PURPOSE OF THE STUDY To evaluate, in a retrospective study, injuries to the urogenital tract in patients with pelvic ring fractures. MATERIAL In the years 1998-2007, a total of 308 patients with pelvic ring fractures were treated. The study did not comprise patients with low-energy fractures, such as apophyseolysis in children, osteoporotic bone fractures or pathologic fractures. It also did not include patients with multiple injuries who died within 6 hours of admission to the hospital. The group consisted of 186 men and 122 women with an average age of 34 (range, 6 to 76) years. RESULTS The fractures sustained were classified as type A in 5 %, type B in 57 % and type C in 38 % of the patients. The average follow-up was 71 (range, 13 to 121) months. A primary injury to the urogenital tract was recorded in 50 (16 %) patients. Injury to the urethra was found in 23 (7.5%) and urinary bladder trauma in 18 (6%) patients, vaginal injury was in four women (1%), and penis injury in three (1%) and lacerated testicles in two men (1%). Injury to the urogenital tract was associated with a pelvic ring fracture type A in 5 %, type B in 34 % and type C in 61 % of the patients. Out of the 23 patients with urethral trauma, only six (26 %) were free from functional and subjective complaints; eight (35 %) continued to receive therapy for urethral stenosis seven (30 %) reported urinary incontinence, and seven men (30 %) had erection problems. In six patients (26%) the lasting sequelae were combined. The 18 patients with injury to the bladder reported no subjective complaints at a one-year follow-up. Two patients with penis root injury had erectile dysfunction. Two patients with the loss of both testicles were in the care of a psychiatrist. The patient´s satisfaction was evaluated on a 0-to10-point scale. The average value for the whole group was 4.1 points. In the patients with erectile dysfunction, the value was 0.8, and in those with isolated injury to the urinary bladder it was 9.4 points. DISCUSSION The increasing number of injuries to the urogenital tract associated with permanent sequelae is caused by a growing number of pelvic ring fractures as well as, and this is more important, by decreasing mortality in patients with severe trauma to the pelvic ring The extent of urogenital injury is related to the degree of dislocation of the pelvic skeleton. Injury to the male urethra is the most frequent urogenital trauma because of the male anatomy. It occurs most often in unstable C type fractures when the pelvic ring is disrupted with bone displacement due to shear force at the site of urethra attachment. The consequences are related to the quality of treatment of urogenital tract injury as well as to how the skeletal injury is managed. The lasting effects of the primary injury to nerve structures are beyond repair by therapy. CONCLUSIONS Injury to the urethra results in erectile dysfunction in 50 % of the injured patients it is often associated with urinary incontinence that has a strong effect on the patient´s life quality. Isolated trauma to the urinary bladder has a good prognosis. The incidence of post-traumatic incontinence is not high, but reduces the patient´s personal and social comfort. A prerequisite for a successful therapeutic outcome is a good cooperation of the orthopaedic surgeon and urologist.

• MeSH
• dítě MeSH
• dospělí MeSH
• erektilní dysfunkce etiologie   MeSH
• fraktury kostí komplikace   MeSH
• infertilita etiologie   MeSH
• inkontinence moči etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pánevní kosti zranění   MeSH
• senioři MeSH
• urogenitální systém zranění   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY The aim of this retrospective study was to evaluate the group of 27 patients with distal humeral fractures treated by the locking compression plate and distal humerus plate (LCP-DHP) system. MATERIAL Between January 2006 and June 2008, a total of 62 distal humeral fractures (61 patients) were treated in our department, of which 27 were managed by LCP-DHR The group comprised 15 women (55.5 %) and 12 men (45.5 %), with an average age of 53.6 years (range, 18 to 84 years). METHODS Conservative reduction and subsequent immobilization were done in all fractures. The surgical procedure was indicated within 24 hours of injury, with neurological deficit or an open fracture this was 6 hours. Access to the fracture was from a longitudinal dorsal incision with intra-articular osteotomy of the olecranon. The ulnar nerve was released and transposed. The fractures were reduced with an effort of maximal restoration of the articular surface, and then fixed with LCP-distal humerus plates. Antibiotic prophylaxis was administered and the wound was drained and a drain was inserted. The arm was immobilized in a plaster cast or a removable brace for 2 to 4 weeks, according to the fracture type. The patients had clinical and X-ray follow-up at 6 weeks, then at 3, 6 and 12 months after surgery. The evaluation was based on the Mayo elbow performance score (MEPS). RESULTS The injury was caused by a fall in 24 patients (88.9 %), sustained in a car accident in two (7.4 %) and as the result of a gunshot in one patient (3.7 %). Multiple injuries to the musculoskeletal system were diagnosed in five patients (18.5 %). One patient with polytrauma after a fall from 6 metres suffered an ipsilater fracture of the distal femur (3.7 %). The two patients involved in car accidents (7.4 %) had injury to the contralateral acetabulum. Two patients (7.4 %) sustained distal radial fractures on the other side. Surgery was carried out within 10.5 hours (4 to 47) of injury on the average. The average hospital stay was 6.4 days (2 to 12). All 27 fractures were classified as AO type C fractures, of these seven were open fractures. Complete bony union was achieved at an average of 4 months, with a range of 3 to 9 months (in two patients 7.4 %) after surgery. The early post-operative complications included wound dehiscence due to superficial infection in two patients. In two patients early removal of the implants was indicated, and this was for ulnar nerve irritation and motion range restriction in one and deep infection in the other. No migration or failure of the implants was recorded. The average MEPS of the patient group was 91.6, which is in the range of excellent to very good results. DISCUSSION The group of our patients is by age, sex and AO type C fractures comparable with the groups of other authors. The number of complications is lower and the MEPS evaluation is comparable. Even when full anatomic reduction and stable fixation are achieved, the outcome may be compromised by heterotrophic ossification, joint rigidity or ulnar neuropathy, the facts described by the majority of authors. Similarly, it is reported that good results are obtained with intra-articular osteotomy of the olecranon and ulnar nerve transposition. An important component of the treatment is good quality physical therapy restoring a satisfactory range of motion. CONCLUSIONS The study provided evidence that the use of LCP-DHP provides stable fixation of type C fractures, even in patients with osteoporosis, and when completed with early rehabilitation, it has good clinical outcomes.

• MeSH
• dospělí MeSH
• fraktury humeru chirurgie   MeSH
• hojení fraktur MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• muži MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY To analyse retrospectively complications of the surgical treatment of displaced acetabular fractures. MATERIAL In the years 1996 to 2006 a total of 251 patients with acetabular fractures were treated. The group comprised 162 men and 89 women; the average age was 35 years. The average follow-up was 71 months (range, 16 to 138). Based on the AO classification, type A fractures were found in 58 %, type B in 23 % and type C in 19 % of the patients. Indications for surgical intervention were hip instability or hip incongruence. RESULTS The complications included intra-operative, and early and late post-operative problems. Of the intra-operative complications, 2 % were vascular injuries, 5 % were damage to the static nerve, 13 % were due to incomplete reduction and 2 % due to bone non-union. Early post-operative complications in five patients (2 %) required revision surgery for early infection in two, haematoma in the wound in one and failed osteosynthesis in two patients. In one patient failed osteosynthesis was associated with hip dislocation. Late complications included aseptic necrosis in 7 %, post-traumatic arthritis in 17 %, para-articular ossification grades III and IV of the Brooker classification in 7 % and late infection in 0.5 % of the patients. DISCUSSION The outcome of surgical treatment depends on quality reconstruction of the articular surface and complications, and is related to the fracture type and method of treatment. Not every poor outcome means it is a complication, nor is it always related to the type of fracture. Some fracture types are bound to heal poorly. The complex anatomy of the joint involves rather frequent injury to nerve structures and imperfect reduction and fixation. CONCLUSIONS The most frequent complication is the development of post-traumatic arthritis due to imperfect reduction. However, the current limit of achieving correct reduction and weight-bearing surface reconstruction remains an open issue. Aseptic necrosis in type A fractures was three-times as high as in type B and C fractures. Imperfect reconstruction of the acetabulum and failure to restore hip joint congruence were twice higher in type B than type A and C fractures.

• MeSH
• acetabulum chirurgie   zranění   MeSH
• dítě MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• peroperační komplikace MeSH
• pooperační komplikace MeSH
• senioři MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH