OBJECTIVES: To recommend appropriate immobilization after the initial reduction of acetabular displaced fractures in order to minimize the risk of heterotopic ossification formation. DESIGN: Retrospective study of patients treated in our surgical department during the years 2005-2018. MATERIALS AND METHODS: There were 94 patients included in statistical analysis. The factors of injury severity, course of surgery and hospitalization and incidence of complications were recorded. The functional and X-ray results were evaluated at least one year after surgery. RESULTS: The patients were divided into the two groups according to the type of fixation after closed reduction, the external fixation (EF) and the skeletal traction (ST) group. According to the type of fracture there were 33 patients with central displacement and 61 patients with posterior displacement. Ossification grade III. And IV. Occur in 20% of our sample. There was greater incidence of Brooker grade III. And IV. Ossification in the ST group, but statistically insignificant, p = 0.57. There was no statistically significant difference in the occurrence of ossifications regarding the severity of the head injury, p = 0.11, or to the severity of the injury p = 0.54. The combination of posterior displacement and ST results in higher risk for ossifications, specifically in our group at 11.48% compared to the combination of posterior displacement and EF where it is 8.2%. CONCLUSION: Skeletal traction for posterior displaced acetabular fracture appears to be a more risky procedure for the development of ossifications than external fixation.

• MeSH
• acetabulum zranění   chirurgie   MeSH
• externí fixátory * škodlivé účinky   MeSH
• fixace fraktur škodlivé účinky   MeSH
• heterotopická osifikace * epidemiologie   etiologie   prevence a kontrola   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• ankylóza diagnóza   etiologie   komplikace   MeSH
• chřipka lidská * komplikace   MeSH
• heterotopická osifikace * diagnóza   etiologie   terapie   MeSH
• kyčelní kloub diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• umělé dýchání škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE OF THE STUDY In certain patients after treated pelvic fractures, heterotopic ossifications can be observed in the area of the pubic bone, which protrude ventrally, and often also laterally and distally into surrounding soft tissues of the groin or even medially into the proximal thigh. These ossifications are shaped like sharp spikes of various lengths, which is why the authors refer to them as "spicules". In some patients, these ossifications are also associated with pain. The aim of this study was to provide an overview of the morphology of heterotopic ossifications of the anterior segment of the pelvis and to discuss the etiology of their origin, and further to determine the incidence, risk factors and clinical significance of these "spike-like" ossifications. MATERIAL AND METHODS X-ray images of patients treated for pelvic injuries between 2009 and 2018, in whom radiological documentation was available at least 12 months after the injury or surgery were evaluated. Patients with acetabular fractures or combined pelvic and acetabular injuries were not included in the study. Possible risk factors studied included gender, severity of injury, type of fracture according to the AO / ASIF classification, concomitant bladder injury, method of treatment and type of osteosynthesis of the anterior segment of the pelvis. The categorial data concerning risk factors for the observed "spicule" type ossifications was statistically evaluated using the chi-square test at the 5% level of significance. RESULTS The studied group consisted of 218 patients (121 women, 97 men) aged 13 to 92 years of age (mean age was 54 years, median age was 55 years). Heterotopic "spicule" type ossifications occurred in 21 patients (4 females, 17 males) aged 18 to 76 years (mean 39 years, median 41 years). Significant risk factors in the observed ossification group included male sex (p = 0.0004), severity of trauma (predominance of "spicules" was seen in multiple trauma patients, (p = 0.0024), unstable pelvic injury according to AO / ASIF classification (predominance of "spicules" in type B and C fractures over type A fractures, (p = 0.0013), concomitant bladder injury (p = 0.0009) and in patients undergoing surgical treatment of the fracture (p < 0.0001), where all the observed spicules were seen in patients undergoing anterior pelvic segment osteosynthesis. A statistically significant difference was also evident when comparing the osteosynthetic material used in the anterior segment (a increased incidence of ossifications was seen in patients undergoing plate fixation compared to patients in whom pubic screws were used, p = 0.0050). DISCUSSION Heterotopic ossifications are described as relatively common consequences of pelvic fractures, but are not considered a major problem because they usually do not produce any clinical correlations. The causes of post-traumatic and postoperative ossifications in the pelvic area include the effects of high energy traumas, extensive surgical procedures, prolonged artificial lung ventilation, and post-infectious states after complications of surgical treatment. CONCLUSIONS The study identified risk factors for heterotopic "spicule" type ossifications. The identified risk factors include male sex, severity of injury, unstable type of fracture, concomitant bladder injury, surgical treatment, and the use of massive implants. Only the effect of bladder injuries can be partially influenced by performing less invasive surgical techniques during combined pelvic and bladder injuries. Key words: pelvic fracture, pelvic injury, complications, heterotopic ossifications, multiple trauma, unstable pelvic trauma, urinary bladder injury.

• MeSH
• acetabulum MeSH
• fraktury kostí * komplikace   chirurgie   MeSH
• fraktury kyčle * MeSH
• heterotopická osifikace * diagnóza   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pánev MeSH
• pánevní kosti * MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Heterotopic ossification is a frequent and a well-known complication after elective primary total hip arthroplasty. Prophylaxis is crucial since once the ossification is mature, the only treatment option is its surgical removal during revision hip surgery. There are pre-, peri- and postoperative prophylactic modalities. Ranking among the perioperative possibilities is the application of tranexamic acid in blood control management. The aim of our study is to prove the positive side effect of tranexamic acid application on reducing the heterotopic ossification ratio. MATERIAL AND METHODS A cohort of 401 total hip replacements was assessed retrospectively in the period from 2012 to 2016. Particular degrees were stratified based on the Brooker classification, sex, laterality and type of implant fixation. The average follow-up period is 6.10 years (range 40 m to 113 m). The hips treated in 2012 are taken as reference and the hips treated in 2016 are exposed to tranexamic acid protocol. Other secondary prophylactic modalities (pharmacological prophylaxis or radiotherapy), tertiary modalities (revision surgery) and trauma patients were excluded from the study. The acquired data were then statistically assessed. RESULTS Tranexamic acid protocol significantly reduces the incidence of heterotopic ossification after elective primary total hip replacement. In our cohort of 401 hips, the overall incidence of HO is 40.6%. The difference between the control group - 49.7% and the exposed group - 30.2% is statistically significant. More importantly, the clinically relevant types (III and IV) were also significantly reduced (12.7% vs. 4.2%). Other associated parameters such as uncemented implant, female sex and right-sided surgery further reduced the incidence of ossifications. DISCUSSION Identification of the risk patient, risk factors and subsequent care to maintain the range of motion, analgesia or potential removal of ossifications remain to be the priority in managing heterotopic ossifications after THA. Preoperative options to reduce the incidence of this complication are limited. Moreover, both the pharmacological prophylaxis and radiotherapy are associated with major complications and strict patient compliance is fundamental. Inclusion of simple tranexamic acid protocol in surgery management significantly reduces the risk of heterotopic ossification. CONCLUSIONS Development and maturation of heterotopic ossification is still intensively explored, but the main biochemical pathways are still unclear. Therefore, there is no causal treatment option nowadays. Individualisation of prophylactic treatment modalities leads to reduction in ossification development. It has been proven that one of these effective modalities is the tranexamic acid application before and after the procedure. This reduction is statistically significant and clinically relevant. Key words: tranexamic acid, total hip replacement, heterotopic ossification, prophylaxis, fixation type.

• MeSH
• heterotopická osifikace * epidemiologie   etiologie   prevence a kontrola   MeSH
• incidence MeSH
• kyselina tranexamová * terapeutické užití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• heterotopická osifikace etiologie   klasifikace   prevence a kontrola   terapie   MeSH
• lidé MeSH
• muskuloskeletální nemoci * patofyziologie   terapie   MeSH
• nemoci svalů etiologie   patofyziologie   terapie   MeSH
• osteoporóza diagnóza   terapie   MeSH
• poranění míchy * komplikace   MeSH
• svalová atrofie patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Rezistence měkkých tkání u dětí mají ve většině případů nezávažné příčiny, avšak přesto mohou být způsobeny závažným onemocněním, které vyžaduje komplexnější vyšetření a léčbu. Autoři prezentují soubor 3 případů dětí s rezistencemi v měkkých tkáních, u nichž mělo zásadní význam využití nových diagnostických metod na úrovni DNA a RNA. U jedné pacientky vedlo toto vyšetření ke správnému stanovení diagnózy fibrodysplasia ossificans progressiva (FOP) a u dalších dvou pacientů s familiární infantilní myofibromatózou vedlo k určení vhodného typu léčby.

Soft tissue tumors in children are mostly benign, but there are several serious diseases, that require comprehensive examinationand treatment. The authors present 3 case reports of children with soft tissue tumors, in which the new diagnostic methods at thelevel of DNA and RNA were fundamental. In the first patient, this method led to an unexpected diagnosis of fibrodysplasia ossificansprogressiva (FOP), and in the other two patients with familiar infantile myofibromatosis, it resulted in appropriate treatment.

• MeSH
• aktivinové receptory typu I genetika   MeSH
• heterotopická osifikace diagnostické zobrazování   etiologie   MeSH
• imunohistochemie MeSH
• jaderné proteiny genetika   MeSH
• kojenec MeSH
• lidé MeSH
• myofibromatóza * diagnóza   farmakoterapie   genetika   MeSH
• myositis ossificans * diagnóza   farmakoterapie   genetika   MeSH
• nádory měkkých tkání * diagnóza   genetika   terapie   MeSH
• proteiny buněčného cyklu genetika   MeSH
• protokoly antitumorózní kombinované chemoterapie terapeutické užití   MeSH
• růstový faktor odvozený z trombocytů - receptor beta genetika   MeSH
• sekvenování exomu MeSH
• zárodečné mutace MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

Difúzna idiopatická skeletálna hyperostóza je nezápalová degeneratívna choroba postihujúca axiálny skelet kalcifikáciou a progredujúcou hyperostózou predného a zadného longitudinálneho ligamenta, ako aj iných úponov. Choroba postihuje aj periférne úpony – entézy v oblasti ramien, lakťov, panvy, kolien a na pätách. Chorobný proces je výrazný a pri koincidencii s reumatoidnou artritídou dokáže modulovať erozívne kostné zmeny. Popri postihnutí kostí môžu byť prítomné extraoseálne zmeny, ako sú dysfágia, dysfónia a neurologické komplikácie, predovšetkým bolesti v torakolumbálnej chrbtici, stuhnutosť a obmedzenie pohyblivosti, ale aj radikulárny syndróm, myelopatie, úžinový syndróm hornej hrudnej apertúry a zlomeniny stavcov. DISH je spojená s metabolickým syndrómom a jej liečba popri aplikácii analgetík, nesteroidových antiflogistík a myorelaxancií vyžaduje aj rehabilitáciu, fyzikálnu liečbu a balneoterapiu.

Diffuse idiopathic skeletal hyperostosis is a non-inflammatory degenerative disease affecting the axial skeleton by calcifications and progressive hyperostosis of anterior and posterior longitudinal ligaments. The disease also affects the peripheral insertions on the shoulders, elbows, pelvic region, knees and heels. In coincidence with rheumatoid arthritis is the disease able to ameliorate its destructive outcomes. In addition to the affected bone and ligaments of spine may be present extraosseal findings such as dysphagia, dysphonia and neurological complications. Of these especially pain in the thoracolumbar spine, stiffness and limitation of mobility, as well as radicular syndrome, myelopathy, thoracic outlet and vertebral fractures. DISH is associated with the metabolic syndrome and its treatment requires in addition to the analgesics, non-steroidal anti-inflammatory drugs, COX-2 inhibitors and myorelaxants, also rehabilitation, physiotherapy and balneotherapy.

• Klíčová slova
• ankylozující vertebrální hyperostóza,
• MeSH
• difuzní idiopatická skeletální hyperostóza * diagnóza   komplikace   patofyziologie   MeSH
• heterotopická osifikace etiologie   MeSH
• lidé MeSH
• nemoci míchy etiologie   MeSH
• radikulopatie etiologie   MeSH
• úžinové syndromy etiologie   MeSH
• Check Tag
• lidé MeSH

Autor popisuje případ patologické mineralizace zadní komory oka. Histologické vyšetření obalů postiženého oka odhalilo zánět, otok, poruchy cirkulace a známky dystrofické kalcifikace. Strukturálně fázové vyšetření a chemická analýza kalcifikace stanovily, že biominerál je tvořen hydroxyapatitem z relativně malých krystalů s poruchou krystalické mřížky. V popisovaném případě byla tvorba patologického biominerálu ve zrakovém orgánu vyvolána penetrujícím poraněním. Oční úraz mohl způsobit hemoftalmus a chronickou zánětlivou reakci v obalech oka. Tyto procesy mohly způsobit částečnou atrofii oka a vývoj dystrofických a nekrobiotických změn v tkáních. Patologická biomineralizace v postiženém oku se vznikla jako druh dystrofické kalcifikace. Klíčová slova: oko, patologická biomineralizace, hydroxyapatit Do redakce doručeno dne 23. 4. 2014 Do tisku přijato dne 18. 7. 2014

The authors have described the case of pathological biomineralization of ocular posterior chamber. Histological examination of affected eye shells revealed inflammation, oedema, dyscirculatory violations, and signs of dystrophic calcification. Structural-phase and chemical analyses of calcification have revealed that the biomineral consists of hydroxyapatite with relatively small crystallite size and defective crystal lattice. In the described case the formation of pathological biomineral in the vision organ was initiated by penetrating wound. Eye injury might have caused a hemophthalmus and chronic inflammatory reaction in the shells, these processes eventually led to the organ subatrophy and to the development of dystrophic and necrobiotic changes in the tissues. Pathological biomineralization in the affected organ developed as a type of dystrophic calcification. Key words: eye, pathological biomineralization, hydroxyapatite

• Klíčová slova
• patologická biomineralizace,
• MeSH
• heterotopická osifikace diagnóza   etiologie   patofyziologie   MeSH
• hydroxyapatit * izolace a purifikace   MeSH
• kalcinóza * diagnóza   etiologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikroanalýza elektronovou sondou MeSH
• oči patologie   MeSH
• oční nemoci * diagnóza   patofyziologie   patologie   MeSH
• penetrující poranění oka komplikace   MeSH
• transmisní elektronová mikroskopie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

This article describes a practical, clinically based approach to classification of postburn deformities. Burn scar contractures are of either the broad diffuse type or linear band-like type. The former generally respond well to release and insertion of a skin graft or substitute, whereas the latter are generally repaired using a simple or modified Z-plasty or a transpositional flap technique. The pulsed dye laser is a promising technique used to reduce scar thickness and redness. Postburn deformities of the face, upper and lower extremities, and trunk are discussed, in addition to novel techniques for vascularized composite allotransplantation of the face.

• MeSH
• axila zranění   MeSH
• dárci tkání zásobování a distribuce   MeSH
• dolní končetina zranění   MeSH
• heterotopická osifikace etiologie   patologie   terapie   MeSH
• jizva patologie   terapie   MeSH
• kloubní deformity získané patologie   terapie   MeSH
• kontraktura patologie   terapie   MeSH
• kraniocerebrální traumata terapie   MeSH
• laserová terapie metody   MeSH
• lidé MeSH
• loketní kloub zranění   MeSH
• místo odběru štěpu chirurgie   MeSH
• perineum zranění   MeSH
• popálení komplikace   patologie   MeSH
• poranění krku terapie   MeSH
• poranění měkkých tkání terapie   MeSH
• předpověď MeSH
• prsy zranění   MeSH
• transplantace obličeje metody   MeSH
• vaskularizovaná kompozitní alotransplantace metody   MeSH
• výběr dárců metody   MeSH
• záchranná terapie metody   MeSH
• získané deformity nosu terapie   MeSH
• získané deformity ruky patologie   terapie   MeSH
• získané deformity ucha terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: Recent studies describe significant rates of heterotopic ossification (HO) after cervical total disc replacement (CTDR). Little is known about the reasons, and one aspect that requires further in vivo investigation is the biomechanical alteration after CTDR and the role of the implant-related centre of rotation (CORi) in particular. The role of the sagittal position of the CORi on functional outcome in two versions of a semi-constrained disc prosthesis with sagittally different CORi is the topic of this study. METHODS: Patients were candidates for single-level CTDR between C3 and C7 who suffered from CDDD and received a standard or flat version of activ C™ (Aesculap AG, Tuttlingen). Clinical and radiographic assessments were determined preoperatively, intraoperatively, at discharge and again at 6 weeks, 6 months, 1 and 2 years. Radiographic examinations were performed independently using specialized quantitative motion analysis software. RESULTS: Clinical outcome improved significantly regarding NDI as well as VAS on neck and arm pain with no differences in mean improvement by study group. Segmental angle measures show a significantly better lordotic alignment for both groups after surgery, but the degree of correction achieved is higher in the flat group. Correlation analysis proves that the more anterior the CORi is positioned, the higher the lordotic correction is achieved (Pearson rho -0.385). Segmental ROM decreased in the standard group but was maintained for flat implants. At present, our data do not demonstrate a correlation between CORi and ROM at 2 years. Two years after surgery, severe HO grade III-IV was present in 31.6 % standard and 13.1 % flat cases with significant differences. Grouping according to HO severity showed comparable sagittal positions of CORi for flat implants but a more posterior position in the severe HO group for standard implants. CONCLUSIONS: Our results confirm the influence of CORi location on segmental alignment, kinematics and HO for a semi-constrained CTDR, but it also indicates a multifactorial process.

• MeSH
• artroplastika meziobratlové ploténky MeSH
• dospělí MeSH
• heterotopická osifikace etiologie   MeSH
• krční obratle radiografie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lordóza radiografie   MeSH
• meziobratlová ploténka radiografie   chirurgie   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH