Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Oct 2009
[Plate osteosynthesis in vancouver type b1 and b2 periprosthetic fractures].
In a retrospective study we evaluated the results of plate osteosynthesis for treatment of periprosthetic femoral fractures classified as Vancouver types B1 and B2. ⋯ Plate osteosynthesis is a suitable method for treatment of periprosthetic fractures if there is a stable femoral component. LPC implants are not discriminative enough in the range of indications for plate osteosynthesis.The use of plate osteosynthesis in a total hip arthroplasty with signs of loosening is bound to lead to acceleration of loosening and stem migration, and may even result in plate breakage or its expulsion. This implies that, in such THAs, plate osteosynthesis can only be carried out as a palliative procedure in immobile and severely ill old patients. Key words: periprosthetic fractures, total hip arthroplasty, revision total hip arthroplasty, plate fixation, LCP, Vancouver classification.
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Damage control surgery is one of the major advances in surgical techniques used in polytrauma patients in the past 25 years. It is based on a foreshortened pre-operative examination during ongoing resuscitation which includes surgical intervention in an injured patient with severe hypotension due to haemorrhage. In this seven-year retrospective study the authors evaluate the results of damage control laparotomy in patients with injury to the abdominal organs, retroperitoneum and pelvis. ⋯ Damage control laparotomy is an effective procedure in the treatment of severe trauma to the abdominal organs and retroperitoneum in critically injured patients. This time-limited, staged surgical intervention is included in resuscitation of patients with hypothermia, metabolic acidosis and coagulopathy. The outcome of damage control surgery is related to not only the severity of injury, but also experience with comprehensive acute care in trauma centres.
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Acta Chir Orthop Traumatol Cech · Aug 2009
[Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation].
The treatment of femoral neck fractures shows a relatively high number of poor outcomes, usually due to late complications, such as avascular necrosis of the femoral head or pseudoarthrosis. The latter may develop when the osteosynthesis of osteoporotic bone fails. The aim of this retrospective study was to evaluate a group of patients treated by osteo- synthesis for intra-capsular femoral neck fractures at our department, and to verify indication criteria and identify the therapeutic procedures that are best suited to our conditions. ⋯ Our results show a direct relationship between the extent of fracture displacement and late complications, i.e., avascular necrosis and non-union. The quality of fracture reduction had a greater effect on fracture non-union than on the development of femoral head necrosis. The length of time between injury and surgery played a lesser role than it is believed. The use of an anti-rotation screw was not significantly related to the occurrence of late complications. The DHS method is economical and available, and provided sufficient results whose comparisons with the literature data show that this therapeutic approach is correct.
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Acta Chir Orthop Traumatol Cech · Aug 2009
Review[Comparison of therapeutic strategies for hip and knee prosthetic joint infection].
Prosthetic joint infection (PJI) is a feared complication of total joint arthroplasty. Several strategies have been developed to treat it. The purpose of our study was to compare therapeutic strategies for PJI treatment published in the literature. ⋯ A two-stage protocol for PJI treatment had the lowest risk for both PJI recurrence and need for additional surgery in comparison with all other strategies developed for PJI therapy. Therefore, it should be accepted as the method of choice. One-stage hip reimplantation is a less reliable approach in which it is inevitable to strictly respect the indication criteria. Other methods are either less reliable or associated with a high risk of repeat surgeries, or provide functionally unacceptable outcomes.
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Acta Chir Orthop Traumatol Cech · Aug 2009
[Arthrodesis of the carpometacarpal joint of the thumb using a cannulated screw].
To present the results of surgical treatment of carpometacarpal joint arthritis of the thumb, using cannulated screw fixation which is stable and, after bony union, allows the patient to do also harder manual work ⋯ Arthrodesis with cannulated screw fixation is best for treatment of the carpometacarpal joint of the thumb with stage III rhizarthritis (Eaton classification). It results in an axis-stable thumb that is pain free and capable of physical activity and firm grip.