• MeSH
• Humans MeSH
• Sepsis * therapy   MeSH
• Shock, Septic * therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Practice Guideline MeSH

One of the crucial tasks for the planning of surgery of the iliosacral joint is placing an iliosacral screw with the goal of fixing broken parts of the pelvis. Tracking of proper screw trajectory is usually done in the preoperative phase by the acquisition of X-ray images under different angles, which guide the surgeons to perform surgery. This approach is standardly complicated due to the investigation of 2D X-ray images not showing spatial perspective. Therefore, in this pilot study, we propose complex software tools which are aimed at making a simulation model of reconstructed CT (DDR) images with a virtual iliosacral screw to guide the surgery process. This pilot study presents the testing for two clinical cases to reveal the initial performance and usability of this software in clinical conditions. This model is consequently used for a multiregional registration with reference intraoperative X-ray images to select the slide from the 3D dataset which best fits with reference X-ray. The proposed software solution utilizes input CT slices of the pelvis area to create a segmentation model of individual bone components. Consequently, a model of an iliosacral screw is inserted into this model. In the next step, we propose the software CT2DDR which makes DDR projections with the iliosacral screw. In the last step, we propose a multimodal registration procedure, which performs registration of a selected number of slices with reference X-ray, and based on the Structural Similarity Index (SSIM) and index of correlation, the procedure finds the best match of DDR with X-ray images. In this pilot study, we also provide a comparative analysis of the computational costs of the multimodal registration upon various numbers of DDR slices to show the complex software performance. The proposed complex model has versatile usage for modeling and surgery planning of the pelvis area in fractures of iliosacral joints.

• Publication type
• Journal Article MeSH

PURPOSE: Treatment of pelvic fractures is often complicated. Here, we intended to evaluate the intraoperative benefits of using 2D computer navigation when compared with traditional fluoroscopy on X-ray burden, surgical time and screw placement accuracy. METHODS: In this study, we retrospectively evaluated the records of 25 patients who underwent osteosynthesis of a posterior pelvic fracture using fluoroscopy at the University Hospital Ostrava, Czech Republic between 2011 and 2019, and 32 patients from the same department and period in whom 2D computer navigation was used. RESULTS: Intraoperative X-ray burden was significantly lower in the group with 2D computer navigation (median 650 vs 1024 cGy/cm2), as was the duration of the surgery (41 vs 45 min). This was most obvious where two screws were inserted (X-ray dose of 994 vs 1847 cGy/cm2 and 48 vs 70 min, respectively). Correction of the path for wire placement after the original drilling was necessary in 2 patients (6%) from the 2D computer navigation group and 15 patients from the fluoroscopy group (60%). Still, no malposition of the screws nor dislocation of the posterior pelvic segment after 12 months was observed in any patient of either group; of complications, only three superficial infections in the 2D navigation group and 2 in the fluoroscopy group were observed. CONCLUSION: 2D computer navigation is a safe and accurate method for placement of screws during posterior pelvic fracture osteosynthesis, associated with lower intraoperative radiation burden and shorter surgical times compared to standard fluoroscopy, especially if two screws are inserted.

• MeSH
• Surgery, Computer-Assisted * methods   MeSH
• Fluoroscopy methods   MeSH
• Fractures, Bone * diagnostic imaging   surgery   MeSH
• Bone Screws MeSH
• Humans MeSH
• Computers MeSH
• Retrospective Studies MeSH
• Fracture Fixation, Internal methods   MeSH
• Imaging, Three-Dimensional methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Data on the effectiveness of arthroscopic arthrolysis and extraction of osteosynthetic material after osteosynthesis of the proximal humerus in patients with persisting problems are rare and insufficient. In this study, we performed arthroscopic arthrolysis and extraction of fixation screws, and, where protruding, extraction of the nail in 34 patients with problems persisting 12 months after osteosynthesis of the proximal humerus using an intramedullary nail. The effectiveness of the treatment was assessed using the Constant-Murley shoulder score and forward flexion difference between the treated arm and the contralateral one. A median increase of 16 points in CMS score and 30 degrees reduction in the arm forward flexion difference was recorded 12 months after the arthroscopy. The improvement was significantly higher in the patient group with intramedullary nail extraction (however, this group had worse pre-operative values and the screw was only extracted where likely to cause problems). The median time to heal was 11 weeks; no serious peri- or post-procedural complications occurred. Mini-invasive arthroscopic arthrolysis combined with extraction of osteosynthetic material proved to be a safe and effective method for treatment of patients after osteosynthesis of the proximal humerus using an intramedullary nail with persisting pain and/or mobility limitation.

• Publication type
• Journal Article MeSH

Introduction: Reports on the use of computer-assisted trauma surgery of comminuted scapula fracture are still quite rare. In this article, we present a case of comminuted scapula fracture, the surgical reconstruction of which was pre-operatively planned using a complex software solution. Materials and methods: For surgical planning of the fracture, we used the TraumaTech software facilitating virtual reconstruction (both manual and automatic), surgery planning, design of the implant, planning of screw placement and lengths, and production of a 3D print model of the fracture and the implant. The software also supported ordering such custom-made plate from a plate producer who was capable of fast and precise production of the plate. Results: The surgery using the custom-ordered plate was successful. The actual used screw lengths did not differ from the planned ones by more than 2 mm. One year after the surgery, the patient was capable of more demanding activities and doing sports activities. Conclusion: This approach provides a great way to prevent complications of the surgery and to shorten its duration. To the best of our knowledge, this is the first description of the treatment of a scapula comminuted fracture utilizing computer-assisted preoperative planning.

• Publication type
• Case Reports MeSH

Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.

• MeSH
• Hemothorax * diagnostic imaging   etiology   surgery   MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Aortic Rupture * complications   diagnostic imaging   surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Case Reports MeSH

ÚVOD: U zlomenin zadní části pánve a dysjunkcí sakroiliakálního kloubu jsou používány iliosakrální šrouby, které transfixují sakrální výběžek kosti kyčelní s křížovou kostí v oblasti segmentu S1 případně S2. Správné umístění těchto šroubů v křížové kosti je důležité proto, aby nedošlo k poranění sakrálních nervových pletení nebo poranění měkkých tkání ventrálně a dorzálně od křížové kosti. 3D navigace poskytuje možnost přesnější kontroly vrtání a zavádění šroubů. Pracuje na podkladě 3D skenu pořízeným přímo na operačním sále C ramenem s možností 3D skenování. Cílem práce je zjištění operačních časů, dávky peroperačního rentgenového záření a také výskyt pooperačních komplikací při zavádění iliosakrálních šroubů do zadního segmentu pánve pod kontrolou 3D navigace. MATERIÁL A METODA: V letech 2014–2020 jsme na Klinice úrazové chirurgie provedli 13 osteosyntéz zadního segmentu pánve pomocí iliosakrálních šroubů pod kontrolou 3D navigace. Osteosyntézu jsme provedli pomocí jednoho nebo dvou kanylovaných šroubů o průměru 7,0 mm. Během operací byly použity skiaskopický přístroj Ziehm Flat panel 3D a počítačová navigace Vector Vision. U jednotlivých operací jsme sledovali operační čas v minutách, dávku peroperačního RTG záření v cGY na cm2 a také čas peroperační skiaskopie v sekundách. Pooperačně jsme provedli RTG kontroly umístění iliosakrálních šroubů ve čtyřech projekcích, při nejasnostech jsme upřesnili pozici šroubů CT vyšetřením. Sledovali jsme výskyt pooperačních komplikací do 90 dnů po operaci. Po roce od operace jsme provedli kontrolní RTG pánve ve čtyřech projekcích s cílem zjištění případné migrace osteosyntetického materiálu nebo dislokace zadního segmentu pánve po osteosyntéze. VÝSLEDKY: V souboru 13 pacientů bylo osm mužů a pět žen. Všechny zlomeniny byly typ C Dle AO-OTA klasifikace. U osmi pacientů (74 %) byla provedena osteosyntéza jedním šroubem a u pěti pacientů (26 %) dvěma šrouby. Medián věku všech pacientů v souboru byl 51 let (rozpětí: 33–73 let). Medián hmotnosti všech pacientů v souboru byl 83 kg (rozpětí: 65–107 kg). Medián času peroperačního RTG záření všech pacientů byl 1,14 min (rozpětí: 0,50–2,35 min). Medián dávky RTG záření byl 853 cGy/cm2 (rozpětí: 591–1369 cGy/cm2). Medián celkové doby operace byl 42 minut (rozpětí: 28–62 min). ZÁVĚR: Osteosyntéza zadního segmentu pánve pomocí 3D navigace je přesnější než skiaskopická kontrola této operace a také 2D navigace protože umožňuje sledování vrtání v jednotlivých řezech sakrální kosti. Je možné posoudit intraoseální pozici během celého vrtání kanálu pro iliosakrální šroub. Na malém souboru pacientů jsme nepozorovali pooperační komplikace ve smyslu poranění nervově-cévních struktur a také malpozici šroubů.

• Keywords
• Vector Vision,
• MeSH
• Surgery, Computer-Assisted methods   MeSH
• Bone Screws MeSH
• Humans MeSH
• Sacroiliac Joint surgery   injuries   MeSH
• Sacrococcygeal Region surgery   injuries   MeSH
• Fracture Fixation, Internal * methods   MeSH
• Treatment Outcome MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Humans MeSH

ÚVOD: Distální cílení intramedulárních hřebů má celosvětově různá řešení, avšak žádné z nich není standardně používané. Nejčastější používanou metodou v praxi je cílení pomocí zmíněné peroperační skiaskopie, což zvyšuje dávky RTG záření jak pro pacienta, tak pro personál. V roce 2018 byl registrován v České republice intramedulární hřeb pro osteosyntézu zlomenin diafýz humeru s možností cílení distálních jistících šroubů pomocí elektromagnetického systému pro distální cílení. CÍL PRÁCE: Popis nové metody a prvních zkušeností distálního cílení intramedulárního hřebu humeru pomocí elektromagnetického systému pro distální cílení. MATERIÁL A METODA: Na Klinice úrazové chirurgie FN Ostrava jsme doposud provedli šest osteosyntéz zlomenin diafýz humeru pomocí intramedulárního hřebu s elektromagnetickým distálním cílením u šesti pacientů - pěti mužů a jedné ženy. Průměrný věk pacientů byl 38 let (24–52). K osteosyntéze jsme indikovali zlomeniny typu 12 A (n-4) a 12B (n-2) dle AO/OTA klasifikace. VÝSLEDKY: Průměrný operační čas byl 56 minut, průměrný čas přípravy elektromagnetického cílení byl 13,33 minut, průměrný čas distálního jištění byl 8,33 minut, průměrný skiaskopický čas během operace byl 4,05 minut. ZÁVĚR: Systém pro distální cílení dlouhých humerálních hřebů Ezy-aim firmy Austofix představuje možnost inovativního cílení a vrtání otvorů pro distální jistící šrouby. Jeho výhodou je minimalizace rentgenového záření během operace a také přesnost vrtání. Nevýhodou je složitější příprava ramene pro distální cílení a jeho kalibrace a také propojení s řídící jednotkou kabely.

• Keywords
• distální cílení hřebu, elektromagnetický systém, Ezy-aim,
• MeSH
• Diaphyses surgery   injuries   MeSH
• Humeral Fractures surgery   MeSH
• Fracture Fixation, Intramedullary * methods   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

INTRODUCTION: Distal targeting of intramedullary nails has different solutions worldwide, but none of them is used as a standard. The most common method used in practice is targeting by means of the aforementioned peroperative skiascopy, which increases the dose of Xrays for both the patient and the staff. In 2018, an intramedullary nail for osteosynthesis of humeral diaphyseal fractures with the possibility of targeting the distal locking screws using an electromagnetic system for distal targeting was registered in the Czech Republic. AIM OF THE STUDY: Description of a new method and first experience with distal targeting of the intramedullary humeral nail using an electromagnetic system for distal targeting. MATERIAL AND METHOD: At the Department of Trauma Surgery, Ostrava University Hospital, we have so far performed 6 osteosyntheses of humeral diaphyseal fractures using an intramedullary nail with electromagnetic distal targeting in 6 patients - 5 men and one woman. The average age of patients was 38 years (24-52). Osteosynthesis was indicated for type 12A (n-4) and 12B (n-2) fractures according to the AO/OTA classification. RESULTS: The average operative time was 56 min, the average electromagnetic targeting preparation time was 13.33 min, the average distal fixation time was 8.33 min, the average skiascopic time during the operation was 4,05 min. CONCLUSION: The Austofix Ezy-aim distal targeting system for long humeral studs offers an innovative way of targeting and drilling holes for distal locking screws. Its advantage is the minimization of X-ray radiation during the operation and also the accuracy of drilling. The disadvantage is more complex preparation of the arm for distal targeting and its calibration, as well as connection to the control unit by cables.

• Keywords
• distální cílení hřebu, elektromagnetický systém, Ezy-aim,
• MeSH
• Diaphyses surgery   injuries   MeSH
• Humeral Fractures surgery   MeSH
• Fracture Fixation, Intramedullary * methods   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

INTRODUCTION: For fractures of the posterior part of the pelvis and disjunction of the sacroiliac joint, iliosacral screws are used, which transfix the sacral process of the hip bone with the sacrum in the region of the S1 or S2 segment. The correct placement of these screws in the sacrum is important in order to avoid injury to the sacral nerve fibres or soft tissue injury ventrally and dorsally to the sacrum. 3D navigation provides the possibility of more precise control of drilling and screw insertion. It works on the basis of a 3D scan taken directly in the operating room using a C-arm with the possibility of 3D scanning. The aim of the work is to determine the operating times, the dose of intraoperative X-ray radiation and also the occurrence of postoperative complications during the introduction of iliosacral screws into the posterior segment of the pelvis under the control of 3D navigation. MATERIAL AND METHODS: In the years 2014–2020, we performed 13 osteosyntheses of the posterior segment of the pelvis using iliosacral screws under the control of 3D navigation at the Department of Surgery and Trauma and Emergency Surgery. We performed osteosynthesis using one or two cannulated screws with a diameter of 7.0 mm. The Ziehm Flat panel 3D fluoroscopy device and Vector Vision computer navigation were used during the surgery. For individual surgeries, we monitored the operating time in minutes, the dose of intraoperative X-ray radiation in cGY per cm2, as well as the time of intraoperative fluoroscopy in seconds. Postoperatively, we performed an X-ray check of the location of the iliosacral screws in four projections, in case of uncertainty, we clarified the position of the screws by CT examination. We monitored the incidence of postoperative complications within 90 days after surgery. One year after the surgery, we performed a control X-ray of the pelvis in four projections with the aim of detecting possible migration of osteosynthetic material or dislocation of the posterior segment of the pelvis after osteosynthesis. RESULTS: The group of 13 patients consisted of eight men and five women. All fractures were type C according to the AO-OTA classification. Eight patients (74 %) underwent osteosynthesis with one screw and five patients (26 %) with two screws. The median age of all patients in the cohort is 51 years (range: 33–73 years). The median weight of all patients in the cohort is 83 kg (range: 65–107 kg). The median intraoperative X-ray time of all patients is 1.14 min (range: 0.50–2.35 min). The median X-ray radiation dose is 853 cGy/cm2 (range: 591–1369 cGy/cm2). The median total operative time is 42 minutes (range: 28–62 min). CONCLUSION: Osteosynthesis of the posterior segment of the pelvis using 3D navigation is more accurate than fluoroscopic control of this surgical procedure and also 2D navigation because it allows drilling to be monitored in individual sections of the sacral bone. It is possible to assess the intraosseous position throughout the drilling of the channel for the iliosacral screw. In a small group of patients, we did not observe post-operative complications in the sense of injury to neurovascular structures and also malposition of screws.

• Keywords
• Vector Vision,
• MeSH
• Surgery, Computer-Assisted methods   MeSH
• Bone Screws MeSH
• Humans MeSH
• Sacroiliac Joint surgery   injuries   MeSH
• Sacrococcygeal Region surgery   injuries   MeSH
• Fracture Fixation, Internal * methods   MeSH
• Treatment Outcome MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Humans MeSH