Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca[JOURNAL]
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200 papers
[Newborn with Bilateral Lower Limb Amputation Due to Twin Anemia Polycythemia Sequence].
Sadovský P, Papežová L
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153820 · Publisher ↗
We present a case report of a newborn with bilateral lower limb ischemic gangrene caused by spontaneous Twin anemia polycythemia sequence (TAPS). Due to the extent of tissue damage, bilateral lower limb amputation was pe...
We present a case report of a newborn with bilateral lower limb ischemic gangrene caused by spontaneous Twin anemia polycythemia sequence (TAPS). Due to the extent of tissue damage, bilateral lower limb amputation was performed on the fourth day after birth-left knee disarticulation and right transfemoral amputation. The postoperative course was uneventful, and the wounds healed by primary intention. This case represents an exceptionally rare complication of TAPS, in which timely prenatal diagnosis could have enabled early intrauterine intervention.
Impact of Treadmill Running Intensity on Lubricin Levels in Rat Achilles Tendons.
Shu-Fen LI, Song CX, Liu SY … +2 more , Liu W, Shao-Yong XU
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153819 · Publisher ↗
PURPOSE OF THE STUDY: The Achilles tendon is crucial for transferring force from the calf muscles to the heel bone. Lubricin, a key glycoprotein, ensures smooth tendon gliding. This study investigated the effects of diff...
PURPOSE OF THE STUDY: The Achilles tendon is crucial for transferring force from the calf muscles to the heel bone. Lubricin, a key glycoprotein, ensures smooth tendon gliding. This study investigated the effects of different treadmill running intensities on lubricin levels in rat Achilles tendons and explored the associated molecular mechanisms. MATERIAL AND METHODS: Eighteen rats were divided into three groups: Strenuous Treadmill Running (STR), Moderate Treadmill Running (MTR), and a sedentary Control group (CON). The running protocols were conducted over eight weeks. Post-intervention, tendon samples were analyzed for histological changes (collagen fiber integrity and cell count), lubricin levels, and the expression of TGF-β1 (a growth factor involved in tendon healing) and IL-1 (a pro-inflammatory cytokine). RESULTS: The STR group exhibited significantly greater collagen fiber damage compared to the other groups. In contrast, the MTR group showed higher cell proliferation, elevated lubricin levels, and increased TGF-β1 expression. The STR group had reduced lubricin levels, likely due to elevated IL-1 expression. DISCUSSION: MTR enhances tendon health by upregulating TGF-β1, increasing lubricin production, and improving load transmission. Conversely, STR may promote tendon degeneration by elevating IL-1, reducing lubricin levels, and increasing the risk of tendinopathy. These findings support previous research indicating that moderate mechanical loading maintains tendon homeostasis, whereas excessive loading leads to inflammation and structural damage. CONCLUSIONS: Moderate-intensity treadmill running boosts lubricin levels via TGF-β1 regulation, supporting tendon function, while strenuous running decreases lubricin due to IL-1 upregulation, increasing tendon injury risk. These results emphasize the importance of optimal exercise intensity in preventing tendinopathies and maintaining tendon health. The findings could guide exercise recommendations for athletes and rehabilitation programs. Future research should explore therapeutic strategies targeting the TGF-β1 and IL-1 pathways.
Poller K-Wires versus Screws in Distal Tibial Nailing: Non-Inferior Union with Superior Efficiency and Better Alignment.
Yildirim AM, Bayram S, Karaçam MI … +2 more , Balci HI, Akpinar F
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153818 · Publisher ↗
PURPOSE OF THE STUDY: To compare the short-term outcomes and complications of the poller screw (PS) and the poller K-wire (PW) in distal tibia nailing. MATERIAL AND METHODS: In the present study, a retrospective analysis...
PURPOSE OF THE STUDY: To compare the short-term outcomes and complications of the poller screw (PS) and the poller K-wire (PW) in distal tibia nailing. MATERIAL AND METHODS: In the present study, a retrospective analysis was performed on prospectively collected data, 43 cases were included in the study. 16 patients were included in the PS group and 27 patients in the PW group. Demographic data, fracture union times, RUST scores, alignment in the coronal and sagittal planes, associated fibula fractures and fixation, malunion, and complications were compared. A subgroup analysis was performed according to fibula fixation and the number of distal locking screws. RESULTS: There was no significant difference between PS and PW groups in respect to age, gender, trauma etiology, fracture-joint distance and AO classification of fractures. In the PS group, the operation time and final coronal angulation were significantly higher (operation time: 81.5 ± 15.27 minutes and 72.22 ± 11.79 minutes, respectively, p = 0.031; coronal angulation: 3.12° ± 3.2° and 1.24° ± 1.76°, respectively, p = 0.044). No statistically significant difference was found in terms of fracture healing time and RUST scores. Non-union was observed in one patient in the PS group. There was no significant difference in fracture healing times and RUST scores when subgroup analysis was performed according to fibula fixation and distal locking screw numbers. DISCUSSION: The PW technique offers significant advantages in terms of surgical efficiency and reduction quality in the coronal plane. Although the risk of wire displacement remains a disadvantage that must be minimised with careful technique, these advantages make PW a preferable alternative to PS for assisting reduction in distal tibial nailing, where PS has disadvantages such as longer operating times and less optimal alignment control. CONCLUSIONS: The use of PW instead of PS has no negative effect on fracture union time and also improves alignment and decreases the operative time.
Comparison of Clinical and Radiological Outcomes of Four Different Proximal Femoral Nailing Systems in the Treatment of Intertrochanteric Fractures.
Karagoz B, Keceli O, Bayrak HC
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153817 · Publisher ↗
PURPOSE OF THE STUDY: This study aimed to compare the clinical and radiological outcomes of four different proximal femoral nailing systems-Proximal Femoral Nail Antirotation (PFNA), Dynamic Locked Trochanteric (DLT) nai...
PURPOSE OF THE STUDY: This study aimed to compare the clinical and radiological outcomes of four different proximal femoral nailing systems-Proximal Femoral Nail Antirotation (PFNA), Dynamic Locked Trochanteric (DLT) nail, Intertan, and Talon Distalfix-used in the surgical treatment of intertrochanteric femoral fractures. The goal was to evaluate the differences between systems both statistically and in terms of clinical relevance. MATERIAL AND METHODS: A retrospective analysis was conducted on 309 patients who underwent PFN procedures between January 2015 and December 2019. Patients were categorized into four groups based on the type of nail used. Parameters assessed included operative time, intraoperative blood loss, fluoroscopy time, fracture union time, Harris Hip Score, WOMAC score, reduction quality, and complication rates. Additionally, Minimal Clinically Important Difference (MCID) values were calculated to assess the clinical significance of any observed differences. RESULTS: The Talon Distalfix group demonstrated significantly lower operative time, blood loss, and fluoroscopy duration (all p < 0.001). Since these differences exceeded MCID thresholds, they were considered not only statistically significant but also clinically meaningful. No significant differences were observed among the groups in terms of functional outcomes (Harris Hip Score, WOMAC score), fracture union time, or reduction quality. The overall complication rate was 22.9%, with screw cut-out being the most common complication (14.2%). Complication rates did not differ significantly between the groups. CONCLUSIONS: The Talon Distalfix nail was found to offer both statistically and clinically significant advantages in terms of shorter operative time, reduced blood loss, and less fluoroscopy exposure. While functional outcomes and complication rates were similar across all groups, the findings suggest that implant design may play a decisive role in intraoperative parameters.
Dual Plating Through a Single Anterior Approach for Distal Femoral Fractures.
Özkayin N, Yener C, Aljasim O
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153816 · Publisher ↗
PURPOSE OF THE STUDY: Comminuted distal femoral fractures and very low periprosthetic fractures present significant treatment challenges, which are commonly associated with nonunion and varus collapse. Dual plating has e...
PURPOSE OF THE STUDY: Comminuted distal femoral fractures and very low periprosthetic fractures present significant treatment challenges, which are commonly associated with nonunion and varus collapse. Dual plating has emerged as an effective solution to address these issues. The aim of this study was to evaluate the clinical outcomes of osteosynthesis with double plates through a single anterior incision. MATERIAL AND METHODS: Forty-nine patients (38 females, 11 males, mean age 65.7 ± 16.2 years, range 23-90 years) were included. The study comprised 18 acute distal femoral fractures (AO/OTA 33-C2/C3), 15 acute periprosthetic fractures (Su classification 2-3), and 16 distal femoral nonunions (13 with a history of acute distal femoral fractures and 3 with periprosthetic fractures). Demographic data, hospitalization time, follow-up duration, union time, and complications were assessed. RESULTS: The mean hospitalization time was 5.5 ± 3 days, with a mean follow-up of 13.6 ± 10.3 months (range 6-42 months). All fractures healed with a mean union time of 4.8 ± 1.6 months. Union times were 4.2 ± 1.5 months for distal femoral fractures, 4.1 ± 1 months for periprosthetic fractures, and 5.8 ± 1.5 months for nonunion fractures. Complications included one implant failure after a fall, one intraoperative vascular injury, and two superficial infections. CONCLUSIONS: Dual plating through a single anterior incision is a reliable technique for comminuted distal femoral fractures, very low periprosthetic fractures, and distal femoral nonunion. It provides stable fixation, promotes early healing, and minimizes soft tissue complications.
Analysis of the Efficacy of Arthroscopic Suture Anchor "X" Fixation for Lateral Femoral Condyle Osteochondral Fractures.
ChengShang Y, Li S, Cai M … +4 more , Zhang C, Liu G, Zhou S, Zheng Z
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153815 · Publisher ↗
PURPOSE OF THE STUDY: To evaluate and compare the clinical efficacy of arthroscopic suture anchor "X" fixation and hollow compression screw fixation in treating lateral femoral condyle osteochondral fractures. MATERIAL A...
PURPOSE OF THE STUDY: To evaluate and compare the clinical efficacy of arthroscopic suture anchor "X" fixation and hollow compression screw fixation in treating lateral femoral condyle osteochondral fractures. MATERIAL AND METHODS: This retrospective study analyzed 31 patients diagnosed with lateral femoral condyle osteochondral fractures, treated at our hospital between June 2015 and July 2024. Patients were divided into two groups based on the surgical approach: Group A received arthroscopic suture anchor "X" fixation, while Group B underwent arthroscopic hollow compression screw fixation combined with a spacer. HSS scores and excellent outcome rates were assessed at postoperative day 3, 1 month, 3 months, and 6 months. Additionally, postoperative complications were evaluated through a second arthroscopic procedure. RESULTS: The surgical duration in Group A was significantly longer than in Group B (P < 0.05). No significant differences in HSS scores were found between the groups at postoperative day 3 and 1 month, while Group A showed significantly higher HSS scores at 3 months and 6 months compared to Group B (P < 0.05). The incidence of postoperative knee joint complications was lower in Group A than in Group B, with a statistically significant difference (P < 0.05). CONCLUSIONS: The suture anchor system is effective for both non-weight-bearing and weight-bearing areas of the lateral femoral condyle, especially for small bone fragments, showing favorable clinical results. Compared to traditional hollow compression screw fixation, the suture anchor system significantly reduces postoperative complications and improves knee joint function.
The Effect of Bone Minerals Density on Mortality of Elderly Patients Applying with a Proximal Fracture of the Femur.
Yiğit Ş, Ozkul E, Çevik N … +2 more , Kaydu A, Yigit A
Acta Chir Orthop Traumatol Cech · 2026 May · PMID 42153814 · Publisher ↗
PURPOSE OF THE STUDY: This study aimed to evaluate the risk of mortality in elderly hip fracture patients within one year after surgery, and to compare it with DXA values and to evaluate the predictive value of DXA value...
PURPOSE OF THE STUDY: This study aimed to evaluate the risk of mortality in elderly hip fracture patients within one year after surgery, and to compare it with DXA values and to evaluate the predictive value of DXA values. MATERIAL AND METHODS: This is a prospective study including data from 160 elderly hip fracture patients treated in our hospital. The patient data included the following; DXA values of spine, neck, intertrochanteric, total and ward's T-scores, age, blood values (preoperative CRP (mg/dl), CRP/Albumin ratio, albumin (g/dl), sex, creatine value (mg/dL), American Society of Anesthesiologists (ASA) scores, and type of surgery. RESULTS: The risk of mortality was 5.06 times higher in patients with neck DXA values ≤-2.2 cut-off value (DXA values of neck odds ratio (OR) = 5.06, 95%CI: 544-.723, P: 0.02). There was a statistically significant difference between the DXA values of spine, intertrochanteric, wards, creatine, and albumin values between the groups (respectively p=0.002, p=0.005, p=0.01, p=0.003, and p=0.01). CONCLUSIONS: Biomarkers to assess mortality one year postoperatively in elderly patients undergoing surgery for hip fracture are lacking. The mortality rate was found to be 5.06 times higher in patients with DXA values of neck ≤-2.2 cut-off. Severe osteoporosis is a disease with high mortality. The initiation of osteoporosis treatment should be started earlier.
There Is No Clinical and Radiological Difference between Suspensory and Cortical Button Fixation at the Treatment of Medial Meniscus Posterior Root Tear.
Sarikaya G, Paksoy AE, Karaşahin Ö … +3 more , Köse M, Ollivier MP, Kocaoğlu B
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41873874 · Publisher ↗
PURPOSE OF THE STUDY: The purpose of this prospective study was to compare the two surgical techniques; (Transosseous Fixation with the Suspensory Fixation System technique and Pull Out Suture Repair) for clinical and ra...
PURPOSE OF THE STUDY: The purpose of this prospective study was to compare the two surgical techniques; (Transosseous Fixation with the Suspensory Fixation System technique and Pull Out Suture Repair) for clinical and radiologic scores and to investigate the effects on meniscal extrusion in Medial Meniscus Posterior Root Tear (MMPRT). MATERIAL AND METHODS: This was a prospective single-center study. Patients undergoing MMPRT were divided into two groups. Group 1 patients were repaired with Transosseous Fixation with The Suspensory Fixation System technique while Group 2 patients were repaired with Pull Out Suture Repair with Cortical Button. Lysholm and Tegner Score, Visual Analog Scale (VAS), meniscus extrusion on magnetic resonance imaging (MRI) and K-L grade were recorded preop and postop at minimum one year follow-up. RESULTS: Meniscal extrusion on MRI increased in both groups at 12 months postoperatively compared to preoperative evaluation, but this increase was not statistically significant in both methods (Group 1: p = 0.670, Group 2: p = 0.211). There was no statistically significant difference in the pre-postoperative change in Lysholm knee score, Tegner activity score and meniscal extrusion on MRI in Group 1 compared to Group 2 (p = 0.575, p = 0.257 and, p = 0.141 respectively). Both Lysholm Knee Score (Group 1: p = 0.001, Group 2: p = 0.001) and Tegner Activity Score (Group 1: p = 0.008, Group 2: p < 0.001) increased statistically significantly at 12 months postoperatively compared to preoperative evaluation in Group 1 and Group 2. No patient in either group underwent total knee arthroplasty(TKA) at one-year follow-up. CONCLUSIONS: The Suspensory Fixation System technique in MMPRT repair has been shown to be a feasible treatment method with similar functional and radiologic results compared to Pull Out Suture Repair with Cortical Button. At short-term follow-up, the addition of a suspensory device to the conventional transtibial pullout repair did not result in a statistical difference on meniscal extrusion on MRI.
Comparison of Usability of Sagittal Plane Parameters with Baumann Angle in Radiological Imaging of Supracondylar Humerus Fractures.
Koray Ülgen N, Gencer B, Doğan Ö
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41873873 · Publisher ↗
PURPOSE OF THE STUDY: Radiological studies in supracondylar humerus fractures (SCHF) often focus on coronal plane imaging. In our study, we focused on the measurements used in elbow sagittal plane imaging. We investigate...
PURPOSE OF THE STUDY: Radiological studies in supracondylar humerus fractures (SCHF) often focus on coronal plane imaging. In our study, we focused on the measurements used in elbow sagittal plane imaging. We investigated the role of humeral shaft condylar angle (SCA) and lateral capitellohumeral angle (LCHA) in determining the reduction quality by comparing them with Baumann angle (BA). İnvestigated its effectiveness in assessing the reduction of the teardrop figure and in the follow-up period. MATERIAL AND METHODS: Eighty-eight patients with SCHF were included in the study. BA, SCA and LCHA measurements were taken on the non-fractured contralateral elbow. The same measurements were made on the post-reduction radiographs of the fractured side and the two groups were compared. Angular measurements were performed on 98 healthy children to determine the normal values of SCA and LCHA. Teardrop figure was evaluated and compared as present or absent in the pre-fracture, post-reduction and 3-month control radiographs of 88 surgically treated patients. RESULTS: SCA and LCHA were found to be statistically different between the two groups (p = 0.002 and p < 0.001). BA was statistically consistent in both groups (p = 0.160). The reformation of the teardrop figure compared to post-fracture; when compared in post-reduction and postoperative 3rd-month radiographs, was statistically significant (p = 0.027, p < 0.001). CONCLUSIONS: BA is an important parameter for evaluating reduction. SCA and LCHA were found to be unsuccessful in evaluating reduction. Additionally, evaluating the teardrop figure after reduction and in follow-ups is important in terms of assessing reduction quality and monitoring healing.
Morphometric Analysis of Lumbar Vertebral Pedicles According to Age and Gender.
Kasar ZS, Tuzcu G
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41873872 · Publisher ↗
PURPOSE OF THE STUDY: A thorough understanding of pedicle morphometrics is crucial for selecting suitable pedicle screws and their optimal trajectory in spinal stabilization. This study aims to provide a detailed morphom...
PURPOSE OF THE STUDY: A thorough understanding of pedicle morphometrics is crucial for selecting suitable pedicle screws and their optimal trajectory in spinal stabilization. This study aims to provide a detailed morphometric analysis of lumbar pedicles in a Turkish population from the Aegean region, considering gender and age based on CT scans. MATERIAL AND METHODS: This retrospective study analyzed CT scans of 500 lumbar vertebrae from 100 healthy individuals (50 females, 50 males) residing in the Aegean region of Turkey. RESULTS: Our study found that pedicule axial length (PAL), pedicle width (PW), pedicle height (PH), and foramen vertebra transverse diameter (FTD) parameters were significantly higher in males than in females (p < 0.05). In both genders, from L1 to L5, there was an increase in PW (left and right), FTD, pedicle transverse angle (PTA) (left and right), and a decrease in pedicle length (PL) (left and right) and foramen vertebra sagittal diameter (FSD). PTA right values were significantly lower than PTA left values at L1 and L2 levels in females and at L2 and L3 levels in males (p < 0.05). However, there were no statistically significant differences between the left and right mean measurements for the remaining parameters in both genders (p > 0.05). DISCUSSION: Recent studies indicate significant racial and gender variations in pedicle morphometry, making gender a crucial factor in screw size selection. Our study found notable gender-based differences in PAL, PH, PW, PTA, and PSA. Prior research showed no significant asymmetry in left and right pedicle dimensions. Consistent with these findings, our study observed symmetrical left-right pedicle measurements in both genders, with the exception of PTA. CONCLUSIONS: Gender and race differences had a significant impact on the characteristics of pedicle morphometry. This study demonstrates significant gender-based differences in lumbar vertebral morphometric parameters, independent of age. The presented morphometric data provide valuable reference information for the local population and contribute to the expanding body of knowledge in the field.
[Comparison of MRI of Paraspinal Muscles in Patients after Open and Minimally Invasive Percutaneous Stabilisation of Thoracic and Lumbar Spine Fractures].
Matějka T, Matějka J, Zeman J … +2 more , Belatka J, Salášek M
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41873871 · Publisher ↗
PURPOSE OF THE STUDY: Magnetic resonance imaging (MRI) was used to evaluate paraspinal muscle damage after classic open surgery (OPEN) and minimally invasive spine surgery (MISS) after injury. In a randomised prospective...
PURPOSE OF THE STUDY: Magnetic resonance imaging (MRI) was used to evaluate paraspinal muscle damage after classic open surgery (OPEN) and minimally invasive spine surgery (MISS) after injury. In a randomised prospective study, we evaluated our hypothesis that MISS would result in a lower extent of atrophy and fibrosis as detected by MRI. MATERIAL AND METHODS: MRI was performed after the injury and not earlier than 3 months after the removal of implants. 16 OPEN and 16 MISS patients underwent the final follow-up. Both atrophy and muscle fibrosis were assessed based on the progression of the condition after the surgery from the pre-operative state. Atrophy was assessed using T2-weighted axial scans based on the progression of fat tissue growth in the muscle and muscle tissue regression, while muscle fibrosis was assessed using T1-weighted scans before and after the administration of a contrast agent. RESULTS: Mean fibrotic changes were found to be higher in the OPEN group than in the MISS group, but insignificantly (p = 0.1100). Muscular atrophy was higher in the MISS group (p = 0.2099). Occurrence of fibrosis correlated positively with muscular atrophy only in the MISS group (R = 0.617 (0.174-0.852), p = 0.0094). DISCUSSION: Minimally invasive percutaneous methods of spinal stabilization and other types of less invasive spinal surgeries are more gentle to the paraspinal muscles than standard OPEN approaches. Their importance is clear despite certain disadvantages such as longer duration of surgery and higher radiation exposure (in case of insertion without robotic assistance or 3D CT guidance). The condition of the paraspinal muscles is more suitable for the follow-up physiotherapy, enabling easier and quicker recovery. In the long term, the muscles are more capable of maintaining spinal balance and allowing for a wider range of movement, despite in this study is a mild controversy in the higher percentage of muscle atrophy in MISS procedures. CONCLUSIONS: MISS procedures are more gentle to the paraspinal muscles than OPEN procedures. The condition of muscles is better for physiotherapy, enabling easier and quicker recovery.
[Ultrasound-Guided Injection of the Thoracolumbar Fascia in the Treatment of Low Back Pain: Methodological Approach and Anatomical Study].
Novotný T, Naňka O, Nalos D … +1 more , Mezian K
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41873870 · Publisher ↗
PURPOSE OF THE STUDY: To develop an anatomically verified protocol for ultrasound-guided analgesic interventions targeting the thoracolumbar fascia region for the treatment of both acute and chronic back pain. MATERIAL A...
PURPOSE OF THE STUDY: To develop an anatomically verified protocol for ultrasound-guided analgesic interventions targeting the thoracolumbar fascia region for the treatment of both acute and chronic back pain. MATERIAL AND METHODS: One cadaver was embalmed using the Fix-4-Life method, which preserves tissue properties suitable for subsequent ultrasound visualization. Under ultrasound guidance, a needle was inserted to the thoracolumbar fascia at the level of the transverse process of the fourth lumbar vertebra. Upon contact with the transverse process, 5 ml of diluted red latex dye was injected. The distribution of the injected fluid was then observed through anatomical dissection. RESULTS: This cadaveric study confirmed that ultrasound-guided injection into the middle layer of the thoracolumbar fascia is both accurate and technically feasible. The dye demonstrated substantial potential to spread within the targeted area, distributing mediolaterally among the structures of the m. erector trunci and cranio-caudally over a range exceeding 10 cm, encompassing nearly four spinal segments. DISCUSSION: Back pain of various etiologies remains a major interdisciplinary challenge. Refining therapeutic techniques may improve the outcomes. The thoracolumbar fascia represents a promising target for delivering local anesthetics, depot corticosteroids, and next-generation hyaluronic acid derivatives. CONCLUSIONS: This study confirms the accuracy and feasibility of ultrasound-guided interventions targeting the thoracolumbar fascia.
Dry Needle Arthroscopy of the Elbow with a 1.9 mm Chip-on-Tip System: a Cadaveric Study.
Reiser D, Adolfsson L, Thórdardóttir Á … +1 more , Sagerfors M
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41873869 · Publisher ↗
Arthroscopy has evolved significantly with advancements in instrumentation and surgical techniques. The introduction of needle arthroscopy represents a promising minimally invasive alternative and, has for the wrist prov...
Arthroscopy has evolved significantly with advancements in instrumentation and surgical techniques. The introduction of needle arthroscopy represents a promising minimally invasive alternative and, has for the wrist proven to offer a reduced soft tissue trauma with still maintained diagnostic and therapeutic efficacy. The purpose of this study was to evaluate the safety and visualization capabilities of needle arthroscopy of the elbow using cadaveric specimens. Six fresh-frozen cadaveric elbows (three right, three left) were examined using a needle arthroscope, followed by dissection to assess portal safety and proximity to neurovascular structures. The arthroscopic portals evaluated included the proximal anteromedial (PAMP), anteromedial (AMP), mid-anterolateral (MALP), postero-lateral (PLP), direct lateral, and direct posterior portals. The visualization quality of the needle arthroscope was found satisfactory and the smaller diameter (1.9 mm), allowed enhanced maneuverability. Needle arthroscopy offers improved access and acceptable visualization, potential risks remain, particularly concerning neurovascular structures. Notably, the anteromedial portal was in close proximity to the median nerve and medial antebrachial cutaneous nerve (MABCN), with one documented case of PBMACN (Posterior Branch of the MABCN) injury. Our results support the use of the needle arthroscope for elbow arthroscopy. However, caution is required to minimize neurovascular injury. Further studies are needed to establish standardized protocols and confirm the long-term safety and efficacy of needle arthroscopy in clinical practice.
[Usability of Ultrasonography in the Diagnosis of Pediatric Fractures].
Krutský J, Kubov Š, Čepelík M … +2 more , Havránek P, Pešl T
Acta Chir Orthop Traumatol Cech · 2026 Mar · PMID 41854483 · Publisher ↗
The study aims to evaluate the usability of ultrasonography in the diagnosis of pediatric fractures. Ultrasound examination of patients with fractures diagnosed using radiography at the Clinic of Pediatric and Trauma Sur...
The study aims to evaluate the usability of ultrasonography in the diagnosis of pediatric fractures. Ultrasound examination of patients with fractures diagnosed using radiography at the Clinic of Pediatric and Trauma Surgery, Third Faculty of Medicine, Charles University and UTH between 27 May 2024 and 31 December 2024. We identified a total of 11 areas to be examined - clavicle, proximal humerus, elbow, forearm, metacarpal bones, fingers of the upper limb, sternum, femur, tibia, ankle, and metatarsal bones. The examination was performed independently by a surgeon and a radiologist, who selected the patients randomly during their treatment at the clinic. The entire bone was examined by ultrasound in all available projections, and signs of skeletal trauma (cortical bumping, cortical disruption, offset of bone fragments, chimney effect, or indirect signs such as joint effusion) were sought. A total of 61 patients were examined, of whom 24 girls (39%) and 37 boys (61%). The mean age of patients was 10 years (1-17 years). The overall agreement between ultrasound and radiologic examinations is 94%. Ultrasonography failed to visualize two fractures, namely a nondisplaced SH type II fracture of the distal fibula epiphysis and a nondisplaced SH type III fracture of the distal phalanx epiphysis. Two suspected fractures of the distal forearm detected by radiography were not observed by ultrasonography. The fracture was ruled out by a follow-up radiography, and the sonographic finding was found to be correct. Ultrasonography is a usable diagnostic method for skeletal trauma. The estimated sensitivity of this examination is around 97%. Our results indicate greater specificity of ultrasound in the forearm region. In agreement with literature, ultrasound can be considered usable for the diagnosis of fractures in all examined areas. In certain locations, it can also be used to measure displacement. The weak point of the study is the limited number of patients, therefore further investigation into these matters is necessary. Ultrasonography appears to be a useful screening method for skeletal trauma in children, serving as a basis for indication for radiography. This could help reduce the number of radiologic examinations performed by up to two-thirds, thereby reducing the radiation exposure in pediatric patients. Further research on these matters is needed, and diagnostic reliability indicators shall be defined. In the phase two of the study, we plan to determine the sensitivity, specificity, positive and negative predictive values for all anatomical regions. The secondary objective is to evaluate the results achieved by the surgeon and the radiologist, the painfulness of the examination, and the usability of portable ultrasound devices.
[Our Experience with Trabecular Metal Total Ankle System].
Popelka S, Bek J, Popelka S … +2 more , Verešová N, Hromádka R
Acta Chir Orthop Traumatol Cech · 2026 Jan · PMID 41504407 · Publisher ↗
PURPOSE OF THE STUDY: One of the surgical treatment options for advanced ankle joint destruction with various etiologies is the total joint replacement. Its significant upside is the preservation of range of motion of th...
PURPOSE OF THE STUDY: One of the surgical treatment options for advanced ankle joint destruction with various etiologies is the total joint replacement. Its significant upside is the preservation of range of motion of the ankle joint and less stress on forefoot joints compared to ankle arthrodesis. Since 2022, we have been using the Zimmer Trabecular Metal Total Ankle inserted via a lateral transfibular approach. This study aims to evaluate the initial outcomes and experience with this implant. PATIENTS AND METHODS: Between 2022 and 2024, 65 total ankle replacements were performed in 63 patients using the lateral transfibular approach. Long oblique osteotomy is newly performed in the frontal plane, replacing the original type of osteotomy in the sagittal plane. After releasing and removing the distal fragment of the fibula distally and dorsally, the lower limb and ankle are placed in an alignment frame, which is fixed with Steinmann pins to the calcaneus, anterior border of the tibia, and the talus bone. The centre of rotation of the ankle is identified using the side bars anchored in the frame. Using the burs, guided by Cutting Guides that are locked to the frame, the talus and distal tibia are removed. After testing, rail holes are drilled in the resected surfaces for the original implants. After releasing the tourniquet, the original components are inserted and osteosynthesis of the fibula is performed. During the study, the previously performed fibula osteosynthesis with LCP was replaced by lag screws. Postoperatively, the ankle is supported with a brace for the period of 5 weeks, after which the patient is permitted to fully weight-bear. RESULTS: A total of 63 patients (32 women and 31 men) were followed, in whom 65 total ankle replacements were performed. The mean age of the patient was 56 years (age range 30 to 80 years). The mean follow-up period was 14.6 ± 9.3 months (3 to 38 months). The most frequent indication was post-traumatic ankle arthritis, namely in 46 cases (70.8%). Furthermore, there were 5 patients (7.7%) with post-traumatic ankle ankylosis, 9 patients (13.8%) with primary osteoarthritis, and in 5 patients (7.7%) the indication was the damage caused by rheumatoid arthritis. Deep bacterial infection of the prosthesis requiring revision was reported in 3 cases (4.6%). Superficial infection of the surgical wound was seen in 4 other cases (6.2%), which did not require hospitalization. Plate osteosynthesis of the fibula was removed in 7 cases (13.8%), 5 times due to infection and 2 times due to soft tissue irritation. One case of asymptomatic non-union of fibula was observed. DISCUSSION: The benefit of total ankle replacement is the preservation of motion of the operated joint, whereas the complication rate is twice as high as in arthrodesis. Contraindications for ankle replacement include significant varus and valgus deformities of the ankle, ankle instability, necrosis of the talus, severe diabetes mellitus, and severe limb ischemia. The advantage of the transfibular approach is the ability to partly correct deformities of the ankle joint and the position of varus or valgus. It provides a better view of the dorsal structures of the ankle and allows accurate identification of the centre of rotation. Another advantage is the low thickness of the components, requiring minimal bone resection. The main disadvantage is the longer operative time and longer learning curve. Other disadvantages include the complications associated with osteosynthesis and fibula healing, such as non-union or soft tissue irritation by plate. The incidence of superficial and deep infection is also slightly higher compared to the anterior approach. CONCLUSIONS: The Zimmer Trabecular Metal Total Ankle system is one of the treatment options for ankle joint destruction provided it is correctly indicated. However, the surgical procedure is a challenge and requires an experienced surgeon. When the indication is correct, the system brings very good short-term outcomes. Nonetheless, longer follow-up period is necessary since the incidence of complications will certainly increase over time.
[On-Table Reconstruction of Radial Head Fractures].
Herůfek R, Pavlacký T, Kelbl M … +1 more , Trávník J
Acta Chir Orthop Traumatol Cech · 2025 Dec · PMID 41504406 · Publisher ↗
PURPOSE OF THE STUDY: Fractures of the proximal radius constitute a significant proportion of elbow joint injuries, representing approximately one-third of all such fractures and 75% of proximal forearm fractures. In adu...
PURPOSE OF THE STUDY: Fractures of the proximal radius constitute a significant proportion of elbow joint injuries, representing approximately one-third of all such fractures and 75% of proximal forearm fractures. In adults, they account roughly for 4% of all fractures. Treatment of these fractures varies depending on their severity. No uniform guidelines have been published to date for the treatment of severely comminuted fractures. MATERIAL AND METHODS: The study included 16 patients who underwent on-table reconstruction, with a mean age of 49 years. Half of the cases involved Mason type III fractures, while the other half involved Mason type IV fractures. The 2.0mm (1.5mm) LCP system was used for osteosynthesis. Dislocated fragments were treated using the on-table method, i.e., reconstruction on the instrument table. The patients were followed up for 54 months on average. The results were evaluated using the Mayo Elbow Performance Index (MEPI), and X-ray images were assessed (healing, degenerative changes). RESULTS: According to MEPI, in 6 patients excellent results were achieved, in 5 patients good results were observed, and in 5 patients fair results were reported. No patient showed poor results. The range of motion in the operated elbow was 125-140° for flexion, 0-45° for extension, and the rotation (supination and pronation) was 45-90°. Complications included partial aseptic necrosis in three cases, non-union and implant failure in two cases. No neurological, vascular, or infectious complications were observed. Revision surgery was performed in 10 patients, with the most common reason being simple removal of the material (7 cases). Moreover, in one case the implantation of a cervicocapital endoprosthesis for non-union was performed. DISCUSSION: Humeroradial joint reconstruction is particularly important in unstable fractures. In the past, when open reduction and internal fixation (ORIF) were impossible, radial head excision according to Mason was used. This procedure, however, often resulted in subluxation, arthrosis, and persistent pain. The "on-table" reconstruction method for comminuted fractures of the radial head was first described by Businger and is considered a promising alternative with a low risk of head necrosis, which is also confirmed by other published studies. Even though the radial head replacement in comminuted fractures provides excellent short-term outcomes, complications such as humeral erosion, limited range of motion and pain, or the development of degenerative changes in the joint occur in the medium to long term. CONCLUSIONS: The on-table method has proven to be an effective treatment for comminuted fractures of the radial head with good functional outcomes. Considering the risks associated with radial head replacement, preservation surgery should be opted for if the nature of the fracture allows it. Further follow-up should help standardize treatment guidelines for comminuted fractures of the proximal radius to be able to more accurately assess the effectiveness of individual methods.
[Simultaneous Ruptures of All Four Extensor Mechanism Tendons in Both Knees: a Rare and Challenging Case in a Chronic Kidney Disease Patient].
Koluman AC, Salmanoglu SE, Kural C
Acta Chir Orthop Traumatol Cech · 2026 Jan · PMID 41504405 · Publisher ↗
We report a rare and remarkable case of simultaneous bilateral injuries to all four extensor mechanism tendons in a 39-year-old male with a history of diabetes and chronic kidney disease. Physical examination revealed pr...
We report a rare and remarkable case of simultaneous bilateral injuries to all four extensor mechanism tendons in a 39-year-old male with a history of diabetes and chronic kidney disease. Physical examination revealed pronounced swelling, palpable gaps above and below both patellae, and complete loss of active knee extension. Imaging confirmed complete ruptures of the right quadriceps and left patellar tendons, alongside partial ruptures of the left quadriceps and right patellar tendons. Surgical repair was performed using suture anchors to ensure secure tendon reattachment. Postoperatively, both knees were immobilized with hinged braces for six weeks, followed by a structured rehabilitation program. At the 12-month follow-up, the patient demonstrated full recovery, with complete restoration of knee range of motion and muscle strength.
[Distal Radius Intra-Articular Malunion Corrected with Arthroscopy Assisted Open Osteotomy: a Case Report].
Kunc V, Mišičko R, Veigl D
Acta Chir Orthop Traumatol Cech · 2025 Dec · PMID 41503665 · Publisher ↗
Distal radius malunions, particularly those involving both intra-articular and extra-articular components, present significant surgical challenges. While extra-articular osteotomies are well-established, intra-articular...
Distal radius malunions, particularly those involving both intra-articular and extra-articular components, present significant surgical challenges. While extra-articular osteotomies are well-established, intra-articular corrections - especially at the sigmoid notch - are rarely described and difficult to execute. This case report introduces a novel technique combining arthroscopic and open approaches for the correction of a complex distal radius malunion. A patient with persistent pain and functional impairment following conservative treatment of a distal radius fracture was diagnosed with a complex malunion, featuring dorsal angulation, an intra-articular die-punch fragment, and distal radioulnar joint (DRUJ) incongruity with a 2 mm articular step-off at the sigmoid notch. A combined extra- and intra-articular osteotomy was performed under arthroscopic guidance using a dry technique via posterior DRUJ portals. The intra-articular fragment was mobilized and repositioned under arthroscopic and fluoroscopic visualization, followed by osteosynthesis with a dorsal plate. Postoperative imaging confirmed alignment correction. At 12 months, the patient reported full, painless prono-supination, near-complete wrist range of motion, and satisfaction with the outcome. The technique allowed for precise osteotomy execution despite challenges including limited DRUJ visualization. This is the first documented case of a sigmoid notch osteotomy guided by dry arthroscopy through DRUJ portals. The approach demonstrates the feasibility of combining arthroscopic visualization with traditional osteotomy techniques to address complex distal radius malunions. Despite technical limitations, this method offers a promising avenue for precise intra-articular correction and joint preservation in select patients.
[One Year of Experience with Robotic Total Knee Arthroplasty - ROSA System].
Musil P, Lehovec R
Acta Chir Orthop Traumatol Cech · 2025 Dec · PMID 41503663 · Publisher ↗
PURPOSE OF THE STUDY: The study aimed to evaluate the initial experience with robot-assisted total knee arthroplasty (TKA) using the ROSA system. It focuses on surgical techniques, alignment options, and the pros and con...
PURPOSE OF THE STUDY: The study aimed to evaluate the initial experience with robot-assisted total knee arthroplasty (TKA) using the ROSA system. It focuses on surgical techniques, alignment options, and the pros and cons of the system. It also provides an analysis of the pre- and post-operative range of motion measured by the robotic system. MATERIAL AND METHODS: In the period from 5 December 2023 to 8 August 2024, a total of 197 total knee arthroplasties were performed at the Dr. Pírek Clinic using the ROSA system and Persona implants with a medial congruent tibial insert. Complete data were available for 124 patients (63 men, 61 women) with a mean age of 68.7 ± 8.2 years and a mean BMI of 30.6 ± 4.3. The mean length of hospital stay was five days. Preoperative and postoperative assessments included the range of motion (flexion and extension), soft tissue laxity (varus and valgus stress tests), and data on the planned axial position of the limb. A t-test was used for statistical comparisons. The surgeries were performed using the "image-less" mode of the ROSA system. All procedures were performed via a medial parapatellar approach. After thorough cleaning of the joint and positioning of trackers, the total range of motion and laxity of the joint were measured. Soft tissue balance was ensured based on kinematic alignment principles. RESULTS: The study confirmed an improvement in the range of motion and accuracy of limb axis alignment. Statistical analysis showed significant postoperative improvement in flexion and mechanical axis. The use of the ROSA system enabled precision in bone cuts and increased reproducibility of results with the aim of maintaining the predefined limits for the resulting limb axis. DISCUSSION: The results obtained are consistent with those reported in the available literature, indicating that robot-assisted TKA helps improve surgical accuracy and reduce the incidence of deviations. Compared to conventional methods, robotic assistance requires less soft tissue release and can thus minimize blood loss. The disadvantages of this system include operative time and cost. Another challenge, for surgeons, is the learning curve and variability of approaches to alignment. The study also underlines the importance of personalized alignment, as different knee phenotypes may require different approaches. CONCLUSIONS: Robot-assisted TKA using the ROSA system offers advantages in terms of surgical precision, reproducibility of results, and early postoperative functional recovery. The study indicates that the introduction of robotic systems may help improve patient satisfaction and long-term implant durability. However, further research with larger patient cohorts and long-term follow-up is necessary to confirm these results.
[Septic Arthritis of the Right Elbow Joint in an Infant - Caused by Salmonella enterica Subspecies IV. (houtenae)].
Sadovský P, Helešicová G
Acta Chir Orthop Traumatol Cech · 2025 Dec · PMID 41503638 · Publisher ↗
Case report of an eight-month-old infant with infection of the right elbow joint caused by a rare subspecies of Salmonella enterica IV. houtenae, typical of cold-blooded vertebrates.
Case report of an eight-month-old infant with infection of the right elbow joint caused by a rare subspecies of Salmonella enterica IV. houtenae, typical of cold-blooded vertebrates.
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