Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

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.

Ultrasound-guided interventions for the wrist and hand provide valuable therapeutic options for managing various conditions. This article reviews common procedures including injections into the radiocarpal joint, first metacarpophalangeal joint, ganglions, and tendon sheaths, as well as the interventional management of De Quervain's tenosynovitis, trigger finger, and carpal tunnel syndrome. Detailed instructions are provided on probe selection, patient positioning, and procedural techniques tailored to each anatomical target. The importance of careful needle placement, and appropriate risk management is emphasized. Risks such as nerve injury, tendon rupture, and damage to adjacent structures are considered. Advanced techniques like hydrodissection in carpal tunnel syndrome are also described. Text is supplemented with anatomical notes.

Ultrasound imaging of the shoulder is a highly valuable modality that enhances diagnostic accuracy and facilitates precise injection therapy for a variety of shoulder conditions. This article provides a review of ultrasound-guided interventions, including intra-articular injections of the glenohumeral joint, subacromial-subdeltoid bursa, injections into the biceps tendon recess, and acromioclavicular joint. Comprehensive guidance is presented on probe selection, patient positioning, and step-by-step procedural protocols tailored to specific anatomical targets. Emphasis is placed on optimizing needle placement using in-plane and out-of-plane techniques, minimizing risks such as neurovascular injury or inadvertent intratendinous injection, and ensuring effective delivery of therapeutic agents. Additional considerations include the use of advanced techniques like capsular hydrodilatation in management of adhesive capsulitis. Text is supplemented with anatomical notes.

Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this approach is to provide patients with this disorder the best quality of life. Although CP can affect both upper and lower limbs, the functional expectation of upper limb is much higher and complex. This implies particularly to hand and wrist based on complex functional movements expected of them. This puts orthopaedic surgeons in a unique position in managing these patients. It is worth mentioning here that it is not about offering them a surgical intervention the emphasis should lie on the entire process of selection, evaluation, and intervention. All these steps need to be considered very thoroughly so that the best outcome is achieved based on patients' expectation at present and keeping the future consideration in mind as well. This paper focuses only on children with hand and wrist deformity. Although children have a great healing potential, but they have high functional demand and longer-life expectancy in general so getting things right for the first time should be of paramount importance. This paper tries to address this issue by reviewing the literature to help orthopaedic surgeons in developing an algorithm in their mind when offering intervention. The consideration of inclusion and exclusion criteria along with review of literature has been considered with this background in mind. This paper primarily addresses the surgical aspect of disease and steps that are critical in this regard. Follow up planning, long-term outcome, rehabilitation planning, use of conservative treatment has not been considered in this review.

Purpose of the study: The study aimed to evaluate the timeliness and effectiveness of treatment of all patients who underwent surgery for septic arthritis of the wrist at our department between 2003 and 2023.

Material and methods: The retrospective study included 38 patients (26 men and 12 women). The mean age of the patients was 68 years. All patients underwent surgery for culture-positive arthritis of the native wrist. Patients with periprosthetic and extraarticular infections were excluded from the study. Once the diagnosis was established based on the clinical examination and laboratory analysis of blood and synovial fluid, antibiotic treatment was administered and revision surgery was performed. Arthroscopic procedure was used in the unaffected wrist, whereas open surgery was opted for in case of any degenerative changes of the wrist joint and extra-articular spread of infection. A total of 50 surgeries were performed, of which 6 arthroscopies, 32 open arthrotomies, 2 open surgeries with proximal row carpectomy, 6 open surgeries with simultaneous resection arthrodesis, 2 revision surgeries with arthrodesis via internal fixation for prolonged healing, 2 revision surgeries for another postoperative complication.

Results: In our study cohort of patients with septic arthritis, the arthritis of the wrist represented 7%. The most common pathogen was Staphylococcus aureus (60.5%). In 35 patients (92%) at least one risk factor for septic arthritis was present. In all patients, signs of local inflammation were present. 17 patients showed signs of system-wide inflammation and in 32 patients laboratory markers of inflammation were reported. In 6 cases both sides were affected. In our cohort the lethality reached 8%. These were patients with severe immunodeficiency and multiple loci of infection. Full recovery was achieved in 35 patients (92%), i.e. in all surviving patients, in whom the wrist joint was stable upon treatment completion and the self-care was not limited.

Discussion: The prevailing part of the patients (92.10%) with septic arthritis of the wrist showed risk factors for the development of septic arthritis, i. e. poor overall health condition of the patient, immunosuppression, organ failure, diabetes, age over 65 years, rheumatoid arthritis, surgery or trauma, drug or alcohol abuse. In case of bacteremia or sepsis, the risk factors include also chronic degenerative or inflammatory changes in the wrist region, with synovitis constituting a predisposition for hematogenous spread of septic arthritis of the wrist. Our cohort clearly confirms that the system-wide signs and laboratory markers of inflammation are nonspecific markers which cannot conclusively confirm the diagnosis of septic arthritis of the wrist, but the development of their values over time demonstrates the effect of treatment used. The presence of degenerative changes of the wrist joint infl

Ultrasound-guided interventions for the ankle and foot offer precise treatment for musculoskeletal conditions. This article reviews injections of the talocrural joint, first metatarsophalangeal joint, Achilles tendon (via stripping and retrocalcaneal bursa injections), plantar aponeurosis, and tibialis posterior tendon, detailing probe selection, patient positioning, and procedural techniques. Precise needle guidance is emphasized to prevent complications like nerve injury and tendon rupture. Text is supplemented with anatomical notes.

Purpose of the study: The study aims to point out the risks and matters associated with the inclusion of a new anterior approach in total hip replacement methods and to determine when and whether the values of investigated parameters would come close to those of the established surgical technique. Another aim was to compare the blood loss in AMIS and DLA approaches.

Material and methods: The study covers 62 total hip arthroplasties in a breakdown by surgical approach. It investigated the progress of the entire surgical team - surgeon's learning curve, time curve of preparation for surgery, placement of the acetabular component, blood loss, and postoperative haemoglobin drop. The control group consisted of patients in whom the established surgical technique, i.e. the direct lateral approach, was used. The component placement was assessed on standard centered AP view radiographs of the operated joint by using the ellipse method to calculate the Liaw's anteversion and inclination.

Results: A total of 62 surgeries were included in the study. The AMIS group (31 surgical procedures) was composed of 19 women and 12 men, with the mean age of 70 years. The preparation of the operating field took 11.5 minutes on average and the duration of surgery from incision to suture was 66 minutes. The blood loss reached 295 ml, with the mean Hb drop of 16 g/l. The mean anteversion and inclination were 22° and 43°, respectively. The DLA group (31 surgical procedures) was composed of 14 women and 17 men, with the mean age of 67.5 years. The preparation of the operating field took 8 minutes on average and the duration of surgery from incision to suture was 53 minutes. The blood loss reached 300 ml, with the mean Hb drop of 21 g/l. The mean anteversion and inclination were 17° and 43°, respectively. The duration of the 1st to 10th AMIS surgeries was 80 minutes; the duration of the 11th to 20th surgeries was 58 minutes; and in the case of the 21st to 31st surgeries it was 55 minutes.

Conclusions: The results showed that there is no need to worry about an excessively long learning curve of the surgeon and the entire team when introducing a new surgical procedure as long as they have a positive attitude thereto. The data obtained in other countries reveal that the AMIS approach is on the rise ever more often. The authors therefore hope that this study will contribute to its widespread adoption.

Ultrasound imaging of the hip is a highly valuable modality that enhances diagnostic precision and facilitates injection therapy with remarkable accuracy. This article reviews the use of ultrasound in various hip interventions, including intra-articular injections, iliopsoas and trochanteric bursa treatments, lateral femoral cutaneous nerve blocks, and interventions for adductor and hamstring tendinopathies. Comprehensive guidance is offered on probe selection, patient positioning, and step-by-step procedural protocols tailored for specific conditions and anatomical targets. Key aspects include optimizing needle placement using in-plane and out-of-plane techniques, minimizing procedural risks such as neurovascular injury, and ensuring effective delivery of therapeutic agents. Text is supplemented with anatomical notes.