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

Locking Compression Plate (LCP) has the advantageous feature that screws can be locked in the plate leaving an angular stable construct. There is no need to have contact between the plate and the bone to achieve stability resulting from friction of the plate-bone-construct. Therefore the plate does not need to be contoured exactly to the bone and the healing bone's periosteal blood supply is not affected. The LCP is used as a bridging plate to gain relative stability in multi-fragmentary, diaphyseal or metaphyseal fractures. Depending on the fracture, the combination hole can also allow the LCP to achieve absolute stability similar to conventional fixation techniques. Osteoporotic fractures have significant impact on morbidity and mortality. Proximal humeral and distal radius fractures are typical examples. These osteoporotic and often comminuted fractures are ideal settings/indications for LCP utilization in the upper extremity. However, the data quality is due to mostly small study populations not so powerful. Unquestionably there has been a clear and fashionable trend to choose operative treatment for these fractures, because the angular stability allows stable fixation and early functional mobilization.

• MeSH
• fraktury humeru chirurgie   MeSH
• fraktury vřetenní kosti chirurgie   MeSH
• kostní destičky MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury * chirurgie   MeSH
• poranění paže chirurgie   MeSH
• senioři MeSH
• vnitřní fixace fraktury * metody   přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY The frequency of periprosthetic fractures related to total knee arthroplasty is increasing, with a prevalence of 1.3 % on the average and with women being affected more often (4 out of 5 patients). Fractures of the distal femur are common, while tibial fractures are rare. Crucial for treatment is to distinguish fractures of the metaphysis above the femoral component, which remains firmly fixed, from those involving the knee joint replacement and component loosening. Supracondylar periprosthetic fractures are almost always managed surgically, using methods of osteosynthesis with an angle condylar or DCS plate, or a short retrograde- inserted supracondylar intramedullary nail. The recent use of implants such as LCPs with angle-stable screws has offered good prospects. This retrospective study presents our first experience with an LCP for treatment of supracondylar periprosthetic fractures of the knee joint. MATERIAL AND METHODS Between 2005 and 2008, a total of 13 supracondylar periprosthetic knee fractures were treated by the LCP technique. The patient group included 10 women and three men the average age was 67.4 (range, 56-81) years. The fractures were classified using the system proposed by Su et al. and the AO classification system. According to the Su classification, 12 types I and II fractures and one type III fracture were indicated for osteosynthesis. Based on the AO classification, there were four type 33 A1 fractures, five 33 A2 fractures, three 33 A3 fractures and one 33 C2 initially incorrectly classified as type 33 A3 fracture. The average time between total knee arthroplasty and injury was 6.8 years. In all patients fractures occurred after primary implantation of a cemented condylar total knee replacement without a femoral stem.The fractures were treated by a less invasive technique of LCP implantation within an average of 2.5 days of injury. The patients were followed up until radiographic fracture union, and complications were recorded. RESULTS The 13 patients were treated by LCP osteosynthesis through a less invasive approach. One patient had primary spongioplasty, two had spongioplasty after an interval of 7 weeks. One patient died of a disease unrelated to trauma and surgery at 3 months after osteosynthesis. In one patient, osteosynthesis failed with fragment dislocation shortly after the operation. The case analysis showed that the initial indication was marginal and the comminuted zone was too low above the implant, with the fracture line extending to the component. Subsequently, conversion to revision total knee arthroplasty involving a stem was carried out. In nine patients, bone union was achieved in an average of 18 weeks, with radiographic evidence of fracture union. No complications such as wound infection, delayed wound healing or thromboembolic disease were recorded. No bone union failure and pseudoarthrosis development occurred. DISCUSSION There are only few reports on the treatment of supracondylar periprosthetic knee fractures and evaluation of its results in the literature, and the groups evaluated are small. In a meta-analysis of cases from the 1981 to 2006 period, Herrera et al. have found only 29 assessable studies with a total of 415 cases, i.e., an average of 14 cases per study. The usual method of treatment was DCS plate osteosynthesis. Complications associated with conventional osteosynthesis techniques, as reported by various authors, may reach up to 30% (pseudoarthrosis development, 9% osteosynthesis failure, 4% necessity of revision surgery, 13% fracture malunion, 47%). Good results have been achieved with a retrograde-inserted intramedullary nail. The use of an LCP has been reported in the literature only occasionally. The classification system described by Rorabeck et al. is most widely used, but the system proposed by Su et al. seems more convenient to us, because fractures are placed in three groups, according to the localisation of a fracture line and its distance from the femoral component, as follows: type 1 fracture, fracture line is proximal to the femoral component type 2 fracture, fracture line starts at the level of a proximal edge of the femoral component and runs proximally type 3 fracture, fracture line extends below the upper end of the femoral component. Type 1 fracture is indicated for a retrograde- inserted intramedullary nail, type 2 fracture for LCP osteosynthesis, and type 3 fracture for revision total knee arthroplasty. The use of LCPs in the treatment of supracondylar fractures of total knee arthroplasty, with a success rate of 86%, is described by Ricci et al. Other authors also report better outcomes with the use of LISS or LCP methods than with conventional osteosynthesis techniques. CONCLUSIONS Osteosynthesis with an angle-stable LCP is an efficient method suitable also for the treatment of periprosthetic fractures of the distal femur above total knee arthroplasty. It offers all advantages of angle-stable implants. It is more effective for osteoporotic bone than a DCS implant or a condylar plate, because it provides better fixation stability for the distal fragment. However, further studies are needed to compare its efficiency with that of an IM nail.

• MeSH
• fraktury femuru chirurgie   MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• biomechanika přístrojové vybavení   trendy   účinky záření   MeSH
• dlahy využití   MeSH
• lidé MeSH
• ortopedické fixační pomůcky trendy   využití   MeSH
• ortopedické výkony přístrojové vybavení   trendy   MeSH
• vnitřní fixace fraktury klasifikace   přístrojové vybavení   trendy   MeSH
• Check Tag
• lidé MeSH

THE AIM OF THE STUDY: The aim of our study was to assess treatment results of angular deformities in distal radius by a system of the locking compression plates (LCP) at our clinic. METHODS: Our source data was collected prospectively from the records of patients where the locking compression plate was used for angulation correction of distal forearm between 2006 and 2007. The patients were divided by sex, the age range was defined and two groups were formed based on the initial diagnosis: the group of posttraumatic deformities (2 patients; 29 %) and the group of no traumatic deformities (3 patients with congenital shortening of ulna, valgus deformity and overgrowth of radius and 2 patients with exostoses multiplices with shortening of ulna and overgrowth of radius with ulnar angulation). The following parameters were set: radial articular angle and carpal slip prior to and after angulation correction, the healing period, the range of movement of the surrounding joints and occurrence of complications. RESULTS: We recorded only one case of delayed healing which was subsequently sustained by autospongioplastics and adjusted to normal. In the rest of the cases deformity correction occurred and the defined parameters were then corrected to normal. We observed no postoperative complications or permanent consequences. CONCLUSIONS: A two-year follow-up period monitoring treatment and therapeutic results of deformities in the forearm bones at our clinic, confirmed a minimal incidence of complications and a high percentage of successfully treated cases.

• MeSH
• dítě MeSH
• fraktury ulny komplikace   MeSH
• fraktury vřetenní kosti komplikace   MeSH
• hojení fraktur MeSH
• interní fixátory MeSH
• kostní destičky MeSH
• lidé MeSH
• mladiství MeSH
• radius abnormality   chirurgie   MeSH
• ulna abnormality   chirurgie   MeSH
• vrozené deformity končetin chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

To report on the surgical treatment of intra-articular calcaneal fractures by open reduction and internal fixation with a calcaneal locking compression plate (LCP) from an extended lateral approach, and to retrospectively analyze the mid-term results in a group of patients treated by this technique. MATERIAL: In the period from August 2005 till March 2007, a total of 49 patients with 61 calcaneal fractures were treated. Of these, 11 (18 %) were treated conservatively. Reduction combined with Kirschner-wire fixation was used in four fractures (6.6 %). Open reduction with internal calcaneal LCP fixation (ORIF- calcaneal LCP) from an extended lateral approach was carried out to treat 46 fractures (75.4 %) in 38 patients. The group evaluated here comprised 29 patients with 33 calcaneal fractures treated by ORIF-calcaneal LCP at a follow-up longer than 6 months. The fractures were classified on the basis of computer tomography (CT) findings as Sanders types I to IV. The group had two woman (6.9 %) and 27 men (93.1 %) with an average age of 34.2 years (range, 19-55 years). In 11 fractures (33.3 %), the primary treatment included filling a central cancellous bone defect area. Calcium phosphate bone substitute material (resorbable ChronOS) was used in nine cases (27.3 %), a self-solidifying hydroxyapatite implant was injected in two (6.1 %) cases (X3 Wright and Norian SRS, respectively), and a bone allograft was implanted in one case (3 %). METHODS: Indicated for surgery were patients with an intra-articular calcaneal fracture, Sanders type II or type III, with articular surface displacement by more than 1 mm. Contraindications included age over sixty years, poor cooperation, smoking habits, peripheral vascular disease or skin infection. Surgery was performed only after oedema had resolved. The aim of our treatment was to achieve anatomical reconstruction of all articular surfaces, to restore the height, length, width and axis of the heel bone, to carry out primary stable osteosynthesis, and to enable the patient to begin rehabilitation with early mobilization.A passive rehabilitation usually started on the first post-operative day, and full weight-bearing of the extremity was allowed not earlier than 3 months post-operatively. Regular check-ups were at 6 weeks, 3, 6 and 12 months and then every year. The mid-term results were evaluated by the system of Rowe et al., scoring rest pain, possibility of return to preinjury jobs, use of walking aids, restriction of physical activity and limping. RESULTS The most frequent cause of injury was a fall or jump from height; this was recorded in 27 patients (93.1 %). An open fracture was diagnosed on two occasions (6.9 %). Bilateral calcaneal fractures were found in six patients (20.7 %); four (13.8 %) were treated by bilateral ORIF-calcaneal LPC and two (6.9 %) underwent closed reduction on one and Kirschnerwire transfixation on the other extremity. A combined injury to the musculoskeletal system was diagnosed in 11 patients (38 %), in whom four (13.8 %) had a tibial pylon fracture of the contralateral limb and four (13.8 %) had a thoracolumbar spine fracture. The surgical procedure was performed on average within 11.7 days of injury, and the average hospital stay was 18.2 days (range, 6 to 18 days). Early post-operative complications were recorded in six patients (20.7 %). Wound dehiscence was found in two (6.9 %), necrosis of wound edges in two (6.9 %), and early superficial infection responding to antibiotic therapy also in two patients (6.9 %). Deep infection, non-union or post-operative compartment syndrome were not recorded. Excellent Rowe scores were achieved in 10 patients (34.5 %), good in 15 (51.7 %) and satisfactory in two (6.9 %). Only two patients (6.9 %) reported poor outcome. DISCUSSION: The methods of classification and treatment of calcaneal fractures continue to be a frequently discussed topic. The technique of ORIF-calcaneal LCP from an extended lateral approach has recently been preferred for patients with displaced Sanders type II or III calcaneal fractures. In agreement with other literature references, this approach allowed us to observe the fracture, to reduce both the subtalar and calcaneocuboid articulations, to stabilize the fracture by internal fixation and to begin early rehabilitation. Because of the risk of early complications, the timing of surgery and a thorough consideration of indications and contraindications are of principal importance.We agree with other authors that filling calcaneal bone defects is not necessary. Pre- and post-operative CT scans are necessary. In accordance with literature data, fractures developing compartment syndrome are indicated for urgent fasciotomy and ORIF-calcaneal LCP should be postponed. In patients with multiple trauma and also in those with open calcaneal fractures, a temporary stabilization with an external fixator medially is performed first, and then converted to a second-stage, ORIF-LCP procedure. CONCLUSIONS: The surgical treatment of displaced intra-articular fractures that involves open reduction from an extended lateral approach and internal fixation with a calcaneal LCP shows very good preliminary results. A CT examination is required for the diagnosis and classification of fractures and a correct indication for surgery. Good timing is of principal importance. An urgent surgical intervention is necessary in open fractures or in those in which soft tissues are squashed by bone fragments. In the other fractures, surgery is carried out after oedema subsidence. Foot compartment syndrome is a serious complication of calcaneal fractures and urgent fasciotomy is the only adequate therapy. Full weight-bearing of the operated extremity depends on the rate of bone healing; it is usually allowed at 3 months after surgery.

• MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• patní kost chirurgie   radiografie   zranění   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY In a prospective study of patients with calcaneal fractures treated by open reduction from an extensile lateral approach and LCP osteosynthesis, the authors evaluated the basic epidemiological data, mechanism of injury, type of fracture, essen- tial data on surgery, days of hospital stay and the number of complications. MATERIAL AND METHODS In the period from September 1, 2006 to July 31, 2010, a total of 230 patients with 243 calcaneal fractures were trea- ted. The fractures were classified as either open or closed and according to the Essex-Lopresti system. Of the total num- ber of patients, 135 (55.6 % of all fractures) were indicated for conservative treatment and 108 (44.4% of all fractures) for surgical intervention. Indications for surgery based on the generally accepted criteria enabled us to select 77 patients with 82 fractures (33.7 % of all fractures) for treatment by the method of open reduction and LCP osteosynthesis. These pa- tients constituted the group evaluated here. The other patients were treated using other techniques (21 fractures, i.e., 8.6 % of all fractures, by the Stehlík-Štulík transfixation method and further five [2.1 %] by screw osteosynthesis). Six surgeons were involved in the treatment of this group. For the diagnosis of fractures, plain radiographs in lateral and axial projection and axial and coronal CT images were used. All fractures were treated after subsidence of oedema by the method of open reduction and LCP fixation from an extensile lateral approach, with the use of a tourniquet. The follow-up period for the evaluation of functional outcome and bone union was 3 to 48 months. Fifty patients were followed up for over one year. RESULTS The group evaluated comprised 58 men (75.3 %) with 63 fractures (76.8 %) and 19 women (24.7 %) with 19 fractures (23.2 %). The average age of the group was 42 years, with 41 years (range, 22-61 years) in men and 47 years (range, 30-70 years) in women. The most frequent cause of injury was a fall from a height below 1 metre and this was recorded in 38 patients (49.4 %); 18 patients (24.3 %) had a fall from a height below 3 metres. Eight fractures were caused by a fall from the window, seven calcaneal fractures, as part of .polytrauma, were sustained in road accidents (9.1 %) and six calcaneal bones were inju- red due to ankle sprain in walking on a flat surface (7.8 %). Bilateral fractures occurred in five (6.5 %) patients, the right and left heel bones were injured in 31 (40.3 %) and 41 (53.2 %) fracture cases, respectively. An open fracture was recorded on three occasions (3.7 %). Of the 82 evaluated fractures, 23 were type IIa fractures (28 %) and 59 were type IIb fractures (72 %) according to the Essex-Lopresti classification system. The average injury-surgery interval was 10 days (range, 1 - 23 days). The average operative time was 77 minutes (ran- ge, 45-175 min) and the average duration of tourniquet application was 61 minutes (range, 20-130 min). The average length of hospital stay was 18 days (range, 7-61 days). In 15 patients (18.3 % of osteosynthesis cases) wound healing was delayed. Deep wound infection developed in three cases (3.7 %); these required revision surgery which involved implant removal before bone union in two cases and hea- ling of the wound after revision without implant removal in one case. A necrotic lesion in one case (1.2 %) was treated by muscle flap transfer. Complications which varied in type and severity were recorded in 22 % of the patients. The Rowe score was used to evaluate functional outcomes, which were excellent in 44 %, good in 46 %, satisfactory in 4 % and poor in 6 % of the surgically treated patients.. DISCUSSION Only about one-third of the patients with calcaneal fractures were indicated for open LCP osteosynthesis. This is in agre- ement with the strict indication criteria established by the foreign authors with Professors Zwipp and Sanders at the head. It appears that this fracture chiefly occurs in the population of young active men (Kočiš reported only men and no woman with this fracture in his study). The authors focus on exact radiographic diagnosis including CT examination, as recom- mended by Stehlík and Štulík in their book. They recommend to use the Essex-Lopresti system for primary classification and, because of the frequency of LCP osteosynthesis procedures performed, also recommend to carry out this treatment in specialised institutions. The rate of serious complications in this study was relatively low and in accordance with the fin- dings of Zwipp, Zeman and others. CONCLUSIONS The analysis of basic data on the group of patients with calcaneal fractures treated by open reduction and LCP fixation showed the following: chiefly young active men sustained this fracture; calcaneal fracture was usually due to a fall or jump from a level not too high; X-ray examination (lateral and axial projection) was sufficient to make a diagnosis; for a deci sion to operate it was useful to complete the diagnosis by CT examination; the prerequisite for minimising post-operative com- plications was strict adherence to the established indication criteria, surgery only after oedema had subsided and use of the correct surgical technique. The number of complications and their nature did not differ from the data reported by other authors. Key words: calcaneal fracture, LCP, open reduction, epidemiology, demography.

• MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• interní fixátory MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• patní kost chirurgie   zranění   MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Background. The aim of the experiment was to compare the mechanical properties of intact spinal segment with impaired intervertebral disc and impaired intervertebral disc fixed by TSLP (Thoracolumbar Spine Locking Plate). Methods and results. Spinal specimens were taken from domestic swine. A total of 8 test mechanical states (intact, impaired and fixed) were modeled and the mechanical properties, expressed by the value of moment of couple necessary to twist the specimen at tensile force F = 200 N and the value of moments necessary for extension straining, were determined. The study was based on in vitro biomechanical testing of the TSLP plate used to stabilize the front thoracolumbar column of spinal segments taken from a pig. The plate was used for monosegmental fixation. The disc was cut by scalpel to simulate the Type A injury to front spinal column. In each state (intact, impaired or fixed), specimens were subjected to a tension load of prescribed force and, then, twisted by a given angle. Subsequently, extension load of intact, impaired and impaired & fixed segment was measured. Statistical evaluation verified the hypothesis of the different behavior of intact, impaired and fixed specimens – both for tension & torsion load and extension load. The analyses did not indicate different mechanical behavior of intact and fixed specimens. In other words, monosegmental fixation of both impaired and intact specimens by TSLP Synthes implant will lead to similar mechanical behavior of these specimens. Further, we found that intact and fixed specimens show non-symmetric behavior at positive and negative twisting angles. This was not observed for impaired specimens. Conclusion. Several stabilization systems were developed to stabilize the front thoracolumbar spinal column. Surgery of the anterior column of injured spine should restore the correct position of the spine, ensure decompression of vertebral canal when neural structures are compressed, and stabilize the spine to allow immediate loading and mobilization of the patient. The aim of this study was to compare mechanical properties of intact spinal segment, impaired spinal segment and impaired spinal segment stabilized by TSLP Synthes implant. The problems were solved by experimental modeling using a testing machine that simulated loads for several mechanical states of the spinal segment. Favorable mechanical properties of TSLP Synthes fixator were demonstrated. The experimental results will be used for subsequent computational modeling of the spinal segment in all experimentally solved states.

• MeSH
• bederní obratle chirurgie   MeSH
• biomechanika MeSH
• financování organizované MeSH
• hrudní obratle MeSH
• kostní destičky MeSH
• meziobratlová ploténka MeSH
• nemoci páteře chirurgie   patofyziologie   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• srovnávací studie MeSH

PURPOSE OF THE STUDY In a retrospective study we evaluated the results of plate osteosynthesis for treatment of periprosthetic femoral fractures classified as Vancouver types B1 and B2. MATERIAL AND METHODS The group comprised 19 patients with post-operative periprosthetic fractures treated by open reduction and internal fixation with plate osteosynthesis at our department between the beginning of 2004 and June 2007. Perioperative fractures were not included. The average age of the patients was 72.0 (range, 53 to 88) years. A locking compression plate (PCL) was used in 16 patients. The average follow-up was 21 months, with 6 months at least. We evaluated radiographs of the fracture and, in the majority of cases, also those before a periprosthetic fracture occurred. We focussed on the signs of potential femoral component loosening and the course of fracture line; fractures were classified according to the Vancouver classification system. Follow-up included both clinical and radiographic examination. RESULTS Thirteen patients showed bone union and a good functional outcome. One patient was present at follow-up only once and was not included in the final evaluation. Non-union was recorded in five patients (27.7 %), marked implant migration occurred in three (all had type B2 fracture) and osteosynthesis failed in two patients. DISCUSSION We consider the Vancouver classification to be the most suitable classification system. The relatively high proportion of non-union fractures can be accounted for by an inappropriate indication for osteosynthesis in fractures with stem loosening.The assessment of stem stability based on a radiograph only may, in some cases, be questionable;therefore, if doubtful, we prefer an intra-operative evaluation of implant stability. We also discuss a contribution of angle-stable plates to the osteosynthesis of periprosthetic fractures as well as their bone fixation technique. CONCLUSIONS Plate osteosynthesis is a suitable method for treatment of periprosthetic fractures if there is a stable femoral component. LPC implants are not discriminative enough in the range of indications for plate osteosynthesis.The use of plate osteosynthesis in a total hip arthroplasty with signs of loosening is bound to lead to acceleration of loosening and stem migration, and may even result in plate breakage or its expulsion. This implies that, in such THAs, plate osteosynthesis can only be carried out as a palliative procedure in immobile and severely ill old patients.

• MeSH
• fraktury femuru MeSH
• fraktury kostí MeSH
• fraktury kyčle chirurgie   MeSH
• hojení fraktur MeSH
• kostní destičky MeSH
• kyčelní protézy škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu metody   škodlivé účinky   MeSH
• následné studie MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• selhání protézy MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• hodnotící studie MeSH

Locking compression plate (LCP) systems are beneficial for treating proximal tibial fractures as they combine the benefits of external and internal fixators, providing greater stability, vascular preservation, superior healing, and fewer complications. However, the translation of these properties to functional benefits for patients remains to be elucidated. Aims: To evaluate the clinical outcomes of tibial plateau fractures (TPFs) treated by LCP and by a combination of posterior and anterior lateral approaches. Methods: This prospective study enrolled 34 patients aged > 18 years, from both genders, with TPFs (Schatzker type 4, 5, 6.) Patients were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) by LCP. They were followed up at 6 weeks, 3 months and 6 months postoperatively. Treatment results were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results were statistically analyzed using chi-square test and Wilcoxon signed rank test. p ≤ 0.05 indicated statistical significance. Results: With a mean age of 39.29 ± 8.85 years and M:F of 33:1, most patients showed Schatzkers type VI fractures (82.35 %). Anterolateral approach was most used (73.53 %). Most patients achieved good results (44.12 %), showing healing within 14–20 weeks. No association was found between age-group and Schatzkers type (p > 0.05). A significant post-operative reduction in WOMAC scores was noted for total as well as component (pain, stiffness, functional limitation) scores (p < 0.001). Conclusion: LCP is associated with significant improvements in patient’s experience of pain, stiffness and functional limitations.

• Klíčová slova
• locking compression plate, zamykací dlaha,
• MeSH
• dospělí MeSH
• fraktury tibie * chirurgie   diagnostické zobrazování   klasifikace   MeSH
• interní fixátory MeSH
• kostní destičky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• ortopedické výkony * metody   MeSH
• osteoartróza chirurgie   diagnostické zobrazování   MeSH
• prospektivní studie MeSH
• statistika jako téma MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Indie MeSH