Significant malrotation of the femur after osteosynthesis is a serious complication of treatment and has a number of consequences for the patients and causes deterioration of their quality of life. Therefore, it is necessary to be familiar with intraoperative techniques to control the correct rotation, mostly clinical and radiological, which give us the possibility to minimize rotational errors. In the postoperative period, with even a slight suspicion of malrotation, it is necessary to proceed to its exact verification and, in indicated cases, to perform necessary correction. We recommend one of the CT techniques as a very reliable method, however in younger patients we prefer to use MRI. Early diagnosis of the rotational error and especially its size is essential from the point of view of potential reconstructive surgery, which is then chosen also with regard to the location of the original lesion. Key words: femoral osteosynthesis, limb malrotation, methods of measuring.
- MeSH
- femur chirurgie diagnostické zobrazování MeSH
- fraktury femuru * chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- počítačová rentgenová tomografie MeSH
- pooperační komplikace diagnóza etiologie MeSH
- vnitřní fixace fraktury * škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
This study aimed to characterize the mechanical properties of native human ligamentum flavum (LF) and correlate them with histopathological changes. Mechanical property gradients across the cranial, medial, and caudal regions of LF were mapped and compared with histological sections. We also compared lumbar spinal stenosis (LSS) samples with disc herniation (DH) samples as reference material to identify differences in mechanical properties and histopathological features. Our results revealed significant heterogeneity in LF mechanical properties, with local variations correlating with specific histopathological changes such as chondroid metaplasia and loss of elastic fibers. These findings underscore the importance of considering LF heterogeneity in mechanical characterization and provide insights into its behavior under pathological conditions.
- MeSH
- bederní obratle * patologie MeSH
- biomechanika MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum flavum * patologie MeSH
- mechanický stres MeSH
- senioři MeSH
- spinální stenóza * patologie MeSH
- výhřez meziobratlové ploténky * patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Fracture Liaison Service (FLS), nástroj zaměřený na pacienty po fraktuře, kteří jsou ve vysokém riziku další fraktury, účinně zvyšuje záchyt a proléčenost osteoporózy, snižuje riziko fraktur, mortalitu a je nákladově efektivní. Naprostá většina pacientů v ČR (cca 90 %) po prodělané osteoporotické fraktuře zůstává neléčena. Cílem projektu bylo zřídit ve Fakultní nemocnici Královské Vinohrady (FNKV) lokální FLS a zhodnotit realizovatelnost a efektivitu projektu. Z Ortopedicko-traumatologické kliniky byli k osteologickému vyšetření objednáváni pacienti po nízkotraumatické zlomenině proximálního humeru nebo distálního předloktí. Za sledované období 9 měsíců bylo z 403 pacientů s uvedenými zlomeninami odesláno 65 (16,1 %), k vyšetření však dorazila pouze třetina. U většiny (81 %) pacientů byla zahájena antiosteoporotická léčba. Realizace FLS v podmínkách FNKV je reálná, pilotní data jsou slibná, existuje zde však prostor pro zlepšení.
Fracture Liaison Service (FLS) represents an effective tool for patients after low-energy fracture who are at high risk of other fractures. FLS increases the rate of diagnosis and therapy of osteoporosis, decreases fracture rate and mortality and seems to be cost-effective. The vast majority of patients in Czechia (approx. 90 %) after osteoporotic fracture remains untreated. The aim of our project was to organize local FLS in Faculty Hospital Královské Vinohrady (FNKV) and assess its feasibility and efficacy. Patients treated at Orthopedic clinic FNKV with the fracture of distal forearm or proximal humerus, classified as low-energy fracture, were sent to osteologic examination. In the pilot period of 9 months, out of 403 patients with these types of fractures, 65 (16,1 %) were sent to bone specialist. Only one third arrived at the visit but the vast majority of them (81 %) started antiosteoporotic treatment. FLS in FNKV is feasible, pilot data is very promising, however, the optimization remains challenging.
- MeSH
- bederní obratle patologie zranění MeSH
- fixace fraktur metody MeSH
- hrudní obratle patologie zranění MeSH
- krční obratle patologie zranění MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- páteř anatomie a histologie diagnostické zobrazování patologie MeSH
- poranění míchy diagnóza komplikace terapie MeSH
- poranění páteře * diagnóza komplikace terapie MeSH
- protetické prostředky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- fixace fraktur metody MeSH
- fraktury femuru diagnóza klasifikace komplikace terapie MeSH
- fraktury krčku femuru diagnóza komplikace terapie MeSH
- fraktury kyčle diagnóza komplikace terapie MeSH
- fraktury proximálního femuru * diagnóza komplikace terapie MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- Check Tag
- lidé MeSH
- MeSH
- fixace fraktur metody škodlivé účinky MeSH
- fraktury kostí * chirurgie komplikace MeSH
- hojení fraktur fyziologie MeSH
- lidé MeSH
- vnitřní fixace fraktury metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the results of the selected surgical therapy, survival time of the patients and postoperative complications. MATERIAL AND METHODS We retrospectively evaluated the group of patients operated on from 2012 to 2021. The study included 45 patients (24 women and 21 men) with a pathological lesion or a pathological fracture in the area of the proximal femur. The average age was 67 years (38-90). There were 30 (67%) cases of pathological fracture and 15 (33%) cases of pathological lesions in the cohort. In each patient, the perioperative biopsy or resected sample was sent for histological examination. The type of primary malignancy with the localization of lesions and fractures was assessed. Furthermore, we evaluated the outcomes of the surgical method chosen and its complications. We monitored the patients' functional score using the Karnofsky performance status and survival interval. RESULTS The most common primary malignancy was multiple myeloma in 10 cases (22%), followed by seven cases (16%) of breast and lung cancer and 6 cases (13%) of clear cell renal cell carcinoma. Internal fixation was used in 15 cases (33%). Tumor resection with hip joint replacement was performed in 29 patients (64%). One patient was treated with percutaneous femoroplasty. Out of a total of 45 patients, 10 patients (22%) survived for less than three months. The survival rate of more than one year was observed in 21 patients (47%). A total of seven complications occurred in six patients (15%). Fewer complications occurred in the group of patients with a pathological fracture compared to the group with an impending fracture. DISCUSSION Pathological lesions in the bone or an already existing pathological fracture are signs of advanced cancer. Better outcomes are reported in patients who underwent prophylactic surgery, which was, however, not confirmed by our study. The incidence of individual primary malignancies, the postoperative complications and the patient survival corresponded to the statistical data reported by the other authors. CONCLUSIONS In patients with a pathological lesion of the proximal femur, operative treatment will increase the quality of life, either when choosing osteosynthesis or joint replacement, while prophylactic treatment is usually associated with a better prognosis. As a less invasive procedure with lower blood loss, osteosynthesis is indicated for palliative therapy in patients with a limited expected survival time or in patients with a prognosis of healing of the lesion. Reconstruction of the joint with an arthroplasty is indicated in patients with a better prognosis or in cases excluding safe osteosynthesis. Our study confirmed good outcomes with the use of an uncemented revision femoral component. Key words: metastasis, osteolysis, pathological fracture, proximal femur.
- MeSH
- femur chirurgie MeSH
- fraktury femuru * etiologie chirurgie MeSH
- fraktury spontánní * etiologie chirurgie MeSH
- kvalita života MeSH
- lidé MeSH
- nádory * komplikace MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures. MATERIALS AND METHODS: The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon's experience as possible risk factors for limb malrotation after trochanteric fracture surgeries. RESULTS: The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error. CONCLUSION: Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.
- MeSH
- femur diagnostické zobrazování chirurgie MeSH
- fraktury femuru * diagnostické zobrazování etiologie chirurgie MeSH
- fraktury kyčle * komplikace diagnostické zobrazování chirurgie MeSH
- intramedulární fixace fraktury * škodlivé účinky metody MeSH
- kostní hřeby škodlivé účinky MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
