Posttraumatic intercostal pulmonary herniation - case report.

INTRODUCTION: Pulmonary hernias are rare conditions, most are the results of an injury or previous thoracic surgery. CASE REPORT: We present a case of a 48-year-old woman injured in a car accident. The examination in the trauma centre revealed a chest injury with herniation of the lung parenchyma into the chest wall and fractures of long bones of lower limbs. Initially, an osteosynthesis of the left femur and the right tibia fracture were performed. The patient underwent a subsequent surgery to repair the pulmonary hernia. CONCLUSION: A pulmonary hernia is diagnosed either directly during a clinical examination or by imaging. A sovereign diagnostic method is a computed tomography. The method of treatment is a surgical repair with primary suture of the chest wall defect or implantation of a mesh to repair the pulmonary hernia.

[Metal Debris with Cobalt Intoxication and Heart Damage as a THA Complication]. / Kovový oter s otravou kobaltem a poskozením srdce jako komplikace TEP kycelního kloubu.

Total hip replacement is currently a standard orthopaedic procedure. A number of complications caused by wear of the articulating parts of the endoprosthesis were described in the past. In recent years, there have been reports of systemic manifestations of metal components wear, leading to the development of chronic metal poisoning and organ damage. Our case report documents two cases of heart damage, resulting in heart failure with the need for heart transplantation, caused by metal poisoning originating from a failed THA.

[All-polyethylene tibial component in Walter-Motorlet total knee arthroplasty. Long-term outcomes]. / ALL-POlY standardní tibiální komponenta náhrady kolenního kloubu Walter-Motorlet v dlouhodobém hodnocení

PURPOSE OF THE STUDY: An analysis of long-term results of the all-polyethylene tibial component in Walter-Motorlet cemented condylar knee arthroplasty, with a standard tibial plateau (STP) of our own design. MATERIAL AND METHODS: A total of 49 patients underwent knee replacement; of them, 35 (71.4%) with 38 Walter-Motorlet implants using the STP were evaluated. The average age at the time of evaluation was 87.3 years. The follow-up ranged from 18 to 27 years (average, 24.6 years). Mechanical properties of the STP were tested by experimental measurements and in a photoelasticimetric study. The clinical results were evaluated according to the EULAR Knee Assessment Chart (EKACH). Twenty-four patients (26 knees; 49%) had osteoarthritis (OA) and 11 (12 knees; 23%) had rheumatoid arthritis (RA). Of the 14 (28.6%) patients not included in evaluation, seven (14.3%), with seven knees, required revision arthroplasty and seven (14.3%), with 10 knees, were lost to follow-up. RESULTS: Of the 38 implants evaluated by the EKACH at an average of 24.6 years, subjectively, 14 (36.8%) knees were free from pain and 14 (36.8%) were mildly painful. The remaining 10 (26.4%) joints were acutely painful on walking up or down the hill. In 14 (36.8%) cases the patients experienced their knees as stable. Light domestic chores were routinely performed by 17 patients (10 OA and 7 RA; 48.6%). One (2.9%) OA patient had a full-time job, and nine (25.7%) patients were socially independent. The functional outcome was significantly related to the patient's age at the time of evaluation. Complications included STP aseptic loosening in five (13.1%) and late infection in two (5.2%) knees. Radiography showed translucent zones below an all-polyethylene component in 14 (36.8%) knees. DISCUSSION The five cases of aseptic loosening may have been due to insufficient hardness of a U-shaped polyethylene component and long-term stress at the bone-implant interface. In the majority of knees the anterior cruciate ligament was defective or missing completely. Maintenance of the posterior cruciate ligament facilitates absorption of the greater part of forces at the cement-bone interface, as also reported by other authors. The high incidence of complications associated with patellar components, as described in the literature of the late 1970s and the early 1980s, led us to avoid the primary use of a patellar implant. CONCLUSIONS: Our evaluation showed that, in 73% of the cases, the all-polyethylene tibial component was a suitable and inexpensive implant with very good or good long-term results on average at 24.6 years of follow-up. Since the quality of currently produced polyethylene is high, we recommend the use of all-polyethylene tibial components in all indicated cases.

The National Register of Joint Replacements of the Czech Republic.

The National Register of Joint Replacements of the Czech Republic was established as part of the National Health Information System in 2002. The register's administrator is the Institute of Health Information and Statistics of the Czech Republic, the Czech Society for Orthopaedics and Traumatology acts as its guarantor of scientific quality. The register is financed from governmental sources. It was launched into full operation in 2003 and it currently focuses on hip joint replacements. Register of knee and shoulder joint replacements is in the process of preparation. The register provides aggregate epidemiological data and other statistics, including the Revision Rate (RR) and curves of cumulative survival probability (Kaplan-Meier) for the main monitored groups of patients and implants used. In years 2003-2012 there were 101,734 primary implantations and 13,459 revision surgeries registered. In terms of gender distribution there is a predominance of females amounting to 59.4% in primary implantations and to 63.49% in revision surgeries. The age structure covers the entire range of adult population; however, more than 50% of the replacements are being implanted between 60-74 years of age. Most frequent indications for primary implantation are primary coxarthrosis (69.85%), post-fracture conditions (13.41%) and post-dysplasia arthritis (8.73%). The most frequent indications for revision surgery are aseptic loosening of acetabular component (38.15%), aseptic loosening of femoral component (22.01%) and recurrent dislocation (6.5%). 45,450 (44.68%) of primary implantations were cemented, 36,477 (35.86%) uncemented, 16,559 (16.28%) hybrid with cemented femur and 656 (0.64%) hybrid with cemented acetabulum. There were also records of 2,592 cervicocapital prostheses (2.55%). Most commonly used is the classic anterolateral approach 75.86% in primary implantations and 50.06% in revision surgeries. Mini-invasive approaches in primary implantations did not exceed 3.2% of all cases. Bone grafts were used in 23.89% of primary implantations and 39.55% of revisions. Most widely used implants in primary implantations were cemented PE cup type Muller (Aesculap) 14,000 pcs, original Czech cemented steel Stem with conical neck 12/14 AK (Beznoska) 13,433 pcs, from uncemented models Plasmacup SC (Aesculap) 9,762 pcs and Stem SL "Zweymüller Alloclassic" (Zimmer) 4,337 pcs. Generally most widely used implants in revision surgeries are uncemented Czech Oval cup MO (Medin) with titanium & hydroxyapatite porous coat 956 pcs and uncemented Stem SL WAGNER, lateralised, cone 12/14 (Zimmer) 712 pcs. The Revision Rate for primary implants due to infection for period 2003-2012 represented 0.06% at the end of the followup as of June 30, 2013. Cumulative survival probability (Kaplan-Meier) in year 11 of the follow-up is 95.69% in cemented implants, 94.55% in uncemented, 92.90% in hybrids with cemented femur and 84.11% in hybrids with cemented cup.

[Middle-third clavicle fracture with ipsilateral acromioclavicular dislocation]. / Zlomenina strední tretiny klícní kosti spojená s ipsilaterální akromioklavikulární luxací

A rare case of a middle-third clavicle fracture concurrent with ipsilateral acromioclavicular dislocation in a 46-year-old women who had fallen off her bicycle is presented. The clavicular fracture was managed by locking plate osteosynthesis. The acromioclavicular joint was stabilised by traction osteorrhaphy that was removed at 7 weeks after the procedure. Both the radiographic and clinical outcomes were very good. The epidemiology, aetiology, diagnosis and therapy of this injury are discussed.

[Posterior dislocation of the talus]. / Zadní luxace talu.

This report presents a rare case of an open total talar extrusion. The patient was treated by reduction and transarticular Kirschner-wire fixation of the talus, suture of an associated Achilles tendon rupture and plaster cast immobilisation. The plaster cast and Kirschner wires were removed after 6 weeks. At 10 weeks after injury, the patient started to walk with full weight-bearing of the operated extremity. At 18 months after injury, the patient was free from subjective complaints, with persisting slight restriction of ankle dorsiflexion range of motion and recurrent perimalleolar oedema. Neither MRI nor radiographic examination showed any avascular necrosis of the talus. The authors discuss the aetiology, diagnosis, therapeutic options and the most serious complications of this injury.

[Our experience with AES total ankle replacement]. / Nase zkusenosti s náhradou hlezna AES.

PURPOSE OF THE STUDY: The method of choice for the treatment of severe ankle arthritis is either arthrodesis or joint arthroplasty. Each has its advantages and disadvantages. Arthrodesis is the definitive therapy for severe ankle destruction and instability. Joint arthroplasty has an advantage in maintaining ankle mobility. However, its range of indications and its reliability and durability are more limited. The aim of this study is to present our experience with the AES prosthesis and draw attention to some drawbacks of this surgical treatment. MATERIAL: From September 2003 till June 2008, 51 AES ankle replacements were carried out in 51 patients (33 women and 18 men). Their average age at the time of surgery was 53.8 years. The youngest patient was 23 and the oldest was 88 years old. The indication for surgery was rheumatoid arthritis in 10, primary arthritis in six and post-traumatic ankle arthritis in 35 patients. METHODS: The patients were evaluated in 2008. The follow-up ranged from 4 months to 5 years. The patients were examined for ankle joint mobility and pain. Radiographs were assessed for potential signs of component loosening. RESULTS: The results presented here are short-term ones. The pre-operative AOFAS score of 33.7 increased to 82.3 points post-operatively. The range of motion was on average 20 degrees of plantar flexion and 5 to 10 degrees of dorsiflexion. Thirty- five patients (68.7 %) were free from pain, 11 (21.5 %) experienced slight pain while walking, and five (9.8 %) patients reported more intensive pain in the joint treated. Intra-operative complications included a fracture of the medial malleolus in two (3.9 %) patients subsequently treated with screw osteosynthesis. Post-operatively, seven (13.7 %) patients experienced slow healing of the operative wound. One patient had dislocation of the polyethylene liner at 3 months after surgery. Revision surgery was carried out in seven (13.7 %) patients. Two patients suffering from increasing pain around medial malleolus underwent revision and removal of ossifications. One patient developed necrosis of the talus at 1 year after surgery. She underwent extraction of the prosthesis and ankle arthrodesis with a retrograde locking nail inserted through the heel. A large bony effect arising due to extraction of the necrotic talus was repaired using bone graft. Three (5.8 %) patients developed post-operative instability of the ankle that required revision surgery. The radiographs of another three (5.8 %) patients showed bone cysts and signs of tibial component loosening. Of these, one patient underwent surgical revision with replacement of the polyethylene liner. Cavities were freed from granuloma induced by polyethylene wear debris, and filled with bone graft from the iliac crest. DISCUSSION: Total ankle replacement is a complicated surgical procedure that may results in various technical difficulties and complications. These are inversely proportional to the surgeon's experience, as also shown by literature data. CONCLUSIONS: The longevity of a total ankle replacement depends, much more than in other joint replacements, on an accurate implantation technique and correct indication.

[Different forms of tuberculous hip arthritis (case study)]. / Tuberkulózní koxitida - stupne postizení (soubor kazuistik).

Tuberculous hip arthritis ranks third in the classification of orthopedic tuberculosis, after tuberculosis of the spine and knee joint. It accounts for about 15 % of all orthopedic tuberculosis. The aim of this paper is to demonstrate the etiology, clinical presentation and forms of disease on the case reports of six patients. The scope of disease is wide - from a mild reversible synovial form, then fibrous or bone ankylosis, to severe destruction of the hip with subluxation or dislocation, pseudoarthrosis or chronic arthritis with a fistula. The wide diversity of clinical findings and difficulties is making diagnosis are often responsible for a late start of therapy. However, only an early and adequate treatment permits the prevention of irreversible damage to the hip joint or further complications. Key words: tuberculous hip arthritis.

[Our experience with total knee arthroplasty following tuberculous arthritis (1980-2005)]. / Nase zkusenosti s endoprotetikou kolenního kloubu po tuberkulózní artritide (1980-2005).

PURPOSE OF THE STUDY: Orthopedic tuberculosis is number one in non-pulmonary forms of tuberculosis and, among these, knee joint tuberculosis ranks second after spinal tuberculosis. Arthritic lesions are currently treated by total knee arthroplasty (TKA). MATERIAL: A group of 10 patients who, after having gone through tuberculous gonarthritis, underwent TKA was evaluated for the period from 1980 to 2005. It consisted of six women and four men, whose average age at the time of arthroplasty was 65 years. METHODS: The most frequent indication for TKA after tuberculous gonarthritis was post-inflammatory arthritis (80 %); the other indication was fibrous ankylosis (20 %). No conversion of arthrodesis to total replacement was carried in our group. All patients underwent pre-operative microbiological tests including PCR, as well as histological examination. Pre- and post-operative prophylaxis included anti-tuberculous (AT) drugs (rifampicin and izoniazid) combined with a cephalosporin antibiotic. AT drugs were administered for 3 to 5 months after surgery in accordance with the results of laboratory tests. RESULTS: In 1980 to 2005, ten patients after tuberculous gonarthrosis underwent TKA at our department. No complications were recorded. The average range of flexion was 0 to 90 degrees. None of the patients needed any walking aid, and all were able of full weight-bearing on the treated limb. There was no recurrent tuberculosis in this group. DISCUSSION: Any implantation of an endoprosthesis in a post-inflammatory terrain is always difficult. Subjective evaluation by the patients was good. At long-term follow-up, clinical, radiographic and laboratory findings were within standards, which is in agreement with the results of other authors. The pre- and post-operative therapy with AT drugs and antibiotics was used in all patients. CONCLUSIONS: Compared to arthrodesis, TKA brings about a significant improvement in the patient's mobility as well as a better quality of life. Before the patient is indicated for TKA, emphasis is placed on recording a thorough medical history, complete laboratory examination, radiography, CT scans, or magnetic resonance imaging, relevant orthopedic, internal and pulmonary examination including X-ray of the heart and lungs, as well as the assessment of the patient's somatic and psychical state with regard to the post-operative rehabilitation course.

[Effect of ultrasonic shock waves on the bone-bone cement interface]. / Pusobení ultrazvukové rázové vlny na spojení kostního cementu s kostí.

PURPOSE OF THE STUDY: Identification of the impact of ultrasound shock wave on the integration of bone cement in the bone and the examination of a potential application of this method in order to facilitate the extraction of cemented implants, mainly femoral component of total hip arthroplasty. MATERIAL: We used pig proximal femurs from which we made fragments involving approximately one third to one half of the profile of the bone and Palacos bone cement. METHOD: We made a groove in the cancellous bone, pressed bone cement with a wire loop in the cavity and let it harden. The samples were divided by random selection into two groups. Samples from A group were exposed to ultrasound shock waves and group B served as a control group. Then we measured the force needed for the extraction of the cement plug from the bone. RESULTS: Our measuring has shown an evident decrease of the force necessary for the extraction of the bone cement after the application of ultrasound shock wave. We did not find out any macroscopically evident damage of the bone cement or of the surrounding cortical bone. DISCUSSION: The results of our measuring are influenced by a different shape and size of the examined samples which also substantially differ from the situation when a stem of the endoprosthesis is implanted in the femoral canal and is surrounded by a cement mantle. As concerns risks associated with the application of the shock wave in this indication there is a risk of a fracture of the cortical bone around THR stem (the literature does not mention this complication) and a risk of the increase of pressure in the medullary cavity of the femur combined with a risk of fat embolism. In our view this increase of pressure is comparable with the effect of the implantation of femoral component. This method cannot be used for releasing cementless implants as the surrounding cortical bone gets damaged before the implant is released. CONCLUSION: Ultrasound shock wave is still used rarely in orthopaedics, however, the existing results are promising in many aspects. Of great importance is the fact that it is a non-invasive method. The field dealt with by this work covers only experiments in vitro but the results provide hope for a future clinical use.

[Effect of shock waves on hip prosthesis implantation (preliminary report)]. / Pusobení rázové vlny na implantovanou kycelní náhradu (predbezné sdelení).

Revision of total hip arthroplasty has increased dramatically and it began to be a big problem, because of the number of reoperation is growing directly with the number of primoimplantation. Extraction of bone cement from the canal of the femur is timely and technically very difficult and related with many complications. Therapy by ESWL was applicated in clinical praxis for the first time in the therapy of urolithiasis and then choledocholithiasis. Now it is used in orthopedy for the therapy of pseudoarthrosis, entesopathia and anthores. In our experiment we used models of pork femur to which we implanted the endoprothesis to bone cement. We expouned these samples to ESWL and controlled the ability of releasing of the endoprothesis. We replayed the experiment for four times after an abnormal number of shockwaves (more than 8,000 shocks), in two cases endoprothesis release spontaneously, in one case we needed a little power to release it and in the four cases the releasing was not achieved. These results show the probable influence of the shockwaves between the layers metal-cement and cement-bone spongiosa.

[Norms for authors of Mexican medical journals in 1994 and 1995]. / Normas para los autores de revistas médicas mexicanas en 1994 y 1995.

OBJECTIVE: To find out how much information of the Vancouver Norms (VANNOR) are given to prospective authors in the Instructions for Authors (IFA) in a sample of Mexican medical journals (MMJ) published in 1994 and 1995. DESIGN: Prospective, cross sectional, descriptive, observational. MEASUREMENTS: The IFA in the last issue of the MMJ that were published in 1994 and 1995, were reviewed and 121 characteristics in the VANNOR were scored in nine categories (characteristics, presentation, title page, summary and key words, text order and contents, references, tables, illustrations and other instructions). A one point score was given to any characteristic present in order to obtain a score for each category and a total score for each journal. The total scores in the VANNOR affiliated journals (N = 33) versus the non-affiliated ones (N = 27) were evaluated by the Mann-Whitney and exact Fisher test with alpha = 0.05 (two-tailed). RESULTS: A statistically significant higher score was found in the IFA of VANNOR journals in 22 of the 121 characteristics, in six of the nine categories, as well as in the total score. CONCLUSION: VANNOR affiliated journals offer a significantly higher amount of information regarding the IFA than those not affiliated.

[Nephropathy in Schönlein-Henoch purpura]. / Nefropatía en la púrpura de Henoch Schonlein.

Over one hundred patients diagnosed with vascular purpura at the National Institute of Pediatrics between 1979 and 1988 were retrospectively studied. Frequency was similar for both sexes. 82% were between the ages of six months and 11 years old. The extrarenal clinical manifestations were: petechias in 98%; abdominal pain 78% arthralgias 45%; melena 39%; and arthritis in 19% of the cases, 49 patients had nephropathy of different degrees and they did differently, 32 had hematuria with or without proteinuria within a nephrotic range, seven suffered from a nephrotic syndrome, one with a nephritic syndrome and nine others had a combination of two or three syndromes (nephritic/nephrotic/renal failure) with an unfavorable evolution towards terminal renal failure in eight of them; on the other hand, this was not seen in the remaining patients. Thirteen renal biopsies were taken from patients with more severe clinical manifestations, finding in them mesangial proliferation or endo- and extracapillary proliferation. These findings suggest that the initial clinical presentation of the illness allows for the prediction of the future.

Women and hospice care.

The hospice movement has grown extensively in the last ten years. This article examines the role of women in hospice, components of hospice care and a profile of 544 admissions to an inpatient hospice unit over a five year period. Case studies are given to illustrate the needs of women in hospice. Regulatory processes facing hospice programs today are reviewed.