INTRODUCTION: German-speaking surgeons have left a deep imprint on the history of diagnostics and treatment of proximal femur fractures. Some of the studies published in German have fell into oblivion, others are cited until today, although sometimes quite inaccurately. The cause of such inaccuracies are citations from secondary sources due to unavailability of the original or inability to read it because of a language barrier. In the current literature, globally predominated by English articles, the "German history" of treatment of proximal femur fractures remains undervalued. The aim of the present article is to point out its contribution. MATERIALS AND METHODS: Literature search was performed in original publications and historical sources. RESULTS: The German-speaking surgeons have considerably contributed to the development of the treatment of proximal femur fractures. The analyzed period between 1847 and 1970 may be divided into three basic periods. In the first period (1847-1896), the German-speaking surgeons (Langenbeck, Trendelenburg, König, Heine, Dolinger) were the first worldwide to start treating the fractures of proximal femur operatively. In the second period (1897-1935), mainly in the 1930s, the initiative in Europe was taken over by surgeons publishing studies in France and in Belgium. Overseas, American surgeons were coming to the forefront. In Germany, only Pauwels developed the first biomechanical classification of femoral neck fractures. In the third period (1936-1970), mainly in the 1940s and 1950s, implants were designed (Pohl, Künstcher), based on close collaboration between German engineers and surgeons, that served as a model for a dynamic hip screw and a proximal femoral nail, which are currently the implants of choice in the treatment of trochanteric fractures. CONCLUSION: The historical contribution of German-speaking surgeons to understanding the issue of proximal femur fractures and their operative treatment is far more significant than presented in the historical studies published in English.
PURPOSE: The study evaluates long-term results in patients treated by valgus intertrochanteric osteotomy (VITO) for partial avascular necrosis of the femoral head (ANFH) after fracture of the femoral neck in adolescent age. Although this method is mentioned in literature frequently, there are only few studies in the literature dealing with it in detail. METHODS: Authors evaluated five patients at the interval of 15 to 20 years following VITO. The mean age of the patients at the time of injury was 13.6 years and at the time of VITO 16.7 years. The studied parameters included resorption of necrotic segment of femoral head, development of posttraumatic osteoarthritis and leg shortening. RESULTS: Comparison of radiographs and MRI scans before and after VITO showed resorption of the necrotic segment of the femoral head and its remodeling in all five patients. However, two patients gradually developed slight osteoarthritic changes. In one patient, remodeling of the femoral head occurred during the first 6 years postoperatively. Subsequently, the patient developed severe osteoarthritis with marked clinical symptoms. CONCLUSION: VITO can improve the long-term function of the hip joint in adolescents with ANFH after a femoral neck fracture, but cannot restore completely the original shape and structure of the femoral head.
- MeSH
- fraktury krčku femuru * diagnostické zobrazování etiologie chirurgie MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- nekróza hlavice femuru * diagnostické zobrazování etiologie chirurgie MeSH
- osteoartróza * MeSH
- osteotomie škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
Maisonneuveova zlomenina (MZ) je definována jako luxační zlomenina hlezna, kde došlo vždy ke zlomenině proximální čtvrtiny fibuly a roztržení lig. tibiofibulare anterius a lig. tibiofibulare interosseum. Další poranění jsou variabilní. Recentní CT studie ukázaly, že MZ je mnohem komplexnější poranění, než se předpokládalo. Proto je třeba zásadním způsobem změnit pohled na tuto problematiku. MZ je spojena přibližně v 80 % případů se zlomeninou malleolus posterior a dále s malpozicí distální fibuly v incisura fibularis tibiae (IFT). Přesné zhodnocení těchto poranění vyžaduje úrazové CT, které by mělo být u MZ v dnešní době standardem. Hlavním cílem ošetření je anatomická repozice distální fibuly do IFT. To vyžaduje v případě odlomení většího fragmentu malleolus posterior provést nejdříve jeho repozici a fixaci z posterolaterálního přístupu. Tím dojde k obnovení integrity IFT. Zavřená repozice distální fibuly je spojena s malpozicí až v 50 % případů. Proto se dává přednost otevřené repozici z krátkého anterolaterálního přístupu. Přesnost repozice je nutné vždy ověřit pooperačním CT.
Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.
- Klíčová slova
- Maisonneuveova zlomenina,
- MeSH
- dislokace kloubu chirurgie MeSH
- fibula * chirurgie diagnostické zobrazování zranění MeSH
- fraktury fibuly * chirurgie diagnostické zobrazování MeSH
- fraktury kotníku * chirurgie diagnostické zobrazování MeSH
- lidé MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: The calcar femorale (femoral calcar) is used in the English literature to designate the thickened medial cortex of the femoral neck. This term is, however, incorrect, as the calcar femorale is actually quite another structure. METHODS: Searching was performed in original and historic publication. RESULTS: The importance of the thickened medial cortex of the proximal femur in femoral neck fractures was discussed already by Robert Adams in 1834-1836. Therefore, the German surgeon C.W. Streubel, in 1847, called it Adamscher Knochenbogen (Adams' arch). Due to misspelling, this term was gradually changed to Adambogen, and at the turn of twentieth century, it was commonly used primarily in the German literature. Then, it fell into oblivion and its "renaissance" came as late as during the 1960s, again in the German literature, in connection with operative treatment of trochanteric fractures. CONCLUSIONS: However, under the influence of the English literature, it has been replaced by the term calcar femorale (femoral calcar), used ever since. The term Adams' arch should be reserved for the thickened medial cortex of the proximal femur, while the term calcar femorale (femoral calcar) should be used for the vertical plate arising from the medial cortex close below the lesser trochanter.
- MeSH
- dolní končetina MeSH
- femur * diagnostické zobrazování chirurgie MeSH
- kostní destičky MeSH
- krček femuru * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Bosworthova zlomenina (BZ) je vzácné, ale závažné poranění hlezna, charakterizované dislokací fragmentu zlomené fibuly (většinou typ Weber B) z incisura fibularis tibiae na zadní plochu distální tibie. V 70 % případů je doprovázeno zlomeninou malleolus posterior. Toto poranění není příliš známé, v literatuře bylo dosud popsáno 175 případů. BZ vyžaduje CT vyšetření včetně 3D rekonstrukcí. Zavřená repozice je téměř vždy neúspěšná a opakované pokusy zvyšují riziko kompartment syndromu. Proto je vždy indikována operační léčba. Výsledek operace je třeba zkontrolovat na pooperačním CT.
Bosworth fracture (BF) is a rare, but a severe injury to the ankle, characterized by displacement of a fragment of the fractured fibula (mostly of Weber B type) from the tibiofibular incisure to the posterior surface of the distal tibia. In 70% of cases, it is associated with a fracture of the posterior malleolus. This injury is not quite well known, with only 175 cases described in the literature to date. BF requires CT examination, including 3D reconstructions. Closed reduction almost always fails as there is an increased risk of compartment syndrome, mainly after repeated attempts at closed reduction. Therefore, operative treatment is indicated as a standard. The outcome of the operation should be always checked by postoperative CT examination.
- Klíčová slova
- Bosworthova zlomenina,
- MeSH
- fraktury kotníku * chirurgie diagnostické zobrazování komplikace MeSH
- klinická studie jako téma MeSH
- kompartment syndrom etiologie MeSH
- lidé MeSH
- ortopedické výkony metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
PURPOSE: During study of anatomy of a fractured posterior malleolus of the ankle on CT scans, the authors noticed a prominent crest on the lateral malleolus, which they termed the lateral malleolar crest (LMC). As, in their view, LMC is a clinically important structure which was only briefly mentioned by a few authors without an official term, they focused on the anatomy of this structure. MATERIALS AND METHODS: A total of 352 dry fibulae were analyzed and the following parameters recorded: (F) length of the fibula, (LMC) total length of LMC, (A) length of the part of the examined crest from the superior border of the articular facet of the lateral malleolus (AFLM) to its most proximal intersection with the midline of the fibula, (B) height of the medial triangular rough surface, and (A/F) A/F ratio. RESULTS: The crest was observed in all specimens. (F) was 346.5 ± 26 mm (95% confidence interval [CI] 344-349), (LMC) was 85.4 ± 11.6 mm (95% CI 84.2-86.6), (A/F) was 25% ± 3% (95% CI 24.7-25.3) in the whole group. (A) was 25.9 ± 6.5 mm (95% CI 24.8-26.8) in the whole group, (B) was 34.9 ± 4.7 mm (95% CI 34.3-35.5) in the whole group, 36 ± 6.1 mm (95% CI 35.1-36.9). CONCLUSION: LMC is an important structure on the lateral malleolus. The knowledge of its anatomy is essential for placement of syndesmotic screws or/and the fibular plate.
- MeSH
- fibula * diagnostické zobrazování anatomie a histologie MeSH
- fraktury kotníku * diagnostické zobrazování chirurgie MeSH
- hlezenní kloub diagnostické zobrazování chirurgie anatomie a histologie MeSH
- klinická relevance MeSH
- kotník MeSH
- lidé MeSH
- tibie anatomie a histologie MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: The aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism. METHODS: The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21-87), with a "Double Maisonneuve fracture". Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings. RESULTS: The distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Injury to the deltoid ligament was revealed in six cases; a bicollicular fracture of the medial malleolus was found in five patients. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Avulsion of the Chaput tubercle was detected in four cases. Injury to the interosseous tibiofibular ligament was assessed in nine patients. CONCLUSION: Double Maisonneuve fracture is a rare but probably underreported injury that must be taken into consideration during examination, as it may be easily overlooked. The essential part of diagnosis is a careful clinical examination and radiological assessment of the lower leg with additional CT examination of the ankle.
- MeSH
- fibula diagnostické zobrazování MeSH
- fraktury kotníku * diagnostické zobrazování chirurgie MeSH
- hlezenní kloub patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mnohočetné fraktury * MeSH
- poranění kotníku * diagnostické zobrazování chirurgie MeSH
- tibie zranění MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Poraněním AC kloubu u zlomenin lopatky se detailně dosud nikdo nezabýval. Cílem této studie je proto popsat pathoanatomii těchto poranění. Metody: V souboru 519 zlomenin lopatky u dospělých pacientů vzniklém v období 2002−2020 jsme identifikovali celkem 20 (3,9 %) případů spojených s AC luxací. Jednalo se o 17 mužů a 3 ženy průměrného věku 49 roků (21−78). U všech pacientů byl proveden rtg snímek ramenního kloubu a následně CT vyšetření včetně 3D rekonstrukcí. Tato obrazová dokumentace umožnila hodnocení typu zlomeniny lopatky a typu poranění AC kloubu. Výsledky: V 15 případech byla AC luxace spojena pouze s jednoduchou zlomeninou lopatky (7x zlomenina báze proc. coracoideus, 4x zlomenina akromia nebo laterální spiny, 2krát zlomenina těla lopatky, 1x zlomenina horního glenoidu a 1x zlomenina dolního glenoidu). V 5 případech se jednalo o vícečetné nebo komplexní zlomeniny lopatky (1x kombinace zlomeniny proc. coracoideus a laterální části spina scapulae, v 1 případě kombinace zlomeniny horního glenoidu a akromia, ve 2 případech komplexní intraartikulární zlomenina a v 1 případě skapulotorakální disociace). Závěr: AC luxace je méně častým poraněním doprovázejícím zlomeniny lopatky. Nejčastěji se vyskytuje u zlomenin proc. coracoideus, akromia/ laterální spiny nebo horního glenoidu. Nebyla zaznamenána u zlomenin krčku lopatky.
Introduction: No detailed study dealing with an injury to the AC joint in combination with scapular fractures has been published to date. The aim of this study is to describe pathoanatomy of these injuries. Methods: In a series of 519 scapular fractures in adult patients from the period of 2002−2020 we identified a total of 20 (3.9%) cases associated with AC dislocation. The group comprised 17 men and 3 women with the mean age of 49 years (range, 21−78). Radiographs of the shoulder joint followed by CT examination, including 3D reconstructions, were performed in all patients. This documentation allowed assessment of the scapular fracture pattern and type of injury to the AC joint. Results: AC dislocation was associated with a simple scapular fracture in 15 cases (7 fractures of the coracoid base, 4 fractures of the acromion or the lateral spine, 2 fractures of the scapular body, 1 fracture of the superior and 1 fracture of the inferior glenoid). In 5 cases AC dislocation accompanied multiple or complex scapular fractures (once a combination of a coracoid fracture and a fracture of the lateral scapular spine, once a combination of a fracture of the superior glenoid and of the acromion, 2 cases of a complex intraarticular fracture and 1 case of scapulothoracic dissociation). Conclusion: AC dislocation is relatively infrequent injury accompanying scapular fractures. It is most commonly associated with fractures of coracoid, acromion/lateral spine or superior glenoid. No case of AC dislocation was recorded in a fracture of the scapular neck.
639 stran : ilustrace (některé barevné) ; 29 cm
The university textbook focuses on scapular fractures.
- Konspekt
- Učební osnovy. Vyučovací předměty. Učebnice
- Ortopedie. Chirurgie. Oftalmologie
- NLK Obory
- traumatologie
- ortopedie
- NLK Publikační typ
- učebnice vysokých škol
- kolektivní monografie
INTRODUCTION: The circumflex scapular artery (CSA) has been described in detail in the literature, but the groove, i.e., the circumflex sulcus (CFS), formed by the artery on the lateral pillar of the scapula has been completely neglected. The aim of the present study was to describe the variability and anatomy of the CFS. MATERIALS AND METHODS: The study was based on the examination of 103 pairs of dry bone specimens of adult scapulae, i.e., 206 specimens, including 92 (46 pairs) male and 114 (57 pairs) female specimens. In the first step, quantitative criteria were defined for assessment of the CFS presence and type. Subsequently, statistical analysis of the obtained data was performed. RESULTS: The study revealed considerable variability of the arterial groove, which was well developed in 33% (type A), shallow in 40% (type B), and absent in 27% (type C) of cases. The mean distance between CFS and the infraglenoid tubercle was 3.3 cm CI0.95 (3.1-3.3), which corresponds to the proximal third of the lateral border of the scapula. CONCLUSION: The study has confirmed variability of the arterial groove (CFS) and its localization in relation to the inferior glenoid rim. The findings are clinically important, particularly in relation to the Judet approach to scapular fractures (localization of the CSA course).
- MeSH
- arterie anatomie a histologie MeSH
- dospělí MeSH
- lidé MeSH
- lopatka anatomie a histologie MeSH
- syndrom chronické únavy * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
