PURPOSE: The authors present clinical results in patients following transplantation of deep-frozen menisci within ten years following the surgery. METHODS: A cohort of 46 patients who were transplanted altogether 49 menisci was subject to prospective study following six months, two, five and ten years after meniscus transplantation. For subjective assessment, we used KOOS, IKDC and Lysholm scores; objective assessment was based on load X-ray examination of the operated knee at two, five and ten years after the surgery, MRI examination of 34 patients in the interval of two and ten years after the operation, control arthroscopy was performed in 23 patients eight of whom suffered a new injury. RESULTS: All 38 patients who have completed ten year follow-up without any new injury of the operated joint demonstrated statistically significant improvement of mobility in the period of six months and two, five and ten years following the meniscal transplantation. Further follow-up demonstrated different results in patients with a new injury and without a new injury of the operated knee joint. In eight patients (17.3%), the follow-up was disturbed by a new injury of the operated joint within three to eight years after the meniscal transplantation. In three patients with the damaged meniscal transplant, a cartilage deterioration from degree II to degree IIIa was found. In second-look arthroscopy, the patients with no injury showed signs of the improved condition of cartilage by one degree according to ICRS classification on average. The MRI imaging showed relatively frequent (47%) extrusion of the anterior and medial part of meniscus (2.5-3.8 mms) without the followed-up dynamics of changes at two and ten years after the surgery. CONCLUSION: All patients in the selected cohort proved the positive benefit of meniscus transplant when it comes to the improvement of clinical symptoms and improvement of mobility of the operated knee joint. The higher mobility following the transplantation compared to the activity prior to the surgery could have contributed to a new injury of the operated joint in 17% of the patients in the cohort.
- MeSH
- Arthroscopy MeSH
- Knee Joint diagnostic imaging surgery MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Meniscus * diagnostic imaging surgery MeSH
- Menisci, Tibial diagnostic imaging surgery MeSH
- Follow-Up Studies MeSH
- Tibial Meniscus Injuries * diagnostic imaging epidemiology surgery MeSH
- Prospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The preoperative planning in habitual dislocation of the patella should take into account all pathologies and the procedure should address all abnormalities. One of them might be also the rotational deformity of the femur. The purpose of this prospective study was to confirm the hypothesis that the only correction of pathological femoral anteversion by derotational intertrochanteric osteotomy (in the absence of another pathology) or the correction of femoral anteversion with simultaneous reconstruction of the patellofemoral joint provide adequate stability for the patellofemoral joint, with respect to the elimination of the risk of recurrent dislocation of the patella. MATERIAL AND METHODS In the course of 15 years, 17 patients (20 knee joints) with habitual dislocation of the patella were included in the study, in whom the CT scan also confirmed the femoral anteversion of 35° and greater. The group was female-dominant, often with BMI > 30. The mean age was 26 years. In 4 cases only derotational intertrochanteric osteotomy was performed, in 16 patients the osteotomy was followed by the stabilization of the patella in the knee region (always individually in dependence on the diagnosed pathology), of whom in 2 cases as the second step procedure because of thrombophilic disorders detected earlier. Immediately after the surgery, or at 6 weeks postoperatively (depending on the knee procedure done), individual rehabilitation was commenced. Partial weight bearing was recommended for the period of 3 months after the surgery. The mean follow-up period was 39 months (minimum of 36 months). RESULTS In one case a failure of osteosynthesis was observed and revision osteosynthesis with an intramedullary nail was performed. In all the other cases, primary healing of the osteotomy was achieved. The other complications were less significant (1 case of asymptomatic deep vein thrombosis of the lower limb, evacuation of subcutaneous haematoma in 1 case, 3 cases of the knee stiffness solved by manipulation under general anaesthesia at 6 weeks after surgery). Recurrent patellar dislocation was not observed in any of the patients. No pain in the upper thigh was reported by patients during the last follow-up control (at least 3 years postoperatively). Three female patients reported an isolated feeling of patellar instability. DISCUSSION There are very few studies focusing on the femoral derotational osteotomy for habitual dislocation of the patella in world literature. If any at all, they concern supracondylar and not intertrochanteric femoral osteotomy and the groups of patients were smaller than the group evaluated by us. CONCLUSIONS Preoperative planning for habitual dislocation of the patella should definitely reflect all pathologies. Therefore, the femoral derotational osteotomy should certainly be mastered by the orthopaedic surgeon, though it is a larger and more exacting procedure than patellar stabilizations in the knee region. Indications for this type of osteotomy should include anteversion greater than 30°, or 35°. The derotational intertrochanteric osteotomy alone or its combination with the stabilization of the patella in the knee region brings reliable results with no risk of recurrent dislocation. Key words: patella, habitual dislocation, femur, anteversion, derotational osteotomy.
- MeSH
- Adult MeSH
- Femur diagnostic imaging surgery MeSH
- Knee Joint MeSH
- Humans MeSH
- Osteotomy MeSH
- Patella * MeSH
- Patellofemoral Joint * diagnostic imaging surgery MeSH
- Prospective Studies MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The method of stabilising the osteoporosis-related spinal fractures using an expandable stent (vertebral body stent - VBS) and bone cement is generally accepted for its minimal invasiveness, a low risk of complications and confirmed analgesic effect. The efficiency of reduction of a compressed vertebra is, however, still discussed in the literature. Our hypothesis was that the stent expansion in the vertebral body can achieve a statistically significant reduction in the anterior, middle and posterior part of the vertebra. MATERIAL AND METHODS The patients in whom the VBS technique was used to treat an osteoporosis-related fracture of Th/L spine in the period 2010-2014 were included in the study, namely 29 patients with 31treated fractures. The following radiographic parameters were monitored - anterior, middle and posterior vertebral body height, kyphotic angle between the upper and lower endplates of the vertebral body. Also, the radiation burden, painfulness according to VAS score and occurrence of complications were monitored. The minimum follow-up was 12 months. RESULTS The mean height of the anterior part of the vertebral body before the surgery, on the 1st postoperative day and at 6 weeks, 3 months, 6 months and 12 months was 23.5/25.4/23.9/23.6/23.6 mm respectively. The mean height of the middle part of the vertebral body at the same intervals was 17.9/24.0/23.4/22.9/22.9/22.9 mm. The mean height of the posterior part of the vertebral body was 29.6/29.8/29.4/29.3/29.2/29.2 mm. The kyphotic angle between the endplates of the vertebral body was 8.6/5.3/7.4/7.9/8.0/8.0°. The mean VAS values were 8.2/2.4/2.0/1.9/1.8/1.7. The mean duration of surgery was 54.3 minutes. The mean time of fluoroscopy was 33.4 s. The mean radiation dose was 443.1 cGycm2. The observed complications comprised 2 cases of dilatation balloon rupture, one case of a failure to expand the stents in a healed fracture due to incorrect indication. In total, four cases of cement leakage outside the vertebral body were reported, always with no clinical response. DISCUSSION All the authors agree that the method brings immediate analgesic effect, comparable to kyphoplasty or vertebroplasty. In our cohort, good reduction ability of the implant in the middle part of the vertebral body was confirmed. This has been confirmed also by other authors. Nonetheless, at a longer time interval the loss of correction was observed, which was reported only by Hartmann (5). The other authors mostly did not take into account the longer-term outcomes. CONCLUSIONS The hypothesis that the stent is capable of a statistically significant reduction in the anterior, middle and posterior portion of the vertebral body was only partially confirmed. A statistically significant reduction was seen only in the middle portion of the vertebral body. In the anterior portion of the vertebral body the reduction was demonstrable only immediately after the surgery, while the later follow-up checks revealed the loss of correction. The statistically significant improvement of the kyphotic angle between the endplates of the injured vertebra was also seen only on the first postoperative radiographs and at later follow-up checks the improvement was no more significant. The change in the height of the posterior portion of the vertebral body was not statistically significant at any of the follow-up intervals. Key words:osteoporosis, vertebral fracture, vertebral body augmentation, stentoplasty, vertebral body stent.
- MeSH
- Lumbar Vertebrae MeSH
- Spinal Fractures * surgery MeSH
- Thoracic Vertebrae MeSH
- Fractures, Compression * MeSH
- Bone Cements MeSH
- Humans MeSH
- Osteoporosis * MeSH
- Stents MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY Acromioclavicular joint dislocations (AC) represent one of the most frequent injury to the shoulder gridle. Low grade injuries type Rockwood I-II are treated non-operatively. Whereas high grade injuries type Rockwood III-VI are usually treated operatively. At present a wide spectrum of surgical techniques is used: Bosworth screw, hook plate, pinning and tension banding, PDS-sling. In our study the pinning and tension banding technique and the modified orthocord sling technique were compared. The goal of this study was to determine whether there are any clinical and radiological differences between these two techniques. MATERIAL AND METHODS This retrospective non-randomized level 3 evidence study included 58 patients. All of them have sustained a Tossy III AC dislocation. Of the 58 patients, 31 were treated with pinning and tension banding. Modified orthocord (absorbable knitted strand) sling technique (One 2.0-2.5 mm Kirchner wire, orthocord tension banding and coraco-clavicular ligament suture) was used in 27 patients. The same regime was used in postoperative follow up. For the clinical assessment the ASES and Constant score were used. The presence of calcification, degenerative changes, clavicular dislocation were assessed during the X-ray follow-ups. RESULTS The mean treatment time was 18.7 ± 4.9 weeks in the pinning and tension band group (Group A), whereas 15.8 ± 2.8 weeks in the modified orthocord sling technique (Group B). There was a significantly shorter period of healing in Group B. There were no statistically significant differences in the K wire removal time (Group A: 12.6 ± 3.7, Group B: 11.9 ± 3.2). No significant difference was observed between Group A and Group B on the ASES score (Group A: 95 ± 5.8, Group B: 98 ± 3.1) and on the Constant score (Group A: 97.7 ± 3.2, Group B: 97.9 ± 2.9). There were significant differences in both groups between the injured and non-injured shoulder on the Constant score. The mean secondary clavicular dislocation in Group A was 7.2 ± 1.8 mm in the operated shoulder and 4.8 ± 2.0 mm in the non-operated shoulder. The secondary dislocation in Group B was 7.5 ± 2.0 mm in the injured shoulder and 4.2 ± 1.2 mm in the non-injured shoulder. There was a significant difference between the injured and the non-injured shoulder in both groups. Calcification in coraco-clavicular ligament was observed in 15 (48.4%) Group A cases and in 13 (48.1%) Group B cases. Secondary AC joint arthrosis was observed in 8 (25.8%) Group A cases and in 1 (3.7%) Group B case. DISCUSSION No significant difference in clinical outcomes between both the surgical techniques was found. These results are comparable with other, recently published studies. On the other hand, we observed a significantly decreased treatment time with the modified orthocord sling technique. One, centrically inserted Kirschner wire, might better tolerate small rotation movements in the AC joint. Secondary clavicular dislocation, Kirschner wire dislocations and wound complications were similar in both groups and comparable to other, recently published studies. CONCLUSIONS Even though the tension banding and orthocord modified sling rank among the oldest and the cheapest techniques available for AC dislocation treatment, their results are comparable with modern and costly techniques. The orthocord modified sling technique has an advantage of fast and cheap material extraction in outpatient conditions. Key words: AC dislocation, acromioclavicular joint dislocation, orthocord sling, tension banding, AC disruption, acromioclavicular joint disruption.
- MeSH
- Acromioclavicular Joint * MeSH
- Joint Dislocations * MeSH
- Immobilization MeSH
- Humans MeSH
- Shoulder Dislocation * therapy MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Úvod: Fournierova gangréna je zřídka se vyskytující, nicméně rychle progredující závažný stav s vysokou mortalitou. Ve většině případů je charakterizována jako nekrotizující fasciitida oblasti perinea a zevního genitálu. Amyandova hernie je vzácným stavem, kdy je apendix céka obsahem vaku tříselné kýly. Zánětlivé změny apendixu tvoří pouze 0,1 % případů při verifikaci Amyandovy kýly. Fournierova gangréna vzniklá jako komplikace při pozdě diagnostikované apendicitidě uložené v tříselném kanálu je v literatuře popsána v ojedinělých kazuistických sděleních. Kazuistika: Kazuistika 70letého pacienta s probíhající Fournierovou gangrénou vzniklou na podkladě gangrenózní apendicitidy Amyandovy hernie. Závěr: Fournierova gangréna jako komplikace Amyandovy hernie je raritním stavem, v literatuře referovaným pouze jako ojedinělá kazuistická sdělení. Vzhledem k vzácnosti patologie a nedostatku randomizovaných kontrolovaných studií je obtížné určení optimálního léčebného postupu dle principů evidence-based medicine. Vhodným přístupem k této patologii se jeví spojení vypracovaných guidelines v terapii Amyandovy hernie dle Losanoffa a Bassona, spolu s doporučovaným zlatým standardem terapie u Fournierovy gangrény, tj. včasným a radikálním chirurgickým débridement, adekvátní antibiotickou terapií a intenzivní péčí o pacienta.
Introduction: Fournier's gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand's hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand's hernia is verified. Fournier's gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier's gangrene resulting from gangrenous appendicitis of Amyand's hernia. Conclusion: Fournier's gangrene as a complication of Amyand's hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand's therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier's gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.
- Keywords
- Amyandova kýla,
- MeSH
- Appendectomy MeSH
- Appendicitis diagnosis therapy MeSH
- Fasciitis, Necrotizing diagnosis therapy MeSH
- Fournier Gangrene * diagnosis etiology therapy MeSH
- Hernia, Inguinal * surgery complications MeSH
- Humans MeSH
- Obesity pathology MeSH
- Critical Care MeSH
- Aged MeSH
- Negative-Pressure Wound Therapy MeSH
- Rare Diseases MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Introduction: Conservative approach is the golden standard for treatment of diaphyseal humeral fractures, supplemented with plate osteosynthesis in specific indications. However, nail osteosynthesis is becoming more popular in the recent years, namely due to a significant improvement in the areas of surgical techniques and implants used, which have resulted in a decrease of complications. This technique has become the treatment of choice at our centre. Aim: The aim of our work was to assess the success rate of diaphyseal humeral fractures osteosynthesis in a retrospectively evaluated patient population, and also to define the risk factors of potential non-healing. Methods: A total of 167 patients who were operated at the Trauma Hospital of Brno between 2011 and 2016 were enrolled into the retrospective clinical trial with 3rd degree quality evidence. The assessed parameters included the outcome of healing and the number of complications, such as paresis of n. radialis, prolonged healing or incidence of non-unions. Furthermore, we assessed in more detail a group of 17 patients with a diagnosed non-union, and concentrated upon possible predisposing factors. Results: We identified a total of 9 (5.4 %) patients with the complication of postoperative paresis of n. radialis. Six of these patients were operated using nail osteosynthesis; plate osteosynthesis was used in the remaining three patients. We also observed 10 patients (6.0 %) who manifested signs of prolonged healing, and a total of 17 (10.2 %) patients in whom the definition of non-union was confirmed on radiography examination. Of these patients, 15 (12.2 %) were operated using the nailing technique (12.2 %); two patients were treated with plates (5.6 %). The performed analysis of these patients revealed that the profile patient with a predisposition for occurrence of a non-union is a female in the seventh decade of her life, with a fracture in the middle third of the diaphysis, type A1 or B1 according to AO, with type 2 diabetes mellitus, and body weight on the border of obesity. None of the other observed factors has been proven significant. Conclusion: Plate osteosynthesis and intramedullary nailing for the treatment of diaphyseal humeral fractures present fully-fledged alternatives to the conservative approach. According to current literature, there exist no significant differences when comparing these techniques as far as the success rate of healing is concerned, although our experience suggests slightly better outcomes on radiography in patients treated with plate osteosynthesis, and a smaller incidence of n. radialis injury associated with the nailing technique.
Úvod: Zlatým standardem ošetření zlomenin diafýzy pažní kosti je konzervativní postup, doplněný ve specifických indikacích o dlahovou osteosyntézu. V posledních letech se naproti tomu začíná více prosazovat osteosyntéza hřebová, a to především z důvodu výrazného zlepšení chirurgické techniky a využívaných implantátů, které vedlo ke snížení množství komplikací. Na našem pracovišti se tak postupně stala metodou volby. Cíl: Účelem naší práce bylo zhodnotit úspěšnost osteosyntézy diafýzy pažní kosti v retrospektivně hodnoceném souboru pacientů a zároveň definovat rizikové faktory potenciálního nezhojení. Metoda: Do retrospektivní klinické studie III. stupně kvality důkazů bylo zařazeno 167 pacientů operovaných v letech 2011–2016 v Úrazové nemocnici v Brně se zlomeninou diafýzy pažní kosti. Hodnocena byla míra zhojení a množství komplikací jako, je paréza n. radialis, prodloužené hojení či vznik pakloubu. Dále jsme podrobněji analyzovali skupinu 17 pacientů s diagnostikovaným pakloubem se zaměřením na možné predisponující faktory. Výsledky: V našem souboru jsme nalezli celkem devět (5,4 %) pacientů s komplikací ve formě pooperační parézy n. radialis. Z těchto bylo šest operovaných hřebem a tři dlahou. Dále 10 (6,0 %) pacientů, kteří vykazovali známky prodlouženého hojení a celkem 17 (10,2 %) pacientů, u kterých RTG nález naplnil definici pakloubu. Z nich 15 (12,2 %) bylo operováno hřebovou technikou (12,2 %) a dva dlahou (5,6 %). Z analýzy této skupiny pacientů vyplývá, že profilovým pacientem predisponovaným pro vznik pakloubu je žena v sedmé dekádě života s frakturou ve střední třetině diafýzy typu A1 či B1 dle AO s DM II. typu a vahou na hranici obezity. Žádný jiný ze sledovaných faktorů se neprokázal jako signifikantní. Závěr: Dlahová syntéza i nitrodřeňové hřebování jsou při ošetření zlomenin diafýzy pažní kosti plnohodnotnou alternativou konzervativního postupu. Podle současné literatury nejsou signifikantní rozdíly při vzájemném srovnání těchto metod co do úspěšnosti zhojení, přestože naše zkušenosti naznačují mírně lepší rentgenové výsledky při osteosyntéze dlahou a naproti tomu menší frekvenci poranění n. radialis u osteosyntézy hřebové.
Aim of the work: The aim of this work is to evaluate the results of the treatment of the non-unions of humeral diaphysis after primary intramedullary nailing. Material and method: From January 2010 to January 2017, 209 patients with fractures of the humeral diaphysis with an intramedullary nail were operated at the Trauma Hospital in Brno. The group involved retrospectively evaluated patients with a nonunion of humeral diaphysis originated after primary treatment of fracture with an intramedullary nail These nonunions were treated by nail extraction and stabilization by autocompression or LCP. The shortest follow-up period of the patients after nonunion surgery was at least 12 months. Evaluated criteria of the group of non-unions included primary fracture types, types of nonunions, Constant shoulder score, disabilities of the arm, shoulder and hand (DASH) score, bone healing time after revision surgery and possible complications. Results: 14 patients were included in the group of patients with nonunion following primary intramedullary osteosynthesis of the humeral diaphysis fracture addressed by nail extraction and splint stabilization. In all patients, the nail was primarily inserted in the antegrade procedure. The mean follow-up after the revision surgery was 26 months. Eight cases were hypertrophic, two in oligotrophic and in four patients arthophic. The healing of the nonunion occurred in all operated patients in an average period of 4.1 months. The DASH score was 13 points at the end of the follow-up of the group of revision surgeries. Constant shoulder score was 77 points on average. After the revision surgery, 3 patients had transient paresis of the radial nerve. In two cases, nerve function was fully restored. In one case, distal forearm and hand hyperaesthesia persist. Conclusion: Fractures of type A1 and B1 according to the AO classification appear to be predisposed for the possible development of nonunion. The solution of each nonunion should be approached individually with good preoperative planning.
- MeSH
- Diaphyses MeSH
- Humeral Fractures * surgery MeSH
- Fracture Fixation, Intramedullary methods MeSH
- Humans MeSH
- Postoperative Complications MeSH
- Pseudarthrosis surgery diagnostic imaging etiology MeSH
- Reoperation statistics & numerical data MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
