Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Distal shortening osteotomy of the metatarsals using the Weil technique: surgical treatment of metatarsalgia and dislocation of the metatarsophalangeal joint].
Weil technique of the distal shortening osteotomy of metatarsal is a relatively new method of the surgical treatment of metatarsalgia and dislocation of metatarsophalangeal (MTP) joints. A retrospective study evaluates the first experience in Weil osteotomy at the authors' department. ⋯ Weil osteotomy allows a planned controlled shortening of metatarsal with a stable fixation. Osteotomy heals well. Osteotomy is intraarticular which on one side provides the possibility to correct dislocation in the MTP joint, however, on the other hand it poses a risk of the limitation of the range of motion of this joint. The main contribution the authors see in the new possibility of surgical treatment of more severe matatarsalgia and deformities of the forefoot with the preservation of joints.
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Cementless socket fixation based on the "press-fit" concept in total hip joint arthroplasty].
The key problem of implant fixation in THR is stress distribution, i.e. load transmission between bone and implant. The closer the load transfer is to the original physiological situation, the easier the adaptation of the periprosthetic bone to the new biomechanical conditions after implantation of the cup and the safer is its longlasting fixation. The aims of the studies were 1) to get information about the physiological load transfer in the normal hip joint, 2) to get information about the load transfer between acetabulum and acetabular sockets and vice versa, 3) to measure the periacetabular pelvic bone deformation as the stimulator of the remodelling process (third stage of osseointegration) in the normal hip joint and in hip joints fitted with different acetabular cups, 4) to study the morphological stages of osseointegration of a non-cemented press-fit cup and to compare the morphological structure of the periacetabular bone with the biomechanical data obtained by the in vitro studies and finally, 5) to compare the clinical and radiological outcome of follow-up studies of the senior author's "Press-Fit cup" with the theoretical hypotheses according to the experimental observations. ⋯ The studies have shown that the subchondral bone plate of the acetabulum has very little supportive function for non-cemented press-fit cups. For the preparation of the acetabulum it is, therefore, more important to ream the sclerotic subchondral bone until there is a well vascularized, well bleeding bone bed to facilitate osseointegration of a non-cemented acetabular socket than to preserve the subchondral bone plate as is the case in cement fixation. A non-cemented press-fit socket must transmit load predominantly to the cortical bone of the acetabular rim. Therefore, a too far medial positioning of the cup, and therefore loosing contact to the cortical rim, must be avoided under all circumstances. The clinical experience with acetabular revisions and with conversions of hip arthrodeses into a THR (where there is no subchondral bone at all) have shown the superiority of a well vascularized over a sclerotic (even mechanically stronger) bone bed. Furthermore, it has been shown that the additional use of screws for fixation of an acetabular cup is not only unnecessary but can be deleterious and causes complications including osteolysis and aseptic loosening.
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Osteosynthesis of trochanteric fractures using proximal femoral nails].
Presentation of the existing experience in the use of Proximal Femoral Nail Synthes (PFN) in trochanteric fractures. ⋯ PFN is a method of choice in trochanteric fractures, namely in high subtrochanteric fractures (31-A3).
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Combined method of treating dislocated fractures of the calcaneus].
The treatment of dislocated intraarticular fractures of calcaneus is still an unsolved chapter of traumatology. Our own poor long-term results of a purely conservative procedure has led us to develop a combined method of a direct and indirect reduction of calcaneus with the subsequent stabilization which we have been using since 1994. The basic principle of the method consists in the combination of a direct reduction of dislocated fragments of articular surfaces and indirect of calcaneus as a whole with the subsequent transfixation of calcaneus by K-wires. ⋯ The proposed method requires neither a specialist nor any expensive technical equipment and as a result it may be used both at orthopaedic and surgical departments and due to its undemanding nature and short hospitalization it is also very acceptable from the economic viewpoint.
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In this retrospective study, the outcomes of anterior and posterior approaches, performed either simultaneously or consecutively, in the radical surgical treatment of tumors of the thoracolumbar spine were compared in terms of surgery duration, intra-operative blood loss, neurological findings and complications. ⋯ We prefer an active and radical approach to the therapy of spinal tumors. The simultaneous surgery resulted in an operative time reduced by about 100 min (29%). The consecutive treatment, on the other hand, produced lower blood losses by 813 ml (24%). Complete surgery under one anesthesia was preferred.