Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

{"title":"[The Use of BTB Allograft in Revision Reconstruction of the Anterior Cruciate Ligament and Its Success Rate in Terms of Subjective Patient Satisfaction].","authors":"J Sklenský, P Vališ, M Repko, M Rouchal, M Maršálek, D Hrůzová","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY A retrospective evaluation of the success rate of revision ACL reconstruction performed using BTB allograft in terms of the life expectancy of the procedure up to and over five years from surgery. MATERIAL AND METHODS Over a ten-year period, from 2003 to 2013, we performed 47 revision ACL reconstruction surgeries. The majority of the primary ACL reconstructions using BTB autografts were not performed at our site. The group observed included 16 women (34%) and 31 men (66%). The women were aged between 25 and 48 years, the median age being 32.5, and the men were aged between 25 and 46 years with the median age of 35. We were able to make a full pre- and post-operative evaluation of 22 out of 47 patients who underwent secondary ACL reconstruction surgery using a cadaverous BTB graft. This evaluation included an objective clinical testing and a subjective evaluation of the function and stability of the knee joint using the Tegner activity score, Lysholm score, and a modified Cincinatti score. The set of 22 patients was split into two groups: up to five years from revision surgery and over five years from the procedure. RESULTS In the group of patients who were fully evaluated within five years of revision reconstruction there was an average improvement of 16.4 points on the Cincinatti score, 19.9 points on the Lysholm score, and an upward movement averaging 1.5 levels on the Tegner activity score. In the over five years from surgery category the average improvement was 15.5, 15.9, and 1.2 levels upward movement, respectively. We were unable to prove a significantly increased level of failure in BTB allografts after five and more years from revision ACL reconstruction. DISCUSSION The two strongest factors affecting the life expectancy of ACL replacements are the age of the patient and the type of the graft used, allograft or autograft. The most at risk, in terms of how long the graft will last, is the age group of 10 - 19 years old. With each ten-year increase in age the risk of rupture is reduced more-or-less by half. Patients with ACL allograft replacement show a fourfold increased risk of the graft rupturing. The younger and more active the patient requiring revision ACL reconstruction is, the greater the need for an autograft. If an allograft has been used in revision reconstruction on an athlete, a great emphasis must be placed on the necessity of delaying the return to previous sporting activities for at least nine months. CONCLUSIONS The mid-term results of revision ACL reconstruction show that, subject to reasonable levels of stress, a correctly performed procedure using cadaverous BTB grafts is a good option to restore the stability of the knee joint over a period of five years and more from surgery. An increased incidence of reruptures or greater insufficiency of the cadaverous graft were not evident in our group after five and more years. The risk of cadaverous grafts failure is just like in the autologous replace","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 2","pages":"106-113"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Periprosthetic Femoral Fractures after Total Hip Replacement: Our Results and Treatment Complications].","authors":"T Pavelka, M Salášek, D Weisová","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The study consists of a retroactive evaluation of results of surgical treatment in patients with periprosthetic femoral fracture after total hip replacement and a comparison with results reported in the literature. MATERIAL AND METHODS In the period from 2003 to 2013, a total of 83 patients with periprosthetic femoral fracture after total hip replacement were treated at our clinic, namely 69 women and 14 men. The mean age in the cohort was 74 years (range 47-87). The Vancouver classification was used to grade the fractures. The cohort included 31 patients with type B1 fracture, 25 patients with type B2 fracture, 8 patients with type B3 fracture, and 19 patients with type C fracture. Altogether 80 patients underwent a surgery, 3 patients with non-displaced type B1 fracture were treated conservatively. The mechanism of injury was a simple fall in 75 % of primary endoprostheses and in 56% of revision endoprostheses. The average time to fracture was 7.6 years in primary implant and 3.6 years in revision endoprosthesis. In fractures with a well-fixed stem (type B1 and C) plate osteosynthesis was used. In case of a comminution zone, osteosynthesis was followed by spongioplasty. In patients with a loose stem (type B2 and B3), the fracture was treated with a revision uncemented stem. In two cases a combination of a revision stem and a massive corticocancellous bone graft was used. The evaluation was performed using the Harris Hip Score and the minimum follow-up from the surgery was 3 years. RESULTS In the group of patients with type B1 fracture, 28 patients were treated surgically. An excellent result was achieved in 22 patients (84%), in 4 patients (16%) the result was very good. The remaining 2 patients failed to meet the requirement of the minimum follow-up of 3 years. In the group of patients with type B2 fractures, composed of 25 patients, the femoral component was replaced with a revision uncemented stem with cerclage wires or titanium tapes or cables. Osseointegration of the stem was recorded in 24 patients, one female patient died 4 months after the surgery. An excellent result was achieved in 16 patients (64%), a very good result in 4 patients (16%). The remaining 5 patients (20%) failed to meet the minimum follow-up of 3 years. In 8 patients with type B3 trauma, the reimplant of a revision stem was supplemented by spongioplasty, in 2 cases by solid corticocancellous bone grafts with cerclage. In this group osseointegration occurred in all the cases within 6-9 months. The follow-up was affected by the older age of patients and 6 patients died during the follow-up period. The requirement of a follow-up longer than 3 years was met in 2 patients (25%) only and the result was considered very good. In the group of 19 patients with type C fracture, plate osteosynthesis was performed, which was in 12 cases complemented with spongioplasty. Healing occurred within 6 months in 13 patients (72%), within 9 months in 3 patients (17","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 1","pages":"52-58"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34777450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthrodesis of the Ankle.","authors":"H Zwipp","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>About 90 % of all cases of painful posttraumatic ankle arthritis can be very successfully treated with a minor invasive ankle arthrodesis technique by using a small anterior approach and a fixation with four 6. 5 mm screws of which the posteromedial and transfibular one are inserted percutaneously. The results with this standardized procedure have been reported previously as excellent and good in a mid-term run of 6 years (34). This technique leads to a high union rate of 99% (92 of 93) with rapid bone healing within 8 ± 2 weeks, it causes a low minor complication rate of 8 % and enables a significant increase of the AOFAS ankle/hindfoot score (17) from 36 preoperatively to 85 postoperatively as well as a midtarsal movement of 24° ± 16°. In some cases of ankle arthritis due to chronic syndesmotic instability a 5th screw is additionally used to compress the reamed espace claire for regaining a stable ankle fork. A 5th screw is used also in case of necessary shortening of the fibula or in cases of idiopathic ankle arthritis with gross varus deformity when a transfibular approach becomes necessary instead of the anterior approach. About 10% of ankle arthrodesis need different procedures like in cases of malunited ankle or pilon fractures with low grade infection, larger bony defects due to resection of necrotic bone, due to primary bone loss in open fractures or due to secondary bone loss in failed ankle replacement cases. They need usually a two stage procedure with primary debridement and temporary joint transfixation and secondary anterior double plate fixation with autogenous bone grafting. In case of critical anterior soft tissues a posterolateral approach with a bladeplate-fixation is performed. In the very rare cases of severe ankle infection a three stage procedure is recommended with a radical necrectomy of infected soft tissues or dead bone and/or combined with taking biopsies, filling the defects with Gentamycin-PMMA- beads and stabilizing the reamed joint with a threaded compression Charnley fixator in the first stage. A re-debridement in the second stage might need additionally a permanent lavage with sensitive antibiotics according to the probes and in the third stage a third debridement with finally autogeneous bonegrafting is done. Key words: ankle arthrodesis, anterior, posterolateral, transfibular ankle approach, 4- to 5-screw fixation technique, double plate fixation, autogeneous bonegrafting, Charnley compression fixator.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 1","pages":"13-23"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34777562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Patellar Resurfacing in Total Knee Arthroplasty for Symptomatic Valgus Degenerative Deformity.","authors":"O B Vukadin,&nbsp;Z B Blagojević,&nbsp;Z Lj Baščarević,&nbsp;N S Slavković,&nbsp;V Stevanović,&nbsp;B D Vukomanović","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Patellar surface replacement during total knee arthroplasty is still a matter of discussion among orthopedic surgeons. The purpose of this study was to examine possible benefits of patellar surface replacement in selected patients with symptomatic degenerative valgus deformity. We have not found any studies in the literature that compare the results of patella management solely for valgus or varus knee deformity nor those that compare both. MATERIAL AND METHODS Patients were randomly assigned to a group that would receive patellar surface replacement during total knee arthroplasty and a group of patients in whom total knee arthroplasty was performed without patellar surface replacement. 60 patients were included in the study. Total knee arthroplasty with patellar resurfacing (TKAPR) was performed in 30, and without PR (TKA) in 30 of them. Results were prospectively gathered and compared at regular intervals. RESULTS There were no significant differences between groups for examined parameters except for Oxford Knee Score at 6 months which was in favor of patellar resurfacing group. DISCUSSION The decision whether to replace the patella or not is currently exclusively a matter of surgeon's choice. Establishing selection criteria for patients that would benefit from patella resurfacing could, therefore, be very useful for both patients and orthopaedic surgeons performing total knee replacement. CONCLUSIONS Although evidence in our study could not strongly suggest performing patella resurfacing in patients with valgus deformity, the results were slightly better in the patella resurfacing group and this trend could increase if larger series of patients would be employed. A longer follow-up period would be required for clear-cut decisions and more prospective studies are warranted. Key words: knee, arthroplasty, patella, replacement, valgus, deformity.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 1","pages":"30-34"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34777564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison between the Range of Movement Canine Real Cervical Spine and Numerical Simulation - Computer Model Validation].","authors":"R Srnec,&nbsp;Z Horák,&nbsp;R Sedláček,&nbsp;M Sedlinská,&nbsp;M Krbec,&nbsp;A Nečas","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY In developing new or modifying the existing surgical treatment methods of spine conditions an integral part of ex vivo experiments is the assessment of mechanical, kinematic and dynamic properties of created constructions. The aim of the study is to create an appropriately validated numerical model of canine cervical spine in order to obtain a tool for basic research to be applied in cervical spine surgeries. For this purpose, canine is a suitable model due to the occurrence of similar cervical spine conditions in some breeds of dogs and in humans. The obtained model can also be used in research and in clinical veterinary practice. MATERIAL AND METHODS In order to create a 3D spine model, the LightSpeed 16 (GE, Milwaukee, USA) multidetector computed tomography was used to scan the cervical spine of Doberman Pinscher. The data were transmitted to Mimics 12 software (Materialise HQ, Belgium), in which the individual vertebrae were segmented on CT scans by thresholding. The vertebral geometry was exported to Rhinoceros software (McNeel North America, USA) for modelling, and subsequently the specialised software Abaqus (Dassault Systemes, France) was used to analyse the response of the physiological spine model to external load by the finite element method (FEM). All the FEM based numerical simulations were considered as nonlinear contact statistic tasks. In FEM analyses, angles between individual spinal segments were monitored in dependence on ventroflexion/ /dorziflexion. The data were validated using the latero-lateral radiographs of cervical spine of large breed dogs with no evident clinical signs of cervical spine conditions. The radiographs within the cervical spine range of motion were taken at three different positions: in neutral position, in maximal ventroflexion and in maximal dorziflexion. On X-rays, vertebral inclination angles in monitored spine positions were measured and compared with the results obtain0ed from FEM analyses of the numerical model. RESULTS It is obvious from the results that the physiological spine model tested by the finite element method shows a very similar mechanical behaviour as the physiological canine spine. The biggest difference identified between the resulting values was reported in C6-C7 segment in dorsiflexion (Δφ = 5.95%), or in C4-C5 segment in ventroflexion (Δφ = -3.09%). CONCLUSIONS The comparisons between the mobility of cervical spine in ventroflexion/dorsiflexion on radiographs of the real models and the simulated numerical model by finite element method showed a high degree of results conformity with a minimal difference. Therefore, for future experiments the validated numerical model can be used as a tool of basic research on condition that the results of analyses carried out by finite element method will be affected only by an insignificant error. The computer model, on the other hand, is merely a simplified system and in comparison with the real situation cannot fully e","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 2","pages":"133-137"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35324564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison of Short-Therm Results of Conservative versus Operative Treatment of Distal Ulna Fractures Associated with Distal Radius Fracture Treated by Plate Osteosynthesis].","authors":"P Meluzinová,&nbsp;L Kopp,&nbsp;P Dráč,&nbsp;K Edelmann,&nbsp;P Obruba","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY The study aims to evaluate and compare the results of conservative and operative treatment of individual types of distal ulna fractures associated with distal radius fracture treated by plate osteosynthesis and to verify the conclusions of the other authors regarding the recommended therapeutic procedures in these fractures. MATERIAL AND METHODS In the period from 08/2013 to 09/2015, a total of 81 patients participated in the prospective randomised study, with the mean follow-up period of 24 months (6-36). All the fractures of distal two thirds of ulnar styloid process were treated conservatively. The patients with the other types of ulnar fractures (fractures of the proximal third of ulnar styloid process, ulnar head fractures, subcapital fractures) were systematically divided into two cohorts, based on which the subsequent (conservative vs. operative) treatment of distal ulna fractures was indicated. The operative treatment of all the types of distal ulna fractures was performed by plate osteosynthesis using LCP Distal Ulna Plate implant so that a uniform method is applied. RESULTS In the post-operative follow-up not a single patient with tip fracture of ulnar styloid process in the cohort showed a posttraumatic instability or disorder of distal radioulnar joint (DRUJ) biomechanics (ROM 96.6% (91-100), MWS 61.3 points (75-100), QDASH 2.9 points (0-6.8)). The patients with a fracture of the proximal third of ulnar styloid process, a fracture of ulnar head and a subcapital fracture, treated operatively, achieved better early radiographic and functional outcome (ROM 95.7% (60-100), MWS 91.2 points (75-100), QDASH 3.5 points (0-11.4)) than patients treated conservatively (ROM 89.6% (64-100), MWS 70.4 points (35-85), QDASH 18.4 points (0-52.3)). DISCUSSION The study confirms the conclusions drawn by the other authors that tip fractures of ulna do not cause posttraumatic DRUJ instability and do not require operative treatment. Conservative treatment of ulnar base fractures led to non-union in 60% of cases and to malunion in 25% of cases, altogether in 15 patients (75%) the clinical examination revealed a conclusive posttraumatic DRUJ instability of various severity and these patients showed healing in malunion ad latus greater than 2 mm and non-union of the fracture. By performing anatomical reduction and osteosynthesis of ulnar \"base fractures\", the stability and DRUJ function were restored in all the patients, thus also a better functional outcome was attained. Conservative treatment of ulnar head fractures brought worse outcomes due to malunion of fractures resulting in a noncongruent articular surface of DRUJ or a change in axial position of the distal end of the bone. The change in DRUJ biomechanics resulted in a limited rotation of radius and a limited range of forearm mobility. The operative treatment of subcapital ulna fracture had a very good early outcome as compared to conservative treatment of the fracture which","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 3","pages":"182-188"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35324570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Occurrence and Progression of Early Radiolucent Lines around Total Knee Arthroplasty].","authors":"M Holinka,&nbsp;J Gallo,&nbsp;R Pavličný","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY Radiolucent (RL) lines may appear around the total knee arthroplasty (TKA); they occur much more frequently under the tibial component than under the femoral one. The RL lines are gaps between the TKA and the cement, or between the cement and the bone bed. They are clearly visible immediately after the surgery or may appear later. They constitute pathology of the interface and are subject to research mainly due to their potential association with aseptic loosening. The aim of this study was to assess how often they are clearly visible on the first postoperative radiograph in everyday clinical practice, how they develop during the following two years, and to compare the results with the available professional literature. Another aim was to assess the relation between RL lines and the alignment of components, the patient's habitus and clinical outcomes of the surgery. MATERIAL AND METHODS The group included 62 patients with a total number of 69 TKA implants, of which 28 were men (45.2%) and 34 women (54.8%) aged 46 to 79 years of age. The occurrence of RL lines was monitored on the first postoperative radiograph and subsequently at a one-year interval during the following 2 years. The location of RL lines and the placement of components were assessed radiographically in terms of the concept by Meneghini et al. The evaluation of surgical outcomes was done using the Knee Society Score (KSS), and the habitus was assessed with the BMI index. Subjective evaluation of the surgical outcome was done using the 4-point satisfaction scale. RESULTS The first postoperative radiographs showed a RL line at 9 (0.8%) locations in 9 (13.0%) TKAs. The control radiographs made 1 year after the surgery showed a RL line at 42 (3.8%) locations in 29 (42.0%) TKAs. During the last check conducted 2 years after the surgery, a RL line was detected at 60 (5.4%) locations in 33 (47.8%) TKAs. Throughout the follow-up period, progression of the existing RL line occurred at 6 locations in 6 (8.7%) TKAs. On the very contrary, the RL line disappeared at 8 locations in 6 (8.7%) TKAs. An association was found between the RL line occurrence and postoperative limb axis (a higher risk was posed by the varus deformity). Moreover, the frequency of RL lines increased with the growing BMI value. No relation was found between the KSS and satisfaction with the surgery and the occurrence of RL lines. DISCUSSION AND CONCLUSIONS The occurrence of RL lines corresponds roughly with the frequency stated in literature. Some lines show progression, other disappear. So far, we have been unable to distinguish the predictively significant RL lines from the insignificant ones. Important will undoubtedly also be the size of surface of RL lines and their cause. More frequent RL lines were observed in the postoperative varus deformity of TKA and with the growing BMI value. The RL lines under the anterior part of the femoral component showed a tendency to progress. In order to avoi","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 5","pages":"347-354"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35752012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Periprosthetic Infection of the Knee Megaprosthesis following a Resection of Malignant Tumours around the Knee].","authors":"J Včelák,&nbsp;Z Matějovský,&nbsp;I Kofránek,&nbsp;R Kubeš,&nbsp;J Lesenský","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The study presents the monocentric retrospective study of a group of patients with malignant tumours around the knee, treated by a wide resection and a reconstruction with megaprosthesis due to infectious complications. Provided is a detailed analysis of each operative treatment due to the manifestation and process of periprostethic infection of the knee megaprosthesis and the use of external fixator during a two-stage revision. MATERIAL AND METHODS Between 01/1993 and 12/2013, a total of 67 cemented megaprostheses were assessed, with a detailed analysis of 12 patients with periprosthetic infection. The Kaplan-Meier method and MSTS for lower extremity clinical assessment were used and a range of motion was evaluated. RESULTS The endoprosthesis failed due to all kinds of complications (mechanical, biological, infection) in 27 (40.3%) patients. The estimated one-year survival rate from the surgery was 94%, the five-year survival rate was 72%, and the ten-year survival rate was 46%. Based on the statistical analysis of the implant survival due to infection, the one-year survival rate was 94%, the five-year survival rate was 75%, and the ten-year survival rate was 57%. Three patients were treated with radical surgical debridement. Five patients were treated with a two-stage revision with a cement spacer and external fixator, and three patients underwent nail fixation. Clinical values before and two years after the revision surgery for periprosthetic infection using MSTS were assessed. The mean of the difference of clinical values was 1.91 and the p value of paired t-test was 0.24, therefore there was no prove of the clinical result difference using MSTS before and after the revision surgery. DISCUSSION The acute radical debridement and lavage is preferred, if the surgery can be done up to three weeks after the first clinical signs of infection under the condition of good retention of the implant. In case of extensive infectious damage, when abscess, fistula and loosening of the implant are present and when the patient has a good oncological prognosis, we prefer a twostage revision with a cement spacer stabilized by an external fixator. In patients with mitigated infection or uncertain oncological prognosis we prefer a two-stage revision with the combination of a cement spacer and intramedullary nail fixation. CONCLUSIONS The study presents the results of operative treatment of periprosthetic infection of megaprosthesis and the modification of the two-stage replantation of infected MP with the use of external fixation for stabilisation of a non-articulated cement spacer allowing the patient to remain active during the time before the second stage. Key words: periprosthetic infection, megaprosthesis, bone tumour, external fixator, two-stage revision.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 1","pages":"46-51"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34777567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Talar Neck Fractures Treated Using Percutaneous Screw Fixation].","authors":"R Veselý,&nbsp;M Kelbl,&nbsp;J Kacián,&nbsp;V Hulka,&nbsp;J Kočiš,&nbsp;R Kunovský","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Closed reduction and percutaneous fixation of nondisplaced talar neck fractures have been applied by some authors. The aim of this paper is to assess the results and complications of this minimally invasive technique. MATERIAL AND METHODS In the period from 2009 to 2014, twenty-one patients with a talar neck fracture were observed after closed reduction and percutaneous screw fixation in the Traumatological Hospital in Brno. The mean age of the patients was 38 years (range 18-56 years). The mechanism of injury was a motor vehicle accident in 11 cases, a fall from height in six cases, a sports injury in 3 cases, and a fall from stairs in one case. Injuries were classified according to the Hawkins classification. Conventional preoperative 3-dimensional CT scans of the fractures were analysed. Under the guidance of C-arm fluoroscopy, Kirscher wires were used for closed reduction and temporary percutaneous fixation. Subsequently, 3.5 and 4.5 mm diameter cannulated screws were inserted. The outcome was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. RESULTS The average follow-up was 32 months (21-42 months). The average healing time was 15.5 weeks (13-19 weeks). The average AOFAS score was 82.3 points (69-96 points). 75% of patients with type I injury achieved excellent results and 72% of patients with type II injury achieved excellent or good results. None of the patients developed wound complications. Two patients developed partial avascular necrosis and three patients subtalar traumatic arthritis after surgery. DISCUSSION Talar neck fractures are relatively uncommon fractures. Most of the published studies are small. Tenuous blood supply and displaced talar neck fracture predispose to avascular necrosis of the talus. Closed reduction and percutaneous fixation can reduce the soft tissue damage and disturbance to the blood supply. CONCLUSIONS Preoperative 3D CT scans, early surgery, anatomic articular surface reduction and percutaneous screw fixation increase the fracture healing rate and reduce the incidence of talar avascular necrosis. Key word: talus, closed reduction, percutaneous fixation, screw.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 2","pages":"120-124"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35324562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Canine Elbow Humeroulnar Incongruity Measurements Using Computed Tomography].","authors":"R Snášil,&nbsp;P Proks,&nbsp;A Nečasová,&nbsp;K Michalčáková,&nbsp;A Nečas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The purpose of the study is to compare the repeatability and reproducibility of quantitative and subjective evaluation of elbow humeroulnar incongruity (HUI) using computed tomography (CT) on an in vivo canine model. MATERIAL AND METHODS HUI was evaluated on canine (n = 50) elbow joints (n = 100). The computed tomography of elbow joints was performed under intravenous sedation. Multiplanar reconstructions (MPR) were produced. HUI was evaluated on sagittal MPR images subjectively and by measuring the subluxation index (SI). The SI was defined by measuring the distance between the centres of two circles, the shape of which corresponded the most with the shape of the trochlear notch of the ulna at sagittal crest and the shape of humeral trochlea. This distance was divided by the radius of the circle (r) defining the humeral trochlea. HUI was subjectively evaluated based on the width of the joint space at the greatest caudal convexity of the trochlear notch of the ulna. Three categories of HUI were established: 0 (congruent), 1 (moderately incongruent), 2 (strongly incongruent). Measurement and evaluation of HUI was conducted by two evaluators twice at a one-month interval between the first and second measurement. The statistical analysis was carried out using the repeated measures ANOVA and the Cohen s kappa coefficient. RESULTS The mean SI was 11.14 (SD 8.703). The SI values measured by two evaluators were statistically significantly different (p < 0.05). Contrarily, there was no statistically significant difference between the two measurements of the same evaluator (p > 0.05). The subjective evaluation of HUI done by two evaluators showed a mean to substantial agreement (Kappa = 0.53-0.79). There was a substantial to almost perfect agreement between the results of two evaluations carried out by a single evaluator (Kappa = 0.79-0.83). DISCUSSION The radiographic detection of moderate incongruity is unreliable, especially on account of wrongly positioned elbow joint, superposition of bone structures and due to the evaluation of three-dimensional bone structure through a two-dimensional image. Evaluation of humeroulnar congruity by computed tomography (CT) enables to assess the congruity of joints without the superposition of neighbouring bone structures. The quantification of humeroulnar incongruity using the SI does not show a higher degree of agreement between two evaluators as against the subjective evaluation of HUI. On the contrary, the agreement between two measurements of a single evaluator was high in both the cases. CONCLUSIONS Dog is a suitable model animal for evaluation of HUI of elbow joints due to frequent incidence of elbow dysplasia associated with HUI. The quantification of HUI at the expense of subjective evaluation of HUI is often overrated in radiological studies. Key words: dog, elbow, humeroulnar incongruity.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"84 4","pages":"299-303"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35532712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}