Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca[JOURNAL]
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200 papers
Surgical Treatment of Wrist and Hand Deformity in Children with Cerebral Palsy.
Patel R, Khan MM, Gurukiran G … +2 more , Carsi MB, Singh RA
Acta Chir Orthop Traumatol Cech · 2025 Aug · PMID 40878452 · Publisher ↗
Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this ap...
Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this approach is to provide patients with this disorder the best quality of life. Although CP can affect both upper and lower limbs, the functional expectation of upper limb is much higher and complex. This implies particularly to hand and wrist based on complex functional movements expected of them. This puts orthopaedic surgeons in a unique position in managing these patients. It is worth mentioning here that it is not about offering them a surgical intervention the emphasis should lie on the entire process of selection, evaluation, and intervention. All these steps need to be considered very thoroughly so that the best outcome is achieved based on patients' expectation at present and keeping the future consideration in mind as well. This paper focuses only on children with hand and wrist deformity. Although children have a great healing potential, but they have high functional demand and longer-life expectancy in general so getting things right for the first time should be of paramount importance. This paper tries to address this issue by reviewing the literature to help orthopaedic surgeons in developing an algorithm in their mind when offering intervention. The consideration of inclusion and exclusion criteria along with review of literature has been considered with this background in mind. This paper primarily addresses the surgical aspect of disease and steps that are critical in this regard. Follow up planning, long-term outcome, rehabilitation planning, use of conservative treatment has not been considered in this review.
[Septic Arthritis of the Wrist Joint: Cohort of Patients Treated between 2003 and 2023, Guidelines for the Diagnosis and Treatment].
Papežová L, Vodička Z, Musil D … +1 more , Klouda J
Acta Chir Orthop Traumatol Cech · 2025 Aug · PMID 40878451 · Publisher ↗
PURPOSE OF THE STUDY: The study aimed to evaluate the timeliness and effectiveness of treatment of all patients who underwent surgery for septic arthritis of the wrist at our department between 2003 and 2023. MATERIAL AN...
PURPOSE OF THE STUDY: The study aimed to evaluate the timeliness and effectiveness of treatment of all patients who underwent surgery for septic arthritis of the wrist at our department between 2003 and 2023. MATERIAL AND METHODS: The retrospective study included 38 patients (26 men and 12 women). The mean age of the patients was 68 years. All patients underwent surgery for culture-positive arthritis of the native wrist. Patients with periprosthetic and extraarticular infections were excluded from the study. Once the diagnosis was established based on the clinical examination and laboratory analysis of blood and synovial fluid, antibiotic treatment was administered and revision surgery was performed. Arthroscopic procedure was used in the unaffected wrist, whereas open surgery was opted for in case of any degenerative changes of the wrist joint and extra-articular spread of infection. A total of 50 surgeries were performed, of which 6 arthroscopies, 32 open arthrotomies, 2 open surgeries with proximal row carpectomy, 6 open surgeries with simultaneous resection arthrodesis, 2 revision surgeries with arthrodesis via internal fixation for prolonged healing, 2 revision surgeries for another postoperative complication. RESULTS: In our study cohort of patients with septic arthritis, the arthritis of the wrist represented 7%. The most common pathogen was Staphylococcus aureus (60.5%). In 35 patients (92%) at least one risk factor for septic arthritis was present. In all patients, signs of local inflammation were present. 17 patients showed signs of system-wide inflammation and in 32 patients laboratory markers of inflammation were reported. In 6 cases both sides were affected. In our cohort the lethality reached 8%. These were patients with severe immunodeficiency and multiple loci of infection. Full recovery was achieved in 35 patients (92%), i.e. in all surviving patients, in whom the wrist joint was stable upon treatment completion and the self-care was not limited. DISCUSSION: The prevailing part of the patients (92.10%) with septic arthritis of the wrist showed risk factors for the development of septic arthritis, i. e. poor overall health condition of the patient, immunosuppression, organ failure, diabetes, age over 65 years, rheumatoid arthritis, surgery or trauma, drug or alcohol abuse. In case of bacteremia or sepsis, the risk factors include also chronic degenerative or inflammatory changes in the wrist region, with synovitis constituting a predisposition for hematogenous spread of septic arthritis of the wrist. Our cohort clearly confirms that the system-wide signs and laboratory markers of inflammation are nonspecific markers which cannot conclusively confirm the diagnosis of septic arthritis of the wrist, but the development of their values over time demonstrates the effect of treatment used. The presence of degenerative changes of the wrist joint influences the choice of surgical procedure. CONCLUSIONS: Septic arthritis of the wrist ranks among the less common types of arthritis. Early diagnosis should promptly be followed by adequate surgical treatment. Correct early management increases the likelihood of full recovery, even in high-risk patients.
[Septic Arthritis of the Glenohumeral Joint: Treatment Options and Outcomes Achieved in Our Study Population].
Mařík J, Klouda J, Musil D … +1 more , Sadovský P
Acta Chir Orthop Traumatol Cech · 2025 Aug · PMID 40878450 · Publisher ↗
PURPOSE OF THE STUDY: The study aimed to evaluate the patients treated for septic arthritis of the glenohumeral joint at our department in the period between 2018 and the end of 2023. MATERIAL AND METHODS: Between the be...
PURPOSE OF THE STUDY: The study aimed to evaluate the patients treated for septic arthritis of the glenohumeral joint at our department in the period between 2018 and the end of 2023. MATERIAL AND METHODS: Between the beginning of 2018 and the end of 2023, a total of 37 patients were treated at our department for septic arthritis of the native glenohumeral joint. The study population consisted of 15 women and 22 men, with the mean age of 66.4 years. The youngest patient was 20 years old, and the oldest patient was 94 years of age. Patients with prosthetic joint infection were excluded from the study. The study included all patients with the diagnosis of shoulder arthritis who underwent surgery at our department in the period 2018-2023. The patients were enrolled based on the clinical finding, laboratory results and bacteria culture tests. Arthroscopy and shoulder joint lavage were performed in the shortest possible time, with revision of both the glenohumeral and subacromial spaces and insertion of drains into both these spaces, or a 24-hour arthroscopic irrigation lavage. During the hospital stay, inflammatory markers were monitored, antibiotics were administered intravenously and after discharge orally for the period of at least 6 weeks. The surgical outcomes were evaluated by clinical follow-up of the patients, who were asked to complete the forms of the UCLASS and CONSTANT scoring systems that are used to determine the patients' satisfaction with their treatment and postoperative status. RESULTS: Between 2018 and 2023, a total of 13,441 surgeries were performed. The total number of shoulder joint surgeries was 1,357, of which, 1,131 were arthroscopic procedures and 226 were total shoulder arthroplasties. Arthritis of the glenohumeral joint was diagnosed in 37 patients, in whom a total of 54 surgical procedures were performed. The main symptoms were local pain, limited range of motion, swelling, and mild fever. The symptoms persisted for 4 days on average. Revision surgery was performed in 9 patients. The most common pathogen was Staphylococcus aureus. In all cases, appropriate therapy resulted in full recovery. DISCUSSION: Even through septic arthritis of the shoulder joint is less frequent than septic arthritis of the knee, in our study population it ranked second in terms of frequency, or third when also infectious complications of total joint replacements are considered. Very rarely it affects a native joint of young and otherwise healthy patients. CONCLUSIONS: Early diagnosis, timely surgical treatment, and appropriate antibiotic therapy are crucial in the management of septic arthritis.
The Role of Sonication in Improving the Detection of Periprosthetic Joint Infections: a Prospective Analysis.
Rapi J, Apostolopoulos V, Růžička F … +3 more , Vaněrková M, Brančík P, Tomáš T
Acta Chir Orthop Traumatol Cech · 2025 Aug · PMID 40878449 · Publisher ↗
PURPOSE OF THE STUDY: The diagnosis of periprosthetic joint infection (PJI) can be particularly challenging in cases of low-grade chronic infection. The suspicion of infection is typically confirmed through cultures of s...
PURPOSE OF THE STUDY: The diagnosis of periprosthetic joint infection (PJI) can be particularly challenging in cases of low-grade chronic infection. The suspicion of infection is typically confirmed through cultures of synovial fluid and periprosthetic tissue. However, these methods may not always detect low-grade infections, which can lead to persistent infection and early failure of the prosthesis. The purpose of this study was to evaluate the effectiveness of sonication in enhancing the detection of PJI using polymerase chain reaction (PCR) analysis. MATERIAL AND METHODS: A prospective cohort of 26 patients, suspected of having mitigated PJI, underwent surgery at the First Department of Orthopaedic Surgery, St. Anne's University Hospital in Brno between 2019 and 2024. The cohort included 16 women and 10 men, aged 56 to 82 years, with infections involving hip (11 cases) or knee prostheses (15 cases). Standard PCR and sonication followed by PCR were used to confirm PJI. RESULTS: In 20 out of 26 cases, both standard PCR and sonication-assisted PCR detected the infection(p= 0.014). However, in 6 cases, standard PCR failed to identify the pathogen, whereas sonication followed by PCR confirmed the infection. Among these, 4 cases had significantly positive results, and 2 showed weak positivity. The most common pathogens detected were coagulase-negative Staphylococcus (12 cases), followed by Staphylococcus aureus, Pseudomonas aeruginosa, and others. CONCLUSIONS: The findings of this study indicate that the integration of sonication with PCR markedly enhances the detection of PJI, especially in instances where standard PCR techniques may be insufficient, such as in low-grade chronic infections.
[Comparison of Abductor Muscle Strength and Harris Hip Score after Total Hip Arthroplasty].
Pařík D, Zídka M
Acta Chir Orthop Traumatol Cech · 2025 Jul · PMID 40874799 · Publisher ↗
PURPOSE OF THE STUDY: The study aimed to compare the postoperative outcomes of patients with total hip arthroplasty performed through Watson-Jones anterolateral approach and Röttinger minimally invasive anterolateral app...
PURPOSE OF THE STUDY: The study aimed to compare the postoperative outcomes of patients with total hip arthroplasty performed through Watson-Jones anterolateral approach and Röttinger minimally invasive anterolateral approach (MIS-AL). The hypothesis was that the MIS-AL approach enables faster recovery and better clinical outcomes in terms of abductor muscle strength and Harris Hip Score (HHS). MATERIAL AND METHODS: The prospective comparative study included 136 patients who underwent surgery between 2018 and 2021. In 88 patients the Watson-Jones procedure was performed and in 48 patients Röttinger minimally invasive procedure was opted for. The Harris Hip Score (HHS) was used to evaluate the outcomes at three time points (before surgery, at 3 and 6 months after surgery) and the abductor muscle strength was measured using the dynamometer at four time points (before surgery, at 17 days, 3 and 6 months after surgery). The statistical analyses were conducted using the independent samples t-test at the level of significance p < 0.05. RESULTS: In the MIS-AL group, the HHS after 3 months was 86.32 ± 4.8 points, which was a higher score than that achieved in the Watson-Jones group (78.76 ± 5.6; p = 0.0015). After 6 months the difference remained in favour of MIS-AL (94.68 ± 4.7 vs. 90.28 ± 5.4; p = 0.0078). The maximum abductor muscle strength after 6 months improved from 125.52 ± 14.8 N to 170.91 ± 16.2 N in the Watson-Jones group and from 142.78 ± 15.3 N to168.11 ± 15.8 N in the MIS-AL group, with no statistically significant difference between the two groups (p > 0.05). DISCUSSION: The results show that the differences in abductor muscle strength between the MIS-AL approach and the Watson-Jones anterolateral approach were statistically insignificant. However, better results of the Harris Hip Score in patients in whom the MIS-AL approach was used are supported by the trend of faster functional recovery and higher satisfaction rate of patients undergoing less invasive surgical procedures. CONCLUSIONS: The Röttinger minimally invasive anterolateral approach provides faster improvement of the HHS during the first six months after surgery. The differences in abductor muscle strength between the groups were statistically insignificant.
[Intra-Articular Use of Hyaluronic Acid Preparations in the Treatment of Knee Osteoarthritis].
Turan M, Gallo J
Acta Chir Orthop Traumatol Cech · 2025 Jul · PMID 40874798 · Publisher ↗
PURPOSE OF THE STUDY: The knee is the most common peripheral site of osteoarthritis (KOA; knee osteoarthritis). The mainstay of non-operative treatment is education, exercise, weight reduction, and pharmacological therap...
PURPOSE OF THE STUDY: The knee is the most common peripheral site of osteoarthritis (KOA; knee osteoarthritis). The mainstay of non-operative treatment is education, exercise, weight reduction, and pharmacological therapy. Intra-articular hyaluronic acid (HA) injection is a non-operative treatment option. The aim of our study was to assess the most recent data on the efficacy of intra-articular administration of HA in KOA therapy and to compare it with intra-articular injections of platelet-rich plasma (PRP), corticosteroids (CS) and placebo (saline solution). MATERIAL AND METHODS: The PubMed and Cochrane Library databases were searched for randomized clinical trials (RCTs) conducted between 2012 and 2023 comparing the efficacy of HA with PRP, CS, or placebo. The efficacy was mostly assessed using the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and VAS (Visual Analogue Scale) for pain. The Rob2 (Risk of Bias 2) tool developed by the Cochrane Collaboration was used to assess the risk of bias. RESULTS: The data pooled from 29 studies (2032 patients treated with HA, 965 with PRP, 376 with CS and 697 with placebo) were analysed. The efficacy was assessed mostly at 1, 3, 6 and 12 months after the administration of the investigated substance. All types of interventions (HA, PRP, CS) were found to have a beneficial effect on the knee affected by KOA, namely through symptom relief. The greatest effect was achieved with PRP, which lasted longer than that of HA or CS. HA offered a moderate relief of symptoms, which was still apparent at 6 months after administration. The administration of CS resulted in a rapid onset of pain relief which was, however, of short duration and started to diminish as early as after the first month of follow-up. In placebo-controlled studies, the follow-up did not exceed 6 months. DISCUSSION AND CONCLUSIONS: Intra-articular administration of HA continues to be the most common intra-articular therapy for patients with KOA. We should therefore take an interest in its outcomes. This intervention is recommended by the OARSI as 1B level treatment. The ACR, on the contrary, has turned from both the HA and PRP. The NICE in its opinion on non-surgical management of KOA also advises against HA. In our study, on the other hand, we concluded that all three active pharmaceutical ingredients (HA, PRP and CS) improved the KOA symptoms, with PRP showing the most significant, longest lasting and most consistent overall beneficial effects. This conclusion does not imply that HA offers no or only negligible effect. The particular size of effect of intra-articular administration of HA depends on a number of circumstances. Further research should therefore be conducted which would look into the HA benefit in relation to the specific patient, KOA phenotype, stage of inflammation, or healing processes.
Cementless THA with Femoral Shortening Osteotomy Provides Excellent Results for Patients with Crowe Type IV Hip Dysplasia.
Fahri E, Uluyardimci E, Tahta M … +2 more , Karaaslan AA, Işik Ç
Acta Chir Orthop Traumatol Cech · 2025 Jul · PMID 40874797 · Publisher ↗
INTRODUCTION: This study aimed to present the clinical and radiological results and look for complications of total hip arthroplasty (THA) performed with subtrochanteric transverse femoral shortening osteotomy (STFO) for...
INTRODUCTION: This study aimed to present the clinical and radiological results and look for complications of total hip arthroplasty (THA) performed with subtrochanteric transverse femoral shortening osteotomy (STFO) for Crowe type IV developmental dysplasia of the hip (DDH). MATERIAL AND METHODS: Ninety-four patients who underwent STFO and THA for Crowe type IV DDH between 2013 and 2018 were retrospectively evaluated. The mean follow-up period of the patients was 40 months (range 25 to 55) and the mean operation time was 58 min (range 52 to 70). We examined the results of routine anteroposterior and lateral hip radio- graphy. The time required for healing of the osteotomy line, preoperative and postoperative Harris Hip Score (HHS), limb length discrepancies, the level of limping and Trendelenburg tests were evaluated for all patients. All complications were noted. RESULTS: The mean healing time was 5.4 months (range 4 to 10). The preoperative HHS improved from a mean of 52 points (range 42 to 61) to 84 points (range 75 to 96) after the operation (p < 0.001). Only two patients had postoperative positive Trendelenburg tests. There were no cases of nonunion or sciatic nerve palsy. An interoperative femoral fracture was observed in one case. CONCLUSIONS: This study demonstrates that excellent clinical outcomes can be achieved with no revisions, no nonunion, and minimal residual limping in patients who undergo shortening with STFO using a Wagner cone for the femur and a primary cup for the acetabulum.
[Funtional Outcomes of Pediatric Trigger Digits - Outcomes of Two Centers].
Vlach M, Máška D, Schmoranzová A … +2 more , Kšírová E, Havlas V
Acta Chir Orthop Traumatol Cech · 2025 Jul · PMID 40874796 · Publisher ↗
PURPOSE OF THE STUDY: The study evaluates the functional outcomes of the treatment of pediatric trigger digits in two centers and compares them with data from the available literature. The secondary objective is to verif...
PURPOSE OF THE STUDY: The study evaluates the functional outcomes of the treatment of pediatric trigger digits in two centers and compares them with data from the available literature. The secondary objective is to verify the possibilities of collecting data on patients' health status through questionnaire surveys using remote communication via a web interface. MATERIAL AND METHODS: Patients operated on at the Hand and Plastic Surgery Institute in Vysoké nad Jizerou (ÚCHRaPCH) and the Motol University Hospital, Department of Orthopaedics (FNM) between 2018 and 2021 were evaluated. An analysis of demographic data, affected digits, and an assessment of functional outcomes using the Quick-DASH questionnaire were performed. The data were collected through Google Forms and then statistically analyzed. The subgroups were compared using the chi-square test and two-tailed unpaired t-test and logistic regression with Firth's correction was used to compare the obtained Quick-DASH scores. RESULTS: A total of 124 trigger digits in 102 patients were evaluated, including 113 thumbs and 11 fingers; bilateral findings were observed in 20.6% of patients. The mean age at the time of surgery was 3.7 years. The questionnaire was completed by 57.8% of patients treated at ÚCHRaPCH and 57.9% at FNM. The median Quick-DASH score was 0.0, indicating no disability or hand function limitation. The average Quick-DASH score was 1.7. No significant differences were found between the centers in demographic parameters or achieved scores. The prevalence of a non-zero Quick-DASH score was 24%. DISCUSSION: Our results, in line with global literature, confirm that surgical release of the A1 pulley is an effective method for treating pediatric trigger thumb or fingers with minimal complications. The online questionnaire survey proved beneficial for data collection. The limitation is the low response rate and the unavailability of suitable validated questionnaires for the given age group. The relatively high risk of a non-zero Quick-DASH score may be influenced by the inappropriate choice of questionnaire given the age of the subjects. An advantage of the data collection method used is the ability to require full completion of the questionnaire before submission, thereby eliminating the need to discard incomplete questionnaires. CONCLUSIONS: Surgical treatment of pediatric trigger digits provides excellent outcomes, and the use of online questionnaires is suitable for health data collection. Further research is needed to validate questionnaires for pediatric age categories and subsequently to expand the concept of web-based data collection.
[Fixation of Osteochondral Lesions of the Knee Using MAGNEZIX Implants in Pediatric Patients: Midterm Clinical and MRI Results].
Hanák F, Koukolská V, Krsková B … +2 more , Kynčl M, Havlas V
Acta Chir Orthop Traumatol Cech · 2025 Jul · PMID 40874795 · Publisher ↗
PURPOSE OF THE STUDY: Fixation of osteochondral fragments is a relatively common procedure in pediatric orthopaedic surgery. This study analyzes clinical and MRI results of biodegradable MAGNEZIX® magnesium alloy implant...
PURPOSE OF THE STUDY: Fixation of osteochondral fragments is a relatively common procedure in pediatric orthopaedic surgery. This study analyzes clinical and MRI results of biodegradable MAGNEZIX® magnesium alloy implants used to fix osteochondral knee lesions in pediatric patients. MATERIAL AND METHODS: 18 pediatric patients with unstable or displaced OCD lesions or osteochondral fractures were treated with MAGNEZIX® screws or pins. Clinical examinations were conducted at regular intervals, and the final clinical and MRI assessments were performed 24 months after surgery. RESULTS: The overall functional scores at 24 months were found to be good, with a VAS score of 1.22 points ± 1.83, Lysholm score of 87.61 points ± 11.31, and IKDC score of 76.94 points ± 10.85 for both groups. On MRI, 14 patients (77.78%) showed complete union, four patients (22.22%) showed incomplete union, and none of the patients experienced healing failure. Complete implant absorption was examined in eight patients (44.44%) on MRI. Most patients exhibited varying degrees of chondropathy, and one patient required reoperation due to screw breakage and migration. CONCLUSIONS: The use of MAGNEZIX® implants in the treatment of pediatric osteochondral fractures and OCD lesions has shown good clinical outcomes and favorable healing of osteochondral lesions. However, varying degrees of chondropathy have been observed in most cases.
[History of Internal Fixation of Fractures in the Czech Lands].
Bartoníček J, Naňka O
Acta Chir Orthop Traumatol Cech · 2025 Jul · PMID 40874794 · Publisher ↗
The beginnings of osteosynthesis (OS) in the Czech lands, dating back to the second half of the 19th century, are associated with the German surgeons W. Heine and C. Gussenbauer working in Prague. Development of the Czec...
The beginnings of osteosynthesis (OS) in the Czech lands, dating back to the second half of the 19th century, are associated with the German surgeons W. Heine and C. Gussenbauer working in Prague. Development of the Czech musculoskeletal surgery began with the appointment of K. Maydl to the head of the Czech University Department of Surgery in Prague in 1891. In 1908, his pupil K. Kukula published the first "OS manifesto" in the Czech literature, including his own original method of fixation of diaphyseal fractures with a magnezium peg. Further development of OS of fractures came as late as in the 1920s. The first to publish his own results in a cohort of 37 patients was K. Šantrůček, followed by V. Novák. At the beginning of the 1930s, A. Jirásek presented an extensive review of the issues concerning OS of fractures based on his experience obtained from 476 operations. In 1939, J. Zahradníček published an extensive study focused on non-unions, including his own classification that was later modified by Weber and Čech. In 1941, E. Polák published the first Czech monograph dealing with nailing of femoral neck fractures. Immediately after World War II, development of intramedullary osteosynthesis took place, surprisingly first in peripheral departments. In the 1950s, osteosynthesis further progressed. Worth mentioning is the nail designed by A. Pavlík, who is known worldwide as the author of the harness used in management of DDH. Instrumental in introduction of AO principles into the clinical practice were O. Čech and F. Stryhal, who became familiar with the technique of stable OS during the 1960s. In 1972, they published an original Czech textbook of osteosynthesis, merely 9 years after the first AO textbook. In 1973, O. Čech together with B.G. Weber won worldwide recognition for their monograph Pseudarthrosen. During the 1970s, domestic production of implants was established in cooperation with S. Beznoska from Poldi Kladno. At the turn of the 1980s, operative treatment of fractures in our country reached the European level. Key words: osteosynthesis, history, operative treatment of fractures, Czech Republic.
[Acute Pancreatitis as a Result of Supramesocolic Ischemia after Scoliosis Surgery].
Včelák J, Štulík J, Barna M … +1 more , Špeldová A
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862589 · Publisher ↗
Ischemic complications in the supramesocolic anatomical region with the development of acute pancreatitis due to compression of the celiac artery or superior mesenteric artery are rare but potentially serious complicatio...
Ischemic complications in the supramesocolic anatomical region with the development of acute pancreatitis due to compression of the celiac artery or superior mesenteric artery are rare but potentially serious complications after major spine surgery. A case report of two patients with idiopathic scoliosis who underwent posterior instrumented correction and fusion with subsequent development of acute pancreatitis due to vascular compression of the retroperitoneum is presented. The manifestation of an acute abdomen within 24 hours after the surgery with elevation of pancreatic obstruction enzymes and confirmation of acute pancreatitis on CT angiography with abdominal pain, gastrectasia, and ileus clinical findings. In both cases, due to the clinical progression, acute revision spinal surgery was performed with release of the original deformity correction. Subsequently, in combination with conservative treatment of the acute abdomen, both patients achieved full clinical recovery.
Effects of General Anesthesia in Combination with Saphenous Nerve Block-Tibial Nerve Block on Analgesia for Total Knee Arthroplasty and Hemodynamic Indexes.
Liu D, Wang Y, Tang W
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862588 · Publisher ↗
PURPOSE OF THE STUDY: We aimed to assess the effects of general anesthesia (GA) plus saphenous nerve block-tibial nerve block (SNB-TNB) on analgesia for total knee arthroplasty (TKA) and hemodynamic indexes. MATERIAL AND...
PURPOSE OF THE STUDY: We aimed to assess the effects of general anesthesia (GA) plus saphenous nerve block-tibial nerve block (SNB-TNB) on analgesia for total knee arthroplasty (TKA) and hemodynamic indexes. MATERIAL AND METHODS: A control group and an observation group were set for equal allocation of 106 patients with knee osteoarthritis (KOA) treated with TKA during November 2021 and November 2023 through a random number table. GA was used for the control group, and GA plus SNB-TNB was performed for the observation group. Clinical indexes, analgesic effect, joint motion range, hemodynamic indexes and safety were compared between the two groups. RESULTS: The observation group had decreased fentanyl dosage, patient-controlled intravenous analgesia pump pressing times, morphine dosage, extubation time, and recovery time compared with those of the control group (P<0.05). The static and dynamic Visual Analog Scale scores at different time points were lower in the observation group than in the control group (P<0.05). The observation group had higher maximum flexion degree than that of the control group at different time points (P<0.05). The incidence rate of adverse reactions in the observation group was lower than that of the control group (P<0.05). DISCUSSION: SNB-TNB can comprehensively intervene with the tissues surrounding the knee joint, and nerve block techniques are capable of intercepting harmful inputs in a targeted manner, elevating pain threshold, inhibiting signaling transmission from nerve endings, and thus terminating the pain perception ability of the cortex. Nerve block mainly depends on local anesthesia, and is helpful for lowering the additional dose of opioids and maintaining the hemodynamic stability. CONCLUSIONS: Compared with simple GA, GA plus SNB-TNB applied in TKA is more conducive to accelerating the recovery of patients, reducing the anesthetic dosage, enhancing the analgesic effect, with more stable hemodynamics and higher safety.
[Functional Outcomes of Treatment of the Mallet Finger with a Bone Fragment Using the Ishiguro Extension].
Vlach M, Krejčí D, Havlas V
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862587 · Publisher ↗
PURPOSE OF THE STUDY: The study aims to evaluate the mid-term functional and subjective outcomes of treatment of the mallet finger with a bone fragment using the Ishiguro extension block pinning. The hypothesis was that...
PURPOSE OF THE STUDY: The study aims to evaluate the mid-term functional and subjective outcomes of treatment of the mallet finger with a bone fragment using the Ishiguro extension block pinning. The hypothesis was that this technique provides reliable and high-quality outcomes with a low complication rate. MATERIAL AND METHODS: The study included 54 patients aged 7-17 years who underwent surgery at our department between 2017 and 2022. The inclusion criteria were the diagnosis of the mallet finger with a Doyle type IVa and IVb bone fragment, subluxation of the distal interphalangeal joint, fracture fragment size greater than 30% of the articular surface on lateral view radiographs, and fragment dislocation greater than 2 mm. The surgeries were performed in line with the original description of the Ishiguro technique, with reduction and closed osteosynthesis of the fragment using Kirschner wires. The surgery was followed by fixation with a plaster cast for 4 weeks on average, and rehabilitation was recommended after pin removal. The outcomes were assessed using the QuickDASH questionnaire and the Crawford criteria. RESULTS: The mean QuickDASH score was 3.8, the median score was 0.0. A total of 59% of patients reported no difficulty or limitations, and 37% described minimal extension deficit with no subjective difficulty. Only 4% of patients experienced more severe difficulty such as significant extension deficit or pin track infection. No secondary subluxation of the distal interphalangeal joint was observed. DISCUSSION: The results of our study are in agreement with global literature, which also shows a predominantly excellent and good effect of the treatment of mallet finger by extension block pinning. Complications were associated with delayed treatment and patient noncompliance. The studies comparing different techniques show that the extension block pinning provides outcomes comparable to those achieved by other methods, or even better. CONCLUSIONS: The Ishiguro extension block pinning is a reliable, technically and financially undemanding technique that provides excellent outcomes in treating the mallet finger with a bone fragment. The use of this technique is also supported by the fact that it can be performed as an outpatient surgery under local anaesthesia and by its low complication rate. Nonetheless, further research is necessary to specify more accurately the indication criteria for surgical management of Doyle IVa and IVb lesions.
[Predictors of Knee Replacement Following Meniscal Tear Arthroscopy: a 7-Year Risk Prediction Model].
Fidler E, Sloviak M, Langová K … +1 more , Gallo J
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862586 · Publisher ↗
PURPOSE OF THE STUDY: The aim of this study was to analyze the outcomes of knee arthroscopy (KA) for degenerative meniscal tears in relation to early total knee arthroplasty (TKA) in the elderly population. The study foc...
PURPOSE OF THE STUDY: The aim of this study was to analyze the outcomes of knee arthroscopy (KA) for degenerative meniscal tears in relation to early total knee arthroplasty (TKA) in the elderly population. The study focused on identifying the factors that influence the need for TKA within seven years after previous arthroscopic partial meniscectomy (APM). MATERIAL AND METHODS: A total of 526 patients older than 64 years who underwent APM between January 1, 2010, and December 31, 2015, were included in the study. The patients were divided into three groups according to age. Specific patient data were extracted from the hospital information system. Preoperative, intraoperative, and postoperative data were collected according to a predefined protocol. RESULTS: A total of 118 patients (22.4%) underwent TKA within seven years after KA, with a mean time to TKA of 35.5 months. Notably, up to 30% of patients required TKA within one year of their initial KA. The mean age at the time of TKA was 72.2 years. Women had a higher risk than men (24.4% vs. 19.2% men; p = 0.195). When all factors were analyzed, postoperative pain (OR = 4.17; 95% CI: 2.03-8.553), varus knee alignment (OR = 2.45; 95% CI: 1.20-5.01), and BMI (OR = 1.11; 95% CI: 0.02-1.20) were significant predictors of TKA. When considering only preoperative factors, varus alignment on radiographs (OR = 2.39; 95% CI: 1.21-4.71), a higher radiographic grade of knee osteoarthritis (OR = 1.85; 95% CI: 1.12-3.07), and BMI (OR = 1.09; 95% CI: 1.01-1.17) were the strongest predictors of early TKA. Among intraoperative/postoperative findings, the presence of medial chondropathy confirmed during KA (OR = 2.07; 95%CI: 1.52-2.83) and postoperative pain (OR = 5.02; 95% CI: 2.75-9.17) were the only significant predictors. DISCUSSION AND CONCLUSIONS: This study highlights the risk of TKA in elderly patients undergoing APM. Previous studies have cautioned against performing this procedure in older patients, yet the optimal treatment for symptomatic knees with degenerative meniscal tears remains uncertain. Several factors may influence the progression of knee osteoarthritis in these patients, with knee biomechanics and pre-existing osteoarthritis being the most critical. Both can potentially be addressed with appropriate knee osteotomy, a procedure that has recently been shown to be effective in patients with knee osteoarthritis. Interestingly, age itself did not increase the risk of TKA in our study. In conclusion, our retrospective analysis showed that more than one-fifth of patients undergoing KA for degenerative meniscal tears may require TKA within seven years. In addition, preoperative varus knee alignment, advanced knee osteoarthritis, and higher BMI were identified as the strongest risk factors, suggesting that KA should be indicated with caution in such patients.
[Comparison of the Results of Expanded Arthroscopic Debridement and 18-Gauge Percutaneous Tenotomy in Lateral Epicondylitis].
Adigüzel IF, Bayrak HC, Orman O … +1 more , Ordu S
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862377 · Publisher ↗
PURPOSE OF THE STUDY: This retrospective comparative study aims to evaluate the clinical outcomes, cost-effectiveness, and complication rates associated with two minimally invasive surgical techniques: extended arthrosco...
PURPOSE OF THE STUDY: This retrospective comparative study aims to evaluate the clinical outcomes, cost-effectiveness, and complication rates associated with two minimally invasive surgical techniques: extended arthroscopic debridement and 18-gauge percutaneous tenotomy. MATERIAL AND METHODS: The study included 31 patients with resistant lateral epicondylitis who underwent either arthroscopic debridement (n=14) or percutaneous tenotomy (n=17) between January 2019 and June 2023. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) at preoperative, 3-month, 6-month, and 12-month intervals. Additionally, a detailed cost analysis was performed to compare the economic implications of both surgical techniques. RESULTS: The results demonstrated significant improvements in both groups at 3 and 6 months postoperatively. However, by the 12-month follow-up, the arthroscopic group maintained stable clinical outcomes, while the percutaneous group showed a decline in MEPS and PRTEE scores, suggesting a potential regression in long-term efficacy. Despite this, the percutaneous tenotomy group benefited from a shorter procedure time, fewer complications, and a quicker return to work, making it a highly cost-effective alternative. CONCLUSIONS: In conclusion, while extended arthroscopic debridement offers sustained clinical benefits, particularly in long-term follow-up, 18-gauge percutaneous tenotomy emerges as a viable primary intervention due to its simplicity, low complication rate, and significant cost savings. Future studies with larger cohorts and longer follow-up periods are warranted to further elucidate the long-term effectiveness and patient satisfaction associated with these techniques.
[Preoperative Incidence of Deep Venous Thrombosis and Its Risk Factors in Older Patients with Hip Fracture].
Pan T, Zhong D, Zhang H … +3 more , Xu J, Guan J, Peng X
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862373 · Publisher ↗
PURPOSE OF THE STUDY: Hip fractures in the elderly are commonly complicated by deep venous thrombosis (DVT), particularly in the preoperative phase. This retrospective study aimed to determine the preoperative incidence...
PURPOSE OF THE STUDY: Hip fractures in the elderly are commonly complicated by deep venous thrombosis (DVT), particularly in the preoperative phase. This retrospective study aimed to determine the preoperative incidence of DVT and identify its risk factors in older patients with hip fractures. MATERIAL AND METHODS: This single-center retrospective study enrolled 278 patients (aged ≥ 60 years) with unilateral hip fracture, who underwent color Doppler ultrasonography of the lower extremity veins on the day of surgery at the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine between 1st January 2015 and 31st December 2020. Demographic data, clinical characteristics, and surgical history were analyzed. Multivariate logistic regression was used to identify independent risk factors for preoperative DVT. RESULTS: The incidence of DVT was 15.5%, including peripheral venous thrombosis at 18.6% and central venous thrombosis at 5.4%. Univariate analysis showed no significant differences in gender, age, and type of fracture. However, delayed admission, longer time from admission to surgery, and atrial fibrillation were significant risk factors. Multivariate logistic regression analysis identified delayed admission (OR = 2.597, 95% CI 1.275-5.290, P = .009), prolonged time from admission to surgery (OR = 1.166, 95% CI 1.034-1.314, P = .012), and atrial fibrillation (OR = 2.848, 95% CI 1.115-7.275, P = .029) as significant independent risk factors for DVT. CONCLUSIONS: Early admission and prompt surgery of elderly patients with hip fractures are critical to prevent the occurrence of DVT. Atrial fibrillation remains a significant risk factor that requires close attention. Prospective studies are warranted to validate these findings and optimize prophylactic strategies.
[Isolated Lateral Subtalar Dislocation Due to Low-Energy Trauma].
Ülgen NK, Gencer B, Yeni TB … +1 more , Özgür D
Acta Chir Orthop Traumatol Cech · 2025 Jun · PMID 40862370 · Publisher ↗
Isolated subtalar dislocations constitute 1% of all dislocations and are extremely rare. They frequently occur as a result of high-energy trauma. Dislocations are classified based on the direction of the dislocation, wit...
Isolated subtalar dislocations constitute 1% of all dislocations and are extremely rare. They frequently occur as a result of high-energy trauma. Dislocations are classified based on the direction of the dislocation, with 80% being medial. Closed reduction under anesthesia without delay is the optimal treatment method. In our case, we present an extremely rare instance of an isolated lateral subtalar dislocation resulting from a low-energy injury. Although isolated subtalar dislocations are frequently reduced with closed reduction, open reduction was necessary in our case. The structure obstructing reduction in lateral dislocations is often reported to be the tibialis posterior tendon. During open reduction, we identified and documented the tibialis posterior tendon as the obstructing structure. We have also discussed the post-reduction follow-up protocol.
[Biomarkers and Their Role in Understanding Osteoarthritis].
Hlubek R, Kušnierová P, Walder P … +2 more , Bystroňová I, Douša P
Acta Chir Orthop Traumatol Cech · 2025 Mar · PMID 40145590 · Publisher ↗
Osteoarthritis (OA) is a degenerative joint disease characterized by progressive damage and loss of articular cartilage with concomitant structural and functional changes in the joint. It is the most common cause of join...
Osteoarthritis (OA) is a degenerative joint disease characterized by progressive damage and loss of articular cartilage with concomitant structural and functional changes in the joint. It is the most common cause of joint pain globally and the resulting productivity loss to the economy. The clinical symptoms of osteoarthritis are mostly determined by the difficulties of patients related to the development of articular degenerative changes, which secondarily lead to joint stiffness and functional limitation. The diagnosis of this disease is currently based on typical clinical symptoms and radiographic findings (e.g. joint space narrowing, osteophytes, subchondral sclerosis, etc.). These parameters, however, are difficult to detect in the early stages of the disease and are most often recognized in the advanced stages. For these reasons, the diagnosis of osteoarthritis is often delayed until irreversible destruction of joint tissue occurs and conservative treatment is less effective. Despite recent scientific progress in understanding the genetic and molecular principles of joint degeneration, currently there is no reliable causal therapy for OA. This review aims to summarize current knowledge of osteoarthritis and possible future directions for diagnosis and early intervention. One of such directions is the study of the so-called biomarkers. A biomarker is defined as an indicator of biological processes and can include radiographic, histological, physiological, or molecular characteristics. In particular, molecular biomarkers are widely studied in knee OA. Attention of the research community is focused on the study of biomarkers as a method of detection and prediction of the early stages of osteoarthritis before irreversible joint damage occurs. Biomarkers help develop more effective and, above all, personalized treatment, thus improve the overall clinical approach to the patient.
[Combined Proximal Radius Reconstruction Following Resection for Oncological Indication].
Malina M, Majerčík M, Naser Y
Acta Chir Orthop Traumatol Cech · 2025 Mar · PMID 40145589 · Publisher ↗
Early surgical treatment of giant cell tumour of the bone has very good functional outcomes with a relatively low risk of local recurrence and metastatic spread.In case of a pathologic fracture, extraosseous extension, a...
Early surgical treatment of giant cell tumour of the bone has very good functional outcomes with a relatively low risk of local recurrence and metastatic spread.In case of a pathologic fracture, extraosseous extension, and tumor location in an anatomically difficult area, surgical treatment may represent a big challenge with an uncertain functional outcome.Our case report presents a 35-year-old patient with a delayed diagnosis of giant cell tumor of the proximal radius of the dominant limb, with pulmonary metastases. Following neoadjuvant Denosumab therapy, with a major treatment effect on both the primary tumor and pulmonary metastases, we performed a wide resection and combined biological reconstruction with fibular autograft, radial head endoprosthesis, and comprehensive elbow ligament reconstruction.At 24 months after surgery, the patient is self-sufficient, capable of more physically demanding work, with a satisfactory functional outcome of reconstruction (MSTS 66.6%, TESS 69%), with no signs of local recurrence and regression of pulmonary metastases at 18 months after the last administration of Denosumab.
[Early Surgical Treatment Options for Anterior Cruciate Ligament Injury].
Hušek F, Mizera R, Čapek L … +1 more , Horák Z
Acta Chir Orthop Traumatol Cech · 2025 Mar · PMID 40145588 · Publisher ↗
Anterior cruciate ligament (ACL) is one of the most commonly injured structures in distortion injuries of the knee joint. Currently, there is no consensus among the professional community regarding the basic principles a...
Anterior cruciate ligament (ACL) is one of the most commonly injured structures in distortion injuries of the knee joint. Currently, there is no consensus among the professional community regarding the basic principles and timing of ACL injury management. An analysis of several retrospective studies from the 2008-2023 period provides information on ACL preservation procedures and a comparison of these results with those of ACL reconstruction surgery using a graft. The most comprehensive information was provided by a large meta-analysis conducted by Van der List et al. in 2019, which compared 1101 patients from 13 studies who had undergone an ACL preservation surgery. Wilson et al. carried out a retrospective study of patients who underwent ACL repair with InternalBrace (Arthrex© implant system) ligament augmentation. In their meta-analysis, Van der List et al. reported the failure rate of 7-11% and the functional outcome score > 85% of maximum scores in the scoring systems used (Lysholm, KOOS, IKDC score) for the preservation procedures. Wilson et al. in their retrospective study reported the failure rate of 10.4% and the functional outcome > 87% of maximum scores in the scoring systems used. These values are consistent with similar outcomes reported in patients undergoing ACL reconstruction surgery using a graft. According to the available literature, the primary ACL refixation with InternalBrace augmentation for proximal ruptures appears to be a safe technique with satisfactory outcomes when properly timed and indicated. In acute proximal ruptures, this technique should be considered as an alternative to ACL reconstruction using a graft, with potential benefits of preserving the original tissue and proprioception of the ligament. A prospective randomized study which would compare these two surgical techniques is still lacking in the literature.
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