Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

{"title":"Type IV Titanium Hypersensitivity: Rare, or Rarely Detected?","authors":"J. Voves, O. Merka, K. Čabanová, J. Janošek, G. Bajor","doi":"10.55095/achot2023/012","DOIUrl":"https://doi.org/10.55095/achot2023/012","url":null,"abstract":"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.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 2 1","pages":"85-91"},"PeriodicalIF":0.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49098429","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 Tibia Plafond Horizontal Orientation Angle for Frontal Alignment Evaluation of the Distal Lower Extremity.","authors":"M. Alshrouf, M. Ahrend, C. Konrads","doi":"10.55095/achot2023/018","DOIUrl":"https://doi.org/10.55095/achot2023/018","url":null,"abstract":"PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The aim of this study was to determine if the Tibia Plafond Horizontal Orientation Angle (TPHA) is a reliable measure for describing ankle alignment of the distal tibia in the coronal plane. MATERIALS AND METHODS This retrospective study included patients who underwent supracondylar rotational osteotomies for correction of femoral torsion. All patients had standing radiographs taken preoperatively and postoperatively with both knees pointed forward. Five variables, including Mechanical Lateral Distal Tibia Angle (mLDTA), Mechanical Malleolar Angle (mMA), Malleolar Horizontal Orientation Angle (MHA), Tibia Plafond Horizontal Orientation Angle (TPHA), and Tibio Talar Tilt Angle (TTTA), were collected. The preoperative and postoperative measurements were compared to each other using the Wilcoxon signed rank test. RESULTS A total of 146 patients were included in the study, with a mean age of 51.47 ± 11.87 years. There were 92 (63.0%) males and 54 (37.0%) females. MHA decreased from 14.0° ± 5.32° preoperatively to 10.59° ± 3.93° (p < 0.001) postoperatively, and TPHA decreased from 4.88° ± 4.07° preoperatively to 3.82 ± 3.10° (p = 0.013) postoperatively. The change in TPHA was significantly correlated with the change in MHA (r = 0.185, CI 0.023 - 0.337; p = 0.025). No differences were found between the measurements of mLDTA, mMA, and mMA pre- and postoperatively. DISCUSSION The orientation of the ankle should be taken into consideration during preoperative planning of osteotomies and should be measured in cases of postoperative ankle pain. CONCLUSIONS The TPHA is a reliable measure for describing ankle alignment of the distal tibia in the frontal plane. Key words: osteotomy, ankle, realignment, coronal alignment, preoperative planning.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 2 1","pages":"133-137"},"PeriodicalIF":0.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47291021","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":"Treatment of Hip Dislocation in Cerebral Palsy with Extraarticular Intervention.","authors":"I. Sarikaya, S. E. Birsel, O. Erdal, B. Görgün, A. Seker, M. İnan","doi":"10.55095/achot2023/013","DOIUrl":"https://doi.org/10.55095/achot2023/013","url":null,"abstract":"PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 2 1","pages":"92-99"},"PeriodicalIF":0.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48562050","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":"Comments on Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 - What to Do in the Initial Hours?","authors":"P. Sklienka, M. Frelich, E. Kušíková, F. Burša, Z. Cichý, R. Madeja","doi":"10.55095/achot2023/011","DOIUrl":"https://doi.org/10.55095/achot2023/011","url":null,"abstract":"","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48590340","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":"[Benefit of Arthroscopy in Differential Diagnostics and Therapy of Lateral Epicondylitis].","authors":"A. Křiváček, Z. Vodička, F. Krejcí, L. Papezova, D. Musil","doi":"10.55095/achot2023/006","DOIUrl":"https://doi.org/10.55095/achot2023/006","url":null,"abstract":"PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18-61 years) in men and 45.8 years (range 18-60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen - either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0-5 very good, 6-15 good, 16-35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95-2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50-6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. Key words: lateral epicondylitis, r","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"41-46"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48911750","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":"[Posterior Tibial Slope as a Morphological Risk Factor for Anterior Cruciate Ligament Reconstruction: a Retrospective Cohort Study].","authors":"R. Kalina, D. Melecký, P. Neoral, J. Gallo, M. Sigmund","doi":"10.55095/achot2023/007","DOIUrl":"https://doi.org/10.55095/achot2023/007","url":null,"abstract":"PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p&lt;0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p &lt; 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p &lt; 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL rec","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"47-52"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43637591","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":"[Instabilities of the Thumb Carpometacarpal Joint: Our Surgical Outcomes].","authors":"J. Pilný, D. Kachlík, P. Zeman, K. Horáčková, P. Hájek","doi":"10.55095/achot2023/004","DOIUrl":"https://doi.org/10.55095/achot2023/004","url":null,"abstract":"PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique. MATERIAL AND METHODS The authors present a set of 53 CMC joints of patients with an average age of 26.8 years (15-43 years) operated on in the years 2005-2017. Post-traumatic conditions were found in 10 patients and in 43 cases instability was caused by hyperlaxity, also demonstrated in other joints. The operation was performed from the Wagner's modified anteroradial approach. After the operation, a plaster splint was applied for 6 weeks, after which rehabilitation (magnetotherapy, warm-up) began. Patients were evaluated using the VAS (pain at rest and during exercise), DASH score in the work module, and subjective evaluation (no difficulties, difficulties not limiting normal activities, and difficulties limiting normal activities) before surgery and 36 months after surgery. RESULTS During the preoperative assessment, the average VAS value was 5.6 at rest and 8.3 during exercise. During the VAS assessment at rest, the values at 6, 12, 24 and 36 months after surgery were 5.6, 2.9, 0.9, 1, 2 and 1.1. When evaluated in the given intervals under load, the detected values were 4.1, 2, 2.2 and 2.4. The DASH score in the work module was 81.2 before surgery, 46.3 at 6 months, 15.2 at 12 months, 17.3 at 24 months, and 18.4 at 36 months after surgery. In the subjective self-assessment made at 36 months after surgery, 39 patients (74%) assessed their condition as having no difficulties, ten patients (19%) reported difficulties that did not limit normal activities, and four patients (7%) reported difficulties limiting normal activities. DISCUSSION Most authors present the results of their surgeries in patients with post-traumatic joint instability, and they report excellent results at two to six years after surgery. There is a negligible number of studies addressing instabilities in patients with instability caused by hypermobility. When using the conventional method described by the authors in 1973, our results of the evaluation performed at 36 months after surgery are comparable to those reported by other authors. We are well aware of the fact that this is a short-term follow-up and that this method does not prevent developing degenerative changes in the case of long-term follow-up, but reduces clinical difficulties and may delay the development of severe rhizarthrosis in young individuals. CONCLUSIONS CMC instability of the thumb joint is a relatively common disorder, although not all individuals experience clinical difficulties. In the case of difficulties, the instability needs to be diagnosed and treated as this is how the development of early rhizarthrosis in the predisposed individuals can be preve","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"29-33"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48343044","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":"Scapholunate Ligament Partial Tears; Tear Localization, Extrinsic Ligament Injury Association and Conservative Treatment Responses Prior to Instability: Cross-Sectional Study.","authors":"B. Karaalioglu, O. Korkmaz, K. Yilmaz, S. Sarı, B. Sener, A. Kara","doi":"10.55095/achot2023/003","DOIUrl":"https://doi.org/10.55095/achot2023/003","url":null,"abstract":"PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"22-28"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42883335","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":"[Management Strategy and Evaluation of Surgical Outcomes in Patients with Recurrent Patellar Instability between 2010-2020].","authors":"R. Čapek, D. Musil, L. Nevšímal, P. Sadovsky, T. Trnka","doi":"10.55095/achot2023/001","DOIUrl":"https://doi.org/10.55095/achot2023/001","url":null,"abstract":"PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vastus med","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"9-16"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44277482","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":"High-Grade Chondrosarcoma of the Proximal Phalanx: an Unusual Case of a Rare Entity.","authors":"A. Pagnotta, V. Formica, S. Taccogna, G. Summa, C. Zoccali","doi":"10.55095/achot2023/010","DOIUrl":"https://doi.org/10.55095/achot2023/010","url":null,"abstract":"Chondrosarcoma of the hand is a rare disease, but is one of the more common malignancies of the hand. Biopsies and imaging are a fundamental step in determining correct diagnosis, grading and selection for best treatment. We describe the case of a 77-year-old male complaining of a painless swelling in the proximal phalanx of the third ray of left hand. A biopsy was performed and the histology revealed a G2 chondrosarcoma. The patient underwent III ray amputation with metacarpal bone disarticulation and sacrifice of the radial digit nerve of the fourth ray. Definitive histology revealed grade 3 CS. Eighteen months after surgery, the patient is apparently disease-free with a good functional and aesthetic outcome although with persistent paresthesia of the fourth ray. Although there is no agreement in the literature for the treatment of low-grade chondrosarcomas, wide resection or amputation can be considered the mainstay treatment for high-grade tumors. Key words: chondrosarcoma, proximal phalanx, ray amputation, surgical treatment, tumor hand.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"63-66"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49211754","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}