Due to the aging population, there is an increasing number of fragility fractures of the pelvis (FFP). They are the result of low energy trauma. The bone breaks but the ligaments remain intact. Immobilizing pain at the pubic region or at the sacrum is the main symptom. Conventional radiographs reveal pubic rami fractures, but lesions of the dorsal pelvis are hardly visible and easily overlooked. CT of the pelvis with multiplanar reconstructions show the real extension of the lesion. Most patients have a history of osteoporosis or other fragility fractures. The new classification distinguishes between four categories of different and increasing instability. FFP Type I are anterior lesions only, FFP Type II are non-displaced posterior lesions, FFP Type III are displaced unilateral posterior lesions and FFP Type IV are displaced bilateral posterior lesions. Subgroups discriminate between the localization of the dorsal instability. FFP Type I lesions are treated non-operatively. FFP Type II lesions are fixed in a percutaneous procedure when a trial of conservative treatment was not successful. FFP Type III lesions are treated with open reduction and internal fixation (ORIF). FFP Type IV lesions are treated with bilateral ORIF or with a bridging osteosynthesis. Iliosacral screw osteosynthesis is widely used, but has an elevated risk of screw loosening due to diminished bine mineral density. Transsacral bar osteosynthesis enable interfragmentary compression and does not have this danger of loosening. Bridging plate osteosynthesis is used as an additional fixation to iliosacral screw osteosynthesis. Lumbopelvic fixation is restricted to highly unstable lumbopelvic dissociations. More studies are needed to find the optimal treatment for each type of instability. Key words: pelvis, fragility fracture, diagnosis, classification, treatment.

• MeSH
• inhibitory kostní resorpce terapeutické užití   MeSH
• lidé MeSH
• management bolesti MeSH
• osteoporotické fraktury klasifikace   diagnostické zobrazování   terapie   MeSH
• pánevní kosti zranění   chirurgie   MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• techniky fyzikální terapie MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• inhibitory kostní resorpce MeSH

BACKGROUND: Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated. OBJECTIVE: This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management. METHODS: This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a dynamic spinal orthosis (Spinfast®). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured. RESULTS: The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p< 0.0001). CONCLUSION: The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.

• Klíčová slova
• Osteoporosis, rehabilitation, spinal orthoses, spine, vertebral fractures,
• MeSH
• bolesti zad rehabilitace   terapie   MeSH
• fraktury páteře * rehabilitace   MeSH
• hodnocení výsledků péče pacientem MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření bolesti MeSH
• osteoporotické fraktury * rehabilitace   MeSH
• prospektivní studie MeSH
• protetické prostředky * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zpráva o sobě 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
• multicentrická studie MeSH

This study demonstrates the effect of essential fatty acid deficiency on the postnatal skeletal development in the rat. Four groups (n = 10) of newborn Wistar rats were fed diets containing high and low proportions of essential fatty acids in the lipid fraction until day 16 after birth. Suckled littermates were used as controls. X-ray and histological studies showed the occurrence of multiple pathological fractures of the long bones in 1-month-old rats fed a diet deprived of essential fatty acids. No effect of high (51,000 IU/100 g diet) and low (5,100 IU/100 g diet) concentrations of vitamin D2 was observed in our experiment. Thus, these data suggest the importance of essential fatty acids for bone pathology in the rat.

• MeSH
• dietní tuky farmakologie   MeSH
• ergokalciferoly farmakologie   MeSH
• fraktury femuru patologie   MeSH
• fraktury tibie patologie   MeSH
• krysa rodu Rattus MeSH
• mastné kyseliny farmakologie   MeSH
• potkani Wistar MeSH
• vývojové onemocnění kostí patologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• dietní tuky MeSH
• ergokalciferoly MeSH
• mastné kyseliny MeSH

Hip fractures are ranked among the frequent injuries. These fractures have been often coupled with high energy trauma in children and in patients with normal bone structure, low energy trauma and osteoporotic fracture (fragility fracture) is typical in elder patients. Hip fractures are divided into five groups: femoral head fracture, femoral neck fracture, pertrochanteric, intertrochateric and subtrochanteric fracture. Surgical treatment is indicated in all patients unless contraindications are present. Long bed rest has been accompanied by a high risk of development of thromboembolic disease, pneumonia and bed sore. Healing in the wrong position and nonunions are often the result of conservative treatment. Screw osteosynthesis is performed in isolated femoral head factures. Three cannulated screws or a DHS plate (dynamic hip screw) are used in fractures of the femoral neck with normal femoral head perfusion, total hip replacement is recommended in elder patients and in case of loss of blood supply of the femoral head. Pertrochanteric and intertrochanteric fractures can be stabilized by the femoral nails (PFN, PFN A, PFH - proximal femoral nail), nails are suitable for minimally invasive insertion and provide higher stability in the shaft, or plates (DHS) designed for stable pertronchanteric and intertrochanteric fractures. Subtrochanteric fractures can be fixed also intramedullary (nails - PFN long, PFN A long) and extramedullary (plates - DCS dynamic condylar screw, proximal femoral LCP - locking compression plate). Open reduction with internal plate fixation is advantageous for pathological fractures, as biopsy sampling can be performed. Hip fracture rehabilitation is integral part of the treatment, including walking on crutches or with a walker with partial weight bearing for at least six weeks.

• Klíčová slova
• proximal femur - fracture - hip - femoral nails - plate osteosynthesis - osteoporosis.,
• MeSH
• fraktury kyčle chirurgie   MeSH
• fraktury spontánní chirurgie   MeSH
• kostní destičky MeSH
• kostní hřeby MeSH
• kostní šrouby MeSH
• lidé MeSH
• náhrada kyčelního kloubu metody   MeSH
• osteoporotické fraktury chirurgie   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The 2-year, randomized, double-blind, active-controlled fracture endpoint VERO study included postmenopausal women with established osteoporosis, who had at least 2 moderate or 1 severe baseline vertebral fractures (VFx), and bone mineral density (BMD) T-score ≤-1.5. Patients were treated with either s.c. daily teriparatide 20 μg or oral weekly risedronate 35 mg. As previously reported, the risk of new VFx and clinical fractures (a composite of clinical VFx and nonvertebral fragility fractures [NVFFx]) was statistically significantly reduced with teriparatide compared with risedronate. Here we present the prospectively planned subgroup analyses of fracture data across subgroups, which were predefined by the following baseline characteristics: age, number and severity of prevalent VFx, prevalent nonvertebral fractures (NVFx), glucocorticoid use, prior osteoporosis drugs, recent bisphosphonate use, clinical VFx in the year before study entry, and baseline BMD. Heterogeneity of the treatment effect on the primary endpoint (new VFx), and the four key secondary endpoints (including clinical fractures and NVFFx) were investigated by logistic and Cox proportional hazards regression models. A total of 1360 women were randomized and treated (680 per group). Mean age was 72.1 years, mean (SD) number of prevalent VFx was 2.7 (2.1), 55.4% had a BMD T-score <-2.5, 36.5% had a recent clinical VFx, 28.3% had a prior major NVFx, 43.2% were osteoporosis drug-naïve, 39.3% were recent bisphosphonate users, and 9.3% were taking glucocorticoids at a prednisone-equivalent dose of >5 mg/d. For most fracture endpoints, the risk reduction of teriparatide versus risedronate did not significantly differ in any of the subgroups analyzed (treatment-by-subgroup interaction p > 0.1), with most subgroups mirroring results from the total study population. In conclusion, in postmenopausal women with severe osteoporosis, the antifracture efficacy of teriparatide compared with risedronate was consistent in a wide range of patient settings, including treatment-naïve and previously treated patients. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

• Klíčová slova
• BISPHOSPHONATES, POSTMENOPAUSAL OSTEOPOROSIS, SUBGROUP ANALYSIS, TERIPARATIDE, VERTEBRAL FRACTURES,
• MeSH
• dvojitá slepá metoda MeSH
• fraktury páteře farmakoterapie   metabolismus   patologie   MeSH
• kyselina risedronová aplikace a dávkování   MeSH
• lidé MeSH
• osteoporóza farmakoterapie   metabolismus   patologie   MeSH
• postmenopauza * MeSH
• rizikové faktory MeSH
• senioři MeSH
• teriparatid aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• kyselina risedronová MeSH
• teriparatid MeSH

PURPOSE OF THE STUDY Fragility fractures of the pelvic ring in the elderly population are a serious problem in orthopaedics. The treatment options range from conservative treatment to diverse operative options. We present a balloon guided new technique of implanting cement augmented screws aiming at improved implant anchorage and reduced cement leakage. MATERIAL AND METHODS We describe a new technique of balloon- guided cement augmented iliosacral screws. After the balloon has been insufflated and contrast medium has been instillated for leakage detection, iliosacral screws can safely be placed with a relevant cement depot. RESULTS All patients (n = 8) treated in this way were allowed to weight bear on both legs and mobilisation was tolerated the next day after surgery. In the post-operative controls including X-ray and CT scan we noticed no cement leakage. Pain level as measured by the visual analog scale was significantly reduced to pre- surgery (mean 7.6 pre-operatively, mean 2.5 postoperatively). In addition pain medication could be reduced gradually soon after surgery. CONCLUSIONS The described procedure to address fragility fractures of the pelvic ring is a safe and easy to handle method. There are three advantages: First the osteoporotic S1 vertebral body can by stabilised by the amount of cement; second the cement leakage can be prevented by the balloon-compaction of the cancellous bone and the possibility to control the created cavity with contrast medium; third the bone - screw interface is much stronger compared to other procedures and is biomechanically superior against vertical shear stress. In contrast to sacroplasty, the cement application is guided by the previous use of a balloon. Key words:pelvic ring, fragility fracture, osteoporosis, elderly.

• MeSH
• časné pohybování MeSH
• fraktury páteře diagnostické zobrazování   chirurgie   MeSH
• kostní cementy terapeutické užití   MeSH
• kostní šrouby * MeSH
• křížová kost diagnostické zobrazování   zranění   chirurgie   MeSH
• lidé MeSH
• os ilium diagnostické zobrazování   chirurgie   MeSH
• osteoporotické fraktury diagnostické zobrazování   chirurgie   MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kostní cementy MeSH

Fragility fractures have been a cause for concern because of their high incidence. For the prevention and treatment of osteoporotic fractures, it is important to understand how to promote bone formation and increase bone mass. This study investigated miR-296-3p expression and function in fragility fracture. The study enrolled 98 patients with hip fractures, 90 patients with wrist fractures and 35 healthy controls. RT-qPCR was used to detect the miR-296-3p level changes before and after surgery in fracture patients and during the differentiation of human bone mesenchymal stem cells (BMSCs). The starBase bioinformatics database was used for prediction of the miR-296-3p target gene, and dual luciferase report was used for verification of the target relationship. Our results demonstrated that miR-296-3p levels are up-regulated in fracture patients, while they gradually decrease during human BMSC differentiation. The up-regulation of miR-296-3p inhibited the proliferation and differentiation ability of human BMSCs, while inhibition of its expression had the opposite effects. miR-296-3p negatively regulates osteogenic differentiation, and over-expression of inhibitor of β-catenin and TCF (ICAT) could counteract the negative regulatory effect. miR-296-3p targets ICAT and affects the expression of key proteins in the Wnt/β-catenin signalling pathway. In conclusion, miR-296-3p can regulate the division and differentiation of osteoblasts by affecting the expression of ICAT and participate in fracture healing.

• Klíčová slova
• BMSCs, ICAT, fragility fractures, miR-296-3p,
• MeSH
• buněčná diferenciace * genetika   MeSH
• hojení fraktur * genetika   fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezenchymální kmenové buňky metabolismus   cytologie   MeSH
• mikro RNA * metabolismus   genetika   MeSH
• osteogeneze * genetika   MeSH
• proliferace buněk genetika   MeSH
• senioři MeSH
• signální dráha Wnt genetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• mikro RNA * MeSH
• MIRN296 microRNA, human MeSH Prohlížeč

PURPOSE OF THE STUDY Continuous epidemiologic data on changes in the spectrum of acetabular fractures is rare. The purpose of this study is to evaluate changes in the types of acetabular fractures over the last two decades. MATERIAL AND METHODS In the period between 2007 and 2016, a total of 522 patients were treated at the authors department (Traumacentre Level I) for acetabular fractures. 15 patients sustained bilateral fractures. The group consisted of 361 men and 161 women, with the mean age of 49 years (the range of 10-96 years). Standard procedure was applied to diagnose the fractures (X-ray and CT scan). Non-operative treatment was opted for in fractures without displacement, fractures with minimum displacement of acetabular weight bearing area less than 2 mm, confirmed by the CT scan (e.g. low fractures of anterior column, low transverse fractures), fractures with secondary congruence in patients over the age of 70, and fractures in patients contraindicated for surgery due to their serious overall medical condition or severe osteoporosis. A surgery was indicated in case of instability or incongruent acetabular joint space due to the displacement of weight bearing area fragments, or a bone fragment or soft tissue interposition. A surgery was indicated also in a non-displaced acetabular injury with concurrent femoral head injury. AO/ASIF classification was used to classify the fractures. The following data was monitored in the referred to group of patients: gender, age, mechanism of injury, associated injuries, type of fracture, and treatment method. RESULTS Type A fracture was reported in 293 patients (56%), type B fracture in 150 patients (29%) and type C fracture in 79 patients (15%). A high-energy trauma occurred in 334 patients (64%), namely 254 men and 50 women, with the mean age of 41 years. A low-energy trauma was sustained by 188 patients (36%), namely 77 men and 111 women, with the mean age of 69 years (56-91). This difference in the share of men and women with respect to the seriousness of the mechanism of injury was statistically significant (p < 0.0001). Non-operative treatment was used in 248 patients (48%), of whom 167 were men and 81 were women. The mean age in this sub-group was 60 years, namely 58 years in men and 62 years in women. Operative treatment was opted for in 272 patients (52%), of whom 206 were men and 50 were women, with the mean age of 45 years in women as well as in men. The statistical processing of differences between the non-operative and operative treatment in dependence on the type of fractures revealed a significantly higher percentage of operative treatment in type C fractures compared to type A and B fractures (p < 0.0001, or p = 0.0009). In the group of patients treated by the authors in the 1996-2002 period, type A fractures constituted 45% of all fractures, where A1 fractures prevailed with 29%, A2 fractures represented 9% and A3 fractures only 6 %. In the recent group of patients, type A fractures constituted 56%, but A3 fracture were seen in 29% of patients, which was a significant increase (p < 0.0001). A3 fractures (anterior wall or anterior column fractures) were associated with a low-energy mechanism of injury and occurred in 48% of patients (73, mostly elderly women). DISCUSSION When compared to the published groups of other authors, the monitored group showed no difference in the mean age and gender ratio. There was an obvious increase in the number of patients with a low-energy mechanism of injury. The authors believe that this is the result of population ageing. It is also related to the growing share of patients treated non-operatively. The number of patients with a high-energy mechanism injury increased to a lesser degree. The spectrum of fractures significantly changed over the last 20 years. It was caused by an increase in low-energy injuries and partly also by improved diagnostics. CONCLUSIONS In the last 20 years, the authors noticed a rise in some types of acetabular fractures. It was caused by a statistically significantly higher number of fractures with a low-energy mechanism of injury, especially in elderly patients, the so-called "fragility fractures". Therefore, the share of non-operatively treated acetabular fractures increased as well. The number of acetabular fractures in young patients as a result of a high-energy injury grew more slowly, and it was only the share of posterior-wall acetabular fractures that was significantly higher. Key words: epidemiology of acetabular fractures, mechanism of injury, types of acetabular fractures.

• MeSH
• acetabulum diagnostické zobrazování   zranění   MeSH
• dítě MeSH
• dospělí MeSH
• fraktury kostí * diagnostické zobrazování   epidemiologie   chirurgie   MeSH
• fraktury kyčle * diagnostické zobrazování   epidemiologie   chirurgie   MeSH
• fraktury páteře * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• radiografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Osteoporosis is defined as a systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration leading to increased fracture risk. Osteoporosis incidence increases with age in both post-menopausal women and aging men. Among other important contributing factors to bone fragility observed in osteoporosis, that also affect the elderly population, are metabolic disturbances observed in obesity and Type 2 Diabetes (T2D). These metabolic complications are associated with impaired bone homeostasis and a higher fracture risk. Expansion of the Bone Marrow Adipose Tissue (BMAT), at the expense of decreased bone formation, is thought to be one of the key pathogenic mechanisms underlying osteoporosis and bone fragility in obesity and T2D. Our review provides a summary of mechanisms behind increased Bone Marrow Adiposity (BMA) during aging and highlights the pre-clinical and clinical studies connecting obesity and T2D, to BMA and bone fragility in aging osteoporotic women and men.

• Klíčová slova
• aging, bone fragility, bone marrow adiposity, obesity, osteoporosis, type 2 diabetes (T2D),
• MeSH
• adipozita MeSH
• diabetes mellitus 2. typu * metabolismus   MeSH
• fraktury kostí * metabolismus   MeSH
• kostní dřeň patologie   MeSH
• lidé MeSH
• obezita metabolismus   MeSH
• osteoporóza * patologie   MeSH
• senioři MeSH
• stárnutí MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

PURPOSE OF THE STUDY To evaluate a possible association between hip fracture and statin use. MATERIAL AND METHODS In this case-control study we compared the use of statins between two groups of 210 patients: the first group (case group) included patients hospitalized for hip fractures while the second group (control group) included patients who did not suffer femur bone injuries. The two groups were matched for age, sex, year of hospitalization and possible confounding factors. Inside the group of cases, we also evaluated the differences in terms of fracture type, presence of previous fragility fracture and mortality between statin users and non-users. RESULTS The use of statins was most common among patients without previous fractures (OR=0.54; 95% CI=0.33-0.89; p=0.0138), especially in older patients (OR=0.40; 95% CI=0.22-0.76). We did not find any significant difference in statin intake between men and women in the control group. In the case group, those who did not use statins were more likely to undergo a medial hip fracture (28.5% vs 16.1%). Patients from case group also presented a greater mortality (27.9% vs 19.35%) and an higher percentage of previous hip fractures (20.11% vs 9.7%). However, they didn't presented a significant higher rate of fragility fractures in other sites. DISCUSSION AND CONCLUSIONS Our study suggests a reduced hip fracture risk, especially in cases aged 80 or more, a different fracture pattern (lower percentage of medial fractures) and a reduced mortality at 9 months in patients treated with HMG-CoA reductase inhibitors, confirming the previous evidences reported in literature. Key words: statin, hip fractures, fracture risk, osteoporosis.

• MeSH
• fraktury kyčle * epidemiologie   prevence a kontrola   MeSH
• kosti a kostní tkáň MeSH
• lidé MeSH
• osteoporóza * MeSH
• senioři MeSH
• statiny * škodlivé účinky   MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• statiny * MeSH