• MeSH
• bederní obratle patologie   zranění   MeSH
• fixace fraktury metody   MeSH
• hrudní obratle patologie   zranění   MeSH
• krční obratle patologie   zranění   MeSH
• lidé MeSH
• ortopedické výkony metody   MeSH
• páteř anatomie a histologie   diagnostické zobrazování   patologie   MeSH
• poranění míchy diagnóza   komplikace   terapie   MeSH
• poranění páteře * diagnóza   komplikace   terapie   MeSH
• protetické prostředky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• fixace fraktury metody   škodlivé účinky   MeSH
• fraktury kostí * chirurgie   komplikace   MeSH
• hojení fraktur fyziologie   MeSH
• lidé MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• fixace fraktury metody   MeSH
• fraktury femuru diagnóza   klasifikace   komplikace   terapie   MeSH
• fraktury krčku femuru diagnóza   komplikace   terapie   MeSH
• fraktury kyčle diagnóza   komplikace   terapie   MeSH
• fraktury proximálního femuru * diagnóza   komplikace   terapie   MeSH
• lidé MeSH
• ortopedické výkony metody   MeSH
• Check Tag
• lidé MeSH

Periprosthetic femoral fractures around the femoral stem of a hip prosthesis constitute a serious challenge. The number of these fractures, associated with a high failure rate and a high number of overall complications, including higher mortality, has been on an increase worldwide. Stable femoral stems are indicated for osteosynthesis, while in case of loosening the method of choice is the replacement by a revision implant. The aim of osteosynthesis of periprosthetic femoral fractures is a stable fixation with soft tissue preservation which results in faster union allowing the patient to return to pre-injury activities. Biomechanical studies on cadavers or on synthetic models and computer simulations make it possible to evaluate the fixation strength in various types of implants in dependence on fracture characteristics and bone quality, but cannot be substituted for clinical trials since there is no direct proportion between fixation rigidity and fracture union. Fundamental principles that shall be followed in osteosynthesis of periprosthetic fractures can be deduced from the available studies. Proximal fixation by screws or a combination of screws and cables are biomechanically more advantageous than the Ogden fixation by cerclage wires or cables. Bicortical fixation enabled by state-of-the-art implants of LAP-LCP or NCB type represents a significantly more stable construction compared to monocortical fixation and led to reduced use of structural allografts. Better stability can be achieved by "double plating" technique which is applied especially in revision surgeries, but also in osteoporotic periprosthetic fractures with a defect zone. In these cases, osteosynthesis with long plates is recommended, bridging the entire femur, i.e. distally with femoral condyles fixation since this prevents the risk of a fracture below the plate. In shorter plates, this risk created by stress concentration at the end screw is amplified when a distal bicortical locking screw is used. That is why it is beneficial to reduce this stress by a monocortical screw or with the use of a conventional screw. Adherence to the principles regarding the position, type and number of screws constitutes the key parameter of successful osteosynthesis of periprosthetic fractures. Key words: hip joint, arthroplasty, periprosthetic fractures, biomechanics of osteosynthesis.

• MeSH
• fraktury femuru * chirurgie   MeSH
• kostní destičky MeSH
• kostní šrouby MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• periprotetické fraktury * chirurgie   MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Publikace určená všeobecným chirurgům, traumatologům i studentům medicíny se zabývá celým systémem ošetření a léčení zlomenin horního konce stehenní kosti.; Odborná publikace zabývající se problematikou ošetření zlomenin proximálního femuru.

• MeSH
• femur anatomie a histologie   zranění   MeSH
• fraktury femuru chirurgie   komplikace   terapie   MeSH
• peroperační péče MeSH
• rehabilitace MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• chirurgie
• traumatologie
• NLK Publikační typ
• kolektivní monografie

• MeSH
• artróza kyčelních kloubů chirurgie   patofyziologie   terapie   MeSH
• chirurgie operační metody   MeSH
• femur patofyziologie   zranění   MeSH
• fraktury femuru * chirurgie   patofyziologie   terapie   MeSH
• fraktury kostí chirurgie   komplikace   parazitologie   terapie   MeSH
• heterotopická osifikace chirurgie   patofyziologie   terapie   MeSH
• intraartikulární fraktury chirurgie   patofyziologie   terapie   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• kosti dolní končetiny patofyziologie   zranění   MeSH
• lidé MeSH
• náhrada kyčelního kloubu metody   škodlivé účinky   MeSH
• nekróza hlavice femuru chirurgie   patofyziologie   terapie   MeSH
• nestabilita kloubu chirurgie   patofyziologie   terapie   MeSH
• ortopedické výkony metody   škodlivé účinky   MeSH
• poranění dolní končetiny chirurgie   komplikace   patofyziologie   terapie   MeSH
• poranění kyčle chirurgie   patofyziologie   terapie   MeSH
• protézy kloubů MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY The aim of the study was to compare the duration of corrective surgery for scoliosis in relation to the intra-operative use of either fluoroscopic or CT navigation. MATERIAL AND METHODS The indication for surgery was adolescent idiopathic scoliosis in younger patients and degenerative scoliosis in middleage or elderly patients. In a retrospective study, treatment outcomes in 43 consecutive patients operated on between April 2011 and April 2014 were compared. Only patients undergoing surgical correction of five or more spinal segments (fixation of six and more vertebrae) were included. RESULTS Transpedicular screw fixation of six to 13 vertebrae was performed under C-arm fluoroscopy guidance in 22 patients, and transpedicular screws were inserted in six to 14 vertebrae using the O-arm imaging system in 21 patients. A total of 246 screws were placed using the C-arm system and 340 screws were inserted using the O-arm system (p < 0.001). The procedures with use of the O-arm system were more complicated and required an average operative time longer by 48% (measured from the first skin incision to the completion of skin suture). However, the mean time needed for one screw placement (the sum of all surgical procedures with the use of a navigation technique divided by the number of screws placed using this technique) was the same in both techniques (19 min). DISCUSSION With good teamwork (surgeons, anaesthesiologists and a radiologist attending to the O-arm system), the time required to obtain one intra-operative CT scan is 3 to 5 minutes. The study showed that the mean time for placement of one screw was identical in both techniques although the average operative time was longer in surgery with O-arm navigation. The 19- minute interval was not the real placement time per screw. It was the sum of all operative times of surgical procedures (from first incision to suture completion including the whole approach within the range of planned stabilization) which used the same navigation technique divided by the number of all screws inserted during the procedures. The longer average operative time in procedures using O-arm navigation was not related to taking intra-operative O-arm scans. The authors consider surgery with an O-arm imaging system to be a safer procedure and use it currently in surgical correction of scoliosis. CONCLUSIONS The study focused on the length of surgery to correct scoliosis performed using either conventional fluoroscopy (C-arm) or intra-operative CT scanning (O-arm) showed that the mean placement time for one screw was identical in both imaging techniques when six or more vertebrae were stabilised. The use of intra-operative CT navigation did not make the surgery longer, and the higher number of inserted screws provides evidence that this technique is safer and allows us to achieve good stability of the correction procedure. Key words: virtual CT guidance, O-arm, scoliosis, transpedicular screw.

• MeSH
• chirurgie s pomocí počítače přístrojové vybavení   metody   MeSH
• délka operace MeSH
• fluoroskopie přístrojové vybavení   metody   MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• ortopedické fixační pomůcky * MeSH
• peroperační péče MeSH
• počítačová rentgenová tomografie přístrojové vybavení   metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• skolióza diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVES: The most common cause of femoral fractures after osteosynthesis of trochanteric fractures with short nails is weakening of the femoral cortex via distal locking and stress concentrations at the tip of the nail. The aim of the study was to verify whether the incidence of peri-implant fractures is dependent upon the distal locking technique. METHODS: We prospectively analysed a group of 849 pertrochanteric fractures (AO/ASIF 31-A1+2) managed with short nails from 2009 to 2013. Unlocked nailing was performed in 70.1% and distal dynamic locking was performed in 29.9%. The mean age was 82.0 years. Peri-implant fractures were divided into 3 groups according to the height of the fracture in relation to the tip of the nail. RESULTS: In total 17 fractures (2.0%) were detected. One peri-implant fracture occurred after locked nailing, whereas 16 cases occurred after unlocked nailing (p=0.037). Patients without distal locking had an 85.7% greater risk of peri-implant fracture. Fractures of the proximal femur (Type I) occurred significantly earlier than fractures at the tip of the nail (Type II) (p=0.028). CONCLUSION: Unlocked nails do not guarantee sufficient stability. Distal locking serves to prevent postoperative femoral fractures. We recommend the routine use of distal locking when utilizing short nails.

• MeSH
• fraktury femuru diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• fraktury kyčle komplikace   patofyziologie   chirurgie   MeSH
• incidence MeSH
• intramedulární fixace fraktury * škodlivé účinky   metody   MeSH
• kostní hřeby MeSH
• lidé MeSH
• periprotetické fraktury diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• pooperační komplikace diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• prospektivní studie MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

PURPOSE: The aim of this study was to evaluate a sample of patients who sustained hip fractures during the years 1997-2011 and identify risk factors for a subsequent contralateral hip fracture; one-year mortality rates were compared in both groups. METHODS: A total of 5,102 patients with hip fractures were prospectively studied to identify patients who had also suffered a subsequent, contralateral, hip fracture (SCHF). Those patients who had sustained a second fracture within 18 months of the initial fracture were then studied. All data were statistically processed. RESULTS: Within 18 months of the first fracture, a SCHF occurred in 105 patients (2.1 %). These patients were an average of three years older than those in the single fracture group. Risk factors for the development of a SCHF included: female gender, residing in a residential care facility, and limited mobility prior to injury. Trochanteric fractures did not represent a statistically significant risk factor for SCHF. More than three-quarters of patients with subsequent injuries suffered the same type of fractures on the opposite side. Patients with subsequent fractures had lower one-year mortality rates than patients with only one fracture. CONCLUSION: Patients at greatest risk for a SCHF were women with limited mobility who resided in nursing homes for the elderly. The lower mortality rate associated with second fractures shows that the prognosis for such patients is good. Since the at-risk group is so well defined, prophylactic measures for these patients should be utilized in order to minimize the risk of additional fractures.

• MeSH
• fraktury krčku femuru epidemiologie   MeSH
• fraktury kyčle epidemiologie   MeSH
• lidé MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH