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
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
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
Hallux extensus is a persistent dorsiflexion of the first metatarsophalangeal joint. Apart from many other causes, it can also be caused by contracture of the extensor hallucis longus muscle, in our case resulting from surgical treatment of crural fracture. The authors present the case of a 17-year-old soccer player who sustained a fracture of both shin and calf bone during a soccer match and underwent surgical treatment with intramedullary nailing. While compartment syndrome wasn't observed, a postoperative complication in the form of progressive development of a dynamic type of hallux extensus was reported. The reason behind this complication was later found to be the interaction of the osteosynthesis material with the extensor hallucis longus muscle, which led to its scarring and shortening. A Z-lengthening of the musculus extensor hallucis longus tendon was indicated and performed with a good clinical outcome. During surgery, an anatomical variation in the course of the extensor hallucis longus was observed, which had to be taken into account to achieve a successful surgical outcome. Key words: cock-up big toe deformity, musculus extensor hallucis longus contracture, Z-lengthening tenotomy, crural fracture complication.
- MeSH
- fotbal zranění MeSH
- fraktury kostí chirurgie komplikace MeSH
- intramedulární fixace fraktury škodlivé účinky metody MeSH
- lidé MeSH
- mladiství MeSH
- palec nohy * chirurgie MeSH
- pooperační komplikace etiologie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky 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
[Osteosynthesis of fractures in the preaseptic period]
První úspěšnou osteosyntézu u pacienta s otevřenou zlomeninou bérce v předaseptickém období provedl pomocí zlatého drátu vlámský chirurg Dominique Le Roy v roce 1796 v Antverpách. V první polovině 19. století našel řadu následovníků, mezi nimi i Achille-Cléophase Flauberta, otce spisovatele Gustava Flauberta, kteří ošetřili otevřenou operací jak akutní zlomeniny, tak paklouby. Prakticky ve všech případech došlo ke hnisání, u některých pacientů se kost přesto zhojila, jiné případy skončily amputací nebo dokonce smrtí. Přes řadu neúspěchů byly jednotlivé operace inspirací pro další generaci chirurgů. Trvalo však dalších 40 let, než byly belgickým chirurgem Albinem Lambottem položeny základy moderní osteosyntézy.
The first successful internal fixation in the pre-aseptic period was performed by the Flemish surgeon Dominique Le Roy in 1796 in Antwerpen, using a gold wire in a patient with an open fracture of the lower leg. In the first half of 19th century, he was followed by a number of other surgeons, among them Achille-Cléophase Flaubert, father of the famous novelist Gustav Flaubert, who treated both acute fractures and non-unions. Almost all operations resulted in suppuration, however, in many patients the fracture healed, while other cases ended in amputation or even death. Despite a series of failures, individual operations inspired the next generation of surgeons. Nevertheless, it took another 40 years before the foundations of modern internal fixation were laid by the Belgian surgeon Albin Lambotte.
- MeSH
- dějiny 19. století MeSH
- dějiny lékařství MeSH
- fraktury kostí terapie MeSH
- infekce MeSH
- lidé MeSH
- vnitřní fixace fraktury * dějiny MeSH
- Check Tag
- dějiny 19. století MeSH
- lidé MeSH
- Publikační typ
- historické články MeSH
- práce podpořená grantem MeSH
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
INTRODUCTION: German-speaking surgeons have left a deep imprint on the history of diagnostics and treatment of proximal femur fractures. Some of the studies published in German have fell into oblivion, others are cited until today, although sometimes quite inaccurately. The cause of such inaccuracies are citations from secondary sources due to unavailability of the original or inability to read it because of a language barrier. In the current literature, globally predominated by English articles, the "German history" of treatment of proximal femur fractures remains undervalued. The aim of the present article is to point out its contribution. MATERIALS AND METHODS: Literature search was performed in original publications and historical sources. RESULTS: The German-speaking surgeons have considerably contributed to the development of the treatment of proximal femur fractures. The analyzed period between 1847 and 1970 may be divided into three basic periods. In the first period (1847-1896), the German-speaking surgeons (Langenbeck, Trendelenburg, König, Heine, Dolinger) were the first worldwide to start treating the fractures of proximal femur operatively. In the second period (1897-1935), mainly in the 1930s, the initiative in Europe was taken over by surgeons publishing studies in France and in Belgium. Overseas, American surgeons were coming to the forefront. In Germany, only Pauwels developed the first biomechanical classification of femoral neck fractures. In the third period (1936-1970), mainly in the 1940s and 1950s, implants were designed (Pohl, Künstcher), based on close collaboration between German engineers and surgeons, that served as a model for a dynamic hip screw and a proximal femoral nail, which are currently the implants of choice in the treatment of trochanteric fractures. CONCLUSION: The historical contribution of German-speaking surgeons to understanding the issue of proximal femur fractures and their operative treatment is far more significant than presented in the historical studies published in English.
