Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

• MeSH
• bércové vředy chirurgie   etiologie   patologie   terapie   MeSH
• dospělí MeSH
• imunosupresiva škodlivé účinky   MeSH
• komorbidita MeSH
• lidé MeSH
• neúspěšná terapie MeSH
• poranění dolní končetiny chirurgie   komplikace   patologie   terapie   MeSH
• tibie * chirurgie   patologie   zranění   MeSH
• záchrana končetiny metody   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: The aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism. METHODS: The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21-87), with a "Double Maisonneuve fracture". Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings. RESULTS: The distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Injury to the deltoid ligament was revealed in six cases; a bicollicular fracture of the medial malleolus was found in five patients. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Avulsion of the Chaput tubercle was detected in four cases. Injury to the interosseous tibiofibular ligament was assessed in nine patients. CONCLUSION: Double Maisonneuve fracture is a rare but probably underreported injury that must be taken into consideration during examination, as it may be easily overlooked. The essential part of diagnosis is a careful clinical examination and radiological assessment of the lower leg with additional CT examination of the ankle.

• MeSH
• fibula diagnostické zobrazování   MeSH
• fraktury kotníku * diagnostické zobrazování   chirurgie   MeSH
• hlezenní kloub patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mnohočetné fraktury * MeSH
• poranění kotníku * diagnostické zobrazování   chirurgie   MeSH
• tibie zranění   MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Although Maisonneuve fracture (MF) is a well-known type of ankle fracture-dislocation, there is still a lack of information about the epidemiology and the extent of all associated injuries. The aim of study is to describe MF pathoanatomy on the basis of radiographs, CT scans and intraoperative findings. MATERIALS AND METHODS: The study comprised 54 adult patients. MF was defined as an ankle fracture-dislocation with a fracture of the fibula in its proximal quarter. Ankle radiographs and lower leg radiographs were obtained in all patients. Computed tomography (CT) examination was performed in 43 patients, of these in 34 patients in combination with 3D CT reconstructions. A total of 51 patients were treated operatively, and in 38 of these an open procedure was performed. RESULTS: The fibular fracture-fibular head was involved in four cases, and the subcapital region of the proximal quarter of the fibula was affected in 50 cases. Fractures of the posterior malleolus were identified in 43 of 54 patients (80%). Injury to the deltoid ligament was recorded in 27 cases (50%), a fracture of the medial malleolus in 20 cases (37%) and medial structures were intact in 7 cases (13%). Position fibula in fibular notch-in 9 cases the position changed only minimally, in 11 cases the space between the tibia and the fibula was larger than 2 mm, in 20 cases widening of the tibiofibular space was associated with external rotation of the fibula, in 2 cases fibula was trapped behind the posterior tibial tubercle and in 1 case it was associated with a complete tibiofibular diastasis. CONCLUSION: MF is a variable injury, always associated with rupture of the anterior and interosseous tibiofibular ligaments. CT examination should be employed widely in MF, and MRI should be considered under special circumstances.

• MeSH
• dislokovaná fraktura * diagnostické zobrazování   patologie   MeSH
• dospělí MeSH
• fraktury kotníku * diagnostické zobrazování   patologie   MeSH
• fraktury tibie * diagnostické zobrazování   patologie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• tarzální kosti * diagnostické zobrazování   zranění   patologie   MeSH
• tibie * diagnostické zobrazování   zranění   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Introduction A standard osteosynthetic material for maxillofacial skeleton is titanium and its alloys. The convenience of degradable material is avoiding of second surgery in cases, where removal of the material is necessary. Magnesium biodegradable alloys have similar mechanic properties as cortical bone - reasonable corrosion and sufficient biologic properties. They might be used in facial skeleton fixation. Materials and methods The study included a total of 16 rabbits, and they were randomly divided into two groups. Each group received two screws (WE4 and titanium as a standard material) in artificially drilled defect into right tibia. Animals were euthanized at four-week intervals. Bone samples with implants underwent microfocus CT scans and were histologically examined. Results WE43 alloys showed fragmentation of the material on the 16th week - statistically significant volume loss was found between weeks 12 and 16. Bone healing around the WE43 screws was of similar quality as around titanium screws, and no adverse effect was noticed. Conclusion The study showed good quality of bone healing around WE43 implants. From this point of view, the WE43 alloy meets the requirements of osteosynthetic material for maxillofacial skeleton.

• MeSH
• hořčík škodlivé účinky   chemie   MeSH
• kostní šrouby * škodlivé účinky   MeSH
• králíci MeSH
• povrchové vlastnosti MeSH
• slitiny škodlivé účinky   chemie   MeSH
• tibie zranění   patologie   chirurgie   MeSH
• titan škodlivé účinky   chemie   MeSH
• vstřebatelné implantáty * škodlivé účinky   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• zevní fixace,
• MeSH
• artrodéza metody   MeSH
• chirurgie operační metody   MeSH
• fraktury kostí chirurgie   komplikace   patofyziologie   terapie   MeSH
• fraktury tibie * chirurgie   komplikace   patofyziologie   terapie   MeSH
• intramedulární fixace fraktury metody   škodlivé účinky   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• kosti dolní končetiny patofyziologie   zranění   MeSH
• lidé MeSH
• ortopedické výkony metody   škodlivé účinky   MeSH
• peroperační komplikace chirurgie   terapie   MeSH
• poranění dolní končetiny chirurgie   komplikace   patofyziologie   terapie   MeSH
• tibie patofyziologie   zranění   MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH

• MeSH
• cévy anatomie a histologie   MeSH
• chirurgie operační metody   MeSH
• dospělí MeSH
• fraktury kostí chirurgie   komplikace   patofyziologie   terapie   MeSH
• fraktury tibie * chirurgie   patofyziologie   terapie   MeSH
• intramedulární fixace fraktury * metody   škodlivé účinky   MeSH
• kompartment syndrom chirurgie   patofyziologie   terapie   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• kosti dolní končetiny patofyziologie   zranění   MeSH
• lidé MeSH
• ortopedické výkony metody   škodlivé účinky   MeSH
• osteitida chirurgie   patofyziologie   terapie   MeSH
• osteonekróza chirurgie   patofyziologie   terapie   MeSH
• pooperační komplikace chirurgie   terapie   MeSH
• poranění dolní končetiny chirurgie   komplikace   patofyziologie   terapie   MeSH
• pseudoartróza chirurgie   patofyziologie   terapie   MeSH
• tibie anatomie a histologie   patofyziologie   zranění   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• Klíčová slova
• zevní fixace,
• MeSH
• chirurgie operační metody   MeSH
• fraktury kostí chirurgie   komplikace   patofyziologie   terapie   MeSH
• fraktury tibie * chirurgie   komplikace   patofyziologie   terapie   MeSH
• infekce terapie   MeSH
• intramedulární fixace fraktury metody   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• kosti dolní končetiny patofyziologie   zranění   MeSH
• lidé MeSH
• ortopedické výkony metody   škodlivé účinky   MeSH
• poranění dolní končetiny chirurgie   komplikace   patofyziologie   terapie   MeSH
• tibie patofyziologie   zranění   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé MeSH

Cíl práce: Cílem práce bylo představit diagnostický a léčený postup při proximální tibiofibulární luxaci. Materiál a metody: Autoři popisují diagnostiku a léčbu anterolaterální proximální tibiofibulární luxaci u 27letého pacienta po pádu na levé koleno. Diagnostika se zakládala hlavně na klinickém vyšetření, které bylo doplněno rentgenem (rtg) a vyšetřením výpočetní tomografie (CT). Zavřenou repozici autoři provedli v analgezii pacienta, a to při flexi v koleni a dorzální flexi nohy tlakem na hlavu fibuly. Po repozici bylo provedeno kontrolní CT vyšetření a naložena ortéza. Pacient byl a je bez neurologické léze. Výsledky: Pacient je půl roku od úrazu bez potíží. Pohyby v koleni jsou plné, bez známek nestability. Závěr: Popsaný postup při tomto raritním poranění je v souladu s literárními poznatky.

Purpose of study: The aim of this work was to introduce diagnostic and terapeutic process in therapy of pro­ximal tibiofibular dislocation. Material and methods: The authors describe diagnostic process and therapy of proximal anterolateral tibio­fibular dislocation in 27 years old patients after fall to left knee. The diagnosis was founded on clinical examination a­ppenden with plain films and computed tomography. After analgetization of patient dislocation was treated by closed reduction. The knee was flexed and the foot dorsiflexed and externally rotated. Pressure was applied over the fibular head, until a “pop” was heard. Afret reduction authors made control computed tomography and applied orthesis. Patient was without neurologic laesion. Results: Patient is now without any problems. Patient is able to burden fully his limb and the range of motion (ROM) in knee joint is without any restrictions. Conclusion: Described diagnostic and terapeutic procedure are accord with literature.

• MeSH
• dislokace kloubu MeSH
• dospělí MeSH
• fibula diagnostické zobrazování   zranění   MeSH
• lidé MeSH
• luxace kolena * diagnostické zobrazování   etiologie   terapie   MeSH
• protetické prostředky MeSH
• tibie diagnostické zobrazování   zranění   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Ankle fractures still remain a significant issue in bone and joint trauma surgery that has not yet been adequately resolved. The history of treatment of these fractures is interesting and it is no wonder that it has been the subject of many studies [1–8]. The first detailed historical overview was published by Astley Paston Cooper Ashhurst (1876–1932) in 1922 [1]. This valuable resource was most probably used by Niels Lauge (later known as Lauge-Hansen) (1899–1973) in 1948 [5] and also by Josiah Grant Bonnin (1909–1989) in 1950 [8]. Lauge’s treatise was the most detailed historical study at that time to focus on ankle fractures, a large part of which was later used by Bernhard Georg Weber (1927–2002) in his book “Die Verletzungen des oberen Sprunggelenkes” [9]. Although it may seem that there is nothing to add to this mosaic of historical study, it is not quite true. The facts presented are not always accurate and differences of interpretation may also be found. Depending on each author’s perspective, certain information may have been highlighted or alternatively neglected. Now and then a newly traced fragment of information may be added to the mix [2–4, 7] and thereby present a modified view of the history of ankle fractures. This current historical review focuses on several aspects of the history of posterior malleolar fractures, including the role of radiology, classifications of these fractures, and their operative treatment.

• MeSH
• dějiny 20. století MeSH
• fraktury kotníku * dějiny   klasifikace   terapie   MeSH
• kotník chirurgie   MeSH
• lidé MeSH
• ortopedické výkony dějiny   MeSH
• radiologie dějiny   MeSH
• tibie chirurgie   zranění   MeSH
• Check Tag
• dějiny 20. století MeSH
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

healing disturbances occur in 5-10% of the cases. The anatomical region of the lower limb predisposes the tibia for bone healing disturbances. Reports about the incidence of non-unions of the tibial shaft are inhomogeneous. Different treatment strategies have been published which depend on the type of non-union as well as the history of the patient. These range from conservative approaches to complex procedures including segmental resection and bone transport. This review aimed to summarize the state of the art treatment of tibial non-unions and report about recent basic research results that may improve bone healing. Key words: tibial non-unions, treatment strategies, bone healing.

• MeSH
• fraktury tibie chirurgie   MeSH
• hojení fraktur MeSH
• konzervativní terapie MeSH
• lidé MeSH
• nezhojené fraktury epidemiologie   terapie   MeSH
• ortopedické výkony MeSH
• tibie zranění   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH