Pirminis mišraus ir mechaninio tvirtinimo klubo sąnario endoprotezavimas. Vėlyvieji 5–10 metų rezultatai

Jaunius Kurtinaitis, Narūnas Porvaneckas, Manvylius Kocius, Rimvaldas BrogaVilniaus universiteto Ortopedijos-traumatologijos ir plastinės chirurgijos klinikaVilniaus greitosios pagalbos universitetinė ligoninėŠiltnamių g. 29, LT-2043 Vilnius.El paštas: [email protected] Įvadas / tikslas Dažniausia endoprotezuoto klubo sąnario problema – gūžduobinio komponento intarpo susidėvėjimas arba jo išklibimas. Vieni autoriai pripažįsta cementinio, kiti – mechaninio tvirtinimo metodiką. Abiem atvejais vėlyvieji rezultatai yra panašūs. Kiekviena metodika tam tikru endoprotezuoto sąnario laikotarpiu išryškina jai būdingas problemas. Mūsų darbo tikslas – įvertinti vėlyvuosius mišraus ir mechaninio tvirtinimo klubo sąnario pirminio endoprotezavimo rezultatus po operacijos praėjus 5–10 metų. Ligoniai ir tyrimo metodai 1993–1998 metais VGPUL Ortopedijos, traumatologijos ir plastinės chirurgijos klinikoje buvo operuoti 36 ligoniai, kuriems buvo atliktos 39 pirminės klubo sąnario endoprotezavimo operacijos naudojant Bi-Metric mechaninio ir mišraus tvirtinimo endoprotezus (EP). Į tyrimą įtraukti 27 ligoniai (29 endoprotezai – 18 mechaninio ir 11 mišraus tvirtinimo), 2002–2003 metais atvykę pasitikrinti. Vidutinis pacientų su mechaninio tvirtinimo protezais stebėjimo laikas (mediana) siekė 7 metus, o su mišraus tvirtinimo – 5 metus. Visiems atvykusiems pacientams buvo atliktos ir įvertintos priekinės abiejų klubo sąnarių rentgenogramos, nustatyta klubo sąnario funkcija pagal Harris Hip Score skalę. Rezultatai 2002–2003 m. ištirta 29 (80%) iš 36 ligonių, operuotų 1993–1998 m. Rentgenologinių tyrimų rezultatai parodė, kad aplink mechaninio tvirtinimo komponentus linijinės demarkacijos nėra. Visi komponentai buvo stabilūs. Kaulas įaugo į mechaninio tvirtinimo komponentus 100% atvejų. Įvertintos osteolizinio proceso aplink gūžduobinį ir šlaunikaulinį komponentus ypatybės, polietileninio intarpo susidėvėjimo prognozės veiksniai atsižvelgiant į endoprotezo tipą, ektopinė osifikacijos įtaka vėlyviesiems klubo sąnario funkciniams rezultatams. Išvados Įvertinti pagal HHS skalę mechaninio ar mišraus tvirtinimo endoprotezavimo rezultatai po 5–10 metų yra geri ir labai geri. Lyginant rentgenologinius pokyčius aplink gūžduobinį ir šlaunikaulinį komponentus matyti, kad pokyčiai aplink mechaninio ir cementinio tvirtinimo šlaunikaulinius komponentus yra gerokai mažesni negu aplink gūžduobinius. Statistiškai patikimo skirtumo tarp polietileno intarpo susidėvėjimo ir panaudoto endoprotezo tipo nebuvo. Gūžduobinio ir šlaunikaulinio komponentų osteoliziniai procesai yra besimptomiai. Šie procesai ir 76% atvejų nustatyta ektopinė osifikacija neturi įtakos geriems ir labai geriems vėlyviesiems operuoto klubo sąnario funkciniams rezultatams. Prasminiai žodžiai: pirminis klubo sąnario endoprotezavimas, mechaninio tvirtinimo endoprotezai, mišraus tvirtinimo endoprotezai. Primary hybrid and cementless total hip arthroplasty. 5 to 10 year follow-up results Jaunius Kurtinaitis, Narūnas Porvaneckas, Manvylius Kocius, Rimvaldas Broga Background / objective The major issue of hip arthroplasty is the wearout or loosening of the acetabular component. Some authors prefer cemented and others cementless hip arthroplasty. In both cases the outcome is similiar. Each method in different periods has its own problems. The aim of the study was to evaluate the late outcome of primary cementless and hybrid total hip replacement 5–10 years after operation. Patients and methods There were 36 patients operated on and 39 operations of primary total hip arthroplasty performed using Bi-Metric hybrid and cementless endoprostheses in 1993–1998. The study included 27 patients (29 endoprostheses) who responded to invitation in 2002–2003. Anteroposterior radiographs of the hip joints were performed for the patients and the functional outcome was evaluated using the Harris Hip score scale. Results During 2002–2003 investigation was carried out on 29 (74%) of 36 hip arthroplasties performed in 1993–1998. Analysis of the data showed no radiolucency signs around the cementless fixation components. All of the components were stable. Bone ingrowth into the cementless prosthesis components was observed in 100% of cases. The osteolysis zones around the acetabular and femoral components were related to the wearout of polythene insertion, but it was asymptomatic. There was no reliable difference between polythene insertion wearout and the type of prosthesis. Ectopic ossification was observed in 76% of cases. Conclusions The study based on HHS score revealed good and very good results 5–10 years after operation. They were comparable with the findings in similar studies. Rentgenological features indicated that there were less alterations around the femoral component compared to the acetabular. Osteolysis around the femoral and acetabular components was asymptomatic and ectopic ossification found in 76% of cases did not interfere with the good functional results. Keywords: primary total hip arthroplasty, cementless prostheses, hybrid prosthese

Blauzdikaulio diafizės osteosintezė intrameduline vinimi su skersiniu tvirtinimu

Blauzdikaulio diafizės osteosintezė intrameduline vinimi su skersiniu tvirtinimu: pirmųjų metų patirtis ir rentgenologinė analizė Jaunius Kurtinaitis, Valentinas Uvarovas, Rimvaldas Broga, Manvilius KociusVilniaus universiteto Bendrosios, plastinės chirurgijos,ortopedijos ir traumatologijos klinikaVilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Įvadas / tikslas Blauzdikaulio osteosintezė intrameduline užrakinama vinimi yra plačiai naudojama kaip pirmo pasirinkimo metodas uždariems ir atviriems blauzdikaulio diafizės lūžiams gydyti. Mūsų klinikoje šis metodas buvo pradėtas taikyti 2004 m. gegužę. Dažniausios metodo komplikacijos yra ašinės deformacijos. Darbo tikslas – retrospektyviai įvertinti blauzdikaulio ašį frontalinėje ir sagitalinėje plokštumoje po osteosintezės, technines komplikacijas operacijos metu, klaidų skaičiaus bei operacijos trukmės priklausomybę nuo atliktų operacijų skaičiaus, klaidų pasiskirstymą pagal lūžių lokalizaciją ir atliekant reosteosintezę dėl pseudartrozės. Ligoniai ir metodai 2004–2005 metais VGPUL Bendrosios ir plastinės chirurgijos, ortopedijos-traumatologijos klinikoje 20 chirurgų 78 pacientams atlikto 80 blauzdikaulio diafizės osteosintezių intrameduline vinimi su skersiniu tvirtinimu. Atliktos 68 pirminės sintezės dėl lūžių, 12 reosteosintezių – dešimt dėl pseudoartrozės ir dvi dėl lūžio ir plokštelės pasislinkimo. Atlikta blauzdos rentgenogramų frontalinėje ir sagitalinėje plokštumoje analizė. Didesnė nei 5° deformacija vertinta kaip nepatenkinama. Rezultatai Įvertinta 71 (69 pacientų) blauzdų rentgenograma po operacijos. Nepatenkinami ašies matavimo rezultatai buvo 13 (16,3%) atvejų. Blogiausi rezultatai gauti po blauzdikaulio proksimalinio trečdalio ir segmentinių lūžių osteosintezių. Techninio pobūdžio operacijų komplikacijos buvo 10 atvejų (12,5%). Klaidų skaičius, lyginant pirmas ir paskutines 40 operacijų, reikšmingai (p = 0,04) priklauso nuo patirties – atliktų operacijų skaičiaus. Išvados Proksimalinio blauzdikaulio trečdalio ar segmentinių lūžių su trumpu proksimaliniu fragmentu osteosintezė turėtų būti atliekama naudojant pusiau ištiestos kojos poziciją ir (ar) blokuojančius sraigtus. Geriausi rezultatai pasiekti atliekant blauzdikaulio vidurinio trečdalio osteosintezę. Atliekant distalinio trečdalio osteosintezę reikėtų tinkamai centruoti vinį blauzdikaulio kanale. Operacijos trukmė ir klaidų skaičius mažėja didėjant atliktų operacijų skaičiui. Reikšminiai žodžiai: blauzdikaulio lūžiai, pseudoartrozė, intramedulinė vinis, osteosintezė, ašinė deformacija Locking intramedullary nailing of tibial shaft: first-year experience and Radiographic analysis Jaunius Kurtinaitis, Valentinas Uvarovas, Rimvaldas Broga, Manvilius KociusVilnius University Clinic of General, Plastic Surgery,Orthopaedics and TraumatologyVilnius University Emergency Hospital,Šiltnamių str 29, LT-04130 Vilnius, LithuaniaE-mails: [email protected] Background / objective Locked intramedullary nailing for open and closed tibial shaft fractures is widely used as a first choice method of treatment. In our clinic, the first operation of this type was performed in May 2004. The most common complication of this method of treatment is malalignment. The goal of the study was evaluation of the tibial axis after nailing in the frontal and sagittal planes, technical complications, correlation between duration, number of errors and operation count, malalignment distribution according to fracture localization and reosteosynthesis of nonunion. Patients and methods Between May 2004 and May 2005, 20 surgeons performed 80 operations of interlocking nailing of tibial shaft for 78 patients. There were 68 primary operations for acute fractures and 12 secondary: 10 for nonunion and 2 for fracture and plate migration. Radiographic analysis in the frontal and sagittal planes was performed. Malalignment was defined as a 5° angulatory deformity in any plane. Results 71 (69 patients) tibia were available for radiological analysis. Malalignment occurred in 13 cases (16.3%). The worst results were observed in proximal 1/3 and segmental fractures. Technical complications were seen in 10 (12.5%) cases. Error mean difference comparing the first and the last 40 operations was significant (p = 0.04). Conclusions Nailing a proximal or segmental fracture with a short proximal fragment, the semiextended position and/or blocking screws should be used. The best results were observed nailing middle 1/3 tibial fractures. Good nail alignment is important performing distal 1/3 tibial fracture nailing. Average error count and duration depends on the number of procedures performed. Key words: tibial fractures, nonunion, intramedullary nailing, osteosynthesis, malalignmen

Primary hybrid and cementless totai hip arthroplasty. 5 to 10 year follow-up results

Background / objective. The major issue of hip arthroplasty is the wearout or loosening of the acetabular component. Some authors prefer cemented and others cementless hip arthroplasty. In both cases the outcome is similiar. Each method in different periods has its own problems. The aim of the study was to evaluate the late outcome of primary cementless and hybrid total hip replacement 5–10 years after operation. Patients and methods There were 36 patients operated on and 39 operations of primary total hip arthroplasty performed using Bi-Metric hybrid and cementless endoprostheses in 1993–1998. The study included 27 patients (29 endoprostheses) who responded to invitation in 2002–2003. Anteroposterior radiographs of the hip joints were performed for the patients and the functional outcome was evaluated using the Harris Hip score scale. Results During 2002–2003 investigation was carried out on 29 (74%) of 36 hip arthroplasties performed in 1993–1998. Analysis of the data showed no radiolucency signs around the cementless fixation components. All of the components were stable. Bone ingrowth into the cementless prosthesis components was observed in 100% of cases. The osteolysis zones around the acetabular and femoral components were related to the wearout of polythene insertion, but it was asymptomatic. There was no reliable difference between polythene insertion wearout and the type of prosthesis. Ectopic ossification was observed in 76% of cases. Conclusions: The study based on HHS score revealed good and very good results 5–10 years after operation. They were comparable with the findings in similar studies. Rentgenological features indicated that there were less alterations around the femoral component compared to the acetabular. Osteolysis around the femoral and acetabular components was asymptomatic and ectopic ossification found in 76% of cases did not interfere with the good functional results

Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures

Mortality After Femoral Neck Fractures: A Two-Year Follow-up

Background and Objective. To identify the survival and standardized mortality ratio with respect to gender, age, and treatment method of patients treated for femoral neck fractures. Material and Methods. A retrospective review of medical records of 736 patients treated for femoral neck fractures at Vilnius University Emergency Hospital during 2004–2006 was carried out. Results. The overall 1- and 2-year survival rates were 77.4% and 67.1%, respectively. Lower survival rates were observed in the internal fixation group than in the primary and secondary total hip arthroplasty groups (63.2% vs. 72.0% and 75.1%). Cox proportional hazards model analysis showed patient age to be a significant risk factor for survival (hazard ratio, 1.05; 95% CI, 1.04– 1.07; P<0.001). The overall standardized mortality ratio was 2.50. The standardized mortality ratios for men and women were 3.07 and 2.27, respectively, but the difference between these groups was not significant. Conclusions. Standardized mortality and survival rates decreased with increasing patients’ age. Significantly lower survival rates were documented in the internal fixation group as compared with primary and secondary total hip arthroplasty groups. There was a trend toward a higher standardized mortality ratio in men than women, but the difference was not significant

Reciprocal haematogenous osteomyelitis of the femurs caused by Anaerococcus prevotii: a rare case report

Introduction: Haematogenous osteomyelitis is an extremely rare disease occurring in adults, especially in developed countries. It is clearly a systemic infection, because bacteraemia spreads over proximal and distal long bones or paravertebral plexuses, resulting in acute or chronic bone infection and destruction. [1] Case summary: A 46-year-old Caucasian male was complaining of a left thigh pain. It is known from the anamnesis that the patient developed severe pneumonia three months ago before the onset of these symptoms. The patient was diagnosed with haematogenous osteomyelitis, which developed a turbulent course and required complex combination therapy. The primary pathogen is thought to be Anaerococcus prevotii, which caused pneumonia before the onset of signs of osteomyelitis. Unfortunately, due to the complexity of identifying anaerobes and contributing nosocomial infections, the primary pathogen was not extracted immediately. After the manifestation of this disease, pathological fractures occurred in both femurs, as well as purulent processes in the lungs and molars accompanied. The patient received broad-spectrum antibiotic therapy and countless amounts of orthopaedic and reconstructive surgeries, but no positive effect was observed. The patient underwent osteosynthesis using an Ilizarov’s external fixation apparatus, re-fixations, external AO, debridements, intramedullary osteosynthesis with a silver-coated intramedullary nail, abscessotomies. The right femur healed completely after the pathological fracture and osteomyelitis did not recur. Left femur could not be saved due to non-healing, knee contracture and bone destruction. After almost three years of struggle, it was decided to amputate the left limb, after which the signs of osteomyelitis no longer appeared. Conclusions: To sum it all up, more serious or chronic osteomyelitis requires surgery to remove the infected tissue and bone. Osteomyelitis surgery prevents the infection from spreading further or getting even worse up to such condition that amputation is the only option left

Functional outcomes and quality of life after surgical treatment of spinopelvic dissociation: a case series with one-year follow-up

Spinopelvic dissociation is a transverse sacral fracture in conjunction with a vertical fracture of the sacrum on both sides, which causes the dissociation of the upper sacrum and spine from the pelvis. The most common causes of these fractures are high energy injuries such as falls from height or motor vehicle accidents. Spinopelvic dissociation is rare and heterogenous with severe associated injuries. The aim of this study was to assess the injury characteristics, changes in the quality of life and functional outcomes in the 1-year period after spinopelvic dissociation