• Publication type
• Overall MeSH

Multidisciplinární lékařský tým z několika českých nemocnic se zúčastnil v rámci projektu MEDEVAC mise do nemocnice v ukrajinském městě Vynnyky. Civilním pacientům byla poskytnuta specializovaná chirurgické péče ve spolupráci s plastickými chirurgy u úrazů v souvislosti s bojovými operacemi i bez ní. Krátce je popsán případ komplexní otevřené zlomeniny předloketních kostí s rozsáhlým defektem měkkých tkání i skeletu u 32letého civilního pacienta.

A multidisciplinary medical team from several Czech hospitals participated in a mission to a hospital in the Ukrainian town of Vynnyky as part of the MEDEVAC project. Civilian patients were provided with specialized surgical care in cooperation with plastic surgeons for injuries related to combat operations and without it. A case of a complex open fracture of the forearm bones with extensive defect of soft tissues and skeleton in a 32-year-old civilian patient is briefly described.

Traumatologický plán je soubor opatření pro zmírnění následků poranění při mimořádných událostech a krizových situacích. Na I. chirurgické klinice Všeobecné fakultní nemocnice byl aktivován v prosinci 2023 v den, kdy došlo k tragické střelbě v budově Filozofické fakulty Univerzity Karlovy v Praze. Díky cvičným aktivacím byly bez komplikací připraveny během 20 minut týmy, prostory a byla uvolněna lůžka. Mimořádným případem bylo střelné poranění, k němuž došlo na vzdálenost 350 metrů (na druhém břehu Vltavy), jehož původu si však pacient – cizinec – nebyl vědom a byl referován jako zlomenina femuru po pádu při útěku.

The Trauma Plan is a set of measures to mitigate the consequences of injury in emergencies and crisis situations. It was activated at the First Surgical Clinic of the General University Hospital in December 2023, on the day of the tragic shooting in the building of the Faculty of Arts of Charles University in Prague. Thanks to the practice activations, teams, premises and beds were prepared within 20 minutes without complications. An exceptional case was a gunshot wound that occurred at 350 meters (on the other bank of the Vltava River), the origin of which, however, the patient-foreigner was not aware of and was reported as a fracture of the femur after a fall while fleeing.

Pacientka náhle v domácím prostředí dušnost, kolaps a bezvědomí. Provedena laická telefonicky navigovaná kardiopulmonální resuscitace, po příjezdu lékaře rychlé záchranné služby úspěšná rozšířená kardiopulmonální resuscitace a poté pacientka převezena na oddělení urgentního příjmu Nemocnice České Budějovice. Byla provedena základní stabilizace klinického stavu, zajištění pacientky, intubace a odvoz na CT. Zde byla pomocí CT verifikována masivní bilaterální plicní embolie. Ihned v prostorách urgentního příjmu byla provedena trombolýza, stabilizace oběhu a pacientka byla uložena na ARO. Za hodinu na oddělení ARO znovu těžká oběhová nestabilita – vysoká podpora oběhu noradrenalinem. Provedeno UZ a následně CT břicha s nálezem masivního hemoperitonea. Urgentní chirurgické konzilium a doporučena operace z vitální indikace. Provedena urgentní laparotomie u hemodynamicky těžce nestabilní pacientky s TK 60/30 a pulzy 180/min. Za masivní oběhové podpory a převodů erymasy odsáty 4 l zcela nesrážlivé krve v oblasti jater. Játra byla tržena na několika místech od zlomených žeber a nejvíce dorzálně v levém laloku v oblasti jaterních žil. Chirurgicky při těžké oběhové nestabilitě neověřitelné a bylo rozhodnuto o stabilizaci pomocí perihepatického packingu a pacientka byl uložena na ARO RES. ARO pokračuje v konzervativní terapii a dochází k postupnému zmenšení odpadů do drénu. Provedena second-look operace za 48 hod – revize původní ranou, odstranění roušek. Nalezeny mnohočetné trhliny na pravém laloku od zlámaných žeber a dorzálně silně krvácející jaterní žíla. Provedena kombinace selektivních sutur s elektrokoagulací trhlin, pro přetrvávající oběhovou nestabilitu se znovu rozhodujeme dát pouze perihepatický packing. Pacientku znovu necháváme na ARO k oběhové stabilizaci a domlouváme se znovu na operační revizi po stabilizaci oběhu za 48 hod. Přistupujeme k další operační revizi. Provádíme znovu revize perihepatického prostoru a anatomickou resekci jaterního segmentu II a III a selektivní podvaz jaterní žíly. Následně dochází k hemodynamické stabilizaci oběhu. V rámci pooperačního průběhu nejprve dochází k rozvoji fluidothoraxu, který byl vyřešen hrudní drenáží, a akutní akalkulozní cholecystitidě, která byla vyřešena punkční cholecystostomií. Pacientka je nyní primárně zhojena a angiologiem nasazena trvalá antikoagulační terapie. Příčina plicní embolizace nebyla zjištěna.

The patient suddenly experienced shortness of breath, collapse, and loss of consciousness at home. Layperson-performed, telephone-guided cardiopulmonary resuscitation was initiated, and upon the arrival of the emergency medical team, successful extended CPR was performed, after which the patient was transported to the emergency department at Hospital of České Budějovice. Basic stabilization of the clinical condition was carried out, the patient was secured, intubated, and transported to the CT scanner. A massive bilateral pulmonary embolism was verified byCT. Thrombolysis was immediately performed in the emergency room, circulation was stabilized, and the patient was transferred to the ICU. An hour later, the patient experienced severe circulatory instability in the ICU, requiring high-dose norepinephrine support. Ultrasound was performed, followed by a CT scan of the abdomen, which revealed massive hemoperitoneum. An urgent surgical consultation was performed, and surgery was recommended on a vital indication. An urgent laparotomy was performed on a hemodynamically unstable patient with the blood pressure 60/30 and the pulse 180/min. Despite massive circulatory support and erythrocyte transfusion, 4 liters of noncoagulable blood were drained from the hepatic region. The liver was torn in several places due to fractured ribs, most severely in the left lobe at the hepatic veins. Due to severe circulatory instability, the injury was deemed inoperable, and it was decided to stabilize the condition with perihepatic packing, after which the patient was transferred to the ICU. The ICU continued conservative therapy, and there was a gradual reduction in the drainage output. A second-look operation was performed after 48 hours – revision of the original wound and removal of the drapes. Multiple fissures were found in the right lobe, caused by broken ribs, with heavy bleeding from the dorsal hepatic veins. A combination of selective suturing and electrocoagulation of the fissures was performed. Due to ongoing circulatory instability, the decision was made to use perihepatic packing once again. The patient was left in the ICU for further circulatory stabilization, with a plan to do another surgical revision after stabilization in 48 hours. Another surgical revision was performed, revisiting the perihepatic space and performing an anatomical resection of liver segments II and III, followed by selective ligation of the hepatic vein. Hemodynamic stabilization was achieved. Postoperatively, a fluidothorax developed, which was managed by thoracic drainage, and acute acalculous cholecystitis, which was treated with puncture cholecystostomy. The patient is now primarily healed and has been started on long-term anticoagulation therapy by the angiologist. The cause of the pulmonary embolism was not determined.

• MeSH
• Adult MeSH
• Esthetics, Dental MeSH
• Tooth Fractures therapy   MeSH
• Humans MeSH
• Malocclusion therapy   MeSH
• Incisor injuries   MeSH
• Composite Resins therapeutic use   MeSH
• Tooth Injuries therapy   MeSH
• Tooth Discoloration therapy   MeSH
• Dental Prosthesis * methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Článek popisuje případ štěněte pomeraniana, které utrpělo zlomeninu kostí levého antebrachia. Malá a miniaturní plemena psů jsou ke vzniku zlomenin antebrachia predisponována. Díky anatomickým a biomechanickým specifikům je nutno přistupovat k řešení těchto traumat odlišně než u jiných zlomenin. Článek představuje použití orthogonal plating u konkrétního pacienta a snaží se objasnit filozofii této metody.

The article describes a case of a Pomeranian puppy that suffered a fracture of the left antebrachium. Toy and miniature breeds of dogs are predisposed to antebrachial fractures. Due to some anatomical and biomechanical specifics, it is necessary to approach these traumas differently than other fractures. The article presents the use of orthogonal plating in a specific patient and tries to clarify the philosophy of this method.

• MeSH
• Arm Bones * injuries   MeSH
• Animal Diseases MeSH
• Dogs MeSH
• Fracture Fixation, Internal * veterinary   MeSH
• Animals MeSH
• Check Tag
• Dogs MeSH
• Animals MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: The acromion projects laterally in a curving orientation. When a fracture of the acromion occurs, despite being rare, matching the best-fit fixation plate is challenging due to few options and limited availability of fixation plate types. Alternative fixation methods can carry risk of nonunion complications. PURPOSE: The objective of this study was to investigate the morphological curvature pattern of the acromion to assess the level of the fixation plates fitness and provide the suitable imaging modalities for evaluating the acromion curvature. BASIC PROCEDURES: The correlation between the acromion curvature and five fixation plates were calculated and their fitness level was evaluated statistically. The curvature of acromion and the five available fixation plates were photographed and assessed digitally by software (FIJI ImageJ and Microsoft Excel). The method entails plotting seven points along the curving surface and margins of the acromion, while the Excel Solver function calculates the regression, ultimately giving curvature values. First, the acromion parameters were studied on 180 paired healthy dry scapulae. Then, the acromion curvature values were compared to the fixation plates curvatures. Likewise, the acromion curvature was assessed as applicable on 153 (100 AP- views, 50 Y- views, and 3 superior-views) retrospective plain X-rays and 40 3D-CT scapula reconstructions of healthy acromia. MAIN FINDINGS: The mean length of the acromion was 48.70 ± 5.29 mm, mean thickness was 8.51 ± 1.67 mm, and mean width was 25.97 ± 5.97 mm. The calculated values of the mean curvatures were 0.050 ± 0.015 mm-1 for the mean acromion surface, 0.042 ± 0.027 mm-1 for the internal margin, and 0.055 ± 0.010 mm-1 for the external margin. The curved geometry of the acromion was plotted on a graph giving a spectrum of curvature patterns with distribution values revealing fixation plates fitness represented by area under the curve with frequencies of 4.32 % for the acromion-specific fixation plate, 14.28 % for the large clavicle fixation plate, 0.26 % for the small clavicle fixation plate, 53.38 % for the flexible universal fixation plate, and none for the rigid universal fixation plate. PRINCIPAL CONCLUSIONS: Approximately 27.76 % of the acromion surface curvatures distribution does not overlap with any of our measured fixation plates. Evaluating the acromion surface curvature was possible on plain X-rays in the Y-view only.

• MeSH
• Acromion * diagnostic imaging   injuries   anatomy & histology   surgery   MeSH
• Fractures, Bone * surgery   diagnostic imaging   MeSH
• Bone Plates * MeSH
• Humans MeSH
• Scapula * diagnostic imaging   anatomy & histology   MeSH
• Radiography MeSH
• Fracture Fixation, Internal * methods   instrumentation   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Mobile health (mHealth) is increasingly being used in contemporary health care provision owing to its portability, accessibility, ability to facilitate communication, improved interprofessional collaboration, and benefits for health outcomes. However, there is limited discourse on patient safety in real-world mHealth implementation, especially as care settings extend beyond traditional center-based technology usage to home-based care. OBJECTIVE: This study aimed to explore health care professionals' perspectives on the safety aspects of mHealth integration in real-world service provision, focusing on Hong Kong Special Administrative Region (SAR) and Wuhan city in mainland China. In Hong Kong SAR, real-world mHealth care provision is largely managed by the Hospital Authority, which has released various mobile apps for home-based care, such as Stoma Care, Hip Fracture, and HA Go. In contrast, mHealth care provision in Wuhan is institutionally directed, with individual hospitals or departments using consultation apps, WeChat mini-programs, and the WeChat Official Accounts Platform (a subapp within the WeChat ecosystem). METHODS: A multicenter qualitative study design was used. A total of 27 participants, including 22 nurses and 5 physicians, from 2 different health care systems were interviewed individually. Thematic analysis was used to analyze the data. RESULTS: The mean age of the participants was 32.19 (SD 3.74) years, and the mean working experience was 8.04 (SD 4.05) years. Most participants were female (20/27, 74%). Nearly half of the participants had a bachelor's degree (13/27, 48%), some had a master's degree (9/27, 33%), and few had a diploma degree (3/27, 11%) or a doctoral degree (2/27, 7%). Four themes emerged from the data analysis. Considering the current uncertainties surrounding mHealth implementation, participants emphasized "liability" concerns when discussing patient safety. They emphasized the need for "change management," which includes appropriate referral processes, adequate resources and funding, informed mHealth usage, and efficient working processes. They cautioned about the risks in providing mHealth information without ensuring understanding, appreciated the current regulations available, and identified additional regulations that should be considered to ensure information security. CONCLUSIONS: As health care systems increasingly adopt mHealth solutions globally to enhance both patient care and operational efficiency, it becomes crucial to understand the implications for patient safety in these new care models. Health care professionals recognized the importance of patient safety in making mHealth usage reliable and sustainable. The promotion of mHealth should be accompanied by the standardization of mHealth services with institutional, health care system, and policy-level support. This includes fostering mHealth acceptance among health care professionals to encourage appropriate referrals, accommodate changes, ensure patient comprehension, and proactively identify and address threats to information security.

• MeSH
• Patient Safety * MeSH
• Adult MeSH
• Qualitative Research MeSH
• Humans MeSH
• Mobile Applications MeSH
• Telemedicine * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• China MeSH
• Hong Kong MeSH

BACKGROUND: Lateral plating of calcaneal fractures using variable-angle locking plates is still the golden standard for severely comminuted cases. The aim of this study is to explore the possibilities of improving stability of osteosynthesis by changing screw directions. It provides an assessment and comparison of cadaveric biomechanical experiment with retrospective radiologic data analysis. METHODS: In the cadaveric study 8 intact calcaneus-talus specimens were obtained from 4 deceased donors. Fracture type 2b according to Sanders' classification was created in each specimen and fixed with variable-angle locking plate. The specimens were divided in 2 groups differing in orientation of anterior screws and fixed in PMMA base. A push-in test was performed by a two-column testing machine until gross failure. Retrospective cohort study was performed, reviewing data of 74 patients which underwent surgical treatment of calcaneal fractures with the same construct. Evaluation was performed at scheduled CT and X-Ray controls. Direction of inserted screws and implant failure were noted. FINDINGS: The cadaveric study proved that there is no significant difference in mean failure force between two abovementioned screw configurations in Sanders 2b fracture. A significant difference was observed in initial stiffness. The radiologic retrospective study showed that difference in screw position within all fracture types but type 2b is significant. INTERPRETATION: Screw configuration in the anterior part of variable-angle locking plate appears to affect primary stiffness and stability of the construct. Particularly in more comminuted fractures, screw inserted in the direction of sustentaculum improves the stability and lowers risk of implant failure.

• MeSH
• Biomechanical Phenomena MeSH
• Adult MeSH
• Fractures, Bone * surgery   diagnostic imaging   physiopathology   MeSH
• Intra-Articular Fractures * surgery   diagnostic imaging   physiopathology   MeSH
• Bone Plates * MeSH
• Bone Screws * MeSH
• Middle Aged MeSH
• Humans MeSH
• Cadaver MeSH
• Calcaneus * surgery   diagnostic imaging   injuries   MeSH
• Radiography MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Fracture Fixation, Internal * methods   instrumentation   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

PURPOSE: The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) have proposed procollagen type I N propeptide (PINP) and β isomerized C-terminal telopeptide of type I collagen (β-CTX-I) as reference bone turnover markers (BTMs) for osteoporosis. This report examines the published literature since the 2011 IOF-IFCC position paper in order to determine the clinical potential of the reference BTMs and newer markers for the prediction of fracture risk and monitoring the treatment of osteoporosis. METHODS: Evidence for the relationship between BTMs and subsequent fractures was gathered from prospective studies through literature review of the Medline database from years 2011 to May 2024. The impact of treatment on BTMs was also studied by examining publications in that period. Studies of the accuracy of BTMs in the assessment of bone turnover in the setting of advanced chronic kidney disease were also examined. RESULTS: Increased BTM concentrations are associated with higher fracture risk in postmenopausal women. PINP and β-CTX-I measured in blood are associated with fracture risk but their interaction with other risk factors has not been sufficiently studied limiting their incorporation into fracture risk algorithms. Treatment-induced changes in PINP and β-CTX-I account for a substantial proportion of fracture risk reduction and are useful for improving adherence; they are recommended for inclusion in studies to examine adherence in individual patients. However, total PINP (tPINP) and β-CTX-I may be elevated in CKD due to renal retention. Bone alkaline phosphatase (BALP), intact PINP (iPINP), and tartrate resistant acid phosphatase 5b (TRACP5b) show the most promise in discriminating high and low turnover bone diseases in patients with advanced CKD and for predicting fracture risk, monitoring treatment response, and assessing the risk of treatment-related complications. CONCLUSION: We re-affirm the use of serum/plasma tPINP and plasma β-CTX-I as reference BTMs with appropriate patient preparation and sample handling and measurement by standardized/harmonized assays in clinical studies to accumulate further data, and for monitoring treatment of osteoporosis in the setting of normal renal function in clinical practice. BALP and TRACP5b, measured by standardized assays, are recommended as reference BTMs for CKD-associated osteoporosis and should be included in observational and intervention studies to ascertain their utility for risk-evaluation, treatment initiation, and assessment of treatment response in CKD-associated osteoporosis.

• MeSH
• Biomarkers blood   MeSH
• Risk Assessment methods   MeSH
• Bone Density Conservation Agents therapeutic use   MeSH
• Collagen Type I blood   MeSH
• Consensus MeSH
• Humans MeSH
• Osteoporotic Fractures prevention & control   etiology   MeSH
• Osteoporosis * diagnosis   physiopathology   drug therapy   blood   therapy   MeSH
• Peptide Fragments blood   MeSH
• Peptides blood   MeSH
• Procollagen blood   MeSH
• Bone Remodeling * physiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Review MeSH