PURPOSE: Proximal femoral fractures are among the most commonly sustained fractures. The current treatment of stable proximal femoral fractures located in trochanteric region primarily involves the use of two systems: extramedullary dynamic hip screws and intramedullary hip nails. Given that these fractures are mainly found in the elderly population, the necessity of a repeat, due to failure of the first, may jeopardize the patient's life. Decisive factors contributing to the healing of a fracture (or the failure thereof) include fracture pattern, technical implementation of the operation (i.e., position of the implant), implant's properties and its changes in relation to the surrounding bone tissue during loading. Each screw insertion variant results in damage to various load-bearing bone structures, which can be expected to influence healing quality and stability of newly formed bone. METHOD: With the aid of a numerical model and finite element methods, the authors analyzed several different positions of IMHN/PFH-nails in the proximal femur, with the objective of determining positions with an increased risk of failure. RESULTS AND CONCLUSION: In model situations, it has been shown that in stable fractures results do not depend on absolutely precise positioning and small deflections in the nails and neck screws positions do not significantly increase the risk of failure for the entire fixation. Damage to load-bearing structures relative to various implant placements does not impact the resultant overall fixation stability. Therefore, it is not necessary to re-introduce implants in the ideal position, which can lead to reduced patient radiation doses during surgery.

• Klíčová slova
• Bone fixation, Complications, Finite element method analyses, Intramedullary hip nail, Stable pertrochanteric fracture,
• MeSH
• analýza metodou konečných prvků MeSH
• biomechanika MeSH
• femur zranění   chirurgie   MeSH
• fraktury kyčle chirurgie   MeSH
• intramedulární fixace fraktury přístrojové vybavení   metody   MeSH
• kostní hřeby * MeSH
• lidé MeSH
• neúspěšná terapie MeSH
• rizikové faktory MeSH
• senioři MeSH
• teoretické modely MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The purpose of our work was to verify the hypothesis that muscle insertions and ligament attachments have an impact on the course of typical break lines in the area of the trochanteric massif, i.e., to provide a more detailed description of the origins and insertions of the musculo-ligamentous apparatus on the surface of the proximal femur, and to find a potential morphological correlate between muscle insertions and ligament attachments to the proximal femur and the course of the break line in a typical pertrochanteric fracture. METHODS: A detailed dissection of areas of trochanter major et minor, linea et crista intertrochanterica was performed in 50 anatomical preparations of the proximal femur, and the insertions of the muscular-ligamentous structures were described. The set of 600 radiographs were used to obtain projections of typical break lines on the proximal femur, and corresponding areas of exposed bone surface were identified in the anatomical preparations based on the projections and on 15 real specimens of patients after the pertrochanteric fracture osteosynthesis. RESULTS AND CONCLUSION: Bone covered only with the periosteum, with no reinforcing elements of the origin or insertions of muscles or attachments of ligaments, represents the locus minoris resistentiae for beginning of fractures. Variability in the sizes and shapes of pertrochanteric fracture fragments also depends on variability of the locations and sizes of soft tissue attachment areas at specified sites on the proximal femur.

• MeSH
• disekce MeSH
• fraktury krčku femuru diagnostické zobrazování   chirurgie   MeSH
• fraktury kyčle diagnostické zobrazování   chirurgie   MeSH
• intramedulární fixace fraktury metody   MeSH
• kloubní ligamenta anatomie a histologie   MeSH
• kosterní svaly anatomie a histologie   diagnostické zobrazování   MeSH
• kostní hřeby MeSH
• krček femuru anatomie a histologie   MeSH
• lidé MeSH
• mrtvola MeSH
• radiografie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

This study examines the epidemiological data of patients with hip fractures from 1997-2007. Adult patients treated for hip fracture between the years 1997-2007 were included in the study. Retrospective statistical assessment of continually gathered data focussed on epidemiology and demographics. The study involved 3,683 patients (2,678 women and 1,005 men). Patients older than 70 years accounted for 82% of all cases. There were 2.7 times more women; in patients younger than 60 years men significantly outnumbered women (p < 0.001). The mean patient age was 77.9 years (SD ± 12.6; women, 80.3 years; men, 71.5 years). There was a slight increase in the average age in both sexes. Trochanteric fractures accounted for 54.7% and femoral neck fractures accounted for 45.3% of fractures. The ratio of men to women was the same in femoral neck (AO-31B) and trochanteric (AO-31A) fractures. The average year-to-year increase in the number of fractures was 5.9%. For femoral neck fractures (AO-31B), there was a statistically insignificant increase in the number of fractures (p = 0.63); for intertrochanteric factures (AO-31A3) there was a statistically insignificant decrease (p = 0.65). There was an increase in the number of hip fractures resulting in a significant increase in pertrochanteric fractures (AO-31A1+2) (p < 0.001). The ratio of trochanteric to neck fractures increased from 0.99 to 1.53. Continual monitoring of patients with hip fracture offers data which allows comparisons between regions and countries. There has been a continual increase in the number of patients with hip fractures.

• MeSH
• demografie trendy   MeSH
• fraktury krčku femuru diagnostické zobrazování   epidemiologie   MeSH
• fraktury kyčle diagnostické zobrazování   epidemiologie   MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH