Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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To present the current tends in the diagnosis and management of isolated atlas fractures based on the retrospectively evaluated group of patients with this trauma. ⋯ Isolated fractures of the first cervical vertebra, in terms of therapy, are stable and unstable. Stable fractures heal within 8 to 12 weeks. A Philadelphia collar or halo-vest provide sufficient immobilization. Surgical stabilization or a halo-vest immobilization for a period of 12 weeks are recommended in unstable injuries that are characterized by the lateral mass displacement of more than 7 mm or extension of the space before the dens (predental space) by more than 3 mm, or in which magnetic resonance imaging demonstrated injury to the transverse ligament. After the halo-vest removal, it is necessary to perform functional examination of the cervical spine for detection of potential atlantoaxial instability.
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Acta Chir Orthop Traumatol Cech · Jan 2004
[Complications and risks associated with an anticoagulation therapy combining low molecular weight heparin and Warfarin after total replacement of large joints--our experience].
This study deals with the efficacy and safety of anticoagulation therapy, using a combination of low molecular weight heparin (LMWH) and Warfarin, administered after total arthroplasty (TA) of large joints. Patients with a high rate of complications due to bleeding comprised the first evaluated group. After the causes had been analyzed and eliminated (or reduced), the second group of patients was evaluated. The aim of the study was to ascertain whether risks and complications did not overweight the benefits of Warfarin administration in the prophylaxis of deep venous thrombosis (DVT) and whether this combined anticoagulation therapy, which is cheaper than LMWH alone, was generally applicable. ⋯ The results of this study suggests that correctly administered, preventive drug treatment of thromboembolic events is an important adjunct to other measures, such as early rehabilitation including standing and walking, compression of the lower extremities or sufficient liquid intake, taken to prevent the development of deep venous thrombosis. The combination of LMWH with Warfarin was used as an anticoagulation therapy in this study. The effective and safe Warfarin treatment should be based on the experience of an attending physician, who starts and monitors the therapy. Warfarin administration requires careful and relatively complex follow-up, with frequent INR check-ups. However, the use of appropriate dosage and thorough follow-up do not make Warfarin administration completely safe in all cases. For instance, a high INR value at Warfarin initiation, which is difficult to influence, carries a high risk of bleeding for patients with occult gastrointestinal lesions. The authors do not routinely use preventive treatment with LMWH alone, primarily for its high cost.
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Acta Chir Orthop Traumatol Cech · Jan 2004
Randomized Controlled Trial Comparative Study Clinical Trial[Diclofenac 75mg. and 30 mg. orfenadine (Neodolpasse) versus placebo and piroxicam in postoperative analgesia after arthroscopy].
Arthroscopy is often performed in an out-patient department or as one-day surgery. Opioids often used as postoperative analgesics may have unwanted side effects that may postpone the patient's discharge from hospital. This study was designed to evaluate a substitute for the most frequently used opioid pethidine. For pain relief, non-steroid anti-inflammatory drugs are recommended, but they offer a limited choice for parenteral administration. We used a new agent (Neodolpasse) based on diclophenac and orphenadine, and compared its efficacy with piroxicam and placebo. ⋯ The main result of this study is the finding that Neodolpasse significantly reduces the intensity of postoperative pain and increases the duration of postoperative analgesia after knee joint arthroscopy.
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Acta Chir Orthop Traumatol Cech · Jan 2004
[Personal experience with treatment of acetabular fractures].
The article presents a retrospective evaluation of a group of 119 patients treated for acetabular fractures between 1996 and 2002. ⋯ The treatment of displaced fractures of the acetabulum is on principle surgical. Satisfactory results are produced only by anatomical reconstruction of the weight-bearing area of the acetabulum. Surgical treatment is highly demanding and the long-term results not always correspond to the efforts made.
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Acta Chir Orthop Traumatol Cech · Jan 2004
[Percutaneous osteosynthesis of scaphoid fractures: preliminary results].
To evaluate the results of percutaneous osteosynthesis of scaphoid fractures and to verify whether this approach is more effective than conservative treatment. ⋯ Our preliminary results show that, in indicated fractures types, the percutaneous osteosynthesis of a fractured scaphoid provides better functional outcomes than conservative treatment.