Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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The aim of this study was to evaluate the accuracy of correction and short-term outcomes of treatment by opening-wedge tibial osteotomy with the use of allograft and a modified Puddu plate fixation. ⋯ Opening-wedge tibial osteotomy with the use of a Puddu plate and allograft in our modification is an effective, exact and simple method of correcting the lower extremity axis, and is associated with few complications. We do not recommend this method for interventions planned to achive corrections of more than 16 degrees, because these have a higher occurrence of complications. The use of allograft seems to have good prospects; another option for achieving large correction includes application of an LCP plate.
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In the period from 1990 and June 2003, 885 total knee replacements were performed at the orthopedic ward of the Ceske Budejovice Hospital. Of these, 19 (2.14 %) patients underwent revision surgery; in addition, 25 patients who had had primary surgery in other hospitals were operated on. Of these 44 patients, 25 were followed up and evaluated. The aim of the study was to evaluate the pre-operative treatment including examination for bacterial infection by cultivation, the selection of an optimal procedure (one- or two-stage operation, surgical approach and implantation technique) and postoperative therapy. ⋯ We strongly emphasize the employment of all possible means to prevent loosening, i. e., to use an appropriate surgical technique for primary implantation, to observe aseptic principles and to administer antibiotic therapy in conditions suspected of bacteremia. The shorter the interval between the onset of complaints and the reimplantation, the better results. Early loosening should be treated by two-stage surgery. Our method of bacteriological examination gives good results. Because of complexity of the problem, patients with a loose knee prosthesis should be referred to orthopedic departments with experienced and skilled surgical teams and high-quality examination facilities.With the observation of appropriate procedures, there is a great chance of achieving good results. Arthrodesis is still regarded as a justified "salvage" operation, particularly in cases with pre-operative findings of Staphylococcus aureus. Procedures for repeat surgery following the failure of a reimplanted joint have so far yielded doubtful results and still await further development.
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Acta Chir Orthop Traumatol Cech · Jan 2005
[Surgical treatment for disorders of the cervicothoracic junction region].
The complex anatomy of the cervicothoracic junction region makes a reliable assessment of plain radiographs in lateral projection difficult or even impossible, which may result in failure to detect fracture or other pathology in this region of the spine. The aim of this study was to evaluate the patients with spinal disorders in the region of the seventh cervical to the third thoracic vertebrae treated at our department. ⋯ Injuries and diseases of the spine at the cervicothoracic junction present a complex issue with a high potential for mistakes and complications. The principle of success lies in a high-quality X-ray examination, CT scans with sagittal and frontal reconstruction, and magnetic resonance imaging of the region affected. The complex anatomy of that region requires demanding surgical procedures, which can be performed only by a highly qualified and specialized team with appropriate facilities.
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Acta Chir Orthop Traumatol Cech · Jan 2005
[Treatment of focal articular cartilage lesions of the knee with autogenous osteochondral grafts].
A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. Many surgical techniques have been studied in an attempt to restore the damaged articular cartilage. Autogenous osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness, however, only a few series have been reported in the literature. ⋯ There was no correlation of the clinical results with the underlying diagnoses. It appears that an osteochondral graft has the potential to prevent or delay the development of degenerative changes of the knee in the medium-term follow-up. Autogenous osteochondral graft is considered as a good method in the treatment of knees with moderately sized articular cartilage defects.
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Acta Chir Orthop Traumatol Cech · Jan 2005
[Monteggia's lesion in childhood--proposal for a new classification system].
The former classification systems have failed to provide an exact characterization of Monteggia's lesions (ML) in a growing skeleton. We studied the stability of both ulnar fracture and injury to the radio-humero-ulnar joint and our clinical findings fully warrant the proposal of a new classification system. ⋯ Our classification allows us to predict the stability of each Monteggia's lesion and to choose an appropriate approach to its treatment.