PURPOSE OF THE STUDY: Intraarticular fractures of the distal femur rank among the most severe musculoskeletal injuries. Various treatment options, such as plate osteosynthesis or retrograde nailing, can be employed. This study aims to evaluate the clinical outcomes and complications of intraarticular distal femoral fractures treated with retrograde femoral nail, with particular emphasis on C3 fractures. MATERIAL AND METHODS: Between January 2016 and January 2023, 18 AO/33.C3 fractures were treated with a retrograde femoral nail. Of these, two were classified as 33.C1, eight as 33.C2 and eight as 33.C3. Twelve of the fractures were open. After the initial treatment and stabilizing the patient's overall condition, we proceeded with the definitive osteosynthesis. The first phase involved open reduction and fixation using individual screws to reconstruct the articular surface. The second phase consisted in retrograde nailing with correction of the length, axis and rotation of the femur. The evaluation criteria included: complication rate, number of revisions, knee range of motion, mechanical axis and length of the lower extremity, progression of gonarthrosis, pain level, need of walking support, Lysholm and Tegner Activity Score for functional outcome. RESULTS: Overall, we evaluated the complications and the outcomes of 12 patients (13 fractures). Of these, 8 patients experienced some kind of postoperative complications, primarily insufficient healing or nonunion, which were managed through revision surgery. Plate reosteosynthesis was used in 2 patients who were then excluded from the final clinical evaluation. No cases of deep infection or deep vein thrombosis were reported and no patient required total knee replacement. Seven AO/33.C3 fractures were individually evaluated. The average knee range of motion was nearly 0-93°, maximum flexion was 120°. On average, the lower extremity was 1.6 cm shorter and 7.3° varus to the mechanical axis. Only little progression of gonarthrosis was observed along with low levels of pain. The Lysholm Score ranged between 52 and 84 points (averaging 73.1). The mean Tegner Activity Score was 3.4. All results showed adequate improvement in 33.C2 and 33.C1 groups. DISCUSSION: The retrograde femoral nail demonstrates several advantages over the locking compression plate, particularly in biomechanical aspects. Various clinical studies have reported superior outcomes in terms of healing, complication rate, blood loss and functional outcome. Our study findings align with some of those international studies, particularly in the rate of infectious complications (0%), mean Lysholm Score (79.3 p.) and Tegner Activity Score (4.1). On the other hand, we observed a higher rate of revision surgery (53.8 %), mainly due to evaluating 33.C fractures only. The main advantage of this method lies in complete visualization, leading to better reconstruction of the articular surface coupled with excellent biomechanical properties of the intramedullary nail. CONCLUSIONS: Intraarticular distal femoral fractures pose significant challenges to treatment and frequently lead to permanent damage. The primary treatment goals involve achieving anatomical reposition of the articular surface, stable osteosynthesis, correction of the femoral length and axis and early rehabilitation. Our study demonstrates good clinical outcomes with a relatively low rate of complications. Patients are capable of walking without pain, achieving a good range of motion, returning to their occupations and becoming self-sufficient. Moreover, there were no infectious complications and no significant progression of gonarthrosis. KEY WORDS: retrograde femoral nail, intraarticular distal femoral fracture, functional outcome, complication rate.
- MeSH
- fraktury femuru * chirurgie MeSH
- intraartikulární fraktury chirurgie MeSH
- intramedulární fixace fraktury metody přístrojové vybavení MeSH
- kostní hřeby * MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace etiologie MeSH
- reoperace metody MeSH
- rozsah kloubních pohybů MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY Extended lateral approach to calcaneus fractures is associated with a high risk of infection. Such risk can be reduced by using mini-invasive approaches. The sinus tarsi approach provides a good overview of the posterior joint facet of the calcaneus and can also be done as a mini-invasive procedure. The authors present their fi rst experience with osteosynthesis of joint depression calcaneal fractures using the anterolateral locking plate inserted through the sinus tarsi approach. MATERIAL AND METHODS During the period from 1 February 2020 to 31 January 2022, 18 patients were treated by the anterolateral locking plate in the authors' department (3 women, 15 men). Eleven fractures were classifi ed according to Sanders as IInd grade, fi ve as IIIrd grade and two fractures were classifi ed as tongue-type (as described by Essex-Lopresti). The fractures were treated by open reduction through the sinus tarsi approach and osteosynthesis by the anterolateral locking plate combined with headless screws. The following factors were examined: time from injury, duration of surgery, quality of reduction (post-op control with multiplanar CT scans), wound and technical complications, loss of reduction after treatment, substance abuse and comorbidities. The follow-up was 12-36 months (median 17). At one year after surgery, the functional outcomes were evaluated using the AOFAS Hindfoot score. RESULTS The most common negative predispositions for successful healing were smoking (9 cases), alcohol abuse, drug abuse, mild mental retardation, personality disorder, insulin-dependent diabetes and epilepsy (1 case each), hypothyreodism and bronchial asthma (2 cases each). The time from injury to surgery and duration of surgery surgery were measured. The quality of reduction was excellent in 12 patients (dislocation less than 1 mm), good in 6 patients (dislocation less than 2 mm), dislocation more than 2 mm was not present in the group. In one case, a revision surgery was performed because of screw malposition into the subtalar joint, delayed wound healing was observed in two cases. There was no case of deep surgical site infection or loss of reduction. The mean AOFAS score after one year was 85 points. The most common complaints were scar pain or discomfort. DISCUSSION The current studies on osteosynthesis of calcaneal fractures favor the sinus tarsi approach for its lower risk of wound-related complications compared to the extended lateral approach. The sinus tarsi approach requires the use of different osteosynthetic material than the conventional calcaneal plate. If a conventional locking plate is to be used, the surgical approach has to be modifi ed. In 2021, Wang et al. published an intermediate step leading to the reduction of early complications and the use of conventional locking calcaneal plate inserted through the sinus tarsi approach, with an additional incision. The sinus tarsi approach is used also when intramedullary nailing is performed, which is preferred by biomechanical studies evaluating the rigidity of osteosynthesis. However, when comparing nails and locking plates, the differences are insignifi cant. The use of anterolateral locking plates was presented by Xie et al., with results similar to those of our own group of patients. CONCLUSIONS The results of the followed-up group of patients confi rm low complication rate of the sinus tarsi approach as reported by current literature. At the same time, it provides good options for reduction even in complicated fractures. For successful osteosynthesis, the anterolateral locking plate with headless screws may be used. The incidence of post-operative complications is low even in high-risk patients. Adhesions of peroneal tendons can be treated with material removal and tissue release. They could be prevented by good physiotherapy. Key words: calcaneus, osteosynthesis, anterolateral plate, peroneal tendons, sinus tarsi approach.
- MeSH
- fraktury kostí * chirurgie MeSH
- intraartikulární fraktury * chirurgie MeSH
- kostní destičky MeSH
- kostní šrouby MeSH
- lidé MeSH
- patní kost * chirurgie zranění MeSH
- počítačová rentgenová tomografie MeSH
- poranění kolena * MeSH
- poranění kotníku * MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- dislokace kloubu diagnóza komplikace terapie MeSH
- intraartikulární fraktury diagnóza komplikace terapie MeSH
- kloubní ligamenta zranění MeSH
- klouby * anatomie a histologie zranění MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Minimal and limited access techniques are gaining increasing interest for the treatment of displaced intra-articular calcaneal fractures. The ideal treatment method is however still debated and largely based on individual case factors and surgeon experience. Aim of this study was thus to compare the treatment characteristics and radiographic correction potential of a locking nail system with a sinus tarsi approach to plate fixation via an extended lateral approach. MATERIAL AND METHODS We retrospectively reviewed 39 cases of patients with calcaneal fractures that received primary fracture treatment for displaced intra-articular calcaneal fractures between July 2017 and March 2020. Patient characteristics, time to surgery, time to discharge, OR time and the correction achieved were analyzed and comparative statistics performed. RESULTS In total 19 patients treated with the locking nail and 20 patients treated with plate fixation were analyzed. Patient age and fracture severity according to the Sanders classification were comparable between the groups. Overall surgical time, as well as the achieved reduction was equal between both groups. Time to surgery, as well as time from surgery to discharge was significantly shorter in the locking nail group. 2 additional soft tissue procedures were necessary in the extended lateral approach group. DISCUSSION AND CONCLUSIONS The results with the locking calcaneus nail and sinus tarsi approach suggest, that similar treatment results can be achieved as with plate osteosynthesis and an extended lateral approach. Soft tissue management, as well as pre- and postoperative timing and discharge management can be improved with the nail. Further controlled trials comparing the longterm outcome between the treatment options are needed. Key words: calcaneus fracture, sinus tarsi approach, calcaneal nail, C-Nail.
- MeSH
- fraktury kostí * diagnostické zobrazování chirurgie MeSH
- intraartikulární fraktury * chirurgie MeSH
- kostní destičky MeSH
- lidé MeSH
- patní kost * diagnostické zobrazování chirurgie MeSH
- poranění kolena * MeSH
- poranění kotníku * MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Almost 70 scapular fractures in children and adolescents, up to the age of 17 years, have been described in detail in the literature since 1839. The diagnosis of these injuries was based on autopsy, radiographs, CT and MRI examinations. The most frequent findings were fractures/epiphyseolyses of the coracoid, followed by fractures of the infraspinous part of the body and avulsion of the inferior angle of the scapular body. Less common were fractures of the acromion. Intra-articular fractures of the glenoid, or separation of an intact glenoid along the line of the anatomical or surgical necks, were reported only sporadically. Scapulothoracic dissociation was also recorded in several cases. The majority of fractures were treated non-operatively; operative treatment was used in glenoid fractures, certain fractures of the coracoid and fractures of the scapular body with intrathoracic penetration. Except for scapulothoracic dissociation, outcomes of treatment of these injuries were very good.
- MeSH
- akromion MeSH
- dítě MeSH
- fraktury kostí * diagnostické zobrazování chirurgie MeSH
- fraktury proximálního humeru * diagnostické zobrazování MeSH
- intraartikulární fraktury * MeSH
- lidé MeSH
- lopatka chirurgie MeSH
- mladiství MeSH
- poranění hrudníku * MeSH
- radiografie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF THE STUDY Fractures of the scapula are less frequent, with the incidence reported in literature of approximately 1% of all fractures and 3-5% fractures of shoulder. These fractures are predominantly treated non-operatively. Osteosynthesis is indicated in displaced intra-articular fractures and severely displaced extra-articular fractures of the scapular body, its lateral border in particular. Apart from open reposition and osteosynthesis, also minimally invasive osteosynthesis under fluoroscopic and arthroscopic control has recently been used to treat intra-articular fractures of the scapula. The arthroscopy facilitates debridement of the fracture line in the intra-articular region and control over the insertion of the osteosynthesis material in the subchondral bone of the glenoid and it also makes visible the accuracy of reduction of fractures of the glenoid articular surface. MATERIAL AND METHODS In 2013-2017, osteosyntheses of 9 intra-articular fractures of the scapula were performed with the use of both perioperative fluoroscopy and arthroscopy. The group included 7 men and 2 women, with the mean age of 37 years (range 24-52 years). 4.5 mm cannulated screws inserted in the subchondral bone either from the cranial or dorso-caudal part of the glenoid in dependence on the type of the fracture were used as osteosynthesis material. Postoperatively, the extremity was fixed by Desault type shoulder brace for 4 weeks. Rehabilitation using standard procedures for shoulder joint followed. The patients were followed up at regular intervals, namely on 10th day, at 4 weeks, 3, 6, 12 and 24 months postoperatively. The clinical outcomes and radiologic signs of healing were evaluated continuously and two years after the surgery the clinical outcomes were assessed using the Constant score. Arm elevation was assessed separately, as a dominant indicator of shoulder joint function. RESULTS No perioperative complications were reported, the operative times ranged from 45 to 120 minutes. Reduction was always performed in fractures with intra-articular displacement of less than 2 mm, which was measured both arthroscopically and on perioperative and postoperative radiographs. No complications of wound healing were observed. One patient experienced temporary paresthesia in the innervation zone of the sensitive branch of the radial nerve. The mean healing time of fractures was 121 days (range 107-146 days). The mean Constant score at two years after surgery was 83 points (range 78-87 points), the resulting restriction of elevation was 12° on average (range 0-23°). DISCUSSION There are not many papers covering a similar topic in world literature, most of them present the benefits of arthroscopy in some types of osteosyntheses of intra-articular fractures of the scapula. Most frequently mentioned are osteosyntheses of the anterior portion of the glenoid in case of a bony Bankart lesion. These papers highlight the benefits of minimal invasiveness of this procedure. CONCLUSIONS By visualising the fracture line, the arthroscopy facilitates a more accurate reduction of fragments and a minimally invasive osteosynthesis of some intra-articular fractures of the scapula when compared to closed reduction with fluoroscopic intraoperative control only. The use of arthroscopy in these interventions is conditional on perfect mastering of the surgical technique and also the use of special instruments both for arthroscopy and minimally invasive osteosynthesis. If these criteria are observed and the surgical technique mastered, the authors consider this method beneficial in treating the glenoid fractures. Key words: minimally invasive osteosynthesis, glenoid fractures.
- MeSH
- artroskopie MeSH
- dospělí MeSH
- fraktury proximálního humeru * MeSH
- intraartikulární fraktury * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka diagnostické zobrazování chirurgie MeSH
- mladý dospělý MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Zjistit, jak často vzniká artróza po úrazu distálního radia a zda působí významné klinické potíže. Úvod: Artróza je nezánětlivé chronické onemocnění kloubu, které může vyústit v závažné klinické potíže. Většina artróz vzniká na traumatickém podkladě, idiopatické příčiny jsou vzácné. Radiokarpální artróza se projevuje bolestí při pohybu, omezením rozsahu pohybu a sníženou silou stisku. Materiál a metodika: Do retrospektivní studie byli zařazeni pacienti s dobou sledování nejméně 10 let po intraartikulární zlomenině distálního radia. Ke zhodnocení byli vybíráni pacienti se zlomeninou typu C dle AO. Vyloučeni byli pacienti s pakloubem ossis scaphoidei a po neadekvátně ošetřené ruptuře skafolunátního vazu. Hodnocení potraumatické artrózy probíhalo podle škály Knirka a Jupitera, klinické hodnocení dle Modified Mayo Wrist Score. Výsledky: V letech 2007 a 2008 bylo ošetřeno 749 pacientů se zlomeninou distálního radia, 112 z nich typu C dle AO. Průměrný věk při vzniku zlomeniny v intraartikulární lokalizaci byl 53,2 let. Ke kontrole po 11–12 letech se podařilo pozvat 31 pacientů, u 10 z nich (32,3 %) byla diagnostikována forma radiokarpální artrózy. Průměrné skóre u pacientů bez artrózy dosahovalo 92,1 bodů ze 100, u pacientů s formou artrózy 69,5 bodů ze 100. Špatný klinický výsledek byl pozorován u třech pacientů s radiokarpální artrózou. Radiokarpální artróza se během sledovaného období rozvinula u osmi pacientů se schodkem kloubní plochy distálního radia nad 2 mm. Žádný z pacientů s radiokarpální artrózou nevyžadoval operační řešení. Diskuze: Ve studii švédských autorů došlo k rozvoji artrózy u 38 pacientů z 63 sledovaných, artróza neměla vliv na funkční výsledek. Při patnáctiletém sledování autorů z USA došlo k vzniku artrózy u všech ze 16 pacientů po osteosyntéze intraartikulární zlomeniny distálního radia. Funkční výsledky také nesouvisely se stupňem artrózy. Knirk a Jupiter ve své práci popisují po šesti letech po operaci intraartikulární zlomeniny radia vznik artrózy v 91 %. 52 pacientů z 66 v další studii ze Švédska dosahovalo po 9–13 letech dobrého funkčního výsledku nezávisle na typu zlomeniny, artróza se vyvinula jen u jednoho z nich. Závěr: Zlomeniny distálního radia, zasahující do radiokarpálního kloubu se schodkem více než 2 mm jsou velikým rizikovým faktorem pro vznik posttraumatické artrózy, vedoucí k bolestivému omezení funkce zápěstí. I přes tento nález bývá však funkční stav zápěstí pro pacienty často přijatelný, bez nutnosti indikace operačního řešení.
Objective: To determine how often arthrosis develops after a distal radius injury and whether it causes significant clinical problems. Introduction: Arthrosis is a non-inflammatory chronic joint disease that can result in serious clinical problems. Most of the arthroses develop on a traumatic basis; idiopathic causes are rare. Radiocarpal arthrosis is manifested by pain in motion, limitation of the range of motion, and reduced handgrip strength. Material and methodology: Patients with a follow-up period of at least 10 years after intraarticular fracture of distal radius were included in the retrospective study. Patients with type C fractures according to AO classification were selected for the evaluation. Patients with ossis scaphoidei nonunion and after inadequately treated scapholunate ligament rupture were excluded. The evaluation of post-traumatic arthritis was performed according to the Knirk and Jupiter scale, clinical assessment according to the Modified Mayo Wrist Score. Results: In 2007 and 2008, 749 patients with distal radius fractures were treated, 112 of them with type C according to AO classification. The average age at the time of the fracture in an intraarticular localisation was 53.2 years. 31 patients were invited for a check-up after 11–12 years; a form of radiocarpal arthrosis was diagnosed in 10 of them (32.3 %). The average score in patients without arthrosis was 92.1 points out of 100, in patients with a certain form of arthrosis it was 69.5 points out of 100. Poor clinical outcome was observed in 3 patients with radiocarpal arthrosis. During the reference period, radiocarpal arthrosis developed in 8 patients with a distal radius articular surface deficit of more than 2 mm. None of the patients with radiocarpal arthrosis required surgery. Discussion: In a study by Swedish authors, arthrosis developed in 38 out of 63 monitored patients; the arthrosis did not affect the functional outcome. During a 15-year follow-up of authors from the USA, all 16 patients developed arthrosis after the osteosynthesis of intraarticular distal radius fracture. The functional results did not relate to the grade of arthrosis either. In their thesis, Knirk and Jupiter describe the development of arthrosis in 91 % in 6 years after the intraarticular radius fracture surgery. 52 out of 66 patients in another study from Sweden achieved a good functional result in 9–13 years regardless of the type of fracture; arthrosis developed in one of them only. Conclusion: Fractures of the distal radio, interfering with the radiocarpal joint with a deficit of more than 2 mm, represent a major risk factor for the development of post-traumatic arthrosis, leading to painful restriction in wrist function. Despite this finding, however, wrist function is often acceptable to patients, without the need of indication for surgery.
PURPOSE OF THE STUDY The aim of this study was to evaluate and present the current concepts in the treatment of intra-articular calcaneal fractures. MATERIAL AND METHODS During the period of ten years (1/2007-12/2016) 162 dislocated intra-articular calcaneal fractures in 145 patients were treated and evaluated at the Trauma Department of University Hospital in Bratislava. The study group included 97 male (67%) and 48 (33%) female patients. The mean age was 42 years (10-66). 17 cases (11.7%) were bilateral calcaneal fractures. Twelve patients suffered a calcaneal fracture associated with polytrauma (8%), and 15 (10.3%) of such fractures were associated with a spinal injury. All of the avaluated fractures n=162 were classified according to Essex-Lopresti -101 (62.5%) were depression type, 38 (23.5%) were tongue type and 23 (14%) were comminutive. The other used classification was according to Sanders - 95 fractures (59 %) were Sanders type II, 44 (27 %) Sanders type III and 23 (14 %) Sanders type IV. In operative treatment the indication criteria considered were fracture morphology, soft tissue involvement, age and overal patient physical condition. Plate osteosynthesis was used in 80 cases (49%) - in 34 fractures of Sanders type II, 44 in Sanders III and two cases Sanders IV type. Palmer s modified approach (limited lateral approach) was used in 21 fractures (13%) - where 7 fractures (4.3%) were treated by screws, 12 (7.4%) with the C-nail and K-wires were used in 2 pediatric patients (1.2%). In 38 patients (23%) in tongue-type fractures we performed percutaneous reduction (Essex-Lopresti/Westhues) and osteosynthesis with three or four 6.5 mm cancelous screws. 21 fractures Sanders type IV (13%) were treated with the external fixator. RESULTS The regular follow-up period was 6-36 months, with various functional results evaluated according to two scoring systems, namely the Creighton-Nebraska Health Foundation Assessment Score (C-N scoring system) and the AOFAS Ankle-Hindfoot Scale (A-H scoring system). In the whole study group in 125 (77%) treated fractures good and excellent results achieved, in 21 (13%) cases the results were satisfactory and in 16 (10%) cases they were poor. No deep infection complications were recorded, but in 14 cases (8.6%) iatrogenic complications such as incomplete reduction or mal-reduction, inproper indication or misdiagnosed compartment syndrome and 15 (9.2%) superficial infection were observed. DISCUSSION Despite the controversy as to the proper treatment of intra-articular calcaneal fractures, mainly in simpler types of Sanders type IIA and IIB it is of benefit to use a combination of percutaneous reduction of calcaneal body along with the posterior articular surface from the Palmer s modified approach. CONCLUSSIONS At our department we prefer percutaneous reduction and osteosynthesis as a method of choice in tongue-type fractures, and the Palmer s modified approach is the preferred method in Sanders type IIA and IIB fractures. In Sanders type III fractures we advise to use the plate osteosynthesis and for Sanders type IV fractures an external fixator is recommended. Key words:individual treatment concept.
- MeSH
- dítě MeSH
- dospělí MeSH
- fraktury kostí * chirurgie MeSH
- intraartikulární fraktury * MeSH
- kostní destičky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- patní kost * zranění MeSH
- poranění kotníku * chirurgie MeSH
- senioři MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.
- MeSH
- biomechanika MeSH
- časové faktory MeSH
- chůze (způsob) fyziologie MeSH
- chůze fyziologie MeSH
- dislokovaná fraktura diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- fraktury kostí diagnostické zobrazování chirurgie MeSH
- hodnocení rizik MeSH
- index tělesné hmotnosti MeSH
- intraartikulární fraktury diagnostické zobrazování chirurgie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- neparametrická statistika MeSH
- patní kost zranění chirurgie MeSH
- plantární plocha MeSH
- poranění nohy (od hlezna dolů) diagnostické zobrazování chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- skóre závažnosti úrazu MeSH
- tlak MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- zatížení muskuloskeletálního systému fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
