AIMS: To assess the results of a biomechanical test of cadaveric specimens, comparing 2 methods of fixation of modified Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint. METHODS: A total of 12 cadaveric specimens were used in the test. Arthrodesis of the first MTP joint was in all patients fixed with a Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7. Two methods of fixation of the Lapidus arthrodesis were compared, i.e. fixation with two screws in the PS (plate-screw) version versus fixation with X-Locking Plate 2.4/2.7 in the PP (plate-plate) version. Measurements were obtained with the use of a testing machine ZWICK Z 020-TND with an optical device Mercury RT for measuring deformities. Each specimen was subjected to 3 loading options, a. displacement 5 mm, the support is placed under the proximal phalanx, b. displacement 5 mm, the support is placed under the first metatarsal head and c. load to failure, the support is placed under the first metatarsal head. RESULTS: In all specimens the PS construct showed a statistically considerably higher stiffness than the PP construct. In all specimens treated with the PP construct the load to failure was lower than in the PS construct. For loading mode a., at a significance level of 0.05 (P<0.05), the P-value was 0.036, for mode b. the P-value was 0.007 and for loading mode c. the P-value was 0.006. In addition, age-related decrease in stiffness of the specimen was proved at a significance level of 5% (P=0.004). CONCLUSION: In all the three loading modes, the PS (plate-screw) construct showed a statistically higher stiffness than the PP (plate-plate) construct.

• MeSH
• artrodéza * metody   MeSH
• biomechanika MeSH
• kostní destičky MeSH
• lidé MeSH
• metatarzofalangeální kloub * chirurgie   MeSH
• mrtvola MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation without fusion for treating type A3 and A4 thoracolumbar fractures. Traumatic thoracolumbar burst fracture is a common pathology without a consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) systems have been recently introduced in the treatment of spinal fractures to reduce the adverse effects associated with the conventional open approaches, such as iatrogenic muscle denervation and pain. METHODS: A prospective analysis was made to evaluate consecutive 46 patients with type A3 and A4 thoracolumbar fractures. Patients were divided into a percutaneous pedicle screw fixation group (PPSF) and an open pedicle screw fixation group (OPSF). The mean age of patients in PPSF group (12 men, 11 woman) was 49.9 years and in OPSF group (10 men, 13 women) 52.2 years. For the purpose of evaluation, the radiological assessment of the bisegmental Cobb angle, the loss of correction, the volume of blood loss, operation time, cumulative radiation time and dose were recorded and compared. RESULTS: All patients were followed up for 12 months. There were no significant differences between OPSF and PPSF in the Cobb angle preoperative and postoperative angle and the loss of bisegmental correction. In PPSF group, the mean preoperative Cobb angle was 10.9° and improved by 4.5° postoperatively, and in OPSF group the preoperative angle was 12.1° and postoperatively improved by 3.8°. Significant differences between OPSF and PPSF were found in the mean cumulative radiation time, radiation dose and operation time. PPSF group also had a significantly lower perioperative blood loss. CONCLUSIONS: Both open and percutaneous short-segment pedicle fixation were safe and effective methods to treat thoracolumbar burst fractures. Percutaneous fixation without fusion seems to be suitable for type A3 and A4 fractures.

• MeSH
• bederní obratle zranění   chirurgie   MeSH
• dávka záření MeSH
• délka operace MeSH
• dospělí MeSH
• fraktury páteře chirurgie   MeSH
• hrudní obratle zranění   chirurgie   MeSH
• kohortové studie MeSH
• krvácení při operaci MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mladý dospělý MeSH
• pedikulární šrouby * MeSH
• prospektivní studie MeSH
• senioři MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY The method of stabilising the osteoporosis-related spinal fractures using an expandable stent (vertebral body stent - VBS) and bone cement is generally accepted for its minimal invasiveness, a low risk of complications and confirmed analgesic effect. The efficiency of reduction of a compressed vertebra is, however, still discussed in the literature. Our hypothesis was that the stent expansion in the vertebral body can achieve a statistically significant reduction in the anterior, middle and posterior part of the vertebra. MATERIAL AND METHODS The patients in whom the VBS technique was used to treat an osteoporosis-related fracture of Th/L spine in the period 2010-2014 were included in the study, namely 29 patients with 31treated fractures. The following radiographic parameters were monitored - anterior, middle and posterior vertebral body height, kyphotic angle between the upper and lower endplates of the vertebral body. Also, the radiation burden, painfulness according to VAS score and occurrence of complications were monitored. The minimum follow-up was 12 months. RESULTS The mean height of the anterior part of the vertebral body before the surgery, on the 1st postoperative day and at 6 weeks, 3 months, 6 months and 12 months was 23.5/25.4/23.9/23.6/23.6 mm respectively. The mean height of the middle part of the vertebral body at the same intervals was 17.9/24.0/23.4/22.9/22.9/22.9 mm. The mean height of the posterior part of the vertebral body was 29.6/29.8/29.4/29.3/29.2/29.2 mm. The kyphotic angle between the endplates of the vertebral body was 8.6/5.3/7.4/7.9/8.0/8.0°. The mean VAS values were 8.2/2.4/2.0/1.9/1.8/1.7. The mean duration of surgery was 54.3 minutes. The mean time of fluoroscopy was 33.4 s. The mean radiation dose was 443.1 cGycm2. The observed complications comprised 2 cases of dilatation balloon rupture, one case of a failure to expand the stents in a healed fracture due to incorrect indication. In total, four cases of cement leakage outside the vertebral body were reported, always with no clinical response. DISCUSSION All the authors agree that the method brings immediate analgesic effect, comparable to kyphoplasty or vertebroplasty. In our cohort, good reduction ability of the implant in the middle part of the vertebral body was confirmed. This has been confirmed also by other authors. Nonetheless, at a longer time interval the loss of correction was observed, which was reported only by Hartmann (5). The other authors mostly did not take into account the longer-term outcomes. CONCLUSIONS The hypothesis that the stent is capable of a statistically significant reduction in the anterior, middle and posterior portion of the vertebral body was only partially confirmed. A statistically significant reduction was seen only in the middle portion of the vertebral body. In the anterior portion of the vertebral body the reduction was demonstrable only immediately after the surgery, while the later follow-up checks revealed the loss of correction. The statistically significant improvement of the kyphotic angle between the endplates of the injured vertebra was also seen only on the first postoperative radiographs and at later follow-up checks the improvement was no more significant. The change in the height of the posterior portion of the vertebral body was not statistically significant at any of the follow-up intervals. Key words:osteoporosis, vertebral fracture, vertebral body augmentation, stentoplasty, vertebral body stent.

• MeSH
• bederní obratle MeSH
• fraktury páteře * chirurgie   MeSH
• hrudní obratle MeSH
• kompresivní fraktury * MeSH
• kostní cementy MeSH
• lidé MeSH
• osteoporóza * MeSH
• stenty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Zlatým standardem ošetření zlomenin dia­fýzy pažní kosti je konzervativní postup, doplněný ve specifických indikacích o dlahovou osteosyntézu. V posledních letech se naproti tomu začíná více prosazovat osteosyntéza hřebová, a to především z důvodu výrazného zlepšení chirurgické techniky a využívaných implantátů, které vedlo ke snížení množství komplikací. Na našem pracovišti se tak postupně stala metodou volby. Cíl: Účelem naší práce bylo zhodnotit úspěšnost osteosyntézy diafýzy pažní kosti v retrospektivně hodnoceném souboru pacientů a zároveň definovat rizikové faktory potenciálního nezhojení. Metoda: Do retrospektivní klinické studie III. stupně kvality důkazů bylo zařazeno 167 pacientů operovaných v letech 2011–2016 v Úrazové nemocnici v Brně se zlomeninou diafýzy pažní kosti. Hodnocena byla míra zhojení a množství komplikací jako, je paréza n. radialis, prodloužené hojení či vznik pakloubu. Dále jsme podrobněji analyzovali skupinu 17 pacientů s diagnostikovaným pakloubem se zaměřením na možné predisponující faktory. Výsledky: V našem souboru jsme nalezli celkem devět (5,4 %) pacientů s komplikací ve formě pooperační parézy n. radialis. Z těchto bylo šest operovaných hřebem a tři dlahou. Dále 10 (6,0 %) pacientů, kteří vykazovali známky prodlouženého hojení a celkem 17 (10,2 %) pacientů, u kterých RTG nález naplnil definici pakloubu. Z nich 15 (12,2 %) bylo operováno hřebovou technikou (12,2 %) a dva dlahou (5,6 %). Z analýzy této skupiny pacientů vyplývá, že profilovým pacientem predisponovaným pro vznik pakloubu je žena v sedmé dekádě života s frakturou ve střední třetině diafýzy typu A1 či B1 dle AO s DM II. typu a vahou na hranici obezity. Žádný jiný ze sledovaných faktorů se neprokázal jako signifikantní. Závěr: Dlahová syntéza i nitrodřeňové hřebování jsou při ošetření zlomenin diafýzy pažní kosti plnohodnotnou alternativou konzervativního postupu. Podle současné literatury nejsou signifikantní rozdíly při vzájemném srovnání těchto metod co do úspěšnosti zhojení, přestože naše zkušenosti naznačují mírně lepší rentgenové výsledky při osteosyntéze dlahou a naproti tomu menší frekvenci poranění n. radialis u osteosyntézy hřebové.

Introduction: Conservative approach is the golden standard for treatment of diaphyseal humeral fractures, supplemented with plate osteosynthesis in specific indications. However, nail osteosynthesis is becoming more popular in the recent years, namely due to a significant improvement in the areas of surgical techniques and implants used, which have resulted in a decrease of complications. This technique has become the treatment of choice at our centre. Aim: The aim of our work was to assess the success rate of diaphyseal humeral fractures osteosynthesis in a retrospectively evaluated patient population, and also to define the risk factors of potential non-healing. Methods: A total of 167 patients who were operated at the Trauma Hospital of Brno between 2011 and 2016 were enrolled into the retrospective clinical trial with 3rd degree quality evidence. The assessed parameters included the outcome of healing and the number of complications, such as paresis of n. radialis, prolonged healing or incidence of non-unions. Furthermore, we assessed in more detail a group of 17 patients with a diag­nosed non-union, and concentrated upon possible predisposing factors. Results: We identified a total of 9 (5.4 %) patients with the complication of postoperative paresis of n. radialis. Six of these patients were operated using nail osteosynthesis; plate osteosynthesis was used in the remaining three patients. We also observed 10 patients (6.0 %) who manifested signs of prolonged healing, and a total of 17 (10.2 %) patients in whom the definition of non-union was confirmed on radiography examination. Of these patients, 15 (12.2 %) were operated using the nailing technique (12.2 %); two patients were treated with plates (5.6 %). The performed analysis of these patients revealed that the profile patient with a predisposition for occurrence of a non-union is a female in the seventh decade of her life, with a fracture in the middle third of the diaphysis, type A1 or B1 according to AO, with type 2 diabetes mellitus, and body weight on the border of obesity. None of the other observed factors has been proven significant. Conclusion: Plate osteosynthesis and intramedullary nailing for the treatment of diaphyseal humeral fractures present fully-fledged alternatives to the conservative approach. According to current literature, there exist no significant differences when comparing these techniques as far as the success rate of healing is concerned, although our experience suggests slightly better outcomes on radiography in patients treated with plate osteosynthesis, and a smaller incidence of n. radialis injury associated with the nailing technique.

• MeSH
• chirurgie operační metody   MeSH
• fraktury páteře chirurgie   komplikace   patofyziologie   terapie   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• krční obratle patofyziologie   zranění   MeSH
• lidé MeSH
• ochrnutí hlasivek patofyziologie   terapie   MeSH
• ortopedické výkony metody   MeSH
• páteř patofyziologie   MeSH
• poranění krku chirurgie   patofyziologie   terapie   MeSH
• poranění nervového systému patofyziologie   terapie   MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY Patellar dislocation is a fairly frequent knee joint injury in young patients. In most cases, this injury can be treated conservatively or surgically. In many cases, patellar cartilage or lateral femoral condyle or both these parts of articular surface are injured, and in conservative treatment this chondral damage very often remains undiagnosed. The purpose of this study is to evaluate the outcomes of treatment in patients who underwent surgery for patellar dislocation and in whom extensive traumatic cartilage lesions of the patella were found. MATERIAL AND METHODS The authors carry out a retrospective evaluation of outcomes in 34 patients from the period 2005-2014, in whom extensive chondral defect of the posterior side of the patella after its traumatic dislocation with the mean size of 4.1 cm2 (the maximum size was 28x18 mm) was found, namely in 21 women and 13 men aged 13-28 years. The patients were indicated for arthroscopic surgery based on the clinical examination which revealed a clear traumatic patellar dislocation. In 2 radiographs only, an osteochondral fragment was found, and in these patients a CT scan of the injured knee was made. The patients were retrospectively broken down into 3 sub-groups by the method of treatment of the chondral defect. The mean size of the defect in the debridement group was 2.7 cm2 compared to 4.6 cm2 in the group with cartilage fixation. In group I reinsertion through MiniSynthes 2.0 screws (5 patients) was performed, in group II reinsertion of the chondral fragment was done using transosseous PDS sutures (19 patients), in group III debridement of injured cartilage was carried out (10 patients). RESULTS The patients were assessed postoperatively using Kujala score and IKDC score. The mean age of patients at the time of injury was 19.6 years, with mean follow-up of 30.2 months. No group reported limitations of range of motion at the time of evaluation. Knee pain under load was present in 3 patients in group I, in 1 patient in group II and in 7 patients in group III. No patient suffered from another patellar dislocation. The mean Kujala score was 84.7 (group I), 89.3 (group II), and 78.5 (group III). The IKDC was 84.6 in group I, 87.2 in group II, and 74.3 in group III. At the time of evaluation, pre-injury activities were resumed by 72% of patients from group I, 82% of patients from group II, and 69% of patients from group III. DISCUSSION Treatment of primary patellar dislocation is still subject to discussions on whether to pursue conservative or surgical treatment. The main topic of studies is the subsequent rate of patellar re-dislocation and the rate of cartilage damage in patellofemoral joint, examined is also the scope of performed surgery, while only very few papers focus on treating the injured cartilage of the patella. Despite numerous studies, the optimal method of treatment of this injury has been identified as yet. CONCLUSIONS Where a serious, extensive fragment of patellar cartilage is found, the fixation of cartilage with the use of transosseous PDS sutures brings very good and good results, without the necessity of another surgery, while the simultaneous treatment of medial patellar retinacula considerably decreases the risk of patellar re-dislocation, thus reducing the risk of further damage to cartilage of patelofemoral joint. The use of transosseous suture fixation is considered by the authors to be more appropriate than the use of screws, mostly because no further surgery to remove fixation screws is necessary. Key words: acute patellar dislocations, chondral lesions, chondral repair, arthroscopy.

• MeSH
• artroskopie metody   MeSH
• dospělí MeSH
• kloubní chrupavka diagnostické zobrazování   zranění   chirurgie   MeSH
• lidé MeSH
• luxace pately diagnostické zobrazování   chirurgie   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• rentgendiagnostika MeSH
• retrospektivní studie MeSH
• šicí techniky 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
• hodnotící studie MeSH

PURPOSE OF THE STUDY In the management of dens axis fractures in patients older than 65 years of age the posterior approach is preferred due to osteoporosis and the risk of a failure of anterior osteosynthesis. The posterior approach, however, is associated with a higher incidence of complications. A combination of anterior transarticular fixation of C1/2 (ATS) with compression osteosynthesis of dens axis significantly increases the stability of osteosynthesis. MATERIAL AND METHODS In the period from 2009 to 2015 our hospital admitted 13 patients older than 65 years of age with a diagnosed type III dens axis fracture based on AO classification. 8 patients sustained a dens axis fracture combined with a stable atlas fracture. The cohort consisted of 13 women aged 67 to 90 years, with the mean age of 82.3 years. None of the female patients were affected neurologically. The dens axis fracture was treated by anterior approach. Once the screw was inserted in the dens axis, two more screws were added, the entrance points of those screws were medial and lateral to the odontoid screw and direction was divergently via C1/2 joints in order to reinforce stability. The patients were monitored at 6-week, 3-, 6- and 12-month follow-ups. Bone healing was confirmed by CT scan. RESULTS No complications were recorded during the surgery in any of the 13 patients. In one female patient the stabilization failed in the early postoperative period. A reoperation from anterior approach with the use of the same method was necessary. In eleven patients bone healing occurred after 6 to 12 months. In two patients pseudoarthrosis was formed with no clinical symptoms. No neurological deterioration or a patient s death was reported in the monitored period within 12 months after the treatment. DISCUSSION Where dens axis fractures in elderly patients are managed operatively, the posterior approach and transarticular fixation of C1/2 with sublaminar loop are preferred. This procedure is considered more reliable, owing to the fears of a failure of osteosynthesis by anterior approach. The most frequent cause of a failure is the pulling out of the screw through the anterior wall of dens axis base in patients with osteoporosis. Concurrently, the anterior approach is regarded as more considerate. The ATS fixation increases stability compared to isolated compression osteosynthesis, which makes it possible to manage the dens axis fractures by a more considerate anterior approach. CONCLUSIONS The ATS is a method that increases stability of compression osteosynthesis in managing dens axis in elderly patients. Key words: dens axis, upper cervical spine fracture, elderly, triple screw technique, anterior transarticular C1/2 stabilization.

• MeSH
• dens axis zranění   MeSH
• fraktury páteře chirurgie   MeSH
• hojení ran MeSH
• kostní šrouby MeSH
• krční obratle chirurgie   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Closed reduction and percutaneous fixation of nondisplaced talar neck fractures have been applied by some authors. The aim of this paper is to assess the results and complications of this minimally invasive technique. MATERIAL AND METHODS In the period from 2009 to 2014, twenty-one patients with a talar neck fracture were observed after closed reduction and percutaneous screw fixation in the Traumatological Hospital in Brno. The mean age of the patients was 38 years (range 18-56 years). The mechanism of injury was a motor vehicle accident in 11 cases, a fall from height in six cases, a sports injury in 3 cases, and a fall from stairs in one case. Injuries were classified according to the Hawkins classification. Conventional preoperative 3-dimensional CT scans of the fractures were analysed. Under the guidance of C-arm fluoroscopy, Kirscher wires were used for closed reduction and temporary percutaneous fixation. Subsequently, 3.5 and 4.5 mm diameter cannulated screws were inserted. The outcome was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. RESULTS The average follow-up was 32 months (21-42 months). The average healing time was 15.5 weeks (13-19 weeks). The average AOFAS score was 82.3 points (69-96 points). 75% of patients with type I injury achieved excellent results and 72% of patients with type II injury achieved excellent or good results. None of the patients developed wound complications. Two patients developed partial avascular necrosis and three patients subtalar traumatic arthritis after surgery. DISCUSSION Talar neck fractures are relatively uncommon fractures. Most of the published studies are small. Tenuous blood supply and displaced talar neck fracture predispose to avascular necrosis of the talus. Closed reduction and percutaneous fixation can reduce the soft tissue damage and disturbance to the blood supply. CONCLUSIONS Preoperative 3D CT scans, early surgery, anatomic articular surface reduction and percutaneous screw fixation increase the fracture healing rate and reduce the incidence of talar avascular necrosis. Key word: talus, closed reduction, percutaneous fixation, screw.

• MeSH
• dospělí MeSH
• fraktury kostí diagnostické zobrazování   chirurgie   MeSH
• kostní šrouby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• talus diagnostické zobrazování   zranění   chirurgie   MeSH
• uzavřená repozice fraktury škodlivé účinky   přístrojové vybavení   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH