PURPOSE OF THE STUDY Surgical treatment of trochanteric fractures with intramedullary nailing still remains controversial as to which nail design is the best with no postoperative complications. The purpose of this study was to provide a comparative evaluation of complications in the treatment of trochanteric fractures using 2-screw proximal femoral nail versus proximal femoral anti-rotational blade nail. MATERIAL AND METHODS A retrospective review was conducted between March 2013 and March 2019. The study included 519 patients (358 females and 161 males) treated surgically for trochanteric fractures. The mean age was 79.8±12.0 (24-100) years. A1.2 type of fracture occurred in 153 (29.5%) cases, A1.3 type in 155 (29.9%), A 2.2 type in 90 (17.4%), A2.3 type in 95 (18.3%), A3.1 type in 11 (2.1%), A3.2 type in 7 (1.3%) and A3.3 type in 8 (1.5%) cases. Patients were treated either by 2-screw nail PFN (393 patients (75.7%) or by anti-rotational blade nail PFNA (126 patients (24.3%). RESULTS Our primary objective was to evaluate the implant related complications (e.g. cut-out, back-out, irritation, peri-implant fractures). Other complications (infection) and revision surgeries were also recorded. Complications were observed in 38 (9.7%) patients with PFN nail and 7 (5.6 %) patients with PFNA blade nail (p = 0.15). Screw back-out (n = 11) and cut-out (n = 11) were the most frequent complications in patients treated by 2-screw PFN nail and occurred in 5.6%. In the PFNA group, cutout occurred in 1.6% (n = 2) of cases while no cases of back-out were reported. Infection (n=3) was the most common complication in the latter group and represented 2.4%. In the PFN group the infection rate was 2.3% (n = 9). There were no statistically significant differences between both the groups considering implant-related complications (p = 0.14) and infections (p = 1.0). Revision surgery was performed in 33 patients (66.7%). DISCUSSION Biomechanical studies of intramedullary nails suggest good results with minimal complications if a two-screw implant is used. When antirotational blade is used, compression of spongiosis around blade is observed, which increases stability, especially in an osteoporotic bone. In our study, complications in these two types of nails were retrospectively compared. Considered as the limitation of our study is the retrospective nature of evaluation, which made it impossible the create two study groups with equal or similar number of patients, to follow up the patients postoperatively for a long period of time and to evaluate fracture union and limb function. CONCLUSIONS In our study no statistically significant difference in postoperative mechanical and infectious complications was confirmed between the 2-screw proximal femoral nail and the proximal femoral nail with antirotational blade. We have arrived at the conclusion that both types of nails are equivalent in treating trochanteric fractures. Key words: intramedullary nail, screw, blade, trochanteric fracture, complication.
- MeSH
- fraktury kyčle * chirurgie MeSH
- intramedulární fixace fraktury * škodlivé účinky MeSH
- kostní hřeby MeSH
- kostní šrouby MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The standard procedure in treating distal humerus fractures is the open reduction internal fixation (ORIF). The surgical approach is still a matter of discussion. The submitted study focuses on comparing the conventional approach with olecranon osteotomy and the paratricipital approach. MATERIAL AND METHODS Since January 2015 a total of 18 patients have been operated on, who met the inclusion criteria of the study on type C distal humerus fracture without the use of olecranon osteotomy. This group of patients was subsequently compared with a control group of patients in whom the olecranon osteotomy was performed in the period 2010-2015. The patients were assessed using the Mayo Elbow Performance Score (MEPS), the range of motion and complications, including the need for removal of osteosynthesis material. RESULTS The control group (Group 1), in which 22 patients operated directly by olecranon osteotomy were assessed, was compared with the group of operated patients (Group 2) consisting of 18 patients. When comparing the range of motion and MEPS, no significant difference was found between the groups (flexion: p = 0.519, extension: p = 0.382, MEPS: p = 0.110). Unlike Group 2, in Group 1 the osteosynthesis material of cerclage was removed in 13 cases. DISCUSSION Apart from the complexity of fracture and choice of fixation technique, it is the choice of surgical approach which constitutes another factor having effect on the final elbow function. Basically, the approaches to distal humerus can be divided into 4 groups, namely splitting, reflecting and sparing approaches and olecranon osteotomy which offers the best access to the fracture during fixation and which is recommended by many experts in treating these complex fractures which, however, has its disadvantages such as longer duration of surgery, longer healing time, non-union or malunion, protruding osteosynthesis material and secondary procedures necessary to remove the material. CONCLUSIONS In our study no significant difference in functional outcomes was found between the examined approaches. A difference was identified with respect to protruding material of the cerclage and soft tissue irritation with subsequent removal of osteosynthesis material after the olecranon osteotomy. Key words:distal humerus fracture, internal fixation, surgical approach, olecranon osteotomy, paratricipital approach, tricepssparing approach, triceps reflecting anconeus pedicle approach.
- MeSH
- algoritmy MeSH
- fraktury humeru * chirurgie MeSH
- humerus MeSH
- lidé MeSH
- olecranon * MeSH
- rozsah kloubních pohybů MeSH
- vnitřní fixace fraktury * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The vast majority of studies on fractures of the acetabulum are concerned with surgical treatment. All displaced fractures are presented as surgically treated. The purpose of this study was to evaluate the results of surgical and conservative treatment of patients with acetabular fractures in relation to the degree of fracture displacement. MATERIAL AND METHODS: We analysed 140 fractures of the acetabulum treated in our institution by different methods between 2009 and 2013. In addition to the use of Letournel ́s classification, we allocated each fracture to one of six groups: 1. Sixty displaced fractures treated surgically, 2. Twenty three fractures with a displacement of more than 6 mm, 3. Eighteen slightly displaced fractures (2-3 mm in the acetabular roof or 4-5 mm in other parts of the acetabulum), 4. Twenty non-displaced fractures, 5. Six pelvic fractures involving the acetabulum and 6. Thirteen fractures of old people, mostly displaced but not examined by CT. Groups 2 to 6 were treated conservatively. In all patients, demographic and epidemiologic factors were analysed in relation to the patient's group assignment. In 107 patients, hip function was assessed using the Matta clinical grading system at a minimum follow-up of 12 months (average 3.16 years). Radiological status, time of admission, start of weight-bearing after the accident, working ability, mortality and complications were also evaluated. RESULTS: Non-displaced fractures were often associated with serious injury or polytrauma in 20 patients; not all of them had excellent functional outcome. (mean score, 17.25). Excluding two patients who developed avascular necrosis, fourteen slightly displaced fractures had a fixal score of 16.92. Sixteen patients with displaced fractures were managed conservatively due to their poor medical condition and other circumstances. Their functional outcome (mean score, 15.25) was significantly worse than that of the patients with non-displaced fractures (p=0.02) and worse than the outcome in patients with slightly displaced fractures, but the difference was not significant (p=0.32). No occurrence of accelerated post-traumatic arthritis was observed in these groups. The mean clinical score of 14.80 and 60% of excellent and good results were achieved in surgically treated patients. Eight of them were treated by primary hip arthroplasty and osteosynthesis. A total of 11 patients required total hip arthroplasty because of post-traumatic osteoarthritis, but only one from the group of slightly displaced fractures, all others from the group of surgically treated patients. DISCUSSION: Displaced fractures of the acetabulum are best treated by open reduction and internal fixation. The type of fracture and the quality of reduction influence the functional outcome. There are a few studies reporting long-term outcomes in conservatively treated acetabular fractures. Although conservative treatment continues to be the mainstay of treatment in most centres in the developing countries, it is obvious that not all of acetabular fractures can or must be treated surgically or identically. We found that, in many cases, surgery was too dangerous for the patient and his/her medical condition or that the result of surgery was doubtful, mostly because of a late presentation. In some cases, primary hip arthroplasty is a solution. Secondary total hip replacement is technically more demanding and has a higher rate of failure. CONCLUSIONS: Conservative treatment is the method of choice for the treatment of non-displaced acetabular fractures. Excellent or very good results can also be expected in slightly displaced fractures if acetabular roof involvement is minor. In displaced fractures, if the result of surgery is doubtful under various circumstances or if high-risk medical conditions are present in the patient, conservative treatment can be the method of choice with satisfying results. Key words: acetabular fractures, conservative treatment, degree of displacement, epidemiology of acetabular fractures.
- MeSH
- acetabulum zranění patologie radiografie chirurgie MeSH
- fixace fraktury metody MeSH
- fraktury kostí epidemiologie patologie radiografie terapie MeSH
- lidé MeSH
- náhrada kyčelního kloubu metody MeSH
- následné studie MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- hodnotící studie MeSH
- Geografické názvy
- Československo MeSH
208 stran ; 21 cm
- MeSH
- týmová péče o pacienty zákonodárství a právo MeSH
- veřejné zdravotnictví zákonodárství a právo MeSH
- Publikační typ
- sborníky MeSH
- Konspekt
- Právo
- NLK Obory
- právo, zákonodárství
- veřejné zdravotnictví
Športová aktivita je obvykle odporúčaná v rámci nemedikamentóznych opatrení na prevenciu žilovej trombózy. Van Stralenom bolo dokázané, že akýkoľvek druh pravidelnej športovej aktivity redukuje riziko venózneho tromboembolizmu. Ak sa nedodržiavajú preventívne opatrenia, športová činnosť môže byť sprevádzaná javmi, ktoré prispejú k uplatneniu Virchowovho trias, výsledkom čoho je vznik zrazeniny v žile a prípadná pľúcna embolizácia.
Sport is an activity recommended by physicians in the prevention of venous thromboembolism. Regular sport activities decrease the risk of venous thromboembolism. However, when preventive measures are not respected sport activities may lead to enforcing Virchow trias and formation of clot in vein or pulmonary embolism.
- Klíčová slova
- vrcholový sport, rekreační sport,
- MeSH
- antikoagulancia terapeutické užití MeSH
- cvičení fyziologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní embolie farmakoterapie prevence a kontrola MeSH
- rizikové faktory MeSH
- sporty * fyziologie MeSH
- žilní tromboembolie * etiologie farmakoterapie prevence a kontrola MeSH
- žilní trombóza farmakoterapie prevence a kontrola MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY: Fractures of the thoracic spine involve injury at the levels of Th2 to Th10. Because of pedicle morphology, pedicle screw fixation is a demanding procedure. However, evidence on the reliability and efficiency of this technique has recently been provided by several studies. The aim of this study was to analyse a group of patients with thoracic spine fractures treated by pedicle screw fixation and to evaluate treatment outcomes. MATERIAL AND METHODS: A total number of 33 patients treated by pedicle screw fixation for thoracic spine fractures between January 2007 and December 2011 were enrolled in this retrospective study. The mean age was 39.7 ± 16.7 years. The evaluation included demographic data, mechanism of injury, associated injuries, neurological status, fracture type (AO classification), levels of the fractured vertebrae, injury-surgery interval, type and duration of surgery, type and length of pedicle screw fixation and complications. The position of pedicular screws in relation to the pedicle walls and correction of kyphotic deformity were assessed on post-operative CT scans. RESULT: Of the 33 patients, 24 had associated injuries (72.7%), 22 had thorax injury (66.7%) and 17 had neurological deficit (51.5%). The most frequent spinal fracture type was type B2, 15 (45.5%); followed by type C, nine (33.3%); and type B1, five (15.1%). The mean injury-to-surgery interval was 5.2 ± 4.3 days. The mean operative time was 210 ± 56 min. The most frequently used configuration of pedicle screw fixation involving two segments above and two below the fracture level was used in 20 cases (58.8%). The position of 149 out of 282 pedicle screws (52.8%) was evaluated on post-operative CT scans as follows: 98 % of the pedicle screws were placed in acceptable positions, 76% were placed completely within pedicle borders. The mean pre-operative Cobb angle was 18.7° ± 8.2°, the mean post-operative Cobb angle was 9.3 ± 3.4°. Six intraoperative and three post-operative complications occurred. During follow-up no instrumentation failure or apparent loss of correction was recorded. DISCUSSION: Early stabilisation of thoracic spine fractures reduces the risk of complications, shortens the hospital stay and allows for faster recovery of patients. Early thoracic spine stabilisation is most beneficial in patients with a high ISS (Injury Severity Score). In the case of small-sized pedicles there is the possibility of pedicle screw insertion via an extrapedicular or parapedicular trajectory. Recommended pedicle screw fixation is two levels above and two levels below the fracture level. CONCLUSIONS: Pedicle screw fixation of thoracic spine fractures is a safe therapeutic method with a low risk of complications. It facilitates effective reduction and stable fixation with a low risk of secondary displacement and implant failure. Key words:transpedicular stabilisation, thoracic spine, fracture, pedicle screws.
- MeSH
- délka operace MeSH
- dospělí MeSH
- fraktury páteře chirurgie MeSH
- hrudní obratle zranění chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- pedikulární šrouby * MeSH
- peroperační komplikace MeSH
- retrospektivní studie MeSH
- skóre závažnosti úrazu MeSH
- vnitřní fixace fraktury škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
