• MeSH
• Joint Dislocations diagnosis   complications   therapy   MeSH
• Humeral Fractures diagnostic imaging   complications   therapy   MeSH
• Ulna Fractures diagnostic imaging   complications   therapy   MeSH
• Elbow Fractures * diagnostic imaging   complications   therapy   MeSH
• Radius Fractures diagnostic imaging   complications   therapy   MeSH
• Humans MeSH
• Elbow Joint surgery   diagnostic imaging   pathology   MeSH
• Orthopedic Procedures methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

PURPOSE OF THE STUDY Aseptic pseudoarthrosis (nonunion, PSA) of the humeral shaft is one of the serious complications in the treatment of fractures in this area. In a retrospective study, the authors described different methods of treating patients with this complication using predictive factors. MATERIAL AND METHODS Based on the definition of nonunion and the criteria, 14 patients (N=14) with the mean age of 56 years (32-78), namely 8 men and 6 women were included in the study. All patients were followed up clinically and radiologically at 1, 3, 6, 9, 12 months and every 3 months until the condition stabilized. The follow-up period was 11-72 months, with the average of 22 months. According to the AO classification, the fractures were classified as: 4-A1, 1-A2, 4-A3, 1-B1, 3-B2 and 1-C2. Based on the Weber-Čech classification, 2 cases of pseudoarthrosis were hypertrophic, 4 oligotrophic and 8 atrophic. According to the Non-Union Scoring System (NUSS), 5 patients reached the score under 25 points, 3 patients received 25-50 points, 4 patients 51-75 points and two patients over 76 points. In five cases, the fracture displacement index (FDI) was above 100%. In 11 patients, PSA was in the proximal and middle third and in three patients in the distal third of the humerus. METHODS Of the whole group (N=14), the nail was used in 5 cases (36%) - in 3 cases NUSS of up to 50 points and in 2 cases over 76 points. The plate was used in 9 cases (64%). In patients with NUSS of up to 50 points - in 1 case after conservative treatment, in 1 case for augmentation of nail, in 3 cases for augmentation of Prévot nails. In 4 cases with NUSS of 51-75 points a plate was replaced. Osteosynthesis was always supplemented by Judet's decortication or resection of atrophic bone and spongioplasty by autologous graft. RESULTS Shoulder function measured by the Constant Murley score (C-M) improved from 53 to 89 points (from the range of 36-76 points to the range of 75-100 points). The function of the elbow joint also improved, namely from the Mayo Elbow Performance Score (MEPS) of 65 points to 90 points (from the range of 45-70 points to the range of 80-100 points). In 11 cases (79%) the nonunion was healed and in 3 cases (21%) the failure to heal was reported. In the group with unhealed nonunions, in one case with NUSS of 51-75 points a thermoplastic casting was used and in two patients with NUSS above 76 points a palliative surgery was performed using a 12mm interlocking intramedullary nail. DISCUSSION The results of our study focused on the treatment of aseptic nonunion of the humeral shaft confirm the conclusions arrived at by other authors. As to the osteosynthesis materials, the plate remains the gold standard and provides sufficient stability for bone healing. For unhealed treatment-resistant PSA, we offer a stable intramedullary nail instead of prosthetic replacement or amputation, which provides good stability required for limb function. CONCLUSIONS When planning the treatment of aseptic pseudoarthrosis of the humeral shaft, it is necessary to have a thorough knowledge of etiopathogenesis with all predictive factors. The NUSS classification provides good guidance in treating this complication. Key words: aseptic nonunion, NUSS classification, predictive factors.

• MeSH
• Humeral Fractures * diagnostic imaging   surgery   MeSH
• Fracture Healing MeSH
• Humerus MeSH
• Fracture Fixation, Intramedullary * methods   MeSH
• Bone Plates MeSH
• Middle Aged MeSH
• Humans MeSH
• Prostate-Specific Antigen MeSH
• Pseudarthrosis * diagnosis   surgery   etiology   MeSH
• Retrospective Studies MeSH
• Fracture Fixation, Internal methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

PURPOSE OF THE STUDY Most humeral nonunions can be successfully treated with a single procedure, but some are more difficult to heal. Humeral nonunions which have two or more surgical procedures were defined as refractory humeral nonunions, and this condition is a very challenging condition. The aim of the study is to show the results of atrophic refractory humeral nonunion treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty. MATERIAL AND METHODS Refractory humeral nonunions treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty from January 2010 to March 2019 were included this study retrospectively. Patient baseline information, number of previous surgeries, comorbidities, follow-up time, fracture union time, and complications were recorded. The functional outcome was evaluated with the Constant scores and Mayo scores at the end of the first year. The primary outcome variable was mentioned as bony union. RESULTS A total of 13 refractory humeral nonunions included this study. The average age of the patients was 50.92±15.55 years (range, 26-78 years), and 8 of them were female. Preoperative and postoperative mean Mayo scores were; 56.54±17.84, and 85.38±7.49 respectively (p<0.001). Preoperative and postoperative mean Constant scores were; 45±11.71, and 80.62±5.38 respectively (p<0.001). DISCUSSION The strict application of basic nonunion principles can result in successful salvage of refractory humeral nonunions. But this concept may not provide sufficient solution for each situation. On the other hand, we also applied the basic nonunion principles. Compression plating and autogenous bone grafting and spongioplasty have been considered as the gold standard in the management of humeral shaft nonunion. CONCLUSIONS Open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty should be considered as an alternative for the treatment of refractory atrophic humeral nonunions, whose treatment is a very challenging condition for surgeons. Key words: block graft, bone grafting, nonunion, refractory humeral nonunion, spongioplasty.

• MeSH
• Adult MeSH
• Humeral Fractures * diagnostic imaging   surgery   MeSH
• Fracture Healing MeSH
• Humerus surgery   MeSH
• Bone Plates MeSH
• Middle Aged MeSH
• Humans MeSH
• Fractures, Ununited * surgery   MeSH
• Ilium MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Bone Transplantation methods   MeSH
• Fracture Fixation, Internal methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY Treatment of nonunion of humerus continues to be a matter of debate. For this purpose, many treatment methods have been reported. The aim of this retrospective cohort study is to evaluate the results of patients who underwent revision surgery with compressive intramedullary nailing implemented a single type of surgical technique in aseptic humeral nonunions without bone defects. MATERIAL AND METHODS Data of 15 patients with humerus nonunion, all were treated with compressive intramedullary nailing between 2000 and 2019 were retrospectively evaluated. Three patients were hypertrophic and 12 were atrophic types. The mean ages of patients at the surgery was 47.3±18 years. In all cases, maximal bone contact was created between the proximal and distal bone fragments after reaming and debridement, and fixation was performed with compressive intramedullary nailing. Radiological assessment of union was performed based on the RUSHU criteria, and functional outcomes were assessed according to Constant-Murley scoring criteria. RESULTS The ten out of 15 patients were male. The radiological union was achieved at a mean duration of 16.6±2.3 weeks in 14 patients. The average time of follow-up after nonunion treatment was 25.2±8.8 months. Twelve out of 15 patients implemented bone grafting taken form iliac bone with spongiosa obtained via reaming. The functional results were made according to the Constant-Murley score and excellent functional results were obtained in nine patients, good in four patients and poor functional results in one patient. Implant failure was not observed. One patient has had post-operative transient ulnar nerve palsy and another patient developed transient radial nerve palsy. CONCLUSIONS Compressive intramedullary nailing is a useful method that provides excellent union in the surgical treatment of aseptic non-union of the humerus, without bone defects. Key words: intramedullary compressive humeral nail, nonunion, failed intramedullary nailing humerus fracture, fracture fixation, autologous bone grafting.

• MeSH
• Adult MeSH
• Humeral Fractures * diagnostic imaging   surgery   MeSH
• Humerus surgery   MeSH
• Fracture Fixation, Intramedullary * adverse effects   methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Fractures, Ununited * surgery   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Objective: To assess the treatment of supracondylar fractures of the distal humerus in children, which were treated in Tomas Bata Hospital, Zlin. To evaluate the results in the context of contemporary studies. Introduction: Study presents the supracondylar fracture. Method: Retrospective study of a group of 228 patients with this type of fracture, treated between the years 2014-2018 in Traumatology department of Tomas Bata Hospital, Zlin. Results: In this group, 4 children underwent closed reduction and splinting in general anesthesia, 95 were operated on, from which 94,5 % urgently (less than 6 hours after first contact with the patient). The prefered method was closed reduction and percutaneous pinning by crossed Ki wires (CRCPP). In 12 cases (12,6 % of the operations) it was necessary to perform an open reduction, mostly from the limited posterior access. In the group of operatively treated children, there have been noticed 20 cases of some neural injury, mostly n. ulnaris (12), both n. ulnaris and medianus (4), n. medianus only (3). There were 2 cases of pale-pulsless hand after the reduction, which led to the revision of the neurovascular structures from the anterior access. None of the children displayed permanent consequences envolving their eve­ryday lives. In minority of cases (14) at the end of the follow-up, persisted slight deficiency of the fle­xion, or slight hyperextension of the elbow, or the combination of both. We have recorded 2 cases of the cubitus varus deformity. In this cohort, there was no incidence of the compartment syndrome nor the Volkmann contracture of the extremity. Conclusion: Supracondylar fracture is a frequent injury with relatively high risk of complications. Some questions of the optimal treatment have still not been answered and need further research.

• MeSH
• Child MeSH
• Fracture Fixation MeSH
• Humeral Fractures * surgery   diagnostic imaging   epidemiology   etiology   classification   complications   pathology   therapy   MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH

Cíl: Posoudit léčbu suprakondylických zlomenin distálního humeru u souboru dětí s tímto poraněním, léčených v KNTB Zlín. Zhodnotit výsledky léčby, včetně procen­tuálního zastoupení jednotlivých komplikací. Úvod: Shrnuje současný pohled na problematiku suprakondylické zlomeniny. Metodika: Retrospektivní studie souboru dětí, ošetřených na Traumatologickém oddělení KNTB Zlín v letech 2014-2018 s tímto poraněním. Výsledky: V daném období bylo ošetřeno celkem 228 pacientů, z toho čtyři repozicí a sádrovou fixací v celkové anestezii a 95 repozicí a osteosyntézou retrográdně zavedenými Ki dráty. Většina pacientů (94,7 %) byla operována urgentně (do šesti hodin od příchodu do ambulance). Preferovanou metodou na našem pracovišti je zkřížená perkutánní fixace Ki dráty (CRCPP). U 12 dětí (12,6 % operovaných) bylo nutno přistoupit k repozici otevřené, prováděné převážně z limitovaného zadního přístupu. Ve skupině operovaných dětí bylo zaznamenáno 20 případů (21,5 %) neurologických komplikací, z toho nejčastěji poranění n. ulnaris (12), případně n. ulnaris i n. medianus (4), nebo samostatně n. medianus (3), u dvou případů byla vzhledem k přetrvávající poruše prokrvení periferie indikována otevřená repozice s revizí NC svazku z předního přístupu. Žádné z ošetřených dětí nevykazovalo závažné trvalé následky. Nejčastějším následkem bylo lehké omezení hybnosti, vyjádřené lehkým omezením flexe, lehkou hyperextenzí lokte, nebo kombinací obojího (celkově 14 případů). V celkovém souboru pacientů jsme pozorovali dva případy poruchy růstu ve smyslu cubitus varus. Nebyl zaznamenán kompartment syndrom ani Volkmannova kontraktura končetiny. Závěr: Suprakondylická zlomenina humeru je častý úraz s relativně vysokým rizikem komplikací. Některé otázky ohledně optimálního managementu této zlomeniny stále nebyly přesvědčivě zodpovězeny a zaslouží si další zkoumání.

• MeSH
• Child MeSH
• Fracture Fixation MeSH
• Humeral Fractures * surgery   diagnostic imaging   epidemiology   etiology   classification   complications   pathology   therapy   MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH

Introduction: One of the surgical methods to manage proximal humeral fractures is the nailing osteosynthesis, which reports good results for certain spectre of fractures. At the Trauma Hospital in Brno is has therefore become the method of choice for type A fractures and a part of type B fractures according to the AO. Objective: The objective of our work was to evaluate clinical results of osteosynthesis of proximal humeral fractures managed by nailing osteosynthesis. Method: 95 patients operated for proximal humeral fracture by antegrade nailing at the Trauma Hospital in Brno in 2014-2018 were enrolled in the retrospective study. Healing time, resulting mobility range, and number of complications were evaluated. Results: The nailing osteosynthesis was used in 34 % of all 391patients operated due to proximal humeral fracture. The average age was 61 years. 95 patients were included in the study. Complete extraction of metal was performed in 7 patients and partial extraction was performed in 7 patients. Pseudoarthrosis formed in 2 patients; necrosis of the head occurred in 4 patients. No significant differences in results were found in two most frequently used nails. Conclusion: Nailing osteosynthesis of proximal humeral fractures is a reliable method for the indicated fractures, with results comparable to those of plating osteosynthesis, particularly in respect of type AO A2 and B fractures.

• Keywords
• hřebová osteosyntéza,
• MeSH
• Humeral Fractures * surgery   diagnostic imaging   therapy   MeSH
• Humerus surgery   diagnostic imaging   MeSH
• Fracture Fixation, Intramedullary * methods   statistics & numerical data   MeSH
• Bone Nails adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Osteonecrosis etiology   complications   prevention & control   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Fracture Fixation, Internal methods   statistics & numerical data   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Evaluation Study MeSH

Úvod: Jednou z metod operačního řešení zlomenin proximálního humeru je hřebová osteosyntéza, která pro určité spektrum zlomenin vykazuje dobré výsledky. V Úrazové nemocnici v Brně se se tak stala metodou volby pro zlomeniny typu A a část zlomenin typu B dle AO. Cíl: Cílem naší práce bylo zhodnotit klinické výsledky osteosyntézy zlomenin proximálního humeru řešené hřebovou osteosyntézou. Metoda: Do retrospektivní studie bylo zařazeno 95 pacientů operovaných antegrádním hřebem v letech 2014-2018 v Úrazové nemocnici v Brně se zlomeninou proximálního humeru. Hodnoceny byly doba zhojení, výsledný rozsah pohybů a množství komplikací. Výsledky: Ze všech 391 pacientů operovaných pro frakturu proximálního humeru byla hřebová osteosyntéza použita ve 34 %. Průměrný věk byl 61 let. Do studie bylo zařazeno 95 pacientů. U sedmi pacientů byla provedena kompletní extrakce kovu, u sedmi parciální. Pakloub se vyvinul u dvou pacientů, u čtyřech došlo k nekróze hlavice. U dvou nejpoužívanějších hřebů nebyly shledány signifikantní rozdíly ve výsledcích. Závěr: Hřebová osteosyntéza zlomenin proximálního humeru je u indikovaných zlomenin spolehlivá metoda se srovnatelnými výsledky s dlahovou osteosyntézou, zejména u zlomenin typu AO A2 a B.

• Keywords
• hřebová osteosyntéza,
• MeSH
• Humeral Fractures * surgery   diagnostic imaging   therapy   MeSH
• Humerus surgery   diagnostic imaging   MeSH
• Fracture Fixation, Intramedullary * methods   statistics & numerical data   MeSH
• Bone Nails adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Osteonecrosis etiology   complications   prevention & control   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Fracture Fixation, Internal methods   statistics & numerical data   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Evaluation Study MeSH

• MeSH
• Child MeSH
• Humeral Fractures * surgery   diagnostic imaging   MeSH
• Clinical Studies as Topic MeSH
• Humans MeSH
• Radiation Exposure MeSH
• Radiographic Magnification methods   MeSH
• Check Tag
• Child MeSH
• Humans MeSH

• MeSH
• External Fixators utilization   MeSH
• Fracture Fixation classification   methods   MeSH
• Humeral Fractures diagnostic imaging   surgery   MeSH
• Ankle Fractures diagnostic imaging   surgery   MeSH
• Humeral Head diagnostic imaging   surgery   injuries   MeSH
• Humans MeSH
• Shoulder Dislocation * diagnostic imaging   surgery   MeSH
• Metacarpal Bones diagnostic imaging   surgery   injuries   MeSH
• Finger Injuries surgery   MeSH
• Hand Injuries diagnostic imaging   surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Overall MeSH