• MeSH
• diafýzy * anatomie a histologie   zranění   MeSH
• fixace fraktur metody   MeSH
• fraktury femuru diagnóza   etiologie   komplikace   terapie   MeSH
• fraktury humeru diagnóza   etiologie   komplikace   terapie   MeSH
• fraktury tibie diagnóza   etiologie   komplikace   terapie   MeSH
• lidé MeSH
• ortopedické výkony metody   MeSH
• tromboembolie prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• klinické protokoly MeSH
• lidé MeSH
• mezioborová komunikace MeSH
• muskuloskeletální systém diagnostické zobrazování   zranění   MeSH
• ortopedické výkony metody   MeSH
• polytrauma * diagnóza   komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• chondrom diagnóza   patologie   MeSH
• chondrosarkom diagnóza   patologie   terapie   MeSH
• Ewingův sarkom diagnóza   patologie   terapie   MeSH
• lidé MeSH
• metastázy nádorů MeSH
• mnohočetný myelom diagnóza   patologie   terapie   MeSH
• myositis ossificans diagnóza   etiologie   terapie   MeSH
• nádory kostí * diagnóza   klasifikace   terapie   MeSH
• obrovskobuněčný nádor kosti diagnóza   patologie   terapie   MeSH
• osteom osteoidní chirurgie   diagnóza   patologie   MeSH
• osteom chirurgie   dietoterapie   etiologie   MeSH
• osteosarkom diagnóza   patologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

This textbook for medical students include an overview of essential information on etiology, pathogenesis, clinical picture, diagnostics and treatment of developmental and acquired orthopedic diseases and disorders, including musculoskeletal injuries. It also includes an overview of essential conservative and surgical procedures used in orthopedics and traumatology of the musculoskeletal system in adult and child patients. As this textbook is intended as an aid for the preparation of the final state exam in surgical fields for the students at the Third Faculty of Medicine, Charles University, the chapters are arranged according to questions taken from the "pool" of Orthopedics and Traumatology used in this exam. However, we believe that this textbook can help students from other medical faculties of Charles University as a tool for quick and easy reference to a range of orthopedic diseases and injuries to the musculoskeletal system.

• Klíčová slova
• Chirurgie, ortopedie, traumatologie,
• MeSH
• ortopedie MeSH
• traumatologie MeSH

• NLK Obory
• ortopedie
• traumatologie

A collection of works that focus on orthopedics and traumatology. Intended for university students.

• MeSH
• ortopedie MeSH
• traumatologie MeSH
• Publikační typ
• sborníky MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• ortopedie
• traumatologie
• NLK Publikační typ
• učebnice vysokých škol

PURPOSE OF THE STUDY To compare the outcomes of parallel and convergent iliosacral screw insertion into the body of vertebra S1 in the treatment of posterior pelvic arch injuries. MATERIAL AND METHODS Radiographs of 120 patients (43 women, 77 men), aged between 14-79 years, treated with iliosacral screw fixation for posterior pelvic ring fractures between 1.1.2009 and 31.12.2019 were reviewed for inclusion in the study. In each case two screws were inserted into the body of vertebra S1. The screws were inserted in either parallel or convergent orientation. Convergent orientation allows the threads of both screws to be interconnected. In this technique, the first screw is inserted into the centre of the body of vertebra S1 as a compression screw. The second screw is inserted as a positioning screw and is placed so that the threads of both screws lock together. We believe that the interlocking of the threads of both screws and contact of the second screw with three cortices (two of the iliac bone and one of the sacrum) increase the stability of the fixation. Migration of loosened screws was measured on radiographs of the pelvis obtained at six weeks and at three, six and twelve months postoperatively. Migration of five millimetres or more within the first six weeks was considered to be clinically significant. Only patients after primary fracture treatment and with a complete one-year follow-up were included in the study. Cases of non-union and failure of osteosynthesis of the anterior pelvic arch and patients with incomplete follow-up were excluded. The incidence of significant screw migration between the two techniques was compared using Fisher's exact test with a 5% level of significance. RESULTS Sixty-three patients (23 women, 40 men) aged 17 to 79 years were included in the study. Parallel screws were used in 24 patients (8 women, 16 men) and convergent screws were used in 39 patients (15 women, 24 men). Clinically significant migration occurred in nine (38%) patients after parallel insertions. In two of these cases there was unstable fixation of the anterior pelvic arch. Migration of convergently placed iliosacral screws occurred in four (10%) cases. In three of these cases this was due to unstable fixation of the anterior pelvic arch. The difference in screw migration between the two groups was shown to be significant (p = 0.0219). DISCUSSION Iliosacral screws ensure sufficient stability of the posterior arch in type B and C pelvic fractures provided that the anterior pelvic arch is stable. Convergent insertion of iliosacral screws may increase the stability of fixation. Minimally invasive surgery with sufficient stability may be advantageous for early treatment of patients after multiple trauma and in elderly patients. The weaknesses of this study are its relatively small number of patients, which prevented reliable statistical analysis of screw migration according to the type of pelvic fractures. The second main limitation is the failure to perform densitometric examination of the skeleton in patients with X-ray proven screw migration for confirmation of osteoporosis as one of the possible causes of fixation failure. CONCLUSIONS The results of the study suggest that convergent insertion of iliosacral screws into S1 is associated with a lower risk of screw migration and subsequent failure of fixation of the posterior pelvic arch. Key words: pelvic fracture, pelvic injury, iliosacral screw, parallel screws, convergent screws, migration of iliosacral screws.

• MeSH
• dospělí MeSH
• fraktury kostí * chirurgie   MeSH
• kostní šrouby škodlivé účinky   MeSH
• křížová kost diagnostické zobrazování   zranění   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pánevní kosti * zranění   MeSH
• senioři MeSH
• vnitřní fixace fraktury škodlivé účinky   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The aim of this retrospective study was to assess the subjective evaluation of treatment by patients with respect to their return to work and recreational sport following the fracture of clavicle diaphysis with posttraumatic shortening of 1.5 cm, or more, treated non-operatively and surgically. MATERIAL AND METHODS Our group of patients consisted of 51 patients (14 females, 37 males) aged between 18 and 89 years (average age 46 years). We concentrated on the parameters of sex, age, side of injury, extent of posttraumatic shortening, method of treatment, return to work or recreational sport, DASH score at one year post non-operative or surgical treatment. Patients who sustained a pathological fracture, fractures of the clavicle combined with an injury of the acromioclavicular joint or simultaneous fracture of the humerus or the ribs were excluded from the study. Patients with open fractures or re-fractures were excluded as well. The indication for treatment selection was based on pre-operative discussion of the doctor with the patient and the Informed Consent was signed. The patient was informed about different treatment options. A shorter period of fixation of the arm and post-operative physiotherapy was mentioned in connection with surgical treatment as well as potential surgical complications. A statistical analysis comparing the data in both groups was conducted using the Fisher exact test. The p-value of 0.05 or less was considered as statistically significant. RESULTS The right side was affected 26 times, the left side 25 times. The shortening ranged from 1.5 to 3.7 cm. 24 patients (8 females, 16 males) aged 21 to 89 years (average 54 years) were treated non-operatively. 27 patients (6 females, 21 males) aged 18 to 74 years (average 38 years) underwent surgery. The difference in sex distribution in both groups was not statistically significant (p = 0.5311). According to the Robinson classification, there were 17 patients with type 2A2 fractures, of whom 8 underwent surgery and 9 were treated non-operatively, 19 patients with type 2B1 fractures, of whom 9 underwent surgery and 10 were treated non-operatively, and 15 patients with type 2B2, of whom 10 underwent surgery and 5 were treated non-operatively. The surgically treated patients prevailed in type 2B2 only, but this difference was not statistically significant (p = 0.2350). In the non-operatively treated group, 23 out of 24 patients returned to pre-injury activities in 3 months on average. Ten patients (48%) reported reaching the same function as on the other side. In the DASH score evaluation, 11 patients reached the value of 0-3.3, five patients 3.4-10, six patients 10.1-30.0 and two reached the score of more than 30. In the evaluation of capacity to work, 15 out of 24 patients were able to work, 11 of them without any restrictions or difficulties. In the evaluation of the sport and playing musical instrument module, 9 out of 24 patients did not engage in sports activities or do not play any musical instruments. In the surgically treated group, 26 out of 27 patients returned to pre-injury activities within 6 weeks. 19 (70%) patients reported reaching the same function as on the other side. In the DASH score evaluation, 19 patients reached the value of 0-3.3, two patients 3.4-10, 5 patients 10.1-30.0 and one patient with nonunion 72.5. Comparison of the average values of the DASH score demonstrated slightly better results achieved by surgical treatment (9.03 vs 6.77). When assessing the work module, 24 out of 27 patients returned to work, 20 of them without any restrictions or difficulties. Out of 27 patients, 4 patients were no longer able to engage in sports activities or to play a musical instrument. Of the 23 remaining patients, 18 did not have any problems, 5 suffered from minimal problems. The group of patients treated non-operatively included one case of non-union and the same applies to the surgically treated group. In 3 patients the removal of hardware was performed, 3 patients underwent revision of the surgical wound because of infection. DISCUSSION The recommendation of the weight-bearing of the upper extremity was similar in both groups, 12 weeks post injury/surgery on average. It is clear that sooner return to work or sports activities in the surgically treated group was preferred by younger patients who expected quicker recovery. Younger patients were less patient and more eager to return to work and sports, while the older patients, on the other hand, were more cautious about possible complications of surgery. CONCLUSIONS The results of our study did not identify any correlation between the clavicle shortening and the indication for surgical treatment. Surgical treatment was preferred by younger patients, more frequently by males. The rationale was supported by the perspective of sooner return to work and favourite sports activities. Their decision was not affected by the known risks of surgical treatment. Evaluation of the DASH score at one year after injury/surgery showed similar results. A higher incidence of complications in the surgically treated group did not lead to negative evaluation of the selected treatment modality by the highly motivated group of patients either. Key words: fractures of the clavicle diaphysis, non-operative treatment, surgical treatment, return to work, return to sports activities, functional results at 1 year.

• MeSH
• diafýzy MeSH
• dospělí MeSH
• fraktury kostí * komplikace   chirurgie   MeSH
• klíční kost zranění   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sporty * MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie 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

Vysokoškolské učební texty, které se zaměřují na ortopedii a traumatologii.

• MeSH
• ortopedie MeSH
• traumatologie MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• ortopedie
• traumatologie
• NLK Publikační typ
• učebnice vysokých škol

Skripta jsou určená studujícím medicíny a obsahují přehled základních informací o etiologii, patogenezi, klinickém obrazu, diagnostice a léčbě vývojových a získaných ortopedických onemocnění včetně poranění pohybového ústrojí. Zahrnují rovněž přehled základních konzervativních a operačních postupů používaných v ortopedii a traumatologii pohybového aparátu u dospělých pacientů i pacientů v dětském věku. Skripta vznikla jako pomůcka k přípravě na státní závěrečnou zkoušku z chirurgických oborů pro studenty 3. lékařské fakulty Univerzity Karlovy, proto jsou jednotlivé kapitoly řazené podle otázek z "koše" Ortopedie a traumatologie používaných právě u této zkoušky. Přesto věříme, že skripta mohou pomoci i studentům ostatních lékařských fakult Univerzity Karlovy ke snadnému a rychlému pochopení celého spektra ortopedických onemocnění a poranění pohybového ústrojí.

• Klíčová slova
• Chirurgie, ortopedie, traumatologie,
• MeSH
• ortopedie MeSH
• traumatologie MeSH

• NLK Obory
• ortopedie
• traumatologie

INTRODUCTION The purpose of the study was to evaluate the injury-treatment time interval in a group of patients with limb bone fractures over the period of one year; and to compare this interval in the most frequent fractures of the upper and lower limb. MATERIAL AND METHODS The followed-up group of the prospective one-year monocentric study included 3,148 patients treated consecutively for 3,909 fractures. For the purpose of sub-analysis of the injury-treatment time interval in limb bone fractures, excluded from the group were the patients with multiple fractures (520 pts), patients with spinal fractures (356 pts) and pelvic fractures (210 pts). The statistical significance of the achieved results was tested with the use of contingency tables (chi-square test of independence). The significance level for the quantified tests was set at 5%. RESULTS The sub-analysis covered 1,727 patients whose medical records mentioned the exact time of injury and first examination. Within the first 6 hours after the injury, 536 (56.0%) patients with an upper limb bone fracture and 429 (55.7%) patients with a lower limb bone fracture were treated. Within 24 hours after the injury, 683 (71.4%) patients with an upper limb bone fracture and 572 (74.3%) patients with a lower limb bone fracture were treated. Within the first 24 hours after the injury, 104 (76.4%) patients with a proximal humerus fracture, 240 (84.5%) patients with a distal radius fracture and only 174 (55.5%) patients with metacarpal and phalanx fractures were treated. In the first hours after the injury, most frequently treated were the patients who sustained a distal radius fracture, and the longest injurytreatment time interval was seen in patients with hand bone fractures. The difference in the 24hour injury-treatment interval was significant when comparing distal radius fractures and proximal humerus fractures (p = 0.047) and when comparing distal radius fractures and hand bone fractures (p < 0.001). Within 24 hours after the injury, 166 (83.3%) patients with a proximal humerus fracture, 128 (79.1%) patients with an ankle fracture and 142 (63.4%) patients with metatarsal and phalanx fractures were treated. The shortest injury-treatment interval was reported in patients with a proximal femoral fracture and an ankle fracture, and relatively the lowest number of treated patients in the first hours after the injury was reported among patients with metatarsal and toe fractures. When evaluating the 24hour injury-treatment time interval, this difference was significant only when comparing proximal femoral fractures and metatarsal and phalanx fractures (p < 0.001), while when comparing proximal femoral fractures and ankle fractures the difference was not significant (p = 0.283). DISCUSSION There are not many studies of other authors focused on monitoring the injury-treatment time interval in the most frequent limb bone fractures. They also confirm that the treatment is sought out most quickly by patients with fractures that make walking or self-care impossible. CONCLUSIONS The results of the study confirmed that the fastest treatment was requested in patients with fractures which made the selfcare (distal radius) or walking (proximal femur, ankle) impossible; less painful fractures (metacarpal, phalanx fractures) and fractures that do not compromise walking (metatarsal fractures) were treated in the first 24 hours after the injury significantly less frequently. The patients with ankle fractures sought out treatment the most quickly compared to the patients with other fractures; it concerned largely occupational or sports injuries sustained by young men who were brought for treatment immediately after the injury, directly from their workplace or sports ground. The treatment of osteoporotic fractures (proximal humerus, distal radius, proximal femur) was spread over the first 6 hours due to the lack of independence of elderly patients after sustaining a fall at home; in majority of them transport to treatment was arranged for by relatives or neighbours only with a certain delay, once they became aware of their injury. Key words: fracture epidemiology, limb bone fractures, trauma-treatment time interval.

• MeSH
• fraktury femuru * MeSH
• fraktury proximálního humeru * MeSH
• lidé MeSH
• metakarpální kosti * MeSH
• pánevní kosti * MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH