Avascular necrosis (AVN) of the talus in a posttraumatic setting describes a condition of temporary or permanent bone death of a different extent, initiated by a circulatory disturbance. It is estimated that about 75% of all talar AVNs are caused by a prior trauma. The incidence of posttraumatic AVN rises with higher energy of injury, severity of talar body or neck displacement, fracture comminution, and injury to the soft tissues and major vessels in the lower leg and ankle region. These conditions are often seen in open fractures, fracture dislocations, and pure dislocations.
- MeSH
- fraktury kostí komplikace MeSH
- lidé MeSH
- osteonekróza * etiologie terapie prevence a kontrola MeSH
- talus * zranění MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Praktičtí lékaři a gynekologové zajišťují léčbu perorálními aminobisfosfonáty u lidí, kteří podle anamnézy, klinického a laboratorního vyšetření a výsledku osteodenzitometrie (BMD v některém ze standardních míst skeletu ≤ 2,5 T skóre) trpí primární (involuční nebo postmenopauzální) osteoporózou nebo utrpěli nízkotraumatickou zlomeninu, ale nemají velmi vysoké riziko zlomenin. Pacienty, u kterých je zjištěna suspektní sekundární osteoporóza, a pacienty s velmi vysokým rizikem zlomenin při primární osteoporóze předávají do péče ambulantních specialistů. Zejména však mají praktičtí lékaři a gynekologové nezaměnitelné postavení při včasné prevenci primární a sekundární osteoporózy, která zůstává vzhledem k nákladnosti screeningu, diagnostiky a léčby onemocnění v rozsáhlé populaci osob starších 50 let rozhodujícím opatřením pro snížení incidence nízkotraumatických zlomenin. Článek zmiňuje populační program časného záchytu osteoporózy, doporučené postupy a praktické aspekty léčby primární osteoporózy perorálními aminobisfosfonáty.
General practitioners and gynecologists provide treatment with oral aminobisphosphonates in people who, according to their medical history and results of clinical, laboratory, and bone densitometry examinations have primary (involutionary or postmenopausal) osteoporosis, or have suffered a low-traumatic fracture but do not have a very high risk of fractures. Patients who are diagnosed or suspected of secondary osteoporosis and patients with a very high risk of fractures in primary osteoporosis are referred to outpatient specialists. In particular, however, general practitioners and gynecologists have an unmistakable position in the early prevention of primary and secondary osteoporosis, which remains a decisive measure for reducing the incidence of low-traumatic fractures due to the cost of screening, diagnosis, and treatment of the disease in a large population of people over 50 years of age. The article mentions the population-based program for early detection of osteoporosis, recommended procedures, and practical aspects of the treatment of primary osteoporosis using oral aminobisphosphonates.
- MeSH
- adherence k farmakoterapii MeSH
- bisfosfonátová osteonekróza čelistí etiologie prevence a kontrola terapie MeSH
- denzitometrie MeSH
- fraktury kostí etiologie prevence a kontrola MeSH
- inhibitory kostní resorpce farmakologie škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- organofosfonáty farmakologie škodlivé účinky terapeutické užití MeSH
- osteoporóza * epidemiologie etiologie farmakoterapie prevence a kontrola MeSH
- riziko MeSH
- služby preventivní péče metody MeSH
- statistika jako téma MeSH
- vápník aplikace a dávkování MeSH
- vitamin D aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Background: Antiresorptive drugs are widely used to reduce bone mineral loss in patients with osteoporosis and to prevent skeletal-related events in patients with metastatic cancers and multiple myeloma (MM). Both the bisphosphonates (BP) and denosumab typically used in this indication were shown to be effective and relatively safe. Obviously, this medication could have some adverse effects; one of them is osteonecrosis of the external auditory canal. Only sporadic cases of external auditory canal osteonecrosis have been published yet. Here, we provide a case of denosumab-related osteonecrosis of the external auditory canal successfully treated surgically in the early stage of the disease. Case report: A 68-year-old patient with breast cancer underwent comprehensive oncological treatment, including denosumab administration. She was diagnosed with osteonecroses in the jaw and ear canal. The necrotic bones in both regions were resected with primary wound closure. Both affected sites healed well with no signs of necrosis recurrence. Conclusions: Osteonecrosis of the external auditory canal is a rare but probably underdiagnosed complication of antiresorptive medication. It has a negative impact on patient quality of life if left untreated. Early surgical treatment appears to be effective. The authors highlight several similarities with medication-related osteonecrosis of the jaw. Therefore, an analogous disease staging and treatment rationale is suggested.
- MeSH
- bisfosfonátová osteonekróza čelistí chirurgie etiologie MeSH
- denosumab * škodlivé účinky terapeutické užití MeSH
- inhibitory kostní resorpce * škodlivé účinky MeSH
- lidé MeSH
- nádory prsu * farmakoterapie chirurgie MeSH
- nemoci ucha chemicky indukované chirurgie MeSH
- osteonekróza * chemicky indukované chirurgie MeSH
- senioři MeSH
- zvukovod * chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY: The study aimed to evaluate the results of closed reduction and epiphyseodesis of unstable slips of the proximal femoral epiphysis. The hypothesis was that the clinical and radiological results of this method and incidence of avascular necrosis are comparable to the results of closed reduction and open reduction using surgical hip dislocation reported by literature. MATERIAL AND METHODS: In the period 2013-2023, 20 patients were treated for unstable slips in one institution. Whereas the boys were older (mean age of 13.4 years) than girls (mean age of 11.6 years), the gender distribution was equal. Acute on chronic slips prevailed over the acute slips (ratio 3:1). The slips were treated using the closed reduction, transphyseal fixation and capsular decompression at 6 to 240 hours after slip (81 hours on average). All patients were treated concurrently on the contralateral side as the prevention of the slip or to treat the grade I slips (two patients). The follow-up ranged from 7 months to 7 years. Clinical results were evaluated according to two scores: 1) own score (Bulovka University Hopspital score) based on the reduction of ROM, shortening of extremity and limitations of activities; 2) D'Aubigne-Postel score. In the radiological evaluation, correction of slip angle, alpha-angle, avascular necrosis (AVN) and the prominence of the anterior margin of the femoral neck on axial radiographs were evaluated. RESULTS: According to the Bulovka University Hospital score, there were 10 excellent results (50%) with no limitation of activity, including sport, in tree cases the results were very good (15%) and in five cases good (25%), respectively, with some limitation of activity, and two results were unsatisfactory (10%) with severe limitation of activity due to the AVN. According to the D'Aubigne-Postel score, there were 14 excellent results (70%), four good results (20%), and two unsatisfactory results (10%). The slip reduction was as follows: under 20 deg. in five patients; under 30 deg. in 10 patients, and over 30 deg. in five patients, respectively. Alfa-angle was greater than 63 degrees (range 45-88 deg.) on average. Prominence of the off-set epiphysis-femoral neck and femoroacetabular impingement (FAI) were observed in six patients. Remodelling of this prominence was seen in one patient four years after surgery. Shortening of the femoral neck over 1 cm was reported in two patients. Complete AVN with severe deformity of the hip was noted in two patients. DISCUSSION: Our hypothesis was confirmed because the results of treatment of the unstable slips by closed reduction are comparable with the published results of the same method and with surgical hip dislocation. The results correspond with those of large published cohorts of patients concerning the correction as well as rate of complications. CONCLUSIONS: According to our results, urgent gentle closed reduction, transphyseal fixation and capsular decompression represent efficient and relatively safe methods of treatment of unstable slips with low incidence of complication. Residual deformity of the off-set epiphysis-femoral neck and FAI represent limitations of this method. KEY WORDS: slipped proximal femoral epiphysis, unstable slips, closed reduction, transphyseal fixation.
- MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- nekróza hlavice femuru * chirurgie diagnostické zobrazování MeSH
- rozsah kloubních pohybů MeSH
- skluz proximální femorální epifýzy chirurgie diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
INTRODUCTION: The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS: The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS: A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS: A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.
- MeSH
- bisfosfonátová osteonekróza čelistí * epidemiologie etiologie terapie diagnóza MeSH
- dospělí MeSH
- inhibitory kostní resorpce terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sexuální faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- 3D tisk MeSH
- experimentální implantáty MeSH
- lidé MeSH
- mladý dospělý MeSH
- ortopedické výkony MeSH
- osteonekróza * chirurgie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- bisfosfonátová osteonekróza čelistí patofyziologie MeSH
- bisfosfonáty aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- denosumab aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- mnohočetný myelom * farmakoterapie komplikace MeSH
- nežádoucí účinky léčiv MeSH
- osteolýza * chemicky indukované MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
The authors present the cases of monozygotic male twins with right-sided Legg-Calvé-Perthes disease (LCPD) with different formation of the lumbosacral junction. This is likely the fi rst description of a lumbosacral junction formation disorder associated with identical twins who were both treated for LCPD as children. The disease began at 6 and 9 years of age and during treatment as well as in adulthood signifi cantly different bone formation of the lumbosacral transitional vertebra, was observed in both brothers. Twin A has a unilateral right-sided fusion of the enlarged L5 transverse process with the ipsilateral sacral ala, twin B has a complete sacralization of the fi fth lumbar vertebra. The LCPD treatment outcomes in the twins were consistent with the results from large studies, i.e., age at the time of LCPD onset is the main factor infl uencing the prognosis, however the morphological difference in the transitional vertebrae in these monozygotic twins was signifi cantly. Key words: lumbosacral transitional vertebra, lumbosacral junction formation, sacralization of lumbar vertebra, megatransverse of vertebra L5.
- MeSH
- bederní obratle diagnostické zobrazování MeSH
- dítě MeSH
- dvojčata monozygotní MeSH
- křížová kost diagnostické zobrazování MeSH
- lidé MeSH
- nemoci páteře * MeSH
- Perthesova nemoc * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
BACKGROUND: Mid-term results (clinical and radiographic) of ultra-short anatomical cementless stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) has not often been presented. The aim of this study is to evaluate THA using the Proxima stem in patients with ONFH in the mid-term. METHODS: The study consists of 73 patients (97 THAs) with a Proxima stem implanted between 2006 and 2015. The mean age of patients was 47.4 years, with a mean follow-up 105.2 months. The clinical results include preoperative and postoperative Harris Hip Scores (HHSs). Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. The complications and revisions were registered. Kaplan-Meier survival analysis was performed to determine the implant survival. RESULTS: The average HHS improved significantly from 40.3 preoperatively to 98.0 at the final evaluation (p ˂ 0.0001). Stem migration (subsidence and "varisation") was observed in 11 hips (in 9 of them up to 6th postoperative month without any further progression, in 2 with progressive migration and radiological loosening). Bony trabecular development was detected in modified Gruen zones (1,2,4,6,7 for Proxima stem): in zone 1 (0%), 2 (67.0%), 4 (64.9%), 6 (64.9%), 7 (0%). Radiolucent lines were observed in 1 cup and 6 stems (2 were loose, 4 with fibrous stable fixation). Complications were found in 5 hips (5.1%): squeezing hip once, repeated dislocation in 1, 1 early deep infection, and 2 loose stems. 2 hips (2.1%) were revised (dislocation, infection). The implant survival was 98.9% and 97.9% clinically and radiologically, respectively. CONCLUSIONS: Observations in the mid-term show that the clinical and radiological results of the Proxima stem in patients with ONFH are promising. The stem design preserves the proximal femoral bone stock. The bony trabecular appearance confirms physiological proximal femoral load transmission.
- MeSH
- hlavice femuru chirurgie MeSH
- kyčelní protézy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky metody MeSH
- následné studie MeSH
- nekróza hlavice femuru * diagnostické zobrazování chirurgie MeSH
- protézy - design MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
