Zlomenina hlavice femuru byla poprvé popsána Birkettem v r. 1869. K poznání této zlomeniny významně přispěla studie Christophera z r. 1924 a především Pipkinova publikace z r. 1957, jehož klasifikace se používá dodnes. V české literatuře ji poprvé popsal Morávek v r. 1912. Z historického hlediska je pro zlomeninu hlavice femuru korektní eponym Birkitt-Pipkinova zlomenina.
Femoral head fracture was initially described by Birkett in 1869. Of essential importance in this respect were the publications by Christopher in 1924 and, particularly, Pipkin's study of 1957, including his classification that is still in use today. In the Czech literature, the first description was published by Morávek in 1912. A historically correct eponym for a femoral head fracture would therefore be Birkitt-Pipkin fracture.
- MeSH
- acetabulum patologie zranění MeSH
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- dějiny lékařství MeSH
- fraktury femuru * chirurgie klasifikace komplikace MeSH
- hlavice femuru * patofyziologie patologie zranění MeSH
- klasifikace metody MeSH
- lidé MeSH
- ortopedické výkony * dějiny metody využití MeSH
- ortopedie dějiny metody organizace a řízení MeSH
- radiografie dějiny metody využití MeSH
- Check Tag
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- lidé MeSH
- Publikační typ
- historické články MeSH
- kazuistiky MeSH
Úvod: Cílem studie je stanovit spolehlivost FAI rtg charakteristik - alfa úhel (AA) a offset ratio (OR) - na 50 resekovaných hlavicích a srovnání s konkrétními hodnotami naměřenými na rtg v přesné antero-posteriorní (AP) a axiální projekci. Metody: FAI diagnostické parametry AA a OR byly naměřeny na 50 konsekutivně resekovaných hlavicích. Tyto parametry byly měřeny skrz maximální deformitu na cerviko-kapitální junkci po nařezání oscilační pilou. Parametry byly srovnány s rtg AP a rtg na axiálních projekcích. Padesát hlavic bylo vybráno náhodně a neselektivně. Výsledky: Střední hodnota AA byla 76,47° na resekovaných hlavicích vs. 75,81° na axiální rtg projekci (p = 0,688). Střední hodnota OR byla 0,132 na resekovaných hlavicích vs. 0,220 na axiálních rtg (p < 0,001). Střední AA na ideálních AP rtg projekcích byl 79,46° vs. 81,51° na AP stojících rtg snímcích (p = 0,431) před implantací totální protézy. U AA měření na rtg AP a axiální rozpůlených hlavic byla zjištěna úzká souvislost. Závěr: V naší sérii měření AA na axiálních rtg vysoce korelovaly s AA na resekovaných hlavicích. Nicméně riziko chrupavčité destrukce v kyčelním kloubu nemůže být jasně předpovězeno vzhledem k vyšetření již artrotických hlavic.
Purpose: The purpose of this study was to determine whether X-ray attributes of the femoro-acetabular impingement (FAI) - alpha angle (AA) and offset ratio (OR) reflect real measurements on resected femoral heads. Methods: FAI AA and OR were assessed on 50 consecutively resected femoral heads. The parameters were measured on heads cut through the maximum range of the deformity and compared to the same parameters on standardized X-ray projections (anteriorposterior [AP] and axial views). Results: Mean AA was 76.47° on dissected heads vs. 75.81° on axial X-ray (p = 0.688). Mean OR was 0.132 on dissected heads vs. 0.220 on axial X-ray (p < 0.001). Mean AA on ideal AP X-ray was 79.46° vs. 81.51° on AP standing plain X-ray view (p = 0.431). AA measurements on plain X-ray AP and axial view of halved femoral heads correlated highly. Conclusions: AA on axial X-ray view reflected the real AA in our series, but the risk of cartilage damage cannot be predicted.
The balanced initial fixation of an implant makes up a crucial condition for its long-term survival. However, the quantification of initial fixation is no easy task and, to date, only qualitative assessments can be made. Although the concept of measuring fixation by means of vibration analysis is already widely used in dental implantology, the rigorous application of this method for the assessment of the fixation of femoral and acetabular components remains a challenge. Moreover, most studies on this subject have tended to focus solely on the femoral stem even though acetabular cup fixation is also important and even more difficult with respect to qualitative measurement. This study describes a comprehensive experiment aimed at assessing acetabular cup fixation. Fixation is expressed in terms of the impact force and polar gap variables, which are correlated with the modal properties of the acetabular implant during the various insertion stages. The predictive capabilities of modal frequencies and frequency functions were investigated by means of surrogate models based on the Gaussian process and functional principal component analysis. The prediction accuracy of the proposed models was in the range 82-94%. The results indicate that natural frequencies, reduced frequency, impact force and polar gap features provide great potential in terms of the prediction of implant fixation.
- MeSH
- dítě MeSH
- fotografování MeSH
- hlavice femuru anatomie a histologie krevní zásobení patologie MeSH
- lidé MeSH
- mladiství MeSH
- počítačové zpracování obrazu MeSH
- předškolní dítě MeSH
- skluz proximální femorální epifýzy * etiologie patologie MeSH
- věkové faktory MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY: The aim of the study was to investigate the occurrence of avascular necrosis (AVN) of the femoral head following the osteosynthesis of intracapsular fracture of the femoral neck in relation to the time interval between injury and surgery and the type of fracture. MATERIAL AND METHODS: The data of patients with intracapsular fractures of the femoral neck surgically treated in the period from 2001 to 2011 were reviewed. Of 1555 patients treated for this fracture, 125 (7%) underwent osteosynthesis. The evaluated group included 115 patients who came for examination at one-year follow-up. There were 59 (52%) women and 56 (48%) men. Dynamic hip screw (DHS) osteosynthesis with an anti-rotation screw was performed in 103 patients and lag-screw osteosynthesis involving three parallel cannulated cancellous screws was employed in 12 patients. The patients were allocated to groups according to the injury-to-surgery interval and to sub-groups on the basis of the Garden classification of femoral fracture stage. RESULTS: In the group of 58 patients treated within 6 h of injury, AVN developed in 10 (17%). When the type of fracture was considered, 4% of the non-displaced fractures and 30% of the displaced fractures developed AVN. The patients with Garden stage I and II (non-displaced) fractures treated within 6 h of injury had a significantly lower risk of AVN development than those with Garden stage III or IV (displaced) fractures. The group treated between 6 and 24 post-injury hours comprised 21 patients, of whom four (19%) had AVN. In non-displaced and displaced fracture sub-groups, 25% of the patients in the former and 16% in the latter had AVN. The stage of displacement had no effect on AVN development. The two groups together (patients treated by 24 h) had a significantly lower AVN incidence than the patients treated after 24 h (p = 0.0025). In this group of 36 patients, 16 had AVN (44%) and the fracture stage made no significant difference (p = 0.6985; nondisplacement sub-group, 41%; displacement sub-group, 55%). CONCLUSIONS: The study showed a significantly lower AVN occurrence in the patients surgically treated within 24 h of injury. In the patients treated within 6 h of injury, AVN incidence was significantly lower in the patients with non-displaced fractures, as compared with those who had displaced fractures. This was not true for the two patient groups treated later (6-24 and later than 24 h) in which the differences between AVN development after non-displaced fractures and that after displaced fractures were similar.
- MeSH
- fraktury femuru patologie chirurgie MeSH
- fraktury krčku femuru patologie chirurgie MeSH
- hlavice femuru patologie chirurgie MeSH
- hojení fraktur MeSH
- incidence MeSH
- kostní šrouby MeSH
- krček femuru patologie chirurgie MeSH
- lidé MeSH
- nekróza hlavice femuru etiologie patologie chirurgie MeSH
- peroperační komplikace etiologie MeSH
- rizikové faktory MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE: Our aim was to assess operative treatment for post-traumatic avascular necrosis of the femoral head (ANFH) in adolescents. METHODS: Eleven patients with an average age of 17 (range 14-26) years were operated up on for ANFH after proximal femoral fractures. The average interval between injury and reconstructive surgery was four (range two to eight) years. The average follow-up of the entire cohort was 89 (range 48-132) months. Five patients with total ANFH were treated by total hip replacement (THR). Six patients with partial ANFH were treated with valgus intertrochanteric osteotomy (VITO). RESULTS: In all patients, operation improved hip function. The average preoperative Harris Hip Score (HHS) was 70 points and average postoperative HHS was 97 points. Comparison of magnetic resonance imaging (MRI) scans before and after VITO demonstrated resorption of the necrotic segment of the femoral head and its remodelling in all six patients with partial ANFH. A complication was encountered in one patient. CONCLUSION: Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.
- MeSH
- coxa vara etiologie chirurgie MeSH
- dospělí MeSH
- fraktury krčku femuru komplikace patologie chirurgie MeSH
- hlavice femuru patologie chirurgie MeSH
- kohortové studie MeSH
- kyčelní kloub patofyziologie chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nekróza hlavice femuru etiologie patologie chirurgie MeSH
- obnova funkce MeSH
- osteotomie MeSH
- pooperační komplikace MeSH
- posuzování pracovní neschopnosti MeSH
- remodelace kosti MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie MeSH
- zdravotní stav MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
We analysed data from 155 revisions of identical cementless hip prostheses to determine the influence of patient-, implant- and surgery-related factors on the polyethylene wear rate and size of periprosthetic osteolysis (OL). This was calculated by logistic regression analysis. Factors associated with an increased/decreased wear rate included position of the cup relative to Kohler's line, increase in abduction angle of the cup, traumatic and inflammatory arthritis as a primary diagnosis, and patient height. Severe acetabular bone defects were predicted by an increased wear rate (odds ratio, OR = 5.782 for wear rate above 200 mm(3)/y), and increased height of the patient (OR = 0.905 per each centimetre). Predictors of severe bone defects in the femur were the increased wear rate (OR = 3.479 for wear rate above 200 mm(3)/y) and placement of the cup outside of the true acetabulum (OR = 3.292). Variables related to surgical technique were the most predictive of polyethylene wear rate.
- MeSH
- acetabulum chirurgie patologie MeSH
- dospělí MeSH
- hlavice femuru chirurgie patologie MeSH
- kyčelní kloub chirurgie patofyziologie MeSH
- kyčelní protézy MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- mechanický stres MeSH
- náhrada kyčelního kloubu škodlivé účinky MeSH
- odds ratio MeSH
- osteolýza epidemiologie etiologie patologie MeSH
- polyethylen MeSH
- protézy - design MeSH
- reoperace MeSH
- rizikové faktory MeSH
- selhání protézy MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
The purpose of this article is to update the reader on the latest trends in treatment of the pathologic adolescent hip due to femoroacetabular impingement (FAI). FAI is now becoming increasingly recognized as a cause of hip pain in the adolescent and may be a cause of hip degeneration later in life. Early diagnosis and treatment may possibly delay the future onset of hip arthritis. Recent published articles discuss the most useful and latest techniques of diagnostic tests, radiographic studies, and surgical management of FAI and associated labral tears. Recent literature discusses short-term and mid-term outcome data of surgical treatment in the adolescent and young adult hips, including elite athletes. The two basic mainstays of surgical management are arthroscopic osteoplasty versus open dislocation with osteoplasty to address the bony impingement. Both techniques address labral disorder and cartilage injury and specifics about the techniques are discussed. Both methods have good short-term and mid-term results, though comparison studies of both techniques are still lacking. In conclusion, FAI is becoming increasingly recognized as a cause of hip pain in the adolescent and possibly a cause of early hip degeneration later in life. The clinician should be familiar with FAI and treatment options.
- MeSH
- acetabulum chirurgie patofyziologie patologie MeSH
- artralgie diagnóza etiologie MeSH
- artroskopie využití MeSH
- diagnostické zobrazování využití MeSH
- hlavice femuru chirurgie patofyziologie patologie MeSH
- klinický obraz nemoci MeSH
- kyčel patofyziologie MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- luxace kyčle diagnóza etiologie chirurgie MeSH
- magnetická rezonanční tomografie využití MeSH
- medicína založená na důkazech MeSH
- miniinvazivní chirurgické výkony metody využití MeSH
- mladiství MeSH
- mladý dospělý MeSH
- náhrada kyčelního kloubu metody trendy využití MeSH
- ortopedické výkony metody trendy využití MeSH
- počítačová rentgenová tomografie využití MeSH
- pooperační komplikace MeSH
- radiografie využití MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- zákroky plastické chirurgie metody trendy využití MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- Publikační typ
- přehledy MeSH
Legg-Calve-Perthes disease (osteochondrosis of the femoral head) has been recognized in archaeological material for nearly a century but is extremely rare. We describe two Czech cases from archaeological findings. The first case was diagnosed in the skeleton of a man older than 50 years with the left hip affected. The skeleton was in grave Number 2 of the Langobard cemetery at Luzice (Moravia) and dated to the end of the fifth century and the beginning of the sixth century AD. The second case was described by J. Chochol in 1957 on the left femur and half of the pelvis of a skeleton from an archaeological investigation in Brandysek (Bohemia), ninth to tenth centuries AD. Using the diagnostic criteria of Ortner and Putschar, we excluded slipped capital femoral epiphysis in both cases. We discuss the differential diagnosis of Legg-Calve-Perthes disease versus unilateral and bilateral osteochondroses of the femoral head in archaeological and current clinical material.
- MeSH
- archeologie MeSH
- dějiny středověku MeSH
- hlavice femuru patologie radiografie MeSH
- kyčelní kloub patologie radiografie MeSH
- lidé MeSH
- paleopatologie MeSH
- pánev patologie radiografie MeSH
- Perthesova nemoc dějiny patologie radiografie MeSH
- Check Tag
- dějiny středověku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- historické články MeSH
- Geografické názvy
- Česká republika MeSH
The unstable slipped capital femoral epiphysis (SCFE) continues to be associated with occasional but severe complications such as osteonecrosis of the femoral head. Persistent deformity of the proximal femur, a previously accepted outcome, is now believed to hold an uncertain prognosis. The concept of femoroacetabular impingement and the persistence of occasional severe complications have prompted rapid change in the treatment of unstable SCFE. A recent retrospective review suggested that osteonecrosis occurs more frequently in patients treated with in situ pinning between 24 and 72 hours of the onset of symptoms. Its incidence also was found to be associated with intra-operative reduction of the slip angle of more than 10°, anterior physeal separation of 4 mm or more, and intra-operative reduction of anterior physeal separation. Interestingly, a recent MRI study suggested that not all patients who cannot bear weight have evidence of mechanical instability. Although in situ pinning remains the standard treatment in North America, surgical hip dislocation for unstable SCFE is reviewed in concert with the presentation of early promising results in a case series. The growing list of risk factors for the development of osteonecrosis in patients with unstable SCFE continues to be modified. Surgical hip dislocation remains an enticing management option but its ability to prevent impingement symptoms, resultant arthrosis and maybe even osteonecrosis has yet to be proven by a large series or randomized trial.
- MeSH
- chirurgie operační metody MeSH
- epidemiologické studie MeSH
- hlavice femuru patologie MeSH
- kyčelní kloub patologie MeSH
- lidé MeSH
- luxace kyčle chirurgie MeSH
- mladiství MeSH
- osteonekróza MeSH
- skluz epifýzy chirurgie komplikace MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- Publikační typ
- přehledy MeSH
