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PURPOSE OF THE STUDY Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients’ preoperative difficulties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated – especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients’ clinical outcomes and difficulties. MATERIAL AND METHODS The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease – lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. RESULTS In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically significant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically significant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A significant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically significant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignificant. DISCUSSION The authors confirmed significant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confirm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the findings of other published manuscripts. The authors failed to confirm a significant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. CONCLUSIONS Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically significant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Superior Capsule Reconstruction (SCR) of the shoulder joint has recently been included in the portfolio of interventions as a solution to irreparable rotator cuff tears. One of the options is to use a long head of the biceps tendon (LHBT) autograft. This paper presents the fi rst clinical outcomes of the SCR of the shoulder joint using the LHBT autograft. MATERIAL AND METHODS It is a prospective non-randomised study in which 14 patients were included, namely 7 men and 7 women. The patients were evaluated using the pain VAS, UCLA (The University of California at Los Angeles) Shoulder Rating Scale and ASES (The American Shoulder and Elbow Surgeons) Shoulder Score. The minimum follow-up was 12 months after surgery. The measured values were analysed using the standard statistical methods. RESULTS From August 2020 to January 2022, a total of 14 SCR with biceps tendon autograph were performed at our department. The mean age of the patients was 62 years (40–72). The mean value of the UCLA Shoulder Score was 12.36 ± 2.92 points preoperatively, while after surgery the obtained values increased to the mean value of 28.86 ± 3.08 points. The ASES score was 25.48 ± 3.89 points preoperatively and 82.41 ± 7.95 points at one year after surgery. The preoperative mean VAS score was 6.14 ± 1.10 points and 1.36 ± 0.93 points at one year after surgery. The mean active shoulder fl exion measured preoperatively was 140 degrees, whereas at one year after surgery it was 171 degrees. The mean active abduction reached 123 degrees before surgery and 169 degrees after surgery. The mean active external rotation of the shoulder joint was 59 degrees preoperatively and 52 degrees postoperatively. The mean active external rotation at 90 degrees of abduction was 52 degrees preoperatively and 60 degrees postoperatively. Whereas the improvement as against the preoperative status measured by the UCLA, ASES and pain VAS was signifi cant, the differences in the range of motion were signifi cant in the case of active fl exion and abduction only. DISCUSSION Painful irreparable rotator cuff tear constitutes an indication for SCR. The reconstruction is performed using autografts, allografts and xenografts. In literature, several SCR surgical techniques using a long head of the biceps tendon have been presented. In most of these techniques the supraglenoid insertion of the LHBT was left intact. Our study showed a signifi - cant relief from problems and good functional outcomes at 1 year after surgery when the biceps tendon had been used. Similar results are reported also by other studies using the biceps tendon for SCR. When comparing this study and the other study we published earlier on SCR with xenografts, there is no signifi cant difference in the clinical outcomes between these two techniques. On the very contrary, they are slightly better in some parameters. CONCLUSIONS Arthroscopic SCR of the shoulder joint with the biceps tendon reports good clinical outcomes at one year after surgery both with regard to the relief from problems and range of motion. Due to low morbidity of graft harvesting, low cost, and easy surgical technique, it appears to be the fi rst-choice method for superior capsule reconstruction of an irreparable tear of supraspinatus or infraspinatus if the long head of the biceps tendon is preserved. A longer follow-up period and evaluation of a larger study population would be necessary to defi nitely confi rm the success rate of the described procedure. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The primary aim is to assess the proportion of children younger than two years with a femoral fracture who underwent a skeletal survey. The secondary aim of the study is to evaluate the patients’ demographics, reported trauma mechanism, type of fracture, type of treatment and complication rate. MATERIAL AND METHODS This was a retrospective study of children younger than two years examined at the Department of Imaging Methods for a femoral fracture between 2015-2022. The type and site of the fracture were assessed on radiographs. The patient's medical records were used to assess which steps had been taken to evaluate for possible abusive etiology of the fracture. The data were correlated with the published guidelines for performing skeletal survey in young children with fractures. The patient's demographics, medical history, time interval from trauma or symptoms onset to medical examination, type of treatment, duration of orthopaedic follow-up in addition to the clinical findings at the last orthopaedic follow-up visit were also retrieved from the patients’ medical records. RESULTS A total of 40 children were included in the study, 21 of whom were girls (52.5%). The mean age was 13.8 months. 5 children (12.5 %) were younger than 6 months. 36 children (90%) had a history of trauma, the vast majority of whom suffered a fall. 21 patients (52.5%) sustained a distal metaphyseal fracture, 19 patients (47.5%) suffered a diaphyseal fracture. A spica cast was used in 12 patients (30%), which was applied under general anaesthesia in most cases. 28 patients (70%) received a long leg cast. A certain degree of stiffness following cast removal was the only documented complication. Based on the published guidelines, it was estimated that in 23 patients (57.5%) a skeletal survey should have been performed. However, this investigation was performed in 2 patients (5%) of the study population only. DISCUSSION Femoral fractures in young children are rare, especially in those younger than six months of age. The fractures were located in femoral diaphysis and in distal femoral metaphysis. Surgical treatment was not required, and no significant complications were observed. Nonetheless, the study showed that the rate of child abuse screening was low. The skeletal survey was performed in two cases only, both children were younger than six months and had no history of trauma. Based on the published guidelines, however, it may be assumed that the skeletal survey should have been performed in more than half of the patients in the study. The failure to perform this investigation might have led to the abuse not being detected and the child being returned to the abusive environment. CONCLUSIONS Management of femoral fractures in patients younger than two years does not usually require hospitalisation and is not associated with the risk of complications. However, potential further harm may be caused if abusive etiology of the femoral fracture fails to be discovered. This study has shown that the rate of abuse evaluation is low. It is essential to initiate a multidisciplinary discussion on this topic to raise the physicians’ awareness and to implement the screening for child abuse among young children with femoral fractures. This scientific paper also includes a summary of necessary steps to be taken in the evaluation of a young child with a femoral fracture. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The paper focuses on the potential use of nail osteosynthesis in diaphyseal metastases of long bones. The purpose of the paper is to assess the outcomes of intramedullary osteosynthesis in pathologic and impending pathologic fractures, to evaluate patient survival and potential complications. MATERIAL AND METHODS The retrospective study evaluated a cohort of 42 patients (19 men and 23 women) in whom intramedullary osteosynthesis was performed for complete pathologic fracture (28 patients) or impending pathologic fracture (14 patients) between 2010 and 2019. Of the total number of 42 patients, 31 patients’ lower limbs were affected, namely by 17 pathologic fractures and 14 impending fractures. There were 11 humerus fractures. The mean age was 61.8 years (range 41-84 years). In the followed-up cohort, the patient survival after osteosynthesis with intramedullary nails, complications occurred and post-operative mobility of the patient were assessed. The functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system. The unpaired Mann-Whitney test was used to test the significance of the difference in functional outcomes and survival between the followed-up groups. Survival longer than 6 months was evaluated using Fisher’s exact test. The level of statistical significance used for the test was p 0.05. RESULTS The investigated indicator was patient survival, which was 11.3 months (range 1–50 months) on average. In the group of impending fractures, the mean survival was 13.5 months. In the group of pathologic fractures, the survival was 10 months. The functional outcome in 16 followed-up patients at three months after intramedullary osteosynthesis according to the MSTS score was 46.9% (30–66.7%). At the level of significance of p 0.05, the statistically significant difference in the functional outcomes between the group with preventive intramedullary osteosynthesis and the group with nail osteosynthesis of the pathologic fracture was not confirmed (p=0.952). When comparing the patient survival after nail osteosynthesis with impending pathologic fracture and the survival of patients with pathologic fracture, a statistically significant difference in survival between these two groups (p=0.520) was not confirmed. The patient survival of longer than 6 months was 71% in the group of impending fractures and 40% in the group of pathologic fractures. DISCUSSION The occurrence of pathologic fracture is associated with increased pain, loss of function, and according to some authors, a higher risk of death. Surgical treatment options include intramedullary osteosynthesis, plate osteosynthesis with cement filling, implantation of an intercalary spacer, and implantation of tumor endoprostheses. When deciding on a surgical procedure, an account is taken of the expected survival of the patient. In patients with an expected survival of up to 6 months, intramedullary osteosynthesis is indicated as a palliative surgical intervention. The most common complications include implant failure and metastatic progression. CONCLUSIONS Intramedullary osteosynthesis is the method of choice in treating pathologic fractures or impending pathologic diaphyseal fractures of long bones in patients with an expected predicted survival of up to 6 months. Intramedullary osteosynthesis aims to reduce pain and enable early verticalization. The study confirmed the importance of preventive intramedullary osteosynthesis and its effect on survival compared to the survival of patients with a pathologic fracture. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This paper aims to detect, through a retrospective study, the migration of the tips of used metal implants (K-wires or a screw) in the direction out from the proximal femoral epiphysis as a part of studied basic radiometric characteristics of the cohort, with no intention of the authors to evaluate the therapy outcomes. MATERIAL AND METHODS It was a retrospective multicentre study including patients of two orthopaedic clinics and one department of orthopaedics treated in the period 2005–2018. The same treatment procedure was used in all three centres. The “in situ” fixation was indicated in patients, in whom the Southwick angle in anteroposterior and Lauenstein views was not much greater than 30°, whether primarily due to a mild slip or thanks to careful reduction either in acute or acute-on-chronic forms. All X-rays were measured by a single author (M.S.). In AP and Lauenstein view, overlap of the implant tip (K-wire or a screw) above the subcapital growth plate, the height of epiphysis and Southwick angle are measured at the beginning and at the end of treatment. In a smaller group of patients, also the inter-observer error (M.S. and J.P.) was identified. RESULTS K-wire transfixation was used in 43 patients (50 joints), with the mean age of 11.7 years and the mean duration of transfixation of 18.2 months. The slip of the implant tip out of the head, assessed separately for each introduced K-wire and then averaged, was in both views considered statistically significant (in AP view the level of significance was 5% (p-value = 1.393 x 10^(-6) < 0.05), in Lauenstein view the level of significance was also 5% (p-value = 0.0001652 < 0.05)). The Wilcoxon signed rank test with continuity correction was used. Transfixation by screw alternatively with one K-wire was used in 23 patients (28 joints), with the mean age of 12.4 years and the mean duration of transfixation of 14.4 months. The slip of the screw tip outside the head was assessed as significant (in AP view at the level of significance of 5% (p-value = 9.41 x 10^(-5) < 0.05), in Lauenstein view at the level of significance of 5% (p-value = 0.003557 < 0.05)). The Wilcoxon signed rank test with continuity correction was used. DISCUSSION This paper aims to detect, through a retrospective study, the so-called migration of the tips of used metal implants (K-wires or a screw) outside the femoral head. Smooth and thin implants such as Kirschner wires should not compromise the continuing growth from subcapital growth plate contrary to the AO screw with threads in the femoral head, the screw head rested against the lateral cortical bone and the screw inserted as a compression one. Nonetheless, with some exceptions, the literature confirms the continued growth of the femoral neck even in the case of screws. In general, implants that do not compromise femoral neck growth provide an opportunity to remodel the anterolateral prominence of the femoral metaphysis, especially in younger patients. In agreement with other authors, the data from our study confirmed, even after a short period of time, a certain degree of proximal femoral remodelling expressed by changes in the Southwick angle. CONCLUSIONS Our study confirmed that in the case of “smooth” K-wires as well as cannulated screws the tips of both implants migrate outside the head. The differences were statistically significant. Therefore, the introduction of a conventional cannulated screw cannot be claimed to immediately produce the effect of epiphyseodesis. Yet, smooth implants less compromise the growth of the femoral neck, which is why they have recently been preferred. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Unplanned revision spinal surgeries constitute a complication in the treatment algorithm for the patient, surgeon and the entire treatment team. Any complication leading to an unplanned revision surgery is therefore undesirable. The percentage of complications referred to in publications on this topic focusing on unplanned revision surgeries only varies from 0.7% to 29.8%, with obvious diversity of causes and significant risk factors. The purpose of the submitted paper is to carry out a prospective evaluation of the most serious complications requiring unplanned revision spinal surgeries in the course of 13 years at a single department performing a broad range of spinal surgeries, namely 1300 procedures annually on average. MATERIAL AND METHODS In the period 2006 – 2018, a total of 16872 patients underwent a surgery at our department. During this period, in 556 patients an unplanned revision spinal surgery was performed. In agreement with literature, the patients were categorised by cause for revision: 1/ impaired wound suprafascial (superficial) healing – superficial infection, 2/ impaired wound subfascial (deep) healing – deep infection, 3/ surgical wound hematoma, 4/ deterioration or occurrence of new neurological symptoms, 5/ cerebrospinal fluid leak (liquorrhoea) and 6/ others. The patients operated on for inflammatory diseases of the spine with subsequent infectious complications, primarily treated at another department, and the patients with open spinal injury were excluded from the study. According to these criteria, a cohort of 521 patients was followed up, namely 236 (45.3%) women and 285 (54.7%) men, aged 1 year to 86 years, with the mean age of 55.0 years (median 60 years). Demographic effects, tobacco smoking and comorbidities were followed up in the cohort, together with the effects of surgery, diagnosis, surgical approach and physician. All parameters were statistically evaluated at a p-value below 0.05, including comparison with the control group. RESULTS Of the total number of 16872 operated patients, a group of 521 (3.09%) patients undergoing a revision surgery for complications was analysed in detail. Impaired wound healing – infection (SSI) was found in 199 (1.18%) patients, of whom superficial infection in 124 cases (0.73%) and deep infection in 75 cases (0.44%). Hematoma in a surgical site was detected in 149 (0.88%) patients. In 63 (0.37%) cases, deterioration of the existing neurological finding or occurrence of a new neurological finding were observed, in 68 (0.40%) cases cerebrospinal fluid leak was reported and in 40 (0.24%) cases other complications were identified. As concerns the surgical assistant, the percentage of complications in a board-certified physician is 2.77 (1.14 – 3.29%), in a medical resident it increases to 3.60 (0.00 – 9.38%) (p<0.05). The prevalence of smokers in the group with complications (N=521) was 34.7%. The control group (N=3650) included 30.1% of smokers (p<0.05). The mean age of patients in the group with complications (N=521) was higher, i.e. 55.0 years, with the median age of 60.0 years, than in the primary cohort (N=16872) with the mean age of 49.8 years and the median age of 52.0 years (p<0.05). The mean BMI in the group with complications was (N=521) 27.3, the median BMI was 26.9. In the control group (N=16872), the mean BMI was 27.11, the median BMI was 26.8. In this case the significance (p>0.05) was not confirmed. The complications prevailed strongly in posterior surgical approach, namely in 483 patients (92.7%). As concerns the surgically treated segment, lumber spine dominates with 320 (61.4%) cases. Corticosteroid therapy was used twice as often in women, namely in 13.1% vs. 6.3%. The group of patients with complications (N=521) showed a much higher average length of hospital stay of 12.8 days compared to the average of 4.6 days (N=16872). DISCUSSION In our cohort, the complication rate was 3.09%, of which infections constituted 1.18%, which is in agreement with similarly focused papers. As regards the patient-related factors, in our study the results reported by literature were confirmed with respect to the age, smoking and comorbidities. Moreover, the posterior surgical procedure, lumber spine surgery and presence of a medical resident are essential (p<0.05). No major age difference was observed between women and men (p>0.05). Obesity is one of the key risk factors, especially in infectious complications. In our cohort, a higher BMI did not increase the risk of complications in general (p>0.05). CONCLUSIONS In correlation with current literature, our cohort confirmed a significantly higher risk of complications leading to revision spinal surgery associated with age, smoking, posterior surgical procedure in thoracic or lumber spine, and presence of a medical resident as a surgical assistant. The average length of hospital stay was demonstrably longer in complicated patients, it almost tripled compared to the whole cohort. Contrary to literature, the effect of obesity on the occurrence of complications was not confirmed. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study aims to determine the incidence of fracture-related infection (hereinafter referred to as the FRI) at a Level I trauma centre over a three-year period. It also aimed to determine the risk factors, to observe confirmatory and suggestive criteria in line with the applicable recommendations, and to evaluate the bacterial spectrum in a diagnosed FRI. MATERIAL AND METHODS It is a retrospective-prospective study carried out through studying the documentation. The study included all patients di)agnosed with FRI and treated between 2019 and 2021, except for the patients with hand fractures since minor phalangeal fractures of the fingers were largely treated by the outpatient department, no osteosynthesis was performed in the operating room, and these patients were not followed up at our department. RESULTS The FRI incidence was 2.33% of all osteosyntheses performed at the Level 1 trauma centre in the period 2019–2021. The FRI was most often caused by pyogenic cocci agents and the FRI developed most frequently within 6 months after os)teosynthesis. The site at risk was the lower limb region. The FRI incidence was most often indicated by suggestive clinical criteria (redness, secretion, pain) and radiological criteria (delayed healing, non-union). Overall, 42.19% of treated non)unions were later diagnosed as FRI. At the time of FRI diagnosis, the CRP values were normal in 21.7% of patients. DISCUSSION The FRI incidence rate in 2019–2021 was 2.33%, which corresponds with the values reported in other papers focusing on the incidence of infectious complications after osteosynthesis. Fang and Depypere reported 1–2% of infectious complications. The most common risk factors are open fractures, which account for 20.16% in our cohort. Ktistakis and Depypere describe the incidence of osteomyelitis in 30% of treated open fractures. In our cohort, the incidence of FRI was significantly higher in lower limb fractures. Bezstarosti, Wang and Pesch published similar results, with some deviations. The time from os)teosynthesis to final FRI diagnosis varied from a few weeks to several years. In more than half of the patients the FRI developed within 6 months after performed osteosynthesis. Metsemakers and Fang refer to the very same trend. The CRP levels in the study population varied a lot. Xing-qi Zhao describes CRP as a less sensitive (sensitivity 65.6%) but more specific marker (specificity 75.4%). According to the available literature, the most common agents causing infectious complications of osteosynthesis are gram-positive cocci, S. aureus in particular. In our study, G+ pyogenic cocci were clearly the most commonly detected, which is consistent with the results of studies by Fang and Depypere, focused on the incidence of infectious complications. The most common FRI clinical manifestations included wound secretion, redness, swelling and pain. Furthermore, suggestive radiological criteria, especially delayed healing and non-union also indicated the FRI occurrence. According to Fang, the most common clinical manifestations of infectious complications include pain, swelling, redness and wound dehiscence. Fang reports that the most common radiologic findings are the periosteal reaction, loosening of the implant and delayed healing or non-union, which is consistent with our cohort. In the cohort of non-unions surgically treated at our department, FRI was subsequently confirmed in 42.19% of cases. CONCLUSIONS The incidence of FRI at Level 1 trauma centre was 2.33% of operated fractures in 2019-2021, with pyogenic cocci being the most common infectious agents. The FRI usually developed within 6 months after osteosynthesis. The typical site for the FRI development was the lower limb region, the ongoing FRI was indicated by suggestive clinical criteria (redness, secretion, pain) and radiological criteria (delayed healing and a non-union). Overall, 42.19% of treated non-unions were later diagnosed as FRI. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) “The Surgical Treatment of the Degenerative Diseases of the Spine”. MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondy-lolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The paper presents a monocentric retrospective study of patients treated surgically for spinal tuberculosis. Clinical and radiological results are analysed, early and late complications are recorded. The study aims to answer the following questions. 1. Can we use instrumentation to restore the stability and alignment in the infected spinal focus? 2. Should we always perform radical anterior resection of TBC lesions? 3. What is the prognosis of surgical treatment of TBC patients with neurological deficit manifestation? MATERIAL AND METHODS Between 2010 and 2020, a total of 12 patients were treated for spinal tuberculosis at our department, of whom 9 patients (5 men, 4 women) with the mean age of 47.3 years (range 29 to 83 years) underwent a surgery. A total of three patients were operated on before the final confirmation of the TBC and treatment with antituberculosis medication, four patients in the initial therapy phase and two patients in the continuous phase. Two patients only underwent a non-instrumented decompression surgery followed by external support fixation. In the other seven patients, always with spinal deformity, instrumentation was used (3 cases of isolated posterior decompression, transpedicular fixation, posterior fusion, 4 cases of anteroposterior instrumented reconstruction). In 2 cases a structural bone graft and in 2 cases an expandable titanium cage were used for anterior column reconstruction. RESULTS Of the total number of patients, altogether eight patients were assessed at 1 year after surgery (one 83-year-old patient died from heart failure 4 months after surgery). Of the remaining eight patients, three patients exhibited a neurological deficit and postoperative regression of the finding. The McCormick score improved from the preoperative mean score of 3.25 to 1.62 at 1 year after surgery (p < 0.001). The clinical VAS score regressed from 5.75 to 1.63 at 1 year after surgery (p < 0.001). Radiographic healing of the anterior fusion was achieved in all patients, both after decompression and instrumented surgery. The initial mean kyphosis of 20.36 degrees of the operated segment measured by the mCobb angle was corrected to 14.6 degrees postoperatively, with a subsequent slight deterioration to 14.86 degrees (p < 0.05). The greatest correction was achieved in patients who had undergone a two-stage surgery with anterior resection and AP reconstruction. DISCUSSION In our cohort, titanium instrumentation was used in seven of nine patients. One patient only manifested persistent tuberculosis with nonspecific bacterial flora superinfection. Revision surgery with anterior radical debridement and subsequent treatment with antituberculotic drugs healed the patient. There were four patients with major preoperative neurological deficit persisting more than 2 weeks before the final treatment with subsequent improvement in all cases. These patients were treated with anteroposterior reconstruction and anterior radical debridement. CONCLUSIONS No increased risk of recurrent infection associated with the use of spinal instrumentation was found in the study. Anterior radical debridement is performed in patients with manifested kyphotic deformity and spinal canal compression, followed by reconstruction with a structural bone graft or a titanium cage. The other patients are treated based on the principle of “optimal” debridement with or without the use of transpedicular instrumentation. If adequate spinal canal decompression and stability are achieved, neurological improvement can be anticipated even in case of a major neurological deficit. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Fractures of the scapula are less frequent, with the incidence reported in literature of approximately 1% of all fractures and 3-5% fractures of shoulder. These fractures are predominantly treated non-operatively. Osteosynthesis is indicated in displaced intra-articular fractures and severely displaced extra-articular fractures of the scapular body, its lateral border in particular. Apart from open reposition and osteosynthesis, also minimally invasive osteosynthesis under fluoroscopic and arthroscopic control has recently been used to treat intra-articular fractures of the scapula. The arthroscopy facilitates debridement of the fracture line in the intra-articular region and control over the insertion of the osteosynthesis material in the subchondral bone of the glenoid and it also makes visible the accuracy of reduction of fractures of the glenoid articular surface. MATERIAL AND METHODS In 2013-2017, osteosyntheses of 9 intra-articular fractures of the scapula were performed with the use of both perioperative fluoroscopy and arthroscopy. The group included 7 men and 2 women, with the mean age of 37 years (range 24-52 years). 4.5 mm cannulated screws inserted in the subchondral bone either from the cranial or dorso-caudal part of the glenoid in dependence on the type of the fracture were used as osteosynthesis material. Postoperatively, the extremity was fixed by Desault type shoulder brace for 4 weeks. Rehabilitation using standard procedures for shoulder joint followed. The patients were followed up at regular intervals, namely on 10th day, at 4 weeks, 3, 6, 12 and 24 months postoperatively. The clinical outcomes and radiologic signs of healing were evaluated continuously and two years after the surgery the clinical outcomes were assessed using the Constant score. Arm elevation was assessed separately, as a dominant indicator of shoulder joint function. RESULTS No perioperative complications were reported, the operative times ranged from 45 to 120 minutes. Reduction was always performed in fractures with intra-articular displacement of less than 2 mm, which was measured both arthroscopically and on perioperative and postoperative radiographs. No complications of wound healing were observed. One patient experienced temporary paresthesia in the innervation zone of the sensitive branch of the radial nerve. The mean healing time of fractures was 121 days (range 107-146 days). The mean Constant score at two years after surgery was 83 points (range 78-87 points), the resulting restriction of elevation was 12° on average (range 0-23°). DISCUSSION There are not many papers covering a similar topic in world literature, most of them present the benefits of arthroscopy in some types of osteosyntheses of intra-articular fractures of the scapula. Most frequently mentioned are osteosyntheses of the anterior portion of the glenoid in case of a bony Bankart lesion. These papers highlight the benefits of minimal invasiveness of this procedure. CONCLUSIONS By visualising the fracture line, the arthroscopy facilitates a more accurate reduction of fragments and a minimally invasive osteosynthesis of some intra-articular fractures of the scapula when compared to closed reduction with fluoroscopic intraoperative control only. The use of arthroscopy in these interventions is conditional on perfect mastering of the surgical technique and also the use of special instruments both for arthroscopy and minimally invasive osteosynthesis. If these criteria are observed and the surgical technique mastered, the authors consider this method beneficial in treating the glenoid fractures. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010–2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010–2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the Insall-Salvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1–11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28–100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12–30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15–30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1–1.74). Postoperatively, the index decreased by 0.11 on average (–0.00 to –0.26) to 1.22 (0.92–1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall- Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vastus medialis transfer or arthroscopic lateral release are performed as well. CONCLUSIONS When correctly indicated, proximal, distal realignment or their combination can bring very good functional outcomes with a low risk of recurrent dislocation and postoperative complications. The importance of MPFL reconstruction is confirmed by low incidence of recurrent dislocation in the group investigated in this study, namely when compared with studies referred to in this paper, in which the patients underwent patellar stabilisation using the Elmslie-Trillat procedure. Conversely, leaving the bone malalignment untreated during the isolated MPFL reconstruction increases the risk of its failure. Judging from the obtained results, tibial tubercle ventromedialization also has a positive effect on the patella height through its distalization. Provided the stabilisation procedure is correctly indicated and performed, the patients can get back to their normal activities, often even sports activities. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Osteoarthritis (OA) of the joints of the hand is one of the most common musculoskeletal disorders in the elderly population. It is a complex, degenerative disease affecting all components of the joint. Surgical treatment is indicated when conservative therapy fails. The ultimate solution is arthrodesis of the distal interphalangeal (DIP) joint. Various methods of arthrodesis have been described, ranging from the use of K-wires or compression screw to different types of intra-articular (intramedullary) implants. The aim of this study is to evaluate the surgical outcomes of arthrodesis of the distal interphalangeal (DIP) joint of the fingers using intramedullary implants. MATERIAL AND METHODS Since 2011, arthrodesis of the distal interphalangeal joint using an intramedullary implant has been performed at our department 97 times in total, in 59 patients. 9 patients (15 cases of arthrodesis) were excluded from the study group due to their failure to complete the questionnaire, 1 female patient died. In the fi nal group, 82 cases of arthrodesis in 49 patients (47 women, 2 men) were evaluated. In 72% of cases, the surgery was performed on the dominant hand. The mean age at the time of surgery was 58 years (median 59 years). The patients were indicated for surgery after the failure of all conservative treatment options. In addition to radiographs, also the hand function and pain were assessed based on the preand postoperative DASH score questionnaires. RESULTS The surgical outcomes for all implants are satisfactory. In all 82 patients, the surgical wounds healed per primam. In one case, implant extraction was performed due to infection. Another complication was an unhealed fusion and formation of a non-union with minimum pathological mobility (the patient is satisfi ed with the outcome). In three patients, a fracture at the base of the distal phalanx was observed on postoperative radiographs, which fully healed within 3 months after surgery. The mean DASH score decreased from 41.95 preoperatively to 14.93 postoperatively. The mean time to healing of the arthrodesis observed on radiographs was 9.1 weeks. DISCUSSION Currently, there are many different types of arthrodesis of the distal interphalangeal joint of the hand. Each method has its pros and cons. Arthrodesis using an intramedullary implant has the advantages of the older methods while minimizing postoperative complications. Our results are comparable to those reported in the foreign literature. CONCLUSIONS Based on the evaluated outcomes, arthrodesis of the distal interphalangeal joint using an intramedullary implant can be considered valid. It defi nitely deserves to be included in the portfolio of surgical treatment of osteoarthritis of the DIP joints of the hand. According to our observation, the differences between various types of implants are minimal and their outcomes are comparable to those reported in foreign publications. The pain relief, restored fi nger function and fusion rate are comparable to, if not better than, those achieved by the older surgical methods. The advantage of this method is mainly easier implantation, fewer complications, and the possibility of implantation without the use of an X-ray image intensifi er, which ultimately reduces the cost of surgery. The main disadvantage is the higher purchase price of the implant. [ABSTRACT FROM AUTHOR]

INTRODUCTION During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy. MATERIAL AND METHODS The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced. RESULTS The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80–84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85–89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average – in the 80–84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85–89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery. CONCLUSIONS Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The paper aims to evaluate the effect of COVID-19 pandemic on a change in the number of major trauma cases, their mechanism and length of hospital stay as seen by a Level I Trauma Centre. MATERIAL AND METHODS The retrospective study included a total of 755 major trauma patients (ISS ≥ 16) treated at our Level I Trauma Centre in the period 2018–2019 (“pre-COVID-19 time”) and 2020–2021 (“COVID-19 time”). The effect of COVID-19 infection on the change in the number and nature of major trauma, mechanism of injury, length of treatment during prehospital care, length of hospital stay, and mortality. RESULTS Of the total number of 755 patients with major trauma, in the “pre-COVID-19 time” 399 patients were treated, while in the “COVID-19 time” it was 356 patients (p = 0.10). The mechanism of major trauma did not change, road traffic accidents prevailed (61% vs. 56%, p = 0.25), the proportion of injuries due to falls from height increased (25% vs. 32.5%, p = 0.08), a significant decrease was observed in the category of severe skiing injuries (7 vs. 2, p = 0.003). The severity of injuries evaluated by Injury Severity Score remained unchanged (25 vs. 25, p = 0.08), but an increased number of patients with traumatic brain injury (TBI) marked by the Abbreviate Injury Score (AIS) ≥ 4 was observed (38 vs. 56, p = 0.03). The total length of a hospital stay shortened (18 vs. 15 days, p = 0.04), but the mortality rate spiked (52 vs. 73 patients, p = 0.08). DISCUSSION In the “COVID-19 time”, the total number of major trauma cases dropped just like in the other European countries. Despite restrictive measures imposing mobility restrictions, no change was reported in the mechanism of injury, with traffic accidents still prevalent, except for skiing injuries. Unlike the US, we did not see an increase in penetrating injuries due to interpersonal violence or suicidal behaviour. However, there was an increase in the percentage of patients with an isolated TBI as a result of a fall from height. An increase in mortality was reported due to an increase in severe TBI. The length of hospital stay was reduced as a result of efforts to maintain hospital bed availability. CONCLUSIONS During the COVID-19 pandemic, compared to the two years immediately preceding, no significant decrease in the number of major trauma cases was reported, despite the introduction of restrictive measures. The proportion of road traffic injuries remained the same, whereas the number of falls from height slightly increased, which consequently led to an increase in the number of severe TBI. The number of penetrating injuries due to acts of violence did not increase, but due to the lockdown there was a significant decrease in severe skiing-related injuries. The anti-epidemic measures in place did not prolong the pre-hospital care for severely injured patients. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The authors focused on the topic of tibiotalocalcaneal arthrodesis. It is a surgical procedure used to manage severe comprehensive ankle and hindfoot pathology. The scope of surgery and the negative impact on the walking stereotype are offset by preserving a weight-bearing and pain-free limb. The purpose of the study was to evaluate the group of patients who had undergone surgery at the First Department of Orthopaedic Surgery, St. Anne s University Hospital Brno and to identify the most suitable fixation for arthrodesis. It also aimed to compare the outcomes achieved by the authors with those reported by other departments. MATERIAL AND METHODS The group included patients operated on at the authors department between 2011 and 2021. The surgery was indicated in patients with severe concomitant arthritis of the upper and lower ankle, complex hindfoot instability, Charcot arthropathy. Contraindications included acute infection, decompensated diabetes and heavy smoking. The study compares fixation using a lateral plate, a retrograde nail and a retrograde nail with fibula acting as biological plate. The patients were scored preoperatively and postoperatively using the AOFAS Ankle-Hindfoot Score. Statistical analysis of the results was also carried out. RESULTS The group included 23 patients, of whom a lateral plate was opted for in 7 patients, a retrograde nail in 8 patients and a retrograde nail with fibula used as a biological plate in 8 patients. The patients of the group were followed up for the period ranging from 0.5 to 9 years after surgery. Serious complications were observed by the authors in 6 patients of the group. The failure of osteosynthesis material was reported in 2 cases with lateral plating fixation. A stress fracture above the apex of the nail developed in 2 cases. A serious infection was observed by the authors in 1 patient. The method associated with the lowest incidence of complications was the fixation with a retrograde nail and fibula used as a biological plate. DISCUSSION The forms of fixation for tibiotalocalcaneal arthrodesis have recently advanced considerably, the methods of fixation for arthrodesis in particular. The modern implants enable to compress the individual structures, to provide stable fixation and potentially to avoid long-term plaster cast fixation. Nonetheless, these surgical procedures are associated with a high complication rate. Currently, there is no consensus in international studies on the optimal fixation for arthrodesis. Numerous papers describe complications including postoperative infections, failure of osteosynthesis material and fractures close to osteosynthesis material. The number and the type of complications observed by the authors in their group of patients were similar to those reported by other authors. CONCLUSIONS Tibiotalocalcaneal arthrodesis is a surgical procedure reserved exclusively for patients indicated based on strict criteria and should be performed by an experienced team able to cope with potential complications. In the followed-up group of patients, the optimal method of fixation for arthrodesis appeared to be the fixation with a retrograde nail and fibula used as a biological plate. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Acromioclavicular (AC) joint dislocation and its surgical treatment still raises a number of questions that remain to be answered. In some types of dislocations, Rockwood type III in particular, the indication for surgical treatment as such is relative. There are numerous techniques and implants available for the reconstruction of AC joint. In our research we focused on the necessity of coracoclavicular (CC) joint reconstruction. MATERIAL AND METHODS In this paper, a cohort of 56 patients with Rockwood type III AC joint injury who underwent surgical treatment at our department in 2010–2016 period was retrospectively evaluated. The patients were treated with open reduction with AC joint stabilisation using hook plate or tension band. The patients were divided into 2 groups, namely group 1 with CC ligament reconstruction and group 2 without CC ligament reconstruction. The assessment was done at 6 months, 1 year and 2 years after surgery. The clinical outcomes were assessed based on the absolute Constant score (CS) and coracoclavicular distance (CCD) on the X-ray. Subsequently, the outcomes were statistically processed and compared using the Student s ttest. RESULTS The least invasive surgical intervention, as to the length of incision, was the reconstruction using the hook plate without CC ligament suture, whereas the longest incision was performed in tension band with CC ligament suture. In the CC ligament suture group, the mean operative time was 10 minutes longer. When evaluating the CS of the compared groups with and without CC ligament reconstruction, no statistically significant difference (p > 0.05) was found between the two groups. Similarly, the CCD values at 2-year follow-up did not show any statistically significant difference between the two groups (p > 0.05). CONCLUSIONS The available outcomes suggest that the surgical methods used by us are adequately safe and reliable. Good clinical outcomes can be achieved by open reduction and fixation of Rockwood type III AC joint dislocation even without CC ligament reconstruction. [ABSTRACT FROM AUTHOR]

PURPOSE OF STUDY Total joint replacements (TJR) have become the cornerstone of modern orthopedic surgery. A great majority of TJR employs ultrahigh molecular weight polyethylene (UHMWPE) liners. TJR manufacturers use many different types of UHMWPE, which are modified by various combinations of crosslinking, thermal treatment, sterilization and/or addition of biocompatible stabilizers. The UHMWPE modifications are expected to improve the polymer’s resistance to oxidative degradation and wear (release of microparticles from the polymer surface). This manuscript provides an objective, non-commercial comparison of current UHMWPE formulations currently employed in total knee replacements. MATERIALS AND METHODS UHMWPE liners from 21 total knee replacements (TKR) were collected which represent the most implanted liners in the Czech Republic in the period 2020–2021. The UHMWPEs were characterized using several methods: infrared microspectroscopy (IR), non-instrumented and instrumented microindentation hardness testing (MH and MHI), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and solubility measurements. The above-listed methods yielded quite complete information about the structure and properties of each UHMWPE type, including its potential long-term oxidation resistance. RESULTS For each UHMWPE liner, IR yielded information about immediate oxidative degradation (in the form of oxidation index, OI), level of crosslinking (trans-vinylene index, VI) and crystallinity (CI). The MH and MHI testing gave information about the impact of structure changes on mechanical properties. The remaining methods (DSC, TGA, and solubility measurements) provided additional information regarding the structure changes and resistance to long-term oxidative degradation. Statistical evaluation showed significant differences among the samples as well as interesting correlations among the UHMWPE modifications, structural changes, and mechanical performance. DISCUSSION Surprisingly enough, UHMWPE materials from different manufacturers showed quite different properties, including the resistance against the long-term oxidative degradation, which is regarded as one of the main reasons of TJR failures. The most promising UHMWPE types were crosslinked materials with biocompatible stabilizers. CONCLUSIONS Current UHMWPE liners from different manufactures used in total knee replacements exhibit significantly different structure and properties. From the point of view of clinical practice, the traditional UHMWPE types, which contained residual radicals from irradiation and/or gamma sterilization, showed inferior resistance to oxidative degradation and should be avoided. The best properties were observed in modern UHMWPE types, which combined crosslinking, biocompatible stabilizers, and sterilization by ethylenoxide or gas plasma. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study aimed to evaluate the results of closed reduction and epiphyseodesis of unstable slips of the proximal femoral epiphysis. The hypothesis was that the clinical and radiological results of this method and incidence of avascular necrosis are comparable to the results of closed reduction and open reduction using surgical hip dislocation reported by literature. MATERIAL AND METHODS In the period 2013–2023, 20 patients were treated for unstable slips in one institution. Whereas the boys were older (mean age of 13.4 years) than girls (mean age of 11.6 years), the gender distribution was equal. Acute on chronic slips prevailed over the acute slips (ratio 3:1). The slips were treated using the closed reduction, transphyseal fixation and capsular decompression at 6 to 240 hours after slip (81 hours on average). All patients were treated concurrently on the contralateral side as the prevention of the slip or to treat the grade I slips (two patients). The follow-up ranged from 7 months to 7 years. Clinical results were evaluated according to two scores: 1) own score (Bulovka University Hopspital score) based on the reduction of ROM, shortening of extremity and limitations of activities; 2) D’Aubigne-Postel score. In the radiological evaluation, correction of slip angle, alpha-angle, avascular necrosis (AVN) and the prominence of the anterior margin of the femoral neck on axial radiographs were evaluated. RESULTS According to the Bulovka University Hospital score, there were 10 excellent results (50%) with no limitation of activity, including sport, in tree cases the results were very good (15%) and in five cases good (25%), respectively, with some limitation of activity, and two results were unsatisfactory (10%) with severe limitation of activity due to the AVN. According to the D’Aubigne-Postel score, there were 14 excellent results (70%), four good results (20%), and two unsatisfactory results (10%). The slip reduction was as follows: under 20 deg. in five patients; under 30 deg. in 10 patients, and over 30 deg. in five patients, respectively. Alfa-angle was greater than 63 degrees (range 45-88 deg.) on average. Prominence of the off-set epiphysis-femoral neck and femoroacetabular impingement (FAI) were observed in six patients. Remodelling of this prominence was seen in one patient four years after surgery. Shortening of the femoral neck over 1 cm was reported in two patients. Complete AVN with severe deformity of the hip was noted in two patients. DISCUSSION Our hypothesis was confirmed because the results of treatment of the unstable slips by closed reduction are comparable with the published results of the same method and with surgical hip dislocation. The results correspond with those of large published cohorts of patients concerning the correction as well as rate of complications. CONCLUSIONS According to our results, urgent gentle closed reduction, transphyseal fixation and capsular decompression represent efficient and relatively safe methods of treatment of unstable slips with low incidence of complication. Residual deformity of the off-set epiphysis-femoral neck and FAI represent limitations of this method. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study describes changes in gait parameters (temporal-spatial parameters, kinematic parameters represented by the global Gait Deviation Index) of individuals with Adolescent Idiopathic Scoliosis (AIS) compared to the healthy population. The hypothesis assumed a difference in the observed parameters between the two mentioned groups. MATERIAL AND METHODS In a retrospective study, the temporal-spatial parameters and Gait Deviation Index (GDI) of a cohort of 45 AIS patients (36 girls and 9 boys with the mean age of 15.2 years, the mean Cobb angle of the thoracic curve of 47.3° and the lumbar curve of 51.8°) were compared to a typically developing population of 12 healthy individuals with no musculoskeletal pathology. The difference of followed-up parameters in patients with AIS compared to normal values was assessed by one-sample Student’s T-test at the significance level of p = 0.05. RESULTS The gait analysis shows significant deviations in the gait stereotype of patients with AIS compared to the healthy population. Statistically significant differences within temporal-spatial parameters were confirmed for cadence, walking speed, step time, stride time for left leg, step length, stride length and step width. The mean GDI of the cohort reached the value of 91.07 that indicates a slight alteration of gait, however, even this change is statistically significant. DISCUSSION In our cohort of patients with AIS, we identified a significantly reduced walking speed (on average 15.4% compared to normal values. At the same time, a reduction in cadence (by an average of 7.5%) and an increase of the stride time (by an average of 12%) were recorded. Our mean GDI values were 91.07, which is consistent with the results reported in the literature for comparable groups of AIS patients. CONCLUSIONS Our study demonstrated that AIS significantly affects gait stereotype. The differences compared to the group of healthy individuals within temporal-spatial parameters were confirmed for cadence, walking speed, duration and length of step and stride, and step width. The kinematic analysis of gait using the global (GDI) index in patients with AIS demonstrated its slight alteration. A better understanding of the change in movement stereotypes and gait in patients with AIS can bring wider possibilities for individualizing conservative treatment and also can help prevent secondary changes in the locomotor system. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. MATERIAL AND METHODS The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher’s surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. RESULTS In the EXT group, the mean elbow fl exion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow fl exion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. CONCLUSIONS Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Our study aims to compare the results of preoperative radiography and intraoperative visual assessment of the cartilage with histological assessment of joint surfaces of the medial and lateral compartments resected in patients during the total knee replacement. MATERIAL AND METHODS The cohort included 20 patients (9 men and 11 women) with the mean age of 66.6 (±7.0) years who met the inclusion criteria of the study. Degenerative changes of the knee joint seen on a preoperative weight-bearing anteroposterior X-ray were evaluated according to the Kellgren-Lawrence grading system separately for the medial and lateral compartment. Based on the visual appearance, the condition of articular surfaces was assessed using the International Cartilage Repair Society Score (ICRS Grade). The histological assessment of degenerative changes was conducted by a pathologist with the use of the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment System based on six grades of articular cartilage degeneration. RESULTS The mean degree of degenerative changes based on the radiological classification was assessed as 3.5 (±0.6) for the medial compartment and 2.1 (±0.4) for the lateral compartment. The visually assessed chondropathy according to the ICRS Grade was 3.7 (±0.6) for the medial femoral condyle and 1.8 (±1.0) for the lateral femoral condyle. The histological score obtained using the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment was 4.9 (±1.1) for the medial femoral condyle and 2.4 (±0.7) for the lateral femoral condyle. In respect of the medial compartment, there was no statistically significant parametric correlation between the intraoperative visual assessment of the cartilage degeneration and the preoperative radiological grade r = 0.45. The histological assessment showed a statistically significant concordance both with the degree of chondropathy r = 0.76 and the radiological grade r = 0.64. In the lateral compartment, the parametric test showed a statistically significant concordance only between the radiological grade and the histological score r = 0.72. The correlation between the visual assessment of chondropathy and the radiological grade r = 0.27 as well as the histological score r = 0.24 was very low. DISCUSSION In our cohort assessing the early degenerative changes of the lateral compartment as well as the more advanced degenerative changes of the medial compartment, the correlation between the intraoperative assessment of cartilage degeneration as a diagnostic method to examine the lateral compartment and the preoperative radiological grade was not confirmed. Our results failed to confirm a better reporting value of the visual cartilage degeneration assessment of the lateral compartment as against the preoperative X-ray. The space width without narrowing on an X-ray has no reporting value for this compartment in case of varus deformity. CONCLUSIONS The results clearly indicate that the assessment of macroscopic appearance of the cartilage degeneration during arthroscopy does not necessarily guarantee good long-term clinical outcomes after high tibial osteotomy. The respective degrees of cartilage degeneration identified during the intraoperative visual assessment and the radiological grading of osteoarthritic changes did not correlate in either compartment. In the lateral compartment, the initial radiological and histological findings preceded the visually detectable cartilage changes. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The term toddler’s fracture was first coined by J. S.Dunbar in 1964 as a nondisplaced fracture of the distal tibia in children aged 9 months to 3 years. Over time, many other authors extended this definition as to the location as well as age range. The purpose of this paper is to provide a comprehensive overview of the existing studies focusing on the topic of toddler’s fractures, to compare individual diagnostic and therapeutic approaches, and to specify the term toddler’s fracture. Also, a group of patients with this diagnosis is presented, treated at our department. MATERIAL AND METHODS A retrospective study of a group of patients treated at the Department of Paediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University in the period from 1. 1. 2012 to 2. 8. 2017. The defined age range of patients was 9 months up to 3 years. The most frequent type of skeletal injury at this age was identified. Also, the etiology of injuries, the method and duration of fixation were examined. Moreover, an overview of foreign articles, with a focus on diagnosis and therapeutic approach is presented. RESULTS In the respective five-year period, a total of 15,679 children with a skeletal injury were treated at the Department of Paediatric and Trauma Surgery, of whom 57 patients at the age of a toddler (9 months to 3 years of age) sustained a nondisplaced distal tibial metaphyseal fracture (0.4%). In addition, 147 patients were treated for nondisplaced fracture of the first metatarsal base (0.9%) – in 98 of whom it was a torus fracture, in 49 patients the fracture line extended into the physis; therefore, it concerned the Salter-Harris type II separation of epiphysis. The group included only one patient with a nondisplaced calcaneal fracture. DISCUSSION Despite differences in the definition as to the location and age of patients, the toddler’s fractures can always be defined as nondisplaced, and in many cases, they are difficult to diagnose based on the initial X-rays. Crucial for a differential diagnosis is to distinguish them from osteomyelitis, synovitis of the hip joint, or a tumour. In case of unclear history, also the Child Abuse and Neglect syndrome shall be considered. When any of the aforementioned diagnoses is suspected, methods with a higher diagnostic yield (but in case of computed tomography and scintigraphy also with a higher burden) – ultrasound, CT or scintigraphy – can be used. CONCLUSIONS We recommend that the term “toddler’s fracture” is used for nondisplaced fractures of the distal third of the tibia with respect to the original criteria proposed by Dunbar. We consider as an option to include in this group also the first metatarsal fractures due to their frequency in this age group, provided that the stated conditions are met. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Tantallum trabecular metal implants (Trabecular Metal Technology – TMT) considerably changed the acetabular reconstruction options in revision surgeries with extensive bone defects and distorted pelvic ring integrity. The purpose of this study is to ascertain the short-term to medium-term outcomes of acetabular reconstruction through TMT implants in patients with Paprosky type 3a and 3b acetabular defects and in case of pelvic discontinuity. MATERIAL AND METHODS The prospective monocentric study included patients in whom the revision of acetabular components in total hip arthroplasty was performed, the acetabular defect was classified as Paprosky 3a and higher, a TMT implant was used for reconstruction, and the follow-up period was at least 2 years after surgery. In total, 87 patients who had met the inclusion criteria were operated on and followed-up. The patients in the study group underwent a clinical examination, an X-ray and also an assessment using the Harris hip score. Moreover, the patients were asked about their satisfaction with the surgical outcome, their willingness to undergo the same procedure again in case of difficulties, and they were also asked to rate the outcome in percentage term and by assigning grades. Also, an analysis of the reasons for revision and subsequent complications was carried out. Implant integration and its migration were evaluated on an X-ray. RESULTS 32 men and 55 women were subjects to evaluation, with a balanced number of operated sides (44:43 in favour of the right side). One-stage procedures prevailed, which were performed in a total of 74 cases, while two-stage revisions were performed in 13 cases in the study group. In three patients (3.5%) pelvic discontinuity was diagnosed, 69 patients (79%) suffered from Paprosky 3a defect and 15 patients (17%) from Paprosky 3b defect. The first patients underwent surgery in 2009 and the mean follow-up period in the study group was 48 months. In 1 patient the TMT implant was removed for infectious complications, in the remaining part of the group the TMT implant was fully integrated with no signs of loosening or migration in the monitored period. In the assessment using the Harris hip score, the mean score of 80.4 (range 36–99) was achieved. When assessing the satisfaction with the surgical outcome, the mean value achieved was 94.4%, and the mean assigned grade was 1.26 (on a school grading scale). DISCUSSION Extensive bone defects and pelvic discontinuity represent an issue in revisions of the acetabular component in total hip arthroplasty. There are several options how to address these conditions. State-of-the-art TMT implants thanks to their shortterm and medium-term outcomes appear as one of the most beneficial option with a low failure rate both in our study group and in published papers. CONCLUSIONS Evaluation of this monocentric prospective study reveals encouraging short-term and medium-term outcomes of the use of TMT implants in managing extensive acetabular bone defects of Paprosky 3a and 3b type and supports their further introduction into practice at our department. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This manuscript aims to introduce our surgical technique, with an emphasis on the latest recommendations. The AMIS technique is discussed in more detail in patients with Class II and Class III obesity. We seek to prove the premise claiming that the anteversion and inclination values observed in this group of patients do not differ significantly from those observed in patients with the recommended BMI index. We will also compare the risk of neurovascular bundle injury and postoperative complication rate regarding the surgical wound. MATERIAL AND METHODS Patients who underwent surgery using the AMIS method in the period between 1/2020 and 4/2023 were assessed retrospectively. The study included 1150 implantations. The entire study population was assessed for neurovascular bundle injury and surgical wound healing complications. For this purpose, the patients were divided into two groups based on the BMI, namely BMI < 35 kg/m² (n=1042) and BMI > 35 kg/m² (n=108). In patients with the BMI ≤ 25 kg/m² (n=280) and BMI ≥ 35 kg/m² (n=108), the inclination and anteversion values were compared. Standard centered AP view X-rays of their operated joints were assessed. The Liaw’s method was used to calculate the anteversion and inclination. RESULTS In group one of patients with BMI ≤ 25 kg/m² (208 women and 72 men), the arithmetic mean of acetabular anteversion was 25.4° (median 25°) and inclination was 38.3° (median 38°). In group two, which consisted of patients with BMI ≥ 35 kg/m² (59 women and 49 men), the total arithmetic mean of acetabular anteversion was 25.1° (median 25) and inclination was 37.6° (median 37.5°). The anteversion and inclination were assessed using the Mann-Whitney test for equality of medians. The value of 0.05 was chosen as the level of significance. The resulting p-value was 0.5359 in anteversion and 0.3763 in inclination. Since the p-value of both anteversion and inclination was greater than the chosen level of significance, their medians have not been confirmed to differ significantly. A total of 6 cases of femoral nerve injury was reported, i.e. 0.5% out of 1150. Therefore, the risk of injury was 0.4% in the group with BMI < 35 kg/m² (n=1042). On the contrary, in the group of patients with BMI > 35 kg/m² (n=108), the risk was 2%. No injury to femoral artery was reported. The surgical wound healing complications were seen in a total of 87 cases (7.6%). In the group with BMI < 35 kg/m², healing complications of the surgical wound were observed in 7.4% of cases, with the need for revision surgery in 7 patients. In the group with BMI > 35 kg/ m², healing complications occurred in 13% of patients and wound revision was necessary in 4 cases. DISCUSSION Our results are consistent with those in the published studies that also show no significant difference in anteversion and inclination of components in the compared groups of obese patients. We also agree with the other authors that the rate of complications regarding surgical wound healing is higher in these patients. The risk of neurovascular bundle injury in this study population is not higher than the standard. CONCLUSIONS The results obtained in our study population show that this method can also be used in patients with higher BMI, with no concern about the implantation of components in malposition or a higher risk of neurovascular injury. Nonetheless, potentially higher risk of surgical wound healing should be considered when this approach is opted for. With the appropriate surgical technique, AMIS is a safe method and, in our view, the first choice especially for obese patients. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This manuscript aims to present the method of arthroscopic assisted subtalar arthrodesis and to evaluate the benefits of this surgery on our study population. MATERIAL AND METHODS In the period from 9/2007 to 1/2020, a total of 33 subtalar arthrodesis were performed in 31 patients aged 19–66 years (mean 48 years, median 50 years). The indication for arthrodesis was subtalar arthritis causing pain and gait disorders, or hindfoot deformities (most commonly after a calcaneus bone fracture). The arthroscopic assisted subtalar arthrodesis was performed with autologous tricortical bone block graft harvesting from the pelvis, supplemented by autologous cancellous bone graft. Stabilization was achieved by cannulated screws inserted in neutral ankle position. Patients in our retrospective study were followed up for a mean of 48 months (range, 24–130 months). The patients were evaluated preoperatively and at 2 years after surgery. The hindfoot angles and height (TCA – talocalcaneal angle, CIA – calcaneal inclination angle, TCH – talocalcaneal height) were evaluated on radiographs, bone union was assessed on radiographs and CT scans. The clinical assessment was performed using the ankle-hindfoot scale (AHS) of AOFAS (AOFAS score). RESULTS The preoperative AOFAS score was 35–68 points (mean 52, median 54), the postoperative AOFAS score at 2 years after arthrodesis was 58–94 points (mean 82, median 82). Both the mean and median values of AOFAS score showed a significant progress from the poor result to the good and excellent result. After 2 years the TCA value decreased in 18 patients (56%) by no more than 3°. The CIA decrease observed in 21 patients (64%) was by 1° on average. The TCH decrease of 1–5 mm after 2 years since the surgery was seen in 16 patients. In 2 patients incomplete healing of arthrodesis was observed, manifested as a clinically asymptomatic non-union. No deep infection was reported. DISCUSSION In agreement with the current literature, the arthroscopic subtalar arthrodesis has been confirmed to be a safe method for the management of consequences of hindfoot fractures, with minimum complications and leading to accelerated bone fusion. Differences can be found in the approach, position, use of cancellous bone graft and surgical techniques. In recent years, prone position, posterior approaches, use of cancellous bone graft, distraction and fixation with 2–3 screws divergently inserted into the bone prevail. The degree of healing of the bone fusion is generally an important factor. In our study population, non-healing was recorded in 2 patients, namely in the form of a clinically silent non-union. Neurological or early complications and/or osteosynthesis material failure occurred in up to a maximum of 10% of cases. The conclusive results of minimally invasive arthrodesis based on the AOFAS score have been confirmed by us as well as by most authors. CONCLUSSIONS Our study confirmed that the arthroscopic assisted subtalar arthrodesis is a successful, reliable and safe minimally invasive method, with minimum complications, leading to stable arthrodesis. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The authors present the outcomes of more than ten-year clinical follow-up of patients who underwent surgical treatment of deep chondral defect of the knee (medial or lateral condyle). The method of treatment was the implantation of autologous cultured chondrocytes in the form of a solid chondral graft. The aim was also to compare the mid-term and long-term outcomes and to evaluate how the knee condition affects the everyday life and sports activities more than 10 years after surgery. MATERIAL AND METHODS Thirty patients of the total of 56 patients (26 patients dropped out of the long-term follow-up) operated in the period between 2001 and 2012 were available for retrospective evaluation of the clinical condition before surgery, at 1, 2, 5 years after surgery and at 10+ years after surgery. The mean follow-up period of patients was 14.5 years (10-20.5 years) after surgery. The clinical evaluation was performed using the Lysholm Knee Scoring Scale and the Tegner Activity Scale. RESULTS The mean preoperative Lysholm score of the followed-up study population was 37.5. During the first two years, improvement was achieved to the maximum value of 83.1. At 5 years and subsequently also at more than 10 years after surgery, a slight decline was reported to the mean value of 78.6. When comparing the outcomes at 5 years and at more than 10 years after surgery, the decline in the value was statistically non-significant. The mean value of the Tegner Activity Scale at more than 10 years after surgery was 4.5 points out of 10 points. DISCUSSION Management of a chondral defect especially in younger patients constitutes a common challenge in everyday orthopaedic practice. There are multiple methods at hand, all of which have their pros and cons. The size of the chondral lesion appears to be the limiting and decisive factor. The greatest pitfall are large chondral lesions (>4cm2 ), where many methods fail to yield satisfactory outcomes. One of the suitable options is the autologous chondrocyte implantation method. CONCLUSIONS The clinical outcomes of patients followed-up for more than 10 years after surgery do not show a statistically significant decline compared to the mid-term outcomes. Based on the data obtained, we continue to consider the autologous chondrocyte implantation as an effective method to manage deep chondral defects in the knee. The patients were mostly able to get back to normal life, including their sports activities, with a significant improvement of its quality compared to that before surgery. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study aimed to propose an optimal based fl ap creation with the view to ensure long-term survival of the interposition arthroplasty. MATERIAL AND METHODS A total of 28 dorsal wrist capsules were collected from 16 cadavers (with age range at death 18 to 80 years, with no visible wrist pathology). Altogether 112 histological specimens were obtained from these 28 samples. Post-hoc Dunn’s tests were used to analyse the percentage of vascularisation of individual sides of the dorsal capsule (circumference and area) at the 0.05 level of significance. Spearmann’s correlation analysis was used to assess the effect of age on vascularization of the dorsal wrist capsule. In cadavers in whom both capsules were collected, the limbs were compared. For the sake of comparison, the Wilcoxon matched pairs test was used. RESULTS Regarding statistical significance, the largest share of the total circumference and area of the measured vessels of the dorsal capsule is constituted by the distal side (35.2% of the circumference and 30.9% of the area). The blood supply of the dorsal capsule received on the ulnar side is the lowest (12.9% of the circumference and 17.6% of the area). There was no significant effect of age on vascularization of the dorsal wrist capsule confirmed. Also, the comparison of vascularization of both limbs from a single cadaver did not yield any statistically significant results. DISCUSSION Proximal row carpectomy is a long-established surgical technique used to manage the degenerative changes in the wrist. Our results showed the best vascularization on the distal and radial sides of the dorsal wrist capsule. In this light, the distally-based flap or the flap described by Berger, which respects the clinically important ligaments, appear to be the least invasive and help maintain the future stability of the wrist. CONCLUSIONS In clinical practice, we advise that a radially-based fl ap according to Berger is created and the distal side of the dorsal capsule, the most vascularized portion based on our results, is preserved as much as possible. The flap created in this manner also preserves the important carpal ligaments and appears to the authors of this study to be the most beneficial, also with respect to the presence of the largest arteries, contrary to the distal side. Another option is to use a distally-based flap for interposition arthroplasty. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Extended lateral approach to calcaneus fractures is associated with a high risk of infection. Such risk can be reduced by using mini-invasive approaches. The sinus tarsiapproach provides a good overview of the posterior joint facet of the calcaneus and can also be done as a mini-invasive procedure. The authors present their first experience with osteosynthesis of joint depression calcaneal fractures using the anterolateral locking plate inserted through the sinus tarsiapproach. MATERIAL AND METHODS During the period from 1 February 2020 to 31 January 2022, 18 patients were treated by the anterolateral locking plate in the authors‘ department (3 women, 15 men). Eleven fractures were classified according to Sanders as IInd grade, five as IIIrd grade and two fractures were classified as tongue-type (as described by Essex-Lopresti). The fractures were treated by open reduction through the sinus tarsiapproach and osteosynthesis by the anterolateral locking plate combined with headless screws. The following factors were examined: time from injury, duration of surgery, quality of reduction (post-op control with multiplanar CT scans), wound and technical complications, loss of reduction after treatment, substance abuse and comorbidities. The follow-up was 12–36 months (median 17). At one year after surgery, the functional outcomes were evaluated using the AOFAS Hindfoot score. RESULTS The most common negative predispositions for successful healing were smoking (9 cases), alcohol abuse, drug abuse, mild mental retardation, personality disorder, insulin-dependent diabetes and epilepsy (1 case each), hypothyreodism and bronchial asthma (2 cases each). The time from injury to surgery and duration of surgery surgery were measured. The quality of reduction was excellent in 12 patients (dislocation less than 1 mm), good in 6 patients (dislocation less than 2 mm), dislocation more than 2 mm was not present in the group. In one case, a revision surgery was performed because of screw malposition into the subtalar joint, delayed wound healing was observed in two cases. There was no case of deep surgical site infection or loss of reduction. The mean AOFAS score after one year was 85 points. The most common complaints were scar pain or discomfort. DISCUSSION The current studies on osteosynthesis of calcaneal fractures favor the sinus tarsiapproach for its lower risk of wound-related complications compared to the extended lateral approach. The sinus tarsiapproach requires the use of different osteosynthetic material than the conventional calcaneal plate. If a conventional locking plate is to be used, the surgical approach has to be modified. In 2021, Wang et al. published an intermediate step leading to the reduction of early complications and the use of conventional locking calcaneal plate inserted through the sinus tarsiapproach, with an additional incision. The sinus tarsiapproach is used also when intramedullary nailing is performed, which is preferred by biomechanical studies evaluating the rigidity of osteosynthesis. However, when comparing nails and locking plates, the differences are insignificant. The use of anterolateral locking plates was presented by Xie et al., with results similar to those of our own group of patients. CONCLUSIONS The results of the followed-up group of patients confirm low complication rate of the sinus tarsiapproach as reported by current literature. At the same time, it provides good options for reduction even in complicated fractures. For successful osteosynthesis, the anterolateral locking plate with headless screws may be used. The incidence of post-operative complications is low even in high-risk patients. Adhesions of peroneal tendons can be treated with material removal and tissue release. They could be prevented by good physiotherapy. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion – the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett‘s and Tukey‘s multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows us not only to make good decision about the treatment modality but to some extent also to estimate the final outcome, particularly with respect to restoring a functional and stable hip. CONCLUSIONS The total dislocation rate was 1.6% for primary THAs and 3.4% for revision THAs. The first-time dislocation of the positional type shall be treated conservatively. Conversely, in the other types of dislocations and in recurrent dislocations, surgical treatment is more likely to achieve a good clinical outcome. The worst outcomes are to be expected in an instability due to combination of multiple causes, which leads to the removal of THA more often than in other types of dislocations. Also, the benefit of preventive measures in high-risk patients over time has been confirmed. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study aimed to draw up a diagnosis and treatment guidelines for the management of the most common compression fractures of the thoracolumbar spine in children. MATERIAL AND METHODS Between 2015 and 2017, pediatric patients with a thoracolumbar injury aged 0–12 years were followed up in the University Hospital in Motol and the Thomayer University Hospital. The age and gender of the patient, injury etiology, fracture morphology, number of injured vertebrae, functional outcome (VAS and ODI modified for children), and complications were assessed. An X-ray was performed in all patients, in indicated cases also an MRI scan was done, and in more severe cases a CT scan was obtained as well. RESULTS The average vertebral body kyphosis in patients with one injured vertebra was 7.3° (range 1.1°–12.5°). The average vertebral body kyphosis in patients with two injured vertebrae was 5.5° (range 2.1°–12.2°). The average vertebral body kyphosis in patients with more than two injured vertebrae was 3.8° (range 0.2°–11.5°). All patients were treated conservatively in line with the proposed protocol. No complications were observed, no deterioration of the kyphotic shape of the vertebral body was reported, no instability occurred, and no surgical intervention had to be considered. DISCUSSION Pediatric spine injuries are in most cases treated conservatively. Surgical treatment is opted for in 7.5–18% of cases, in dependence on the evaluated group of patients, age of the patients and philosophy of the department concerned. In our group, all patients were treated conservatively. CONCLUSIONS 1. To diagnose F0 fractures, two unenhanced orthogonal view X-rays are indicated, whereas MRI examination is not routinely performed. In F1 fractures, an X-ray is indicated, and an MRI scan is considered based on the age and extent of injury. In F2 and F3 fractures, an X-ray is indicated and subsequently the diagnosis is confirmed by MRI, in F3 fractures also a CT scan is performed. 2. In young children (under 6 years of age), in whom an MRI procedure would require general anaesthesia, MRI is not routinely performed. 3. In F0 fractures, crutches or a brace are not indicated. In F1 fractures, verticalization using crutches or a brace is considered in dependence on the patient’s age and extent of injury. In F2 fractures, verticalization using crutches or a brace is indicated. 4. In F3 fractures, surgical treatment is considered, followed by verticalization using crutches or a brace. In case of conser)vative treatment, the same procedures as in F2 fractures are applied. 5. Long-term bed rest is contraindicated. 6. Duration of spinal load reduction (restriction of sports activities, or verticalization using crutches or a brace) in F1 injuries is 3–6 weeks based on the age of the patient, it increases with the age, with the minimum being 3 weeks. 7. Duration of spinal load reduction (verticalization using crutches or a brace) in F2 and F3 injuries is 6–12 weeks based on the age of the patient, it increases with the age, with the minimum being 6 weeks. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the results of the selected surgical therapy, survival time of the patients and postoperative complications. MATERIAL AND METHODS We retrospectively evaluated the group of patients operated on from 2012 to 2021. The study included 45 patients (24 women and 21 men) with a pathological lesion or a pathological fracture in the area of the proximal femur. The average age was 67 years (38–90). There were 30 (67%) cases of pathological fracture and 15 (33%) cases of pathological lesions in the cohort. In each patient, the perioperative biopsy or resected sample was sent for histological examination. The type of primary malignancy with the localization of lesions and fractures was assessed. Furthermore, we evaluated the outcomes of the surgical method chosen and its complications. We monitored the patients' functional score using the Karnofsky performance status and survival interval. RESULTS The most common primary malignancy was multiple myeloma in 10 cases (22%), followed by seven cases (16%) of breast and lung cancer and 6 cases (13%) of clear cell renal cell carcinoma. Internal fixation was used in 15 cases (33%). Tumor resection with hip joint replacement was performed in 29 patients (64%). One patient was treated with percutaneous femoroplasty. Out of a total of 45 patients, 10 patients (22%) survived for less than three months. The survival rate of more than one year was observed in 21 patients (47%). A total of seven complications occurred in six patients (15%). Fewer complications occurred in the group of patients with a pathological fracture compared to the group with an impending fracture. DISCUSSION Pathological lesions in the bone or an already existing pathological fracture are signs of advanced cancer. Better outcomes are reported in patients who underwent prophylactic surgery, which was, however, not confirmed by our study. The incidence of individual primary malignancies, the postoperative complications and the patient survival corresponded to the statistical data reported by the other authors. CONCLUSIONS In patients with a pathological lesion of the proximal femur, operative treatment will increase the quality of life, either when choosing osteosynthesis or joint replacement, while prophylactic treatment is usually associated with a better prognosis. As a less invasive procedure with lower blood loss, osteosynthesis is indicated for palliative therapy in patients with a limited expected survival time or in patients with a prognosis of healing of the lesion. Reconstruction of the joint with an arthroplasty is indicated in patients with a better prognosis or in cases excluding safe osteosynthesis. Our study confirmed good outcomes with the use of an uncemented revision femoral component. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The increasing prevalance of patients with metastatic bone cancer and their improved survival puts more emphasis on the quality of treatment of bone metastases. Although most pelvic lesions are treated non-operatively, extensive destruction of the acetabular segment poses a therapeutic challenge. A potential treatment option may be the modified Harrington procedure. MATERIAL AND METHODS At our department, this surgical procedure has been opted for in 14 patients (5 men and 9 women) since 2018. The mean age at the time of surgery was 59 years (range 42 to 73). Twelve patients suffered from metastatic cancer, one patient had a fibrosarcoma metastasis and one female patient presented with aggressive pseudotumor. Radiological and clinical followup of the patients was performed. Pain was assessed using the Visual Analogue Scale, and the Harris Hip Score and the MSTS score were used to evaluate the functional outcome. The paired samples Wilcoxon test was used to analyze the statistical significance of the difference. RESULTS The mean follow-up period was 25 months. At the time of assessment, ten patients were alive with the mean follow-up of 29 months (range 2 to 54 months) and four patients had died of cancer progression, with the mean follow-up being 16 months. No perioperative death or mechanical failure were reported. One female patient developed a hematogenous infection during febrile neutropenia, which was successfully managed with early revision and implant preservation. Statistically, a significant improvement in the MSTS (median 23) and HHS (median 86) functional scores compared to the preoperative values (MSTS median 2, p<0.01, r-effect size = 0.6; HHS preop median 0, p<0.005, r-effect size = –0.7) was observed. There was also a statistically significant reduction in pain (VAS postoperative median 1, VAS preoperative median 8, p<0.01, r-effect size = –0.6). All patients were capable of independent ambulation after the surgery, nine patients walked without support. DISCUSSION There are not many alternatives to this surgical procedure. Apart from non-operative palliative treatment, the options include ice cream cone prostheses or customized 3D implants which are, impractical in terms of time and cost. Our results are comparable to other studies, confirming the reproducibility and reliability of the method. CONCLUSIONS The Harrington procedure is an efective method for management of large acetabular tumor defects with good functional outcomes, an acceptable perioperative risk and a low risk of failure in the medium term, thus suitable also for patients with good cancer prognosis. [ABSTRACT FROM AUTHOR]

Disasters (more than 50 people affected) and mass casualty incidents (more than 10 people affected) which are the result of natural or civilisation disasters, traffic accidents or terrorist attacks are characterised by a large number of injured persons. In these critical situations, triage - prioritisation of patients based on the severity and type of the injury must be performed. Patients are sorted into those who need immediate medical intervention and those whose care can wait. Triage is a generally accepted tool assisting the health-care professionals in treating large numbers of injured people following mass casualty incidents. It is a stressful situation requiring not only professional expertise, but also experience and the ability to stay on top of things. Fortunately, such situations do not occur very often in our country. This paper aims to present experience gained during humanitarian missions abroad (Iraq, Kurdistan, Nepal), internships in hospitals in Israel and in Chris Hani Baragwanath Hospital in Johannesburg, South Africa. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p<0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p < 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p < 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL reconstruction failure. Since the posterior tibial slope is easily measured on the baseline X-rays, we recommend to perform this measurement routinely before each ACL reconstruction. In the case of a high posterior tibial slope, slope correction should be considered to prevent potential ACL reconstruction failure. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18–61 years) in men and 45.8 years (range 18–60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen – either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0–5 very good, 6–15 good, 16–35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95–2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50–6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique. MATERIAL AND METHODS The authors present a set of 53 CMC joints of patients with an average age of 26.8 years (15–43 years) operated on in the years 2005–2017. Post-traumatic conditions were found in 10 patients and in 43 cases instability was caused by hyperlaxity, also demonstrated in other joints. The operation was performed from the Wagner's modified anteroradial approach. After the operation, a plaster splint was applied for 6 weeks, after which rehabilitation (magnetotherapy, warm-up) began. Patients were evaluated using the VAS (pain at rest and during exercise), DASH score in the work module, and subjective evaluation (no difficulties, difficulties not limiting normal activities, and difficulties limiting normal activities) before surgery and 36 months after surgery. RESULTS During the preoperative assessment, the average VAS value was 5.6 at rest and 8.3 during exercise. During the VAS assessment at rest, the values at 6, 12, 24 and 36 months after surgery were 5.6, 2.9, 0.9, 1, 2 and 1.1. When evaluated in the given intervals under load, the detected values were 4.1, 2, 2.2 and 2.4. The DASH score in the work module was 81.2 before surgery, 46.3 at 6 months, 15.2 at 12 months, 17.3 at 24 months, and 18.4 at 36 months after surgery. In the subjective self-assessment made at 36 months after surgery, 39 patients (74%) assessed their condition as having no difficulties, ten patients (19%) reported difficulties that did not limit normal activities, and four patients (7%) reported difficulties limiting normal activities. DISCUSSION Most authors present the results of their surgeries in patients with post-traumatic joint instability, and they report excellent results at two to six years after surgery. There is a negligible number of studies addressing instabilities in patients with instability caused by hypermobility. When using the conventional method described by the authors in 1973, our results of the evaluation performed at 36 months after surgery are comparable to those reported by other authors. We are well aware of the fact that this is a short-term follow-up and that this method does not prevent developing degenerative changes in the case of long-term follow-up, but reduces clinical difficulties and may delay the development of severe rhizarthrosis in young individuals. CONCLUSIONS CMC instability of the thumb joint is a relatively common disorder, although not all individuals experience clinical difficulties. In the case of difficulties, the instability needs to be diagnosed and treated as this is how the development of early rhizarthrosis in the predisposed individuals can be prevented. Our conclusions suggest a possibility of a surgical solution with good results. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This study aimed to evaluate the clinical outcomes and the rate of recurrence in patients who had undergone arthroscopic Bankart repair with remplissage for anterior instability of the glenohumeral joint. MATERIAL AND METHODS The study included 96 arthroscopic Bankart procedures with remplissage performed between 2013 and 2019 at our department in 93 patients (81 men and 12 women; with the mean age of 33 years). We gathered and analysed preoperative data, including a 3D-CT scan of the affected shoulder. Apart from stability, the functional results were assessed postoperatively using the WOSI, SSV, Rowe score, and by measuring the strength of shoulder girdle muscles. The non-parametric Mann- Whitney U-test was used to identify the predisposing factors for recurrence of glenohumeral instability. RESULTS The arthroscopic Bankart repair with remplissage was indicated in 74 shoulders for primary TUBS and in 22 shoulders as a revision procedure. The recurrent instability was observed in 13 of 96 operated shoulders (13.5%). Subjective instability (positive apprehension test in the extreme positions of the shoulder joint, in abduction and external rotation in particular) was reported by 10 patients (10/13; 77%), three patients experienced a redislocation of the glenohumeral joint in the postoperative follow-up (3/13 patients; 23%). The risk of recurrence of the glenohumeral instability was not correlated with either the number of previous stabilisation procedures, or any other preoperative or intraoperative parameters. Conversely, a new postoperative injury was a factor of key importance. The patients with recurrent instability (subjective instability or glenohumeral dislocation) achieved a significantly lower Rowe score, SSV, postoperative VAS, and worse overall satisfaction with the procedure compared to the group with no recurrent instability. The remplissage induced minor limitations of external rotation at 0° abduction and internal rotation at 90° abduction. After rehabilitation, the muscle strength of the operated shoulder in both groups was comparable to that of the untreated shoulder in all planes of the shoulder range of motion. DISCUSSION Our study confirms the clinical relevance of the addition of remplissage to the arthroscopic Bankart procedure for reducing the rate of recurrent glenohumeral instability in TUBS with a clinically significant Hill-Sachs lesion. Satisfaction with the surgical outcome is high; the functional outcomes are very good, including muscle strength. Surprisingly, though, the risk of recurrent instability does not correlate with the number of implants used in the stabilisation procedure. CONCLUSIONS Addition of remplissage to the arthroscopic Bankart stabilisation in patients with a clinically significant Hill-Sachs lesion shows a low risk of recurrence of glenohumeral instability after surgery compared to the conventional arthroscopic Bankart repair alone. The remplissage does cause minor restrictions in the glenohumeral joint external rotation, but it was not reflected in the satisfaction of patients or a lower clinical score of the shoulder joint. The preoperative assessment of the Hill- Sachs lesion using the “glenoid track” on a 3D-CT scan helps improve the preoperative planning and prediction of outcomes of the stabilisation procedure. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Limb lengthening has always belonged to the most complex surgical techniques in paediatric orthopaedics. In our study, we compared the results of femoral and tibial lengthening using three different surgical techniques. The presented study aimed to shorten the duration of external fixation to a minimum and to reduce the complication rate. MATERIAL AND METHODS The retrospective study compared 74 patients (38 boys, 36 girls) who had undergone stepwise progressive lengthening of the femur or tibia between the years 2007 and 2019. The most frequent indication was the proximal focal femoral deficiency (PFFD, 33 patients). The total number of lengthening procedures was 130 (femur 72, tibia 58), the follow-up period was 2–14 years. The following modifications of surgical techniques were used: (i) standard approach, i.e. corticotomy with a two-stage removal of the fixator, (ii) preventive fixation with elastic stable intramedullary nails (ESIN) and also with a two-stage removal of the fixator, and (iii) standard approach with an early removal of the external fixator and plate osteosynthesis. RESULTS The mean lengthening achieved was 56 ± 18 (27–114) mm in femur and 54 ± 16 (25–110) mm in tibia. There was no statistical difference in the lengthening achieved by different modifications. The mean duration of external fixation in femur and tibia lengthening was comparable (166 and 164 days). The complications were observed in 60% of lengthening procedures, the most frequent being the pin release or axial malalignment of the lengthening (33 cases, 25%). The patients with ESIN displayed statistically the lowest complication rate (26%), the highest complication rate was seen in children with osteosynthesis using a plate (80%). CONCLUSIONS It follows from our results that fixation with intramedullary nails in comparison with the standard approach and plate osteosynthesis helped decrease the number of complications by more than 50%. The plate osteosynthesis is indicated in patients with repeated lengthening (achondroplasia, hypochondroplasia or PFFD with pronounced shortening) since it significantly reduces the duration of external fixation. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Many physicians believe that loco-regional anaesthesia and analgesia improve the postoperative course of patients indicated for total hip arthroplasty compared to general anaesthesia. However, there are many patients who refuse subarachnoid or epidural anaesthesia, or have contraindications or conditions making the use of such techniques impossible. An alternative option is the combination of general anaesthesia and a peripheral nerve blockade. The aim of this prospective randomized open-label clinical trial was to compare the efficacy and quality of postoperative analgesia between fascia iliaca block combined with general anaesthesia (GA) and subarachnoid anaesthesia with morphine and bupivacaine (SAB). MATERIAL AND METHODS After having obtained the ethics committee approval and the patients consent, a prospective, open-label, randomized trial was conducted in patients referred for total hip arthroplasty (THR). The GA group was administered ultrasound-guided fascia iliaca block with 40 ml of 0.25% bupivacaine solution after the induction of general anaesthesia. In the SAB group, subarachnoid blockade was performed with a mixture of 3 ml of 0.5% bupivacaine with 0.150 mg morphine prepared in the hospital pharmacy. Right after surgery the patients were taken to the ICU for 24 hours, after which they were transferred to a general ward. In addition to vital signs monitoring, pain intensity using a 0-10 numeric rating scale (NRS), first morphine administration at NRS >4, total morphine consumption and potential adverse effects were observed over the period of 72 hours. RESULTS There was no statistical difference between the GA (14 persons) and the SAB (14 persons) group in demographic parameters, time to first morphine administration (10 hrs vs. 19 hrs, p=0.10), number of persons with no need for morphine after surgery (5 vs. 7), tingling sensation (1 vs. 0) or numbness of the limb (0 vs. 1). There was no difference in cardiorespiratory parameters or side effects of therapy. In neither case was there respiratory depression or delayed rehabilitation. No patient developed delirium after surgery, and no patient reported dissatisfaction with pain management. DISCUSSION The fascia iliaca block and subarachnoid anaesthesia using local anaesthetic with opioid addition have been repeatedly published for patients after total hip arthroplasty, but this study is unique by comparing the two methods. The study added a new piece of knowledge to the findings of several recent meta-analyses on the comparable outcomes of general and subarachnoid anaesthesia for hip replacement in the perioperative period. CONCLUSIONS If subarachnoid anaesthesia cannot be used in hip arthroplasty, general anaesthesia with fascia iliaca block provides comparable analgesia and quality of postoperative course. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Aseptic pseudoarthrosis (nonunion, PSA) of the humeral shaft is one of the serious complications in the treatment of fractures in this area. In a retrospective study, the authors described different methods of treating patients with this complication using predictive factors. MATERIAL AND METHODS Based on the definition of nonunion and the criteria, 14 patients (N=14) with the mean age of 56 years (32-78), namely 8 men and 6 women were included in the study. All patients were followed up clinically and radiologically at 1, 3, 6, 9, 12 months and every 3 months until the condition stabilized. The follow-up period was 11-72 months, with the average of 22 months. According to the AO classification, the fractures were classified as: 4-A1, 1-A2, 4-A3, 1-B1, 3-B2 and 1-C2. Based on the Weber-Čech classification, 2 cases of pseudoarthrosis were hypertrophic, 4 oligotrophic and 8 atrophic. According to the Non-Union Scoring System (NUSS), 5 patients reached the score under 25 points, 3 patients received 25-50 points, 4 patients 51-75 points and two patients over 76 points. In five cases, the fracture displacement index (FDI) was above 100%. In 11 patients, PSA was in the proximal and middle third and in three patients in the distal third of the humerus. METHODS Of the whole group (N=14), the nail was used in 5 cases (36%) - in 3 cases NUSS of up to 50 points and in 2 cases over 76 points. The plate was used in 9 cases (64%). In patients with NUSS of up to 50 points - in 1 case after conservative treatment, in 1 case for augmentation of nail, in 3 cases for augmentation of Prévot nails. In 4 cases with NUSS of 51-75 points a plate was replaced. Osteosynthesis was always supplemented by Judet's decortication or resection of atrophic bone and spongioplasty by autologous graft. RESULTS Shoulder function measured by the Constant Murley score (C-M) improved from 53 to 89 points (from the range of 36-76 points to the range of 75-100 points). The function of the elbow joint also improved, namely from the Mayo Elbow Performance Score (MEPS) of 65 points to 90 points (from the range of 45-70 points to the range of 80-100 points). In 11 cases (79%) the nonunion was healed and in 3 cases (21%) the failure to heal was reported. In the group with unhealed nonunions, in one case with NUSS of 51-75 points a thermoplastic casting was used and in two patients with NUSS above 76 points a palliative surgery was performed using a 12mm interlocking intramedullary nail. DISCUSSION The results of our study focused on the treatment of aseptic nonunion of the humeral shaft confirm the conclusions arrived at by other authors. As to the osteosynthesis materials, the plate remains the gold standard and provides sufficient stability for bone healing. For unhealed treatment-resistant PSA, we offer a stable intramedullary nail instead of prosthetic replacement or amputation, which provides good stability required for limb function. CONCLUSIONS When planning the treatment of aseptic pseudoarthrosis of the humeral shaft, it is necessary to have a thorough knowledge of etiopathogenesis with all predictive factors. The NUSS classification provides good guidance in treating this complication. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Our study aimed to assess the mid-term outcomes and complications with the ICON hip resurfacing system and to carry out a detailed analysis of pitfalls and risks associated with pairing the bearing surfaces of metal-on-metal hip implants. MATERIAL AND METHODS A total of 52 hip joints were assessed in 43 patients who received the ICON hip resurfacing system at our department between 2009 and 2013. The cohort included 34 men and 9 women. Their age at the time of primary surgery ranged from 34 to 67 years, with the mean age of 51.8 years. The mean follow-up was 7.6 years. The evaluation focused on the position and osseointegration of both components, bone remodelling around the implant, and signs of potential aseptic loosening. The functional status of the hip was assessed by Harris Hip Score. RESULTS The primary stability of both components was always good, there were no femoral neck fractures reported in our cohort. All the acetabular components were stable, showing appropriate osseointegration, with no radiolucent zones or signs of osteolysis around them. There was not a single case of the femoral component stem being in a biomechanically disadvantageous varus position. In zone I and III according to Beaulé, cancellous bone osteolysis developed in two patients. The narrowing of the femoral neck below the end of the femoral component, compared to postoperative X-rays, achieved the mean value of 1.3% according to Grammatopolouse. The HHS increased from 64 to 95.5 points. An excellent outcome was observed in 48 joints, whereas the outcome of the remaining 4 joints was very good. The mean survival rate of the resurfacing hip implant calculated using the Kaplan-Meier analysis achieved 100%. The cobalt and chromium levels in the blood of patients did not exceed the reference physiological value. DISCUSSION The resurfacing system enables to preserve the bone tissue of the metaphysis and a part of the femoral head. The reduced mechanical endurance of the peripheral part of femoral components smaller in size caused by implant malposition resulted in fatal consequences in the ASR system. Greater range of motion conditioned by the design of the resurfacing system led to a mechanical wear, with a significant increase in the concentration of metal particles in the effective joint space. The elevated levels of cobalt and chromium ions in some patients induced delayed-type hypersensitivity with subsequent development of aseptic lymphocyte-dominated vasculitis associated lesions presented as peri-acetabular changes (pseudotumors to osteolysis) with subsequent failure of implant fixation. We have not observed this complication in the ICON system as yet. In patients suffering from hip pain after the resurfacing hip arthroplasty and simultaneous high chromium and cobalt blood levels, pelvic CT/MRI is indicated with reduction of artefacts around the metal material. Surgical treatment of soft tissue affections, bone defects and reimplantation using conventional or revisioncementless components is a possible treatment option. CONCLUSIONS The ideal patient indicated for hip resurfacing is a physically active man under 60 years of age (with a femoral head size of 54–60 mm), with primary or secondary osteoarthritis, no joint deformity, with a good quality bone tissue in the femoral neck and head region. As for the functional performance, the resurfacing system allows the patients a large range of motion with very good joint stability immediately after surgery. Despite that, the metal-on-metal tribological pairing must be approached with caution. The risk of developing lesions associated with ALVAL is unpredictable. In our cohort of patients with ICON hip resurfacing system, mostly excellent outcomes with minimum complications were reported provided the indication criteria and the correct surgical procedure had been complied with. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Partial knee replacement appears to be an appropriate surgical solution of unicompartmental knee joint osteoarthritis in correctly indicated cases. The purpose of our study was to evaluate the mid-term outcomes of unicondylar knee replacement using the Oxford Phase III system in the group of patients treated by the First Department of Orthopaedic Surgery, St. Anne s University Hospital Brno. MATERIAL AND METHODS The prospective study evaluated 47 patients (in 4 patients bilaterally) after the Oxford unicompartmental knee replacement performed between 2011 and 2016. The patients were evaluated using the Knee Society Score (KSS), Oxford Knee Score (OKS) and radiological examination performed at 7.3 years after surgery on average. All the patients were operated on by the same surgeon. RESULTS Based on the questionnaires and the clinical examination, the clinical and functional status was assessed, using the Knee Society Score (KSS). The mean preoperative KSS and FS values were 59.8 and 56.5, respectively. The postoperative KSS and FS values were 91.2 and 83.4. The mean preoperative value of the Oxford Knee Score (OKS) was 27.3. Postoperatively the values reached 40.7 on average. Based on the radiological examination, the lower limb correction of axis in the frontal plane was assessed. The mean axis correction was 3.1°. The mean tibial component slope measured on lateral radiograph was 82.7°. The basic analysis of X-rays did not reveal any component malposition. The implant survival rate was calculated using the Kaplan-Meier cumulative survival curve. In our group of patients, the mean survival rate of Oxford Phase III unicondylar knee replacement at 7.3 years postoperatively is 98.0%. DISCUSSION Many studies have reported excellent results of unicondylar knee replacement and a long survival rate of over 90%. Still debated, however, are the indication criteria and also the importance of the surgeon s experience and mastery of the surgical technique. CONCLUSIONS The results of the study confirm our excellent clinical experience and the survival rate of 98% at the mean follow up of 7.3 years after surgery shows great promise for quality long-term results. Overall, crucial for the success of UKR continues to be the compliance with the indication criteria for surgery. The choice of the type of implant and, last but not least, the correct surgical technique and postoperative rehabilitation programme are also important. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The retrospective study of patients treated for sacral chordoma with respect of complications, clinical outcomes and longterm survival is presented. Three main hypotheses have been formulated. Hypothesis 1: survival of patients with respect to generalization of the disease, manifestation of local recurrence and metastases with a R0 resection margin achieved is longer than survival of patients with a R1 or R2 resection margin. Hypothesis 2: survival of patients with the tumor resected from low endplate of S2 distally is longer than in tumors with resection above this level. Hypothesis 3: resection of large tumors with tumor volume greater than 800 cm³ is associated with a significantly shorter survival than resection of tumors with tumor volume less than 800 cm³. MATERIAL AND METHODS A total of 12 patients (7 women, 5 men), with the mean age of 54.3 years, underwent surgical treatment at our department in 1998–2018. Sacral chordoma proximally achieved S1 level in three cases, S2 level in four cases and S3 level in five cases with volume less than 800 cm³ in eight and greater in four patients. In nine patients sacrectomy using isolated posterior approach was performed and in three patients antero-posterior approach was applied. The Kaplan-Meier survival curve was calculated to estimate the survival of patients. The patients were divided into groups and subsequently compared with respect of achieved radicality of surgical resection, i.e. R0 vs. R1 or R2 resection, secondly of the proximal margin of the tumor/resection, i.e. S1 or S2 vs. S3 distally, and thirdly of the volume of the tumor, i.e. less than 800 cm³ vs. more than 800 cm³. RESULTS At the time of evaluation, a total of seven patients were alive (58.3%), with the mean survival of 9.5 years. One patient died from complications associated with the treatment of obstructive ileus manifested 10 months after primary surgery. The remaining four patients died in relation to the generalization of the disease 14.8 years after primary surgery on average. All the patients, in whom R0 resection was achieved, at the average time of evaluation of 7.3 years (range 2.8–15.8 years) showed no signs of local recurrence or generalization of the disease, whereas in group with R1, R2 resection at the time of evaluation only two patients were still alive, both 16.8 years on average (range 15.2–18.4 years) after surgery with repeatedly treated recurrencies. Frequent postoperative complications were observed in a total of five patients (41.7%). DISCUSSION The study did not confirm any difference in patient’s survival with respect of the proximal margin affection of sacrum or tumor size. The decisive factor for survival of patients with sacral chordoma is achieving the R0 resection. The size of the chordoma and proximal achievement increase the complexity of surgery, manifestation of early perioperative and subsequently postoperative complications. CONCLUSIONS In primary surgical treatment of sacral chordoma, we always try to achieve R0 resection. In the case of low-volume tumors from S3 distally, we resect the tumor using the isolated posterior approach. The anterior-posterior approach is preferred in the case of large tumors presenting in the S1/2 region. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Radial head fractures in paediatric patients account for 5–19% of all elbow injuries and approximately 1% of all fractures in children. Non-displaced fractures are treated with plaster cast fixation. If the fracture is displaced, we proceed to closed reduction, or to osteosynthesis in case of unstable fragments. If closed reduction fails, we opt for open reduction and osteosynthesis. The prospective randomised clinical study aims to compare the two methods of minimally invasive osteosynthesis using the pre-bent Kirschner wire or Prévot nail and to identify differences between them. MATERIAL AND METHODS The prospective randomised clinical study was conducted in 2015–2019. The final cohort included 32 patients who met the inclusion criteria. The patients in whom other osteosynthesis implants had been used or in whom open reduction had to be performed were excluded from the study. Also excluded were the patients with serious concomitant injuries of elbow. For patients included in the cohort, demographic data, precise evaluation of the displacement and location of the fracture as well as the duration of plaster cast fixation and osteosynthesis implants used were recorded. In the clinical part, the methods were compared based on the achievement of full range of motion in dependence on the degree of original displacement, use of osteosynthesis implant, and occurrence of early and delayed complications. Clinical and radiological outcomes were compared. In both types of minimally invasive osteosynthesis, Métaizeau surgical technique was used. RESULTS Based on the clinical trial criteria, 26 (81%) excellent, 4 (13%) good and 2 (6%) acceptable outcomes were achieved. In 3 cases the loss of rotation was up to 20°, in 1 case the loss of flexion was up to 10°. In one patient the loss of flexion was 15° and rotation up to 30°. In another patient the loss of rotation was up to 40°. The radiological assessment showed 14 (44%) excellent outcomes, 15 good (47%) and 3 (9%) acceptable outcomes. The statistical analysis of both the groups of the cohort using non-parametric tests revealed no statistically significant differences in individual demographic parameters. The comparisons of both types of osteosynthesis in dependence on the degree of displacement by non-parametric Fisher’s exact test showed no statistically significant difference in the radiologic or clinical results. The only statistically significant difference was observed in the duration of metal implant placement. DISCUSSION Comparable studies report excellent or good clinical outcomes in 80-95% of cases (1,13,16). In our cohort, excellent or good clinical outcomes were achieved in 30 patients (94%). In two patients, in whom Prévot nail was used, the outcomes were acceptable. Nonetheless, this fact did not result in any statistical significance when comparing the two methods separately or in comparisons based on the degree of displacement. CONCLUSIONS The comparison of the two methods of minimally invasive osteosynthesis revealed no statistically significant difference, namely not even when both the methods were compared based on the degree of displacement. When Kirschner wire is used, the possibility to remove the metal implant in the outpatient setting is considered to be an advantage. The drawback consists in potential penetration of the sharp Kirschner wire in the radiocapitellar joint, which we did not encounter when the second technique of osteosynthesis was used. The advantage of Prévot nail includes a lower risk of pin-tract infection. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The preferred treatment of giant cell tumor of bone is curettage with the use of local adjuvant. If the tumor spreads beyond the bone into soft tissues, en bloc excision should be performed. Intralesional curettage allows joint preservation, but it is associated with a high recurrence rate. The purpose of the study was to identify the risk factors for local recurrence and to compare the functional outcomes after both types of surgical procedures. MATERIAL AND METHODS The group included 16 patients (5 women, 11 men) with giant cell tumor of bone in distal forearm treated at the First Department of Orthopedic Surgery, St. Anne s University Hospital Brno in 2005–2019. The mean age of patients was 38 years (22–53). The follow-up period was 6.75 years (2–15) on average. The most common location of the tumor was distal radius (14). In 6 patients denosumab treatment was indicated. Based on the obtained data, we compared the effects of gender, Campanacci grade, type of surgery and administration of denosumab on the risk of local recurrence. The functional outcomes were evaluated retrospectively based on the Musculoskeletal Tumor Society scoring system for upper limb salvage surgeries. RESULTS Resection and reconstruction using an osteocartilaginous allograft was performed in 9 patients. Seven patients were treated with tumor curettage with bone cement used to fill the cavity. The group of patients who underwent curettage showed a significantly higher mean MSTS score 89% compared to the group of patients with resection with the mean MSTS score 66% (P < 0.05). Local tumor recurrence was reported in 3 patients (18.75%). No statistically significant difference was found in gender, tumor grade, radicality of surgery or administration of targeted therapy with respect to the incidence of local recurrence. Altogether 6 complications (37.5%) were observed in the group. DISCUSSION The treatment of a giant cell tumor of bone aims to completely remove the tumor and to preserve the best possible function of the limb. The complications in distal forearm involve particularly an increase incidence of local recurrence and painful or limited range of motion of the wrist. Whereas curettage with the use of local adjuvant is burdened with a higher recurrence rate, resection with allograft reconstruction of bone defect is usually associated with poorer functional outcomes. CONCLUSIONS Tumor curettage using local adjuvant is preferred in a well-circumscribed tumor and offers an excellent functional outcome. En bloc tumor resection and reconstruction using an osteocartilaginous allograft is a suitable treatment option for a locally advanced tumor with a low risk of local recurrence. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Axial deformities of the lower limbs of various aetiologies are relatively common orthopaedic diagnoses in paediatric population. Fixed deformity is an indication for correction in order to reduce the pain and to delay the early osteoarthrosis of adjacent joints and pain. Temporary hemiepiphysiodesis is technically a fairly simple method for modulating growth at the level of the growth plate and thus correcting the skeletal axis. MATERIAL AND METHODS 59 patients who underwent axial deformity correction of lower limbs at KDCHOT FN Brno were retrospectively analysed. Group 1 consisted of 21 patients with Blount staples implantation, Group 2 consisted of 38 patients to whom eight-figure plates had been applied. Anthropometric parameters (BMI, age, gender, intermalleolar distance (IMD)), duration of therapy, X-ray parameters (anatomical lateral distal femoral angle (aLDFA), anatomical medial proximal tibial angle (aMPTA)) and complications were recorded. The rate of correction was evaluated as the difference in X-ray parameters before and after surgery with respect to the time interval of the therapy. RESULTS The groups were comparable in terms of anthropometric parameters (BMI (p=0.800), IMD (p=0.334), gender (p=0.87)). The only statistically significant difference was found when comparing the mean age of the groups (p=0.005), with Group 1 (12.7±0.7) containing patients with a higher mean age than Group 2 (11.6±1.5). The groups were also comparable in terms of the average rate of correction over a one-month interval (aLDFA p=0.393; aMPTA p=0.831). The mean correction rate for Group 1 was: aLDFA 0.52±0.20/month, aMPTA 0.12±0.08/month; for Group 2: aLDFA 0.56±0.28/month, aMPTA 0.12±0.20/month. Individual implants differed in the type of complications, but no significant statistical difference in the incidence of complications was found between the analysed groups (p=0.526). DISCUSSION Recently, the system of eight-figure plates has been adopted as a standard method for correction of axial deformities of limbs. Although the benefits of this system are indisputable, when comparing the average monthly correction rate, no significant difference was found between the system of eight-figure plates and Blount staples in our study. Another monitored parameter was the occurrence of complications, which was evaluated fairly strictly. Even in this case, no statistically significant difference was found. We believe that the issue of using eight-figure plates is still open, as evidenced by studies, which often produce different results and conclusions. Therefore, a precise evaluation of the indication for correction, including individual characteristics of patients, is needed. CONCLUSIONS Based on the results, it can be concluded that the use of eight-figure plates in comparison with Blount staples provides neither faster correction of axial deformities nor lesser occurrence of complications. It can therefore be argued that the Blount staples still have their place in the indication of correction of axial deformities. The use of eight-figure plates represents a suitable solution for children of younger age to whom anchoring of the screws of eight-figure plates is a suitable solution in the cartilaginous epiphysis of long bones of younger children. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY To present the technique, learning curve, complications, postoperative pain levels and cost-effectiveness analysis of 24 patients with symptomatic rotator cuff tear operated with Drillbone Tunneler - a novel transosseous suture-passing device designed for arthroscopic use. MATERIAL AND METHODS Between February and May 2021, 24 patients underwent arthroscopic transosseous rotator cuff repair. During the study, the time spent preparing the tunnels was recorded along with the occurrence of complications during the operation. Price calculation of the delivered transosseous cuff repair and an alternative procedure with suture anchors was made. During the postoperative period, the patients rated their pain (on the VAS scale) twice a day, in the morning and in the evening, for 4 weeks, based on which the average values per each week were calculated. RESULTS The average time it took to prepare the tunnels and pull through the sutures was 6.2 minutes. In one case it was impossible to pull the shuttle loop through and that is why during the surgery arthroscopic transosseous-equivalent repair using suture anchors was performed instead. Apart from this, no other complications occurred. The patients reported rapid reduction of postoperative pain during the second and third week after surgery. The cost price analysis proved an average saving of CZK 9.463 per procedure. DISCUSSION There is a growing body of evidence that arthroscopic transosseous rotator cuff repairs achieve equivalent clinical outcomes as suture anchor repairs or even better clinical outcomes. These techniques are safe and effective; there is an earlier reduction of postoperative pain. Healing is more biological due to better vascularity, larger footprint coverage and clinically optimal biomechanical strength. Moreover, these techniques significantly save costs and meet requirements of the upcoming era of value-based surgery. CONCLUSIONS In our cohort, a favourable learning curve and minimum occurrence of complications were established. The study confirmed the data published so far on early relief of postoperative pain. We also proved that significant saving of costs of the materials used was achieved. [ABSTRACT FROM AUTHOR]