PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.
PURPOSE: Treatment of pelvic fractures is often complicated. Here, we intended to evaluate the intraoperative benefits of using 2D computer navigation when compared with traditional fluoroscopy on X-ray burden, surgical time and screw placement accuracy. METHODS: In this study, we retrospectively evaluated the records of 25 patients who underwent osteosynthesis of a posterior pelvic fracture using fluoroscopy at the University Hospital Ostrava, Czech Republic between 2011 and 2019, and 32 patients from the same department and period in whom 2D computer navigation was used. RESULTS: Intraoperative X-ray burden was significantly lower in the group with 2D computer navigation (median 650 vs 1024 cGy/cm2), as was the duration of the surgery (41 vs 45 min). This was most obvious where two screws were inserted (X-ray dose of 994 vs 1847 cGy/cm2 and 48 vs 70 min, respectively). Correction of the path for wire placement after the original drilling was necessary in 2 patients (6%) from the 2D computer navigation group and 15 patients from the fluoroscopy group (60%). Still, no malposition of the screws nor dislocation of the posterior pelvic segment after 12 months was observed in any patient of either group; of complications, only three superficial infections in the 2D navigation group and 2 in the fluoroscopy group were observed. CONCLUSION: 2D computer navigation is a safe and accurate method for placement of screws during posterior pelvic fracture osteosynthesis, associated with lower intraoperative radiation burden and shorter surgical times compared to standard fluoroscopy, especially if two screws are inserted.
- MeSH
- chirurgie s pomocí počítače * metody MeSH
- fluoroskopie metody MeSH
- fraktury kostí * diagnostické zobrazování chirurgie MeSH
- kostní šrouby MeSH
- lidé MeSH
- počítače MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury metody MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Persistent catabolism is one of the main causes of delayed healing in polytrauma patients. The purpose of this study is to verify the effect of early administration of an anabolic steroid in combination with vitamin D on the process of bone healing in polytrauma patients. MATERIAL AND METHODS In this prospective study, the patients with a serious trauma were divided into two groups (a control group and a treatment group), with the treatment group being treated with nandrolone decanoate, an anabolic steroid in combination with vitamin D. In all the patients, bone metabolism markers and sex hormone levels (men only) were monitored through lab testing for the period of 70 days and the results of both the groups were subsequently compared. RESULTS The study included a total of 64 patients, 32 in the control group and 32 in the treatment group. The differences between the groups in gender (p = 0.387) as well as in the age of patients (p = 0.436) were statistically non-significant. There was a significant difference in the Injury Severity Score (48 in the treatment group as against 41 in the control group, p = 0.022). Even though this difference was statistically significant, it cannot be considered clinically significant since all the patients met the major trauma criteria. No positive effect of this treatment on bone metabolism parameters was established; on the very contrary, the only statistically significant changes were observed in the control group. To be specific, in levels of one of the bone formation markers, bone alkaline phosphatase on Day 7 after the injury (an increased level in the control group; p = 0.002) and in one of the bone resorption markers (bone acid phosphatase) on Day 70 after the injury (an increased level in the treatment group; p = 0.042). In the treatment group, 70 days after the injury a higher 25(OH)vitamin D level (p < 0.001) was reported and starting from Day 7 in men in the treatment group a significantly lower testosterone level and free testosterone level were observed. The level of androgenic hormones dramatically dropped in both the groups during the first days after the trauma, the dynamics of its normalization was faster in patients in the control group than in the treatment group. DISCUSSION The administration of nandrolone decanoate, an anabolic steroid, in combination with vitamin D did not produce the expected effect, i.e. an improvement in bone healing markers in polytrauma patients. One would expect that in polytrauma patients with a bone fracture or fractures during bone healing higher levels of all the markers of bone resorption as well as bone formation will persist. Similar increases in bone metabolism levels, however, were observed also in patients with injuries in other somatic regions. This indicates the importance of bone tissue involvement in the overall response of the organism to polytrauma. A faster normalization of the levels of testosterone, dihydrotestosterone and free testosterone in the control group compared to the treatment group corresponds with the supplemental effect of anabolic steroids and reduced production of these hormones as a feedback to hypothalamic-pituitary-adrenal axis. CONCLUSIONS In the follow-up period, the positive effect of anabolic steroid and vitamin D administration on bone metabolism in polytrauma patients was not confirmed. Key words: polytrauma, anabolic steroids, vitamin D, bone metabolism.
- MeSH
- anabolika * škodlivé účinky MeSH
- lidé MeSH
- nandrolon dekanoát MeSH
- polytrauma * farmakoterapie MeSH
- prospektivní studie MeSH
- systém hypofýza - nadledviny MeSH
- systém hypotalamus-hypofýza MeSH
- vitamin D MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky kontrolované MeSH
ÚVOD: U zlomenin zadní části pánve a dysjunkcí sakroiliakálního kloubu jsou používány iliosakrální šrouby, které transfixují sakrální výběžek kosti kyčelní s křížovou kostí v oblasti segmentu S1 případně S2. Správné umístění těchto šroubů v křížové kosti je důležité proto, aby nedošlo k poranění sakrálních nervových pletení nebo poranění měkkých tkání ventrálně a dorzálně od křížové kosti. 3D navigace poskytuje možnost přesnější kontroly vrtání a zavádění šroubů. Pracuje na podkladě 3D skenu pořízeným přímo na operačním sále C ramenem s možností 3D skenování. Cílem práce je zjištění operačních časů, dávky peroperačního rentgenového záření a také výskyt pooperačních komplikací při zavádění iliosakrálních šroubů do zadního segmentu pánve pod kontrolou 3D navigace. MATERIÁL A METODA: V letech 2014–2020 jsme na Klinice úrazové chirurgie provedli 13 osteosyntéz zadního segmentu pánve pomocí iliosakrálních šroubů pod kontrolou 3D navigace. Osteosyntézu jsme provedli pomocí jednoho nebo dvou kanylovaných šroubů o průměru 7,0 mm. Během operací byly použity skiaskopický přístroj Ziehm Flat panel 3D a počítačová navigace Vector Vision. U jednotlivých operací jsme sledovali operační čas v minutách, dávku peroperačního RTG záření v cGY na cm2 a také čas peroperační skiaskopie v sekundách. Pooperačně jsme provedli RTG kontroly umístění iliosakrálních šroubů ve čtyřech projekcích, při nejasnostech jsme upřesnili pozici šroubů CT vyšetřením. Sledovali jsme výskyt pooperačních komplikací do 90 dnů po operaci. Po roce od operace jsme provedli kontrolní RTG pánve ve čtyřech projekcích s cílem zjištění případné migrace osteosyntetického materiálu nebo dislokace zadního segmentu pánve po osteosyntéze. VÝSLEDKY: V souboru 13 pacientů bylo osm mužů a pět žen. Všechny zlomeniny byly typ C Dle AO-OTA klasifikace. U osmi pacientů (74 %) byla provedena osteosyntéza jedním šroubem a u pěti pacientů (26 %) dvěma šrouby. Medián věku všech pacientů v souboru byl 51 let (rozpětí: 33–73 let). Medián hmotnosti všech pacientů v souboru byl 83 kg (rozpětí: 65–107 kg). Medián času peroperačního RTG záření všech pacientů byl 1,14 min (rozpětí: 0,50–2,35 min). Medián dávky RTG záření byl 853 cGy/cm2 (rozpětí: 591–1369 cGy/cm2). Medián celkové doby operace byl 42 minut (rozpětí: 28–62 min). ZÁVĚR: Osteosyntéza zadního segmentu pánve pomocí 3D navigace je přesnější než skiaskopická kontrola této operace a také 2D navigace protože umožňuje sledování vrtání v jednotlivých řezech sakrální kosti. Je možné posoudit intraoseální pozici během celého vrtání kanálu pro iliosakrální šroub. Na malém souboru pacientů jsme nepozorovali pooperační komplikace ve smyslu poranění nervově-cévních struktur a také malpozici šroubů.
- Klíčová slova
- Vector Vision,
- MeSH
- chirurgie s pomocí počítače metody MeSH
- kostní šrouby MeSH
- lidé MeSH
- sakroiliakální kloub chirurgie zranění MeSH
- sakrokokcygeální krajina chirurgie zranění MeSH
- vnitřní fixace fraktury * metody MeSH
- výsledek terapie MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
INTRODUCTION: For fractures of the posterior part of the pelvis and disjunction of the sacroiliac joint, iliosacral screws are used, which transfix the sacral process of the hip bone with the sacrum in the region of the S1 or S2 segment. The correct placement of these screws in the sacrum is important in order to avoid injury to the sacral nerve fibres or soft tissue injury ventrally and dorsally to the sacrum. 3D navigation provides the possibility of more precise control of drilling and screw insertion. It works on the basis of a 3D scan taken directly in the operating room using a C-arm with the possibility of 3D scanning. The aim of the work is to determine the operating times, the dose of intraoperative X-ray radiation and also the occurrence of postoperative complications during the introduction of iliosacral screws into the posterior segment of the pelvis under the control of 3D navigation. MATERIAL AND METHODS: In the years 2014–2020, we performed 13 osteosyntheses of the posterior segment of the pelvis using iliosacral screws under the control of 3D navigation at the Department of Surgery and Trauma and Emergency Surgery. We performed osteosynthesis using one or two cannulated screws with a diameter of 7.0 mm. The Ziehm Flat panel 3D fluoroscopy device and Vector Vision computer navigation were used during the surgery. For individual surgeries, we monitored the operating time in minutes, the dose of intraoperative X-ray radiation in cGY per cm2, as well as the time of intraoperative fluoroscopy in seconds. Postoperatively, we performed an X-ray check of the location of the iliosacral screws in four projections, in case of uncertainty, we clarified the position of the screws by CT examination. We monitored the incidence of postoperative complications within 90 days after surgery. One year after the surgery, we performed a control X-ray of the pelvis in four projections with the aim of detecting possible migration of osteosynthetic material or dislocation of the posterior segment of the pelvis after osteosynthesis. RESULTS: The group of 13 patients consisted of eight men and five women. All fractures were type C according to the AO-OTA classification. Eight patients (74 %) underwent osteosynthesis with one screw and five patients (26 %) with two screws. The median age of all patients in the cohort is 51 years (range: 33–73 years). The median weight of all patients in the cohort is 83 kg (range: 65–107 kg). The median intraoperative X-ray time of all patients is 1.14 min (range: 0.50–2.35 min). The median X-ray radiation dose is 853 cGy/cm2 (range: 591–1369 cGy/cm2). The median total operative time is 42 minutes (range: 28–62 min). CONCLUSION: Osteosynthesis of the posterior segment of the pelvis using 3D navigation is more accurate than fluoroscopic control of this surgical procedure and also 2D navigation because it allows drilling to be monitored in individual sections of the sacral bone. It is possible to assess the intraosseous position throughout the drilling of the channel for the iliosacral screw. In a small group of patients, we did not observe post-operative complications in the sense of injury to neurovascular structures and also malposition of screws.
- Klíčová slova
- Vector Vision,
- MeSH
- chirurgie s pomocí počítače metody MeSH
- kostní šrouby MeSH
- lidé MeSH
- sakroiliakální kloub chirurgie zranění MeSH
- sakrokokcygeální krajina chirurgie zranění MeSH
- vnitřní fixace fraktury * metody MeSH
- výsledek terapie MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY Fractures of the scapula are less frequent, with the incidence reported in literature of approximately 1% of all fractures and 3-5% fractures of shoulder. These fractures are predominantly treated non-operatively. Osteosynthesis is indicated in displaced intra-articular fractures and severely displaced extra-articular fractures of the scapular body, its lateral border in particular. Apart from open reposition and osteosynthesis, also minimally invasive osteosynthesis under fluoroscopic and arthroscopic control has recently been used to treat intra-articular fractures of the scapula. The arthroscopy facilitates debridement of the fracture line in the intra-articular region and control over the insertion of the osteosynthesis material in the subchondral bone of the glenoid and it also makes visible the accuracy of reduction of fractures of the glenoid articular surface. MATERIAL AND METHODS In 2013-2017, osteosyntheses of 9 intra-articular fractures of the scapula were performed with the use of both perioperative fluoroscopy and arthroscopy. The group included 7 men and 2 women, with the mean age of 37 years (range 24-52 years). 4.5 mm cannulated screws inserted in the subchondral bone either from the cranial or dorso-caudal part of the glenoid in dependence on the type of the fracture were used as osteosynthesis material. Postoperatively, the extremity was fixed by Desault type shoulder brace for 4 weeks. Rehabilitation using standard procedures for shoulder joint followed. The patients were followed up at regular intervals, namely on 10th day, at 4 weeks, 3, 6, 12 and 24 months postoperatively. The clinical outcomes and radiologic signs of healing were evaluated continuously and two years after the surgery the clinical outcomes were assessed using the Constant score. Arm elevation was assessed separately, as a dominant indicator of shoulder joint function. RESULTS No perioperative complications were reported, the operative times ranged from 45 to 120 minutes. Reduction was always performed in fractures with intra-articular displacement of less than 2 mm, which was measured both arthroscopically and on perioperative and postoperative radiographs. No complications of wound healing were observed. One patient experienced temporary paresthesia in the innervation zone of the sensitive branch of the radial nerve. The mean healing time of fractures was 121 days (range 107-146 days). The mean Constant score at two years after surgery was 83 points (range 78-87 points), the resulting restriction of elevation was 12° on average (range 0-23°). DISCUSSION There are not many papers covering a similar topic in world literature, most of them present the benefits of arthroscopy in some types of osteosyntheses of intra-articular fractures of the scapula. Most frequently mentioned are osteosyntheses of the anterior portion of the glenoid in case of a bony Bankart lesion. These papers highlight the benefits of minimal invasiveness of this procedure. CONCLUSIONS By visualising the fracture line, the arthroscopy facilitates a more accurate reduction of fragments and a minimally invasive osteosynthesis of some intra-articular fractures of the scapula when compared to closed reduction with fluoroscopic intraoperative control only. The use of arthroscopy in these interventions is conditional on perfect mastering of the surgical technique and also the use of special instruments both for arthroscopy and minimally invasive osteosynthesis. If these criteria are observed and the surgical technique mastered, the authors consider this method beneficial in treating the glenoid fractures. Key words: minimally invasive osteosynthesis, glenoid fractures.
- MeSH
- artroskopie MeSH
- dospělí MeSH
- fraktury proximálního humeru * MeSH
- intraartikulární fraktury * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka diagnostické zobrazování chirurgie MeSH
- mladý dospělý MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Práce je zaměřená na měření kvality života pacientů po polytraumatu, které zanechává ve velkém měřítku trvalé následky. Vlivem zavádění nových léčebných metod dochází k vysokému procentu přeživších tohoto zranění. Následky pak mohou zraněným přinášet problémy v sociální interakci s prostředím. Cíl: Zjistit subjektivní výši kvality života, zda má výše kvality života souvislost s ISS (Injury Severity Score), zda souvisí subjektivní kvalita života a spokojenost se zdravím s uplynulou dobou po těžkém úrazu a jaké má zraněný předpoklady uplatnit se na trhu práce. Metoda: Nemocniční informační systém a statistické vyhodnocení dotazníků respondentů. Respondenti byli pacienti léčení na Klinice úrazové chirurgie Fakultní nemocnice Ostrava. K měření jsme použili dotazník WHOQOL-BREF (WHO, 2008) a porovnali s populační normou subjektivní kvality života podle Dragomirecké et al. (2006). Metoda: Statisticky bylo zhodnoceno 49 dotazníků, u kterých respondenti hodnotili ve třech doménách svoji kvalitu života výše, než uvádí interval populační normy. Doménu Sociální vztahy hodnotili všichni respondenti jako velmi špatnou. Taktéž odpovědi na kvalitu života a spokojenost se zdravím byly pod průměrem populační normy. Závěr: Subjektivní kvalita života pacientů po polytraumatu jistě stojí v popředí pozornosti sociální práce, a to zejména vzhledem k trvalým následkům, a tím o možnost uplatnění se na trhu práce. Velký rozptyl dat v našem souboru a různé metody měření uváděné v literatuře nás dovedly k závěru, že průkaznější způsob měření bude cesta kvalitativními metodami, společně s pacientem od doby úrazu, léčení, rehabilitaci až po resocializaci.
Introduction: The aim of the presented work was to measure the quality of life of patients after polytrauma, which is associated with significant permanent consequences for the patient. Introduction of new treatment techniques results in a high percentage of these patients surviving this type of injury. Permanent consequences may cause problems for the injured, especially in social interaction with their environment. Aim: To determine the subjective of quality of life and to determine whether the quality of life is associated with the ISS score (Injury Severity Score), whether the subjective quality of life and satisfaction with medical condition are associated in any way with the period of time which has elapsed from the serious injury, and what are the prerequisites for successful reintegration of these patients onto the labour market. Method: The authors performed a literature review using the PubMed online database, hospital information system, and statistical evaluation of questionnaires from the responders. The group of responders consisted of patients treated at our department. In order to perform the measurements, the authors used the WHOQOL-BREF (WHO, 2008) questionnaire, and compared the obtained results with the population standard of subjective quality of life reported by Dragomirecká et al. (2006). Results: A total of 49 questionnaires were statistically evaluated; the responders evaluated their quality of life to be higher than the interval of population standard in three domains. The domain of Social Relations was evaluated as very bad in all responders. Also the responses to questions concerning the quality of life and satisfaction with medical condition were below the average value of the population standard. The quality of life was not related to the ISS score of the trauma in any way. The period, which has elapsed from the injury, influences the subjective quality of life of the individual, and the satisfaction with medical condition. Conclusion:The subjective quality of life of patients after polytrauma certainly is in the foreground of attention of social work, especially due to the permanent consequences, limiting the patient’s abilities to find application at the labour market. The broad distribution of data in our dataset and various measurement techniques presented in the literature lead the authors to the conclusion that more conclusive means of measurement will include qualitative techniques, working together with the patient, ever since the injury, over the treatment period, physiotherapy, up to social reintegration.
- Klíčová slova
- Injury Severity Score (ISS),
- MeSH
- kvalita života * MeSH
- lidé MeSH
- polytrauma * MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- biomechanika MeSH
- externí fixátory MeSH
- fixace fraktur * metody MeSH
- fraktury kostí chirurgie MeSH
- Ilizarovova technika klasifikace normy přístrojové vybavení MeSH
- klinické laboratoře MeSH
- lidé MeSH
- otevřené fraktury chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- fixace fraktur MeSH
- fraktury kostí * chirurgie MeSH
- Ilizarovova technika MeSH
- klinické laboratoře MeSH
- lidé MeSH
- otevřené fraktury chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
