Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2011
[A contribution of multidetector computed tomography to indications for chest wall stabilisation in multiple rib fractures].
Multidetector computed tomography (MDCT) is more sensitive for the detection of injury to the thoracic wall and intra-thoracic organs than a plain chest radiograph. The chest wall deformity and instability following multiple rib fracture involves fractures of four or more adjacent ribs at two levels, sometimes including a sternal fracture. It may also be associated with lung trauma (pneumothorax, haemothorax, rupture, laceration or pulmonary contussion). An isolated multiple-rib fracture can successfully be treated conservatively. Early intubation and mechanical ventilation are indicated in patients with progressive respiratory insufficiency. Indications for surgical stabilisation of this fracture are based on the signs of respiratory failure and the results of imagining methods (MDCT at the present time). ⋯ Based on 3D reconstruction from MDCT images, it is possible to make the pre-operative considerations for rib osteo- synthesis more specific and to choose the best approach. At the same time MDCT enables us to diagnose associated intra-thoracic injuries and provides indications for their treatment. In addition, it gives us a possibility to evaluate the role of a flail segment in breathing dysfunction and to establish indications for surgical stabilization in multiple rib fractures. Rib osteosynthesis allowed for early stabilization of the chest wall and improved the mechanics of breathing, thus requiring a shorter period of mechanical ventilation. The evaluation of statistical significance of these facts will be made when a larger group of patients examined by MDCT is available.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Identification of the lumbosacral nerve plexus during the extreme lateral interbody fusion procedure].
The aim of this clinical observation study was to determine the extent to which muscle relaxation induced by anesthesia must be intra-operatively reversed for a reliable identification, by intra-operative monitoring, of the lumbosacral (LS) nerve roots during extreme lateral interbody fusion (XLIF). MATERAL AND METHODS: General anesthesia (midazolam, propofol, sufentanil, oxygen/air/sevofluran - rocuronium) was administrated to all pa - tients. Train-of-four (TOF) stimulation of the ulnar nerve at 10-second intervals and an electromyographic response of the adductor pollicis muscle were used, and the duration of neuromuscular block was measured by the value of the TOF-ratio. When the level of recovery from neuromuscular block was TOF-count = 2, reversion to normal function was still accelerated by sugammadex administration at a dose of 2 mg.kg-1. Subsequently, it was determined at which level of muscle relaxation subsidence the first responses to LS nerve root stimulation were evident. Intra-operative neurophysiologial monitoring (IOM) with use of the NIM - Neuro® 3.0 device allowed for assessment of a triggered electromyographic reaction (tEMG) of LS roots to stimulation during surgery. The neuromuscular reactions were evaluated in 11 patients, five men and six women. The results were analysed by descriptive statistics and presented as median and interquartile-range values. ⋯ 1. For a reliable intra-operative identification of LS nerve roots by electric stimulation at a 10 mA intensity it is recommended to achieve the value of TOF ratio equal to at least 0.70. When stimulation at a lower intensity (5 mA) is used, a TOF ratio of . 0.90 is necessary. 2. Administration of sugammadex to reverse an action of the muscle relaxant rocuronium is an effective and quick method to achieve the values required.
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Acta Chir Orthop Traumatol Cech · Jan 2011
[Surgical treatment of intra-articular calcaneal fractures].
PURPOSE OF THE STUDY The calcaneus is one of the most complex bones in the human body. If fractured, restoration of its anatomy is demanding and displaced fractures may have permanent consequences affecting both daily living and work activities of the patient. In this prospective study, the authors present the results of surgical treatment of 48 dislocated intra-articular fractures of the heel bone. ⋯ CONCLUSIONS The method of percutaneous reduction and osteosynthesis is the optimal treatment for Sanders II dislocated fractures. Severely dislocated fractures (Sanders II and III) require open reduction and plate osteosynthesis. Comminuted fractures should be treated first by external fixation and by arthrodesis at the second stage if problems arise.
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Acta Chir Orthop Traumatol Cech · Jan 2011
Randomized Controlled Trial Comparative StudySerum-cobalt levels with metal-on-metal bearings in the cement-free total hip arthroplasty results covering two years; prospective study.
Total hip arthroplasty increases the use of alternate bearings to prevent polyethylene wear as the number of younger and more active patients has drastically risen. We carried out a prospective randomized study, to assess and compare clinical results and radiological changes, serum-cobalt- and serum-aluminium-levels when metal-on-metal and ceramic-on-ceramic bearings are applicated. ⋯ Our prospective randomized study showed after two years no difference clinically between the two groups of metal-on-metal and ceramic-on-ceramic bearings with total endoprostheses of the hip. Although medium serum-cobalt level in the metal-on-metal group with 1,2u/L is a significant higher value, whereas it lies in the ceramic-on-ceramic group below the detectable limit.
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Acta Chir Orthop Traumatol Cech · Jan 2011
Review[Current role of methylprednisolone in the treatment of acute spinal cord injury].
High doses of methylprednisolone (MPSS) came into use as part of a therapeutic protocol for acute spinal cord injuries following the published results from the NASCIS II study in 1992; they soon became a standard of care around the world. However, the results of this study have been critically reviewed and questioned by many authors since the beginning. The major argument is based on the fact that its effectiveness in reducing post-injury neurological damage has not been conclusively proved; in addition, there has been increasing evidence of serious side effects of steroids administered at high doses. ⋯ Current evidence suggests that MPSS administration in a 24-hour regimen after an initial dose given within 8 hours of injury is the therapeutic procedure that needs individual consideration in each patient according to their state of health and potential complications. MPSS administration at an interval longer than 8 hours after injury and for more than 24 hours is not justified, nor is it justified to use a high MPSS dose at the place of injury by an emergency ambulance crew. Key words: corticosteroids, methylprednisolone, spinal cord trauma, neurological damage.