[Management of Glenoid Defect by a Bone Graft in Reverse Total Shoulder Arthroplasty - Surgical Technique and Two-Year Clinical Outcomes]. / Resení defektu glenoidu kostním stepem pri implantaci reverzní totální endoprotézy ramene ­ operacní technika a dvouleté klinické výsledky.

PURPOSE OF THE STUDY The purpose of the study is to share the first experience of authors with the management of glenoid defects by a bone graft in reverse total shoulder arthroplasty. MATERIAL AND METHODS Evaluation of 7 patients was conducted, who underwent reverse total shoulder arthroplasty at the authors' department. Due to the presence of glenoid bone defect, augmentation was performed by bone graft, obtained either as an autograft harvested from the humeral head of the patient intraoperatively or as an allograft from the femoral head from the bone tissue bank. In all the implantations, a glenoid component with an extra-long "revision" peg was used. Postoperative fixation was secured only by a shoulder brace. Limited rehabilitation was commenced on the first postoperative day, full rehabilitation 5 weeks after the surgery. RESULTS The total ASES Shoulder Score increased from the mean 39.8 preoperatively to 75.2 postoperatively. Also, the overall range of motion improved, with the preoperative ventral flexion increasing from the mean 65.5° to 135.2°, abduction increasing from 63.9° preoperatively to 127.7° postoperatively, and external rotation increasing from 27.4° preoperatively to 45.1° postoperatively. In the evaluated group, 2 complications were observed, namely 1 case of bone graft breakage intraoperatively, necessitating the harvesting of a new bone graft, and 1 case of postoperative paresthesia of the fourth and the fifth finger, which completely disappeared within 4 months after the surgery. In the group of followed-up patients, no loosening of endoprosthetic components has so far been reported. DISCUSSION Glenoid defect constitutes one of the problems that need to be dealt with by the surgeon during the reverse total shoulder arthroplasty, most often it is accompanied by glenoid retroversion. The basic approach to defect management is to use the eccentric reaming technique which is, however, limited by the size of glenoid retroversion and can also worsen the already present glenoid medialization, with all the resulting consequences. Another option is to use solid bone grafts to correct glenoid version and simultaneously to lateralize the glenoid component. Yet another option is to use the prefabricated glenoid augments that are, however, not commonly available in the Czech market. CONCLUSIONS The short-term clinical outcomes of patients, in whom glenoid defect was during the reverse total shoulder arthroplasty managed by bone grafts, are very good. Radiological signs of bone-to-graph incorporation were present in all the patients of the followed-up group. Nonetheless, for the sake of evaluation of this method, more patients shall be included in the group and a longer follow-up is needed for their evaluation. Key words: reverse total shoulder arthroplasty, glenoid bone loss, glenoid retroversion, augmented implant.

[Sacral bone dysgenesis in a child whose mother has diabetes]. / Niedorozwój kosci krzyzowej u dziecka matki chorej na cukrzyce.

We introduced 2.5-year old girl with gait and miction disturbances as a result of sacral bone dysgenesis (only S1 existed) and abnormal position of nerve roots of medulla. The 28-year old mother of the child has been treated for diabetes mellitus type I since she was 15.

[Anomalies of the cervical spine in children]. / Anomalie w zakresie kregoslupa szyjnego u dzieci.

Two children are presented with congenital anomalies of the cervical spine and associated malformations of the nervous and urinary systems. The attention is paid to the usefulness of the cervical spine assessment in children in cases of recurrent cerebellar manifestations of unclear aetiology or combined malformations of the urinary system.

Location and fate of the nonpalpable testis in children.

The records of 261 children who were treated surgically for cryptorchidism between 1975 and 1980 were reviewed to determine the incidence, exact location and results of treatment of nonpalpable testes. Of these 261 patients 71 had 80 nonpalpable testes (27 per cent). Of these 80 nonpalpable testes 17 (21 per cent) were determined to be absent at the time of thorough intra-abdominal and retroperitoneal exploration. Of the 63 testes found at surgical exploration 34 (56 per cent) were intra-abdominal (intraperitoneal), 10 (16 per cent) were in a preperitoneal position behind the internal inguinal ring, 15 (24 per cent) were canalicular and 4 (5 per cent) were located in the superficial inguinal area. Seventeen (27 per cent) testes were removed because of postpubertal age, testicular atrophy or anatomic deformity inconsistent with an attempt at orchiopexy. In the remaining testes the success rate of orchiopexy was compared on the basis of the original anatomic location of the testis and the type of surgical procedure performed. Of those testes deemed suitable for orchiopexy 89 per cent in a preperitoneal or more distal location and 74 per cent of intraperitoneal testes were placed successfully in the scrotum.

Cystitis follicularis in children with primary vesicoureteral reflux.

In an attempt to determine whether cystitis follicularis affects the spontaneous resolution of primary vesicoureteral reflux we reviewed the records of 65 children with reflux and cystitis follicularis. A group of children with primary vesicoureteral reflux but without cystitis follicularis was included as controls. The data did not reveal a statistically significant difference in either the rate of spontaneous resolution of reflux or the need for surgical correction between these 2 groups of children.