PURPOSE OF THE STUDY Exploring the therapeutic potential of pathological fractures treatment of the proximal femur in childhood with LCP paediatric hip plate system according to the principles of AO. MATERIAL AND METHODS Six children with pathological fractures of the proximal femur and with an unicameral bone cyst have undergone surgery in our institution, in the period between June 2018 up until December 2020. All patients were young boys with a mean age of 11.83 ± 3.43 years. According to the classification of Delbet-Colonna, three of the fractures were Type IV - intertrochanteric fractures and three were Type III - basocervical fractures. ccording to the AO Trauma classification, one of the fractures was complete transtrochanteric multifragmentary (31-M/3.2.III), two were complete transtrochanteric simple (31-M/3.1.III), one was Complete basocervical multifragmentary (31-M/3.2.II) and two were complete basicervical simple (31-M/3.1.II). All patients have undergone open reposition and osteosynthesis with a 130° LCP pediatric hip plate system (DePuy Synthes Pediatric LCP Plate System). In four of the patients, one or two of the proximal locking screws pass through the growth plate, to ensure more stability. The anatomical correction of the proximal femur has been measured through the cervico-diaphyseal angle, consolidation of the fracture, the spontaneous reparation of the cyst according to the Capanna classification and cystic index, presence of avascular necrosis of the epiphysis, shortening of the extremity, and functional grading by the Musculoskeletal Tumor Society (MSTS) staging system. The Mann-Whitney (Wilcoxon W) test was used for data processing. RESULTS The mean timing of the follow-up after the surgery was 22 months (range 6-32). A radiographically supported consolidation of the fracture has occurred at an average timing of 4.8 months (range 3-6) in all patients. There is no clinical or radiological evidence of postoperative avascular necrosis in any of the patients. According to the classification of Capanna, in five of the six patients a spontaneous reparation of the cyst has occurred. In one of the cases, the reparation is classified as grade II with a pathological cystic index of 2.27. A postoperative correction of the varus fracture deformity of the proximal femur has been achieved in all children. The cervical-diaphysary angle of 112.50° preoperatively has been corrected to 137.17° (p=0.002). The achieved correction is lasting and the average value of the CDS at the final follow-up is 138.17° (p=0.794). Intraoperative correction, statistically equal to the CDA of the healthy side (p=0.942) is achieved with this operative technique. Data from the MSTS show functional correction on the third postoperative month with 38.33% of the norm (p=0.002) and 85% on the final follow-up (p=0.002). A contralateral distal femoral surgical epiphysiodesis by the method of Métaizeau has been used for the correction of the difference in the length of the extremities (with an average of 2.9 cm). CONCLUSIONS Osteosynthesis with an LCP paediatric hip plate system gives the opportunity for anatomical correction of the proximal femur with a low risk of avascular necrosis and achieving optimal functional results in pathological basocervical and intertrochanteric fractures in childhood. The use of 5mm plates and penetration of the proximal screw through the growth plate holds an increased risk of growth disruption. Key words: LCP paediatric hip plate system, pathological fracture, unicameral bone cysts, proximal femur.

• MeSH
• dítě MeSH
• femur chirurgie   MeSH
• fraktury kyčle * etiologie   chirurgie   MeSH
• fraktury spontánní * etiologie   MeSH
• kostní destičky MeSH
• lidé MeSH
• mladiství MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Osteoporotic hip fractures commonly associated with comorbid diseases and use of multiple drugs. Polypharmacy status and the comorbidity-polypharmacy score (CPS) are the most common two grading system to predict mortality risk for the trauma patients older than 45 years. The purpose of the study was to determine whether the CPS or polypharmacy can predict the mortality risk in the older patients had a surgery due to an osteoporotic hip fracture. MATERIAL AND METHODS Consecutive patients aged > 65 years had an osteoporotic hip fracture due to a simple trauma were enrolled in the study. Detailed data were collected included comorbid conditions, medications, T-scores and additional fractures. Patients were divided into four groups according to CPS classification and polypharmacy status was indicated in case of using five or more drugs before admission. Overall mortality was assessed using Kaplan-Meier survival testing. Factors influencing 1-year, 2-year and 5-year mortality were evaluated using a multivariate logistic regression model with adjusted odds ratios (AORs) and a threshold significance at p < 0.05. RESULTS A total of 109 patients (65% women) with a mean age 80 ± 8.06 were included in the study. The mean time to death from the surgery was 42.06 ± 34.9 months. The Kaplan-Meier survival curves showed a significant difference in mortality among CPS groups. (Log-Rank test < 0.001). CPS presented a significant prediction in 1-year (AOR: 4.2; p < 0.05) and 2-year mortality (AOR: 2.9; p < 0.05) after adjustment for several covariates (including age, gender, surgical procedure) whereas 5-year mortality did not reveal a significant prediction (p = 0.46) Polypharmacy existence did not independently predict both overall or year-based mortality (p > 0.05) . CONCLUSIONS CPS is a better predictor for mortality risk than polypharmacy existence in the first two years in the patients underwent surgery for an osteoporotic hip fracture. Key words:osteoporotic hip fracture, mortality, polypharmacy, comorbidity.

• MeSH
• fraktury kyčle epidemiologie   etiologie   mortalita   MeSH
• komorbidita MeSH
• lidé MeSH
• osteoporotické fraktury epidemiologie   etiologie   mortalita   MeSH
• polypharmacy * MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ukazatele zdravotního stavu MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The pilot study deals with the current situation in proximal femoral fractures in culturally diverse regions, namely in Afghanistan (AFG) and in the Czech Republic (CZ). The study aimed to find out whether there are any differences in proximal femoral fractures in dependence on the selected criteria between the two culturally diverse areas. The study used the data of patients who underwent surgery for proximal femoral fracture at the Department of Orthopaedics of the 1 s t Medical Faculty of the Charles University and the Military University Hospital and at the Military Base Hospital Kabul. MATERIAL AND METHODS The study included patients aged 21 years or older who sustained a proximal femoral fracture in the period from October 2013 to February 2014. For the period concerned, the evaluation comprised 44 patients with a proximal femoral fracture from the Military Base Hospital Kabul, of whom 25 women and 19 men, and a total of 71 patients with a proximal femoral fracture from the Department of Orthopaedics of the 1st Medical Faculty of the Charles University and the Military University Hospital, of whom 43 women and 28 men. Based on the medical documentation, the following evaluation parameters were selected: age, sex, type of fracture. The data was processed using descriptive statistics, one-way and multifactorial analysis (ANOVA) and the POST-HOC test (Fisher LSD test, confidence interval = 95%) RESULTS The mean age of all the patients who suffered a fracture of proximal femur in AFG (58 years) was considerably lower (p < 0.001) than in patients in CZ (81 years). Similarly, a significant difference (p <0.001) was identified in the age of men and women treated for a proximal femoral fracture in both the countries. In AFG there was a statistically significant difference (p = 0.002) between the age of men and women, where women sustaining fractures were younger (54 years) compared to men (63 years). In CZ no significant age difference was reported (83 years vs 78 years). In AFG, the observed fractures occurred generally in their 6th and 7th decade, whereas in CZ only in their 9th decade. The incidence of proximal femoral fractures in Afghan women is the highest in their 5th and 6th decade. Pertrochanteric fractures and intracapsular fractures prevailed in both countries. The lowest age in both types of the fracture was reported in Afghan women (52 years in femoral neck fracture, p <0.001, 54 years in trochanteric fracture, p = 0.039). DISCUSSION Significant differences between the patients in AFG and CZ concern several factors. Afghanistan is a country with the lowest average life expectancy. In the Afghan population a major Vitamin D deficiency was confirmed. This is related to the conservative dress code, especially in women, when the Vitamin D synthesis is suppressed. That can cause the occurrence of osteoporosis in women at a considerably younger age than in the population in the Czech Republic, which is subsequently accompanied by an increased incidence of proximal femoral fractures. Similar results, however, were also obtained in men. One of the risk factors of osteoporosis development is also low physical activity throughout the lifetime. This risk factor is significant primarily in female population in the Muslim world. Afghanistan also faces serious malnutrition. All of that is reflected in low life expectancy in the given country, incidence of osteoporosis and injuries in this region. There is reasonable evidence that the mortality in a causal relationship with proximal femoral fracture is substantially higher in this region than in Western Europe. CONCLUSIONS The results of the pilot study showed that there are significant differences in age and frequency of fractures in dependence on sex and country. The obtained results can be considered valuable since there are virtually no scientific or professional studies on osteoporosis and fractures in the given area that would help physicians get ready for significant differences. These results may become a source of valuable information not only for medical practitioners coming to Afghanistan to help as volunteers in the framework of developmental assistance from all over the world, but also for physicians from Europe, with respect to the wave of migrants coming from this area. Key words: proximal femur, fracture, gender, age, Afghanistan, Czech Republic.

• MeSH
• fraktury femuru epidemiologie   etiologie   MeSH
• fraktury krčku femuru epidemiologie   etiologie   MeSH
• fraktury kyčle epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury epidemiologie   etiologie   MeSH
• pilotní projekty MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Afghánistán MeSH
• Česká republika MeSH

• MeSH
• bisfosfonáty * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• epidemiologické studie MeSH
• fraktury kostí * diagnóza   etiologie   prevence a kontrola   MeSH
• fraktury kyčle diagnóza   etiologie   prevence a kontrola   MeSH
• fraktury páteře diagnóza   etiologie   prevence a kontrola   MeSH
• fraktury proximálního humeru diagnóza   etiologie   prevence a kontrola   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• osteoporóza * diagnóza   komplikace   terapie   MeSH
• poranění zápěstí diagnóza   etiologie   prevence a kontrola   MeSH
• preventivní lékařství metody   MeSH
• prospektivní studie MeSH
• recidiva MeSH
• statistika jako téma MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) metody   MeSH
• Check Tag
• lidé MeSH

• MeSH
• bisfosfonáty aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• denzitometrie metody   MeSH
• epidemiologické studie MeSH
• fraktury femuru diagnóza   etiologie   prevence a kontrola   MeSH
• fraktury kostí * diagnóza   etiologie   prevence a kontrola   MeSH
• fraktury kyčle diagnóza   etiologie   prevence a kontrola   MeSH
• fraktury páteře diagnóza   etiologie   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury diagnóza   farmakoterapie   prevence a kontrola   MeSH
• osteoporóza * diagnóza   farmakoterapie   prevence a kontrola   MeSH
• poranění zápěstí * diagnóza   etiologie   prevence a kontrola   MeSH
• retrospektivní studie MeSH
• statistika jako téma MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Korejská republika MeSH

BACKGROUND: Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation. METHODS: The sample consisted of CT scans from 313 female and 40 male volunteers (158 with proximal femoral fracture, 145 age-matched controls and 50 fallers without hip fracture). Detailed Cortical Bone Maps (c.5580 measurement points on the unfractured hip) were created before registering each hip to an average femur shape to facilitate statistical parametric mapping (SPM). Areas where cortical and trabecular bone differed from controls were visualised in 3D for location, magnitude and statistical significance. Measures from the novel regions created by the SPM process were then tested for their ability to classify fracture versus control by comparison with traditional CT measures of areal Bone Mineral Density (aBMD). In women we used the surgical classification of fracture location ('femoral neck' or 'trochanteric') to discover whether focal osteoporosis was specific to fracture type. To explore whether the focal areas were osteoporotic by histological criteria, we used micro CT to measure trabecular bone parameters in targeted biopsies taken from the femoral heads of 14 cases. RESULTS: Hip fracture patients had distinct patterns of focal osteoporosis that determined fracture type, and CBM measures classified fracture type better than aBMD parameters. CBM measures however improved only minimally on aBMD for predicting any hip fracture and depended on the inclusion of trabecular bone measures alongside cortical regions. Focal osteoporosis was confirmed on biopsy as reduced sub-cortical trabecular bone volume. CONCLUSION: Using 3D imaging methods and targeted bone biopsy, we discovered focal osteoporosis affecting trabecular and cortical bone of the proximal femur, among men and women with hip fracture.

• MeSH
• biopsie MeSH
• fraktury kyčle etiologie   patologie   MeSH
• kortikální kost patologie   MeSH
• krček femuru patologie   MeSH
• lidé MeSH
• odds ratio MeSH
• osteoporóza komplikace   patologie   MeSH
• plocha pod křivkou MeSH
• ROC křivka MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• fraktury krčku femuru klasifikace   MeSH
• fraktury kyčle etiologie   MeSH
• fraktury proximálního femuru * klasifikace   MeSH
• krček femuru zranění   MeSH
• Publikační typ
• přehledy MeSH

Ženy a muži starší 75 let s již prodělanou zlomeninou v oblasti kyčle mají vysoké riziko další zlomeniny. Důsledkem zlomeniny proximálního femuru je nejenom zhoršení mobility a kvality života, ale také zvýšené riziko úmrtí. Náklady na léčení těchto zlomenin jsou vysoké. Přesto není sekundární prevence fraktur u pacientů s prodělanou zlomeninou v oblasti kyčle dostatečně zajišťována. Onemocnění osteoporózou je často považováno za příliš pokročilé a neléčitelné. Rozhodování o nutných opatřeních je také ovlivňováno komorbiditami a očekávanou délkou života pacientů. V tomto společném stanovisku odborných společností jsou na základě výsledků klinických studií uvedeny možnosti antiosteoporotické a osteoanabolické léčby ke snížení rizika zlomenin u pacientů ve věku 75 let a vyšším, a to se zvláštním zaměřením na účinnost a bezpečnost opatření u nemocných se zlomeninou proximálního femuru. Ověřené farmakoterapeutické postupy u pacientů v této věkové skupině zahrnují antiresorpční přípravky (vápník, vitamin D, aminobisfosfonáty a denosumab) a osteoanabolický teriparatid. Vzhledem k častým komorbiditám u starých pacientů je nezbytné individuálně zvažovat bezpečnost léků.

Hip fractures disproportionately affect elderly male and female patients, and may result in impairment of mobility, loss of quality of life, increased health resource utilization and even in death. Despite strong evidence indicating that the occurrence of a hip fracture increases the risk of other osteoporotic fractures including recurrent hip fractures, secondary prevention of fractures in older patients with hip fractures is not adequately provided. One explanation for this decrease is the perception that it is too late to alter the course of the disease in its late stage. The management of such patients should include assessing clinical diagnosis, treating osteoporosis and preventing falls. Based on clinical trials and experience, this collective position of professional societies reviews the anti-fracture measures and efficacy and safety of antiosteoporotic agents in this high-risk elderly population of patients with recent low trauma hip fractures. Available pharmacological therapies for the treatment of osteoporosis include calcium and vitamin D, antiresorptive drugs such as bisphosphonates and denosumab, and the bone forming drug teriparatide. Many elderly patients with established osteoporosis have multiple comorbid conditions, and demonstrated drug safety in this frail population is critically important.

• Klíčová slova
• stroncium ranelát, risedronát,
• MeSH
• alendronát aplikace a dávkování   MeSH
• bisfosfonáty aplikace a dávkování   MeSH
• denosumab MeSH
• diferenciální diagnóza MeSH
• fraktury femuru etiologie   prevence a kontrola   MeSH
• fraktury kyčle * etiologie   prevence a kontrola   MeSH
• hodnocení rizik MeSH
• hojení fraktur MeSH
• humanizované monoklonální protilátky aplikace a dávkování   MeSH
• imidazoly aplikace a dávkování   MeSH
• inhibitory kostní resorpce * terapeutické užití   MeSH
• kostní denzita účinky léků   MeSH
• kyselina etidronová analogy a deriváty   aplikace a dávkování   MeSH
• kyselina zoledronová MeSH
• lidé MeSH
• nemoci kostí diagnóza   MeSH
• osteoporotické fraktury * prevence a kontrola   MeSH
• osteoporóza diagnóza   farmakoterapie   MeSH
• potravní doplňky MeSH
• předání pacienta do jiné péče MeSH
• primární zdravotní péče metody   MeSH
• remodelace kosti účinky léků   MeSH
• rizikové faktory MeSH
• sekundární prevence * metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• terapie cvičením MeSH
• teriparatid aplikace a dávkování   MeSH
• thiofeny aplikace a dávkování   škodlivé účinky   MeSH
• úrazy pádem prevence a kontrola   MeSH
• vápník aplikace a dávkování   MeSH
• věkové faktory MeSH
• vitamin D aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH
• směrnice pro lékařskou praxi MeSH

PURPOSE OF THE STUDY: Evaluation of a group of patients with coxarthrosis who sustained fractures of the proximal femur and were treated by dynamic hip screw (DHS) osteosynthesis. MATERIAL AND METHODS: The group comprised 23 DHS osteosyntheses in 22 patients treated between the years 1997 and 2012. The indication to osteosynthesis in all 23 cases was a stable pertrochanteric fracture of the femur; all patients had grade III or grade IV coxarthrosis (assessed on the Kellgren & Lawrence scale) and their physical health was classified as ASA 3 or 4. Preventive antibiotic therapy was administered within 48 hours of surgery. The evaluated factors included operative time, blood loss, specific complications such as infection, osteosynthetic material fractiure or osteosynthesis failure, requirement of revision surgery, post-operative mobility and patient survival. The follow-up was 2 years. RESULTS: The operative time was 35 min to 85 min (average, 49 min); blood losses ranged from 50 ml to 450 ml (average, 189 ml). Of the 23 hips, infectious complication was found in one (4.3%) and osteosynthetic material fractiure also in one (4.3%). There was no necessity of revision surgery due to osteosynthesis failure, nor any conversion to total hip arthroplasty. Postoperative mobility (with use of walking aids or forearm crutches) was achieved in 17 (77.3%) patients. The average survival of the patients was 6.3 months, the range from 7 days to 3 years. DISCUSSION: DHS osteosynthesis is a reliable method for the treatment of proximal femoral fractures due to osteoporosis. These fractures in patients with coxarthosis are primarily indicated to total hip arthroplasty. However, this is questionable in polymorbid elderly patients in whom hip replacement carries high risk. In such patients DHS osteosynthesis is preferred as a less risky procedure. CONCLUSIONS: DHS osteosynthesis is indicated for stable pertrochanteric fractures of the femur in a limited number of patients with advanced coxarthrosis in whom total hip replacement would be associated with an undue risk. The majority of patients after surgery became mobile, but with short-term survival.

• MeSH
• artróza kyčelních kloubů komplikace   MeSH
• délka operace MeSH
• fraktury kyčle etiologie   chirurgie   MeSH
• kostní šrouby * MeSH
• krvácení při operaci MeSH
• lidé MeSH
• náhrada kyčelního kloubu kontraindikace   MeSH
• následné studie MeSH
• osteoporotické fraktury etiologie   chirurgie   MeSH
• senioři MeSH
• vnitřní fixace fraktury škodlivé účinky   přístrojové vybavení   metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• hodnotící studie MeSH

The aim of this study was to calculate rates of hospitalization for hip fracture and the incidence of hip fractures in the Czech Republic over a period of 29 years. A second aim was to use the most recent data to populate a FRAX(®) model for the assessment of fracture probability in individual patients. Data on hospitalizations for hip fracture (1981-2009) and number of women and men with hip fractures (2000-2009) were obtained, and incidences were computed for the entire population ≥50 years of age. Incidence of hospitalization for hip fracture in the Czech population aged ≥50 years increased progressively by calendar year. Age-standardized incidence of hip fractures increased to 2004 but leveled off thereafter and decreased after 2005. Data for hip fracture risk in 2008 and 2009 and the death hazard were used to populate a Czech-specific FRAX model for the computation of 10-year fracture probability. The customized FRAX model, using the verified epidemiological data, will be used to identify patients at increased fracture risk.

• MeSH
• fraktury kyčle epidemiologie   etiologie   MeSH
• kostní denzita fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporóza komplikace   epidemiologie   MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH