Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Apr 2006
Review[Antibiotic treatment for prevention of infectious complications in joint replacement].
Prophylactic antibiotic treatment is mandatory in every operation involving an orthopedic implant. Carefully selected and correctly administered antibiotics can provide effective protection of the implant from bacterial colonization. The prevention of deep wound infection in joint replacement includes several procedures and measures which constitute three basic groups: 1) Promotion of patient's ability to resist infection (careful pre-operative preparation, elimination of potential infectious loci, good nutritional status, etc). 2) Optimal conditions for the operative wound (surgical technique, prophylactic antibiotics). 3) Reduction of the number of bacteria brought in the wound (control measures, super-sterile operating theatres). ⋯ Because of difficulties related to the right choice of antibiotic, it is recommended to keep a record of complications in each patient in order to provide feedback and to facilitate the establishment of reliable antibiotic-based prevention. The prevention of infection in orthopedics is a comprehensive issue. It cannot be expected that prophylactic antibiotic treatment will compensate for mistakes made in operative protocols, for inadequate operative techniques, for shortcomings in operating theatre equipment or insufficient preparation of patients.
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Acta Chir Orthop Traumatol Cech · Apr 2006
[Injury to major blood vessels in anterior thoracic and lumbar spinal surgery].
The anterior approach to the thoracic and lumbar spine is used with increasing frequency for various indications. With the advent of prosthetic intervertebral disc replacement, its use has become even more frequent and has often been associated with serious complications. The aim of this study was to evaluate vascular complications in patients who underwent anterior spinal surgery of the thoracic and lumbar spine. ⋯ The technique of anterior approach is safe only in the hands of experienced spinal surgeons with long experience. In institutions where anterior spinal surgery is not a routine method it is advisable to involve a vascular or cardiac surgeon. However, the most important point is to know when not to operate.
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Acta Chir Orthop Traumatol Cech · Apr 2006
[Three-dimensional geometry of the proximal humerus and rotator cuff attachment and its utilization in shoulder arthroplasty].
The aim of the study was to provide a method of measurement and data collection, based on morphologic analysis of the proximal humerus, that would facilitate precise placement of the humeral stem and would be easy to apply in clinical medicine in patients requiring shoulder arthroplasty. ⋯ The values provided here can be used for a more precise construction of implants for shoulder replacement. The method of three-dimensional presentation of the proximal humerus may aid in a more exact implantation procedure during shoulder arthroplasty. An optimal position of the implant can also be based on parameters obtained from the healthy contralateral shoulder joint.
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Minimally invasive technique have recently gained importance because of their apparent advantages. One of them is arthroscopic stabilization of the shoulder used for treatment of traumatic anterior glenohumeral dislocation with subsequent instability. In this study we describe the results of and experience with this technique. ⋯ Arthroscopic shoulder joint stabilization is a reliable method. It is a surgical procedure suitable for treatment of shoulder instability and is also indicated in patients with acute traumatic dislocation, because it significantly reduces the risk of recurrent dislocation that is high in conventional treatment. In the hands of an experienced surgeon this technique is fast and simple and, because of its minimal invasiveness, convenient for the patient. In comparison with open stabilization techniques, arthroscopy is associated with higher failure, but a classical open procedure can still be used for treatment of recurrent dislocations.
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Acta Chir Orthop Traumatol Cech · Jan 2006
[Use of post-operative drainage and auto-transfusion sets in total knee arthroplasty].
The aim of the study was to show advantages of post-operative collection of shed blood and its return to the patient's circulation, using blood-reinfusion sets, in terms of requirements for homologous blood, transmission of infections and posttransfusion reactions in total knee arthroplasty. ⋯ Our results showed that, in total knee arthroplasty, post-operative collection of shed blood and its reinfusion in the circulation can lower the need for homologous blood transfusion and reduce associated risks. If all conditions are observed, i. e., blood reinfusion within 6 h of surgery and the maximum of returned blood not exceeding 800 ml, the method is a safe way of compensating for blood losses in elective knee surgery.