Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Feb 2007
[Scapholunate instability of the wrist following distal radius fracture].
Scapholunate (SL) ligament disruption frequently occurs together with distal radius fractures. If it is not diagnosed and treated, instability develops and will eventually be manifested as arthritic lesions known as scapholunate advanced collapse (SLAC) of the wrist. The aim of this study was to record the occurrence of SL ligament disruption in the patients treated conservatively for displaced fractures of the distal radius and to find out which fracture types are most often associated with injury to the SL ligament. ⋯ Fractures of the distal radius are no longer frequent only in elderly women, as has recently been common, but they are found more and more often in active young persons. Because their bones are healthier, soft tissues are affected more frequently. Injury to the SL joint results in the development of arthritic lesions which may rapidly progress in active patients. SLAC development can be prevented by early diagnosis of soft tissue lesions on X-ray images, because these are usually apparent after reduction or at follow-up. If doubts arise, arthroscopy or another examination should be done, even though these may not be sufficiently reliable.
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Anatomic changes associated with aseptic loosening make conditions for revision of total knee arthroplasty more diffi-cult. The aim of this study was to evaluate the results of revision total knee replacement at an average follow-up of 6.1 years. ⋯ The authors recommend to avoid filling large bone defects with bone cement. They prefer bone grafting. In the case of good quality metaphyseal bone, they use standard components or posterior stabilized components with or without additi-onal cemented or cementless short stem extensions. In the case of poor quality metaphyseal bone with defects, they use revision implants with cementless long stems. The authors have achieved good results with off-set stems.
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Acta Chir Orthop Traumatol Cech · Feb 2007
[Treatment of intracapsular femoral neck fractures with the use of a proximal femoral nail].
The management of intracapsular femoral neck fractures remains an unsolved issue of the present-day trauma surgery of the musculoskeletal system. These fractures are conventionally treated with the use of spongious screws or a dynamic hip screw combined with an antirotational spongious screw. The aim of this study was to evaluate the outcomes of surgical therapy using a different type of implant (proximal femoral nail) for intracapsular femoral neck fractures. ⋯ Our results show that the bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap, Germany) is useful for management of intracapsular femoral head fractures because of the following advantages: it eliminates the risk of lateral protrusion of the implant, it allows for even distribution of weight bearing and thus reduces the risk of pseudoarthrosis development, it has a low probability of the sliding screw getting jammed.
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Acta Chir Orthop Traumatol Cech · Feb 2007
[Our results of surgical management of unstable pelvic ring injuries].
The authors present a group of patients treated for pelvic fractures in a period of 6 years and they evaluate radiographic findings and clinical outcomes following surgical management of type B and type C fractures. ⋯ An active approach to the treatment of patients with unstable pelvic fractures, which is based on the correct diagnosis, comprehensive multi-disciplinary care, urgent primary stabilization and early definitive fixation by internal osteosynthesis, offers a prospect of survival and a good functional outcome for the patient. However, a high proportion of lasting sequelae due to altered biomechanics of the pelvic ring, and irreversible injuries to neural structures and the urogenital system may lessen good results achieved by a demanding surgical procedure on the skeleton.