Operační terapie je nejčastěji indikovaná u spastického typu (formy) dětské mozkové obrny (DMO). V oblasti kyčelních kloubů je nejčastěji addukční postavení s různě vyjádřenou flexí a vnitřní rotací. Kolenní klouby bývají ve flexi, méně často v extenzi, v oblasti hlezna je základní deformitou pes equinus. Vzpřímený stoj je umožněn plantigrádním postavením nohou, extenzí kolen a kyčlí. Vzhledem k tomu, že se jednotlivé oblasti navzájem ovlivňují, je třeba hlezna, kolena a kyčle léčit jako jeden celek Nejčastějším problémem, který musíme řešit v oblasti kolenních kloubů jsou flekční kontraktury, méně často extenční, které jsou způsobeny spasticitou musculus (m.) quadriceps femoris. Dalším problémem je chybění aktivní extenze kolenního kloubu vytažením ligamentum patellae, s tím související vysoký stav pately, která se dostává proximálně mimo interkondylický žlábek. Všechny svaly a jejich nerovnováha může ovlivňovat vývoj kolenního kloubu, způsobit distenzi vazivového aparátu a ovlivňovat sklon kloubních ploch tlakem na epifyzární ploténky (8, 23, 348/PŮVODNÍ PRÁCE ORIGINAL PAPER
PURPOSE OF THE STUDYFixation of osteochondral fragments are relatively common procedures in pediatric orthopaedic surgery. The use of biodegradable magnesium implants in these indications appears to be a promising alternative to polymer implants due to their favorable mechanical properties and biological behavior. The purpose of this study is to evaluate the short-term clinical and radiological outcomes of the fixation of unstable or displaced osteochondral fractures and osteochondritis dissecans lesions in the knee joint using MAGNEZIX® screws and pins in pediatric patients. MATERIAL AND METHODSIn this study, 12 patients (5 girls, 7 boys) were included. The inclusion criteria were as follows (1) age below 18 years; (2) unstable or displaced osteochondral fragments secondary to trauma or as a result of osteochondritis dissecans, Grades III and IV in the ICRS (International Cartilage Repair Society) score, confirmed by imaging methods and indicated for surgical fixation; (3) fixation performed using screws or pins made of the magnesium-based MAGNEZIX® alloy; (4) minimum postoperative interval of 12 months. X-rays and clinical evaluation were assessed 1 day, 6 weeks, 3, 6, and 12 months after the operation. MRIs were performed 1-year postoperatively for evaluation of bone response and degradation behavior of implants. RESULTSThe mean age at surgery was 13.3 ± 1.6 years. A total of 25 screws were used in 11 patients, a mean of 2.4 ± 1 per patient, 4 pins were used in 1 patient. In 2 patients, fixation with screws was complemented with fibrin glue. The mean follow-up was 14.2 ± 3.3 months. All patients exhibited complete functional recovery while showing no signs of pain at 6 months postoperatively. No adverse local reactions were observed. At 1-year follow-up, no implant failure has been reported. Complete radiographic healing occurred in 12 cases. Mild radiolucent zones were observed around the implants. CONCLUSIONSThe use of screws and pins MAGNEZIX® has been found to provide satisfactory outcomes in terms of fracture healing and very good functional outcomes at 1 year postoperatively.
Our paper presents a unique case of a 64-year-old patient after a fall, treated with oral antidiabetic drugs for type II diabetes mellitus.Following a series of examinations, a bilateral injury was diagnosed -patellar ligament tear on the right side and rupture of quadriceps femoris muscle on the left side. It is a rare injury, complicated by simultaneous involvement of both knee joints. The used therapy consisted of a bilateral surgery followed by gradual verticalisation, first with the support of a walking frame and later with the use of forearm crutches. During the final examination, the patient demonstrated full flexion at both knees, while an extension deficit of approx. 5 degrees was still present on the left side. The right knee X-ray showed a proper position of the patella after the removal of temporary tension band wire.Although the clinical results of operative treatment of both the patellar ligament rupture and rupture of quadriceps femoris muscle are in most cases good, early operative treatment, proper technique and post-operative rehabilitation are a prerequisite for success.
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