Úvod: Autoři referují případ 65letého muže, který pádem z kola utrpěl zlomeninu acetabula vpravo s poraněním větve arteria glutea superior. Krvácení bylo diagnostikováno CT-angiografií provedenou pro oběhovou nestabilitu. Pro špatnou chirurgickou přístupnost krvácející tepny bylo k zástavě krvácení použito selektivní embolizace. Ta je u poranění a. glutea superior metodou volby zástavy krvácení pro její miniinvazivitu a vysokou úspěšnost. Závěr: Na rozdíl od zlomenin křížové kosti je závažné krvácení u zlomenin acetabula poměrně vzácné, přesto je na ně nutné myslet při hemodynamické nestabilitě pacienta.
Introduction: The authors report a case of a 65-year old man who suffered right acetabular fracture with bleeding from a superior gluteal artery branch after fall from bicycle. Bleeding was diagnosed with CT-angiography done because of circulatory instability. Selective embolization was used to stop bleeding because of complicated surgical access to the bleeding artery. Embolization is the method of choice to stop bleeding from the superior gluteal artery since it is minimally invasive with high success rate. Conclusion: Unlike fractures of the sacrum, dangerous bleeding is relatively rarely associated with fractures oft he acetabulum, yet we still need to keep it in mind if hemodynamic instability of the patient is present.
- MeSH
- acetabulum * krevní zásobení zranění MeSH
- arterie chirurgie zranění MeSH
- CT angiografie MeSH
- krvácení diagnóza chirurgie MeSH
- lidé MeSH
- radiografie MeSH
- senioři MeSH
- sportovní úrazy chirurgie terapie MeSH
- terapeutická embolizace * metody MeSH
- tříštivé fraktury * diagnóza MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVE: The aim of the study was to identify factors contributing to the development of non-union after fixation of diaphyseal humeral fractures using Hackethal's intramedullary nailing technique. METHODS: In the time period from 2001 to 2010 156 patients with diaphyseal humeral fractures were treated surgically using Hackethal's technique. Six of them (3.8%) developed non-union. This group included three women and two men aged 63-69 years and one woman aged 37 years. The following parameters of the patients were recorded: age, gender, comorbidities, substance abuse, mechanism of injury, fracture type and location according to the AO/ASIF classification, and the operative technique. RESULTS: A non-union developed in six patients treated with Hackethal´s method (3.8%). Five of six non-unions (83%) were observed in patients in their sixties. In the subgroup of sexagenarians, non-union developed in 20.8% of surgically treated patients, as compared to 3.8 % in entire group. In the union group, fractures have been caused by high energy trauma in 52% of patients. In patients who developed non-union, high energy trauma caused 67% of fractures. With correct surgical technique the development of a non-union was observed in 0.7% of patients, with incorrect technique in 35.7% (p<0.001). CONCLUSION: Treatment of diaphyseal humeral fractures with Hackethal's intramedullary elastic bundle nailing resulted in an overall high union rate. Factors contributing to the development of non-union were extension of this method to AO type B3 and C fractures and technical imperfection during implantation. Level of Evidence III, Prospective, Case-Control Study.
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim was to determine indication criteria for use of arthroscopy in the treatment of post-traumatic changes in the elbow joint, to present the surgical technique and to evaluate the results of a prospective study involving early follow-up of functional and radiographic outcomes of this treatment. MATERIAL AND METHODS: Between February 2010 and February 2013, arthroscopic surgery was carried out on 14 elbows in 14 patients at the Clinic of traumatology of Masaryk hospital in Ústí nad Labem. The group comprised seven men and seven women, with an average age of 40 years (range, 20 to 67 years). The indications for elbow arthroscopy included conditions after intraarticular fractures in fie, elbow dislocation in one, severe elbow contusion in four and complex injury to the elbow joint in four patients. Arthroscopic surgery was performed at an average of 11 months after the primary injury. The prospective follow-up lasted for an average of 12 months (range, 6 to 25). The outcomes of surgery were evaluated on the basis of radiograms and multiplanar reconstructions of CT images, elbow function was assessed using two rating systems, i.e., the Mayo Elbow Performance Score (MEPS) and Hospital for Special Surgery (HSS) score. RESULTS: The average active range of motion (ROM) at the elbow joint was 118°/33° (145°-90°/60°-5°) before surgery and improved to 131°/5° (150°-90°/15°-0°), i.e., by 13°/28° (150°-90°/60°-0°) intra-operatively. The average fial value of elbow ROM after functional stabilization was 126°/16° (145°-90°/70°-0°), which means improvement by 8°/17° (45°-0°/50°-0°) or a total of 25°. On post-operative radiograms, the fidings were stable in 11 (79%) patients; elbows in three patients (21%) showed progression of degenerative changes (osteophyte formation and periarticular ossifiation). The fial functional scores, as assessed using the MEPS and HSS score systems, were 88.93 (55-100) and 88.29 (50-100) points (average/ range), respectively. DISCUSSION: The study showed, in agreement with other authors' reports, that the degree of improvement in active range of motion and functional performance of the elbow is directly related to the severity of post-traumatic conditions. A certain residual ROM restriction usually remains. The outcome was poorer in patients with complex injuries of the elbow or in those with displaced intra-articular fractures of the joint and was also related to the severity of joint injury. Patients who were treated after a longer injury-to-surgery period and who suffered a more serious joint injury had more advanced arthritis, higher degree of joint contracture, worse pre-operative functional scores and less improvement in post-operative ROM of the elbow joint. CONCLUSIONS: From the results of early functional assessments and radiographic fidings it can be concluded that the elbow joint arthroscopy is a safe and reliable technique to treat post-traumatic conditions caused by intrinsic factors in mild and moderate elbow stiffness. However, this method cannot be recommended in severe stiffness of the elbow or in stiffness due to extrinsic causes. Although the improvement in ROM achieved during the surgical procedure cannot be maintained in its full extent, this technique relieves persisting pain and signifiantly improves ROM of the elbow joint.
- MeSH
- artroskopie metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- loketní kloub patofyziologie chirurgie MeSH
- mladý dospělý MeSH
- nemoci kloubů etiologie patofyziologie chirurgie MeSH
- prospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Autoři popisují případ 16letého pacienta, který v rámci polytraumatu utrpěl komplexní otevřenou zlomeninu v oblasti hlezna. I přes správné primární ošetření došlo postupně k rozvoji avaskulární nekrózy těla talu. Dva roky od úrazu pacient s výrazně limitovanou a algickou hybností, rentgenově varózní osová úchylka a těžká deformita těla talu s artrózou obou hlezenných kloubů. Stav byl v další době řešen ve spolupráci s Klinikou úrazové a rekonstrukční chirurgie v Drážďanech dlahovou artrodézou. Tento typ artrodézy není v našich podmínkách příliš rozšířen, její správné provedení však řeší všechny komplikace v jednom výkonu.
Authors describe a case of polytraumatised 16-years old male patient, that suffered a complex open fracture of talus and malleoli. Despite of proper primary treatment it came to development of avascular necrosis of talar body. Two years af-ter surgery patient suffers from severe painful ROM limitation, varus axial deviation and arthrosis of upper and lower ankle joint. The situation was solved in cooperation with Clinic of traumatology and reconstructive surgery Dresden, Germany by performing double plate arthrodesis of both ankle joints. This technique does not prevale in our conditions, but is capable of solving whole pathology in one step.
- MeSH
- artrodéza * metody MeSH
- hlezenní kloub chirurgie radiografie MeSH
- kostní destičky MeSH
- kostní šrouby MeSH
- lidé MeSH
- mladiství MeSH
- osteoartróza komplikace MeSH
- osteonekróza * etiologie komplikace MeSH
- otevřené fraktury * chirurgie radiografie MeSH
- polytrauma MeSH
- pooperační komplikace MeSH
- reoperace MeSH
- talus * chirurgie zranění MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
