Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

Periprosthetic infections caused by multi-resistant bacteria are one of the most fearsome complications in current orthopedics. Despite using aseptic modern practices, the number of infectious complications caused by multidrug-resistant strains is rising worldwide. We present a case of a woman with a non-healing wound after hip arthroplasty revision surgery performed in Egypt for periprosthetic femoral fracture. Upon admission, 11 days after surgery, she presented with a purulent secretion from surgical wound and signs of sepsis. Carbapenem-resistant E. coli was proven from a wound swab. Two-stage revision with a 6-week-long interval of targeted parenteral antibiotic therapy was indicated. During explantation, excessive femoral bone loss after inadequately performed trauma revision surgery was discovered. After antibiotic hip spacer period, the patient underwent implantation of a cemented tumorous revision hip implant followed by 6 weeks of antibiotic therapy. The patient was discharged in more than satisfactory condition, being self-sufficient using French crutches. In follow-up visits during next 2 years, no relapse of carbapenem-resistant infection occurred. In patients hospitalized or operated in high-risk areas, epidemiological anamnesis is of great importance and the possibility of importing multi-resistant bacteria should be considered. Infections caused by these bacteria prolong therapy and increase the cost of treatment significantly. The combination of arthroplasty extraction and targeted antibiotic therapy is recommended to treat periprosthetic infections.

Case report of an eight-month-old infant with infection of the right elbow joint caused by a rare subspecies of Salmonella enterica IV. houtenae, typical of cold-blooded vertebrates.

Ultrasound imaging of the knee is a highly valuable modality that enhances diagnostic accuracy and optimizes the precision of injection therapy. This article reviews the application of ultrasound in various knee interventions, including intra-articular injections, treatments for prepatellar bursitis and patellar ligament tendinopathy, pes anserinus, iliotibial band procedures, and guidance for popliteal fossa pathologies. Detailed guidance is provided on probe selection, patient positioning, and procedural techniques for specific anatomical targets. Key considerations include optimizing needle placement using in-plane and out-of-plane techniques, ensuring accurate interventions, minimizing risks such as cartilage injury or vascular complications, and achieving effective therapeutic delivery. Text is supplemented with anatomical notes.

Purpose of the study: The diagnosis of periprosthetic joint infection (PJI) can be particularly challenging in cases of low-grade chronic infection. The suspicion of infection is typically confirmed through cultures of synovial fluid and periprosthetic tissue. However, these methods may not always detect low-grade infections, which can lead to persistent infection and early failure of the prosthesis. The purpose of this study was to evaluate the effectiveness of sonication in enhancing the detection of PJI using polymerase chain reaction (PCR) analysis.

Material and methods: A prospective cohort of 26 patients, suspected of having mitigated PJI, underwent surgery at the First Department of Orthopaedic Surgery, St. Anne's University Hospital in Brno between 2019 and 2024. The cohort included 16 women and 10 men, aged 56 to 82 years, with infections involving hip (11 cases) or knee prostheses (15 cases). Standard PCR and sonication followed by PCR were used to confirm PJI.

Results: In 20 out of 26 cases, both standard PCR and sonication-assisted PCR detected the infection(p= 0.014). However, in 6 cases, standard PCR failed to identify the pathogen, whereas sonication followed by PCR confirmed the infection. Among these, 4 cases had significantly positive results, and 2 showed weak positivity. The most common pathogens detected were coagulase-negative Staphylococcus (12 cases), followed by Staphylococcus aureus, Pseudomonas aeruginosa, and others.

Conclusions: The findings of this study indicate that the integration of sonication with PCR markedly enhances the detection of PJI, especially in instances where standard PCR techniques may be insufficient, such as in low-grade chronic infections.

Poland Anomaly (PA) represents pectoral muscle hypoplasia in combination with various forms of hand anomalies. We report a case of PA with pectoral hypoplasia, an upper limb deficiency and an accessory extremity/digit on the ipsilateral thoracic wall (thoracomelia). To our knowledge, this is the first reported case of thoracomelia in PA.

Purpose of the study: This study aimed to evaluate patients' knowledge and opinions about robotic total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Material and methods: In order to assess patients' knowledge and opinions about robotic THA and TKA surgery, a descriptive questionnaire consisting of a total of 17 questions assessing patients' demographic information (age, gender, education level, occupation, income level, marital status) and their knowledge and opinions about robotic surgery was designed and applied to 200 participants by face-to-face interviews.

Results: The mean age of participants was 62.6 ± 7.1 years (range: 43-82), with 53% female. Among participants, 39% were university graduates, 9% were healthcare professionals, and 61.5% had an income between 10,000-20,000 Turkish lira. 60% (n = 120) had information about robotic surgeries, primarily sourced from newspapers, TV (35%), and social media (33%). 68.3% believed robotic surgery positively impacts surgical outcomes, and 77.5% preferred robotic surgery for knee and hip procedures. Those informed via social media had a mean age of 57.6 ± 6.5 years, while those informed through patient recommendations had a mean age of 64.0 ± 6.9 years (p = 0.001). Higher education levels correlated with increased knowledge of robotic surgery (p = 0.001), as did private-sector employment and higher income (p = 0.001, p = 0.001).

Conclusions: This study is an important step to understand the awareness and attitudes of robotic surgery among patients. There is a difference between the level of knowledge of the participants about robotic surgery and real scientific facts. Lack of knowledge and misconceptions about robotic surgery may affect patients' decision-making processes. Orthopaedic surgeons has responsibility to evaluate the new technological products in the light of strong scientific evidence when recommending to their patients. Also, media sources and social media platforms should maintain accurate information on emerging technologies.

The text is an introduction to six articles on ultrasound-guided musculoskeletal interventions for the major extremity joints. Each article provides a detailed overview of injections for the shoulder, elbow, wrist and hand, hip, knee, ankle, and foot. The text of this manuscript emphasizes general advantages, techniques, and practical considerations of ultrasound guided injections. It highlights the benefits of ultrasound guidance over traditional palpation-based methods, emphasizing improved accuracy, safety, and therapeutic efficacy. Various ultrasound-guided techniques, including in-plane and out-of-plane needle approaches and indirect marking methods, are discussed. Key factors influencing procedural success, such as needle visibility optimization, proper ultrasound settings, and aseptic precautions, are explored in detail. Additionally, the article briefly describes training methods for mastering ultrasound-guided injections.

Ultrasound imaging of the elbow is an invaluable tool that enhances diagnostic precision and facilitates therapeutic procedures with high accuracy. Compared to palpation-guided techniques, ultrasound-guided interventions significantly improve precision. This article reviews ultrasound-guided techniques for elbow joint interventions, including intra-articular injections, tennis elbow, golfer's elbow, triceps and distal biceps tendinopathy, and ulnar nerve neuropathy. Practical guidance is provided on probe selection, patient positioning, and step-by-step procedural details. Special emphasis is placed on optimizing needle placement and minimizing risks such as nerve injury or other inadvertent damage. Ultrasound-guided procedures represent a pivotal advancement in conservative orthopedics and rehabilitation, enabling precise treatment delivery and improving patient outcomes. Text is supplemented with anatomical notes.

Purpose of the study: Subtalar dislocations are rare orthopedic emergencies characterized by simultaneous dislocation of the talocalcaneal and talonavicular joints without an associated talar neck fracture. While these injuries are commonly managed with closed reduction and immobilization, they are often associated with chronic instability and other long-term complications due to underdiagnosed soft tissue injuries.This study aims to evaluate the role of magnetic resonance imaging (MRI) in the management of isolated medial subtalar dislocations and propose a routine MRI protocol to predict and address chronic instability.

Material and methods: A prospective case series was conducted, including 13 patients with isolated medial subtalar dislocations. All patients underwent MRI to assess soft tissue injuries, particularly the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL). Functional outcomes were evaluated using the Visual Analog Scale (VAS) for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) scores.

Results: MRI identified complete or partial tears of the CFL and ATFL in the majority of patients. Patients with complete ligament tears reported worse outcomes, with lower AOFAS scores and higher VAS pain scores, compared to those with partial or no ligament involvement. Conservative management was effective in mild cases, while surgical reconstruction was required for patients with significant instability.

Conclusions: Routine MRI in the management of isolated subtalar dislocations enhances the detection of soft tissue injuries, facilitating timely interventions and reducing the risk of chronic instability. Integration of MRI into the diagnostic and follow-up protocol for improved patient outcomes.

Purpose of the study: The study aimed to evaluate the patients treated for septic arthritis of the glenohumeral joint at our department in the period between 2018 and the end of 2023.

Material and methods: Between the beginning of 2018 and the end of 2023, a total of 37 patients were treated at our department for septic arthritis of the native glenohumeral joint. The study population consisted of 15 women and 22 men, with the mean age of 66.4 years. The youngest patient was 20 years old, and the oldest patient was 94 years of age. Patients with prosthetic joint infection were excluded from the study. The study included all patients with the diagnosis of shoulder arthritis who underwent surgery at our department in the period 2018-2023. The patients were enrolled based on the clinical finding, laboratory results and bacteria culture tests. Arthroscopy and shoulder joint lavage were performed in the shortest possible time, with revision of both the glenohumeral and subacromial spaces and insertion of drains into both these spaces, or a 24-hour arthroscopic irrigation lavage. During the hospital stay, inflammatory markers were monitored, antibiotics were administered intravenously and after discharge orally for the period of at least 6 weeks. The surgical outcomes were evaluated by clinical follow-up of the patients, who were asked to complete the forms of the UCLASS and CONSTANT scoring systems that are used to determine the patients' satisfaction with their treatment and postoperative status.

Results: Between 2018 and 2023, a total of 13,441 surgeries were performed. The total number of shoulder joint surgeries was 1,357, of which, 1,131 were arthroscopic procedures and 226 were total shoulder arthroplasties. Arthritis of the glenohumeral joint was diagnosed in 37 patients, in whom a total of 54 surgical procedures were performed. The main symptoms were local pain, limited range of motion, swelling, and mild fever. The symptoms persisted for 4 days on average. Revision surgery was performed in 9 patients. The most common pathogen was Staphylococcus aureus. In all cases, appropriate therapy resulted in full recovery.

Discussion: Even through septic arthritis of the shoulder joint is less frequent than septic arthritis of the knee, in our study population it ranked second in terms of frequency, or third when also infectious complications of total joint replacements are considered. Very rarely it affects a native joint of young and otherwise healthy patients.

Conclusions: Early diagnosis, timely surgical treatment, and appropriate antibiotic therapy are crucial in the management of septic arthritis.