Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Feb 2010
[Urogenital trauma associated with pelvic ring fractures].
To evaluate, in a retrospective study, injuries to the urogenital tract in patients with pelvic ring fractures. MATERIAL In the years 1998-2007, a total of 308 patients with pelvic ring fractures were treated. The study did not comprise patients with low-energy fractures, such as apophyseolysis in children, osteoporotic bone fractures or pathologic fractures. It also did not include patients with multiple injuries who died within 6 hours of admission to the hospital. The group consisted of 186 men and 122 women with an average age of 34 (range, 6 to 76) years. ⋯ Injury to the urethra results in erectile dysfunction in 50 % of the injured patients it is often associated with urinary incontinence that has a strong effect on the patient's life quality. Isolated trauma to the urinary bladder has a good prognosis. The incidence of post-traumatic incontinence is not high, but reduces the patient's personal and social comfort. A prerequisite for a successful therapeutic outcome is a good cooperation of the orthopaedic surgeon and urologist. Key words: pelvic ring fractures, urogenital injury.
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Acta Chir Orthop Traumatol Cech · Feb 2010
[Magnetic resonance imaging for detection of rotational deformities in children with femoral shaft fractures treated by the ESIN method].
The aim of the study was to evaluate the results of elastic stable intramedullary nailing (ESIN).used in the treatment of children with femoral shaft fractures, with a focus on post-traumatic rotational deformity assessed by magnetic resonance imaging (MRI). An alternative hypothesis was established assuming a significantly high incidence of this post-traumatic complication. Also, the advantages of MRI for the diagnosis of rotational deformity were assessed in comparison with ultra- sonography and physical examination. ⋯ The method of measuring rotational deformity after femoral shaft fracture using MRI gave exact results and posed no risk for the child, and is therefore presented as a novel and important part of post-traumatic follow-up of children with this injury. In the ESIN- treated patients, this diagnostic method did not reveal any statistically significant occurrence of serious post-traumatic rotational deformity during the healing of a femoral shaft fracture.
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In conclusion, radial head fractures with 3 or more fragments have a high incidence of complications when treated with ORIF including hardware failure, malunion, nonunion, and the need for re-operation. Radial head arthroplasty has demonstrated good success in the treatment of complex, comminuted radial head fractures which are not amenable to non-opeative treatment or ORIF. Success can be optimized by diligent surgical dissection, avoiding inadvertent nerve injury, placement of an appropriately sized implant, repair of associated injuries, and early protected motion.
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The method of choice for the treatment of severe ankle arthritis is either arthrodesis or joint arthroplasty. Each has its advantages and disadvantages. Arthrodesis is the definitive therapy for severe ankle destruction and instability. Joint arthroplasty has an advantage in maintaining ankle mobility. However, its range of indications and its reliability and durability are more limited. The aim of this study is to present our experience with the AES prosthesis and draw attention to some drawbacks of this surgical treatment. ⋯ The longevity of a total ankle replacement depends, much more than in other joint replacements, on an accurate implantation technique and correct indication.
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Acta Chir Orthop Traumatol Cech · Feb 2010
[Low-grade renal trauma (part I): diagnostic validity of haematuria].
The aim of the study was to evaluate the diagnostic validity of haematuria findings in patients with low-grade renal trauma. ⋯ The finding of haematuria is a valuable piece of information in low grade renal trauma. Particularly, if imaging methods fail to detect an injury, haematuria is a sign indicating renal trauma following a typical blunt force mechanism, even though our results of its evaluation were not statistically significant. The absence of macroscopic or microscopic haematuria did not exclude the existence of renal trauma in our group, and it is therefore necessary to pay increased attention to the evaluation of findings obtained by imaging methods in patients involved in a typical blunt force accident.