[Posterior Dislocation of the Shoulder with Compression Fracture of the Humeral Head. Our Experience with McLaughlin Procedure and Its Modification]. / Zadní glenohumerální luxace s impresní zlomeninou hlavice. Nase zkusenosti s operací dle McLaughlina a její modifikací.

PURPOSE OF THE STUDY The purpose of this study is to remind of the specific features of diagnosis and therapy of dorsal dislocations of the glenohumeral joint to prevent frequent neglect or misdiagnosis during primary treatment. Also, we strived to present our experience and outcomes of posterior dislocation treatment by McLaughlin procedure and its modified version. MATERIAL AND METHODS We retrospectively evaluated 7 patients who had been treated at our department in the period 2015-2019 by McLaughlin procedure or its modification. The group consisted of 5 men and 2 women aged 33-79 years. In five patients, the dislocation occurred during an epileptic seizure, in two patients during an accident. The patients were treated by McLaughlin procedure or the Neer modification of McLaughlin procedure. The deltoideopectoral surgical approach was always used. Based on the preoperative planning, we decided, or intraoperatively changed our decision, as to whether mere transposition of the subscapularis is satisfactory or whether transposition of the lesser tuberosity to the defect, a bone graft and arthroplasty are necessary. Postoperatively, the operated limb was fixed for 6 weeks in neutral position, which was followed by rehabilitation. RESULTS We evaluated subjective and objective outcomes of the surgery, the radiological finding and in 2 patients also a control CT scan. The function of the shoulder was assessed using the Constant shoulder score and the OSIS scoring system. The resulting score: the mean OSIS was 55.7 points (92.8%) and the mean Constant score was 86.2 points (86.2%), which we regard as a very good result. All patients consider the surgery successful and are satisfied with the outcome. No patient reported recurrent dislocation. DISCUSSION When treating the posterior dislocation of the shoulder, vital is the shoulder reducibility and also the presence or the size of reverse Hill-Sachs defect. The transfer of the subscapularis tendon can be performed as an open procedure or arthroscopically. Inveterate irreducible posterior dislocation of the shoulder is quite a rare diagnosis, which is why even at our department the McLauglin procedure is performed in the order of units per year only. CONCLUSIONS The surgical solution of inveterate posterior dislocation of the shoulder is hardly ever uncomplicated. The reduction alone is often insufficient and some other way of shoulder stabilisation is necessary, often times addressing the humeral head defect. In our to date experience, the McLaughlin procedure or the Neer s modification is an elegant and safe method to treat posterior dislocation with a humeral head defect. The functional outcomes are very good and enable the patients to reengage in everyday activities. Thanks to this procedure shoulder joint arthroplasty can be avoided in younger patients. Nonetheless, in defects that are greater than 50% of the head the replacement is necessary. Due to frequently associated rotator cuff injuries, the most often procedure indicated by us is the reverse total shoulder replacement. Key words: posterior dislocation of the shoulder, reverse Hill-Sachs defect, McLaughlin procedure, Neer s modification.

[Proximal Row Carpectomy - Five-Year Results]. / Proximální karpektomie ­ petileté výsledky.

PURPOSE OF THE STUDY This study aims to evaluate the results of patients treated by proximal row carpectomy at a follow-up of at least 5 years after the surgery. MATERIAL AND METHODS A total of 25 patients were treated by proximal row carpectomy for degenerative changes of the wrist as a consequence of the previous trauma or avascular necrosis of the lunate bone, of whom 21 patients underwent a follow-up examination at least 5 years postoperatively. Proximal row carpectomy was indicated in 15 patients for SLAC wrist, in 4 patients for avascular necrosis of the lunate bone, in 1 patient for SNAC wrist, and in 1 patient for inveterate dislocation of the wrist. The follow-up clinical and radiological examinations were performed at least 5 years after the surgery. The range of wrist motion, grip strength, presence of pain at rest or pain under loads, total clinical score according to the Green and O'Brien scoring system, patient satisfaction with the outcome of surgery were assessed. By fluoroscopy the range of wrist motion, degenerative changes of the radiocapitate joint, and translation of the capitate bone with respect to the distal radius were evaluated. RESULTS Postoperative improvements in the range of motion and grip strength were confirmed. Also, the pain relief at rest and under loads was achieved. Five years after the surgery, most of the patients (85.6%) reported an overall improvement. The total clinical score according to the Green and O'Brien scoring system improved from 35.8 preoperatively to 63.1 postoperatively. DISCUSSION The advantage of this procedure is a low percentage of complications, relative technical simplicity, maintenance of functional motion of the wrist, satisfactory grip strength, and pain relief. There are no complications related to the implant, no risk of a non-union. CONCLUSIONS As shown by our results obtained 5 years after the surgery as well as the published data, in the indicated cases the proximal row carpectomy is an appropriate surgical technique to treat the degenerative changes of the wrist. In most of the patients, favourable functional results and pain relief can be expected. Key words:proximal row carpectomy, SLAC wrist, SNAC wrist, avascular necrosis of the lunate bone, dislocation of the wrist.

Strong Evidence for Nucleon Resonances near 1900 MeV.

Data on the reaction γp→K^{+}Λ from the CLAS experiments are used to derive the leading multipoles, E_{0+}, M_{1-}, E_{1+}, and M_{1+}, from the production threshold to 2180 MeV in 24 slices of the invariant mass. The four multipoles are determined without any constraints. The multipoles are fitted using a multichannel L+P model that allows us to search for singularities and to extract the positions of poles on the complex energy plane in an almost model-independent method. The multipoles are also used as additional constraints in an energy-dependent analysis of a large body of pion and photoinduced reactions within the Bonn-Gatchina partial wave analysis. The study confirms the existence of poles due to nucleon resonances with spin parity J^{P}=1/2^{-}, 1/2^{+}, and 3/2^{+} in the region at about 1.9 GeV.

Beam-Target Helicity Asymmetry for γ[over →]n[over →]→π

We report the first beam-target double-polarization asymmetries in the γ+n(p)→π^{-}+p(p) reaction spanning the nucleon resonance region from invariant mass W=1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN^{*} resonance photocouplings.

HAS A GLOMUS TUMOR ALWAYS A QUICK DIAGNOSIS?

INTRODUCTION: Glomus tumor is a rare and benign vascular tumor. Although symptoms specific for this tumor are quite clear, there is still a delay between the onset of symptoms, diagnosis and subsequent surgical therapy. The authors monitor the time from the onset of symptoms to the diagnosis and management of the problems. MATERIAL AND METHODS: Between 2004-2012, a total of 5 patients were diagnosed with subungual glomus tumor in the area of the distal phalanges of the hand. It involved 3 women and 2 men with the mean age of 32.2 years (26-47 years). During the first examination, we monitored the duration of symptoms, number and specialty of the doctors who examined the patient, and what examinations were performed. When the cold test was positive, MRI was performed and the patients were indicated for surgical revision. Tissue samples in all patients were histologically examined. Patients were followed for 2 years. RESULTS: It was found that the patients had clinical symptoms for an average of 2.4 years. In our group, the patients were examined by an average of 5.4 physicians (3-9 physicians). On examination before surgery, three patients reported changes in the nail bed and two patients reported no change. When following the patients 2 years after the surgery, relapse occurred in one patient and it was treated with reoperation. During regular follow-up 2 years after the surgery, 4 patients were without nail deformity. In one patient, there was resulting nail deformity. Relapse occurred in only one case. DISCUSSION: Because the glomus tumor is a rare lesion, occurring most frequently in the nail bed, early diagnosis is still a problem. Even in literature, we encounter a similar time frame from the onset of symptoms until the final diagnosis of 1.9 to 8 years. CONCLUSION: Although clinical signs and problems concerning the glomus tumor are very obvious, there still remains a long time for diagnosis. It would certainly be most beneficial for patients with persistent symptoms not to be referred to different specialists, but directly to a department that specializes in hand surgery.

[Our results of the Brandes-Keller procedure and Helal metatarsal osteotomy in patients with forefoot deformity]. / Nase zkusenosti s operacní rekonstrukcí prednozí u pacientu s hallux valgus a metatarzalgiemi pri pes transversoplanus.

PURPOSE OF THE STUDY: The most frequent valgus deformity of the big toe is often associated with a collapse of the traverse arc of the foot. The purpose of the present study was to assess the results of forefoot reconstruction by the Brandes-Keller resection arthro- plasty of the first metatarsophalangeal joint and the Helal metatarsal osteotomy when this deformity was present. MATERIAL: A retrospective study of 40 consecutive patients with severe forefoot deformities was performed.The patients were treated at our department in the period from 1997 to 2003.The average age at the time of surgery was 54.7 years.Twelve patients underwent bilateral surgery. The results of 52 operations were evaluated. RESULTS: Each patient returned for a personal interview by an independent investigator and a clinical examination. A post-operative forefoot score was calculated according to the system of the American Orthopaedic Foot and Ankle Society (AOFAS). This 100-point scale includes items related to pain, level of activity, deformity and motion. The average AOFAS score was 85.5 points post-operatively. No pain was reported in 38 (75 %) forefeet, mild pain in 12 (23 5 %) forefeet and moderate pain in 1 (2 %) forefoot. The complications included slow healing of the wound in two patients (3.8 %) and asymptomatic pseudoarthrosis after metatarsal osteotomy in two patients (3.8 %). Five patients (9.6 %) reported persisting swelling of the foot dorsum for a period longer than 3 months. DISCUSSION In agreement with the majority of the published data we are of the opinion that the Brandes-Keller resection arthroplasty is a surgical method suitable to treat valgus deformities of the big toe with concomitant arthritis of the first metatarsophalangeal joint (MTP) in elderly patients whose weight-bearing demands are low. This treatment permits early post-operative weight-bearing. In younger patients with valgus deformity of the big toe without arthritis it is preferred to use techniques preserving the joint. The use of total replacement of the first MTP joint is open to discussion. CONCLUSIONS: The Brandes-Keller procedure with the Helal metatarsal osteotomy, if correctly performed in indicated cases, results in painless walking in patients with forefoot deformity.

[Arthritis development following untreated scapholunate instability of the wrist]. / Rozvoj artrózy po nelécené skafolunátní nestabilite zápestí.

PURPOSE OF THE STUDY: Complete disruption of the scapholunate (SL) ligament results in the development of arthritic lesions known as scapholunate advanced collapse (SLAC) of the wrist. MATERIAL AND METHODS: The authors present the results of a prospective study of seven patients in whom radiography showed an acute com- plete rupture of the scapholunate ligament and who refused SL ligament reconstruction.This group (1) was compared with a group of 17 patients (2) who underwent ligament reconstruction soon? after an acute rupture had been detected. All patients were examined at 36 months after injury for hand function and pain using the Wrightington Hospital Wrist Scoring (WHWS) System, and for the presence or absence of SLAC by radiography. Group 1 patients underwent arthroscopic examination in order to evaluate the extent of arthritic lesions. RESULTS: As assessed by the WHWS system, in group 1 excellent, good and satisfactory results were achieved in 29%, 42% and 29% of the patients, respectively in group 2 these results were found in 59%, 35% and 6% of the patients. The radiography showed, in group 1, 14% patients free from SLAC, 43% with stage I SLAC, 29% with stage IIa SLAC and 14% with stage IIb SLAC. In group 2, 94% of the patients were free from signs of SLAC and 6% had stage IIa SLAC due to infectious complications. The arthroscopic evaluation of group 1 revealed SLAC signs in all ;patients as follows: stage I, 29% stage IIa, 42% and stage IIb, 29%. CONCLUSIONS: In patients with complete disruption of the SL ligament there is a rapid onset of arthritic lesions in the wrist detectable by radiography. Arthroscopic examination, however, shows a much higher extent of damage to cartilage of the wrist. Key words: wrist arthritis, scapholunal instability, arthroscopy of the wrist.

[Chronic lunotriquetral instability of the wrist. Presentation of our method of treatment]. / Chronické lunotriquetrální nestability zápestí--vlastní metoda osetrení

PURPOSE OF THE STUDY: One of the causes of pain on the ulnar side of the wrist is post-traumatic lunotriquetral (LTq) instability, which is difficult to detect on radiographs. For diagnosis, arthroscopic examination is most reliable. The methods for treatment of LTq instability include mere immobilization, ligament reconstructions and LTq joint stabilization with Kirschner's wires in acute conditions, and stabilization of the LTq joint by tenodesis or arthrodesis. In this study our method of treating chronic isolated injury to the lunotriquetral ligament is described. MATERIAL: The group comprised 43 wrists with isolated lunotriquetral ligament injuries diagnosed by arthroscopy. In 19 patients with persisting complaints, stabilization was performed using our original method. At 4 months after surgery, the results were evaluated by the method of Green and O'Brien. METHODS: Access to the LTq joint was gained through the fifth extensor compartment. At about 3 cm proximal to the ulnar head, one third of the extensor capri ulnaris (ECU) tendon was detached, without doing damage to the tendinous sheath on the ulnar head, and stretched distally up to the triquetrum-hamate joint level. Using a 3.2-mm drill, a tunnel was made on the dorsal side of the triquetrum, starting at the distal third of the ulnar side of the triquetrum and opening at the attachment site of the dorsal LTq ligament. In the middle part of the dorsal side of the lunate, a groove 4 mm deep and 6 mm long was made with a cutter and a two-suture Mitek anchor was inserted in its radial side. The graft was passed through the tunnel in the triquetrum, tightened up and inserted in the groove on the lunate, and sutured to the anchor. The rest of the tendon was reinserted to the ECU tendon. After suturing the dorsal structures and skin, a high plaster cast reaching up above the elbow was applied for 4 weeks, followed by application of a short plaster splint for another 2 weeks. RESULTS: Using the method of Green and O'Brien, we assessed pain, function (return to full activity), range of motion and grip strength. An excellent result was recorded in 48%, good in 42% and satisfactory in 10% of the patients; there were no poor results. DISCUSSION: Our method gives better results than the published methods of tenodesis, because it secures stability of both the triquetrum and lunate bones. Also, these methods restrict motion to a lesser degree than LTq joint arthrodesis. CONCLUSIONS: LTq instability of the wrist is a limiting condition for the patient's daily activities. It appears when, for gripping, the hand is positioned in dorsal flexion and ulnar duction. The diagnosis and therapy are complicated and only arthroscopy is reliable for LTq instability detection. The method described here provides an option for treating this disorder with good outcome and, in case of failure, does not interfere with a subsequent LTq joint arthrodesis.

piN-->etaN data require the existence of the N(1710) P11 resonance, reducing the 1700-MeV continuum ambiguity.

In spite of long-lasting discussions, the agreement on the existence of the N(1710) P11 resonance has not yet been reached, so the Particle Data Group declares it as a 3-star resonance only. We show that the proper inclusion of inelastic channels in the coupled-channel formalism indisputably demands the existence of the N(1710) P11 state, and that it presumably stays hidden within the continuum ambiguity of a typical single-channel partial-wave analysis. Consequently, the Particle Data Group confidence rating of this state should be raised to a 4-star resonance.

A mathematical model for the effect of red light penetration depth on tumor growth.

The effect of different local temperature increase in normal and tumorous tissue, influenced by red light commonly used in photodynamic therapy, on tumor growth rate was reanalyzed, taking into account the tumor tissue penetration depth of the light used. The rear part of the tumor is definitely not receiving the same light dose, and consequently the same amount of heat energy, as the front part. The effect is taken into account by using a mathematical model of tumor growth for the rear part of the tumor. Positive experimental results of hyperthermia due to the energy deposited by the red light, are more encouraging after such a correction than previously reported.