The study was aimed at the clinical and biomechanical analyses of the sliding hip screw breakage with the use of finite element method. We have identified two patients with the sliding screw breakage. In the first patient, the biomechanical analysis revealed the reduced stress values σ not exceeding the yield limit or strength limit of the implant. The yield limit was exceeded in second one. Clinical and biomechanical analyses have demonstrated that adherence to technical requirements of the appropriate osteosynthesis implementation is the principal condition of timely healing since it prevents the material failure.

PURPOSE OF THE STUDYTo present the results of primary total hip arthroplasty (THA) with use of the hemispheric threaded Ultima cup at 8.5-year follow-up. MATERIALBetween 1996 and 1999, a total of 40 Ultima acetabular components were used in 33 patients (15 men and 18 women). The average age at the time of surgery was 61.2 years (range, 45 to 71). By the end of 2006, 36 cups were assessed. Indications for the primary THA procedure included primary arthritis in 32 hips, post-traumatic arthritis in three, post-dysplastic arthritis in two, femoral neck fracture in two and rheumatoid arthritis in one. METHODSThe average follow-up was 8.5 years (range, 7 to 10). The indication criteria for primary implantation were evaluated, i.e., body mass index, patients' activity and their age. THA outcome was evaluated on the basis of clinical rating (Harris hip score) and pain assessment and on radiographic findings on which the acetabulum before and cup position after THA were compared, and potential changes in cup position, acetabular cup loosening or para-articular ossifications were observed. RESULTSGood outcomes were found in 88.9 % of the hips. In most, cup position was satisfactory. One acetabular component was implanted in a varus position (34°). An intraoperative complication included fracture of the greater trochanter, which was left untreated for spontaneous healing.The early-postoperative complications were one dislocation, two wounds with serous secretion not requiring revision surgery, and one large haematoma. Stem fracture as a late complication was recorded in two THAs. Radiolucencies were found in six hips and paraarticular ossifications in four. Migration of the cup with protrusion into the acetbulum occured in one patient 3 years after THA. Four cups showed aseptic loosening within 3 to 7 years of surgery. No infection was recorded in this THA group. DISCUSSIONInformation on mid-and long-term outcomes of the use of cementless acetabular cups in the relevant literature is sparse. The Ultima cup is dealt with only in the report by Pazdírek et al., whose results are in agreement with ours, but involve a lower number of implanted cups and a shorter follow-up. In this study, loosening was recorded only in cups larger than 32 mm in diameter. In comparison with our group of cementless BMT acetabular components, the use of cementless Ultima cups gives better results at mid-term follow-up. CONCLUSIONSAt 8.5-year follow-up, 88.9 % of the Ultima acetabular components were without radiographic signs of loosening. Attention should be paid primarily to THA patients with a thin wall acetabulum requiring a larger cup and a 32-mm liner.

PURPOSE OF THE STUDYTo present the results of Dynamic Hip Screw (DHS) osteosynthesis for the treatment of proximal femoral fractures with a focus on specific complications of this method. MATERIALFrom 1997 till 2007, the authors performed 367 DHS osteosyntheses to treat 341 patients with fractures of the proximal femur. The average patient age was 81.8 years (21-101). Twenty-six patients had surgery for bilateral fractures. METHODSOsteosynthesis was always carried out using a 135° DHS (Medin, Nové Město na Moravě, Czech Republic) to manage fractures of the femoral neck (13 ); trochanteric and basicervical fractures (349 ) and subtrochanteric fractures (5). At the end of 2009 the group was evaluated in terms of specific complications, i.e., intra-operative, early and late post-operative complications, and reoperation incidence. Hip radiographs were made before the patient was discharged, at 6 weeks, then at 3, 6 and 12 months post-operatively.When there were no complications, X-ray examination was repeated every 12 months. RESULTSA total of 39 specific complications of the DHS system (11 %) were recorded. The 17 intra-operative complications included: insufficient reduction (10), broken tip of a K-wire (3), faulty technical procedure (2) and fracture of the distal fragment during surgery (2). In addition, 22 post-operative complications (both early and late) were recorded: "cut-out" phenomenon (6), avascular necrosis of the femoral head (5), progression of coxarthrosis (4), screw breakage (2) , femoral fracture under the plate (2), pseudoarthrosis (2) and late infection (1).Complications in relation to the fracture site were as follows: femoral neck fractures, 3/13 (23 %) all requiring revision surgery; trochanteric fractures, 35/349 (10 %), of these 12 reoperated; subtrochanteric factures, 1/5 (20 %) no revision surgery required. Of the 367 fractures treated by DHS osteosynthesis, 15 (4 %) required revision surgery for specific complications. The mortality rate within one year of surgery was 49 %. DISCUSSIONEnough information on treatment options for proximal femoral fractures can be found in the literature. However, less attention is paid to their complications. The authors used DHS osteosynthesis to treat 367 fractures during 11 years, and recorded 11 % of complications. These can be prevented by the correct indication (the final decision of the implant to be used is sometimes made only after a fracture reduction under an X-ray image intensifier on the operating theatre), correctly performed procedure and thorough post-operative care. The high one-year mortality was due to the high average age in the group. CONCLUSIONSThe authors regard DHS as an effective method to treat stable pertrochanteric fractures and fractures of the femoral neck in younger patients. Complications most often occur as a result of technical mistakes made by surgeons.

PURPOSE OF THE STUDYThe outcome of surgical treatment in hallux valgus is sometimes unsatisfactory for both the patient and the surgeon. The valgus position of the big toe in the metatarsophalangeal joint is associated with a deviation to varus of the first metatarsal, resulting in the space between the first and second metatarsals called the intermetatarsal (IMT) angle. In most patients the angle is between 10 and 20 degrees. These patients were indicated for scarf osteotomy as this method has been reported to achieve good outcomes. The results are compared with the relevant literature data on foot osteotomy. MATERIALOur group involved 62 scarf osteotomies carried out on 49 patients who were followed up for an average of 18 months (range, 6-36 months). Three patients underwent surgery on both feet in one stage, five had bilateral surgery in two stages. The average pre-operative IMT angle was 16 degrees (range, 9-21 degrees) and the average hallux valgus angle was 37 degrees. METHODSThe patients were indicated for surgery on the basis of subjective complains and weight-bearing radiographs. Scarf osteotomy was performed by the Barouk technique. From a signle incision in the first intermetatarsal space, the lateral articular capsule was released, adductor tendon was dissected and sesamoid bones were reduced. The first metatarsal was exposed from an incision along its medial axis, the bunion was excised and Z-osteotomy of the metatarsal was performed. The distal fragment was shifted laterally, fixed with two 3.5 mm Poldi screws, and the capsule was closed under tension with transosseal suture. If necessary, an additional procedure on the big toe phalanges or osteotomy of the other metatarsals are carried out. From the second post-operative day the patients were allowed to walk on the heel, after removal of sutures they walked wearing a special sandal and, from the third week onwards, full weight-bearing was allowed. The average hospital stay lasted 4 days. The evaluation of post-operative results was based on radiograms, subjective feelings of the patients and clinical assessment of the range of big toe motion. RESULTSOut of 62 operations carried out on 49 patients (average age, 41.5 years), 23 were performed on the right and 23 on the left foot; bilateral surgery was carried out in three patients in one stage and in five patients in two stages. Simultaneously, the Weil osteotomy was performed on six feet, Akin osteotomy of the big toe phalanges on five feet, Braggard surgery of the second toe on three feet, and scarf osteotomy of the fifth metatarsal on three feet. All feet were indicated for scarf osteotomy because of pain and, in 56 feet, also esthetic reasons were involved. The patients' subjective post-operative assessments were as follows: satisfaction with the outcome in 58 feet, pain associated with tight shoes in two feet, pain while walking in six feet, and dissatisfaction with the big toe shape in one patient. The average IMT angle of 16 degrees and hallux valgus angle of 37 degrees on the pre-operative r...

PURPOSE OF THE STUDYTo present the results of surgical repair of ruptures of the distal tendon of the biceps brachii muscle and thus show the adequacy of this treatment. MATERIALBetween 1987 and 2006, 19 patients had surgery for distal biceps tendon rupture. Only one side was affected in each patient. All patients were men between 28 and 69 years (average age, 47.5 years) at the time of injury (surgery). When the patients were evaluated at the end of 2007, 18 patients were included, because one died a year after surgery. METHODSThe surgical repair always included a single-incision anatomical reattachment into the radial tuberosity. In 11 patients, a modified Mac Reynolds method with screw and washer fixation was used; in seven patients the insertion was fixed with Mitek anchors and, in one, it was sutured to the adjacent soft tissues. The average follow-up was 7 years (range, 1 to 20.5 years). The patients were evaluated for the cause of injury, their physical activity, age, dominance of the injured arm, surgical procedure and complications. RESULTSIn 18 patients surgical repair was done early and, in one, at 16 days after injury. In all of them the tendon was detached from its site of insertion, but never torn. The intra-operative complications included, in one patient, bleeding owing to iatrogenic damage to a branch of the brachial artery, and difficult separation of the tendon due to its previous healed injury in another patient. Early post-operative complications included superficial skin necrosis in one patient and transient neurological deficit of the dorsal brand of the radial nerve and of the lateral cutaneous nerve of the forearm in two and one patient, respectively. The late complications were heterotropic ossification in three patients and screw migration in the one treated by the Mac Reynolds method. Excellent results were recorded in 11 patients (61 %), and good outcomes with a slight restriction of motion or muscle strength not limiting the patient's physical activities were in six (33.5 %) patients; only one patient (5.5 %) experienced pain on moderate exercise and had recurrent heterotropic ossification. Apart from this condition, there was no difference in the frequency of complications associated with the method used. DISCUSSIONOnly sparse information on distal biceps tendon ruptures has been available in the relevant Czech literature and, if so, only small groups with short follow-ups have been involved. Conservative treatment or the methods of non-anatomical reattachment have poor functional outcomes. Much better results are achieved by anatomical reattachment. Based on our experience with the Mac Reynolds technique, an anterior single-incision approach using fixation with Mitek anchors can be recommended. CONCLUSIONSEarly surgical repair involving anatomical reattachment from the anterior singleincision approach with two Mitek anchors is recommended when a rupture of the distal tendon insertion of the biceps brachii is diagnosed.