Subject of the study is diagnostics and treatment of urogenital and defecation dysfunction as a permanent sequelae after pelvic fracture. Retrospectively-prospective study will take place on a narrowly defined group - woman, 18-60 years of age, pelvic fracture, follow-up > 1 year. The study will evaluate subjective state and objective findings retrospectively in about 30 patients treated for pelvic fracture in last years with respect to type of fracture, treatment and final function (urogenital and defecation function). The study will observe and evaluate subjective state and objective findings prospectively on group of 30 patients during the course of the study with respect to type of fracture, treatment and final function. The study will validate ifthe subjectively perceived ailments and objectively verified findings are in joint and significant relationship. The study will try to approximate indication extent for conservative and operational treatment of mentioned sequelae in these patients.

Předmětem řešení je diagnostika a léčba poruch urogenitálních a vyprazdňovacích funkcí jako trvalých následků po zlomenině pánve. Retrospektivně-prospektivní studie proběhne na úzce definovaném souboru -žena, 18-60 let, zlomenina pánve, sledována > 1 rok. Zhodnotit subjektivní stav a objektivní nález retrospektivně u souboru přibližně 30 pacientek léčených pro zlomeninu pánve v posledních letech s ohledem na typ zlomeniny, způsob ošetření, výslednou funkci (chůze, urogenitální a defekační funkce). Sledovat a zhodnotit subjektivní stav a objektivní nález (sonografie 2D a 3D, urodynamika, anorektální manometrie čtyřkanálová) prospektivně u souboru cca 30 pacientek v průběhu trvání studie s ohledem na typ zlomeniny, způsob ošetření, výslednou funkci. Zjistit, zda subjektivně vnímané obtíže a objektivně ověřená tíže nálezů jsou ve vzájemném a signifikantním vztahu. Pokusit se aproximovat indikační šíři konzervativní (rehabilitace) a operační (rekonstrukce) léčby trvalých následků u těchto pacientek.

• MeSH
• Fecal Incontinence diagnosis   therapy   MeSH
• Fractures, Bone complications   MeSH
• Urinary Incontinence diagnosis   therapy   MeSH
• Aftercare MeSH
• Pelvis injuries   MeSH
• Pelvic Bones injuries   MeSH
• Prospective Studies MeSH
• Retrospective Studies MeSH
• Sexual Dysfunction, Physiological MeSH
• Urologic Diseases diagnosis   therapy   MeSH
• Women MeSH

• Conspectus
• Gynekologie. Porodnictví
• NML Fields
• traumatologie
• gynekologie a porodnictví
• chirurgie
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

PURPOSE OF THE STUDY To present the results of a three-year study on micturition, defecation, gynecological and sexual disorders in middle-aged women who sustained pelvic fractures. MATERIAL AND METHODS A group of 33 female patients who were treated for unstable pelvic fractures (AO types B or C) in the 2004-2009 period were evaluated (treated group) and compared with 31 women who had given vaginal birth at least once and went to see a urologist because of urinary problems in the period from 2009 to 2010 (control group). The questionnaires used in the study included ICIQ, UIQ, UDI and PISQ12 instruments. Urodynamic tests included flow cystometry, urethral pressure profile at rest and under stress and uroflowmetry. For a comparison of continuous variables of normal distribution, the t-test for independent samples was used. In the questionnaire study when responses were classified as nominal-ordinal variables, the Mann-Whitney U-test was used. Differences between the two patient groups in qualitative variables were tested by Pearson s 2 test. When the expected number of answers in contingency table was lower than 5, Fisher s exact test was used; when the number of answers was 0, Haldane s correction was employed. The results in all tests were considered significant when the level of significance was lower than 5%, i.e. p-value < 0.05. RESULTS The age of patients in the treated group ranged from 17 to 55 years (average, 32 years), the age in the control group was between 30 and 78 years (average, 58 years). The difference was significant (p<0.001). The control group patients had significantly more serious urination disorders than the treated group patients. Some micturition problems were reported by 25 patients (75%) of the treated group and by all patients of the control group (p<0.001). Intestinal disorders were more frequent in the treated group, in which 19 (61%) patients reported problems as against seven (21%) in the control group. Gynaecological problems involving feelings of genital prolapse had 13 (39%) control patients (p = 0.041). Sexual disorders were markedly worse in the treated group, with 16 (52%) of the patients having problems in comparison with only seven (21%) in the control group. DISCUSSION A comparison of patient groups composed using the method described here is disputable. The first difficulty lay with a low compliance of the treated patients, of whom only 33 underwent examination out of 52 originally enrolled. The other problem was the necessity of having an exactly defined control group of patients willing to undergo urological and gynaecological examination including urodynamic testing. The groups composed by our method were comparable only in the micturition disorder characteristic. A significantly higher age of the control group affected the comparison of defecation, gynaecological and sexual problems. CONCLUSIONS The results of this study showed a high occurrence of micturition, defecation and sexual disorders in middle-aged women after pelvic injury. However, the problems are usually not serious enough to make the patients seek help of a specialist. The authors recommend that these problems should be looked for by disorder-directed inquiry in the final period of pelvic fracture treatment and help of a specialist in urology, gynaecology, sexuology or proctology should be offered to the patients in whom disorders have been identified.

• MeSH
• Defecation MeSH
• Adult MeSH
• Fractures, Bone complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pelvic Bones injuries   MeSH
• Urination Disorders etiology   MeSH
• Aged MeSH
• Sexual Dysfunction, Physiological etiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Comparative Study MeSH

PURPOSE OF THE STUDY The patients with pelvic ring injury involve two groups: 1) young and middle-age persons, mostly men, with serious injury to the pelvic ring due to high-energy trauma; and 2) older patients, mostly women, with osteoporotic fractures due to a simple fall. The aim of this study was to show significant differences in the selected epidemiological characteristics between these two groups. MATERIAL AND METHODS The group comprised 225 patients older than 15 years with pelvic fractures who were treated between January 1, 2007, and December 31, 2009. In this retrospective descriptive study, the patients' data on age, gender, mechanism of injury and a type of fracture according to the AO classification were retrieved and analysed. Categorical data at a level of significance of 5% were compared using the Chi-square test. RESULTS In the group reviewed there were 113 women and 112 men, with an average age of 51 years (women, 53 years; men, 49 years) in the range of 15 to 95 years. More men than women were in the age range of 15 to 60 years (with the difference being significant only in the sixth decade of life; p=0.043). In the age category of over sixty, women outnumbered men, and this was significant in the eight and ninth decades (p=0.023 and p=0.04, respectively). Significantly more men were involved in motorbike accidents (p=0.047) or had falls from heights (p=0.004) and particularly those at a worksite (p<0.001). Fractures due to a simple fall were significantly more frequent in women than men (p<0.001) and, generally, were most often found in the old-age category, in which women were eight years senior to men. Type A fractures were found in 58, type B fractures in 140 and type C fractures in 27 patients. The most frequent fractures (A2.2, p=0.054; B2.1, p=0.038) occurred more often in women and at a much higher age than in men (the age difference was 15 years in type A2.2 fractures and "only" 7 years in type B2.1 fractures). The patients who sustained either of these fractures in a simple fall were about 35 years older than those in whom these fractures were caused by high-energy trauma. DISCUSSION The fact that pelvic injuries most often occur in men at young or middle age has been confirmed by several epidemiological studies with a conclusion that age-related risky male behaviours play a significant role. The findings of this study showed that pelvic fractures due to simple falls were mostly found in old-age patients, with women eight years older than men. This provides evidence for the existence of two distinct groups of patients with pelvic fractures. The existence of two epidemiologically different groups of patients with pelvic fractures, in the authors' opinion, is demonstrated by a correlation of AO fracture type, patient gender and age in each group. A mere comparison of the age of patients indicates that older patients had mostly type A and B fractures. Unilateral fractures of the pubic ramus after a simple fall, which are regarded as related to osteoporosis, were recorded in a significantly higher number of women of the oldest age. The authors suggest that epidemiological studies of pelvic injuries should use the age of 70+ as an exclusion criterion in the patients with type A2.2 and B2.1 fractures. This will remove the bias of epidemiological data on patients with severe pelvic injuries, resulting from involvement of patients with osteoporotic fractures. CONCLUSION The evaluation of epidemiological data in this study allows us to conclude that younger men are those most frequently sustaining pelvic injuries due to high-energy trauma and that old age (80+) is characteristic for patients of both sexes, with female sex predominance, who have fractures due to simple falls. These findings give support to the concept that, in a group of patients with pelvic injuries, a subgroup with fractures different in terms of epidemiology and aetiology (osteoporotic fracture) can be identified.

• MeSH
• Adult MeSH
• Epidemiologic Methods MeSH
• Financing, Organized MeSH
• Fractures, Bone epidemiology   etiology   classification   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pelvic Bones injuries   MeSH
• Sex Distribution MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Athletic Injuries epidemiology   etiology   MeSH
• Accidental Falls MeSH
• Age Distribution MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH

PURPOSE OF THE STUDY The aim of the study was to assess the clinical outcomes and permanent sequelae of pelvic fractures at one year after injury and to identify factors that influenced these results. MATERIAL AND METHODS The group evaluated consisted of 151 patients older than 15 years treated for pelvic fractures in 2007 at seven hospi- tals in the Czech Republic and Slovakia. This one-year descriptive prospective study included all basic epidemiological data concerning the patients and the evaluation of their clinical results using the Majeed score. The obtained data were statistically analysed by the ?2 test of independence and contingency tables at a 5% level of significance. For data obtai- ned at a low frequency, only descriptive statistical methods were used. RESULTS From the original group of 237 patients (101 women and 136 men), 16 died (7 women and 9 men) and 70 were lost for follow-up (28 women and 42 men), leaving 151 patients (64%) for evaluation. This final group comprised 66 women (44%) and 85 men (56%) with the age range of 16 to 82 and an average age of 42.7 years (women, 45.3 years; men, 40.7 years). Age distribution, causes of injury, types of pelvic fracture, associated injuries and methods of treatment in this group were similar to those in the original group. The clinical outcomes evaluated using the pelvic Majeed score were excellent and good in 85%, fair in 12% and poor in 3% of the patients. The prediction of clinical outcome was more accurate when based on the extent of dislocation of the dorsal segment after fracture healing than on the type of pelvic fracture The permanent sequelae were recorded in 22 patients (15%) and a total of 43 specific complaints were identified; some patients had multiple sequelae involving neurological, urological and sexual problems. Neurological deficit was related to the type of pelvic injury and its highest occurrence was associated with type C pelvic fractures. Permanent neurological deficits were found in 15 patients (10% of patients in the final group), of whom 10 were diagnosed early after injury as having neurological lesions (7% of the final group) and in five the diagnosis was made after surgery (8 %of surgically trea - ted patients). Fifteen permanent urological disorders were recorded in 13 patients and they also were most frequent in type C fractures. However, they were more strongly associated with primary urethral injury and primary or post-operative neu- rogenic lesions. Sexual sequelae were also found in association with type C fractures; almost all patients with these pro- blems had injury to the lower urinary tract or neurogenic lesions. Permanent gastrointestinal sequelae were in three pa- tients; all of them sustained unstable pelvic fractures and were diagnosed with post-operative neurogenic lesions. DISCUSSION Based on the evaluation of basic patient data, the patient group described here can be regarded as a representative sample of the originally treated patients. Therefore, in the authors' view, the results presented here can be taken as valid. In agreement with other authors, the study recorded poorer clinical outcomes in the patients with more serious types of pelvic injury, and dramatically worse results in relation to the extent of dislocation of the dorsal segment after the pelvic fracture had healed. The authors confirmed that permanent neurological and urological sequelae occur more frequently in patients with a more serious pelvic injury. Urological and sexual problems were more often associated with the presence of neurologi- cal deficit than with the type of pelvic fracture and injury to the lower urinary tract. CONCLUSIONS The evaluation of patient data at one year after pelvic injury in this prospective longitudinal study justify the authors to draw the following conclusions: clinical outcomes were worse in unstable pelvic fractures; worse clinical results were rela- ted to the extent of residual dislocation of the dorsal pelvic segment; permanent neurological sequelae were most fre quent and were perceived by the patients with strong negative feelings particularly when they manifested clinically after surgery; permanent urological, sexual and gastrointestinal problems were more closely associated with neurological deficits than with the severity of primary injury to the pelvic skeleton, lower urinary tract, sexual organs or digestive system. Key words: pelvic fracture, associated injuries, clinical outcomes, neurological sequelae, urological sequelae, sexual seque- lae, gastrointestinal sequelae.

• MeSH
• Adult MeSH
• Financing, Organized MeSH
• Fractures, Bone surgery   complications   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pelvic Bones injuries   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Multicenter Study MeSH

PURPOSE OF THE STUDY The aim of the study was to record the frequency of L5 transverse process fractures associated with pelvic injuries and to find out whether in unstable pelvic fractures the frequency is significantly higher. MATERIAL AND METHODS The group evaluated comprised 106 patients (38 women and 68 men; average age, 43.4 years; range, 16 to 95 years) treated for pelvic ring fractures at two trauma centres in the period from January 1 to December 31, 2007. Their radiographs and CT scans were retrospectively reviewed in order to identify fractures of the L5 transverse processes and to obtain exact descriptions of injuries to the dorsal pelvic structures. The results were statistically analysed using the Chi-square test with a 5 % level of significance. RESULTS The evaluation of radiographs and CT scans identified L5 process fractures in 21 patients; none of these had type A pelvic fracture. An L5 transverse process fracture was found in 10 (15 %) of 69 patients with type B pelvic fracture and in 11 (73 %) of 15 patients with type C pelvic fracture, i.e., only in the patients with unstable injury to the pelvis classified as type C or type B. The occurrence of L 5 transverse process fractures was significantly higher in completely unstable, type C pelvic trauma than in partially unstable, type B pelvic injury (p < 0.001). DISCUSSION Our results showed that evaluation of the radiographs was not sufficient for the identification of L5 transverse process fractures and trauma to the dorsal pelvic structures. The reason was either poor quality or incorrect positioning. This gives support to the recommendations of many authors that CT scans should be the standard method for identification of all pelvic injuries. The study also confirmed that L5 transverse process fractures are associated with unstable pelvic injuries. Their significantly high occurrence is in agreement with other relevant studies which, however, have reported the results without statistical evaluation. CONCLUSIONS The study shows a significantly higher occurrence of L5 transverse process fractures in patients with unstable pelvic ring injuries. The finding of such a fracture should focus attention to looking for trauma to the dorsal pelvic structures.

• MeSH
• Lumbar Vertebrae radiography   injuries   MeSH
• Adult MeSH
• Fractures, Bone radiography   MeSH
• Spinal Fractures radiography   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pelvic Bones radiography   injuries   MeSH
• Tomography, X-Ray Computed MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH

Úvod: Cílem této práce je prezentovat výsledky získané ve tříleté studii zaměřené na problematiku mikčních, defekačních, a sexuálních poruch u žen aktivního věku. Metoda: Sledovaný soubor tvořilo 33 pacientek léčených v letech 2004–2009 pro nestabilní zlomeninu pánve (typ B nebo C podle AO klasifikace). Zlomeninu typu B utrpělo 25 pacientek, typu C 8 pacientek. Věk pacientek sledovaného souboru kolísal v rozmezí 17–55 let (průměr 32 let). Anamnestická data byla získaná na základě formulářů UIQ, UDI a PISQ12. Při odpovědích na jednotlivé otázky, které představovaly nominální–ordinální proměnné, byl použit neparametrický Mannův-Whitneyho U-test. V případě nálezu statisticky významného rozdílu v odpovědích mezi oběma skupinami pacientek bylo pomocí Pearsonova χ2-testu zjišťováno, mezi kterými odpověďmi tento statisticky významný rozdíl vzniká. Pokud byl počet odpovědí na některou otázku menší než 5, byl použit přesný Fisherův test. V případě, že se četnost rovnala 0, byla použita Haldanova korekce. Všechny testy byly považované za statisticky významné, pokud byla hladina významnosti menší než 5 %. Výsledky: Výskyt urologických obtíží byl vyšší u pacientek po zlomenině typu B (84 % vs. 50 %), avšak postižení byla závažnější u pacientek po zlomenině typu C. Střevní obtíže byly u pacientek po zlomenině typu C častější (75 % vs. 52 %) i závažnější. Rovněž sexuální obtíže byly u pacientek po zlomenině typu C častější (75 % vs. 40 %), i když podle jednotlivých odpovědí se nedalo konstatovat, že by jejich sexuální život byl jednoznačně horší. Závěr: Rozbor porovnání mikčních, sexuálních a defekačních problémů u pacientek s ročním odstupem po nestabilní zlomenině pánve prokázal v některých ohledech větší obtíže u pacientek po zlomenině typu C. Důležitější jsou však tato konstatování týkající se obecně pacientek po nestabilních zlomeninách pánve: 1. výskyt mikčních, sexuálních a defekačních obtíží byl nečekaně vysoký, 2. bez aktivního zjišťování traumatologem v průběhu doléčování uniknou „malé“ obtíže pozornosti a mohou pak v dalším období negativně ovlivnit život každé jednotlivé pacientky, 3. cílený dotazníkový způsob zjišťování uvedených potíží by mohl vést k jejich odhalení, 4. urolog, urogynekolog, sexuolog a proktolog mají neoddiskutovatelné místo při léčení žen po závažném traumatu pánve.

Introduction: The objective of this work is to present results obtained in a three-year study focussed on micturition, defecation and sexual disorders in women of active age. Methods: The monitored set consisted of 33 female patients treated in 2004–2009 for unstable pelvic fracture (B-type or C-type according to AO classification). Out of them 25 patients suffered B-type fracture and 8 patients suffered C-type fracture. Their age ranged between 17 and 55 years (the average age was 32 years). Anamnestic data were obtained based on UIQ, UDI and PISQ12 questionnaires. The non-parametric Mann-Whitney U-test was used for answers to individual questions representing nominal/ordinal variables. After finding a statistically significant difference in answers between both groups of patients, it was investigated by means of Pearson χ2-test which answers are behind this statistically significant difference. If the number of answers to any question was less than 5, the exact Fisher test was used. In the event the rate equalled 0, Haldane correction was applied. All tests were considered statistically significant if the significance level was below 5%. Results: The occurrence of urologic problems was higher in the B-type fracture patients (84% vs. 50%), however, afflictions were more severe in the C-type fracture patients. Intestinal problems were more frequent in the C-type fracture patients (75% vs. 52%) and they were also more severe. Also sexual problems were more frequent in the C-type fracture patients (75% vs. 40%), although according to individual answers it was not possible to state that their sexual life was unequivocally worse. Conclusion: The analysis of comparison of micturition, sexual and defecation problems in patients one year after the unstable pelvic fracture showed in some respects higher problems in the patients who had suffered the C-type fracture. However, more important are the following observations, generally related to unstable pelvic fracture patients: 1. The occurrence of micturition, sexual and defecation problems was unexpectedly high; 2. Without active examination by a traumatologist during the after-treatment ”minor” problems may escape his/her attention and may negatively affect life of each individual patient in the longer run; 3. A targeted method of detection of problems by means of questionnaires could lead to their disclosure; 4. A urologist, urogynaecologist, sexologist and proctologist have an indisputable place in the treatment of women who suffered a severe pelvic trauma.

• Keywords
• nestabilní zlomeniny pánve, sexuální potíže, defekační obtíže, urologické obtíže,
• MeSH
• Adult MeSH
• Fecal Incontinence epidemiology   MeSH
• Financing, Organized MeSH
• Fractures, Bone complications   MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Pelvis injuries   MeSH
• Pelvic Bones injuries   MeSH
• Urination Disorders epidemiology   MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Sexual Dysfunction, Physiological epidemiology   MeSH
• Statistics as Topic MeSH
• Severity of Illness Index MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Female MeSH

• Keywords
• zlomeniny pánve, poranění uretry, poranění močového měchýře, poruchy sexuality,
• MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Urinary Tract injuries   MeSH
• Pelvis injuries   MeSH
• Pelvic Floor MeSH
• Pregnancy MeSH
• Genitalia, Female injuries   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Review MeSH

PURPOSE OF THE STUDY The aim of the study was to make a basic analysis of the patients treated for pelvic fractures in the year 2007 at 14 institutions in the Czech Republic and Slovakia. MATERIAL AND METHODS The group investigated consisted of 474 patients treated in 2007. In a one-year prospective descriptive study, patients? data were recorded according to a unified protocol. They included age, gender, mechanism of injury, fracture type, associated injuries, method of treatment, post-operative complications, length of hospital stay, injury/surgery-to-standing time and number of deaths during primary hospitalization. The .2 test of independence in a contingency table was used to compare categorical data. The level of significance for the test was set at 5%. RESULTS The group comprised 192 women and 282 men with an average age of 45.9 years (range, 15 to 95). In men, the frequency of pelvic fractures was significantly higher (p<0.001), because men significantly outnumbered women in the largest middle-age categories (30 to 59 years). Pelvic fractures were significantly higher only in women over 80 years of age. The most frequent cause of injury was a road traffic accident (237 patients, 50%). Significantly more men than women were injured in motorbike accidents (p=0.015), due to a fall from height (p=0.001) or by a falling object (p=0.040). Women more frequently suffered injury as a result of a suicidal attempt by jumping (p=0.051) or a simple fall (p<0.001). Type A2.2 fractures (115 patients, 24%; average age, 51.8 years) and type B2.1 (77 patients, 16%; average age, 43.5 years) were most frequent. In 248 patients (52%), a pelvic fracture was part of multiple trauma. These patients had an average ISS of 30 points. Conservative treatment was used in 287 patients (61%). In 71 patients, skeletal traction (30 patients, 6%), C-clamp (19 patients, 4%) or external fixation (22 patients, 5%) was temporarily applied during the primary treatment. Surgery was carried out in 187 patients (39%). The average operative time was 114 minutes (range, 45 to 315). Post-operative complications were recorded in 58 patients (30% of the surgically treated). The most frequent local complication was wound infection (11 patients, 6%). The average hospital stay was 27 days (range, 2 to 266); 181 patients (38%) required care at an anaesthesia and acute care department for an average of 14 days (range, 1 to 127). The injury/surgery-to-standing time was 30 days on average (range, 2 to 118 days). Twenty-six patients; nine women and 17 men (5%), died during primary hospitalization. Their average age was 62.5 years (74.1 years in women and 56.4 years in men). DISCUSSION The higher number of injured men in the middle-age categories suggests a more risky behaviour of these men in driving motor cars and motorbikes and at work (falls from height, objects falling on them). Women significantly outnumbered men in simple falls (which can be explained by a higher occurrence of pubic ramus fractures due to osteoporosis in women at a higher age) and a difference at the margin of statistical significance was recorded in suicidal attempts (any explanation is beyond the scope of this study as well as beyond the field of trauma medicine). The higher number of type A2.2 and also type B2.1 fractures can too be explained by a higher occurrence of these fractures due to simple falls in elderly women with osteoporosis. CONCLUSIONS The evaluation of the basic demographic and epidemiologic data of patients with pelvic fractures included in this multi- centre study revealed the following facts: pelvic fractures were significantly more frequent in men; the most frequent cause of pelvic fracture was a road traffic accident; the number of injured men was highest at age 40 to 50, in motorbike accidents, falls from height and in injuries by falling objects; women outnumbered men at the age category over 80 and in suicidal jumping from a height; the most frequent types of fractures were those affecting osteoporotic bone in elderly women (A2.2, B2.1); surgical treatment of pelvic fractures was associated with a relatively high number of complications; death during primary hospitalization was higher in elderly patients.

• MeSH
• Adult MeSH
• Financing, Organized MeSH
• Fractures, Bone etiology   surgery   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pelvic Bones surgery   injuries   MeSH
• Postoperative Complications MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Vital Statistics MeSH
• Traumatology statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH

Autoři prezentují kazuistiky dvou pacientů s poraněním močového měchýře u zlomeniny pánve typu B vzniklé působením zevněrotačního mechanizmu úrazu. Předpokládají trakční poranění močového měchýře. Na základě literárních informací diskutují možný anatomický substrát tohoto poranění. Přesné vymezení anatomické struktury je velmi obtížné, i když v písemnictví se uvádí jako možná příčina tah za lig. pubovesicale.

Authors describe cases of two patients with urinary bladder injury in type B pelvic fracture which were caused by externalrotation trauma mechanism. Authors assume traction injury of the urinary bladder. Based on literature sources they discussed anatomical substratum of this type of injury. Exact definition of the anatomical structure is very difficult even if there is a possibility of traction by pubovesical ligament presented in literature.

• MeSH
• Adult MeSH
• Financing, Organized MeSH
• Fractures, Bone diagnosis   surgery   MeSH
• Humans MeSH
• Urinary Bladder surgery   physiopathology   injuries   MeSH
• Orthopedic Procedures methods   utilization   MeSH
• Pelvic Bones surgery   physiopathology   injuries   MeSH
• Urologic Surgical Procedures, Male methods   instrumentation   utilization   MeSH
• Fracture Fixation, Internal methods   instrumentation   utilization   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Autoři uvádějí kazuistiku 36leté pacientky, která si po pádu z 5. patra obytného domu způsobila nestabilní poranění pánevního kruhu. Krvácení ze spongiózy obou massae laterales sacri vedlo k významné destabilizaci oběhu v období bezprostředně poúrazovém, ale i v následujících hodinách po tamponádě a stabilizaci pánve zevní fixací. Prolongované krevní ztráty si vyžádaly v průběhu prvních 12 hodin hospitalizace podání 38 jednotek erytrocytární masy, 48 jednotek mražené plazmy, 1500 IU antitrombinu III, 1000 mg fibrinogenu a 6 jednotek tromboseparátoru. Vzhledem k pokračujícímu krvácení a vyčerpání krevních derivátů dostupných ve zdravotnickém zařízení, bylo rozhodnuto v intenzivní hemoterapii nepokračovat a léčbu racionalizovat. Při následné hypotenzi se systolickým tlakem v rozmezí 40–60 mm Hg a pravděpodobně i postupným zahřátím pacientky se stav začal během další hodiny proti očekávání stabilizovat. Hodnota systémové tenze se pak ustálila na hranici 80 mm Hg a TF 100/min. Po asi čtyřhodinovém intervalu této hypotenze byly podány další 3 jednotky erytrocytární masy a 4 jednotky mražené plazmy přivezené ze vzdálené nemocnice. Poté se systémová tenze stabilizovala na hodnotách TK kolem 120/80 a TF na 90/min. V průběhu následujících dvou dní nebyla potřeba pokračovat v podpoře oběhu katecholaminy. Autoři se domnívají, že krvácení z odhalené spongiózní kosti při výrazné dislokaci fragmentů může vést ke vzniku masivního a dostupnými prostředky obtížně ztišitelného krvácení se závažným rizikem pro život pacienta a ani cílená intenzivní pooperační péče nemusí toto závažné krvácení zvládnout.

The authors present the case of 36 years old woman, who suffered from unstable fracture of pelvis after she fell from the 5th floor. The spongiosa bleeding from both massae laterales sacri caused significant blood circuit destabilisation not only immediately after the injury but also in hours following the external fixation of pelvis. Due to persistent blood losses it was necessary to apply 38 RBC units, 48 FFP units, 1500 IU of antithrombin III, 1000 mg of fibrinogen and 6 platelet units within first 12 hospitalisation hours. With respect to ongoing bleeding and lack of accessible blood products it was decided to stop intensive hemotherapy and rationalize the treatment. The rationalization led to the hypotension (systolic blood pressure was 40–60 mm Hg), which along with gradual increase of body temperature caused unexpectable patient stabilisation. The systolic blood pressure was stabilized on 80 mm Hg and heart rate about 100/min. After 4 hours another 3 RBC units and 4 FFP units brought from the nearest reachable hospital were applied. The following blood pressure measurement was 120/80 and heart rate about 90/min. In the course of following 2 days it was possible to stop the catecholamine treatment. The authors are of opinion, that uncovered spongiosa caused by expresive dislocation of fragments may lead to massive bleeding that is difficult to stop by accessible means. The bleeding may be an essential risk for patients life and neither targeted intensive postoperative care can settle the matter.

• MeSH
• Adult MeSH
• Fractures, Bone surgery   complications   radiography   MeSH
• Sacrum injuries   MeSH
• Hemorrhage diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Pelvic Bones surgery   radiography   injuries   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH