OBJECTIVES: To recommend appropriate immobilization after the initial reduction of acetabular displaced fractures in order to minimize the risk of heterotopic ossification formation. DESIGN: Retrospective study of patients treated in our surgical department during the years 2005-2018. MATERIALS AND METHODS: There were 94 patients included in statistical analysis. The factors of injury severity, course of surgery and hospitalization and incidence of complications were recorded. The functional and X-ray results were evaluated at least one year after surgery. RESULTS: The patients were divided into the two groups according to the type of fixation after closed reduction, the external fixation (EF) and the skeletal traction (ST) group. According to the type of fracture there were 33 patients with central displacement and 61 patients with posterior displacement. Ossification grade III. And IV. Occur in 20% of our sample. There was greater incidence of Brooker grade III. And IV. Ossification in the ST group, but statistically insignificant, p = 0.57. There was no statistically significant difference in the occurrence of ossifications regarding the severity of the head injury, p = 0.11, or to the severity of the injury p = 0.54. The combination of posterior displacement and ST results in higher risk for ossifications, specifically in our group at 11.48% compared to the combination of posterior displacement and EF where it is 8.2%. CONCLUSION: Skeletal traction for posterior displaced acetabular fracture appears to be a more risky procedure for the development of ossifications than external fixation.
- MeSH
- acetabulum zranění chirurgie MeSH
- externí fixátory * škodlivé účinky MeSH
- fixace fraktury škodlivé účinky MeSH
- heterotopická osifikace * epidemiologie etiologie prevence a kontrola MeSH
- lidé MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS: The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS: Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION: Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.
- MeSH
- aorta thoracica diagnostické zobrazování zranění MeSH
- dopravní nehody mortalita statistika a číselné údaje MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- radiografie MeSH
- retrospektivní studie MeSH
- ruptura aorty diagnostické zobrazování epidemiologie etiologie mortalita MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- traumatologická centra statistika a číselné údaje MeSH
- zpomalení škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Hongkong MeSH
PURPOSE OF THE STUDY Presentation of technical experience and the clinical and functional results of intramedullary fixation of forearm shaft fractures. MATERIAL AND METHODS Between January 1994 and December 2009, a total of 96 patients with 144 radial and/or ulnar fractures (ulna, 33; radius,15; both, 48) were treated by nailing (True/Flex®). According to the AO classification there were 22-A, 22-B and 22-C type fractures in 39 (41%), 44 (46%) and 13 (13%).cases, respectively. Of these, 82 (85%) were closed (types: 0, 48; I, 33; II, 1) and 14 (15%) were open (types: I, 13; II, 1; III, 0) fractures. Seventy-eight patients (81%) were followed up and their functional outcomes were evaluated according to the criteria of Anderson et al. The average interval between the operation and final follow-up was 28 months (15 to 96 months). RESULTS The average time to surgery was 2.2 days (0 to 25 days). Early complications were recorded in 4% of the patients (1x bursitis olecrani; 1x end cup replacement; 1x bending of nails) and late complications in 15% (5x non-union; 2x delay union; 4x bursitis olecrani; 1x ruptured tendon). Bone healing was achieved in 95% of the cases and took on average 16 weeks (7 to 34 weeks). No infection, refracture or synostosis occurred. Primary loss of reduction was recorded in four cases due to distraction in one, bent nails in two and a wrong size of the implant in one; secondary loss of reduction was found in three cases, with two cases of radius shortening and one 10°malrotation. No primary malrotation was recorded, but secondary loss of alignment was seen in the distal part of the radius and the proximal part of the ulna. Functional results according to the Anderson criteria were excellent and good in 87% of the cases. DISCUSSION Intramedullary mailing provides good stability to mid- and distal-third shaft fractures of the ulna and mid- and proximal-third shaft fractures of the radius, particularly in AO type A and type B fractures. The technical aspects of the method are analysed in detail in this paper. CONCLUSIONS True/Flex® intramedullary nailing, because of its minimally invasive approach and close reduction, allows us to minimise the risk of wound and neurovascular complications, especially in proximal shaft fractures of the radius.
- Klíčová slova
- hřeby TrueFlex,
- MeSH
- chirurgické fixační pomůcky MeSH
- diafýzy chirurgie zranění MeSH
- hojení fraktur MeSH
- intramedulární fixace fraktury metody přístrojové vybavení využití MeSH
- kosti paže a předloktí chirurgie MeSH
- kostní hřeby MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody využití MeSH
- radiografie využití MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY: To present the authors' technical experience with the use of the Expert Tibial Nail (ETN) technique and its clinical results. MATERIAL AND METHODS: Between December 2005 and the end of 2007, the ETN technique was used in 41 patients to treat 41 diaphyseal tibial fractures. All patients were followed-up prospectively. RESULTS: The injury Severity Score (ISS) was in the range of 4 to 25 (average, 5.9). Eight patients suffered multiple trauma, 33 had isolated injuries. Of the 41 fractures, 31 were closed and 10 were open injuries. The fracture types according to the Tscherne classification were as follows: closed 0 type (n=10); closed type I (n=18); closed type II (n=3); open type I (n=3); open type II (n=5); open type III (n=2). The injury-to-surgery interval ranged from 1h and 50 min to 25 h and 12 min (median, 8 h and 52 min).The operative time ranged from 50 to 170 min (average, 87 min). Infectious complications or a secondary loss of reduction were not recorded. Three cases of insufficient primary reduction underwent repeat surgery during the first stay in hospital. Full weight-bearing with no pain was reported in the range of 10 to 24 weeks (average, 18 weeks) after surgery. DISCUSSION: A choice of the nail diameter in relation to the marrow cavity width can be made during surgery with no loss of reduction (guidewire; undreamed/reamed nail). Because of a shorter straight lower part of the nail (compared to a UTN), a very steep position of the nail is necessary at its insertion in a short proximal metaphyseal fragment. The blunt lower ETN end can produce fracture line distraction when an effort is made to drive the nail as deep as possible into the short distal meta- physeal block, if this has not been reamed. CONCLUSIONS: The ETN provides sufficient stability of diaphyseal tibial fractures including those involving the metaphysis. However, in some instances, poler screws are still indispensable. Sufficient reduction is necessary before nail insertion.
- MeSH
- diafýzy chirurgie MeSH
- dospělí MeSH
- fraktury tibie chirurgie radiografie MeSH
- intramedulární fixace fraktury metody přístrojové vybavení MeSH
- kostní hřeby MeSH
- lidé středního věku MeSH
- lidé MeSH
- skóre závažnosti úrazu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
CÍL: Vyhodnocení vlastních výsledků léčby diafyzárních zlomenin tibie nitrodřeňovou osteosyntézou a porovnání s výsledky ostatních autorů. MATERIÁL A METODA: Retrospektivní analýza výsledků léčby souboru pacientů léčených na naší klinice pro diafyzární zlomeninu tibie v letech 2002–2004. Všichni pacienti byli operováni nepředvrtaným zajištěným hřebem. Při kontrole s minimálním odstupem jednoho roku byl sledován typ zlomeniny, stupeň poranění měkkých tkání, celková doba léčby, výskyt časných i pozdních komplikací a funkční výsledek hodnocený IOWA skóre. VÝSLEDKY: Z celkového počtu 108 se ke kontrole dostavilo 48 pacientů (45 %). U tří pacientů (6,25 %) byla zaznamenána neinfekční ranná komplikace. Nebyla zjištěna žádná infekční ranná komplikace. U dvou pacientů (4,2 %) se zavřenou zlomeninou se pooperačně rozvinul kompartment syndrom. Průměrná doba hojení dle RTG byla 17,1 týdne. Průměrná doba do plné zátěže byla 24,1 množství krevních ztrát ve srovnání s nepředvrtaným hřebováním. U otevřených zlomenin je popisováno více infekčních komplikací u předvrtaného hřebování, u nepředvrtaného hřebování častější zlomeniny zajišťovacích šroubů, doba hojení je v této skupině srovnatelná. ZÁVĚR: Naše výsledky nekorespondují s výsledky některých autorů, zejména pokud jde o výsledky nepředvrtaného hřebování zavřených zlomenin. Možným vysvětlením je, že nedostatky v technice provedení mohou být u předvrtaného hřebu vyváženy větší stabilitou, zatímco u nepředvrtaného hřebu se většina těchto chyb promítne do doby hojení a případného výskytu komplikací.
AIM: Evaluation of results in treatment of tibia shaft fractures by intramedullary nail and comparison with other authors. MATERIAL AND METHOD: Retrospective study of results in treatment of patient admitted to our department for tibia shaft fracture in 2002– 2004. All patients were operating by unreamed tibia nail (UTN, Synthes®). Minimal follow-up was 12 months after operation. Types of fracture, grade of soft tissue damage, time to union, early and late complications were recorded. Functional result was evaluated according to IOWA score. RESULTS: 48 patients of 108 (45 %) were checked up. In three cases (6,25 %) were recorded non - infectious complications. Any infectious complication was recorded. Compartment syndrome occurred in two cases (4,2 %) with close fracture. Average time to healing according to X-ray was 17,1 week. Average time to the full painless weight bearing was 24,1 week. Delayed union occurred in five cases (10,5 %). Nonunion wasn’t recorded. The anterior knee pain occurred in sex cases (12,5 %). Any implant failure was recorded. DISCUSSION: In the case of closed fracture many studies evidence shorter time to healing with reamed nail because of his higher mechanical stability, but currently document longer operation time, X-ray exposure and blood loss quantity in comparison with unreamed nailing. In case of open fracture there are document more infection complications by reamed nailing and more implant failure by unreamed nailing, but time to healing is comparable. CONCLUSION: Ours records uncorresponded with some authors, especially in unreamed nailing of closed fractures. Possible explanation is that insufficient experience with unreamed nailing could bring more complications and longer time to healing because of lower mechanical stability compared with reamed nail.
- MeSH
- fraktury tibie chirurgie MeSH
- intramedulární fixace fraktury metody MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- srovnávací studie MeSH
- MeSH
- adheze tkání chirurgie komplikace prevence a kontrola MeSH
- ileus etiologie komplikace terapie MeSH
- laparotomie metody škodlivé účinky MeSH
- lidé MeSH
- následná péče metody využití MeSH
- peritoneální dutina chirurgie patofyziologie MeSH
- pooperační komplikace diagnóza etiologie chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
