Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2003
Less invasive stabilization system (LISS) in the treatment of distal femoral fractures.
The treatment of distal femoral fractures has been associated with a high rate of complications for a long time. Although implants and surgical techniques have improved, plate osteosynthesis and intramedullary nailing have been accompanied by a high occurrence of infection, non-union and malalignment. The treatment of soft tissue envelopes using "biological" osteosynthesis and minimally invasive approaches has resulted in a decrease in complication rates and ultimately led to the concept of the less invasive stabilization system (LISS). ⋯ Infection, delayed union and non-union rates are low, as shown by yet unpublished data from our clinic. Primary bone grafting, which is rarely necessary with this system, is carried out only when there is a great bone loss. Implant failure, such as screw loosening or secondary malalignment, is not seen.
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Acta Chir Orthop Traumatol Cech · Jan 2003
[Current diagnostic and therapeutic approaches in liver injuries].
The recent improvements in hospital care system (centralized specialized care) and the use of new imaging methods and modern technologies in surgical treatment have greatly enhanced successful outcomes of therapy in liver injury. The aim of the study was to evaluate the contribution of procedures included in the diagnostic-therapeutic algorithms to the treatment of blunt injury to the liver in our patient population. ⋯ 1. The treatment strategy in a patient with blunt liver trauma is determined by the patient's hemodynamic status; in a stable patient, spinal CT examination of the thorax and abdomen is mandatory. 2. Urgent laparotomy is indicated when the patient with blunt liver trauma is hemodynamically unstable due to diagnosed hemoperitoneum or suspected intraperitoneal bleeding. 3. Conservative therapy is applied when the criteria for non-surgical treatment are fulfilled. 4. Surgical strategy for blunt liver trauma is based on the extent and localization of the injury, the patient's overall status and severity of associated injuries. Resection of the injured parenchyma is indicated when laceration of a liver lobe occurs. 5. The prognosis of blunt liver injury is influenced, apart from hemorrhagic shock reversibility, by the severity of associated injuries in multiple trauma.
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The authors present their 10-year experience with the computed tomography (CT) assisted insertion of implants in the sacroiliac (SI) region and acetabular region. Indications for these interventions and their detailed descriptions are reported. ⋯ The CT-guided surgical procedure allows us to assess both the shape and course of fracture lines or distance between the injured structures. It also enables us to choose the optimal direction, in relation to these structures, for an implant to be inserted and to respect important anatomical structures in the surroundings. It helps us to determine the exact length of implants to be used. During the procedure, repeated CT scans facilitate checking the direction and position of both instruments and implants. In the closing phase of the operation, it is possible to assess closeness of the bones screwed together, the definitive placement of the implants and their reliable fixation. This method also permits to check whether a screw did not penetrate through the opposite cortical bone.
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Acta Chir Orthop Traumatol Cech · Jan 2003
[Conservative treatment of femoral fractures in children in data from the Orthopedic Clinic of the 2nd Medical Faculty of Charles University].
Conservative therapy is the method of choice for treating femoral fractures in younger children all over the world. At the Department of Orthopedic Surgery of the Second Faculty of Medicine, Charles University in Prague, this approach has had a long tradition and has only partly been replaced by other, more recent methods. It is not always necessary to abandon well-established and reliable techniques because of new achievements and this is demonstrated by the results of our study. ⋯ Well-established methods of conservative treatment of femoral fractures in children were evaluated with the objective to advocate their importance for today's orthopedic surgery. Although the children treated by these methods are confined to bed for a longer period than when more recent techniques are used, they may avoid many of the complications that accompany these new approaches.
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We describe the collection, storage and examination of allogenic bone grafts and their use in revision hip arthroplasty, indicated because of acetabular loosening, that involved either an uncemented cup or an augmentation device with a cemented cup according to the extent and nature of acetabular defects. ⋯ Our patients showed good allogenic bone ingrowth in relation to the acetabular bed and good bone restructuring and incorporation in relation to the implant. Neither mechanical failure of implants nor graft rejection were recorded. The risk of infection transfer was low and comparable with routine blood transfusion. The necessary prerequisite for revision hip arthroplasty is a well-operating bone tissue bank.