- MeSH
- bisfosfonáty terapeutické užití MeSH
- denosumab terapeutické užití MeSH
- fraktury krčku femuru mortalita MeSH
- kortikální kost MeSH
- lidé MeSH
- osteoporotické fraktury * mortalita prevence a kontrola MeSH
- osteoporóza * farmakoterapie patofyziologie MeSH
- raloxifen hydrochlorid terapeutické užití MeSH
- trabekulární kostní tkáň MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
We present the case report of a 21-year-old man with a late diagnosis of retrosternal dislocation of the sternoclavicular joint with a fractured sternal end of the clavicle. The first symptom leading to the diagnosis was dysphagia associated with physical activity. The diagnosis was based on computed tomography examination. In the first place, the fragment of the medial clavicular end was fixed with two screws. During surgery the sternoclavicular joint was wrongly identified; this fact was revealed by the following radiographic examination. On revision surgery, the sternoclaviculr ligament was reconstructed using a semitendinosus tendon graft. The reconstructed ligament was augmented with two Orthocord sutures running between the clavicle and the first rib. At 2 years after surgery the functional outcome and sternoclavicular joint stability were excellent.
PURPOSE OF THE STUDY Since 2000 arthroscopically-assisted surgery on hip joints has become more widely used. The technique is relatively demanding and should be used only after arthroscopic procedures on other large joints are mastered to perfection. A thorough study on cadaverous specimens should be a prerequisite for adopting it as a routine method. The aim of this study was to evaluate indications for hip arthroscopy as, from the year 2006, this was gradually introduced and more widely used at our department. MATERIAL AND METHODS Forty-two hip joints were assessed out of the 83 hips which had been treated by arthroscopic surgery before the date of evaluation and which had been followed up for at least 2 years. The patient group evaluated consisted of 25 men and 17 women, with an average age of 40.3 years and a range of 21 to 65 years. Patients with a follow-up shorter than 2 years and those subsequently undergoing total hip arthroplasty were not evaluated. Indications for arthroscopic surgery included the presence of intra-articular bodies, labro-cartilaginous lesions and impingement syndromes. Neurovascular disorder affecting the limb and a higher degree of osteoporosis were considered contraindications. The outcome of surgery and its indications were evaluated on the basis of the questionnaire which recorded the patient's objective findings and subjective feelings at 3 and 6 months and then at 1 and 2 years after surgery. RESULTS The average VAS score was 7.83 points before surgery, and 3.87 points at 3 months and 2.01 points at 2 years after surgery. Nearly all patients (98%) reported their willingness to undergo the surgery again. The complications included transient hyperesthesia in the perineal region completely resolved within 4 weeks of surgery in three cases and subcutaneous extravasation after extensive capsulotomy in one patient. It subsided within 48 hours without compartment syndrome development. DISCUSSION A good view allowing for comprehensive exploration of the central as well as peripheral compartments enables us to treat all pathologies, which are manageable by arthroscopic intervention, in one procedure. Patient recovery is faster and the risk of intra- and post-operative complications is lower that in open surgery. The avoidance of extensive capsulotomy and the possibility of leaving the femoral head in place with only minimum distractions and without injury to the ligamen-tum capitis are the most important advantages of this method. Complications were found in 8.4% of the cases, which is in agreement with the literature data. The method can be applied in both the diagnosis and therapy of chronic conditions such as femoroacetabular impingement, as well as in the treatment of post-traumatic conditions ranging from traumatic labral lesions to the correction of incongruence of articular surfaces in acetabular fractures. CONCLUSIONS Arthroscopically-assisted surgery enables us to achieve very good results, but requires appropriate, high-standard facilities and a well-mastered operative technique. It should be adopted as the method of choice for young adults still free of arthritic changes including hip impingement syndrome. Similarly to arthroscopic procedures on shoulders and knees, it is associated with low risk factors, and rapid recovery allows the patient to return soon to normal daily activities.
PURPOSE OF THE STUDY Motion-preservation technologies for spinal disorders have evolved and come into use in the last decade. Three principal systems are currently available: total disc replacement, posterior neutralisation transpedicular system and interspinous implants. The aim of this retrospective study was to evaluate our group of lumbar total disc replacements at a follow-up of 2 years. MATERIAL AND METHODS A total of 42 disc prostheses were implanted in 37 patients. Of these, 31 with 35 artificial discs were followed up for 2 years. There were 11 men and 20 women with an average age of 42.9 years (range, 21 to 61 years). The indication for surgery was lumbar disc pain without radicular syndrome and contraindications included advanced degenerative facet joint disease and obesity with a body mass index over 30. Surgery was carried out through the pararectal retroperitoneal approach. Early and late complications were recorded. The group evaluation was based on radiological outcomes, and VAS and ODI scores reported by the patients at 6 weeks, and 3, 6, 12 and 24 months after surgery. RESULTS The average operative time was 68 minutes (range, 36 to 120 min) for single-level lumbar total disc replacement and 92 minutes (range, 72 to 130 min) for two-level procedures. The average hospital stay was 5.2 days (range, 3 to 12). Both keels of the prosthesis were in the exact center in 25 cases, they were shifted laterally in nine cases up to 2 mm and in one case more than 2 mm. Horizontal rotation of the prosthesis was seen in two patients, but not more than 5 degrees to the left. There was no disc loosening or subsidence, and no acceleration of adjacent segment degeneration. Two patients showed heterotopic ossification. Subjective evaluation was recorded as marked improvement in 15, partial improvement in 11 and no change in five patients. None of the patients reported deterioration. Low back pain assessed by the VAS score had an average value of 66.3 before surgery and 14.1 at 2 years after surgery. The average pre-operative ODI value was 48.9 and that at 2 years post-operatively was 24.5. DISCUSSION Pain relief evaluated by the VAS score in our study is comparable with or slightly better than is reported by the other authors. Some recorded average values for lumbago were 74 before surgery and 35 at 2 years of follow-up, or 62.3 before and 25.4 at 2 years after surgery, while our patients had the average VAS score of 66.3 before surgery and that of 18.4 at 2 years after surgery. The ODI values in our group were similar to those of other authors. When we compare this group with the group of our patients who were treated by spinal fusion surgery, the outcomes at 1 year are better in the total disc replacement group, as shown by the VAS for lumbago of 17.8 and ODI of 24.5 in the former versus the respective values of 18.1 and 29.0 in the latter group. CONCLUSION Based on the results it can be concluded that total disc replacement is an efficient method of treating degenerative inter-vertebral disc disease of the lumbar spine in young, active and motivated patients with no posterior spinal structure degeneration.
- MeSH
- bederní obratle chirurgie MeSH
- degenerace meziobratlové ploténky chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
The authors describe the concomitant presence of plantar fibromatosis and Dupuytren's disease in a 33-year-old man. A lesion located under the sesamoid bones of the first metatarsophalangeal joint on the right showed an aggressive tendency (rapid growth, pain, impossibility to put weight on the medial side of the foot). Another lesion located proximal to the first one was smaller and painless. Neither plain radiography nor computed tomography showed any structural changes of the skeleton. Contrast-enhancement on magnetic resonance imaging revealed two lesions on the sole of the foot. Since a concurrence of plantar fibromatosis and malignant tumour could not be ruled out, an excision of both lesions and the adjacent plantar aponeurosis was made for biopsy examination. The operative procedure was carried out from two incisions. The intra-operative findings included proliferative growth and bleeding in the lesion located under the first metatarsophalangeal joint, and delimited growth without noticeable bleeding in the other lesion. Based on histological examination, the diagnosis of plantar fibromatosis was made for both lesions. The differential diagnosis and therapy of plantar fibromatosis is discussed.
- MeSH
- dospělí MeSH
- Dupuytrenova kontraktura diagnóza chirurgie komplikace MeSH
- fibrom diagnóza chirurgie klasifikace MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nemoci nohy (od hlezna dolů) diagnóza chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY To make comprehensive diagnoses of the infections associated with revision total knee and hip arthroplasties in our group of patients. MATERIAL AND METHODS From September 2002 till November 2004, a group of 69 patients undergoing revision total joint replacement (65 hips and four knees) were evaluated. The period between primary and revision surgery ranged from 6 months to 25 years. The patients were examined for CRP, erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts. The samples of their periprosthetic tissue were assessed for biopsy and microbial findings. The removed prosthetic components were sonicated. The samples were cultured in both aerobic and anaerobic conditions for 16 days. A finding of more than 10 neutrophils per viewing field was taken as a positive biopsy result. The definition of an infection was based on the detection of a microorganism with the identical phenotype in two or more samples. RESULTS Before surgery, 13 patients had a suspected infection which was subsequently diagnosed. A positive culture result in at least one of the collected samples was found in 48 patients; of these, a positive culture finding of a phenotypically identical microorganism in two or three samples was in 32 patients, who thus met the definition of infection. The average values for the whole group were: CRP, 16 mg/L (1-109); ESR, 25 mm/h (3-110); peripheral WBC count, 6.2x109/L (3.6-11.6). The microorganisms most frequently growing in culture were coagulase-negative staphylococci and propionibacteria accounting for 41 % and 29 % of the total isolates obtained, respectively. From the total number of samples, positive culture results were obtained in 36 % of sonicate femoral components; 40 % of sonicate acetabular cups, 51 % of periprosthetic tissues and 48 % of swabs. In these positive microbial cultures strictly anaerobic microorganisms were found in 41 % of femoral component, 49 % acetabular component and 42 % periprosthetic tissue samples and in 27 % of swabs taken at arthrotomy. Prolonged cultivation of the 151 isolates initially obtained yielded 81 (54%) isolates which would have failed to be detected by primary culture. The results of laboratory tests in the patients with negative culture findings, in those with a phenotypically identical microorganism found in one sample, and in those with positive findings in two or more samples were: CRP, 4.3 mg/L; 9.8 mg/L; and 21.7 mg/L, respectively; ERS, 13.5 mm/h; 20.1 mm/h; and 33.0 mm/h, respectively; and WBC counts, 6.27x109/L; 6.25x109/L; and 6.16x109/L, respectively. The t-test was used for the statistical analysis of CRP, ESR and WBC count values, and it revealed a significant differences between the patients with negative microbial findings and those with positive microbial findings in two and more samples in all three values, i.e., CRP (p=0.01), ESR (p=0.01) and WBCs (p=0.96). Biopsy findings showed a sensitivity of 62.5 % and a specificity of 91 % in relation to the microbial findings. DISCUSSION Our results as well as relevant literature data suggest that microorganisms may survive on implant surfaces even in the cases regarded as aseptic. They often grow slowly and, theoretically, can have an adverse effect on the longevity of revision arthroplasty. However, because of current endoprosthetic practices and the ubiquitous presence of microorganisms, contamination of some samples cannot be excluded. CONCLUSIONS In our group of patients, the CRP and ESR values proved to be useful in making the diagnosis of infection. For this purpose, WBC counts in blood samples were not sensitive enough. Biopsy findings had low sensitivity, but appeared to be a specific marker of infection. Prolonged cultivations of samples and cultivation under anaerobic conditions resulted in a marked increase in isolates obtained, as compared with the routine cultivation technique.
The authors report on a pre-school child with a typical presentation of the trauma caused by a car safety belt and termed the seat-belt syndrome. The deceleration mechanism which throws the upper body forward in the presence of a rigid belt over the abdominal region results in large contusions of the abdominal wall and trauma to the spine, retroperitoneum, and intra-abdominal organs, or even the chest. In making the diagnosis a thorough examination of the spine is necessary as well as a repeated surgical examination of the abdomen, because seat-belt syndrome is often associated with small intestine rupture, a symptom which can remain unrecognised at the early stage. In the case of a four-year-old boy described here, two loops of the small intestine were resected for perforation; stabilization of the vertebral column was indicated on the 5th post-injury day because of decompensated diabetes and deteriorated health state following intra-abdominal surgery. In this boy, poor compensation of juvenile diabetes resulted in infectious complications requiring repeated drainage of an abscess of the abdominal wall injured by the seat belt. The abdominal wall healed within 2 months, diabetes was managed with insulin therapy and good spondylodesis was achieved at 9 months after the injury.
- MeSH
- bezpečnostní pásy sedadel škodlivé účinky MeSH
- dopravní nehody MeSH
- lidé MeSH
- poranění břicha etiologie MeSH
- poranění páteře etiologie MeSH
- předškolní dítě MeSH
- ruptura MeSH
- střeva zranění MeSH
- syndrom MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY The aim of this retrospective study was to evaluate the group of 27 patients with distal humeral fractures treated by the locking compression plate and distal humerus plate (LCP-DHP) system. MATERIAL Between January 2006 and June 2008, a total of 62 distal humeral fractures (61 patients) were treated in our department, of which 27 were managed by LCP-DHR The group comprised 15 women (55.5 %) and 12 men (45.5 %), with an average age of 53.6 years (range, 18 to 84 years). METHODS Conservative reduction and subsequent immobilization were done in all fractures. The surgical procedure was indicated within 24 hours of injury, with neurological deficit or an open fracture this was 6 hours. Access to the fracture was from a longitudinal dorsal incision with intra-articular osteotomy of the olecranon. The ulnar nerve was released and transposed. The fractures were reduced with an effort of maximal restoration of the articular surface, and then fixed with LCP-distal humerus plates. Antibiotic prophylaxis was administered and the wound was drained and a drain was inserted. The arm was immobilized in a plaster cast or a removable brace for 2 to 4 weeks, according to the fracture type. The patients had clinical and X-ray follow-up at 6 weeks, then at 3, 6 and 12 months after surgery. The evaluation was based on the Mayo elbow performance score (MEPS). RESULTS The injury was caused by a fall in 24 patients (88.9 %), sustained in a car accident in two (7.4 %) and as the result of a gunshot in one patient (3.7 %). Multiple injuries to the musculoskeletal system were diagnosed in five patients (18.5 %). One patient with polytrauma after a fall from 6 metres suffered an ipsilater fracture of the distal femur (3.7 %). The two patients involved in car accidents (7.4 %) had injury to the contralateral acetabulum. Two patients (7.4 %) sustained distal radial fractures on the other side. Surgery was carried out within 10.5 hours (4 to 47) of injury on the average. The average hospital stay was 6.4 days (2 to 12). All 27 fractures were classified as AO type C fractures, of these seven were open fractures. Complete bony union was achieved at an average of 4 months, with a range of 3 to 9 months (in two patients 7.4 %) after surgery. The early post-operative complications included wound dehiscence due to superficial infection in two patients. In two patients early removal of the implants was indicated, and this was for ulnar nerve irritation and motion range restriction in one and deep infection in the other. No migration or failure of the implants was recorded. The average MEPS of the patient group was 91.6, which is in the range of excellent to very good results. DISCUSSION The group of our patients is by age, sex and AO type C fractures comparable with the groups of other authors. The number of complications is lower and the MEPS evaluation is comparable. Even when full anatomic reduction and stable fixation are achieved, the outcome may be compromised by heterotrophic ossification, joint rigidity or ulnar neuropathy, the facts described by the majority of authors. Similarly, it is reported that good results are obtained with intra-articular osteotomy of the olecranon and ulnar nerve transposition. An important component of the treatment is good quality physical therapy restoring a satisfactory range of motion. CONCLUSIONS The study provided evidence that the use of LCP-DHP provides stable fixation of type C fractures, even in patients with osteoporosis, and when completed with early rehabilitation, it has good clinical outcomes.
- MeSH
- dospělí MeSH
- fraktury humeru chirurgie MeSH
- hojení fraktur MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- muži MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
