Nailing of pertrochanteric fractures is indicated when DHS is associated with high rate of complications. Thus in unstable comminuted fractures, mainly with posterolateral defect and instability, with Adam´s arch defect and medial instability and in cases when fracture line extends into the subtrochanteric region. The increase in number of nailed pertrochanteric fractures has both its rational and irrational reasons; irrational, as until now there is no clear evidence, that nailing is a faster, safer and easier procedure with a lower rate of complications compared with DHS, a rational, as a proven increase in number of unstable and comminuted fractures has to be reflected in treatment changes. Thus, with respecting the operative techniques principles, intramedullary nailing provides evident biomechanical advantages with the possibility of full weight-bearing and a very low rate of complications.

• MeSH
• fraktury kyčle chirurgie   MeSH
• intramedulární fixace fraktury metody   normy   MeSH
• lidé MeSH
• tříštivé fraktury chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY To evaluate the long-term results of intramedullary nailing of extra-articular proximal humerus fractures. MATERIAL AND METHODS Thirty-six patients with 36 extra-articular fractures, types 11-A2 and 11-A3, treated by intramedullary nailing were reassessed after an average follow-up of 54 (30-86) months. The group included five type 11-A2 and 31 type 11-A3 fractures according to the AO/OTA classification. Radiographic and clinical outcomes - the absolute Constant score (CSabs) and the relative Constant score (compared to the contralateral side, CSrel) were evaluated. The rate of complications was assessed. RESULTS All fractures healed. The mean long-term CSabs was 73 pts, the mean CSrel was 89% of the unaffected side. Thirty (83%) patients achieved excellent or good results (CSrel higher than 80%), four (11%) had satisfactory and two patients (5.5%) had poor results (CSrel less than 60%). No significant difference was observed in functional results between different age groups. No non-union, loss of reduction or deep infection was encountered. Two cases of prolonged healing were observed, one implant-related complication happened due to locking screw breakage. Conclusion Nailing can be recommended for the safe treatment of extra-articular fractures of the proximal humerus. If the procedure is performed properly, the possibility of excellent functional results is high and the rate of complications is minimal. Age does not influence the final functional result. Key words: proximal humerus, extra-articular fractures, intramedullary nail, long-term results.

• MeSH
• epifýzy MeSH
• fraktury humeru * chirurgie   MeSH
• humerus MeSH
• intramedulární fixace fraktury * MeSH
• lidé MeSH
• pooperační komplikace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: The aim of the work is to provide an overview of the existing experience in Synthes unreamed humeral nail (UHN). MATERIAL: Between August 1996 and February 2000 we treated by means of UHN a group of 37 patients (12 men and 25 women), average age 55 years (range, 18-87 years) with a fracture of humeral shaft. According to AO classification in 10 patients it was a case of a fracture of proximal humerus involving the shaft (11B-3) and in 27 cases a fracture of the shaft (12 A, B, C). The whole group was operated on by 11 surgeons. METHOD: In 26 cases we used the antegrade method and in 11 cases the retrograde one, in dependence on the type and location of the fracture. The assessment was performed in the form of a prospective study. The follow-up including radiograph checks was carried out at the intervals of 6 weeks, 3, 6, 9 and 12 months after the operation or at another 6 weeks or 3 months after the extraction of the nail, if any. In addition we invited the whole group, i.e. 37 patients for the final control examination which all of them attended. This examination was performed by the first author of the work. The average follow-up was 38 months (range, 12-55 months). RESULTS: The average duration of the surgery in the whole group was 80 minutes, the average duration of x-ray exposure was 3.1 minutes. Peroperative complications occurred in total 42 times in 23 patients. Seven cases required a supplementary incision, i.e. open reduction of the fracture; insufficient nail placement (not into the proper depth) in the humeral head and its prominence into joint line evaluated on the post-operative radiograph) in antegrade nailing occurred 6 times. Problems with locking were encountered 15 times in 10 patients. Comminution of the fragments peroperatively during the insertion of the nail occurred 3 times, peroperative injury of the radial nerve was recorded in total 4 times, always in the antegrade method of the insertion during distal locking from the lateral side. A postoperative complication occurred 16 times in 12 patients, 6 times the radiograph showed penetration of the end of the nail into the shoulder and 6 times the locking screws loosened. No infect was recorded. The mentioned complications required in total 10 revision surgeries in 6 patients (5 of them were treated by the antegrade method). The fracture healed in a good anatomical position in 33 cases. In 4 cases there occurred non-union which was 3 times treated with a plate re-fixation and cancellous bone grafting of which twice successfully. In 2 cases the healing required another revision surgery. A good subjective as well as objective result was achieved almost in 90% of patients. A risk factor from the viewpoint of the limitation of the range of motion in the shoulder proved to be the fracture of 11B3 type and also the antegrade method of nailing, in case of the elbow the retrograde method of nailing. However, the greatest risk was posed by the necessity of a longer post-operative immobilisation of the limb in the case of a not quite stable internal fixation. DISCUSSION: A relatively high number of complications in our group results from strict criteria we have set. However, also literary data present a relatively high number of variously serious complications. Our results as well as the average duration of the surgery is comparable with other authors. CONCLUSION: The main indication of UHN are comminuted or multi-level fractures of humerus in the central three fifths of its length. If possible we prefer the retrograde method of nailing, in the antegrade method we recommend distal locking from the anterior aspect of the arm. Transverse or short oblique fractures can be successfully treated by a simpler Hackethal technique. Long spiral fractures are ideally treated conservatively or by plate fixation.

• MeSH
• dospělí MeSH
• fraktury humeru diagnostické zobrazování   chirurgie   MeSH
• humerus diagnostické zobrazování   MeSH
• intramedulární fixace fraktury škodlivé účinky   přístrojové vybavení   metody   MeSH
• kostní hřeby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• následné studie MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tříštivé fraktury diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular. This study aims to evaluate the group of patients in whom the suprapatellar approach was used and who were followed up for the period of at least 12 months. MATERIAL AND METHODS The prospective study included 55 cases of osteosynthesis of diaphyseal fractures of the tibia with the surgery performed in the period from January 2013 to June 2015, of which in 53 patients (17 women and 36 men) with the mean age of 49.6± 16.7 years the ETN nail by DePuy Synthes ® was inserted through a suprapatellar approach. In 38 cases (70.1%) an isolated trauma was involved, 15 patients (29.9%) were treated for multiple injuries or polytrauma. In nine cases (17%) it was an open fracture (2times - GA grade I, 7times - GA grade II). A multiple fracture or a fracture of the proximal third was recorded in 19 cases (34.5%). The functional and radiological results of the treatment were assessed prospectively at 12 months after the surgery using the Lysholm (LS) score. RESULTS The final functional results were successfully assessed in 49 performed osteosyntheses (89.1%). The mean duration of surgery was 72.7± 19.57 min (40-140 min, median 65 min). A total of 48 (98%) fractures healed by primary intention. In five cases (10.2%) a delayed healing occurred and in one case (2 %) non-union was reported, requiring a revision surgery. In three cases (6.1%) complete implant was removed (twice by SP and once by IP approach). The mean Lysholm score was 93.4 ± 8.39 points (59-100 points, median score of 95 points). An excellent or a good result was observed in 45 patients (91.8%), a satisfactory result in three patients (6.2%), and a poor result in one patient (2%). A statistically significant correlation (p = 0.006) between the LS score values and the age of the patients was confirmed. In patients up to 60 years of age the LS score was 96.2 ± 4.51 points (89-100, median 96), at the age of more than 60 years it was 86.9 ± 11.46 (59-100, median 89). CONCLUSIONS The suprapatellar approach in treating the tibial diaphyseal fractures represents a safe alternative nail insertion technique. If an appropriate surgical technique is applied, the risks inherent in this approach are negligible. The approach allows for an easy reduction of challenging fractures of the proximal third diaphyseal fracture of the tibia and multiple fractures of the tibia and facilitates an easy check of the axial position of the extremity. The functional results of the knee joint are comparable to those achieved with the infrapatellar nailing technique. The final LS score correlates with the age of the patients. Key words:tibial fractures, suprapatellar approach, intramedullary nailing, knee pain.

• MeSH
• diafýzy diagnostické zobrazování   zranění   chirurgie   MeSH
• dospělí MeSH
• fraktury tibie klasifikace   diagnostické zobrazování   chirurgie   MeSH
• intramedulární fixace fraktury přístrojové vybavení   metody   MeSH
• kostní hřeby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• Lysholmovo skóre MeSH
• otevřené fraktury diagnostické zobrazování   chirurgie   MeSH
• prospektivní studie MeSH
• radiografie MeSH
• senioři MeSH
• uzavřené fraktury diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• FRACTURES/experimental *,
• MeSH
• fraktury kostí * MeSH
• intramedulární fixace fraktury * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

In a prospectively followed up group of 163 nailed tibiae in 157 casualties after 4-48 months, on average after 15 months following implantation 20 patients (12.5%) developed complications. In two instances the nail broke or was bent (1.25%), the remaining complications were not associated with the implant or instruments. Subsequent tests however did not prove defective material of the damaged nails. Medin nails are a reliable, readily available and cheap implant.

• MeSH
• dospělí MeSH
• fraktury tibie chirurgie   MeSH
• intramedulární fixace fraktury škodlivé účinky   přístrojové vybavení   MeSH
• kostní hřeby * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• Klíčová slova
• FEMUR/fractures *,
• MeSH
• femur * MeSH
• fraktury femuru * MeSH
• fraktury kostí * MeSH
• intramedulární fixace fraktury * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• FEMUR NECK/fractures *,
• MeSH
• fraktury krčku femuru * MeSH
• intramedulární fixace fraktury * MeSH
• krček femuru * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• burzitida etiologie   MeSH
• dospělí MeSH
• infekce etiologie   MeSH
• intramedulární fixace fraktury škodlivé účinky   MeSH
• kostní hřeby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• pooperační komplikace MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• dospělí MeSH
• fraktury femuru diagnostické zobrazování   chirurgie   MeSH
• intramedulární fixace fraktury * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH