RESUMEN

PURPOSE OF THE STUDY The method of stabilising the osteoporosis-related spinal fractures using an expandable stent (vertebral body stent - VBS) and bone cement is generally accepted for its minimal invasiveness, a low risk of complications and confirmed analgesic effect. The efficiency of reduction of a compressed vertebra is, however, still discussed in the literature. Our hypothesis was that the stent expansion in the vertebral body can achieve a statistically significant reduction in the anterior, middle and posterior part of the vertebra. MATERIAL AND METHODS The patients in whom the VBS technique was used to treat an osteoporosis-related fracture of Th/L spine in the period 2010-2014 were included in the study, namely 29 patients with 31treated fractures. The following radiographic parameters were monitored - anterior, middle and posterior vertebral body height, kyphotic angle between the upper and lower endplates of the vertebral body. Also, the radiation burden, painfulness according to VAS score and occurrence of complications were monitored. The minimum follow-up was 12 months. RESULTS The mean height of the anterior part of the vertebral body before the surgery, on the 1st postoperative day and at 6 weeks, 3 months, 6 months and 12 months was 23.5/25.4/23.9/23.6/23.6 mm respectively. The mean height of the middle part of the vertebral body at the same intervals was 17.9/24.0/23.4/22.9/22.9/22.9 mm. The mean height of the posterior part of the vertebral body was 29.6/29.8/29.4/29.3/29.2/29.2 mm. The kyphotic angle between the endplates of the vertebral body was 8.6/5.3/7.4/7.9/8.0/8.0°. The mean VAS values were 8.2/2.4/2.0/1.9/1.8/1.7. The mean duration of surgery was 54.3 minutes. The mean time of fluoroscopy was 33.4 s. The mean radiation dose was 443.1 cGycm2. The observed complications comprised 2 cases of dilatation balloon rupture, one case of a failure to expand the stents in a healed fracture due to incorrect indication. In total, four cases of cement leakage outside the vertebral body were reported, always with no clinical response. DISCUSSION All the authors agree that the method brings immediate analgesic effect, comparable to kyphoplasty or vertebroplasty. In our cohort, good reduction ability of the implant in the middle part of the vertebral body was confirmed. This has been confirmed also by other authors. Nonetheless, at a longer time interval the loss of correction was observed, which was reported only by Hartmann (5). The other authors mostly did not take into account the longer-term outcomes. CONCLUSIONS The hypothesis that the stent is capable of a statistically significant reduction in the anterior, middle and posterior portion of the vertebral body was only partially confirmed. A statistically significant reduction was seen only in the middle portion of the vertebral body. In the anterior portion of the vertebral body the reduction was demonstrable only immediately after the surgery, while the later follow-up checks revealed the loss of correction. The statistically significant improvement of the kyphotic angle between the endplates of the injured vertebra was also seen only on the first postoperative radiographs and at later follow-up checks the improvement was no more significant. The change in the height of the posterior portion of the vertebral body was not statistically significant at any of the follow-up intervals. Key words:osteoporosis, vertebral fracture, vertebral body augmentation, stentoplasty, vertebral body stent.

Asunto(s)

Fracturas por Compresión , Osteoporosis , Fracturas de la Columna Vertebral , Cementos para Huesos , Humanos , Vértebras Lumbares , Fracturas de la Columna Vertebral/cirugía , Stents , Vértebras Torácicas , Resultado del Tratamiento

RESUMEN

PURPOSE OF THE STUDY Closed reduction and percutaneous fixation of nondisplaced talar neck fractures have been applied by some authors. The aim of this paper is to assess the results and complications of this minimally invasive technique. MATERIAL AND METHODS In the period from 2009 to 2014, twenty-one patients with a talar neck fracture were observed after closed reduction and percutaneous screw fixation in the Traumatological Hospital in Brno. The mean age of the patients was 38 years (range 18-56 years). The mechanism of injury was a motor vehicle accident in 11 cases, a fall from height in six cases, a sports injury in 3 cases, and a fall from stairs in one case. Injuries were classified according to the Hawkins classification. Conventional preoperative 3-dimensional CT scans of the fractures were analysed. Under the guidance of C-arm fluoroscopy, Kirscher wires were used for closed reduction and temporary percutaneous fixation. Subsequently, 3.5 and 4.5 mm diameter cannulated screws were inserted. The outcome was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. RESULTS The average follow-up was 32 months (21-42 months). The average healing time was 15.5 weeks (13-19 weeks). The average AOFAS score was 82.3 points (69-96 points). 75% of patients with type I injury achieved excellent results and 72% of patients with type II injury achieved excellent or good results. None of the patients developed wound complications. Two patients developed partial avascular necrosis and three patients subtalar traumatic arthritis after surgery. DISCUSSION Talar neck fractures are relatively uncommon fractures. Most of the published studies are small. Tenuous blood supply and displaced talar neck fracture predispose to avascular necrosis of the talus. Closed reduction and percutaneous fixation can reduce the soft tissue damage and disturbance to the blood supply. CONCLUSIONS Preoperative 3D CT scans, early surgery, anatomic articular surface reduction and percutaneous screw fixation increase the fracture healing rate and reduce the incidence of talar avascular necrosis. Key word: talus, closed reduction, percutaneous fixation, screw.

Asunto(s)

Tornillos Óseos , Reducción Cerrada/métodos , Fracturas Óseas/cirugía , Astrágalo/lesiones , Adolescente , Adulto , Reducción Cerrada/efectos adversos , Reducción Cerrada/instrumentación , Fracturas Óseas/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Tomografía Computarizada por Rayos X , Adulto Joven

RESUMEN

PURPOSE OF THE STUDY In the management of dens axis fractures in patients older than 65 years of age the posterior approach is preferred due to osteoporosis and the risk of a failure of anterior osteosynthesis. The posterior approach, however, is associated with a higher incidence of complications. A combination of anterior transarticular fixation of C1/2 (ATS) with compression osteosynthesis of dens axis significantly increases the stability of osteosynthesis. MATERIAL AND METHODS In the period from 2009 to 2015 our hospital admitted 13 patients older than 65 years of age with a diagnosed type III dens axis fracture based on AO classification. 8 patients sustained a dens axis fracture combined with a stable atlas fracture. The cohort consisted of 13 women aged 67 to 90 years, with the mean age of 82.3 years. None of the female patients were affected neurologically. The dens axis fracture was treated by anterior approach. Once the screw was inserted in the dens axis, two more screws were added, the entrance points of those screws were medial and lateral to the odontoid screw and direction was divergently via C1/2 joints in order to reinforce stability. The patients were monitored at 6-week, 3-, 6- and 12-month follow-ups. Bone healing was confirmed by CT scan. RESULTS No complications were recorded during the surgery in any of the 13 patients. In one female patient the stabilization failed in the early postoperative period. A reoperation from anterior approach with the use of the same method was necessary. In eleven patients bone healing occurred after 6 to 12 months. In two patients pseudoarthrosis was formed with no clinical symptoms. No neurological deterioration or a patient s death was reported in the monitored period within 12 months after the treatment. DISCUSSION Where dens axis fractures in elderly patients are managed operatively, the posterior approach and transarticular fixation of C1/2 with sublaminar loop are preferred. This procedure is considered more reliable, owing to the fears of a failure of osteosynthesis by anterior approach. The most frequent cause of a failure is the pulling out of the screw through the anterior wall of dens axis base in patients with osteoporosis. Concurrently, the anterior approach is regarded as more considerate. The ATS fixation increases stability compared to isolated compression osteosynthesis, which makes it possible to manage the dens axis fractures by a more considerate anterior approach. CONCLUSIONS The ATS is a method that increases stability of compression osteosynthesis in managing dens axis in elderly patients. Key words: dens axis, upper cervical spine fracture, elderly, triple screw technique, anterior transarticular C1/2 stabilization.

Asunto(s)

Vértebras Cervicales/cirugía , Fijación Interna de Fracturas/instrumentación , Apófisis Odontoides/lesiones , Fracturas de la Columna Vertebral/cirugía , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Humanos , Resultado del Tratamiento , Cicatrización de Heridas

RESUMEN

PURPOSE OF THE STUDY Patellar dislocation is a fairly frequent knee joint injury in young patients. In most cases, this injury can be treated conservatively or surgically. In many cases, patellar cartilage or lateral femoral condyle or both these parts of articular surface are injured, and in conservative treatment this chondral damage very often remains undiagnosed. The purpose of this study is to evaluate the outcomes of treatment in patients who underwent surgery for patellar dislocation and in whom extensive traumatic cartilage lesions of the patella were found. MATERIAL AND METHODS The authors carry out a retrospective evaluation of outcomes in 34 patients from the period 2005-2014, in whom extensive chondral defect of the posterior side of the patella after its traumatic dislocation with the mean size of 4.1 cm2 (the maximum size was 28x18 mm) was found, namely in 21 women and 13 men aged 13-28 years. The patients were indicated for arthroscopic surgery based on the clinical examination which revealed a clear traumatic patellar dislocation. In 2 radiographs only, an osteochondral fragment was found, and in these patients a CT scan of the injured knee was made. The patients were retrospectively broken down into 3 sub-groups by the method of treatment of the chondral defect. The mean size of the defect in the debridement group was 2.7 cm2 compared to 4.6 cm2 in the group with cartilage fixation. In group I reinsertion through MiniSynthes 2.0 screws (5 patients) was performed, in group II reinsertion of the chondral fragment was done using transosseous PDS sutures (19 patients), in group III debridement of injured cartilage was carried out (10 patients). RESULTS The patients were assessed postoperatively using Kujala score and IKDC score. The mean age of patients at the time of injury was 19.6 years, with mean follow-up of 30.2 months. No group reported limitations of range of motion at the time of evaluation. Knee pain under load was present in 3 patients in group I, in 1 patient in group II and in 7 patients in group III. No patient suffered from another patellar dislocation. The mean Kujala score was 84.7 (group I), 89.3 (group II), and 78.5 (group III). The IKDC was 84.6 in group I, 87.2 in group II, and 74.3 in group III. At the time of evaluation, pre-injury activities were resumed by 72% of patients from group I, 82% of patients from group II, and 69% of patients from group III. DISCUSSION Treatment of primary patellar dislocation is still subject to discussions on whether to pursue conservative or surgical treatment. The main topic of studies is the subsequent rate of patellar re-dislocation and the rate of cartilage damage in patellofemoral joint, examined is also the scope of performed surgery, while only very few papers focus on treating the injured cartilage of the patella. Despite numerous studies, the optimal method of treatment of this injury has been identified as yet. CONCLUSIONS Where a serious, extensive fragment of patellar cartilage is found, the fixation of cartilage with the use of transosseous PDS sutures brings very good and good results, without the necessity of another surgery, while the simultaneous treatment of medial patellar retinacula considerably decreases the risk of patellar re-dislocation, thus reducing the risk of further damage to cartilage of patelofemoral joint. The use of transosseous suture fixation is considered by the authors to be more appropriate than the use of screws, mostly because no further surgery to remove fixation screws is necessary. Key words: acute patellar dislocations, chondral lesions, chondral repair, arthroscopy.

Asunto(s)

Cartílago Articular/lesiones , Cartílago Articular/cirugía , Luxación de la Rótula/cirugía , Adolescente , Adulto , Artroscopía/métodos , Cartílago Articular/diagnóstico por imagen , Femenino , Humanos , Masculino , Luxación de la Rótula/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Técnicas de Sutura , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven

RESUMEN

PURPOSE OF THE STUDY: Total talar extrusion is a rare injury. It is frequently associated with severe soft tissue injury. There is no consensus about an appropriate treatment for an extruded talus. Total extrusion of the talus has a high possibility of avascular necrosis of the talus or infection. The primary goal of this study is a retrospective evaluation of the patients with open total talar dislocation treated by immediate reimplantation. MATERIALS AND METHODS: We evaluated six patients (mean age, 29.6 years) with an open total talar dislocation treated in the Traumatological Hospital Brno. The dislocated talus, after debridement, was reduced, held in the correct position by Kirschner wires and spanned by external fixation, with two pins placed in the calcaneus and two in the distal tibia. The patients were evaluated on the basis of clinical and radiographic examination. Two patients underwent secondary reconstruction procedures. The four remaining patients were evaluated using the AOFAS score. RESULTS: The mean follow-up period was 24.2 months (range, 18-32). Two patients had an infection and one developed avascular necrosis of the talus. One patient required arthrodesis of the subtalar joint and one talectomy with tibiocalcaneal arthrodesis and callus distraction of the tibia. CONCLUSIONS: A primary reimplantation of the talus can produce good functional outcome. It is reasonable to replace an extruded talus as soon as possible after debridement. Infection and avascular necrosis of the talus seem to be difficult to predict.

Asunto(s)

Traumatismos del Tobillo/cirugía , Luxaciones Articulares/cirugía , Astrágalo/lesiones , Adolescente , Adulto , Traumatismos del Tobillo/diagnóstico por imagen , Desbridamiento/métodos , Fijadores Externos , Estudios de Seguimiento , Humanos , Luxaciones Articulares/diagnóstico por imagen , Radiografía , Infección de la Herida Quirúrgica/etiología , Astrágalo/diagnóstico por imagen , Adulto Joven

RESUMEN

PURPOSE OF THE STUDY: Frozen tibial shaft bone allografts filled with autologous cancellous bone chips were used for anterior column reconstruction in Th12 and L1 fractures. The aim of this retrospective study was to evaluate the five-year results of the treatment on the basis of radiographic findings. MATERIAL AND METHODS: Twenty-six patients treated in 2005 and 2006 for isolated Th12 or L1 fractures, with no neurological deficit, were evaluated. In all patients, the spine was stabilised from an isolated anterior approach or through a combined posterior and anterior approach, and angle-stable implants were used. On radiographic examination the loss of correction and lateral compression of the segment involved were measured on standard X-ray views. Data on bone union at graft-bone interfaces were obtained from spiral CT scans. For assessment of the stage of bone healing, a scale of 0-25-50-75-100 % was established, and each patient was evaluated by two independent radiologists. Based on the average results, bone union was defined as non-union, 0-24 %; incomplete union, 25-74 %; complete union, 75-100 %. RESULTS: The average loss of correction measured by Beck's method was 0.77 degree. In four patients, the lateral compression angle deteriorated on the average by 1.1 degree (range, 0.7°-1.8°) during the treatment. The proximal graft-bone interface showed complete union in 19 patients (73 %), and the distal interface was completely healed in 20 patients (77 %). Incomplete bone union at the proximal and the distal interface was found in seven (27 %) and six (23 %) patients, respectively. Nonunion was not recorded. No complications occurred. CONCLUSIONS: The use of tibial shaft bone allografts filled with autologous cancellous bone chips resulted in stable reconstruction of the anterior column of the thoracolumbar spine which showed a low loss of correction and good bone union.

Asunto(s)

Trasplante Óseo/métodos , Vértebras Lumbares , Fracturas de la Columna Vertebral , Vértebras Torácicas , Cirugía Asistida por Video/métodos , Aloinjertos , República Checa , Femenino , Curación de Fractura , Humanos , Cuidados Intraoperatorios , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Periodo Posoperatorio , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Tibia/trasplante , Tomografía Computarizada Espiral/métodos , Trasplante Homólogo/métodos

RESUMEN

PURPOSE OF THE STUDY: To compare the anchorage strength of Socon CS cannulated pedicle screws (B. Braun, Aesculap) with that of Socon screws in human cadaver vertebrae, using pull-out strength testing. MATERIAL: Twelve samples involving T12 to L3 vertebrae were prepared and a total of 20 pedicle screws, 10 Socon CS and 10 Socon screws, were inserted in them. All screws were 55 mm in length and 6 mm in diameter. After placement, Socon CS pedicle screws were augmented with bone cement (Cimplant cement application kit, B. Braun, Aesculap). METHODS: Both Socon CS and Socon screws were subjected to monotonous loading in the testing device ZWICK Z 020-TND with tensile stress applied in the screw axis. We evaluated the magnitude of strength resulting in screw loosening and the relationship between this strength and bone density of the sample. RESULTS: Bone density of measured samples corresponded either to osteopenia, i.e. T-score range of -1 to -2.5 SD (standard deviation) or osteoporosis, i.e. T-score -2.5 SD. The average bone density of all samples corresponded to a T-score of -3.1 SD. Bone-screw linkage was found to be associated with both bone-cement and screw-cement interface. Pull-out strength was significantly higher for the Socon CS than the Socon screws (t-test, p<0.0005). In the Socon screws, the linear correlation between pull-out strength and bone density was significant at a 5% level of statistical significance (p=0.008) while, in the Socon CS screws, it was not significant (p=0.065). DISCUSSION: The poor quality of osteoporotic bone is responsible for a higher frequency of implant failure due to loosening, particularly when implants developed for healthy bone are used. In this biomechanical study, we tested one of the possibilities of how to reduce the risk of implant failure by pedicle screw augmentation with bone cement. CONCLUSIONS: The results of this study confirm the hypothesis that the anchorage of Socon CS cannulated pedicle screws with bone cement augmentation is disrupted by significantly higher pull-out strength than that of Socon screws, when subjected to monotonous loading. However, more clinical studies are needed to evaluate clinical outcomes.

Asunto(s)

Tornillos Óseos , Vértebras Lumbares/lesiones , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Densidad Ósea , Cadáver , Humanos , Técnicas In Vitro , Vértebras Lumbares/fisiopatología , Vértebras Lumbares/cirugía , Fracturas Osteoporóticas/fisiopatología , Fracturas de la Columna Vertebral/fisiopatología , Vértebras Torácicas/fisiopatología , Vértebras Torácicas/cirugía

RESUMEN

PURPOSE OF THE STUDY: Both the range of motion and load transfer of the sacroiliac (SI) joint improve considerably after lumbar spine surgery. When, following surgery, SI joint pain develops in spite of appropriate physical therapy, injection of an anaesthetic with added corticosteroid into the SI joint is a first choice treatment. The aim of this presentation is to provide information on our experience with this therapy. MATERIAL AND METHODS: Thirty-four patients after lumbar spine fusion reported lumbalgia different form pain before surgery. In 14 (41%) of them, pain in one of the SI joints was diagnosed as the cause. This group included 12 women and two men at an average age of 56 (range, 47 to 68) years. Ten patients underwent lumbosacral fixation and four had segmental ("floating") lumbar spine fusion. All patients experienced lumbalgia at more than 3 months following surgery, at 8 months on the average (range, 4 to 12 months). None of them had SI joint pain before surgery. The diagnosis was based on specific manoeuvres on physical examination of the joint. Each patient was given an injection of 20 mg (0.5 ml) Methylprednisolone (Depo-Medrol®, Pfizer, Puurs, Belgium) and 4.5 ml 1% Mesocain (Zentiva, Praha, CR).They were inquired as to pain relief 24 h later and then at 1, 3 and 6 months after injection. Subjective feelings were assessed by a visual analogue scale (VAS). The results were analysed using descriptive statistics. RESULTS: All patients reported pain relief within 24 h of injection, but not its complete resolution. The average VAS score before and after the blockage of the SI joint was 9.1 points (8-10) and 4.8 points (2-7), respectively; this implies improvement by an average of 4.3 points (1-6), i.e., approximately by 47.3% (12.5-62.5). The duration of effects varied greatly from patient to patient. The average interval between injection and pain recurrence lasted for 5 weeks (1-28). Most frequently, relief was experienced for 2 weeks, or for 6.8 weeks with the standard deviation included. DISCUSSION Sacroiliac joint dysfunction is a very frequent cause of lumbalgia, particularly after lumbar spine surgery. Physical therapy may not always be effective. SI joint arthrodesis is indicated only in rare cases. One of the few possibilities of pain relief involves intra-articular injection of an anaesthetic with corticosteroid for booster effect. The treatment of SI joint blockage after spinal fusion has recently been dealt with in three reports in the international literature; their conclusions are in accordance with the results of this study. CONCLUSIONS: Lumbar spine stabilisation surgery may result in overloading the SI joints as the "adjacent segments". An intra-articular injection of anaesthetic can be considered a reliable method for ascertaining the SI joint as the source of a patient's problems. However, even with corticosteroid added, pain relief is not usually long-lasting.

Asunto(s)

Anestésicos Locales/administración & dosificación , Dolor de la Región Lumbar/terapia , Vértebras Lumbares/cirugía , Metilprednisolona/análogos & derivados , Fusión Vertebral , Trimecaína/administración & dosificación , Anciano , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Metilprednisolona/administración & dosificación , Acetato de Metilprednisolona , Persona de Mediana Edad , Dimensión del Dolor , Articulación Sacroiliaca

RESUMEN

We describe the case of an 80-year-old female patient who had undergone anterior C1-C2 transarticular stabilisation and was subsequently treated by the triple-screw method for failed compression osteosynthesis of a AO type III dens axis fracture. Key words: dens axis, upper cervical spine fracture, eldery, triple screw technique, anterior transarticular C1-C2 stabilisation.

Asunto(s)

Vértebras Cervicales/cirugía , Fijación Interna de Fracturas , Apófisis Odontoides/lesiones , Fracturas de la Columna Vertebral/cirugía , Accidentes por Caídas , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Humanos , Apófisis Odontoides/cirugía , Insuficiencia del Tratamiento

RESUMEN

PURPOSE OF THE STUDY: The aim of the study is to remind the medical community of the occurrence of rare dorsal glenohumeral dislocations and of the need to pay increased attention to radiographic and clinical examination in the patients in whom signs of this injury are also supported by medical history. When this dislocation becomes a chronic disorder, it can frequently be managed only by surgical intervention. The treatment algorithm used at the authors' institutions is described. MATERIAL: In the period from 2000 to 2008, a total of l7 patients (9 women and 8 men) with an average age of 65.5 years (51 to 89 years) had surgery for inveterated dorsal glenohumeral dislocation. The average injury-surgery interval was 5.6 weeks (1 to 18 weeks). The average follow-up was 38 months (101 to 13 months). METHODS: Surgery was performed via an anterior deltoideopectoral approach. Under pathological conditions, the subscapular muscle was identified. When a large reverse Hill-Sachs defect was present, the lesser tuberosity with the subscapular tendon was osteomited (10 patients). After scar and granulation tissue had been removed, the humeral head was reduced. Using Neer's modification of the McLaughlin procedure, the excised lesser tuberosity fragment was transferred into the antero-medial defect in the humeral head and fastened with a screw. In the case of an unstable humeral head, this was held in the reduced position by two Kirschner wires either passed through the acromion or fixed to the glenoid (11 patients). The arm was immobilized in a brace for four weeks. Then the wires were removed and rehabilitation was started with avoidance of internal rotation. RESULTS: None of the patients had recurrent dislocation. All were satisfied with the outcome and capable of resuming their daily activities sufficiently. Six patients complained of occasional pain. The average value of active elevation was 113° (40° to 160°). Reduced muscle strength in abduction, as compared with the contralateral arm, was observed in two patients. Injury to the axillary vein was recorded in one patient. Two patients had a large haematoma of the arm with swelling of the whole extremity. Two of the 11 patients treated with Kirschner wires developed infection around the wires that healed after their removal at four weeks after surgery. DISCUSSION The open reduction and stabilization of a posterior inveterated glenohumeral dislocation can be regarded as a rare procedure performed only occasionally even in specialized institutions. The international literature also provides information on only a few tens of such cases over a number of years. Causal procedures, performed through both an anterior and posterior approach, as well as extrafocal (rotational) osteotomy have been recommended. Currently, surgery from an anterior approach is preferred, because a reverse Hill-Sachs defect, if present, can be managed either by transfer of the lesser tuberosity with the subscapular tendon or by massive allograft. CONCLUSIONS The authors' experience suggests that Neer's modification of the McLaughlin procedure is the optimal treatment for posterior inveterated glenohumeral dislocation with an anteromedial defect of the humeral head. The excision of the lesser tuberosity with the subscapular tendon provides good access to the shoulder joint and thus allows for its reliable reduction. The fastening of a tuberosity fragment into the compression defect resolves one of the major risks for recurrent dislocation, without necessity to use allogenic material. Transfixation of the humeral head with Kirschner wires for four weeks is a reliable method of holding the head in the glenoid without risk of significantly restricting shoulder motion in the future.

Asunto(s)

Luxación del Hombro/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Luxación del Hombro/diagnóstico

RESUMEN

PURPOSE OF THE STUDY: A retrospective analysis of patients with thoracolumbar junction fractures who underwent video-assisted thoracoscopic surgery via a minimally invasive approach (minithoracotomy) for reconstruction of the anterior spinal column. MATERIAL: Between 2002 and 2006, a total of 127 patients were treated by this technique. The age of the group, including 75 men and 52 women, ranged from 18 to 75 years (average, 45.9 years). L1 and Th12 fractures were treated in 71 and 66 patients, respectively. Based on CT scans and operative findings, the fractures were assessed as type A in 81, type B in 42 and type C in four patients. The causes of injury were a fall from height in 72, a pedestrian's fall in 29, a traffic accident in 23 and other in three patients. On admission 19 patients had a neurological deficit of varying degree: Frankel grade A, eight patients; grade B, four; grade C, five; and grade D, two patients. METHODS: The patients were treated by either posterior stabilization and, at the second stage, the minimally invasive technique via an anterior approach, or the minimally invasive anterior procedure alone. Transpedicular posterior stabilization was performed in 52 patients. All of them had an anterior procedure completed with screw-rod-screw stabilization, and the vertebral body was replaced with an allograft or an expandable titanium cage in 50 and two patients, respectively. The anterior approach alone was used in 75 patients, who received a bisegmental angle-stable implant in 43 and a monosegmental plate in 32 cases. To replace the vertebral body, allografts were used in 71 and an expandable titanium cage in four patients. RESULTS: The average follow-up period was 3.9 years (range, 1 to 6 years). In the anterior procedure, the average operative time was 90 min (range, 50 to 130 min) and blood loss ranged from 200 ml to 2300 ml. A complication due to deep infection occurred in one patient and required removal of both the anterior and posterior implants. Bony fusion without complications was achieved in all patients within a year of surgery. The loss of correction after the anterior procedure with an allograft or titanium cage was up to 2 degrees at 1-year follow-up. No conversion of the minimally invasive technique to a conventional approach due to visceral or vascular injury was necessary; nor was revision surgery for fluidothorax needed. No loosening of an anterior implant or cage dislocation was recorded. Hypesthesia in the operative wound area was found in four patients (3.1%). Improvement in neurological status by at least one Frankel grade was found in 10 of the 19 affected patients. DISCUSSION: The anterior approach is recommended for reconstruction of the anterior spinal column in burst fractures of the thoracolumbar junction in particular. An isolated posterior approach may result in implant failure during bony union or in the loss of correction after implant removal that can lead to the recurrence of kyphosis. Conventional thoracotomy is often associated with significant morbidity and hence there is a need for a minimally invasive approach to treat thoracolumbar junction injury. CONCLUSIONS: The minimally invasive approach (minithoracotomy up to 6-7 cm) combined with thoracoscopy is an alternative to an exclusively endoscopic technique enabling us to provide safe surgical treatment of the anterior spinal column.

Asunto(s)

Vértebras Lumbares/lesiones , Fracturas de la Columna Vertebral/cirugía , Cirugía Torácica Asistida por Video , Vértebras Torácicas/lesiones , Adolescente , Adulto , Anciano , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Cirugía Torácica Asistida por Video/métodos , Vértebras Torácicas/cirugía , Adulto Joven

RESUMEN

The aim of this restrospective study was to compare treatment outcomes of C2 dens fractures following their conservative or surgical management, using direct osteosynthesis with canalised screws and the Dens Access device. During 1999-2006, 108 patients with type II and type III dens injuries, based on the Anderson-D'Alonzo classification, were treated in the Brno Traumatology Hospital (Urazová nemocnice Brno). Patients with type I injuries were excluded from the study. The study included 32 patients, who presented for a chek-up. Out of the total, 15 patients had undergone surgery, 17 had been managed conservatively. The mean age was 56 years (17-83 y.o.a.), 19 subjects were males and 13 subjects were females. The conservative treatment included the following methods: treatment with a Philadelphia collar (4 subjects) or a halo apparatus (13 subjects). Only patients, in whom at least a year elapsed since their injury, were included in the study. The control group showed inferior results on ROM (range of motion), VAS (Visual analogue scale) and x-ray examinations. Overall, in the conservative group, 3 subjects showed restricted cervical range of motion, compared to a single subject in the operated group. The mean VAS was 3.6 (0-7) in the conservative group, compared to the mean VAS of 2.9 (0-6) in the operated group. No fragment displacements or development of a pseudojoint was recorded in the operated subjects. In the conservative group, fragment displacement was observed in 2 subjects. In the both subjects, the bone healed. The Fisher's exact test and the Mann-Whitney U-test were used for statistical analysis of the data.

Asunto(s)

Vértebras Cervicales/lesiones , Apófisis Odontoides/lesiones , Fracturas de la Columna Vertebral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/diagnóstico por imagen , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Apófisis Odontoides/diagnóstico por imagen , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven

RESUMEN

BACKGROUND: The merits of different operative approaches in the management of spinal injury is debated. The aim of this study was to assess, retrospectively, the outcome of treatment of injuries of the lower cervical spine by an anterior approach, in terms of fusion rate and complications. MATERIALS AND METHODS: Between 1995 and 2004, 270 patients with an injury of the lower cervical spine were operated on by an anterior approach in our hospital. There were 67 females and 203 males. Using the Aebi and Nazarian classification, 22% of patients had a type A injury, 23% of patients had a type B injury and 55% of patients had a type C injury. All had an anterior approach with monocortical stabilisation using a cervical spine locking plate [Synthes]. RESULTS: Radiological evidence of fusion was found in all but one patient at 6 months. Complications occurred in a small proportion of the series. Recurrent laryngeal nerve injury was noted in seven patients, an abscess in the wound in one patient, a haematoma requiring re-operation for evacuation in two patients. The cervical locking plate broke in one patient and this patient went on to develop a pseudoarthrosis from failure to fuse. In another patient there was release of the plate osteosynthesis. CONCLUSIONS: Treatment of the injured lower cervical spine by an anterior operation and plate fixation was successful in achieving bone fusion in almost every patient and was followed by a complication in only a small proportion of our series. Similar results in other reports indicate that this approach is a safe and effective procedure.

Asunto(s)

Vértebras Cervicales/lesiones , Vértebras Cervicales/cirugía , Complicaciones Intraoperatorias/etiología , Complicaciones Posoperatorias/etiología , Fusión Vertebral/efectos adversos , Traumatismos Vertebrales/cirugía , Anciano , Anciano de 80 o más Años , Placas Óseas/efectos adversos , Placas Óseas/normas , Vértebras Cervicales/patología , Estudios de Cohortes , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/instrumentación , Descompresión Quirúrgica/métodos , Falla de Equipo/estadística & datos numéricos , Femenino , Humanos , Complicaciones Intraoperatorias/patología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/prevención & control , Prótesis e Implantes/efectos adversos , Prótesis e Implantes/normas , Radiografía , Estudios Retrospectivos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Traumatismos Vertebrales/diagnóstico por imagen , Traumatismos Vertebrales/patología , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Insuficiencia del Tratamiento , Parálisis de los Pliegues Vocales/epidemiología , Parálisis de los Pliegues Vocales/prevención & control

RESUMEN

Covering soft-tissue injuries on the lower third of the leg, ankle joint and on the calcaneal part of the foot has so far been the domain for free flap use. The distally based superficial sural artery flap with vascular axis of the sural nerve was first described by Masquelet. We treated 31 patients after injuries with this method. No flap failed. Necrosis of the edges affected three flaps. Most flaps showed slight venous congestion. The authors present their clinical experience using this technique. The advantages are the following: the blood supply is reliable, elevation is easy and quick and major arteries are not sacrified.

Asunto(s)

Traumatismos de la Pierna/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Adolescente , Adulto , Traumatismos del Tobillo/cirugía , Femenino , Traumatismos de los Pies/cirugía , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos/irrigación sanguínea

RESUMEN

AIM OF THE STUDY: Retrospective assessment of a patient group, including patients with osteoporotic thoracolumbal fractures. Only patients over 65 years of age were included in the study. METHODS: During IX/2005 VII/2006, 45 patients with osteoporotic fractures were managed: 28 females, 17 males aged 65-85 y.o.a, their mean age was 72.6 y.o.a. The mechanisms of the injury included falls in 39 subjects, car- motocycle accidents in 5 subjects, a submerge accident in a single subject. Three patients sufferred from neurological symptoms. TI-TI0 injury was diagnosed in 8 subjects, T11-L2 in 43 subjects, L3-L5 in 5 subjects. Type A injuries prevailed--in 47 subjects, type B injury were diagnosed in 4 subjects, type C in 2 subjects. Conservative therapy was indicated in 25 subjects; transpedicular stabilization in 15 subjects, stabilization using isolated anterior approach in one patient, vertebroplasty in 5 patients. The majority of the injuries were monotraumas--31 subjects, associated traumas in 12 subjects, polytraumas in 2 subjects. RESULTS: The authors assessed data collected from 25 patients. 6 patients exited, 14 failed to turn up for their follow up examination at 12 months. GDW (Grunddeckplattenwinkel), VAS (Visual Analog Scale) and Oswestry score and complication rates were assessed. Prior to the therapy, the mean VAS score in the conservative group, surgical management and vertebroplasty groups was 7.0: 8.2 and 7.9, respectively; at 12 months the score was reduced to 3.8; 3.4 and 3.7, respectively. The Oswestry score figures in the respective treatment groups were 25.3%, 27.1% and 23.5%. There were no statistically significant differencies between the results. At the time of the injury, the mean GDW in the conservative group was -2 degrees, at 12 months -6 degrees. Prior to vertebroplasty it was +4 degrees, following the procedure +6 degrees, and at 12 months +2 degrees. Prior to surgical stabilization it was -10 degrees, postoperatively +3 degrees and at 12 months 0 degrees. An early infectious complication, a wound absces, was recorded in one patient. A late complication, implant failure, was recorded in the same patient at 6 months postoperatively. CONCLUSION: Treatment of osteoporotic thoracolumbal spinal fractures requires individual thorough assessment of therapeutical options.

Asunto(s)

Vértebras Lumbares/lesiones , Osteoporosis/complicaciones , Fracturas de la Columna Vertebral/terapia , Vértebras Torácicas/lesiones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Osteoporosis/terapia , Fracturas de la Columna Vertebral/complicaciones

RESUMEN

PURPOSE OF THE STUDY: In this retrospective evaluation the authors present the group of patients with intraarticular calcaneal fractures that were treated from an extended lateral approach. MATERIAL: In the period from 2001 to 2003, 32 patients with intra-articular calcaneal fractures were treated by osteosynthesis, using a plate, from the extended lateral approach. All patients were men at an average age of 41.7 years (range, 20 to 63 years). The most frequent cause of injury was a fall from height. A combined injury was recorded in eight patients. The right calcaneus was broken in 11 and the left one in 21 patients. Patients with bilateral calcaneal fractures were not included in the evaluation. METHODS: Preoperative X-ray and CT examinations of the fractured calcaneus were carried out in all patients. The Sanders classification of calcaneal fractures was used for fracture evaluation. All patients were treated from the extended lateral approach by osteosynthesis with the use of a plate. Spongioplasty using an autologous graft from the iliac crest or an allogenous graft was carried out in 21 and 11 patients, respectively. The patients were operated on within an average of 7.3 days of admission (1 to 16 days), and were followed up for at least one year (average, 30 months) after surgery. Postoperative evaluation was based on radiographs and the results of the Kerr rating system obtained from questionnaires. RESULTS: The outcomes were excellent, 36 %; very good, 44 %; good, 17 %; and poor, 3 %. The Böhler angle postoperatively assessed on radiographs was on average + 28.5 degrees. All patients showed bone union, and no pseudoarthrosis was recorded. One patient had to be treated for a late purulent complication requiring metal removal. One patient underwent early wound revision due to postoperative hematoma. The metal was removed on average at 13 months postoperatively (range, 2.5 to 26 months). DISCUSSION: The treatment of intra-articular calcaneal fractures is determined by the type of injury, state of soft issues in the limb injured, patient's status and surgeon's experience. CONCLUSIONS: Our results as well as literature data show that exact reduction of the posterior subtalar joint with internal osteosynthesis can achieve good clinical outcomes in patients with intraarticular calcaneal fractures, particularly when the fractures are classified as Sanders II and III types.

Asunto(s)

Calcáneo/lesiones , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Adulto , Articulación del Tobillo/patología , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Radiografía

RESUMEN

AIM: The authors introduce a group of patients with thoracolumbar spinal fractures, following their combined management. The aim of this work is to retrospectively assess the allograft bone reconstruction and loss of spinal axis correction rate in the fused segments, following extraction of the posterior instrumentation. MATERIAL: During the period from 2002 to 2005, the authors managed 71 patients with spinal fractures in Th 11-12 segments, using the combined procedure, excluding anterior fixation, in the Traumatology Clinic of LF MU Brno. The study group included 37 patients, at least 6 months after extraction of the posterior stabilizator. The patient group included 12 females and 25 males, aged between 17 to 62 years. The mean age was 29.7 years. METHODS: The patients were managed with transpedicular stabilization method as the first step and with anterior monosegmental spondylodesis using coticospongious allografts, excluding futher use of metal implants, as the second step. Assessment of the bone reconstruction and incorporation of the allograft at the anterior spondylodesis site, was based on x-ray and CT examinations. Loss of correction in the fused segment was assessed based on measurement of GDW angles (Grund-Deckplattenwinkel) on x-rays following extraction of the implant. The findings were compared to those following stabilization. Upon CT examination, bone structure of the implanted allograft and its reconstruction and incorporation between the two vertebrae, was assessed. Furthermore, the concerned bone density was measured. RESULTS: Out of our patient group, no loss of correction was detected in five subjects, only. In 32 subjects, the correction loss ranged from 1 degrees up to 34 degrees. The mean was 7.08 degrees. Based on the CT examination, partial resorption of the graft edge occured in all subjects, in 32 subjects the allograft was fragmented, particullarly in its central part, with densities ranging from 122 HU to 246 HU, the mean of 158 HU. The graft's outline was partially undetectable in 20 subjects. Outer hypodense zone surrounding the allograft was detected in all subjects. DISCUSSION: Injured discs next to the injured vertebra undergo degeneration and, later on, collaps, which results in the correction loss. Therefore, fusion of the segments is an essential part of stabilization procedures. Either posterolateral fusion, inter-intraarticular fusion or anterior intercorporal fusion methods may be applied. The authors concentrate primarily on adequate completion of the anterior fusion, which may prevent a serious secondary complication--posttraumatic kyphosis. However, opinions on management of the anterior segments and anterior spondylodesis, are not uniform. Also, best methods which would result in firm spondylodeses, are currently under discussion. CONCLUSION: The aim of the anterior column therapy is to create anterior spondylodesis firm enough to prevent future onset of a posttraumatic kyphosis. Anterior fusion based on conticospongious allografts without anterior instrumentation may frequently result in kyphotic spinal deformities, due to its partial resorption and fragmentation. Therefore, the authors would not recommend using corticospongious allografts without anterior instrumentation.

Asunto(s)

Trasplante Óseo , Vértebras Lumbares/lesiones , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/lesiones , Adolescente , Adulto , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Vértebras Torácicas/cirugía

RESUMEN

UNLABELLED: Erectile dysfunction is a serious consequence of pelvic injuries. The aim of the study was to review and assess erectile dysfunction rates in mono and polytraumatized males with the pelvic injury, and to highlight the impotence-type of the pelvic injury relation and to evaluate the therapeutic response of the patients. METHODS: In total, 231 mono- or polytraumatized males with the pelvic injury were mailed a private letter including the HEF-5 International Index of Erectile Function questionnaire. The AO classification was used to assess the relation of the pelvic injury type and the onset of the erectile dysfunctin. The c2 test was used to assess the statistical significance. The peroral treatment with the phosphodiesterase 5 (PDE5) inhibitors was the therapeutical method of first choice. The therapeutical effect was assessed using the IIEF 5 questionnaire. RESULTS: We concluded that the erectile dysfunction affects nearly a third (31.5%) of the males who suffered pelvic injuries. The fact, whether the patient suffered an isolated pelvic injury or a pelvic injury in a polytrauma, has no influence on the erectile dysfuntion onset (p = 0.218), however, the onset of impotence has a significant connection to the type of the pelvic injury. We confirmed a statistically significant increase in the erectile dysfuncion rates in patients with the pelvic ring injury type B and C (p = 0.023). The mean IIEF-5 score prior to the treatment initiation was 11.5. In 85% of the patients the peroral treatment of the erectile dysfunctin using the PDES inhibitors was successful and resulted in achievement of the pair sexual satisfaction. The score of the IIEF-5 questionnaire reached physiological values 23 (22-25) following the treatment. Based on the findings, the authors recommend, during their hospitalization, to inform the males who suffered the type B and C pelvic ring injury about a possibility of their sexual dysfunction, and to advise them to contact a sexual disorders specialist.

Asunto(s)

Disfunción Eréctil/etiología , Pelvis/lesiones , Anciano , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones

RESUMEN

PURPOSE OF THE STUDY: The authors present the results of arthroscopic reduction of a displaced fracture of the intercondylar eminence and stabilization of the fracture with a tension band wire and absorbable, double PDS sutures. MATERIAL: In the years 1998 to 2002, a fracture of the intercondylar eminence was arthroscopically diagnosed in 34 patients, 21 women and 13 men in the age range of 17 to 46 years. Five patients had type I fracture, 13 had type II fracture and 16 had type III fracture, as classified by the Meyers and McKeever system. Arthroscopic stabilization was used for all type II and type III fractures in a total of 29 patients. Double PDS sutures no. 1 were always applied. One double PDS loop was used in eight patients and, in the rest, two or three double PDS loops were employed. METHODS: PDS no. 1 sutures were inserted, by means of wire loops, through bone tunnels. These were drilled with 2-mm Kirschner's wires, using an anterior cruciate ligament (ACL) reamer, medial to the tibial tuberosity. Double PDS sutures were applied to the distal portion of the ACL, which permits good stabilization even in comminuted fractures of the eminence. The strength of a double PDS loop is sufficient and facilitates speedy recovery. Before terminating surgery it is necessary to check joint mobility and fixation stability. Only good stability allows for early mobilization of the joint. The postoperative treatment involved immobilization of the knee joint with a rigid brace in a semi-flexed position at 20 degrees for 6 weeks. However, from the second postoperative day, the brace was removed during targeted rehabilitation. Exercise on a continuous passive motion device, strengthening of the thigh muscles, patellar mobilization, walking with the use of crutches, while wearing the brace, with partial weight bearing until pain were practised. A treadmill without loading was used from the fifth postoperative week. RESULTS: Twenty-nine patients in whom stabilization with PDS sutures was used were evaluated. Of them 26 were completely free from any complaints and fully healed, always without findings of displacement on X-ray. In one patient, a fragment of the comminuted fracture was loosened and interfered with full extension. It was removed by arthroscopy and full recovery without consequences ensued. One patient underwent repeat surgery for hematoma in the wound; after wound healing and rehabilitation, he achieved a full range of motion. One patient showed signs of fibrosis of Hoffa's fat pad. All patients returned to the style of life as before injury. At follow-up of 1 to 4 years, Lysholm scores were excellent in 23 patients, very good in four patients, satisfactory in one patient (repeat surgery) and one patient was not examined. DISCUSSION: Fracture of the intercondylar eminence is caused by a mechanism similar to that causing rupture of the anterior cruciate ligament but, in addition, the margin of the intercondylar fossa is pressed against the eminence which breaks off. Displaced fractures (types II and III according to the Meyers and McKeever classification) are indicated for surgical stabilization. Fixation of the fractured eminence by means of absorbable material is sufficient, and insertion of metal material and its subsequent removal thus can be avoided. Arthroscopic inspection permits exact reduction; this procedure is minimally invasive. CONCLUSIONS: Arthroscopic stabilization of a fractured eminence by means of PDS sutures is a gentle surgical procedure that provides good mechanical support, facilitates early rehabilitation and achieves good outcomes. The use of absorbable sutures allows us to avoid further surgery in order to remove fixation material.

Asunto(s)

Artroscopía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Femenino , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Técnicas de Sutura , Fracturas de la Tibia/diagnóstico por imagen

RESUMEN

PURPOSE OF THE STUDY: Arthroscopic examination of joints has recently gained wide application. Due to hip joint shape and a difficult approach to it, hip arthroscopy has long remained outside the attention and abilities of arthroscopists. The authors present their first experience with operative hip arthroscopy that offers new options for the treatment of intra-articular pathology of the hip joint. MATERIAL: In the years 2001-2003, 24 hip arthroscopies were performed. The following pathological conditions were diagnosed and treated: loose bodies, chondral lesions of the femoral head and acetabulum, ruptures of the labrum acetabuli and ligamentum teres, impingement syndrome of the labrum acetabuli, and coxitis. No post-operative neurologic symptoms or vascular complications were observed. METHODS: All procedures were carried out on patients in a supine position, with the treated joint in traction. A standard 30 degrees device and common instruments for arthroscopic surgery were used. The instruments were inserted in the articular fissure with the use of an X-ray intensifier. Movement in the hip joint during surgery is very limited due to traction, joint shape and the length of working canals. After traction is released, it is possible to examine also the intra-articular part of the femoral neck. RESULTS: The pre-operative complaints (clunking, painful joint) were relieved up to 4 to 6 weeks after surgery in 23 patients. In one patient primarily diagnosed with coxitis, infection was not eradicated after lavage and debridement and, because inflammation deeply affected the femoral head, the hip was eventually treated by Girdlestone arthroplasty. The results were evaluated clinically and on the basis of the Merle d'Aubigne and Postel questionnaire assessing pain and walking abilities by both the patients and the surgeon. All 24 patients reported poor or average conditions before surgery and, after surgery, 23 experienced improvement to a very good or average condition. One patient's state failed to improve and was evaluated as poor both before and after surgery. DISCUSSION: Hip arthroscopy is a minimal invasive technique which allows us to diagnose and, at the same time, treat intra-articular pathology in a gentle manner. In arthroscopic surgery, correct diagnosis (X-ray, CT and MRI), correct patient's position, their body mass (obesity), selection of appropriate approaches to the joint, surgeon's experience and potentials of arthroscopic instruments all play an important role. We assume that, with increasing experience, the number of patients as well as the scope of diagnosed and treated pathological conditions of the hip joint will grow. The outcomes of operative arthroscopy were very good (improvement in 23 of 24 patients) and it is probable that this technique can slow down or prevent early wear-and-tear hip arthritis. CONCLUSIONS: In our country, operative arthroscopy of the hip is only at its beginning. However, it can be assumed that, similarly to other large joints, it will soon become a widely used, indispensable diagnostic and therapeutic method.

Asunto(s)

Artroscopía , Articulación de la Cadera/cirugía , Artroscopía/métodos , Humanos , Artropatías/diagnóstico , Artropatías/cirugía , Complicaciones Posoperatorias