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J Bartonícek

Publications and source records attributed to J Bartonícek.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Duration of surgery in osteosynthesis of fractures of the trochanter].

PURPOSE OF THE WORK: To analyze duration of surgery in individual types of internal fixation of fractures of the trochanteric massif and identify factors which have an impact on it. MATERIAL: Analysis covered a group of 137 patients treated with Ender nailing (EN), 314 patients by means of Dynamic Hip Screw (DHS), 74 patients by means of Gamma nail, 37 patients by means of Proximal Femoral Nail (PFN) and 13 patients by means of 130 degrees angled blade plate. The groups of patients included basicervical femoral neck fractures (29 cases), peritrochanteric and subtrochanteric fractures. Peritrochanteric fractures were evaluated according to Kyle classification, types I and II as stable (174 cases), type III unstable (159 cases) similarly as type IV (peri/subtrochanteric fractures or comminuted fractures of the whole trochanteric massif--35 cases). High subtrochanteric fractures (55 cases) were evaluated after Seinsheimer. From the viewpoint of AO/ASIF classification they were 31A1, 31A2, 31A3 fractures. EN was indicated mainly in Kyle I through IV fractures, DHS for basicervical fractures and Kyle I through III fractures, Gamma nail for Kyle I through IV fractures and high subtrochanteric fractures, PFN mainly for high subtrochanteric fractures and Kyle III fractures, 130 degrees angled blade plate was indicated only for stable peritrochanteric Kyle I fractures. RESULTS: The average duration of surgery, i.e. starting from the skin incision until the suture of the wound, was in DHS 47 min., in EN 52 min., in 130 degrees angled blade plate 54 min., in PFN 58 min. and in Gamma nail 70 min. The shortest time intervals were achieved in stable peritrochanteric fractures of Kyle I and II (EN, DHS, Gamma), the longest ones in high subtrochanteric fractures (Gamma, PFN). The impact of the learning curve was analyzed in DHS. In 1995 the average duration was 70 min. (35 patients/year), in 2000 already only 39 min. (123 patients/year). DISCUSSION: If we wish to make a serious evaluation of the duration of surgery of any method we must not forget that apart from it there is a whole number of other factors by which it is influenced. In case of proximal femur it is the type of fracture, the number and experience of surgeons, mastering the learning curve, annual frequency of surgeries at the respective Department as well as variation within the surgical technique (e.g. in DHS the number of distal locking and the number of locking screws, etc.) A significant role in this study was also played by the development of internal fixation at the Department of the authors. For instance, considerably shorter duration of surgery as well as minimum of complications in PFN were achieved thanks to mastering of the learning curve on the Gamma nail which we had started to use 3 years before. An objective evaluation requires also a sufficient number of cases in order to eliminate errors caused by low numbers and other variable factors. CONCLUSION: Surgery duration data which we present are comparable with the values included in the world literature. It applies not only to the duration of surgery in individual implants but also in individual types of proximal femur fractures. At present at our Department the average duration of surgery ranges in dependence on the applied implant, type of fracture and skills of the surgeon between 30 and 60 minutes. Relatively shortest duration can be achieved in DHS, in Gamma nail and PFN the duration is slightly longer. However, the duration of surgery is only a supporting factor. Of much greater importance for the patient is the quality of the surgery. Thus favouring any method only on the basis of the duration of surgery is absolutely irrelevant.

Bone Nails↗
PubMed2001

[Unreamed locking intramedullary nailing of humeral fractures--basic evaluation of a patient group].

PURPOSE OF THE STUDY: The aim of the work is to provide an overview of the existing experience in Synthes unreamed humeral nail (UHN). MATERIAL: Between August 1996 and February 2000 we treated by means of UHN a group of 37 patients (12 men and 25 women), average age 55 years (range, 18-87 years) with a fracture of humeral shaft. According to AO classification in 10 patients it was a case of a fracture of proximal humerus involving the shaft (11B-3) and in 27 cases a fracture of the shaft (12 A, B, C). The whole group was operated on by 11 surgeons. METHOD: In 26 cases we used the antegrade method and in 11 cases the retrograde one, in dependence on the type and location of the fracture. The assessment was performed in the form of a prospective study. The follow-up including radiograph checks was carried out at the intervals of 6 weeks, 3, 6, 9 and 12 months after the operation or at another 6 weeks or 3 months after the extraction of the nail, if any. In addition we invited the whole group, i.e. 37 patients for the final control examination which all of them attended. This examination was performed by the first author of the work. The average follow-up was 38 months (range, 12-55 months). RESULTS: The average duration of the surgery in the whole group was 80 minutes, the average duration of x-ray exposure was 3.1 minutes. Peroperative complications occurred in total 42 times in 23 patients. Seven cases required a supplementary incision, i.e. open reduction of the fracture; insufficient nail placement (not into the proper depth) in the humeral head and its prominence into joint line evaluated on the post-operative radiograph) in antegrade nailing occurred 6 times. Problems with locking were encountered 15 times in 10 patients. Comminution of the fragments peroperatively during the insertion of the nail occurred 3 times, peroperative injury of the radial nerve was recorded in total 4 times, always in the antegrade method of the insertion during distal locking from the lateral side. A postoperative complication occurred 16 times in 12 patients, 6 times the radiograph showed penetration of the end of the nail into the shoulder and 6 times the locking screws loosened. No infect was recorded. The mentioned complications required in total 10 revision surgeries in 6 patients (5 of them were treated by the antegrade method). The fracture healed in a good anatomical position in 33 cases. In 4 cases there occurred non-union which was 3 times treated with a plate re-fixation and cancellous bone grafting of which twice successfully. In 2 cases the healing required another revision surgery. A good subjective as well as objective result was achieved almost in 90% of patients. A risk factor from the viewpoint of the limitation of the range of motion in the shoulder proved to be the fracture of 11B3 type and also the antegrade method of nailing, in case of the elbow the retrograde method of nailing. However, the greatest risk was posed by the necessity of a longer post-operative immobilisation of the limb in the case of a not quite stable internal fixation. DISCUSSION: A relatively high number of complications in our group results from strict criteria we have set. However, also literary data present a relatively high number of variously serious complications. Our results as well as the average duration of the surgery is comparable with other authors. CONCLUSION: The main indication of UHN are comminuted or multi-level fractures of humerus in the central three fifths of its length. If possible we prefer the retrograde method of nailing, in the antegrade method we recommend distal locking from the anterior aspect of the arm. Transverse or short oblique fractures can be successfully treated by a simpler Hackethal technique. Long spiral fractures are ideally treated conservatively or by plate fixation.

Adolescent↗
PubMed1999

[Economic aspects of treatment of proximal femoral fractures in the Czech Republic].

BACKGROUND: The number of publications evaluating economic and social aspects of the treatment of proximal femur fractures increased steadily in the last 20 years in the foreign literature. Due to the absence of similar studies in the domestic literature the authors decided to investigate this issue in the Czech Republic and to present outcomes. The aim of the presented study is to inform about the costs of treatment of patients with proximal femur fractures in an orthopaedic department and estimate the costs of such treatment on a nationwide scale. METHODS AND RESULTS: A detailed follow up of 244 patients treated for a proximal femur fracture was carried out at the Orthopaedic Clinic of the 3rd Medical Faculty and Faculty Hospital, Královské Vinohrady in 1997, including economic aspects and the fate of patients after their discharge from the hospital in the course of one year after their injury or surgery. The average cost of primary treatment of a patient in this group amounted to 38,000 Kc, on a nation-wide scale this sum totalled 29,000. The obtained results were compared with national data acquired from the Institute of Health Care Informations and Statistics and from the General Health Insurance Company. The monitored group accounted for 2% of the national group of patients with this diagnosis. CONCLUSIONS: Exact data on the costs of primary treatment of patients with a proximal femur fracture were obtained only in the monitored group of our patients, in 1997 these costs amounted to 9,389,848 CZK. The costs in the whole Czech Republic may be only estimated at approximately 450 million CZK.

Adult↗
PubMed1994

[Trans-pedicular stabilization of fractures of the thoraco-lumbar spine. I].

Proceeding from the literature survey and on the basis of his own experience the author presents a current concept review of the problems of the transpedicular stabilization in fractures of the thoracolumbar spine. Individual chapters are devoted to the biomechanics and transpedicular screw placement, classification of implants and to the transpedicular operations on the injured vertebral body. Based on both his own experience and survey of the literature the author recommends the following: in order to increase the stability of osteosynthesis to place transpedicular screw in anteromedial direction (Magerl approach) close to the anterior cortex of the vertebral body or (in case of osteoporosis) to performate it by tip of the screw; in fractures with the compression of vertebral body (mainly in case of burst fractures) to perform transpedicular reduction and cancellous bone grafting after Daniaux and Dick. Out of the implants so far used the author considers the best Fixateur intern (Dick) allowing faultless reduction as well as a longterm stabilization of the fracture.

Fracture Fixation, Internal↗
PubMed1994

[Transpedicular stabilization in fractures of the thoracolumbar spine. II].

Proceeding from the literature survey and on the basis of his own experience the author presents a current concept review of the problems of the transpedicular stabilization in fractures of the thoracolumbar spine. Individual chapters are devoted to the biomechanics and transpedicular screw placement, classification of implants and to the transpedicular operations on the injured vertebral body. Based on both his own experience and survey of the literature the author recommends the following: in order to increase the stability of osteosynthesis to place transpedicular screw in anteromedial direction (Magerl approach) close to the anterior cortex of the vertebral body or (in case of osteoporosis) to perforate it by tip of the screw. in fractures with the compression of vertebral body (mainly in case of burst fractures) to perform transpedicular reduction and cancellous bone grafting after Daniaux and Dick. Out of the implants so far used the author considers the best Fixateur interne (Dick) allowing facultless reduction as well as a longterm stabilization of the fracture.

Bone Screws↗
PubMed1993

[Radiodiagnosis of fractures of the thoracolumbar spine].

The article presents a most detailed description of the individual radiologic methods used for the examination of the fractures of the thoracolumbar spine, i.e. CAT examination including 3-D reconstruction and magnetic resonance. Apart from technical procedures and the assessment of individual methods the article also shows their comparison.

Humans↗
PubMed1990

[Weitbrecht's retinacula of the hip joint].

On the basis of his own cadaver studies and data presented in the literature (mainly those presented by Anseroff) the author describes synovial folds of the hip joint also called retinacula of Weitbrecht and deals with the significance of these folds for the blood supply of the proximal end of the femur. In total there are three retinacula of Weitbrecht in the hip joint. Retinaculum anterius passes along the anterior surface of the neck originating from linea intertrochanterica toward the femoral head. It has the shape of a flat fold which is quite often divided into more stripes. Sometimes it is missing. Retinaculum mediale sometimes called Amantini's fold passes from the lesser trochanter to fovea capitis femoris along the medial surface of the neck. In children it has the shape of a single strip, in adults it most often has the shape of an upside-down "T". Its occurrence is constant. This applies also to retinaculum lateral passing along the superior surface of the neck from the greater trochanter toward the head. This retinaculum has always the shape of a flat plate. Corresponding to the number and course of retinacula is also the classification of the so called neck arteries into three groups as presented by Tucker and Ogden. In the lateral retinaculum there pass also so called posterosuperior retinacular vessels, in the medial one the so called posteroinferior retinacular vessels. Both groups of vessels originating from a profundus a. circumflexae femoris medialis supply the femoral head. In the anterior retinaculum there pass vessels of the same name originating from r. transversus a. circumflexae femoris lateralis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Ender nailing in fractures of the proximal femur. II. Analysis of our cohort].

The work presents the analysis of the group of 172 patients with the fracture of the proximal femur treated by the technique of Ender nailing between June 1985 and December 1988. The group comprised 45 male (26 per cent) and 127 female (74 per cent) patients. Their average age was 76 years (ranging from 20 to 97 years of age) out of which 75 per cent of patients were older than 70 years and 40 per cent older than 80 years. Indication of Ender nailing in patients under 60 years of age we consider exceptional. In our group we operated on in total 14 patients under 60 years of age (ranging from 20 to 57 years of age) and namely in case of the comminuted type of fracture increased risk of infection or serious total condition. The whole group was operated on by 21 variously experienced surgeons. 147 operations were performed in the general anesthesia and 25 in the epidural one. The fractures of the proximal femur were divided into basicervical--10 (6 per cent), stable pertrochanteric 96 (56 per cent), unstable pertrochanteric--38 (22 per cent), per-subtrochanteric--19 (11 per cent) and subtrochanteric--9 (5 per cent). For the objective evaluation we compared our classification of the fracture of the trochanteric part with these of Evens, Kyle and Jensen. For stable fractures we considered the types I and II according to Kyle, for unstable the type III of Kyle classification. Per-subtrochanteric fractures (Kyle IV) we singled out for their seriousness as a separate group of unstable pertrochanteric fractures. Almost the same spectrum of fractures was in the group of 108 patients in which we evaluated longterm results. The minimum observence period was 3 months the mean period 6.3 months. Almost all patients from this group were followed up until complete healing. The mean duration of operation was 52 minutes, the mean duration of anesthesia was 81 minutes and the duration of X-ray exposure was 2.6 minutes. These data were calculated also for individual types of fractures. In this case the time intervals differed according to the seriousness of the fracture. The comparison of our time data with other authors reliably evaluating the results of Ender nailing has proved that it is necessary to free this intervention from the myth of a quick and easy operation. The average number of nails inserted in one patient was 3.6.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗