Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 1998
[Complications of osteosynthesis of proximal femur fractures by the gamma nail.].
Based on the analysis of their group of 75 patients treated for the fracture of proximal femur by means of the Gamma nail and on the analysis of data from the literature the authors present a comprehensive list of all complications resulting from this technique: inadequate reduction, -jamming of nail, fracture displacement by nail isertion, perforation of the head, incorrect length of the lag screw, problems with distal locking, fracture of the femoral shaft, rotation of head on the lag screw, rotation of diaphysis on the nail, failure of the healing of the wound and infection, breaking of the nail, non-union, healing in the varus position, aseptic necrosis of the head, incorrect rotational position of the limb, unequal length of lower limbs, problems with the set of instruments, migration of the set screw. Ensuing from the analysis are the main principles of the surgical technique. ⋯ unstable intertrochanteric fractures, comminuted fractured (Kyle IV) of trochanteric regions and some subtrochanteric fractures. Reduction: in case of unstable fractures it is advantageous to correct them in a slightly valgus position, in the lateral projection it is necessary to achieve linear position of fragments. Antibiotics: recommended in case of elderly patients, in younger patients, only in risk involving cases. Position: the leg to be operated on has to be in adduction with regard to the body. Selection of the nail: diameter 12 mm, angle 130 degrees . Reaming: in the distal direction it is necessary to ream medullary cavity by 2 mm more than is the diameter of the nail, in the proximal direction it must be reamed up to 17 mm. Insertion of the nail: should be done manually, never use a hammer! If too much resistance is felt when advancing the nail, it is necessary to ream a larger hole or choose a thinner nail. Insertion of the lag screw: in AP projection along the longitudinal axis of the neck and head or slightly below, in the axial one exactly along the axis of the neck and head. Compression: only in cases where there is a diastasis between the fragments alignment with the tro-chanteris region. Compression: only in cases where there is a diastasis between the fragments alignment with the trochanteris region. Fixation of the set screw: should be done in such a way to prevent rotation but at the same time to allow free sliding of the lag screw, i. e. to screw it and subsequently unscrew by one quarter of a turn. Releasing of the traction after the insertion of the lag screw: in cases where there is diastasis between the femoral shaft and trochanteric region, special care should be taken in case of subtrochanteric fractures. Distal locking: is performed by one screw inserted in the proximal hole, care should be taken not to lever the targeting device or the guide sleeve, slipping of the drill bit should be avoided. The use of a short screw is not suitable. Tightening should be done carefully, checking by image intensifier is recommendend. R-drainage: always into the nail wound, in case of the lag screw incision it should be considered from the viewpoint of bleeding. Key words: proximal femur fracture, Gamma nail, summary of complications.
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Acta Chir Orthop Traumatol Cech · Jan 1997
[Gastrointestinal Tonometry in Orthopaedics (Results of a Prospective Randomized Pilot Study GATOAN-1 in Patients with General and Regional Anaesthesia During Replacement of the Hip Joint).].
In the submited pilot study the authors present a recently introduced method of monitoring of the regional perfusion by gastric tonometry during implantation of an endoprosthesis of the hip joint. The objective of the investigation was in addition to introduction of a new method to assess the influence of the type of anaesthesia on markers of the gastrointestinal tract perfusion. The method was used in 10 patients aged 27 - 75 years where in four instances a cemented endoprosthesis was implanted and an uncemented one in six cases. ⋯ Statistical evaluation revealed a significant difference in pH gap and CO2 gap values in favour of regional anaesthesia (p = 0,03). The results of the trial indicate a better gastrointestinal perfusion in patients under regional anaesthesia and a pathological state of organ perfusion while the values of standard systemic values are unaltered. Key words: gastrointestinal tonometry, general anaesthesia, regional anaesthesia, total replacement of the hip joint.
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Acta Chir Orthop Traumatol Cech · Jan 1995
[Contribution to the problem of classification of fractures of the proximal end of the humerus in adults.].
A classification is useful only if it helps the surgeon to resolve a given fracture. This applies obviously also to fractures of the proximal end of the humerus. In the submitted paper the authors review the problem of classification of fractures of the proximal humerus which could help orthopaedists and traumatologists to decide on the therapeutic approach to these serious injuries. ⋯ The mentioned modern classifications meet to a certain extent their purpose and each department which is used to a method will find it difficult to switch over to another one. Because all classifications comprise also therapeutic guidelines for treatment of different types of fractures, the therapeutic results achieved by the given department in the treatment of fractures of the proximal humerus by using a certain classification are decisive. Key words: classification of fractures of the proximal humerus.
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Acta Chir Orthop Traumatol Cech · Jan 1993
Case ReportsWave plate osteosynthesis as a salvage procedure.
The load axis of the curved-shaped proximal femur lies not inside, but outside the bone. Therefore high bending forces are acting, the medial cortex absorbing pressure, the lateral cortex absorbing tension. ⋯ This dilemma is compensated by a wave-plate with bone graft: The compression forces are detoured to the lateral cortex and the plate is again subjected to tension. Furthermore since the plate is standing away from the bone, the plate does not disturb the blood supply at the fracture side and bone healing.
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Acta Chir Orthop Traumatol Cech · Jan 1993
[Radiodiagnosis of fractures of the thoracolumbar spine].
The article presents a most detailed description of the individual radiologic methods used for the examination of the fractures of the thoracolumbar spine, i.e. CAT examination including 3-D reconstruction and magnetic resonance. Apart from technical procedures and the assessment of individual methods the article also shows their comparison.