Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jun 2010
[Distal femoral periprosthetic fractures: classification and therapy].
Periprosthetic fracture is one of the most serious complication of total knee arthroplasty. In our retrospective clinical study we designed our classification with rules for treatment of those fractures. ⋯ According to our results: Type I: Conservative treatment possible. Osteosynthesis with condylar plate is recommended. Type IIa: Indication for condylar plate osteosynthesis. Type IIb: The most problematic group. Osteosynthesis with condylar plate with augmentation or condylar plate placed from medial side. Type IIc: Plate osteosynthesis possible, intramedullary nail is recommended. Type IId: Osteosynthesis with augmentation is possible in some cases; revision TKA is recommended. Type III: Indication for revision TKA.
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Acta Chir Orthop Traumatol Cech · Apr 2010
[Low grade renal trauma (Part II): diagnostic validity of ultrasonography].
The aim of the study was to verify whether ultrasonography can be considered a reliable method for the diagnosis of low-grade renal trauma. ⋯ The results of this study demonstrated that the validity of ultrasonography for the diagnosis of low-grade renal injury is not significant, because this examination can reveal only some of the renal injuries such as perirenal haematoma. An injury to the renal parenchyma is also indicated by hypoechogenic areas of varying sizes in the renal cortex. A negative ultrasonographic finding is no proof of the absence of renal trauma. As low-grade renal injury is difficult to detect by mere clinical examination or by a single imaging method, the authors regard as necessary to actively look for them, taking into consideration the mechanism of injury, haematuria findings and evaluation of ultrasonographic and CT scans.
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Acta Chir Orthop Traumatol Cech · Apr 2010
[The effect of complications on the quality of life after surgery for lumbar spine degenerative disease].
To evaluate the effect of complications on the quality of life in patients after elective stabilisation surgery on the lumbar spine. ⋯ Complications are a serious issue of spinal surgery. The majority of complications in our group were associated instrumentation--most frequently with incorrect screw misinsertion. On the whole, the complications did not significantly influence the quality of life and pain intensity after surgery. Most of them were treated successfully with no permanent consequences. The permanent neurological deficit in three patients, because of the small number, had no effect on the whole group results. A reduction in the number of complications would not produce any expected improvement of functional out- come.
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Acta Chir Orthop Traumatol Cech · Apr 2010
[Surgical treatment of pelvic ring and acetabular fractures using the Stoppa approach].
The Stoppa approach used in acetabular and pelvic ring fractures provides an excellent visualisation of the anterior column, quadrilateral plate and part of the posterior column for its exact reduction. Our first experience of this surgical approach and preliminary results are reported. ⋯ The Stoppa approach changes the conditions for treatment of acetabular and pelvic ring fractures fundamentally. It affords an excellent visualisation of the anterior column and quadrilateral plate and allows for an exact reduction and stable fixation of their fractures. In combination with other approaches it permits anatomic reconstruction of the most serious fractures of the acetabulum and pelvic ring.
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Acta Chir Orthop Traumatol Cech · Apr 2010
[Adjacent segment degeneration after lumbosacral fusion in spondylolisthesis: a retrospective radiological and clinical analysis].
Whereas the posterior lumbar interbody fusion (PLIF) technique with pedicle screw fixation has shown satisfactory clinical results, solid fusion has been reported to accelerate degenerative changes at adjacent unfused levels, especially at the cranial level. The aim of this retrospective study was to evaluate a group of patients with adjacent segment disease (ASD) developed after 360-degrees lumbar fusion for spondylolisthesis performed by PLIF with transpedicular fixation and posterolateral fusion (PLF).Radiographic examinations were focused on the origin or progression of degenerative changes at the adjacent segments after the operation, with statistical evaluation of some parameters. Clinical evaluations included back pain or neurologic symptomatology which emerged later in the post-operative period in patients with adjacent segment degeneration. ⋯ An increased occurrence of degenerative changes and the instability predominately at the level immediately above single-segment instrumented 360-degree fusion with clinical deterioration give support to the view that this is due to increased mechanical stress at the motion segments adjacent to fusion. However, the size of our sample was not large enough to allow us to draw generally valid conclusions from the results of radiological angular characteristics. The causes of instability in younger patients could also include spine overloading, damage to the stability of ligaments and bone structures sustained during the operation, or a combination of both. The authors recommend a permanent reduction in physical activity after lumbar or lumbosacral spinal fusion and, in cases where symptomatic instability or degeneration of the adjacent motion segment is manifested, the use of 360-degree instrumented fusion (ALIF or PLIF), dynamic or semi-rigid stabilisation or total disc replacement. A thorough examination of levels adjacent to the planned spinal fusion will prevent termination of the fusion at the potentially painful segment, with a possibility to use a fusion or combined with dynamic neutralisation at the adjacent segment.