Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2011
Case Reports[Non-union after a vertical fracture of the sacral central zone with a conical dislocation of the pelvic ring].
A longitudinal (vertical) fracture of the sacrum passing through the central sacral canal is a very rare injury, reported in the literature mostly as case reports. Out of 24 reference found, non-union associated with this fracture has been reported only once. A longitudinal fracture of the sacrum is always associated with injury to the anterior pelvic ring. ⋯ The implants were introduced percutaneously using CT guidance. Stabilisation of the anterior part of the pelvis was performed by using a supra-acetabular external pelvic fixator; the original implant was left in situ. Consequently, the sacral non-union healed within one year.
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The development of a cervical kyphotic deformity can be associated with a degenerative disease, trauma, tumour, developmental anomaly and also a surgical procedure. Post-operative kyphosis can develop after both the anterior and posterior surgical approaches. The deformity can also result from systemic diseases, such as ankylosing spondylitis or rheumatoid arthritis. The aim of the study was to make the clinical and radiographic evaluation of a group of patients with kyphotic deformity treated at our department. ⋯ The results of the study showed a marked improvement in the patients' quality of life after kyphosis correction, improved neurological status and an improved posture seen on radiograms of the cervical spine. The study also revealed a higher number of potential complications associated, in particular, with corrective osteotomy. The best results were achieved with the combined surgical approach; however, the choice of a surgical method was independent of the patient's clinical status.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Injection of anaesthetic-corticosteroid to relieve sacroiliac joint pain after lumbar stabilisation].
Both the range of motion and load transfer of the sacroiliac (SI) joint improve considerably after lumbar spine surgery. When, following surgery, SI joint pain develops in spite of appropriate physical therapy, injection of an anaesthetic with added corticosteroid into the SI joint is a first choice treatment. The aim of this presentation is to provide information on our experience with this therapy. ⋯ Lumbar spine stabilisation surgery may result in overloading the SI joints as the "adjacent segments". An intra-articular injection of anaesthetic can be considered a reliable method for ascertaining the SI joint as the source of a patient's problems. However, even with corticosteroid added, pain relief is not usually long-lasting.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Multidirectional screw fixation in the treatment of distal radius fractures using angle-stable plates].
Intra-articular fractures of the distal radius are treated predominantly by open reduction and internal fixation with various types of angle-stable plates. In this study we compare functional and radiographic outcomes in patients with intra-articular distal radius fractures treated with either angle-stable plates with rigid-direction screw insertion or multidirectional angle-stable plates. ⋯ The LCP group included 37 patients with an average age of 50 years (range 20-81 years) who were treated using angle-stable plates with rigid-direction screw insertion (LCP, Synthes). The APTUS group comprising 41 patients with an average age of 48.9 years (range 22-77 years) was treated by angle-stable implants in which screws can pivot freely in all directions (Aptus, Medartis). There was no significant difference between the groups in relation to fracture severity, age or other relevant characteristics. In all cases we used the volar approach. The final evaluation of treatment outcome was made at 12 months after surgery. We measured the range of wrist motion and hand grip strength, and compared the values with those obtained in the contralateral wrist. The results evaluated on the scoring systems of Gartland and Werley and of Castaing, and the DASH score were compared between the groups. The findings on radiographs were compared with the anatomical standard in the distal radius region. RESULTS In the LCP group, the average values, as compared with the contralateral side, were as follows: volar flexion, 84.2 %; dorsal flexion, 82.4 %; radial deviation, 83.2 %; ulnar deviation, 89.1 %; pronation, 98.6 %; supination, 97.4 %. In the APTUS group, the values in comparison with the other wrist were: volar flexion, 84.1 %; dorsal flexion, 91.8 %; radial deviation, 95.1 %; ulnar deviation, 92.8 %; pronation, 99.0 %; supination, 98.1 %. The values statistically comparable with the contralateral side were those in pronation, supination and hand grip strength in both groups. In addition, in the APTUS group, the values corresponding to the healthy wrist function were achieved in both radial and ulnar deviation. There were no differences in the values based on the scoring systems between the LCP and APTUS groups. As for the radiographic parameters, only the reconstruction of radial length was optimal. The other parameters differed from the anatomical standard. However, all patients met the criteria of successful healing of a distal radius fracture. Secondary fragment displacement during healing was recorded in two patients of the LCP group and in one of the APTUS group. Transient irritation of the median nerve was observed in five LCP group patients and in only one APTUS group patient. One patient in each group had an extensor tendon rupture. Reflex sympathetic dystrophy syndrome was diagnosed in two LCP group patients and in three APTUS group patients. DISCUSSION The surgical treatment of complex fractures of the distal radius using the angle-stable implants has generally achieved very good functional and radiographic outcomes with a low rate of complications. In the APTUS group, in contrast to the LCP group, the extent of radial and ulnar deviation corresponded to that found in the healthy wrist. The reason was a low-profile design of the plate and the screws, and the system with multidirectional angle-stable screws. The fewer cases of median nerve irritation in the APTUS group can be explained by the use of a different operative approach reducing the risk of direct mechanical nerve injury. In contrast to other authors, flexor tendon ruptures were not recorded in our groups. CONCLUSIONS The treatment of distal radius fractures by the angle-stable locking plate system from the volar approach achieved comparable functional and radiographic outcomes with both rigid-direction screw insertion and multidirectional screw insertion.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Failed compression osteosynthesis of the dens axis treated by anterior C1-C2 transarticular stabilisation. Case report].
We describe the case of an 80-year-old female patient who had undergone anterior C1-C2 transarticular stabilisation and was subsequently treated by the triple-screw method for failed compression osteosynthesis of a AO type III dens axis fracture. Key words: dens axis, upper cervical spine fracture, eldery, triple screw technique, anterior transarticular C1-C2 stabilisation.