I. Sarikaya, S. E. Birsel, O. Erdal, B. Görgün, A. Seker, M. İnan
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
{"title":"Treatment of Hip Dislocation in Cerebral Palsy with Extraarticular Intervention.","authors":"I. Sarikaya, S. E. Birsel, O. Erdal, B. Görgün, A. Seker, M. İnan","doi":"10.55095/achot2023/013","DOIUrl":"https://doi.org/10.55095/achot2023/013","url":null,"abstract":"PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 2 1","pages":"92-99"},"PeriodicalIF":0.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48562050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Sklienka, M. Frelich, E. Kušíková, F. Burša, Z. Cichý, R. Madeja
{"title":"Comments on Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 - What to Do in the Initial Hours?","authors":"P. Sklienka, M. Frelich, E. Kušíková, F. Burša, Z. Cichý, R. Madeja","doi":"10.55095/achot2023/011","DOIUrl":"https://doi.org/10.55095/achot2023/011","url":null,"abstract":"","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48590340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Křiváček, Z. Vodička, F. Krejcí, L. Papezova, D. Musil
PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18-61 years) in men and 45.8 years (range 18-60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen - either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0-5 very good, 6-15 good, 16-35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95-2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50-6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. Key words: lateral epicondylitis, r
{"title":"[Benefit of Arthroscopy in Differential Diagnostics and Therapy of Lateral Epicondylitis].","authors":"A. Křiváček, Z. Vodička, F. Krejcí, L. Papezova, D. Musil","doi":"10.55095/achot2023/006","DOIUrl":"https://doi.org/10.55095/achot2023/006","url":null,"abstract":"PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18-61 years) in men and 45.8 years (range 18-60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen - either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0-5 very good, 6-15 good, 16-35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95-2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50-6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. Key words: lateral epicondylitis, r","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"41-46"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48911750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Kalina, D. Melecký, P. Neoral, J. Gallo, M. Sigmund
PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p<0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p < 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p < 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL rec
{"title":"[Posterior Tibial Slope as a Morphological Risk Factor for Anterior Cruciate Ligament Reconstruction: a Retrospective Cohort Study].","authors":"R. Kalina, D. Melecký, P. Neoral, J. Gallo, M. Sigmund","doi":"10.55095/achot2023/007","DOIUrl":"https://doi.org/10.55095/achot2023/007","url":null,"abstract":"PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p<0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p < 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p < 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL rec","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"47-52"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43637591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Pilný, D. Kachlík, P. Zeman, K. Horáčková, P. Hájek
PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique. MATERIAL AND METHODS The authors present a set of 53 CMC joints of patients with an average age of 26.8 years (15-43 years) operated on in the years 2005-2017. Post-traumatic conditions were found in 10 patients and in 43 cases instability was caused by hyperlaxity, also demonstrated in other joints. The operation was performed from the Wagner's modified anteroradial approach. After the operation, a plaster splint was applied for 6 weeks, after which rehabilitation (magnetotherapy, warm-up) began. Patients were evaluated using the VAS (pain at rest and during exercise), DASH score in the work module, and subjective evaluation (no difficulties, difficulties not limiting normal activities, and difficulties limiting normal activities) before surgery and 36 months after surgery. RESULTS During the preoperative assessment, the average VAS value was 5.6 at rest and 8.3 during exercise. During the VAS assessment at rest, the values at 6, 12, 24 and 36 months after surgery were 5.6, 2.9, 0.9, 1, 2 and 1.1. When evaluated in the given intervals under load, the detected values were 4.1, 2, 2.2 and 2.4. The DASH score in the work module was 81.2 before surgery, 46.3 at 6 months, 15.2 at 12 months, 17.3 at 24 months, and 18.4 at 36 months after surgery. In the subjective self-assessment made at 36 months after surgery, 39 patients (74%) assessed their condition as having no difficulties, ten patients (19%) reported difficulties that did not limit normal activities, and four patients (7%) reported difficulties limiting normal activities. DISCUSSION Most authors present the results of their surgeries in patients with post-traumatic joint instability, and they report excellent results at two to six years after surgery. There is a negligible number of studies addressing instabilities in patients with instability caused by hypermobility. When using the conventional method described by the authors in 1973, our results of the evaluation performed at 36 months after surgery are comparable to those reported by other authors. We are well aware of the fact that this is a short-term follow-up and that this method does not prevent developing degenerative changes in the case of long-term follow-up, but reduces clinical difficulties and may delay the development of severe rhizarthrosis in young individuals. CONCLUSIONS CMC instability of the thumb joint is a relatively common disorder, although not all individuals experience clinical difficulties. In the case of difficulties, the instability needs to be diagnosed and treated as this is how the development of early rhizarthrosis in the predisposed individuals can be preve
{"title":"[Instabilities of the Thumb Carpometacarpal Joint: Our Surgical Outcomes].","authors":"J. Pilný, D. Kachlík, P. Zeman, K. Horáčková, P. Hájek","doi":"10.55095/achot2023/004","DOIUrl":"https://doi.org/10.55095/achot2023/004","url":null,"abstract":"PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique. MATERIAL AND METHODS The authors present a set of 53 CMC joints of patients with an average age of 26.8 years (15-43 years) operated on in the years 2005-2017. Post-traumatic conditions were found in 10 patients and in 43 cases instability was caused by hyperlaxity, also demonstrated in other joints. The operation was performed from the Wagner's modified anteroradial approach. After the operation, a plaster splint was applied for 6 weeks, after which rehabilitation (magnetotherapy, warm-up) began. Patients were evaluated using the VAS (pain at rest and during exercise), DASH score in the work module, and subjective evaluation (no difficulties, difficulties not limiting normal activities, and difficulties limiting normal activities) before surgery and 36 months after surgery. RESULTS During the preoperative assessment, the average VAS value was 5.6 at rest and 8.3 during exercise. During the VAS assessment at rest, the values at 6, 12, 24 and 36 months after surgery were 5.6, 2.9, 0.9, 1, 2 and 1.1. When evaluated in the given intervals under load, the detected values were 4.1, 2, 2.2 and 2.4. The DASH score in the work module was 81.2 before surgery, 46.3 at 6 months, 15.2 at 12 months, 17.3 at 24 months, and 18.4 at 36 months after surgery. In the subjective self-assessment made at 36 months after surgery, 39 patients (74%) assessed their condition as having no difficulties, ten patients (19%) reported difficulties that did not limit normal activities, and four patients (7%) reported difficulties limiting normal activities. DISCUSSION Most authors present the results of their surgeries in patients with post-traumatic joint instability, and they report excellent results at two to six years after surgery. There is a negligible number of studies addressing instabilities in patients with instability caused by hypermobility. When using the conventional method described by the authors in 1973, our results of the evaluation performed at 36 months after surgery are comparable to those reported by other authors. We are well aware of the fact that this is a short-term follow-up and that this method does not prevent developing degenerative changes in the case of long-term follow-up, but reduces clinical difficulties and may delay the development of severe rhizarthrosis in young individuals. CONCLUSIONS CMC instability of the thumb joint is a relatively common disorder, although not all individuals experience clinical difficulties. In the case of difficulties, the instability needs to be diagnosed and treated as this is how the development of early rhizarthrosis in the predisposed individuals can be preve","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"29-33"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48343044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Karaalioglu, O. Korkmaz, K. Yilmaz, S. Sarı, B. Sener, A. Kara
PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.
{"title":"Scapholunate Ligament Partial Tears; Tear Localization, Extrinsic Ligament Injury Association and Conservative Treatment Responses Prior to Instability: Cross-Sectional Study.","authors":"B. Karaalioglu, O. Korkmaz, K. Yilmaz, S. Sarı, B. Sener, A. Kara","doi":"10.55095/achot2023/003","DOIUrl":"https://doi.org/10.55095/achot2023/003","url":null,"abstract":"PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"22-28"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42883335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Čapek, D. Musil, L. Nevšímal, P. Sadovsky, T. Trnka
PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vastus med
本研究回顾性回顾了2010-2020年期间在我科进行的髌骨稳定手术的结果。目的是提供更全面的评估，比较不同类型的MPFL重建，并确认胫骨结节腹内化对髌骨高度的有益影响。材料与方法2010-2020年，我科共对60例客观髌骨不稳(OPI)患者进行了72例髌股关节稳定手术。采用回顾性调查问卷评估手术治疗结果，包括术后Kujala评分。对42例(70%)完成问卷调查的患者进行全面检查。在远端复位的情况下，评估TT-TG距离和InsallSalvati指数的变化，作为手术的指征。结果42例患者(70%)，46例手术干预(64%)。随访期1 ~ 11年，平均6.9年。在研究组中，仅有1例(2%)患者出现新脱位，2例(4%)患者出现半脱位。使用学校成绩的平均分数为1.76。38例患者(90%)对手术结果满意，39例患者在另一侧肢体出现相同问题时将进行手术。术后平均Kujala评分76.8分，范围28 ~ 100分。研究组术前CT扫描(33x) TT-TG平均距离15.4 mm (12-30 mm)。胫骨结节转位的TT-TG平均距离为22.2 mm (15-30 mm)。胫骨结节腹内化前Insall-Salvati平均指数为1.33(1-1.74)。术后指数平均下降0.11(-0.00 ~ -0.26)~ 1.22(0.92 ~ 1.63)。研究组未出现感染并发症。在复发性髌骨脱位患者中，不稳定常常是由髌股关节的病理形态学异常引起的。对于临床表现为髌骨不稳定和TT-TG距离生理值的患者，通过内侧髌股韧带(MPFL)重建进行孤立的近端重新调整。在TT-TG距离的病理值的情况下，通过胫骨结节腹中化进行远端重新定位，以获得TT-TG距离的生理值。在研究组中，胫骨结节腹中化使Insall-Salvati指数平均降低0.11点。这对髌骨高度有积极的副作用，从而增加其在股沟中的稳定性。对于近端和远端排列不一致的患者，需要进行两期手术。在严重不稳定的孤立病例中，如果存在外侧髌骨高压症状，也可以进行股内侧肌转移或关节镜下外侧松解。结论:如果指示正确，近端、远端复位或两者联合复位可带来良好的功能效果，且脱位复发和术后并发症的风险较低。本研究中所调查的组中复发性脱位的发生率较低，即与本文中使用Elmslie-Trillat手术对患者进行髌骨稳定的研究相比，证实了MPFL重建的重要性。相反，在孤立性强腓骨韧带重建过程中，不治疗骨不正会增加其失败的风险。从所获得的结果来看，胫骨结节腹中化通过其远端化对髌骨高度也有积极的影响。如果稳定过程得到正确指示和执行，患者可以恢复正常活动，通常甚至是体育活动。关键词:客观髌骨不稳，髌骨稳定，强韧带外突，胫骨结节转位。
{"title":"[Management Strategy and Evaluation of Surgical Outcomes in Patients with Recurrent Patellar Instability between 2010-2020].","authors":"R. Čapek, D. Musil, L. Nevšímal, P. Sadovsky, T. Trnka","doi":"10.55095/achot2023/001","DOIUrl":"https://doi.org/10.55095/achot2023/001","url":null,"abstract":"PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vastus med","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"9-16"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44277482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Pagnotta, V. Formica, S. Taccogna, G. Summa, C. Zoccali
Chondrosarcoma of the hand is a rare disease, but is one of the more common malignancies of the hand. Biopsies and imaging are a fundamental step in determining correct diagnosis, grading and selection for best treatment. We describe the case of a 77-year-old male complaining of a painless swelling in the proximal phalanx of the third ray of left hand. A biopsy was performed and the histology revealed a G2 chondrosarcoma. The patient underwent III ray amputation with metacarpal bone disarticulation and sacrifice of the radial digit nerve of the fourth ray. Definitive histology revealed grade 3 CS. Eighteen months after surgery, the patient is apparently disease-free with a good functional and aesthetic outcome although with persistent paresthesia of the fourth ray. Although there is no agreement in the literature for the treatment of low-grade chondrosarcomas, wide resection or amputation can be considered the mainstay treatment for high-grade tumors. Key words: chondrosarcoma, proximal phalanx, ray amputation, surgical treatment, tumor hand.
{"title":"High-Grade Chondrosarcoma of the Proximal Phalanx: an Unusual Case of a Rare Entity.","authors":"A. Pagnotta, V. Formica, S. Taccogna, G. Summa, C. Zoccali","doi":"10.55095/achot2023/010","DOIUrl":"https://doi.org/10.55095/achot2023/010","url":null,"abstract":"Chondrosarcoma of the hand is a rare disease, but is one of the more common malignancies of the hand. Biopsies and imaging are a fundamental step in determining correct diagnosis, grading and selection for best treatment. We describe the case of a 77-year-old male complaining of a painless swelling in the proximal phalanx of the third ray of left hand. A biopsy was performed and the histology revealed a G2 chondrosarcoma. The patient underwent III ray amputation with metacarpal bone disarticulation and sacrifice of the radial digit nerve of the fourth ray. Definitive histology revealed grade 3 CS. Eighteen months after surgery, the patient is apparently disease-free with a good functional and aesthetic outcome although with persistent paresthesia of the fourth ray. Although there is no agreement in the literature for the treatment of low-grade chondrosarcomas, wide resection or amputation can be considered the mainstay treatment for high-grade tumors. Key words: chondrosarcoma, proximal phalanx, ray amputation, surgical treatment, tumor hand.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"63-66"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49211754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Uzel, M. Gem, İ. Şahin, M. O. Ziyadanoğulları, M. Eskandari, H. Arslan
PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.
{"title":"Functional and Radiologic Results of Posteromedial Limited Surgery in Developmental Dysplasia of the Hip.","authors":"K. Uzel, M. Gem, İ. Şahin, M. O. Ziyadanoğulları, M. Eskandari, H. Arslan","doi":"10.55095/achot2023/002","DOIUrl":"https://doi.org/10.55095/achot2023/002","url":null,"abstract":"PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"17-21"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48908007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Demel, L. Planka, R. Štichhauer, A. Vrtková, G. Bajor, M. Havlícek, L. Pleva
PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.
{"title":"5th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?","authors":"J. Demel, L. Planka, R. Štichhauer, A. Vrtková, G. Bajor, M. Havlícek, L. Pleva","doi":"10.55095/achot2023/008","DOIUrl":"https://doi.org/10.55095/achot2023/008","url":null,"abstract":"PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"90 1 1","pages":"53-58"},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44128075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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