PURPOSE OF THE STUDY This study aimed to analyse the outcome following intramedullary nailing for metastases of the femur in a large cohort with special regard to mechanical, implant associated complications and patient survival. Furthermore, we aimed to identify factors influencing the overall survival. MATERIAL AND METHODS All patients (n = 74) that underwent intramedullary nailing for metastatic disease of the femur between 2004 and 2008 and were retrospectively reviewed. Data were recorded from the patients' medical record and the outpatients' clinics files. Details about the tumour biology, the surgery performed as well as the postoperative care were documented. Survival data were extracted from patient records or obtained via communication with outpatient oncologists or the community registration office. RESULTS 74 (28 (37.8%) male, 46 (62.2%) female; p = 0.048) patients with a mean age of 64.4 ± 11.7 years were included. Breast (25, 33.8%), lung (18, 24.3%), bone marrow (7, 9.5%) and kidney (6, 8.1%) were the primary tumours in more than 75% of all patients. The mean overall survival was 17.5 (95% CI: 9.6 - 25.5) months. Patients with osseous metastases had a significant longer survival than patients with visceral and/or cerebral metastases (p = 0.025 and p = 0.032). CONCLUSION Intramedullary nailing represents a valuable fixation method for pathologic fractures or impending fractures of the femur in patients with an advanced stage of metastatic disease. It provides adequate stability to outlast the patient s remaining life-span. However, the balance must be found between therapeutic resignation and surgical overtreatment since operative treatment may be accompanied with serious complications. Key words: bone metastases, intramedullary nailing, metastatic disease, cement augmentation, osteolytic defect.

• MeSH
• femur chirurgie   MeSH
• fraktury femuru etiologie   chirurgie   MeSH
• fraktury spontánní etiologie   chirurgie   MeSH
• intramedulární fixace fraktury přístrojové vybavení   MeSH
• kostní hřeby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• metastázy nádorů MeSH
• nádory kostí komplikace   sekundární   chirurgie   MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The present study aimed to analyse both, the functional outcome and quality of life after surgical treatment of periprosthetic fractures following TKA. MATERIAL AND METHODS A retrospective review of all periprosthetic fractures following knee arthroplasty which have been surgically treated at our institution between January 2005 and January 2012 was conducted. Beside epidemiologic data, type of surgery and postoperative complications were recorded. The functional outcome was assessed using range of motion, Knee Society Score and VAS to evaluate pain. Quality of life was evaluated using SF-36 and WOMAC. Furthermore patients mobility and comorbidities were analysed. RESULTS 25 (mean age 76 ± 8 years; m:w 5:20) patients were included. The overall complication rate was 24%. Mean KSS knee score was 73 ± 19 and a function score was 41 ± 36. Range of motion revealed 95° ± 24° (active) and 98° ± 16° (passive). The total SF-36 scored a mean of 41 ± 6 and 29 ± 19 in average considering the WOMAC index (pain: 19 ± 20; stiffness: 23 ± 27; daily: 47 ± 29). 20% were able to mobilise without help as opposed to 80% that were in need for assistance. Our analysis revealed no influence of the final outcome as a function of fracture type or type of treatment. Multiple regression analysis could not reveal significant influence of the comorbidities. CONCLUSION Periprosthetic fractures following knee arthroplasty are accompanied by a significant decrease of the knee function and quality of life as well as high complication rates. Since patient's quality of life apparently depends on the functional outcome, future efforts should aim to improve these parameters. Key words: periprosthetic fracture, total knee arthroplasty, quality of life, functional outcome, locking plate.

• MeSH
• kvalita života * MeSH
• lidé MeSH
• periprotetické fraktury chirurgie   MeSH
• pooperační komplikace psychologie   MeSH
• protézy kolene škodlivé účinky   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři MeSH
• totální endoprotéza kolene škodlivé účinky   MeSH
• vizuální analogová stupnice MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Evaluation of outcome after surgical treatment of humerus metastases with a focus on tumour and patient derived factors, timing and strategy of intervention, surgical outcome and complications. MATERIAL AND METHODS Sixty-fie patients with a mean age of 64.3 years (range 25-89) with 66 metastases of the humerus were surgically treated in a 7-year time-period and retrospectively reviewed. RESULTS Renal cell carcinoma and breast cancer were the most abundant types of primary tumour. The mean time from diagnosis of primary tumour to fist metastasis was 14.5 months (range 0-173). The mean time from diagnosis of metastasis to surgery was 21.4 months (range 0-173). 38/28 intramedullary nails/locking plates were used for 58/8 manifest/impending pathological fractures. Mean cumulative survival was 16.3 months and implant failure rate was 6.1% with a mean time from initial surgery to revision of 22.2-20.6 months. CONCLUSIONS Our data indicate that treatment with intramedullary fiation or cement augmented plate osteosynthesis is successful for the vast majority of patients, but thorough clinical evaluation and precise decision making adapted to the patient's estimated life expectancy must be applied to avoid overtreatment or risk of implant failure. Key words: bone metastases, skeletal metastatic disease, humerus metastasis, pathologic fracture, impending fracture.

• MeSH
• dospělí MeSH
• fraktury humeru etiologie   patologie   chirurgie   MeSH
• fraktury spontánní etiologie   patologie   chirurgie   MeSH
• hojení fraktur MeSH
• humerus patologie   chirurgie   MeSH
• intramedulární fixace fraktury metody   MeSH
• kostní cementy * MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory kostí patologie   sekundární   chirurgie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Intramedullary nailing is a minimally invasive technique that respects humeral head. However, limited surgical approach does not permit an anatomical reduction. The significance of the reduction on the functional outcome has not been sufficiently investigated. The aim of the study was to examine the functional and radiological postoperative outcome in patients with proximal humeral fractures treated with intramedullary nailing and the significance of reduction. MATERIALS AND METHODS: The study population consisted of 43 patients with proximal humeral fractures that were treated with the Proximal Humerus Nail System (Targon, Aesculap). Mean follow-up period was 23.2 months (SD: 8.9). Shoulder function was assessed with the Constant-Murley Score. Reduction was examined radiographically anteroposterior and true lateral plane. Radiographs of 50 healthy shoulders served as controls. Malreduction was analyzed for 10°, 15° and 20° in both planes. RESULTS: The overall functional results were satisfying; mean CS of all patients at the last follow-up visit was 74.8 (SD: 19.3). Mean normalized CS for age and gender was 78.15 (SD 17.8). Fracture severity seemed to affect clinical outcome to a certain extent; 4-part fractures exhibited inferior results. Mean NSA was 126.5 (SD: 16.9) in anteroposterio and 137.4 (SD: 15.4) in true lateral view. The respective values in the control group were 134.1° (SD 7.1°) in anteroposterior and 133.7° (SD 12.8°) in true lateral view. A malreduction of >20° in the anteroposterior plane and >15° in both anteroposterior and true lateral planes resulted in significantly inferior clinical outcome. Thirteen complications were recorded, four of them being major. DISCUSSION The quality of reduction affected the postoperative outcome to a certain extent. Especially the anteroposterior reduction seemed to play a more important role in the postoperative function than reduction in the true lateral plane. However, this difference was statistically significant only after > 20° malreduction. The worst results in Constant Score were shown, as expected, in the group with malreduction in both planes; even a 15°malreduction resulted in statistically significant difference. The importance of anteroposterior reduction could be due to achievement of better ROM in the frontal plane, most probably because of better levers on the tuberosities. However an absolute anatomical reduction does not have to be achieved at all costs. The overall good results of the fractures in this study despite absence of anatomical reduction could partly result from the limited surgical approach. CONCLUSIONS: The majority of the patients treated with closed reduction and internal fixation with PHN show good postoperative functional results. However, fracture malreduction reduction cannot be always avoided with the use of PHN. Nevertheless, the evaluation of the Constant-Murley score shows an absolute anatomical reduction in not necessary for satisfying functional outcome. The reduction in anteroposterior plane seems to play a more important role in the postsurgical functional outcome. A malreduction that exceeds 15° in both planes or a malreduction of more than 20° in either plane should be avoided.

• MeSH
• dospělí MeSH
• fraktury humeru radiografie   chirurgie   MeSH
• hlavice humeru zranění   chirurgie   MeSH
• intramedulární fixace fraktury škodlivé účinky   metody   MeSH
• kostní hřeby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• následné studie MeSH
• nezhojené fraktury diagnóza   etiologie   chirurgie   MeSH
• reoperace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ukazatel závažnosti úrazu 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
• klinické zkoušky kontrolované MeSH