OBJECTIVE: Acetabular fractures can lead to serious complications such as avascular necrosis of the femoral head (AVN), osteoarthritis, non-union. Total hip replacement (THR) is a treatment option for these complications. The purpose of this study was to assess the functional and radiological outcomes of THR at least 5 years after the primary implantation. METHODS: This retrospective study analysed clinical data from 77 patients (59 males, 18 females) who were treated from 2001 to 2022. Data was collected on the incidence of AVN of the femoral head, complications, interval from fracture to THR, reimplantation. The modified Harris Hip Score (MHHS) was used to evaluate outcome. RESULTS: The mean age at the time of fracture was 48 years. Avascular necrosis developed in 56 patients (73%), with 3 cases of non-union. Osteoarthritis without AVN developed in 20 patients (26%), non-union without AVN in one patient (1%). The mean time from fracture to THR was 24 months for AVN with non-union, 23 months for AVN alone, 22 months for AVN with arthritis, 49 months for hip osteoarthritis without AVN. The time interval was significantly shorter for cases of AVN than for cases of osteoarthritis without AVN (p = 0.0074). Type C1 acetabular fracture was found to be a risk factor for femoral head AVN (p = 0.0053). Common complications of acetabular fractures included post-traumatic sciatic nerve paresis (17%), deep venous thrombosis (4%), infections (4%). Hip dislocation was the most common complication of THR (17%). There were no cases of thrombosis following THR. According to Kaplan-Meier analysis, the proportion of patients without revision surgery within 10-year period was 87.4% (95% CI 86.7-88.1). The results of the MHHS after THR: 59.3% of patients had excellent results, 7.4% good, 9.3% satisfactory results, and 24.0% had poor results. The mean MHHS was 84 points (95% CI 78.5-89.5). Paraarticular ossifications were observed in 69.4% of patients in the radiological evaluation. CONCLUSION: Total hip replacement is an effective treatment for serious complications of acetabular fracture treatment. Its results are comparable to THR peformed for other indications, although it is associated with a higher number of paraarticular ossifications. Type C1 acetabular fracture was found to be a significant risk factor for early femoral head AVN.
- MeSH
- acetabulum diagnostické zobrazování chirurgie zranění MeSH
- artróza kyčelních kloubů * diagnostické zobrazování etiologie chirurgie MeSH
- fraktury kyčle * chirurgie MeSH
- fraktury páteře * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- osteonekróza * MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY It was a prospective, randomised, unblinded study. Effects of the application of platelet-rich fibrin (PRF) on the anatomic anterior ligament reconstruction were examined. MATERIAL AND METHODS A total of 40 patients who underwent a surgery between 2012 and 2014 were enrolled in the study. The patients were randomised into two groups: the group with PRF application (n=20) and the group without PRF application (n=20, control group). The study included 11 women and 29 men, with the mean age at the time of inclusion into the study 29.1 years. Vivostat ® PRF was obtained perioperatively from the patient s blood and applied intraoperatively to the hamstring tendon graft. The ACL graft healing was assessed through magnetic resonance (MRI) at 6 and 12 months postoperatively. The clinical outcomes (the Lysholm score and the IKDC Subjective score, return to pre-injury sport levels, Pivot-shift test, graft failure) as well as standardised laxity measurements using GenouRob arthrometer were performed preoperatively and 12 months after surgery. RESULTS The study was completed by thirty-three (33) patients (17 in the PRF group and 16 in the control group). In two cases, postoperative graft failure was reported (both cases in the control group). No significant differences were found in the process of graft ligamentization evaluated through MRI (p=0.07). No significant difference between the groups was identified with respect to return to pre-injury sport levels (p=0.232), or the Lysholm score and IKDC Subjective score (p=0.259, and p=0.364 respectively). The postoperative knee laxity measurement using Genourob arthrometer did not reveal any significant differences between the PRF group and the control group. DISCUSSION Results similar to those arrived at by our study have recently been published also by other authors worldwide. We can therefore assume that the application of PRF can be of benefit, especially at the early stage of healing. The results still need to be verified on a larger study group, the study design should focus on the development in the early postoperative period. CONCLUSIONS In our study group, no significant difference was observed in the evaluated subjective and objective clinical parameters. Only the parameter regarding the ACL graft failure fell just short of statistical significance, namely to the disadvantage of the group without the PRF application. Key words: anterior cruciate ligament, arthroscopy, anatomic ACL reconstruction, magnetic resonance imaging of the graft, platelet-rich fibrin, graft healing, MRI signal intensity of the graft.
- MeSH
- fibrin bohatý na krevní destičky * MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- nestabilita kloubu * chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- prospektivní studie MeSH
- rekonstrukce předního zkříženého vazu * metody MeSH
- šlachy hamstringů * transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Publikační typ
- abstrakt z konference MeSH
A 13-year-old girl suffered fracture of her left clavicle. A figure-of-8 bandage was placed during initial treatment. Six days after trauma her distal arm, elbow and proximal forearm were swollen, pain and tenderness of distal part of brachial vein was recognized during clinical examination. Duplex ultrasonography revealed partial thrombosis of the brachial vein. Bandage was immediately removed and administration of LMWH (enoxaparin) was started. Complete recanalization was achieved after a few days. The fracture was healed without further complication, patient was without sonographic and clinical signs of post-thrombotic syndrome. The second case report describes a 14-year-old boy. Initially, the fixation was a figure-of-8 bandage. 5 days after the injury he had swollen arm and elbow on the injured side, according to duplex ultrasonography deep venous thrombosis of the axillary and the brachial vein was recognized. There was only partial recanalization at the first sonographic follow up, the patient was converted to Warfarin for 3 months after injury after initial LMWH therapy. At the last follow-up, fracture of the left clavicle was healed and there were no DUSG or clinical signs of post-thrombotic syndrome. Key words: clavicle, deep venous thrombosis of the upper extremity, anticoagulant therapy.
- MeSH
- COVID-19 * komplikace MeSH
- dítě MeSH
- fraktury kostí * komplikace terapie MeSH
- heparin nízkomolekulární terapeutické užití MeSH
- klíční kost diagnostické zobrazování zranění MeSH
- konzervativní terapie škodlivé účinky MeSH
- lidé MeSH
- mladiství MeSH
- žilní trombóza * diagnostické zobrazování farmakoterapie etiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
AIM OF THE STUDY: Epidemiologic evaluation of pelvic ring injuries in children. METHODS: Retrospective analysis over a period of 13 years, excluding pathological fractures. AO/OTA type, epidemiological data, type of treatment, and complications were recorded. Data were assessed using Fisher's exact test and Wilcoxon test. RESULTS: 243 boys, 115 girls, mean age (SD) 14.1 ± 3.0 years, AO/OTA types: 281 A, 52 B, 25 C. Multiple trauma: 62, combined trauma: 59, mono-trauma: 237. 281 patients were treated non-operatively, 97 surgically. ETIOLOGY: traffic accidents 88, falls from a great height 37, crushing injuries four, and sports injuries 192, simple falls 30, others seven. High-energy mechanisms prevailed in types B and C. Low-energy mechanism in type A (p < 0.0001). Similar differences were found between type A (p = 0.0009) and in case type C requiring surgery and cases treated non-operatively (p < 0.0001). Twenty-six patients (7.3%) had complications (pelvic asymmetry 5, neurological deficits 5, non-union 1, ectopic calcification 4, others 7). Higher complication rates were associated with types B and C (p = 0.0015), with surgically treated cases (p < 0.0001) and multiple trauma (p = 0.0305). DISCUSSION: Results of this trial were comparable with other studies. CONCLUSION: Sports injuries accounted for most type A injuries, while types B and C tended to be associated with high-energy trauma. Complications were associated with the severity of pelvic trauma, more common in surgically treated group of patients; this is primarily linked to the surgical cases being more serious as well as the associated injuries.
- MeSH
- dítě MeSH
- fraktury kostí * epidemiologie chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- pánevní kosti * zranění chirurgie MeSH
- polytrauma * MeSH
- retrospektivní studie MeSH
- traumatologická centra MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY The study gives a retrospective assessment of the outcomes of surgical treatment in patients who sustained a subtrochanteric fracture. MATERIAL AND METHODS In the period 2010-2018, a total of 118 patients with a subtrochanteric fracture, namely 75 males and 43 females, the mean age 61 years, were treated at our department. The study group included the patients who met the following inclusion criteria: age 18+, fracture treated by intramedullary nailing, follow-up for at least 12 months, in case of impaired healing and need for revision surgery follow-up until complete healing was achieved. Exclusion criteria - pathological fractures, periprosthetic fractures, pertrochanteric fractures with extension into subtrochanteric region, intertrochanteric fractures, fractures during bisphosphonate treatment, incomplete radiological documentation, non-compliance with the condition of 12-month follow-up. In 54 patients (46%) the injury was caused by high-energy impact, in the remaining 64 patients (54%) the fracture was the consequence of low energy mechanism. In 51 patients (43%) closed reduction was performed and 67 patients (57%) underwent open reduction. In 27 patients (23%) a small incision laterally was necessary to insert the reduction instrument in order to achieve correct position of the fracture. In 40 patients (34%) lateral approach was used for the reduction and proper placement of fragments was ensured by one or more cerclage wires prior to nailing. Nails made by Synthes were used for osteosynthesis: PFN A Long in 95 patients, PFN A in 11 patients and LFN in 12 patients. RESULTS In 76 patients (64%) fractures healed within 6 months, in 107 patients (90%) within 9 months. In 11 patients (10%) nonunion was observed that required another surgery. The outcomes were assessed using the Sanders and Regazzoni scoring system. Excellent outcome was achieved in 79 cases (67%), good outcome in 25 cases (21%), satisfactory outcome in 13 cases (11%), poor outcome in 1 case (1%). DISCUSSION At any age subtrochanteric fractures are always treated surgically. Currently, intramedullary nailing is the method of choice. The outcome of the surgery depends on correct reduction and fixation which shall ensure the balance of compression forces transmitted to the medial cortical bone, traction forces transmitted to the lateral femoral cortical bone. Intramedullary nailing has biomechanical advantages which outweigh the often difficult closed reduction. The nail decreases the position vector (of the force moment) and reduces torsional forces at the fracture site. Open reduction and additional cerclage wires are described as a risk factor for impaired healing. Nevertheless, the achievement of anatomical reduction offsets the risk of poor blood supply at the fracture site. Persistent displacement disturbs the balance of forces and results in impaired healing and implant failure. CONCLUSIONS Treatment of subtrochanteric fractures relies on precise reduction. Today, when minimally invasive methods of treatment are preferred, the most commonly used are the intramedullary implants. Displacement to varosity, flexion displacement or a combination of both cause impaired healing with non-union and failed osteosynthesis. Treatment of non-union is extremely challenging and always consists in the correction of anatomical relationships. Key words: subtrochanteric fractures, surgical treatment, outcomes, complications.
- MeSH
- fraktury kyčle * diagnostické zobrazování chirurgie MeSH
- hojení fraktur MeSH
- intramedulární fixace fraktury * škodlivé účinky MeSH
- kostní dráty MeSH
- kostní hřeby MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Continuous epidemiologic data on changes in the spectrum of acetabular fractures is rare. The purpose of this study is to evaluate changes in the types of acetabular fractures over the last two decades. MATERIAL AND METHODS In the period between 2007 and 2016, a total of 522 patients were treated at the authors department (Traumacentre Level I) for acetabular fractures. 15 patients sustained bilateral fractures. The group consisted of 361 men and 161 women, with the mean age of 49 years (the range of 10-96 years). Standard procedure was applied to diagnose the fractures (X-ray and CT scan). Non-operative treatment was opted for in fractures without displacement, fractures with minimum displacement of acetabular weight bearing area less than 2 mm, confirmed by the CT scan (e.g. low fractures of anterior column, low transverse fractures), fractures with secondary congruence in patients over the age of 70, and fractures in patients contraindicated for surgery due to their serious overall medical condition or severe osteoporosis. A surgery was indicated in case of instability or incongruent acetabular joint space due to the displacement of weight bearing area fragments, or a bone fragment or soft tissue interposition. A surgery was indicated also in a non-displaced acetabular injury with concurrent femoral head injury. AO/ASIF classification was used to classify the fractures. The following data was monitored in the referred to group of patients: gender, age, mechanism of injury, associated injuries, type of fracture, and treatment method. RESULTS Type A fracture was reported in 293 patients (56%), type B fracture in 150 patients (29%) and type C fracture in 79 patients (15%). A high-energy trauma occurred in 334 patients (64%), namely 254 men and 50 women, with the mean age of 41 years. A low-energy trauma was sustained by 188 patients (36%), namely 77 men and 111 women, with the mean age of 69 years (56-91). This difference in the share of men and women with respect to the seriousness of the mechanism of injury was statistically significant (p < 0.0001). Non-operative treatment was used in 248 patients (48%), of whom 167 were men and 81 were women. The mean age in this sub-group was 60 years, namely 58 years in men and 62 years in women. Operative treatment was opted for in 272 patients (52%), of whom 206 were men and 50 were women, with the mean age of 45 years in women as well as in men. The statistical processing of differences between the non-operative and operative treatment in dependence on the type of fractures revealed a significantly higher percentage of operative treatment in type C fractures compared to type A and B fractures (p < 0.0001, or p = 0.0009). In the group of patients treated by the authors in the 1996-2002 period, type A fractures constituted 45% of all fractures, where A1 fractures prevailed with 29%, A2 fractures represented 9% and A3 fractures only 6 %. In the recent group of patients, type A fractures constituted 56%, but A3 fracture were seen in 29% of patients, which was a significant increase (p < 0.0001). A3 fractures (anterior wall or anterior column fractures) were associated with a low-energy mechanism of injury and occurred in 48% of patients (73, mostly elderly women). DISCUSSION When compared to the published groups of other authors, the monitored group showed no difference in the mean age and gender ratio. There was an obvious increase in the number of patients with a low-energy mechanism of injury. The authors believe that this is the result of population ageing. It is also related to the growing share of patients treated non-operatively. The number of patients with a high-energy mechanism injury increased to a lesser degree. The spectrum of fractures significantly changed over the last 20 years. It was caused by an increase in low-energy injuries and partly also by improved diagnostics. CONCLUSIONS In the last 20 years, the authors noticed a rise in some types of acetabular fractures. It was caused by a statistically significantly higher number of fractures with a low-energy mechanism of injury, especially in elderly patients, the so-called "fragility fractures". Therefore, the share of non-operatively treated acetabular fractures increased as well. The number of acetabular fractures in young patients as a result of a high-energy injury grew more slowly, and it was only the share of posterior-wall acetabular fractures that was significantly higher. Key words: epidemiology of acetabular fractures, mechanism of injury, types of acetabular fractures.
- MeSH
- acetabulum diagnostické zobrazování zranění MeSH
- dítě MeSH
- dospělí MeSH
- fraktury kostí * diagnostické zobrazování epidemiologie chirurgie MeSH
- fraktury kyčle * diagnostické zobrazování epidemiologie chirurgie MeSH
- fraktury páteře * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie MeSH
- radiografie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dítě MeSH
- 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
Heparin-induced thrombocytopenia is a rare complication of treatment with both unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Antibodies against the complex heparin-platelet factor 4 are the main cause of pathogenesis, resulting in the activation of thrombocytes, coagulation, endothelium, monocytes, neutrophils and subsequent highly prothrombotic state. The prothrombotic state can result not only in venous but also in arterial thrombosis at different locations (which is manifested apart from venous thromboembolic disease also by acute limb ischemia, acute myocardial infarction, ischemic stroke, skin necrotizing lesion exanthema). If HIT is not adequately treated, it may be fatal in up to 10% of patients. For early diagnosis, a combination of 4T scores and diagnostic lab tests for HIT is required. Immediate discontinuation of heparin therapy (UFH, LMWH) and switching to non-heparin anticoagulants (fondaparinux, bivalirudin, argatroban or in some situations DOACs) are essential in HIT treatment. The case report describes the patient after primary knee replacement, complicated by the development of HIT with no evidence of venous thromboembolic disease. Preoperatively, the patient was administrated nadroparin due to paroxysmal atrial fibrillation, after the development of HIT, anticoagulation was modified to fondaparinux and subsequently to warfarin after the platelet count normalization. Key words: unfractioned heparin, low molecular weight heparin, thrombocytopenia, total knee replacement.
- MeSH
- antikoagulancia škodlivé účinky MeSH
- heparin škodlivé účinky MeSH
- lidé MeSH
- totální endoprotéza kolene * MeSH
- trombocytopenie chemicky indukované diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Non-operative and operative treatment of acetabular fractures is associated with a risk of development of posttraumatic avascular necrosis of femoral head or with the development of posttraumatic coxarthrosis. The purpose of the study was to identify the occurrence of these two complications in patients in our group and to determine the risk factors for the development of these complications. MATERIAL AND METHODS The retrospective study was conducted in two Level I trauma centres in the period from 2009 to 2014. The group included patients with an acetabular fracture. The inclusion criteria were the following: outpatient follow-up for the period of 3 years after the injury, full radiology and CT documentation. The exclusion criteria were the following: pathological fractures, missing documentation after the union, insufficient follow-up period or dissent of the patient. The inclusion criteria were met by 192 patients, 48 women and 144 men, with the mean age of 48.9 years. The following basic epidemiological data were monitored: age, sex, cause of injury, type of fracture according to the Letournel classification, occurrence of associated injuries and type of therapy. The patients undergoing non-operative treatment as well as patients undergoing operative treatment underwent clinical and radiological examinations at 3 and 6 weeks after the injury, then at 3, 6 and 12 months after the injury, subsequent follow-up checks were done at a year-interval up to 3 years after the injury. RESULTS The posttraumatic avascular necrosis of femoral head developed in 22 patients (11.7%, 17 men, 5 women, p = 0.1159), with the mean age of 55.3 years (STDEVP 15.5, range from 22 to 82). The average time to the development of femoral head necrosis was 13.1 months (STDEVP 17.0, range from 1 to 80), median 6 months, 95% percentile 34 months. In a total of 16 patients necrosis developed within 18 months after injury, while in 6 patients after a longer period of time. Progression of coxarthrosis was observed in 63 patients (33.5%, 44 men and 19 women, p = 0.0447). Within 24 months progression was seen in 55 patients, beyond 2 years in 8 patients. Confirmed as risk factors for the development of posttraumatic avascular necrosis of femoral head and progression of posttraumatic coxarthrosis were the age 60 years and above (p = 0.0023), posttraumatic medialisation of the femoral head greater than 2 mm (p < 0.0001), displacement in the weight bearing area within the acetabulum greater than 2 mm (p < 0.0001), operative treatment (p = 0.0014), combined surgical approach (p = 0.0044), and higher caput-collum-diaphyseal (CCD) angle of proximal femur (p = 0.0142). At risk for the development of avascular necrosis were the A5 type fractures (p = 0.0214) and B2 type fractures (p = 0.0218), at risk for the development of coxarthrosis were the C1 type fractures (p = 0.0122). The isolated fractures of the anterior column were by contrast associated with a significantly lower risk for development of both the AVN (p = 0.0052) and posttraumatic coxarthrosis (p = 0.0006), the isolated fractures of the posterior wall were associated only with a higher risk for AVN and coxarthrosis summation (p = 0.0399), and the same applies to the T fractures (B3, p = 0.0200). DISCUSSION Majority of current studies regarding acetabular fractures focuses on operative treatment, short-term complications and comparison of outcomes of operative and non-operative treatment. Only a few studies are dedicated to epidemiological data, or risk factors for the development of medium-term and long-term complications. In the presented study attention was paid to two main complications arising from these fractures and requiring subsequent operative treatment: posttraumatic avascular necrosis of femoral head and posttraumatic coxarthrosis. The limitations of the study are its retrospective nature, summation of groups from two trauma centres (potential bias in patient enrolment or in assessing radiographs), lower frequency of clinical surveillance in non-operatively treated patients after healing, a fairly low number of non-operatively treated patients - especially those with osteoporosis-related insufficiency fractures. Ranking among the relative limitations is also the Letournel classification which, though most commonly used at present, shows a low level of correlation in comparisons by more evaluators. CONCLUSIONS Confirmed as significant risk factors for the development of posttraumatic avascular necrosis of the femoral head and posttraumatic coxarthrosis progression were the age of 60 and above, posttraumatic medialisation of the femoral head greater than 2 mm, displacement involving the weight bearing area of the acetabulum greater than 2 mm, operative treatment, combined operative approach. At risk are also the transverse fractures (A5 according to the Letournel classification), transverse posterior wall fractures (B2 according to the Letournel classification) and at risk for the development of coxarthrosis are both-column fractures with the high fracture line of the anterior column (C1 according to the Letournel classification). Femoral neck valgosity was a risk factor for the development of femoral head necrosis. Conversely, sex and instability of osteosynthesis detected on the radiograph within 3 months postoperatively were not confirmed as the risk factors for the development of aforementioned complications. To verify the results of this retrospective study other multicentric and prospective studies should be conducted. Key words: complications of treatment of acetabular fractures, risk factors for avascular necrosis of femoral head, risk factors for coxarthrosis.
- MeSH
- acetabulum zranění MeSH
- artróza kyčelních kloubů etiologie MeSH
- fraktury kostí komplikace terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nekróza hlavice femuru etiologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
