Introduction: The present study compares the outcome of the long cemented stem and the revision uncemented stem used in periprosthetic femoral fractures. We propose that the revision with a long stem cemented prosthesis does not compromise fracture healing. Patients and Methods: A consecutive series of 37 patients, operated between 2010 and 2017, were enrolled in a retrospective analysis. A long cemented stem was implanted in 21 patients (study group; age at operation: 63 to 89 years). A distally tapered fluted uncemented stem was used in 16 patients (control group; age at operation: 35 to 77 years). The clinical outcome was evaluated with Merle d'Aubigné and Postel scoring system. Standard radiographs were taken before surgery, at 3, 6, and 12 months postoperatively, and last follow-up. Any and all complications during the follow-up period were recorded. Results: Although a significant difference (P = 0.006) was observed in the post-operative Merle d´Aubigné score over the 12-month follow-up period, no significant difference (P = 0.066) was found in the post-operative pain score between the study and control groups. Periodic radiographic assessments showed the disappearance of radiolucent lines and the diaphyseal part of the fracture was healed in all 34 followed-up cases during the first annual follow-up. Early surgical complications were seen in both groups, the medical complications were observed only in the study group. Conclusion: Based on our results, periprosthetic fractures of the femur after a total hip arthroplasty were associated with significant morbidity and increased mortality in elderly patients. Revision with a long-stem cemented prosthesis provided early pain-free weight-bearing without compromising the healing of femoral fractures in elderly patients with osteoporotic bone, altered mobility, poor balance, and reduced cognitive capacity.

• MeSH
• femur chirurgie   MeSH
• fraktury femuru * chirurgie   MeSH
• kyčelní protézy * MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• periprotetické fraktury * chirurgie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The aim of this study was to evaluate the mid-term outcomes of the surgical reconstruction of Charcot Foot Neuroarthropathy in diabetic patients with failed conservative treatment and indicated for a below-knee amputation. MATERIAL AND METHODS In the period from 2010 to 2015 the surgical reconstruction of inactive, chronic Charcot Foot Neuroarthropathy classified as type II and III by Sanders and Frykbeg was performed in 16 patients with failed conservative treatment. All these patients were by the diabetes centres initially indicated for a below-knee amputation. The performed evaluation focused on the clinical outcome (limb preservation, walking in footwear, full weight-bearing capability, the radiographic result (talar-first metatarsal angle, calcaneal inclination - negative, neutral, positive), complications (associated and not associated with the surgery). RESULTS The mean follow-up period was 4.7 years (2.5-7.5 years). From the original group of 16 patients indicated for a below-knee amputation following the failure of conservative treatment, the amputation was performed in one patient only. After the surgical reconstruction 15 patients were able to fully weight-bear when achieving plantigrade foot position, of whom 9 wore regular footwear and 6 customised diabetic footwear. The talar-first metatarsal angle was corrected from the mean 30 degrees (20-45) to the mean 5 degrees (0-10). The calcaneal inclination was corrected from the negative preoperative value in all the cases to neutral in 5 patients and positive in 10 patients. The surgery-associated complications were the following: infectious complications - positive preoperative cultivation in 10 out of 16 patients, secondary healing of the surgical wound in 7 patients, the need of additional ablation of plantar prominence of tarsal skeleton in 2 patients, screw prominence in 2 patients with the need of extraction - all healed without complications. In one case a lower limb amputation was performed due to secondary limb ischemia. The complications not associated with the surgery consisted of a soft tissue injury due to neuropathy. DISCUSSION Conservative treatment remains the basic approach to Charcot foot neuroarthropathy which is often associated with a long-term off-loading of the affected limb on a wheelchair, repeated hospital stays, changes of wound dressing of plantar ulcers. These are stated as the most frequent indications for a major amputation. Nonetheless, even the major amputation is accompanied by complications. The candidate for a reconstruction surgery should be a cooperating, compensated, informed diabetic patient with Charcot foot neuroarthropathy, either instable or stable, but non-plantigrade. It is necessary to diagnose and treat the impairment of leg blood supply and osteomyelitis, and to provide an appropriate rehabilitation. CONCLUSIONS Of the original 16 indications for a lower limb amputation in diabetic patients with Charcot foot neuroarthropathy, only one amputation was performed. Positive mid-term outcomes of surgical reconstruction justify further development of this method, bearing in mind the necessity of careful indication and preoperative preparation of the patient in cooperation with diabetologists. Precise and accurate surgical technique and relevant postoperative care are essential to minimise the potential complications. Key words:Charcot arthropathy, diabetic neuropathy, rocker - bottom foot deformity, foot reconstruction.

• MeSH
• amputace MeSH
• diabetická noha * chirurgie   MeSH
• lidé MeSH
• neuropatická artropatie * MeSH
• noha (od hlezna dolů) MeSH
• zákroky plastické chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY When treating tears of the distal biceps brachii muscle tendon, we repeatedly noticed a difference between the preoperative ultrasound findings and the operative findings. The aim of the study was to retrospectively correlate these findings in order to determine the sensitivity of the ultrasound examination in everyday orthopaedic practice. Moreover, we compared the results and complications of surgical treatment through two operative techniques used at our department. MATERIAL AND METHODS In the 2004-2016 period 20 patients underwent a surgery at our department for total tear of the distal tendon of the biceps brachii muscle. In 18 patients an ultrasound examination was performed preoperatively. In 3 patients it was repeated. Therefore, there were a total of 21 ultrasound observations made in this group of patients. Excluded were the cases of chronic tendinoses or inveterated tears. The group was divided into two sub-groups. The first sub-group was composed of patients in whom the preoperative ultrasound examination was performed by a radiologist-specialist in the musculoskeletal system, the second sub-group was composed of patients examined by a non-specialist. The ultrasound findings were compared with the operative findings. With the use of a formula for the calculation of sensitivity of the test, the sensitivity of the ultrasound examination was determined for proper recognition of a complete tear of the tendon concerned. Also, we compared the results and complications of the two operative methods applied: the technique using bone anchor vs. the Boyd-Anderson technique of transosseous reinsertion. RESULTS The sensitivity of the ultrasound examination was 91% in examinations performed by a radiologist-specialist and 40% in examinations performed by no-specialists. Both the surgical techniques brought very good results in our group of patients. The reported complications included 2 cases of temporary radial nerve palsy, 1 case of formation of heterotopic ossifications. DISCUSSION The sensitivity of ultrasound is adequate according to the literature. In our group of patients, the same applied only to examinations performed by a radiologist-specialist in the musculoskeletal system. This is because the ultrasound examination of the distal biceps tendon is a highly specialised examination. When performed by a non-specialist, the result of examination obtained in our observations is rather misleading, thus could lead to an improper method of treatment. Partial tears of this tendon are very rare according to the literature. Indirect signs of the partial tear presence at this location detected by ultrasound resulted in most cases in an incorrect diagnosis, therefore the description of a partial tear visualised by the ultrasound should be reserved exclusively for cases when intact fibrils are clearly detected during the examination. For unclear cases, the MRI scan is indicated. The results of both the surgical techniques of reinsertion applied were very good. The method using the bone anchors is technically easier to perform. Nonetheless, it has its specifics. CONCLUSIONS To diagnose correctly the tear of the distal biceps muscle tendon it is essential to perform a thorough clinical examination and to obtain the medical history of the patient, especially the mechanism of injury. Sonography can be beneficial only provided the examination is carried out by a specialist in the musculoskeletal system, with the use of appropriate device and under standard conditions. For surgical treatment of this injury we prefer the technique using a bone anchor, namely particularly since it is technically easier to perform. The functional results are very good. Key words: distal biceps tendon, elbow, tendon tear, ultrasound, suture anchors.

• MeSH
• dospělí MeSH
• korelace dat MeSH
• kosterní svaly * patologie   patofyziologie   MeSH
• kotvící implantáty * MeSH
• lidé MeSH
• neuropatie nervus radialis * diagnóza   etiologie   MeSH
• paže diagnostické zobrazování   patofyziologie   MeSH
• pooperační komplikace * diagnóza   etiologie   MeSH
• poranění šlachy * diagnóza   patofyziologie   chirurgie   MeSH
• senzitivita a specificita MeSH
• šlachy diagnostické zobrazování   MeSH
• tenodéza * škodlivé účinky   přístrojové vybavení   metody   MeSH
• ultrasonografie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The aim of the study was to compare the clinical outcomes following elective and traumatic total hip arthroplasty in Parkinson's disease patients. MATERIALS AND METHODS: Ten patients with osteoarthritis comprise the elective group (mean age at operation 74 years; mean follow-up 82 months). Thirteen patients with femoral fracture comprise the hip fracture group (mean age 76 years; mean follow-up 54 months). All patients were followed up at 6 and 36 months postoperatively and at the time of the latest follow-up. RESULTS: Despite the significant improvement in Merle d'Aubigné-Postel and pain scores, disability related to Parkinson's disease increased during the follow-up. Whereas more than 1/3 of hip fracture patients and all elective patients walked independently at 36 months after total hip arthroplasty, 43% of living patients from both groups were able to walk independently at the time of the latest follow-up. The medical complications were seen mainly in patients with hip fracture. CONCLUSIONS: Excellent pain relief with preserved walking ability without support of another person and acceptable complication profile was observed in Parkinson's disease patients at 36 months after elective total hip arthroplasty. This procedure may be indicated in Parkinson's disease patients after careful and individualized planning.

• Publikační typ
• časopisecké články MeSH

Kazuistika 36letého rekreačního potápěče, u kterého se rozvinula avaskulární nekróza hlavice humeru, s největší pravděpodobností po rychlé dekompresi. Tento případ kesonové nemoci s následným rozvojem osteonekrózy v oblasti hlavice proximálního humeru byl na našem pracovišti léčen artroskopicky s dobrým funkčním výsledkem.

Case report of 36 year old recreational scubadiver who developed avascular necrosis of humeral head following fast decompresion. In this case report we present well documentated case of avascular necrosis of humeral head in caisson disease. Patient was treated arthroscopicaly with satisfactory clinical result.

• MeSH
• artroskopie MeSH
• dekompresní nemoc * etiologie   patologie   MeSH
• dospělí MeSH
• hlavice humeru chirurgie   patologie   MeSH
• lidé MeSH
• osteonekróza * diagnóza   etiologie   chirurgie   radiografie   MeSH
• potápění škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Though mid-term survival rates of over 95% in several series have been published, there is still a paucity of related literature regarding the role of vertical stem instability in the osteointegration of fluted tapered stems. This paper presents a comprehensive and prospective assessment on short-term experiences with uncemented modular femoral stem in the treatment of defective femur during revision surgery of total hip replacement. MATERIALS AND METHODS: Clinical and radiological monitoring of 20 consecutive patients with implanted tapered fluted revision stem (Lima Corporate, Udine, Italy) was of 27 months in average (20-35 months). The average pre-operative Merle d'Aubigné and Postel method score was 6.3 points (3-10 points). The frequency of femur defects, classified according to Paprosky, was IIIA = 9 and IIIB = 11. RESULTS: During last follow-up, the Merle d'Aubigné and Postel hip score was on average 11.7 (6-16 points). Compared to post-operation radiograph, stem migration of 1.9 mm (0-11 mm) on average was found. This vertical stem migration was observed only when comparing hip radiographs immediately after surgery, and at 6 weeks post-surgery. The Paprosky IIIA defects group, presented a subsided stem by an average of 1.5 mm. In the group of Paprosky IIIB defects, the stem subsidence was on average 2.3 mm. All 20 patients in the study showed excellent osteointegration of the uncemented revision modular stem. CONCLUSIONS: This study found and excellent osteointegration of the Lima uncemented tapered fluted revision modular stem in defective femur with a cortical bone segment present in the diaphyseal isthmus area. The initial vertical instability leading to stem migrating during the first six weeks following surgery did not, however, affect its osteointegration.

• MeSH
• kyčelní kloub radiografie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * metody   MeSH
• nestabilita kloubu * diagnóza   etiologie   chirurgie   MeSH
• obnova funkce MeSH
• ortopedické fixační pomůcky MeSH
• pooperační komplikace diagnóza   chirurgie   MeSH
• reoperace * škodlivé účinky   přístrojové vybavení   metody   MeSH
• retrospektivní studie MeSH
• selhání protézy MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

The aim of this study is to evaluate the results of total hip arthroplasty in patients with Parkinson's disease during a period of five years, focusing on the assessment of the risks and benefits of surgery. During this period we performed total hip arthroplasty in 14 patients (15 hips) with Parkinson's disease. Patients were evaluated by subjective symptoms and objective findings, with a focus on the use of support while walking and walking distance, severity of Parkinson's disease before surgery and at the time of the last follow-up. During the postoperative period, the following parameters were assessed: length of ICU stay, mobilization, complications, the total duration of hospitalization and follow-up care after discharge. Of the 11 patients (12 hips) followed-up 1-5 years with an average of 3 years after operation 8 cases showed progression of neurological disability. 5 patients (6 hips) showed an increased dependence on the use of support when walking and reduced distance that the patient was able to walk. Subjectively, 10 hip joints were completely painless and 2 patients complained of only occasional mild pain in the operated hip. Complications that were encountered were urinary tract infection (5 patients), cognitive impairment (3 patients) and pressure ulcer (2 patients). We did not observe any infection or dislocation of the prosthesis. Three patients fell and fractured the femur and 3 patients in our cohort died during follow up. Implantation of total replacement is possible with judicious indication after careful evaluation of neurological finding in patients with minimal or mild functional impairment of the locomotor system. Prerequisite for a good result is precise surgical technique and optimal implant position with balanced tension of the muscles and other soft tissues around the hip.

• MeSH
• fraktury kyčle komplikace   chirurgie   MeSH
• kohortové studie MeSH
• lidé MeSH
• náhrada kyčelního kloubu * MeSH
• nekróza hlavice femuru komplikace   chirurgie   MeSH
• Parkinsonova nemoc komplikace   chirurgie   MeSH
• periprotetické fraktury komplikace   chirurgie   MeSH
• reoperace MeSH
• selhání protézy MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH