• MeSH
• fraktury vřetenní kosti diagnóza   komplikace   terapie   MeSH
• fraktury zápěstí diagnóza   komplikace   terapie   MeSH
• lidé MeSH
• poranění předloktí * diagnóza   komplikace   terapie   MeSH
• poranění ruky diagnóza   komplikace   terapie   MeSH
• poranění zápěstí diagnóza   komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• lidé MeSH
• obvazy * klasifikace   škodlivé účinky   MeSH
• sádrové obvazy škodlivé účinky   MeSH
• trakce metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• entezopatie diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• muskuloskeletální nemoci * diagnóza   etiologie   terapie   MeSH
• ortopedické výkony MeSH
• osteochondróza diagnóza   etiologie   terapie   MeSH
• osteonekróza diagnóza   etiologie   terapie   MeSH
• ostruha kosti patní diagnóza   etiologie   terapie   MeSH
• tendinopatie diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY Many physicians believe that loco-regional anaesthesia and analgesia improve the postoperative course of patients indicated for total hip arthroplasty compared to general anaesthesia. However, there are many patients who refuse subarachnoid or epidural anaesthesia, or have contraindications or conditions making the use of such techniques impossible. An alternative option is the combination of general anaesthesia and a peripheral nerve blockade. The aim of this prospective randomized open-label clinical trial was to compare the efficacy and quality of postoperative analgesia between fascia iliaca block combined with general anaesthesia (GA) and subarachnoid anaesthesia with morphine and bupivacaine (SAB). MATERIAL AND METHODS After having obtained the ethics committee approval and the patients consent, a prospective, open-label, randomized trial was conducted in patients referred for total hip arthroplasty (THR). The GA group was administered ultrasound-guided fascia iliaca block with 40 ml of 0.25% bupivacaine solution after the induction of general anaesthesia. In the SAB group, subarachnoid blockade was performed with a mixture of 3 ml of 0.5% bupivacaine with 0.150 mg morphine prepared in the hospital pharmacy. Right after surgery the patients were taken to the ICU for 24 hours, after which they were transferred to a general ward. In addition to vital signs monitoring, pain intensity using a 0-10 numeric rating scale (NRS), first morphine administration at NRS >4, total morphine consumption and potential adverse effects were observed over the period of 72 hours. RESULTS There was no statistical difference between the GA (14 persons) and the SAB (14 persons) group in demographic parameters, time to first morphine administration (10 hrs vs. 19 hrs, p=0.10), number of persons with no need for morphine after surgery (5 vs. 7), tingling sensation (1 vs. 0) or numbness of the limb (0 vs. 1). There was no difference in cardiorespiratory parameters or side effects of therapy. In neither case was there respiratory depression or delayed rehabilitation. No patient developed delirium after surgery, and no patient reported dissatisfaction with pain management. DISCUSSION The fascia iliaca block and subarachnoid anaesthesia using local anaesthetic with opioid addition have been repeatedly published for patients after total hip arthroplasty, but this study is unique by comparing the two methods. The study added a new piece of knowledge to the findings of several recent meta-analyses on the comparable outcomes of general and subarachnoid anaesthesia for hip replacement in the perioperative period. CONCLUSIONS If subarachnoid anaesthesia cannot be used in hip arthroplasty, general anaesthesia with fascia iliaca block provides comparable analgesia and quality of postoperative course. Key words: total hip arthroplasty, general anaesthesia, fascia iliaca block, subarachnoid anaesthesia, postoperative analgesia, postoperative course.

• MeSH
• bupivakain terapeutické užití   MeSH
• celková anestezie MeSH
• fascie MeSH
• lidé MeSH
• morfin terapeutické užití   MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• nervová blokáda * metody   MeSH
• pooperační bolest farmakoterapie   etiologie   prevence a kontrola   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• fixace fraktur * metody   škodlivé účinky   MeSH
• fraktury vřetenní kosti dějiny   etiologie   klasifikace   terapie   MeSH
• komplexní regionální syndromy bolesti etiologie   MeSH
• lidé MeSH
• neuropatie nervus radialis etiologie   MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY In a prospective study of patients with calcaneal fractures treated by open reduction from an extensile lateral approach and LCP osteosynthesis, the authors evaluated the basic epidemiological data, mechanism of injury, type of fracture, essen- tial data on surgery, days of hospital stay and the number of complications. MATERIAL AND METHODS In the period from September 1, 2006 to July 31, 2010, a total of 230 patients with 243 calcaneal fractures were trea- ted. The fractures were classified as either open or closed and according to the Essex-Lopresti system. Of the total num- ber of patients, 135 (55.6 % of all fractures) were indicated for conservative treatment and 108 (44.4% of all fractures) for surgical intervention. Indications for surgery based on the generally accepted criteria enabled us to select 77 patients with 82 fractures (33.7 % of all fractures) for treatment by the method of open reduction and LCP osteosynthesis. These pa- tients constituted the group evaluated here. The other patients were treated using other techniques (21 fractures, i.e., 8.6 % of all fractures, by the Stehlík-Štulík transfixation method and further five [2.1 %] by screw osteosynthesis). Six surgeons were involved in the treatment of this group. For the diagnosis of fractures, plain radiographs in lateral and axial projection and axial and coronal CT images were used. All fractures were treated after subsidence of oedema by the method of open reduction and LCP fixation from an extensile lateral approach, with the use of a tourniquet. The follow-up period for the evaluation of functional outcome and bone union was 3 to 48 months. Fifty patients were followed up for over one year. RESULTS The group evaluated comprised 58 men (75.3 %) with 63 fractures (76.8 %) and 19 women (24.7 %) with 19 fractures (23.2 %). The average age of the group was 42 years, with 41 years (range, 22-61 years) in men and 47 years (range, 30-70 years) in women. The most frequent cause of injury was a fall from a height below 1 metre and this was recorded in 38 patients (49.4 %); 18 patients (24.3 %) had a fall from a height below 3 metres. Eight fractures were caused by a fall from the window, seven calcaneal fractures, as part of .polytrauma, were sustained in road accidents (9.1 %) and six calcaneal bones were inju- red due to ankle sprain in walking on a flat surface (7.8 %). Bilateral fractures occurred in five (6.5 %) patients, the right and left heel bones were injured in 31 (40.3 %) and 41 (53.2 %) fracture cases, respectively. An open fracture was recorded on three occasions (3.7 %). Of the 82 evaluated fractures, 23 were type IIa fractures (28 %) and 59 were type IIb fractures (72 %) according to the Essex-Lopresti classification system. The average injury-surgery interval was 10 days (range, 1 - 23 days). The average operative time was 77 minutes (ran- ge, 45-175 min) and the average duration of tourniquet application was 61 minutes (range, 20-130 min). The average length of hospital stay was 18 days (range, 7-61 days). In 15 patients (18.3 % of osteosynthesis cases) wound healing was delayed. Deep wound infection developed in three cases (3.7 %); these required revision surgery which involved implant removal before bone union in two cases and hea- ling of the wound after revision without implant removal in one case. A necrotic lesion in one case (1.2 %) was treated by muscle flap transfer. Complications which varied in type and severity were recorded in 22 % of the patients. The Rowe score was used to evaluate functional outcomes, which were excellent in 44 %, good in 46 %, satisfactory in 4 % and poor in 6 % of the surgically treated patients.. DISCUSSION Only about one-third of the patients with calcaneal fractures were indicated for open LCP osteosynthesis. This is in agre- ement with the strict indication criteria established by the foreign authors with Professors Zwipp and Sanders at the head. It appears that this fracture chiefly occurs in the population of young active men (Kočiš reported only men and no woman with this fracture in his study). The authors focus on exact radiographic diagnosis including CT examination, as recom- mended by Stehlík and Štulík in their book. They recommend to use the Essex-Lopresti system for primary classification and, because of the frequency of LCP osteosynthesis procedures performed, also recommend to carry out this treatment in specialised institutions. The rate of serious complications in this study was relatively low and in accordance with the fin- dings of Zwipp, Zeman and others. CONCLUSIONS The analysis of basic data on the group of patients with calcaneal fractures treated by open reduction and LCP fixation showed the following: chiefly young active men sustained this fracture; calcaneal fracture was usually due to a fall or jump from a level not too high; X-ray examination (lateral and axial projection) was sufficient to make a diagnosis; for a deci sion to operate it was useful to complete the diagnosis by CT examination; the prerequisite for minimising post-operative com- plications was strict adherence to the established indication criteria, surgery only after oedema had subsided and use of the correct surgical technique. The number of complications and their nature did not differ from the data reported by other authors. Key words: calcaneal fracture, LCP, open reduction, epidemiology, demography.

• MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• interní fixátory MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• patní kost chirurgie   zranění   MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Úvod: Zlomeniny v oblasti ruky a zápěstí jsou jedny z nejčastějších zlomenin. V našem souboru tvořily tyto fraktury 32 %. Jejich léčba není vždy jednoduchá a i přes naši snahu může dojít k různému stupni reziduálního omezení funkce ruky. V naší prospektivní studii jsme se zaměřili na zjištění epidemiologických údajů pacientů s poraněním ruky ošetřených na naší klinice v průběhu jednoho roku, na četnost a typ poranění jednotlivých kostí a na způsob jejich ošetření. Metoda a materiál: Sledovaný soubor tvořilo 242 pacientů ošetřených pro zlomeninu ruky či zápěstí v roce 2008. Jednalo se o 61 žen (25 %) a 181 mužů (75 %). Průměrný věk souboru byl 35,1 let (rozmezí 15-91 let). V prospektivní studii jsme do databázového formuláře zaznamenávali z karty pacienta základní epidemiologické ukazatele (pohlaví a věk), dále mechanizmus úrazu, lokalizaci poranění na skeletu ruky, typy poranění a počet fragmentů. Získané údaje jsme vyhodnotili deskriptivními statistickými metodami, pohlavní distribuce byla zhodnocena ?2- testem na 5% hladině významnosti. Výsledky: Poranění se nejčastěji vyskytovala u mužů do 35 let. Nejčastějším mechanizmem úrazu byl prostý pád (59,5 %). Nejvíce ošetřených bylo shodně v srpnu a říjnu (29). Nejméně zlomenin v oblasti ruky a zápěstí jsme zaznamenali v květnu. Nejčastější poraněnou kostí na ruce byl V. metakarp - celkem 65 (7krát společně se čtvrtým metakarpem) (26,4 %). Skafoideum bylo druhou nejvíce poraněnou kostí, celkem 17 zlomenin (6,8 %). Diskuze: V literatuře jsme našli jen ojedinělé práce týkající se epidemiologických studií poranění zápěstí a ruky. Převážná část literárních údajů v souladu s naším pozorováním udává vyšší frekvenci poranění kostí ulnární strany ruky, většina zlomenin v oblasti ruky a zápěstí se vyskytuje u mužů do třiceti let věku, nejčastější zlomeninou zápěstí je skafoideum.

Introduction: Hand and wrist fractures range among the most common fractures. In the authors´ sample these fractures represented 32 %. The treatment of such fractures is not always easy, and despite the doctor's efforts they can result in different degrees of residual dysfunction of the hand. In their prospective study, the authors focused on the findings from epidemiological data of patients with hand injuries treated in the authors' clinic during one year, on the frequency and type of bone injury and methods of treatment. Method and material: A group of 242 patients was treated for a broken arm or wrist in 2008. This included 61 women (25%) and 181 men (75%). The average age was 35.1 years (age group 15-91 years). In their prospective study, the authors recorded the basic epidemiological characteristics (gender and age), as well as the mechanism of injury, localization of the fracture on the hand skeleton, types of injuries and the number of fragments in a database form. The collected data were evaluated using descriptive statistical methods; gender distribution was evaluated by the ?2 test at 5% significance level. Results: The injuries occurred most frequently in men under 35 years of age. The most common mechanism of injury was a simple fall (59.5%). The highest number of patients was treated in August as well as in October (29 each). The lowest number of hand and wrist fractures was recorded in May. The most commonly injured bone was the fifth metacarpus - a total of 65 cases (7 times in conjunction with the fourth metacarpal bone) (26.4%). The skafoideum bone was the second most frequently injured bone - 17 fractures (6.8%). Discussion: In the literature the authors found only several articles relating to epidemiological studies of wrist and hand injuries. Most of the literature is consistent with the authors´ observations of a higher frequency of ulnar bone injuries of the hand, with the majority of fractures of the hand and wrist occurring in men to thirty years of age, and the most frequently broken bone of the wrist being the skafoideum bone.

• Klíčová slova
• skafoideum, metakarp, Trabecular Titanium,
• MeSH
• dospělí MeSH
• epidemiologické studie MeSH
• fraktury kostí etiologie   klasifikace   terapie   MeSH
• interpretace statistických dat MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• poranění ruky etiologie   klasifikace   terapie   MeSH
• poranění zápěstí etiologie   klasifikace   terapie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• rozložení podle pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• geriatrie dějiny   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stárnutí MeSH
• terminologie jako téma MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH

PURPOSE OF THE STUDY The aim of the study was to evaluate the outcomes of corrective osteotomy for malunited fractures of the distal radius, to assess the degree of correction or its loss, if it happened, after bone union, and to compare the clinical and radiographic results with the relevant literature reports. MATERIAL AND METHODS In the period from September 2002 and October 2004, a total of 16 patients (six men and 10 women) underwent surgery for malunited fractures of the distal radius. The average patient age was 49.3 years, with a range of 23 to 73 years. For the sake of evaluation, records were made of patients' subjective feelings, objective measurements of motion range and muscle strength and exact measurements of relevant parameters on radiographs. Plain radiographs of the distal radius of both upper extremities in anteroposterior and lateral projections were made before and after surgery, and at final follow-up after osteotomy healing. The following parameters were measured: length of the radius, ulnar inclination angle and tilt of the distal articular surface of the radius. Because we evaluated our patients in retrospect, it was not always possible to find the exact values of motion range and muscle strength as they existed before surgery. Therefore, for comparison, we used the values obtained on the unhurt extremity. Corrective surgery included radius opening-wedge osteotomy with bone graft insertion and subsequent fixation with a 3.5-mm T plate. The final evaluation was based on the New York Orthopaedic Hospital Wrist Rating Scale. RESULTS The highest lengthening achieved by corrective osteotomy was 9 mm. The largest change in the ulnar inclination angle was 34 degrees. The best correction of a dorsal deformity was 24 degrees. The result evaluation was: 30 % excellent, 50 % good, and 20 % fair. DISCUSSION Corrective osteotomy of the distal radius with graft insertion is one of the options for the restoration of anatomical conditions following malunited fractures. The timing and technique of the surgical procedure were in agreement with the data reported in the literature, as well as the results achieved in this study. CONCLUSIONS Corrective osteotomy and bone graft insertion are surgical procedures used for the treatment of malunited fractures of the distal radius. They are indicated in active younger patients with proven symptoms and correlating radiographic evidence. The surgery should be preceded by a thorough radiographic examination and pre-operative planning.

• MeSH
• dospělí MeSH
• fraktury vřetenní kosti chirurgie   radiografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• osteotomie MeSH
• radius chirurgie   MeSH
• senioři MeSH
• špatně zhojené fraktury chirurgie   radiografie   MeSH
• transplantace kostí MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH