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INTRODUCTION: In the literature, there are only few articles about the metal breakage after the Dynamic Hip Screw (DHS) osteosynthesis. We have evaluated our group of patients focusing on these specific complications. MATERIAL AND METHODS: We have evaluated a group of 428 patients (321 female and 107 male subjects) who underwent a total of 456 135 degrees 1"-collar DHS osteosyntheses, for primary proximal femoral fractures. The patients were aged 82.3 years on average, the procedures were performed during 1996-2009. We focused on the ostesynthetic material breakage (K-wire, sliding screw, hip plate, cortical screws). The follow-up period was 2 years. RESULTS: Out of 16 DHS used for intracapsular femoral neck fractures, metal breakage was recorded in one case (6.25%)-(K-wire) and no reoperation was required. Out of a total of 436 DHS procedures performed for stable pertrochanteric fractures, metal breakage complications were recorded in 8 cases (1.8%)-(3 times K-wire, 3 times cortical screws, 2 times sliding screw), and reoperation was indicated in 4 cases (2 times sliding screw, 2 times cortical screws). Out of a total of 4 DHS procedures used for subtrochanteric fractures, osteosynthetic material breakage was recorded in two cases (50%)-(1 times K-wire, 1 times cortical screws) and no reoperation was required. No cases of hip plate breakage were recorded. Out of a total of all 456 DHS procedures metal breakage was recorded in 11 cases in total (2.4%), reoperation was required in 4 cases (0.9%). CONCLUSION: In the literature, the authors found only several articles related to the osteosynthetic material breakage after DHS surgery. Correct indication and operation technique can reduce occurence of this specific complication and the reoperation rates. In future, the authors plan to employ computer modelling methods and biomechanic analysis.

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PURPOSE OF THE STUDY To present the results of surgical repair of ruptures of the distal tendon of the biceps brachii muscle and thus show the adequacy of this treatment. MATERIAL Between 1987 and 2006, 19 patients had surgery for distal biceps tendon rupture. Only one side was affected in each patient. All patients were men between 28 and 69 years (average age, 47.5 years) at the time of injury (surgery). When the patients were evaluated at the end of 2007, 18 patients were included, because one died a year after surgery. METHODS The surgical repair always included a single-incision anatomical reattachment into the radial tuberosity. In 11 patients, a modified Mac Reynolds method with screw and washer fixation was used; in seven patients the insertion was fixed with Mitek anchors and, in one, it was sutured to the adjacent soft tissues. The average follow-up was 7 years (range, 1 to 20.5 years). The patients were evaluated for the cause of injury, their physical activity, age, dominance of the injured arm, surgical procedure and complications. RESULTS In 18 patients surgical repair was done early and, in one, at 16 days after injury. In all of them the tendon was detached from its site of insertion, but never torn. The intra-operative complications included, in one patient, bleeding owing to iatrogenic damage to a branch of the brachial artery, and difficult separation of the tendon due to its previous healed injury in another patient. Early post-operative complications included superficial skin necrosis in one patient and transient neurological deficit of the dorsal brand of the radial nerve and of the lateral cutaneous nerve of the forearm in two and one patient, respectively. The late complications were heterotropic ossification in three patients and screw migration in the one treated by the Mac Reynolds method. Excellent results were recorded in 11 patients (61 %), and good outcomes with a slight restriction of motion or muscle strength not limiting the patient's physical activities were in six (33.5 %) patients; only one patient (5.5 %) experienced pain on moderate exercise and had recurrent heterotropic ossification. Apart from this condition, there was no difference in the frequency of complications associated with the method used. DISCUSSION Only sparse information on distal biceps tendon ruptures has been available in the relevant Czech literature and, if so, only small groups with short follow-ups have been involved. Conservative treatment or the methods of non-anatomical reattachment have poor functional outcomes. Much better results are achieved by anatomical reattachment. Based on our experience with the Mac Reynolds technique, an anterior single-incision approach using fixation with Mitek anchors can be recommended. CONCLUSIONS Early surgical repair involving anatomical reattachment from the anterior singleincision approach with two Mitek anchors is recommended when a rupture of the distal tendon insertion of the biceps brachii is diagnosed. Key words: biceps radii muscle, biceps tendon injury, tendon fixation, bone screw and washer use.

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Based on their own observation the authors describe pneumococcal coxitis in a young man. With regard to the atypical clinical picture of the disease the authors draw attention to the necessity to consider in the differential diagnosis of pain in the inguinal and coxal area also infectious arthritis. This concerns in the first place physicians in the first line of contact.

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Authors summarize their longterm outcomes of the use of 130 degrees angled blade plate in intertrochanteric fractures. The group comprises 110 patients operated on by this technique in the period of 1988-1997. The analysis of the results has proved that this technique was justified in stable fracture classification according to AO/ASIF - A1.1 A1.2. In other fractures A1.3 A2.1 A2.2 A2.3 there occurs after 6 months a varus position and in extreme cases the internal fixation fails. In the second part of the article the authors inform about the results in a group of 24 patients 3 to 6 years after operation. The patients have been subdivided into two groups according to the stability of the fracture; based on the Harris score evidently better results have been recorded in patients with a stable intertrochanteric fracture. Half of these patients reached the score of 81 points and more according to Harris. Key words: intertrochanteric fracture of proximal femur, technique of 130 degrees angled blade plate.