Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Floating Hip Injuries: Treatment Outcomes and Complications].
PURPOSE OF THE STUDY The aim of this retrospective study was to evaluate the results of surgical management of patients with ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip). MATERIAL AND METHODS A total of 54 patients with injury to the pelvic ring or acetabulum concomitant with an ipsilateral femoral fracture were treated at our Department in the period from 2005 to 2013. The group consisted of 35 men and 19 women with an average age of 36.5 (22 to 72) years. ⋯ They are related to types of fracture and experience of the operating team. Complications in floating hip injuries are not higher in number, but their combination may have unpleasant consequences. Key words: floating hip, surgical treatment, complications, outcomes.
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Callus Distraction in the Treatment of Post-Traumatic Defects of the Femur and Tibia].
PURPOSE OF THE STUDY Evaluation of the results in patients treated for post-traumatic defects by the method of callus distraction of the femur and tibia using a monolateral external fixator. MATERIAL AND METHODS The group comprised 42 patients, 38 men and 4 woman, who underwent callus distraction using a monolateral external fixator in the Trauma Hospital Brno in the period from 2003 to 2010. The average age of the patients on the day gradual callus distraction was commenced was 32 (18-64) years. ⋯ The treatment procedure depends on the extent of bone loss, size and type of soft tissue damage and presence or absence of infection. We prefer the use of monolateral external fixators for their ability of form adjustment and of 6-mm pins coated with hydroxyapatite. Key words: callus distraction, post-traumatic bone defect, external fixator.
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PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a frequent complication and had to be removed in six patients (4.5%). No early infection was recorded and late infection was treated in three patients. The prosthesis had to be removed and ankle arthrodesis performed in seven patients (5.3%). All had necrosis of the talus with ankle instability. In five, the retrograde nail Medin was used and extensive defects remaining after talar necrosis were filled with massive bone grafts obtained from a bone bank. One patient required tibio-calcaneal arthrodesis with external fixator; surgery in one case involved the use of a Zimmer Trabecular Metal Ankle Fusion Spacer with retrograde nail fixation. The development of cystic radiolucencies adjacent to tibial or talar components presents another post-operative complication. It was recorded mostly in the patients after AES implantation, in whom eight of 52 (15.3%) had these findings. DISCUSSION Total ankle arthroplasty is a complicated surgical procedure potentially associated with various technical problems. The occurrence of complications is indirectly related to the experience of the orthopaedist performing surgery; literature data show that the number of complication decreases with an increased frequency of ankle replacements done. CONCLUSIONS Total ankle arthroplasty, as every orthopaedic surgery, has its advantages and disadvantages. The positive aspects are pain relief and improved mobility of the ankle allowing for physiological gait. However, it shows a lower survivorship rate that the other large joint replacements. A successful outcome depends on the correct indication. The ankle should be stable, the talus without signs of necrosis and valgus or varus deviations of the ankle should not exceed 10 to 15 degrees. ⋯ total ankle arthroplasty, re-implantation, aseptic loosening, retrograde nail, Trabecular Metal spacer, revision arthroplasty.
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PURPOSE OF THE STUDY Peripheral fractures of the talus (lateral talar process and posterior talar process) are rare injuries, easy to miss on examination due to their location and clinical manifestation. They account for 0.3% to 1.0% of all fractures of the talus. An incorrect or late treatment of talar process fractures can result in permanent pain, impingement syndrome, healing in malposition, pseudoarthrosis development and also, due to joint instability, in a potential development of severe subtalar arthritis. ⋯ Fractures of talar processes often show symptoms and signs similar to those of more serious forms of dislocation of the talus and therefore a careful assessment of standard X-ray images taken for a "swollen ankle" is necessary. If the findings are not clear, CT examination is indicated. Key words: fracture, talus, processus lateralis tali, processus posterior tali.
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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.