Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

Purpose of the study: The study aims to evaluate the mid-term functional and subjective outcomes of treatment of the mallet finger with a bone fragment using the Ishiguro extension block pinning. The hypothesis was that this technique provides reliable and high-quality outcomes with a low complication rate.

Material and methods: The study included 54 patients aged 7-17 years who underwent surgery at our department between 2017 and 2022. The inclusion criteria were the diagnosis of the mallet finger with a Doyle type IVa and IVb bone fragment, subluxation of the distal interphalangeal joint, fracture fragment size greater than 30% of the articular surface on lateral view radiographs, and fragment dislocation greater than 2 mm. The surgeries were performed in line with the original description of the Ishiguro technique, with reduction and closed osteosynthesis of the fragment using Kirschner wires. The surgery was followed by fixation with a plaster cast for 4 weeks on average, and rehabilitation was recommended after pin removal. The outcomes were assessed using the QuickDASH questionnaire and the Crawford criteria.

Results: The mean QuickDASH score was 3.8, the median score was 0.0. A total of 59% of patients reported no difficulty or limitations, and 37% described minimal extension deficit with no subjective difficulty. Only 4% of patients experienced more severe difficulty such as significant extension deficit or pin track infection. No secondary subluxation of the distal interphalangeal joint was observed.

Discussion: The results of our study are in agreement with global literature, which also shows a predominantly excellent and good effect of the treatment of mallet finger by extension block pinning. Complications were associated with delayed treatment and patient noncompliance. The studies comparing different techniques show that the extension block pinning provides outcomes comparable to those achieved by other methods, or even better.

Conclusions: The Ishiguro extension block pinning is a reliable, technically and financially undemanding technique that provides excellent outcomes in treating the mallet finger with a bone fragment. The use of this technique is also supported by the fact that it can be performed as an outpatient surgery under local anaesthesia and by its low complication rate. Nonetheless, further research is necessary to specify more accurately the indication criteria for surgical management of Doyle IVa and IVb lesions.

Isolated subtalar dislocations constitute 1% of all dislocations and are extremely rare. They frequently occur as a result of high-energy trauma. Dislocations are classified based on the direction of the dislocation, with 80% being medial. Closed reduction under anesthesia without delay is the optimal treatment method. In our case, we present an extremely rare instance of an isolated lateral subtalar dislocation resulting from a low-energy injury. Although isolated subtalar dislocations are frequently reduced with closed reduction, open reduction was necessary in our case. The structure obstructing reduction in lateral dislocations is often reported to be the tibialis posterior tendon. During open reduction, we identified and documented the tibialis posterior tendon as the obstructing structure. We have also discussed the post-reduction follow-up protocol.

Purpose of the study: This retrospective comparative study aims to evaluate the clinical outcomes, cost-effectiveness, and complication rates associated with two minimally invasive surgical techniques: extended arthroscopic debridement and 18-gauge percutaneous tenotomy.

Material and methods: The study included 31 patients with resistant lateral epicondylitis who underwent either arthroscopic debridement (n=14) or percutaneous tenotomy (n=17) between January 2019 and June 2023. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) at preoperative, 3-month, 6-month, and 12-month intervals. Additionally, a detailed cost analysis was performed to compare the economic implications of both surgical techniques.

Results: The results demonstrated significant improvements in both groups at 3 and 6 months postoperatively. However, by the 12-month follow-up, the arthroscopic group maintained stable clinical outcomes, while the percutaneous group showed a decline in MEPS and PRTEE scores, suggesting a potential regression in long-term efficacy. Despite this, the percutaneous tenotomy group benefited from a shorter procedure time, fewer complications, and a quicker return to work, making it a highly cost-effective alternative.

Conclusions: In conclusion, while extended arthroscopic debridement offers sustained clinical benefits, particularly in long-term follow-up, 18-gauge percutaneous tenotomy emerges as a viable primary intervention due to its simplicity, low complication rate, and significant cost savings. Future studies with larger cohorts and longer follow-up periods are warranted to further elucidate the long-term effectiveness and patient satisfaction associated with these techniques.

Purpose of the study: The study aimed to systematically review the available literature focusing on upper cervical spine injuries in children, namely the age and sex of patients, epidemiology of injuries, classifications used, diagnosis and treatment methods, neurologic deficit, concomitant injuries, and potential complications.

Material and methods: The systematic review was elaborated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The studies assessing pediatric upper cervical spine injuries were searched for in the MEDLINE database in September 2023. The studies included were published between 1991 and 2022.

Results: A total of 1354 studies were found through the database search. Subsequently, 53 articles were excluded as duplicates and 1217 due to irrelevant title or abstract. The full text of 84 studies was reviewed. Sixty-nine manuscripts failed to meet the predefined criteria. In the end, the systematic review was based on 15 studies. In the cohort of paediatric patients with upper cervical spine injuries, the girls accounted for 51.1% and boys for 48.9%. X-ray (64.9%) and CT (56.2%) were the most commonly used imaging for diagnosis, with MRI (51.5%) being the least used diagnostic method. Surgical procedure was opted for in treating more than a quarter of cases (27.6%). Most of the surviving patients were neurologically intact (69.2%), a fairly large number of patients (14.4%) died. The most common concomitant injury was craniocerebral trauma (39%) and the most common treatment complication was the instrumentation failure (11.3%).

Discussion: Upper cervical spine injuries are rare in children and represent a relatively heterogeneous group. The literature on this topic is mostly inconsistent. Currently, there is just a few studies dealing with pediatric upper cervical spine injuries as a whole; more often the papers focus on a single type of injury. Inconsistencies also occur in defining the age limit for the pediatric spine and in defining the upper cervical spine. For these reasons, comparing the results of individual studies can be difficult.

Conclusions: The mean age of pediatric patients with upper cervical spine injuries was 6.7 years, with a slight predominance of girls. The most common cause of injury was traffic accidents. X-ray and CT were the most commonly used diagnostic methods and surgical therapy was opted for in treating more than a quarter of cases. More than two-thirds of the surviving patients were neurologically intact. Instrumentation failure was the most common treatment complication and craniocerebral trauma was the most common concomitant injury.

Early surgical treatment of giant cell tumour of the bone has very good functional outcomes with a relatively low risk of local recurrence and metastatic spread.In case of a pathologic fracture, extraosseous extension, and tumor location in an anatomically difficult area, surgical treatment may represent a big challenge with an uncertain functional outcome.Our case report presents a 35-year-old patient with a delayed diagnosis of giant cell tumor of the proximal radius of the dominant limb, with pulmonary metastases. Following neoadjuvant Denosumab therapy, with a major treatment effect on both the primary tumor and pulmonary metastases, we performed a wide resection and combined biological reconstruction with fibular autograft, radial head endoprosthesis, and comprehensive elbow ligament reconstruction.At 24 months after surgery, the patient is self-sufficient, capable of more physically demanding work, with a satisfactory functional outcome of reconstruction (MSTS 66.6%, TESS 69%), with no signs of local recurrence and regression of pulmonary metastases at 18 months after the last administration of Denosumab.

Purpose of the study: Given the risk of venous thromboembolism (DVT) and pulmonary embolism (PE) after large joint replacement, the role of thromboprophylaxis is crucial. This retrospective study aims to evaluate the effectiveness of aspirin as thromboprophylaxis in patients undergoing TKA or THA.

Material and methods: In this retrospective review of a database of patients who underwent total hip and total knee replacements between 2021 and 2023, we divided patients into two groups: those with no anticoagulation therapy before surgery and those on chronic anticoagulant use prior to surgery. The primary endpoint was the number of patients with complications after aspirin use in the postoperative period. We collected patient demographic information, history of anticoagulant use, postoperative anticoagulant usage, comorbidities, type of surgery, reactions to anticoagulants, complications related to thromboembolism, length of hospital stay, and hospital readmissions.

Results: For patients who underwent elective THA or TKA, no significant difference in overall VTE or PE rates was detected when comparing aspirin with other anticoagulants. No mortality events were reported. However, there were differences in bleeding event rates between the aspirin group and other anticoagulant groups.

Conclusions: Proper patient selection and early postoperative mobilization support the use of aspirin as a thromboprophylaxis therapy. The results of this study confirm that aspirin is a safe alternative to other anticoagulants in the postoperative management of THA and TKA.

Purpose of the study: Pelvic avulsion fractures in children are rare and usually associated with sports. The study aimed to evaluate the epidemiology, complications, and displacement cutoff value for surgical treatment.

Material and methods: In a retrospective study (2007-2022), we used a group of 201 boys and 20 girls (p < 0.0001). The mean age of boys was 14.9 ± 1.7, and 14.0 ± 1.9 years for girls (p = 0.0129). Injuries included 86 anterior superior iliac spine (ASIS), 83 anterior inferior iliac spine (AIIS), 28 ischial tuberosity (ITU), 13 iliac crest, nine reflected head of the rectus femoris avulsions, and two ipsilateral ASIS + AIIS avulsions. The displacement cutoff value was determined using logistic regression. Complications were assessed using Cox regression and Kaplan-Meier plots.

Results: The mean incidence of avulsions was 21 per 1,000,000 children per year. The highest prevalence of osteosynthesis was in ITU (10 out of 28, 35.71%); iliac crest and reflexed head avulsions were treated conservatively. Running was related to the highest risk of ASIS, football for AIIS, and gymnastics for ITU. Most avulsions occurred in September, the fewest in July. Displacement cutoff values were calculated as 10.5 mm for ASIS, 9.5 mm for AIIS, and 14.5 mm for ITU. The most common healing complication was distraction 31 (14.0%), refracture in 2 ITU and non-union in 1 ITU; ITU complications were treated with osteosynthesis. According to the Cox regression, the following items significantly affected outcomes: fracture type (p < 0.0001), early verticalization (p = 0.0062), and initial displacement (p < 0.0001).

Discussion: Our study had several limitations, such as it was retrospective, there was a loss of patients from follow-up, and a lack of functional evaluations, for example, using Majeed's score modified for pediatric patients. The positives of the study included a relatively large group of patients from multiple hospitals, the use of logistic regression to determine displacement values to help differentiate between OS and conservative treatment, the inclusion of fracture incidence data, and the inclusion of patients with both surgical and conservative treatment.

Conclusions: In the case of ASIS and AIIS avulsions, osteosynthesis can be considered for displacements ≥ 1 cm and ≥ 1.5 cm for ITU avulsions. Early verticalization was associated with a lower risk of healing complications in distraction injuries.

Osteoarthritis (OA) is a degenerative joint disease characterized by progressive damage and loss of articular cartilage with concomitant structural and functional changes in the joint. It is the most common cause of joint pain globally and the resulting productivity loss to the economy. The clinical symptoms of osteoarthritis are mostly determined by the difficulties of patients related to the development of articular degenerative changes, which secondarily lead to joint stiffness and functional limitation. The diagnosis of this disease is currently based on typical clinical symptoms and radiographic findings (e.g. joint space narrowing, osteophytes, subchondral sclerosis, etc.). These parameters, however, are difficult to detect in the early stages of the disease and are most often recognized in the advanced stages. For these reasons, the diagnosis of osteoarthritis is often delayed until irreversible destruction of joint tissue occurs and conservative treatment is less effective. Despite recent scientific progress in understanding the genetic and molecular principles of joint degeneration, currently there is no reliable causal therapy for OA. This review aims to summarize current knowledge of osteoarthritis and possible future directions for diagnosis and early intervention. One of such directions is the study of the so-called biomarkers. A biomarker is defined as an indicator of biological processes and can include radiographic, histological, physiological, or molecular characteristics. In particular, molecular biomarkers are widely studied in knee OA. Attention of the research community is focused on the study of biomarkers as a method of detection and prediction of the early stages of osteoarthritis before irreversible joint damage occurs. Biomarkers help develop more effective and, above all, personalized treatment, thus improve the overall clinical approach to the patient.

Purpose of study: Inadequate treatment of displaced fractures of the navicular bone may result in malalignment, formation of non-union, accelerated development of osteoarthritis or avascular necrosis and thus a fundamental limitation of mobility and gait disturbance. The aim of our study was to evaluate the results in our group of patients undergoing surgery for navicular fractures.

Material and method: Our retrospective monocentric study included all surgically treated navicular fractures in patients over 18 years of age performed in our department between 2009 and 2018. A total of 18 patients met these criteria and were invited for clinical and radiographic follow-up. One patient refused to attend and two were lost to follow-up. The remaining 15 patients underwent clinical assessment, including the use of AOFAS midfoot and VAS scores, and the grade of osteoarthritis was determined using radiographs.

Results: Our final group of patients consisted of six women and nine men. The mean age of the patients at the time of surgery was 43 (21-67) years, with mean follow-up duration of 68 (18-130) months. The most common mechanism of trauma was high-energy injury occurring in nine of cases. According to the Schmid classification, six fractures were Type I and II each whereas three cases were Type III fractures. Concomitant injuries involving the foot and ankle were present in six cases. All fractures healed.Open reduction and internal fixation (ORIF) was performed in 14 cases. The radiographs showed the presence of osteoarthritis grade 0 or I in nine patients and osteoarthritis grades II and III in six patients. The AOFAS Midfoot scale was excellent and good in eleven cases, satisfactory in two and poor also in two cases. The average AOFAS Midfoot scale was 87.7 points. A procedure-related complication was a case of skin necrosis in a patient eventually undergoing cuneonaviculotalar arthrodesis in another hospital.

Discussion: Consistent with literature data, our group showed a higher incidence of concomitant injuries in the foot region. Use of two approaches was not associated with an increased risk of developing avascular necrosis. We do not recommend the use of Kirschner wires for definitive osteosynthesis although we do use them as part of staged treatment or as an additional type of fixation. Like other authors, we observed higher grades of post-traumatic osteoarthritis in the subgroup of patients with more severe injuries.

Conclusion: Open reduction and stable osteosynthesis of navicular fracture-displacements are associated with good outcomes in most patients. The most serious consequences of these fractures are post-traumatic arthritis and pain. It is critical to search for concomitant injuries. Given the rarity of these fractures, they should be preferably treated in specialised medical centres.

Anterior cruciate ligament (ACL) is one of the most commonly injured structures in distortion injuries of the knee joint. Currently, there is no consensus among the professional community regarding the basic principles and timing of ACL injury management. An analysis of several retrospective studies from the 2008-2023 period provides information on ACL preservation procedures and a comparison of these results with those of ACL reconstruction surgery using a graft. The most comprehensive information was provided by a large meta-analysis conducted by Van der List et al. in 2019, which compared 1101 patients from 13 studies who had undergone an ACL preservation surgery. Wilson et al. carried out a retrospective study of patients who underwent ACL repair with InternalBrace (Arthrex© implant system) ligament augmentation. In their meta-analysis, Van der List et al. reported the failure rate of 7-11% and the functional outcome score > 85% of maximum scores in the scoring systems used (Lysholm, KOOS, IKDC score) for the preservation procedures. Wilson et al. in their retrospective study reported the failure rate of 10.4% and the functional outcome > 87% of maximum scores in the scoring systems used. These values are consistent with similar outcomes reported in patients undergoing ACL reconstruction surgery using a graft. According to the available literature, the primary ACL refixation with InternalBrace augmentation for proximal ruptures appears to be a safe technique with satisfactory outcomes when properly timed and indicated. In acute proximal ruptures, this technique should be considered as an alternative to ACL reconstruction using a graft, with potential benefits of preserving the original tissue and proprioception of the ligament. A prospective randomized study which would compare these two surgical techniques is still lacking in the literature.