Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Apr 2008
Comparative Study[Fractures of the dens in patients older than 65 years: direct osteosynthesis of the dens versus C1-C2 posterior fixation].
Surgical treatment is preferred in our department in all patients with type II and type III dens fractures, regardless of their age, with the exception of non-displaced or completely reduced fractures in young patients. The aim of this study was to evaluate patients over 65 years of age treated by direct osteosynthesis of the dens or posterior atlanto-axial fixation and spondylodesis. ⋯ Surgical treatment can significantly improve the quality of life in elderly patients who have suffered a fracture of the dens. The surgical technique should be chosen to take bone quality, degenerative changes of the spine and overall health of the patient into consideration. Mortality after surgery is not related to the technique selected but to patient's age. Elderly patients with neurological deficit usually die due to co-morbidity, regardless of the therapy used.
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Acta Chir Orthop Traumatol Cech · Apr 2008
[Posterior stabilization of L5 burst fractures without reconstruction of the anterior column].
To evaluate a group of 11 patients with L5 burst fractures treated by L4-S1 posterior instrumented spinal fusion without reconstruction of the anterior column. ⋯ Only a few references referring to a relatively low number of patients with L burst fractures treated by surgery were found in the literature. Most of the authors report limitations of reduction and good clinical outcomes. CONCLUSIONS The posterior instrumented spinal fusion of L5 alone is sufficient for the treatment of most L5 burst fractures. Early removal of the fixator is indicated in active patients. Often good clinical outcomes are in contradiction with radiological findings. The possibilities of spinal canal decompression by ligamentotaxis at this level of injury are limited. When significant spinal stenosis is present, laminectomy or hemilaminectomy is necessary to achieve decompression of the spinal canal.
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Acta Chir Orthop Traumatol Cech · Apr 2008
[Neuromuscular deformity of the pelvis and its surgical treatment].
To evaluate the efficacy of surgical treatment in pelvic deformities associated with neuromuscular spine deformity, using radiographic parameters and clinical outcome analysis. In the lumbo-pelvic region, spinal deformity is most frequently combined with pelvic obliquity, lumbar hyperlordosis, hip deformity and leg-length discrepancy. Pelvic deformities include an excessive posterior or anterior pelvic tilt, obliquity or rotation and windblown hip syndrome. ⋯ The radiographic and clinical findings in the patients treated showed good correction of pelvic deformities in the frontal and sagittal planes. Pelvic obliquity correction thus contributes to the improvement of sitting stability in physically disabled patients.
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Acta Chir Orthop Traumatol Cech · Apr 2008
[Tibiotalocalcaneal arthrodesis using a retrograde nail locked in the sagittal plane].
To evaluate our experience with the use of a retrograde nail locked in the sagittal plane for tibiotalocalcaneal arthrodesis indicated in severe post-traumatic arthritis of the ankle. ⋯ Patients' satisfaction is the primary goal we strive to achieve in severe post-traumatic conditions of the talus and foot. Repeat surgery, spongioplasty, external fixation revision for pin-tract infection, persistent pain, activity restriction and poor clinical results reduce patients' satisfaction. In our group, the rate of healed arthrodesis was high and the number of complications was low, therefore our patients' satisfaction was high.
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Surgical treatment of spondylodiscitis is associated with many complications and raises a number of issues for discussion. The aim of the study was to evaluate a group of patients who had undergone surgery for inflammation of the spine, and to discuss the optimal operative procedure. ⋯ Radical debridement with deformity correction and segmental stabilization provide an efficient method of treatment for the most frequent anterior forms of pyogenic and tuberculous spondylodiscitis. The use of titan implants does not significantly increase the risk of persistent infection or its recurrence.