Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

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.

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.

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 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.

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: 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 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.