PURPOSE OF THE STUDY: Arthroscopic examination of joints has recently gained wide application. Due to hip joint shape and a difficult approach to it, hip arthroscopy has long remained outside the attention and abilities of arthroscopists. The authors present their first experience with operative hip arthroscopy that offers new options for the treatment of intra-articular pathology of the hip joint. MATERIAL: In the years 2001-2003, 24 hip arthroscopies were performed. The following pathological conditions were diagnosed and treated: loose bodies, chondral lesions of the femoral head and acetabulum, ruptures of the labrum acetabuli and ligamentum teres, impingement syndrome of the labrum acetabuli, and coxitis. No post-operative neurologic symptoms or vascular complications were observed. METHODS: All procedures were carried out on patients in a supine position, with the treated joint in traction. A standard 30 degrees device and common instruments for arthroscopic surgery were used. The instruments were inserted in the articular fissure with the use of an X-ray intensifier. Movement in the hip joint during surgery is very limited due to traction, joint shape and the length of working canals. After traction is released, it is possible to examine also the intra-articular part of the femoral neck. RESULTS: The pre-operative complaints (clunking, painful joint) were relieved up to 4 to 6 weeks after surgery in 23 patients. In one patient primarily diagnosed with coxitis, infection was not eradicated after lavage and debridement and, because inflammation deeply affected the femoral head, the hip was eventually treated by Girdlestone arthroplasty. The results were evaluated clinically and on the basis of the Merle d'Aubigne and Postel questionnaire assessing pain and walking abilities by both the patients and the surgeon. All 24 patients reported poor or average conditions before surgery and, after surgery, 23 experienced improvement to a very good or average condition. One patient's state failed to improve and was evaluated as poor both before and after surgery. DISCUSSION: Hip arthroscopy is a minimal invasive technique which allows us to diagnose and, at the same time, treat intra-articular pathology in a gentle manner. In arthroscopic surgery, correct diagnosis (X-ray, CT and MRI), correct patient's position, their body mass (obesity), selection of appropriate approaches to the joint, surgeon's experience and potentials of arthroscopic instruments all play an important role. We assume that, with increasing experience, the number of patients as well as the scope of diagnosed and treated pathological conditions of the hip joint will grow. The outcomes of operative arthroscopy were very good (improvement in 23 of 24 patients) and it is probable that this technique can slow down or prevent early wear-and-tear hip arthritis. CONCLUSIONS: In our country, operative arthroscopy of the hip is only at its beginning. However, it can be assumed that, similarly to other large joints, it will soon become a widely used, indispensable diagnostic and therapeutic method.
- MeSH
- artroskopie * metody MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- nemoci kloubů diagnóza chirurgie MeSH
- pooperační komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY: The authors present their experience with arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint in young patients. MATERIAL: In up to 80% of patients younger than 25 years, traumatic dislocation of the glenohumeral joint is associated with its recurrence within one year of treatment even in well performed conservative therapy. Repeated dislocations gradually damage the joint and eventually result in the development of arthritis. The articular capsule becomes loose, glenoid surface is reduced and cartilage of the humeral head is affected. Repeated dislocation, reduction and immobilization are causes of patients' discomfort as well as morbidity. For these reasons, the stabilization of recurrent dislocations of the glenohumeral joint is performed by an open procedure or, most recently, arthroscopic method. Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint is an invasive yet gentle method that permits an exact reconstruction of the injured articular capsule and provides good conditions for complete healing of the affected tissues. METHOD: In order to prevent dislocations from recurring, we offered to perform minimal invasive arthroscopic stabilization in 30 patients who had undergone reduction of a primary dislocation of the glenohumeral joint in the 1999/2001 period. Of these, 18 (45%) accepted this offer. In 11 men and 7 women (average age, 22 years) 12 right and six left glenohumeral joints were treated arthroscopically with the use of absorbable or non-absorbable sutures. The procedure was performed at 2 to 7 days after injury and reduction. The joint was immobilized in an elastic Desault bandage for 6 weeks, but with exercising the elbow. From the 4th postoperative week, the glenohumeral joint was passively exercised in the sagittal plane, but abduction and external rotation were avoided. From the 7th week on, the joint was exercised to achieve its full range of motion. RESULTS: The patients were followed up for 12 to 26 months. No repeated dislocation occurred. The range of motion comparable with the contralateral healthy joint was achieved in all patients by 12 weeks after surgery. One patient with a combined injury involving fracture of the first lumbar vertebra with signs of articular fibrosis underwent redress of the glenohumeral joint under general anesthesia at 6 weeks after arthroscopy. All patients returned to their previous everyday life, working and sports activities. DISCUSSION: Arthroscopic stabilization of the glenohumeral joint is an invasive though gentle method which, when exactly performed and followed by adequate postoperative rehabilitation, can considerably or even completely reduce recurrence of joint dislocation. Its disadvantages include costs of surgery and hospital stay, and a risk of potential intra- or post-operative complications. The statistical evaluation of primary dislocations in young patients showed that, in 80% of them, recurrent dislocations would probably require surgical treatment. In addition, a joint suffering from repeated dislocation may develop lesions to such an extent that dislocation may continue to recur even after surgical treatment; this happens in about 10% of the cases. Our estimate was that only 20% of the patients with primary traumatic dislocation (ruptured articular capsule) would not be in need of further repair. However, it was impossible to determine who they would be. Our results, i. e., the absence of recurrent dislocations, suggest a way of reducing the recurrence of dislocations following a primary injury of the glenohumeral joint. CONCLUSIONS: Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint in young patients (under 25 or maximally 30 years of age) is the method that allows us, invasively but with a good outcome, to reduce a high number of post-traumatic dislocations and to return sporting and/or manually working subjects to their previous way of life.
- MeSH
- artroskopie * MeSH
- dospělí MeSH
- lidé MeSH
- luxace ramenního kloubu patologie chirurgie MeSH
- ortopedické výkony metody MeSH
- ramenní kloub chirurgie MeSH
- recidiva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The apophysis of the ischial tuberosity usually becomes united with the hipbone by 25 years of age. The highest incidence of avulsion in this region occurs between 15 and 17 years in young active persons. Apophysitis should be differentiated from apophyseolysis or an avulsion fracture of the ischial tuberosity. Apophysitis may be associated with chronic excessive sports activities in young men and women and is manifested by pain in the region involved. Its presence is confirmed by radiographic findings. The patient with an avulsion fracture of the ischial tuberosity reports an injurious event, usually a sudden movement during sports activities, associated with immediate pain. The diagnosis is again confirmed by radiology. Apophysitis is treated conservatively with no resulting problems. The poor healing of an avulsion fracture may result in chronic complaints, particularly painful sitting. This condition is treated by resection of the fractured apophysis. The authors describe the case of a 28-year-old man who complained of experiencing pain when sitting. At 20 years of age, he suffered an avulsion fracture of the ischial tuberosity that was treated conservatively. He was examined at our department and an unhealed fracture of the ischial tuberosity was diagnosed by radiology and computed tomography. The separated bony fragment was removed and the patient was followed up to 1 year. He remained free from any complaints. An avulsion fracture of the ischial tuberosity is an injury rarely reported in our as well as foreign literature. The available case reports are discussed.
- MeSH
- dospělí MeSH
- lidé MeSH
- nezhojené fraktury * diagnostické zobrazování chirurgie MeSH
- os ischii zranění MeSH
- radiografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The authors present a case of extensive metallosis of the knee joint resulting from the secondary abrasive wear of components of a unicompartmental alloplasty. Eight years after medial condyle replacement, an eighty-year-old patient presented with a break of the femoral component. This resulted in a rapid wear of tibial polyethylene and the development of secondary friction between two metal surfaces. The generation of a large number of metal particles produced an increase in the actual metal surface. This extensive articular metallosis affected not only intra-articular but also extraarticular tissues and the subchondral bone. Histological examination confirmed the presence of a large amount of opaque pigment in histiocytes. The condition was treated by total knee arthroplasty with resection of the posterior cruciate ligament (stabilizing plateau). The authors discuss the causes of metallosis development and its various types; they draw attention to the scarcity of literature data on this condition. Metallosis is a combined chemical and toxic reaction which, if the contact surface of a metal implant is large, may cause extensive damage to the surrounding tissue, the bone included.
- MeSH
- kolenní kloub patologie MeSH
- kovy škodlivé účinky MeSH
- lidé MeSH
- protézy kolene škodlivé účinky MeSH
- reakce na cizí těleso etiologie patologie MeSH
- selhání protézy MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- kovy MeSH
BACKGROUND: Injuries represent the major cause of mortality in the age group up to 45 years. In the Czech Republic, the majority of injuries is caused by traffic accidents. According of statistic data incidence of injuries is increasing. METHODS AND RESULTS: Traumatological Hospital Brno is Trauma Centre level I for two districts (2 mil. people). In 1999, the epidemiological prospective study was initiated, monitoring patients with injured at least two body structures and with Injury Severity Score higher than 16. After four years, the group includes 880 patients (75.7% of males). The average age was 39.3 years (14-97 years). The main cause of injury was a traffic accident (72%), the second cause was a downfall (20%). CONCLUSIONS: The average value of ISS is 27, the mortality decreased significantly from 22% in 1999 to 11% in 2002. Occurrence and types of injuries in traffic participants are analysed.
- MeSH
- dopravní nehody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- polytrauma epidemiologie etiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- skóre závažnosti úrazu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
PURPOSE OF THE STUDY: The treatment of deep chondral defects is one of the key issues in current orthopedics and traumatology. We developed a new technique that greatly improved the outcome of treatment in young active patients. The method is based on transplantation of in vitro cultured autologous chondrocytes carried on the fibrin glue Tissucol. MATERIAL: In the years 2000 to 2002, 19 patients with deep chondral defects were treated by chondrocyte transplantation with the use of Tissucol. At 1 year, 14 defects (average size, 4.31 cm2; range, 2.0 to 10.0 cm2) in 12 patients were evaluated. The defects were localized on the weight-bearing areas of the femoral condyle, tibial plateau and femoropatellar joint in 10, one and three patients, respectively. METHODS: The Lysholm knee score and IKDC subjective score were used for outcome evaluation. Second-look arthroscopy and repair assessment, on the basis of ICRS, were carried out in four patients. RESULTS: The patients were examined at 5 and 12 months after surgery. The average value of the Lysholm knee score before surgery was 45.6 points and those at 5 and 12 months after surgery were 72.0 points and 81.5 points, respectively. Good or excellent outcomes were achieved in seven patients. The average preoperative IKDC subjective score was 39.0 points and the postoperative values were 60.0 and 71.2 points at 5 and 12 months, respectively. Second-look arthroscopy was performed in four patients at 3 to 5 months after the transplantation. A very good, complete healing of the graft was observed in two patients and partial chondrograft degeneration (30% graft area) was seen in two patients. The graft surfaces were evaluated according to the cartilage repair assessments system (ICSR-cartilage score) and the average value obtained was 8.5 points, i.e., almost a normal graft surface. During the second-look arthroscopy, samples for examination by light and electron microscopy were collected. In the healing defects, they showed the presence of hyaline-like cartilage characterized by typical spherical chondrocytes, extracellular collagenous filaments and formation of typical isogenetic cell groups. In the regions of graft degeneration (fissuration), neovascularization of the issue with the presence of fibroblast-like cells was recorded. DISCUSSION: Excellent and very good outcomes were observed in 58% of our patients. Similar studies reported excellent and good results in 80 to 85% of the patients. On comparison, our group included more serious cases with the high presence of severe concomitant injuries, which influenced the final outcome. However, improvement was achieved in all 12 evaluated patients. CONCLUSIONS: The method described is effective for treating deep chondral knee injuries and can be recommended for use in clinical practice.
- MeSH
- chondrocyty transplantace MeSH
- dospělí MeSH
- fibrinová tkáňová adheziva MeSH
- kloubní chrupavka zranění chirurgie MeSH
- kolenní kloub chirurgie MeSH
- kultivované buňky MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- osteochondritis dissecans chirurgie MeSH
- poranění kolena chirurgie MeSH
- tkáňové inženýrství * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- fibrinová tkáňová adheziva MeSH
PURPOSE OF THE STUDY: Chondral and osteochondral defects represent an important topic in the knee surgery. The knee traumas are often followed by premature development of osteoarthritis due to limited reparative processes in the cartilage. Today's diagnostic possibilities and progress in arthroscopic techniques promote the early diagnostics and exact classification of osteochondral defects. Authors present therapeutic ways for treatment of cartilage injuries and adjacent part of the subchondral bone. New possible method for treatment of deep chondral defects on the weight-bearing area of the knee is the application of autologous cultivated chondrocytes in Tissucol (Baxter, Austria). MATERIAL AND METHODS: Chondrocyte retrieval and in vitro cultivation is today a commonly known method. The goal of the knee surgery is to find a suitable three-dimensional bearer for chondrocyte culture. After serial laboratory tests we decided to use the tissue fibrin glue Tissucol (Baxter, Austria) as a chondrocyte carrier. Very good cell viability and capability of cell migration and outgrow in Tissucol were documented. Authors describe a new chondrograft type, its characteristics. They focused on quality control and documentation of key parameters necessary for graft use in humans. Following methods for quality control were used: Sterility control Determination of cells number Determination of cell viability by trypan blue staining. Viability between 90-95% was demonstrated. Determination of proliferative activity was tested using growth quality control. Migration and outgrowth of chondrocytes was documented. The morphological characteristics were studied by: Light microscopy (haematoxylin-eosin staining). Electron microscopy (transmission and scanning). A good stage of cellular organelles and production of extracellular matrix with protocollagenic fibrils were found in all cases. Immuno-fluorescence microscopy (using monoclonal antibodies against vimentin). RESULTS: Preclinical testing on pigs and cadaverous was provided following laboratory investigations. Testing on cadaverous demonstrated a chondrograft ability to fill up completely the chondral defect to renovate the anatomic surface of the joint cartilage. Tests on pigs described hyaline-like cartilage. Publication contains detailed description of chondrograft preparation to allow reproducibility of described technique. Chondrograft transplantation consists of following phases: Arthroscopic diagnostic of defect. Arthroscopic sampling of cartilage for in vitro cultivation. Transport of samples to tissue bank. Enzymatic isolation, in vitro cultivation of chondrocytes. Graft formation (combination of fibrin glue Tissucol with chodrocytes), quality control. Transplantation (chondrograft agglutination into defect). DISCUSSION: The goal of the nowadays tissue engineering is to find an optimal three-dimensional carrier for autologous chondrocyte culture. A new type of carrier based on hyaluronic acid--Hyalograft C was presented by Marcani et al in 2001 year. Published results from the first 20 clinical cases using Hyalograft C do not report any method complications. Our chondrograft technique represents an alternative option when compared to method described by Marcani. CONCLUSIONS: Based on the successful preclinical outcomes observed in this study, authors conclude that autologous chondrocyte transplantation in Tissucol offers an important treatment option for large full thickness chondral lesions located on the weight-bearing surfaces of the femur.
- MeSH
- chondrocyty transplantace MeSH
- fibrinová tkáňová adheziva MeSH
- kloubní chrupavka cytologie chirurgie MeSH
- kolenní kloub chirurgie MeSH
- kultivované buňky MeSH
- lidé MeSH
- tkáňové inženýrství * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- fibrinová tkáňová adheziva MeSH
OBJECTIVE: The objective of the submitted paper is to demonstrate the results of sports fractures of the diaphysis of the humerus and possible complications. METHOD: During a five-year period 18 men were followed up and treated during hospitalization with a spiral fracture of the diaphysis of the humerus. Their average age was 31.3 years. The mechanism of injury was in all rotational. In ten instances a fracture contracted during a "levered" fight was involved, in the remaining eight patients the cause of fracture was a fall from a bicycle or occurred during skiing. Five patients were not operated because the position of the fragments was favourable. In the remaining patients osteosynthesis was performed. An intramedullary nail was used in 7 and osteosynthesis by means of a splint in 6. The function of the shoulder joint and elbow was evaluated and compared with the sound side, as well as the muscular strength and subjective feeling of the patients. RESULTS: In all conservatively treated cases the fracture healed. The original function of the extremity was fully restored. In operated patients three times a pseudoarthrosis developed which was treated by surgical revision and four times injuries of the radial nerve. The subsequent rehabilitation was however quicker and in all instances complete function was achieved. CONCLUSIONS: The majority of spiral fractures of the humerus heals after conservative treatment. Early functional treatment is essential for preserving the function of the affected extremity. Surgical treatment should be indicated carefully and the radial nerve should be carefully protected.
- MeSH
- dospělí MeSH
- fraktury humeru diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- radiografie MeSH
- sportovní úrazy diagnostické zobrazování chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Indication for arthrodesis of the knee joint is nowadays most frequently failure of a total endoprosthesis, usually septic. A less frequent indication is purulent gonitis, frequently after corticoid administration, the condition after a complicated intraarticular fracture with subsequent arthritis or oncological disease of the bones in the area of the knee joint. MATERIAL AND METHODS: In the course of 2000 to 2002 at the authors' department 15 arthrodeses were implanted. In three cases the indication for arthrodesis was purulent gonitis, in three cases the condition after an open articular injury associated with infectious complications and in the remaining nine cases failure of an endoprosthesis of the knee, incl. seven caused by infection. The patients were three men and 12 women, mean age 64 years (30-75 years). For stabilization of the arthrodesis 9x external fixation was used, 5x plates and 1x intramedullary osteosynthesis. RESULTS: In all cases consolidation of the arthrodesis was achieved. In one case the external fixation had to be replaced by a system of two fixation devices and in one case correction of the axial position of the extremity was made. The presence of external fixation was perceived negatively in particular by female patients. DISCUSSION: Plate osteosynthesis and the use of external fixation devices are relatively quick, cheap and considerate methods of arthrodesis. External fixation must be used in acute virulent infections while plate osteosynthesis can be indicated in its absence. The characteristic of intramedullary fixation is similar, however special nails used for arthrodesis of the knee are several times more expensive than the previous types of stabilization. The advantage is the possibility to use a massive bone graft to fill the defect.
- MeSH
- artrodéza * metody MeSH
- dospělí MeSH
- infekční artritida chirurgie MeSH
- interní fixátory MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění kolena chirurgie MeSH
- protézy kolene škodlivé účinky MeSH
- radiografie 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
- časopisecké články MeSH
Authors analyze some new knowledge in treatment of rectal and anal injuries proceeded from own clinical experience in comparison with studies of a range of foreign authors published recently. During last ten years together 24 injured patients with this diagnose were operated in Traumatological Hospital Brno, primary reconstruction was performed in 10 patients, secondary reconstruction after precise examination of pelvic fundus pathophysiology in 14 patients, mostly transferred from other clinics. Authors prefer primary treatment in 3 hours after injury. This opinion is supported by control examinations after performed reconstructions.
