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 fraktur 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

The authors present a case of 74-year-old female patient who suffered a flail chest in motor vehicle accident. First day after injury a descending thoracic aorta was injured, most likely during manipulation with the patient. This injury was verified by operation, which was indicated 26 hours after the hospital admission, because of a sudden decrease of blood pressure with blood loss over 600 ml through the chest tube. The female patient died during surgery despite all efforts. Due to our experience with this rare case and after literature studying, we would recommend to consider early surgical revision. Based on the close contact of severely displaced sharp edges of ribs to the descending aorta, which was visible on the CT scan. Even through the absence of clear leak of contrast in the CT examination. We could resect these parts of ribs. Key words: flail chest, descending thoracic aortic injury.

• MeSH
• fraktury žeber * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• paradoxní dýchání * MeSH
• počítačová rentgenová tomografie MeSH
• poranění hrudníku * diagnostické zobrazování   chirurgie   MeSH
• senioři MeSH
• žebra MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Luxace kolenního kloubu je poměrně vzácný vysokoenergetický úraz s postižením všech struktur kolenního kloubu s výskytem mnoha časných i pozdních komplikací. Zatímco samotná diagnóza nečiní obtíže, komplikace jako poranění a. poplitea nebo rozvoj kompartment syndromu jsou klíčové a mohou uniknout pozornosti a je třeba po nich aktivně pátrat. Autoři v této kazuistice prezentují jeden takový případ luxace kolene s poraněním a. poplitea. Řešením byla revaskularizace popliteopopliteálním bypassem s použitím autologního štěpu v. saphena magna a trombektomie bércových tepen a protektivní fasciotomie pro hrozící kompartment syndrom.

Luxation of the knee joint is a relatively rare high-energy injury with a disability of all knee joints with many early and late complications. While the diagnosis itself does not make it difficult, complications such as lesion of popliteal artery or compartment syndrome are key points and can escape attention and are needed to be actively pursued. One such case of knee luxation with revascularization by popliteopopliteal bypass using the autologous graft v. Saphena magna and thrombectomy of the leg arteries and protective fasciotomy for impending compartment syndrome is presented by the authors in this case study.

• MeSH
• angiografie MeSH
• arteria poplitea * chirurgie   zranění   MeSH
• autologní štěp MeSH
• fasciotomie MeSH
• kompartment syndrom chirurgie   MeSH
• lidé MeSH
• luxace kolena * chirurgie   komplikace   MeSH
• mladiství MeSH
• tlakový index kotník-paže MeSH
• transplantace cév MeSH
• trombektomie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

ÚVOD: Zlomeniny stehenní kosti jsou nejčastěji výsledkem vysokoenergetického mechanizmu. Jejich primární ošetření, definitivní řešení a řešení poruch hojení jsou stále námětem k diskuzi. CÍL: Cílem práce bylo analyzovat příčiny poruchy kostního hojení stehenní kosti, infekční komplikace a možnosti jejich řešení. METODIKA: Jedná se o retrospektivní studii 1433 pacientů z let 2014 až 2018. Zaměřili jsme se na skupinu sdruženě poraněných pacientů s NISS > 15, kteří zároveň utrpěli zlomeninu diafýzy nebo distální části stehenní kosti. Z tohoto souboru 178 pacientů zemřelo. Ze zbylých 998 pacientů s NISS > 15 utrpělo 82 pacientů (8 %) současně zlomeninu diafyzární nebo distální části stehenní kosti. VÝSLEDKY: Ke zhojení zlomeniny bez nutnosti další intervence došlo v 84 % případů. U dvou pacientů (2,6 %) byl stav hodnocen jako prodloužené hojení. K primárnímu nezhojení došlo celkem u 6 pacientů (8 %). DISKUZE: K řešení poruchy hojení stehenní kosti se nejčastěji používá výměna hřebu za silnější po předvrtání dřeňové dutiny a s možným přidáním vymezovacích šroubů. Úspěšnost této techniky se pohybuje mezi 75 a 100 %. Další možnou operační technikou je augmentace stávajícího hřebu přídatnou dlahou, která se osvědčila zejména v infraistmické části diafýzy, tedy v distální třetině. Úspěšnost této metody překračuje 90 %. Třetí možnou operační technikou je konverze nitrodřeňové osteosyntézy na dlahovou. Její význam spatřujeme při nutné konverzi relativní na absolutní stabilitu. ZÁVĚR: Příčiny poruchy hojení kosti jsou mechanické, biologické a kombinace obojího. Mechanickou příčinou může být nedostatečná stabilita nebo naopak přílišná rigidita osteosyntézy, která nevede ke tvorbě svalku. Biologickou příčinou je nejčastěji porucha výživy fragmentů zlomeniny. Odhalením příčiny poruchy hojení pak můžeme správnou intervencí dosáhnout zhojení.

• MeSH
• diafýzy chirurgie   MeSH
• fraktury femuru chirurgie   etiologie   MeSH
• hojení fraktur MeSH
• hojení ran MeSH
• lidé MeSH
• mnohočetné fraktury chirurgie   MeSH
• osteointegrace MeSH
• pooperační komplikace diagnostické zobrazování   epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: Femoral fractures are most often the result of a high-energy mechanism. Their primary treatment, definitive management and addressing of impaired healing are still a matter of discussion. AIM: The aim of the study was to analyse the causes of impaired healing of femur, infectious complications and their possible solutions. METHODOLOGY: It is a retrospective study of 1,433 patients from years 2014 to 2018. We focused on a group of polytrauma patients with NISS > 15, who also suffered a diaphyseal or distal femur fracture. Of this cohort, 178 patients died. Of the remaining 998 patients with NISS > 15, 82 patients (8 %) suffered a concomitant diaphyseal or distal femur fracture. RESULTS: The fracture healed without the need for further intervention in 84 % of cases. In two patients (2.6 %), the condition was assessed as prolonged healing. Primary non-healing occurred in a total of 6 patients (8 %). DISCUSSION: Replacement of the nail with a thicker nail after reaming the medullary cavity and with the possible addition of positional screws is most commonly used to manage the impaired healing of femur. The success rate of this technique ranges from 75 to 100 %. Another possible surgical technique is the augmentation of the existing nail with an additional plate, which has proven to be particularly successful in the infraisthmic portion of the diaphysis, i.e. in the distal third. The success rate of this method exceeds 90 %. The third possible surgical technique is a conversion of intra-articular osteosynthesis to plate osteosynthesis. Its importance is seen in the necessary conversion of relative to absolute stability. CONCLUSION: The causes of impaired bone healing are mechanical, biological, and a combination of both. The mechanical cause may be insufficient stability or, on the contrary, excessive rigidity of the osteosynthesis, which does not result in muscle formation. The biological cause is most often a malnutrition of the fracture fragments. Then, by discovering the cause of the impaired healing, we can achieve healing with the right intervention.

• MeSH
• diafýzy MeSH
• fraktury femuru * chirurgie   etiologie   MeSH
• hojení fraktur MeSH
• hojení ran MeSH
• lidé MeSH
• osteointegrace MeSH
• polytrauma MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY Comparison of the outcomes of clavicle midshaft fractures using two different surgical techniques, namely intramedullar osteosynthesis using elastic stable intramedullary nailing (ESIN) with medial cap and extramedullar plate osteosynthesis. MATERIAL AND METHODS The prospective randomized trial was conducted at the Department of Trauma Surgery of the Department of Surgery of the University Hospital Hradec Králové in the Czech Republic at the Level I Trauma Center between 2014 and 2018 and compared two types of osteosynthesis of clavicle midshaft fractures. 60 patients were enrolled in the study and were randomly assigned to one of the two groups. In Group 1, the participants were treated by ESIN and in Group 2 by plate osteosynthesis. The operative technique was chosen by the sealed envelope method. According to the randomization list created by a specialised statistical company, every envelope was marked with a unique number and contained the intramedullar "IM", or the extramedullar "EM" sign. RESULTS The observation of statistical parameters by unpaired t test detected significantly different results: a shorter incision using ESIN osteosynthesis (median = 2.9 cm) compared with plate osteosynthesis (median 14 cm, p < 0.001), longer X-ray exposure using ESIN (median = 325 s) compared with plate osteosynthesis (median = 16.5 s, p < 0.001) and radiation dose using ESIN (median = 996 cGy/cm2) compared with plate osteosynthesis (median = 4 cGy/cm2, p < 0.001). The difference in other parameters such as operative time, in-patient length of stay and duration of rehabilitation was not statistically significant. The time to clavicle fracture repair was comparable in both the surgical arms, i.e. approximately 3 months. Also, the duration of incapacity for work was not statistically different. Functional Constant Shoulder Score at a one-year followup is comparable in both the two arms (p = 0.268). The Dunn s method necessitated a longer operative time when treating multifragmental midshaft clavicle fracture by the ESIN compared to simple fractures. No statistically significant difference was detected in the operative time of different procedures and in the number of bone fragments. The functional outcome was excellent in 25 patients (83%) in each method. DISCUSSION Most midshaft clavicle fractures are still treated non-operatively with good outcomes. The indication for surgical treatment is the dislocation of fragments greater than the width of the clavicle bone, the shortening of fragments greater than 2 cm and the angulation of more than 30°. Patient after operative treatment profits from bone healing by absolute or relative stability. In recent years, new intramedullar techniques other than open plate reduction and fixation have emerged. For example, elastic stable intramedullary titan nailing. Both the methods are full-fledged without functional differences in longterm follow-up. CONCLUSIONS We consider the intramedullar osteosynthesis to be the most appropriate surgical approach for simple midshaft spiral, oblique and transverse clavicle fractures and also wedge oblique fractures. Plate osteosynthesis is useful for all types of fractures. No statistically significant difference in the rate of bone healing was observed after intramedullar or extramedullar ostesynthesis, but multifragmentary fractures healed faster when plate osteosynthesis was used. The determining factor for the received radiation dose is solely the surgical method, not the type of fracture. There is a statistically significant difference in shorter X-ray exposure and lower received radiation dose in plate fixation and reduction. The complication rate is comparable in both the methods. Key words: elastic stable intramedullary nailing, midshaft clavicle fracture, ESIN, TEN, titan elastic nail, clavicle plate osteosynthesis, 3.5 LCP clavicular plate, indication for midshaft fracture treatment.

• MeSH
• fraktury kostí chirurgie   MeSH
• hojení fraktur MeSH
• klíční kost zranění   chirurgie   MeSH
• kostní destičky MeSH
• kostní hřeby MeSH
• lidé MeSH
• prospektivní studie MeSH
• vnitřní fixace fraktury přístrojové vybavení   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

Cíl: Určení indikací k angiografickému ošetření poraněné sleziny. Typ práce: Krátké shrnutí a kazuistika. Materiál a metodika: Kazuistika a krátký přehled literatury. Závěr: U hemodynamicky stabilních pacientů s poraněním sleziny ≤ IV. stupně může být riziko sekundární ruptury významně sníženo angiografickým ošetřením. Toto ale vyžaduje aktivní a diferencovaný přístup v jednotlivých případech.

• MeSH
• endovaskulární výkony MeSH
• lidé MeSH
• poranění břicha MeSH
• ruptura sleziny * chirurgie   diagnostické zobrazování   MeSH
• úrazy a nehody MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• hodnotící studie MeSH

Objective: Determination of indications for angiographic treatment of injured spleen. Type of thesis: Short summary and case report. Material and methodology: Case report and short overview of literature. Conclusion: In haemodynamically stable patients with spleen injury grade ≤ 4. the risk of secondary rupture may be significantly reduced by angiographic treatment. However, this requires an active and differentia­ted approach in individual cases.

• MeSH
• endovaskulární výkony MeSH
• lidé MeSH
• poranění břicha MeSH
• ruptura sleziny * chirurgie   diagnostické zobrazování   MeSH
• úrazy a nehody MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• hodnotící studie MeSH

OBJECTIVE: Blunt thoracic aortic injury is life-threatening injury. High suspicion on this clinical condition can be made by initial chest X-ray on emergency department. The aim of study was to detect which other signs, except widened mediastinum, are specific for rupture of the thoracic aorta. METHODS: To the study were included all Triage positive patients primary headed from the scene of injury to the Trauma center Level I from January to December 2014 and which have performed chest X-ray on emergency department followed by CT of chest, abdomen and pelvis. On chest X-ray were evaluated diameter of superior mediastinum, deviation of trachea, deviation of left and right main bronchus, aortic arch, fracture of first or second rib on the left side and obliteration of aortopulmonary space. RESULTS: Totally n=208 patients were enrolled to the study. Seven patients had blunt thoracic aortic injury on CT angiography. All these patients had widened superior mediastinum more than 80 mm (p=0.021). Six patients with blunt thoracic aortic injury had obliteration of aortic arch (p=0.0001) and obliteration of aortopulmonary space (p=0.0001). CONCLUSION: All patients after high energy trauma with widened mediastinum together with obliteration of aortic arch and obliteration of aortopulmonary space on initial chest X-ray without initial CT, must be indicated to the CT after initial stop the bleeding procedures for the exclusion of traumatic rupture of thoracic aorta.

• MeSH
• aorta thoracica diagnostické zobrazování   MeSH
• bronchy diagnostické zobrazování   MeSH
• CT angiografie MeSH
• dospělí MeSH
• fraktury žeber diagnostické zobrazování   MeSH
• kohortové studie MeSH
• lidé MeSH
• mediastinum diagnostické zobrazování   MeSH
• polytrauma diagnostické zobrazování   MeSH
• poranění hrudníku diagnostické zobrazování   MeSH
• rentgendiagnostika hrudníku MeSH
• retrospektivní studie MeSH
• ruptura aorty diagnostické zobrazování   MeSH
• skóre závažnosti úrazu MeSH
• trachea diagnostické zobrazování   MeSH
• tupá poranění diagnostické zobrazování   MeSH
• zkrácená stupnice závažnosti úrazů MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.

• MeSH
• aorta chirurgie   MeSH
• balónková okluze * MeSH
• dopravní nehody MeSH
• fraktury kostí komplikace   MeSH
• hemoragický šok chirurgie   MeSH
• lidé MeSH
• pánevní kosti zranění   MeSH
• polytrauma etiologie   terapie   MeSH
• resuscitace metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH