Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

Purpose of the study: Rotator cuff tears are a common disease and various radiological measurement methods are still being investigated to make the diagnosis. The aim of this study was to investigate whether the coracoclavicular distance is associated with rotator cuff tears.

Material and methods: Shoulder magnetic resonance imaging (MRI) examinations of 101 patients who underwent shoulder arthroscopy due to rotator cuff tears and 158 patients with normal MRI findings were evaluated retrospectively. Coracohumeral distance, acromiohumeral distance and supraspinatus volume were measured.

Results: When the acromiohumeral distance, coracoclavicular distance and supraspinatus volume were compared between the groups, each measurement was found to be statistically significantly lower in the tear group (Group 2) (p<0.001). In the analysis of ROC for the detection of full-thickness supraspinatus tear, the following findings were observed: if the coracoclavicular distance measured less than 12.4mm, a sensitivity of 89% and specificity of 73% were determined. Similarly, if the acromiohumeral distance measured less than 7.5mm, a sensitivity of 73% and specificity of 84% were determined. In full-thickness supraspinatus tears, if the supraspinatus volume measured below 51 cm3, a sensitivity of 89% and specificity of 72% were determined.

Conclusions: Our study, conducted on a limited population, demonstrated that coracoclavicular distance is a significant metric for detecting supraspinatus tears. We believe that we have identified a new parameter that may be useful in the diagnosis of rotator cuff tears.

Purpose of the study: Reconstruction of acetabular posterior wall fractures is challenging. This study evaluates the use of iliac crest graft to reconstruct the posterior wall of the acetabulum.

Material and methods: The study population included all patients with high-grade acetabular posterior wall fractures who were treated with acetabular posterior wall reconstruction using iliac strut graft. In this study, patients with high-grade acetabular posterior wall fracture (based on Letournel and Judet's classification of acetabular fracture equivalent to grade 2 or 3 and based on AO type A1 classification) were treated with acetabular posterior wall reconstruction using iliac strut patients over 70 years old and under 18 years old were excluded from the study.

Results: In this study, 14 patients, 10 men and 4 women, with posterior acetabular wall fractures were treated using the acetabular posterior wall reconstruction method using iliac strut graft. The average age of these patients was 60 years. One patient had evidence of avascular necrosis after 6 months. In all 8 patients, the radiological results showed that the femoral head did not completely match the acetabulum after the operation. The condition of the 48-year-old patient was good to excellent. Three patients under 50 years of age without post-traumatic osteoarthritis at the time of reconstruction had good clinical results and good radiological results. Patients with post-traumatic osteoarthritis at the time of reconstruction had poor clinical and radiological results and sometimes required THA.

Conclusions: The results of this study show that reconstruction of the posterior wall of the acetabulum with iliac crest graft is a suitable option for children or adult patients without post-traumatic osteoarthritis at the time of reconstruction. Mid-term follow-up showed good to excellent clinical results. However, this method is not recommended for adult patients with post-traumatic osteoarthritis during reconstruction. Such patients are likely to require THA.

Fractures of the posterior margin of the distal end of the tibia, also referred to as posterior malleolus fractures, represent an important but often underestimated component of ankle injuries. They are rarely isolated but rather occur as part of more complex fractures classified as Weber type B and C, or they accompany high-energy pilon tibial fractures and spiral fractures of the tibial shaft. In recent decades, there has been a significant shift in the understanding of biomechanical importance of the posterior malleolus, which plays a key role in maintaining the stability of the distal tibiofibular syndesmosis and preserving the congruency of the ankle joint surface. Indications for surgical treatment as well as surgical approaches and fixation techniques have changed dramatically. This review article aims to summarize current knowledge of these fractures, with a focus on anatomy, diagnosis, classification, and particularly surgical treatment options, including the choice of approach and methods of fragment reduction. The literature search was conducted in the PubMed and Web of Science databases, focusing on publications released before the end of 2024. The search included the following keywords: "posterior malleolus fracture," "posterior tibial margin," "ankle fracture," "CT classification," "syndesmosis injury," and "surgical fixation." Original clinical studies, review articles, anatomical and biomechanical studies as well as case reports that provide clinically relevant information on the diagnosis and surgical management of these fractures were included in the review. The introduction of CT imaging has significantly contributed to a better understanding of the morphology of the posterior margin and led to the development of new classification systems (Haraguchi, Bartoníček and Rammelt, Mason), which serve as a guide in selecting the optimal surgical approach. Fixation of the posterior malleolus has a positive effect on ankle and syndesmotic stability even in small fragments. The choice of surgical approach is individualized - the posterolateral, posteromedial, transfibular, or modified lateral approach are used most commonly. Direct reduction and stabilization of the fragment allow for more accurate restoration of the joint surface and are associated with a lower risk of secondary displacement compared to indirect fixation. Surgical treatment of posterior tibial margin fractures should rely on a precise CT scan-based diagnosis and careful assessment of fracture morphology. Direct visualization, anatomical reduction, and fixation of the fragment provide better clinical and functional outcomes and should be preferred in displaced or complex fractures.

Purpose of the study: Diagnosing shoulder pathologies is rather challenging. The reason is not only the anatomical structure and biomechanics of the joint, but also the concomitant conditions, specifically of cervical spine, which can significantly contribute to the pathophysiology. The aim of this study was to evaluate the diagnostic accuracy of clinical examination and magnetic resonance imaging in relation to the actual intraoperative finding in patients with selected shoulder pathologies.

Material and methods: The data of patients in whom shoulder arthroscopy was performed at the Department of Trauma Surgery, University Hospital Ostrava in the 2018-2019 period were extracted retrospectively from the hospital information system. Our attention was focused on 4 diagnoses, namely rotator cuff tear (RCT), anterior shoulder instability due to lesion of the anterior capsular-labral complex (STA), shoulder impingement syndrome (impingement) and SLAP lesion - superior labral anterior posterior tear (SLAP).

Results: The study included 71 patients, of whom 46 were men (65%) and 25 women (35%). The difference in the median age of men and women was not significant (p = 0.740). High specificity (clinical examination 91.8%, MRI 91.8%) and low sensitivity (clinical examination 58.0%, MRI 61.0%) were evident in all diagnoses. In shoulder instability (STA) the sensitivity was significantly higher than in the other diagnoses. The accuracy of both methods was also high (clinical examination 79.9%, MRI 81.0%).

Discussion: These matters have already been described in literature. Nonetheless, most of the studies compared the MRI and arthroscopy findings. Our study reflects the actual diagnostic procedure, i.e. the examination of the patient, referral for MRI for suspected pathology and subsequent surgery to confirm or rule out the diagnosis. Magnetic resonance imaging can detect also other pathological findings that are not apparent during shoulder arthroscopy.

Conclusions: High specificity of clinical examination as well as MRI was confirmed by this study. The sensitivity of both examination methods was significantly lower, except for the diagnosis of anterior shoulder instability (STA), where it was satisfactorily high for both methods. In the case of a positive clinical finding, in rotator cuff tear (RCT) diagnosis the MRI scan provides higher accuracy and eliminates false positives, which was, however, not confirmed in the other diagnoses. In the case of a negative clinical finding, the MRI helps refine the diagnoses. This does not apply to the STA diagnosis, where we may assume that a negative finding of clinical examination will most likely mean a negative intraoperative finding and this negative predictive value will not be increased by the MRI.

Distal radius malunions, particularly those involving both intra-articular and extra-articular components, present significant surgical challenges. While extra-articular osteotomies are well-established, intra-articular corrections - especially at the sigmoid notch - are rarely described and difficult to execute. This case report introduces a novel technique combining arthroscopic and open approaches for the correction of a complex distal radius malunion. A patient with persistent pain and functional impairment following conservative treatment of a distal radius fracture was diagnosed with a complex malunion, featuring dorsal angulation, an intra-articular die-punch fragment, and distal radioulnar joint (DRUJ) incongruity with a 2 mm articular step-off at the sigmoid notch. A combined extra- and intra-articular osteotomy was performed under arthroscopic guidance using a dry technique via posterior DRUJ portals. The intra-articular fragment was mobilized and repositioned under arthroscopic and fluoroscopic visualization, followed by osteosynthesis with a dorsal plate. Postoperative imaging confirmed alignment correction. At 12 months, the patient reported full, painless prono-supination, near-complete wrist range of motion, and satisfaction with the outcome. The technique allowed for precise osteotomy execution despite challenges including limited DRUJ visualization. This is the first documented case of a sigmoid notch osteotomy guided by dry arthroscopy through DRUJ portals. The approach demonstrates the feasibility of combining arthroscopic visualization with traditional osteotomy techniques to address complex distal radius malunions. Despite technical limitations, this method offers a promising avenue for precise intra-articular correction and joint preservation in select patients.

Purpose of the study: The study aimed to evaluate the initial experience with robot-assisted total knee arthroplasty (TKA) using the ROSA system. It focuses on surgical techniques, alignment options, and the pros and cons of the system. It also provides an analysis of the pre- and post-operative range of motion measured by the robotic system.

Material and methods: In the period from 5 December 2023 to 8 August 2024, a total of 197 total knee arthroplasties were performed at the Dr. Pírek Clinic using the ROSA system and Persona implants with a medial congruent tibial insert. Complete data were available for 124 patients (63 men, 61 women) with a mean age of 68.7 ± 8.2 years and a mean BMI of 30.6 ± 4.3. The mean length of hospital stay was five days. Preoperative and postoperative assessments included the range of motion (flexion and extension), soft tissue laxity (varus and valgus stress tests), and data on the planned axial position of the limb. A t-test was used for statistical comparisons. The surgeries were performed using the "image-less" mode of the ROSA system. All procedures were performed via a medial parapatellar approach. After thorough cleaning of the joint and positioning of trackers, the total range of motion and laxity of the joint were measured. Soft tissue balance was ensured based on kinematic alignment principles.

Results: The study confirmed an improvement in the range of motion and accuracy of limb axis alignment. Statistical analysis showed significant postoperative improvement in flexion and mechanical axis. The use of the ROSA system enabled precision in bone cuts and increased reproducibility of results with the aim of maintaining the predefined limits for the resulting limb axis.

Discussion: The results obtained are consistent with those reported in the available literature, indicating that robot-assisted TKA helps improve surgical accuracy and reduce the incidence of deviations. Compared to conventional methods, robotic assistance requires less soft tissue release and can thus minimize blood loss. The disadvantages of this system include operative time and cost. Another challenge, for surgeons, is the learning curve and variability of approaches to alignment. The study also underlines the importance of personalized alignment, as different knee phenotypes may require different approaches.

Conclusions: Robot-assisted TKA using the ROSA system offers advantages in terms of surgical precision, reproducibility of results, and early postoperative functional recovery. The study indicates that the introduction of robotic systems may help improve patient satisfaction and long-term implant durability. However, further research with larger patient cohorts and long-term follow-up is necessary to confirm these results.