• MeSH
• artroskopie metody   MeSH
• kosterní svaly MeSH
• lidé středního věku MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• pooperační komplikace MeSH
• pooperační péče MeSH
• poranění rotátorové manžety * diagnóza   patofyziologie   terapie   MeSH
• radiografie metody   MeSH
• ramenní kloub patofyziologie   patologie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři MeSH
• šlachy hamstringů * transplantace   MeSH
• statistika jako téma MeSH
• tenodéza metody   přístrojové vybavení   MeSH
• tenotomie * metody   přístrojové vybavení   MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH

INTRODUCTION The clubfoot ranks among the most frequent paediatric structural deformities of the lower extremity. Currently, the Ponseti method is considered the gold standard for the treatment. To evaluate the degree and severity of the deformity, clinical classification systems have been developed, commonly used in clinical practice. This study aims to verify whether the Pirani and Dimeglio clinical scoring systems can be used to predict the results of treatment by the Ponseti method. MATERIAL AND METHODS The study included 31 patients. The patients had been referred from the neonatal departments to the Department of Paediatric Surgery, Orthopaedics and Traumatology in Brno with the diagnosed clubfoot deformity, where they were treated by an erudite orthopaedist experienced in this field according to the Ponseti treatment standards. The Pirani and Dimeglio clinical scoring of the deformity were performed always before the commencement of the therapy and after the second plaster cast fixation. The number of plaster cast fixations, the necessity to carry out achillotomy and the relapse rate were set as the parameters of treatment results. In the first stage of statistical analysis, the respective clinical systems were correlated with the treatment results, in the second part of the study the patients were based on the clinical evaluation divided into 3 groups depending on the severity of the deformity, and these groups were subsequently compared. RESULTS 22 patients from the group (71%) underwent percutaneous achillotomy and in 3 patients (9.7%) a relapse occurred. To correct deformities 7.1 corrective casts were used on average. The correlation between the number of plaster cast fixations and classification systems was significant in all the cases, with the strongest dependency shown by the correlation with the Pirani score after the second corrective cast (r = 0.594, p < 0.001). Positive correlation was found also between the necessity to perform achillotomy and both the classification systems. In this case the strongest correlation was established in the case of the Pirani clinical scoring after the second plaster cast fixation (r = 0.488, p = 0.003). Conversely, significant correlation was not established between the relapse rate and the used classification systems, not even in a single case (p ≥ 0.05). In the second stage of the statistical analysis, in the case of the Pirani scoring before the therapy no difference was found between the individual groups with diverse severity of clubfoot deformity during the evaluation of the aforementioned parameters of treatment results. In the Pirani classification after the second plaster cast fixation, a statistically significant difference was established in the number of plaster cast fixations (p = 0.003) and the necessity to perform achillotomy (p = 0.012). When the Dimeglio scoring was applied before the therapy, a statistically significant difference between the groups was found in the number of plaster cast fixations (p = 0.031) and after the second plaster cast fixation in the relapse rate (p = 0.035). DISCUSSION Although the clinical scoring systems belong to key indicators of severity of the deformity and are commonly used in clinical practice, the current literature provides only an inconsistent picture of their application in predicting the course and the results of treatment. Concurrently, the authors opinions on this issue differ. The scoring in later stages of treatment shows a better predictive value than the scoring at the beginning of the treatment, which was confirmed also by the results of our study. CONCLUSIONS Even though the clinical scoring systems show a certain dependency on the parameters of the treatment results, in practice their predictive function can be used to a limited degree only. The complexity of the evaluation of the deformity itself and subsequently of the results of treatment requires also the use of other parameters than the clinical classifications only so that the prediction of the course and results of the treatment of clubfoot according to Ponseti shows a higher degree of reliability. Key words:clubfoot, Ponseti, Pirani classification, Dimeglio classification.

• MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• pes equinovarus klasifikace   diagnostické zobrazování   chirurgie   MeSH
• prediktivní hodnota testů MeSH
• recidiva MeSH
• reprodukovatelnost výsledků MeSH
• sádrové obvazy normy   MeSH
• stupeň závažnosti nemoci MeSH
• tenotomie metody   MeSH
• výsledek terapie MeSH
• výzkumný projekt normy   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The aim of this study was to assess the role of sonographic evaluation of Talar dysplasia in predicting the outcome of standard Ponseti method in the treatment of clubfoot deformity. METHODS: A total 23 children (15 boys and 8 girls; mean age: 18.2 ± 5.4 days (8-32)) who underwent Ponseti treatment were included in the study. Before the treatment, maximal talus length of affected and non-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. The patients were categorized 2 groups according to RTDR: group A - mild and group B - severe deformity. Pirani score was used for clinical evaluation. The groups were compared in terms of number of the applied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformity recurrence. RESULTS: Pirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of casts significantly differed between groups (p < 0.001) and positive correlation was found (r = 0.851, p < 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statistically significant difference was obtained (p = 0.162). Recurrence occurred in 2 patients belonging to group B without significant difference compared to group A (p = 0.502). CONCLUSION: Talar dysplasia assessment appeared as a promising prognostic factor for predicting the outcome of the Ponseti technique in treatment of clubfoot deformity. LEVEL OF EVIDENCE: Level IV, diagnostic study.

• MeSH
• Achillova šlacha chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pes equinovarus * diagnóza   patologie   patofyziologie   chirurgie   MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• recidiva MeSH
• sádrové obvazy MeSH
• talus * abnormality   diagnostické zobrazování   MeSH
• tenotomie * metody   statistika a číselné údaje   MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

PURPOSE OF THE STUDY: The aim of the study was to clinically and radiographically evaluate the results of a two-stage surgical technique used in our department to treat congenital vertical talus. MATERIAL AND METHODS: In the years 1990-2010 we treated eight patients (nine feet). We used a two-stage surgical technique, with lengthening of the dorsiflexor muscles of the leg and the tibialis anterior muscle at the first stage. This was followed by cast fixation with the ankle in plantar flexion for 6 weeks. At the second stage, through a Cincinnati approach, the talonavicular and calcaneocuboid joints were reduced and the Achilles tendon and peroneal tendons were elongated. Two patients underwent the Grice extra-articular subtalar arthrodesis at the third stage. The post-operative outcomes were assessed based on radiographic findings of dorsoplantar views of the talocalcaneal angle (TC AP) and talar axis-first metatarsal base angle (TAMBA AP), lateral views of the weight-bearing talocalcaneal angle (TC LAT), talar axis-first metatarsal base angle (TAMBA LAT) and talotibial angle (TT). In all patients but one who was lost to follow-up, the radiographic and objective findings were evaluated with the 10-point scale described by Adelaar et al. RESULTS: The average follow-up was 8 years and 9 months. All radiographic findings showed improvement in all angles measured. The pre-operative values decreased in TC AP from 64.2° to 27.6°; in TC LAT from 48.8° to 30.4°; in TT from 158° to 109.3°; in TAMBA AP from 54.7° to 17.4°; in TAMBA LAT from 57.3° to 5.7°. The Adelaar scoring system was employed in seven patients of whom three had excellent, three good and one fair results. Two patients required additional surgery due to recurrence of the deformity DISCUSSION: Studies in recent years have shown a gradual diversion from extensive surgical procedures and a trend toward techniques like manipulation, serial casting application and minimal surgical intervention with talonavicular reduction and fixation. The Dobbs technique has so far shown good results but no long-term results have yet been available and therefore the number of recurrent cases is not known. CONCLUSIONS: The two-stage surgical technique used in our department proved to be very successful in a long-term follow-up, but the group of patients was too small to provide conclusive evidence. However, benefits of this technique are clearly apparent from the post-operative radiographic and objective findings assessed as very good.

• MeSH
• Achillova šlacha chirurgie   MeSH
• artrodéza metody   MeSH
• kosterní svaly chirurgie   MeSH
• lidé MeSH
• následné studie MeSH
• sádrové obvazy MeSH
• talus radiografie   chirurgie   MeSH
• tenotomie metody   MeSH
• vrozené deformity nohy (od hlezna dolů) radiografie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• hodnotící studie MeSH

Mallet deformita, nazývaná aj deformita kladivkového prsta, je poranením extenzorového aparátu v zóne I, ktoré sa vyskytuje pomerne často v ambulanciách chirurgických odborov. Prejavuje sa nemožnosťou aktívnej extenzie v distálnom interfalangeálnom kĺbe. Môže ísť o samostatné poškodenie extenzorového mechanizmu bez poškodenia kožného krytu alebo s jeho poškodením, prípadne môže zahŕňať intraartikulárne poškodenie alebo subluxáciu distálneho interfalangeálneho kĺba. Manažment mallet deformity závisí od typu poranenia a zahŕňa dlahovanie, zatvorenú repozíciu, perkutánnu fixáciu Kirschnerovým drôtom, otvorenú repozíciu a vnútornú fixáciu extenzorového mechanizmu alebo kostných fragmentov. Neliečená mallet deformita môže prejsť do chronickej formy, ktorá vyžaduje špecifickú terapiu. Správne rozpoznanie a promptné ošetrenie akútneho poranenia môže zvýšiť predpoklad na úplnú obnovu pohybu. Článok je zameraný na zásady ošetrenia a následnú starostlivosť zatvorených, otvorených a chronických poranení extenzorového aparátu v zóne I.

Mallet finger is deformity of the extensor mechanism in the zone I, which is frequently encountered at surgical outpatientęs – departments. Active extension of distal phalanx is impossible. These injuries ranging from disruption of the extensor mechanism alone without skin disruption, with skin disruption to those that have articular involvement and subluxation of distal interphalangeal joint. The management of mallet finger injuries depends on injury pattern and includes splinting, closed reduction, percutaneous pinning with Kirschner wire, open reduction and internal fixation of extensor mechanism or bone abruptions. Non treated mallet deformity can result in chronic form, when specific therapy is needed. Correctly identified acute injury and immediate therapy can increase a possibility to complete restoration of full range of motion. This paper is focused on therapeuthic principles and aftercare of closed, open and chronic injuries of extensor mechanism in the zone I.

• Klíčová slova
• mallet deformita,
• MeSH
• artrodéza metody   MeSH
• časové faktory MeSH
• chronická nemoc terapie   MeSH
• dlahy MeSH
• fixace fraktury metody   MeSH
• fraktury kostí chirurgie   MeSH
• kostní dráty MeSH
• lidé MeSH
• ortopedické výkony metody   MeSH
• poranění prstů ruky chirurgie   terapie   MeSH
• poranění šlachy chirurgie   terapie   MeSH
• šicí techniky MeSH
• syndrom kladívkového prstu * chirurgie   terapie   MeSH
• tenotomie metody   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY: In this prospective randomised study, the short-term results of arthroscopic transcapsular iliopsoas tenotomy approached from the peripheral versus the central compartment for internal snapping hip syndrome are presented. MATERIAL AND METHODS: A group of 19 patients (15 women and four men; mean age, 24.3 years) who underwent arthroscopic transcapsular iliopsoas tenotomy for internal snapping hip syndrome in the period between September 2010 and December 2011 were prospectively evaluated. No injury, hip surgery or feeling of hip instability was recorded in their personal histories. Radiographs did not show any dysplasia, retroversion of the acetabulum or cam lesions. The patients were allocated to two groups using sealed envelope randomisation: Group 1 patients (n=10) were treated by tenotomy from the peripheral compartment and group 2 patients (n=9) underwent tenotomy from the central compartment during traction of the lower extremity. The evaluation included pre-operative 3T MRI findings, arthroscopically detected intra-articular lesions, duration of traction and post-operative complications. The pre-operative WOMAC scores were compared with those at one-year follow-up. In comparison of the two groups, the Mann-Whitney exact test was used for WOMAC scores and Fisher's exact test for post-operative complications. Statistical significance was set at a 0.05 level. RESULTS: In comparing post-operative complications, a significant difference (p=0.0468) between the groups was found only for genital paresthesia, which did not occur in group 1. The other differences were not statistically significant. The pre-operative WOMAC scores did not differ significantly between the groups (p=0.79). The post-operative WOMAC scores were significantly higher in group 1 (p=0.02). In each group the change in WOMAC scores was different and was statistically significant in group 1 (p=0.0014). Associated intra-articular hip pathologies, most frequently synovitis of the peripheral compartment, acetabular chondropathy, or labral lesions, were diagnosed in 90% of group 1 patients and in 66.7% of group 2 patients. DISCUSSION: Most of the authors comparing the results of two different ilioproas tenotomy techniques at one-year follow-up did not report any statistically significant differences in WOMAC scores between them. In accordance with the data reported, an increase in the post-operative WOMAC score, i.e., improvement of clinical outcome, was achieved in all our patients and, in group 1, it was significantly higher (p=0.0015), as compared with a similar study by Ilizaliturri. However, further follow-up of the patients and evaluation of long-term results will be necessary. CONCLUSIONS: The technique of arthroscopic ilioproas tenotomy approached from the peripheral compartment resulted in significantly fewer cases of genital paresthesia and provided significantly better clinical outcomes in comparison with tenotomy from the central compartment.

• MeSH
• artroskopie metody   MeSH
• bederní svaly chirurgie   MeSH
• dospělí MeSH
• kompartment syndrom diagnóza   chirurgie   MeSH
• kyčel chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladý dospělý MeSH
• nemoci kloubů diagnóza   chirurgie   MeSH
• prospektivní studie MeSH
• šlachy chirurgie   MeSH
• syndrom MeSH
• tenotomie metody   MeSH
• úžinový syndrom chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH