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 fraktury 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
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
Background: The occurrence of retroperitoneal bleeding and the manner of detection was retrospectively evaluated in patients with life-threatening traumatic bleeding. Methods: The cohort included patients who died in the Trauma Centre of the University Hospital Hradec Kralove in Czech Republic between 2008 and 2012 due to traumatic hemorrhagic shock. Findings of retroperitoneal bleeding and the findings found for life (i.e., CT, FAST, pre-operative findings) were compared. Results: During the five-year period, deaths due to the post-mortem diagnosis of traumatic hemorrhagic shock were recorded in 75 patients, 26 of which (35%) were verified by post-mortem autopsy to have hemodynamically significant bleeding into the retroperitoneum (HSBR) from 31 sources. HSBR was identified for life in 10 patients with HSBR (38.5%). Sensitivity was 55% in CT angiography and 36% in laparotomy without previous CT. The sensitivity of laparotomy with surgical exploration of the retroperitoneum was 67%. A predisposing factor for hemodynamically significant bleeding into the retroperitoneum, which may escape the surgeon’s attention, is high-energy blunt trauma to the trunk. Conclusions: In the acute stage of treatment of patients with life-threatening bleeding due to high-energy blunt trauma, the surgeon has to decide whether the patient’s condition allows CT and whether hematoma of the retroperitoneum should be revised surgically. However, in the present cohort few patients with HSBR underwent surgical exploration of the retroperitoneum because the hematoma was ascribed to the known injury of the pelvis and spine.
- MeSH
- hemoragický šok MeSH
- krvácení * diagnóza etiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- polytrauma MeSH
- poranění břicha komplikace terapie MeSH
- prognóza MeSH
- retroperitoneální prostor * chirurgie patologie MeSH
- traumatický šok MeSH
- tupá poranění MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- pozorovací studie MeSH
OBJECTIVES: This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS: The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS: Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION: Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.
- MeSH
- aorta thoracica diagnostické zobrazování zranění MeSH
- dopravní nehody mortalita statistika a číselné údaje MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- radiografie MeSH
- retrospektivní studie MeSH
- ruptura aorty diagnostické zobrazování epidemiologie etiologie mortalita MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- traumatologická centra statistika a číselné údaje MeSH
- zpomalení škodlivé účinky 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
- Geografické názvy
- Hongkong MeSH
PURPOSE OF THE STUDY The purpose of this study is to retrospectively evaluate the treatment and the complications in patients with extracapsular proximal femoral fractures. MATERIAL AND METHODS The evaluation focused on a group of patients who underwent a surgery at the authors department in the period from 1 January 2011 to 31 December 2013. The inclusion criteria were a simple fall and a monotrauma. The injury-to-surgery interval, course of the surgery and hospital stay, occurrence of early and late complications were assessed. RESULTS In the respective period 286 patients underwent surgery, with the mean age of 79 years (36-101). A basicervical fracture was suffered by 20 patients, a pertrochanteric fracture by 228 patients and 38 patients sustained a subtrochanteric fracture. Osteosynthesis using the DHS was applied in 113 patients, in 110 patients PFNA osteosynthesis was performed and in 51 patients osteosynthesis using an Ender nail was conducted. Yet another type of plate osteosynthesis was opted for in 12 patients. The most frequent postoperative complication was delirium, which was reported in a total of 38 patients. Non-infectious early seroma and hematoma type collection was observed in 6 patients. An infection occurred in one patient. Apart from 8 patients who died during the primary hospital stay, the fracture healing was followed up in 252 patients (91% of 278). The length of healing was 15 weeks on average, delayed healing was reported in five patients. Primary malposition was seen in 9 patients (3%) and secondary malposition occurred in five patients (2%). There were five cases of non-union (2% of 278) in our group of patients. In the followed-up period, a total of 86 patients (30 % of 286) died within one year after the injury. In cases of death, the follow-up was 100% thanks to the data obtained from the Institute of Health Information and Statistics of the Czech Republic (UZIS). Death as a direct consequence of proximal femur fracture occurred in 66 patients (23% of 286). DISCUSSION The results of complications in our group (infection, delayed healing, malposition and non-union) are comparable to those identified by other authors, with the exception of one-year lethality, which is lower in the presented group. CONCLUSIONS The occurrence of complications after proximal femur surgeries is affected by multiple factors. The most important are the choice of a suitable implant, technically correct execution of osteosynthesis and intensive postoperative treatment, including the continuity of care after hospital discharge. Key words:extracapsular proximal femoral fractures, complications.
- MeSH
- delirium * diagnóza etiologie MeSH
- fraktury femuru chirurgie MeSH
- fraktury krčku femuru chirurgie MeSH
- hematom * diagnóza etiologie MeSH
- hojení fraktur MeSH
- kostní destičky MeSH
- lidé MeSH
- pooperační komplikace diagnóza MeSH
- retrospektivní studie MeSH
- senioři MeSH
- subluxační postavení kloubu * diagnóza etiologie MeSH
- vnitřní fixace fraktury škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Posttraumatic pelvic nonunions in combination with malposition are uncommon in the present-day era of modern pelvic surgery. The case describes a new surgical technique for treatment of the nonunion localized to iliosacral joint. A 42-year-old polytraumatized male presented with a pelvic fracture (type 61-C2.3) associated with a complex acetabular fracture. The patient was treated and the pelvis stabilized according to damage control principles (external fixation and pelvic C-clamp) and subsequently definitively treated according to principles of current pelvic surgery. The posterior pelvis was stabilized by bilateral S1 iliosacral screws, however the posterior pelvic ring injury on the left side was not well reduced. The result was a nonunion formation in the left sacroiliacal joit with screw loosening. Two attemps at bone grafting and repeat stabilization were done, but the nonunion did not heal. The end result was a nonunion through left sacroiliacal joint with destruction of the lateral part of sacral bone. The nonunion was treated with nonvascularised autologous fibular strut graft in combination with allogenic corticocancellous grafting. The fibular graft was placed into the bone void after the removal of the iliosacral screw. Radiographically the nonunion healed completely six months after the fibular grafting and the patient had improved clinical outcome. The described technique solves both instability and bone defect in posterior pelvic ring even in the case with low contact areas. The nonvascularised autologous fibular grafting is an effective technique for sacroiliac joint nonunion treatment even in case with large bone defect. Key words: pelvis; nonunion; fibular graft.
- MeSH
- acetabulum zranění MeSH
- dospělí MeSH
- fibula transplantace MeSH
- lidé MeSH
- nezhojené fraktury chirurgie MeSH
- pánevní kosti zranění MeSH
- transplantace kostí * MeSH
- vnitřní fixace fraktury * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVE: The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. MATERIALS AND METHODS: This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. RESULTS: Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. CONCLUSIONS: Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- artrodéza metody MeSH
- dospělí MeSH
- drenáž metody MeSH
- kombinovaná terapie metody MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- mladiství MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie metody MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- sakroiliitida diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
