Úvod: Antibiotickým cementem potažené nitrodřeňové hřeby (ACCINs – antibiotic cement-coated intramedullary nails) jsou stále oblíbenější metodou v terapii FRI (fracture-related infections). FRI je velká výzva, která představuje pro ošetřujícího lékaře a zdravotní systém velký problém jak v nákladech na terapii, časové náročnosti, tak v komplikovanosti léčby s nejistým výsledkem. Cílem našeho sdělení je zhodnocení výsledků operační léčby pomocí ACCINs u pacientů s FRI, kteří byli léčeni během pětiletého období na našem pracovišti. Metody: Retrospektivní zhodnocení výsledků operační léčby ACCINs u pacientů s diagnózou FRI léčených na Klinice úrazové chirurgie LF MU a FN Brno v letech 2018–2022. Na základě exkluzních kritérií bylo ze studie z celkového počtu 18 pacientů vyloučeno 5 pacientů z následujících důvodů: doba sledování byla kratší než 6 měsíců, chronická imunosupresivní medikamentózní terapie, pacient s onkologickým nebo autoimunitním onemocněním. Mezi inkluzní kritéria pro léčbu ACCINs jsme zařadili kostní infekty v oblasti diafýzy femuru, tibie a infekce v oblasti hlezenního kloubu. Sledovaný soubor tvořilo 13 pacientů (3 ženy, 10 mužů), průměrný věk v souboru byl 48 let a medián pak 44 let. U 3 pacientů se jednalo o infekt po osteosyntézách v oblasti diafýzy femuru, u 7 pacientů o infekt v oblasti diafýzy tibie a u 3 pacientů v oblasti hlezenního kloubu. Výsledky: V našem souboru bylo pozorováno kostní zhojení bez klinických a laboratorních známek infekce nebo stabilní artrodéza u 7 (54 %) pacientů. Ve 3 případech (23 %) probíhá hojení bez známek infekce. U 3 pacientů (23 %) byla nutná další operační léčba, jednak z důvodu nezhojení zlomeniny (n=1) a také z důvodu kombinace nezhojení kosti s infekcí (n=2). Celková míra záchrany končetiny byla 100 %. Závěr: Použití ACCINs naplňuje po důkladném debridementu další tři základní principy terapie kostního infektu: lokální působení ATB (antibiotik), vyplnění mrtvého prostoru a stabilizace skeletu. ACCINs je účinnou metodou v terapii FRI diafýz dlouhých kostí a septických artritid hlezna.

Introduction: Antibiotic cement-coated intramedullary nails (ACCINs) are an increasingly popular method in the treatment of FRI (fracture-related infections). FRI is a major challenge that poses a major problem for the treating physician and the health care system, both in terms of cost of therapy, time required, and the complexity of treatment with an uncertain outcome. The aim of our report is to evaluate the results of surgical management using ACCINs in patients with FRI who were treated during a 5-year period at our institution. Methods: A retrospective evaluation of the results of surgical treatment using ACCINs in patients with FRI treated at the Department of Trauma Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University in Brno in 2018–2022. Based on the exclusion criteria, 5 out of 18 patients were excluded from the study for the following reasons: a follow-up period less than 6 months, chronic immunosuppressive drug therapy, and any oncological or autoimmune disease. Bone infections in the femoral diaphysis, tibial diaphysis and infections in the ankle joint were among the inclusion criteria for the use of ACCINs. The study population consisted of 13 patients (3 women, 10 men); mean age was 48 years and median age was 44 years. Three patients had an infection after osteosynthesis in the femoral diaphysis, 7 patients had an infection in the tibial diaphysis and 3 had an infection in the ankle joint. Results: In our cohort, bone healing without any clinical and laboratory signs of infection or stable arthrodesis was observed in 7 (54%) patients. In 3 cases (23%), healing proceeded without any signs of infection. In 3 patients (23%), further surgical treatment was required because of fracture nonhealing (n=1) and because of the combination of bone nonhealing and infection (n=2). The overall limb salvage rate was 100%. Conclusion: The use of ACCINs fulfills the three basic principles of bone infection therapy after thorough debridement: local action of antibiotics, filling of the dead space, and stabilization of the skeleton. ACCINs provide an effective method in the treatment of FRI of the diaphysis of long bones and septic arthritis of the ankle.

• Keywords
• antibiotickým cementem potažené nitrodřeňové hřeby,
• MeSH
• Arthrodesis MeSH
• Diaphyses diagnostic imaging   pathology   MeSH
• Lower Extremity diagnostic imaging   pathology   MeSH
• Adult MeSH
• Bone Cements * MeSH
• Bone Nails MeSH
• Middle Aged MeSH
• Humans MeSH
• Osteomyelitis * diagnostic imaging   therapy   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH

• MeSH
• Colles' Fracture * surgery   diagnostic imaging   complications   MeSH
• Diaphyses abnormalities   surgery   diagnostic imaging   MeSH
• Adult MeSH
• Radius Fractures surgery   diagnostic imaging   complications   MeSH
• Humans MeSH
• Osteotomy methods   MeSH
• Tomography, X-Ray Computed methods   instrumentation   MeSH
• Pronation MeSH
• Range of Motion, Articular MeSH
• Supination MeSH
• Ulna abnormalities   surgery   diagnostic imaging   MeSH
• Hand Deformities, Acquired surgery   diagnostic imaging   MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

The cross-sectional geometry (CSG) of long bone diaphyses is used in bioanthropology to evaluate their resistance to biomechanical constraints and to infer life-history-related patterns such as mobility, activity specialization or intensity, sexual dimorphism, body mass and proportions. First limited by technical analytical constraints to the analysis of one or two cross sections per bone, it has evolved into the analysis of cross sections of the full length of the diaphyseal part of long bones. More recently, researchers have developed analytical tools to map the cortical thickness of entire diaphyses to evaluate locomotor signatures. However, none of these analytical tools are easy to use for scientists who are not familiar with computer programming, and some statistical procedures-such as mapping the correlation coefficients of the diaphyseal thickness with various parameters have yet to be made available. Therefore, we developed an automated and open-source application that renders those analyses (both CSG and cortical thickness) in a semiautomated and user friendly manner. This application, called "Diaphysator", is associated with another free software ("Extractor", presented in Dupej et al. (2017). American Journal of Physical Anthropology, 164, 868-876). Diaphysator can be used as an online application (https://diaphysator.shinyapps.io/maps) or as a package for R statistical software. Along with the mean maps of cortical thickness and mean CSG parameter graphs, the users can evaluate the correlations and partial correlations of both CSG parameters at every cross section along the diaphyseal length, and cortical thickness data points of the entire diaphysis, with any factor such as age, sex, stature, and body mass.

• MeSH
• Anatomy, Cross-Sectional MeSH
• Anthropology, Physical methods   MeSH
• Diaphyses anatomy & histology   diagnostic imaging   MeSH
• Femur anatomy & histology   diagnostic imaging   MeSH
• Internet MeSH
• Data Interpretation, Statistical MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Software * MeSH
• Tibia anatomy & histology   diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular. This study aims to evaluate the group of patients in whom the suprapatellar approach was used and who were followed up for the period of at least 12 months. MATERIAL AND METHODS The prospective study included 55 cases of osteosynthesis of diaphyseal fractures of the tibia with the surgery performed in the period from January 2013 to June 2015, of which in 53 patients (17 women and 36 men) with the mean age of 49.6± 16.7 years the ETN nail by DePuy Synthes ® was inserted through a suprapatellar approach. In 38 cases (70.1%) an isolated trauma was involved, 15 patients (29.9%) were treated for multiple injuries or polytrauma. In nine cases (17%) it was an open fracture (2times - GA grade I, 7times - GA grade II). A multiple fracture or a fracture of the proximal third was recorded in 19 cases (34.5%). The functional and radiological results of the treatment were assessed prospectively at 12 months after the surgery using the Lysholm (LS) score. RESULTS The final functional results were successfully assessed in 49 performed osteosyntheses (89.1%). The mean duration of surgery was 72.7± 19.57 min (40-140 min, median 65 min). A total of 48 (98%) fractures healed by primary intention. In five cases (10.2%) a delayed healing occurred and in one case (2 %) non-union was reported, requiring a revision surgery. In three cases (6.1%) complete implant was removed (twice by SP and once by IP approach). The mean Lysholm score was 93.4 ± 8.39 points (59-100 points, median score of 95 points). An excellent or a good result was observed in 45 patients (91.8%), a satisfactory result in three patients (6.2%), and a poor result in one patient (2%). A statistically significant correlation (p = 0.006) between the LS score values and the age of the patients was confirmed. In patients up to 60 years of age the LS score was 96.2 ± 4.51 points (89-100, median 96), at the age of more than 60 years it was 86.9 ± 11.46 (59-100, median 89). CONCLUSIONS The suprapatellar approach in treating the tibial diaphyseal fractures represents a safe alternative nail insertion technique. If an appropriate surgical technique is applied, the risks inherent in this approach are negligible. The approach allows for an easy reduction of challenging fractures of the proximal third diaphyseal fracture of the tibia and multiple fractures of the tibia and facilitates an easy check of the axial position of the extremity. The functional results of the knee joint are comparable to those achieved with the infrapatellar nailing technique. The final LS score correlates with the age of the patients. Key words:tibial fractures, suprapatellar approach, intramedullary nailing, knee pain.

• MeSH
• Diaphyses diagnostic imaging   injuries   surgery   MeSH
• Adult MeSH
• Tibial Fractures classification   diagnostic imaging   surgery   MeSH
• Fracture Fixation, Intramedullary instrumentation   methods   MeSH
• Bone Nails * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lysholm Knee Score MeSH
• Fractures, Open diagnostic imaging   surgery   MeSH
• Prospective Studies MeSH
• Radiography MeSH
• Aged MeSH
• Fractures, Closed diagnostic imaging   surgery   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cíl: Porovnání výsledků operační léčby zlomeniny dia­fýzy klíční kosti pomocí nitrodřeňově zavedených Kirschnerových drátů a otevřené repozice a stabilizace úhlově stabilní zamykatelnou dlahou. Materiál a metoda: Soubor 44 pacientů se zlomeninou diafýzy klíční kosti, jejichž průměrný věk činil 42,5 roků (33 mužů a 11 žen). První skupina označená IM zahrnuje 29 pacientů, u kterých byly ke stabilizaci zlomeniny použity intramedulárně zavedené Kirschnerovy dráty. Do druhé skupiny označené ORIF je zařazeno 15 pacientů, kteří byli léčeni metodou otevřené repozice a stabilizace zamykatelnou dlahou pro zlomeniny diafyzární části klíční kosti LCP 3,5 mm (firma Synthes, Švýcarsko). Kritéria k operační terapii po zavřené repozici jsou: zkrat ve zlomenině o více než 10 mm, dislokace ad latus o více než šíři kosti, hrozící perforace kožního krytu kostním fragmentem. Stabilizace Ki dráty byla užívána pro maximálně třífragmentové zlomeniny, složitější zlomeniny byly léčeny zamykatelnou dlahou. Výsledky: Migrace osteosyntetického materiálu bez redislokace kostních fragmentů nastala pouze ve skupině IM v pěti případech (17,3 %), k selhání osteosyntézy došlo pouze v jednom případě (3,4 %) též ve skupině IM. Pakloub byl ve skupině IM pozorován dvakrát (6,9 %) a ve skupině ORIF jedenkrát (6,7 %). Závěr: Operační léčby zlomenin diafýzy klíční kosti pomocí nitrodřeňově zavedených Kirschnerových drátů a metodou stabilizace zamykatelnou dlahou nevykazují zásadní rozdíly v délce hojení, funkčních výsledcích léčby a počtu závažných komplikací. Indikacemi ke stabilizaci Kirschnerovými dráty jsou jednoduché, maximálně třífragmentové zlomeniny. Pro zlomeniny s větším počtem fragmentů je metodou volby osteosyntéza zamykatelnou dlahou.

Objective: The issue of the study is to compare the treatment results of clavicular midshaft fractures stabilisated using intramedullarly introduced Kirschner wires and by open reduction et internal stabilisation using angle stable plate. Material and methods: Set of 44 patients with diaphyseal fractures of the clavicle whose average age was 42.5 years (33 men and 11 women). The first group “IM” includes 29 patients in which intramedullarly introduced Kirschner wires were used for fracture fragments stabilization. The second group “ORIF” contains 15 patients who were treated by open reduction and stabilization by locking plates for diaphyseal fractures of the clavicle - LCP 3.5 mm (Synthes, Switzerland). Criteria for surgical treatment after closed reduction are: shortening of the fracture more than 10 mm, dislocation ad latus more than the width of bone and imminent perforation of skin from bone fragment. Results: Migration of osteosynthetic material without dislocation of bone fragments occurred only in the group IM in five cases (17.3 %), osteosynthesis failure occurred in only one case (3.4 %) also in the group IM. Nonunion was observed in the group IM twice (6.9 %) and in group ORIF once (6.7 %). Conclusion: Surgical treatment of diaphyseal fractures of the clavicle using intramedullarly introduced Kirschner wires and method of stabilization using locking plates do not show significant differences in the length of healing, functional results of treatment or serious complications. Indications to stabilization by Kirschner wires are simple, maximally tree-fragmet fractures. For fractures with multiple fragments, the method of choice is fixation by locking plates.

• MeSH
• Diaphyses diagnostic imaging   injuries   MeSH
• Splints MeSH
• Fractures, Bone diagnostic imaging   surgery   therapy   MeSH
• Clavicle * diagnostic imaging   injuries   MeSH
• Bone Wires MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Fracture Fixation, Internal * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH