Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jun 2010
Case Reports[Successful urgent thoracotomy in a patient with penetrating heart injury--case report].
The case of a patient with a penetrating cardiac injury successfully treated by thoracotomy is reported. In a suicidal attempt, he suffered a self-inflicted thoracic stub wound penetrating the left ventricle. During transport to the hospital, he developed circulatory instability. ⋯ Intermittent myoclonus had persisted since admission, and a CT scan showed diffuse cerebral oedema due to post-hypoxic brain damage. During the following hospitalisation, the patient underwent the SSEP examination (evoked potentials) and no signs of decortication were found. At four weeks after injury, the patient was transported to his regional hospital he was afebrile, with stable circulation, spontaneous ventricular function and the GCS of 8 to 9.
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Acta Chir Orthop Traumatol Cech · Jun 2010
[Dynamic neutralization using the Dynesys system for treatment of degenerative disc disease of the lumbar spine].
Degenerative disc disease (DDD) is a spinal condition resulting from degeneration of the intervertebral discs. It is associated with symptoms of sciatica, back pain and leg weakness and also with degenerative instability of the spine. To arrest the degenerative cascade of disc disease, and taking into consideration stress placed on the adjacent discs managed by decompression and stabilisation by instrumented fusion, the lumbar spine was treated by dynamic posterior stabilisation of the segments affected. Based on the classification described by Dubois et al., the Dynesys system was used. The aim of this study was to evaluate the mid-term results of this method in DDD patients. ⋯ The results of 102 patients, with 146 segments treated by posterior dynamic neutralisation using the Dynesys system, show that this method improved subjective feelings, morphological findings and pain and functional status in the patients with DDD in the three-year post-operative period. This had a good effect on the quality of life in these patients.
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In this study the arthroscopic reconstruction of a rupture of the subscapularis tendon is described and the results of the technique are evaluated, with the aim to show the advantages and effectiveness of this surgical procedure. ⋯ Arthroscopy is the most suitable method to diagnose as well as manage ruptures of the subscapularis tendon classified as Lafosse grades I to IV. Arthroscopic tear repair results in a significant improvement in function of the shoulder joint and pain relief. Based on these results, the arthroscopic treatment of all Lafosse grade I-IV ruptures in our institution is recommended.
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Acta Chir Orthop Traumatol Cech · Jun 2010
[Distal femoral periprosthetic fractures: classification and therapy].
Periprosthetic fracture is one of the most serious complication of total knee arthroplasty. In our retrospective clinical study we designed our classification with rules for treatment of those fractures. ⋯ According to our results: Type I: Conservative treatment possible. Osteosynthesis with condylar plate is recommended. Type IIa: Indication for condylar plate osteosynthesis. Type IIb: The most problematic group. Osteosynthesis with condylar plate with augmentation or condylar plate placed from medial side. Type IIc: Plate osteosynthesis possible, intramedullary nail is recommended. Type IId: Osteosynthesis with augmentation is possible in some cases; revision TKA is recommended. Type III: Indication for revision TKA.
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Acta Chir Orthop Traumatol Cech · Jun 2010
Iliosacral screw fixation of the unstable pelvic ring injuries.
To report on the early results and possible complications of iliosacral screw fixation in the management of unstable pelvic ring injuries. ⋯ Iliosacral screw fixation is a useful method of stabilizing unstable pelvic ring injuries. It is a difficult technique, with a steep learning curve. The surgeon must understand the complex and variable sacral anatomy. High quality fluoroscopic imaging is a must. Especially in vertically unstable injuries the sacroiliac screws need to be augmented by sound anterior fixation. Low rates of infection, wound healing problems and minimal blood loss are advantages of this method.