Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2014
ReviewFracture healing: fracture healing understood as the result of a fascinating cascade of physical and biological interactions. Part I. An Attempt to Integrate Observations from 30 Years AO Research.
The choice of best procedure in fracture treatment relies on a proper understanding of tissue reactions to the prevailing mechanical and biological conditions. Investing time and effort is rewarding as it opens up access to a fascinating world and improves fracture treatment based on logical decision making. An intact bony skeleton enables mechanical functions of the human body such as locomotion. ⋯ The following paper addresses a fascinating interplay between physical and biological processes that enable fractured bone to bridge solidly and remodel to regain its "pre-fracture" function and structure. no one of the different treatment modalities or healing patterns is best on its own. for a given situation the goal is to recover the function of the bone, limb and patient early and permanently by choosing the optimal procedure and implant. Understanding bone reactions permits a rational choice and replaces subjective predilection and monomania. The stability of the fiation and the blood supply are priority considerations, which must often be weighed against each other.
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Acta Chir Orthop Traumatol Cech · Jan 2014
Randomized Controlled Trial[Surgical treatment of humeral diaphyseal fractures].
The aim of the study was to compare two surgical methods of treating diaphyseal fractures of the humerus. ⋯ Intramedullary nailing has not yet shown such good outcomes in humeral as in tibial fractures. The results of metaanalysis have indicated that humeral fractures treated by plate osteosynthesis have fewer complications and require repeat surgery less frequently. However, as shown by most recent studies, this difference is getting smaller. The MIPO technique was adopted at our department several years ago and the aim was to compare our results with those of other centres. The studies so far published have show that MIPO and conventional open plate osteosynthesis give comparable outcomes. CONCLUSIONS The statistical evaluation using the unpaired t-test did not show any significant differences in either the functional results or the number of complications between the two methods. Both achieved about 90% of excellent and good results and had 26% of complications. The only significant difference was found in the length of operative time (136 min in MIPO versus 117 min in EHN). With use of the Chi-Square test, a significant correlation between AO fracture type and treatment outcome in the MIPO group was found, i.e., no poor result was recorded for type A fractures, as assessed by the CM/LES score. No such correlation between the fracture type and the functional outcome was seen in the EHN group.
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Acta Chir Orthop Traumatol Cech · Jan 2014
Functional results following titanium elastic-stable intramedullary nailing (ESIN) of mid-shaft clavicle fractures.
INTRODUCTION While plate fixation remains the gold standard for surgical treatment for displaced mid-shaft clavicle fractures (DMCF), intramedullary fixation has emerged as a promising alternative. However, due to its more demanding technique and depending on the fracture's nature, an open reduction can be necessary. Aim of this study was to compare the outcome of open reduction versus closed reduction of DMCF using ESIN. ⋯ CONCLUSION There was no significant difference comparing patients who were treated with an open versus a closed technique. If appropriately indicated we believe that using ESIN is an adequate and successful operative technique for DMCF. There were no significant differences in shoulder function after either procedure.
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Acta Chir Orthop Traumatol Cech · Jan 2014
[Fixation of acetabular fractures. a novel method of pre-operative Omega plate contouring].
The aim of the study was to describe a novel Omega plate and the procedure for obtaining an accurate pelvic inlet view, the mode of pre-operative plate contouring, the surgical procedure used and the evaluation of results in the first 15 patients treated using this method. ⋯ Pre-operative contouring of an Omega plate based on a post-injury CT scan of the uninjured half of the pelvis is over 80% accurate or almost accurate. The multi-functional 3.5-mm pelvic plate Omega allows us to stabilise complicated fractures of the superior ramus of the pubic bone, anterior acetabular column or quadrilateral plate as well as fractures above the linea arcuata or uncomplicated fractures of the posterior column. The stabilisation of all fragments of the anterior column and quadrilateral plate is very firm and the Omega plate is resistant to fragment redisplacement. Also, it is its advantage that it can remain in situ if total hip arthroplasty is required later.
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Acta Chir Orthop Traumatol Cech · Jan 2014
[Scaphoid excision and four-corner fusion using the variable angle locking intercarpal fusion plate for treatment of post-traumatic degenerative changes of the wrist].
The aim of this study is to compare functional and X-ray results before and after four-corner arthrodesis using an angular stable dorsal circular plate in patients with post-traumatic degenerative changes of the wrist. ⋯ Four-corner arthrodesis of the wrist using angular stable dorsal circular plate fixation provides pain relief with acceptable preservation of the range of motion and no consolidation problems. Long-term follow-up and a larger group of patients would be necessary to confirm these hopeful results.