Biomedical subjects
Publications and source records attributed to J Palarcík.
The author analyzes a group of casualties with concussion of the brain hospitalized in 1997-2001 in the Traumatological Hospital in Brno. From the discussion ensue some questions and suggestions--the role of the neurologist in assessment of the diagnosis, indications for CT examination, referring patients to hospital, care of patients with concurrent intoxications, discharge on patient's own wish.
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In 1993-1999 in the Traumatological Hospital in Brno 141 syntheses DHS Medin were made in patients with fractures of the proximal femur. (Eighteen DHS syntheses of other manufacturers were also made. The latter were however not analyzed). During the primary operations twice revision was necessary on account of a technical mistake of the surgeon ad twice an early infection developed. Seven late complications occurred--4 times a pseudoarthrosis and three times an aseptic necrosis of the head of the femur. All complications were resolved by total replacement of the hip joint. In no instance failure of the implant was recorded.
In the Traumatological Hospital in Brno in 1999 4975 operations were made incl. 1064 (21%) during emergency services. Thus there are on average 3 (2.91) operations per emergency shift. 88 operations were made after midnight. The operations implemented during emergency shifts can be divided into three groups: urgent operations, operation on the common schedule which were delayed but partly also non-urgent operations which are performed because of economic pressure. The legal changes limiting overtime work make it important to seek ways how to preserve under the new conditions the scope of surgery while it is assumed that there will be a greater pressure to refer patients to the centre. The financial conditions of the Institute as regards funds are at variance with the efforts made.
The authors present the results of another investigation of a group of casualties with fractures of the calcaneum treated by open reposition and stabilization with a splint and screws in 1994 to 1996, followed up after an interval of 57-74 months after the injury, on average after 66 months. Sixteen patients (20 calcanea) could be followed up, 7 patients were lost (8 calcanea). Again two evaluation patterns were compared. According to the authors the results were evaluated 12x as excellent, 6x as good and 2x as poor. On subjective evaluation 13 patients were satisfied, another three satisfied with reservations. During the subsequent follow up no complications developed. In all patients the osteosynthetic material was extracted and in one also ossificates in the planta. In two patients spontaneous talocalcaneal fusion occurred. Since 1997 in the Casualty Hospital as the basic method for treatment of dislocated intraarticular fractures of the calcaneum ligamentotaxis by exterior fixation is used (the authors give an account of all therapeutic methods used between 1994 and 2000). The authors evaluated a group of 28 casualties (36 fractures of the calcaneum) treated by external fixation, 18-81 months after injury, on average after 34.3 months. The evaluation proceeded in the same way. According to the authors' pattern the result was excellent 8x, good 13x and poor 15x. Spontaneous talocalcaneal fusion occurred 9x, 2x desis was performed and 1 desis is planned. As to subjective evaluation, 11 patients were satisfied, 15 were satisfied with reservations and two were not satisfied. According to the authors' opinion to achieve reposition of fragments of a fractured calcaneum in addition to other possibilities open reposition and synthesis using screws (possibly plate and screws) remains the basic method.
In a prospectively followed up group of 163 nailed tibiae in 157 casualties after 4-48 months, on average after 15 months following implantation 20 patients (12.5%) developed complications. In two instances the nail broke or was bent (1.25%), the remaining complications were not associated with the implant or instruments. Subsequent tests however did not prove defective material of the damaged nails. Medin nails are a reliable, readily available and cheap implant.
The author analyzes a group of casualties referred in 1997 to the Casualty Hospital Brno from other institutions where the patients were hospitalized after the injury, if the period did not exceed 30 days. Thus 361 casualties were referred. The reasons are summarized. Problematic is according to the author the admission of 37 patients with multiple injuries and 30 patients with a single injury. During the contemplated reduction of the number of health departments incl. surgical ones in the Czech Republic it will be difficult to justify the further existence of departments which are unable to cope permanently with uncomplicated bone fractures.
The authors present the short-term results of a prospective group of 23 casualties with 28 intraarticular dislocated fractures of the calcaneus who were treated between November 1994 and May 1996 by open reposition and stabilization by means of a plate, supplemented in 22 cases by autospongioplasty. The most frequent complication as regards healing were infections which were recorded seven times, incl. one case with a deep infection, which penetrated to the bone. By subsequent treatment the infection was in all instances cured, the next follow-up period being on average 5.6 months (2-8 months). Metal was extracted in 14 cases, incl. seven cases where it was part of treatment of the infection. For closure of the secondary defect in two instances a microsurgically transferred flap was needed. The patients were followed-up on average for 21 months after the primary operation (6-23 months). A total of 26 calcanei from 21 patients were evaluated. The authors compare two evaluation patterns. According to the authors in 16 instances an excellent result was achieved, a good result in 7 and a poor result in 3 patients. The authors are of the opinion that intraarticular fractures of the calcaneus should be treated by open reposition and stable synthesis. It is not necessary to operate non-dislocated and minimally dislocated fractures, while grossly comminutive fractures should be primarily indicated for arthrodesis. The surgeon must be prepared for the treatment of complications incl. a microsurgical solution of secondary defects.
The authors present an account on a group of their first 28 patients/29 nails/treated during a 6-month period from May 1995 by synthesis using Medin nails/14 tibial, 12 femoral and 3 reconstruction nails/. The nails and instruments are briefly described. The main objective of the development of nails was to enable the professional public to obtain the necessary implants from local manufacturers and thus at much lower prices.
The authors discuss indications for the use of a femoral reconstruction nail-synthesis of a diaphyseal fracture of the femur by an intramedullary nail with the necessity of concurrent treatment of cervical fracture or the necessity to safeguard by screws in the cervix a too short proximal fragment. The authors present short-term results obtained in a group of 13 clinical patients (followed up for 2-12 months, mean 6.6 months) who were operated using a Russel-Taylor reconstruction nail: 10 on account of a new fracture and the remaining three on account of complications of the original synthesis. The authors present the case-histories of three patients. They also describe attempts to produce a reconstruction nail in the Czech Republic, the price of which would be accessible for our departments. They submit also one case-history of the first casualty treated using a Medin reconstruction nail.
The submitted retrospective investigation analyzes a group of 108 casualties with injuries of the skeleton of the foot who were hospitalized in the years 1985-90. Excluded was the group of patients with fractures of the talus and calcaneus because they consider problems of these fractures specific. The structure of the group is influenced by the specialty of the authors' workplace--i.e. treatment of multiple injuries. The characteristic of the group, the mechanism of the injury, data concerning time, a summary of the diagnoses, primary treatment and complications are summarized in tables. Twenty-eight of the patients were checked after a time interval of 24-89 months (mean 51.5 months) following injury. X-ray revealed in all cases consolidation of the fracture, however, frequently in a dislocated position. The basis for evaluation was therefore the clinical examination: in 20 patients the finding was evaluated as normal (physiological); permanent sequelae recorded in eight patients are listed. Subjective evaluation was in most instances more favourable than the objective finding, in particular in patients with multiple injuries. The authors recommend to pay appropriate attention even to so-called "minor" injuries which must be also properly treated at the right time.
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The authors analyze all total endoprostheses which were performed at their department in 1985-1990 for traumatic indications--an injury or its immediate sequelae: 6 times an implantation was made because of fracture, 11 times because of failure of primary synthesis or serious aseptic necrosis of the head after synthesis. There were no prostheses on account of late deforming arthritis which developed on a posttraumatic background. Seventeen total endoprostheses made on account of traumatic indication account for 7.4% of all total endoprostheses during the period of investigation. One patient died from pulmonary embolism after the operation, although heparin prevention was used and one patient developed a minor complication. All eight patients who were checked on average after 22.4 months following implantation had excellent or good results. The authors reached the conclusion that total endoprostheses should be indicated more frequently to the benefit of younger casualties and that the total numbers of total endoprostheses on account of traumatic indications are low. Therefore it is necessary to concentrate alloplasties mainly on orthopaedic departments which have experience also with other indications. Certain types of fractures of the neck and head of the femur or acetabulum cannot treated nowadays as effectively by any other technique.
The authors submit an analysis of a group of 143 patients to whom in 1985-1990 in the Traumatological Research Institute in Brno a cervicocapital endoprosthesis was implanted. Indication for implantation was in all instances a fracture of the neck of the femur, most frequently a subcapital fracture--a total of 92. Women predominated 5:1. The mean age was 75 years, the range 37-93 years. In 119 patients the endoprosthesis was implanted on account of a new injury, in the remaining 24 on account of the sequelae of an injury. In 32 patients 1-4 operations preceded. The most frequent cause was a fall in the home. Fifteen patients were operated on the day of the injury and 80 were operated within five days after the injury. In the group 60 complications were recorded, 1-4 complications in 46 patients (32% of the group). The causes of complications are discussed. During the investigation 46 patients died (32% of the group), incl. half during the first hospitalization on account of the investigated injury. Only 27 patients of the group could be followed up, results are presented (excellent and good in 20 patients) and the reasons are discussed why patients cannot be followed up. Finally the authors conclude that in future it will be necessary to indicate endoprostheses as primary treatment more frequently, although secondary operations have similar results. The operation should be made as soon as the patient's condition permits it; the urgency is not acute as in syntheses; it should permit early mobilization of the patient. The unsatisfactory percentage of complications must be reduced by a complex of measures starting with organization of the workplace and the regime of the operating theatres and ending with the technical skill of the surgeon. The authors emphasize the problem of subsequent rehabilitation but do not analyze it in the present work.
The author analyzes a group of casualties who were brought to the Institute of Traumatology and Special Surgery in Brno by helicopter, when the latter was introduced among the equipment of the emergency service, between July 1, 1988 and December 31, 1990. A total of 80 casualties were transported by helicopter. The tables provide accurate data on the numbers of casualties in different years, the mechanism of their injury and summary of injuries they suffered. One of the tables offers orientation on the activities of the Institute during the period of investigation. From an analysis of the group it is apparent that the helicopter is used for transport of patients in an expedient way. Its use is optimal in various large scale events, in the control of accidents on highways and for transport of casualties from remote places. Perspectively casualties should be transferred from the site of accident directly to the centre which will provide definite treatment regardless of the distance in order to avoid incompetent stages of treatment. On the other hand, the use of helicopters in urban areas is of minor importance and the possibilities of their use are limited. In future it will be necessary to build landing sites at specialized centres which are the destination of the casualties.
The author submits an analysis of a group of casualties with clavicular fractures treated in the Traumatological Research Institute in Brno in 1986. Based on the analysis, recommendations were adopted for the surgical treatment and for increased attention to the termination of conservative treatment. As a control, a group of patients with clavicular fractures treated in 1989 was analyzed. The assembled results are discussed and the conclusion is reached that predominantly conservative treatment of clavicular fractures is still indicated. No other method of immobilization gives better results than mere suspension of the extremity. In a certain percentage of injured patients subjective complaints typical for the healing of the fracture persist. The period of work incapacity must be assessed individually.
The author analyzes retrospectively a group of 11 casualties who had treatment during 1985-1990 in VUTSCH Brno on account of a Monteggia fractures. The low frequency of these fractures is compared with the overall activity of the Institute. The fractures were caused most frequently by traffic injuries, less frequently by a fall. The author presents an account of associated injuries in the investigated group of patients. Classification into different types based on X-ray examination was possible only in a general way, the majority of dislocations was not typical, mainly fractures caused by considerable force were involved. The author describes treatment (with the exception of one patient who died from associated surgical injuries) and the results achieved: two subjects died during the early postoperative period from sequelae not associated with the Monteggi fracture, two patients could not be traced. In the remainder excellent results were recorded three times, good results twice and poor results once; one female patient is still being treated and it is assumed that the results will be excellent. From the discussion the following conclusions ensued: 1. Monteggia fractures should be considered important for the function of the affected extremity and should be treated as such without delay and perfectly. 2. The basis of treatment is anatomical reconstruction of the ulna by stable osteosynthesis. 3. Surgical reposition of the head of the radius is reserved for those cases where spontaneous reposition failed. Fractures of the head of the radius must be treated, however, primary resection and extirpation must be avoided. 4. Additional external fixation must not be excessive.
The author presents an account of the development of scintigraphic methods in the detection of inflammatory processes of the musculoskeletal system. The original method used in vitro 111In labelled separated leucocytes. It was improved by the possibility to label leucocytes by means of HMPAO 99mTc. In vivo leucocytes can be labelled by means of monoclonal antibodies. Nanocolloid offers similar possibilities as regards use and gives a good yield. Its use is simple and the preparation is available. Scintigraphy with nanocolloid must be considered nowadays the first scintigraphic method used when an inflammatory process is suspected, in particular of the extremities. Scintigraphy with nanocolloid can differentiate in planned revision alloplasty septic and aseptic loosening. The mentioned finding can be used for planning, implementation and ensuring the operation. The author was able, in collaboration with the department of nuclear medicine, to test scintigraphy with nanocolloid in five patients with complains after alloplasty of obscure origin. Patients' data are listed in table a and two cases are discussed in more details.