The aim of the study was to determine the relationship between implant-associated complications and Dynamic Hip Screw (DHS) placement in the femoral neck, based on a Finite Element (FE) Analysis. Very diverse implant failures and subsequent complications can be encountered after introduction of the DHS. We evaluated 308 dynamic hip screw osteosyntheses for pertrochanteric fractures in 297 patients. The ABAQUS 6.9 program was used for development of the FE model, and the analyses were performed in 5 modelled situations corresponding to five different screw locations. Complications occurred in 10% of patients and re-operation was necessary in 3.9%. The highest risk of implant failure was associated with the screw situation in the upper third of the femoral neck. Placing a dynamic hip screw in the middle third of the neck significantly reduced stresses in the plate and screw. The screw position in the upper third of the neck significantly increased these stresses. The finite element analysis confirmed our clinical experience that the optimum position of the dynamic hip screw is in the middle third of the femoral neck.

• MeSH
• analýza selhání vybavení * metody   statistika a číselné údaje   MeSH
• fraktury krčku femuru * chirurgie   radiografie   MeSH
• fraktury kyčle chirurgie   radiografie   MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanický stres MeSH
• počítačová simulace MeSH
• reoperace statistika a číselné údaje   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury * metody   přístrojové vybavení   škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Ankylosing spondylarthritis (AS) is associated falsely increased lumbar spine bone mineral density (BMD). New tool for discrimination of subjects at fracture risk is needed. Vertebral fracture (VF) prediction of routine methods for osteoporosis assessment, BMD and trabecular bone score (TBS), in patients with AS. Cross-sectional study of all AS patients regularly followed at the rheumatology outpatient clinics of two centers. All subjects undergone BMD measurement at lumbar spine (LS), total hip (TH) and femoral neck (FN) using Hologic® Horizon device. TBS at L1-4 in all subjects by TBS InSight® software were assessed. Vertebral fracture assessment (VFA) was performed using the lateral spine imaging IVATM and graded using Genant semi-quantitative approach. 119 AS subjects (90 males/29 females), mean age 47.6 years were included in the study. In 20 patients 34 VFs were detected, from whom 7 patients had multiple fractures. Subjects with VF were older and had lower FN BMD, TBS in comparison to non-VF subjects. No differences in LS BMD, FN BMD or BASDAI between groups were observed. Among patients with VF only 3 had T-score less than -2.5 but 7 has TBS less than 1.23 which means highly degraded microarchitecture. AS patients with VF have lower TBS and FN BMD in comparison to non-VF subjects. In addition, TBS was able to detect 20 % more VFs than BMD. Therefore, TBS seems promising in VF discrimination among patients with AS.

• MeSH
• ankylózující spondylitida komplikace   patologie   MeSH
• dospělí MeSH
• fraktury páteře etiologie   MeSH
• kostní denzita * MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• průřezové studie MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• trabekulární kostní tkáň patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

• MeSH
• absorpční fotometrie metody   MeSH
• denzitometrie metody   MeSH
• fraktury páteře diagnostické zobrazování   MeSH
• kostní denzita MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury diagnostické zobrazování   klasifikace   prevence a kontrola   MeSH
• postmenopauzální osteoporóza diagnostické zobrazování   MeSH
• prediktivní hodnota testů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH

• MeSH
• denzitometrie metody   MeSH
• fraktury spontánní prevence a kontrola   MeSH
• poranění páteře MeSH

Úvod: Cílem práce je identifikovat rizikové faktory predikující nález fraktury na CT krční páteře na základě údajů uvedených na žádance. Metody: Do retrospektivní studie byli zařazeni všichni pacienti starší 18 let, kteří podstoupili CT hlavy a krční páteře ve FN Brno v roce 2019 za účelem vyloučení čerstvého traumatu. Analyzované potenciální rizikové faktory zahrnovaly: pohlaví, věk nad 65 let, bezvědomí či poruchu vědomí, mechanismus úrazu, parestezie či plegie podezřelá na asociaci s traumatem, bolesti krční páteře, jiná neurologická symptomatologie, přítomnost krčního límce, přítomnost nitrolebního krvácení na CT hlavy, přítomnost fraktury lebky na CT hlavy. Výsledky: Celkem byla popsána fraktura krční nebo horní hrudní páteře u 51 z 1177 pacientů (4,3 %). Jako statisticky významné rizikové faktory pro frakturu krční páteře na CT byly identifikovány mechanismus úrazu v podobě autonehody nebo skoku do vody (OR 2,52; p=0,004), bolest v oblasti krční páteře (OR 1,81; p<0,001), parestezie či plegie pravděpodobně související s úrazem (OR 2,81; p=0,024) a přítomnost krčního límce na CT vyšetření krční páteře (OR 7,22; p<0,001). Při provedení CT krční páteře pouze při přítomnosti vybraných rizikových faktorů (věk nad 65 let a/nebo autonehoda a skok do vody a/nebo přítomnost bezvědomí a/nebo bolestivost krční páteře), které se vyskytly u 77 % pacientů, by bylo zachyceno 50 z 51 fraktur (senzitivita 98 %). Závěr: Na základě informací uvedených na žádance lze identifikovat signifikantní rizikové faktory asociované s nálezem fraktury na CT krční páteře.

Introduction: The study identifies risk factors predicting cervical spine fracture on CT based on information in the referral form. Methods: All patients aged over 18 years with a CT scan of the head and cervical spine completed at the University Hospital Brno in the year 2019 to exclude any fresh trauma were included in the retrospective study. The analyzed potential risk factors included gender, age over 65 years, unconsciousness or impaired consciousness, mechanism of injury, paresthesia or plegia suspected to be associated with trauma, cervical spine pain, other neurological symptomatology, presence of cervical collar, presence of intracranial hemorrhage on head CT, and presence of skull fracture on head CT. Results: In total, a cervical or upper thoracic spine fracture was described in 51 of 1177 patients (4.3%). Statistically significant risk factors for cervical spine fracture on CT scan were identified as mechanism of injury similar to car accident or jumping into water (OR 2.52; p=0.004), pain of the cervical spine (OR 1.81; p<0.001), paresthesia or plegia probably related to the injury (OR 2.81; p=0.024) and presence of cervical collar at the time of the CT of the cervical spine (OR 7.22; p<0.001). If cervical spine CT had been performed only in the presence of selected risk factors (age over 65 years and/or car accident and water jump and/or presence of unconsciousness and/or cervical spine pain), which were present in 77% of the patients, 50 of 51 fractures would have been captured (sensitivity 98%). Conclusion: Significant risk factors associated with fracture findings on cervical spine CT can be identified based on the information provided in the referral form.

• MeSH
• dospělí MeSH
• fraktury páteře * diagnostické zobrazování   epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• poranění krku diagnostické zobrazování   epidemiologie   etiologie   MeSH
• poranění nervového systému * komplikace   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• statistika jako téma MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation. METHODS: The sample consisted of CT scans from 313 female and 40 male volunteers (158 with proximal femoral fracture, 145 age-matched controls and 50 fallers without hip fracture). Detailed Cortical Bone Maps (c.5580 measurement points on the unfractured hip) were created before registering each hip to an average femur shape to facilitate statistical parametric mapping (SPM). Areas where cortical and trabecular bone differed from controls were visualised in 3D for location, magnitude and statistical significance. Measures from the novel regions created by the SPM process were then tested for their ability to classify fracture versus control by comparison with traditional CT measures of areal Bone Mineral Density (aBMD). In women we used the surgical classification of fracture location ('femoral neck' or 'trochanteric') to discover whether focal osteoporosis was specific to fracture type. To explore whether the focal areas were osteoporotic by histological criteria, we used micro CT to measure trabecular bone parameters in targeted biopsies taken from the femoral heads of 14 cases. RESULTS: Hip fracture patients had distinct patterns of focal osteoporosis that determined fracture type, and CBM measures classified fracture type better than aBMD parameters. CBM measures however improved only minimally on aBMD for predicting any hip fracture and depended on the inclusion of trabecular bone measures alongside cortical regions. Focal osteoporosis was confirmed on biopsy as reduced sub-cortical trabecular bone volume. CONCLUSION: Using 3D imaging methods and targeted bone biopsy, we discovered focal osteoporosis affecting trabecular and cortical bone of the proximal femur, among men and women with hip fracture.

• MeSH
• biopsie MeSH
• fraktury kyčle etiologie   patologie   MeSH
• kortikální kost patologie   MeSH
• krček femuru patologie   MeSH
• lidé MeSH
• odds ratio MeSH
• osteoporóza komplikace   patologie   MeSH
• plocha pod křivkou MeSH
• ROC křivka MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVE: To assess the decrease in serum calcitriol concentrations after hip fracture. METHODS: Serum concentrations of calcitriol, 25(OH)D, parathyroid hormone (PTH), directly measured free 25(OH)D, and indices of bone formation were measured in elderly patients with hip fracture (HF) and patients with elective hip replacement (EHR) at admission and after 7 weeks. RESULTS: A total of 45 patients with HF and 17 patients with EHR completed this prospective study. Baseline serum calcitriol levels were ≤ 60 pmol/l in 26% of the HF patients. After 7 weeks, they significantly decreased (p < 0.001). In patients with EHR, serum calcitriol was within the reference range in all but one patient and did not change during the 7-week recovery phase. Seven weeks after HF, a significant positive relationship was observed between the change in calcitriol and serum 25(OH)D concentration (r = 0.385, p = 0.009) and free 25(OH)D (r = 0.296, p = 0.048), and a decrease in calcitriol during recovery was associated with a decrease in serum PTH (p = 0.038). Seven weeks after HF, changes in both serum PTH and serum 25(OH)D concentrations contributed to the prediction of changes in serum calcitriol (R2 = 0.190, p = 0.012). CONCLUSIONS: Unlike patients with EHR, subjects with HF had low serum 25(OH)D and low free 25(OH)D concentrations at admission, while their serum 1,25D levels were relatively elevated. Decreases in circulating calcitriol levels in the 7 weeks following hip surgery were associated with a resolution of secondary hyperparathyroidism and low availability of free 25(OH)D.

• MeSH
• fraktury kyčle krev   MeSH
• hojení fraktur fyziologie   MeSH
• kalcitriol krev   MeSH
• lidé MeSH
• náhrada kyčelního kloubu MeSH
• osteogeneze MeSH
• parathormon krev   MeSH
• prospektivní studie MeSH
• referenční hodnoty MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vitamin D analogy a deriváty   krev   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Fractures of the femoral neck have been serious health and social issues of the recent decades. Although up-to-date implants and perioperative care are now available, the treatment is still associated with an increased risk of postoperative complications. The aim of this study was to specify early postoperative complications and to ascertain which factors, if any, can predict them. MATERIAL AND METHODS Between October 2005 and February 2007, a total of 155 patients were treated for femoral neck fractures in our department. The group of elderly patients (n=82) who underwent elective total hip arthroplasty for osteoarthritis served as controls. The selected pre-, peri- and post-operative characteristics were prospectively collected. Each patient was followed-up for at least one month after surgery. The data were first compared by univariate analysis and then, for statistically significant factors, their predictors were identified by the logistic regression. RESULTS The average age of the patients with femoral neck fracture was 77 years and that of the control patients was 75 years. The ratio of men to women was similar in both groups; the groups differed in body height, weight, preoperative morbidity, ASA score, lymphocyte counts, severity of brain atherosclerosis, independence in walking, and self-sufficient living. The number of complications in the hip-fracture group was 87 while, in the control group, it was only 15 (p=0.0002). The hip-fracture group showed significantly higher occurrence of postoperative delirium (34 versus 4; p=0.001) and prosthesis dislocation (12 versus 0; p=0.009). The subsequent multifactorial analysis showed that the risk of postoperative delirium was associated with preoperative lack of self-sufficiency (odds ratio, OR=4.814; 95 % Cl, 1.551-14.942) and the length of operative time (OR=0.970; 95% Cl, 0.951-0.989). Prosthesis dislocation was predicted by an increased height of the patient (OR=1.087 per each cm; 95% Cl 1.001-1.159). An interval between injury and surgery longer than 48 hours was not associated with higher mortality. DISCUSSION Postoperative delirium is a complication found in up to 60% of the patients with surgery for femoral neck fracture. The frequency of this complication depends on the instruments used to identify cognitive dysfunction - with a more sensitive instrument cognitive dysfunction is probably detected in more patients. The higher occurrence of dislocation in the hip-fracture group is also in agreement with the literature data. On the other hand, its association with patient height should not be overestimated, because a coincidence of several other factors may have been involved in the mechanism of dislocation. Displacement can be prevented by the use of offset acetabular components and 36-mm femoral heads for primary implantation in such patients. CONCLUSIONS A significantly higher frequency of prosthesis dislocation and postoperative delirium was found in the patients undergoing total hip arthroplasty for traumatic indication than in the patients after elective surgery. A subsequent multifactorial analysis revealed a potential association of prosthesis dislocation with the patient's height and that of postoperative delirium with the duration of operative time and the degree of preoperative self-sufficiency.

• MeSH
• fraktury krčku femuru chirurgie   MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   MeSH
• pooperační komplikace MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY The hip fracture is the leading cause of disability and deaths in elderly. If left untreated, the hip fracture results in inability to walk, and therefore the patient is dependent on the other's people help. The aim of this study was to determine the predictive values of the functional status, present comorbidities, and the types of treatment on the long-term functional status and mortality in patients with the hip fracture. MATERIAL AND METHODS We analyzed the data about the patients with the hip fractures treated in the period between 01.07.2006. and 01.07.2016., with the mean follow-up period between 34.3±4.9 months. The data included radiographs, age, comorbidities, functional status on admission, functional status on discharge, and follow-ups. RESULTS Female sex, increasing age, and poorer functional status upon admission, conservative treatment, trochanteric fracture, the presence of neurological or lung disease, diabetes, were all significant risk factors leading to poorer functional outcomes on the latest follow-up (p < 0.05). On the other hand, the patients who were mobile upon admission had a longer survival (38.1±3.51 months) as compared with the other patients (12.3±5.1 months; χ2=25.202, p = 0.001). Besides, the results of this study revealed that the direct, statistically significant relationship exists between the untreated internal and neurological diseases, and increased mortality and poorer functional outcomes on the latest follow-up. CONCLUSIONS These results are useful for the orthopedic and trauma surgeons, who are treating these patients, the physical medicine and rehabilitation specialists, who are performing the rehabilitation of these patients, but also the health policy makers, who may promote the programmes of healthy aging (treating the diseases, maintaining fitness, etc.) Key words: hip fracture; comorbidity; mortality; functional status.

• MeSH
• činnosti denního života MeSH
• fraktury kyčle * epidemiologie   terapie   MeSH
• funkční status * MeSH
• komorbidita MeSH
• lidé MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• denzitometrie MeSH
• fraktury kostí MeSH
• menopauza MeSH
• Check Tag
• ženské pohlaví MeSH