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
• dospělí MeSH
• fraktury humeru * diagnostické zobrazování   chirurgie   MeSH
• hojení fraktur MeSH
• humerus chirurgie   MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• nezhojené fraktury * chirurgie   MeSH
• os ilium MeSH
• retrospektivní studie MeSH
• senioři MeSH
• transplantace kostí metody   MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články 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
• dospělí MeSH
• fraktury humeru * diagnostické zobrazování   chirurgie   MeSH
• humerus chirurgie   MeSH
• intramedulární fixace fraktury * škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nezhojené fraktury * chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Pakloub představuje jednu ze základních komplikací při hojení zlomenin. Diagnostika se opírá především o klinický a RTG/CT nález. Paklouby klasifikujeme dle Webera a Čecha na vitální a avitální. U pakloubů vitálních je základní příčinou nezhojení nízká mechanická stabilita osteosyntézy a cílem léčby je její zvýšení. U pakloubů avitálních chybí biologická aktivita a součástí léčby musí být navíc podpora biologie ve formě spongioplastiky a dekortikace. Léčba pakloubů je časově a finančně náročná a frekvence jejich výskytu se nesnižuje. Díky pochopení příčin jejich vzniku a rozvoji osteosyntetických materiálů však došlo v posledních desetiletích k výraznému pokroku a vyšší úspěšnosti v léčbě pacientů s touto poruchou hojení kosti. Prezentovaný případ hojení pakloubu po periprotetické zlomenině zahrnuje podrobný popis terapeutických rozvah a technik v jednotlivých fázích léčby včetně radiologické a obrazové dokumentace. Úspěšného zhojení bylo dosaženo po 6 měsících od užití předehnuté dlahy. Předehnutá dlaha (wave plate, Wellenplatte) je v našich zemích vzácně užívaný implantát, který však svými specifickými biomechanickými a biologickými vlastnostmi významně zvyšuje pravděpodobnost zhojení vybraných typů diafyzárních pakloubů.

Nonunion is one of the common fracture healing complications. Its diagnosis is based on clinical and X-ray/CT findings. Nonunions can be classified, according to Weber and Cech, as vital and nonvital. Low mechanical stability is the main underlying factor in the development of vital nonunions and therefore, the treatment should be focused on increasing their stability. Absence of biological activity is the causal factor in the development of nonvital nonunions; thus the therapy must be bolstered by bone grafting and decortication. Treatment of nonunions is time consuming and costly and the frequency of their incidence is not decreasing. However, significant progress has been made in the treatment of patients with this bone healing defect over the last decades owing to improved understanding of its genesis and the development of osteosynthetic materials. The presented case of nonunion after periprosthetic fracture includes a detailed description of the therapeutic considerations and techniques used in subsequent phases of treatment, accompanied by radiologic and pictorial documentation. Six months after application of a wave plate, the nonunion was successfully healed. The wave plate is a rarely used implant in our countries; however, its specific biomechanical and biological characteristics significantly support healing of indicated diaphyseal nonunions.

• MeSH
• biomechanika MeSH
• fraktury femuru * chirurgie   patologie   MeSH
• hojení fraktur MeSH
• kostní destičky MeSH
• lidé MeSH
• nezhojené fraktury * chirurgie   diagnostické zobrazování   etiologie   MeSH
• senioři MeSH
• transplantace kostí MeSH
• vnitřní fixace fraktury MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE OF THE STUDY The clinical prospective study presents the results of minimally invasive harvesting of cancellous bone tissue in trauma indications. We focused on evaluating the clinical outcomes of this technique, particularly on the amount of cancellous bone harvested, the effectiveness of its use and complications. The pain in the bone graft harvest site is evaluated and compared with the pain after a standard harvest from the iliac crest. MATERIAL AND METHODS All the patients aged 18-90 years, in whom cancellous bone was harvested by minimally invasive technique using a bone cutter were included prospectively in the study. It was used to fill the defect in treating a fracture or in surgical treatment of non-union. The patients, in whom the grafts harvested in this manner were combined with another substitute, were not included in the study. Thus, 57 adult patients (40 men, 17 women) were included in the group in the period from March 2012 to March 2016. 37 patients, i.e. 65% of the total number of 57 patients, arrived for the evaluation of the clinical outcome. The minimally invasive graft harvesting was performed using the Aesculap® cutters. The graft was harvested either from the skeleton directly in the area of surgical wound or by a mini incision above the harvest site in the area under surgical drapes. The diameter of the cutter was selected based on the planned necessary number of grafts and with account taken of the harvest site. There were 6 harvest sites selected - proximal humerus, proximal ulna, iliac crest, greater trochanter of femur, distal femur and proximal tibia. The age and gender of patients, harvest site, type of the used cutter and the total number of harvested grafts were recorded in the study. The patients underwent a clinical follow-up at 6 weeks, 3 months, 6 months and 1 year postoperatively. The healing of the fracture or non-union was assessed on radiographs and in case of any doubt a CT scan was indicated. The pain at the graft harvest site was quantified with the use of the VAS score. A possible correlation between the age and the harvest site pain was explored by means of the Pearson s correlation coefficient. RESULTS In surgical management of fractures, 10.98 cm³ of bone marrow (σ 5.32) was harvested on average, in non-unions it was 10.85 cm³ (σ 5.52). With the above described technique, the mean healing time of lower extremity fractures was 26 weeks, in upper extremity it was 22 weeks. The non-unions of lower extremity and upper extremity healed after 28 weeks and 19 weeks, respectively. The average pain at the harvest site was 4.08 (σ 2.21, p ˂ 0.001). By calculating the Pearson's correlation coefficient it was confirmed that there is no correlation between the age and pain VAS score at the harvest site (r = -0.05). No early complications at the graft harvest site were observed in our group of patients. DISCUSSION On average, 10.98 cm³ of bone marrow was harvested in treated fractures, which in comparison to standard harvests from the iliac crest offers sufficient amount of tissue to treat complicated fractures and non-unions. Technically, the standard harvest site of cancellous bone tissue from the iliac crest is replaceable. The harvesting technique offers an interesting alternative also in terms of the duration of surgery and material. CONCLUSIONS Our study confirmed that by the minimally invasive technique of bone graft harvesting adequate amount of tissue to treat defect fractures and non-unions can be harvested. Spongioplasty using grafts harvested in this manner is effective, with a minimum percentage of non-unions. The advantage of this technique is the proximity of the harvest site and the operative field and low level of pain. The minimally invasive graft harvesting represents a technique with a low risk of postoperative and late complications. Key words: bone graft, autografts, minimally invasive surgery, ilium, pain.

• MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nezhojené fraktury chirurgie   MeSH
• odběr tkání a orgánů metody   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trabekulární kostní tkáň transplantace   MeSH
• transplantace kostí metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH

PURPOSE OF THE STUDY Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS Classification of distal radius fractures was established according to the AO classification. Inital assessment and followup were made by conventional x-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behavior. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseaseas, like chronic nephropathy and osteoporosis, have to be carried out. Key words: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts.

• MeSH
• diabetes mellitus 2. typu patologie   patofyziologie   MeSH
• fraktury vřetenní kosti patologie   patofyziologie   MeSH
• hojení fraktur fyziologie   MeSH
• lidé MeSH
• nezhojené fraktury patologie   patofyziologie   chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Posttraumatic pelvic nonunions in combination with malposition are uncommon in the present-day era of modern pelvic surgery. The case describes a new surgical technique for treatment of the nonunion localized to iliosacral joint. A 42-year-old polytraumatized male presented with a pelvic fracture (type 61-C2.3) associated with a complex acetabular fracture. The patient was treated and the pelvis stabilized according to damage control principles (external fixation and pelvic C-clamp) and subsequently definitively treated according to principles of current pelvic surgery. The posterior pelvis was stabilized by bilateral S1 iliosacral screws, however the posterior pelvic ring injury on the left side was not well reduced. The result was a nonunion formation in the left sacroiliacal joit with screw loosening. Two attemps at bone grafting and repeat stabilization were done, but the nonunion did not heal. The end result was a nonunion through left sacroiliacal joint with destruction of the lateral part of sacral bone. The nonunion was treated with nonvascularised autologous fibular strut graft in combination with allogenic corticocancellous grafting. The fibular graft was placed into the bone void after the removal of the iliosacral screw. Radiographically the nonunion healed completely six months after the fibular grafting and the patient had improved clinical outcome. The described technique solves both instability and bone defect in posterior pelvic ring even in the case with low contact areas. The nonvascularised autologous fibular grafting is an effective technique for sacroiliac joint nonunion treatment even in case with large bone defect. Key words: pelvis; nonunion; fibular graft.

• MeSH
• acetabulum zranění   MeSH
• dospělí MeSH
• fibula transplantace   MeSH
• lidé MeSH
• nezhojené fraktury chirurgie   MeSH
• pánevní kosti zranění   MeSH
• transplantace kostí * MeSH
• vnitřní fixace fraktury * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Although non-unions in the upper limb are rare different treatment options of this challenging situation are still affected with up to 20% of failure rate due to current literature. Risk factors for delayed and non-union of fractures are mainly the size of the fracture gap and bone loss of open fractures or in primary surgery followed by other relevant internal and external factors. In the upper limb non-unions of long bones are described with up to 30% after operative intervention. Especially in the upper limb range of motion is limited in non-union cases and disables adjacent joints like the shoulder, elbow and wrist hence reducing the total activity level of affected patients. Beside careful investigation of the causes leading to the non-union a comprehensive treatment plan should be defined to achieve successful results. Treatment can be non-operative in several, selected cases, but in the majority of cases revision surgery is necessary to achieve osseous healing. Our own experience showed that non-union in the upper limb are rare and account for only 1.7% of all surgical managed upper limb fractures. Non-union of upper limb fractures occur most frequently in clavicle fractures followed by humeral fractures. Atrophic non-union is the most frequent reason for osseous non-union (57%) and osseous healing after revision surgery in non-unions is completed after a mean of 6.45 months. This article will give a brief overview of the genesis, clinical evaluation, treatment options and recommendations in upper limb non-unions according to the current literature. Key words: fracture, upper-limb, non-union, osteosynthesis, cancellous bone-graft.

• MeSH
• fraktury kostí chirurgie   MeSH
• humerus zranění   MeSH
• klíční kost zranění   MeSH
• kosti horní končetiny zranění   MeSH
• lidé MeSH
• management nemoci MeSH
• nezhojené fraktury chirurgie   MeSH
• reoperace MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY: Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS: Classification of distal radius fractures was established according to the AO classification. Inital assessment and follow-up were made by conventional X-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS: The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behaviour. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS: To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseases, like chronic nephropathy and osteoporosis, have to be carried out.

• MeSH
• diabetes mellitus metabolismus   patofyziologie   MeSH
• fraktury vřetenní kosti patofyziologie   chirurgie   MeSH
• glukosa metabolismus   MeSH
• hojení fraktur fyziologie   MeSH
• komplikace diabetu metabolismus   MeSH
• kostní svalek růst a vývoj   patologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nezhojené fraktury chirurgie   MeSH
• osteoblasty patologie   fyziologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Non-union in forearm fractures is an uncommon but complex problem. This is especially given the unique anatomical structure and function of the forearm, making treatment distinctly different to that of other long bone fractures. Anatomical restoration of length, alignment, rotation and the radial bow maintains the optimal stabilising effects of the forearm muscles and interosseous membrane, as well as maximising the range of movement, particularly pronation and supination. Contemporary plate osteosynthesis using variations of the dynamic compression plate (DCP) developed by the AO group combined with established techniques of internal fixation have revolutionised the treatment of diaphyseal forearm fractures. Non-union rates have been minimised to below 5% and good to excellent functional outcomes are achieved. Non-union of the forearm is also intimately associated with a significant pain experience, marked pre-operative functional disability and physical and psychosocial morbidity. This review examines the literature and presents a guide to management as well as the current controversies and future directions related to this challenging problem.

• MeSH
• fraktury ulny diagnóza   chirurgie   MeSH
• fraktury vřetenní kosti diagnóza   chirurgie   MeSH
• interní fixátory MeSH
• lidé MeSH
• nezhojené fraktury diagnóza   patofyziologie   chirurgie   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• předloktí * patofyziologie   radiografie   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• vnitřní fixace fraktury * škodlivé účinky   přístrojové vybavení   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY: By the expression of several growth factors from activated thrombocytes, the application of Platelet Rich Plasma (PRP) stimulates angiogenesis and regeneration thus stimulating recovery through cell differentiation. This study aimed to evaluate the effects of PRP injection on patients who had undergone surgery for fracture and in whom delayed union or nonunion had been determined. MATERIAL AND METHODS: The study comprised 20 patients (male 17, female 3; median age 33.5 range 15-77) who had undergone lower extremity fracture surgery and were diagnosed with aseptic delayed union (8 patients) or non-union (12 patients). Blood taken from the patients was centrifuged to separate PRP, which was then activated by calcium chloride. The prepared PRP was injected into the fracture line under fluoroscopy guidance for totally three times once a week. The application of PRP was made at median 6 (range 6-8) months after fracture surgery. All patients were followed-up with clinical examinations and radiographs over a median period of 11 (range 8-12) months. RESULTS: Fracture union was achieved in six patients at median 15 (range 8-24) weeks. There was non-union of the fracture in eleven patients during the follow-up period and these patients underwent revision surgery. Sufficient union was not determined radiologically and clinically in three patients. Fracture union was achieved in six of eight patients in the delayed union group. There was no patient in the non-union group with fracture union. CONCLUSIONS: Fracture healing is a process affected by many factors. Although PRP has been reported in literature to be a biological treatment which increases healing, adequate healing was not determined in the treatment of non-union with PRP injection. However, in selected patients determined with delayed union, PRP injection can be recommended in non-surgical treatment.

• MeSH
• dospělí MeSH
• fraktury femuru chirurgie   terapie   MeSH
• fraktury tibie chirurgie   terapie   MeSH
• hojení fraktur fyziologie   MeSH
• injekce subkutánní MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nezhojené fraktury chirurgie   terapie   MeSH
• plazma bohatá na destičky * MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• 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