[Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint]. / ASKP stabilizace první traumatické luxace GH kloubu.

PURPOSE OF THE STUDY: The authors present their experience with arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint in young patients. MATERIAL: In up to 80% of patients younger than 25 years, traumatic dislocation of the glenohumeral joint is associated with its recurrence within one year of treatment even in well performed conservative therapy. Repeated dislocations gradually damage the joint and eventually result in the development of arthritis. The articular capsule becomes loose, glenoid surface is reduced and cartilage of the humeral head is affected. Repeated dislocation, reduction and immobilization are causes of patients' discomfort as well as morbidity. For these reasons, the stabilization of recurrent dislocations of the glenohumeral joint is performed by an open procedure or, most recently, arthroscopic method. Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint is an invasive yet gentle method that permits an exact reconstruction of the injured articular capsule and provides good conditions for complete healing of the affected tissues. METHOD: In order to prevent dislocations from recurring, we offered to perform minimal invasive arthroscopic stabilization in 30 patients who had undergone reduction of a primary dislocation of the glenohumeral joint in the 1999/2001 period. Of these, 18 (45%) accepted this offer. In 11 men and 7 women (average age, 22 years) 12 right and six left glenohumeral joints were treated arthroscopically with the use of absorbable or non-absorbable sutures. The procedure was performed at 2 to 7 days after injury and reduction. The joint was immobilized in an elastic Desault bandage for 6 weeks, but with exercising the elbow. From the 4th postoperative week, the glenohumeral joint was passively exercised in the sagittal plane, but abduction and external rotation were avoided. From the 7th week on, the joint was exercised to achieve its full range of motion. RESULTS: The patients were followed up for 12 to 26 months. No repeated dislocation occurred. The range of motion comparable with the contralateral healthy joint was achieved in all patients by 12 weeks after surgery. One patient with a combined injury involving fracture of the first lumbar vertebra with signs of articular fibrosis underwent redress of the glenohumeral joint under general anesthesia at 6 weeks after arthroscopy. All patients returned to their previous everyday life, working and sports activities. DISCUSSION: Arthroscopic stabilization of the glenohumeral joint is an invasive though gentle method which, when exactly performed and followed by adequate postoperative rehabilitation, can considerably or even completely reduce recurrence of joint dislocation. Its disadvantages include costs of surgery and hospital stay, and a risk of potential intra- or post-operative complications. The statistical evaluation of primary dislocations in young patients showed that, in 80% of them, recurrent dislocations would probably require surgical treatment. In addition, a joint suffering from repeated dislocation may develop lesions to such an extent that dislocation may continue to recur even after surgical treatment; this happens in about 10% of the cases. Our estimate was that only 20% of the patients with primary traumatic dislocation (ruptured articular capsule) would not be in need of further repair. However, it was impossible to determine who they would be. Our results, i. e., the absence of recurrent dislocations, suggest a way of reducing the recurrence of dislocations following a primary injury of the glenohumeral joint. CONCLUSIONS: Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint in young patients (under 25 or maximally 30 years of age) is the method that allows us, invasively but with a good outcome, to reduce a high number of post-traumatic dislocations and to return sporting and/or manually working subjects to their previous way of life.

[Treatment of chondral and osteochondral defects of the knee]. / Soucasné moznosti resení chondrálních a osteochondrálních defektu kolene.

Chondral and osteochondral defects play an important role in the knee surgery. The knee traumas are often followed by preterm development of osteoarthritis due to limited reparative processes in the cartilage. Today's diagnostic possibilities and progress in arthroscopic techniques promote the early diagnostic and exact classification of osteochondral defects. The prognosis of these injuries is improved by following early treatment. Authors present therapeutic ways of solving the defects of cartilage and adjacent part of the subchondral bone. The new possible method of solving the deep chondral defects on the weight-bearing site of the knee by combined mosaic plasty and autologous cultivated chondrocytes is described.

[The Medin intramedullary nails]. / Nitrodrenové hreby Medin.

The authors present an account on a group of their first 28 patients/29 nails/treated during a 6-month period from May 1995 by synthesis using Medin nails/14 tibial, 12 femoral and 3 reconstruction nails/. The nails and instruments are briefly described. The main objective of the development of nails was to enable the professional public to obtain the necessary implants from local manufacturers and thus at much lower prices.

[Reconstruction with intramedullary femoral nailing (a new implant made by Medin, A.S. for synthesis of concurrent fractures of the femoral shaft and neck--preliminary report)]. / Rekonstrukcní nitrodrenový femorální hreb (Nový implantát k syntéze soucasných zlomenin tela a krcku téhoz femoru firmy Medin, a.s.--predbezná informace.

The authors discuss indications for the use of a femoral reconstruction nail-synthesis of a diaphyseal fracture of the femur by an intramedullary nail with the necessity of concurrent treatment of cervical fracture or the necessity to safeguard by screws in the cervix a too short proximal fragment. The authors present short-term results obtained in a group of 13 clinical patients (followed up for 2-12 months, mean 6.6 months) who were operated using a Russel-Taylor reconstruction nail: 10 on account of a new fracture and the remaining three on account of complications of the original synthesis. The authors present the case-histories of three patients. They also describe attempts to produce a reconstruction nail in the Czech Republic, the price of which would be accessible for our departments. They submit also one case-history of the first casualty treated using a Medin reconstruction nail.

[Pitfalls and complications of the Weidner-Ender method of osteosynthesis in the treatment of fractures of the proximal part of the femur]. / Uskalí a komplikace osteosyntézy podle Weidnera-Endera pri lécení zlomenin proximální cásti stehenní kosti.

Ender's method is associated not only with advantages but also with some pitfalls and risks. The advantages--adequate stability, small surgical stress, small blood losses during operation, minimal risk of infection. Complications during operation, during the postoperative period and during subsequent by evaluation of the general condition of the patient and the type of fracture, by perfect reposition, correct surgical procedure--selection of a trepanation aperture, correct length of wires, adequate number of wires, early mobilization and gradual bordening of the operated extremity during walking. The authors present a group of 174 operated patients, incl. 159 where Ender's method of osteosynthesis was applied: in a total of 18 basicervical, 148 pretrochanteric and 8 subtrochanteric fractures. Complications developed in 11 patients--8 times distal dislocation of the wires, 6 times various dislocations of the fragments, 7 patients died after operation.