Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

{"title":"Popliteal Fossa Sarcomas.","authors":"O Erdogan,&nbsp;A Çeli K,&nbsp;A N T Yildirim,&nbsp;E Tekçe,&nbsp;G Altun,&nbsp;S Demi Röz,&nbsp;Y Güler,&nbsp;K Ozkan,&nbsp;V Gurkan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%-5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample. MATERIAL AND METHODS Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes. The minimum follow-up was 24 months. RESULTS The mean age of the patients was 48 ± 21.23 (range 3-72) years at the time of diagnosis. The mean follow-up was 41.79 ± 16.97 (range 24-120) months. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), unidentified fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (26%). At the latest followup, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease. CONCLUSIONS Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins. Key words: fossa poplitea, sarcoma.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 3","pages":"181-187"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121243","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":"[Incidence, Diagnosis and Risk Factors for Fracture-Related Infection (FRI): 3-Year Experience of Level I Trauma Centre].","authors":"J Řimsa,&nbsp;M Doležalová Hrubá,&nbsp;J Urban,&nbsp;M Peml,&nbsp;K Holub,&nbsp;M Kloub","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY The study aims to determine the incidence of fracture-related infection (hereinafter referred to as the FRI) at a Level I trauma centre over a three-year period. It also aimed to determine the risk factors, to observe confirmatory and suggestive criteria in line with the applicable recommendations, and to evaluate the bacterial spectrum in a diagnosed FRI. MATERIAL AND METHODS It is a retrospective-prospective study carried out through studying the documentation. The study included all patients diagnosed with FRI and treated between 2019 and 2021, except for the patients with hand fractures since minor phalangeal fractures of the fingers were largely treated by the outpatient department, no osteosynthesis was performed in the operating room, and these patients were not followed up at our department. RESULTS The FRI incidence was 2.33% of all osteosyntheses performed at the Level 1 trauma centre in the period 2019-2021. The FRI was most often caused by pyogenic cocci agents and the FRI developed most frequently within 6 months after osteosynthesis. The site at risk was the lower limb region. The FRI incidence was most often indicated by suggestive clinical criteria (redness, secretion, pain) and radiological criteria (delayed healing, non-union). Overall, 42.19% of treated nonunions were later diagnosed as FRI. At the time of FRI diagnosis, the CRP values were normal in 21.7% of patients. DISCUSSION The FRI incidence rate in 2019-2021 was 2.33%, which corresponds with the values reported in other papers focusing on the incidence of infectious complications after osteosynthesis. Fang and Depypere reported 1-2% of infectious complications. The most common risk factors are open fractures, which account for 20.16% in our cohort. Ktistakis and Depypere describe the incidence of osteomyelitis in 30% of treated open fractures. In our cohort, the incidence of FRI was significantly higher in lower limb fractures. Bezstarosti, Wang and Pesch published similar results, with some deviations. The time from osteosynthesis to final FRI diagnosis varied from a few weeks to several years. In more than half of the patients the FRI developed within 6 months after performed osteosynthesis. Metsemakers and Fang refer to the very same trend. The CRP levels in the study population varied a lot. Xing-qi Zhao describes CRP as a less sensitive (sensitivity 65.6%) but more specific marker (specificity 75.4%). According to the available literature, the most common agents causing infectious complications of osteosynthesis are gram-positive cocci, S. aureus in particular. In our study, G+ pyogenic cocci were clearly the most commonly detected, which is consistent with the results of studies by Fang and Depypere, focused on the incidence of infectious complications. The most common FRI clinical manifestations included wound secretion, redness, swelling and pain. Furthermore, suggestive radiological criteria, especially delayed healing and non-union al","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 3","pages":"211-218"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744281","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":"Antimicrobial Activity of the Most Common Antibiotic-Releasing Systems Employed in Current Orthopedic Surgery: in vitro Study.","authors":"R Štícha,&nbsp;P Fulín,&nbsp;O Nyč,&nbsp;V Gajdošová,&nbsp;D Pokorný,&nbsp;M Šlouf","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY Infections of joint replacements represent one of the most serious problems in contemporary orthopedics. The joint infections treatment is usually multimodal and involves various combinations of drug delivery and surgical procedures. The aim of this study was to evaluate and compare the bacteriostatic and bactericidal properties of the most common antibiotic carriers used in orthopedic surgery: bone cements mixed with antibiotic and porous calcium sulfate mixed with antibiotic. MATERIAL AND METHODS Three commercial bone cements (Palacos®, Palacos® R+G, Vancogenx®) and commercial porous sulfate (Stimulan®) were prepared with a known concentration of vancomycin (a glycopeptide antibiotic). Specifically, for the purpose of our study, the testing specimens were prepared to release 0, 1, 2, 4, 8, 16, 32, 64, 128, 256, and 512 mg of vancomycin into 1 liter of solution. The specimens with increasing amount of antibiotic were placed in a separate tubes containing 5 mL of Mueller-Hinton broth inoculated with a suspension (0.1 m, McFarland 1) of the reference strain CCM 4223 Staphylococcus aureus to evaluate their bacteriostatic properties (broth dilution method). After this initial incubation and evaluation of the broth dilution method, an inoculum from each tube was transferred onto blood agar plates. After another 24-hour incubation under the same conditions, we evaluated the bactericidal properties (agar plate method). As many as 132 of independent experiments were performed (4 specimens × 11 concentrations × 3 repetitions = 132). RESULTS The bacteriostatic properties of all investigated samples were excellent, perhaps with the exception of the first bone cement (Palacos®). The sample Palacos® started to exhibit bacteriostatic properties at concentrations ≥ 8 mg/mL, while all other samples (Palacos R+G®, Vancogenx®, and Stimulan®) were bacteriostatic in the whole concentration range starting from 1 mg/mL. The bacteriocidic properties did not show such clear trends, but correlated quite well with different properties of the investigated samples during mixing - the most homogeneous samples seemed to exhibit the best and the most reproducible results. DISCUSSION The reliable and reproducible comparison of ATB carriers is a difficult task. The situation is complicated by high numbers of local antibiotic carriers on the market, numerous antibiotics used, and differences in clinical trials at different laboratories. Simple in vitro testing of bacteriostatic and bacteriocidic properties represents a simple and efficient approach to the problem. CONCLUSIONS The study confirmed that the two most common commercial systems used in the orthopedic surgery (bone cements and porous calcium sulfate) prevent bacterial growth (bacteriostatic effect), but they may not be 100% efficient in complete elimination of bacteria (bacteriocidic effect). The scattered results in the case of bacteriocidic tests seemed to be connected with the homogeneity ","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 3","pages":"188-197"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744282","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":"5th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?","authors":"J Demel,&nbsp;L Planka,&nbsp;R Stichhauer,&nbsp;A Vrtkova,&nbsp;G Bajor,&nbsp;M Havlicek,&nbsp;L Pleva","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1","pages":"53-58"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9512936","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":"Reliability of Ellman Classification System in Partial Thickness Rotator Cuff Tears on Magnetic Resonance Views.","authors":"G Ilyas,&nbsp;O Gokalp","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The current study aimed to investigate the intra- and inter-observer reliability of the Ellman classification system in partialthickness rotator cuff tears through magnetic resonance imaging (MRI) scans instead of arthroscopic views. MATERIAL AND METHODS Pre-operative MRI scans of 45 patients, with confirmed partial-thickness rotator cuff rupture in previous arthroscopic surgeries (performed by the senior author), were obtained from Picture Archiving and Communication Systems records. The observers (n=8) were asked to categorize MRI scans according to Ellman's classification of location and grade. There were four orthopedic surgeons less experienced in rotator cuff operations in the first group and four more experienced orthopedic surgeons in the second group. They were asked to re-evaluate the MRI scans six weeks later, without access to their previous answers. Reliability evaluation was performed within and among the groups. It was also evaluated if the surgeon's experience increased the reliability of the classification. Fleiss kappa coefficient was used for the inter-observer reliability and Cohen kappa coefficient for the intra-observer reliability, and post hoc analysis was performed. RESULTS When all observers were examined in the inter-observer evaluation, it was seen that there was moderate agreement in the first location evaluation (κ=0.414); however, there was fair agreement in all other evaluations in both groups (κ=0.339- 0.383-0.337, respectively). When all observers were examined in the mean intra-observer evaluation, it was seen that there was substantial agreement in both evaluations (κ=0.795-0.721, respectively). DISCUSSION A classification system must be valid, reliable, and reproducible. It should establish a standard terminology for both surgeons and researchers. The correct identification of the tear configuration is crucial for selecting the correct repair technique. In our study, in which we evaluated the Ellman classification, which is frequently used in arthroscopic diagnosis, we investigated its intra-observer and inter-observer reliability on MRI scans. Although the mean intra-observer evaluation results were substantial agreement (κ=0.795-0.721, respectively), inter-observer evaluation results were fair agreement (κ=0.339- 0.383-0.337, respectively) except for the first location evaluation (κ=0.414). CONCLUSIONS Although intra-observer reliability was satisfactory, the Ellman system used in the classification of partial-thickness rotator cuff tears was not found to be useful by using only MRI views because of fair inter-observer reliability except for the first location evaluation, which was moderate agreement. Key words: partial, rotator cuff, tear, Ellman classification, reliability, validity.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 4","pages":"259-266"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563463","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":"[Short-term Outcomes of Touch® Prosthesis for Thumb Carpometacarpal Joint].","authors":"D Filuś,&nbsp;R Pavličný","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 4","pages":"277-282"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563466","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":"Type IV Titanium Hypersensitivity: Rare, or Rarely Detected?","authors":"J Voves,&nbsp;O Měrka,&nbsp;K Čabanová,&nbsp;J Janošek,&nbsp;G Bajor","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The presented review aims to summarize the current knowledge of hypersensitivity to titanium - a material widely used in medical applications thanks to its exceptional chemical stability, resistance to corrosion, low specific weight and high strength. The hypersensitivity to metals is usually caused by the Type IV immunopathological reaction. Case reports on allergic reactions to titanium are rare but the actual occurrence can be expected to be much higher, especially due to its problematic detection. Although cutaneous patch tests are widely accepted and used for the diagnosis of hypersensitivity of numerous metals (e.g. Ni), it is notoriously unreliable in case of allergies to titanium, which may be associated with the low percutaneous transport of titanium and its salts. The Lymphocyte Transformation Test has superior sensitivity but it remains mostly unknown among clinicians and there are not many laboratories capable of performing it. This review presents numerous case reports indicating, in combination with the above-mentioned facts, that hypersensitivity to titanium should be considered as a possible cause also in non-specific problems associated with titanium implant failure. Key words: titanium, allergy, patch test, lymphocyte transformation test.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 2","pages":"85-91"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9431810","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":"[Surgical Treatment of Tuberculous Spondylodiscitis].","authors":"J Včelák,&nbsp;A Král,&nbsp;M Šlégl,&nbsp;J Lesenský,&nbsp;M Macko","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY The paper presents a monocentric retrospective study of patients treated surgically for spinal tuberculosis. Clinical and radiological results are analysed, early and late complications are recorded. The study aims to answer the following questions. 1. Can we use instrumentation to restore the stability and alignment in the infected spinal focus? 2. Should we always perform radical anterior resection of TBC lesions? 3. What is the prognosis of surgical treatment of TBC patients with neurological deficit manifestation? MATERIAL AND METHODS Between 2010 and 2020, a total of 12 patients were treated for spinal tuberculosis at our department, of whom 9 patients (5 men, 4 women) with the mean age of 47.3 years (range 29 to 83 years) underwent a surgery. A total of three patients were operated on before the final confirmation of the TBC and treatment with antituberculosis medication, four patients in the initial therapy phase and two patients in the continuous phase. Two patients only underwent a non-instrumented decompression surgery followed by external support fixation. In the other seven patients, always with spinal deformity, instrumentation was used (3 cases of isolated posterior decompression, transpedicular fixation, posterior fusion, 4 cases of anteroposterior instrumented reconstruction). In 2 cases a structural bone graft and in 2 cases an expandable titanium cage were used for anterior column reconstruction. RESULTS Of the total number of patients, altogether eight patients were assessed at 1 year after surgery (one 83-year-old patient died from heart failure 4 months after surgery). Of the remaining eight patients, three patients exhibited a neurological deficit and postoperative regression of the finding. The McCormick score improved from the preoperative mean score of 3.25 to 1.62 at 1 year after surgery (p &lt; 0.001). The clinical VAS score regressed from 5.75 to 1.63 at 1 year after surgery (p &lt; 0.001). Radiographic healing of the anterior fusion was achieved in all patients, both after decompression and instrumented surgery. The initial mean kyphosis of 20.36 degrees of the operated segment measured by the mCobb angle was corrected to 14.6 degrees postoperatively, with a subsequent slight deterioration to 14.86 degrees (p &lt; 0.05). The greatest correction was achieved in patients who had undergone a two-stage surgery with anterior resection and AP reconstruction. DISCUSSION In our cohort, titanium instrumentation was used in seven of nine patients. One patient only manifested persistent tuberculosis with nonspecific bacterial flora superinfection. Revision surgery with anterior radical debridement and subsequent treatment with antituberculotic drugs healed the patient. There were four patients with major preoperative neurological deficit persisting more than 2 weeks before the final treatment with subsequent improvement in all cases. These patients were treated with anteroposterior reconstruction and anterior r","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 2","pages":"116-123"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9438376","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":"[How Does Affect the Type of Instability after Total Hip Arthroplasty the Outcomes? Our Experience between 1999 and 2020].","authors":"J Špička,&nbsp;J Gallo,&nbsp;K Langová","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 4","pages":"239-250"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563468","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":"A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children.","authors":"S Barik,&nbsp;V Garg,&nbsp;S K Sinha,&nbsp;S Chaudhary,&nbsp;P Kandwal,&nbsp;V Singh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Although there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODS Electronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms \"supracondylar\", \"humerus\", \"fracture\", \"Gartland type 3\" and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTS Pooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%-98.5%), as compared to closed group (97.5%, 95% CI 96.3%-98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%- 96.1%) as compared to closed group (98.5%, 95% CI 97.5%-99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86-0.99). CONCLUSIONS Closed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high. Key words: supracondylar humerus, open reduction, percutaneous pinning, Flynn criteria.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 3","pages":"198-205"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744280","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}