Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2013
Controlled Clinical TrialThe treatment of the proximal humeral fracture with the use of the PHN Nailing System: the importance of reduction.
Intramedullary nailing is a minimally invasive technique that respects humeral head. However, limited surgical approach does not permit an anatomical reduction. The significance of the reduction on the functional outcome has not been sufficiently investigated. The aim of the study was to examine the functional and radiological postoperative outcome in patients with proximal humeral fractures treated with intramedullary nailing and the significance of reduction. ⋯ The majority of the patients treated with closed reduction and internal fixation with PHN show good postoperative functional results. However, fracture malreduction reduction cannot be always avoided with the use of PHN. Nevertheless, the evaluation of the Constant-Murley score shows an absolute anatomical reduction in not necessary for satisfying functional outcome. The reduction in anteroposterior plane seems to play a more important role in the postsurgical functional outcome. A malreduction that exceeds 15° in both planes or a malreduction of more than 20° in either plane should be avoided.
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At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. ⋯ Pseudoarthrosis or varus malalignment in a healed hip should be managed by valgus osteotomy. When the femoral head or the acetabulum is damaged, total hip arthroplasty is indicated. A prerequisite for successful surgical outcome is urgently and correctly performed osteosynthesis allowing for early rehabilitation and mobilisation of the patient.
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Acta Chir Orthop Traumatol Cech · Jan 2013
Cervical spondylotic myelopathy: the outcome and potential complications of surgical treatment.
Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in patients over 60 years old. Symptoms often develop gradually and insidiously and are characterized by neck stiffness, arm pain, numbness and clumsiness of hands, as well as weakness of the hands and legs frequently leading to a change in mobility. Surgery is performed primarily to prevent the progression of symptoms but also with the aim of improving existing symptoms. Aim of our study was to assess the outcomes and potential complications of surgical decompression of cervical spondylotic myelopathy (CSM). ⋯ Surgical decompression offers a real chance of improvement in the functional outcome of CSM, especially during the earlier stages of the disease. The surgical decision needs to be considered carefully due to the advanced age of the patient population and the greater burden of co-morbidities, which increase the surgical risks significantly.
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Acta Chir Orthop Traumatol Cech · Jan 2013
[Unstable injuries to the upper cervical spine in children and adolescents].
Injuries to the upper cervical spine in children are rare and account for 0.6 to 9.5% of all cervical spine injuries. We present a detailed analysis of the children and adolescents with unstable upper cervical spine injuries treated at our spinal centre. ⋯ 1. Injuries to the upper cervical spine are most frequently found in the youngest children and in adolescents who, however, frequently have injury also to the lower cervical spine. 2. Neurological deficit is relatively frequent but has a better prognosis than in adults. The youngest children with mild deficits have the best prognosis. 3. The mortality rate in young children with upper cervical spine injuries is evidently high, mostly due to associated head, chest and abdomen trauma 4. Therapy, particularly in small children, is strictly individual.
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Acta Chir Orthop Traumatol Cech · Jan 2013
[DHS osteosynthesis for proximal femoral fractures: infectious complications].
Evaluation of infectious complications in patients with proximal femoral fractures treated by osteosynthesis using dynamic hip screws (DHS). ⋯ Infectious complications following osteosynthesis with dynamic hip screws are rare events in the treatment of proximal femoral fractures. Staphylococcus aureus was the most frequently isolated infectious agent. Each infectious complacation was associated with one or more risk factors. Antibiotic prophylaxis is important particularly in patients at risk.