A saddle-horn injury of the pelvis can be considered a separate category of injuries. They occur during horse riding, when a horse rider hits the horn of the saddle and suffers from anteroposterior compression of the pelvic ring. The hits can cause symphyseolysis or even sacroiliac joint injury, and thus also pelvic ring instability. So far, just a few articles have been published dealing with horse saddle-related injuries. Our report describes a rare case of abnormal haemorrhage in vascular anastomosis called corona mortis. The discussion part is then about appropriate treatment of such injury and the role of interventional radiology in similar injuries. Erectile dysfunction as a frequent complication in men with pelvic injuries from horse saddles requires attention, too. Key words: symphyseolysis, erectile dysfunction, saddle, pelvis, haemorrhage.
- MeSH
- Erectile Dysfunction * etiology MeSH
- Horses MeSH
- Hemorrhage complications MeSH
- Humans MeSH
- Bone Diseases * MeSH
- Pelvis MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Animals MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Case Reports MeSH
The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.
- MeSH
- Biomechanical Phenomena MeSH
- Time Factors MeSH
- Gait physiology MeSH
- Walking physiology MeSH
- Fracture Dislocation diagnostic imaging surgery MeSH
- Adult MeSH
- Fractures, Bone diagnostic imaging surgery MeSH
- Risk Assessment MeSH
- Body Mass Index MeSH
- Intra-Articular Fractures diagnostic imaging surgery MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Statistics, Nonparametric MeSH
- Calcaneus injuries surgery MeSH
- Plantar Plate MeSH
- Foot Injuries diagnostic imaging surgery MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Injury Severity Score MeSH
- Pressure MeSH
- Fracture Fixation, Internal methods MeSH
- Treatment Outcome MeSH
- Weight-Bearing physiology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
PURPOSE OF THE STUDY Currently, operative treatment is preferred in dislocated calcaneal fractures. Most frequently used is the extended lateral approach, the disadvantage of which is the risk of early complications. Therefore, less invasive operative techniques are sought that would reduce the risk of such complications. The presented study aimed to compare the two different surgical approaches with respect to the restoration of gait stereotype using the objective pedobarography. We assume that the limited operative approach in osteosynthesis of intra-articular calcaneal fractures results in comparable or earlier restoration of gait stereotype with regard to temporal and dynamic parameters compared to the extended lateral approach. MATERIAL AND METHODS The research study comprised a total of 22 patients who underwent the surgical treatment of intra-articular calcaneal fractures, divided into two groups by the applied operative approach. The first group consisted of 10 patients treated with less invasive sinus tarsi operative approach (ST). For osteosynthesis a calcaneal nail (C-nail, Medin, CR) was used. The second group consisted of 12 patients, to whom extended lateral approach (EXT) was applied. For osteosynthesis a calcaneal plate 3.5 mm (DePuy Synthes, Switzerland) was used. Pedobarographic measurement using a tensometric platform was performed in all the patients, always six months post-operatively. Temporal and dynamic variables of the gait cycle during the interaction of the foot with the ground were monitored. RESULTS In the EXT group, significant differences between the injured and healthy foot were found in walking 6 months after the surgery in most of temporal and dynamic variables. The ST group, however, showed no significant differences between the values for the injured and healthy foot in most of temporal and dynamic variables. DISCUSSION Six months after the surgery, the patients continue to carefully load the heel, regardless of the selected surgical approach, due to which the pressure at this place is significantly reduced and tends to be transferred to the midfoot or forefoot. This finding corresponds with previous studies. The patients undergoing a less invasive surgical approach load both the operated and healthy feet. Also, with regards to temporal parameters, as early as 6 months after the surgery correct gait stereotype is restored under the heel in these patients. We believe this is achieved thanks to less pain due to a limited extent of the surgical approach. On the very contrary, the extended lateral approach can cause deterioration of conditions for the restoration of gait stereotype due to the presence of extensive scarring on the heel side with a limited mobility of talocalcaneal joint or also an impaired mobility of peroneal tendons outside the ankle bone. CONCLUSIONS Six months after the surgical treatment of calcaneal fractures changes still persist in gait stereotype. The analysis of temporal and dynamic gait parameters in the followed-up group of patients reveals that the limited sinus tarsisurgical approach results in an earlier restoration of gait stereotype compared to the extended lateral approach. A higher number of patients in the respective groups is necessary in order to obtain more general results. Key words:sinus tarsi; extended lateral approach; plantar pressure; force; contact time.
- MeSH
- Gait * MeSH
- Adult MeSH
- Fractures, Bone diagnosis surgery MeSH
- Outcome Assessment, Health Care MeSH
- Intra-Articular Fractures diagnosis surgery MeSH
- Bone Plates MeSH
- Bone Nails MeSH
- Middle Aged MeSH
- Humans MeSH
- Calcaneus * diagnostic imaging injuries surgery MeSH
- Postoperative Period MeSH
- Subtalar Joint * physiopathology surgery MeSH
- Fracture Fixation, Internal * adverse effects instrumentation methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular. This study aims to evaluate the group of patients in whom the suprapatellar approach was used and who were followed up for the period of at least 12 months. MATERIAL AND METHODS The prospective study included 55 cases of osteosynthesis of diaphyseal fractures of the tibia with the surgery performed in the period from January 2013 to June 2015, of which in 53 patients (17 women and 36 men) with the mean age of 49.6± 16.7 years the ETN nail by DePuy Synthes ® was inserted through a suprapatellar approach. In 38 cases (70.1%) an isolated trauma was involved, 15 patients (29.9%) were treated for multiple injuries or polytrauma. In nine cases (17%) it was an open fracture (2times - GA grade I, 7times - GA grade II). A multiple fracture or a fracture of the proximal third was recorded in 19 cases (34.5%). The functional and radiological results of the treatment were assessed prospectively at 12 months after the surgery using the Lysholm (LS) score. RESULTS The final functional results were successfully assessed in 49 performed osteosyntheses (89.1%). The mean duration of surgery was 72.7± 19.57 min (40-140 min, median 65 min). A total of 48 (98%) fractures healed by primary intention. In five cases (10.2%) a delayed healing occurred and in one case (2 %) non-union was reported, requiring a revision surgery. In three cases (6.1%) complete implant was removed (twice by SP and once by IP approach). The mean Lysholm score was 93.4 ± 8.39 points (59-100 points, median score of 95 points). An excellent or a good result was observed in 45 patients (91.8%), a satisfactory result in three patients (6.2%), and a poor result in one patient (2%). A statistically significant correlation (p = 0.006) between the LS score values and the age of the patients was confirmed. In patients up to 60 years of age the LS score was 96.2 ± 4.51 points (89-100, median 96), at the age of more than 60 years it was 86.9 ± 11.46 (59-100, median 89). CONCLUSIONS The suprapatellar approach in treating the tibial diaphyseal fractures represents a safe alternative nail insertion technique. If an appropriate surgical technique is applied, the risks inherent in this approach are negligible. The approach allows for an easy reduction of challenging fractures of the proximal third diaphyseal fracture of the tibia and multiple fractures of the tibia and facilitates an easy check of the axial position of the extremity. The functional results of the knee joint are comparable to those achieved with the infrapatellar nailing technique. The final LS score correlates with the age of the patients. Key words:tibial fractures, suprapatellar approach, intramedullary nailing, knee pain.
- MeSH
- Diaphyses diagnostic imaging injuries surgery MeSH
- Adult MeSH
- Tibial Fractures classification diagnostic imaging surgery MeSH
- Fracture Fixation, Intramedullary instrumentation methods MeSH
- Bone Nails * MeSH
- Middle Aged MeSH
- Humans MeSH
- Lysholm Knee Score MeSH
- Fractures, Open diagnostic imaging surgery MeSH
- Prospective Studies MeSH
- Radiography MeSH
- Aged MeSH
- Fractures, Closed diagnostic imaging surgery MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
UNLABELLED: PURPOSE OF THE STUDY The aim of the study was to analyse the options for sustentacular screw placement in osteosynthesis of intra-articular fractures of the heel bone and to assess the effect of various screw positions on failure to maintain the reduction in the postoperative period. In addition, problems related to screw-end protrusion over the medial cortical bone or to screw penetration into the talocalcaneal joint were assessed. MATERIAL AND METHODS The group comprised 23 patients with a total of 25 intra-articular fractures of the heel bone treated by surgery. The procedure involved insertion of a sustentacular screw under fluoroscopic guidance. Post-operatively, screw position in the sustentacular fragment was evaluated on CT scans. During follow-up, attention was focused on the effect of screw placement on maintenance of fracture reduction, and clinical symptoms potentially associated with screw malposition were recorded. RESULTS All sustentacular screws were fixed sustentacular fragments. Seven screws (28%) were inserted in the talar shelf, seven (28%) were placed under and nine (36%) over the sustentaculum tali. Two screws penetrated into the talocalcaneal joint (8%). The end of a screw projecting by 2 mm over the medial wall of the calcaneus was found in 11 cases (44%). Two patients with screws penetrating into the talocalcaneal joint had problems. On the other hand, no clinical effect of a screw extending over the medial wall of the calcaneus was recorded. No significant association of screw position with late //delayed failure of fracture reduction was detected. DISCUSSION Although the ideal trajectory for a sustentacular screw have been defined using a model of the calcaneus, it is not easy to achieve optimal screw placement due to the complex anatomy of the calcaneus and limited possibilities of intra-operative control of screw insertion. Any sustentacular screw malposition is a potential risk factor, particularly if the screw has penetrated into the talocalcaneal joint. Therefore, it will be useful to seek methods allowing for safer screw insertion and elimination of risks associated with screw misplacement. The technique of sustentacular screw insertion by means of a compression-based device, described by the authors, designated to allow for screw placement in distal humerus fractures is one of the options. CONCLUSIONS Optimisation of techniques for sustentacular screw insertion in the osteosynthesis of calcaneal fractures should contribute to reduction of risks related to screw malposition. The assessment of effects which the position of a screw may have on delayed failure of fracture reduction should be based on a thorough biomechanical study. KEY WORDS: sustentacular screw, calcaneal fracture, insertion, malposition.
- MeSH
- Fracture Fixation instrumentation methods statistics & numerical data MeSH
- Fluoroscopy MeSH
- Intra-Articular Fractures diagnostic imaging surgery MeSH
- Bone Screws * MeSH
- Humans MeSH
- Calcaneus diagnostic imaging injuries surgery MeSH
- Tomography, X-Ray Computed methods MeSH
- Fracture Fixation, Internal instrumentation methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Úvod: Kvalita ošetření zlomenin páteře s neurologickým postižením spočívá ve volbě správné operační strategie, ve správném načasování její realizace a ve správném technickém provedení. Selhání kterékoliv z uvedených složek ošetření výrazně negativně ovlivňuje další péči o zraněného. Korektnost technického provedení je v řadě případů velmi sporná. Je třeba věnovat pozornost zdokonalení techniky použití spinálních implantátů, aby mohla postakutní i chronická fáze péče o pacienty s neurologickým postižením probíhat nerušeně. Materiál a metoda: Retrospektivní analýza kvality primárního chirurgického ošetření pacientů s traumatickou míšní lézí hospitalizovaných na spinální jednotce Krajské nemocnice Liberec v letech 2003–2012 a na spinální jednotce FN v Motole v letech 2004–2012. Výsledky: V průběhu sledovaného období bylo nevhodné ošetření zjištěno u 191 pacientů ze 775 (24,6 %). V suboptimálním ošetření dominovala chybná repozice u 111 případů (58,1 %) a chybné zavedení pedikulárních šroubů v 78 případech (48,8 %). Následovala chybná dekomprese v 52 případech (27,2 %). U 85 pacientů (44,5 %) bylo nutné kompletní přepracování stabilizace. Nebyl zaznamenán žádný vývoj v počtu nesprávně ošetřených pacientů v jednotlivých letech. U suboptimálně ošetřených pacientů s poraněním v krční, hrudní i bederní oblasti se shodně prodloužila hospitalizace v průměru o 9,58 dne. Závěr: Autoři doporučují důsledné dodržování operační techniky a kritické pooperační rentgenové kontroly. Další pokrok spatřují v kvalitním vzdělávacím systému ve spondylochirurgii.
Introduction: Right surgical strategy, optimal timing and correct surgical technique are crucial for the quality of treatment of spinal fractures associated with neurological deficit. Failure of any of these parts of treatment has an immensely negative effect on subsequent patient care. In many cases, the quality of technical performance of the surgery is controversial. It is desirable to improve the use of spinal implants to achieve undisturbed course of subacute and chronic phases of treatment. Material and methods: Retrospective analysis of the quality of primary surgical treatment of patients with posttraumatic spinal cord injury treated at the Spinal Unit of the Regional Hospital Liberec between 2003 and 2012 and at the Spinal Unit of the University Hospital Motol in Prague between 2004 and 2012. Results: Incorrect surgical treatment was delivered in 191 of 775 cases (24.6%). Wrong fracture reduction was preformed in 111 cases (58.1%). Incorrect pedicle screw insertion was found in 78 cases, followed by insufficient decompression of the spinal channel in 52 cases. A revision surgery with complete reinstrumentation was required in 85 patients (44.5%). We identified no development in the number of suboptimally treated patients over the analyzed years. The length of hospital stay in suboptimally treated patients was prolonged by the mean of 9.58 days. Conclusion: The authors recommend strict compliance with the surgical technique and rigorous post-operative X-ray follow ups. This field could further be improved with high-quality spinal surgery educational system. Key words: spinal cord injury – spinal cord decompression – spinal fracture reduction – spine stabilization The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Keywords
- dekomprese míchy, stabilizace páteře, repozice zlomenin páteře,
- MeSH
- Lumbar Vertebrae surgery injuries MeSH
- Decompression, Surgical methods adverse effects statistics & numerical data MeSH
- Medical Errors * statistics & numerical data adverse effects MeSH
- Length of Stay statistics & numerical data MeSH
- Adult MeSH
- Spinal Fractures surgery MeSH
- Spinal Fusion adverse effects MeSH
- Thoracic Vertebrae surgery injuries MeSH
- Internal Fixators adverse effects MeSH
- Bone Screws statistics & numerical data adverse effects MeSH
- Cervical Vertebrae surgery injuries MeSH
- Humans MeSH
- Manipulation, Orthopedic adverse effects MeSH
- Pedicle Screws MeSH
- Postoperative Complications MeSH
- Spinal Cord Injuries * etiology surgery MeSH
- Reoperation statistics & numerical data MeSH
- Retrospective Studies MeSH
- Quality Control MeSH
- Fracture Fixation, Internal adverse effects MeSH
- Outcome and Process Assessment, Health Care * statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Multicenter Study MeSH
PURPOSE OF THE STUDY The effect of an early surgical intervention in the traumatised spine on resolution of neurological deficit still remains a topic of professional discussions. The aim of this retrospective study was to find a correlation between the length of an injury-to-surgery interval and the development of a post-operative neurological deficit, and thus to answer the question of whether early surgical decompression and stabilization gives better chance of neurological recovery. MATERIAL AND METHODS Medical records of consecutive surgical patients admitted between 2007 and 2010 with traumatic spinal cord injury were reviewed and the injury-to-surgery interval and post-operative development of neurological deficit at a minimum follow-up of 6 months was evaluated. The initial neurological finding and the finding at 6 months of follow-up were classified on the Frankel scale and the outcome was assessed as improved or unimproved. The patients were allocated to four subgroups according to the time that elapsed between injury and surgery, i.e., time up to 24 h, 24 - 72 h, 72 h - 1 week, and longer than 1 week. The percentage of improved patients was calculated in each subgroup and the results were statistically evaluated using the Kruskal-Wallis test at a significance level of 0.1. RESULTS Out of the total number of 32 evaluated patients, 28 had at least partial neurological recovery. In the subgroup treated within first 24 h, improvement was found in 93 % of the patients, in the 24 - 72 h subgroup it was 80%, in the 72 h - 1 week subgroup it was 60% and surgery later than a week after injury resulted in improvement in 42% of the patients. Based on statistical evaluation, the time between injury and surgery appeared to be a significant prognostic factor. When a paired comparison of subgroups was made, the only significant difference was found between the subgroup treated within 24 hours of injury and that operated on later than a week after injury. The other paired comparisons failed to show a significant difference due to a small number of patients; however, a tendency to better functional results was observed in all earlier-treated subgroups. DISCUSSION The authors are aware of few limitations of the study. Its retrospective character, a relatively small number of patients and a single institution setup may limit the interpretation. Despite this fact, the message is clear. Similar studies carried out prospectively at several institutions may, however, provide results with a higher validity. CONCLUSIONS Patients with traumatic spinal cord injury who undergo early decompression and stabilisation have a higher chance of at least partial neurological recovery.
The neurosphere assay has been used to maintain neural progenitor cells (NPCs) in the undifferentiated state. These cells are multipotent and gave rise to neurons and glial cells. Here we show that within 10 days of culture, neurospheres contained precursors and differentiated progeny of all three major central nervous system (CNS) cell lineages and these occupied distinct zones. The microenvironment of the inner zone supported cell differentiation. Cells of oligodendroglial lineage generated within the neurosphere were frequently observed. Of these cells, A2B5(+) cells were homogeneously distributed in the neurospheres, NG2(+) cells preferentially occupied the outer zone and O4(+) cells were localized at the inner zone of 10 day-old neurospheres. We prevented a massive cell death of dissociated neurosphere cells seen after differentiation triggered with adhesion and fetal calf serum by adding epidermal growth factor and basic fibroblast growth factor to the culture medium. Under these conditions, less than one third of cells did not express cell specific markers, glial fibrillary acidic protein-positive astroglia represented 43.4%, NG2(+) and/or O4(+) oligodendroglia represented 24.3%, and betaIII-tubulin(+) neurons 3.1% of cells recovered after neurosphere differentiation. We present evidence that oligodendroglial cells differentiate in a stepwise process as a result of their distribution in subsets that represent distinct developmental stages according to antigenic and morphological criteria. These include oligodendrocyte progenitors, preoligodendrocytes, and oligodendrocytes. The highly complex morphology of mature oligodendrocytes was compatible with functional cells.
- MeSH
- Antigens metabolism MeSH
- Astrocytes physiology metabolism MeSH
- Cell Differentiation MeSH
- Spheroids, Cellular MeSH
- Phenotype MeSH
- Financing, Organized MeSH
- Glial Fibrillary Acidic Protein metabolism MeSH
- Mice, Inbred Strains MeSH
- Cells, Cultured MeSH
- Mice MeSH
- Oligodendroglia physiology metabolism MeSH
- Proteoglycans metabolism MeSH
- Tubulin metabolism MeSH
- Animals MeSH
- Check Tag
- Mice MeSH
- Animals MeSH
