Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].
PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma patients died within 24 hours of injury (61.5%). CONCLUSIONS Chest injury, almost always blunt, is often diagnosed in polytrauma patients. A prevalent cause of multiple trauma is a traffic accident. Chest injury most frequently involves pulmonary contusion. Nearly half of chest injuries require surgery, of which 2/3 are urgent procedures. The procedure most frequently performed in polytrauma patients with chest injury is chest drainage and this is also a sufficient procedure in 75% of surgically treated patients. ⋯ polytrauma, chest injury, pulmonary contusion, surgical treatment, chest drainage.
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Acta Chir Orthop Traumatol Cech · Jan 2016
Review Case Reports[Infectious Inflammation of Pubic Symphysis (Symphysitis Pubis Purulenta): Five Case Reports and Literature View].
Purulent inflammation of the pubic symphysis is a rare condition involving the symphysis and parasymphyseal parts of the pubic bones. It is usually found in immuno-compromised patients and its most frequent cause is Staphylococcus aureus. Conservative treatment is based on long-term administration of antibiotics and has been efficient, as reported, in about 50% of the patients. ⋯ Based on the experience with the treatment of five patients with infection of the pubic symphysis, the authors suggest that the late phase with abscess formation or purulent discharge should be managed by surgery. This treatment has good clinical outcomes although it may be complicated by slow healing of soft tissues around the symphysis and instability of the anterior pelvic segment with its sequelae. Key words: infection of the symphysis, infection of the pubic symphysis, septic arthritis of the pubic symphysis, pubic osteomyelitis.
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PURPOSE OF THE STUDY Peripheral fractures of the talus (lateral talar process and posterior talar process) are rare injuries, easy to miss on examination due to their location and clinical manifestation. They account for 0.3% to 1.0% of all fractures of the talus. An incorrect or late treatment of talar process fractures can result in permanent pain, impingement syndrome, healing in malposition, pseudoarthrosis development and also, due to joint instability, in a potential development of severe subtalar arthritis. ⋯ Fractures of talar processes often show symptoms and signs similar to those of more serious forms of dislocation of the talus and therefore a careful assessment of standard X-ray images taken for a "swollen ankle" is necessary. If the findings are not clear, CT examination is indicated. Key words: fracture, talus, processus lateralis tali, processus posterior tali.
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Injury to the Scapholunate Ligament in Distal Radius Fractures: Peri-Operative Diagnosis and Treatment Results].
PURPOSE OF THE STUDY Injury to the scapholunate ligament is frequently associated with a fracture of the distal radius. At present neither a unified concept of treatment nor a standard method of diagnosis in these concomitant injuries is available. The aim of the study was to evaluate a group of surgically treated patients with distal radius fractures in order to assess a contribution of combined conventional X-ray and intra-operative fluoroscopic examinations to the diagnosis of associated lesions and to compare short-term functional outcomes of sugically treated patients with those of patients treated conservatively. ⋯ Subjectively, however, they feel more pain and more restriction in performing daily activities. Therefore, the treatment of an injured scapholunate ligament together with distal radius fracture at one-stage surgery seems to be a good alternative for the patient. Key words: distal radius fractures, scapholunate ligament, radiographic, diagnosis, outcome distal radius fracture.
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Acta Chir Orthop Traumatol Cech · Jan 2016
Comparative Study[Surgical Treatment for Advanced Rhizarthrosis. Comparison of Results of the Burton-Pellegrini Technique and Trapeziometacarpal Joint Arthroplasty].
The aim of the study was to compare results of the Burton-Pellegrini trapeziectomy with ligamentoplasty using the flexor carpi radialis tendon with those of trapeziometacarpal joint replacement in the treatment of advanced rhizarthrosis. ⋯ The two techniques present valuable contributions to the treatment of advanced rhizarthrosis. In our patients, better outcomes are shown in trapeziometacarpal joint replacement though, in comparison with resection interposition arthroplasty, the indication criteria for this surgery are limited by factors such as the height of the trapezium bone and bone quality necessary for good osseointegration.