Úvod: Cílem práce je pomocí analýzy vlastního souboru pacientů a aktuálních odborných publikací stanovit, v jakých případech lze zlomeniny střední části skafoidea léčit konzervativně krátkodobou sádrovou fixací s malým rizikem vzniku pakloubu. Materiál a metoda: Soubor 19 pacientů (17 mužů a 2 ženy) s průměrným věkem 31 let (rozsah 20–43, SD 7,3) se zlomeninami střední části člunkové kosti zápěstí indikovanými ke konzervativní léčbě. Diagnostika byla prováděna na základě RTG a CT vyšetření. Konzervativní terapie spočívala v přiložení sádrové fixace zápěstí a palce na dobu min. 6 týdnů u zcela nedislokovaných zlomenin (průměr 6,4 týdne, rozsah 6–10 týdnů). Ostatní zlomeniny byly imobilizovány sádrou celkem 9 týdnů. Všichni pacienti byli sledováni min. 6 měsíců. Výsledky: V odstupu 6 měsíců od úrazu uváděli 2 z pacientů mírné klidové bolesti (1× při zhojené zlomenině, 1× při pakloubu). Bolesti při pohybu nastávaly u 5 pacientů s rozvinutým pakloubem. Dobré zhojení zlomeniny v anatomickém postavení bylo pozorováno u 10 pacientů (53 %), ve 2 případech (11 %) došlo v průběhu hojení k úhlové dislokaci a v 7 případech (37 %) se rozvinul pakloub. Závěr: Konzervativní terapie je vhodná pro zlomeniny střední části skafoidea nedislokované a s dislokací kostních fragmentů do 1,5 mm. U těchto zlomenin je při konzervativní terapii nízké riziko rozvoje pakloubu. RTG zobrazení je nedostatečné. CT vyšetření je nutné zhotovit při nezachycení linie lomu na RTG snímcích při výrazném klinickém nálezu, obzvlášť ve skupině pacientů s typickým výskytem zlomeniny střední části skafoidea, tzn. u mladých mužů ve věku mezi 25. a 40. rokem. Rozhodnutí o druhu léčby musí vždy vycházet z CT vyšetření.

Introduction: The goal of this work is to determine, using the analysis of our own patient group and current professional publications, in which cases fractures of the scaphoid waist can be treated conservatively by short-term plaster fixation with a low risk of non-union developing. Material and method: A group of 19 patients (17 men and 2 women) with the mean age 31 years (range 20–43, SD 7.3) with fractures of scaphoid waist were indicated for conservative treatment. The diagnosis was made on the basis of X-ray and CT examination. Conservative therapy consisted of applying plaster fixation of the wrist and thumb for a minimum of 6 weeks in completely non-dislocated fractures (mean 6.4 weeks, range 6–10 weeks). The other fractures were immobilized with a plaster cast for a total of 9 weeks. All patients were followed for at least 6 months. Results: At 6 months after the injury, 2 of the patients reported mild pain at rest (1× with healed fracture, 1× with a non-union). Pain during movement occurred in 5 patients with a developed non-union. Good healing of the fracture in the anatomical position was observed in 10 patients (53%), in 2 cases (11%) an angular dislocation occured during healing, and in 7 patients (37%) the result of treatment was a non-union. Conclusion: Conservative therapy is suitable for fractures of the scaphoid waist without dislocation and with dislocation of bone fragments up to 1.5 mm. In these fractures, conservative therapy has a low risk of non-union developing. X-ray imaging is insufficient. In case the fracture line does not appear on the X-ray and there is a significant clinical finding, especially in the group of patients with a typical occurrence of a fracture of the scaphoid waist, i.e. in young men aged between 25 and 40 years, CT examination must be performed. The decision on the type of treatment must always be based on the CT scan.

• MeSH
• člunkovitá kost * diagnostické zobrazování   zranění   MeSH
• dospělí MeSH
• fixace fraktury MeSH
• fraktury kostí diagnostické zobrazování   terapie   MeSH
• konzervativní terapie * MeSH
• lidé MeSH
• poranění zápěstí terapie   MeSH
• pseudoartróza diagnostické zobrazování   etiologie   MeSH
• sádrové obvazy MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY: This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. MATERIAL AND METHODS: The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. RESULTS: In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. CONCLUSIONS: Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. KEY WORDS: radial head, elbow, fracture, dislocation, resection, prosthesis.

• MeSH
• dislokace kloubu * chirurgie   MeSH
• dospělí MeSH
• fraktury hlavice a krčku vřetenní kosti MeSH
• fraktury vřetenní kosti * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• loketní kloub * chirurgie   patofyziologie   MeSH
• mladý dospělý MeSH
• nestabilita kloubu * chirurgie   etiologie   MeSH
• poranění lokte MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tříštivé fraktury * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Ulnární deviace prstů je součástí rozvinuté kolapsové deformity zápěstí a ruky. Porucha centrálního pilíře ruky začíná ulnární translokací karpu ve frontální rovině. Dle Shapirovy teorie se karpus a metakarpální krajina biomechanicky chovají jako celek a ulnární posun zápěstí a jeho inklinace radiálně je sledován radiální inklinací metakarpů a ulnární deviací prstů. V oblasti MCP kloubů vzniká vlivem uvolnění vazivového aparátu tendence k dislokaci průběhu extenzorových šlach II. až V. prstu ulnárně. Jejich sklouznutí z vrcholu MCP kloubu do intermetakarpálních prostorů má za následek omezení jejich extenční schopnosti. Extenzory se v novém, patologickém průběhu stávají i ulnárními duktory prstů a dále zesilují a fixují ulnární deviaci. Operační výkony, které vedou k zachycení posunu karpu ulnárně jsou prevencí vzniku kolapsové deformity a tím i ulnární deviace prstů. Základním výkonem je časná synovektomie dorzální části karpu a peritenosynovektomie extenzorových šlach doplněná šlachovou transpozicí, dále synovektomie MCP kloubů spolu s výkony, které reponují fyziologický průběh extenzorových šlach. Používají se i limitované dézy v proximální řadě karpálních kostí. Tonizace radiálních kolaterálních vazů a transpozice úponů ulnárních interoseálních a lumbrikálních svalů na radiální část základního článku vedlejšího prstu patří k nejsložitějším operačním výkonům v této krajině. Jejich kombinace s implantacemi umělých náhrad MCP kloubů bývá v rozvinutých případech nezbytná.

The ulnar deviation of the fingers is a part of a developed collapse deformity of the wrist and hand. The central pillar disorder of the hand begins with ulnar translocation of the carp in the frontal plane. According to Shapiro's theory, the carpus and metacarpal landscape behave biomechanically as one unit and the ulnar deviation and radial inclination of the wrist is followed by the radial inclination of the metacarpus and the ulnar deviation of the fingers. In the area of MCP joints, there is a tendency to ulnarly dislocate the course of the extensor tendons of the 2nd to 5th finger due to the loosening of the ligament apparatus. Their slipping from the top of the MCP joint into the intermetacarpal spaces results in a limitation of their extension ability. Extensors in their new, pathological course become ulnar ductors of the fingers and further strengthen and fix ulnar deviation.Surgical interventions that lead to the capture of the ulnar carpus deviation prevent the collapse deformity and thus ulnar deviation of the fingers. The basic procedure comprises early synovectomy of the dorsal portion of the carpus and peritenosynovectomy of the extensor tendons followed by tendon transposition, synovectomy of the MCP joints together with interventions that repose the physiological course of the extensor tendons. Limited joint fusions in the proximal row of carpal bones are also used. Tonalization of radial collateral ligaments and transposition of insertions of ulnar interosseal and lumbrical muscles to the radial part of the proximal phalanx of the next finger is one of the most complicated surgical procedures in this region. Their combination with implantation of artificial MCP joint replacements is necessary in developed cases.

• Klíčová slova
• revmatická ruka, revmatochirurgie ruky, revmatická deformita, ulnární deviace prstů,
• MeSH
• chirurgie operační metody   MeSH
• deformity ruky * chirurgie   MeSH
• lidé MeSH
• revmatické nemoci chirurgie   patologie   MeSH
• ruka chirurgie   patologie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Rheumatosurgery is a discipline managing the symptoms of rheumatoid arthritis of the musculoskeletal system. In a vast number of patients this disease starts in the wrist and hand. The portfolio of surgical procedures performed on the skeleton and soft tissues in these regions can be divided into two groups that, however, often times overlap in practice. Commonly, a combination of these surgical interventions is used. The surgical management should commence with prophylactic interventions that aim to slow down the development of rheumatoid deformities. These are followed by reconstructive surgery which shall manage the already developed rheumatoid deformities and their complications. The prophylactic interventions include early and late synovectomy, peritenosynovectomy, tenodeses, tendon transpositions and limited arthrodeses. The reconstructive surgery procedures comprise osteotomy, resection procedures, alloplasties, total arthrodesis and tendon reconstructions. Key words: rheumatoid arthritis, rheumatosurgery, hand, wrist.

• MeSH
• artrodéza MeSH
• klouby ruky chirurgie   MeSH
• lidé MeSH
• revmatoidní artritida komplikace   chirurgie   MeSH
• ruka chirurgie   MeSH
• šlachy chirurgie   MeSH
• synovektomie MeSH
• získané deformity ruky etiologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY A single treatment procedure for multi-fragmented non-reconstructible radial head fractures has not been established as of yet. One of the available treatment methods can be the implantation of an endoprosthesis, but there is no consensus in available publications. We therefore decided to trial their use and to obtain our own experience. This study includes the evaluation of the outcomes of treatment at one year postoperatively. MATERIAL AND METHODS Our group included eight patients (six men and two women with the mean age of 46.1 years, ranging from 24 to 80 years) with an implanted ExploR® (Biomet, U.S.A.) radial head endoprosthesis. The radial head fractures were of three to six fragment type, in six cases there was an associated dislocation. In one case, there was a concomitant diaphyseal fracture of the ulna which was stabilised using the Würzburger intramedullary nail (TRUE-Instrumente GmbH, Germany). The surgical approach through Kocher's interval was used in all cases. Fixation using a plaster splint from metacarpophalangeal joints up to the shoulder was applied postoperatively for a period of two to three weeks in all patients. RESULTS The assessment was carried out on average at 13 months (range 12-15 months) after the surgery. The mean elbow flexion was 7.5° to 136.9°, forearm supination was 0° to 86.3° and forearm pronation was 0° to 80.0°. The elbow joint maintained its stability in all cases. Neurological deficit did not develop in any of the patients. The DASH score reached the mean value of 11.2. The mean value of the Mayo Elbow Performance Score (MEPS) was 92.5. Radiological signs of implant loosening were observed in three cases. In two of these cases, bone resorption occurred surrounding the stem of endoprosthesis. In two patients, heterotopic ossification were found and in one case, an oversized endoprosthesis head was implanted. No recurrent elbow dislocation was seen in any of the patients. DISCUSSION The application of radial head endoprosthesis is indicated for comminuted radial head fractures and concurrent ligamentous injuries (fracture-dislocations, terrible triad, Essex-Lopresti injuries). Equally good functional outcomes may be achieved with the use of an endoprosthesis as by osteosynthesis. The complications of arthroplasty tend to be late, at ten or more years postoperatively. Further follow-up of our patients will be necessary, along with a further expansion of our group of patients. Complications may be prevented with the use of longer-stem implants and more up-to-date cemented bipolar endoprostheses which, according to recent studies, achieve equally good functional outcomes and reduce the number of necessary revision surgeries - implant removal in particular. CONCLUSIONS In treating the comminuted radial head fractures, the implantation of endoprosthesis helps to achieve a quick restoration of the elbow joint function along with good functional outcomes and prevents instabilities in case of associated ligamentous injuries. A basic precondition for successful treatment is the choice of an adequate size head. The radiological signs of stem loosening do not necessarily have to affect the functional outcomes. Key words: fracture, radial head, endoprosthesis, Kocher approach.

• MeSH
• dospělí MeSH
• fraktury vřetenní kosti chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• loketní kloub chirurgie   MeSH
• mladý dospělý MeSH
• protézy lokte MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza loketního kloubu * MeSH
• tříštivé fraktury chirurgie   MeSH
• vnitřní fixace fraktury MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Cílem naší studie bylo posoudit výsledky léčby zlomenin střední části klíční kosti pomocí nitrodřeňově zavedeného hřebu. Metoda: Hodnotíme soubor 58 pacientů se zlomeninami klíční kosti stabilizovanými implantátem Hofer Clavicula Pin (HCP, firma Hofer GmbH & Co KG, Fürstenfeld, Německo). V 43 případech byl použit statický a v 15 dynamický implantát. Průměrný věk pacientů činil 39,1 roku (rozsah 18−71, SD 4,4), poměr muži : ženy byl 43:15, pravostranná klíční kost byla zlomena u 26 pacientů, levostranná u 32. Průměrná doba mezi úrazem a operací činila 10,2 dne (rozsah 2−19, SD 4,4). Soubor zahrnoval 24 dvou-, 14 tří- a 20 čtyřfragmentových zlomenin střední třetiny klíční kosti. Ve všech případech byla zlomenina reponována otevřeně, implantát byl zaváděn nepřímou metodou, nejdříve ze zlomeniny antegrádně do laterálního fragmentu, následně retrográdně do mediálního fragmentu. Výsledky: Průměrná doba sledování pacientů byla 7,1 měsíce (rozsah 6−23, SD 5,5). Rentgenové známky hojení byly patrny ve všech případech, ke zhojení došlo v průměru po 8,4 týdne (rozsah 6−20, SD 4,1). V jednom případě (1,7 %) však ke zhojení nedošlo, v odstupu 18 dnů po extrakci byla diagnostikována refraktura bez jednoznačného dalšího mechanismu úrazu, další dvě refraktury byly způsobeny opětovným úrazem. Ve čtyřech případech (6,9 %) došlo ke zlomení hrotu pinu. Ve dvou případech (3,4 %) došlo k angulaci pinu, přesto však došlo k plné prostavbě zlomenin v uspokojivém postavení. Prominence pinu byla pozorována celkem ve 23 případech (39,7 %), ve 13 případech (22,4 %) si vynutila předčasnou extrakci implantátu pro perforaci nebo iritaci kůže a bolesti. Asymptomatických bylo 10 případů (17,2 %) prominence. U šesti případů perforace kůže implantátem došlo k rozvoji klinických známek infekce, po extrakci pinu a aplikaci antibiotik došlo vždy ke zhojení rány. Velice dobrý funkční nález v ramenním kloubu byl pozorován u 57 pacientů (98,2 %). DASH skóre dosáhlo průměrné hodnoty 8,1 bodu (rozsah 0,8–30,8, SD 4,4), Constant score 93,1 (rozsah 42,8–98,1, SD 3,2). Závěr: Nitrodřeňová stabilizace dvou- až čtyřfragmentových zlomenin střední části klíční kosti pomocí Hofer Clavicula Pin poskytuje v průběhu hojení velice dobrou stabilitu a vede k dobrému zhojení zlomenin. Komplikacemi metody jsou zejména dráždění měkkých tkání až perforace kůže v oblasti laterálního konce implantátu, prevencí může být adekvátní zanoření pinu blíže ke kosti, které však může způsobit jeho obtížnou extrakci.

Introduction: The aim of our study was to assess treatment outcomes in fractures of the middle part of the clavicle using an intramedullary nail. Methods: We have evaluated a total of 58 patients with a clavicle bone fracture stabilized by the Hofer Clavicula Pin implant (HCP, Hofer GmbH & Co KG, Fürstenfeld, Germany). A static implant was used in 43 cases, and a dynamic implant was used in the remaining 15. The mean age of patients was 39.1 years (range 18−71, SD 4.4), the male-to-female ratio being 43:15. The right collarbone was broken in 26 patients, the left one in 32. The average time between accident and surgery was 10.2 days (range 2–19, SD 4.4). The set included 24 two-, 14 three- and 20 four-fragment fractures of the clavicle midshaft. Open reduction was used in all the cases. The implant was introduced by the indirect method: first, insertion of the pin from the fracture antegrade into the lateral fragment took place, then it was inserted retrogradely into the medial fragment. Results: The average patient follow-up was 7.1 months (range 6−23, SD 5.5). X-ray signs of healing were evident in all cases, with healing occurring at 8.4 weeks on average (range 6−20, SD 4.1). In one case (1.7%), however, healing did not occur – refracture was diagnosed 18 days following pin extraction with no clear mechanism of injury; two more refractures were caused by a new accident. The apex of the pin was broken in four cases (6.9%). In two cases (3.4%), angulation of the pin occurred; however, full fracture healing was satisfactorily achieved. Pin prominence was observed in a total of 23 cases (39.7%), requiring premature extraction of the implant due to perforation or irritation of skin and pain in 13 (22.4%) cases. 10 cases (17.2%) of prominence were asymptomatic. Six cases with skin perforation by the implant developed clinical signs of infection, wound healing was always achieved after extraction of the pin and application of antibiotics. A very good functional finding in the shoulder joint was observed in 57 patients (98.2%). The DASH score reached an average of 8.1 points (range 0.8–30.8, SD 4.4). Constant score was 93.1 (range 42.8–98.1, SD 3.2). Conclusion: Intramedullary stabilization of two-, three- and four-fragment fractures of the middle part of the clavicle using the Hofer Clavicula Pin provides very good stability during healing and leads to good healing of fractures. The complications of the method are soft tissue irritation or even skin perforation in the region of the lateral end of the implant. Preventive insertion of the pin closer to the bone may prevent such complications, but also result in difficult pin extraction.

• Klíčová slova
• nitrodřeňové hřebování,
• MeSH
• dospělí MeSH
• fraktury kostí diagnostické zobrazování   komplikace   terapie   MeSH
• klíční kost * diagnostické zobrazování   zranění   MeSH
• kostní hřeby MeSH
• lidé středního věku MeSH
• lidé MeSH
• vnitřní fixace fraktury * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY The aim of our study was to determine the indications for radial head resection at the present day. MATERIAL AND METHODS The radial head resection was performed in the period from 2008 to 2015 in 63 patients divided into three groups. The first group marked "CR" consisted of 33 patients with the Mason type III fracture. The second group marked "CRLUX" included 20 patients with the Mason-Johnston type IV fracture, i.e. a fracture of the proximal end of the radius with a dislocation of the elbow joint. Within this group, in 8 cases also the coronoid process of the ulna was fractured. The third group marked as "CRFR " was composed of 10 patients, in whom concomitant proximal radial fracture and proximal ulna fracture occurred, and in all the cases osteosynthesis of the proximal ulna fracture was performed. For subjective evaluation of the upper limb function the DASH score was used. The functional outcomes were expressed using the Mayo Elbow Performance Score (MEPS). Moreover, the range of motion in the elbow and forearm (flexion and extension of the elbow, pronation and supination of the forearm), elbow joint stability and presence of neurological lesions were assessed. The radiological assessment consisted of measuring the proximalization of the radius, monitoring the heterotopic ossifications, signs of arthrosis, recurrent re-dislocation of elbow and proximal ulna fracture healing. RESULTS The mean follow-up period was 17.6 months (range of 13.2 - 81.0 months, SD 11.5). The mean DASH score was 15.6 (range of 0 - 60, SD 15.3) in the CR group, 12.0 (range of 0 - 52.7, SD 16.7) in the CRLUX group and 17.5 (range of 0 - 62.3, SD 12.8) in the CRFRgroup. A considerably limited mobility was seen in the CR group in three cases (9.1%), in the CRLUX group in four cases (20.0 %) and in the CRFRgroup in two cases (20.0 %). The MEPS score showed similar results in all the groups, excellent and good results were always achieved in more than ¾ of patients. Elbow stiffness did not develop in any of the patients. In the CRLUXgroup, one case a re-dislocation of the elbow occurred. In the CRFRgroup, in one case an injury to the interosseous membrane and distal radioulnar joint ligaments failed to be diagnosed and a clinically significant proximalization of the radius (9 mm shift) occurred, which subsequently required ulnar shortening osteotomy. Additional two proximalization of the radius with a minor shift (2 and 3 mm) in the group CR and CRLUX were not associated with major mobility limitations. Heterotopic ossification occurred in a total of 11 cases (17.5 %) and in four cases it caused major mobility limitations (two cases in the CR group, one case in the CRLUX and CRFRgroups). Surgical treatment was indicated in one case with a good functional effect, in one case the range of motion improved after actinotherapy. In the CR group, one case of neuroma of the radial nerve developed and the condition was treated by sural nerve transplantation. DISCUSSION The current papers view simple proximal radial resection positively unless elbow instability is present. In literature, references are made to serious, mainly late complications (arthrosis, valgus deformity, considerable limitation of elbow range of motion, proximal radial-ulnar synostosis, proximalization of the radius and symptomatic radioulnar joint subluxation). Resection of the radial head is contraindicated in the so called "terrible triad" of the elbow, i.e. the combination of a radial head fracture, a coronoid process fracture and elbow dislocation, and in the Essex-Lopresti injury, i.e. a radial head fracture with a concomitant tear of the interosseous membrane of the forearm and radioulnar joint dislocation. The Essex-Lopresti injury is often overlooked during the initial examination, proximalization of the radius can occur gradually only after several months. CONCLUSIONS The evaluation of our groups of patients showed that the radial head resection can be a good treatment option with no serious early complications in the Mason type III fractures. Serious complications occurred only in cases when the fracture was accompanied by a concomitant injury, i.e. in the Mason-Johnson type IV fractures and in concomitant proximal ulna fracture. When an indication for radial head resection is made, it is essential to correctly diagnose the injury which is clearly a contraindication to this method, i.e. the Essex-Lopresti and the "terrible triad" injuries. Key words: fracture, radial head, resection.

• MeSH
• dislokace kloubu * diagnóza   chirurgie   MeSH
• dospělí MeSH
• fraktury ulny chirurgie   MeSH
• fraktury vřetenní kosti chirurgie   MeSH
• hodnocení výsledků zdravotní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• loketní kloub * diagnostické zobrazování   patofyziologie   MeSH
• osteotomie škodlivé účinky   metody   MeSH
• pooperační komplikace * etiologie   prevence a kontrola   MeSH
• poranění lokte MeSH
• recidiva MeSH
• ukazatel závažnosti úrazu MeSH
• vnitřní fixace fraktury škodlivé účinky   metody   MeSH
• výběr pacientů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Our study aimed to evaluate a group of patients who in the period from 2005 to 2014 underwent a four-corner arthrodesis of the wrist in our department. We also wanted to verify the hypothesis as to whether the use of conventional dorsal plate without the application of bone grafts leads to comparable results as the use of dorsal locking plates and routine application of bone grafts. MATERIAL AND METHODS Throughout the years 2005 to 2014 the four-corner arthrodesis of the wrist was performed in our department in a total of 62 patients, in two cases bilaterally. The indication was the diagnosis of SLAC/SNAC grade III. Normed RondoFix implant was used in all the cases. Following the surgery, the wrist was immobilized by a volar plaster splint for the period of 2 weeks and subsequently orthosis was applied for additional 4 weeks. The wrist mobilisation started in week seven when the orthosis was removed, the patients were allowed full load on the wrist 3 months after the surgery. Our group of patients was evaluated retrospectively, a total of 53 operated wrists in 51 patients were assessed. The assessment was carried out based on a radiograph of the wrist, range of motion, Mayo Modified Wrist Score, DASH Score and grip strength test. RESULTS The mean range of motion in sagittal plane was 63.7°, in frontal plane the mean value was 32.1°. According to the Mayo Modified Wrist Score 37 patients were rated "excellent" or "good". Due to the presence of moderate pain, the result in other 10 patients was assessed as "satisfactory". In a total of 4 patients the result was assessed as "weak", in two of them for a presence of non-union and in other two for severe pain under load. One of these patients underwent bilateral surgery and reported severe pain in both the wrists. Regarding DASH score, the best result equalled 0, the worst 65.83, with the mean of 20.5. The grip strength ranged from 8 to 54 kg, with the mean value of 27.5 kg. In two patients, a non-union occurred. In the first case the extraction of implant and re-arthrodesis was performed due to severe pain and screw migration. The patient is now 22 months after the surgery and the radiographs show that the arthrodesis has healed and the patient has no clinical difficulties. The second patient did not report any difficulties, therefore he is only subject to follow-up. No cases of screw or plate breakage were reported. In one case, the patient reported pain in the region of radial styloid process. A revision was indicated with radial styloidectomy and decompression of tendons of m. extensor pollicis brevis and m. abductor pollicis longus. As a result the patient had no clinical difficulty. One case of wrist radial deviation was recorded. It was managed by corrective wedge osteotomy and reosteosynthesis using a circular dorsal plate. In one patient dorsal impingement occurred, accompanied by limited range of motion and pain. Extraction of OS material was indicated and the patient was relieved of any difficulties. We have recorded aseptic necrosis of lunate bone in one case. DISCUSSION When comparing the functional results such as the range of motion and grip strength, our results are fully comparable to previously published papers. In papers where DASH was referred to, its value ranges from 13 to 29.82, which is fully consistent with our observations with the final value of 20.5. The incidence of non-union and the degree of complications is not deviating from the values included in other publications either. In all the mentioned publications the authors refer to routine use of bone grafts. The publications evaluating the use of locking plates do not report different results either. CONCLUSIONS In case of correct indication, the four-corner arthrodesis of the wrist represents a very good solution. In our group of patients, we confirmed the hypothesis that equally good results as with the use of locking plates can be achieved when using a non-locking plate system. Essential is the proper correction of DISI and primary good congruence between fused carpal bones instead of the use of bone grafts. Key words: SLAC wrist, SNAC wrist, four-corner arthrodesis, partial wrist fusion.

• MeSH
• artrodéza * MeSH
• kostní destičky * MeSH
• lidé MeSH
• poranění zápěstí patofyziologie   chirurgie   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• síla ruky MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Cíl: Porovnání výsledků operační léčby zlomeniny dia­fýzy klíční kosti pomocí nitrodřeňově zavedených Kirschnerových drátů a otevřené repozice a stabilizace úhlově stabilní zamykatelnou dlahou. Materiál a metoda: Soubor 44 pacientů se zlomeninou diafýzy klíční kosti, jejichž průměrný věk činil 42,5 roků (33 mužů a 11 žen). První skupina označená IM zahrnuje 29 pacientů, u kterých byly ke stabilizaci zlomeniny použity intramedulárně zavedené Kirschnerovy dráty. Do druhé skupiny označené ORIF je zařazeno 15 pacientů, kteří byli léčeni metodou otevřené repozice a stabilizace zamykatelnou dlahou pro zlomeniny diafyzární části klíční kosti LCP 3,5 mm (firma Synthes, Švýcarsko). Kritéria k operační terapii po zavřené repozici jsou: zkrat ve zlomenině o více než 10 mm, dislokace ad latus o více než šíři kosti, hrozící perforace kožního krytu kostním fragmentem. Stabilizace Ki dráty byla užívána pro maximálně třífragmentové zlomeniny, složitější zlomeniny byly léčeny zamykatelnou dlahou. Výsledky: Migrace osteosyntetického materiálu bez redislokace kostních fragmentů nastala pouze ve skupině IM v pěti případech (17,3 %), k selhání osteosyntézy došlo pouze v jednom případě (3,4 %) též ve skupině IM. Pakloub byl ve skupině IM pozorován dvakrát (6,9 %) a ve skupině ORIF jedenkrát (6,7 %). Závěr: Operační léčby zlomenin diafýzy klíční kosti pomocí nitrodřeňově zavedených Kirschnerových drátů a metodou stabilizace zamykatelnou dlahou nevykazují zásadní rozdíly v délce hojení, funkčních výsledcích léčby a počtu závažných komplikací. Indikacemi ke stabilizaci Kirschnerovými dráty jsou jednoduché, maximálně třífragmentové zlomeniny. Pro zlomeniny s větším počtem fragmentů je metodou volby osteosyntéza zamykatelnou dlahou.

Objective: The issue of the study is to compare the treatment results of clavicular midshaft fractures stabilisated using intramedullarly introduced Kirschner wires and by open reduction et internal stabilisation using angle stable plate. Material and methods: Set of 44 patients with diaphyseal fractures of the clavicle whose average age was 42.5 years (33 men and 11 women). The first group “IM” includes 29 patients in which intramedullarly introduced Kirschner wires were used for fracture fragments stabilization. The second group “ORIF” contains 15 patients who were treated by open reduction and stabilization by locking plates for diaphyseal fractures of the clavicle - LCP 3.5 mm (Synthes, Switzerland). Criteria for surgical treatment after closed reduction are: shortening of the fracture more than 10 mm, dislocation ad latus more than the width of bone and imminent perforation of skin from bone fragment. Results: Migration of osteosynthetic material without dislocation of bone fragments occurred only in the group IM in five cases (17.3 %), osteosynthesis failure occurred in only one case (3.4 %) also in the group IM. Nonunion was observed in the group IM twice (6.9 %) and in group ORIF once (6.7 %). Conclusion: Surgical treatment of diaphyseal fractures of the clavicle using intramedullarly introduced Kirschner wires and method of stabilization using locking plates do not show significant differences in the length of healing, functional results of treatment or serious complications. Indications to stabilization by Kirschner wires are simple, maximally tree-fragmet fractures. For fractures with multiple fragments, the method of choice is fixation by locking plates.

• MeSH
• diafýzy diagnostické zobrazování   zranění   MeSH
• dlahy MeSH
• fraktury kostí diagnostické zobrazování   chirurgie   terapie   MeSH
• klíční kost * diagnostické zobrazování   zranění   MeSH
• kostní dráty MeSH
• lidé MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

A spontaneous tendon rupture is a direct consequence of rheumatoid inflammation and can appear without any noticeable impact, often during sleep. The patient then presents with inability to flex or extend metacarpophalageal or interphalangeal joints. Multiple ruptures resulting in impaired function of several fingers can also occur and markedly limit the hand's grip strength. A tear may arise from either mechanical injury to the tendon along its course over bone or connective tissues, or by biochemical action of lysosomal enzymes, released during the inflammation process, on the connective tissue of the tendon. Ischaemic damage to a part of the tendon due to constriction of vessels supplying the peritenonium is found in hypertrophic peri-tenosynovitis. Spontaneous ruptures can be prevented, in the first place, by early synovectomy and then by a number of prophylactic procedures on soft tissues and carpal bones, which can stop or at least slow down the development of severe axial deformities of the wrist and hand. Simple end-to-end suture of the stumps is usually not possible; tendon repair surgery using free grafts or, more often, intact tendon transfer is necessary. In the flexor part, transfer of the superficial flexor tendon to a stump of the deep flexor tendon is frequently performed; a free graft can also be used at a two-stage tendon reconstruction. The repair of flexor tendons is technically more demanding and the results are less satisfactory compared to repair surgery on the extensor tendon. Key words: rheumatoid arthritis, metacarpophalageal joint, interphalangeal joint, tendon rupture.

• MeSH
• lidé MeSH
• poranění ruky etiologie   prevence a kontrola   MeSH
• poranění šlachy chirurgie   MeSH
• revmatoidní artritida komplikace   chirurgie   MeSH
• spontánní ruptura etiologie   prevence a kontrola   MeSH
• tenosynovitida MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH