Comparison of bone remodelling around short stem and conventional straight stem in total hip replacement: a prospective randomized radiographic and dual-energy X-ray absorptiometric study.

OBJECTIVE: The aim of study was to evaluate periprosthetic bone mineral density (BMD) changes of proximal femur, osseointegration and clinical outcomes after implantation of short-stemmed and conventional straight-stemmed prostheses. METHODS: This prospective, randomized study included 50 patients with unilateral total hip replacement. The patients were randomized into 2 cohorts: patients with a cementless short stem Metha (n=25) and patients with a cementless conventional straight stem Bicontact evaluated as the control (n=25). Periprosthetic BMD changes were measured using a DEXA performed at one-week, 3-monts, 6-months and 1-year follow up. Clinical evaluation with Harris hip score (HHS) and radiographic assessment were performed through a 1 year follow up. RESULTS: Compared to 1-week postoperative assessment, there were differences in BMD changes between the groups at the final follow-up in all ROIs, with statistical significances in ROI 1, 2, 3, 6 and 7. The loss of periprosthetic BMD in all ROIs around straight stems at each time-point was observed. There was a tendency towards a regain of BMD in all ROIs at 1-year follow-up compared to the 3-months postoperative assessment with the short stems. Less pronounced bone loss was observed around the short stems that the straight stems in ROI 1 (‒2.9 % % vs ‒16.2 %), 5 (‒4.7 % vs ‒8.9 %) and 7 (‒8.6 % vs ‒20 %). The periprosthetic BMD exceeded baseline values in the short stem cohort in ROI 2 (+4.4 % vs ‒5 %), 3 (+5.6 % vs ‒2.5 %) and 6 (+4.3 % vs ‒10 %). All stems had a radiographically stable fixation. Stress shielding-related bone resorption was markedly lower in the short stem cohort. The HHS score was comparable between the two cohorts. CONCLUSION: The implant-specific stress shielding altered the proximal loading condition for both stems; however, the results of this study suggest a more physiological strain distribution with the short stems versus the straight stems (Tab. 3, Fig. 3, Ref. 25).

[Long-Term Results of Computer-Navigated Total Knee Arthroplasties Performed by Low-Volume and Less Experienced Surgeon]. / Vplyv pocítacovej navigácie na dlhodobé výsledky po implantáciách totálnych endoprotéz kolenného klbu vykonaných menej skúseným operatérom.

PURPOSE OF THE STUDY The study aims to evaluate the long-term results of computer-navigated total knee arthroplasties performed by less experienced surgeon performing a small number of procedures per year. MATERIAL AND METHODS In the prospective randomised study functional and radiological results, rate of revision and probability of clinical and radiological survival were compared in 30 computer-navigated (in 28 patients: 19 women, 9 men, with the mean age of 66.9 years) and 31 conventionally implanted (in 30 patients: 27 women, 3 men, with the mean age of 66.5 years) cemented total knee replacements without patellar resurfacing. The group was composed of patients who underwent surgery performed by the same surgeon who at the time of enrolment of patient in the study had no previous experience with the total knee replacement surgery and performed up to 30 such procedures annually. The mean follow-up of patients was 11 years. RESULTS No statistically significant differences were detected regarding the mean age, sex, body mass index and etiology of osteoarthritis of the operated knee. The mean duration of computer-navigated surgeries (101±14.1; 80-140 min) was considerably longer than the duration of conventional joint replacements (94±8.2; 80-100 min; p = 0.01). When evaluating the radiological results, a statistically significant difference was found between the groups only with respect to the mean value of dorsal inclination of the tibial component (88.2˚±2.1 vs 86.2˚±3, p = 0.02). The mean values of other monitored angles did not show any significant differences. The number of correct implants (with a deviation of 3 degrees from the target values) was statistically significantly higher in the group of computer-navigated joint replacement surgeries in all the monitored parameters (aFT: 87% vs. 67%, p = 0.04; α: 87% vs. 71%, p = 0.04; ß: 87% vs. 65%, p = 0.03; γ: 93% vs. 74%, p = 0.02; δ: 90% vs. 77%, p = 0.04). Radiologic signs of unstable fixation were detected in 2 cases of computer-navigated joint replacement surgeries and in 7 cases of conventional replacements. Cumulative probability of radiologic survival at 10 years reached 93% in the compute-navigated surgery and 77.4% (p = 0.047) in the group with conventional procedure. In total, 4 revision surgeries with a reimplantation of at least one prosthetic component were reported. All the cases came from the conventional implantation group due to aseptic loosening of the endoprosthesis. In the computer-navigated group, one revision was performed for patellar pain, without replacing or adding any endoprosthetic component. The probability of clinical survival in computer-navigated replacements after 10 years was 100%, in conventional total knee replacements it was 87% (p = 0.04). The cumulative total endoprosthesis revision rate in the computer-navigated group was 3.3%, whereas in the group with conventional total knee replacements it was 12.9% (p = 0.04). The clinical assessment based on the WOMAC and Knee Society Scores showed no statistically significant differences. DISCUSSION The most common cause of the failure of total knee arthroplasties is the malposition of implants which results in early aseptic loosening. The radiologically correct position of knee endoprosthesis is seen in 80% of standard replacement surgeries performed by experienced surgeons. The potential error rate can even increase if the arthroplasties are performed by less experienced orthopaedic surgeons. The computer-navigated total knee replacement was introduced to make the position of implants more accurate. However, the question remains unanswered if more accurate positioning of the implants achieved with computer navigation decrease the revision rate and extend the long-term survival of knee endoprostheses. CONCLUSIONS Kinematic computer navigation allowed a less experienced and low-volume orthopaedic surgeon to make the implantation of endoprostheses more accurate, to decrease the total revision rate, and thus to ensure a higher probability of long-term survival of total knee arthroplasties. Key words:computer navigation, total replacement, knee joint, long-term outcomes, low-volume surgeon, less experienced surgeon.

Dissociative electron attachment and electronic excitation in Fe(CO)5.

In a combined experimental and theoretical study we characterize dissociative electron attachment (DEA) to, and electronically excited states of, Fe(CO)5. Both are relevant for electron-induced degradation of Fe(CO)5. The strongest DEA channel is cleavage of one metal-ligand bond that leads to production of Fe(CO)4-. High-resolution spectra of Fe(CO)4- reveal fine structures at the onset of vibrational excitation channels. Effective range R-matrix theory successfully reproduces these structures as well as the dramatic rise of the cross section at very low energies and reveals that virtual state scattering dominates low-energy DEA in Fe(CO)5 and that intramolecular vibrational redistribution (IVR) plays an essential role. The virtual state hypothesis receives further experimental support from the rapid rise of the elastic cross section at very low energies and intense threshold peaks in vibrational excitation cross sections. The IVR hypothesis is confirmed by our measurements of kinetic energy distributions of the fragment ions, which are narrow (∼0.06 eV) and peak at low energies (∼0.025 eV), indicating substantial vibrational excitation in the Fe(CO)4- fragment. Rapid IVR is also revealed by the yield of thermal electrons, observed in two-dimensional (2D) electron energy loss spectroscopy. We further measured mass-resolved DEA spectra at higher energies, up to 12 eV, and compared the bands observed there to resonances revealed by the spectra of vibrational excitation cross sections. Dipole-allowed and dipole/spin forbidden electronic transitions in Fe(CO)5-relevant for neutral dissociation by electron impact-are probed using electron energy loss spectroscopy and time-dependent density functional theory calculations. Very good agreement between theory and experiment is obtained, permitting assignment of the observed bands.

Dissociative electron attachment to 2,4,6-trichloroanisole and 2,4,6-tribromoanisole molecules.

2,4,6-trichloroanisole and 2,4,6-tribromoanisole were investigated by means of electron transmission spectroscopy and two different types of dissociative electron attachment spectrometers. The results obtained were interpreted with the support of density functional theory calculations. The dominant dissociative decay channels of the temporary molecular negative ions lead to the formation of Cl- and Br- in the low electron energy region. Formation of long-lived parent anions is observed at thermal electron energies. Their relative intensity depends on the experimental time window, ∼36 µs in the case of the static magnet mass analyzer and ∼200 µs for the quadrupole mass analyzer employed. The results obtained may be useful for rapid detection of these compounds in wine and pharmaceutical industries, as well as other branches connected to the food industry, e.g., packaging.

Feasibility of an eHealth application "OncoKompas" to improve personalized survivorship cancer care.

PURPOSE: The purpose of this study was to investigate the feasibility of an online self-management application (OncoKompas) among cancer survivors. In OncoKompas, cancer survivors can monitor their quality of life (QOL) via participant reported outcomes (PROs) ("Measure"), which is followed by automatically generated individually tailored feedback ("Learn") and personalized advice on supportive care services ("Act"). METHODS: A pretest-posttest design was used, conducting a survey before providing access to OncoKompas, and 2 weeks after, followed by an interview by a nurse. Adoption was defined as the percentage of cancer survivors that agreed to participate in the study and returned the T0 questionnaire. Implementation was defined as the percentage of participants that actually used OncoKompas as intended (T1). General satisfaction was assessed based on the mean score of three study-specific questions: (1) general impression of OncoKompas, (2) the user-friendliness, and (3) the ability to use OncoKompas without assistance (10-point Likert scales). Furthermore, satisfaction was measured with the Net Promotor Scale (NPS). RESULTS: OncoKompas was feasible with an adoption grade of 64 %, an implementation grade of 75-91 %, a mean satisfaction score of 7.3, and a positive NPS (1.9). Sociodemographic and clinical factors and QOL were not associated with satisfaction. Several facilitators and barriers related to the feasibility of OncoKompas were identified. CONCLUSION: OncoKompas is considered feasible, but has to be further improved. In order to enhance feasibility and increase satisfaction, we have to balance the time it takes to use OncoKompas, measurement precision, and tailoring towards personalized advices.

[The incidence of osteopenia and osteoporosis in patients with cementless total hip arthroplasty]. / Incidencia osteopénie a osteoporózy u pacientov plánovaných na implantáciu necementovanej endoprotézy bedrového klbu.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. MATERIAL AND METHODS: The group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., fist, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence classification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. RESULTS: Osteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the fist time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSION Osteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent findings of osteopenia and osteoporosis in this study show that patients with osteoarthritis may not be protected from the development of generalised osteoporosis. Our results are compared with the relevant literature data and potential effects of osteoporosis and vitamin D deficiency on total hip arthroplasty are discussed. CONCLUSIONS: Hip osteoarthritis does not reduce the risk of generalised osteoporosis. We found a relative high incidence of osteopenia and osteoporosis as well as vitamin D deficiency in patient with advanced form of hip osteoarthritis.

[Bone Remodelling in the Proximal Femur after Uncemented Total Hip Arthroplasty in Patients with Osteoporosis]. / Kostná remodelácia proximálneho femuru po implantácii necementovanej endoprotézy bedra u pacientov s osteoporózou.

PURPOSE OF THE STUDY: The aim of the study was to investigate the involvement of osteoporosis during remodelling of the proximal femur after uncemented total hip arthroplasty (THA) and the effect of bisphospohonate treatment on these changes. MATERIAL AND METHODS: Sixty evaluated patients with non-cemented THA were divided into three groups on the basis of pre-operative densitometric examinations. Group 1 (15 patients with osteoporosis) received a single dose of 5 mg zoledronic acid in infusion during the second post-operative week. Group 2 (15 patients with osteoporosis) were not treated by bisphospohonate. The patients of both groups took oral calcium and vitamin D medication. Group 3 (control) comprised 30 patients with normal bone density who did not take any osteoactive drugs. By measurement of bone mineral density (BMD) at 12 months after surgery, changes in periprosthetic bone of the proximal femur in 7 Gruen zones were recorded by densitometry. In addition, radiological findings on native X-ray images were assessed and the patients' clinical health status was rated by the Harris hip score. RESULTS: No significant differences in either the average age or the body mass index were found between the groups at the time of THA surgery. The mean BMD value in all assessed Gruen zones measured at the first post-operative week was higher in patients with normal bone density than in those with osteoporosis. The mean BMD value measured at 12 months decreased in all Gruen zones in comparison with the initial value, and this was found in all three groups. The lowest values were recorded in the untreated patients (group 2); in comparison with the patients who had normal bone density, the difference was statistically significant in Gruen zones 1, 2, 6 and 7. Although the patients with treated osteoporosis also showed lower BMD values, these were not statistically significant compared to group 3. The worst post-operative outcome in clinical health status was recorded in the patients with untreated osteoporosis. X-ray examination revealed stable fibrous ingrowth in one patient with untreated osteoporosis and in one with normal bone density. All remaining patients had stable bone ingrowth fixation. DISCUSSION: In THA the majority of compressive loads are transferred through the stem to the femoral bone below the apex of the stem. This results in reduction of bone density in the calcar and greater trochanter regions. Osteoporosis is the most important factor related to changes in periprosthetic bone mass. Therefore, it can be anticipated that an excess loss of bone mass in the proximal femur may, in a long term, interfere with THA stability and may increase the risk of periprosthetic fractures and aseptic loosening. CONCLUSIONS: The results of our study showed that the patients with untreated osteoporosis, who underwent uncemented THA, experienced a considerable decrease in the periprosthetic bone density of the proximal femur and were in worse clinical health. A bisphospohonate therapy was effective in eliminating this negative outcome. Both the clinical and densitometric findings in patients with treated osteoporosis were similar to those in patients with no osteoporosis.

[Our experience with the metha short hip stem]. / Nase skúsenosti s krátkym femorálnym driekom Metha.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the clinical and radiographic results of total hip arthroplasty (THA) with the Metha short hip stem and their comparison with the outcomes of THA using a conventional cementless stem. MATERIAL AND METHODS: A total of 30 Metha stems and 30 standard Biocontact stems implanted in the period from 2007 to 2012 were evaluated. The Metha patient group comprised 22 women and six men, with the mean age of 58.9 ± SD 8.7 years (43-75), mean height of 164.2 ± 6.3 cm (156-178), mean body mass of 68.2 ± 12 (48-91) and mean BMI of 25 ± 3.9 (19-32). The Biocontact group included 19 women and 11 men, with the mean age of 63.6 ± 10.8 years (45-77), mean height of 166.6 ± 6.6 cm (152-175), mean body mass of 77.6 ± 13.1 (46-104) and mean BMI of 27.6 ± 4.3 (20-37). The evaluation was based on plain X-ray findings and clinical status assessed using the Harris hip score and 10-point visual analogue scale (VAS) for pain before surgery and at final follow-up. RESULTS: In the Metha group the mean pre- and post-operative Harris hip scores were 41.7 ± 9.9 (28-57) and 94.4 ± 5.1 (82-100), respectively. In the Biocontact group the values were 41.5 ± 11.9 (32-64) and 89.3 ± 11.2 (57-100), respectively. The mean VAS for low back and thigh pain improved from the pre-operative value of 7.41 ± 2.1 (4-9) to 0.56 ± 1.0 (0-3) in the Metha group and from 7.29 ± 2.2 (4-9) to 1.64 ± 1.8 (0-5) in the Biocontact group. The post-operative results in both rating systems were significantly better (p<0.05) in the Metha than the Biocontact group patients. All stems showed radiographic evidence of good osteointegration. Stem subsidence and calcar atrophy were recorded in one patient of the Metha group. In the Biocontact group stem subsidence was found in two patients and signs of stress shielding in 14 patients. DISCUSSION: Short hip stems have been introduced in THA implantation with the aim to restore physiological biomechanics as much as possible and to ensure good long-term functioning of the joint replacement as well as to save the proximal femoral bone tissue for potential THA re-implantation. Our results of short hip stem implantation presented in this study are compared with the results of relevant recently published literature. CONCLUSIONS: Short hip stems show adequate osteointegration without need for diaphyseal fixation and allow for more natural weightbearing distribution in the proximal femur. The short- and mid-term clinical results are better than with the use of conventional cementless stems. They can be recommended as an optimal choice for use in younger patients with good bone quality who are expected to require THA re-implantation.

Definitive radiation therapy for treatment of laryngeal carcinoma: impact of local relapse on outcome and implications for treatment strategies.

PURPOSE: The purpose of this work was to evaluate outcome after radiotherapy (RT) for laryngeal carcinoma and investigate effects of local relapse on ultimate disease control, including surgical salvage procedures. METHODS AND MATERIALS: In all, 435 patients with laryngeal carcinoma (cT1-cT4a) treated with primary RT were retrospectively analyzed. Uni- and multivariate analyses were performed to identify prognostic factors for local relapse-free survival and overall survival. RESULTS: Median follow-up was 38 months (range 1-144 months). The cumulative frequency of local recurrence was dependent on T stage: cT1 tumors 10%, cT2 18%, cT3 23%, and cT4 36% (p<0.001). Salvage surgery for local persistent/recurrent disease was performed in 59 of 78 patients (76%). The ultimate local control rates at 5 years (including salvage therapy) were 98, 98, 87, and 68% for cT1, cT2, cT3, and cT4 tumors (p<0.001), respectively. For the patients who developed local recurrence, the 5-year ultimate local control rates were 80, 88, 55, and 26% (p<0.001), respectively. Overall survival at 5 years was 68% for patients without local relapse and 50% for patients experiencing local failure (p<0.001). In univariate analysis, cT stage, cN stage, and tumor volume were statistically significant associated with local relapse-free survival. In multivariate analysis for the cT3-4 tumors, only tumor volume remained statistically significant (HR 1.017, p=0.001) for local relapse-free survival. CONCLUSION: Local control rates for cT1-2 laryngeal carcinomas are favorable and in concordance with previous reports and most recurrences are salvaged. For cT3-4 tumors treated with RT alone, initial local control rates are moderate, and in 60% of recurring cases salvage surgery is attempted, with ultimate local control being achieved in only a subset. For voluminous, locally advanced laryngeal tumors, more aggressive treatment modalities should be considered, including upfront laryngectomy or radiochemotherapy.

[Subtalar dislocation of the foot]. / Luxatio pedis subtalo.

PURPOSE OF THE STUDY: Based on a retrospective analysis, the authors present their experience with treatment of subtalar dislocation of the foot. MATERIAL AND METHODS: Between 1999 and 2011 six patients, all of them men, with the average age of 31 years were treated for subtalar fractures. Five patients were diagnosed with medial dislocation and one with lateral dislocation. In one patient with medial subtalar dislocation it was an open injury. The clinical and radiographic results of the patients followed up for 1 to 12 years (average, 7.8 years) were retrospectively evaluated. RESULTS: The achieved average score, based on the AOFAS ankle and hindfoot scale, was 91.3 points (± 9.77; minimum, 73; maximum, 100). Excellent results were recorded in four patients, good in one and satisfactory in the patient with lateral dislocation. Radiographic signs of subtalar joint osteoarthritis were found in one patient. No neurological or circulation dis - orders, skin necrosis, signs of reflex sympathetic dystrophy, aseptic bone necrosis of the talus, infection or joint instability were recorded. DISCUSSION: A subtalar dislocation of the foot involves simultaneous dislocation of the talocalcaneal and talonavicular joints. It is a rare injury accounting for about 1 to 2% of all traumatic dislocations. It may occur as medial, lateral, anterior or posterior subtalar dislocation. The results of treatment depend on several factors, such as the type of dislocation (medial and open dislocations are at higher risk), associated injuries, or damage to deep skin layers, and also on an exact diagnosis, early and accurate reduction and sufficiently long foot immobilisation.

[Magnetic resonance imaging in the diagnosis of intra-articular lesions of the knee]. / Prínos MRI v diagnostike intraartikulárnych lézií kolenného klbu.

PURPOSE OF THE STUDY: Magnetic resonance imaging (MRI) has the highest sensitivity of all methods for the diagnosis of intra-articular knee injuries. In spite of this, its benefit for the decision-making algorithm is questionable. The aim of this study was to evaluate the real situation in our regional conditions. MATERIAL AND METHODS: The medical records of the patients who underwent knee arthroscopy in 2008 and 2009, and had pre-operative MRI examination, were retrospectively reviewed. The group included 92 patients (46 women and 46 men; average age, 41.7 years) of whom 49 had knee injury in their medical history. RESULTS: In medial meniscus (MM) injuries, the MRI examination had a sensitivity of 0.92 and a specificity of 0.44, and the congruence of MRI and arthroscopic findings was 0.73. In lateral meniscus (LM) tears, the values were 0.70 for sensitivity, 0.81 for specificity and 0.87 for congruence. In injury to the anterior cruciate ligament (ACL), MRI sensitivity was 0.66, specificity was 0.85 and congruence was 0.79. In evaluation of articular chondral lesions, the values were 0.45 for sensitivity, 0.87 for specificity and 0.60 for congruence. DISCUSSION: In our examination of knee structures for MM, LM, ACL and cartilage injuries, the diagnostic value of MRI was lowest for cartilage damage, with sensitivity being only 0.45. This was in agreement with the findings of other authors. Although this fact is known, our arthroscopic findings in patients with no MRI evidence of injury were very high: 22 knees with grade III or grade IV chondral lesions. Therefore, MRI examination is not considered to be sensitive enough to replace arthroscopy in the diagnosis of cartilage injuries. MRI examination is most frequently indicated in suspected meniscal damage. Its sensitivity reported in the literature varies; generally, it is about 0.90 in MM injuries, and about 0.75 in LM lesions, and this is in agreement with our results. However, in view of our previous experience, the high sensitivity of MRI in the diagnosis of MM lesions was an unexpected finding. A detailed statistical analysis showed that its high value was at the expense of a relatively high negative positivity (0.56) and a low predictive value of the positive test (0.65). In LM injuries these values were even worse: in addition to low sensitivity (0.70), the predictive value of the positive test was only 0.50. In the diagnosis of ACL injuries, MRI examination is reported to have a high sensitivity ranging from 0.85 to 0.90. This study showed poorer results; sensitivity was 0.66 and the predictive value of the positive test was 0.62. For injuries in which the orthopaedist is sure about the diagnosis and indicates arthroscopy, it is doubtful to indicate also MRI examination. This should be reserved for clinical presentations that are not clear, for post-operative conditions, serious knee injuries or combined injuries. However, patients with chronic problems and unclear clinical presentations should benefit from MRI examination which can make the diagnosis more accurate and thus reduce the number of arthroscopic procedures done entirely for diagnostic purposes. CONCLUSIONS: There is no consensus regarding the role of MRI in the diagnosis of intra-articular lesions of the knee. To a certain extent, its use is related to local conditions. It can be concluded that MRI examination is not currently as important for the diagnosis of knee injuries as expected by both medical and lay communities.

Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer.

BACKGROUND AND PURPOSE: The goal of this work was to examine toxicity and risk factors after irradiation of the cervical spinal cord. PATIENTS AND METHODS: A total of 437 patients irradiated for a laryngeal and oropharyngeal carcinoma were eligible (median follow-up 27 months). Spinal cord contouring was defined differently over time as anatomically defined spinal cord area (SCA) and the spinal cord on CT (SC) with a margin of 3 or 5 mm (SCP3/SCP5). RESULTS: None developed chronic progressive radiation myelopathy (CPRM) (maximum spinal dose 21.8-69 Gy); 3.9% (17/437) developed a Lhermitte sign (LS) with a median duration of 6 months (range 1-30 months) and was reversible in all patients. Risk factors for developing LS were younger age (52 vs. 61 years, p < 0.001), accelerated RT (12/17 patients, p < 0.005), and dose-volume relationships for SCA with ≥ 45 Gy of 14.15 cm(3) and 7.9 cm(3) for patients with and without LS, respectively. CONCLUSION: LS is more frequently observed in younger patients and in patients treated with accelerated radiotherapy. A dose-volume relationship was seen for V45 in the case of SCA. For higher doses, no clear dose-volume relationships were observed.

[Acute injuries of lateral ankle joint ligaments]. / Akútne poranenia laterálneho väzivového aparátu clenkového klbu.

Acute injuries of the lateral ankle ligaments are one of the most common form of injury involving the musculoskeletal apparatus. Treatment usually range from cast immobilisation or acute surgical repair to functional rehabilitation. The aim of our study was to evaluate the incidence of different grades of acute injuries of lateral ligaments of the ankle joint in our patients group and to compare the results of non surgical versus surgical treatment of third grade injuries. 3148 patients were treated for acute lateral ankle sprain in a period of 5 years at our department. Each patient had stress X-ray of the ankle for evaluation of instability at the first visit. From the 234 patients with third grade injury, 39 were enrolled in our study with non surgical treatment and 18 with surgical treatment. Each group was divided regarding to the age in two subgroups. Functional outcome was evaluated 12 and 24 months after injury with AOFAS clinical rating scale and Sports Ankle Rating System--Single Assessment Numeric Evaluation. Statistical analysis was done with Pearson's Chi quadrate test with P < 0.05. First grade injury was present in 62%, second grade in 31% and only 7% of the patients had third grade injury of the lateral ankle ligaments. Further only third grade injuries were studied. Statistically significant better results were seen in patients under the age of 25, in the patient group with surgical treatment compared to patients over 25 years of age. Also statistically significant better results were seen in patient with surgical treatment to non surgical treatment in each age group. No significant difference was observed in the non surgical treatment group regarding to age. Although the injuries of the ankle ligaments belong to the most common injuries of the musculoskeletal system, there is no consensus in the treatment of such disorders. Our experiences and the results of our study show, that surgical treatment in indicated cases provides better results in residual pain and instability of the ankle joint after acute injury of the lateral ankle ligaments.;