Biomedical subjects

H J Trnka

Publications and source records attributed to H J Trnka.

34 records · Page 2Linked to original sources

PubMed1999

General short-term indomethacin prophylaxis to prevent heterotopic ossification in total hip arthroplasty.

This prospective study evaluated heterotopic ossification prophylaxis with indomethacin for 14 days in 201 consecutive patients undergoing total hip arthroplasty. Ranitidine was administered concurrently to alleviate gastrointestinal side effects. None of the patients with mild gastrointestinal side effects (12%) had to suspend the prophylaxis, and no major postoperative bleeding or gastrointestinal ulcers were observed. After 12 months of follow-up, 67% of patients had no evidence of heterotopic ossification, 32% percent had grades I and 1% had grade III without clinical significance, and 0% had grade IV ossification according to Brooker's classification. These results indicate that short-term indomethacin prophylaxis is an effective, inexpensive, and easily administrated alternative to single-dose radiotherapy for nearly all patients undergoing THA.

Adult↗

PubMed1999

Stable bony integration with and without short-term indomethacin prophylaxis. A 5-year follow-up.

We included in a prospective study of a standardized indomethacin protocol 134 consecutive patients undergoing primary cementless endoprosthetic hip replacement between January and June 1990. Periarticular heterotopic ossification (HO) was graded according to the Arcq classification (grades 0 to III). At final follow-up, all patients were analyzed clinically and radiographically for HO and aseptic loosening. A similar group of 44 patients (mean age of 64 years, range 38-82 years) undergoing total hip replacement (THR) with the same prosthesis and technique in 1987 did not receive HO prophylaxis and served as a control group. The average age of the 134 prophylaxis patients was 66.5 years (range 32-85 years), and the average follow-up was 65 months (range 60-71 months). Thirty patients (25%) were lost to final follow-up (19 died, 10 unknown, 1 amputation). In the study group, 77% had HO grade 0, while none had HO grade III, compared with 18% HO grade 0 and 16% HO grade III in the control group. These differences were statistically significant (P = < 0.001). At a minimum of 60 months follow-up, clinical and radiographic evaluation revealed no aseptic loosening in the study group: 4 cases of prosthesis subsidence during the first year did not progress. In the control group, there was a higher incidence of radiolucency around the femoral component, and one patient met all criteria for radiographic evidence of aseptic loosening. Statistical analysis revealed no significant difference between the two groups (P = 0.104). Based on our clinical and radiological results, indomethacin does not inhibit stable bony integration of the femoral component.

Adult↗

PubMed1998

Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture.

Fracture of the anterior superior process of the calcaneus has been considered an unusual injury. Following a sudden twist there is immediate pain on the outer aspect of the mid-portion of the foot and discomfort on weight-bearing. Three mechanisms of injury have been reported to cause the fracture. The diagnosis is often missed, and prolonged disability and local pain at the calcaneocuboid joint deserve further consideration. Oblique X-rays of the foot are helpful to visualize the fracture. Type III fractures may cause cartilage lesions and arthrosis; therefore, one should not wait long before excision or refixation of the fragment.

Adult↗

PubMed1997

Modified Austin procedure for correction of hallux valgus.

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9 degrees, and the average hallux valgus angle was 29.7 degrees. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8 degrees and an average hallux valgus angle of 11.9 degrees. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

Adolescent↗

PubMed1997

Acquired hallux varus and clinical tolerability.

This retrospective study was undertaken to determine the long-term clinical problems, residual disability, and need for further surgery in patients with iatrogenic hallux varus. Between 1975 and 1985, in 16 (19 feet) of 83 patients who underwent foot surgery for hallux valgus or metatarsus primus varus, hallux varus deformity was noted at 1-year follow-up on dorsoplantar roentgenograms obtained with the patients bearing weight. Thirteen of those patients (16 feet) were reexamined at an average of 18.3 years (220 months) after surgery. The average hallux varus deformity in this group was 10.1 degrees. Eleven patients (12 feet) rated their results as excellent. The average hallux metatarsophalangeal interphalangeal score for all patients was 91.5 points. Only those with extreme hallux varus deformity were dissatisfied or required further surgery.

Adolescent↗

PubMed1996

Clinical and radiological results after Austin bunionectomy for treatment of hallux valgus.

The results of the Austin osteotomies for hallux valgus deformity performed at the Orthopedic Hospital Gersthof were reviewed at least 1 year after surgery. Of the 53 consecutive patients (66 operations) with an average follow-up of 24.3 months, 49 patients (62 feet) were interviewed. Of the reviewed patients 86.6% achieved good or excellent clinical results. The complication rate was 8%, including hallux varus n (3), superficial n (1) and deep n (1) wound infections, hypoaesthesia n (2), and reflex sympathetic dystrophy n (1). There was one case of avascular necrosis of the first metatarsal head and none of non-union. The Austin osteotomy is a safe and effective treatment of mild and moderate hallux valgus deformity.

Adolescent↗

PubMed1996

Helal metatarsal osteotomy for the treatment of metatarsalgia: a critical analysis of results.

We reviewed the results of treatment of 114 feet in 96 patients with pressure metatarsalgia treated with a metatarsal osteotomy performed according to the technique of Helal. Clinical examination was performed according to a standardized evaluation questionnaire using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale. The results were correlated with number of metatarsal osteotomies, the length of the follow up, the age of the patient, and type of additional procedures performed. Sixty-one percent of the patients rated the operation as excellent or good. Patient age and number of osteotomies did not influence the results; however, the length of time following surgery and associated Keller-Brandes resection arthroplasty influenced the outcome negatively. There was a high incidence of increased transfer of weight to adjacent metatarsals. We concluded that the Helal type metatarsal osteotomy is unlikely to predictably achieve symptom relief over a long period.

Adult↗

PubMedDate not supplied

[Short-term results of modified chevron osteotomy with soft tissue technique and guide wire fixation--a prospective study].

AIM: A Chevron osteotomy with lateral soft-tissue release was performed at our department in 1993. In 1994 a prospective study to evaluate the temporary Kirschner wire fixation was started. Aim of this prospective study was to analyse the short-term clinical and radiological results with special attention to stability, necroses, and luxation of the first metatarsal head. METHOD: Between February 1994 and October 1995 45 patients (55 feet) were treated with a Chevron osteotomy combined with a lateral soft-tissue release and temporary Kirschner wire fixation. The average follow-up was 33.9 months. All patients were seen and evaluated preoperatively and at a minimum follow-up of 24 months using a standardized questionnaire based on the Hallux metatarsophalangeal interphalangeal Scale (HMIS) of the American Foot and Ankle Society. RESULTS: Results of the survey of patient satisfaction revealed excellent and good results in 83%, fair in 8%, and poor in 9%. The median HMIS at final follow-up was 86.9 pints of 100 points. The average hallux valgus angle correction was 19.8 (from 28.7 to 8.9) and the average first intermetatarsal angel correction was, 8.2 (from 14.4 to 6.2). No avascular necrosis of the first metatarsal head and no loss of correction were noted. In one case a luxation of the metatarsal head was observed. CONCLUSION: Combining the Chevron osteotomy with an excessive lateral soft-tissue release increases the likelihood of instability of the metatarsal head and consecutive loss of correction. The temporary Kirschner wire fixation increases the stability of the Chevron osteotomy and prevents the loss of correction. The disadvantage of this method is, that the wire has to be removed after 6 weeks.

Adult↗

PubMedDate not supplied

[The modified Ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity].

AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.

Adult↗

PubMedDate not supplied

[The acquired flatfoot: mid-term results of the medial displacement calcaneal-osteotomy with flexor digitorum longus transfer].

AIM: The present retrospective study investigates the mid-term results after medial displacement calcaneal osteotomy combined with flexor digitorum longus transfer for the treatment of acquired flatfoot deformity due to posterior tibial tendon insufficiency at stage II (Johnson and Strom Classification). METHOD: 30 feet in 29 patients (6 male, 23 female) with an average age of 58 years (from 43 to 68 years) had surgery between 1995 and 2001. All feet were examined at an average follow-up of 58.5 months (range 35-97 months) and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score. RESULTS: The average AOFAS-Score was 88.8+/-10.7 points (range 48 to 100) at final follow-up. The AOFAS-pain-subscale score was 34+/-6.2 points. At the latest follow-up were 14 feet (47%) painfree, 14 feet (47%) noted mild pain and 2 feet (6%) had daily pain. One foot (3%) had pain due to subluxation of the musculus flexor digitorum longus tendon, in another one pain was caused by a contract Chopart joint (3%). Further complications were painful prominent hardware (17%) and neuralgia of the sural nerve (7%). CONCLUSION: The authors conclude that the combination of the medial calcaneal displacement osteotomy with flexor digitorum longus transfer may provide optimal results in patients with adult acquired flatfoot deformity and posterior tibialis tendon dysfunction.

Adult↗

PubMedDate not supplied

[Short-term outcome of Weil osteotomy in treatment of metatarsalgia].

INTRODUCTION: The aim of this retrospective study was to analyse the short term results after the Weil-procedure for the treatment for metatarsalgia in 30 consecutive patients. METHODS: 30 patients (69 osteotomies) after the Weil-procedure with an average age of 60 years (range 25 to 78 years) were analysed by clinical and radiological evaluation. The average follow up was 15 months (range 12 to 26 months). Analysis was performed using the patients' records, weight-bearing radiographs and a standardized questionnaire. RESULTS: Subjective evaluation revealed 23 very satisfied and satisfied patients. Based on the Lesser-Metatarsal-Interphalangeal-Scale the objective results showed 77.1 points on average. The results were excellent in 17 cases, good in 4, fair in 3 and unsatisfactory in 6 cases respectively. Recurrent metatarsalgia was noted in 5 cases, whereas no transfermetatarsalgia was observed. The average shortening was 4.4 mm. Subluxation of the metatarsophalangeal joint was corrected in 18 out of 22 cases. A restricted plantar flexion of the metatarsophalangeal joint was noted in 14 cases. 2 patients showed loss of movement. CONCLUSION: Our short-term results reveal that the Weil-osteotomy is a sufficient treatment for metatarsalgia. This technique is able to reestablish the alignment of the metatarsals and to correct luxation and subluxation of the metatarsophalangeal joint. Restricted plantarflexion of the metatarsophalangeal joint is a drawback, which may be avoided by intensive physiotherapy.

Adult↗

PubMedDate not supplied

[Keller-Brandes operation: long-term outcome in young patients with hallux valgus].

PURPOSE: Aim of this retrospective study was to analyse the long term results (10-16 years) after Keller-Brandes' operation for correction of hallux valgus in the younger patient. METHODS: From 1980 to 1986 fifty-one patients (77 feet) at the age of 40 years or younger at the time of surgery (19-40 years, [symbol: see text] 34 years), were operated according to a resection-arthroplasty at our institution. 24 patients (37 feet) were evaluated retrospectively after 10 to 16 years (median: 13 years) in respect to their clinical outcome. Radiological evaluation was performed preoperatively in 23 feet and in 34 feet at follow up. Analysis was performed using a standardized questionnaire based on the HMIS-Score of the American Foot and Ankle Society, an additional clinical score, weight-bearing radiographs, the patient's record and clinical investigation inclusive pedobarographic analysis. RESULTS: Seventy-six % of the patients revealed very good or good subjective overall results. The HMIS-Score revealed excellent or good results in only 57%. Cosmetic was rated very good or good in 64%, 70% of the patients were painfree. Average ROM of the MTP I-joint ranged from 25 degrees flexion to 45 degrees extension. Radiological analysis at follow up: hallux valgus angle-correction: 28 degrees to 19 degrees, no change of the intermetatarsal angle (11 degrees), proximal shift of sesamoids: 9.4 mm to 14.4 mm, neoarticulation gap: 0-2 mm in 23 feet and 3-5 mm in 11 feet, arthritis of IP-joint: 82%: none; 18%: moderate; correction of sesamoid position: 1.7 to 1.4. Metatarsalgia was observed in 27% (10 feet). CONCLUSION: Lateral weight transfer to the lesser metatarsal heads is caused by defunction of the great toe postoperatively which may lead to metatarsalgia (transfer-metatarsalgia). Besides pain relief younger patients require satisfying functional and cosmetic long-term results. To be capable of meeting these requirements, adequate joint preserving procedures like basal or distal metatarsal osteotomies conjuncted with soft tissue procedures should be preferred in respect to the grade of the deformity.

Adult↗

PubMedDate not supplied

[Hallux valgus: a therapy concept and its outcome from 1993 to 1996].

INTRODUCTION: Aim of this study is to present the treatment concept and the results of hallux valgus surgery of our department. PATIENTS AND METHODS: The criteria for decision making are 1st intermetatarsal angle, congruency of the first metatarsophalangeal joint and sesamoid position. According to our concept we performed between 1993 and 1996 42 Chevron osteotomies for mild, 138 Chevron with lateral soft tissue release (Chevron + LSR) for moderate and 93 basal crescentic (Mann) osteotomies with lateral soft tissue release for severe hallux valgus deformities. RESULTS: 31 Chevron, 118 Chevron with lateral soft tissue release and 80 basal crescentic osteotomies (Mann) were seen at an average follow up of 19 months (12-29) after a Chevron, respectively. 16 months (12-43) after Chevron with lateral soft tissue release and 18 months (12-32) after a basal crescentic osteotomy. 83% of all patients classified the results of the surgery as "very satisfactory" and "satisfactory". The average hallux valgus angle was corrected from preoperatively. 25.3 degrees (Chevron), 29.9 degrees (Chevron + LSR) and 41.8 degrees (Mann) to 16.5 degrees (Chevron), 12.1 degrees (Chevron + LSR) and 14.1 degrees (Mann) at final follow up, the average first intermetatarsal angle was corrected from preoperatively 12.1 degrees (Chevron), 14.0 degrees (Chevron + LSR) and 17.4 degrees (Mann) to 7.9 degrees (Chevron), 5.8 degrees (Chevron + LSR) and 7.8 degrees (Mann) at final follow up. CONCLUSION: Our analysis of the three osteotomies revealed that with this differentiated concept we were able to achieve excellent and good results in more than 80% of our patients. Only with a treatment plan that includes different procedures to address the various stages of hallux valgus can one achieve the optimum result for the patient.

Adult↗

PubMedDate not supplied

[Correction of high-grade sesamoid bone dislocation in hallux valgus using Austin's osteotomy with and without lateral soft tissue release].

INTRODUCTION: Aim of this study was to analyze if, using the Austin technique for correction of hallux valgus deformity, the additional soft tissue procedure is capable to achieve better correction of the sesamoid subluxation, the hallux valgus angle and the intermetatarsal angle. PATIENTS AND METHODS: 19 patients with 20 feet operated according to the original Austin technique and 26 patients with 28 feet operated according to a modified technique with lateral soft tissue release both with a preoperative sesamoid subluxation grade 3 were compared with the help of a standardized questionnaire in respect to clinical and radiological results. RESULTS: Analyzing the clinical outcome of the two procedures, there was no statistical difference. Comparison of the radiological results revealed a significantly better correction of the sesamoid position and a better correction of hallux valgus and intermetatarsal angle by using the additional soft tissue procedure. DISCUSSION: The lateral soft tissue procedure with release of the adductor hallucis, dissection of the deep transverse plantar ligament and mobilisation of the sesamoids is capable of a significantly better correction of the sesamoid position. Only a combination of osseus and soft tissue correction is capable to correct the pathomechanism and to guarantee long lasting results.

Adult↗

PubMedDate not supplied

[Long-term results of basal wedge osteotomy in metatarsus primus varus in the young patient].

INTRODUCTION: Aim of this retrospective study was to analyse the long term results after basal closing wedge osteotomy for correction of metatarsus primus varus and hallux valgus in the younger patient. PATIENT AND METHODS: 49 patients (70 feet) were operated according to a basal closing wedge osteotomy from 1974 to 1985 at our institution. Age was under 40 years in all patients at the time of surgery. 34 patients (50 feet) were evaluated in respect to their clinical and 26 patients (37 feet) to their radiological outcome. The average age was 26 years (14-39 years). The follow-up was 12 to 22 years (Median: 18 years). Analysis was performed using the patient's record, weight-bearing X-rays, a standardized questionnaire and clinical investigation. RESULTS: 82% of the patients had very good and good subjective results. Cosmetics was rated very good and good in 78%, 88% of the patients were painfree. Radiological analysis at follow-up: Hallux valgus-angle 19,3 degrees, intermetatarsal I/II-angle 6 degrees, shortening of first metatarsale 5 mm, at average; dorsal elevation of first metatarsale 38%, degenerative arthritis of the metatarsocuneiforme joint 19%, congruency of first metatarsophalangeal joint 54%,sesamoid subluxation: 46% grade 0, 30% grade I, 14% grade II and 10% grade III. In 14 feet (28%) metatarsalgia was found. DISCUSSION: The basal closing wedge osteotomy is rather a technically demanding procedure conjuncted with a higher risk of failure. Satisfactory long term results can be obtained by an ideal operating technique. As undesirable side effects shortening of the first ray and dorsal malangulation of the first metatarsale may occur consecutively leading to metatarsalgia. Lower risk procedures like the crescentic osteotomy according to Mann or chevron osteotomy should be preferred.

Adolescent↗

PubMedDate not supplied

Imaging articular cartilage defects with 3D fat-suppressed echo planar imaging: comparison with conventional 3D fat-suppressed gradient echo sequence and correlation with histology.

PURPOSE: Our goal was to shorten examination time in articular cartilage imaging by use of a recently developed 3D multishot echo planar imaging (EPI) sequence with fat suppression (FS). We performed comparisons with 3D FS GE sequence using histology as the standard of reference. METHOD: Twenty patients with severe gonarthrosis who were scheduled for total knee replacement underwent MRI prior to surgery. Hyaline cartilage was imaged with a 3D FS EPI and a 3D FS GE sequence. Signal intensities of articular structures were measured, and contrast-to-noise (C/N) ratios were calculated. Each knee was subdivided into 10 cartilage surfaces. From a total of 188 (3D EPI sequence) and 198 (3D GE sequence) cartilage surfaces, 73 and 79 histologic specimens could be obtained and analyzed. MR grading of cartilage lesions on both sequences was based on a five grade classification scheme and compared with histologic grading. RESULTS: The 3D FS EPI sequence provided a high C/N ratio between cartilage and subchondral bone similar to that of the 3D FS GE sequence. The C/N ratio between cartilage and effusion was significantly lower on the 3D EPI sequence due to higher signal intensity of fluid. MR grading of cartilage abnormalities using 3D FS EPI and 3D GE sequence correlated well with histologic grading. 3D FS EPI sequence agreed within one grade in 69 of 73 (94.5%) histologically proven cartilage lesions and 3D FS GE sequence agreed within one grade in 76 of 79 (96.2%) lesions. The gradings were identical in 38 of 73 (52.1%) and in 46 of 79 (58.3%) cases, respectively. The difference between the sensitivities was statistically not significant. CONCLUSION: The 3D FS EPI sequence is comparable with the 3D FS GE sequence in the noninvasive evaluation of advanced cartilage abnormalities but reduces scan time by a factor of 4.

Aged↗