• MeSH
• anamnéza MeSH
• diagnostické zobrazování metody   MeSH
• fyzikální vyšetření MeSH
• klinické laboratorní techniky MeSH
• lidé MeSH
• ortopedie * metody   MeSH
• traumatologie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY Ankle fractures are characterised by a high variability of damage to bone and ligament structures which leads to diverse clinical conditions. This study aims to analyse a group of patients with surgically treated ankle fractures, with a focus on evaluating the outcomes of treatment of ankle joint medial structure injuries (medial malleolar fracture, ligament lesions). MATERIAL AND METHODS The analysed group included 186 patients (102 men and 84 women), in whom an ankle fracture surgery was performed in 2015 and 2016. The outcomes of the treatment were evaluated in 111 patients with type B and type C fractures, who underwent a follow-up examination at one year after the surgery consisting in subjective and objective assessment of the condition and an ankle radiograph. The obtained outcomes were processed using the techniques of descriptive statistics and subsequently evaluated through the Pearson´s chi-square test at 5% significance level, or the Fisher´s exact test for low frequencies. RESULTS The mean age of patients in the group was 48.6 years, while it was lower in men than in women (42.8 years compared to 53.9 years). According to Weber classification, 1 % of fractures were classified as a type A fracture, 68 % as a type B, 27 % as a type C. The group of isolated medial malleolar fractures represented 4 % of cases. The medial side of the ankle joint more frequently suffered a ligament lesion (56 %) than a medial malleolar fracture (44 %). The mean age of the patients with a medial malleolar fracture was 51.9 years, whereas the mean age of the patients with a ligament lesion on the medial side of the ankle was 44.2 years. When evaluating the outcomes using the OMA score at one year postoperatively, a statistically significant difference was found (p = 0.002) between the patients with a medial malleolar fracture (OMA 79.9) and the patients with a ligament lesion at the medial side of the ankle joint (OMA 91.2). DISCUSSION The aim of the study was to add more information on medial structures of ankle joint that are of major importance for ensuring stability of ankle fractures. In agreement with the literature, when managing the ankle fractures with an injury suffered on the medial side there is obviously a more uniform approach in cases with medial malleolar fractures. The situation is different in case of the deltoid ligament lesion, when historically there is a certain level of non-uniformity in indications for revision surgeries and treatment of the injured ligament structures. In our group, in the case of ligament lesion on the medial side of the ankle joint an emphasis is put on the fluoroscopy control of the symmetry of tibiotalar joint space before the beginning of the surgery and also after the fibular fracture stabilisation. The revision surgery was indicated in cases where asymmetry of ankle fork was found. The patients considered the treatment outcome better in cases with a ligament lesion than in cases with a medial malleolar fracture. CONCLUSIONS Proper treatment of medial structures of the ankle joint is important for ensuring the stability of ankle fractures. The patients with type B fractures reported better results at one year postoperatively compared to the patients with type C fracture according to the Weber classification. A statistically significantly better results after the ankle fracture surgery were achieved in patients with the presence of a medial ligament lesion compared to the patients with a medial malleolar fracture. Key words:ankle fracture, injury of medial structures, epidemiology, outcomes of treatment.

• MeSH
• dospělí MeSH
• fraktury kotníku epidemiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• poranění kotníku epidemiologie   chirurgie   MeSH
• vnitřní fixace fraktury MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference 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

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

Zlomeniny proximálního femuru, distálního rádia, proximálního humeru a luxační zlomeniny hlezna jsou nejčastěji se vyskytujícími zlomeninami vůbec. První tři jsou velmi často označovány jako zlomeniny z osteoporózy nebo zlomeniny vyššího věku. V některých studiích jsou uváděna zavádějící data o jejich výskytu a nákladech léčení s cílem omluvit drahou farmakologickou prevenci. Studie má získat epidemiologické údaje o zlomeninách, způsobu ošetření, nutnosti hospitalizace a následnésociální péče. V posledních letech bylo na pracovišti autorů ošetřeno ročně kolem 350 pacientů se zlomeninou PF, 330 se zlomeninou DR, 220 se zlomeninou PH a asi 200 se zlomeninou ATC. Při prospektivním sledování v letech 2005-07 (doba trvání navrhovaného grantu) by bylo možnévyhodnotit soubor přibližně 2000-3000 pacientů s uvedenými sledovanými zlomeninami.; Among the most frequent fractures are those of the proximal femur, distal radius, proximal humerus and fracture-dislocations of the ankle. The first three of them are often designated as "osteoporotic fractures" or "geriatric fractures". Some studies often present misleading data on the incidence of these fractures and cost of the treatment. The aim of the study is to investigate into the state of affairs, i.e. basic epidemiologic data, method of treatment, necessity of hospitalization. In the recent years, the autors´Department has treated annually approx. 350 patients with PF fracture, 330 with DR fracture, 220 with PH fracture and about 200 with ATC fracture. With a prospective completing of the group of patients by adding data for 2005 through 2007(planned duration of the proposed project), it would be possible to evaluate the groups of approx. 2000 to 3000 patients with the specified fractures.

• MeSH
• epidemiologický výzkum - projekt MeSH
• fraktury femuru epidemiologie   chirurgie   terapie   MeSH
• fraktury humeru epidemiologie   chirurgie   terapie   MeSH
• fraktury kostí epidemiologie   chirurgie   terapie   MeSH
• fraktury vřetenní kosti epidemiologie   chirurgie   terapie   MeSH
• kotník chirurgie   MeSH
• longitudinální studie MeSH
• registrace statistika a číselné údaje   MeSH
• sběr dat MeSH
• statistika přirozeného pohybu MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• epidemiologie
• demografie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

Autoři sledovali dlouhodobě základní epidemiologické charakteristiky u zlomenin proximálního humeru (1464 pacientů), distálního radia (2514 pacientů), proximálního femuru (3340 pacientů) a luxačních zlomenin hlezna (1195 pacientů). U zlomenin proximálního femuru byl celkový průměrný věk 78 roků, průměrný věk mužů 71, 6 roků a u žen 80,3 roku, poměr muži/ženy byl 27:73. U zlomenin proximálního humeru byl celkový průměrný věk 67 roků, u mužů 58,8 roků, u žen 71,2 roku a poměr muži/ženy činil 30:70. U zlomenin distálního radia byl celkový průměrný věk 59 roků, průměrný věk mužů 45,8 roků a žen 64,7 roků, poměr muži/ženy činil 29:71. Luxačních zlomenin hlezna byl průměrný věk 49 roků, průměrný věk mužů 43,4 roků a žen 54,7 roků, poměr muži/ženy činil 50:50. Do konce 5. dekády bylo u všech zlomenin vyšší zastoupení mužů, od 6. dekády se poměr obrátil. Zavedení nových implantátů (úhlově stabilní dlahy, nová generace hřebů) pro zlomeniny distálního radia a proximálního humeru zvýšilo významně procento operovaných pacientů.

The authors analyze the results of their long-term follow-up of basic epidemiological characteristics in fractures of proximal humerus (1 464 patients), distal radius (2 514 patients), proximal femur (3 340 patients) and fracture-dislocation of the ankle (1 195 patients). In fractures of the proximal femur, the average age was 78 years; 71.6 years in men and 80.3 years in women; male-female ratio was 27:73. In fractures of the proximal humerus, the average age was 67 years; 58.8 years in men and 71.2 years in women; male-female ratio was 30:70. In fractures of the distal radius, the average age was 59 years; 45.8 years in men and 64.7 years in women; male-female ratio was 29:71. In fracture-dislocation of the ankle the average age was 49 years; 43.4 years in men and 54.7 years in women; male-female ratio was 50:50. Until 5th decade men had higher representation in all groups of fractures, starting from 6th decade the ratio changed. Introduction of new implants (locking plate, new generation of nails) for fractures of the distal radius and proximal humerus increased significantly the percentage of patients operated on.

• MeSH
• dislokace kloubu ekonomika   epidemiologie   chirurgie   MeSH
• financování organizované MeSH
• fraktury femuru ekonomika   epidemiologie   chirurgie   MeSH
• fraktury humeru ekonomika   epidemiologie   chirurgie   MeSH
• fraktury vřetenní kosti ekonomika   epidemiologie   chirurgie   MeSH
• hlezenní kloub chirurgie   MeSH
• ortopedické výkony statistika a číselné údaje   MeSH
• věkové faktory MeSH

OBJECTIVES: To evaluate patients with Bosworth-type fibular entrapment injuries of the ankle. DESIGN: Retrospective clinical study and analysis of the literature. SETTING: University hospital. PATIENTS: Six cases treated for Bosworth-type fibular entrapment injuries (the Bosworth lesion) in the period 2001 to 2004. INTERVENTION: Five patients were treated with open reduction and internal fixation (ORIF), and 1 patient was treated with closed reduction and cast. RESULTS: All patients treated by ORIF healed without complications with a good subjective outcome. In 1 case treated nonoperatively, an ankle fusion had to be performed 2 years after injury for severe osteoarthritis. Additionally, we have recorded 3 cases, 2 not previously described in the literature, in which the fracture of the fibula was located at the middle or proximal third of its shaft.In the literature we found another 54 cases with dislocation of the fibula behind the posterior tubercle of the distal tibia. The analysis showed that morphology of the Bosworth lesion, as we prefer to refer to this complex fracture-dislocation, changes with age and may be divided into 3 basic types. In children and adolescents the dislocation of the distal fibula is associated with epiphyseolysis of the distal tibia; in young adults the fibula dislocates without fracture; in middle-aged and older adults, the dislocated fibula fractures, probably because of the decreased elasticity. CONCLUSIONS: The Bosworth lesion is a severe injury of the ankle, and its successful treatment requires a correct diagnosis based on careful initial clinical and radiographic evaluation and early surgical treatment.

• MeSH
• dislokace kloubu chirurgie   komplikace   radiografie   MeSH
• dospělí MeSH
• fibula zranění   MeSH
• financování organizované MeSH
• fixace fraktury metody   MeSH
• fraktury kostí chirurgie   komplikace   radiografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• poranění kotníku komplikace   radiografie   terapie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• ukazatel závažnosti úrazu MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• endoskopie * výchova   MeSH
• multimédia * MeSH
• vyučování * metody   MeSH