Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2015
[Conservative and Surgical Treatment for Distal Ulna Fractures Associated with Distal Radius Fractures].
Fractures of the distal radius and distal ulna require anatomical reconstruction for good restoration of wrist and hand function. In this study we compared the results of conservative treatment with those of plate osteosynthesis management in distal ulna fractures of patients who had concomitant fractures of the distal radius indicated for plate osteosynthesis. Our objective was to specify indications for plate osteosynthesis of a distal ulna fracture in the case of an associated distal radius fracture. ⋯ Views vary on whether the distal ulna should be treated by plate osteosynthesis when, after distal radius fixation, its fracture managed by closed reduction heals well. A distal ulna plate often causes pain and has to be removed. The acute cases of DRUJ instability caused by comminuted distal ulna fracture can be treated by osteosynthesis of the distal ulna and two Kirschner wires inserted into the fracture site in an ulnar-to-radial direction. For chronic radioulnar instability, various methods involving free tendon grafts and dynamic tenodesis are used. Other options include the Sauvé-Kapandji procedure based on inducing artificial non-union of the distal ulna diaphysis and radioulnar arthrodesis; in our modification of this technique we use a single cancellous malleolar screw. In severely comminuted fractures of the distal ulna with injury to articular cartilage, ulnar head replacement can be indicated. CONCLUSIONS Distal ulna fractures can be treated conservatively if osteosynthesis of the distal radius in the anatomical position is achieved together with anatomical reduction of bone fragments of the distal ulna. When a distal radius fracture managed by osteosynthesis is not accompanied by anatomical reduction of distal ulna fragments, or the ulna is shorter or longer than the contralateral bone, an open reduction and stabilisation using an angle-stable locking plate, set at an adequate radius-toulna length ratio, is the method of choice.
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Acta Chir Orthop Traumatol Cech · Jan 2015
Case ReportsTotal knee arthroplasty in patient with paraplegia after spinal cord injury.
The clinical management of paraplegic patients is more complex than in able-bodied subjects. Spinal cord injury (SCI) affects younger, active people more often than the elderly during high-energy fall or traffic accidents. In order to return to work after suffering an SCI, patients need to regain their functional independence, especially their ability to drive. ⋯ Several factors should be taken into account before performing surgery: 1. ability of regaining some of spinal cord locomotor function through intensive gait rehabilitation in SCI patients, 2. presence of muscle imbalance and knee contractures combined with a risk of bone fracture resulting from intensive postoperative rehabilitation, 3. the impaired microvasculature of the skin and subcutaneous tissues and increased risk of occlusion occurrence of the capillaries and small vessels of the leg, 4. higher prevalence of secondary infections via urinary entry sites in patients after SCI, 5. patient's strong determination and willingness to undergo the arthroplasty procedure. TKA might be considered in selected paralyzed patients after SCI, especially in those with severe arthrosis as well as significant knee contractures. Our study reveals the advantage of performing TKA in improving functional state in patients with cord injury.
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Acta Chir Orthop Traumatol Cech · Jan 2015
[Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture].
The aim of the study was to investigate the occurrence of avascular necrosis (AVN) of the femoral head following the osteosynthesis of intracapsular fracture of the femoral neck in relation to the time interval between injury and surgery and the type of fracture. ⋯ The study showed a significantly lower AVN occurrence in the patients surgically treated within 24 h of injury. In the patients treated within 6 h of injury, AVN incidence was significantly lower in the patients with non-displaced fractures, as compared with those who had displaced fractures. This was not true for the two patient groups treated later (6-24 and later than 24 h) in which the differences between AVN development after non-displaced fractures and that after displaced fractures were similar.
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Sternal fractures occur most frequently in vehicle accidents, then due to falls from a height and by other blunt chest trauma. Most of these injuries are simple, non-displaced fractures only rarely requiring surgical management. Based on a retrospective analysis, the authors present their experience with the treatment of sternal fractures, emphasizing the use of osteosynthesis. ⋯ Plate fixation is a suitable method of stable osteosynthesis in complicated sternal fractures. It shortens the duration of mechanical ventilation and repairs post-traumatic chest wall deformities.
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Acta Chir Orthop Traumatol Cech · Jan 2015
[Plate Osteosynthesis of Distal Ulna Fractures with Associated Distal Radius Fractures Treated by Open Reduction and Internal Fixation. Short-Term Functional and Radiographic Results].
The aim of the study was to describe the indication criteria and operative technique and to present the first conclusions of a prospective study dealing with an assessment of functional and radiographic findings in patients with concurrent fractures of the distal ulna and distal radius; the former was treated by osteosynthesis using an LCP Distal Ulna Plate (De Puy Synthes, USA) and the latter by plate osteosynthesis. ⋯ The functional outcome of treatment in our patients corresponded to the severity of their distal forearm fractures. The patients with more serious distal radius fractures, frequently associated with ulnar head fractures, had poorer functional results than the patients with less serious fractures. According to the AO classification, in the distal radius fractures, prevailing fracture types were 23-C3 (78%) and 23-C2 (16%). In relation to the distal ulna fracture type, the patients with ulnar styloid base fractures had better functional results than the patients with ulnar head fractures, because a fracture of the styloid process does not affect the congruency of the distal radioulnar joint (DRUJ). Fractures of the ulnar styloid process base, following distal radius fracture osteosynthesis, were invariably associated with DRUJ instability. This fracture type is always accompanied by injury to the distal radioulnar ligament of the triangular fibrocartilage complex (TFCC) and, in case of a displaced fracture, surgical management is indicated. In agreement with the results of other authors it was found in our study that, when the anatomical position of the distal radioulnar joint had been achieved, both the functional and the radiographic findings were post-operatively very good. The final average values for the range of wrist and forearm motion, hand grip strength and hand and arm function were assessed as very good. CONCLUSIONS The assessment of our results and their comparison with the literature data showed that osteosynthesis of distal ulna fractures with concurrent distal radius fractures managed by open reduction and internal fixation are indicated in displaced fractures of the ulnar styloid process base, displaced comminuted fractures of the ulnar head where fragments interfere with DRUJ congruency, and unstable displaced subcapital fractures of the ulna. The early results of this study provide evidence for the efficiency of plate osteosynthesis in the treatment of distal ulna fractures.