Cílem projektu je výrazně snížit patelární komplikace po aloplastice kolenního kloubu totální endoprotézou bez náhrady čéšky, a to optimálním nastavením rotace femorální i tibální komponenty endoprotézy, a tím minimalizovat počet pacientů vyžadujících reoperaci. Jedná se o mulitidisciplinární projekt řešený Radiodiagnostickou klinikou FN a LF UK v Plzni - měření rotačního postavení obou komponent endoprotézy pomocí CT , ZČU - studium a modelování biomechaniky kolenního kloubu a na počítačovém modelu a Klinikou ortopedie a traumatologie pohybového ústrojí FN a LF UK v Plzni - optimalizace operačního postupu.; The aim of the project is the significant decrease of patellar disorders after total knee artrhroplasty without patellar resurfacing by the setting of the optimal femoral and tibial component rotation. This will minimize the number of patients who will need reoperation. This project requires the multidisciplinary cooperation with West Bohemian University -ZČU (Západočeská universita) because of the necessity to create computer biomechanical model of the knee joint and with the radiodiagnostic clinic FNand LF UK to measure the arotational alignment of both component on CT. Methods 1. Creation of the computer model of the knee to study biomechanics in the correlation to the patellar complications (co-worker ZČU) 2.Usage of the computer tomography (CT) to estimate the value of condylar twist úhlu (CTA) - angle between transepicondylar and condylar femoral axis on the transversal femoral scans (co-worker FN Plzeň)

• MeSH
• artróza kolenních kloubů chirurgie   MeSH
• biomechanika MeSH
• luxace pately komplikace   MeSH
• počítačová rentgenová tomografie MeSH
• počítačová simulace MeSH
• rotace MeSH
• totální endoprotéza kolene MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

Publikace sumarizuje poznatky o nestabilitě páteřního sloupce, sjednocuje klasifikaci jednotlivých typů a nastiňuje diagnostické a obecné operační možnosti u jednotlivých skupin nestabilit.

• MeSH
• bederní obratle abnormality   MeSH
• defekty neurální trubice diagnóza   chirurgie   terapie   MeSH
• diagnostické techniky neurologické MeSH
• fraktury páteře diagnóza   chirurgie   terapie   MeSH
• hrudní obratle abnormality   MeSH
• malformace nervového systému MeSH
• nemoci páteře diagnóza   chirurgie   terapie   MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie

Úvod: Navzdory existenci mnoha doporučených postupů v managementu traumat jsou traumata stále vedoucí příčinou smrti u mladých věkových skupin a mortalita se v České republice za posledních 10 let nesnížila. Nadále není zcela jasně definovaná problematika oběhové stability, indikace podání plné krve, rutinní využití jednotlivých zobrazovacích metod a prioritizace jednotlivých kroků péče. Rozhodli jsme se prostřednictvím dotazníkové studie zmapovat podobu iniciální péče o traumatizované pacienty napříč Českou republikou v rámci 12 traumacenter a najít společnou definici oběhové stability pacienta, která je klíčová pro posloupnost jednotlivých diagnosticko‐terapeutických kroků. Metodika: Vytvořili jsme dotazníkovou multicentrickou studii a oslovili klinická pracoviště všech traumacenter v České republice. Otázky byly zaměřeny na postup při ošetření traumatizovaných pacientů. V květnu 2022 byl dotazník zaslán vedoucím lékařům všech 12 traumacenter v České republice stanovených dle aktuálního Věstníku Ministerstva zdravotnictví. Na základě odpovědí byly vytvořeny doplňující otázky. Vedoucí lékaři traumacenter odpovídali dle vlastního uvážení a aktuální situace na svém pracovišti. Získané odpovědi jsme zpracovali metodou popisné statistiky. Výsledky: V osmi centrech je vedoucím trauma týmu traumatolog. Nejčastěji (ve čtyřech centrech) tvoří trauma tým šest osob. Plnou krev podává pouze pět pracovišť, ačkoliv si sedm z 12 center myslí, že má indikaci k podávání u traumatizovaných pacientů. Oběhovou stabilitu lze definovat jako systolický tlak nad 80–90 mmHg bez vasopresorické podpory a srdeční frekvenci pod 120/min, hraniční stabilitu jako stav, kdy je k udržení systolického TK nad 80–90 mmHg potřeba vasopresorická podpora a srdeční frekvence je 120–130/min a nestabilitu, kdy ani použití vasopresorů nevede ke stabilnímu udržení systolického tlaku nad 80–90 mmHg a srdeční frekvence je nad 130/min. Osm pracovišť má CT vyšetření jako součást urgentního příjmu a rutinní vyšetření RTG hrudníku, pánve a E‐FAST (Extended Focused Assessment with Sonography in Trauma) provádí pouze tři pracoviště. Všech 12 pracovišť se kloní k využití CT vyšetření u FAST pozitivního oběhově stabilního pacienta a čtyři centra i u hraničně stabilního pacienta ke stanovení definitivní diagnózy. Všechna centra jsou schopna provést hrudní drenáž na urgentním příjmu, 10 center provádí urgentní torakotomii a čtyři centra laparotomii. Pouze tři centra využívají katétr REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) na urgentním příjmu. Závěr: Zjistili jsme, že navzdory určité variabilitě v postupu péče o traumata napříč Českou republikou je pojetí oběhové stability, hraniční stability a nestability společné všem traumacentrům. Toho lze využít v další odborné diskuzi směřující k optimalizaci managementu této skupiny pacientů.

Despite the existence of many guidelines in the management of trauma, trauma is still the leading cause of death in young age groups, and mortality has not decreased in the Czech Republic over the past 10 years. The issues of circulatory stability, indications for the administration of whole blood, routine use of imaging methods, and prioritization of individual care steps are still not clearly defined. We decided to use a questionnaire study to map what the initial care of traumatized patients looks like across our country in 12 trauma centers and to define the circulatory stability of the patient, on which the sequence of individual diagnostic and therapeutic steps is built. Methodology: We created a questionnaire-based multicenter study and addressed the clinical workplaces of all trauma centers in the Czech Republic. The questions were focused on the procedure for treating traumatized patients. In May 2022, the questionnaire was sent to the leading physicians of all 12 trauma centers in the Czech Republic, according to the current Bulletin of the Ministry of Health. Additional questions were created based on the answers. The leading physicians of the trauma centers answered at their discretion regarding the current situation at their workplace. We processed the answers obtained using descriptive statistics. Results: In eight centers, the head of the trauma team is a traumatologist. Most often (in four centers), a trauma team comprises six people. Only five centers administer whole blood, although seven of the 12 centers believe it has an indication for administration in traumatized patients. Circulatory stability can be defined as a systolic pressure above 80-90 mmHg without vasopressors and a heart rate below 120/min; borderline stability as a condition where vasopressor support is needed to maintain the systolic blood pressure above 80-90 mmHg, and heart rate is 120-130/min and instability when even the use of vasopressors does not lead to maintain stable systolic pressure above 80-90 mmHg, and heart rate is above 130/min. Eight workplaces have CT scans as part of the emergency department, and routine X-rays of the chest, pelvis, and E-FAST (Extended Focused Assessment with Sonography in Trauma) are performed by only three sites. All 12 centers are inclined to use a CT scan at FAST positive circulatory stable patients, and four centers even in borderline stable patients to establish a definitive diagnosis. All centers can perform chest drainage in the emergency department; ten centers perform emergency thoracotomy, and four centers perform laparotomy. Only three centers use the REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) catheter in the emergency room. Conclusion: Despite certain variability in trauma care management across the Czech Republic, the concepts of circulating stability, boundary stability, and instability are common to all trauma centers. These concepts can be used in further professional discussions to optimize the management of this group of patients.

• MeSH
• balónková okluze metody   MeSH
• lidé MeSH
• neodkladná péče o pacienty s traumatem metody   MeSH
• počítačová rentgenová tomografie metody   MeSH
• průzkumy a dotazníky MeSH
• rány a poranění * terapie   MeSH
• resuscitace metody   MeSH
• traumatologická centra MeSH
• urgentní lékařství * metody   organizace a řízení   MeSH
• Check Tag
• lidé 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
• fraktury femuru * chirurgie   MeSH
• intraartikulární fraktury chirurgie   MeSH
• intramedulární fixace fraktury metody   přístrojové vybavení   MeSH
• kostní hřeby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• reoperace metody   MeSH
• rozsah kloubních pohybů MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE OF THE STUDY It was a prospective, randomised, unblinded study. Effects of the application of platelet-rich fibrin (PRF) on the anatomic anterior ligament reconstruction were examined. MATERIAL AND METHODS A total of 40 patients who underwent a surgery between 2012 and 2014 were enrolled in the study. The patients were randomised into two groups: the group with PRF application (n=20) and the group without PRF application (n=20, control group). The study included 11 women and 29 men, with the mean age at the time of inclusion into the study 29.1 years. Vivostat ® PRF was obtained perioperatively from the patient s blood and applied intraoperatively to the hamstring tendon graft. The ACL graft healing was assessed through magnetic resonance (MRI) at 6 and 12 months postoperatively. The clinical outcomes (the Lysholm score and the IKDC Subjective score, return to pre-injury sport levels, Pivot-shift test, graft failure) as well as standardised laxity measurements using GenouRob arthrometer were performed preoperatively and 12 months after surgery. RESULTS The study was completed by thirty-three (33) patients (17 in the PRF group and 16 in the control group). In two cases, postoperative graft failure was reported (both cases in the control group). No significant differences were found in the process of graft ligamentization evaluated through MRI (p=0.07). No significant difference between the groups was identified with respect to return to pre-injury sport levels (p=0.232), or the Lysholm score and IKDC Subjective score (p=0.259, and p=0.364 respectively). The postoperative knee laxity measurement using Genourob arthrometer did not reveal any significant differences between the PRF group and the control group. DISCUSSION Results similar to those arrived at by our study have recently been published also by other authors worldwide. We can therefore assume that the application of PRF can be of benefit, especially at the early stage of healing. The results still need to be verified on a larger study group, the study design should focus on the development in the early postoperative period. CONCLUSIONS In our study group, no significant difference was observed in the evaluated subjective and objective clinical parameters. Only the parameter regarding the ACL graft failure fell just short of statistical significance, namely to the disadvantage of the group without the PRF application. Key words: anterior cruciate ligament, arthroscopy, anatomic ACL reconstruction, magnetic resonance imaging of the graft, platelet-rich fibrin, graft healing, MRI signal intensity of the graft.

• MeSH
• fibrin bohatý na krevní destičky * MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• nestabilita kloubu * chirurgie   MeSH
• poranění předního zkříženého vazu * chirurgie   MeSH
• prospektivní studie MeSH
• rekonstrukce předního zkříženého vazu * metody   MeSH
• šlachy hamstringů * transplantace   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

PURPOSE OF THE STUDY We present the results of the retrospective study comparing the clinical outcomes of outside-in versus all-inside suture techniques of unstable RAMP lesions (RL) of the medial meniscus in patients with simultaneous ACL lesion with a minimum two-year follow-up. MATERIAL AND METHODS The retrospective evaluation covered two groups of patients who underwent the arthroscopic repair of unstable RL in combination with anterior cruciate ligament reconstruction (ACLR). Group 1 included 42 patients (28 men/24 women). Group 2 consisted of 36 patients (21 men/15 women). In Group 1, RL suture repair using the outside-in technique by posteromedial approach with absorbable PDS suture was performed, while in Group 2 the all-inside technique of RL suture via the standard anteromedial portal was applied using the Fast-Fix system (Smith Nephew, USA). The evaluation was done preoperatively and postoperatively with the mean follow-up of 27.9 months in Group 1 and 30.1 months in Group 2. The patients were assessed using the subjective IKDC score and the side-to-side difference (SSD) in ventral laxity was measured by Genourob (GNRB) laximeter at the applied pressure of 134 N and 250 N. Moreover, the failure rate of RAMP lesion repair, ACL graft, necessity of secondary partial meniscectomy and return to pre-injury level of sport were analysed. RESULTS The median IKDC score increased in Group 1 from 56 points preoperatively to 92 points postoperatively and in Group 2 from 58 points preoperatively to 90 points postoperatively (p>0.05). The median value of SSD in ventral laxity of the knee measured by the GNRB laximeter at the applied pressure of 134 N in Group 1 was 5.6 mm preoperatively and 1.9 mm postoperatively and in Group 2 it was 5.9 mm preoperatively and 2.3 mm postoperatively. At the pressure of 250 N, the median value in Group 1 was 7.9 mm preoperatively and 2.7 mm postoperatively and in Group 2 it was 8.1 mm preoperatively and 3.2 mm postoperatively. When comparing the SSD of the groups postoperatively, no statistically significant difference was found (p>0.05). Revision arthroscopy was performed in 8 patients. In 1 patient (2.4 %) in Group 1 and in 4 patients (11.1%) in Group 2 a rerupture of the RL of the meniscus occurred and partial meniscectomy was performed. In Group 2, statistically significant higher occurrence of the RL suture failure (p<0.05) was reported and there was a need to perform partial medial meniscectomy (p<0.05). The ACL graft failure was observed in 2 patients (4.7%) in Group 1 and in 3 patients (8.3%) in Group 2 (p>0.05). 31 evaluated patients (73.8%) from Group 1 and 24 patients (66.7%) from Group 2 (p>0.05) returned to the pre-injury level of sports activities. DISCUSSION When comparing the outcomes of individual techniques of the RL repair published in recent literature with our conclusions, we may state that the results of subjective as well as objective criteria achieved were similar to those reported by other authors worldwide. No study has so far been published which would compare the outcomes of the by us presented two surgical techniques of the RL suture in an ACL-deficient knee with a minimum follow-up of 24 months. CONCLUSIONS Both the surgical techniques of unstable RL repair in combination with the ACLR using a tendon graft result in a statistically significant improvement of clinical outcomes postoperatively. In Group 2, with the all-inside RL repair, a statistically significant higher failure rate of RL repair was confirmed as well as the need to perform secondary partial meniscectomy compared to Group 1. Key words: RAMP lesion, ACL-deficient knee, unstable medial meniscus lesion, repair of meniscus, all-inside technique, posteromedial technique, ACL reconstruction.

• MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• menisky tibiální chirurgie   MeSH
• poranění předního zkříženého vazu * chirurgie   MeSH
• rekonstrukce předního zkříženého vazu * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Acute knee dislocation is a less common injury of the knee joint. It is, however, a serious injury with a high rate of nerve and vascular damage and it is considered a limb threatening injury with long-term functional disability, which can ultimately lead to amputation. Knee dislocations constitute less than 0.5% of all joint dislocations. Most of these injuries occur in highenergy traumas and careful diagnosis can identify the patient at risk of this injury. MATERIAL AND METHODS The total number of patients with knee dislocation was 37. The incidence of knee dislocation was 2.5 patients per year. The mean age of patients was 49 years. After the evaluation of blood supply to the limb and before the examination of the ligament injury, routine X-ray views of the affected joint were performed. It was necessary to confirm good blood supply of the limb, in which knee dislocation had been suspected. In patients with reduced knee joint and asymmetric pulses in the lower limb, CT angiography was indicated. The absence of peripheral pulses and the presence of serious clinical signs of peripheral blood supply disruption in case of the reduced knee or irreducible knee dislocation necessitated immediate revision by a vascular surgeon performed in the operating room. RESULTS Dislocation of the knee without TKA (a total of 34 cases) was caused by a high-energy trauma in 19 cases (56%) and in 7 cases (21%) it was a part of polytrauma. The most common was a motorcycle accident, namely in 7 cases (21%). In 12 cases (35%), it was a low-energy trauma, a fall or a slip while walking. In three cases (9%), the patients suffered an open knee dislocation. In 18 patients (47%), no knee surgery was performed. The knee ligament injury was treated non-operatively through knee brace fixation. An open revision with sutures of injured ligament structures and knee capsule was performed in 16 patients (42%). In two cases, above-the-knee amputation was done. External fixation was performed in two polytrauma patients. Three cases of infectious complications were reported. Nerve lesions were observed in 9 cases (25%). Vascular lesions were recorded in 9 cases (25%). Deep vein thrombosis was observed in three cases in our study group. The Lysholm knee questionnaire was used to assess subjective difficulties. DISCUSSION In agreement with the literature, these injuries occur most frequently when riding on motorcycle. The patients, in whom a vascular lesion was identified and revascularisation performed within 8 hours, showed a significantly lower incidence of amputations (11%) compared to those who underwent surgery after 8 hours (86%). Majority of vascular surgeons consider 6 hours to be the time limit for the performance of vascular reconstruction since a surgery performed after 6 hours is accompanied by a higher complication rate. Currently, the aim of the final treatment is to perform anatomic suture or reconstruction of knee ligaments and meniscus to achieve a stable, pain-free, functional knee and to prevent any complications. CONCLUSIONS Knee joint dislocation ranks among less common injuries that can be accompanied by a vascular injury in 20% on average and a nerve lesion in 10-40% (around 25% on average). A negative X-ray in spontaneous reduction of knee dislocation can be misleading for proper diagnosis. It is crucial to rule out a vascular injury that might be a limb threatening. In case of a vascular lesion, an early reconstruction of vascular supply is necessary within 6 hours after the injury. The revascularisation performed later is accompanied by a high risk of complications and can ultimately lead to above-the-knee amputation. It is most appropriate to refer such serious injuries to specialised trauma centres that avail of necessary equipment and experience with treating the patients who sustained such complicated orthopaedic injuries. As to the ligament reconstruction, most surgeons prefer to postpone the procedure in majority of cases by 10-14 days. Key words: knee dislocation, vascular injury, neurologic injury, ligament reconstruction, irreducible dislocation.

• MeSH
• dislokace kloubu * MeSH
• kolenní kloub diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• luxace kolena * diagnostické zobrazování   epidemiologie   MeSH
• poranění kolena * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.

• MeSH
• bederní obratle MeSH
• fraktury páteře * komplikace   chirurgie   MeSH
• hrudní obratle MeSH
• kreatinkinasa * metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• myoglobin * metabolismus   MeSH
• nemoci svalů * diagnóza   etiologie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Periprosthetic distal femoral fractures (PDFF) constitute an unpleasant complication in patients with a total knee replacement (TKR). The incidence reported in literature is 0.3-2.5 %. The number of periprosthetic knee fractures has been increasing due to the ageing of population, a growing number of implants, a longer life expectancy of patients, a more intensive physical activity of patients, and osteoporosis. Most of these fractures are treated surgically, non-surgical treatment is reserved solely for patients unable to undergo a surgery for general health conditions. MATERIAL AND METHODS Our retrospective study evaluated the group of patients with PDFF who were treated at out department in the period 2007- 2016 and 2,975 primary TKR were performed. The total number of patients with PDFF was 56. The mean age of patients with PDFF was 77 years (56-94 years) and at the time of fracture the mean age was 71 years in men and 78 years in women. The average time from the TKR to periprosthetic fracture was 8.2 years (0-20 years). The fractures were assessed using the Su classification modified by Krbec. RESULTS A primary TKR was performed in 46 cases for gonarthrosis, in 6 cases for rheumatoid arthritis and in 4 cases for secondary, post-traumatic gonarthrosis. The average incidence of periprosthetic distal femoral fractures was 5-6 cases per year. Women represented 86 %, men 14 %. Su Type I fracture was diagnosed in 25 % of cases, Su Type II fractures in 71 %, and Su Type III fractures 4 %. 52 patients with PDFF were treated surgically, in 4 cases conservative treatment was opted for. The average treatment time of PDFF to healing by callus formation was 6.6 months (3-12 months). Mortality during the first 3 months after osteosynthesis of PDFF was 9 %. A failure of osteosynthesis of PDFF was reported in 4 cases. DISCUSSION Multiple classification systems were developed to assess these fractures. The most appropriate we consider the classification of Su et al. classifying the PDFF into 3 groups, namely based on the height of the fracture line relative to the femoral component. Osteosynthesis by retrograde femoral nail is indicated for periprosthetic fractures, with sufficient bone mass in distal femur, which allows stable distal fixation. The new generation of anatomically shaped angular stable implants gives us yet another option for osteosynthesis of PDFF. Many studies point at the advantages of these implants in osteoporotic bone as against the conventional plates. CONCLUSIONS The number of PDFF has been increasing. The main methods of internal osteosynthesis continue to be the angular stable plates and the retrograde femoral nail. Preoperative planning is important to determine the type and dimensions of the existing femoral component and to distinguish whether or not it has come loose. The choice of the implant may depend on the bone mass available for distal fixation. The retrograde femoral nail is usually the most suitable method of treatment for proximal PDFF (Su Type I). The angular stable plates can be used for PDFF originating at the femoral component (Su Type II and Type III). Very distal fractures classified as Su Type III with a loose femoral component require a revision surgery with a TKR with stems. The surgeon should be prepared for a revision surgery if the intraoperative finding is more complicated than anticipated based on the preoperative radiograph. Key words:total knee arthroplasty, periprosthetic fracture, osteosynthesis.

• MeSH
• fraktury femuru etiologie   chirurgie   terapie   MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury etiologie   chirurgie   terapie   MeSH
• periprotetické fraktury etiologie   chirurgie   terapie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene škodlivé účinky   MeSH
• vnitřní fixace fraktury škodlivé účinky   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The retrospective study aims to compare the outcomes of augmentation of neutral triangle formed after the calcaneal fracture reduction with osteosynthesis using the locking compression plate with the outcomes of osteosynthesis without augmentation. MATERIAL AND METHODS In the period from 2005 to January 2011, 98 patients with 114 calcaneal fractures were treated by open reduction and internal fixation (ORIF) method with the use of calcaneal plate. The group included 15 women (15.3%) and 83 men (84.7%), with the mean age of 39.2 years (12-62 years). There were 16 cases of bilateral calcaneal fractures, of which 2 in women (12.5%) and 14 in men (87.5%). The fractures were classified based on the Sanders classification as Type I -IV. The patients with Type II and III fracture according to the Sanders classification were indicated for surgical treatment with ORIF using the calcaneal LCP. The defect in the region of neutral triangle of the calcaneus was filled with the injectable hydroxyapatite cement. The cohort of operated patients was evaluated based on the AOFAS (American Orthopaedic Foot and Ankle Society) Clinical Rating System. The bilateral fractures were not evaluated. This group shows a substantially higher occurrence of associated injuries, which causes strong distortion of results. RESULTS The cohort of 82 operated patients with Sanders Type II and III fractures were evaluated. In 20 fractures (24.4%) the defect in the calcaneus body was filled with hydroxyapatite cement. In osteosynthesis without defect augmentation an excellent result was achieved in 21 patients (33.9%). A good result was reported in 24 patients (38.7%), a satisfactory result in 12 patients (19.4%) and a poor result in 5 patients (8.0%). In patients with osteosynthesis of the calcaneus with augmentation, an excellent result was achieved in 6 cases (30%), a good result in 5 cases (25%), a satisfactory result in 7 cases (35%) and a poor result in 2 cases (10%). Early postoperative complications were observed in a total of 13 patients (15.8%). In osteosynthesis without defect augmentation, there were 2 cases of wound dehiscence (3.2%), 3 cases of marginal skin necrosis (4.8%), 4 cases of superficial wound infection (6.4%) and 1 case of deep wound infection (1.6%). In patients with performed augmentation, wound dehiscence was seen in 1 case (5%), superficial wound infection in 1 case (5%) and superficial marginal skin necrosis in 1 case (5%). Deep wound infection was not reported in this group. DISCUSSION A question frequently discussed is the filling of defect in the diaphysis of calcaneus. Brodt et al. state a statistically higher stability of the calcaneus in osteosynthesis with augmentation, but he does not use the locking plate. Longino in his study compares the results of calcaneal osteosynthesis with spongioplasty with a graft from pelvis and without it and does not observe any major differences in the final outcome in his cohort. Elsner evaluates the results in 18 patients, in whom calcium phosphate cement augmentation was used for osteosynthesis. Over the period of three years he did not observe a higher rate of complications. Schildhauer assesses the early load of the calcaneus with tricalcium phosphate cement augmentation. After three weeks of full loading no loss of reduction was found. Thordarson evaluates 11 operated patients with Sanders type II and III calcaneal fracture. The defect of the calcaneus was filled by calcium phosphate cement. In this small group 1 case of serious infection complication and 1 loss of reduction with full load at six weeks after the surgery were observed. In our group no differences were observed between the outcomes of patients with performed or not performed defect augmentation in the neutral triangle site. A higher percentage of complications in patients with filled defect of the calcaneus was not observed either. CONCLUSIONS The operative treatment of displaced intra-articular fractures consisting of open reduction from extended lateral approach and internal calcaneal LCP fixation brings good results. We concluded that there is no statistically significant difference in the results of osteosynthesis with a locking plate alone and combined with augmentation of diaphyseal defect of the calcaneus. Filling of the diaphyseal defect in the calcaneus is not necessary, it neither accelerates the healing, nor brings better treatment outcomes Key words: calcaneal fracture, cement augmentation of defect, locking plate, extended lateral approach.

• MeSH
• dítě MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• kostní destičky * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• patní kost zranění   MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury přístrojové vybavení   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH