Treatment algorithms of proximal humerus fractures are still controversially discussed. The enthusiasm towards operative treatment after the introduction of locking implants, has not been justified by the functional results in the elderly population. The majority of those fractures in the geriatric patients can be successfully treated conservatively. Thorough clinical and radiological examination for fracture analysis, dynamic stability control with the use of an image intensifier, and meticulous reduction, in addition with the appropriate orthesis for its retention and rehabilitation, are the keys for the successful treatment of the proximal humerus fracture in the elderly patient. The present review reports on the main treatment aspects of proximal humerus fractures in the geriatric population and proposes a treatment algorithm.

• MeSH
• algoritmy MeSH
• fixace fraktur metody   MeSH
• fraktury proximálního humeru diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• protetické prostředky MeSH
• senioři MeSH
• vylepšení rentgenového snímku metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The demographic change in industrial countries leads to an increasing population that sustains an acetabular fracture in an advanced age. Some authors predicted elderly individuals to be the most rapidly growing subgroup of patients currently sustaining acetabular fractures. Gold standard of treatment of acetabular fractures remains the open reduction and internal fixation. Relevant factors impeding surgical treatment include the significantly decreased bone stock and the incapability of the patients to partially weight bear following surgery. Therefore, special considerations should be performed when dealing with this patient group as surgical treatment is associated with several risks and often accompanied by poor outcomes. This review aims to summarize the current body of knowledge and to give a recommendation concerning a surgical treatment cascade.

• MeSH
• acetabulum zranění   MeSH
• fraktury kyčle chirurgie   MeSH
• lidé MeSH
• rizikové faktory MeSH
• směrnice jako téma MeSH
• stárnutí * MeSH
• vnitřní fixace fraktury * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

healing disturbances occur in 5-10% of the cases. The anatomical region of the lower limb predisposes the tibia for bone healing disturbances. Reports about the incidence of non-unions of the tibial shaft are inhomogeneous. Different treatment strategies have been published which depend on the type of non-union as well as the history of the patient. These range from conservative approaches to complex procedures including segmental resection and bone transport. This review aimed to summarize the state of the art treatment of tibial non-unions and report about recent basic research results that may improve bone healing. Key words: tibial non-unions, treatment strategies, bone healing.

• MeSH
• fraktury tibie chirurgie   MeSH
• hojení fraktur MeSH
• konzervativní terapie MeSH
• lidé MeSH
• nezhojené fraktury epidemiologie   terapie   MeSH
• ortopedické výkony MeSH
• tibie zranění   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY This study aimed to analyse the outcome following intramedullary nailing for metastases of the femur in a large cohort with special regard to mechanical, implant associated complications and patient survival. Furthermore, we aimed to identify factors influencing the overall survival. MATERIAL AND METHODS All patients (n = 74) that underwent intramedullary nailing for metastatic disease of the femur between 2004 and 2008 and were retrospectively reviewed. Data were recorded from the patients' medical record and the outpatients' clinics files. Details about the tumour biology, the surgery performed as well as the postoperative care were documented. Survival data were extracted from patient records or obtained via communication with outpatient oncologists or the community registration office. RESULTS 74 (28 (37.8%) male, 46 (62.2%) female; p = 0.048) patients with a mean age of 64.4 ± 11.7 years were included. Breast (25, 33.8%), lung (18, 24.3%), bone marrow (7, 9.5%) and kidney (6, 8.1%) were the primary tumours in more than 75% of all patients. The mean overall survival was 17.5 (95% CI: 9.6 - 25.5) months. Patients with osseous metastases had a significant longer survival than patients with visceral and/or cerebral metastases (p = 0.025 and p = 0.032). CONCLUSION Intramedullary nailing represents a valuable fixation method for pathologic fractures or impending fractures of the femur in patients with an advanced stage of metastatic disease. It provides adequate stability to outlast the patient s remaining life-span. However, the balance must be found between therapeutic resignation and surgical overtreatment since operative treatment may be accompanied with serious complications. Key words: bone metastases, intramedullary nailing, metastatic disease, cement augmentation, osteolytic defect.

• MeSH
• femur chirurgie   MeSH
• fraktury femuru etiologie   chirurgie   MeSH
• fraktury spontánní etiologie   chirurgie   MeSH
• intramedulární fixace fraktury přístrojové vybavení   MeSH
• kostní hřeby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• metastázy nádorů MeSH
• nádory kostí komplikace   sekundární   chirurgie   MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The present study aimed to analyse both, the functional outcome and quality of life after surgical treatment of periprosthetic fractures following TKA. MATERIAL AND METHODS A retrospective review of all periprosthetic fractures following knee arthroplasty which have been surgically treated at our institution between January 2005 and January 2012 was conducted. Beside epidemiologic data, type of surgery and postoperative complications were recorded. The functional outcome was assessed using range of motion, Knee Society Score and VAS to evaluate pain. Quality of life was evaluated using SF-36 and WOMAC. Furthermore patients mobility and comorbidities were analysed. RESULTS 25 (mean age 76 ± 8 years; m:w 5:20) patients were included. The overall complication rate was 24%. Mean KSS knee score was 73 ± 19 and a function score was 41 ± 36. Range of motion revealed 95° ± 24° (active) and 98° ± 16° (passive). The total SF-36 scored a mean of 41 ± 6 and 29 ± 19 in average considering the WOMAC index (pain: 19 ± 20; stiffness: 23 ± 27; daily: 47 ± 29). 20% were able to mobilise without help as opposed to 80% that were in need for assistance. Our analysis revealed no influence of the final outcome as a function of fracture type or type of treatment. Multiple regression analysis could not reveal significant influence of the comorbidities. CONCLUSION Periprosthetic fractures following knee arthroplasty are accompanied by a significant decrease of the knee function and quality of life as well as high complication rates. Since patient's quality of life apparently depends on the functional outcome, future efforts should aim to improve these parameters. Key words: periprosthetic fracture, total knee arthroplasty, quality of life, functional outcome, locking plate.

• MeSH
• kvalita života * MeSH
• lidé MeSH
• periprotetické fraktury chirurgie   MeSH
• pooperační komplikace psychologie   MeSH
• protézy kolene škodlivé účinky   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři MeSH
• totální endoprotéza kolene škodlivé účinky   MeSH
• vizuální analogová stupnice MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH