[Dislocation of an endoprosthesis of the hip joint operated by the open method.]. / Luxace umelé náhrady kycle osetrené otevrene.

The authors evaluated in a series of endoprostheses of the hip joint the X-ray documentation and peroperative revision findings in 8 patients who from a total of 16 dislocations (2.2%) were subjected to surgical revision. Conditions of a postdysplastic hip joint with previous surgery predominated (62%). In half the reoperated hip joints the cause of dislocation was a malposition of one of the components. The most frequent surgical revision was replacement by a femoral component with a longer neck (88%). Key words: endoprosthesis of the hip joint, dislocation, treatment of dislocation.

[Five years experience with triple osteotomy of the pelvis, as described by steel.]. / Petileté zkusenosti s trojitou pánevní osteotomií podle Steela.

The authors present their five-year experience with triple osteotomy of the pelvis, as described by Steele, in a group of 31 patients and 35 operated hip joints. The mean age of the patients was 20 years, the mean follow up period 28 months (4 - 55). Prerequisites of surgery according to the authors are: 1. congruence of the head of the femur and aceta bulum, spherical or aspherical, before operation; 2. the possibility to achieve spherical or aspherical congruence by surgery; 3. sufficient functional range of movements in the hip joint, in particular inner rotation. The subjective satisfaction of patients with surgery was 79%, objective evaluation according to Harris revealed slight improvement on average from 64 to 76 points from a total of 91 attainable points. The operation does not significantly restrict movement in the hip joint. The mean gain of Sharp's angle was 15 , Wiberg's angle 23 and the AHI index 24%. As to complications, in 60% a pseudoarthrosis of the lower arm of the ischium developed with no impact on subjective or clinical results; a deep infection in one patient led to poor results as a result of severe insufficiency of the pelvifemoral muscles; discission of the femoral vein was treated at operation by suture without serious sequelae. The subjective and clinical results can be adversely influenced by the development of insufficieny of the pelvifemoral muscles due to incorrect reinsection to the blade of the ilium. Triple osteotomy of the pelvis should be performed only by experienced surgeons. However, if the technique is mastered it offers a very good opportunity to resolve insufficiency of the tectum of the head of the femur, possibly in combination with operations of the fe-mur/varisation osteotomy or distalisation of the greater trochanter in a single stage or valgisation distraction osteotomy in two stages. Key words: triple osteotomy of the pelvis according to Steel, osteotomy of the proximal femur.

[Our experience in the surgical treatment of pseudoarthrosis of scaphoids in the period 1977 - 1987.]. / Nase zkusenosti s operacní lécbou pakloubu ossis scaphoidei v letech 1977 - 1987.

The authors present an analysis of the results of the surgical treatment of pseudoarthorsis of scaphoid by the technique after Matti-Russe consisting in spongioplasty and bridging the pseudoarthrosis with corticospongy graft in 35 patients treated in the period 1977-1987. Bone healing was achieved in 83 per cent, in 63 per cent there was a significant remission of subjective complaints. In 57 per cent the osteoarthritic changes of carpus made progress, out of which in 50 per cent there were preoperatively present symptoms of carpal instability, i. e. scapho-lunate dissociation of more than 2 mm and/or increase in volar flexion of scaphoid or its fragments with the loss of colinearity of longitudinal axes of radius and axes of capitatum. Instability of the carpus was never improved by the operation and significantly corelated with the subjective complaints in follow-up examination. The reconstruction operation is not indicated for the pseudoarhtrosis of scaphoid in case of the presence of carpal instability or advanced osteoarthritis. More suitable is to perform later arthrodesis of the wrist. Key words: pseudoarthrosis of scaphoid, reconstruction operation after Matti-Russe, instability of the wrist.

[Reconstruction operations versus amputation in the treatment of complex cases of musculoskeletal infection, two case reports with discussion.]. / Rekonstrukcní výkony versus amputace v lécbe slozitých prípadu muskuloskeletální infekce, Dve kasuistiky.

The author presents case reports of two patients with musculoskeletal infection treated in the beginning by complex reconstruction operations which have finally ended up with the amputation of the extremity with a good functional and subjective result. The author deals in details with the problems of differentiated indication of various methods of treatment depending on the condition of the bone, soft tissues as well as the general condition of the patient mainly with regard to the both general and local immunity response and on technical and personnel possibilities of the clinic or hospital. Key words: musculoskeletal infection, reconstruction operations, amputation.

[Personal experience with lower extremity lengthening]. / Nase zkusenosti s prodluzováním dolních koncetin.

The authors submit results of surgical treatment of unequal extremities in 10 patients. In nine cases by gradual distraction the affected lower extremity was extended, in one female patient the upper extremity. Ilizarov-type fixation devices proved useful. The maximum attainable increment is 8-9 cm, in the described group a prolongation by 2-8.5 cm was achieved, the mean period of distraction being three months. Up to 4 cm the distraction was made at a rate of 1 mm per day. When extending the leg by more than 4 cm, also the Achilles tendon must be extended and a tibiofibular syndesmosis by means of a screw must be made. Indications for surgical prolongation of the extremities must be carefully contemplated.

[Use of Septopal in the treatment of bone infections]. / Pouzití Septopalu pri lécbe kostních infektu.

The authors evaluate a group of 29 patients where they used during treatment of a bone infection gentamicin pellets--Septopal Merck. The mean age of the patients was 46.6 years (9-75 years) the mean duration of the symptoms of inflammation before operation was 20 months. The prerequisite of successful application of Septopal is radical surgical treatment of the site of infection and provision of high standard soft tissue covering and assessment of the sensitivity of the aetiological agent to gentamicin. The most frequent causal agent of infection was Staphylococcus aureus in 48.3% and in combination with Gram-negative rods in 34.5%. In infections of total prostheses of joints one of the pathogenic agents was also Staphylococcus epidermidis. Healing per primam was recorded in 41% per secundam in 28%, in general, treatment was successful in 69%. By application of Septopal high local bactericide concentrations of gentamicin can be achieved for three months without threatening the patient with toxic side effects--local or general. The authors recommend, however, to remove it after cca 8 weeks.