Monografie předních odborníků poskytuje ucelený přehled terapeutických možností v problematice poranění pánve a acetabula a navazuje na čtyři roky starou publikaci Diagnostika zlomenin pánve a acetabula od stejného kolektivu autorů. V posledních dvaceti letech došlo k enormnímu nárůstu těchto zlomenin, nezřídka v rámci polytraumatu s poraněním životně důležitých orgánů.

• MeSH
• acetabulum zranění   MeSH
• fraktury kostí komplikace   rehabilitace   terapie   MeSH
• ortopedické výkony klasifikace   metody   využití   MeSH
• pánevní kosti zranění   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• traumatologie
• NLK Publikační typ
• kolektivní monografie

Monografie předních odborníků poskytuje ucelený přehled terapeutických možností v problematice poranění pánve a acetabula a navazuje na čtyři roky starou publikaci Diagnostika zlomenin pánve a acetabula od stejného kolektivu autorů. V posledních dvaceti letech došlo k enormnímu nárůstu těchto zlomenin, nezřídka v rámci polytraumatu s poraněním životně důležitých orgánů.

• Klíčová slova
• Chirurgie, ortopedie, traumatologie,
• MeSH
• acetabulum zranění   MeSH
• fraktury kostí komplikace   rehabilitace   terapie   MeSH
• ortopedické výkony klasifikace   metody   využití   MeSH
• pánevní kosti zranění   MeSH

• NLK Obory
• ortopedie
• traumatologie

Poměrně řídký výskyt současné zlomeniny proximálního femuru a jeho diafýzy vede v určitém počtu případů k přehlédnutí zlomeniny v horní etáži, čímž dojde ke špatnému zhojení zlomeniny se všemi komplikacemi a nutností dalšího operačního řešení. Použití kombinace standardních metod osteosyntézy izolovaných zlomenin proximálního konce femuru s běžně užívanými metodami osteosyntézy zlomenin diafýzy femuru nedává uspokojivé výsledky. Jako optimální se jeví použití rekonstrukčních hřebů. V současné době neexistuje všeobecně akceptovaná klasifikace ipsilaterálních zlomenin horního konce a diafýzy femuru, která by byla ověřena na dostatečně velkém souboru pacientů a mohla se tak stát všeobecně přijatelnou terapeutickou směrnicí.; Relatively low incidence of proximal femur fractures and its shaft results in a certain number of cases in the neglection of a fracture in the upper level causing fracture mal-union with all complications and requiring additional surgical treatment. Combination of standard methods of internal fixation of isolated proximal femur fractures with currently used methods of internal fixation of femoral shaft does not provide satisfactory results. Optimal method seems to be the use of reconstruction nails. Currently there is no generally accepted classification of ipsilateral fractures of proximal femur and femoral shaft that would be verified on a sufficiently big group of patients and could thus serve as a generally accepted therapeutical guideline.

• MeSH
• diafýzy zranění   MeSH
• fraktury femuru chirurgie   terapie   MeSH
• fraktury krčku femuru chirurgie   terapie   MeSH
• intramedulární fixace fraktury MeSH
• kostní hřeby využití   MeSH
• pooperační komplikace prevence a kontrola   MeSH

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

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

• MeSH
• dospělí MeSH
• lidé MeSH
• pánev zranění   MeSH
• poranění dolní končetiny diagnóza   etiologie   terapie   MeSH
• potravní doplňky MeSH
• stresové fraktury * diagnóza   etiologie   terapie   MeSH
• vápník terapeutické užití   MeSH
• vitamin D terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé 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

• Publikační typ
• abstrakt z konference MeSH

A 13-year-old girl suffered fracture of her left clavicle. A figure-of-8 bandage was placed during initial treatment. Six days after trauma her distal arm, elbow and proximal forearm were swollen, pain and tenderness of distal part of brachial vein was recognized during clinical examination. Duplex ultrasonography revealed partial thrombosis of the brachial vein. Bandage was immediately removed and administration of LMWH (enoxaparin) was started. Complete recanalization was achieved after a few days. The fracture was healed without further complication, patient was without sonographic and clinical signs of post-thrombotic syndrome. The second case report describes a 14-year-old boy. Initially, the fixation was a figure-of-8 bandage. 5 days after the injury he had swollen arm and elbow on the injured side, according to duplex ultrasonography deep venous thrombosis of the axillary and the brachial vein was recognized. There was only partial recanalization at the first sonographic follow up, the patient was converted to Warfarin for 3 months after injury after initial LMWH therapy. At the last follow-up, fracture of the left clavicle was healed and there were no DUSG or clinical signs of post-thrombotic syndrome. Key words: clavicle, deep venous thrombosis of the upper extremity, anticoagulant therapy.

• MeSH
• COVID-19 * komplikace   MeSH
• dítě MeSH
• fraktury kostí * komplikace   terapie   MeSH
• heparin nízkomolekulární terapeutické užití   MeSH
• klíční kost diagnostické zobrazování   zranění   MeSH
• konzervativní terapie škodlivé účinky   MeSH
• lidé MeSH
• mladiství MeSH
• žilní trombóza * diagnostické zobrazování   farmakoterapie   etiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY The study gives a retrospective assessment of the outcomes of surgical treatment in patients who sustained a subtrochanteric fracture. MATERIAL AND METHODS In the period 2010-2018, a total of 118 patients with a subtrochanteric fracture, namely 75 males and 43 females, the mean age 61 years, were treated at our department. The study group included the patients who met the following inclusion criteria: age 18+, fracture treated by intramedullary nailing, follow-up for at least 12 months, in case of impaired healing and need for revision surgery follow-up until complete healing was achieved. Exclusion criteria - pathological fractures, periprosthetic fractures, pertrochanteric fractures with extension into subtrochanteric region, intertrochanteric fractures, fractures during bisphosphonate treatment, incomplete radiological documentation, non-compliance with the condition of 12-month follow-up. In 54 patients (46%) the injury was caused by high-energy impact, in the remaining 64 patients (54%) the fracture was the consequence of low energy mechanism. In 51 patients (43%) closed reduction was performed and 67 patients (57%) underwent open reduction. In 27 patients (23%) a small incision laterally was necessary to insert the reduction instrument in order to achieve correct position of the fracture. In 40 patients (34%) lateral approach was used for the reduction and proper placement of fragments was ensured by one or more cerclage wires prior to nailing. Nails made by Synthes were used for osteosynthesis: PFN A Long in 95 patients, PFN A in 11 patients and LFN in 12 patients. RESULTS In 76 patients (64%) fractures healed within 6 months, in 107 patients (90%) within 9 months. In 11 patients (10%) nonunion was observed that required another surgery. The outcomes were assessed using the Sanders and Regazzoni scoring system. Excellent outcome was achieved in 79 cases (67%), good outcome in 25 cases (21%), satisfactory outcome in 13 cases (11%), poor outcome in 1 case (1%). DISCUSSION At any age subtrochanteric fractures are always treated surgically. Currently, intramedullary nailing is the method of choice. The outcome of the surgery depends on correct reduction and fixation which shall ensure the balance of compression forces transmitted to the medial cortical bone, traction forces transmitted to the lateral femoral cortical bone. Intramedullary nailing has biomechanical advantages which outweigh the often difficult closed reduction. The nail decreases the position vector (of the force moment) and reduces torsional forces at the fracture site. Open reduction and additional cerclage wires are described as a risk factor for impaired healing. Nevertheless, the achievement of anatomical reduction offsets the risk of poor blood supply at the fracture site. Persistent displacement disturbs the balance of forces and results in impaired healing and implant failure. CONCLUSIONS Treatment of subtrochanteric fractures relies on precise reduction. Today, when minimally invasive methods of treatment are preferred, the most commonly used are the intramedullary implants. Displacement to varosity, flexion displacement or a combination of both cause impaired healing with non-union and failed osteosynthesis. Treatment of non-union is extremely challenging and always consists in the correction of anatomical relationships. Key words: subtrochanteric fractures, surgical treatment, outcomes, complications.

• MeSH
• fraktury kyčle * diagnostické zobrazování   chirurgie   MeSH
• hojení fraktur MeSH
• intramedulární fixace fraktury * škodlivé účinky   MeSH
• kostní dráty MeSH
• kostní hřeby MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Continuous epidemiologic data on changes in the spectrum of acetabular fractures is rare. The purpose of this study is to evaluate changes in the types of acetabular fractures over the last two decades. MATERIAL AND METHODS In the period between 2007 and 2016, a total of 522 patients were treated at the authors department (Traumacentre Level I) for acetabular fractures. 15 patients sustained bilateral fractures. The group consisted of 361 men and 161 women, with the mean age of 49 years (the range of 10-96 years). Standard procedure was applied to diagnose the fractures (X-ray and CT scan). Non-operative treatment was opted for in fractures without displacement, fractures with minimum displacement of acetabular weight bearing area less than 2 mm, confirmed by the CT scan (e.g. low fractures of anterior column, low transverse fractures), fractures with secondary congruence in patients over the age of 70, and fractures in patients contraindicated for surgery due to their serious overall medical condition or severe osteoporosis. A surgery was indicated in case of instability or incongruent acetabular joint space due to the displacement of weight bearing area fragments, or a bone fragment or soft tissue interposition. A surgery was indicated also in a non-displaced acetabular injury with concurrent femoral head injury. AO/ASIF classification was used to classify the fractures. The following data was monitored in the referred to group of patients: gender, age, mechanism of injury, associated injuries, type of fracture, and treatment method. RESULTS Type A fracture was reported in 293 patients (56%), type B fracture in 150 patients (29%) and type C fracture in 79 patients (15%). A high-energy trauma occurred in 334 patients (64%), namely 254 men and 50 women, with the mean age of 41 years. A low-energy trauma was sustained by 188 patients (36%), namely 77 men and 111 women, with the mean age of 69 years (56-91). This difference in the share of men and women with respect to the seriousness of the mechanism of injury was statistically significant (p < 0.0001). Non-operative treatment was used in 248 patients (48%), of whom 167 were men and 81 were women. The mean age in this sub-group was 60 years, namely 58 years in men and 62 years in women. Operative treatment was opted for in 272 patients (52%), of whom 206 were men and 50 were women, with the mean age of 45 years in women as well as in men. The statistical processing of differences between the non-operative and operative treatment in dependence on the type of fractures revealed a significantly higher percentage of operative treatment in type C fractures compared to type A and B fractures (p < 0.0001, or p = 0.0009). In the group of patients treated by the authors in the 1996-2002 period, type A fractures constituted 45% of all fractures, where A1 fractures prevailed with 29%, A2 fractures represented 9% and A3 fractures only 6 %. In the recent group of patients, type A fractures constituted 56%, but A3 fracture were seen in 29% of patients, which was a significant increase (p < 0.0001). A3 fractures (anterior wall or anterior column fractures) were associated with a low-energy mechanism of injury and occurred in 48% of patients (73, mostly elderly women). DISCUSSION When compared to the published groups of other authors, the monitored group showed no difference in the mean age and gender ratio. There was an obvious increase in the number of patients with a low-energy mechanism of injury. The authors believe that this is the result of population ageing. It is also related to the growing share of patients treated non-operatively. The number of patients with a high-energy mechanism injury increased to a lesser degree. The spectrum of fractures significantly changed over the last 20 years. It was caused by an increase in low-energy injuries and partly also by improved diagnostics. CONCLUSIONS In the last 20 years, the authors noticed a rise in some types of acetabular fractures. It was caused by a statistically significantly higher number of fractures with a low-energy mechanism of injury, especially in elderly patients, the so-called "fragility fractures". Therefore, the share of non-operatively treated acetabular fractures increased as well. The number of acetabular fractures in young patients as a result of a high-energy injury grew more slowly, and it was only the share of posterior-wall acetabular fractures that was significantly higher. Key words: epidemiology of acetabular fractures, mechanism of injury, types of acetabular fractures.

• MeSH
• acetabulum diagnostické zobrazování   zranění   MeSH
• dítě MeSH
• dospělí MeSH
• fraktury kostí * diagnostické zobrazování   epidemiologie   chirurgie   MeSH
• fraktury kyčle * diagnostické zobrazování   epidemiologie   chirurgie   MeSH
• fraktury páteře * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH