Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Oct 2006
[Linezolid in the treatment of antibiotic-resistant gram-positive infections of the musculoskeletal system].
The growing incidence of resistant microorganisms has been responsible for complications associated with treatment of osteomyelitis, infections following joint arthroplasty, as well as septic arthritis. Their therapy often requires a long-term administration of antibiotics to which the bacterial strain is sensitive. Oxazolidinons present a novel group of antibiotics recently adopted in clinical medicine. However, the only member of this group so far approved for clinical use is linezolid. It is effective for Gram-positive bacteria including antibiotic-resistant strains, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), resistant coagulase-negative staphylococci and penicillin-resistant pneumococci. Linezolid is well absorbed in the intestinal system. Oral administration results in serum levels comparable with those following intravenous injection of the same dose. ⋯ Infections caused by Gram-positive bacteria resistant to common antibiotics present serous epidemiological, therapeutic and economic problems, which will soon be in the focus of attention in the majority of Czech hospitals. In the patients who, due to allergic reactions, intolerance or bacterial resistance, cannot be treated with vancomycin or other antibiotics, linezolid may be a useful option for treatment of musculoskeletal system infections. The possibility of linezolid administration in oral doses markedly reduces hospital stay costs and increases patients' comfort during treatment.
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Spinal injuries in children are rare and account for a low proportion of all childhood injuries. Due to anatomical and biomechanical properties of the growing spine, there are great differences between spinal injury in childhood and adulthood. Because of higher mobility and elasticity of the spine and a lower body mass in children, spinal injuries are not frequent and represent only 2 to 5 % of all spinal injuries. In this retrospective study, the effectiveness of conservative and surgical treatment of injured spines in children is evaluated in a 10-year period. ⋯ Childhood spinal injuries account for only 2 to 5 % of all spinal injuries and for 3.6 % of all skeletal injuries in children. Particularly at the age of 11 to 12 years, they differ significantly from spinal injuries in adults and therefore require different therapeutic approaches. The cervical spine is affected most often in younger children, while the thoracolumbar spine in older children. Multi-segment injuries are typical in the childhood spine, particularly in smaller children. Typically, children show SCIWORA and a more rapid improvement of neurological deficit than adults. Conservative treatment is preferred; surgery before 12 years of age is strictly individual, while after 12 years therapy is similar to that used in adults.
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Acta Chir Orthop Traumatol Cech · Aug 2006
[Treatment of deep cartilage defects of the knee with autologous chondrocyte transplantation on a hyaluronic Acid ester scaffolds (Hyalograft C)].
The treatment of chondral defects by transplantation of autologous chondrocytes has recently shown further development. Various biomaterials are used as carriers facilitating attachment and even distribution of chondrocytes in the defect. Since 2003 Hyalograft C, hyaluronan-based scaffolds, has been used, in a clinical study, for implantation of autologous chondrocytes in the treatment of deep chondral lesions of the knee at our department. ⋯ Based on our results we suggest that the use of Hyalograft C is a safe and effective option for treatment of deep chondral defects of the knee; it is particularly useful in patients in whom the primary defect treatment has failed. The application of Haylograft C is relatively quick and easy; this is convenient when surgery involves more than one procedure (ligament reconstruction, osteotomy). However, a definite evaluation of this method will be possible only after long-term results are available. Key words: deep cartilage defects, chondral defects, cartilage repair, autologous chondrocyte transplantation, hyaluronan- based scaffold, Hyalograft C, cartilage repair assessment, ICRS.
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Acta Chir Orthop Traumatol Cech · Aug 2006
[Hip joint arthroplasty following surgical treatment of acetabular fracture].
A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study. ⋯ Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.
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Acta Chir Orthop Traumatol Cech · Aug 2006
[Early primary total hip arthroplasty for acetabular fractures in elderly patients].
The aim of this pilot study was to evaluate the clinical and functional outcomes of total hip arthroplasty (THA) in patients with acetabular fractures due to a low-energy injury. Acute primary THA included an antiprotrusion cage and autologous bone grafting of the acetabulum. This prospective study was carried out between 1998 and 2004. ⋯ Acute primary THA with the use of a antiprotrusion cage and bone grafting for acetabular fractures in elderly patients allows us to employ only one surgical technique for definitive repair. It provides primary stability and immediate pain relief, permits graded weight-bearing and early pain-free mobilization, and may also treat hip arthritis, if it exists. This technique has also good prospects for a selected group of younger patients in whom the treatment of acetabular fractures has a poor prognosis. Key words: acetabular fracture, elderly patient, primary total hip arthroplasty.