Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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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.
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Acta Chir Orthop Traumatol Cech · Feb 2010
[Magnetic resonance imaging for detection of rotational deformities in children with femoral shaft fractures treated by the ESIN method].
The aim of the study was to evaluate the results of elastic stable intramedullary nailing (ESIN).used in the treatment of children with femoral shaft fractures, with a focus on post-traumatic rotational deformity assessed by magnetic resonance imaging (MRI). An alternative hypothesis was established assuming a significantly high incidence of this post-traumatic complication. Also, the advantages of MRI for the diagnosis of rotational deformity were assessed in comparison with ultra- sonography and physical examination. ⋯ The method of measuring rotational deformity after femoral shaft fracture using MRI gave exact results and posed no risk for the child, and is therefore presented as a novel and important part of post-traumatic follow-up of children with this injury. In the ESIN- treated patients, this diagnostic method did not reveal any statistically significant occurrence of serious post-traumatic rotational deformity during the healing of a femoral shaft fracture.
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Acta Chir Orthop Traumatol Cech · Feb 2010
[Low-grade renal trauma (part I): diagnostic validity of haematuria].
The aim of the study was to evaluate the diagnostic validity of haematuria findings in patients with low-grade renal trauma. ⋯ The finding of haematuria is a valuable piece of information in low grade renal trauma. Particularly, if imaging methods fail to detect an injury, haematuria is a sign indicating renal trauma following a typical blunt force mechanism, even though our results of its evaluation were not statistically significant. The absence of macroscopic or microscopic haematuria did not exclude the existence of renal trauma in our group, and it is therefore necessary to pay increased attention to the evaluation of findings obtained by imaging methods in patients involved in a typical blunt force accident.
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The method of choice for the treatment of severe ankle arthritis is either arthrodesis or joint arthroplasty. Each has its advantages and disadvantages. Arthrodesis is the definitive therapy for severe ankle destruction and instability. Joint arthroplasty has an advantage in maintaining ankle mobility. However, its range of indications and its reliability and durability are more limited. The aim of this study is to present our experience with the AES prosthesis and draw attention to some drawbacks of this surgical treatment. ⋯ The longevity of a total ankle replacement depends, much more than in other joint replacements, on an accurate implantation technique and correct indication.
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Acta Chir Orthop Traumatol Cech · Feb 2010
[Percutaneous release in the treatment of trigger digits].
To evaluate, in a retrospective study, the surgical outcomes of percutaneous A1 pulley release in the treatment of trigger digits. ⋯ Percutaneous release has been adopted as a standard method at our department. Because of its minimal invasiveness, it reduces the risk of complications associated with open procedures. It can be carried out at an outpatient department, is less painful and allows the patient to return to daily activities and work in a shorter time.