We compared technical issues, postoperative outcomes and surgical complications of total hip arthroplasty when using the harmonic scalpel (HS) when compared with conventional techniques (CT) in a prospective, comparative observational study. Thirty patients undergoing total hip arthroplasty were assessed. Operative time, blood loss in drains, postoperative pain, soft tissue injury and complications were recorded. We found no significant differences between the HS and CT groups at baseline. Mean operative time was longer in the HS group compared with the CT of total hip arthroplasty (61 minutes vs. 54 minutes; P<0.05). We found no difference in postoperative pain using a visual analogue scale score, or use of paracetamol. The use of tramadol was reduced in the HS group compared to CT group at the 7th day (83.3 mg vs. 113.3 mg; P<0.05). Drainage volume was significantly lower in the HS group at 24 hours (332 ml vs. 429 ml; P<0.05) and at 48 hours (429 vs. 537 ml; P<0.05). C-reactive protein blood levels were significantly lower in the HS group 75 mg/l vs. 96 mg/l at the third day (P<0.05) and 26 mg /l vs. 54 mg /l at the seventh day (P<0.01). Creatine kinase blood levels were significantly lower in the HS group at 3 and 7 days (2.4 ukat/l compared to 5.3 ukat/l at the 3rd day (P<0.01), respectively 1.1 ukat/l compared to 1.8 ukat/l at the 7th day (P<0.01). We found no significant differences in blood myoglobin levels between the two groups. The use of the HS may reduce postoperative pain, drainage volume, and soft tissue injury in patients undergoing total hip arthroplasty, which may justify the cost of the technique. The use of HS may have further applications in revision hip arthroplasty and tumour surgery.
Aims. To assess the results of a biomechanical test of cadaveric specimens, comparing 2 methods of fixation of modified Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint. Methods. A total of 12 cadaveric specimens were used in the test. Arthrodesis of the first MTP joint was in all patients fixed with a Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7. Two methods of fixation of the Lapidus arthrodesis were compared, i.e. fixation with two screws in the PS (plate-screw) version versus fixation with X-Locking Plate 2.4/2.7 in the PP (plate-plate) version. Measurements were obtained with the use of a testing machine ZWICK Z 020-TND with an optical device Mercury RT for measuring deformities. Each specimen was subjected to 3 loading options, a. displacement 5 mm, the support is placed under the proximal phalanx, b. displacement 5 mm, the support is placed under the first metatarsal head and c. load to failure, the support is placed under the first metatarsal head. Results. In all specimens the PS construct showed a statistically considerably higher stiffness than the PP construct. In all specimens treated with the PP construct the load to failure was lower than in the PS construct. For loading mode a., at a significance level of 0.05 (P<0.05), the P-value was 0.036, for mode b. the P-value was 0.007 and for loading mode c. the P-value was 0.006. In addition, age-related decrease in stiffness of the specimen was proved at a significance level of 5% (P=0.004). Conclusion.In all the three loading modes, the PS (plate-screw) construct showed a statistically higher stiffness than the PP (plate-plate) construct.
PURPOSE OF THE STUDYHallux valgus is a frequent static deformity of feet in shoe-wearing populations. Lasting problems usually require surgical management. The authors evaluate the long-term results of such treatment by either McBride's operation or chevron osteotomy, or by combination of both. MATERIALA group of 72 patients with hallux valgus underwent 84 operations, with the use of McBride's procedure, chevron osteotomy or a combination of both, at the First Department of Orthopedic Surgery, St. Anne's Teaching Hospital in Brno, in the years 1993-1995. At 10-year follow-up they were evaluated on the basis of patients' subjective satisfaction and the degree of correction measured by hallux valgus angle (HVA) and intermetatarsal angle (IMA). METHODSSurgery is carried out under general or spinal anesthesia, with application of a pneumatic tourniquet, after a standard preparation of the operating field.In the modified chevron osteotomy, a "V"-shaped osteotomy of the distal metatarsal is created (V-osteotomy angle is 70 to 80 degrees), which allows the first metatarsal head to be shifted laterally.The modified McBride's procedure is based on transposition of the adductor hallucis tendon onto the first metatarsal head; lateral sesamoidectomy may be necessary.A combination of both techniques involves V-shaped osteotomy of the first metatarsal bone and transposizion of the adductor hallucis tendon, with lateral sesamoidectomy, when necessary.These surgical procedures always include excision of a bursa at the first metatarsal head, removal of a medial eminence of the first metatarsal head and lateral capsulotomy of the first metatarsophalangeal joint.The authors evaluated: 1) the degree of correction by comparing the HVA and IMA on pre-operative radiographs with those measured at 10 years after surgery; 2) subjective satisfaction of the patients who received a questionnaire asking about big-toe position, pain, problems associated with footwear, sores over the metatarsophalangeal joint of the big toe and mobility of this joint. RESULTSOf the patients undergoing chevron osteotomy (20 procedures), 95 % reported satisfaction; the mean degree of correction was 13 degrees for HVA and 4 degrees for IMA. Of the patients undergoing McBride's procedure (45 operations), 60 % were satisfied; this group had the lowest mean degree of correction, i. e., 4.8 degrees for HVA and -0.6 degrees for IMA. Of the patients undergoing the combined technique (19 operations), 74 % reported satisfaction and the mean degree of correction was highest, i. e., 17.9 and 4.5 degrees for HVA and IMA, respectively. Two patients of this group developed hallux varus, but their HVA and IMA values were not included in the assessment because they would adversely affect the objective evaluation of all the patients. However, in the subjective evaluation of the whole group, these two unsatisfied patients were included. DISCUSSIONIn agreements with the majority of published results, the authors conclude that a higher correction is achieved with chevron osteotomy t...
PŮVODNÍ PRÁCE ORIGINAL PAPERzmiňuje Cotterill (4). Termín "hallux limitus" použil pro lehčí stádia v roce 1959 DuVries. V literatuře je uváděna velká řada klasifikací hallux rigidus. Beeson a kol. v roce 2008 prošel dostupnou literaturu a kriticky zhodnotil využití klasifikací pro klinickou praxi. Klasifikace Coughlina a Surnase z roku 2003 je nejblíže tzv."zlatému standardu" (3) a v současnosti je i nejpoužívanější. Vychází s klasifikace Easleho publikované v roce 1999 (9). Klasifikace Coughlina a Surnase je vodítkem k volbě typu operačního výkonu (6). Samozřejmě musíme přihlédnout k potížím a přáním pacienta, k přidruženým statickým deformitám, příp. i artrotickému ÚVODAutoři ve svém článku hodnotí soubor pacientů po artrodéze I. metatarzofalangeálního kloubu. K artrodéze byla ve všech případech použita úhlově stabilní dlaha. Cílem práce je prezentace výsledků, vyzdvihnutí výhod pro pacienta i důvodů volby této metody oproti jiným způsobům fixace. Indikace Hallux rigidusJako první onemocnění popsal v roce 1887 Davies--Colley (7). Ve svém článku použil označení "hallux flexus". Ve stejném roce termín "hallux rigidus" poprvé
PURPOSE OF THE STUDYTo give a description of the patient group, risk factors, classification, therapeutic procedures and treatment outcomes in periprosthetic femoral fractures after total hip arthroplasty treated in the Trauma Hospital in Brno. MATERIAL AND METHODSThis retrospective study comprised of 51 patients treated for a periprosthetic femoral fracture between 2003 and 2013. This included 19 (37%) intra-operative and 32 (63%) post-operative fractures. According to the Vancouver classification, the types of fractures were as follows: 9 patients A; 21 B1; 9 B2; 6 B3 and 6 with type C. RESULTSType A fractures were treated conservatively. Although pseudoarthrosis of the greater trochanter occurred, the patients had no clinical problems. The intra-operative type B1 fractures were managed by cerclage tapes in nine patients and the post-operative B1 fractures were treated by plate osteosynthesis in 10 patients and femoral stem reimplantation in two patients. All post-operative type B2 and type B3 fractures were managed by reimplantation of the femoral stem and type C fractures were treated by plate osteosynthesis. Serious complications requiring revision surgery were recorded in five patients; they included plate failure in two B1 fractures, dislocation of a B2 fracture, a dislocation with femoral component rotation in a B3 fracture and failure of the plate in a type C fracture. CONCLUSIONSThe treatment of a periprosthetic fracture can affect the patient's life. In view of the fracture type, implant type, general health of the patient and all risk factors, the authors prefer one-stage surgical treatment. The Vancouver classification is a guidleine for the therapeutic plan. Osteosynthesis as a single procedure is indicated only if the femoral component is stable and well fixed. When the stem in B2 and B3 fractures is loose, revision surgery with stem replacement is necessary.
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