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
- Hip Fractures * surgery MeSH
- Fracture Fixation, Intramedullary * methods instrumentation adverse effects MeSH
- Bone Nails * MeSH
- Bone Screws * adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Complications etiology epidemiology MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Prosthesis Failure MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
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
- Soccer injuries MeSH
- Fractures, Bone surgery complications MeSH
- Fracture Fixation, Intramedullary adverse effects methods MeSH
- Humans MeSH
- Adolescent MeSH
- Hallux * surgery MeSH
- Postoperative Complications etiology MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Case Reports MeSH
PURPOSE OF THE STUDY: The purpose of this study was to assess the clinical outcomes and complications associated with intramedullary and transverse K-wire fixations of 5th metacarpal neck fractures. MATERIAL AND METHODS: Patients who were operated for 5th metacarpal neck fractures between 2019 and 2022 were evaluated retrospectively. Regarding the surgical treatment methods, patients were assessed by dividing them into two groups. The first group comprised patients who underwent treatment with an intramedullary K-wire. The second group comprises patients who underwent transverse K-wire fixation. RESULTS: The average quick DASH score of all patients was 5.6±4.7 in the intramedullary K-wire fixation group and 5.9±5.1 in the transverse K-wire fixation group. An average 5th finger metacarpophalangeal joint extension limitation was 6.2±5.7° in the intramedullary fixation group and 6.1±5.8° in the transverse K-wire group. The mean radiological union time was 4.9±0.7 weeks in the intramedullary fixation group and 5.1±0.7 weeks in the transverse K-wire group. No statistically significant difference was found between the quick DASH scores and degrees of the MCP joint extension limitation ( p=0.785). Intramedullary fixation and transverse K-wire fixations are effective surgical treatment methods for metacarpal neck fractures. DISCUSSION: It has been reported that the intramedullary fixation method in metacarpal bone fractures is more effective than the fixation methods with cross and transverse K-wire. But our results revealed no difference in clinical outcomes between the two surgical fixation methods. CONCLUSIONS: We observed no statistically significant difference between the two fixation techniques with regard to union, clinical outcomes, or complications. KEY WORDS: intramedullary fixation; metacarpal neck fracture; transverse K-wire fixation.
- MeSH
- Adult MeSH
- Fractures, Bone * surgery MeSH
- Fracture Fixation, Intramedullary * methods instrumentation MeSH
- Bone Wires * MeSH
- Middle Aged MeSH
- Humans MeSH
- Metacarpal Bones * injuries surgery MeSH
- Retrospective Studies MeSH
- Fracture Fixation, Internal methods instrumentation MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Zlomeniny proximálního humeru představují v ortopedické praxi jedinečnou výzvu vzhledem ke složité anatomii a biomechanické komplexnosti této oblasti. Spektrum poranění, která se zde vyskytují, je od nedislokovaných stabilních zlomenin až po komplexní dislokované zlomeniny nebo zlomeniny luxační. Z historického hlediska byla léčba těchto zlomenin předmětem mnohých diskuzí a léčebné postupy zahrnovaly zejména konzervativní přístup, chirurgické řešení bylo poměrně vzácné. V posledních desetiletích došlo ke změně paradigmatu v léčbě zlomenin proximálního humeru nejenom díky pokroku v chirurgických technikách, ale zejména vývojem nových typů úhlově stabilních implantátů a moderních totálních endoprotéz. Rozvoj a dostupnost kvalitních zobrazovacích technik umožnily lepší pochopení charakteru zlomenin a precizní plánování operačních zákroků. Mezi hlavní cíle léčby patří obnovení funkce, úleva od bolesti a prevence komplikací, jako jsou prodloužené hojení nebo nezhojení a avaskulární nekróza. Jako zásadní se při volbě léčby jeví individuální přístup ke každému jednotlivému pacientovi s přihlédnutím ke všem faktorům, které ovlivňují konečný výsledek. Cílem tohoto přehledového článku je poskytnout aktuální přehled současného konceptu léčby zlomenin proximálního humeru. Jsou zde shrnuty trendy v neoperačních i operačních strategiích léčby, indikace k jednotlivým druhům léčby, operační techniky, výsledky a komplikace spojené s jednotlivými přístupy.
Fractures of the proximal humerus present a unique challenge in orthopedic practice due to the complex anatomy and biomechanical complexity of this region. The spectrum of injuries occurring here ranges from nondisplaced stable fractures to complex displaced fractures or fracture-dislocations. Historically, the treatment of these fractures has been the subject of much debate and treatment modalities have mainly involved a conservative approach, with surgical management being relatively rare. In recent decades, there has been a paradigm shift in the treatment of proximal humerus fractures not only due to advances in surgical techniques, but especially with the development of new types of angular-stable implants and modern total arthroplasties. The development and availability of high-quality imaging techniques have enabled better understanding of the nature of fractures and precise planning of surgical interventions. The main goals of treatment include restoration of function, pain relief and prevention of complications such as prolonged healing or non-healing and avascular necrosis. An individualized approach to each individual patient, considering all factors that affect the final outcome, appears to be essential in the choice of treatment. The aim of this review article is to provide an up-to-date overview of the current concept of treatment of proximal humerus fractures. Trends in nonoperative and operative treatment strategies, indications for each type of treatment, operative techniques, outcomes, and complications associated with each approach are summarized.
PURPOSE OF THE STUDY: Surgical options for paediatric femoral fractures include fl exible intramedullary nailing (FIN), plating, and external fi xators. Length unstable fractures are usually spiral, long oblique, or comminuted and are often associated with > 2 cm of shortening. The purpose of this study was to see whether FIN is effective for managing unstable femur fractures in children. MATERIAL AND METHODS: An electronic literature search was performed up to 25 February 2022 in Cochrane Library, PubMed, and Embase databases using a combination of MeSH search terms and keywords related to the population (e.g., "child" AND "diaphyses" AND "femur"), and intervention (e.g., "nail" OR "ESIN"). The data extracted included the study details, Demographic data, surgical details, postoperative immobilization, complications, and outcome. RESULTS: Eight studies with a total sample size of 369 patients were reviewed. The mean operative time, blood loss, and length of stay in the hospital were 67.62±12.32 minutes, 33.82±16.82 ml, and 4.9±1.27 days, respectively. The results were excellent in 61.92% of the patients, satisfactory in 32.61%, and poor in 5.43%. 4.54% of patients had major complications requiring reoperation and 32.46% of patients had minor complications. the most common complication was nail prominence seen in 26.30% of patients. Locked Ender's nail was associated with the least reoperation, malunion, and LLD rate compared to other types of FIN. CONCLUSIONS: FIN along with a single walking spica cast is a good choice in all forms of paediatric femoral fracture patterns allowing proper alignment and rotation. Locked Ender's nail is safe and effective for managing unstable paediatric femur fracture. KEY WORDS: pediatric femur fracture, length unstable, fl exible intramedullary nailing, submuscular plating, Flynn criterion.
- MeSH
- Child MeSH
- Lower Extremity MeSH
- Femur MeSH
- Femoral Fractures * surgery MeSH
- Internal Fixators MeSH
- Fracture Fixation, Intramedullary * adverse effects MeSH
- Humans MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Systematic Review MeSH
PURPOSE OF THE STUDY: Intraarticular fractures of the distal femur rank among the most severe musculoskeletal injuries. Various treatment options, such as plate osteosynthesis or retrograde nailing, can be employed. This study aims to evaluate the clinical outcomes and complications of intraarticular distal femoral fractures treated with retrograde femoral nail, with particular emphasis on C3 fractures. MATERIAL AND METHODS: Between January 2016 and January 2023, 18 AO/33.C3 fractures were treated with a retrograde femoral nail. Of these, two were classified as 33.C1, eight as 33.C2 and eight as 33.C3. Twelve of the fractures were open. After the initial treatment and stabilizing the patient's overall condition, we proceeded with the definitive osteosynthesis. The first phase involved open reduction and fixation using individual screws to reconstruct the articular surface. The second phase consisted in retrograde nailing with correction of the length, axis and rotation of the femur. The evaluation criteria included: complication rate, number of revisions, knee range of motion, mechanical axis and length of the lower extremity, progression of gonarthrosis, pain level, need of walking support, Lysholm and Tegner Activity Score for functional outcome. RESULTS: Overall, we evaluated the complications and the outcomes of 12 patients (13 fractures). Of these, 8 patients experienced some kind of postoperative complications, primarily insufficient healing or nonunion, which were managed through revision surgery. Plate reosteosynthesis was used in 2 patients who were then excluded from the final clinical evaluation. No cases of deep infection or deep vein thrombosis were reported and no patient required total knee replacement. Seven AO/33.C3 fractures were individually evaluated. The average knee range of motion was nearly 0-93°, maximum flexion was 120°. On average, the lower extremity was 1.6 cm shorter and 7.3° varus to the mechanical axis. Only little progression of gonarthrosis was observed along with low levels of pain. The Lysholm Score ranged between 52 and 84 points (averaging 73.1). The mean Tegner Activity Score was 3.4. All results showed adequate improvement in 33.C2 and 33.C1 groups. DISCUSSION: The retrograde femoral nail demonstrates several advantages over the locking compression plate, particularly in biomechanical aspects. Various clinical studies have reported superior outcomes in terms of healing, complication rate, blood loss and functional outcome. Our study findings align with some of those international studies, particularly in the rate of infectious complications (0%), mean Lysholm Score (79.3 p.) and Tegner Activity Score (4.1). On the other hand, we observed a higher rate of revision surgery (53.8 %), mainly due to evaluating 33.C fractures only. The main advantage of this method lies in complete visualization, leading to better reconstruction of the articular surface coupled with excellent biomechanical properties of the intramedullary nail. CONCLUSIONS: Intraarticular distal femoral fractures pose significant challenges to treatment and frequently lead to permanent damage. The primary treatment goals involve achieving anatomical reposition of the articular surface, stable osteosynthesis, correction of the femoral length and axis and early rehabilitation. Our study demonstrates good clinical outcomes with a relatively low rate of complications. Patients are capable of walking without pain, achieving a good range of motion, returning to their occupations and becoming self-sufficient. Moreover, there were no infectious complications and no significant progression of gonarthrosis. KEY WORDS: retrograde femoral nail, intraarticular distal femoral fracture, functional outcome, complication rate.
- MeSH
- Femoral Fractures * surgery MeSH
- Intra-Articular Fractures surgery MeSH
- Fracture Fixation, Intramedullary methods instrumentation MeSH
- Bone Nails * MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Complications etiology MeSH
- Reoperation methods MeSH
- Range of Motion, Articular MeSH
- Fracture Fixation, Internal methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
PURPOSE OF THE STUDY Although there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODS Electronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms "supracondylar", "humerus", "fracture", "Gartland type 3" and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTS Pooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%-98.5%), as compared to closed group (97.5%, 95% CI 96.3%-98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%- 96.1%) as compared to closed group (98.5%, 95% CI 97.5%-99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86-0.99). CONCLUSIONS Closed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high. Key words: supracondylar humerus, open reduction, percutaneous pinning, Flynn criteria.
- MeSH
- Child MeSH
- Humeral Fractures * surgery MeSH
- Humerus MeSH
- Fracture Fixation, Intramedullary * MeSH
- Bone Wires MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Fracture Fixation, Internal adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
PURPOSE OF THE STUDY Aseptic pseudoarthrosis (nonunion, PSA) of the humeral shaft is one of the serious complications in the treatment of fractures in this area. In a retrospective study, the authors described different methods of treating patients with this complication using predictive factors. MATERIAL AND METHODS Based on the definition of nonunion and the criteria, 14 patients (N=14) with the mean age of 56 years (32-78), namely 8 men and 6 women were included in the study. All patients were followed up clinically and radiologically at 1, 3, 6, 9, 12 months and every 3 months until the condition stabilized. The follow-up period was 11-72 months, with the average of 22 months. According to the AO classification, the fractures were classified as: 4-A1, 1-A2, 4-A3, 1-B1, 3-B2 and 1-C2. Based on the Weber-Čech classification, 2 cases of pseudoarthrosis were hypertrophic, 4 oligotrophic and 8 atrophic. According to the Non-Union Scoring System (NUSS), 5 patients reached the score under 25 points, 3 patients received 25-50 points, 4 patients 51-75 points and two patients over 76 points. In five cases, the fracture displacement index (FDI) was above 100%. In 11 patients, PSA was in the proximal and middle third and in three patients in the distal third of the humerus. METHODS Of the whole group (N=14), the nail was used in 5 cases (36%) - in 3 cases NUSS of up to 50 points and in 2 cases over 76 points. The plate was used in 9 cases (64%). In patients with NUSS of up to 50 points - in 1 case after conservative treatment, in 1 case for augmentation of nail, in 3 cases for augmentation of Prévot nails. In 4 cases with NUSS of 51-75 points a plate was replaced. Osteosynthesis was always supplemented by Judet's decortication or resection of atrophic bone and spongioplasty by autologous graft. RESULTS Shoulder function measured by the Constant Murley score (C-M) improved from 53 to 89 points (from the range of 36-76 points to the range of 75-100 points). The function of the elbow joint also improved, namely from the Mayo Elbow Performance Score (MEPS) of 65 points to 90 points (from the range of 45-70 points to the range of 80-100 points). In 11 cases (79%) the nonunion was healed and in 3 cases (21%) the failure to heal was reported. In the group with unhealed nonunions, in one case with NUSS of 51-75 points a thermoplastic casting was used and in two patients with NUSS above 76 points a palliative surgery was performed using a 12mm interlocking intramedullary nail. DISCUSSION The results of our study focused on the treatment of aseptic nonunion of the humeral shaft confirm the conclusions arrived at by other authors. As to the osteosynthesis materials, the plate remains the gold standard and provides sufficient stability for bone healing. For unhealed treatment-resistant PSA, we offer a stable intramedullary nail instead of prosthetic replacement or amputation, which provides good stability required for limb function. CONCLUSIONS When planning the treatment of aseptic pseudoarthrosis of the humeral shaft, it is necessary to have a thorough knowledge of etiopathogenesis with all predictive factors. The NUSS classification provides good guidance in treating this complication. Key words: aseptic nonunion, NUSS classification, predictive factors.
- MeSH
- Humeral Fractures * diagnostic imaging surgery MeSH
- Fracture Healing MeSH
- Humerus MeSH
- Fracture Fixation, Intramedullary * methods MeSH
- Bone Plates MeSH
- Middle Aged MeSH
- Humans MeSH
- Prostate-Specific Antigen MeSH
- Pseudarthrosis * diagnosis surgery etiology MeSH
- Retrospective Studies MeSH
- Fracture Fixation, Internal methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
PURPOSE OF THE STUDY The paper focuses on the potential use of nail osteosynthesis in diaphyseal metastases of long bones. The purpose of the paper is to assess the outcomes of intramedullary osteosynthesis in pathologic and impending pathologic fractures, to evaluate patient survival and potential complications. MATERIAL AND METHODS The retrospective study evaluated a cohort of 42 patients (19 men and 23 women) in whom intramedullary osteosynthesis was performed for complete pathologic fracture (28 patients) or impending pathologic fracture (14 patients) between 2010 and 2019. Of the total number of 42 patients, 31 patients' lower limbs were affected, namely by 17 pathologic fractures and 14 impending fractures. There were 11 humerus fractures. The mean age was 61.8 years (range 41-84 years). In the followed-up cohort, the patient survival after osteosynthesis with intramedullary nails, complications occurred and post-operative mobility of the patient were assessed. The functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system. The unpaired Mann-Whitney test was used to test the significance of the difference in functional outcomes and survival between the followed-up groups. Survival longer than 6 months was evaluated using Fisher's exact test. The level of statistical significance used for the test was p 0.05. RESULTS The investigated indicator was patient survival, which was 11.3 months (range 1-50 months) on average. In the group of impending fractures, the mean survival was 13.5 months. In the group of pathologic fractures, the survival was 10 months. The functional outcome in 16 followed-up patients at three months after intramedullary osteosynthesis according to the MSTS score was 46.9% (30-66.7%). At the level of significance of p 0.05, the statistically significant difference in the functional outcomes between the group with preventive intramedullary osteosynthesis and the group with nail osteosynthesis of the pathologic fracture was not confirmed (p=0.952). When comparing the patient survival after nail osteosynthesis with impending pathologic fracture and the survival of patients with pathologic fracture, a statistically significant difference in survival between these two groups (p=0.520) was not confirmed. The patient survival of longer than 6 months was 71% in the group of impending fractures and 40% in the group of pathologic fractures. DISCUSSION The occurrence of pathologic fracture is associated with increased pain, loss of function, and according to some authors, a higher risk of death. Surgical treatment options include intramedullary osteosynthesis, plate osteosynthesis with cement filling, implantation of an intercalary spacer, and implantation of tumor endoprostheses. When deciding on a surgical procedure, an account is taken of the expected survival of the patient. In patients with an expected survival of up to 6 months, intramedullary osteosynthesis is indicated as a palliative surgical intervention. The most common complications include implant failure and metastatic progression. CONCLUSIONS Intramedullary osteosynthesis is the method of choice in treating pathologic fractures or impending pathologic diaphyseal fractures of long bones in patients with an expected predicted survival of up to 6 months. Intramedullary osteosynthesis aims to reduce pain and enable early verticalization. The study confirmed the importance of preventive intramedullary osteosynthesis and its effect on survival compared to the survival of patients with a pathologic fracture. Key words: skeletal metastases, diaphyseal metastases, intramedullary osteosynthesis, pathologic fracture, impending fracture.
- MeSH
- Adult MeSH
- Humeral Fractures * surgery MeSH
- Fractures, Spontaneous * etiology pathology surgery MeSH
- Fracture Fixation, Intramedullary * adverse effects methods MeSH
- Bone Nails adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasms * complications MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Jessenius
142 stran : ilustrace (některé barevné) ; 30 cm
Fotografický atlas, který se zaměřuje na metody hřebování fraktur proximálního humeru. Obsahuje množství kazuistik. Určeno odborné veřejnosti.; Operační atlas je rozdělen do deseti kapitol a vychází z bohatých zkušeností autora.
- MeSH
- Shoulder Fractures surgery MeSH
- Fracture Fixation, Intramedullary MeSH
- Bone Nails MeSH
- Publication type
- Atlas MeSH
- Case Reports MeSH
- Conspectus
- Ortopedie. Chirurgie. Oftalmologie
- NML Fields
- ortopedie
- traumatologie
- NML Publication type
- fotografické publikace