U 38ročnej pacientky došlo pri operácii femorálnej hernie krurálnym prístupom k poraneniu - prešitiu femorálnej žily dvoma stehami, ktoré nebolo počas operáácie postřehnuté. Pooperačné vznikol hematom v rane z lacerácie žilnej steny. Hematom vypustený a následné sekundárne hojenie rany. Od prvého pooperačného dňa opuch stehna a predkolenia. Tento nález viedol s odstupom času k vykonaniu duplexného sonografického a flebografického vyšetrenia. Zistená stenóza femorálnej žily v dĺžke 35 mm a priemerom žily 3 mm. Po 3 mesiacov od poranenia žily vykonaná reoperácia, pri ktorej uvoľnené stehy, ktoré stenotizovali žilu a parciálny nástrih inquinálneho ligamenta. Zakrátko po operácii vymiznutie opuchu a dilatácia stenózy na priemer 8 mm. V súčasnosti pacientka bez ťažkostí.

In a 38-year-old female patient during surgery of a femoral hernia by the crural approach injury - two stitches of the femoral vein occurred which was not noticed during surgery. After surgery a haematoma developed in the wound from lacerarion of the venous wall. The haematoma was evacuated and the wound healed secondarily. From the first postoperative day swelling of the thigh and foreknee. This finding called after some time for a duplex sonographic and phlebographic examination. Stenosis of the femoral vein, 35 mm in length, and with a 3 mm diameter of the vein was found. Three months after injury of the vein re-operation was performed. During the latter the stitches which stenotized the vein were released and a partial resection of the inguinal ligament was made. Shortly after surgery the oedema receded and the stenosis dilated to a diameter of 8 mm. At present the patient has no complaints.

• MeSH
• chirurgie trávicího traktu škodlivé účinky   MeSH
• dospělí MeSH
• edém etiologie   terapie   MeSH
• femorální hernie chirurgie   MeSH
• lidé MeSH
• plastická chirurgie MeSH
• vena femoralis chirurgie   zranění   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Cílem práce je hodnocení výsledků operační léčby akutního skluzu proximální femorální epifýzy v adolescentním věku. V letech 1996-2003 bylo operováno pro proximální juvenilní femorální epifyzeolýzu 19 dětí (11 chlapců a 8 dívek), z toho 4krát oboustranně, celkem tedy 23 kyčlí. Věk operovaných pacientů byl od 10 do 15 roků. Skluz chronický byl u 17 kyčlí. Do předkládané práce bylo zahrnuto 6 pacientů se skluzem akutním. Délka jejich pooperačního sledování byla 2-8 let s průměrem 4,5 roku. Hodnoceny byly subjektivní obtíže a objektivní nález se zaměřením na rozsah pohybů kyčle, schopnost chůze a délku končetin. Na rentgenových snímcích byly sledovány stupeň skluzu, velikost repozice, pozice šroubů, penetrace šroubů a rozvoj osteonekrózy. Pro mírný skluz byly operovány tři kyčle a pro těžký také tři. Dislokovaná epifýza byla ve třech případech stabilní a ve třech nestabilní. Při klinic-kém hodnocení podle kritérií Heymana a Herndona byl výsledek vynikající u třech kyčelních kloubů se stabilním skluzem. Špatný výsledek byl zjištěn po ošetření nestabilního skluzu pro mírné kulhání při chůzi bez subjektivních obtíží u dvou pacientů a jednoho pro mírné kulhání a pozátěžové bolesti. Bolesti operované kyčle byly zjištěny pouze u jedné dívky se segmentální nekrózou hlavice femuru po neúplné manuální repozici těžkého skluzu a epifyzeodéze.

The aim of the study is to provide the evaluation of the operative treatment results in acute juvenile slipped capital femoral epiphylis. Between 1996 and 2003 twenty-three hip joints were operated on in nineteen children, four children underwent bilateral surgery. The age at the time of surgery was 10-15 years. There was chronical slip in 17 hips. Six patients with acute slipped capital femoral epiphysis were included in the study. The follow-up was 2-8 years with an average period of 4,5 years after the surgery. The postoperative evaluation partly focussed on subjective complaints, on range of motion, walking ability and length of lower extremities with the use of the system published by Heyman and Herndon, and partly focussed on hip radiographs. Mild slipped capital femoral epiphysis was mannaged in 3 hip joints and severe in 3 joints. Stable slipped capital femoral epiphysis was in 3 cases, unstable in 3 hips. The Heyman and Herndon clinical rating was excellent in 3 hip joints. Poor clinical rating for mild limping without pain was in 2 hips and 1 patient had a mild limping and pain after exercise.

• MeSH
• dítě MeSH
• hlavice femuru chirurgie   patologie   radiografie   MeSH
• interpretace statistických dat MeSH
• lidé MeSH
• mladiství MeSH
• nekróza hlavice femuru diagnóza   MeSH
• ortopedické výkony metody   MeSH
• osteotomie metody   MeSH
• skluz epifýzy diagnóza   chirurgie   komplikace   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

• MeSH
• antropometrie MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• nestejná délka dolních končetin terapie   vrozené   MeSH
• paže abnormality   MeSH
• předškolní dítě MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH

V kazuistice je popsán případ 12letého chlapce, u kterého se dva roky po fisuře krčku femuru rozvinula polární avaskulární nekróza hlavice s částečným uzávěrem fýzy hlavice a progredujícím zkrácením končetiny 2 cm. Na základě MR řezů ve frontální a sagitální rovině byla provedena valgizačně-extenční intertrochanterická osteotomie za dva roky po úrazu. Pooperační MR provedená 7 let po operaci potvrdila oprávněnost předoperační rozvahy a prokázala kompletní resorpci nekrotického segmentu hlavice a remodelaci celého proximálního femuru. Tento případ ukazuje, že MR je vhodná metoda pro předoperační plánování a pooperační sledování adolescentních pacientů s parciální avaskulární nekrózou hlavice femuru.

The case report presents a 12-year-old boy who developed two years after a nondisplaced fracture of the femoral neck a polar avascular necrosis of the femoral head (ANFH), with partial closure of capital physis and progressive limb shortening of 2 cm. Based on preoperative MRI scans in the frontal and sagittal planes, the intertrochanteric valgus-extension osteotomy was performed two years after injury. Postoperative MRI scans confirmed correct preoperative planning, 7 years after osteotomy there are no signs of ANFH. This case documents that MRI is a suitable method for preoperative planning and postoperative follow-up in adolescent patients with partial ANFH.

• Klíčová slova
• intertrochanterická osteotomie,
• MeSH
• dítě MeSH
• femur patologie   radiografie   růst a vývoj   MeSH
• financování organizované MeSH
• fraktury krčku femuru komplikace   radiografie   terapie   MeSH
• kloubní deformity získané etiologie   chirurgie   komplikace   MeSH
• krček femuru chirurgie   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie využití   MeSH
• mladiství MeSH
• nekróza hlavice femuru diagnóza   chirurgie   komplikace   MeSH
• nestejná délka dolních končetin etiologie   komplikace   MeSH
• ortopedické výkony metody   přístrojové vybavení   MeSH
• osteotomie metody   MeSH
• úrazy pádem MeSH
• výsledek terapie MeSH
• vývoj mladistvých MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• kosti dolní končetiny MeSH
• kyčelní protézy metody   MeSH
• náhrada kyčelního kloubu metody   MeSH
• ortopedie metody   MeSH
• předoperační péče MeSH
• zdravotní péče - plánování MeSH

BACKGROUND: Because there is limited information concerning the vascular pattern and the role of vessels in patients with proximal femoral focal deficiency, the vascular supply of the lower extremities was studied systematically with use of computed tomographic angiography in order to identify vascular changes, relate any vascular changes to the classification of the deficiency, and establish that there are no major changes in the topographical anatomy of the vessels. METHODS: Standardized computed tomographic techniques were used in twenty-one patients (thirteen boys and eight girls who ranged from one to nineteen years old) with proximal femoral focal deficiency types I through IV and VII, VIII, and IX, according to the Pappas classification. RESULTS: A common anatomical vascular pattern, in which the hypoplastic extremity was supplied through the femoral artery, was detected in nineteen patients. In patients with Pappas type-I through IV disease, the external iliac, femoral, and deep femoral arteries were substantially reduced in length and diameter and the deep femoral artery arose more proximally in comparison with that in the contralateral extremity; however, in the patients with Pappas type-VII, VIII, or IX disease, the diameters of the arteries and the origin of the deep femoral artery were similar to those of the contralateral extremity. In two patients with Pappas type-III disease, atypical anatomy of the vessels was found. The anterior part of the thigh and the pseudarthrosis were supplied through the femoral artery (the external iliac artery) as a terminal branch, while the remainder of the extremity was supplied from the internal iliac artery, which entered the thigh posterior to the hip as the inferior gluteal artery and continued as the artery to the sciatic nerve to the popliteal artery. No substantial anastomoses were found between the femoral and the posterior arteries in these vascular patterns. CONCLUSIONS: Computed tomographic-angiographic reconstruction can be used to depict the spatial configuration of the pseudarthrosis and the vascular pattern of the extremity in patients with proximal femoral focal deficiency. We found distinct vascular changes in the majority of the involved thighs, but there were no typical changes related to the Pappas classification. Because we found atypical vascular patterns in two patients, evaluation of the vessels with use of various diagnostic methods is recommended in patients with severe types of proximal femoral focal deficiency.

• MeSH
• angiografie metody   MeSH
• arteria femoralis anatomie a histologie   radiografie   MeSH
• dítě MeSH
• dolní končetina krevní zásobení   MeSH
• femur abnormality   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• muskuloskeletální abnormality radiografie   MeSH
• počítačová rentgenová tomografie MeSH
• předškolní dítě MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

Antegrade reamed femoral nailing via the piriformis entry point is the technique of choice in treating femoral shaft fractures, with retrograde nailing as an alternative. The supine position is favored to reduce complications, especially rotational malalignment. With navigation and robotic assistance fracture reduction can be supported and the rate of rotational, axis and length malalignement can potentially further reduced. Careful reaming is the procedure of choice to optimize bony healing and reduce systemic and local complications. In multiply injured patients reamed nailing can be safely integrated in the DCO- or ETC-concept and can be performed in the majority of patients, even when additional severe chest and head injuries are present. Initial resuscitation should focus on general stabilization before definitive femur fixation. Plate osteosynthesis of the femur can be an option in selected patients.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• fraktury femuru patofyziologie   chirurgie   MeSH
• intramedulární fixace fraktury metody   MeSH
• kostní destičky MeSH
• kostní hřeby MeSH
• lidé MeSH
• polohování pacienta MeSH
• robotika MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY The paper aimed to evaluate the long-term outcomes of the treatment of diaphyseal femur fractures in children treated with Bryant's vertical traction. Moreover, we also assessed the size of overgrowth in the injured femur. MATERIAL AND METHODS The study included 23 patients with 23 femoral shaft fractures treated with Bryant's vertical traction at our department in 2009-2014. The following parameters were assessed: sex, ïnjured side, weight, age, mechanism of injury, potential abuse, type of fracture, duration of traction, and total length of hospital stay. The healing time of the fracture was the same as the duration of traction. Also assessed was the size of femoral shortening after the removal of traction, the presence of skin complications in the course of treatment and potential development of compartment syndrome. At the mean follow-up of 47.8 months (range 22-85 months) from the date of injury the patients were evaluated clinically and radiologically for: length of limbs, presence of rotational deformity, range of motion of knee and hip joints, potential pain or limping, potential scoliosis of the spine and presence of scars after traction. Finally, through a questionnaire we learned about the opinions of parents as to the treatment method and about the possibility of home traction. RESULTS All the fractures healed. There was a total of 17 injured boys and 6 injured girls. Whereas 12 patients sustained a fracture of the left femur, 11 patients sustained a fracture of the right femur. The mean weight of patients at the time of injury was 13.9 kg (range 5-20 kg). The mean age at the time of traction was 30.8 months (range 1-70 months). The injury most frequently occurred from various falls, altogether in 15 cases (65.2%). Traffic accidents were registered as the cause of injury in 3 cases (13%). No abuse was confirmed. The average duration of traction was 19.8 days (range 8-26 days). The total length of hospital stay took on average 23.6 days (range 9-33 days). Skin excoriation and bullae due to irritation by the traction occurred in 21 children (91.3% cases). All the bullae healed, in 4 (17.4%) patients minor scars of 1x1 cm in size were formed around ankles. Not a single patient developed the compartment syndrome. The average femoral shortening after the removal of traction was 0.8 cm (range 0-2.3 cm). The follow-up examination, performed on average 47.8 months (range 22-85 months) from the date of injury revealed the average discrepancy of spinomalleolar distances in both the lower limps of 0 cm (range -1 to 1 cm). Radiographically measured lengths of both the femurs showed the average difference of 0 cm (range -1.4 to 0.9 cm). The resulting average overgrowth of injured femur was 0.9 cm (range 0.1 to 3.2 cm). Scoliosis of the spine was not reported in any of the patients. In 3 patients femur alignment demonstrated rotation, namely an external rotation of 10° in all the cases. All the children demonstrated full hip and knee joint mobility, identical to the uninjured side. After a heavy load one patient reported pain in the thigh and one walked with limp. The other patients showed no problems whatsoever. Treatment with the use of Bryant's traction was well tolerated by parents. Altogether 15 parents (65.2%) would opt for the same treatment method in case of a recurrent injury. The home traction option would be welcomed by 17 parents (73.9%). DISCUSSION The treatment by Bryant's vertical traction is condemned in Anglo-Saxon countries due to the risk for developing compartment syndrome, described in earlier studies. Neither our cohort, nor more recent studies reported the occurrence of compartment syndrome. The most frequent complication faced in our study was the skin complications underneath the traction, namely in a total of 91.3% of patients. In the literature, the other authors only make references to bullae occurrence, but do not provide any further specifications. Overgrowth after femoral shaft fractures is a very well described phenomenon. The size of femoral overgrowth described in our study was similar to that referred to in the available literature. A method frequently used abroad is the so-called home traction. This method, however, has so far failed to take root in our country, even though this therapeutic technique would be appreciated by parents. CONCLUSIONS The treatment of femoral shaft fractures by Bryant's vertical traction, in children up to the weight of 15 kg, is a simple and safe method with excellent functional outcomes and minimum serious complications. When treating the children with the body weight more than 15 kg, the risk of bullae formation increases, therefore in this weight category treatment shall be decided upon on a case by case basis. The resulting average overgrowth of injured femur was 0.9 cm which corresponds with the findings of other authors. The treatment method using the Bryant's traction is well tolerated by parents, even though most of them would welcome the option of home traction. Key words: traction, femur fracture, overgrowth, children.

• MeSH
• délka pobytu MeSH
• dítě MeSH
• dopravní nehody MeSH
• fraktury femuru terapie   MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• trakce metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Background: Selecting the correct type of osteosynthesis has a crucial impact on the final outcome of shortening operations for leg length discrepancy (LLD). One approach, introduced at the beginning of the 1950's, was fixation of femoral shortening osteotomy using the Pavlik intramedullary nail. AIM: The aim of this paper is to draw attention to the outstanding contribution of this great representative of Czech orthopaedics, to compare his method with other approaches to osteosynthesis, and, in the original patient set, to evaluate the long-term results of femoral shortening based on available medical records. MATERIAL AND METHODS: Of 34 operated patients, a subset of 11 underwent femoral shortening and fixation by the Pavlik nail and were evaluated according to the Merle d'Aubigne and Postel score. Preoperative, postoperative and current radiographs are described. RESULTS: The results were: excellent (6), good (3), and fair (2). There was no infection, thrombembolism, or osteosynthesis failure. Heterotopic ossification was recorded. The general validity of Pavlik's technical orthopaedic thinking is confirmed by stable osteosynthesis, and prevalence of excellent and good results. CONCLUSION: This study has confirmed the general validity of Pavlik's technical and orthopaedic thinking. His intramedullary nail was a suitable instrument for achieving stable osteosynthesis after a shortening femoral osteotomy. There was neither nail migration nor bone fragment dislocation. No additional plaster immobilization was used and this promoted early, progressive and rapid rehabilitation oriented towards active exercises. The low complication rate was evidence of correct methodology. Despite the undoubted value of the Pavlik femoral intramedullary nail, this method has never become widespread.

• MeSH
• femur chirurgie   MeSH
• kostní hřeby MeSH
• lidé středního věku MeSH
• lidé MeSH
• nestejná délka dolních končetin chirurgie   MeSH
• osteotomie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The reimplantation of a cemented femoral component at revision is always a challenge for the orthopaedic surgeon, particularly when the cement mantle is intact. The aim of this study was to provide evidence that the recementing of a femoral stem into the original cement mantle can be included in routine surgical procedures. MATERIAL AND METHODS: A group of 104 patients with femoral stem revision, followed-up for an average of 50.2 months, were retrospectively reviewed. The outcome evaluation was focused, in the first place, on survivorship of the femoral component, acetabular migration, and dislocation and infection after revision arthroplasty. Hip function evaluation was based on the Harris hip scores before surgery and at the latest follow-up. On radiographs Gruen zones were assessed pre-operatively and at the latest follow-up. The results were statistically evaluated using the Kaplan-Meier survival analysis (Statistica 8.0). RESULTS: Of the 104 patients, only three (2.9 %) had stem re-revision due to its loosening. Further 16 patients underwent revision for other post-operative complications. The success rate of reimplantation in our group including all post-operative complications was 81.7 %. The average Harris scores were 56 before surgery and 87 at the latest follow-up. Radiolucent lines in Gruen zones were on average 0.45 mm in width before revision and 0.15 mm at the latest follow-up. Fourteen patients had second revision within 20 months of the first and only five were revised after a long period. DISCUSSION: The cement-within-cement exchange of a femoral component is a relatively frequent orthopaedic procedure. Despite this frequency, however, there have not been enough literature reports based on large patient groups to give support to its routine use. The aim of this study was to demonstrate on a large patient group that recementing a femoral stem into the original intact cement mantle can be considered an established operative technique. Our results suggest that the list of indications for this technique, as described by Lieberman and Nelson, can be extended by the following: broken stem with an intact distal cement mantle, replacement of a monoblock femoral component due to severe head damage, loosening of the femoral component without impairment of the distal cement mantle, conversion of a cervico-capital to a total hip replacement and the need of removing all bone cement. No risk is associated with reimplantation of the original component if there is no need for a different implant to correct angle or length stability. A new implant is always used when any part of the femoral component has been damaged mechanically. If only the proximal stem requires recementing, the use of the original component is preferred because of absolute cement/stem cohesion. The number of our patients in which the technique failed was generally in agreement with the results of other authors. CONCLUSIONS: Utilisation of the original cement mantle of a femoral component is one of the options at revision arthroplasty. It requires rational considerations based on the type of surgery, state of the cement mantle, and type of material used for the femoral stem. The method is indicated preferably in the hips with an intact cement mantle treated for loosening of the acetabular component, recurrent dislocation or unequal leg-length in monoblock femoral components. In such situations the removal of well-fixed cement would also involve a considerable loss of bone tissue. The follow-up outcomes showed that the involvement of the cement-within-cement technique in routinely used surgical procedures is fully justified.

• MeSH
• cementování metody   využití   MeSH
• femur MeSH
• financování organizované MeSH
• interpretace statistických dat MeSH
• kostní cementy MeSH
• kyčelní protézy MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu MeSH
• reoperace metody   MeSH
• retrospektivní studie MeSH
• selhání protézy MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• statistika jako téma MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH