• MeSH
• fraktury kostí terapie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• otevřené fraktury terapie   MeSH
• progrese nemoci MeSH
• rány a poranění komplikace   terapie   MeSH
• senioři MeSH
• terapie ran pomocí řízeného podtlaku * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• novinové články MeSH

INTRODUCTION: Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes. METHODS: Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury. RESULTS: One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05. CONCLUSIONS: In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types.

• MeSH
• dolní končetina MeSH
• hyperbarická oxygenace * MeSH
• kvalita života MeSH
• lidé MeSH
• nekróza MeSH
• otevřené fraktury * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.

• MeSH
• autologní transplantace MeSH
• fibula krevní zásobení   transplantace   MeSH
• fraktury ulny chirurgie   MeSH
• fraktury vřetenní kosti chirurgie   MeSH
• gangréna plynatá chirurgie   terapie   MeSH
• lidé MeSH
• otevřené fraktury chirurgie   terapie   MeSH
• poranění předloktí chirurgie   terapie   MeSH
• předloktí krevní zásobení   chirurgie   MeSH
• přenos šlachy metody   MeSH
• transplantace kostí MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• bérec MeSH
• dolní končetina MeSH
• mezioborová komunikace MeSH
• otevřené fraktury terapie   MeSH
• poranění měkkých tkání terapie   MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• dospělí MeSH
• fraktury vřetenní kosti terapie   MeSH
• hojení ran MeSH
• kompartment syndrom terapie   MeSH
• lidé MeSH
• otevřené fraktury terapie   MeSH
• poranění předloktí terapie   MeSH
• rány a poranění terapie   MeSH
• terapie ran pomocí řízeného podtlaku * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• fixace fraktur metody   MeSH
• hojení fraktur MeSH
• infekce měkkých tkání terapie   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• lidé MeSH
• otevřené fraktury * komplikace   terapie   MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: Open fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in many cases, multiple operations and prolonged rehabilitation. Use of hyperbaric oxygen therapy as an adjunct to standard orthopaedic trauma care has the potential to reduce the complications of musculoskeletal injury and thus improve outcomes. Two previous randomised trials have suggested some positive effect, but neither functional measures nor long-term outcomes were reported. METHODS AND ANALYSIS: An international, multicentre, randomised, open-label, clinical trial. Patients with trauma with an acute open fracture of the tibia with severe soft tissue injury (Gustilo grade 3) and high risk of injury-related complications were recruited from participating major trauma hospitals with hyperbaric facilities. Patients were enrolled with the expectation of commencing 12 sessions of hyperbaric oxygen therapy within 48 h of injury. The primary outcome measure is the incidence of acute complications of the open fracture wound at 14 days. Other short-term outcome measures include amputation, need for fasciotomy, time until wound closure, breakdown of closed wounds, time until definitive orthopaedic fixation, number of operative procedures, intensive care stay and hospital stay. Long-term follow-up will continue for 2 years postinjury. ETHICS AND DISSEMINATION: Ethics approval was given by The Alfred Health Human Ethics Committee (206/04) and the Monash University Human Research Ethics Committee (CF07/4208). Approval was also obtained from the institutional research ethics committee at each participating site. This study will make a significant contribution to the trauma literature and should answer the question of whether hyperbaric oxygen therapy can significantly improve outcomes in severe lower limb trauma. Collective study results will be published in international journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT00264511; Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12607000559415.

• MeSH
• časové faktory MeSH
• fraktury tibie komplikace   terapie   MeSH
• hojení ran * MeSH
• hyperbarická oxygenace * MeSH
• incidence MeSH
• klinické protokoly MeSH
• lidé MeSH
• nekróza etiologie   terapie   MeSH
• otevřené fraktury komplikace   terapie   MeSH
• poranění měkkých tkání komplikace   terapie   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

Otvorené zlomeniny predkolenia so závažným postihnutím mäkkých tkanív a rozsiahlym kostným defektom sú naďalej vážnym terapeutickým problémom. Význam postihnutia mäkkých častí je často v klinickej praxi podceňovaný. V práci na kazuistike prezentujeme možnosti využitie masívnej heterológnej spongioplastiky v kombinácii s autológnymi osteoblastami ako alternatívu ku kalotaxii a prenosu vaskularizovaného kostného laloka. Kľúčové slová: bilaterálne otvorené tibiálne zlomeniny − kritický kostný defekt − svalové rotačné laloky − m.gastrocnemius − vákuum asistovaná terapia

Open tibial fractures with extensive soft tissue injury and accompanying bone defect are still a challenge for surgeons. Soft tissue injury is often underestimated in clinical practice. In our case report, we present the options for clinical usage of heterologous bone grafting combined with autologous bone stem cells as a therapeutic alternative to calotaxis and free bone flaps. Key words: bilateral open tibial fractures − critical size bone defects − local rotational muscle flaps − the gastrocnemius muscle – vacuum-assisted closure

• MeSH
• antibiotická profylaxe MeSH
• chirurgie operační metody   MeSH
• debridement MeSH
• dopravní nehody MeSH
• externí fixátory využití   MeSH
• fraktury tibie * diagnóza   chirurgie   patofyziologie   terapie   MeSH
• hojení fraktur MeSH
• homologní transplantace MeSH
• kosterní svaly transplantace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• osteoblasty MeSH
• otevřené fraktury * diagnóza   chirurgie   patofyziologie   terapie   MeSH
• poranění měkkých tkání etiologie   terapie   MeSH
• rentgendiagnostika MeSH
• transplantace heterologní MeSH
• transplantace kostí metody   MeSH
• transplantace mezenchymálních kmenových buněk využití   MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• délka pobytu statistika a číselné údaje   MeSH
• dítě MeSH
• externí fixátory MeSH
• fixace fraktur přístrojové vybavení   metody   MeSH
• fraktury kostí komplikace   mortalita   radiografie   terapie   MeSH
• lidé MeSH
• míra přežití MeSH
• mladiství MeSH
• nestabilita kloubu komplikace   terapie   MeSH
• otevřené fraktury terapie   MeSH
• pánevní kosti zranění   radiografie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Prevention of infection is a paramount concern after open fracture of the tibia. Previous studies have shown that delay in soft-tissue coverage may raise infection rates. Use of vacuum-assisted closure devices in open fracture wounds has become common. The authors analyzed whether use of the vacuum-assisted closure sponge can allow delay of flap coverage for open tibia fractures without an increase in infection rate. METHODS: The authors identified 38 patients with Gustilo grade IIIB open fractures from their trauma registry with a minimum 1-year follow-up. From the medical record, the authors collected information on the time from injury to definitive wound coverage, type of fixation, type of coverage, and demographics. Infected patients were defined as patients that required surgical debridement after coverage with positive cultures. RESULTS: Patients who underwent definitive coverage within 7 days had a significantly decreased rate of infection (12.5 percent) compared with patients who had coverage at 7 days or more after injury (57 percent) (p < 0.008). The overall infection rate was 36 percent with routine use of the vacuum-assisted closure sponge. Patients who developed infection had a greater mean time to coverage than patients who did not develop infection (8.9 days versus 4.8 days; p < 0.029). CONCLUSIONS: Routine use of vacuum-assisted closure with open tibia fractures is safe and provides a good primary dressing over open wounds. For Gustilo grade IIIB tibia fractures, vacuum-assisted closure therapy does not allow delay of soft-tissue coverage past 7 days without a concomitant elevation in infection rates.

• MeSH
• bakteriální infekce etiologie   prevence a kontrola   MeSH
• časové faktory MeSH
• dospělí MeSH
• fraktury tibie komplikace   terapie   MeSH
• lidé MeSH
• otevřené fraktury komplikace   terapie   MeSH
• terapie ran pomocí řízeného podtlaku * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH