Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

{"title":"[Modern Approach to the Use of Aspirin in Prevention of Venous Thromboembolism Following Total Hip Arthroplasty or Total Knee Arthroplasty. A Retrospective Trial].","authors":"Vadim Benkovich, Artsiom Abialevich, Maria Fiterman","doi":"10.55095/achot2024/070","DOIUrl":"10.55095/achot2024/070","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Given the risk of venous thromboembolism (DVT) and pulmonary embolism (PE) after large joint replacement, the role of thromboprophylaxis is crucial. This retrospective study aims to evaluate the effectiveness of aspirin as thromboprophylaxis in patients undergoing TKA or THA.</p><p><strong>Material and methods: </strong>In this retrospective review of a database of patients who underwent total hip and total knee replacements between 2021 and 2023, we divided patients into two groups: those with no anticoagulation therapy before surgery and those on chronic anticoagulant use prior to surgery. The primary endpoint was the number of patients with complications after aspirin use in the postoperative period. We collected patient demographic information, history of anticoagulant use, postoperative anticoagulant usage, comorbidities, type of surgery, reactions to anticoagulants, complications related to thromboembolism, length of hospital stay, and hospital readmissions.</p><p><strong>Results: </strong>For patients who underwent elective THA or TKA, no significant difference in overall VTE or PE rates was detected when comparing aspirin with other anticoagulants. No mortality events were reported. However, there were differences in bleeding event rates between the aspirin group and other anticoagulant groups.</p><p><strong>Conclusions: </strong>Proper patient selection and early postoperative mobilization support the use of aspirin as a thromboprophylaxis therapy. The results of this study confirm that aspirin is a safe alternative to other anticoagulants in the postoperative management of THA and TKA.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"92 1","pages":"21-27"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717643","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":"[Pelvic Avulsion Fractures in Children: a Retrospective Study from Four Trauma Centers].","authors":"Martin Salášek, Andrej Stančák, Martin Čepelík, Tomáš Pešl, Vojtěch Havlas, Tomáš Pavelka, Petr Havránek, Valér Džupa","doi":"10.55095/achot2024/045","DOIUrl":"10.55095/achot2024/045","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Pelvic avulsion fractures in children are rare and usually associated with sports. The study aimed to evaluate the epidemiology, complications, and displacement cutoff value for surgical treatment.</p><p><strong>Material and methods: </strong>In a retrospective study (2007-2022), we used a group of 201 boys and 20 girls (p < 0.0001). The mean age of boys was 14.9 ± 1.7, and 14.0 ± 1.9 years for girls (p = 0.0129). Injuries included 86 anterior superior iliac spine (ASIS), 83 anterior inferior iliac spine (AIIS), 28 ischial tuberosity (ITU), 13 iliac crest, nine reflected head of the rectus femoris avulsions, and two ipsilateral ASIS + AIIS avulsions. The displacement cutoff value was determined using logistic regression. Complications were assessed using Cox regression and Kaplan-Meier plots.</p><p><strong>Results: </strong>The mean incidence of avulsions was 21 per 1,000,000 children per year. The highest prevalence of osteosynthesis was in ITU (10 out of 28, 35.71%); iliac crest and reflexed head avulsions were treated conservatively. Running was related to the highest risk of ASIS, football for AIIS, and gymnastics for ITU. Most avulsions occurred in September, the fewest in July. Displacement cutoff values were calculated as 10.5 mm for ASIS, 9.5 mm for AIIS, and 14.5 mm for ITU. The most common healing complication was distraction 31 (14.0%), refracture in 2 ITU and non-union in 1 ITU; ITU complications were treated with osteosynthesis. According to the Cox regression, the following items significantly affected outcomes: fracture type (p < 0.0001), early verticalization (p = 0.0062), and initial displacement (p < 0.0001).</p><p><strong>Discussion: </strong>Our study had several limitations, such as it was retrospective, there was a loss of patients from follow-up, and a lack of functional evaluations, for example, using Majeed's score modified for pediatric patients. The positives of the study included a relatively large group of patients from multiple hospitals, the use of logistic regression to determine displacement values to help differentiate between OS and conservative treatment, the inclusion of fracture incidence data, and the inclusion of patients with both surgical and conservative treatment.</p><p><strong>Conclusions: </strong>In the case of ASIS and AIIS avulsions, osteosynthesis can be considered for displacements ≥ 1 cm and ≥ 1.5 cm for ITU avulsions. Early verticalization was associated with a lower risk of healing complications in distraction injuries.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"92 1","pages":"7-14"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717584","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":"[Biomarkers and Their Role in Understanding Osteoarthritis].","authors":"Rudolf Hlubek, Pavlína Kušnierová, Pavel Walder, Iveta Bystroňová, Pavel Douša","doi":"10.55095/achot2024/051","DOIUrl":"10.55095/achot2024/051","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a degenerative joint disease characterized by progressive damage and loss of articular cartilage with concomitant structural and functional changes in the joint. It is the most common cause of joint pain globally and the resulting productivity loss to the economy. The clinical symptoms of osteoarthritis are mostly determined by the difficulties of patients related to the development of articular degenerative changes, which secondarily lead to joint stiffness and functional limitation. The diagnosis of this disease is currently based on typical clinical symptoms and radiographic findings (e.g. joint space narrowing, osteophytes, subchondral sclerosis, etc.). These parameters, however, are difficult to detect in the early stages of the disease and are most often recognized in the advanced stages. For these reasons, the diagnosis of osteoarthritis is often delayed until irreversible destruction of joint tissue occurs and conservative treatment is less effective. Despite recent scientific progress in understanding the genetic and molecular principles of joint degeneration, currently there is no reliable causal therapy for OA. This review aims to summarize current knowledge of osteoarthritis and possible future directions for diagnosis and early intervention. One of such directions is the study of the so-called biomarkers. A biomarker is defined as an indicator of biological processes and can include radiographic, histological, physiological, or molecular characteristics. In particular, molecular biomarkers are widely studied in knee OA. Attention of the research community is focused on the study of biomarkers as a method of detection and prediction of the early stages of osteoarthritis before irreversible joint damage occurs. Biomarkers help develop more effective and, above all, personalized treatment, thus improve the overall clinical approach to the patient.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"92 1","pages":"36-43"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717625","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 Outcomes of Navicular Fracture Surgery].","authors":"Marek Peml, Karel Holub, Martin Pompach, Michal Pešta, Pavel Dráč, Martin Kloub","doi":"10.55095/achot2024/034","DOIUrl":"10.55095/achot2024/034","url":null,"abstract":"<p><strong>Purpose of study: </strong>Inadequate treatment of displaced fractures of the navicular bone may result in malalignment, formation of non-union, accelerated development of osteoarthritis or avascular necrosis and thus a fundamental limitation of mobility and gait disturbance. The aim of our study was to evaluate the results in our group of patients undergoing surgery for navicular fractures.</p><p><strong>Material and method: </strong>Our retrospective monocentric study included all surgically treated navicular fractures in patients over 18 years of age performed in our department between 2009 and 2018. A total of 18 patients met these criteria and were invited for clinical and radiographic follow-up. One patient refused to attend and two were lost to follow-up. The remaining 15 patients underwent clinical assessment, including the use of AOFAS midfoot and VAS scores, and the grade of osteoarthritis was determined using radiographs.</p><p><strong>Results: </strong>Our final group of patients consisted of six women and nine men. The mean age of the patients at the time of surgery was 43 (21-67) years, with mean follow-up duration of 68 (18-130) months. The most common mechanism of trauma was high-energy injury occurring in nine of cases. According to the Schmid classification, six fractures were Type I and II each whereas three cases were Type III fractures. Concomitant injuries involving the foot and ankle were present in six cases. All fractures healed.Open reduction and internal fixation (ORIF) was performed in 14 cases. The radiographs showed the presence of osteoarthritis grade 0 or I in nine patients and osteoarthritis grades II and III in six patients. The AOFAS Midfoot scale was excellent and good in eleven cases, satisfactory in two and poor also in two cases. The average AOFAS Midfoot scale was 87.7 points. A procedure-related complication was a case of skin necrosis in a patient eventually undergoing cuneonaviculotalar arthrodesis in another hospital.</p><p><strong>Discussion: </strong>Consistent with literature data, our group showed a higher incidence of concomitant injuries in the foot region. Use of two approaches was not associated with an increased risk of developing avascular necrosis. We do not recommend the use of Kirschner wires for definitive osteosynthesis although we do use them as part of staged treatment or as an additional type of fixation. Like other authors, we observed higher grades of post-traumatic osteoarthritis in the subgroup of patients with more severe injuries.</p><p><strong>Conclusion: </strong>Open reduction and stable osteosynthesis of navicular fracture-displacements are associated with good outcomes in most patients. The most serious consequences of these fractures are post-traumatic arthritis and pain. It is critical to search for concomitant injuries. Given the rarity of these fractures, they should be preferably treated in specialised medical centres.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"92 1","pages":"28-35"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717602","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":"[Early Surgical Treatment Options for Anterior Cruciate Ligament Injury].","authors":"Filip Hušek, Roman Mizera, Lukáš Čapek, Zdeněk Horák","doi":"10.55095/achot2024/055","DOIUrl":"10.55095/achot2024/055","url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) is one of the most commonly injured structures in distortion injuries of the knee joint. Currently, there is no consensus among the professional community regarding the basic principles and timing of ACL injury management. An analysis of several retrospective studies from the 2008-2023 period provides information on ACL preservation procedures and a comparison of these results with those of ACL reconstruction surgery using a graft. The most comprehensive information was provided by a large meta-analysis conducted by Van der List et al. in 2019, which compared 1101 patients from 13 studies who had undergone an ACL preservation surgery. Wilson et al. carried out a retrospective study of patients who underwent ACL repair with InternalBrace (Arthrex© implant system) ligament augmentation. In their meta-analysis, Van der List et al. reported the failure rate of 7-11% and the functional outcome score > 85% of maximum scores in the scoring systems used (Lysholm, KOOS, IKDC score) for the preservation procedures. Wilson et al. in their retrospective study reported the failure rate of 10.4% and the functional outcome > 87% of maximum scores in the scoring systems used. These values are consistent with similar outcomes reported in patients undergoing ACL reconstruction surgery using a graft. According to the available literature, the primary ACL refixation with InternalBrace augmentation for proximal ruptures appears to be a safe technique with satisfactory outcomes when properly timed and indicated. In acute proximal ruptures, this technique should be considered as an alternative to ACL reconstruction using a graft, with potential benefits of preserving the original tissue and proprioception of the ligament. A prospective randomized study which would compare these two surgical techniques is still lacking in the literature.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"92 1","pages":"45-51"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717636","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":"[Methods of Measuring Limb Malrotation Following Femoral Osteosynthesis].","authors":"J Maléř, M Buk, M Michna, J Skála-Rosenbaum","doi":"10.55095/ACHOT2024/035","DOIUrl":"10.55095/ACHOT2024/035","url":null,"abstract":"<p><p>Significant malrotation of the femur after osteosynthesis is a serious complication of treatment and has a number of consequences for the patients and causes deterioration of their quality of life. Therefore, it is necessary to be familiar with intraoperative techniques to control the correct rotation, mostly clinical and radiological, which give us the possibility to minimize rotational errors. In the postoperative period, with even a slight suspicion of malrotation, it is necessary to proceed to its exact verification and, in indicated cases, to perform necessary correction. We recommend one of the CT techniques as a very reliable method, however in younger patients we prefer to use MRI. Early diagnosis of the rotational error and especially its size is essential from the point of view of potential reconstructive surgery, which is then chosen also with regard to the location of the original lesion. Key words: femoral osteosynthesis, limb malrotation, methods of measuring.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"91 5","pages":"264-268"},"PeriodicalIF":0.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574911","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":"[Screw Angle and Condylar Ratio as Possible Parameters to Monitor the Treatment of Idiopathic Axial lower Limb Deformities Using Eight-Figure Plates].","authors":"J Turek, O Václav, K Urbášek, A Adamová, P Zoufalý, L Plánka","doi":"10.55095/ACHOT2024/046","DOIUrl":"https://doi.org/10.55095/ACHOT2024/046","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;Temporary hemiepiphyseodesis using figure-eight plates is currently one of the main surgical techniques to correct axial deformities of lower limbs in paediatric patients. Comprehensive analysis, correct indication and monitoring of treatment are the basic prerequisites for successful therapy. The aim of the study was to analyse parameters that could become an alternative to standard parameters used nowadays, namely the inserted screw angle (SA), and a new parameter - condylar ratio (CR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The study included 47 patients treated at the Department of Paediatric Surgery, Orthopaedics and Traumatology at the University Hospital in Brno between 2014 and 2021 and diagnosed with idiopathic bilateral axis deviation of lower limbs, namely genu valgum. After having met the inclusion criteria, the patients underwent a clinical check-up, and long leg radiographs were also obtained. Anthropometric parameters (age, sex, BMI, intermalleolar distance (IMD)), duration of treatment as well as radiographic parameters - mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), SA and CR, and their derived parameters expressing the change per unit time and defined as a rate of correction (r-mLDFA, r-mMPTA, r-SA, r-CR) were recorded. The obtained values were subsequently statistically analysed, namely by comparing the pretreatment and posttreatment values and through correlation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of the population was 11.4 years, BMI 26.9 and IMD 14.1. The mean duration of treatment in the study population was 13.9 months. A significant difference was established between the pretreatment and posttreatment values of all measured radiographic parameters (p&lt;.05). A significant correlation was identified between r-mLDFA and r-SA (p=.002), while no significant correlation was found between r-mLDFA and r-CA or between r-CA and r-SA (p=.650; p=.884).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Comprehensive evaluation of the treatment of axial deformities of lower limbs and its optimization are crucial for successful therapy. In addition to the standard mechanical or even anatomical parameters assessing the axis deviation of lower limbs, the authors seek to evaluate also other parameters that may provide a new insight into the deformity or offer additional benefits such as reduced radiation exposure. Such a parameter is for instance the angle of inserted screws in the eight-figure plate system, although there is a difference in opinion among the authors. In our study, we concluded that it is the change in the screw angle that significantly correlates with the mechanical axis of the femur, and thus, under certain circumstances, can become a monitoring parameter. Contrarily, the condylar ratio is a newly introduced quantity which in our study did not show any significant correlation with the mechanical axis of the femur, alth","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"91 6","pages":"325-330"},"PeriodicalIF":0.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942460","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":"Neurogenic Heterotopic Ossification of the Hip: a Case Report.","authors":"M Çelik, S H Başaran","doi":"10.55095/ACHOT2024/033","DOIUrl":"10.55095/ACHOT2024/033","url":null,"abstract":"<p><p>Heterotopic ossification (HO) denotes aberrant osteogenesis in extra-skeletal tissues, often associated with neurological disorders, total hip arthroplasty, and specific traumatic scenarios. Neurogenic heterotopic ossification manifests prominently subsequent to traumatic brain injury or spinal cord injury, with Guillain-Barre Syndrome presenting an infrequent etiological link. This article details the case of a 56-year-old female diagnosed with Guillain-Barre Syndrome, who developed neurogenic heterotopic ossification around both hips within two years of disease onset. The patient's medical history included mechanical ventilation, incomplete tetraplegia, and prolonged immobilization. A conclusive diagnosis of HO was established through radiological and clinical assessments. After neurogenic heterotopic ossification was confirmed, the patient had surgery to remove the lesions, radiation therapy, and medication treatments as planned. Physical therapy was introduced one week post-surgery, with subsequent follow-ups tracking improvements in pain levels, range of motion (ROM), and Activities of Daily Living scores. Key words: neurogenic heterotopic ossification, Guillain-Barre syndrome, hip, excision.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"91 4","pages":"245-247"},"PeriodicalIF":0.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339056","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":"[Healing of Critical-Size Bone Defects with Tricalcium Phosphate Hydrogel: Evaluation of Hydrogel as a Scaffold for Stem Cells and BMP-2].","authors":"M Korbel, L Novotný, L Jandová, P Šponer","doi":"10.55095/ACHOT2024/049","DOIUrl":"https://doi.org/10.55095/ACHOT2024/049","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;The preclinical study aimed to compare the healing of segmental bone defects treated with biodegradable hyaluronic acid and tricalcium phosphate-based hydrogel with the established autologous spongioplasty. Another aim was to evaluate the hydrogel as a scaffold for osteoinductive growth factor of bone morphogenetic protein-2 (BMP-2) and stem cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The study was conducted in an in vivo animal model. A standardized rabbit model of a 15 mm long segmental bone defect of left radius was used. A total of 40 animals were divided into 5 groups of 8 individuals. In the KO- (negative control) group, the created defect was left to heal spontaneously. In the KO+ (positive control) group, the defect was filled with morselized bone autograft prepared from the resected segment. In the study group A, the defect was filled with hydrogel based on hyaluronic acid derivative and tricalcium phosphate. In the study group B, the defect was filled with hydrogel based on hyaluronic acid derivative, tricalcium phosphate and bone marrow aspirate. In the study group C, the defect was filled with hydrogel based on hyaluronic acid derivative, tricalcium phosphate, bone marrow aspirate and BMP-2. Healing was assessed using radiographs at 1, 6, and 12 weeks postoperatively and histology specimens were collected at 16 weeks postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Altogether 35 rabbits survived (KO- 7, KO+ 7, A 7, B 6, C 8) until the end of the study. As concerns the radiographic assessment, the best results were achieved by the groups KO+ and C, where new bone formation across the entire width of the bone defect was clearly seen at 6 and 12 weeks and the osteotomy line was completely healed too. At 12 weeks, complete bone remodelling was observed in all animals in the group KO+, whereas in the group C, bone remodelling was fully completed in 5 animals and partially completed in 3 animals. In terms of histological assessment, however, the best results were achieved by the group C, where the bone defect was completely remodelled into lamellar bone in 7 specimens, while in 1 specimen it healed with bony callus formation. In the group KO+, the defect was healed in 4 specimens by cartilaginous callus with loci of remodelling into bony callus, in 2 specimens the bony callus was predominant with cartilaginous callus areas, and only one defect was completely remodelled into lamellar bone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Compared to autografts that manifest osteogenic, osteoinductive and osteoconductive properties, the biodegradable hyaluronic acid and tricalcium phosphate-based hydrogel has osteoconductive properties only. Thus, it was also tested in our study as a scaffold for bone marrow cells and BMP-2 osteoinductive growth factor. Thanks to its semi-liquid properties, the biodegradable hyaluronic acid and tricalcium phosphate-based hydrogel is a promising material for use in 3D printi","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"91 6","pages":"317-324"},"PeriodicalIF":0.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942457","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":"[Outcomes of Retrograde Femoral Nail Osteosynthesis of Intraarticular Fractures of the Distal Femur].","authors":"J Zeman, J Zeman, P Korpa, T Matějka, P Zeman, J Matějka","doi":"10.55095/ACHOT2024/044","DOIUrl":"https://doi.org/10.55095/ACHOT2024/044","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;Intraarticular fractures of the distal femur rank among the most severe musculoskeletal injuries. Various treatment options, such as plate osteosynthesis or retrograde nailing, can be employed. This study aims to evaluate the clinical outcomes and complications of intraarticular distal femoral fractures treated with retrograde femoral nail, with particular emphasis on C3 fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;Between January 2016 and January 2023, 18 AO/33.C3 fractures were treated with a retrograde femoral nail. Of these, two were classified as 33.C1, eight as 33.C2 and eight as 33.C3. Twelve of the fractures were open. After the initial treatment and stabilizing the patient's overall condition, we proceeded with the definitive osteosynthesis. The first phase involved open reduction and fixation using individual screws to reconstruct the articular surface. The second phase consisted in retrograde nailing with correction of the length, axis and rotation of the femur. The evaluation criteria included: complication rate, number of revisions, knee range of motion, mechanical axis and length of the lower extremity, progression of gonarthrosis, pain level, need of walking support, Lysholm and Tegner Activity Score for functional outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, we evaluated the complications and the outcomes of 12 patients (13 fractures). Of these, 8 patients experienced some kind of postoperative complications, primarily insufficient healing or nonunion, which were managed through revision surgery. Plate reosteosynthesis was used in 2 patients who were then excluded from the final clinical evaluation. No cases of deep infection or deep vein thrombosis were reported and no patient required total knee replacement. Seven AO/33.C3 fractures were individually evaluated. The average knee range of motion was nearly 0-93°, maximum flexion was 120°. On average, the lower extremity was 1.6 cm shorter and 7.3° varus to the mechanical axis. Only little progression of gonarthrosis was observed along with low levels of pain. The Lysholm Score ranged between 52 and 84 points (averaging 73.1). The mean Tegner Activity Score was 3.4. All results showed adequate improvement in 33.C2 and 33.C1 groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The retrograde femoral nail demonstrates several advantages over the locking compression plate, particularly in biomechanical aspects. Various clinical studies have reported superior outcomes in terms of healing, complication rate, blood loss and functional outcome. Our study findings align with some of those international studies, particularly in the rate of infectious complications (0%), mean Lysholm Score (79.3 p.) and Tegner Activity Score (4.1). On the other hand, we observed a higher rate of revision surgery (53.8 %), mainly due to evaluating 33.C fractures only. The main advantage of this method lies in complete visualization, leading to better reconstruct","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"91 6","pages":"339-347"},"PeriodicalIF":0.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942459","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}