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P Dungl

Publications and source records attributed to P Dungl.

At least 19 recordsLinked to original sources
PubMed2003

[Restoration of elbow joint flexion by transfer of the pectoralis major muscle in patients with arthrogryposis multiplex congenita. Part II. Results of electromyographic and histologic examinations].

PURPOSE OF THE STUDY: In the framework of a prospective study on transposition of the m. pectoralis major according to Clark in patients with type I arthrogryposis multiplex congenita, electromyography was carried out in order to determine pre-operative states of the elbow joint flexors and m. pectoralis major and then the post-operative electric activity of a transposed muscle and to correlate changes with clinical findings. Histological examination was performed to reveal changes in muscle morphology and to complete a comprehensive assessment of muscle transposition. MATERIAL AND METHODS: Electromyography was carried out on nine upper limbs of five pediatric patients aged 4.3 to 8.9 years. Using a needle electrode, activities of the elbow flexors (m. biceps and m. brachialis), m. pectoralis major, m. triceps brachii and m. deltoideus were examined. In the post-operative period, activity was repeatedly measured in both the transposed and non-transposed parts of the m. pectoralis major. In one patient, histological examination of muscle tissue was performed at 26 months after transposition; light microscopy of paraffin-mounted sections stained with hematoxylin-eosin was used. RESULTS: Out of seven arms examined by electromyography before muscle transfer, six showed complete and one incomplete atrophy of the m. biceps brachii and m. brachialis. The m. pectoralis major had a five- to four-degree electric activity, which provided enough strength for transposition. Post-operative examination revealed changes leading to re-innervation of the transposed muscle, which corresponded to a partial denervation of the muscle followed by repair of innervation. None of the muscles was markedly atrophic due to denervation. In muscles with a higher electric activity, clinical outcomes were better, although electric activity always slightly exceeded clinical activity. In terms of electric activity, the transposed muscle was stabilized a year after surgery. Non-transposed parts of the muscle were not damaged by the surgical procedure, as shown by electromyography. Histological examination showed the muscle at a state of partial atrophy but with signs of ongoing regeneration of muscle fibers. DISCUSSION: No data on examination of the electric activity of the m. pectoralis major following its transposition in patients with arthrogryposis multiplex congenita have been reported in the literature. Electromyography in this study proved useful for providing information on the electric activity of a muscle before transposition and on contractility of the muscle after surgery; it also allowed us to distinguish between a mechanical failure of transfer and muscle atrophy due to neurogenic or vascular causes. All transposed muscles that were examined revealed changes indicating a minimum denervation followed by re-innervation. This finding was confirmed by the results of histological examination. CONCLUSIONS: Electromyography showed that the electric activity of a transposed muscle corresponded to the clinical presentation of this muscle and thus became an indispensable part of both pre- and post-operative examination. Both electromyographic and histological examination confirmed the applicability of the treatment described here.

Arthrogryposis↗
PubMed2003

[Initial experience with implantation of the cemented Beznoska/S.V.L. total knee joint endoprosthesis].

PURPOSE OF THE STUDY: The authors present the results of their first trial of a new, Beznoska/S. V. L. type, knee prosthesis in order to introduce it to a broad orthopedic public. MATERIAL: Clinical and radiological evaluation was carried out on 34 knee prostheses implanted in 31 patients between September 1997 and October 1999. The average patient age at the time of surgery was 71.3 years and the average interval between surgery and assessment was 22.4 months (range 6 to 31 months). All patients underwent implantation due to primary or secondary gonarthosis. A brief description of the implant and the instrumentation and used surgical technique is provided. METHODS: Clinical outcomes were evaluated according to the "Knee-Society Clinical Rating System" by John N. Insall. The system classifies both knee joint parameters and knee function. X-ray films were assessed on the basis of the "Knee-Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System" by Frederic C. Ewald. In standardized X-ray projections, this allowed us to evaluate the implant position as well as radiolucent lines. RESULTS: On stability evaluation, we found anteroposterior instability up to 5 mm in 85% of the implants and mediolateral instability up to 9 degrees in 97% of them. A maximum flexion of 90 degrees to 120 degrees was achieved in 91% of the implants. The final outcome in terms of knee score was on average 80.3 points (range, 40 to 97 points), which was a very good result. Evaluation by function score showed that only 17% of the patients were not able to walk farther than 500 meters. Although 82% of them had to hold on a railing when going upstairs, all were able of stair ascent and descent; 13% had to use a walking stick permanently. The average function score was 68.4 points (range, 30 to 100), which was a good outcome. Radiograms in anteroposterior projection, assessed according to Ewald, showed the average femoral flexion angle (alpha) to be 95.2 degrees, the average tibial angle (beta) to be 89 degrees and the total valgus angle (omega) to be 3.2 degrees. In lateral projection, the femoral flexion angle (gamma) was on average 2.5 degrees and the average tibial angle (delta) was 86.7 degrees. An optimal position of the patella was achieved in 27 implants. Five radiolucent lines, up to 1 mm, were found in zone 1 of the femoral component and further lines were observed in zones 1, 2 and 4 of the tibial component. DISCUSSION: When assessing the results by the knee and function scores, it had to be taken into consideration that the average age of the patients was 71.3 years. At this age, walking without a stick, or stair ascent or descent without the use of a railing can hardly be expected. The average result of 68.4 points achieved can, therefore, be considered a very satisfactory outcome. The values shown by X-ray examination were close to the normal condition. The patients were also asked for their subjective opinion of the effect of arthroplasty; 97% of them regarded the effect as good or very good, only one patient reported no benefit. CONCLUSIONS: The results of the first trial of the use of a cemented prosthesis, type Beznoska/S. V. L., in total knee arthroplasty are presented, together with practical recommendations. Although the patient sample was small and the follow-up period short, the results are promising and suggest excellent prospects for this implant.

Aged↗
PubMed2003

[Treatment of calcaneal fractures using the medial approach for open reduction].

PURPOSE OF THE STUDY: A comprehensive evaluation of the treatment of calcaneal fractures by open reduction is presented. The long-term results are compared with the relevant literature data. MATERIAL: In the period from 1987 to 2000, 60 displaced fractures of the calcaneus were treated in 51 patients. Of these, 49 patients suffered the fracture by falling from a height, which is generally the most common cause. Only two patients were injured during sports activities. Thirty eight injuries were classified as fractures of the joint depression type and 22 as fractures of the tongue type. The patients had surgery on the day they sustained the injury or after edema had subsided, if this was present on admission. The interval between injury and surgery was 4.6 days on the average. The fracture was fixed with Kirschner's wires (Kw) in 53 cases, a Kirshcner's wire and a hook-nail in five cases and a Kirchner's wire and a spongious screw in two patients. In May 2001, 23 patients were available for evaluation after a follow-up period of 6 to 120 months. METHODS: The patients underwent clinical and radiographic examination and filled a questionnaire. The fracture type was defined on the basis of the Essex-Lopresti classification system. Outcomes were scored according to the Creighton-Nebraska Health Foundation rating system that assessed pain, range of motion, edema, a change in shoe size, patient's activity after therapy termination and return to a job. RESULTS: In May 2001, 23 patients, with a follow-up ranging from 6 to 120 months were checked up. Of them, 20 (86.9%) had neither clinical manifestations nor subjective complaints. Three patients retired because of persisting complaints, two with disability pensions and one with an old-age pension. A total of 19 patients were evaluated by the Creighton-Nebraska Health Foundation rating system. The average score was 90.8 points. The results were excellent in 15 patients, good in three and poor in one patient. The complications reported by the patients included superficial infection in two, thromboembolic disease in one, and hypesthesia on the medial side of the leg in two patients. DISCUSSION: The optimal mode of treatment in dislocated intra-articular fractures of the calcaneus still remains open to discussion. Should conservative or surgical therapy be used? In agreement with others, the authors preferred early surgical intervention. This facilitated a better congruence of the dorsal articular surface. The average remaining dislocation of the articular surface was 1.1 mm in surgically treated as against the average of 4.7 mm in conservatively treated patients. It was possible to restore the length, height and width, and the correct axial position of the calcaneus by this surgery from the medial approach. However, in indicated cases, the procedure required an additional intervention from the lateral approach through a mini-incision. As reported in the literature, other authors have achieved comparable, or even better results but on the basis of either the lateral or the plantar approach. The application of primary spongioplasty or primary arthrodesis of the subtalar joint is discussed. The advantages of preoperative examination by computer-assisted tomography are emphasized. CONCLUSIONS: Good outcomes of the treatment of intra-articular, dislocated calcaneal fractures depend on a correct shape and position of the dorsal articular surface of the calcaneus. The open reduction procedure from the medial approach based on the principles of McReynold's technique allowed us to accomplish both these criteria.

Calcaneus↗
PubMed2002

[Restoration of elbow joint flexion using pectoral muscle transfer in patients with arthrogryposis multiplex congenita. Part I: surgical method, rehabilitation and clinical results].

PURPOSE OF THE STUDY: In patients with type I arthrogryposis multiplex congenita, elbows are fixed in extension. The m. biceps brachii and m. brachialis are usually atrophic. The main objective of arm treatment is to restore flexion in the elbow that would enable the patient to reach the mouth with the hand as well as maintain active extension of the arm for hygienic purposes. This can be achieved by several techniques of muscle transfer. Of these, we selected and modified the method of Clark based on transfer of distal parts of the greater pectoral muscle. The aim of this study was to develop the surgical procedure in detail, to design the course of rehabilitation and to evaluate the outcomes of treatment. MATERIAL AND METHODS: The procedure for optimal transfer of three fifths of the m. pectoralis major was based on an anatomical study. In addition, a unified course of rehabilitation was developed. Between 1996 and 1999, this approach was applied to nine upper limbs in five patients (age range, 4.3 to 9 years). All the patients were evaluated in terms of their clinical state according to selected subjective and objective criteria. RESULTS: The outcomes of transfer of the m. pectoralis major were evaluated as very good and good in six cases. Active movement of the elbow was in the range of 15 degrees to 95 degrees; useful movement ranged from 40 degrees to 70 degrees. The strength of elbow flexion rated 4 or 4+. In three cases, although muscle transfer restricted active elbow extension it did not prevent the upper limb from being used for hygienic purposes. In the remaining three cases, the method failed to restore the patient's ability of reaching the mouth. The analysis of unsuccessful results showed that these were always related to a very limited pre-operative passive flexion of the elbow, restricted movement of the shoulder joint and a failure in distal fixation of the muscle transposed. DISCUSSION: Our results show that transfer of the distal three fifths of the m. pectoralis major, performed by a modified method of Clark, was an effective approach because the working capacity of this muscle was comparable with those of the m. biceps brachii and m. brachialis. Bilateral transfer enabled the patients to reach the mouth with both hands and to use the remaining elbow extension for hygienic purposes. The best function was achieved when active movement of the shoulder had permitted raising the arm above the horizontal and passive elbow flexion had been 90 degrees. Our results are comparable with those reported in the literature. The critical phase of this transfer involved fixation of the m. pectoralis major to the forearm. CONCLUSIONS: The surgical procedure for transfer of the m. pectoralis major and subsequent rehabilitation in patients with type I arthrogryposis are described in detail. Good results are achieved in patients who, pre-operatively, had passive movement of the elbow joint and active movement of the shoulder joint. The method is not suitable for patients with a markedly limited pre-operative movement of both the elbow and the shoulder in whom an alternative surgical treatment should be used.

Arthrogryposis↗
PubMed2002

[Knee joint synovectomy in treatment of juvenile idiopathic arthritis].

PURPOSE OF THE STUDY: The objective of this study was to assess short-term outcomes of knee joint synovectomy in a group of patients with juvenile rheumatoid arthritis and to present the authors' view on this approach. MATERIAL: Between 1990 and 1999, synovectomy of the knee joint was performed in a group of 46 children with juvenile rheumatoid arthritis. This group comprised 19 girls and 27 boys aged 4 to 16 years (mean 9.8 years) with all forms of the disease. A total of 85 synovectomy procedures, including repeat operations, were performed on 58 knee joints. METHODS: Arthroscopic synovectomy was used to treat 21 knee joints, open synovectomy from two approaches was indicated, as a primary procedure, in 37 knees. The assessment of subjective and functional conditions of patients was based on a modified rating systems of Lysholm and X-ray films were evaluated by the Larsen classification. The evaluation was carried out at 1 and 2 years after the primary operation. RESULTS: Articular lesions corresponding to mere synovitis were found in 10 knee joints (17.2%), a developing pannus without erosion was seen in 16 (27.6%) and erosion of the articular surface in 32 (55.2%) knee joints. At 1 year, the value of Lysholm's score rose from 47.9 to 84.3 points and was followed by a decrease to 73.2 at 2 years. Within 2 years of the primary operation, the condition recurred in 9 out of 21 knees (42.8%) treated by arthroscopic synovectomy and in 12 cases (32.4%) operated on by open synovectomy. The relapse was observed mostly in patients with an overall high inflammatory activity and polyarticular and systemic progression of the disease. DISCUSSION: We do not agree with the view of some authors that surgical intervention is not indicated until erosions are radiologically manifested. In children, erosions usually present at a late stage, as shown by 12 findings of articular surface destruction in our group that were not detected by radiography. For indication purposes, we distinguished between preventive and therapeutic synovectomy. We found a significant association between the overall activity and early recurrence of the disease. In 60.7% of the cases (28) with excellent outcomes, this activity was low at the time of surgery. On the other hand, in 75% of the cases (8) with poor outcomes, the activity of disease was very high and had a lasting tendency to recur. These findings are in agreement with the conclusions of several other authors who consider the presence of systemic disease to be a contraindication for synovectomy. Advantages of arthroscopic synovectomy reported in adult patients seem to be relative in children. A good view of and accessibility to individual articular components, which are made an advantage of in the adult knee, are rather exceptional in the "tight" child knee. The evaluation of our patients at a short-term follow-up did not give convincing results although the early effect of synovectomy was very good. The poor outcomes seen in our group, which corresponded with observations of other authors, allow us to learn more about the potentials of synovectomy and thus to promote our policy of a thorough consideration of indications for surgery. CONCLUSION: Indications for surgical treatment in patients with juvenile rheumatoid arthritis are evaluated in cooperation with a rheumatologist after an appropriate conservative therapy administered for at least 6 months. Cases with clear signs of plastic synovitis and skeletal lesions shown by radiography as well as all recurrent conditions are treated by open synovectomy. The state of low disease activity is preferred for surgical intervention. It has to be borne in mind that, from whole range of curative procedures, conservative therapy supervised by a pediatric rheumatologist is the method of choice.

Adolescent↗
PubMed2001

[Indications for the cementless Zweymuller Bicon cup in acetabular fractures].

PURPOSE OF THE STUDY: The aim of the study is an assessment of short-term results after the implantation of cementless Zweymüller Bicon cup in patients with a complicated anatomy after acetabular fractures. MATERIAL: The group of 10 patients indicated for Zweymüller cementless THR in post-traumatic osteoarthritis after acetabular fracture was selected of the total number of 703 primary implantations performed in 1998 and 1999 at the authors' Orthopaedic Department. The group includes patients treated conservatively as well as by means of open reduction and fixation. METHODS: For the evaluation we used Harris Hip Score and radiographic assessment based on radiographs in two projections on which signs of implant loosening and incidence of particular ossifications were monitored. RESULTS: Harris Hip Score was in 6 cases higher than 90 points, in 2 cases its value was 80 points. The low score in another 2 patients related to the limitation of the function resulting from the trauma and in one case from the injury of sciatic nerve during open reduction and fixation with a subsequent common peroneal nerve palsy. Radiographic check did not reveal any signs of loosening of the implant. Within the evaluation of particular ossifications the finding was 3 times classified in Group 1 and twice in Group 2. DISCUSSION: The number of patients of the authors' group corresponds with the numbers of patients presented in literature, however, due to a short time of the follow-up both clinical and radiographic results in our group are better. In all cases a good primary stability and position of the acetabular cup in the complicated anatomical conditions was obtained. Structural bone grafting was not necessary in any of the cases. Peroperative complications were not encountered. CONCLUSION: Short-term results of our small group of patients are very good. Both in the clinical and radiographic evaluation they correspond with the results of Zweymüller THR performed in patients with dysplastic acetabulum.

Acetabulum↗
PubMed2001

[The Zweymuller endoprosthesis in hip joint revision surgery].

PURPOSE OF THE STUDY: The aim of the study is the verification of the applicability of the Zweymüller system of total hip replacement in dependence on the size of defects of acetabulum and femur and evaluation of early results in patients operated on in 1998 and 1999. MATERIAL: In 1998 and 1999 we reimplanted 125 total hip replacements. In 60 revision surgeries we used at least one component of Zweymüller Bicon Plus system. We prospectively followed defects of acetabulum and femur in DGOT classification. The size of the stem was planned, final indication of the cup was determined peroperatively. METHODS: During the implantation of the cup we tried to achieve primary stability of the implant. The cup was implanted in uni- and bisegmental defects. In total we implanted 50 Bicon cups, in 24 hip joints we applied morselized allograft in the defect. In tri-segmental defects we used twice the Burch Schneider cage and in 4 hip joints a bone allo-graft with a cemented cup in combination with SL-Plus stem. In one female patients after the implantation of Bicon cup in type 7 defect there occurred an early failure. When removing bone cement we preferred fenestration of the cortical bone of the femoral shaft. In 30 hips SL-Plus stem was used and in 13 hip joints SLR-Plus was applied. We checked 50 hip joints operated on by the method after Harris and by radiographs in two projections. RESULTS: Fifteen patients are without pain, 14 patients take analgesics. The final result is excellent in 24% of patients, good result in 32%, satisfactory in 24% and poor in 20% of patients followed up. By comparison with HHS value prior to the surgery HHS got worse in two patients who are not satisfied with the result of the operation. Average score prior to surgery was 47.4 points (range, 23-82.6). Five times we encountered a radioluscent line of acetabular component in zone III. Radiograph signs of loosening of the cup or stem were not found in any of the hip joints. CONCLUSION: Zweymüller system is applicable in revision surgeries of both cemented and cementless hip joint replacements. The cup may be applied in uni-segmental and bi-segmental acetabular defects under the condition of achievement of primary stability. Applied morselized bone allografts have a good potential for osteointegration and remodeling. The rectangular stem is suitable for the treatment of defects extending as far as 5 cm below the level of lesser trochanter. Bone cement was extracted from fenestration, transfemoral approach was not required in any of the patients. Even with the use of SLR (revision) stem we did not transfer fixation of the femoral component to the lower half of femur.

Acetabulum↗
PubMed2001

[Revision of total hip replacement operations at the Orthopedic Clinic IPVZ in Prague, 1999].

PURPOSE OF THE STUDY: The aim of the work is to evaluate the results of revision surgeries of total hip replacements at the Orthopaedic Department IPVZ in 1999. MATERIAL: Revision surgery of 61 THR was performed at the Orthopaedic Department IPVZ in 1999. Most of them (54) were reoperated for aseptic loosening of the cup or both components, 4 patients for aseptic loosening of the stem, 1 patient was reoperated for recurring dislocation of THR and 2 patients for septic loosening. Eleven loosened 44/32 Poldi cups were reoperated on average after 160 months, twelv 49/32 Poldi cups on average after 143 months and seven 54/32 Poldi cups on average after 111 months. Sixteen loosened Walter Motorlet cups were reoperated on average after 111 months, 16 loosened Walter-Motorlet cups were revised on average after 83 months, 3 Martin cups on average after 112 months. Another 4 cementless cups of different provenance were reoperated in the interval of 9-54 months after the primary operation. METHODS: For the revision surgery we used 28 times Zweymüller Bicon cementless cup and in 26 hip joints Poldi cemented cup, in 6 patients we applied structural bone allografts, in 31 patients morselized allografts prepared on a bone mill. For the revision surgery of loosened stems we used in 18 patients Zweymüller SL Plus stem and in 7 patients Zweymüller SLR stem. DISCUSSION: From the viewpoint of long-term results THR implanted in patients with a secondary postdysplastic osteoarthritis is more risky than in the patients with a primary degenerative affection of the joint. It has been proved that also a cemented total hip replacement may bring good long-term results comparable with the results of some cementless implants. CONCLUSION: In most of the patients the primary diagnosis was postdysplastic osteoarthritis of the hip joint. Recently the need has started to grow for revision surgery in patients with loosened modern cementless implants. In revision surgeries the system of cementless THR of Zweymüller type proved suitable. The need for the application of bone allografts was quite frequent.

Aged↗
PubMed2000

Congenital pseudarthrosis of the tibia: history, etiology, classification, and epidemiologic data.

Congenital pseudarthrosis of the tibia is a rare disease with a variable history. The pseudarthrosis is usually not present at birth (and therefore is not truly congenital) but occurs during the first decade of life. Paget in 1891 was the first to describe a case. The etiology is unknown. Neurofibromatosis plays a role in approximately 50% of patients. In the others, hereditary and mechanical factors are debated. Various (morphologic) classification systems have been proposed (Andersen, Boyd, Crawford). Because the appearance changes during the course of the disease, all classification systems have limited value: the determining factor is the stage of the disease at which it was classified. Because of the rarity of the disease and the variability of its history, the European Pediatric Orthopaedic Society decided to carry out a multicenter study on this disease. This paper presents the epidemiologic data on the patients involved. Data have been gathered on 340 patients from 13 countries. Two hundred patients were male (58.8%), 140 were female (41.2%). The right side was affected in 165 patients (48.5%) and the left side in 172 (50.6%); 3 patients had bilateral disease. Symptoms of neurofibromatosis were present in 54.7%. Histologic examinations in 192 patients showed a nonspecific appearance in 45.3%; in 15.6% the ultrastructure resembled fibrous dysplasia, and in 39% there was histologic evidence of neurofibromatosis. Most of the lesions were initially localized in the middle or distal third of the tibia. In 29% the localization changed during the course of the disease.

Child↗
PubMed2000

The fibula in congenital pseudoarthrosis of the tibia: the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

Fibular involvement in congenital pseudoarthrosis of the tibia (CPT) can be either a rare isolated pathology or is in association with the tibial changes. Out of 282 patients with CPT who had complete radiographic work-up, 62% (almost two thirds) demonstrated fibular pathology: 36% had true fibular pseudoarthrosis and the rest, i.e., 26% had fibular hypoplasia or dysplastic fibula. Neurofibromatosis was found in 62% of the patients with fibular pathology. The typical radiological features of tibial pseudoarthrosis are often missing in patients with fibular pathology. It is most probably because fibular changes precede the tibial involvement. In 250 patients with tibial surgical treatment, the highest rate of fusion occurred in patients with fibular involvement compared with those with normal fibula.

Child↗
PubMed2000

Treatment approaches for congenital pseudarthrosis of tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This study was designed to analyze the different therapeutic methods used by European Paediatric Orthopaedic Society members from 13 countries for congenital pseudarthrosis of tibia. The treatment data of 340 patients who underwent 1287 procedures for this condition were analyzed. The essential findings were that the method of choice needed to approach the biological problem with the aims of: (1) resecting the pseudarthrosis to provide stability, the basic requirement for bony consolidation; (2) correcting length discrepancy and axial deformity; (3) achieving fusion; and (4) solving the additional problems around the main deformity such as alignment, leg length discrepancy and ankle valgus. The Ilizarov technique emerged as being the optimal method, having the highest rate of fusion (75.5%) of pseudarthrosis and rate of success in correction of the additional deformities. There was also consensus that surgery should be avoided before the third year of life.

Adolescent↗
PubMed2000

Free vascular fibular transfer in congenital pseudoarthrosis of the tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This paper presents a review of the literature, describes the principal author's (B.R.) personal experience and provides the results of the European Paediatric Orthopaedic Society (EPOS) multicenter study. The objective is to evaluate the present status and future role of free vascular fibular transfer in treating congenital pseudoarthrosis of the tibia. Variables such as the selection of cases, age at operation, technical surgical details and postoperative results will be considered. The data on the EPOS study were incomplete at the time of writing, but the considerable amount of information already amassed is a valuable contribution to this updated report.

Child↗
PubMed2000

Functional results at the end of skeletal growth in 30 patients affected by congenital pseudoarthrosis of the tibia.

From a multicentric study on Congenital Pseudoarthrosis of the tibia (CPT) conducted on 340 patients, we evaluated the functional results on a group of thirty patients who were at the end of skeletal growth (age < or = 16 years). The prognosis of CPT is very much related to the radiologic classification. Crawford type 2 and Crawford type 4 pseudoarthrosis have a worse prognosis, with a lower percentage of fusion at the site of pseudoarthrosis. Crawford 4 patients have the worst functional results. Most of them showed a severe leg length discrepancy, needed a permanent brace, with an ankle joint function fair or poor. The presence of fibula pseudoarthrosis seems to be responsible for most of the worst functional results. The level of deformity caused by either the natural course of the disease or its treatment, is decisive in the evaluation of the functional results.

Adolescent↗
PubMed1993

[Results of surgical repositioning of congenital hip dislocation].

The authors submit an analysis of the results of surgical treatment of inborn dislocation of the hip joint in children from the age of one year to completed growth. Decisive for inclusion into this group was surgical reposition. The operated patients were divided into the following three groups by age at the time of operation: 1. first year up to 17 months; 2. 18 to 48 months; 3. patients older than 4 years up to 15 years. Between 1978 and 1992 96 children with inborn dislocation of the hip joint were operated (103 hip joints). Complete documentation was available for 59 hip joints of 54 patients. The follow up period varies between 1 and 14 years after operation. In the first group 24 hip joints of 21 patients were checked, the average age at the time of operation being 8 months. In 17 hip joints at the same time subtrochanteric osteotomy with abbreviation was performed. In these operated hip joints surgical reposition was preceded by distraction either using the "overhead" system or the Pavlanský's method. All hip joints in this group were operated from an anterolateral approach according to Scaglietti's principles. In the second group 19 hip joints of 16 patients were checked, the mean age at the time of operation being 28 months. A standard component of the operation was in addition to surgical reposition also pelvic osteotomy according to Salter's method, in 16 cases at the same time derotation varus osteotomy was performed. The third group comprises 16 hip joints of 15 patients operated at an average age of 9 years and 8 months. Fourteen of the hip joints had been operated previously at least once by different methods. In acetabular dysplasia different techniques were used, most frequently Chiari's osteotomy. The surgical reposition proper was preceded in four instances of high iliac dislocation by preoperative distraction by external fixation. For evaluation of the results clinical and radiological parameters were used, essentially identical with Severin's classification. X-ray evaluation was supplemented y values of the distance between the head and Köhler's protrusion. The best clinical and X-ray results were achieved in the first group; wih the number of previous operations and advancing age the perspective of excellent results declines. In the group as a whole five, i. e. 8.5%, avascular necroses were recorded. From the total number of operated patients good radiological results were achieved in 83%, 17% of the results are considered satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1993

[Juvenile proximal femoral epiphysiolysis--review of the problems and results of surgical therapy].

The authors describe the aetiology and different types of a serious affection of the hip joint which occurs during adolescence--juvenile proximal femoral epiphysiolysis. They describe surgical methods used in non-dislocated and dislocated conditions of this affection of the adolescent hip joint. In the course of ten years at the Orthopaedic Clinic of the Institute of Postgraduate Medical Training a total of 88 epiphysiodeses and stabilizations of the proximal femoral epiphysis were performed, 32 osteotomies at the level of the trochanter minor according to Southwick's method, two osteotomies by Imhäuser-Weber's method and in 42 patients the epiphysiolysis was treated by subcapital osteotomy by Dunn's method. The authors emphasize accurate and early diagnosis of the disease and selection of correct surgical tactics. Adjustment of the anatomical conditions in the hip joint with restoration of articular congruence creates perspectives of its optimal function.

Adolescent↗
PubMed1993

[Wedge resection of the metatarsal head in Freiberg-Köhler disease].

The authors describe a group of 13 patients where during treatment of aseptic necrosis of the head of the metatarsal bone a new surgical method was used--wedge-shaped resection of the head. They describe the aetiology, surgical technique and results. This surgical technique is used at the Orthopaedic Clinic of the Institute for Postgraduate Medical Training Prague-Bulovka since 1987. In the discussion the authors evaluate the disadvantages of hitherto used surgical techniques and compare the methods with the method they use. In the conclusion the achieved results are evaluated which justify wider use of the described method in routine practice of orthopaedic departments.

Adolescent↗