INTRODUCTION: Injuries to the distal tibiofibular syndesmosis are frequent and continue to generate controversy. METHODS: The majority of purely ligamentous injuries ("high ankle sprains") is not sassociated with a latent or frank tibiofibular diastasis and may be treated with an extended protocol of physical therapy. Relevant instability of the syndesmosis with diastasis results from rupture of two or more ligaments that require surgical stabilization. Syndesmosis disruptions are commonly associated with bony avulsions or malleolar fractures. Treatment consists in anatomic reduction of the distal fibula into the corresponding incisura of the distal tibia and stable fixation. Proposed means of fixation are refixation of bony syndesmotic avulsions, one or two tibiofibular screws and suture button. There is no consensus on how long to maintain fixation. Both syndesmotic screws and suture buttons need to be removed if symptomatic. RESULTS/COMPLICATIONS: The most frequent complication is syndesmotic malreduction and may be minimized with open reduction and intraoperative 3D scanning. Other complications include hardware failure, heterotopic ossification, tibiofibular synostosis, chronic instability and posttraumatic arthritis. CONCLUSION: The single most important prognostic factor is anatomic reduction of the distal fibula into the tibial incisura.

• MeSH
• biomechanika fyziologie   MeSH
• dislokace kloubu diagnóza   patofyziologie   chirurgie   MeSH
• fibula chirurgie   MeSH
• fraktury kotníku diagnóza   patofyziologie   chirurgie   MeSH
• fyzikální vyšetření metody   MeSH
• hlezenní kloub chirurgie   MeSH
• kloubní ligamenta zranění   chirurgie   MeSH
• kostní šrouby MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nestabilita kloubu patofyziologie   prevence a kontrola   MeSH
• odstranění implantátu MeSH
• počítačová rentgenová tomografie MeSH
• pooperační komplikace etiologie   MeSH
• poranění kotníku diagnóza   patofyziologie   chirurgie   MeSH
• ruptura chirurgie   MeSH
• šicí techniky MeSH
• tibie chirurgie   MeSH
• torzní deformity etiologie   MeSH
• vnitřní fixace fraktury přístrojové vybavení   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY: A hinged external fixator of the elbow provides stable fixation of the joint while maintaining the range of its motion. The aim of the study was to evaluate a group of patients in whom an external fixator was used to manage severe injuries to the elbow, namely, traumatic unstable dislocation, unstable fracture-dislocation, and elbow fractures not permitting management by primary osteosynthesis. This also involved assessment of early elbow mobilisation and a comparison of this group with a group of patients treated conservatively for less severe elbow injuries. MATERIAL AND METHODS: A group of 25 patients were evaluated at a follow-up of 18 months. There were 10 women and 15 men; the average age was 48 years (range, 20 to 76). The external fixator was applied in 13 patients, of whom eight had unstable elbow dislocation, three had unstable fracture-dislocation and two suffered a comminuted supracondylar fracture of the distal humerus. The hinged fixator was removed at an average of 7.6 weeks (range, 3 to 9 weeks). In the group of 12 patients treated conservatively by plaster cast application and subsequent rehabilitation, five had elbow dislocation without ligament injury and seven had elbow dislocation with ulnar collateral ligament injury. None of them showed any instability. The patients were evaluated on the basis of clinical and radiological findings, with the Mayo elbow performance (MEP) score being used for clinical assessment. RESULTS: At a follow-up of 18 months, the patients with the external fixator showed the average range of motion at the elbow joint of 127° (105° to 140°), the MEP score of 92 points (75 to 100) and restriction of elbow extension by 8° (0° to 40°). In the conservatively treated patients, the range of motion was 133° (112° to 145°), the MEP score was 95 points (85 to 100) and extension restriction by 8° (0° to 22°). X-ray examination showed a congruent joint in both groups. The use of external fixator was associated with minor complications: transient radial nerve irritation in one case, and pin-tract infection in two cases (23%) which healed spontaneously after screw removal. DISCUSSION: The optimal management of a complex elbow injury should results in restoring joint stability and its full range of motion. However, this is often difficult to achieve by surgical means and a marked restriction of movement remains a frequent consequence of severe elbow injury. CONCLUSIONS: Elbow injuries differ from patient to patient and therefore the approach to their treatment has to be individual in every patient. A hinged external fixator provides stable fixation and allows for early movement of the elbow. Maintenance of the range of motion facilitated by the hinged fixator is not at the expense of joint stability or fracture non-union. Based on the results presented here, we recommend the use of external fixation in severe unstable elbow fractures and in fractures in which primary osteosynthesis cannot be used because of soft tissue injury.

• MeSH
• dislokace kloubu patofyziologie   radiografie   rehabilitace   chirurgie   MeSH
• externí fixátory MeSH
• fixace fraktur * škodlivé účinky   přístrojové vybavení   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• loket radiografie   MeSH
• loketní kloub * patofyziologie   radiografie   chirurgie   MeSH
• následné studie MeSH
• nestabilita kloubu etiologie   prevence a kontrola   MeSH
• pooperační komplikace * diagnóza   prevence a kontrola   MeSH
• poranění lokte MeSH
• poranění paže * diagnóza   patofyziologie   rehabilitace   chirurgie   MeSH
• rozsah kloubních pohybů MeSH
• ukazatel závažnosti úrazu MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

A number of surgical and nonsurgical techniques have been used in the recent past for the treatment of this not uncommon traumatic condition. Thus far, no agreement has been reached regarding the method most likely to consistently render good results. Uppermost in determining the treatment has been the degree of displacement of the clavicle and the prevention of possible cosmetically unacceptable complications. Advances in the surgical care of most fractures and dislocations have lead to the current belief and practice among the majority of orthopaedic surgeons that every effort should be made to correct any deviation from the normal produced by the injury. I submit that skilful neglect and acceptance of acromio-clavicular dislocation is an option worth considering. When the dislocation is accepted, the vast majority of patients do well, functionally and aesthetically. Chronic pain is an extremely rare situation; and the resulting deformity, from the cosmetic point of view, an uncommon problem. If this is the case, what is the problem that reconstructive surgery proposes to address?

• MeSH
• akromioklavikulární kloub * zranění   patofyziologie   chirurgie   MeSH
• asymptomatické nemoci MeSH
• biomechanika MeSH
• dislokace kloubu * diagnóza   patofyziologie   chirurgie   MeSH
• klíční kost patofyziologie   MeSH
• lidé MeSH
• lopatka patofyziologie   MeSH
• obnova funkce MeSH
• ortopedické výkony * metody   využití   MeSH
• osteoartróza diagnóza   etiologie   patofyziologie   prevence a kontrola   MeSH
• procedury zbytečné MeSH
• ukazatel závažnosti úrazu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture. METHODS: Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery. RESULTS: The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years). The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain), six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case. CONCLUSIONS: Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.

• MeSH
• artrodéza metody   MeSH
• disekce MeSH
• dislokace kloubu patologie   patofyziologie   chirurgie   MeSH
• dospělí MeSH
• dysfunkce zadní holenní šlachy patologie   patofyziologie   chirurgie   MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola MeSH
• ortopedické výkony metody   MeSH
• plochá noha patologie   patofyziologie   chirurgie   MeSH
• poranění šlachy patologie   patofyziologie   chirurgie   MeSH
• revmatoidní artritida patologie   patofyziologie   chirurgie   MeSH
• ruptura patologie   patofyziologie   chirurgie   MeSH
• subtalární kloub patologie   radiografie   chirurgie   MeSH
• sutura MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Problematika handicapovaných pacientů je širokou oblastí zasahující zejména rehabilitaci, neurologii, neurochirurgii, vnitřní lékařství. Další medicínskou problematikou těchto pacientů je vlastní ošetřovatelství. Nicméně onemocnění čelistního kloubu postihuje i tyto pacienty a velice často může znepříjemňovat jejich již tak komplikovanou situaci. Nejvýraznějším typem onemocnění jsou hypermobilní stavy (luxace kloubu). Autor předkládá 3 kasuistiky handicapovaných pacientů, u kterých bylo onemocnění čelistního kloubu komplikujícím faktorem v jejich životě a léčbě. Ve všech případech se jednalo o luxaci čelistního kloubu.

• MeSH
• dislokace kloubu patofyziologie   terapie   MeSH
• lidé MeSH
• postižení MeSH
• stomatochirurgické výkony klasifikace   metody   využití   MeSH
• temporomandibulární kloub patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• kazuistiky MeSH

The aim of this study was to determine the prevalence of C1/C2 involvement in rheumatoid arthritis (RA) in Czech patients and to identify typical pain symptoms and their relationship to radiologic findings at the C1/C2 level. Four hundred patients with RA were selected randomly and examined by plain X-ray. Cervical spine involvement was found in 45.8% of these patients. Cervicocranial syndrome was the most common symptom of any spine involvement at the C1/C2 level and was present in 54.6%. Cervicocranial syndrome was typical for ventral subluxation 3-6 mm and was found in 52.9%. The distance of 8 mm or more was associated with mild pain. The pain intensity at the C1/C2 level decreased with increasing distance of ventral atlantoaxial subluxation (P < 0.0001).

• MeSH
• atlantoaxiální kloub patofyziologie   radiografie   MeSH
• bolest patofyziologie   MeSH
• dislokace kloubu patofyziologie   radiografie   MeSH
• krční obratle patofyziologie   radiografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření bolesti MeSH
• prevalence MeSH
• revmatoidní artritida patofyziologie   radiografie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• dislokace kloubu patofyziologie   patologie   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH