Introduction: The study is aimed to present patient oriented diagnostics, treatment, remote rehabilitation potential and preliminary outcomes assessment in the group of osteoporotic compression fracture cases.

Methods: 3D postural assessment originally developed of spinal curvatures, semi quantitative radiographic evaluation and QCT BMD measurement were used in the study. The kyphosis angle based on back shape curve was measured on the 3D surface image utilizing dedicated software mimicking Debrunner kyphometer measurement. Radiographic assessment and measurements were performed on digital images using DICOM viewing analytic software (DICOM Vision, Alteris Ltd.). Radiographic assessment of VCF was based on semiquantitative visual and quantitative morphometric assessment. Bone mineral density were measured utilizing DXA BMD (g/cm2) and QCT BMD (mg/cm3) of the lumbar spine. The polish translation of Oswestry Disability Index (ODI) version 2.1a (http://www.orthosurg.org.uk/odi/index.htm). Telerehabilitation service was served as a supplementary service utilizing Internet videoconferencing. Summary and nonparametric statistical analysis was performed.

Results: The group of elderly patients finally enrolled to the study consisted of patients whose data, images, and other examinations were analyzed. Average age of patients was 73,22 years. Average number of fractured vertebra was 3,6 in the study group. The most frequent anatomical location of fractures was lumbar first and third vertebral body. The most frequent fracture types according to Genant et al. classification were Biconcave Grade II (38,6%) and Wedge Grade II (36,9%). The most frequent 53-A1.2 and 53-A2.1 types of fractures. An average QCT bone density was lower than 80 mg/cm3 in whole examined group that represents severe osteoporosis. Bone density lower than 30 mg/cm3 was found in almost one third of the group that coincided with highest number of fractured vertebral bodies. Oswestry disability score was highest along with lowest values of QCT BMD, and significantly improved after vertebral augmentation. Telerehabilitation was considered as successful among computer skilled patients.

Discussion: and Conclusion: Described personalized approach shows the flow of the individual patient from Metabolic Bone Diseases and Osteoporosis Unit through diagnostics and surgery to telerehabilitation service opportunities. The 3D structural light method of posture was developed and implemented. Telerehabilitation service may activate patients at home. Complex personalized, team approach to osteoporotic vertebral fractures consisted of new diagnostics, vertebral augmentation and remote rehabilitation.

The quantitative measurement is required for fracture healing evaluation in clinical studies approaching toward Evidence Based Medicine. Early detection of fracture healing impairment is demanded to introduce as early as possible the optimal treatment leading to recovery. Clinically validated and tested methods usually utilize X-ray and CT data. The aim of this study was to improve assessment of fracture healing progress or impairment examined with X-ray and computed tomography (CT) and to determine the usefulness of quantitative methods based on newly developed 3D image analyzing software. An original software “3D Reconstructor” was developed. The application operates on medical image data stored in DICOM format. 3D Reconstructor v.2.0 allows 2D reconstruction in custom surface directs through data block and 3D reconstruction as well. The usefulness of the application was evaluated for long bone fracture healing with three-dimensional presentation of fracture callus. Twenty otherwise healthy fracture patients (average age 43 years) with fractures of the tibial shaft, humerus, forearm, and clavicle were enrolled and underwent chronological series X-ray imaging and spiral CT scanning when it was clinically justified and necessary. Patients were preselected for CT study because of healing impairment suspicion. Computer Tomography examination was performed 14 to 56 weeks after injury (GE Pro Speed SX, slice 2–3 mm, image reconstruction 1 – 1,5 mm, 120 kV, 100 mAs). Qualitative assessment included fracture line/margins, fracture gap, external callus appearance, callus-to-cortex ratio, bridging, and radiologic union. Quantitative assessment of CT density changes (Hounsfield units [HU]) in the fracture gap was performed in patients using 3D Reconstructor multimodality image analysis software. Regions of interest (ROI) were analyzed in details by quantitative and qualitative assessment. Complete bone union was confirmed in 2 cases, delayed union in 8 cases and nonunions in 10 cases. The use of 3D Reconstructor enhanced quantitative evaluation of fracture callus in all evaluated cases. Low union rate observed in computed tomography derives from patient’s preselection based on clinical observations. Reliable fracture healing assessment can be enhanced with computed tomography and Computer Aided Diagnostic methods that supplement quantitative analysis of CT images. CAD quantitative assessment of the fracture gap and callus was successfully performed using 3D Reconstructor software in clinical cases. Higher accuracy of pseudoarthrosis and delayed union diagnosis was achieved. The reliable diagnosis in fracture cases may be supported with Computer Aided Diagnostic Methods. Still ongoing project, “3D Reconstructor” seems to be more accurate over not “armed” evaluation of original CT DICOM files of fracture healing in selected cases.

Bacteriophage state currently an attractive alternative for antibiotics, especially due to the strong in vitro activity and lack of side effects.

Eight patients with chronic infection in musculoskeletal system.are presented

This group includes: 3 cases of deep periprosthetic infection, posttraumatic osteomyelitis of tibia in 2 cases, infected pseudoarthrosis of femur in 1 case, chronic hematogenous osteomyelitis of tibia in 1 case, chronic infection in diabetic foot in 1 case.

Adequate tissue specimen for bacteriology was taken during operation and selection of bacteria strains was subsequently done and appropriate phage were cultured. Phage were taken orally by patients 4–6 weeks after operation. Despite of paralel phage and systemic antibiotic administration all patients underwent operative debridement of infected bone.

Simultaneously, every 7 days parameters of immunological response was measured in peripheral blood. They were: lymphocyte B activity (PFC and SAC test), lymphocyte T (NK) activity and phagocytose stimulation (PMA 30 test).

There was a two-fold increase of lymphocyte B activity in PFC test with peak on day 7 after phage administration. Additionally slightly increase of NK cells and phagocytic activity and both increase and decrease of lymphocyte B and T activity in SAC test was observed. Eventually remission of infection was achieved in 6 from 8 patients.

It is difficult to state a correlation between in vitro bactericidal effect of bacteriophage, immunological stimulation in peripheral blood and clinical results achieved after both operative and antimicrobial therapy.