[Clinical Outcomes of the Application of Platelet-Rich Fibrin during Anatomic Anterior Cruciate Ligament Reconstruction: Results of Prospective Randomised Study]. / Klinické výsledky aplikace fibrinu bohatého na desticky behem anatomické rekonstrukce predního zkrízeného vazu: výsledky prospektivní randomizované studie.

PURPOSE OF THE STUDY It was a prospective, randomised, unblinded study. Effects of the application of platelet-rich fibrin (PRF) on the anatomic anterior ligament reconstruction were examined. MATERIAL AND METHODS A total of 40 patients who underwent a surgery between 2012 and 2014 were enrolled in the study. The patients were randomised into two groups: the group with PRF application (n=20) and the group without PRF application (n=20, control group). The study included 11 women and 29 men, with the mean age at the time of inclusion into the study 29.1 years. Vivostat ® PRF was obtained perioperatively from the patient s blood and applied intraoperatively to the hamstring tendon graft. The ACL graft healing was assessed through magnetic resonance (MRI) at 6 and 12 months postoperatively. The clinical outcomes (the Lysholm score and the IKDC Subjective score, return to pre-injury sport levels, Pivot-shift test, graft failure) as well as standardised laxity measurements using GenouRob arthrometer were performed preoperatively and 12 months after surgery. RESULTS The study was completed by thirty-three (33) patients (17 in the PRF group and 16 in the control group). In two cases, postoperative graft failure was reported (both cases in the control group). No significant differences were found in the process of graft ligamentization evaluated through MRI (p=0.07). No significant difference between the groups was identified with respect to return to pre-injury sport levels (p=0.232), or the Lysholm score and IKDC Subjective score (p=0.259, and p=0.364 respectively). The postoperative knee laxity measurement using Genourob arthrometer did not reveal any significant differences between the PRF group and the control group. DISCUSSION Results similar to those arrived at by our study have recently been published also by other authors worldwide. We can therefore assume that the application of PRF can be of benefit, especially at the early stage of healing. The results still need to be verified on a larger study group, the study design should focus on the development in the early postoperative period. CONCLUSIONS In our study group, no significant difference was observed in the evaluated subjective and objective clinical parameters. Only the parameter regarding the ACL graft failure fell just short of statistical significance, namely to the disadvantage of the group without the PRF application. Key words: anterior cruciate ligament, arthroscopy, anatomic ACL reconstruction, magnetic resonance imaging of the graft, platelet-rich fibrin, graft healing, MRI signal intensity of the graft.

[Unstable RAMP Lesions of the Medial Meniscus in ACL-Deficient Knee: Comparing the Outcomes of Outside-in versus All-inside Surgical Repair - a Retrospective Study]. / Nestabilní RAMP léze mediálního menisku u LCA deficientního kolena: srovnání výsledku operacní terapie technikou outside-in versus all-inside ­ retrospektivní studie.

PURPOSE OF THE STUDY We present the results of the retrospective study comparing the clinical outcomes of outside-in versus all-inside suture techniques of unstable RAMP lesions (RL) of the medial meniscus in patients with simultaneous ACL lesion with a minimum two-year follow-up. MATERIAL AND METHODS The retrospective evaluation covered two groups of patients who underwent the arthroscopic repair of unstable RL in combination with anterior cruciate ligament reconstruction (ACLR). Group 1 included 42 patients (28 men/24 women). Group 2 consisted of 36 patients (21 men/15 women). In Group 1, RL suture repair using the outside-in technique by posteromedial approach with absorbable PDS suture was performed, while in Group 2 the all-inside technique of RL suture via the standard anteromedial portal was applied using the Fast-Fix system (Smith Nephew, USA). The evaluation was done preoperatively and postoperatively with the mean follow-up of 27.9 months in Group 1 and 30.1 months in Group 2. The patients were assessed using the subjective IKDC score and the side-to-side difference (SSD) in ventral laxity was measured by Genourob (GNRB) laximeter at the applied pressure of 134 N and 250 N. Moreover, the failure rate of RAMP lesion repair, ACL graft, necessity of secondary partial meniscectomy and return to pre-injury level of sport were analysed. RESULTS The median IKDC score increased in Group 1 from 56 points preoperatively to 92 points postoperatively and in Group 2 from 58 points preoperatively to 90 points postoperatively (p>0.05). The median value of SSD in ventral laxity of the knee measured by the GNRB laximeter at the applied pressure of 134 N in Group 1 was 5.6 mm preoperatively and 1.9 mm postoperatively and in Group 2 it was 5.9 mm preoperatively and 2.3 mm postoperatively. At the pressure of 250 N, the median value in Group 1 was 7.9 mm preoperatively and 2.7 mm postoperatively and in Group 2 it was 8.1 mm preoperatively and 3.2 mm postoperatively. When comparing the SSD of the groups postoperatively, no statistically significant difference was found (p>0.05). Revision arthroscopy was performed in 8 patients. In 1 patient (2.4 %) in Group 1 and in 4 patients (11.1%) in Group 2 a rerupture of the RL of the meniscus occurred and partial meniscectomy was performed. In Group 2, statistically significant higher occurrence of the RL suture failure (p<0.05) was reported and there was a need to perform partial medial meniscectomy (p<0.05). The ACL graft failure was observed in 2 patients (4.7%) in Group 1 and in 3 patients (8.3%) in Group 2 (p>0.05). 31 evaluated patients (73.8%) from Group 1 and 24 patients (66.7%) from Group 2 (p>0.05) returned to the pre-injury level of sports activities. DISCUSSION When comparing the outcomes of individual techniques of the RL repair published in recent literature with our conclusions, we may state that the results of subjective as well as objective criteria achieved were similar to those reported by other authors worldwide. No study has so far been published which would compare the outcomes of the by us presented two surgical techniques of the RL suture in an ACL-deficient knee with a minimum follow-up of 24 months. CONCLUSIONS Both the surgical techniques of unstable RL repair in combination with the ACLR using a tendon graft result in a statistically significant improvement of clinical outcomes postoperatively. In Group 2, with the all-inside RL repair, a statistically significant higher failure rate of RL repair was confirmed as well as the need to perform secondary partial meniscectomy compared to Group 1. Key words: RAMP lesion, ACL-deficient knee, unstable medial meniscus lesion, repair of meniscus, all-inside technique, posteromedial technique, ACL reconstruction.

[Diagnosis, Treatment and Complications of Knee Dislocation: a Retrospective Study]. / Diagnostika, terapie a komplikace luxace kolenního kloubu: retrospektivní studie.

PURPOSE OF THE STUDY Acute knee dislocation is a less common injury of the knee joint. It is, however, a serious injury with a high rate of nerve and vascular damage and it is considered a limb threatening injury with long-term functional disability, which can ultimately lead to amputation. Knee dislocations constitute less than 0.5% of all joint dislocations. Most of these injuries occur in highenergy traumas and careful diagnosis can identify the patient at risk of this injury. MATERIAL AND METHODS The total number of patients with knee dislocation was 37. The incidence of knee dislocation was 2.5 patients per year. The mean age of patients was 49 years. After the evaluation of blood supply to the limb and before the examination of the ligament injury, routine X-ray views of the affected joint were performed. It was necessary to confirm good blood supply of the limb, in which knee dislocation had been suspected. In patients with reduced knee joint and asymmetric pulses in the lower limb, CT angiography was indicated. The absence of peripheral pulses and the presence of serious clinical signs of peripheral blood supply disruption in case of the reduced knee or irreducible knee dislocation necessitated immediate revision by a vascular surgeon performed in the operating room. RESULTS Dislocation of the knee without TKA (a total of 34 cases) was caused by a high-energy trauma in 19 cases (56%) and in 7 cases (21%) it was a part of polytrauma. The most common was a motorcycle accident, namely in 7 cases (21%). In 12 cases (35%), it was a low-energy trauma, a fall or a slip while walking. In three cases (9%), the patients suffered an open knee dislocation. In 18 patients (47%), no knee surgery was performed. The knee ligament injury was treated non-operatively through knee brace fixation. An open revision with sutures of injured ligament structures and knee capsule was performed in 16 patients (42%). In two cases, above-the-knee amputation was done. External fixation was performed in two polytrauma patients. Three cases of infectious complications were reported. Nerve lesions were observed in 9 cases (25%). Vascular lesions were recorded in 9 cases (25%). Deep vein thrombosis was observed in three cases in our study group. The Lysholm knee questionnaire was used to assess subjective difficulties. DISCUSSION In agreement with the literature, these injuries occur most frequently when riding on motorcycle. The patients, in whom a vascular lesion was identified and revascularisation performed within 8 hours, showed a significantly lower incidence of amputations (11%) compared to those who underwent surgery after 8 hours (86%). Majority of vascular surgeons consider 6 hours to be the time limit for the performance of vascular reconstruction since a surgery performed after 6 hours is accompanied by a higher complication rate. Currently, the aim of the final treatment is to perform anatomic suture or reconstruction of knee ligaments and meniscus to achieve a stable, pain-free, functional knee and to prevent any complications. CONCLUSIONS Knee joint dislocation ranks among less common injuries that can be accompanied by a vascular injury in 20% on average and a nerve lesion in 10-40% (around 25% on average). A negative X-ray in spontaneous reduction of knee dislocation can be misleading for proper diagnosis. It is crucial to rule out a vascular injury that might be a limb threatening. In case of a vascular lesion, an early reconstruction of vascular supply is necessary within 6 hours after the injury. The revascularisation performed later is accompanied by a high risk of complications and can ultimately lead to above-the-knee amputation. It is most appropriate to refer such serious injuries to specialised trauma centres that avail of necessary equipment and experience with treating the patients who sustained such complicated orthopaedic injuries. As to the ligament reconstruction, most surgeons prefer to postpone the procedure in majority of cases by 10-14 days. Key words: knee dislocation, vascular injury, neurologic injury, ligament reconstruction, irreducible dislocation.

Creatine Kinase and Myoglobin Levels as Indicators of Perioperative Muscle Damage during Open- and Mini-Invasive Stabilization of Thoracic and Lumbar Spine Fracture - a Prospective Randomized Study.

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.

[Treatment of Periprosthetic Distal Femoral Fractures]. / Lécení periprotetických zlomenin distálního femuru.

PURPOSE OF THE STUDY Periprosthetic distal femoral fractures (PDFF) constitute an unpleasant complication in patients with a total knee replacement (TKR). The incidence reported in literature is 0.3-2.5 %. The number of periprosthetic knee fractures has been increasing due to the ageing of population, a growing number of implants, a longer life expectancy of patients, a more intensive physical activity of patients, and osteoporosis. Most of these fractures are treated surgically, non-surgical treatment is reserved solely for patients unable to undergo a surgery for general health conditions. MATERIAL AND METHODS Our retrospective study evaluated the group of patients with PDFF who were treated at out department in the period 2007- 2016 and 2,975 primary TKR were performed. The total number of patients with PDFF was 56. The mean age of patients with PDFF was 77 years (56-94 years) and at the time of fracture the mean age was 71 years in men and 78 years in women. The average time from the TKR to periprosthetic fracture was 8.2 years (0-20 years). The fractures were assessed using the Su classification modified by Krbec. RESULTS A primary TKR was performed in 46 cases for gonarthrosis, in 6 cases for rheumatoid arthritis and in 4 cases for secondary, post-traumatic gonarthrosis. The average incidence of periprosthetic distal femoral fractures was 5-6 cases per year. Women represented 86 %, men 14 %. Su Type I fracture was diagnosed in 25 % of cases, Su Type II fractures in 71 %, and Su Type III fractures 4 %. 52 patients with PDFF were treated surgically, in 4 cases conservative treatment was opted for. The average treatment time of PDFF to healing by callus formation was 6.6 months (3-12 months). Mortality during the first 3 months after osteosynthesis of PDFF was 9 %. A failure of osteosynthesis of PDFF was reported in 4 cases. DISCUSSION Multiple classification systems were developed to assess these fractures. The most appropriate we consider the classification of Su et al. classifying the PDFF into 3 groups, namely based on the height of the fracture line relative to the femoral component. Osteosynthesis by retrograde femoral nail is indicated for periprosthetic fractures, with sufficient bone mass in distal femur, which allows stable distal fixation. The new generation of anatomically shaped angular stable implants gives us yet another option for osteosynthesis of PDFF. Many studies point at the advantages of these implants in osteoporotic bone as against the conventional plates. CONCLUSIONS The number of PDFF has been increasing. The main methods of internal osteosynthesis continue to be the angular stable plates and the retrograde femoral nail. Preoperative planning is important to determine the type and dimensions of the existing femoral component and to distinguish whether or not it has come loose. The choice of the implant may depend on the bone mass available for distal fixation. The retrograde femoral nail is usually the most suitable method of treatment for proximal PDFF (Su Type I). The angular stable plates can be used for PDFF originating at the femoral component (Su Type II and Type III). Very distal fractures classified as Su Type III with a loose femoral component require a revision surgery with a TKR with stems. The surgeon should be prepared for a revision surgery if the intraoperative finding is more complicated than anticipated based on the preoperative radiograph. Key words:total knee arthroplasty, periprosthetic fracture, osteosynthesis.

[Outcomes of Treatment of Calcaneal Fractures Using Locking Compression Plate with or without Augmentation]. / Výsledky lécení zlomeniny patní kosti LCP dlahou s augmentací a bez augmentace.

PURPOSE OF THE STUDY The retrospective study aims to compare the outcomes of augmentation of neutral triangle formed after the calcaneal fracture reduction with osteosynthesis using the locking compression plate with the outcomes of osteosynthesis without augmentation. MATERIAL AND METHODS In the period from 2005 to January 2011, 98 patients with 114 calcaneal fractures were treated by open reduction and internal fixation (ORIF) method with the use of calcaneal plate. The group included 15 women (15.3%) and 83 men (84.7%), with the mean age of 39.2 years (12-62 years). There were 16 cases of bilateral calcaneal fractures, of which 2 in women (12.5%) and 14 in men (87.5%). The fractures were classified based on the Sanders classification as Type I -IV. The patients with Type II and III fracture according to the Sanders classification were indicated for surgical treatment with ORIF using the calcaneal LCP. The defect in the region of neutral triangle of the calcaneus was filled with the injectable hydroxyapatite cement. The cohort of operated patients was evaluated based on the AOFAS (American Orthopaedic Foot and Ankle Society) Clinical Rating System. The bilateral fractures were not evaluated. This group shows a substantially higher occurrence of associated injuries, which causes strong distortion of results. RESULTS The cohort of 82 operated patients with Sanders Type II and III fractures were evaluated. In 20 fractures (24.4%) the defect in the calcaneus body was filled with hydroxyapatite cement. In osteosynthesis without defect augmentation an excellent result was achieved in 21 patients (33.9%). A good result was reported in 24 patients (38.7%), a satisfactory result in 12 patients (19.4%) and a poor result in 5 patients (8.0%). In patients with osteosynthesis of the calcaneus with augmentation, an excellent result was achieved in 6 cases (30%), a good result in 5 cases (25%), a satisfactory result in 7 cases (35%) and a poor result in 2 cases (10%). Early postoperative complications were observed in a total of 13 patients (15.8%). In osteosynthesis without defect augmentation, there were 2 cases of wound dehiscence (3.2%), 3 cases of marginal skin necrosis (4.8%), 4 cases of superficial wound infection (6.4%) and 1 case of deep wound infection (1.6%). In patients with performed augmentation, wound dehiscence was seen in 1 case (5%), superficial wound infection in 1 case (5%) and superficial marginal skin necrosis in 1 case (5%). Deep wound infection was not reported in this group. DISCUSSION A question frequently discussed is the filling of defect in the diaphysis of calcaneus. Brodt et al. state a statistically higher stability of the calcaneus in osteosynthesis with augmentation, but he does not use the locking plate. Longino in his study compares the results of calcaneal osteosynthesis with spongioplasty with a graft from pelvis and without it and does not observe any major differences in the final outcome in his cohort. Elsner evaluates the results in 18 patients, in whom calcium phosphate cement augmentation was used for osteosynthesis. Over the period of three years he did not observe a higher rate of complications. Schildhauer assesses the early load of the calcaneus with tricalcium phosphate cement augmentation. After three weeks of full loading no loss of reduction was found. Thordarson evaluates 11 operated patients with Sanders type II and III calcaneal fracture. The defect of the calcaneus was filled by calcium phosphate cement. In this small group 1 case of serious infection complication and 1 loss of reduction with full load at six weeks after the surgery were observed. In our group no differences were observed between the outcomes of patients with performed or not performed defect augmentation in the neutral triangle site. A higher percentage of complications in patients with filled defect of the calcaneus was not observed either. CONCLUSIONS The operative treatment of displaced intra-articular fractures consisting of open reduction from extended lateral approach and internal calcaneal LCP fixation brings good results. We concluded that there is no statistically significant difference in the results of osteosynthesis with a locking plate alone and combined with augmentation of diaphyseal defect of the calcaneus. Filling of the diaphyseal defect in the calcaneus is not necessary, it neither accelerates the healing, nor brings better treatment outcomes Key words: calcaneal fracture, cement augmentation of defect, locking plate, extended lateral approach.

[Anatomical All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Tendon Graft with Posteromedial Harvest - Clinical Results of Prospective Study at a Minimum 12-Months Follow-up]. / Anatomická all-inside rekonstrukce predního zkrízeného vazu kvadrustepemm. semitendinosus odebraným posteromediálním prístupem ­ klinické výsledky prospektivní studie s minimálním odstupem 12 mesícu od operace.

PURPOSE OF THE STUDY This original paper aims to present the conclusions of the prospective study evaluating the clinical results of anatomical all-inside ACL reconstruction using quadrupled semitendinosustendon graft with posteromedial harvest using suspensory fixation by Tightrope implants at the follow-up of at least 12 months. MATERIAL AND METHODS The prospective study included a total of 119 patients (74 men/39 women) with the mean age of 28.3 (18-52) years, in whom demographic data was collected and a clinical examination was performed. The patients satisfying the "inclusion" and "exclusion" criteria were enrolled in the study and subsequently underwent the same, aforementioned surgical procedure performed by a single surgeon. Preoperatively and at a minimum 12-month follow-up the following subjective criteria were evaluated using the Lysholm and IKDC subjective scores and the Visual Analogue Scale (VAS) (0-10). The objective parameters comprised the side-to-side difference in anterior knee laxity assessed by Genourob arthrometer with an applied pressure of 134 and 250 N, anterior drawer test, and the pivot shift test. The occurrence of graft failure, complications and return to pre-injury sport levels were monitored. The obtained data was statistically evaluated at the statistical significance level of 0.05. RESULTS A total of 89 patients were assessed at the follow-up of at least 12 months after the surgery. The median Lysholm score increased over time from 58.7 preoperatively to 94.2 postoperatively (p < 0.05) and the IKDC subjective score went up from 46.3 to 91.4 (p < 0.05). The median postoperative VAS kept decreasing from 7.3 (Day 2), 5.1 (Day 14), 3.1 (Week 6), 1.2 (Month 6) to 0.3 at 12 months after the surgical procedure. Preoperatively, the results were significantly positive (i.e. C, D) in 52.8% (C) and 21.4% (D), whereas postoperatively the results of the PST were significantly positive only in 4%. Therefore, the surgical procedure was conducive to a statistically significant decrease in rotational knee laxity over time (p < 0.05). The median side-to-side difference in anterior laxity of the operated knee objectively assessed by GNRB arthrometer with the applied pressure of 134 N was 4.2 mm (3.1-6.8) as against the postoperative 1.2 mm (0.4-2.1) and with the applied pressure of 250 N it was 6.2 mm (4.6-8.7) prior to the surgical procedure versus 2.4 mm (1.6-3.5) postoperatively. That concerned a statistically significant decrease of postoperative side-to-side difference in anterior laxity of the operated knee at both the measured pressures (p < 0.05). The graft failed in 3 patients only (3.4%), no major complications associated with the surgical procedure were observed and 62 of the evaluated patients (69.6%) were able to return to the pre-injury level of sport within one year after the surgery. DISCUSSION When comparing the results obtained by our study with the conclusions of clinical studies carried out by other authors and evaluating similar clinical parameters with the identical surgical technique applied, it is obvious that in our group of patients we achieved similar clinical results as the other authors from abroad. CONCLUSIONS The results of our study showed that the all-inside ACL anatomical reconstruction using quadrupled semitendinosus tendon graft with posteromedial harvest with suspensory fixation by Tightrope implants at one year after the surgery bring very good subjective as well as objective clinical results and minimum complications. Key words:anterior cruciate ligament tear, anatomical ACL reconstruction, all-inside technique, posteromedial harvest, quadrupled semitendinosustendon graft, retrograde drilling, suspensory graft fixation.

[Clinical Results of Endoscopic Treatment of Greater Trochanteric Pain Syndrome]. / Výsledky endoskopické terapie bolestivého syndromu velkého trochanteru.

PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (p<0.05) was achieved postoperatively. The mean duration of surgical procedure was 68 minutes. Moreover, in peritrochanteric space apart from chronic bursitis also another pathology was found in a total of 14 cases (74%). In six cases (32%) it was a mild degeneration of m. gluteus medius (treated only with debridement) and in eight patients who underwent surgery (42%) the dorsal third of tractus iliotibialis was hypertrophic and protruding into bursa (treated with an incision of the hypertrophied part of the band). No serious neurovascular or thromboembolic complications were recorded. Only minor postoperative complications in a total of 7 patients who underwent surgery (37%) occurred. DISCUSSION There are lots of studies in literature presenting the results of endoscopic treatment of GTPS either using an independent trochanteric bursectomy or its combination with iliotibial band release. In our study we succeeded in achieving similar clinical results as those achieved by the other authors engaged in this area. CONCLUSIONS It has been proven in this retrospective study that the technique of endoscopic trochanteric bursectomy in patients with greater trochanteric pain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of postoperative complications. Key words: greater trochanteric pain syndrome, peritrochanteric space, recalcitrant trochanteric bursitis, hip arthroscopy, endoscopic trochanteric bursectomy, iliotibial band release.

[Correlation between the Arthroscopic and MRI Findings in Patients Active in Sports with Clinically Suspected Acetabular Labral Tear - Prospective Study Results]. / Korelace artroskopického a MR nálezu u sportovne aktivních pacientu s klinicky suspektní lézí acetabulárního labra ­ výsledky prospektivní studie.

PURPOSE OF THE STUDY The aim of our prospective study was to establish correlation between the arthro-MRI and arthroscopic findings in patients active in sports clinically suspected of having a hip labral tear. We sought to identify the benefits of arthro-MRI for clinical practice prior to the considered hip arthroscopy. MATERIAL AND METHODS The prospective study included 34 patients with hip pain and clinically suspected of having a labral tear. The group consisted of 19 men (55.9%) and 15 women (44.1%) of the mean age of 32.2 years (18 to 50 years). All our patients were active athletes, either professional (12; 35.3%) or recreational (22; 64.7%). Included in the study were exclusively patients aged 18-50 with hip pain lasting longer than 3 months, not responding to conservative therapy, with normal X-ray findings, or FAI syndrome. The patients underwent arthro-MRI and subsequently also hip arthroscopy, namely within no more than 3 months. The description of findings was translated into simple numerical scales, assessed using Spearman s rank correlation coefficient. We also examined the specificity, sensitivity, positive and negative predictive values and the odds ratio at various cut-off values of the scale for arthro-MRI. The statistical significance was set at the alpha level = 5%. The quality of tests was also evaluated using the ROC curve. RESULTS In hips assessed by the radiologist as reliably with no pathological finding (MRI type 1) the negative predictive value achieves 83.3% and the positive predictive value of 85.7%, with 96.0% sensitivity and 55.6% specificity. When evaluating the reliably negative finding together with the likely negative finding (MRI type 2) as against the pathological and certainly pathological findings (MRI type 3 and 4), the negative predictive value is 57.1%, the positive predictive value 95.0%, the specificity 88.9% and the sensitivity 76.0%. DISCUSSION In our study, the values achieved were comparable to or better than those reported by foreign authors in their studies establishing correlations between the arthro-MRI and intraoperative findings. Significantly higher was primarily the negative predictive value. CONCLUSIONS The results of our study indicate that the arthro-MRI performed as a part of preoperative examination prior to hip arthroscopy has adequate specificity and sensitivity in patients with suspected labral tear. Based on this examination a decision can be made as to whether to perform arthroscopy. Our study also shows that it is essential to have a highly competent radiologist to evaluate the arthro-MRI results. Key words: hip arthroscopy, labral tears, arthro-MRI, hip joint, predictive value of tests, sensitivity and specificity, minimally invasive surgical procedures/methods.

[Traumatic Thrombosis of the Renal Artery following Seat-Belt Injury]. / Traumatická trombóza renální tepny pri seat-belt injury.

Renal artery thrombosis is a rare complication of blunt abdominal injury. It occurs most frequently in car accidents in which sudden deceleration results in multiple internal injuries. Renal artery occlusion occurs rarely as an isolated blunt trauma. This report presents a case of traumatic occlusion of the left renal artery with complete ischaemia of the left kidney in a haemodynamically stable girl who suffered multiple seat-belt injuries in a car crash. Ambiguous findings on a CT scan of the abdominal cavity indicated surgical inspection of the abdomen and, since the injury-to-surgery interval was short, an attempt at revascularisation of the left kidney was made. This was performed using laparotomy through a lateral left-side incision, as an uncommon approach to the injured organs. A seat-belt fracture of the L2/3 spine was stabilised at secondstage surgery. Key words: renal artery thrombosis, seat-belt fracture of the lumbar spine.

Fatty acid profile in erythrocyte membranes and plasma phospholipids affects significantly the extent of inflammatory response to coronary stent implantation.

In coronary heart disease, the treatment of significant stenosis by percutaneous coronary intervention (PCI) with stent implantation elicits local and systemic inflammatory responses. This study was aimed at evaluation of the dynamics of inflammatory response and elucidation of the relationship between the fatty acid profile of red blood cell (RBC) membranes or plasma phospholipids and inflammation after PCI. High-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), serum amyloid A (SAA), malondialdehyde (MDA) and the fatty acid profiles were determined in patients with advanced coronary artery disease undergoing PCI before, 24 h and 48 h after drug-eluting stent implantation (n=36). Patients after PCI exhibited a significant increase in studied markers (hsCRP, IL-6, SAA, MDA). Many significant associations were found between the increase of IL-6, resp. SAA and the amounts of n-6 polyunsaturated fatty acids (namely linoleic, dihomo-gamma-linolenic, docosatetraenoic and docosapentaenoic acid), resp. saturated fatty acids (pentadecanoic, stearic, nonadecanoic) in erythrocyte membranes. The magnitude of the inflammatory response to PCI is related to erythrocyte membrane fatty acid profile, which seems to be a better potential predictor of elevation of inflammatory markers after PCI than plasma phospholipids.

[Augmentation of the Anterior Cruciate Ligament in Patients with Symptomatic Isolated Tear of Anteromedial or Posterolateral Bundle: Evaluation of Two-Year Clinical Results]. / Augmentace predního zkrízeného vazu u pacientu se symptomatickou izolovanou rupturou anteromediální nebo posterolaterální porce: zhodnocení dvouletých klinických výsledku.

PURPOSE OF THE STUDY: We present the results of a prospective study of patients with symptomatic partial ACL tears comparing the pre-operative findings with the clinical results at two years after anterior cruciate ligament (ACL) augmentation. MATERIAL AND METHODS: A total of 29 patients (7 women, 22 men; average age, 27.8 years) who were diagnosed with an isolated tear of the posterolateral (PL) bundle (18 patients) or the anteromedial (AM) bundle (11 patients) at 9 to 24 weeks after injury, and underwent ACL augmentation by isolated PL or AM bundle replacement, were evaluated. The characteristics assessed before surgery and at two years after it included the Lysholm and subjective IKDC scores and knee laxity measurement with a GNRB arthrometer (at 134 N and 250 N) and its assessment by the Lachman, anterior drawer and pivot shift tests. In addition, the presence of cyclop syndrome, graft failure and post-operative complications were evaluated. RESULTS: The patients with isolated reconstruction of the PL bundle showed post-operatively statistically significant improvement in the degree of rotational knee laxity (p < 0.05) and the ventral knee laxity assessed by the Lachman test (p < 0.05). Postoperative improvement in the anterior drawer test results was not statistically significant (p = 0.07). The median value of side-to-side difference in knee laxity measured with the GNRB arthrometer decreased at 134 N from 1.7 mm pre-operatively to 0.8 mm at two years post-operatively (p < 0.05) and, at 250 N, from 2.8 mm to 1.5 mm (p < 0.05). The median Lysholm score increased from 74 to 91 points at two post-operative years and the median IKDC score improved from 76 to 92 points (p < 0.05). Graft failure was reported in one patient (5.6%) and 14 subjects (77.8%) reported return to pre-injury sports activities. The patients undergoing isolated reconstruction of the AM bundle achieved, at two years after surgery, a statistically significant decrease in positivity of the Lachman and anterior drawer tests (p < 0.05), while the results of the pivot shift test did not improve significantly (p = 0.09). The decrease in median values of side-to-side difference in knee laxity measured with the GNRB arthrometer was from pre-operative 3.1 mm to 1.2 mm at 134 N (p < 0.05) and from 6.2 mm to 1.9 mm at 250N (p < 0.05). The median Lysholm and IKDC scores increased from 68 to 92 points and from 70 to 94 points, respectively (p < 0.05). Nine patients (81.9%) reported return to pre-injury participation in sports. Apart from early wound bleeding in one patient, no complications were recorded. DISCUSSION: By permitting maintenance of a healthy bundle and replacement of only a torn one, ACL augmentation provides several benefits. It allows for accelerated revascularization and re-innervation of the graft through mechanoreceptors of the healthy portion; it enables the surgeon to get a good anatomical orientation and achieve precise tunnel reaming; in addition the healthy bundle provides protection for the graft in the early post-operative period. Thus rehabilitation can be faster and also return to sports activities. CONCLUSIONS: Our results show that ACL augmentation using isolated replacement of either the AM or the PL bundle brings about statistically significant improvement of all subjective and most of the objective criteria by two years after surgery.

[Anatomical ACL reconstruction by a double- versus a single-bundle technique. Prospective randomised study of short-term clinical results]. / Anatomická rekonstrukce LCA double- versus single-bundle technikou - zhodnocení krátkodobých klinických výsledku prospektivní randomizované studie.

PURPOSE OF THE STUDY: The aim of the study is to present a comparison of short-term results of double- versus single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) using hamstring endons and their fixation with absorbable interference screws. MATERIAL AND METHODS: A total of 110 patients with an isolated ACL lesion and the healthy contralateral knee who met the indication criteria for ACL double bundle reconstruction (TISL, 14 mm; ICNW, 12 mm) were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At 12 months after surgery, 97 patients (DB group, n=49; SB group, n=48), comprising 68 men and 29 women, were evaluated; the average age was 29.1 years and the injury-to-surgery interval was 15.9 weeks. Pre- and post-operative subjective criteria involved the IKDC and Lysholm score. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20° flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. RESULTS: No statistically significant difference was found in pre-operative values between the two groups. Post-operatively, there were no significant differences in the occurrence of complete graft failure (p=0.0755; DB group, n=0; SB group, n=3), range-of-motion deficit (p=0.2277-0.9788) or return to pre-operative sports activity (p=0.2322). In the DB group, side-to-side anterior tibial shifts at a pressure of 124 N (medians=1.3 mm and 2.1 mm for DB and SB groups, respectively; p=0.0007) and at a pressure of 250 N (DB group =2.1 mm; SB group = 3.1 mm; p<0.0001) were significantly different from the corresponding values in the SB group. Positive results for the pivot shift test (PST) were significantly less frequent in the DB than the SB group (Chi-square test =0.0112). The SB group patients had a 2.9-times (odds ratio, 2.8704) higher risk of positive postoperative PST results than the DB group patients. In both groups, a comparison of pre- and post-operative criteria showed significant improvement in both the subjective and the objective results. DISCUSSION: The results of this study, in accordance with other authors' conclusions, suggest that the double-bundle technique provides better control over rotational and anterior knee laxity and therefore restores knee biomechanics better. However, other literature data do not confirm any significantly better outcomes of this method. Since only short-term results have been obtained so far, the study will continue because only the long-term results can provide conclusive evidence of an advantage of one technique over the other. CONCLUSIONS: Our study showed significantly better restoration of knee rotational and anterior laxity in the patients undergoing anatomical reconstruction of the ACL by the double-bundle technique. The other evaluated criteria did not differ in relation to the technique used.

[Surgical treatment of intra-articular calcaneal fractures in children]. / Operacní lécení nitrokloubní zlomeniny patní kosti u detí

Fractures of the heel bone are frequent injuries and they may interfere with the patient's common daily activities for quite a long time. They are most frequently caused by falls and jumps from a height, and occur most often in middle-aged persons; they account for about 2% of all fractures in adults. In children, calcaneal fractures indicated for surgery are rare. The report presents two cases of intra-articular fracture in children treated by open reduction from the extended lateral approach and by osteosynthesis with an angular stable plate. The surgical procedure, reduction, implant and post-operative care were the same as used in adults. A paediatric calcaneal fracture regularly occurs due to a high-energy impact and presents a serious injury. Therefore, it is recommended to treat such fractures at institutions with medical staff experienced in their management.

[Arthroscopic transcapsular iliopsoas tenotomy from the peripheral versus the central compartment in internal snapping hip syndrome. Short-term results of a prospective randomised study]. / Artroskopická transkapsulární tenotomie iliopsoatu u vnitrního typu syndromu lupavé kycle z periferního versus centrálního kompartementu: krátkodobé výsledky prospektivní randomizované studie.

PURPOSE OF THE STUDY: In this prospective randomised study, the short-term results of arthroscopic transcapsular iliopsoas tenotomy approached from the peripheral versus the central compartment for internal snapping hip syndrome are presented. MATERIAL AND METHODS: A group of 19 patients (15 women and four men; mean age, 24.3 years) who underwent arthroscopic transcapsular iliopsoas tenotomy for internal snapping hip syndrome in the period between September 2010 and December 2011 were prospectively evaluated. No injury, hip surgery or feeling of hip instability was recorded in their personal histories. Radiographs did not show any dysplasia, retroversion of the acetabulum or cam lesions. The patients were allocated to two groups using sealed envelope randomisation: Group 1 patients (n=10) were treated by tenotomy from the peripheral compartment and group 2 patients (n=9) underwent tenotomy from the central compartment during traction of the lower extremity. The evaluation included pre-operative 3T MRI findings, arthroscopically detected intra-articular lesions, duration of traction and post-operative complications. The pre-operative WOMAC scores were compared with those at one-year follow-up. In comparison of the two groups, the Mann-Whitney exact test was used for WOMAC scores and Fisher's exact test for post-operative complications. Statistical significance was set at a 0.05 level. RESULTS: In comparing post-operative complications, a significant difference (p=0.0468) between the groups was found only for genital paresthesia, which did not occur in group 1. The other differences were not statistically significant. The pre-operative WOMAC scores did not differ significantly between the groups (p=0.79). The post-operative WOMAC scores were significantly higher in group 1 (p=0.02). In each group the change in WOMAC scores was different and was statistically significant in group 1 (p=0.0014). Associated intra-articular hip pathologies, most frequently synovitis of the peripheral compartment, acetabular chondropathy, or labral lesions, were diagnosed in 90% of group 1 patients and in 66.7% of group 2 patients. DISCUSSION: Most of the authors comparing the results of two different ilioproas tenotomy techniques at one-year follow-up did not report any statistically significant differences in WOMAC scores between them. In accordance with the data reported, an increase in the post-operative WOMAC score, i.e., improvement of clinical outcome, was achieved in all our patients and, in group 1, it was significantly higher (p=0.0015), as compared with a similar study by Ilizaliturri. However, further follow-up of the patients and evaluation of long-term results will be necessary. CONCLUSIONS: The technique of arthroscopic ilioproas tenotomy approached from the peripheral compartment resulted in significantly fewer cases of genital paresthesia and provided significantly better clinical outcomes in comparison with tenotomy from the central compartment.

[Open reduction and plate fixation (ORIF LCP) for treatment of bilateral calcaneal fractures]. / Výsledky lécení oboustranné zlomeniny patní kosti otevrenou repozicí a vnitrní fixací (ORIF LCP).

PURPOSE OF THE STUDY: Calcaneal fractures are frequent injuries which may interfere with the patient's daily activities for a long time. They usually occur as the result of an axial load causing impaction of the talus into the calcaneus. They can also be bilateral. Falls and jumps from height are the most frequent causes. MATERIAL AND METHODS: Between August 2005 and December 2011, the method of open reduction and internal fixation (ORIF) with a calcaneal locking compression plate (LCP) was used to treat 98 patients with 114 calcaneal fractures. Of these, 16 were bilateral fractures found in two women and 14 men. In each patient, plain lateral and axial X-ray films of the calcaneus were taken on the day of injury. Computer tomography (CT) scans in the sagittal, transverse and coronary planes were obtained. Based on these, the fractures were classified as type I to type IV according to the Sanders system. The patients with type II and type III calcaneal fractures were indicated for ORIF treatment. The results were evaluated using the Rowe score. RESULTS: The most frequent cause of fracture was a fall or a jump from height, which was recorded in 81 patients. Bilateral fractures were found in 16 patients. Of the 98 patients, excellent results were in 31, good in 39, satisfactory in 20 and poor in eight patients, as assessed with the Rowe score. Unilateral fractures achieved excellent results in 28, good in 35, satisfactory in 15 and poor in four patients. The results in bilateral fractures were excellent in three, good in four, satisfactory in five and poor in four patients. Early post-operative complications were recorded in a total of 24 patients, of whom 13 had unilateral and 11 had bilateral fractures. DISCUSSION: The Sanders classification based on CT examination is used as an indication scheme in our department. Type II and type III fractures are indicated for ORIF treatment. A calcaneal LCP and an extended lateral approach are preferred. This allows for an almost perfect view of the fracture, an accurate reduction of the subtalar and calcaneocuboid joints and a stable internal fixation. In the patients with bilateral fractures, the occurrence of complications, multiple trauma and associated injuries was significantly higher. Also, they had less satisfactory results than the patients with unilateral fractures. CONCLUSIONS: The surgical treatment of intra-articular fractures using open reduction from the extended lateral approach and internal fixation with a calcaneal LCP has achieved good results. CT scans are necessary for the diagnosis, fracture classification and indication for a surgical procedure. The timing of surgery plays a decisive role. Open fractures and fractures associated with severe soft tissue injury are treated urgently, other fractures at an appropriate time. Our results showed a significantly higher rate of complications in the patients with bilateral calcaneal fractures, as compared with the patients with unilateral fractures, as well as less satisfactory outcomes. High-energy trauma resulting in bilateral fractures predisposes to comminuted fractures with dislocation, which leads to more serious damage to subtalar joint function.

[Evaluation of the clinical results in patients with symptomatic partial tears of the anterior cruciate ligament diagnosed arthroscopically]. / Zhodnocení klinických nálezu u pacientu s artroskopicky prokázanou symptomatickou parciální rupturou predního zkrízeného vazu.

PURPOSE OF THE STUDY: The study presents a retrospective evaluation of clinical data and arthroscopic findings in a group of our patients with symptomatic knee instability due to a partial tear of the anterior cruciate ligament (ACL). MATERIAL AND METHODS: The group included 31 patients diagnosed with symptomatic partial ACL tears, i.e. an isolated tear of the posterolateral (PL) or the anteromedial (AM) bundle. The patients' average age was 26.5 years. A side-to-side difference in ventral knee laxity was assessed using the anterior drawer test and the Lachman test under general anaesthesia before arthroscopy was commenced; rotational knee laxity was evaluated by the pivot shift test. An objective evaluation of side-to-side ventral laxity differences in both knees was performed on the GNRB® arthrometer with an applied pressure of 134 N and 250 N in the conscious patient. During arthroscopic examination, findings on the two ACL bundles were recorded. RESULTS: All 31 patients were diagnosed with symptomatic partial ACL tears, of them 22 had a PL bundle lesion and nine had an AM bundle tear. All patients with PL bundle lesions only reported problems in association with pivot sports, and all patients with AM bundle tears had problems regardless of any sports activities. In all patients with isolated AM bundle tears, the lesion was located close to its femoral attachment. In the patients with PL bundle tears, femoral location was found in 68% and tibial location in 32% of the patients. In the patients with partial PL bundle lesions, + and ++ results in the pivot shift test were recorded in 32% and 68% of the treated patients, respectively. The Lachman test showed + and ++ results in 71% and 9% of the patients, respectively. The anterior drawer test had negative results in 87% and positive + results in 13% of the patients. The side-to-side difference on the GNRB arthrometer ranged from 0.4 to 2.3 mm at a pressure of 134 N and from 1.2 to 4.2 mm at 250 N in the patients with isolated PL bundle lesions. In the patients with AM bundle lesions, the results were as follows: pivot shift test, 89% negative. 11% positive +; Lachman test, 56% negative, 44% positive +; anterior drawer test, 89% +, 11% ++; GNRB test, 2.2 to 4.4 mm at 134 N, and 4.3 to 7.1 at 250 N. DISCUSSION: The diagnosis of partial ACL lesions, i.e., isolated tears of the AM or the PL bundle, requires accurate knowledge of knee anatomy and its biomechanics. In accordance with other authors our results showed that an arthroscopic examination of both bundles of the ligament as well as knee laxity evaluation under general anaesthesia are most essential for making the definite diagnosis in partial ACL tears. They also confirmed that, in isolated AM bundle lesions, ventral laxity is present more often particularly at a higher degree of knee flexion while, in PL bundle lesions, rotational laxity is more frequent and ranges from 0 to 30 degrees of knee flexion. CONCLUSIONS: To make the definite diagnosis of partial ACL tears, patient medical history, clinical knee examination including instability type and degree assessment under general anaesthesia and, most importantly, arthroscopic findings on both ACL bundles are necessary.

[Type AO/ASIF B3 fractures of the thoracic and lumbar spine]. / Poranení hrudní a bederní pátere typu B3 dle AO-ASIF.

PURPOSE OF THE STUDY: Type B3 thoracic and lumbar fractures are often found in spines with previous hyperossification processes such as ankylosing spondylarthritis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). They occur most frequently due to high-energy trauma in a healthy spine and as fall-related domestic injury in a spine affected by hyperossification. Generally, they are less frequent than type B3 cervical spine fractures. In this retrospective study involving two centres, the incidence of these fractures, their characterisation, therapy and complications associated with them were investigated. MATERIAL AND METHODS: Between March 2003 and March 2012, 21 patients with type B3 injuries (Magerl classification) were treated in our centres. The thoracic spine was involved in 14 and the lumbar spine in seven patients. The patients' average age was 61.8 years, with a range of 33 to 87 years. There were three women and 18 men. Six fractures occurred in previously healthy spines, five and 10 were in AS- and DISH-affected spines, respectively. The evaluation included the mechanism of injury, patient's weight and height, neurological findings, type of treatment and its result, outcome after treatment termination, complications and associated diseases and injuries. RESULTS: The mechanism of injury differed between the healthy and disease-affected spines. All five AS patients suffered low-energy fractures while patients with previously healthy spines had high-energy injuries. The DISH patients had both low- and high-energy fractures. Type B3.1.1 fractures were diagnosed in two AS patients and six DISH patients, and in no previously healthy patient. Type B3.1.2 fractures were found in one AS patient, two DISH patients and one previously healthy patient. Type B3.2 fracture occurred in one patient with a previously healthy spine, in two AS and two DISH patients. Type B3.3 fractures were in four patients with previously healthy spines. Neurological deficit was found in five injured patients, four of whom had complete paraplegia (Frankel grade A) which did not improve. One AS patient in whom the spinal fracture was associated with Frankel grade C injury improved to Frankel D after surgery. All patients had an elevated BMI, ranging from 25.1 to 41.9; the average value was 32.2, which is within grade 1 obesity. Associated injuries were found in 11 patients, mostly in those with high-energy trauma. Seventeen patients were treated surgically, four conservatively. Posterior stabilisation was carried out in 10 patients who had either AS or DISH conditions; seven patients had a short spinal stabilisation. Complications included early infection in two patients, cerebrospinal fluid fistula in one, urinary tract infection in one and confused state of mind in two patients. All patients healed well but for one patient who died at 4 months after injury due to multiple complications. DISCUSSION: In the majority of relevant publications these injuries are reported in patients suffering from hyperossification disorders such as AS or DISH. In patients with healthy spines they occur less frequently and the traumatic hyperextension mechanism must have great intensity. Fractures of a hyperossified spine are related to obesity and this was also confirmed by our study in which all patients were overweight or obese. This factor plays an important role in the hyperextension mechanism that produces a sudden overcoming of the resistance of a spinal segment to force, resulting in a type B3 fracture. CONCLUSION: A different approach to these fractures is required in comparison with other spinal fractures. Type B3 fractures have some features common with type C fractures and are frequent in spines affected by spinal disease. In hyperossification disorders, paradoxically associated with advanced osteoporosis, fracture treatment requires long instrumentation. In healthy spines, fractures are treated with short instrumentation. In AS and DISH patients, the diagnosis may be delayed because these patients suffer from chronic spine pain and the pain due to fracture may be attributed to an accelerated chronic condition.

[Surgical treatment for factures of the neck and body of the talus]. / Chirurgické lécení zlomenin krcku a tela talu.

PURPOSE OF THE STUDY: To present a retrospective evaluation of the results of our method of open reduction and internal fixation. MATERIAL AND METHODS: A total of 35 patients were surgically treated for talar fractures at our department between 2004 and 2008. There were 27 men and eight women, with an average age of 31 years (range, 21 to 65). Talar neck fractures were recorded in 21 and talar body fractures in 14 patients. The most frequent cause of injury was a fall from height (77%); motorcar accidents were less frequent (14%). Open fractures were found in 8.5% of the patients, and talar fractures as a single trauma were recorded in 80% of them. Indication criteria for surgery included displaced talar neck (Hawkins type II to type IV) and body fractures, with a displacement exceeding 1 mm. The traction screw osteosynthesis used was combined with plate fixation in some patients. .Full weight-bearing of the extremity was allowed from 12 post-operative months. The patients were followed up at 6 weeks, 3, 6 and 12 months and then at yearly intervals. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate the results. RESULTS: Of the 35 fractures, 16 (45.7%) were treated surgically on the day of injury and 19 (54.3%) on subsequent days. The injury-surgery interval ranged from 0 to 12 days (average, 8 days). Primary bone union was recorded in 34 patients (97%) within 16 weeks of surgery; pseudoarthrosis developed in one patient. The results were excellent in eight (23%), good in 11 (31%) and satisfactory in seven (20%) patients. Poor outcome including function was reported by nine (26%) patients. The poor results were mostly due to associated tibial pilon fractures or because of arthrodesis necessary to be performed for management of necrosis or arthritis. Complications were recorded in 22 patients (63%) and included avascular necrosis in six (17%), traumatic arthritis of the tibiotalar and subtalar joints in 14 (40%) patients and pseudoarthrosis in one (3%) patient. This was treated by corticocancellous graft implantation and repeated osteosynthesis, and bone union occurred within 6 months. Traumatic arthritis was managed by arthrodesis in seven patients. DISCUSSION: Dislocated talar neck and body fractures are always indicated for surgery. The surgical procedure used depends on the patient's injury, surgeon's experience and skills, surgical department's system and fracture type. The timing of surgery is related to the type of injury and soft tissue disturbance. The primary demand is to reduce the fracture as soon as possible; a definite treatment may be postponed. Open fractures require urgent management. The treatment should be completed by an experienced surgeon after subsidence of soft tissue oedema when there is no longer the risk of compartment syndrome development. Injury brings about blood flow disturbance, with its extent relative to the type of injury, which may result in avascular necrosis. However, the timing of surgical treatment plays no role in the development of complications such as avascular necrosis or traumatic arthritis. CONCLUSIONS: Surgical management of dislocated talar neck and body fractures by open reduction and osteosynthesis does not achieve very good results. The definitive treatment should be carried out by an experienced surgeon and at a department with routine performance of these procedures. The results show that a delayed treatment by open reduction and stable osteosynthesis has better long-term outcomes than a rash acute operation done by an incomplete or less experienced operating team.

[Arthroscopically-assisted procedures on the hip joint]. / Artroskopicky asistované výkony na kycelním kloubu.

PURPOSE OF THE STUDY: Since 2000 arthroscopically-assisted surgery on hip joints has become more widely used. The technique is relatively demanding and should be used only after arthroscopic procedures on other large joints are mastered to perfection. A thorough study on cadaverous specimens should be a prerequisite for adopting it as a routine method. The aim of this study was to evaluate indications for hip arthroscopy as, from the year 2006, this was gradually introduced and more widely used at our department. MATERIAL AND METHODS: Forty-two hip joints were assessed out of the 83 hips which had been treated by arthroscopic surgery before the date of evaluation and which had been followed up for at least 2 years. The patient group evaluated consisted of 25 men and 17 women, with an average age of 40.3 years and a range of 21 to 65 years. Patients with a follow-up shorter than 2 years and those subsequently undergoing total hip arthroplasty were not evaluated. Indications for arthroscopic surgery included the presence of intra-articular bodies, labro-cartilaginous lesions and impingement syndromes. Neurovascular disorder affecting the limb and a higher degree of osteoporosis were considered contraindications. The outcome of surgery and its indications were evaluated on the basis of the questionnaire which recorded the patient's objective findings and subjective feelings at 3 and 6 months and then at 1 and 2 years after surgery. RESULTS: The average VAS score was 7.83 points before surgery, and 3.87 points at 3 months and 2.01 points at 2 years after surgery. Nearly all patients (98%) reported their willingness to undergo the surgery again. The complications included transient hyperesthesia in the perineal region completely resolved within 4 weeks of surgery in three cases and subcutaneous extravasation after extensive capsulotomy in one patient. It subsided within 48 hours without compartment syndrome development. DISCUSSION: A good view allowing for comprehensive exploration of the central as well as peripheral compartments enables us to treat all pathologies, which are manageable by arthroscopic intervention, in one procedure. Patient recovery is faster and the risk of intra- and post-operative complications is lower that in open surgery. The avoidance of extensive capsulotomy and the possibility of leaving the femoral head in place with only minimum distractions and without injury to the ligamentum capitis are the most important advantages of this method. Complications were found in 8.4% of the cases, which is in agreement with the literature data. The method can be applied in both the diagnosis and therapy of chronic conditions such as femoroacetabular impingement, as well as in the treatment of post-traumatic conditions ranging from traumatic labral lesions to the correction of incongruence of articular surfaces in acetabular fractures. CONCLUSIONS: Arthroscopically-assisted surgery enables us to achieve very good results, but requires appropriate, high-standard facilities and a well-mastered operative technique. It should be adopted as the method of choice for young adults still free of arthritic changes including hip impingement syndrome. Similarly to arthroscopic procedures on shoulders and knees, it is associated with low risk factors, and rapid recovery allows the patient to return soon to normal daily activities.