Pelc, Marcin, Pili, Daniele, Tomczyk, Łukasz, Operacz, Radosław, Morasiewicz, Piotr

Background: There is no consensus on the best treatment method for calcaneal fractures. The topic of lower limb biomechanics following calcaneal fracture treatment with various fixation methods has not been fully explored. The aim of the study was to assess the balance and load distribution of the lower limbs in patients after various methods of stabilization of calcaneal fractures. Methods: In this two-center study, we retrospectively collected data from 19 patients treated with internal plate fixation at a mean age of 46 years and 27 patients treated with Ilizarov external fixation at a mean age of 50 years. Using the Zebris Medical pedobarophragmatic platform, we assessed the percentage distribution of lower limb loads and balance. Results: There were no significant differences in total load distribution for both the operated (p = 0.489) and non-operated limb (p = 0.46), between the Ilizarov method group and the internal plate group. In the Ilizarov fixation group, total load distribution was 46.89% on the treated limb, and 53.11% on the uninjured limb, p = 0.077. In the internal plate fixation group, the mean total load distribution was 41.57% in the treated limb, and 57.89% in the uninjured limb, p = 0.008. The median CoG (center or gravity) sway path length was 132.41 cm and 170.21 cm in the Ilizarov and internal plate group, respectively, p = 0.023. The median CoG sway areas were 0.84 cm2 and 7.57 cm2 in the Ilizarov method group and internal plate fixation group, respectively, p < 0.001. Conclusions: The Ilizarov method was associated with more symmetrical load distribution and improved balance performance compared to internal plate fixation. Static biomechanical parameters of calcaneal fracture treatment were better in the Ilizarov group compared to patients with internal plate fixation.

2025, Leyko, Paweł, Zaborska, Monika, Walczak, Agnieszka, Tomczyk, Łukasz, Pelc, Marcin, Mnich, Aleksander, Operacz, Radosław, Morasiewicz, Piotr

Background: Developmental knee joint deformities are a common problem in pediatric orthopedics. Children with a valgus or varus deformity of the distal femur or the proximal tibia are commonly treated with hemiepiphysiodesis. Gait analysis in patients with lower limb deformities plays an important role in clinical practice. The purpose of our study was to assess gait parameters in patients who underwent hemiepiphysiodesis procedures of the distal femur or proximal tibia due to a knee deformity and to compare them with those in healthy controls. Methods: We prospectively evaluated 35 patients (14 females and 21 males) after hemiepiphysiodesis and compared the results with a healthy control group (26 participants). Gait was analyzed with a G-Sensor device (BTS Bioengineering Corp., Quincy, MA, USA). We assessed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, and step length. We assessed these gait parameters in a group of patients before and after treatment with hemiepiphysiodesis. We compared the patients’ results before and after treatment to those of a healthy control group. The level of significance was set at p < 0.05. Results: The mean follow-up period was 13 months. There was no difference in the results of gait assessments in patients prior to and after treatment. The median step length was 47.09% in the treated limb after treatment and 54.01% in the intact limb (p = 0.018). There were no other differences in gait parameters in the treated limbs and the healthy, intact limbs in the patient group after treatment. There were no significant differences in the patients before and after treatment compared with those in the healthy control group in all gait parameters. Conclusions: Valgus or varus knee deformity correction with the use of hemiepiphysiodesis does not significantly improve preoperative gait parameters. The biomechanical outcomes of hemiepiphysiodesis in the treatment of valgus or varus knee deformity are good. We observed no differences in gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, gait velocity, cadence, or step length between the experimental and healthy control groups.

2025, Morasiewicz, Piotr, Pelc, Marcin, Tomczyk, Łukasz, Kochanska-Bieri, Joanna, Bobiński, Andrzej, Pili, Daniele, Reichert, Paweł

2024, Pelc, Marcin, Hryniuk, Władysław, Bobiński, Andrzej, Kochańska-Bieri, Joanna, Tomczyk, Łukasz, Pili, Daniele, Urbański, Wiktor, Lech, Marcin, Morasiewicz, Piotr

Background: Up to 75% of calcaneal fractures are intra-articular fractures, which may severely impair foot function and lead to disability. Methods: We retrospectively analyzed 21 patients with intra-articular calcaneal fractures who had been treated with the Ilizarov method in the period 2021–2022. The mean patient age was 47 years (range 25–67 years). We analyzed the following functional parameters: foot function with a revised foot function index (FFI-R) questionnaire and the level of physical activity, with the University of California Los Angeles (UCLA) activity scale, a visual analog scale (VAS), and a Grimby physical activity level scale; and ankle range of motion. Results: We observed a significant improvement in the UCLA activity scores and Grimby activity score at long-term follow-up. Functional outcomes based on the FFI-R questionnaires showed an improvement, from 292 points prior to surgery to 127 points at follow-up, p = 0.013. The post-treatment follow-up measurements revealed a median dorsiflexion at the treated ankle joint of 20 degrees, whereas that at the intact ankle was 40 degrees, p = 0.007. The plantar flexion showed asymmetry, with a median 15 degrees at the treated ankle and 30 degrees at the intact ankle, p = 0.007. The median range of inversion at the ankle joint was 5 degrees in the treated limb and 15 degrees in the intact limb, p = 0.039. Conclusions: Patients with calcaneal fractures treated with the Ilizarov method are recommended to have a longer and more intensive rehabilitation. The range of ankle motion in the treated limb was limited in comparison with that in the intact limb; however, this did not greatly affect the patients’ return to their earlier, pre-injury level of physical activity.

2023, Bobiński, Andrzej, Tomczyk, Łukasz, Pelc, Marcin, Chruścicki, Damian Aleksander, Śnietka, Bartosz, Morasiewicz, Piotr

Background: Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw. Methods: Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7–14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured. Results: The mean follow-up period was 18 months (14–26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, p = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, p = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, p = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, p = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences. Conclusions: The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus.

2025, Leyko, Paweł, Zaborska, Monika, Walczak, Agnieszka, Tomczyk, Łukasz, Pelc, Marcin, Mnich, Aleksander, Kowal, Igor, Morasiewicz, Piotr

Background: Biomechanical disorders may result from joint deformities. The purpose of this prospective research was to assess total load distribution over the lower limbs and balance in individuals before and after an hemiepiphysiodesis procedure performed due to valgus or varus knee deformity. Methods: Thirty-five patients, mean age 12 years, who underwent hemiphysiodesis for valgus or varus deformity of the knee were evaluated in comparison to a healthy control group. In patients, the percentage distribution of weight-bearing capacity between the operated and unoperated limbs was analyzed before and after surgery. Balance was assessed based on CoG (center of gravity) sway area and the CoG path length. Results were collected using the FreeMED MAXI pedobarographic platform. Results: Before surgery, statistically significant lower load on the entire affected limb was noted compared to unaffected limb. The values of path of center of gravity improved statistically significantly after surgery, compared to the values before surgery. There were no differences in the load on the treated lower limb in the study group and the non-dominant limb in the control group. There were no differences between the load on the non-operated limb in the study group and the load on the dominant limb in the control group. In the hemiepiphysiodesis group there were no significant differences between the mean total load on the treated and untreated limb after surgery. The median CoG sway area and path length in the group of patients after hemiphysiodesis and in the healthy control group did not differ. Conclusions: After hemiphysiodesis, the percentage load distribution did not differ between the operated and non-operated lower limb. Hemiepiphysiodesis allows for achieving balance similar to the healthy control group. Performing hemiepiphysiodesis allows for the improvement of balance parameters and load distribution in the lower limbs.

2025, Pelc, Marcin, Hryniuk, Władysław, Bobiński, Andrzej, Kochańska-Bieri, Joanna, Tomczyk, Łukasz, Pili, Daniele, Morasiewicz, Piotr

2024, Pelc, Marcin, Kazubski, Krystian, Urbański, Wiktor, Leyko, Paweł, Kochańska-Bieri, Joanna, Tomczyk, Łukasz, Konieczny, Grzegorz, Morasiewicz, Piotr

Background: The biomechanical outcomes of intra-articular calcaneal fracture treatment have not been fully explored. The purpose of this study was to analyze pedobarographic assessments of balance and body weight distribution over the lower limbs in patients following calcaneal fracture treatment with the Ilizarov method and to compare the results with those of a control group. Materials and Methods: The data for our retrospective study came from cases of intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method in the period between 2021 and 2022. The experimental group (21 patients; 7 women, 14 men) included Sanders classification calcaneal fractures type 2 (n = 3), type 3 (n = 5), and type 4 (n = 13). The control group comprised 21 sex-matched healthy volunteers, with no significant differences from the experimental group in terms of age or BMI. The examination included an assessment of balance and weight distribution over the lower limbs. The device used was a FreeMED MAXI pedobarographic platform (SensorMedica). Results: The mean displacement of the center of gravity in the experimental group was significantly higher at 1307.31 mm than in the control group (896.34 mm; p = 0.038). The mean area of the center of gravity was not significantly different between the groups. An analysis of weight distribution over the operated and uninjured limb in the experimental group and the non-dominant and dominant limb, respectively, in the control group revealed no significant differences. We observed no significant differences in the percentage of weight distribution over the lower limbs between the operated limb in the experimental group and the non-dominant limb in the control group, or between the uninjured limb in the experimental group and the dominant limb in the control group. Conclusions: The use of the Ilizarov method in calcaneal fracture treatment helps normalize the percentage weight distribution in the lower limbs, with the results comparable with those obtained in the healthy control group. The mean displacement of the center of gravity was worse in the experimental group than in controls; whereas the mean area of the center of gravity was comparable between the two groups. Treatment of calcaneal fractures with the Ilizarov method does not help achieve completely normal static parameters of lower-limb biomechanics. Patients treated for calcaneal fractures with the Ilizarov method require longer and more intense rehabilitation and follow-up.