Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Mortality in patients with proximal femoral fractures during the first year after the injury].
The authors present an overview of mortality of patients with proximal femur fractures treated at the authors' Department in 1997 in dependence on different factors relating to the preinjury condition and the treatment itself. The aim of the work was to determine the impact of these factors on the risk of mortality and compare the findings with the data published by other authors dealing with the same issue. ⋯ Based on the evaluation of the data monitored in the group a conclusion was made that absolute mortality risk in the first year after the injury related to patients with pathological fractures due to metastasis. A higher risk related to male patients older than 80 years with the surgical risk of ASA IV and higher and this risk rate was the highest in the time interval within 3 months after the injury or operation.
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Distal shortening osteotomy of the metatarsals using the Weil technique: surgical treatment of metatarsalgia and dislocation of the metatarsophalangeal joint].
Weil technique of the distal shortening osteotomy of metatarsal is a relatively new method of the surgical treatment of metatarsalgia and dislocation of metatarsophalangeal (MTP) joints. A retrospective study evaluates the first experience in Weil osteotomy at the authors' department. ⋯ Weil osteotomy allows a planned controlled shortening of metatarsal with a stable fixation. Osteotomy heals well. Osteotomy is intraarticular which on one side provides the possibility to correct dislocation in the MTP joint, however, on the other hand it poses a risk of the limitation of the range of motion of this joint. The main contribution the authors see in the new possibility of surgical treatment of more severe matatarsalgia and deformities of the forefoot with the preservation of joints.
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Cementless socket fixation based on the "press-fit" concept in total hip joint arthroplasty].
The key problem of implant fixation in THR is stress distribution, i.e. load transmission between bone and implant. The closer the load transfer is to the original physiological situation, the easier the adaptation of the periprosthetic bone to the new biomechanical conditions after implantation of the cup and the safer is its longlasting fixation. The aims of the studies were 1) to get information about the physiological load transfer in the normal hip joint, 2) to get information about the load transfer between acetabulum and acetabular sockets and vice versa, 3) to measure the periacetabular pelvic bone deformation as the stimulator of the remodelling process (third stage of osseointegration) in the normal hip joint and in hip joints fitted with different acetabular cups, 4) to study the morphological stages of osseointegration of a non-cemented press-fit cup and to compare the morphological structure of the periacetabular bone with the biomechanical data obtained by the in vitro studies and finally, 5) to compare the clinical and radiological outcome of follow-up studies of the senior author's "Press-Fit cup" with the theoretical hypotheses according to the experimental observations. ⋯ The studies have shown that the subchondral bone plate of the acetabulum has very little supportive function for non-cemented press-fit cups. For the preparation of the acetabulum it is, therefore, more important to ream the sclerotic subchondral bone until there is a well vascularized, well bleeding bone bed to facilitate osseointegration of a non-cemented acetabular socket than to preserve the subchondral bone plate as is the case in cement fixation. A non-cemented press-fit socket must transmit load predominantly to the cortical bone of the acetabular rim. Therefore, a too far medial positioning of the cup, and therefore loosing contact to the cortical rim, must be avoided under all circumstances. The clinical experience with acetabular revisions and with conversions of hip arthrodeses into a THR (where there is no subchondral bone at all) have shown the superiority of a well vascularized over a sclerotic (even mechanically stronger) bone bed. Furthermore, it has been shown that the additional use of screws for fixation of an acetabular cup is not only unnecessary but can be deleterious and causes complications including osteolysis and aseptic loosening.
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period].
The aim of the study is to present a basic statistical overview of fracture-dislocations of the ankle in adults in a one-year group of patients. ⋯ Fracture-dislocations affect equally men and women. Men prevail until the age of fifty, women afterwards. The average age of patients was 49 years. Most frequent is Weber B Type, least frequent Weber C.
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Acta Chir Orthop Traumatol Cech · Jan 2002
[Replacement of the vertebral body with an expansion implant (Synex)].
This paper describes replacement of the vertebral body with the expansion implant Synex. Usually, autologous bone graft is used to replace the vertebral body. In patients with bone cancer or multiple injuries to the spine, cement filling is preferred whereas, in other indicated cases, implants are inserted, of which Harms' titanium cage has been the most common one. However, this needs filling with a large amount of bone tissue and it is often difficult to adjust its size into the space available. Telescopic devices, on the other hand, are easier to implant and their application requires only a minimum amount of autologous bone tissue. ⋯ Synex is a sophisticated implant to replace severely damaged vertebral bodies regardless of the nature of lesion. Its application required additional stabilization by either posterior or anterior fixation (internal transpedicular fixator and Ventrofix or Kaneda, respectively). Its use is indicated in post-traumatic defects of vertebrae in acute or poorly healed scervical.