Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2012
ReviewTreatment of proximal humeral fractures - a review of current concepts enlightened by basic principles.
Fractures of the proximal humerus commonly affect elderly patients. The vast majority of proximal humeral fractures result from low-energy trauma in presence of osteoporosis. Incidence of proximal humeral fractures dramatically increased over the last decades. ⋯ Outcome of hemiarthroplasty is closely related to anatomical tuberosity healing and restoration of rotator cuff function. Reverse shoulder arthroplasty may provide satisfactory shoulder function in geriatric patients, rotator cuff dysfunction or failure of first-line treatment. Choice of treatment should be individualized and base on careful evaluation of patient-specific, fracture-specific and surgeon-specific aspects.
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Acta Chir Orthop Traumatol Cech · Jan 2012
ReviewManagement of hemodynamic unstable patients "in extremis" with pelvic ring fractures.
The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure .70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. ⋯ Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.
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Acta Chir Orthop Traumatol Cech · Jan 2012
ReviewCurrent concepts review - fractures in the region of the elbow.
Elbow injuries continue to rise with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics of this sophisticated joint, various injury patterns, and the implication of injury to the static and dynamic stabilizers will result in improvement in specific diagnosis, and therapy. The surgical treatment of trauma to the adult elbow has evolved rapidly in recent years and many useful concepts and techniques have been established. This paper reviews the published scientific data and current opinion available to guide patient care.
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Acta Chir Orthop Traumatol Cech · Jan 2012
Review[Arthroplasty for intracapsular fractures of the femoral neck. Current concept review].
The authors discuss arguments concerning indications and selection of implants and operative techniques for arthroplasty in the treatment of femoral neck fractures. Their analysis is based on long-term experience with surgical treatment of patients with hip fractures and on the evaluation of a large number of publications by well-known specialists. The assessed group included 4795 patients treated at their institution between 1997 and 2010, of whom 1532 underwent hip replacement, with 1032 receiving hemiarthroplasty (HA) and 500 having total hip replacement (THR) indicated for femoral neck fractures. ⋯ Even if dislocation and loosening occur in these patients more often than in those with a THR procedure indicated for other reasons (primary or post-dysplastic arthritis), this therapy offers fewer complications and longer functioning in comparison with other methods of treating femoral neck fractures. A cemented prosthesis can be regarded as the standard implant; however, if the proximal femur shows good quality cortical bone, an uncemented implant can be used without a greater risk of future loosening. In the absence of hip arthritis which leads to the development of subchondral sclerosis required for the correct acetabular cup fixation, a hybrid THR with an expansion cup or a screw-in cup is recommended.
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Acta Chir Orthop Traumatol Cech · Jan 2012
Randomized Controlled Trial Comparative Study[Comparison of two surgical methods for treatment of idiopathic thoracic scoliosis - anterior versus posterior approaches].
The aim of this retrospective randomised study is a comparison of two surgical approaches (anterior versus posterior) for the treatment of idiopathic thoracic scoliosis by corrective spondylodesis with segmental instrumentation in adolescents aged 13 to 20 years. ⋯ In terms of surgical treatment selection, the anterior approach is more economical and requires spinal fixation and instrumentation to a lesser extent. However, prolonged chest wound drainage results in a longer hospital stay. The majority of idiopathic scoliosis cases are indicated for a posterior approach. In scoliosis with marked hypo-kyphosis or lordosis, an anterior approach can be considered because it produces an increase in thoracic kyphosis.