[Benefits of the Acetabular Microfracture Technique in Arthroscopic Treatment of Chondral Defects in Femoroacetabular Impingement Syndrome: Two-Year Results of a Multicenter Prospective Randomized Study]. / Prínos provedení mikrofraktur acetabula pri artroskopické terapii chondrálních defektu u femoroacetabulárního impingement syndromu: dvouleté výsledky multicentrické prospektivní randomizované studie.

PURPOSE OF THE STUDY Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoro - acetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. MATERIAL AND METHODS The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In Group 1 (31 patients), microfractures for chondral defects was performed, while in Group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in Group 1 and 31.1 in Group 2. Preoperatively and 6, 12 and 24 months postoperatively the modified Harris Hip Score (mHHS) parameters and VAS score were evaluated and also revision surgeries, conversion to endoprosthesis, and occurrence of complications were recorded. RESULTS Preoperatively, no statistical difference between the two groups was found in the studied parameters (mHHS and VAS). Postoperatively (after 6, 12 and 24 months), in both groups a statistically significant increase in mHHS and VAS score was reported. When comparing the mHHS parameter at individual evaluated times in Group 1 and Group 2, a statistically significant difference was confirmed at 12 and 24 months after surgery (P < 0.001), namely in favour of Group 1. At 6 months postoperatively, no statistically significant difference in this parameter between the two groups was confirmed (P = 0.068). When comparing the VAS score parameter in these two groups at individual times, no statistically significant difference was confirmed at 6 and 12 months after surgery (P= 0.83 / P= 0.39). A statistically significant difference in the VAS score parameter was observed only at 24 months after surgery, namely in favour of Group 1 (P< 0.037). In the course of the follow-up period, altogether 3 patients (2 patients from Group 1) were indicated for revision hip arthroscopy and in 1 female patient an endoprosthesis was implanted. No severe intraoperative or postoperative complications were observed. DISCUSSION In agreement with other authors worldwide, the arthroscopic treatment of FAI syndrome, if indicated and performed correctly, was confirmed to improve the clinical condition of patients postoperatively, regardless of the technique used in treating the chondral defect. Based on our results as well as conclusions of other world authors, in treating the grade IV defects of smaller size it is appropriate, in treating the cartilage, to prefer the microfracture surgery, which is less demanding both technically and financially and contrary to mere debridement allows to fill the original defect by fibrocartilage tissue. CONCLUSIONS The benefits of the acetabular microfracture in patients with the FAI syndrome treated arthroscopically were confirmed. A statistically significant difference between the two studied groups was reported in the mHHS parameter at 12 and 24 months after surgery and also in the VAS parameter at 24 months in favour of the group with performed microfracture. In both the studied groups, the arthroscopy resulted in a statistically significant improvement of the assessed quality of life parameters. Key words: hip arthroscopy, femoroacetabular impingement syndrome, chondral defect, microfracture, abrasive chondroplasty.

[Current options for the treatment of osteoporosis]. / Soucasné moznosti lécby osteoporózy.

The primary aim of osteoporosis treatment is prevention of osteoporotic fractures. The main factors in the development of these fractures are mechanic resistance of the bone and the bone quality. The importance of risk factor identification increases and it is important to consider the structural analysis of the hip-bone when evaluating and deciding whether to prescribe antiresorptive or osteoanabolic drugs or whether to just modify calcium and vitamin D intake. Various options are currently available for the pharmacological treatment of osteoporosis: calcium and vitamin D supplementation together with aminobisphosphonates, or osteoanabolic treatment with parathormone derivatives; monoclonal antibody to RANKL denosumab will also soon become available.

[Geriatric traumatology - vision or reality?]. / Geriatrická traumatologie - vize nebo skutecnost?

The aim of the paper is to provide information on the establishment of the Geriatric Fracture Centre (GFC) at the Department of Orthopaedics and Traumatology, Faculty Hospital at the Faculty of Medicine, Charles University, Pilsner, whose goals and services are in accordance with the principles of the Rochester GFC, USA, and the AO Foundation at Synthes Inc. The paper presents up-to-date information on the methods of osteosynthesis for the skeletal system affected by osteoporosis, the majority of which was obtained in the AO Geriatric Fracture Course in Davos, December 2007. The authors are concerned with the pre-operative examination of geriatric patients who suffered a fracture.The anaesthesiologist's view on our elderly patients, their pre-operative preparation, anaesthesia application and post-operative care are presented.The novel method of two-phase bone densitometry and its role in the therapy of osteoporosis for elderly patients with fractures are also mentioned.

[Osteosynthesis of ipsilateral hip and femoral shaft fractures with the PFN-long]. / Osteosynthese ipsilateraler Frakturen des Femurschaftes und des proximalen Femurs mit dem langen proximalen Femurnagel (PFN-long).

AIM: The paper retrospectively evaluates a set of patients with ipsilateral fractures of the proximal femur and shaft treated with PFN-long. MATERIAL: 19 patients (14 males and 5 females), aged 48 in average, were treated from 1998-2003. The fractures included 2 types: combined intraarticular femoral neck and shaft fractures: 8 cases, and 11 cases of complex extraarticular proximal femoral fractures and its shaft. RESULTS: A total of 17 patients followed up for at least 12 months was evaluated according to the Sanders and Regazzoni scoring scale. Bone union resulted in all patients. This was accomplished within 6 months in 10 patients (59 %), 9 months in 16 patients (94 %), and one patient healed within 12 months. Excellent results were achieved in 59 %, good results in 35 % and a satisfactory result in 6 %. We have recorded 3 cases of postoperative complications (16 %). These complications were all due to imperfect reduction. Early complications included a wound haematoma with necessary operative revision. Late complications, such as delayed healing, were resolved by reoperation in 1 case. CONCLUSION: Long PFN is a quality implant which extends our options in the treatment of ipsilateral hip and femoral shaft fractures. It is one of the most beneficial implants in the category of reconstruction nails. The availability of only 3 nail lengths and 1 diameter presents a certain drawback.

[Marfan's syndrome--application of revised criteria and differential diagnosis in clinical practice]. / Marfanuv syndrom--aplikace revidovaných kritérií a diferenciální diagnostika v klinické praxi.

PURPOSE OF THE STUDY: To design a system of diagnostic criteria that would allow us to differentiate benign articular hyperelasticity from Marfan's or Ehlers-Danlos syndromes and, on the basis of clinical, anthropometric, radiological, biochemical and densitometric findings, their specificity and statistical significance, to draw definitive conclusions for clinical practice. MATERIAL: A total of 240 patients who presented with the diagnosis of one of connective tissue disorders were included. They all were examined and, in 182 of them, the findings were completed to meet the criteria required by differential diagnosis. METHODS: Revised criteria were used for Marfan's syndrome (MFS), Ehlers-Danlos syndrome (EDS), osteogenesis imperfecta (OI), juvenile idiopathic osteoporosis (JIO), cutis laxa (CL) or benign articular hyperelasticity (BAH). All patients provided their medical histories, and underwent clinical, radiological, anthropometric, echocardiographic and biochemical examinations, including that for markers of bone formation and resorption. The anteroposterior bulb length was assessed by ultrasonography; densitomery was performed and vital capacity was measured. All data obtained were processed by computer software and the definitive diagnosis was established. RESULTS: Out of 82 patients initially diagnosed with MFS, only 43 (52.4%) met the revised criteria; of the 53 EDS patients initially, 30 (56.6%) met the revised criteria. Four patients who had been referred to us with MFS were found to meet the criteria for EDS (two) and OI (two). Out of 35 patients with OI, 22 (62.8%) met the diagnostic criteria. All 24 patients with BAH were confirmed to have this diagnosis. On the basis of the revised criteria, none of the patients was diagnosed as having JIO or CL. DISCUSSION: The authors compare their results of decreased levels of procollagen I, the occurrence of scoliosis or acetabular protrusion and reduced vital capacity with the relevant reports in the literature. CONCLUSIONS: The specific criteria for Marfan's syndrome include lens dislocation or an anteroposterior bulb axis longer than 24 mm, ascending aortic dilatation, greater body height and the ratio of lower extremities to the body and that of arm-span to height higher than 1.05. However, some criteria, such as the metacarpal-phalangeal index, are not characteristic of Marfan's syndrome only and, therefore, cannot be regarded as a major diagnostic feature of this disorder.

[Treatment of acetabular fractures]. / Lécení zlomenin acetabula.

The authors present an account of 85 patients with fractures of the acetabulum treated at the Orthopaedic Clinic, Faculty Hospital Plzen in 1985-1991. The fractures are classified according to Lettournel-Judet. The authors investigated associated injuries which prolong the interval between injury and operation as well as the correlation between the mechanism of injury and the patient's age and the incidence of injuries in different months of the year. For indication for operation the quality of reposition evaluated by computed tomography is essential. The authors analyze the length of the interval between injury and operation, administration of antibiotics and anticoagulants. As to early complications, they pay attention in particular to bronchopneumonia, infection and thromboembolic disease. The paper deals also with the most serious late complication--avascular necrosis--and the authors discuss the causes of its development as well as possibilities to influence it. The paper presents also results evaluating patients as regards their return to work, subjective evaluation of gait, pain of the joints and satisfaction with treatment. The case-history is followed by discussion concerned with the importance of computed tomography, the surgical approach, importance of treatment of the sacroiliac complex, the development of heterotopic and ectopic ossifications and the essential time of relief of the operated joint. In the conclusion the authors summarize the basic principles of fractures of the acetabulum.

[Nonspecific spondylodiscitis in childhood. New findings about the disease]. / Nespecifická spondylodiscitis v detském veku. Nekteré nové poznatky o onemocnení.

Nonspecific spondylodiscitis at the child age represents a distinctive disease of intervertebral disc and adjacent subchondral parts of vertebral bodies. Their early diagnostics may be difficult due to latency of radiographic manifestation of the finding and possible mistaking for other pathological conditions, especially tuberculosis spondylitis. The paper demonstrates several cases of the disease which we encountered recently. The authors discuss clinical and X-ray symptoms of the disease with a particular attention to modern methods of visualization, especially computer tomography. Etiopathogenesis of the disease is analyzed and some new knowledge of the disease is presented, differential diagnosis is discussed. In the conclusion attention is paid to early diagnosis of the disease and introduction of proper therapy.

[Unusual complications of anticoagulation therapy]. / Neobvyklé komplikace antikoagulacní lécby.

In the introduction to the work the authors deal with the problems of the prevention of flebotromboses in patients operated on in the area of proximal part of the femur. They analyze ways of physical and pharmacological prevention and point out the potential undesirable effects and unusual complications in the treatment by means of Heparin and Kumarin derivatives--and namely the toxoallergic reaction to Heparin and the necrosis of skin and subcutis in case of the application of Kumarin drugs. In Kumarin necrosis the etiology of the which has not been, unequivocally elucidated, yet, they present views on the causes of its origin and describe the course of the Kumarin necrosis. They summarize predispositional factors which increase the risk of its occurrence and present their own observations of two cases. In the discussion they deal with the views on the etiology of the origin of this complication. In the conclusion they recommend the treatment in compliance with the latest findings.

[The Immunoskintest]. / Imunoskintest.

To evaluate the surgical risk before serious operations it is possible to use as one of the criteria a skin test the principle of which is an immunity reaction to a defined antigen injected strictly intradermally. It helps us to assess simply the state of immunological reactivity of the cellular type in a large number of persons of different age and thus to estimate to a certain extent the incidence of postoperative infectious complications. In a selected group of 68 patients who were hospitalized at the Orthopaedic Clinic in Plzen in 1987 the Immunoskintest was performed. The authors compare the incidence of infectious complications in different groups by the character of the disease, i.e. in a) planned operations in coxarthritis, b) in patients with injuries of the proximal part of the femur immediately after injury, c) in patients with injuries of the proximal part of the femur treated conservatively. The incidence of infectious complications is evaluated in conjunction with the results of the Immunoskintest.