Hallux extensus is a persistent dorsiflexion of the first metatarsophalangeal joint. Apart from many other causes, it can also be caused by contracture of the extensor hallucis longus muscle, in our case resulting from surgical treatment of crural fracture. The authors present the case of a 17-year-old soccer player who sustained a fracture of both shin and calf bone during a soccer match and underwent surgical treatment with intramedullary nailing. While compartment syndrome wasn't observed, a postoperative complication in the form of progressive development of a dynamic type of hallux extensus was reported. The reason behind this complication was later found to be the interaction of the osteosynthesis material with the extensor hallucis longus muscle, which led to its scarring and shortening. A Z-lengthening of the musculus extensor hallucis longus tendon was indicated and performed with a good clinical outcome. During surgery, an anatomical variation in the course of the extensor hallucis longus was observed, which had to be taken into account to achieve a successful surgical outcome. Key words: cock-up big toe deformity, musculus extensor hallucis longus contracture, Z-lengthening tenotomy, crural fracture complication.

• MeSH
• fotbal zranění   MeSH
• fraktury kostí chirurgie   komplikace   MeSH
• intramedulární fixace fraktury škodlivé účinky   metody   MeSH
• lidé MeSH
• mladiství MeSH
• palec nohy * chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: Os vesalianum pedis (OVP) is a rare accessory bone of the foot located at the base of the fifth metatarsal bone. It is usually asymptomatic and incidentally seen on radiographs. When symptomatic, it manifests itself with lateral foot pain. OVP, which can become symptomatic as a result of traumatic injuries, can also be confused with fracture. The aim of this study is to determine the prevalence and morphometric characteristics of OVP in the Turkish population. MATERIAL AND METHODS: Radiographic images of 5268 individuals aged 16 years and older (mean 39.65±17.21) who completed ossification of the fifth metatarsal bone were evaluated for OVP. Of the cases included in the study, 44.8% were female and 55.2% were male. The general and sex-based prevalence of OVP was calculated, and morphometric measurements were done. RESULTS: OVP prevalence in the Turkish population was found to be 0.15% regardless of sex. OVP prevalence was calculated to be 0.24% in men and 0.04% in women. CONCLUSIONS: Anatomy, radiology, orthopedics and emergency medicine physicians are frequently encountered with foot disorders in clinical and educational practices. It is important to keep in mind the rare presence of OVP (0.15%), in the preliminary diagnosis. KEY WORDS: os vesalianum pedis, accessory ossicle, foot, radiography.

• MeSH
• dospělí MeSH
• klinická relevance MeSH
• lidé středního věku MeSH
• lidé MeSH
• metatarzální kosti * diagnostické zobrazování   abnormality   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prevalence MeSH
• rentgendiagnostika metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Turecko MeSH

PURPOSE OF THE STUDY: Intertrochanteric hip fractures in elderly patients are a significant cause of morbidity and mortality, with increasing incidence due to the aging population. Despite advancements in intramedullary nailing (IMN) technology, fixation failure remains a concern. This study aims to evaluate pre-and postoperative radiographic risk factors for varus collapse in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN, Smith & Nephew). MATERIAL AND METHODS: This retrospective study included patients over 60 years with AO 31A1 and 31A2 intertrochanteric femur fractures treated with InterTAN at a tertiary referral center from August 2012 to August 2017. Patients with high-energy fractures, AO 31A3 fractures, or those requiring open reduction were excluded. Data on demographics, fracture classification, implant sizes, imaging studies, and follow-up were collected. Radiographic assessments included Chang's medial cortical support concept, tip-apex distance (TAD), calcar-referenced TAD (CalTAD), neck-shaft angles (NSA), and screw placement according to Cleveland zones. Varus collapse was defined as a >5° change in NSA within three months postoperatively. Multivariate logistic regression analysis was used to identify risk factors for varus collapse. RESULTS: The study included 136 patients with a mean age of 79.8 years, of whom 38.2% were male. The early postoperative tipapex distance (TAD) averaged 21.9mm, with 30.1% of patients experiencing varus collapse greater than 5°. Positive medial cortical support (PMCS) or neutral position (NP) type reduction was highly protective against varus collapse (p < 0.001), as well as TAD less than 25mm (p < 0.001). Additionally, the placement of screws in the central-central or central-inferior zones provided a protective effect against varus collapse (p = 0.031). Conversely, having an OTA/AO type A2.2 or A2.3 fracture significantly increased the risk of varus collapse (p = 0.030). Other factors, such as CalTAD and the nail width to medullary canal ratio, did not significantly predict varus collapse (p = 0.831 and p = 0.952, respectively). DISCUSSION: Our findings align with previous studies highlighting TAD and screw placement as critical factors in preventing fixation failure. The protective effect of PMCS or NP reduction and the increased risk associated with OTA/AO type A2.2 and A2.3 fractures are noteworthy. Unlike previous studies, CalTAD was not significantly associated with varus collapse in our cohort. The study underscores the importance of surgical technique and radiographic parameters in optimizing outcomes for elderly patients with intertrochanteric fractures. CONCLUSIONS: In elderly patients treated with InterTAN nails, varus collapse is influenced by fracture type, TAD, reduction quality, and screw placement. Ensuring a TAD <25mm, achieving PMCS or NP reduction, and placing screws in central-central or central-inferior zones are crucial for minimizing varus collapse. These findings highlight the importance of meticulous surgical technique and radiographic assessment in managing intertrochanteric fractures in the elderly. KEY WORDS: hip fractures, intertrochanteric fractures, internal Fixation, geriatrics, cephalomedullary nail.

• MeSH
• fraktury kyčle * chirurgie   MeSH
• intramedulární fixace fraktury * metody   přístrojové vybavení   škodlivé účinky   MeSH
• kostní hřeby * MeSH
• kostní šrouby * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   epidemiologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• selhání protézy MeSH
• senioři nad 80 let MeSH
• senioři 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

PURPOSE OF THE STUDY: Osteoarthritis (OA) of the joints of the hand is one of the most common musculoskeletal disorders in the elderly population. It is a complex, degenerative disease affecting all components of the joint. Surgical treatment is indicated when conservative therapy fails. The ultimate solution is arthrodesis of the distal interphalangeal (DIP) joint. Various methods of arthrodesis have been described, ranging from the use of K-wires or compression screw to different types of intra-articular (intramedullary) implants. The aim of this study is to evaluate the surgical outcomes of arthrodesis of the distal interphalangeal (DIP) joint of the fingers using intramedullary implants. MATERIAL AND METHODS: Since 2011, arthrodesis of the distal interphalangeal joint using an intramedullary implant has been performed at our department 97 times in total, in 59 patients. 9 patients (15 cases of arthrodesis) were excluded from the study group due to their failure to complete the questionnaire, 1 female patient died. In the final group, 82 cases of arthrodesis in 49 patients (47 women, 2 men) were evaluated. In 72% of cases, the surgery was performed on the dominant hand. The mean age at the time of surgery was 58 years (median 59 years). The patients were indicated for surgery after the failure of all conservative treatment options. In addition to radiographs, also the hand function and pain were assessed based on the preand postoperative DASH score questionnaires. RESULTS: The surgical outcomes for all implants are satisfactory. In all 82 patients, the surgical wounds healed per primam. In one case, implant extraction was performed due to infection. Another complication was an unhealed fusion and formation of a non-union with minimum pathological mobility (the patient is satisfied with the outcome). In three patients, a fracture at the base of the distal phalanx was observed on postoperative radiographs, which fully healed within 3 months after surgery. The mean DASH score decreased from 41.95 preoperatively to 14.93 postoperatively. The mean time to healing of the arthrodesis observed on radiographs was 9.1 weeks. DISCUSSION: Currently, there are many different types of arthrodesis of the distal interphalangeal joint of the hand. Each method has its pros and cons. Arthrodesis using an intramedullary implant has the advantages of the older methods while minimizing postoperative complications. Our results are comparable to those reported in the foreign literature. CONCLUSIONS: Based on the evaluated outcomes, arthrodesis of the distal interphalangeal joint using an intramedullary implant can be considered valid. It definitely deserves to be included in the portfolio of surgical treatment of osteoarthritis of the DIP joints of the hand. According to our observation, the differences between various types of implants are minimal and their outcomes are comparable to those reported in foreign publications. The pain relief, restored finger function and fusion rate are comparable to, if not better than, those achieved by the older surgical methods. The advantage of this method is mainly easier implantation, fewer complications, and the possibility of implantation without the use of an X-ray image intensifier, which ultimately reduces the cost of surgery. The main disadvantage is the higher purchase price of the implant. KEY WORDS: osteoarthritis, distal interphalangeal joint, arthrodesis.

• MeSH
• artrodéza * metody   přístrojové vybavení   MeSH
• kloub prstu ruky * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoartróza * chirurgie   MeSH
• rentgendiagnostika MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

INTRODUCTION: During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy. MATERIAL AND METHODS: The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced. RESULTS: The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80-84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85-89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average - in the 80-84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85-89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery. CONCLUSIONS: Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure. KEY WORDS: total hip arthroplasty, total knee arthroplasty, osteoarthritis, hip fracture, life expectancy.

• MeSH
• lidé MeSH
• míra přežití MeSH
• naděje dožití * MeSH
• náhrada kyčelního kloubu * mortalita   metody   MeSH
• senioři nad 80 let MeSH
• totální endoprotéza kolene * mortalita   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The bone transport technique uses the principle of distraction-osteogenesis and fill bone defects with the aid of an external fixator. In order to evaluate the clinical effect of femoral internal fixation with Ortho-Bridge System after bone transport, 4 patients after femoral bone transport from October 2020 to October 2022 are studied in this paper. Among them, 3 patients ran refracture of femur after removal of the Limb reconstruction system, 1 patient just finish femoral bone transport and request internal fixation. The surgery results show that Ortho-Bridge System can be used in the situation that conventional Locking compression plate and intramedullary nail are not suitable due to anatomical variation after femoral bone transport. Key words: femoral fracture; Ortho-Bridge System; bone transport; postoperative complications of bone transport.

• MeSH
• dospělí MeSH
• externí fixátory MeSH
• femur chirurgie   MeSH
• fraktury femuru * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteogeneze pomocí distrakčního aparátu metody   přístrojové vybavení   MeSH
• pooperační komplikace etiologie   MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Significant malrotation of the femur after osteosynthesis is a serious complication of treatment and has a number of consequences for the patients and causes deterioration of their quality of life. Therefore, it is necessary to be familiar with intraoperative techniques to control the correct rotation, mostly clinical and radiological, which give us the possibility to minimize rotational errors. In the postoperative period, with even a slight suspicion of malrotation, it is necessary to proceed to its exact verification and, in indicated cases, to perform necessary correction. We recommend one of the CT techniques as a very reliable method, however in younger patients we prefer to use MRI. Early diagnosis of the rotational error and especially its size is essential from the point of view of potential reconstructive surgery, which is then chosen also with regard to the location of the original lesion. Key words: femoral osteosynthesis, limb malrotation, methods of measuring.

• MeSH
• femur chirurgie   diagnostické zobrazování   MeSH
• fraktury femuru * chirurgie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• počítačová rentgenová tomografie MeSH
• pooperační komplikace diagnóza   etiologie   MeSH
• vnitřní fixace fraktury * škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

Proximal femur fractures (PFF) pose a major challenge in elderly patients with severe comorbidities and receiving antithrombotic therapy since according to the latest guidelines the surgery should be performed as soon as possible, preferably within 24 hours, to reduce mortality and morbidity. This review outlines the practical approach to surgical management of PFF that relies on increasing evidence of safety of early surgery in patients with PFF receiving antiplatelet and anticoagulant therapy. We have also used information from the existing evidence-based guidelines for elective/planned surgery in patients with antithrombotic therapy. The practical approach can be summarised as follows: • Antiplatelet therapy - discontinuation of acetylsalicylic acid (ASA) and clopidogrel in monotherapy or in combination is not necessary prior to surgery. In case of bleeding, antifibrinolytic therapy is recommended as well as administration of platelet concentrate which is rarely needed. • In patients taking warfarin, reversal of its effects is recommended by early administration of vitamin K to allow surgery to be performed within 24 hours. Prothrombin complex concentrate (PCC) as a second-line drug is reserved for extreme cases only. Warfarin therapy is resumed 24 hours after surgery. • Direct oral anticoagulants must be discontinued 24-48 hours prior to surgery, possibly longer depending on the type of drug, time of administration of the last dose, and renal function. In extreme cases, an antidote (idarucizumab, off-label andexanet) can be administered prior to surgery, or PCC in case they are unavailable. Anticoagulation therapy is resumed in 24-48 hours. • Neuraxial anaesthesia is possible when ASA is taken by the patient and in case of effective warfarin reversal. • In early surgery and rapid restart of anticoagulant therapy, bridging therapy with LMWH is not indicated except for in cases with extreme risk of thrombosis. Key words: proximal femur fracture, antiplatelet therapy, anticoagulant therapy, perioperative management.

• MeSH
• antikoagulancia * škodlivé účinky   aplikace a dávkování   terapeutické užití   MeSH
• Aspirin škodlivé účinky   terapeutické užití   aplikace a dávkování   MeSH
• fraktury femuru chirurgie   MeSH
• fraktury proximálního femuru MeSH
• inhibitory agregace trombocytů * škodlivé účinky   terapeutické užití   MeSH
• lidé MeSH
• warfarin škodlivé účinky   terapeutické užití   aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY: Open (incisional) biopsies have long been accepted as the gold standard in diagnosing bone and soft tissue tumors. However, the main disadvantage of this method is that it can lead to increased contamination, hematoma, infection, and pathological fracture. Compared to open biopsies, percutaneous core needle biopsies are less invasive, do not require hospitalization, have low costs and low complication rates, and there is no need for wound healing in cases that require radiotherapy. This study evaluated the diagnostic accuracy and reliability of percutaneous core needle biopsy. MATERIAL AND METHODS: The study included the results of 250 percutaneous core needle biopsies of 244 patients who presented at the tertiary university hospital between September 2012 - September 2022 and were diagnosed with a bone or soft tissue tumor using the percutaneous core needle biopsy method and then underwent surgical excision in the Orthopaedics and Traumatology Clinic. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy rates were calculated for the percutaneous core needle biopsy method according to the compatibility of the results. RESULTS: A fluoroscopy-guided percutaneous Jamshidi needle biopsy performed by an orthopedist for lesions originating from the bone has a diagnostic accuracy of 96%. CT-guided percutaneous Jamshidi needle biopsy performed by a radiologist for lesions originating from the bone has a diagnostic accuracy of 88.9%. Percutaneous Tru-cut needle biopsy performed by an orthopedist without imaging guidance for lesions originating from soft tissue has a diagnostic accuracy of 92%. USGguided percutaneous Tru-cut needle biopsy performed by a radiologist for lesions originating from soft tissue has a diagnostic accuracy of 96,7% (p<0.001). DISCUSSION: The diagnostic accuracy of open biopsies ranges from 91% to 99% in the literature. Additionally, the diagnostic accuracy of core needle biopsies in recent studies ranges from 76% to 99%. Compared to the literature, our study has shown that biopsies performed by orthopedic specialists have a high diagnostic power (96% for bone-derived lesions; 92% for soft tissue-derived lesions). CONCLUSIONS: Percutaneous core needle biopsy is highly effective and reliable in diagnosing bone and soft tissue tumors. Managing patients by a team using a multidisciplinary approach will increase diagnostic success. KEY WORDS: core needle biopsy, percutaneous, diagnostic accuracy, radiology guided biopsy, bone and soft tissue tumors.

• MeSH
• biopsie dutou jehlou metody   MeSH
• dospělí MeSH
• fluoroskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory kostí * patologie   diagnóza   chirurgie   MeSH
• nádory měkkých tkání * patologie   diagnóza   MeSH
• počítačová rentgenová tomografie metody   MeSH
• prediktivní hodnota testů MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• senzitivita a specificita * MeSH
• ultrazvukem navigovaná biopsie metody   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

PURPOSE OF THE STUDY: Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment. MATERIAL AND METHODS: We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020. Patients were referred to our institution from hospitals across the country. We included all operatively managed Lisfranc injuries, primary procedures, and patients over the age of 16. Revision procedures, open injuries, polytrauma patients, patients under the age of 16, and those with multiple foot injuries were excluded. We assessed post-operative results as per the Wilpulla radiographic and clinical criteria. RESULTS: We treated 27 patients across the study period, of mean age 37.5 (SD 18.3), 55% male and 45% female. 33.3% of our patients were obese as defined by body mass index >30. As per the Myerson classification, we had 2 category A, 24 category B, and 1 category C injuries. Time to operation was median 14 days (range 0-116), with 2 delayed presentations following failure of conservative treatment. Our median length of stay was 1 day (range 0-16). We had 3 complications: 2 wound infections and 1 re-operation for non-union. Post-operative assessment as per Wilpulla demonstrated 74% of good, 18.5% fair and 7% poor fixation results. CONCLUSIONS: In our institutional experience, partial congruity lateral displacement injuries were the majority of surgical referrals. Surgical treatment through open reduction and internal fixation delivers good clinical and radiographically anatomical results. Further to conventional mechanisms of injury, we propose obesity to be an important risk factor for indirect, low-energy injuries that may help identify this injury. KEY WORDS: Lisfranc injury, long-term, orthopaedic surgery, obesity.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• metatarzální kosti zranění   chirurgie   diagnostické zobrazování   MeSH
• mladý dospělý MeSH
• pooperační komplikace etiologie   MeSH
• poranění nohy (od hlezna dolů) chirurgie   diagnostické zobrazování   MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH