Early surgical treatment of giant cell tumour of the bone has very good functional outcomes with a relatively low risk of local recurrence and metastatic spread.In case of a pathologic fracture, extraosseous extension, and tumor location in an anatomically difficult area, surgical treatment may represent a big challenge with an uncertain functional outcome.Our case report presents a 35-year-old patient with a delayed diagnosis of giant cell tumor of the proximal radius of the dominant limb, with pulmonary metastases. Following neoadjuvant Denosumab therapy, with a major treatment effect on both the primary tumor and pulmonary metastases, we performed a wide resection and combined biological reconstruction with fibular autograft, radial head endoprosthesis, and comprehensive elbow ligament reconstruction.At 24 months after surgery, the patient is self-sufficient, capable of more physically demanding work, with a satisfactory functional outcome of reconstruction (MSTS 66.6%, TESS 69%), with no signs of local recurrence and regression of pulmonary metastases at 18 months after the last administration of Denosumab.

• Klíčová slova
• Denosumab, biological reconstruction., giant cell tumor of the bone, proximal radius, wide resection,
• MeSH
• denosumab terapeutické užití   MeSH
• dospělí MeSH
• fibula transplantace   MeSH
• inhibitory kostní resorpce terapeutické užití   MeSH
• lidé MeSH
• nádory kostí * chirurgie   patologie   farmakoterapie   MeSH
• nádory plic * sekundární   farmakoterapie   MeSH
• obrovskobuněčný nádor kosti * chirurgie   farmakoterapie   sekundární   patologie   MeSH
• radius * chirurgie   patologie   diagnostické zobrazování   MeSH
• transplantace kostí metody   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• denosumab MeSH
• inhibitory kostní resorpce MeSH

The authors analyze the results of their long-term follow-up of basic epidemiological characteristics in fractures of proximal humerus (1,464 patients), distal radius (2,514 patients), proximal femur (3,340 patients) and fracture-dislocation of the ankle (1 195 patients). In fractures of the proximal femur, the average age was 78 years; 71.6 years in men and 80.3 years in women; male-female ratio was 27:73. In fractures of the proximal humerus, the average age was 67 years; 58.8 years in men and 71.2 years in women; male-female ratio was 30:70. In fractures of the distal radius, the average age was 59 years; 45.8 years in men and 64.7 years in women; male-female ratio was 29:71. In fracture-dislocation of the ankle the average age was 49 years; 43.4 years in men and 54.7 years in women; male-female ratio was 50:50. Until 5th decade men had higher representation in all groups of fractures, starting from 6th decade the ratio changed. Introduction of new implants (locking plate, new generation of nails) for fractures of the distal radius and proximal humerus increased significantly the percentage of patients operated on.

• MeSH
• dislokace kloubu ekonomika   epidemiologie   MeSH
• dospělí MeSH
• fraktury humeru ekonomika   epidemiologie   MeSH
• fraktury kostí ekonomika   epidemiologie   chirurgie   MeSH
• fraktury proximálního humeru ekonomika   epidemiologie   MeSH
• fraktury vřetenní kosti ekonomika   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náklady na zdravotní péči MeSH
• poranění kotníku ekonomika   epidemiologie   MeSH
• receptory TNF - typ I MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• receptory TNF - typ I MeSH

• MeSH
• dítě MeSH
• lidé MeSH
• radiografie MeSH
• radius diagnostické zobrazování   zranění   MeSH
• skluz epifýzy diagnostické zobrazování   terapie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The presented study was construed as a retrospective multicentric clinical study focused on paediatric skeletal injuries of the proximal radius. As a general rule, the Type I displaced fractures (Judet classification) are treated conservatively, with no reduction. In the case of Type II-IV displacement, the fracture necessitates reduction or is also transfixed by a Kirschner wire (K-wire) or a Prevot nail (P-nail) where subsequent fragment instability occurs. The comparison aimed to ascertain whether there is a statistically significant difference between the two methods. No difference was expected by the authors, therefore a null hypothesis was set. MATERIAL AND METHODS The patients were treated at the Clinic of Paediatric Surgery, Orthopaedics and Traumatology (CPSOT) of the Faculty of Medicine of the Masaryk University and at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System of the University Hospital in Pilsen in the period from 2006 to 2015. Two methods of closed reduction and minimally- invasive osteosynthesis were evaluated. The first method was the elastic stable intramedullary nailing (ESIN) with a P-nail, the second method was an osteosynthesis using a K-wire. In the clinical part of the study, comparisons were made based on the monitoring of the same parameters - final restriction of movement, time to full weight bearing of the extremity and incidence of serious complications. RESULTS The final group comprised a total of 31 patients, of whom 7 boys and 24 girls aged 3-16 years with the median of 9-10 years. Some restriction of movement following the treatment occurred in a total of seven patients (44%) with the K-wire and in four patients (27%) with the P-nail. When comparing the movement at 5% level of significance using the Chi-Square tests, no significant difference was found (p = 0.446). When evaluating the serious complications at 5% level of significance using the Chi-Square tests, the difference between the two methods of treatment was again insignificant (p = 0.365). When the full weight bearing was compared (median K-wire 8 weeks, median P-nail 10 weeks), a statistically significant difference was obtained at 5% level of significance using the Fischer exact test (p = 0.003). DISCUSSION In these fractures, usually the metaphysis or the physis are involved in the injury, in which case the fractures are classified according to Salter and Harris, with the most frequent occurrence of SHII epiphyseal separation and rare SHIII and SHIV epiphyseal fractures. The radial head fractures are mostly caused by valgus force. Therefore, the individuals with a higher elbow valgosity are more prone to injuries. The girls strongly prevail (77%) also in our study. In general, our results as well as the literature have proven that as the displacement increases, the necessity of closed reduction and osteosynthesis grows. The post-treatment complications in our group were observed in 35.5% of patients, namely most often in the form of limited movement. The literature refers to complications in 26.5-53% of patients. CONCLUSIONS The clinical results clearly show that when comparing the complications after the radial head fracture in children there is no statistically significant difference between the methods of osteosynthesis. This study shall serve as a starting point for the currently ongoing prospective multicentric study evaluating the modified ESIN technique using a pre-bent Kirschner wire. Key words:children, fracture, radius, proximal, osteosynthesis.

• MeSH
• dítě MeSH
• fraktury vřetenní kosti * diagnóza   chirurgie   MeSH
• intramedulární fixace fraktury * škodlivé účinky   přístrojové vybavení   metody   MeSH
• konzervativní terapie * škodlivé účinky   metody   MeSH
• kostní dráty MeSH
• kostní hřeby * MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mladiství MeSH
• pooperační komplikace * diagnóza   etiologie   MeSH
• předškolní dítě MeSH
• radius * diagnostické zobrazování   zranění   chirurgie   MeSH
• rozsah kloubních pohybů MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH

The authors present their experience with treatment of injuries of the proximal radius in children. During the period between 1994 and 1998 they treated on account of this injury a total of 59 patients. Ten times they used the open method, 15 times percutaneous fixation and 34 times a conservative approach. They compare the therapeutic results of both surgical methods and demonstrate better results when the miniinvasive approach--percutaneous fixation--is used. The authors recommend this procedure in dislocated injuries type II and III and emphasize the necessity of high standard technical equipment and experience of the working team.

• MeSH
• dítě MeSH
• fraktury vřetenní kosti chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony * metody   MeSH
• mladiství MeSH
• vnitřní fixace fraktury * metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

• Klíčová slova
• BONE DEVELOPMENT *, EPIPHYSES *, EXPERIMENTAL LAB STUDY *, FRACTURE FIXATION *, RABBITS *, RADIUS *, ULNA *,
• MeSH
• chrupavka * MeSH
• cyklické N-oxidy MeSH
• diafýzy * MeSH
• epifýzy * MeSH
• fixace fraktury * MeSH
• králíci MeSH
• lidé MeSH
• radius * MeSH
• růstová ploténka * MeSH
• ulna * MeSH
• vývoj kostí * MeSH
• výzkum * MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cyklické N-oxidy MeSH
• TEMPO MeSH Prohlížeč

CONTEXT: The low bone mineral density (BMD) and alterations in bone geometry observed in patients with Turner syndrome (TS) are likely caused by hypergonadotropic hypogonadism and/or by haploinsufficiency of the SHOX gene. OBJECTIVE: Our objective was to compare BMD, bone geometry, and strength at the radius between prepubertal girls with TS and children with isolated SHOX deficiency (SHOX-D) to test the hypothesis that the TS radial bone phenotype may be caused by SHOX-D. DESIGN AND SETTING: This comparative cross-sectional study was performed between March 2008 and May 2011 in 5 large centers for pediatric endocrinology. PATIENTS: Twenty-two girls with TS (mean age 10.3 years) and 10 children with SHOX-D (mean age 10.3 years) were assessed using peripheral quantitative computed tomography of the forearm. MAIN OUTCOMES: BMD, bone geometry, and strength at 4% and 65% sites of the radius were evaluated. RESULTS: Trabecular BMD was normal in TS (mean Z-score = -0.2 ± 1.1, P = .5) as well as SHOX-D patients (mean Z-score = 0.5 ± 1.5, P = .3). At the proximal radius, we observed increased total bone area (Z-scores = 0.9 ± 1.5, P = .013, and 1.5 ± 1.4, P = .001, for TS and SHOX-D patients, respectively) and thin cortex (Z-scores = -0.7 ± 1.2, P = 0.013, and -2.0 ± 1.2, P < .001, respectively) in both groups. Bone strength index was normal in TS as well as SHOX-D patients (Z-scores = 0.3 ± 1.0, P = .2, and 0.1 ± 1.3, P = .8, respectively). CONCLUSIONS: The similar bone geometry changes of the radius in TS and SHOX-D patients support the hypothesis that loss of 1 copy of SHOX is responsible for the radial bone phenotype associated with TS.

• MeSH
• aberace pohlavních chromozomů MeSH
• dítě MeSH
• genetické asociační studie MeSH
• genetické nemoci vrozené genetika   metabolismus   patologie   patofyziologie   MeSH
• haploinsuficience * MeSH
• homeodoménové proteiny genetika   metabolismus   MeSH
• kosti a kostní tkáň chemie   patologie   MeSH
• kostní denzita MeSH
• lidé MeSH
• mechanické jevy MeSH
• mladiství MeSH
• mutace MeSH
• poruchy růstu etiologie   MeSH
• protein SHOX MeSH
• průřezové studie MeSH
• radius MeSH
• Turnerův syndrom genetika   metabolismus   patologie   patofyziologie   MeSH
• vývoj dítěte MeSH
• vývoj kostí * MeSH
• vývojové onemocnění kostí etiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• homeodoménové proteiny MeSH
• protein SHOX MeSH
• SHOX protein, human MeSH Prohlížeč

The authors describe their own experience with plate stabilization of the fractures of the shaft of the radius in group of 13 patients. The plate-stabilization was performed from the Henry approach by means of semitubular plate. Bone-union without infection or palsy of r. profundus n. radialis was achieved in all cases. Based on their own experience the authors recommend the Henry approach and stabilization of the plate with minimum 3 screw in the proximal and distal fragments. In comminuted fractures the primary iliac bone grafting is necessary. Key words: fractures of the proximal shaft of the radius, Henry approach, plate-stabilization.

• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• Klíčová slova
• ELBOW *, FOREARM INJURIES *, FRACTURE FIXATION *, RADIUS FRACTURES *, ULNA *,
• MeSH
• epifýzy * MeSH
• fixace fraktury * MeSH
• fraktury vřetenní kosti * MeSH
• lidé MeSH
• loket * MeSH
• loketní kloub * MeSH
• poranění předloktí * MeSH
• předloktí * MeSH
• ulna * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Distal radial fracture is one of the most frequent skeletal injuries in the human population. Probably because of this common occurrence, it has long been underestimated and treated as a trivial injury, with the resulting 40% poor outcome. The aim of this study was to analyze relevant characteristics, fracture types and subsequent treatment in patients with distal radial fractures in a one-year follow-up, and to suggest procedures for achieving the best functional results. MATERIAL: A total of 383 patients older than 15 years were treated in our department in 1998. The evaluation of treatment outcomes was based on a special questionnaire and the results of a standard system of check-ups. METHODS: In each patient, the basic characteristics (age, gender, mechanism of injury, period between injury and treatment, etc.), type of fracture and kind of treatment were recorded. The fractures were distributed to groups according to the Fernandez and AO classifications and compared according to selected criteria. RESULTS: Our group consisted of 103 men and 280 women; the mean age was 61.2 years and range 15 to 97 years. The highest incidence of fractures was recorded in women after menopause; 90% of all patients were women older than 60 years. It was possible to determine the type of fracture in 326 patients who had complete radiographic data. DISCUSSION: The results of this study confirmed the foreign literature data. Distal radial fractures are the most common skeletal injuries and affect women, particularly those between 50 and 80 years, three-times more frequently than men. Osteoporosis after menopause is the main factor involved. In men, on the other hand, the highest number of fractures was found in younger age categories. CONCLUSIONS: The evaluation of our patient group gave results comparable with those reported in the literature. It showed that distal radial fractures, in conjunction with fractures of the proximal humerus and the proximal femur, are the most frequent fractures particularly in elder women. Their treatment, therefore, involves both medical and social aspects. The analysis of treatment of distal radial fractures is under progress and the results will be published as Part II of our study.

• MeSH
• dospělí MeSH
• fraktury vřetenní kosti * klasifikace   epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH