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Lower extremity nerve injuries accompanying bone fractures and joint dislocations lead to serious disturbances at the lower limbs and caused significant prolongation of the treatment time. Clinical material consisted of 73 patients treated surgically with lower extremity nerve injuries due to bone fractures and joint dislocation. Based on this material we analysed the most frequent localisations of the nerves lesions and the mechanism of injury. The indications to surgical treatment were also described.

Iatrogenic lesions of the nerve might be of a deliberate or unintentional character. The clinical material consisted of 73 patients treated surgically with unintentional injuries of the lower limbs nerves. Based on this material we analysed the causes of iatrogenic lesions of the lower limbs nerves and the probably mechanism of injury. The methods of prevention of these complications and the indication to surgical treatment were also described.

The principles that ought to be followed in closed fracture operative treatment have been presented. All relevant factors of surgical management were considered, beginning from qualification of the patient with motor system trauma for operative treatment, right choice of stabilization technique, as well as appropriate soft tissue and early posttraumatic care. It was emphasized that, even a "technically perfect" stabilization of fractured bone pieces using the right technique gave no guarantee of success if soft tissue care was inappropriate, inadequate was limb blood supply and if treatment of infection complicated cases in the early stage was solely limited to systematic antibiotic administration.

The aim of this paper was assessment of utility of serum osteocalcin levels in monitoring early stages of bone healing and early detection of bone healing disorders. Serum osteocalcin level and alkaline phosphatase activity was assessed with acute long bone fractures and with delayed bone union and pseudoarthroses. 25 patients underwent the trial. The analysis of the results confirmed the utility of serum osteocalcin level as a prognostic factor in early detecting of union disorders and its correlation to radiological examination.

The author presents in a condensed way an overview of the principles of limb amputations and further treatment of patients who underwent such a procedure. The metabolic cost of walking, load transfer, and wound healing are reviewed in a concise manner. Particular attention is given to blood supply to the wound and methods to determine adequate perfusion with a clear analysis of the pro and cons of the Doppler method. Pediatric amputations, because of their specificity, are considered apart. Disarticulation of limbs is the method of choice in children, because of it retains growth potential of the bone and prevents bony overgrowth of the stump. The article discusses the main indications for limb amputations: trauma, peripheral vascular disease, musculoskeletal tumors and gas gangrene. In every case the specificity of the amputation is considered by the author. Postoperative care is also presented, with a short description of possible complications. Pain is the most common and treatment strategies should be similar to those used in treating patients with major reflex sympathetic causalgia. Edema, joint contracture, wound failure and dermatologic problems are all shortly reviewed. The last part of the article treats with the principles of prosthetics in both the upper and lower limb. These principles are presented basing on the level of amputation: for the upper limb hand, transradial, transhumeral amputations and shoulder disarticulation. For the lower limb foot and ankle, transtibial and transfemoral amputations are considered.

An impact of diminished mechanical loading of lower extremity on bone densitometry has been quantitatively assessed with ultrasound. Seventy-three females with lower limb fracture history, coxarthrosis or scoliosis were evaluated. Both heels were submitted to measurements with Achilles densitometer (Lunar, USA). The following parameters were analyzed: Speed of Sound, Broadband Ultrasound Attenuation and Stiffness Index. Decreased values of all parameters were found in unloaded extremities. Speed of Sound was reduced most and in the group with fracture history. To avoid local bone loss short immobilization, early rehabilitation and pharmacotherapy is suggested.

Tołpa peat preparation at the dose of 5 mg per day was administered to 10 patients with chronic posttraumatic osteomyelitis for 6 weeks period of time. Good clinical result (ceasing of the inflammatory process) was found in 4 patients but 3 of them were concurrently treated surgically. Immunological examination (angiogenesis test and chemiluminescence test) performed before the onset and after completion of the treatment with Tołpa preparation did not reveal meaningful changes indicating immunomodulating action of the preparation on the course of posttraumatic osteomyelitis.

Free cutaneous--muscular flap from the latissimus dorsi muscle was used to cover extensive posttraumatic skin defect of the distal tibia in a patient with lesion of the anterior tibial artery. The technique of flap transfer and vascular anastomosis has been presented. Full healing was achieved.

The authors evaluated various methods of range lengthening of muscular and cutaneous--muscular flaps from the medial head of the gastrocnemius muscle on 18 amputated lower extremities and section specimens. It has been found that lengthening of flaps size by Cheng and transformation of the muscular and cutaneous--muscular flap into the island flap produced marked lengthening of flap arch. The authors believe that incisions of the perimysium can not be recommended as a method of lengthening of flaps range.

The treatment results of pseudoarthrosis of long bones in 25 patients have been presented. There were eight infected pseudoarthroses. The stable Zespol osteosynthesis was used together++ with bone-periosteum-muscle decortication and covering with grafts of autogenous or homogenous spongy bone. Among the treated pseudarthroses, 18 concerned the tibial bone, 3--the femoral bone, 2--the humerus, 1--the radial bone, and 1--the ulnar bone. In 20 cases bone union was achieved at 3-8 months. Three patients needed after--treatment by orthosis, and in two cases, because of skin complications, the Zespol stabilizator had to be removed.

Surgical treatment was applied in 46 patients with simultaneous injury of great vessels of the lower extremities and fractures of the long bones or dislocations of the knee joint. The authors have determined the best in their opinion sequence of surgical procedure. They think that external fixation gives better bone stabilization and is more favorable than internal stabilization. They also recommend lavage of the peripheral vascular bed of the ischemic lower extremity, which prevents post-traumatic insufficiency of the kidneys. They think that early fasciotomy of the crus or fibulectomy is important for the good result of the operation.