PURPOSE OF THE STUDY Acromioclavicular (AC) joint dislocation and its surgical treatment still raises a number of questions that remain to be answered. In some types of dislocations, Rockwood type III in particular, the indication for surgical treatment as such is relative. There are numerous techniques and implants available for the reconstruction of AC joint. In our research we focused on the necessity of coracoclavicular (CC) joint reconstruction. MATERIAL AND METHODS In this paper, a cohort of 56 patients with Rockwood type III AC joint injury who underwent surgical treatment at our department in 2010-2016 period was retrospectively evaluated. The patients were treated with open reduction with AC joint stabilisation using hook plate or tension band. The patients were divided into 2 groups, namely group 1 with CC ligament reconstruction and group 2 without CC ligament reconstruction. The assessment was done at 6 months, 1 year and 2 years after surgery. The clinical outcomes were assessed based on the absolute Constant score (CS) and coracoclavicular distance (CCD) on the X-ray. Subsequently, the outcomes were statistically processed and compared using the Student s ttest. RESULTS The least invasive surgical intervention, as to the length of incision, was the reconstruction using the hook plate without CC ligament suture, whereas the longest incision was performed in tension band with CC ligament suture. In the CC ligament suture group, the mean operative time was 10 minutes longer. When evaluating the CS of the compared groups with and without CC ligament reconstruction, no statistically significant difference (p > 0.05) was found between the two groups. Similarly, the CCD values at 2-year follow-up did not show any statistically significant difference between the two groups (p > 0.05). CONCLUSIONS The available outcomes suggest that the surgical methods used by us are adequately safe and reliable. Good clinical outcomes can be achieved by open reduction and fixation of Rockwood type III AC joint dislocation even without CC ligament reconstruction. Key words: acromioclavicular dislocation, classification, reconstruction, coracoclavicular ligament.
- MeSH
- dislokace kloubu * chirurgie MeSH
- kloubní ligamenta chirurgie MeSH
- lidé MeSH
- luxace ramenního kloubu * chirurgie MeSH
- retrospektivní studie MeSH
- sutura MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Differential diagnosis of tumor processes in orthopedics is a relatively broad and inherently very serious issue, especially if the patients are pediatric patients. A number of examination procedures is used in diagnostics, together with a wide range of complementary laboratory and imaging methods. However, the clinical examination, including the collected anamnestic data, remains to be the cornerstone. In pediatric patients, of major importance is the cooperation with parents, but not always necessary information is provided to make the final diagnosis. In younger children, it is very often impossible to obtain relevant anamnestic data due to a number of factors that are typical for pediatric patients, namely fear, noncooperation, misunderstanding of questions, mainly as a result of mental immaturity. Therefore, diagnosis in these cases is based primarily on clinical and complementary findings. This work presents a complex issue of this diagnosis, with a surprising and unexpected finding of a foreign body in the knee joint of a pediatric patient, which completely changed the subsequent treatment strategy. It concerned a 10-year-old boy referred to our clinic from another workplace for suspected tumor process in the knee joint. The whole process of examination and final diagnosis depends on a number of detailed information that we have tried to obtain throughout the process. Key words: tumor, knee, foreign body, diagnostics, imaging methods.
- MeSH
- cizí tělesa * diagnostické zobrazování chirurgie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- kolenní kloub * diagnostické zobrazování MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION The authors present the long-term clinical outcomes of revision anterior cruciate ligament (ACL) reconstruction. The aim was to compare the surgical technique with respect to the clinical outcomes within 3 years postoperatively. MATERIAL AND METHODS The clinical evaluation of revision anterior cruciate ligament reconstructions performed at our department in 2002-2017 was carried out. A total of 82 patients were included in the study, male as well as female patients. Apart from the clinical outcomes, the associated procedures performed as a consequence of other injuries or damage to other intraarticular structures, the surgical technique as such, potential complications of revision reconstruction and causes of failure were studied. The same criteria were followed up in all the patients - clinical range of motion (ROM) of the operated knee, knee stability - pivot shift test, instrumental Lachman test using Rolimeter, IKDC subjective form, Tegner and Lysholm scores. RESULTS In the group of patients, the surgical technique involved the use of a harmstring tendon autograft as a new graft for revision in 43 patients, a BTB autograft in 25 patients, and a BTB cadaverous graft in 14 patients. In 24 cases, a two-stage surgery was performed. The interval between the first- and the second-stage procedure ranged from 6 weeks up to 6 months, with the median of 62.4 days. During the evaluation, no difference was observed whether one-stage or two-stage surgery was performed, therefore this is not reflected in the overall evaluation. The clinical evaluation resulted in the following mean values when comparing the preoperative and final postoperative findings: The mean value of the IKDC subjective knee form score was 42 (30-62) preoperatively and increased to 77 (66-89) at 3 months. The values obtained at 6 months, 1 year and 3 years were 84 (73-93), 88 (79-100) and 89 (78-100), respectively. The mean value of the Lysholm score in the followedup study population was 63 preoperatively, which indicates a clearly poor result. The score rose to 71 (62-88) at 3 months, to 79 (67-92) at 6 months, to 89 (67-94) at 1 year, and at 3 years the mean score was again 89 (66-95). No serious complications were reported. CONCLUSIONS The results confirmed sufficient postoperative stability of the knee joint. In terms of function and pain perception the treatment was considered appropriate. No major complications occurred during surgeries. Based on the results, the authors foresee the patient s return to sports, at least at recreational level. Key words: anterior cruciate ligament, reconstruction, revision reconstruction, knee arthroscopy, instrumentarium.
- MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- rekonstrukce předního zkříženého vazu * MeSH
- šlachy MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.
- MeSH
- artroskopie MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- rekonstrukce předního zkříženého vazu * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Studie srovnává výsledky otevřené repozice za použití úhlově stabilních implantátů s ligamentotaxí pomocí zevní fixace u zlomenin distálního radia typu 2R3C dle AO klasifikace. Metody: Retrospektivní studie hodnotící výsledky osteosyntéz pacientů se zlomeninami distálního radia typu 2R3C dle AO klasifikace, operovaných do prosince 2018. U 54 pacientů metodou ORIF s úhlově stabilní volární dlahou (LCP), u 33 pacientů nekrvavou repozicí s ligamentotaxí za použití zevní fixace (ZF). Průměrný věk pacientů byl 46,7 roku u skupiny s LCP dlahou a 59,6 roku u skupiny se zevní fixací. U všech byl hodnocen rentgenový a funkční výsledek, dle Green a O’Brien skóre 6 a 12 měsíců od chirurgického zákroku. Výsledky: Podle rentgenu ve 12 měsících ve skupině LCP byl průměrný pozitivní sklon na bočném snímku 10,13°, průměrná radiální inklinace 23,89°, průměrná délka radia 11,84 mm. Ve skupině ZF byl průměrný pozitivní sklon na bočném snímku 6,32°, průměrná radiální inklinace 24,78°, průměrná délka radia 9,89 mm. Dle Green a O‘Brien skóre jsme zaznamenali ve 12 měsících ve skupině LCP průměrné skóre 84,44 bodu, dobrého a vynikajícího výsledku jsme dosáhli u 83,33 % pacientů, u žádného jsme nezaznamenali špatný výsledek, ve skupině ZF byl výsledný průměr 77,27 bodu, dobrého a vynikajícího výsledku jsme dosáhli u 45,46 % pacientů, u jednoho pacienta jsme zaznamenali špatný výsledek. Závěr: Na základě výsledků v našem souboru pacientů lze doporučit využití vnitřního typu osteosyntézy pomocí LCP implantátů jako techniky první volby při ošetřování zlomenin 2R3C dle AO klasifikace.
Introduction: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification. Methods: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and O'Brien score at 6 and 12 months after surgery. Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13° , the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and O'Brien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient. Conclusion: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.
The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.
- MeSH
- artroskopie MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- rekonstrukce předního zkříženého vazu * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The authors present the clinical use of the new instrumentation set for the anterior cruciate ligament (ACL) reconstruction using the hamstring tendons (HS). The positionning of the femoral tunnel and the fixation of the graft play an important role for the results of the surgery. The aim of the study was to confirm the proposed surgical technique and the methods of the graft fixation, especially from the point of view of the clinical midterm results at the evaluation up to eight years after the surgery. MATERIAL AND METHODS The clinical evaluation comprises 58 patients operated from 2007 to 2014 using the new instrumentation set. There were 9 men and 49 women included in the sample. The mean age was 34.6 years (range 18 - 58 yrs), namely 36.7 in women and 32.4 years in men. The evaluation was performed pre-opeatively and at 3 and 6 months, 1, 3, 5 and 8 years post-operatively. All the patients were followed based on the same criteria - clinical range of motion (ROM), stability of the knee - instrumentation Lachman test utilizing Rolimeter, subjective IKDC score and pain VAS scale for the harvesting site. The ocurrence and the rate of post-operative complications were monitored. RESULTS The integration and the ingrowth of the graft were achieved in all cases, the full ROM was gained as well, no pathological instability was observed. The fixation of the HS graft in the bone was confirmed by post-op X ray at 3 months after the surgery. The clinical evaluation showed the following mean differences in the pre-op and final post-op findings. The average preoperative laxity using the Lachmann test was 9.7 mm (range 6-12 mm), at 3 months 1.8 mm (1.4-2.1 mm), at 6 months 1.6 mm (1.2 - 2.2 mm), at 1 year 1.6 mm (1.1-2.3 mm), at 3 years the stability was 1.7 mm (1.2 mm-2.4 mm), at 5 years 2.3 mm (1.2-3.6 mm) and at 8 years after surgery it was 2.5 mm (1.2-3.9 mm). None of the patitents included in the study showed pathological instability that would be considered an indication for revision. In the evaluation of the subjective IKDC score, the pre-operative average was 56, with the range of 42-66, at 3 months post-operatively 79 (69-85), at 6 months 88 (74-92), at 1 year 95 (88-100), at 3 years 96 (89-100), at 5 years 94 (87-100), and at 8 years 92 (84-98). No severe complications were observed. CONCLUSIONS The method provided sufficient post-operative stability of the knee joint. Fixation of the femoral screw satisfied the demands laid on it. Regarding the pain perception, the method was considered positive, the level of pain involved in the procedure was low. No severe complications or technical mistakes occurred during the surgical procedures. The new instrumentation set developed for the ACL reconstruction offers an easy technique and comfortof use. Key words:anterior cruciate ligament, reconstruction, hamstrings, knee arthroscopy, instrumentation set.
- MeSH
- dospělí MeSH
- kolenní kloub MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum cruciatum anterius MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nestabilita kloubu * MeSH
- poranění předního zkříženého vazu * MeSH
- rekonstrukce předního zkříženého vazu * MeSH
- šlachy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
To present the method of functional treatment of distal radius fractures, and to evaluate its results in a group of 57 patients. MATERIAL The method described here was used to treat a Colles fracture in 57 patients between 2001 and 2005. The average age of patients at the time of injury was 62 years (range, 19 to 82). The minimal interval between the end of treatment and the evaluation of the patient group was one year. METHODS The presented method is based on the principles of functional treatment of wrist fractures, as advocated by Sarmiento et al. When the patient has been indicated for this treatment, the arm is immobilised in a classic rigid cast. This cast is changed three weeks after application for a cast permitting full palmar flexion and full ulnar deviation. The cast is removed when callus formation is detected and the fracture site is free of pain. During this treatment, much attention is paid to skin condition, with an emphasis on preventing the development of Sudecks algoneurodystrophy. RESULTS This method of functional treatment resulted in complete fracture healing in all patients. None of them required hospitalization. The total period of immobilization was on average 45 days, ranging from 41 to 57 days. On subjective evaluation the patients regarded both the course and the result of treatment as good. DISCUSSION In this paper the authors address the permanent conflict between concepts of surgical and conservative therapy. Their results fully support the fact that the freedom of motion of all joints for a greater part of treatment is necessary for healing as well as prevention of a subsequent restriction of the range of motion. They also provide evidence that this modified method facilitates healing without complications. The patients were satisfied with the outcome of treatment; there was no poor result reported. CONCLUSIONS The method of functional treatment for distal radius fractures is an effective procedure allowing for good bone healing with a minimum of complications. In addition, the treatment can almost exclusively be carried out in an out-patient department. The mechanism promoting the process of osteogenesis in its course is not known yet. However, it has to be mentioned that the method is time-consuming for both the physician and the patient. Key words: distal radius fracture, functional treatment, Sarmientos method.
- MeSH
- Collesova fraktura radiografie terapie MeSH
- dospělí MeSH
- hojení fraktur MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- sádrové obvazy MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
