Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

The beginnings of osteosynthesis (OS) in the Czech lands, dating back to the second half of the 19th century, are associated with the German surgeons W. Heine and C. Gussenbauer working in Prague. Development of the Czech musculoskeletal surgery began with the appointment of K. Maydl to the head of the Czech University Department of Surgery in Prague in 1891. In 1908, his pupil K. Kukula published the first "OS manifesto" in the Czech literature, including his own original method of fixation of diaphyseal fractures with a magnezium peg. Further development of OS of fractures came as late as in the 1920s. The first to publish his own results in a cohort of 37 patients was K. Šantrůček, followed by V. Novák. At the beginning of the 1930s, A. Jirásek presented an extensive review of the issues concerning OS of fractures based on his experience obtained from 476 operations. In 1939, J. Zahradníček published an extensive study focused on non-unions, including his own classification that was later modified by Weber and Čech. In 1941, E. Polák published the first Czech monograph dealing with nailing of femoral neck fractures. Immediately after World War II, development of intramedullary osteosynthesis took place, surprisingly first in peripheral departments. In the 1950s, osteosynthesis further progressed. Worth mentioning is the nail designed by A. Pavlík, who is known worldwide as the author of the harness used in management of DDH. Instrumental in introduction of AO principles into the clinical practice were O. Čech and F. Stryhal, who became familiar with the technique of stable OS during the 1960s. In 1972, they published an original Czech textbook of osteosynthesis, merely 9 years after the first AO textbook. In 1973, O. Čech together with B.G. Weber won worldwide recognition for their monograph Pseudarthrosen. During the 1970s, domestic production of implants was established in cooperation with S. Beznoska from Poldi Kladno. At the turn of the 1980s, operative treatment of fractures in our country reached the European level. Key words: osteosynthesis, history, operative treatment of fractures, Czech Republic.

Purpose of the study: The knee is the most common peripheral site of osteoarthritis (KOA; knee osteoarthritis). The mainstay of non-operative treatment is education, exercise, weight reduction, and pharmacological therapy. Intra-articular hyaluronic acid (HA) injection is a non-operative treatment option. The aim of our study was to assess the most recent data on the efficacy of intra-articular administration of HA in KOA therapy and to compare it with intra-articular injections of platelet-rich plasma (PRP), corticosteroids (CS) and placebo (saline solution).

Material and methods: The PubMed and Cochrane Library databases were searched for randomized clinical trials (RCTs) conducted between 2012 and 2023 comparing the efficacy of HA with PRP, CS, or placebo. The efficacy was mostly assessed using the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and VAS (Visual Analogue Scale) for pain. The Rob2 (Risk of Bias 2) tool developed by the Cochrane Collaboration was used to assess the risk of bias.

Results: The data pooled from 29 studies (2032 patients treated with HA, 965 with PRP, 376 with CS and 697 with placebo) were analysed. The efficacy was assessed mostly at 1, 3, 6 and 12 months after the administration of the investigated substance. All types of interventions (HA, PRP, CS) were found to have a beneficial effect on the knee affected by KOA, namely through symptom relief. The greatest effect was achieved with PRP, which lasted longer than that of HA or CS. HA offered a moderate relief of symptoms, which was still apparent at 6 months after administration. The administration of CS resulted in a rapid onset of pain relief which was, however, of short duration and started to diminish as early as after the first month of follow-up. In placebo-controlled studies, the follow-up did not exceed 6 months.

Discussion and conclusions: Intra-articular administration of HA continues to be the most common intra-articular therapy for patients with KOA. We should therefore take an interest in its outcomes. This intervention is recommended by the OARSI as 1B level treatment. The ACR, on the contrary, has turned from both the HA and PRP. The NICE in its opinion on non-surgical management of KOA also advises against HA. In our study, on the other hand, we concluded that all three active pharmaceutical ingredients (HA, PRP and CS) improved the KOA symptoms, with PRP showing the most significant, longest lasting and most consistent overall beneficial effects. This conclusion does not imply that HA offers no or only negligible effect. The particular size of effect of intra-articular administration of HA depends on a number of circumstances. Further research should therefore be conducted which would look into the HA benefit in relation to the specific patient, KOA phenotype, stage of inflammation, or healing processes.

Purpose of the study: Fixation of osteochondral fragments is a relatively common procedure in pediatric orthopaedic surgery. This study analyzes clinical and MRI results of biodegradable MAGNEZIX® magnesium alloy implants used to fix osteochondral knee lesions in pediatric patients.

Material and methods: 18 pediatric patients with unstable or displaced OCD lesions or osteochondral fractures were treated with MAGNEZIX® screws or pins. Clinical examinations were conducted at regular intervals, and the final clinical and MRI assessments were performed 24 months after surgery.

Results: The overall functional scores at 24 months were found to be good, with a VAS score of 1.22 points ± 1.83, Lysholm score of 87.61 points ± 11.31, and IKDC score of 76.94 points ± 10.85 for both groups. On MRI, 14 patients (77.78%) showed complete union, four patients (22.22%) showed incomplete union, and none of the patients experienced healing failure. Complete implant absorption was examined in eight patients (44.44%) on MRI. Most patients exhibited varying degrees of chondropathy, and one patient required reoperation due to screw breakage and migration.

Conclusions: The use of MAGNEZIX® implants in the treatment of pediatric osteochondral fractures and OCD lesions has shown good clinical outcomes and favorable healing of osteochondral lesions. However, varying degrees of chondropathy have been observed in most cases.

Purpose of the study: The study aimed to compare the postoperative outcomes of patients with total hip arthroplasty performed through Watson-Jones anterolateral approach and Röttinger minimally invasive anterolateral approach (MIS-AL). The hypothesis was that the MIS-AL approach enables faster recovery and better clinical outcomes in terms of abductor muscle strength and Harris Hip Score (HHS).

Material and methods: The prospective comparative study included 136 patients who underwent surgery between 2018 and 2021. In 88 patients the Watson-Jones procedure was performed and in 48 patients Röttinger minimally invasive procedure was opted for. The Harris Hip Score (HHS) was used to evaluate the outcomes at three time points (before surgery, at 3 and 6 months after surgery) and the abductor muscle strength was measured using the dynamometer at four time points (before surgery, at 17 days, 3 and 6 months after surgery). The statistical analyses were conducted using the independent samples t-test at the level of significance p < 0.05.

Results: In the MIS-AL group, the HHS after 3 months was 86.32 ± 4.8 points, which was a higher score than that achieved in the Watson-Jones group (78.76 ± 5.6; p = 0.0015). After 6 months the difference remained in favour of MIS-AL (94.68 ± 4.7 vs. 90.28 ± 5.4; p = 0.0078). The maximum abductor muscle strength after 6 months improved from 125.52 ± 14.8 N to 170.91 ± 16.2 N in the Watson-Jones group and from 142.78 ± 15.3 N to168.11 ± 15.8 N in the MIS-AL group, with no statistically significant difference between the two groups (p > 0.05).

Discussion: The results show that the differences in abductor muscle strength between the MIS-AL approach and the Watson-Jones anterolateral approach were statistically insignificant. However, better results of the Harris Hip Score in patients in whom the MIS-AL approach was used are supported by the trend of faster functional recovery and higher satisfaction rate of patients undergoing less invasive surgical procedures.

Conclusions: The Röttinger minimally invasive anterolateral approach provides faster improvement of the HHS during the first six months after surgery. The differences in abductor muscle strength between the groups were statistically insignificant.

Introduction: This study aimed to present the clinical and radiological results and look for complications of total hip arthroplasty (THA) performed with subtrochanteric transverse femoral shortening osteotomy (STFO) for Crowe type IV developmental dysplasia of the hip (DDH).

Material and methods: Ninety-four patients who underwent STFO and THA for Crowe type IV DDH between 2013 and 2018 were retrospectively evaluated. The mean follow-up period of the patients was 40 months (range 25 to 55) and the mean operation time was 58 min (range 52 to 70). We examined the results of routine anteroposterior and lateral hip radio- graphy. The time required for healing of the osteotomy line, preoperative and postoperative Harris Hip Score (HHS), limb length discrepancies, the level of limping and Trendelenburg tests were evaluated for all patients. All complications were noted.

Results: The mean healing time was 5.4 months (range 4 to 10). The preoperative HHS improved from a mean of 52 points (range 42 to 61) to 84 points (range 75 to 96) after the operation (p < 0.001). Only two patients had postoperative positive Trendelenburg tests. There were no cases of nonunion or sciatic nerve palsy. An interoperative femoral fracture was observed in one case.

Conclusions: This study demonstrates that excellent clinical outcomes can be achieved with no revisions, no nonunion, and minimal residual limping in patients who undergo shortening with STFO using a Wagner cone for the femur and a primary cup for the acetabulum.

Purpose of the study: The study evaluates the functional outcomes of the treatment of pediatric trigger digits in two centers and compares them with data from the available literature. The secondary objective is to verify the possibilities of collecting data on patients' health status through questionnaire surveys using remote communication via a web interface.

Material and methods: Patients operated on at the Hand and Plastic Surgery Institute in Vysoké nad Jizerou (ÚCHRaPCH) and the Motol University Hospital, Department of Orthopaedics (FNM) between 2018 and 2021 were evaluated. An analysis of demographic data, affected digits, and an assessment of functional outcomes using the Quick-DASH questionnaire were performed. The data were collected through Google Forms and then statistically analyzed. The subgroups were compared using the chi-square test and two-tailed unpaired t-test and logistic regression with Firth's correction was used to compare the obtained Quick-DASH scores.

Results: A total of 124 trigger digits in 102 patients were evaluated, including 113 thumbs and 11 fingers; bilateral findings were observed in 20.6% of patients. The mean age at the time of surgery was 3.7 years. The questionnaire was completed by 57.8% of patients treated at ÚCHRaPCH and 57.9% at FNM. The median Quick-DASH score was 0.0, indicating no disability or hand function limitation. The average Quick-DASH score was 1.7. No significant differences were found between the centers in demographic parameters or achieved scores. The prevalence of a non-zero Quick-DASH score was 24%.

Discussion: Our results, in line with global literature, confirm that surgical release of the A1 pulley is an effective method for treating pediatric trigger thumb or fingers with minimal complications. The online questionnaire survey proved beneficial for data collection. The limitation is the low response rate and the unavailability of suitable validated questionnaires for the given age group. The relatively high risk of a non-zero Quick-DASH score may be influenced by the inappropriate choice of questionnaire given the age of the subjects. An advantage of the data collection method used is the ability to require full completion of the questionnaire before submission, thereby eliminating the need to discard incomplete questionnaires.

Conclusions: Surgical treatment of pediatric trigger digits provides excellent outcomes, and the use of online questionnaires is suitable for health data collection. Further research is needed to validate questionnaires for pediatric age categories and subsequently to expand the concept of web-based data collection.

Purpose of the study: We aimed to assess the effects of general anesthesia (GA) plus saphenous nerve block-tibial nerve block (SNB-TNB) on analgesia for total knee arthroplasty (TKA) and hemodynamic indexes.

Material and methods: A control group and an observation group were set for equal allocation of 106 patients with knee osteoarthritis (KOA) treated with TKA during November 2021 and November 2023 through a random number table. GA was used for the control group, and GA plus SNB-TNB was performed for the observation group. Clinical indexes, analgesic effect, joint motion range, hemodynamic indexes and safety were compared between the two groups.

Results: The observation group had decreased fentanyl dosage, patient-controlled intravenous analgesia pump pressing times, morphine dosage, extubation time, and recovery time compared with those of the control group (P<0.05). The static and dynamic Visual Analog Scale scores at different time points were lower in the observation group than in the control group (P<0.05). The observation group had higher maximum flexion degree than that of the control group at different time points (P<0.05). The incidence rate of adverse reactions in the observation group was lower than that of the control group (P<0.05).

Discussion: SNB-TNB can comprehensively intervene with the tissues surrounding the knee joint, and nerve block techniques are capable of intercepting harmful inputs in a targeted manner, elevating pain threshold, inhibiting signaling transmission from nerve endings, and thus terminating the pain perception ability of the cortex. Nerve block mainly depends on local anesthesia, and is helpful for lowering the additional dose of opioids and maintaining the hemodynamic stability.

Conclusions: Compared with simple GA, GA plus SNB-TNB applied in TKA is more conducive to accelerating the recovery of patients, reducing the anesthetic dosage, enhancing the analgesic effect, with more stable hemodynamics and higher safety.

Ischemic complications in the supramesocolic anatomical region with the development of acute pancreatitis due to compression of the celiac artery or superior mesenteric artery are rare but potentially serious complications after major spine surgery. A case report of two patients with idiopathic scoliosis who underwent posterior instrumented correction and fusion with subsequent development of acute pancreatitis due to vascular compression of the retroperitoneum is presented. The manifestation of an acute abdomen within 24 hours after the surgery with elevation of pancreatic obstruction enzymes and confirmation of acute pancreatitis on CT angiography with abdominal pain, gastrectasia, and ileus clinical findings. In both cases, due to the clinical progression, acute revision spinal surgery was performed with release of the original deformity correction. Subsequently, in combination with conservative treatment of the acute abdomen, both patients achieved full clinical recovery.

Purpose of the study: The aim of this study was to analyze the outcomes of knee arthroscopy (KA) for degenerative meniscal tears in relation to early total knee arthroplasty (TKA) in the elderly population. The study focused on identifying the factors that influence the need for TKA within seven years after previous arthroscopic partial meniscectomy (APM).

Material and methods: A total of 526 patients older than 64 years who underwent APM between January 1, 2010, and December 31, 2015, were included in the study. The patients were divided into three groups according to age. Specific patient data were extracted from the hospital information system. Preoperative, intraoperative, and postoperative data were collected according to a predefined protocol.

Results: A total of 118 patients (22.4%) underwent TKA within seven years after KA, with a mean time to TKA of 35.5 months. Notably, up to 30% of patients required TKA within one year of their initial KA. The mean age at the time of TKA was 72.2 years. Women had a higher risk than men (24.4% vs. 19.2% men; p = 0.195). When all factors were analyzed, postoperative pain (OR = 4.17; 95% CI: 2.03-8.553), varus knee alignment (OR = 2.45; 95% CI: 1.20-5.01), and BMI (OR = 1.11; 95% CI: 0.02-1.20) were significant predictors of TKA. When considering only preoperative factors, varus alignment on radiographs (OR = 2.39; 95% CI: 1.21-4.71), a higher radiographic grade of knee osteoarthritis (OR = 1.85; 95% CI: 1.12-3.07), and BMI (OR = 1.09; 95% CI: 1.01-1.17) were the strongest predictors of early TKA. Among intraoperative/postoperative findings, the presence of medial chondropathy confirmed during KA (OR = 2.07; 95%CI: 1.52-2.83) and postoperative pain (OR = 5.02; 95% CI: 2.75-9.17) were the only significant predictors.

Discussion and conclusions: This study highlights the risk of TKA in elderly patients undergoing APM. Previous studies have cautioned against performing this procedure in older patients, yet the optimal treatment for symptomatic knees with degenerative meniscal tears remains uncertain. Several factors may influence the progression of knee osteoarthritis in these patients, with knee biomechanics and pre-existing osteoarthritis being the most critical. Both can potentially be addressed with appropriate knee osteotomy, a procedure that has recently been shown to be effective in patients with knee osteoarthritis. Interestingly, age itself did not increase the risk of TKA in our study. In conclusion, our retrospective analysis showed that more than one-fifth of patients undergoing KA for degenerative meniscal tears may require TKA within seven years. In addition, preoperative varus knee alignment, advanced knee osteoarthritis, and higher BMI were identified as the strongest risk factors, suggesting that KA should be indicated with caution in such patients.

Purpose of the study: Hip fractures in the elderly are commonly complicated by deep venous thrombosis (DVT), particularly in the preoperative phase. This retrospective study aimed to determine the preoperative incidence of DVT and identify its risk factors in older patients with hip fractures.

Material and methods: This single-center retrospective study enrolled 278 patients (aged ≥ 60 years) with unilateral hip fracture, who underwent color Doppler ultrasonography of the lower extremity veins on the day of surgery at the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine between 1st January 2015 and 31st December 2020. Demographic data, clinical characteristics, and surgical history were analyzed. Multivariate logistic regression was used to identify independent risk factors for preoperative DVT.

Results: The incidence of DVT was 15.5%, including peripheral venous thrombosis at 18.6% and central venous thrombosis at 5.4%. Univariate analysis showed no significant differences in gender, age, and type of fracture. However, delayed admission, longer time from admission to surgery, and atrial fibrillation were significant risk factors. Multivariate logistic regression analysis identified delayed admission (OR = 2.597, 95% CI 1.275-5.290, P = .009), prolonged time from admission to surgery (OR = 1.166, 95% CI 1.034-1.314, P = .012), and atrial fibrillation (OR = 2.848, 95% CI 1.115-7.275, P = .029) as significant independent risk factors for DVT.

Conclusions: Early admission and prompt surgery of elderly patients with hip fractures are critical to prevent the occurrence of DVT. Atrial fibrillation remains a significant risk factor that requires close attention. Prospective studies are warranted to validate these findings and optimize prophylactic strategies.