Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca[JOURNAL]
Sun
200 papers
Antimicrobial Activity of the Most Common Antibiotic-Releasing Systems Employed in Current Orthopedic Surgery: in vitro Study.
Štícha R, Fulín P, Nyč O … +3 more , Gajdošová V, Pokorný D, Šlouf M
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37395426
PURPOSE OF THE STUDY Infections of joint replacements represent one of the most serious problems in contemporary orthopedics. The joint infections treatment is usually multimodal and involves various combinations of drug...
PURPOSE OF THE STUDY Infections of joint replacements represent one of the most serious problems in contemporary orthopedics. The joint infections treatment is usually multimodal and involves various combinations of drug delivery and surgical procedures. The aim of this study was to evaluate and compare the bacteriostatic and bactericidal properties of the most common antibiotic carriers used in orthopedic surgery: bone cements mixed with antibiotic and porous calcium sulfate mixed with antibiotic. MATERIAL AND METHODS Three commercial bone cements (Palacos®, Palacos® R+G, Vancogenx®) and commercial porous sulfate (Stimulan®) were prepared with a known concentration of vancomycin (a glycopeptide antibiotic). Specifically, for the purpose of our study, the testing specimens were prepared to release 0, 1, 2, 4, 8, 16, 32, 64, 128, 256, and 512 mg of vancomycin into 1 liter of solution. The specimens with increasing amount of antibiotic were placed in a separate tubes containing 5 mL of Mueller-Hinton broth inoculated with a suspension (0.1 m, McFarland 1) of the reference strain CCM 4223 Staphylococcus aureus to evaluate their bacteriostatic properties (broth dilution method). After this initial incubation and evaluation of the broth dilution method, an inoculum from each tube was transferred onto blood agar plates. After another 24-hour incubation under the same conditions, we evaluated the bactericidal properties (agar plate method). As many as 132 of independent experiments were performed (4 specimens × 11 concentrations × 3 repetitions = 132). RESULTS The bacteriostatic properties of all investigated samples were excellent, perhaps with the exception of the first bone cement (Palacos®). The sample Palacos® started to exhibit bacteriostatic properties at concentrations ≥ 8 mg/mL, while all other samples (Palacos R+G®, Vancogenx®, and Stimulan®) were bacteriostatic in the whole concentration range starting from 1 mg/mL. The bacteriocidic properties did not show such clear trends, but correlated quite well with different properties of the investigated samples during mixing - the most homogeneous samples seemed to exhibit the best and the most reproducible results. DISCUSSION The reliable and reproducible comparison of ATB carriers is a difficult task. The situation is complicated by high numbers of local antibiotic carriers on the market, numerous antibiotics used, and differences in clinical trials at different laboratories. Simple in vitro testing of bacteriostatic and bacteriocidic properties represents a simple and efficient approach to the problem. CONCLUSIONS The study confirmed that the two most common commercial systems used in the orthopedic surgery (bone cements and porous calcium sulfate) prevent bacterial growth (bacteriostatic effect), but they may not be 100% efficient in complete elimination of bacteria (bacteriocidic effect). The scattered results in the case of bacteriocidic tests seemed to be connected with the homogeneity of ATB dispersion in the systems and with the lower reproducibility of the employed agar plate method. Key words: local release of antibiotics; bone cements; calcium sulfate; antimicrobial susceptibility.
Popliteal Fossa Sarcomas.
Erdogan O, Çeli K A, Yildirim ANT … +6 more , Tekçe E, Altun G, Demiröz S, Güler Y, Ozkan K, Gurkan V
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37395425
PURPOSE OF THE STUDY Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%-5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular invol...
PURPOSE OF THE STUDY Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%-5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample. MATERIAL AND METHODS Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes. The minimum follow-up was 24 months. RESULTS The mean age of the patients was 48 ± 21.23 (range 3-72) years at the time of diagnosis. The mean follow-up was 41.79 ± 16.97 (range 24-120) months. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), unidentified fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (26%). At the latest followup, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease. CONCLUSIONS Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins. Key words: fossa poplitea, sarcoma.
[Effects of Tranexamic Acid on Perioperative Blood Loss and Wound Hematoma Development in Lumbar Spine Surgery: a Prospective Randomized Study].
Stejskal P, Trnka Š, Hrabálek L … +3 more , Wanek T, Jablonský J, Novák V
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37395424
PURPOSE OF THE STUDY Tranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss...
PURPOSE OF THE STUDY Tranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss reduction in specific surgical procedures. The aim of our study was to evaluate the effect of tranexamic acid on reducing intraoperative blood loss, postoperative blood loss into the drain, total blood loss, transfusion requirements, and development of symptomatic wound hematoma in conventional single-level lumbar decompression and stabilization. MATERIAL AND METHODS The study included patients who had undergone a traditional open lumbar spine surgery in the form of single-level decompression and stabilisation. The patients were randomized into two groups. The study group received a 15 mg/kg dose of tranexamic acid intravenously during the induction of anaesthesia and then again 6 hours later. No tranexamic acid was administered to the control group. In all patients, intraoperative blood loss, postoperative blood loss into the drain, and therefore also total blood loss, transfusion requirements and potential development of a symptomatic postoperative wound hematoma requiring surgical evacuation were recorded. The data of the two groups were compared. RESULTS The cohort includes 162 patients, 81 in the study group and the same number in the control group. In the intraoperative blood loss assessment, no statistically significant difference between the two groups was observed; 430 (190-910) mL vs. 435 (200-900) mL. In case of post-operative drain blood loss, a statistically significantly lower volume was reported after the tranexamic acid administration; 405 (180-750) mL vs. 490 (210-820) mL. When evaluating the total blood loss, a statistically significant difference was also confirmed, namely in favour of the tranexamic acid; 860 (470-1410) mL vs. 910 (500- 1420) mL. The reduction of total blood loss did not result in a difference in the number of administered transfusions; transfusions were given to 4 patients in each group. A postoperative wound hematoma requiring surgical evacuation developed in 1 patient in the group with the tranexamic acid and in 4 patients in the control group, but the difference was not statistically significant with respect to the insufficient group size. No patient in our study experienced complications associated with tranexamic acid application. DISCUSSION The beneficial effect of tranexamic acid on reducing blood loss in lumbar spine surgeries has already been confirmed by numerous meta-analyses. The question remains in what types of procedures, at what dose and route of administration its effect is significant. To date, most of the studies have explored its effect in multi-level decompressions and stabilizations. Raksakietisak et al., for instance, report significant reduction in total blood loss from 900 (160, 4150) mL to 600 (200, 4750) mL following an intravenous injection of 2 bolus doses of 15 mg/kg tranexamic acid. In less extensive spinal surgeries, the effect of tranexamic acid may not be that distinct. In our study of single-level decompressions and stabilizations, no reduction in the actual intraoperative bleeding was confirmed at the given dosage. Its effect was seen only in the postoperative period in a significant reduction of blood loss into the drain, thus also in the total blood loss, although the difference between 910 (500, 1420) mL and 860 (470, 1410) mL was not that significant. CONCLUSIONS By intravenous application of tranexamic acid in 2 bolus doses in single-level decompression and stabilization of the lumbar spine a statistically significant reduction in postoperative blood loss into the drain and also total blood loss was confirmed. The reduction in the actual intraoperative blood loss was not statistically significant. No difference was observed in the number of administered transfusions. Following the tranexamic acid administration, a lower number of postoperative symptomatic wound hematomas was recorded, but the difference was not statistically significant. Key words: tranexamic acid, spinal surgeries, blood loss, postoperative hematoma.
[Thoracolumbar Compression Fractures in Children].
Štulík J, Salavcová L, Trč T … +3 more , Havránek P, Pešl T, Barna M
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37395423
PURPOSE OF THE STUDY The study aimed to draw up a diagnosis and treatment guidelines for the management of the most common compression fractures of the thoracolumbar spine in children. MATERIAL AND METHODS Between 2015 a...
PURPOSE OF THE STUDY The study aimed to draw up a diagnosis and treatment guidelines for the management of the most common compression fractures of the thoracolumbar spine in children. MATERIAL AND METHODS Between 2015 and 2017, pediatric patients with a thoracolumbar injury aged 0-12 years were followed up in the University Hospital in Motol and the Thomayer University Hospital. The age and gender of the patient, injury etiology, fracture morphology, number of injured vertebrae, functional outcome (VAS and ODI modified for children), and complications were assessed. An X-ray was performed in all patients, in indicated cases also an MRI scan was done, and in more severe cases a CT scan was obtained as well. RESULTS The average vertebral body kyphosis in patients with one injured vertebra was 7.3° (range 1.1°-12.5°). The average vertebral body kyphosis in patients with two injured vertebrae was 5.5° (range 2.1°-12.2°). The average vertebral body kyphosis in patients with more than two injured vertebrae was 3.8° (range 0.2°-11.5°). All patients were treated conservatively in line with the proposed protocol. No complications were observed, no deterioration of the kyphotic shape of the vertebral body was reported, no instability occurred, and no surgical intervention had to be considered. DISCUSSION Pediatric spine injuries are in most cases treated conservatively. Surgical treatment is opted for in 7.5-18% of cases, in dependence on the evaluated group of patients, age of the patients and philosophy of the department concerned. In our group, all patients were treated conservatively. CONCLUSIONS 1. To diagnose F0 fractures, two unenhanced orthogonal view X-rays are indicated, whereas MRI examination is not routinely performed. In F1 fractures, an X-ray is indicated, and an MRI scan is considered based on the age and extent of injury. In F2 and F3 fractures, an X-ray is indicated and subsequently the diagnosis is confirmed by MRI, in F3 fractures also a CT scan is performed. 2. In young children (under 6 years of age), in whom an MRI procedure would require general anaesthesia, MRI is not routinely performed. 3. In F0 fractures, crutches or a brace are not indicated. In F1 fractures, verticalization using crutches or a brace is considered in dependence on the patient's age and extent of injury. In F2 fractures, verticalization using crutches or a brace is indicated. 4. In F3 fractures, surgical treatment is considered, followed by verticalization using crutches or a brace. In case of conservative treatment, the same procedures as in F2 fractures are applied. 5. Long-term bed rest is contraindicated. 6. Duration of spinal load reduction (restriction of sports activities, or verticalization using crutches or a brace) in F1 injuries is 3-6 weeks based on the age of the patient, it increases with the age, with the minimum being 3 weeks. 7. Duration of spinal load reduction (verticalization using crutches or a brace) in F2 and F3 injuries is 6-12 weeks based on the age of the patient, it increases with the age, with the minimum being 6 weeks. Key words: pediatric spine injury, thoracolumbar compression fractures, children trauma treatment.
[Surgical Treatment of Degenerative Lumbar Stenosis and Spondylolisthesis: Clinical Practice Guideline].
Kaiser R, Kantorová L, Langaufová A … +14 more , Slezáková S, Tučková D, Klugar M, Klézl Z, Barsa P, Cienciala J, Hajdúk R, Hrabálek L, Kučera R, Netuka D, Prýmek M, Repko M, Smrčka M, Štulík J
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37395422
PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part...
PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) "The Surgical Treatment of the Degenerative Diseases of the Spine". MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondylolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). Key words: degenerative lumbar stenosis, degenerative spondylolisthesis, spinal fusion, Clinical Practice Guideline, GRADE, adolopment.
[Pathological Lesions and Fractures of the Proximal Femur].
Urban M, Luňáček L, Bartoška R … +2 more , Maléř J, Skála-Rosenbaum J
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37156003
PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the...
PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the results of the selected surgical therapy, survival time of the patients and postoperative complications. MATERIAL AND METHODS We retrospectively evaluated the group of patients operated on from 2012 to 2021. The study included 45 patients (24 women and 21 men) with a pathological lesion or a pathological fracture in the area of the proximal femur. The average age was 67 years (38-90). There were 30 (67%) cases of pathological fracture and 15 (33%) cases of pathological lesions in the cohort. In each patient, the perioperative biopsy or resected sample was sent for histological examination. The type of primary malignancy with the localization of lesions and fractures was assessed. Furthermore, we evaluated the outcomes of the surgical method chosen and its complications. We monitored the patients' functional score using the Karnofsky performance status and survival interval. RESULTS The most common primary malignancy was multiple myeloma in 10 cases (22%), followed by seven cases (16%) of breast and lung cancer and 6 cases (13%) of clear cell renal cell carcinoma. Internal fixation was used in 15 cases (33%). Tumor resection with hip joint replacement was performed in 29 patients (64%). One patient was treated with percutaneous femoroplasty. Out of a total of 45 patients, 10 patients (22%) survived for less than three months. The survival rate of more than one year was observed in 21 patients (47%). A total of seven complications occurred in six patients (15%). Fewer complications occurred in the group of patients with a pathological fracture compared to the group with an impending fracture. DISCUSSION Pathological lesions in the bone or an already existing pathological fracture are signs of advanced cancer. Better outcomes are reported in patients who underwent prophylactic surgery, which was, however, not confirmed by our study. The incidence of individual primary malignancies, the postoperative complications and the patient survival corresponded to the statistical data reported by the other authors. CONCLUSIONS In patients with a pathological lesion of the proximal femur, operative treatment will increase the quality of life, either when choosing osteosynthesis or joint replacement, while prophylactic treatment is usually associated with a better prognosis. As a less invasive procedure with lower blood loss, osteosynthesis is indicated for palliative therapy in patients with a limited expected survival time or in patients with a prognosis of healing of the lesion. Reconstruction of the joint with an arthroplasty is indicated in patients with a better prognosis or in cases excluding safe osteosynthesis. Our study confirmed good outcomes with the use of an uncemented revision femoral component. Key words: metastasis, osteolysis, pathological fracture, proximal femur.
The Tibia Plafond Horizontal Orientation Angle for Frontal Alignment Evaluation of the Distal Lower Extremity.
Alshrouf MA, Ahrend MD, Konrads C
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37156002
PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The...
PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The aim of this study was to determine if the Tibia Plafond Horizontal Orientation Angle (TPHA) is a reliable measure for describing ankle alignment of the distal tibia in the coronal plane. MATERIALS AND METHODS This retrospective study included patients who underwent supracondylar rotational osteotomies for correction of femoral torsion. All patients had standing radiographs taken preoperatively and postoperatively with both knees pointed forward. Five variables, including Mechanical Lateral Distal Tibia Angle (mLDTA), Mechanical Malleolar Angle (mMA), Malleolar Horizontal Orientation Angle (MHA), Tibia Plafond Horizontal Orientation Angle (TPHA), and Tibio Talar Tilt Angle (TTTA), were collected. The preoperative and postoperative measurements were compared to each other using the Wilcoxon signed rank test. RESULTS A total of 146 patients were included in the study, with a mean age of 51.47 ± 11.87 years. There were 92 (63.0%) males and 54 (37.0%) females. MHA decreased from 14.0° ± 5.32° preoperatively to 10.59° ± 3.93° (p < 0.001) postoperatively, and TPHA decreased from 4.88° ± 4.07° preoperatively to 3.82 ± 3.10° (p = 0.013) postoperatively. The change in TPHA was significantly correlated with the change in MHA (r = 0.185, CI 0.023 - 0.337; p = 0.025). No differences were found between the measurements of mLDTA, mMA, and mMA pre- and postoperatively. DISCUSSION The orientation of the ankle should be taken into consideration during preoperative planning of osteotomies and should be measured in cases of postoperative ankle pain. CONCLUSIONS The TPHA is a reliable measure for describing ankle alignment of the distal tibia in the frontal plane. Key words: osteotomy, ankle, realignment, coronal alignment, preoperative planning.
[Modified Harrington Procedure in the Treatment of Extensive Tumor Defects of the Acetabulum].
Lesenský J, Blecha O, Včelák J
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37156001
PURPOSE OF THE STUDY The increasing prevalance of patients with metastatic bone cancer and their improved survival puts more emphasis on the quality of treatment of bone metastases. Although most pelvic lesions are treat...
PURPOSE OF THE STUDY The increasing prevalance of patients with metastatic bone cancer and their improved survival puts more emphasis on the quality of treatment of bone metastases. Although most pelvic lesions are treated non-operatively, extensive destruction of the acetabular segment poses a therapeutic challenge. A potential treatment option may be the modified Harrington procedure. MATERIAL AND METHODS At our department, this surgical procedure has been opted for in 14 patients (5 men and 9 women) since 2018. The mean age at the time of surgery was 59 years (range 42 to 73). Twelve patients suffered from metastatic cancer, one patient had a fibrosarcoma metastasis and one female patient presented with aggressive pseudotumor. Radiological and clinical followup of the patients was performed. Pain was assessed using the Visual Analogue Scale, and the Harris Hip Score and the MSTS score were used to evaluate the functional outcome. The paired samples Wilcoxon test was used to analyze the statistical significance of the difference. RESULTS The mean follow-up period was 25 months. At the time of assessment, ten patients were alive with the mean follow-up of 29 months (range 2 to 54 months) and four patients had died of cancer progression, with the mean follow-up being 16 months. No perioperative death or mechanical failure were reported. One female patient developed a hematogenous infection during febrile neutropenia, which was successfully managed with early revision and implant preservation. Statistically, a significant improvement in the MSTS (median 23) and HHS (median 86) functional scores compared to the preoperative values (MSTS median 2, p<0.01, r-effect size = 0.6; HHS preop median 0, p<0.005, r-effect size = -0.7) was observed. There was also a statistically significant reduction in pain (VAS postoperative median 1, VAS preoperative median 8, p<0.01, r-effect size = -0.6). All patients were capable of independent ambulation after the surgery, nine patients walked without support. DISCUSSION There are not many alternatives to this surgical procedure. Apart from non-operative palliative treatment, the options include ice cream cone prostheses or customized 3D implants which are, impractical in terms of time and cost. Our results are comparable to other studies, confirming the reproducibility and reliability of the method. CONCLUSIONS The Harrington procedure is an efective method for management of large acetabular tumor defects with good functional outcomes, an acceptable perioperative risk and a low risk of failure in the medium term, thus suitable also for patients with good cancer prognosis. Key words: umor, metastasis, acetabulum, pelvis, Harrington, reconstruction.
[Surgical Treatment of Tuberculous Spondylodiscitis].
Včelák J, Král A, Šlégl M … +2 more , Lesenský J, Macko M
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37156000
PURPOSE OF THE STUDY The paper presents a monocentric retrospective study of patients treated surgically for spinal tuberculosis. Clinical and radiological results are analysed, early and late complications are recorded....
PURPOSE OF THE STUDY The paper presents a monocentric retrospective study of patients treated surgically for spinal tuberculosis. Clinical and radiological results are analysed, early and late complications are recorded. The study aims to answer the following questions. 1. Can we use instrumentation to restore the stability and alignment in the infected spinal focus? 2. Should we always perform radical anterior resection of TBC lesions? 3. What is the prognosis of surgical treatment of TBC patients with neurological deficit manifestation? MATERIAL AND METHODS Between 2010 and 2020, a total of 12 patients were treated for spinal tuberculosis at our department, of whom 9 patients (5 men, 4 women) with the mean age of 47.3 years (range 29 to 83 years) underwent a surgery. A total of three patients were operated on before the final confirmation of the TBC and treatment with antituberculosis medication, four patients in the initial therapy phase and two patients in the continuous phase. Two patients only underwent a non-instrumented decompression surgery followed by external support fixation. In the other seven patients, always with spinal deformity, instrumentation was used (3 cases of isolated posterior decompression, transpedicular fixation, posterior fusion, 4 cases of anteroposterior instrumented reconstruction). In 2 cases a structural bone graft and in 2 cases an expandable titanium cage were used for anterior column reconstruction. RESULTS Of the total number of patients, altogether eight patients were assessed at 1 year after surgery (one 83-year-old patient died from heart failure 4 months after surgery). Of the remaining eight patients, three patients exhibited a neurological deficit and postoperative regression of the finding. The McCormick score improved from the preoperative mean score of 3.25 to 1.62 at 1 year after surgery (p < 0.001). The clinical VAS score regressed from 5.75 to 1.63 at 1 year after surgery (p < 0.001). Radiographic healing of the anterior fusion was achieved in all patients, both after decompression and instrumented surgery. The initial mean kyphosis of 20.36 degrees of the operated segment measured by the mCobb angle was corrected to 14.6 degrees postoperatively, with a subsequent slight deterioration to 14.86 degrees (p < 0.05). The greatest correction was achieved in patients who had undergone a two-stage surgery with anterior resection and AP reconstruction. DISCUSSION In our cohort, titanium instrumentation was used in seven of nine patients. One patient only manifested persistent tuberculosis with nonspecific bacterial flora superinfection. Revision surgery with anterior radical debridement and subsequent treatment with antituberculotic drugs healed the patient. There were four patients with major preoperative neurological deficit persisting more than 2 weeks before the final treatment with subsequent improvement in all cases. These patients were treated with anteroposterior reconstruction and anterior radical debridement. CONCLUSIONS No increased risk of recurrent infection associated with the use of spinal instrumentation was found in the study. Anterior radical debridement is performed in patients with manifested kyphotic deformity and spinal canal compression, followed by reconstruction with a structural bone graft or a titanium cage. The other patients are treated based on the principle of "optimal" debridement with or without the use of transpedicular instrumentation. If adequate spinal canal decompression and stability are achieved, neurological improvement can be anticipated even in case of a major neurological deficit. Key words: spine tuberculosis, tuberculous spondylitis, Pott's disease, anterior debridement, spine instrumentation.
Assessing Knee Stability in Adolescent Athletes with Osgood-Schlatter Disease Using the Y-Balance Test.
Hladky V, Kaplan A, Smetanova J … +1 more , Havlas V
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37155999
PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly wo...
PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.
Fixation of Knee Osteochondral Lesions in Pediatric Patients with Magnesium-Based Implants.
Hanák F, Havlas V
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37155998
PURPOSE OF THE STUDY Fixation of osteochondral fragments are relatively common procedures in pediatric orthopaedic surgery. The use of biodegradable magnesium implants in these indications appears to be a promising alter...
PURPOSE OF THE STUDY Fixation of osteochondral fragments are relatively common procedures in pediatric orthopaedic surgery. The use of biodegradable magnesium implants in these indications appears to be a promising alternative to polymer implants due to their favorable mechanical properties and biological behavior. The purpose of this study is to evaluate the short-term clinical and radiological outcomes of the fixation of unstable or displaced osteochondral fractures and osteochondritis dissecans lesions in the knee joint using MAGNEZIX® screws and pins in pediatric patients. MATERIAL AND METHODS In this study, 12 patients (5 girls, 7 boys) were included. The inclusion criteria were as follows (1) age below 18 years; (2) unstable or displaced osteochondral fragments secondary to trauma or as a result of osteochondritis dissecans, Grades III and IV in the ICRS (International Cartilage Repair Society) score, confirmed by imaging methods and indicated for surgical fixation; (3) fixation performed using screws or pins made of the magnesium-based MAGNEZIX® alloy; (4) minimum postoperative interval of 12 months. X-rays and clinical evaluation were assessed 1 day, 6 weeks, 3, 6, and 12 months after the operation. MRIs were performed 1-year postoperatively for evaluation of bone response and degradation behavior of implants. RESULTS The mean age at surgery was 13.3 ± 1.6 years. A total of 25 screws were used in 11 patients, a mean of 2.4 ± 1 per patient, 4 pins were used in 1 patient. In 2 patients, fixation with screws was complemented with fibrin glue. The mean follow-up was 14.2 ± 3.3 months. All patients exhibited complete functional recovery while showing no signs of pain at 6 months postoperatively. No adverse local reactions were observed. At 1-year follow-up, no implant failure has been reported. Complete radiographic healing occurred in 12 cases. Mild radiolucent zones were observed around the implants. CONCLUSIONS The use of screws and pins MAGNEZIX® has been found to provide satisfactory outcomes in terms of fracture healing and very good functional outcomes at 1 year postoperatively. Key words: biodegradable implants, magnesium-based implants, osteochondral fracture, osteochondritis dissecans, MAGNEZIX®.
Treatment of Hip Dislocation in Cerebral Palsy with Extraarticular Intervention.
Sarikaya IA, Birsel SE, Erdal OA … +3 more , Görgün B, Şeker A, İnan M
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37155997
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotatio...
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
Type IV Titanium Hypersensitivity: Rare, or Rarely Detected?
Voves J, Měrka O, Čabanová K … +2 more , Janošek J, Bajor G
Acta Chir Orthop Traumatol Cech · 2023 · PMID 37155996
The presented review aims to summarize the current knowledge of hypersensitivity to titanium - a material widely used in medical applications thanks to its exceptional chemical stability, resistance to corrosion, low spe...
The presented review aims to summarize the current knowledge of hypersensitivity to titanium - a material widely used in medical applications thanks to its exceptional chemical stability, resistance to corrosion, low specific weight and high strength. The hypersensitivity to metals is usually caused by the Type IV immunopathological reaction. Case reports on allergic reactions to titanium are rare but the actual occurrence can be expected to be much higher, especially due to its problematic detection. Although cutaneous patch tests are widely accepted and used for the diagnosis of hypersensitivity of numerous metals (e.g. Ni), it is notoriously unreliable in case of allergies to titanium, which may be associated with the low percutaneous transport of titanium and its salts. The Lymphocyte Transformation Test has superior sensitivity but it remains mostly unknown among clinicians and there are not many laboratories capable of performing it. This review presents numerous case reports indicating, in combination with the above-mentioned facts, that hypersensitivity to titanium should be considered as a possible cause also in non-specific problems associated with titanium implant failure. Key words: titanium, allergy, patch test, lymphocyte transformation test.
High-Grade Chondrosarcoma of the Proximal Phalanx: an Unusual Case of a Rare Entity.
Pagnotta A, Formica VM, Taccogna S … +2 more , Summa G, Zoccali C
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907586
Chondrosarcoma of the hand is a rare disease, but is one of the more common malignancies of the hand. Biopsies and imaging are a fundamental step in determining correct diagnosis, grading and selection for best treatment...
Chondrosarcoma of the hand is a rare disease, but is one of the more common malignancies of the hand. Biopsies and imaging are a fundamental step in determining correct diagnosis, grading and selection for best treatment. We describe the case of a 77-year-old male complaining of a painless swelling in the proximal phalanx of the third ray of left hand. A biopsy was performed and the histology revealed a G2 chondrosarcoma. The patient underwent III ray amputation with metacarpal bone disarticulation and sacrifice of the radial digit nerve of the fourth ray. Definitive histology revealed grade 3 CS. Eighteen months after surgery, the patient is apparently disease-free with a good functional and aesthetic outcome although with persistent paresthesia of the fourth ray. Although there is no agreement in the literature for the treatment of low-grade chondrosarcomas, wide resection or amputation can be considered the mainstay treatment for high-grade tumors. Key words: chondrosarcoma, proximal phalanx, ray amputation, surgical treatment, tumor hand.
[First Experience with Diaphragm Pacing System in the Czech Republic].
Kříž J, Jaroščiaková S, Šedivá K … +3 more , Hyšperská V, Čadová K, Přikrylová Z
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907585
Patients with impaired diaphragm function are dependent on long-term mechanical ventilation. It is associated with numerous health complications as well as significant economic burden. Intramuscular diaphragm stimulation...
Patients with impaired diaphragm function are dependent on long-term mechanical ventilation. It is associated with numerous health complications as well as significant economic burden. Intramuscular diaphragm stimulation through laparoscopic implantation of pacing electrodes is a safe method which enables restoring breathing using diaphragm in a considerable number of patients. The first implantation of diaphragm pacing system in the Czech Republic was performed in a thirty-four-year-old patient suffering from a high-level cervical spinal cord lesion. After eight years of mechanical ventilation support, just five months from initiation of stimulation, the patient is able to breathe spontaneously for ten hours per day on average, with expected total weaning. Once the insurance companies decide to reimburse the pacing system, a widespread use of the method even in patients with other diagnoses, including children, is expected. Key words: electrical stimulation, diaphragm, spinal cord injury, laparoscopic surgery.
5th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?
Demel J, Planka L, Stichhauer R … +4 more , Vrtkova A, Bajor G, Havlicek M, Pleva L
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907584
PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or con...
PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.
[Posterior Tibial Slope as a Morphological Risk Factor for Anterior Cruciate Ligament Reconstruction: a Retrospective Cohort Study].
Kalina R, Melecký D, Neoral P … +2 more , Gallo J, Sigmund M
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907583
PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retr...
PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p<0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p < 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p < 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL reconstruction failure. Since the posterior tibial slope is easily measured on the baseline X-rays, we recommend to perform this measurement routinely before each ACL reconstruction. In the case of a high posterior tibial slope, slope correction should be considered to prevent potential ACL reconstruction failure. Key words: anterior cruciate ligament reconstruction, ACL graft failure, morphological risk factors, posterior tibial slope.
[Benefit of Arthroscopy in Differential Diagnostics and Therapy of Lateral Epicondylitis].
Křiváček A, Vodička Z, Krejčí F … +2 more , Papežová L, Musil D
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907582
PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better resu...
PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18-61 years) in men and 45.8 years (range 18-60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen - either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0-5 very good, 6-15 good, 16-35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95-2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50-6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. Key words: lateral epicondylitis, radiohumeral plica, elbow arthroscopy.
Which is the Best Solution for Achieving Maximal Interfragmentary Compression of the Scaphoid Fractures - One or Two Herbert Screws?
Simeonov L
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907581
PURPOSE OF THE STUDY To compare the treatment outcome of scaphoid facture fixation with one versus two Herbert screws (HBS). MATERIAL AND METHODS 72 patients underwent open reduction internal fixation (ORIF) following ac...
PURPOSE OF THE STUDY To compare the treatment outcome of scaphoid facture fixation with one versus two Herbert screws (HBS). MATERIAL AND METHODS 72 patients underwent open reduction internal fixation (ORIF) following acute scaphoid fracture, and were followed prospectively by one surgeon. All fractures were Herbert & Fisher classification type B, the most common fracture lines being oblique (n=38) and transverse (n=34). Fractures with similar fracture lines were randomly assigned into two groups; fractures stabilized with one HBS (n=42) and fractures stabilized with two HBS (n=30). A specific methodology was developed for placement of two HBS; in the case of transverse fractures, screws were introduced perpendicular to the fracture line, for oblique fractures the first screw was placed perpendicular to the fracture line and the second screw was placed along the longitudinal axis of the scaphoid. RESULTS Patients were followed for a total 24 months, no patients were lost to follow-up. Outcome measures included bone healing, duration to bone healing, carpal geometry, range of motion (ROM), grip strength, and the Mayo Wrist Score. Patient rated outcomes were measured using DASH. Bone healing was radiographically and clinically confirmed in 70 patients. There were two non-unions after fixation with one HBS. Radiographic angles in both groups did not differ significantly from the physiological values. The mean duration to bone union was 1.8 months for one HBS and 1.5 months for two HBS. Mean grip strength was 47 kg in the group with one HBS (16-70 kg), 94 % of the unaffected hand, and 49 kg in the group with two HBS, 97% unaffected hand. The average Visual Analog Scale (VAS) score for the group with one HBS was 2.5, while for the group with two HBS was 2.0. Both groups had excellent and good results. For the group with two HBS, they are more. (100% for those fixed with two HBS and for those fixed with one HBS = 95% excellent and good and 5% bad results). DISCUSSION A review of the literature confirms that the addition of the second screw increases the stability in the scaphoid fractures by offering added resistance to torque forces. Most authors propose the parallel placing of both screws in all cases. In our study we offer an algorithm for the placement of screws depending of the type of fracture line. For transverse fractures screws are placed parallel and perpendicular to the fracture line, for oblique fractures the first screw is placed perpendicular to the fracture line, and the second screw is placed along the longitudinal axis of the scaphoid. This algorithm covers the main laboratory requirements for maximal fracture compression depending of the fracture line. CONCLUSIONS This study of 72 patients in whom patients with similar fracture geometry were separated into two groups fixed by one HBS and fixed by two HBS. Analysis of the results demonstrate that osteosynthesis with two HBS creates greater fracture stability. The proposed algorithm for fixation of acute scaphoid fractures using two HBS is achieved by simultaneously placing the screw along the axial axis and perpendicular to the fracture line. The stability is improved by the equal distribution of the compression force on the entire fracture surface. Key words: scaphoid fractures, Herbert screw, two screws fixation.
[Instabilities of the Thumb Carpometacarpal Joint: Our Surgical Outcomes].
Pilný J, Kachlík D, Zeman P … +2 more , Horáčková K, Hájek P
Acta Chir Orthop Traumatol Cech · 2023 · PMID 36907580
PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated...
PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique. MATERIAL AND METHODS The authors present a set of 53 CMC joints of patients with an average age of 26.8 years (15-43 years) operated on in the years 2005-2017. Post-traumatic conditions were found in 10 patients and in 43 cases instability was caused by hyperlaxity, also demonstrated in other joints. The operation was performed from the Wagner's modified anteroradial approach. After the operation, a plaster splint was applied for 6 weeks, after which rehabilitation (magnetotherapy, warm-up) began. Patients were evaluated using the VAS (pain at rest and during exercise), DASH score in the work module, and subjective evaluation (no difficulties, difficulties not limiting normal activities, and difficulties limiting normal activities) before surgery and 36 months after surgery. RESULTS During the preoperative assessment, the average VAS value was 5.6 at rest and 8.3 during exercise. During the VAS assessment at rest, the values at 6, 12, 24 and 36 months after surgery were 5.6, 2.9, 0.9, 1, 2 and 1.1. When evaluated in the given intervals under load, the detected values were 4.1, 2, 2.2 and 2.4. The DASH score in the work module was 81.2 before surgery, 46.3 at 6 months, 15.2 at 12 months, 17.3 at 24 months, and 18.4 at 36 months after surgery. In the subjective self-assessment made at 36 months after surgery, 39 patients (74%) assessed their condition as having no difficulties, ten patients (19%) reported difficulties that did not limit normal activities, and four patients (7%) reported difficulties limiting normal activities. DISCUSSION Most authors present the results of their surgeries in patients with post-traumatic joint instability, and they report excellent results at two to six years after surgery. There is a negligible number of studies addressing instabilities in patients with instability caused by hypermobility. When using the conventional method described by the authors in 1973, our results of the evaluation performed at 36 months after surgery are comparable to those reported by other authors. We are well aware of the fact that this is a short-term follow-up and that this method does not prevent developing degenerative changes in the case of long-term follow-up, but reduces clinical difficulties and may delay the development of severe rhizarthrosis in young individuals. CONCLUSIONS CMC instability of the thumb joint is a relatively common disorder, although not all individuals experience clinical difficulties. In the case of difficulties, the instability needs to be diagnosed and treated as this is how the development of early rhizarthrosis in the predisposed individuals can be prevented. Our conclusions suggest a possibility of a surgical solution with good results. Key words: carpometacarpal thumb joint, thumb CMC joint, carpometacarpal thumb instability, joint laxity, rhizarthrosis.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe