[Comparison of Tension Banding and Modified Orthocord Sling in Acromioclavicular Dislocation Treatment - Non-Randomized Retrospective Study]. / Stabilizace akromioklavikulární luxace tahovou cerklází ve srovnání s jedním Kirschnerovým drátem doplneným klickou z cástecne vstrebatelného materiálu ­ nerandomizovaná retrospektivní studie.

PURPOSE OF THE STUDY Acromioclavicular joint dislocations (AC) represent one of the most frequent injury to the shoulder gridle. Low grade injuries type Rockwood I-II are treated non-operatively. Whereas high grade injuries type Rockwood III-VI are usually treated operatively. At present a wide spectrum of surgical techniques is used: Bosworth screw, hook plate, pinning and tension banding, PDS-sling. In our study the pinning and tension banding technique and the modified orthocord sling technique were compared. The goal of this study was to determine whether there are any clinical and radiological differences between these two techniques. MATERIAL AND METHODS This retrospective non-randomized level 3 evidence study included 58 patients. All of them have sustained a Tossy III AC dislocation. Of the 58 patients, 31 were treated with pinning and tension banding. Modified orthocord (absorbable knitted strand) sling technique (One 2.0-2.5 mm Kirchner wire, orthocord tension banding and coraco-clavicular ligament suture) was used in 27 patients. The same regime was used in postoperative follow up. For the clinical assessment the ASES and Constant score were used. The presence of calcification, degenerative changes, clavicular dislocation were assessed during the X-ray follow-ups. RESULTS The mean treatment time was 18.7 ± 4.9 weeks in the pinning and tension band group (Group A), whereas 15.8 ± 2.8 weeks in the modified orthocord sling technique (Group B). There was a significantly shorter period of healing in Group B. There were no statistically significant differences in the K wire removal time (Group A: 12.6 ± 3.7, Group B: 11.9 ± 3.2). No significant difference was observed between Group A and Group B on the ASES score (Group A: 95 ± 5.8, Group B: 98 ± 3.1) and on the Constant score (Group A: 97.7 ± 3.2, Group B: 97.9 ± 2.9). There were significant differences in both groups between the injured and non-injured shoulder on the Constant score. The mean secondary clavicular dislocation in Group A was 7.2 ± 1.8 mm in the operated shoulder and 4.8 ± 2.0 mm in the non-operated shoulder. The secondary dislocation in Group B was 7.5 ± 2.0 mm in the injured shoulder and 4.2 ± 1.2 mm in the non-injured shoulder. There was a significant difference between the injured and the non-injured shoulder in both groups. Calcification in coraco-clavicular ligament was observed in 15 (48.4%) Group A cases and in 13 (48.1%) Group B cases. Secondary AC joint arthrosis was observed in 8 (25.8%) Group A cases and in 1 (3.7%) Group B case. DISCUSSION No significant difference in clinical outcomes between both the surgical techniques was found. These results are comparable with other, recently published studies. On the other hand, we observed a significantly decreased treatment time with the modified orthocord sling technique. One, centrically inserted Kirschner wire, might better tolerate small rotation movements in the AC joint. Secondary clavicular dislocation, Kirschner wire dislocations and wound complications were similar in both groups and comparable to other, recently published studies. CONCLUSIONS Even though the tension banding and orthocord modified sling rank among the oldest and the cheapest techniques available for AC dislocation treatment, their results are comparable with modern and costly techniques. The orthocord modified sling technique has an advantage of fast and cheap material extraction in outpatient conditions. Key words: AC dislocation, acromioclavicular joint dislocation, orthocord sling, tension banding, AC disruption, acromioclavicular joint disruption.

[Arthrodesis of the First Metatarsophalangeal Joint by Locking Plate]. / Artrodéza I. metatarzofalangeálního kloubu úhlove stabilní dlahou.

PURPOSE OF THE STUDY The authors in their paper evaluate a group of patients who underwent arthrodesis of the first metatarsophalangeal joint using a locking plate. MATERIAL AND METHODS In the period 2010-2015, we performed surgery in 51 patients (56 forefeet), of which in 5 cases bilaterally and in 46 cases unilaterally, in 38 women and 13 men. The mean age was 57.8 years, the mean follow-up was 3.1 years. The indications for surgery were hallux rigidus in 23 patients, hallux valgus in 15 patients, hallux varus in 3 patients, and hallux erectus in 2 patients. In 4 patients the surgery was performed for valgus deformity associated with rheumatoid arthritis, 9 patients were indicated for a failure of the prior surgical intervention. In all 56 forefeet, the anatomic, low-profile titanium plate Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7 was used. RESULTS According to Gainor s score the surgical outcomes were assessed as excellent in 46 patients who underwent surgery (90%), good in 4 patients (8%), fair in 1 patient (2%), and poor in 0 patient (0%). In 53 forefeet, the control radiographs showed solid bone union. In 2 patients and 3 forefeet, non-union of the arthrodesis occurred. In 2 forefeet, revision arthrodesis was performed, after which solid bone union followed. Malpositioned union was reported in 5 forefeet, of which in 4 cases into valgosity and in 1 case into dorsiflexion. DISCUSSION Numerous fixation materials can be used for arthrodesis of the first metatarsophalangeal joint. The use of the least stable Kirschner wires (cerclage) is being abandoned and substituted with a more stable fixation by screws, memory staples and locking plates. The achievement of excellent results requires proper positioning of the arthrodesis. Impingement syndrome between the big toe and the second toe can result in painful callosities formation, too large dorsiflexion can lead to a hallux hammertoe, with reduced big toe support function, to metatarsalgia. CONCLUSIONS The arthrodesis is indicated in patients with Grade III and IV hallux rigidus, with severe hallux valgus, hallux varus, and in patients in whom the previous surgeries failed. We tend to prefer stable arthrodesis. Fixation by anatomic LCP plate facilitates early rehabilitation, loading and early return to work and sports activities. Key words: arthrodesis, metatarsophalangeal joint, hallux rigidus, hallux valgus.

[Treatment for Periprosthetic Femoral Fractures after Total Hip Arthroplasty]. / Terapie periprotetických zlomenin femuru po implantaci totální endoprotézy kycelního kloubu.

PURPOSE OF THE STUDY To give a description of the patient group, risk factors, classification, therapeutic procedures and treatment outcomes in periprosthetic femoral fractures after total hip arthroplasty treated in the Trauma Hospital in Brno. MATERIAL AND METHODS This retrospective study comprised of 51 patients treated for a periprosthetic femoral fracture between 2003 and 2013. This included 19 (37%) intra-operative and 32 (63%) post-operative fractures. According to the Vancouver classification, the types of fractures were as follows: 9 patients A; 21 B1; 9 B2; 6 B3 and 6 with type C. RESULTS Type A fractures were treated conservatively. Although pseudoarthrosis of the greater trochanter occurred, the patients had no clinical problems. The intra-operative type B1 fractures were managed by cerclage tapes in nine patients and the post-operative B1 fractures were treated by plate osteosynthesis in 10 patients and femoral stem reimplantation in two patients. All post-operative type B2 and type B3 fractures were managed by reimplantation of the femoral stem and type C fractures were treated by plate osteosynthesis. Serious complications requiring revision surgery were recorded in five patients; they included plate failure in two B1 fractures, dislocation of a B2 fracture, a dislocation with femoral component rotation in a B3 fracture and failure of the plate in a type C fracture. CONCLUSIONS The treatment of a periprosthetic fracture can affect the patient's life. In view of the fracture type, implant type, general health of the patient and all risk factors, the authors prefer one-stage surgical treatment. The Vancouver classification is a guidleine for the therapeutic plan. Osteosynthesis as a single procedure is indicated only if the femoral component is stable and well fixed. When the stem in B2 and B3 fractures is loose, revision surgery with stem replacement is necessary. Key words: periprosthetic fracture, total hip atrhroplasty, Vancouver classification.

[Cementless ceramic-on-ceramic total hip system]. / Necementovaná totální endoprotéza kycelního kloubu, keramika-keramika.

PURPOSE OF THE STUDY: This is an experimental and clinical study on the use of cementless, ceramic-on-ceramic total hip arthroplasty (THA). MATERIAL AND METHODS: In the experimental part, the authors constructed, by means of mathematical analysis of finite elements, surface tension standards for the ceramic liner at various angles of cup inclination, and identified potentials for destruction of the liner. In the clinical trial, they evaluated the outcomes in 50 patients, out of the 249 implanted prostheses, at five-year follow-up. RESULTS: The experiment showed that a slightly steeper inclination the cup provided physical conditions for increased longevity of the ceramic liner. In the clinical study, no post-operative complications, such as fracture of the acetabulum or femur, and dislocation or break of any ceramic part, were recorded. No infection or loosening of the prosthesis occurred. The patients did not complained of any pain in the hip joint, which is typical of non-cemented THA. DISCUSSION: Ceramic-on-ceramic bearing surfaces show the least wear due to high biocompatibility. Computer-assisted surgery can markedly reduce the risk of incorrect positioning of the acetabular component. In this prospective study, the five-year survival of ceramic-on-ceramic THA in 50 patients free from any complications, whose Harris hip score was 97.4 points, suggests that objections to these prostheses, as raised by some authors, are not justified. CONCLUSIONS: In our experience the Plasmacup Bicontact ceramic-on-ceramic prosthesis is one of a few options that has a prospect of remaining the only total hip replacement in one's lifetime. Key words: total hip replacement, ceramic-on-ceramic.

[Total knee replacement following high tibial osteotomy]. / Totální náhrada kolenního kloubu po vysoké osteotomii tibie.

PURPOSE OF THE STUDY: The objective of the study was to find out to what extent anatomical changes due to high osteotomy of the tibia affect knee function after total knee arthroplasty. MATERIAL: Of the patients with knee osteoarthritis treated by cemented total PFC prostheses in 1995, two groups were selected. Group I consisted of 50 patients who had knee replacement without previous tibial osteotomy; the average age of the patients was 71.2 years and the average follow-up was 5.7 years. Group II comprised 50 patients with high tibial osteotomy before total knee replacement. The average age was 73.5 years and average follow-up was 5.4 years. Before arthroplasty, all patients showed knee motion in the range from 10 degrees valgus to 15 degreEs varus, flexion of the knee was up to 20 degrees and there was no marked instability. METHODS: The results of knee arthroplasty were evaluated, in terms of function, according to the Knee Society Clinical Rating System, using the knee scoring system (KSS) and functional system (FS). The length of the patella and patellar ligament were measured, the Insall-Salvati index was calculated and the height of the patella was determined. RESULTS: The average KSS scores were 86.6 and 84.2 points for groups I and II, respectively. Excellent and good outcomes were achieved in 38 group I patients and in 37 group II patients. The average FS scores were 82.7 and 81.4 points in groups I and II, respectively. The average Insall-Salvati indices in groups I and II were 1.09 and 0.91, respectively. No patella infera was recorded in group I but it was found in 21 (42%) patients of group II. DISCUSSION: There was no difference in knee function, as shown by KSS and FS scores, between the two groups. This is in agreement with the results of Billings et al. and Meding et al. who studied 21 and 81 patients with knee arthroplasty, respectively. On the other hand, Windsor et al. and Katz et al., in groups of 45 and 21 patients, respectively, found that high tibial osteotomy prior to knee replacement adversely affected the outcome of arthroplasty in terms of knee function. The authors draw attention to the fact that, after high osteotomy, the detachment of soft tissues around the proximal tibia is more difficult. The surgeon has to deal with changes in shape and sloping of the proximal part of the tibia and its altered position in relation to the diaphysis. CONCLUSIONS: The outcomes of total knee arthroplasty, as assessed by functional scores, were similar in the patients both without and with preceding high tibial osteotomy. This condition had some effect on the development of a patella infera (present in 21 out of 50 patients) but only to a mild degree (Insall-Salvati Index, 0.91).

Direct stabilization of lumbar spondylolysis with a hook screw: mean 11-year follow-up period for 113 patients.

STUDY DESIGN: A retrospective study involving 113 patients with a spondylolysis who underwent direct repair with a hook screw was conducted. OBJECTIVES: Spondylolysis with instability can produce low back pain. In adults, fusion of the affected level is the gold standard of treatment. In the adolescent, direct repair of the lysis can save a functional segment. SUMMARY OF BACKGROUND DATA: It has been proved that direct repair of spondylolysis can accomplish restitutio ad integrum for a functional segment. So far, only short-term results are available in the literature. METHODS: This study involved 113 patients who underwent direct repair of spondylolysis with a hook screw according to Morscher. After an average follow-up period of 11 years, the patients were reviewed. The main issue was the question of fusion. For this purpose, plain radiographs were taken. For doubtful cases or for the patient experiencing pain, conventional tomography scans or computed tomography scans were taken. RESULTS: The pseudarthrosis rate was 13.3%. The fusion rate for patients younger than 14 years was higher than that for older patients, especially those older than 20 years. CONCLUSIONS: Direct repair of spondylolysis can be recommended for patients with a growing skeleton, a slight slip, an instability, or failure of conservative treatment. Thereby, a functional segment can be saved with a relatively small operation.

[Prevention of epidural fibrosis. Initial experiences with non-resorbable membrane]. / Prävention der epiduralen Fibrose. Erste Erfahrungen mit einer nicht resorbierbaren Membran.

Scars around the neural structures after opening the spinal canal are common and severe problems in spine surgery. This paper presents the use of a special membrane to avoid epidural scarring in two cases.

The post-discectomy syndrome. Aetiology, diagnosis, treatment, prevention.

The post-discectomy syndrome (PDS) is a common diagnosis in patients with problems following a disc operation. The different causes of PDS make the establishment of the correct diagnosis and its corresponding efficient treatment difficult. A general overview published in the bibliographical data covering the entity of PDS is rare. The following paper aims to specify PDS according to its aetiology, diagnosis, treatment and prevention. The diagnosis should be made efficiently, so that the patient can receive prompt adequate therapy.

Trauma to the primary and young permanent dentitions.

It is the responsibility of the dentist to stay current on the latest techniques available to treat traumatic injuries. The charts included provide most of the potential emergency treatment possibilities, recommended follow-up treatment, and final treatment outcomes essential to providing the best care for our child patients. It is also the responsibility of the dentist to use evidence-based research when adopting treatment protocols. It is not appropriate to use anecdotal or single case studies as a basis for adopting treatment protocols. It is very difficult in this area of trauma to come up with good scientific research with adequate sample sizes and long-term data. Dr. J.O. Andreasen has excellent compiled long-term research on trauma. His books, Essentials of Traumatic Injuries to the Teeth and An Atlas of Replantation and Transplantation of Teeth are two very good books for any clinical practice.