Úvod: Luxační zlomeniny distálního bérce jsou indikovány k operačnímu řešení. Pokud kvalita měkkých tkání a kůže neumožňuje primární suturu rány, jedná se o závažný problém, který musí operatér řešit. V našem případě jsme po repozici a fixaci skeletu byli schopni provést suturu fascie s reziduálním velkým defektem kůže a podkoží. Rozhodli jsme se pro využití kombinace aplikace Amniodermu a podtlakové terapie. Metodika: Autoři popisují postup léčby akutní rány u mladého morbidně obézního pacienta s poraněním hlezna po dopravní nehodě. Diskuze: Uzávěr operační rány v terénu otoku a hematomu představuje častý problém, se kterým se setkáváme u nemocných po osteosyntéze hlezna. Existuje několik možných způsobů, které lze využít, zcela jistě mezi ně patří i možnost využití podtlakové terapie, jejíž efekt lze umocnit aplikací Amniodermu. Závěr: Přestože se jedná o první využití prezentované techniky, na podkladě našich dalších zkušeností s Amniodermem obecně a častého využití podtlakové terapie z jiných indikací si dovolujeme tvrdit, že se jedná o bezpečnou metodu, která nabízí efektivní řešení složité ultimátní situace.

Introduction: Dislocation fractures of the distal lower leg require surgical treatment. If the quality of the soft tissues and skin does not allow primary suture of the wound, it presents a serious challenge for the surgeon. In our case, after reposition and fixation of the fractures, we were able to perform a fascia suture with a residual large skin and subcutaneous defect. We decided to use a combination of Amnioderm application and negative pressure therapy. Methods: The authors describe the procedure for the treatment of an acute wound in a young, morbidly obese patient with an ankle injury following a traffic accident. Discussion: Closure of the surgical wound in the field of swelling and hematoma is a frequent problem encountered in patients after ankle osteosynthesis. There are several possible approaches, one of which is the use of negative pressure therapy. Its effect can be enhanced by the application of Amnioderm. Conclusion: Although this is the first use of the presented technique, based on our other general experience with Amnioderm and the frequent use of negative pressure wound therapy from other indications, we dare to say that it is a safe method that offers an effective solution to a complex, critical situation.

• Klíčová slova
• Amnioderm,
• MeSH
• biologické krytí MeSH
• dospělí MeSH
• fraktury kotníku * chirurgie   komplikace   MeSH
• hojení ran MeSH
• lidé MeSH
• morbidní obezita komplikace   MeSH
• poranění kotníku chirurgie   komplikace   MeSH
• terapie ran pomocí řízeného podtlaku * MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Traumatologický plán je soubor opatření pro zmírnění následků poranění při mimořádných událostech a krizových situacích. Na I. chirurgické klinice Všeobecné fakultní nemocnice byl aktivován v prosinci 2023 v den, kdy došlo k tragické střelbě v budově Filozofické fakulty Univerzity Karlovy v Praze. Díky cvičným aktivacím byly bez komplikací připraveny během 20 minut týmy, prostory a byla uvolněna lůžka. Mimořádným případem bylo střelné poranění, k němuž došlo na vzdálenost 350 metrů (na druhém břehu Vltavy), jehož původu si však pacient – cizinec – nebyl vědom a byl referován jako zlomenina femuru po pádu při útěku.

The Trauma Plan is a set of measures to mitigate the consequences of injury in emergencies and crisis situations. It was activated at the First Surgical Clinic of the General University Hospital in December 2023, on the day of the tragic shooting in the building of the Faculty of Arts of Charles University in Prague. Thanks to the practice activations, teams, premises and beds were prepared within 20 minutes without complications. An exceptional case was a gunshot wound that occurred at 350 meters (on the other bank of the Vltava River), the origin of which, however, the patient-foreigner was not aware of and was reported as a fracture of the femur after a fall while fleeing.

• MeSH
• dospělí MeSH
• fraktury proximálního femuru chirurgie   diagnostické zobrazování   MeSH
• lidé MeSH
• plánování postupu v případě katastrof MeSH
• střelné rány * chirurgie   diagnostické zobrazování   MeSH
• třídění pacientů MeSH
• tříštivé fraktury * chirurgie   diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Bosworth fractures (BFs) with entrapment of a fibular fragment behind the posterior malleolus (PM) are rare but potentially serious injuries to the ankle. Despite an increased awareness through a more regular use of computed tomography (CT) scanning, there is still a scarcity of clinical outcome studies. METHODS: Over a course of 25 years, data on 23 patients treated for BF at our institutions (mean age 44 years) were collected prospectively. Of those, 16 patients had a Weber type B fracture with displacement of the proximal fibular fragment and 7 patients Weber type C fractures with displacement of the distal fibular fragment behind PM. All but 1 patient, who refused operative treatment, were treated with open reduction and internal fixation. A total of 21 patients were followed up for an average of 66 (range, 18-204) months. RESULTS: The PM was fractured in 96% and the Tillaux-Chaput tubercle in 13% of cases. In 80% of patients with preoperative CT scans, the fibular fragment was entrapped between the posterior aspect of the distal tibia and the displaced PM fragment. An initial attempt at closed reduction was successful in 4 of 7 Weber type C fractures and in none of 16 Weber type B fractures. The overall complication rate was 22%. Eighty-one percent of patients rated their results as good or excellent. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the final follow-up averaged 84.1 (range, 45-100). Risk factors for postoperative osteoarthritis and poor functional results included unsuccessful closed reduction, inadequate open reduction, and avascular necrosis of the talus. Clinical and radiographic results were correlated. CONCLUSION: Unsuccessful initial reduction and failure to achieve anatomic open reduction were associated with posttraumatic arthritis whereas open anatomic reduction and internal fixation resulted in favorable functional and radiographic results in the medium to long term.

• MeSH
• dospělí MeSH
• fibula * zranění   diagnostické zobrazování   chirurgie   MeSH
• fraktury kostí chirurgie   diagnostické zobrazování   MeSH
• fraktury kotníku chirurgie   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• otevřená repozice fraktury metody   MeSH
• počítačová rentgenová tomografie * MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• senioři MeSH
• vnitřní fixace fraktury * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

To evaluate vitamin D levels in children treated with fractures during the healing period. A four-year prospective study, including healthy children treated with diaphyseal fracture of femur or forearm bones. Vitamin D levels were examined four times: at the time of the injury and then one, three, and five months after the injury, together with P1NP, ALP, GGT, and parathormone. In the beginning, patients were blindly divided into two groups, one supplemented with vitamin D3 for the entire follow-up period, the other non-supplemented. Altogether, 107 children underwent examination at the time of their injuries. Of these, 63 were included in the study and examined for the entire follow-up period - 36 supplemented, 27 non-supplemented. At the time of injury, 42 % had a deficit of vitamin D, 36.5 % had insufficiency, only 21.5 % had normal levels. In the children supplemented with cholecalciferol, vitamin D levels increased statistically significantly during the follow-up period (already after 1 month), in contrast with non-supplemented patients, where they did not. When we divided patients according to the initial vitamin D levels (deficit/insufficiency/normal levels) or fracture type (femur/forearm), we also observed significantly better results in supplemented groups. We observed a high prevalence of vitamin D deficit or insufficiency in healthy children at the time of their injuries. Patients supplemented with vitamin D3 had normal levels already after one month and this persisted throughout the follow-up period, in contrast with non-supplemented patients. Therefore, we recommend vitamin D testing and administration for children treated for fractures. Keywords: Vitamin D, Pediatric fracture, Children, Vitamin D supplementation.

• MeSH
• cholekalciferol krev   terapeutické užití   MeSH
• dítě MeSH
• fraktury femuru krev   epidemiologie   MeSH
• hojení fraktur * účinky léků   MeSH
• lidé MeSH
• mladiství MeSH
• následné studie MeSH
• nedostatek vitaminu D * krev   epidemiologie   farmakoterapie   MeSH
• potravní doplňky MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• vitamin D * krev   terapeutické užití   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: No comprehensive treatise on the early history of fractures of posterior malleolus (PM) has yet been published, and many substantial discoveries have fallen into oblivion-particularly if not having been published in English originally. MATERIALS AND METHODS: Literature search was performed in original publications and historical sources. RESULTS: Early history of PM fractures from their first description up to the beginnings of their operative treatment may be divided into three basic periods, covering the era between 1828 and 1940. In the pre-radiological period (1828-1895), description of PM injuries was based merely on the autopsy findings in deceased patients. The first mentions of this injury were published by the British authors. In the radiologic period (1899-1916), the x-ray examination started a revolution also in diagnostics of ankle fractures, with the first radiographs performed as early as in 1899. Radiographic examination had subsequently become an integral part of the diagnostics of these injuries and initiated a number of significant studies of PM fractures. The first detailed mention of a PM injury may be found in the French and German literature. The period of early operative treatment (1918-1940), i.e., open reduction and internal fixation of PM, was started by the younger post-WWI generation, primarily the French surgeons, represented by Gaston Picot. His operative technique and the first six cases treated operatively between 1918 and 1921 were described in 1921 by Edouard Huc. Picot himself published his technique in great detail in 1923. CONCLUSION: The early history of diagnostics and treatment of PM fractures witnesses the remarkable body of knowledge gathered about that topic by numerous visionary surgeons predominantly French and German surgeons immediately before and after World War I. They substantially contributed to the radiological examination and operative treatment of this injury.

• MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• fraktury kotníku * dějiny   chirurgie   diagnóza   MeSH
• lidé MeSH
• radiografie metody   MeSH
• vnitřní fixace fraktury dějiny   metody   MeSH
• Check Tag
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY: Intertrochanteric hip fractures in elderly patients are a significant cause of morbidity and mortality, with increasing incidence due to the aging population. Despite advancements in intramedullary nailing (IMN) technology, fixation failure remains a concern. This study aims to evaluate pre-and postoperative radiographic risk factors for varus collapse in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN, Smith & Nephew). MATERIAL AND METHODS: This retrospective study included patients over 60 years with AO 31A1 and 31A2 intertrochanteric femur fractures treated with InterTAN at a tertiary referral center from August 2012 to August 2017. Patients with high-energy fractures, AO 31A3 fractures, or those requiring open reduction were excluded. Data on demographics, fracture classification, implant sizes, imaging studies, and follow-up were collected. Radiographic assessments included Chang's medial cortical support concept, tip-apex distance (TAD), calcar-referenced TAD (CalTAD), neck-shaft angles (NSA), and screw placement according to Cleveland zones. Varus collapse was defined as a >5° change in NSA within three months postoperatively. Multivariate logistic regression analysis was used to identify risk factors for varus collapse. RESULTS: The study included 136 patients with a mean age of 79.8 years, of whom 38.2% were male. The early postoperative tipapex distance (TAD) averaged 21.9mm, with 30.1% of patients experiencing varus collapse greater than 5°. Positive medial cortical support (PMCS) or neutral position (NP) type reduction was highly protective against varus collapse (p < 0.001), as well as TAD less than 25mm (p < 0.001). Additionally, the placement of screws in the central-central or central-inferior zones provided a protective effect against varus collapse (p = 0.031). Conversely, having an OTA/AO type A2.2 or A2.3 fracture significantly increased the risk of varus collapse (p = 0.030). Other factors, such as CalTAD and the nail width to medullary canal ratio, did not significantly predict varus collapse (p = 0.831 and p = 0.952, respectively). DISCUSSION: Our findings align with previous studies highlighting TAD and screw placement as critical factors in preventing fixation failure. The protective effect of PMCS or NP reduction and the increased risk associated with OTA/AO type A2.2 and A2.3 fractures are noteworthy. Unlike previous studies, CalTAD was not significantly associated with varus collapse in our cohort. The study underscores the importance of surgical technique and radiographic parameters in optimizing outcomes for elderly patients with intertrochanteric fractures. CONCLUSIONS: In elderly patients treated with InterTAN nails, varus collapse is influenced by fracture type, TAD, reduction quality, and screw placement. Ensuring a TAD <25mm, achieving PMCS or NP reduction, and placing screws in central-central or central-inferior zones are crucial for minimizing varus collapse. These findings highlight the importance of meticulous surgical technique and radiographic assessment in managing intertrochanteric fractures in the elderly. KEY WORDS: hip fractures, intertrochanteric fractures, internal Fixation, geriatrics, cephalomedullary nail.

• MeSH
• fraktury kyčle * chirurgie   MeSH
• intramedulární fixace fraktury * metody   přístrojové vybavení   škodlivé účinky   MeSH
• kostní hřeby * MeSH
• kostní šrouby * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   epidemiologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• selhání protézy MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The bone transport technique uses the principle of distraction-osteogenesis and fill bone defects with the aid of an external fixator. In order to evaluate the clinical effect of femoral internal fixation with Ortho-Bridge System after bone transport, 4 patients after femoral bone transport from October 2020 to October 2022 are studied in this paper. Among them, 3 patients ran refracture of femur after removal of the Limb reconstruction system, 1 patient just finish femoral bone transport and request internal fixation. The surgery results show that Ortho-Bridge System can be used in the situation that conventional Locking compression plate and intramedullary nail are not suitable due to anatomical variation after femoral bone transport. Key words: femoral fracture; Ortho-Bridge System; bone transport; postoperative complications of bone transport.

• MeSH
• dospělí MeSH
• externí fixátory MeSH
• femur chirurgie   MeSH
• fraktury femuru * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteogeneze pomocí distrakčního aparátu metody   přístrojové vybavení   MeSH
• pooperační komplikace etiologie   MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

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

Proximal femur fractures (PFF) pose a major challenge in elderly patients with severe comorbidities and receiving antithrombotic therapy since according to the latest guidelines the surgery should be performed as soon as possible, preferably within 24 hours, to reduce mortality and morbidity. This review outlines the practical approach to surgical management of PFF that relies on increasing evidence of safety of early surgery in patients with PFF receiving antiplatelet and anticoagulant therapy. We have also used information from the existing evidence-based guidelines for elective/planned surgery in patients with antithrombotic therapy. The practical approach can be summarised as follows: • Antiplatelet therapy - discontinuation of acetylsalicylic acid (ASA) and clopidogrel in monotherapy or in combination is not necessary prior to surgery. In case of bleeding, antifibrinolytic therapy is recommended as well as administration of platelet concentrate which is rarely needed. • In patients taking warfarin, reversal of its effects is recommended by early administration of vitamin K to allow surgery to be performed within 24 hours. Prothrombin complex concentrate (PCC) as a second-line drug is reserved for extreme cases only. Warfarin therapy is resumed 24 hours after surgery. • Direct oral anticoagulants must be discontinued 24-48 hours prior to surgery, possibly longer depending on the type of drug, time of administration of the last dose, and renal function. In extreme cases, an antidote (idarucizumab, off-label andexanet) can be administered prior to surgery, or PCC in case they are unavailable. Anticoagulation therapy is resumed in 24-48 hours. • Neuraxial anaesthesia is possible when ASA is taken by the patient and in case of effective warfarin reversal. • In early surgery and rapid restart of anticoagulant therapy, bridging therapy with LMWH is not indicated except for in cases with extreme risk of thrombosis. Key words: proximal femur fracture, antiplatelet therapy, anticoagulant therapy, perioperative management.

• MeSH
• antikoagulancia * škodlivé účinky   aplikace a dávkování   terapeutické užití   MeSH
• Aspirin škodlivé účinky   terapeutické užití   aplikace a dávkování   MeSH
• fraktury femuru chirurgie   MeSH
• fraktury proximálního femuru MeSH
• inhibitory agregace trombocytů * škodlivé účinky   terapeutické užití   MeSH
• lidé MeSH
• warfarin škodlivé účinky   terapeutické užití   aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: The aim of this study was to describe the incidence and a complex pathoanatomy of posterior malleolus fractures in a Maisonneuve fracture. METHODS: The study included 100 prospectively collected patients with a complete clinical and radiological documentation of an ankle fracture or fracture-dislocation including a fracture of the proximal quarter of the fibula. RESULTS: A posterior malleolus fracture was identified in 74 patients, and in 27% of these cases it carried more than one quarter of the fibular notch. Displacement of the posterior fragment by more than 2 mm was shown by scans in 72% of cases. Small intercalary fragments were identified in 43% of cases. Fractures of the Tillaux-Chaput tubercle were identified in 20 patients. CONCLUSION: Our study has proved a high rate of posterior malleolus fractures associated with a Maisonneuve fracture, and documented their considerable variability in terms of involvement of the fibular notch, tibiotalar contact area, direction of displacement and frequency of intercalary fragments. Of no less importance is a combination of Tillaux-Chaput fractures with a Maisonneuve fracture.

• MeSH
• dislokovaná fraktura diagnostické zobrazování   MeSH
• dospělí MeSH
• fibula zranění   diagnostické zobrazování   MeSH
• fraktury kotníku * diagnostické zobrazování   chirurgie   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• 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