- Keywords
- trampolína,
- MeSH
- Child MeSH
- Fractures, Bone epidemiology etiology prevention & control MeSH
- Humans MeSH
- Dangerous Behavior MeSH
- Accident Prevention MeSH
- Games, Recreational * injuries MeSH
- Athletic Injuries * epidemiology etiology prevention & control MeSH
- Sports Equipment adverse effects MeSH
- Accidental Falls prevention & control MeSH
- Check Tag
- Child MeSH
- Humans MeSH
PURPOSE OF THE STUDY Acromioclavicular (AC) joint dislocation and its surgical treatment still raises a number of questions that remain to be answered. In some types of dislocations, Rockwood type III in particular, the indication for surgical treatment as such is relative. There are numerous techniques and implants available for the reconstruction of AC joint. In our research we focused on the necessity of coracoclavicular (CC) joint reconstruction. MATERIAL AND METHODS In this paper, a cohort of 56 patients with Rockwood type III AC joint injury who underwent surgical treatment at our department in 2010-2016 period was retrospectively evaluated. The patients were treated with open reduction with AC joint stabilisation using hook plate or tension band. The patients were divided into 2 groups, namely group 1 with CC ligament reconstruction and group 2 without CC ligament reconstruction. The assessment was done at 6 months, 1 year and 2 years after surgery. The clinical outcomes were assessed based on the absolute Constant score (CS) and coracoclavicular distance (CCD) on the X-ray. Subsequently, the outcomes were statistically processed and compared using the Student s ttest. RESULTS The least invasive surgical intervention, as to the length of incision, was the reconstruction using the hook plate without CC ligament suture, whereas the longest incision was performed in tension band with CC ligament suture. In the CC ligament suture group, the mean operative time was 10 minutes longer. When evaluating the CS of the compared groups with and without CC ligament reconstruction, no statistically significant difference (p > 0.05) was found between the two groups. Similarly, the CCD values at 2-year follow-up did not show any statistically significant difference between the two groups (p > 0.05). CONCLUSIONS The available outcomes suggest that the surgical methods used by us are adequately safe and reliable. Good clinical outcomes can be achieved by open reduction and fixation of Rockwood type III AC joint dislocation even without CC ligament reconstruction. Key words: acromioclavicular dislocation, classification, reconstruction, coracoclavicular ligament.
- MeSH
- Joint Dislocations * surgery MeSH
- Ligaments, Articular surgery MeSH
- Humans MeSH
- Shoulder Dislocation * surgery MeSH
- Retrospective Studies MeSH
- Sutures MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION The purpose of our study was to evaluate the clinical outcomes in patients at 3-6 years follow-up after primary implantation of RM Pressfit Vitamys cementless elastic cup and cementless Optimys short stem, including bone tissue remodelling around both the components. MATERIAL AND METHODS The evaluation covered 49 joint replacements in patients who had undergone surgery at our department between 2012 and 2015. The age at the time of primary surgery ranged from 29 to 71 years, with the mean value of 59.2 years. Postoperatively, the position of endoprosthesis, changes in femoroacetabular offset, signs of osseointegration of the implant, bone tissue remodelling around both the components and potential signs of aseptic loosening were assessed. The functional status of the joint was evaluated according to the Harris scale. RESULTS The mean follow-up time of Vitamys cup and Optimys stem was 5.6 years and 4.6 years, respectively. We focused on the combination of RM Pressfit Vitamys (49x), Optimys (28x) and Bionit 2 (41x) implants. All the cups showed good osseointegration. Based on the comparisons with a postoperative X-ray, at least mild osteoporosis in the acetabular roof was confirmed in 6 cases. All Optimys femoral components were in direct contact with the Adams arch and with the endosteal side of lateral cortex of proximal femoral metadiaphysis. Femoroacetabular offset was slightly decreased in 5 patients only. The final evaluation in 2018 did not confirm any radiolucent lines or signs osteolysis around any of the components. In 2 stems only, distal migration less than 2 mm was obvious, with subsequent good osseointegration. Signs of stress shielding were present in 2 femoral components in the form of mild cortical atrophy in the region of the Adams arch. Distal femoral cortical hypertrophy was not observed, the greater trochanter did not show the loss of bone tissue in any of the patients. There were no signs of polyethylene wear. The mean value of HHS increased from 53 to 97 points. An excellent result was achieved in 44 total hip replacements, of which 100 points in 28 cases. In the remaining 5 patients the result was good. The survival rate of both the components was 100% according to the Kaplan-Meier analysis. DISCUSSION The successful functioning of cementless total hip arthroplasty is the correct placement of both components with good primary fixation. Excessive proximal and lateral shift of the centre of rotation results in increased load of endoprosthesis and risk of earlier aseptic loosening, its reduction leads to the weakening of pelvitrochanteric muscles. The shift of the centre of rotation from the original anatomical position should therefore not exceed 5 millimetres. Insufficient cup fixation always results in mechanical failure of an endoprosthesis. Distal migration of stems without contact with external femoral cortex with full weight-bearing of the operated lower extremity in the postoperative period does not constitute a sign of instability, but only its placement enables good osseointegration. Bone remodelling can be assessed by imaging techniques at 2 years after the primary implantation at the earliest. At places with lower load, the bone loss occurs and the loss of bone trabeculae can lead to the failure of fixation of the component. At places with load accumulation, the bone hypertrophy occurs that can be manifested by thigh pain. In case of cementless press-fit cup, the degree of bone remodelling depends on its elasticity, in case of stem on the used material, shape and fixation site. CONCLUSIONS The RM Pressfit Vitamys monobloc cup through its mechanical properties approximates the best the elasticity of bone tissue. The stress distribution around the implant is more symmetrical as against other conventional cementless cups. The Optimys stem enables the reconstruction of anatomical conditions corresponding a healthy hip joint. Respecting the rule of at least three-point fixation is a precondition for good and fast secondary stability of components. Minimising the wear of articulating surfaces and physiological remodelling of adjacent bone tissue are the main factors that help prolong the survivorship of both the components, while also securing more favourable conditions and better outcomes in case of necessity of reimplantation. Key words: cementless elastic cup, short cementless stem, femoroacetabular offset, stress shielding, osseointegration of the implant.
- MeSH
- Acetabulum surgery MeSH
- Hip Joint surgery MeSH
- Hip Prosthesis * MeSH
- Humans MeSH
- Arthroplasty, Replacement, Hip * MeSH
- Follow-Up Studies MeSH
- Polyethylene MeSH
- Prosthesis Design MeSH
- Prosthesis Failure MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.
The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.
The biceps brachii is one of three muscles of the anterior compartment of arm. Variations of the biceps brachii are not rare. The most frequent is the existence of a third head called the humeral head by Le Double (1897) (Rodríguez-Vázquez et al., 1999). Our article is based on the unexpected result of a routine dissection class held for medical students. Dissection was performed according to the guidelines accepted by the anatomy department (Seichert, 1999). We describe a third (accessory) head of the biceps brachii. In addition of two regular heads, the third head originated together with the short head from the coracoid process and had three insertions on the humerus after enfolding the median nerve and the brachial artery. This particular variation is important from a clinical perspective as the third head may cause entrapment syndrome of the median nerve and hypoperfusion of the upper limb due to compression of the brachial artery.
- MeSH
- Dissection MeSH
- Muscle, Skeletal abnormalities MeSH
- Humans MeSH
- Cadaver MeSH
- Median Neuropathy etiology MeSH
- Arm * MeSH
- Aged MeSH
- Nerve Compression Syndromes etiology MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
