CÍL PRÁCE: Cílem práce je zhodnotit výsledky při léčbě osteomyelitidy tibie pomocí zevního (xátoru, srovnat výsledky s ostatními pracovišti a navrhnout řešení ke zlepšení. MATERIÁL A METODIKA: V letech 2000–2006 jsme léčili v Traumatologickém centru FN Ostrava celkem 28 pacientů s osteomyelitidou tibie. Všichni pacienti podstoupili komplexní léčbu, kde rozhodující úlohu má sanace infektu skeletu a léčba vzniklého kostního defektu. Stabilizaci skeletu jsme prováděli výhradně zevními (xátory. Po dvouletém odstupu po skončení léčby jsme zhodnotili výsledky dle ASAMI kritérií. Byly zhodnoceny výsledky kostní, funkční, počty vynucených amputací a návrat do původního zaměstnání. VÝSLEDKY: Získali jsme velmi dobré a dobré výsledky u více jak 80 % pacientů. Výsledky jsme poté srovnali se světovými pracovišti zabývajícími se touto problematikou. Dosáhli jsme srovnatelných výsledků. Přesto léčba trvá dlouho a řada pacientů má trvalé následky ve smyslu omezené hybnosti v hlezenním kloubu, kulhání a nutnosti používání berlí. ZÁVĚR: Komplexní léčba osteomyelitidy je nutnou podmínkou úspěchu léčby. Cesta ke zlepšení výsledků spočívá v časném debridementu a vhodné metodě léčby kostního defektu, v aktivnější spolupráci s plastickými chirurgy při kvalitním krytí vzniklých defektů měkkých tkání nutných pro hojení skeletu a ve spolupráci s fyzioterapeuty při aktivní a časné rehabilitaci hybnosti hlezenního kloubu a nácviku správného stereotypu chůze. Tím se zkrátí doba léčby a sníží se trvalé následky. Nedílnou součástí úspěchu léčby je naučit pacienta pracovat se zevním (xátorem tak, aby vznikl „přátelský vztah“ mezi pacientem a jeho zevním fixátorem.
AIM: The aim of the presented study was to assess the results of treatment of tibial osteomyelitis with external (xator, to compare the outcomes with other centres, and to propose a solution for improvement. MATERIALS AND METHODS: A total of 28 patients with tibial osteomyelitis were treated at the Traumatology Centre of the University Hospital Ostrava between 2000 and 2006. All patients underwent a complex treatment, where the decisive role is played by the remediation of the skeletal infection and treatment of the resulting bone defect. The skeletal stabilization was performed exclusively with external (xators. We evaluated the treatment results at two years after the completion of the treatment according to the ASAMI criteria. We assessed the results of bone healing, together with functional assessment, the number of necessary amputations and return of the patients to their original employment. RESULTS: We obtained results classi(ed as “excellent” and “good” in more than 80 % of the patients. Consequently, we compared the observed results with other centres in the world dealing with this topic. It is possible to conclude, that our results were comparable. Nevertheless, the treatment period in these patients is very long and many patients su5er from permanent consequences of the injury, such as decreased mobility in the malleolar joint, limping and the necessity to use crutches. CONCLUSION: A complex treatment of osteomyelitis is a necessary precondition for successful treatment outcomes. Possible means of improving the results include an early debridement and the use of a suitable method of treatment of the bone defect, more active cooperation with specialists in the plastic surgery in performing a quality coverage of the sustained defects of soft tissues, necessary for healing of the skeleton, and a close cooperation with physiotherapists during an active and early rehabilitation treatment aimed at the quality of mobility of the malleolar joint and training of a correct gait stereotypes. This procedure will result in shortening of the treatment period and decreasing the extent of permanent consequences. An integral part of the treatment success is to teach the patient how to manipulate with the external xator in such a way as to establish a “friendly relationship” between the patient and his external fixator.
- MeSH
- Amputation, Surgical statistics & numerical data MeSH
- Chronic Disease MeSH
- Adult MeSH
- External Fixators MeSH
- Tibial Fractures * surgery complications MeSH
- Fracture Healing MeSH
- Ilizarov Technique * statistics & numerical data utilization MeSH
- Wound Infection complications MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Recovery of Function MeSH
- Osteomyelitis * surgery complications MeSH
- Osteotomy MeSH
- Postoperative Complications MeSH
- Retrospective Studies MeSH
- Chi-Square Distribution MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
Charcotova osteoartropatie s hlubokou infekcí a osteomyelitidou u pacientů se syndromem diabetické nohy patří k nejtěžším stavům často indikovaným k amputační léčbě. Zevní fixace se řadí k modalitám přispívajícím k lepším výsledkům „limb salvage surgery” . Mezi indikace pro zevní fixaci u pacientů s hlubokou infekcí patří patologické fraktury nosného skeletu v infikovaném terénu, akutní Charcotova osteoartropatie a/nebo osteomyelitida s defekty, znemožňující fixaci dlahou, septická artritida a selhání konvenčních osteosyntéz. Za kontraindikaci zevní fixace považujeme střední až vážnou periferní arteriální chorobu bez intervence, progresivní sepsi, non-compliance pacienta. Za základní výhody externí fixace proti jiným druhům fixace pokládáme uspokojivou stabilitu, lepší komfort pro ošetření ran (včetně případného využití vakuové terapie) a relativně časnější možnost zátěže. Z technického hlediska doporučujeme zevní rámovou fixaci. Vhodná délka fixace je 12-25 týdnů při pravidelných kontrolách a úpravách fixátoru. Zevní fixace je často opomíjenou modalitou v léčbě Charcotovy osteoartropatie a osteomyelitidy u syndromu diabetické nohy. Při správné indikaci dává naději na prediktabilní a kladné výsledky léčby.
Charcot osteoarthropathy with a deep infection and osteomyelitis in patients with diabetic foot syndrome belongs to the most severe conditions that are often indicated for the amputation. The external fixation is one of the modalities contributing to better outcomes of limb salvage surgery. Pathological fractures of weight bearing skeleton in contaminated tissue, acute Charcot's osteoarthropathy and/or osteomyelitis with defects that prevent plate fixation, septic arthritis and a failure of conventional osteosynthesis are indicated for the external fixation in patients with a deep infection. The moderate and severe peripheral arteriopathy without intervention, progressive sepsis and patient's non-compliance are considered the contraindications of the external fixation. The basic benefits of the external fixation are good stability, better comfort for wounds nursing with possible application of vacuum therapy and relatively faster possibility of weight bearing. From a technical point of view, we recommend the external fixation with frame. The adequate duration of fixation is 12-25 weeks with regular check ups and adjustments of the fixator. The external fixation is a frequently neglected modality in the treatment of Charcot's osteoarthropathy and osteomyelitis in the diabetic foot syndrome. If correctly indicated it gives hope for predictable and positive outcome of the treatment.
- Keywords
- Charcotova osteoartropatie, zevní fixace,
- MeSH
- Diabetes Mellitus surgery MeSH
- Diabetic Foot surgery complications therapy MeSH
- External Fixators contraindications utilization MeSH
- Fracture Fixation methods utilization MeSH
- Wound Healing MeSH
- Ilizarov Technique contraindications adverse effects utilization MeSH
- Wound Infection surgery therapy MeSH
- Humans MeSH
- Bone Diseases surgery complications therapy MeSH
- Arthropathy, Neurogenic surgery therapy MeSH
- Osteomyelitis surgery therapy MeSH
- Postoperative Care methods MeSH
- Limb Salvage methods MeSH
- Check Tag
- Humans MeSH
Background. Nonunion of the lateral humeral condyle are of the complex pathology of the elbow joint, occurring relatively often and resulting in disability of children. The treatment of nonunion of the lateral humeral condyle of humerus with cubitus valgus remains controversial. Purpose of this report was improvement of the results of surgical treatment of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus with use of differential approach to the surgical strategy. Material and methods. We were observing 28 children (17 boys and 11 girls) with nonunion and longstanding nonunion of lateral condyle of humerus, with various degrees of severity. There were used MRI and Xray investigations for differential study of the patients divided into 3 groups in relation to stability and nonstability of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus. Results. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarovs technique. The mean postoperative humerusulna angle was 6,0 degrees of cubitus valgus. All of reverse Tosteothomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of followup was 7 years. The overall results were excellent in 15(53,5%) patients, good in 11(39,3%) patients, and fair in 2(7,2%) patients. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarovs technique. The mean postoperative humerusulna angle was 6,0 degrees of cubitus valgus. All of reverse Tosteothomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of followup was 7 years. The overall results were excellent in 15(53,5%) patients, good in 11(39,3%) patients, and fair in 2(7,2%) patients. Conclusion. We believe it is reasonable to use our treatment method when dealing with nonunion of the lateral humeral condyle with cubitus valgus. These differential techniques helps to shape the distal part of humerus, thus, restoring the function of the elbow joint.
- MeSH
- Child MeSH
- Humeral Fractures surgery MeSH
- Ilizarov Technique * utilization MeSH
- Joint Deformities, Acquired surgery MeSH
- Humans MeSH
- Elbow Joint * abnormalities anatomy & histology surgery pathology MeSH
- Child, Preschool MeSH
- Shoulder * abnormalities anatomy & histology surgery pathology MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Child, Preschool MeSH
PURPOSE OF THE STUDY Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s. MATERIAL AND METHODS In the years 1990 through 2007 a total of 67 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations. RESULTS In 13 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 54 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 12 cases after the removal of the distraction apparatus. DISCUSSION Our results fully correspond with the data and experience of others cited authors. In addition our study showed deceleration in bone healing in girls over 12 years and in boys over 14 years of age and serious problem in healing when is lack of periostal callus five weeks after surgery. CONCLUSIONS The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach.
- MeSH
- Child MeSH
- External Fixators MeSH
- Femur surgery radiography MeSH
- Fracture Healing MeSH
- Ilizarov Technique utilization MeSH
- Humans MeSH
- Adolescent MeSH
- Follow-Up Studies MeSH
- Leg Length Inequality surgery therapy MeSH
- Osteogenesis, Distraction utilization MeSH
- Child, Preschool MeSH
- Bone Lengthening methods MeSH
- Bone Regeneration MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
