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1.
Rozhl Chir ; 103(6): 219-223, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38991785

RESUMEN

INTRODUCTION: Volkmann's ischaemic contracture (VIC) is a disabling condition resulting from tissue necrosis due to impaired vascular supply to the limb. Over the years VIC has become rare in developed countries with many different aetiologies described. It was alarming to have high incidence of established VIC in our practice in Nepal. A detailed analysis was conducted to accurately describe this issue. METHODS: We collected 47 cases of VIC over six years and noted the age, sex, district of origin and cause of VIC, duration of injury to presentation, and the grade of VIC. Then we compared these characteristics of VIC of each Nepal province and created a map to show the problematic regions. RESULTS: Out of 47 patients, 46 could have been prevented by an early treatment. The most common cause was a tight cast in 25 patients (53.19%), followed by unintentionally self-caused VIC by applying tight bandages in 21 patients (44.68%). Most cases came from province 6 (29.78%). Our group included three mild (6.4%), 35 moderate (74.5%) and nine severe (19.1%) cases of VIC. Only 14 cases (29.78%) had a timely fasciotomy in the past. CONCLUSION: VIC is an irreversible complication of the compartment syndrome which is an easily preventable condition in the setting of developing countries. Our focus should, therefore, aim at preventing such disastrous conditions as 97.87% of cases we encountered could have been avoided by proper primary care. In the case of Nepal most cases came from province 6 and province 3.


Asunto(s)
Países en Desarrollo , Contractura Isquémica , Humanos , Masculino , Nepal/epidemiología , Femenino , Adulto , Contractura Isquémica/etiología , Persona de Mediana Edad , Adolescente , Niño , Extremidad Superior/irrigación sanguínea , Adulto Joven , Preescolar , Anciano
2.
Acta Chir Orthop Traumatol Cech ; 90(5): 329-334, 2023.
Artículo en Checo | MEDLINE | ID: mdl-37898496

RESUMEN

PURPOSE OF THE STUDY Extended lateral approach to calcaneus fractures is associated with a high risk of infection. Such risk can be reduced by using mini-invasive approaches. The sinus tarsi approach provides a good overview of the posterior joint facet of the calcaneus and can also be done as a mini-invasive procedure. The authors present their fi rst experience with osteosynthesis of joint depression calcaneal fractures using the anterolateral locking plate inserted through the sinus tarsi approach. MATERIAL AND METHODS During the period from 1 February 2020 to 31 January 2022, 18 patients were treated by the anterolateral locking plate in the authors' department (3 women, 15 men). Eleven fractures were classifi ed according to Sanders as IInd grade, fi ve as IIIrd grade and two fractures were classifi ed as tongue-type (as described by Essex-Lopresti). The fractures were treated by open reduction through the sinus tarsi approach and osteosynthesis by the anterolateral locking plate combined with headless screws. The following factors were examined: time from injury, duration of surgery, quality of reduction (post-op control with multiplanar CT scans), wound and technical complications, loss of reduction after treatment, substance abuse and comorbidities. The follow-up was 12-36 months (median 17). At one year after surgery, the functional outcomes were evaluated using the AOFAS Hindfoot score. RESULTS The most common negative predispositions for successful healing were smoking (9 cases), alcohol abuse, drug abuse, mild mental retardation, personality disorder, insulin-dependent diabetes and epilepsy (1 case each), hypothyreodism and bronchial asthma (2 cases each). The time from injury to surgery and duration of surgery surgery were measured. The quality of reduction was excellent in 12 patients (dislocation less than 1 mm), good in 6 patients (dislocation less than 2 mm), dislocation more than 2 mm was not present in the group. In one case, a revision surgery was performed because of screw malposition into the subtalar joint, delayed wound healing was observed in two cases. There was no case of deep surgical site infection or loss of reduction. The mean AOFAS score after one year was 85 points. The most common complaints were scar pain or discomfort. DISCUSSION The current studies on osteosynthesis of calcaneal fractures favor the sinus tarsi approach for its lower risk of wound-related complications compared to the extended lateral approach. The sinus tarsi approach requires the use of different osteosynthetic material than the conventional calcaneal plate. If a conventional locking plate is to be used, the surgical approach has to be modifi ed. In 2021, Wang et al. published an intermediate step leading to the reduction of early complications and the use of conventional locking calcaneal plate inserted through the sinus tarsi approach, with an additional incision. The sinus tarsi approach is used also when intramedullary nailing is performed, which is preferred by biomechanical studies evaluating the rigidity of osteosynthesis. However, when comparing nails and locking plates, the differences are insignifi cant. The use of anterolateral locking plates was presented by Xie et al., with results similar to those of our own group of patients. CONCLUSIONS The results of the followed-up group of patients confi rm low complication rate of the sinus tarsi approach as reported by current literature. At the same time, it provides good options for reduction even in complicated fractures. For successful osteosynthesis, the anterolateral locking plate with headless screws may be used. The incidence of post-operative complications is low even in high-risk patients. Adhesions of peroneal tendons can be treated with material removal and tissue release. They could be prevented by good physiotherapy. Key words: calcaneus, osteosynthesis, anterolateral plate, peroneal tendons, sinus tarsi approach.


Asunto(s)
Traumatismos del Tobillo , Calcáneo , Fracturas Óseas , Fracturas Intraarticulares , Traumatismos de la Rodilla , Masculino , Humanos , Femenino , Fracturas Óseas/cirugía , Fijación Interna de Fracturas/métodos , Calcáneo/cirugía , Calcáneo/lesiones , Tomografía Computarizada por Rayos X , Tornillos Óseos , Placas Óseas , Resultado del Tratamiento , Fracturas Intraarticulares/cirugía
3.
Rozhl Chir ; 99(8): 368-372, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33032443

RESUMEN

Fractures of the surgical neck of the scapula combined with a fracture of the coracoid base constitute a specific and rare type of a fracture pattern. When displaced, they present a severe, completely unstable type of surgical neck fracture, requiring a precise CT diagnosis, open reduction and stable internal fixation of the fracture via the Judet approach. The aim of this study is to describe our four cases and discuss three others reported to date.


Asunto(s)
Fracturas Óseas , Fracturas de la Columna Vertebral , Artrodesis , Fijación Interna de Fracturas , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Humanos , Escápula/diagnóstico por imagen , Escápula/lesiones , Escápula/cirugía
4.
Acta Chir Orthop Traumatol Cech ; 84(3): 182-188, 2017.
Artículo en Checo | MEDLINE | ID: mdl-28809637

RESUMEN

PURPOSE OF THE STUDY The study aims to evaluate and compare the results of conservative and operative treatment of individual types of distal ulna fractures associated with distal radius fracture treated by plate osteosynthesis and to verify the conclusions of the other authors regarding the recommended therapeutic procedures in these fractures. MATERIAL AND METHODS In the period from 08/2013 to 09/2015, a total of 81 patients participated in the prospective randomised study, with the mean follow-up period of 24 months (6-36). All the fractures of distal two thirds of ulnar styloid process were treated conservatively. The patients with the other types of ulnar fractures (fractures of the proximal third of ulnar styloid process, ulnar head fractures, subcapital fractures) were systematically divided into two cohorts, based on which the subsequent (conservative vs. operative) treatment of distal ulna fractures was indicated. The operative treatment of all the types of distal ulna fractures was performed by plate osteosynthesis using LCP Distal Ulna Plate implant so that a uniform method is applied. RESULTS In the post-operative follow-up not a single patient with tip fracture of ulnar styloid process in the cohort showed a posttraumatic instability or disorder of distal radioulnar joint (DRUJ) biomechanics (ROM 96.6% (91-100), MWS 61.3 points (75-100), QDASH 2.9 points (0-6.8)). The patients with a fracture of the proximal third of ulnar styloid process, a fracture of ulnar head and a subcapital fracture, treated operatively, achieved better early radiographic and functional outcome (ROM 95.7% (60-100), MWS 91.2 points (75-100), QDASH 3.5 points (0-11.4)) than patients treated conservatively (ROM 89.6% (64-100), MWS 70.4 points (35-85), QDASH 18.4 points (0-52.3)). DISCUSSION The study confirms the conclusions drawn by the other authors that tip fractures of ulna do not cause posttraumatic DRUJ instability and do not require operative treatment. Conservative treatment of ulnar base fractures led to non-union in 60% of cases and to malunion in 25% of cases, altogether in 15 patients (75%) the clinical examination revealed a conclusive posttraumatic DRUJ instability of various severity and these patients showed healing in malunion ad latus greater than 2 mm and non-union of the fracture. By performing anatomical reduction and osteosynthesis of ulnar "base fractures", the stability and DRUJ function were restored in all the patients, thus also a better functional outcome was attained. Conservative treatment of ulnar head fractures brought worse outcomes due to malunion of fractures resulting in a noncongruent articular surface of DRUJ or a change in axial position of the distal end of the bone. The change in DRUJ biomechanics resulted in a limited rotation of radius and a limited range of forearm mobility. The operative treatment of subcapital ulna fracture had a very good early outcome as compared to conservative treatment of the fracture which healed in malunion, the change of axial position of the distal end of the bone resulted in a limited range of forearm mobility. CONCLUSIONS Based on the early functional and radiographic outcomes of RCT study it can be stated, in agreement with the other authors, that the operative treatment of distal ulna fractures associated with the distal radius fracture treated by ORIF should be indicated for base fractures of ulnar styloid process associated with DRUJ instability following the osteosynthesis of distal radius fracture and peripheral fragment dislocation ad axim or ad latus in radial direction by 2 mm and more, and also in case of displaced ulnar head fractures and instable and displaced subcapital fractures of the ulna. Key words: distal ulna fracture, plate osteosynthesis, LCP distal ulna plate.


Asunto(s)
Placas Óseas , Tratamiento Conservador , Fijación Interna de Fracturas , Fracturas del Radio/terapia , Fracturas del Cúbito/terapia , Estudios de Seguimiento , Curación de Fractura , Humanos , Selección de Paciente , Estudios Prospectivos , Fracturas del Radio/complicaciones , Rango del Movimiento Articular , Factores de Tiempo , Resultado del Tratamiento , Fracturas del Cúbito/complicaciones
5.
Rozhl Chir ; 95(11): 386-393, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28033016

RESUMEN

INTRODUCTION: Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and only brief mentions can be found in the literature. METHODS: The group comprised 12 patients (mean age, 39 years), who sustained 13 fractures of the glenoid fossa. In all the fractures, all parts of the glenoid fossa were separated from the scapular neck or body. In total 5 patients (6 fractures) were treated non-operatively and 7 patients were operated on. The method of treatment was based on displacement of the fragments, the patient´s general and local conditions. Indication for operative treatment was displacement of articular fragments of more than 3mm. This criterion was met by 10 patients (11 fractures). Owing to the general or local condition, operation was contraindicated in 2 patients with 3 fractures; one patient refused the operation. One patient with a bilateral fracture was lost to follow-up. RESULTS: According to the site of separation of articular fragments, the fractures were divided into three groups - the separation line passed through the anatomical neck; through the coracoid process or surgical neck of the scapula; or through the scapular body. In 6 of the 7 operated patients, a good or very good result was achieved. In 2 patients with minimal fragment dislocation treated non-operatively, the fractures healed in an anatomical position and full range of motion was achieved. In 2 patients with severe fragment displacement treated non-operatively, the healing resulted in glenoid fossa incongruence and painful and limited range of motion. CONCLUSION: Fractures of the entire glenoid fossa are the most severe injuries to scapula. Their diagnosis requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment from the Judet approach.Key words: scapular fractures glenoid fractures classification, operative treatment Judet approach.


Asunto(s)
Fracturas del Hombro/terapia , Adolescente , Adulto , Anciano , Femenino , Fijación de Fractura , Curación de Fractura , Humanos , Inmovilización , Masculino , Persona de Mediana Edad , Terapia Pasiva Continua de Movimiento , Fracturas del Hombro/diagnóstico por imagen
6.
Acta Chir Orthop Traumatol Cech ; 82(5): 369-76, 2015.
Artículo en Checo | MEDLINE | ID: mdl-26516956

RESUMEN

PURPOSE OF THE STUDY: The aim of the study was to describe the indication criteria and operative technique and to present the first conclusions of a prospective study dealing with an assessment of functional and radiographic findings in patients with concurrent fractures of the distal ulna and distal radius; the former was treated by osteosynthesis using an LCP Distal Ulna Plate (De Puy Synthes, USA) and the latter by plate osteosynthesis. MATERIAL AND METHODS: Between August 2013 and September 2014, 18 patients (3 men and 15 women; average age, 58 years; range, 25-74 years) with a fracture of the distal ulna and a concurrent distal radius fracture were treated by plate osteosynthesis. The indications for surgery included displaced ulnar styloid base fractures in 10 patients, displaced comminuted fractures of the ulnar head in seven patients and a subcapital fracture of the ulna in one patient. The average follow-up was 9 months, with 13 (72%) patients being followed up for 6 months at least. The outcome of surgery was evaluated on the basis of X-ray views and multiplanar reconstruction of CT scans. Functional results were based on measuring the range of motion at wrist and forearm and hand grip strength and on the scores obtained from the Mayo Wrist Score System and Quick DASH Questionnaire. RESULTS: The average values for wrist and forearm range of motion were as follows: 68° in flexion (60-80°), 71° in extension (40- 90°), 87° in pronation (70-90°), 81° in supination (50-90°). This corresponded to a 92% (74-100%) range of motion at the contralateral wrist and forearm. The average hand grip strength measured with a dynamometer was 80.6% (53-100%) of the gripping force exerted by the unaffected extremity. Post-operative X-ray and CT findings showed good reduction of both distal radius and distal ulna fractures as well as good fragment retention by means of LCP implants. During follow-up complete bone union and full stability of the radioulnar joint were achieved in all patients. The functional outcome of treatment was shown by the average Mayo wrist score and Quick DASH score of 84 (55-100) and 7.4 (0-47.7) points, respectively. DISCUSSION: The functional outcome of treatment in our patients corresponded to the severity of their distal forearm fractures. The patients with more serious distal radius fractures, frequently associated with ulnar head fractures, had poorer functional results than the patients with less serious fractures. According to the AO classification, in the distal radius fractures, prevailing fracture types were 23-C3 (78%) and 23-C2 (16%). In relation to the distal ulna fracture type, the patients with ulnar styloid base fractures had better functional results than the patients with ulnar head fractures, because a fracture of the styloid process does not affect the congruency of the distal radioulnar joint (DRUJ). Fractures of the ulnar styloid process base, following distal radius fracture osteosynthesis, were invariably associated with DRUJ instability. This fracture type is always accompanied by injury to the distal radioulnar ligament of the triangular fibrocartilage complex (TFCC) and, in case of a displaced fracture, surgical management is indicated. In agreement with the results of other authors it was found in our study that, when the anatomical position of the distal radioulnar joint had been achieved, both the functional and the radiographic findings were post-operatively very good. The final average values for the range of wrist and forearm motion, hand grip strength and hand and arm function were assessed as very good. CONCLUSIONS The assessment of our results and their comparison with the literature data showed that osteosynthesis of distal ulna fractures with concurrent distal radius fractures managed by open reduction and internal fixation are indicated in displaced fractures of the ulnar styloid process base, displaced comminuted fractures of the ulnar head where fragments interfere with DRUJ congruency, and unstable displaced subcapital fractures of the ulna. The early results of this study provide evidence for the efficiency of plate osteosynthesis in the treatment of distal ulna fractures.


Asunto(s)
Placas Óseas , Fijación Interna de Fracturas/métodos , Traumatismo Múltiple/cirugía , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adulto , Anciano , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico por imagen , Estudios Prospectivos , Radiografía , Fracturas del Radio/diagnóstico por imagen , Recuperación de la Función , Resultado del Tratamiento , Fracturas del Cúbito/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/fisiopatología , Traumatismos de la Muñeca/cirugía , Articulación de la Muñeca/fisiología
7.
Eur J Trauma Emerg Surg ; 41(6): 601-14, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26037997

RESUMEN

INTRODUCTION: Injuries to the distal tibiofibular syndesmosis are frequent and continue to generate controversy. METHODS: The majority of purely ligamentous injuries ("high ankle sprains") is not sassociated with a latent or frank tibiofibular diastasis and may be treated with an extended protocol of physical therapy. Relevant instability of the syndesmosis with diastasis results from rupture of two or more ligaments that require surgical stabilization. Syndesmosis disruptions are commonly associated with bony avulsions or malleolar fractures. Treatment consists in anatomic reduction of the distal fibula into the corresponding incisura of the distal tibia and stable fixation. Proposed means of fixation are refixation of bony syndesmotic avulsions, one or two tibiofibular screws and suture button. There is no consensus on how long to maintain fixation. Both syndesmotic screws and suture buttons need to be removed if symptomatic. RESULTS/COMPLICATIONS: The most frequent complication is syndesmotic malreduction and may be minimized with open reduction and intraoperative 3D scanning. Other complications include hardware failure, heterotopic ossification, tibiofibular synostosis, chronic instability and posttraumatic arthritis. CONCLUSION: The single most important prognostic factor is anatomic reduction of the distal fibula into the tibial incisura.


Asunto(s)
Fracturas de Tobillo/cirugía , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Ligamentos Articulares/lesiones , Fracturas de Tobillo/diagnóstico , Fracturas de Tobillo/fisiopatología , Traumatismos del Tobillo/diagnóstico , Traumatismos del Tobillo/fisiopatología , Fenómenos Biomecánicos/fisiología , Tornillos Óseos , Remoción de Dispositivos , Peroné/cirugía , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/fisiopatología , Luxaciones Articulares/cirugía , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/prevención & control , Ligamentos Articulares/cirugía , Imagen por Resonancia Magnética , Examen Físico/métodos , Complicaciones Posoperatorias/etiología , Rotura/cirugía , Técnicas de Sutura , Tibia/cirugía , Tomografía Computarizada por Rayos X , Anomalía Torsional/etiología
8.
Acta Chir Orthop Traumatol Cech ; 81(6): 399-406, 2014.
Artículo en Checo | MEDLINE | ID: mdl-25651295

RESUMEN

PURPOSE OF THE STUDY: The aim was to determine indication criteria for use of arthroscopy in the treatment of post-traumatic changes in the elbow joint, to present the surgical technique and to evaluate the results of a prospective study involving early follow-up of functional and radiographic outcomes of this treatment. MATERIAL AND METHODS: Between February 2010 and February 2013, arthroscopic surgery was carried out on 14 elbows in 14 patients at the Clinic of traumatology of Masaryk hospital in Ústí nad Labem. The group comprised seven men and seven women, with an average age of 40 years (range, 20 to 67 years). The indications for elbow arthroscopy included conditions after intraarticular fractures in fie, elbow dislocation in one, severe elbow contusion in four and complex injury to the elbow joint in four patients. Arthroscopic surgery was performed at an average of 11 months after the primary injury. The prospective follow-up lasted for an average of 12 months (range, 6 to 25). The outcomes of surgery were evaluated on the basis of radiograms and multiplanar reconstructions of CT images, elbow function was assessed using two rating systems, i.e., the Mayo Elbow Performance Score (MEPS) and Hospital for Special Surgery (HSS) score. RESULTS: The average active range of motion (ROM) at the elbow joint was 118°/33° (145°-90°/60°-5°) before surgery and improved to 131°/5° (150°-90°/15°-0°), i.e., by 13°/28° (150°-90°/60°-0°) intra-operatively. The average fial value of elbow ROM after functional stabilization was 126°/16° (145°-90°/70°-0°), which means improvement by 8°/17° (45°-0°/50°-0°) or a total of 25°. On post-operative radiograms, the fidings were stable in 11 (79%) patients; elbows in three patients (21%) showed progression of degenerative changes (osteophyte formation and periarticular ossifiation). The fial functional scores, as assessed using the MEPS and HSS score systems, were 88.93 (55-100) and 88.29 (50-100) points (average/ range), respectively. DISCUSSION: The study showed, in agreement with other authors' reports, that the degree of improvement in active range of motion and functional performance of the elbow is directly related to the severity of post-traumatic conditions. A certain residual ROM restriction usually remains. The outcome was poorer in patients with complex injuries of the elbow or in those with displaced intra-articular fractures of the joint and was also related to the severity of joint injury. Patients who were treated after a longer injury-to-surgery period and who suffered a more serious joint injury had more advanced arthritis, higher degree of joint contracture, worse pre-operative functional scores and less improvement in post-operative ROM of the elbow joint. CONCLUSIONS: From the results of early functional assessments and radiographic fidings it can be concluded that the elbow joint arthroscopy is a safe and reliable technique to treat post-traumatic conditions caused by intrinsic factors in mild and moderate elbow stiffness. However, this method cannot be recommended in severe stiffness of the elbow or in stiffness due to extrinsic causes. Although the improvement in ROM achieved during the surgical procedure cannot be maintained in its full extent, this technique relieves persisting pain and signifiantly improves ROM of the elbow joint.


Asunto(s)
Artroscopía/métodos , Articulación del Codo/cirugía , Artropatías/cirugía , Adulto , Anciano , Articulación del Codo/fisiopatología , Femenino , Humanos , Artropatías/etiología , Artropatías/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular , Resultado del Tratamiento , Adulto Joven
9.
Acta Chir Orthop Traumatol Cech ; 80(2): 165-70, 2013.
Artículo en Checo | MEDLINE | ID: mdl-23562263

RESUMEN

PURPOSE OF THE STUDY: The aim of this prospective study was to present injury characteristics and to evaluate therapeutic procedures and midterm functional and radiographic results of the surgical management of talus fractures. MATERIAL AND METHODS: In the period from January 1, 2004, to December 31, 2009, a total of 53 patients with 56 talar bone fractures or peritalar dislocations were treated surgically. The prospective study included 39 patients with 42 fractures of the talar neck and body; of these, 31 men had 34 fractures (79.5%) and eight women had eight fractures (20.5%). There were recorded demographic data, medical history, associated injuries, polytrauma criteria, time to surgery and its type, failure of osteosynthesis, complications associated with soft tissue healing, length of hospital stay, duration of follow-up, radiographic evidence of bone healing and the presence of avascular necrosis or arthritis. Fractures were classified according to the systems of Hawkins (modified by Canale), Sneppen and Marti. Outcomes were assessed on the basis of functional and radiographic scores (West Point Ankle Score). The injuries included 21 (50%) talar neck fractures, 12 (28.5%) isolated fractures of the talar body and nine (21.5%) combined fractures of the talar neck and body. There were four (9.5%) open fractures. Twenty-five (64.1%) patients had associated skeletal injuries; eight (20.5%) patients suffered polytrauma. Staged treatment was used in five patients (12.8%). The average time to final surgery was 4.2 days. The technique of minimally invasive osteosynthesis under fluoroscopic or arthroscopic control was used in 18 (42.9%) fractures, and open reduction and internal fixation was carried out in 24 (57.1%) fractures. The average follow-up was 30.9 months. RESULTS: Signs of avascular necrosis partly or completely affecting the talar body were found in six fractures (14.3%), three of which required secondary arthrodesis. Arthritis developed in 10 cases (23.8%) Functional and radiographic results assessed with the West Point Ankle Score, regardless of fracture type, were excellent in 17 (43.5%), good in 11 (28.2%), satisfactory in five (12.8%) and poor in six (15.5%) patients. DISCUSSION: High incidence of polytrauma and complex injuries of the hindfoot makes the timing of surgical management difficult and also affects its outcome. Timing used in our study is in agreement with general trends of staged talus fracture treatment. In accordance with the international practice, the majority of non-displaced talar neck fractures (Hawkins 1) were treated by means of osteosynthesis. We preferred minimally invasive fracture reduction under arthroscopic control in less complicated fracture types of the talar neck and body. The incidence of avascular necrosis, as reported in the literature, has had a decreasing tendency. Incidence of avascular necrosis without talar dome collapse does not necessarily lead to functional impairment. The results of functional and radiographic scoring were in agreement with the literature data and confirmed that functional outcome is related to the severity of fracture. CONCLUSIONS: Our results confirmed that the management of talar fractures by means of osteosynthesis is indicated even in nondisplaced Hawkins type 1 fractures, staged treatment is effective in dislocated and open fractures, delayed surgery is a safe procedure for less dislocated fractures and injuries requiring complex care should be referred to foot surgery centres.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Astrágalo/lesiones , Adolescente , Adulto , Femenino , Fracturas Óseas/clasificación , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Adulto Joven
10.
Acta Chir Orthop Traumatol Cech ; 79(4): 341-6, 2012.
Artículo en Checo | MEDLINE | ID: mdl-22980933

RESUMEN

PURPOSE OF THE STUDY To inform on our experience with the treatment of humeral shaft fractures by intramedullary osteosynthesis using Hackethal's bundle nailing and to evaluate indications for the current use of this technique. MATERIAL AND METHODS From January 2001 to December 2009, a total of 184 patients with humeral shaft fractures were treated surgically and, of these, 147 by Hackethal's nailing. From January 2006 60 patients treated by this technique were prospectively followed up and, of them, 50 were evaluated (83.3%) and included in this study. The average age of the study group was 51.2 years. Fifteen fractures (30%) were in the proximal third, 32 (64%) in the middle third and three (6%) in the distal third of the humeral diaphysis. According to the AO classification, the distal-third diaphyseal fractures were mostly type A2 (26.6%) and type B1 (20.1%) , mid-third fractures were mostly type A3 (31.3%) and distal-third fractures were not evaluated because of their low number. Based on radiographic examination, patients with uncomplicated fractures of the humeral shaft were indicated for surgery. This was performed according to the original Hackethal's procedure with the patient in the prone position using Kirschner wires, 2 mm in diameter, as implants. The patients were followed up at 6 weeks and 3, 6, 9 and 12 months after surgery. On examination, healing of the operative wound, bony union achieved and radiographic findings of the fragment position were evaluated. The range of mo tion at the shoulder and elbow was assessed and subjective patients' feelings were recorded. RESULTS Of the 50 patients evaluated, 45 (90%) healed by first intention, four developed pseudoarthrosis (8%) and one required repeat surgery. No deep wound infection was recorded. Six patients (12%) had humeral angulation up to 10 degrees and one (2%) up to 13 degrees. This angulation was recorded in proximal-third diaphyseal fractures. A deviation in humeral internal rotation was found in two patients (4 %), in one of whom it was 40 degrees. Mild restriction of elbow extension (10 degrees) was found in two patients (4%), five (10%) reported slightly restricted motion of the shoulder and five, chiefly elderly patients with proximal-third diaphyseal fractures, had severe restriction of shoulder motion. Most of the patients (78%) reported full satisfaction, including return to normal daily activities, at 6 months after injury. When the therapy was finished at 12 months after surgery, 44 patients (88%) expressed their full satisfaction. DISCUSSION Our results give support to the previously reported good outcomes of Hackethal's osteosynthesis of the humeral shaft. This method is associated with a minimum of complications if the conditions of correct indication are fulfilled, i.e., uncomplicated fractures of the mid-third humeral diaphysis are considered. Filling the medullary cavity completely with K-wires or nails is an additional condition. Without these being met, good stability of the fracture is not achieved and non-union can develop, as shown by the analysis of cases with non-union in our patient group. CONCLUSIONS Hackethal's technique of osteosynthesis with elastic bundle nailing facilitates safe and easy treatment of uncomplicated diaphyseal fractures of the humerus. Its outcomes are comparable with the other currently used and more expensive methods. It is the method of first choice in the treatment of transverse and short oblique fractures of the mid-third of the humeral shaft. Key words: humeral shaft fractures, bundle nailing, Hackethal's technique.


Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas/métodos , Fracturas del Húmero/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
12.
Acta Chir Orthop Traumatol Cech ; 79(3): 228-32, 2012.
Artículo en Checo | MEDLINE | ID: mdl-22840954

RESUMEN

PURPOSE OF THE STUDY: The aim of this prospective study was to evaluate the clinical and radiographic results in a group of patients with calcaneal fractures treated by means of minimally invasive, arthroscopically-assited osteosynthesis. MATERIAL AND METHODS: A total of 175 calcaneal fractures in 154 patients were treated surgically at the Trauma Centre of Masaryk Hospital between January 2006 and August 2010. Twenty-six patients were enrolled in this prospective study. They had a total of 30 calcaneal fractures, of which 28 were managed by minimally invasive, arthroscopically-assisted osteosynthesis. The patient's records included demographic data, relevant medical history, fracture type by Sander's classification, associated injuries, time to surgery, length of surgery, post-operative quality of reduction, Böhler's angle before and after surgery, healing complications, hospitalisation time, follow-up period, bone union, functional outcome in Rowe score and hardware removal. The patients underwent minimally invasive osteosynthesis under arthroscopic and radiographic guidance. For this procedure, patients with Sanders type IIa and IIb fractures were predominantly indicated. The group also included patients older than 60 years, smokers, patients addicted to alcohol, a diabetic patient, a dialysed patient and a patient with chronic lower-limb lymphoedema. RESULTS: The patient group included 21 men with 25 fractures (83.5%) and five women with five fractures (16.5%). Nine men (42.9%) were heavy smokers; three men (14.3%) and one woman (20 %) were addicted to alcohol. All fractures were closed and, according to the Sanders system, were classified as follows: 16 fractures as type IIa (57.1%); eight fractures as IIb (28.6%); two fractures as IIIab (7.1%) and one IIIac and IIIbc (3.6% respectively). Six patients (23.1%) sustained bilateral fractures of the lower-limb. In the post-operative period, no disturbance of soft tissue healing and no superficial or deep wound infection were observed. The outcome of fracture reduction assessed by CT examination was excellent in 24 fractures (85.6%), satisfactory in one (3.6%) and poor in one fracture (3.6%). The mean Böhler's angle was +7.2 degrees pre-operatively and +35.4 degrees post-operatively. In all patients bone union was achieved within 3 months; hardware was removed in 19 fractures (67.9%). Functional outcomes according to the Rowe score were very good in 18 (69.2%), good in four (15.4%) and satisfactory in four (15.4%) patients. There were no poor results. The mean Rowe score for the whole patient group was 86 points. DISCUSSION: The demographic data are in agreement with the recent literature data. However, most studies have not included smokers and people addicted to alcohol, therefore, no comparison can be made. The comparison with studies on ORIF-treated fractures is also difficult, because our study included a higher number of less severe fracture types. The surgical technique is demanding and was, at the beginning, associated with intra-operative errors. The post-operative values of Böhler's angle are comparable to the results of ORIF techniques, but this does not mean that this technique could substitute the use of ORIF in complex fractures. The absence of any soft- or bone-tissue healing problems is a very good result, considering the number of risk factors in our patient group. The good functional outcomes according to the Rowe score can be attributed to a higher proportion of less complex fractures in the group. CONCLUSIONS: In our group of patients with predominantly less severe types of calcaneal fractures, the quality of post-operative fracture reduction, as a result of minimally invasive, arthroscopically-assisted osteosynthesis, appeared to be comparable with open techniques. The observed complete bone healing and absence of soft-tissue problems could present a surgical option to treatment nihilism in patients contraindicated for ORIF techniques.


Asunto(s)
Artroscopía , Calcáneo/lesiones , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Fracturas Cerradas/cirugía , Adulto , Femenino , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Fracturas Cerradas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto Joven
13.
Acta Chir Orthop Traumatol Cech ; 78(4): 314-20, 2011.
Artículo en Checo | MEDLINE | ID: mdl-21888841

RESUMEN

PURPOSE OF THE STUDY: To evaluate the mid-term results in a group of patients with displaced comminuted (three- and four-fragment) fractures of the proximal humerus treated by angle-stable plate osteosynthesis and compare them with the results in the patients in whom the method of percutaneous Kirschner-wire (K-wire) fixation was used. MATERIAL AND METHODS: The group treated with angle-stable implants (ASI group) consisted of 55 patients, 13 men and 42 women. A Targon Ph nail was used in 32 and a Philos plate in 23 patients. These patients were compared with a group of nine patients, one man and eight women, treated by percutaneous K-wire fixation (K-wire group). At a follow-up of 12 months at least, final Constant (CS) and DASH scores were assessed. The CS was related to the values for the unaffected limb, and an individual relative CS was calculated and expressed in percent. The mean follow-up was 30 (range, 13-55) months in the ASI group and 58 (range, 39-76) months in the K-wire group. The following seven characteristics were evaluated : fracture type, surgical technique, dominance of the affected limb, patient age, injury-surgery interval, and individual relative CS and DASH scores. The results were statistically analysed with a 5% level of statistical significance set for all tests. RESULTS: The average age in the ASI group was 62.1 years, with 64.7 (range, 29-95) years for women and 35.5 (range, 26-76) years for men. In the K-wire group the average age was 66.1 (range, 53-84) years. The functional outcomes in four-fragment fractures were significantly worse than in three-fragment fractures (mean relative CS and DASH scores of 56 and 21 versus 72 and 32). The K-wire group showed a significantly worse functional outcomes than the ASI group in both the mean relative CS score (p<0.001) and the mean DASH score (p=0.003). No significant relationship was found in any other pair of variables. The patient's age had no effect on functional outcome, as assessed by CS (p=0.412) and DASH (p=0.076) and the injury-surgery interval had no influence, either (CS, p=0.220; DASH, p=0.118). There was no relation between the patient's age and choice of the surgical method (p=0.467), between the patient's age and a fracture type (p=0.356) and between the patient's age and injury to either a dominant or a non-dominant limb (p=0.659). Dominance or non-dominance of the affected limb had no effect on CS or DASH scores (p=0.662 and p=0.302, respectively) or on a type of fracture (p=0.183). DISCUSSION: Several surgical techniques used for the treatment of proximal humerus fractures suggest the absence of consensus in therapy. Novel angle-stable implants show better biochemical properties and meet criteria required in minimally invasive techniques. Some authors prefer intramedullary nailing for three-fragment fractures and the use of an angle-stable plate for four-fragment fractures. These indication criteria were also confirmed by the results of our study. CONCLUSIONS: The analysis of functional outcomes showed that the therapeutic effect of K-wire transfixation was significantly worse than the effect of the angle-stable plate technique, and therefore the authors stopped using this method. At present intramedullary nailing is indicated in two- and three-fragment fractures and in some less displaced four-fragment fractures. An angle-stable plate is used in severely displaced four-fragment fractures. If the head is broken or dislocated, older patients are primarily indicated for hemiarthroplasty and younger ones for humeral head reconstruction.


Asunto(s)
Hilos Ortopédicos , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fracturas del Hombro/cirugía , Resultado del Tratamiento
14.
Acta Chir Orthop Traumatol Cech ; 78(2): 120-5, 2011.
Artículo en Checo | MEDLINE | ID: mdl-21575554

RESUMEN

PURPOSE OF THE STUDY: The aim of the study was to assess the clinical outcomes and permanent sequelae of pelvic fractures at one year after injury and to identify factors that influenced these results. MATERIAL AND METHODS: The group evaluated consisted of 151 patients older than 15 years treated for pelvic fractures in 2007 at seven hospitals in the Czech Republic and Slovakia. This one-year descriptive prospective study included all basic epidemiological data concerning the patients and the evaluation of their clinical results using the Majeed score. The obtained data were statistically analysed by the 2% test of independence and contingency tables at a 5% level of significance. For data obtained at a low frequency, only descriptive statistical methods were used. RESULTS: From the original group of 237 patients (101 women and 136 men), 16 died (7 women and 9 men) and 70 were lost for follow-up (28 women and 42 men), leaving 151 patients (64%) for evaluation. This final group comprised 66 women (44%) and 85 men (56%) with the age range of 16 to 82 and an average age of 42.7 years (women, 45.3 years; men, 40.7 years). Age distribution, causes of injury, types of pelvic fracture, associated injuries and methods of treatment in this group were similar to those in the original group. The clinical outcomes evaluated using the pelvic Majeed score were excellent and good in 85%, fair in 12% and poor in 3% of the patients. The prediction of clinical outcome was more accurate when based on the extent of dislocation of the dorsal segment after fracture healing than on the type of pelvic fracture The permanent sequelae were recorded in 22 patients (15%) and a total of 43 specific complaints were identified; some patients had multiple sequelae involving neurological, urological and sexual problems. Neurological deficit was related to the type of pelvic injury and its highest occurrence was associated with type C pelvic fractures. Permanent neurological deficits were found in 15 patients (10% of patients in the final group), of whom 10 were diagnosed early after injury as having neurological lesions (7% of the final group) and in five the diagnosis was made after surgery (8 %of surgically treated patients). Fifteen permanent urological disorders were recorded in 13 patients and they also were most frequent in type C fractures. However, they were more strongly associated with primary urethral injury and primary or post-operative neu-rogenic lesions. Sexual sequelae were also found in association with type C fractures; almost all patients with these problems had injury to the lower urinary tract or neurogenic lesions. Permanent gastrointestinal sequelae were in three patients; all of them sustained unstable pelvic fractures and were diagnosed with post-operative neurogenic lesions. DISCUSSION: Based on the evaluation of basic patient data, the patient group described here can be regarded as a representative sample of the originally treated patients. Therefore, in the authors' view, the results presented here can be taken as valid. In agreement with other authors, the study recorded poorer clinical outcomes in the patients with more serious types of pelvic injury, and dramatically worse results in relation to the extent of dislocation of the dorsal segment after the pelvic fracture had healed. The authors confirmed that permanent neurological and urological sequelae occur more frequently in patients with a more serious pelvic injury. Urological and sexual problems were more often associated with the presence of neurologi- cal deficit than with the type of pelvic fracture and injury to the lower urinary tract. CONCLUSIONS: The evaluation of patient data at one year after pelvic injury in this prospective longitudinal study justify the authors to draw the following conclusions: clinical outcomes were worse in unstable pelvic fractures; worse clinical results were related to the extent of residual dislocation of the dorsal pelvic segment; permanent neurological sequelae were most frequent and were perceived by the patients with strong negative feelings particularly when they manifested clinically after surgery; permanent urological, sexual and gastrointestinal problems were more closely associated with neurological deficits than with the severity of primary injury to the pelvic skeleton, lower urinary tract, sexual organs or digestive system.


Asunto(s)
Fracturas Óseas/terapia , Huesos Pélvicos/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas Óseas/complicaciones , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
15.
Acta Chir Orthop Traumatol Cech ; 78(2): 156-60, 2011.
Artículo en Checo | MEDLINE | ID: mdl-21575560

RESUMEN

PURPOSE OF THE STUDY: We aimed to determine the incidence of pressure sores and their effect on survival in patients older than 70 years who underwent surgery for hip fracture, and to identify the factors which were associated with an increased risk of pressure sores. MATERIAL AND METHODS: The group comprised 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fractures in the Trauma center between January 2003 and June 2005. Follow-up ranged from 12 to 18 months. In a prospective study we assessed relevant medical history, demographic and clinical data, pre-, intra-, and post-operative factors and the presence, location and depth of pressure sores. Statistical significance at a 5 % level of probability was determined by testing null hypotheses for qualitative and quantitative variables, using multivariate analysis adjusted for selected baseline characteristics. RESULT: The average age of the patient group was 81 years (range, 70-99). Pressure ulcers developed in 92 patients (34.2 %); their presence in the post-operative period significantly reduced patient survival (p=0.037). In terms of location, pressure ulcers in the calcaneal region had a more significant effect on patient mortality (p=0.011) than those in the sacral region (p=0.130). Age was not significantly associated with pressure ulcer development (p=0.547), in contrast to male gender (p=0.007). A lower mobility score before injury was a significant risk factor (p=0.007). Co-morbidities adjusted for age and gender had a significant effect (p=0.003). The factors that did not significantly increase the risk of pressure ulcers were as follows: the patient's living environment before injury (p=0.113), AO type of fracture (p=0.653), type of anaesthesia (p=0.702), surgical procedure used (p=0.946), morbidity before injury (p=0.267) and time to surgery (p=0.180). The presence of acute complications was of boundary significance (p=0.083). DISCUSSION The study included only the patients with proximal femoral fractures who underwent surgery. It was the authors' view that, by excluding conservatively treated patients, a more homogenous group was achieved. There is only sparse information in the literature concerning the effect of pressure ulcers on reduced patient survival, and the significance of pressure ulcer location has not been evaluated at all. Similarly, the effect of pre-morbidity on pressure ulcer development has not been reported in any of the studies available. In contrast to other studies, the authors did not find age to be a risk factor for increased ulcer development. They believe that the quality and quantity of the input data (prospective data collection, large sample size, long follow-up) guarantee the validity of the results obtained in this study. The incidence of pressure sores is in agreement with the results of relevant studies involving large numbers of patients and prolonged follow-up. CONCLUSIONS: In patients older than 70 years undergoing surgery for hip fracture, the development of pressure ulcers had a significant effect on reduced survival, with the highest significance for ulcers in the calcaneal region. Factors significantly increasing the risk of ulcer development were male gender, morbidity before injury and pre-existing chronic complications. The presence of acute complications was of boundary significance. The study did not show any significant effect of age, pre-morbidities, time to surgery, patient's living environment before injury, fracture type, type of anaesthesia or surgical procedure used on the incidence of pressure ulcers.


Asunto(s)
Fracturas del Fémur/cirugía , Complicaciones Posoperatorias , Úlcera por Presión/etiología , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/mortalidad , Humanos , Masculino , Factores de Riesgo , Tasa de Supervivencia
16.
Rozhl Chir ; 89(9): 473-6, 2010 Sep.
Artículo en Checo | MEDLINE | ID: mdl-21121160

RESUMEN

Although proximal humeral fractures are common diagnosis in emergency, cases of axillary artery injuries are rare. Authors present a patient, who underwent high energy trauma during a traffic accident like a pedestrian. Comminuted proximal humeral fracture was complicated with an occlusion of the third part of the axillary artery. There was necessary an urgent surgery, ostesynthesis with locking plate and reconstruction of the axillary artery by interposition of expanded polytetrafluoroethylene (ePTFE) graft. Postoperative course was uncomplicated, patient had no symptoms of ischaemia of extremity or claudication and started physiotherapy. In review of the literature authors present possible reasons of arterial injuries, possibilities of treatments to minimize risk of amputation. Axillary artery injury from proximal humeral fracture is rare, but every surgeon must be aware of this entity in order to avoid fatal complications.


Asunto(s)
Arteria Axilar/lesiones , Fracturas del Hombro/complicaciones , Accidentes de Tránsito , Anciano , Arteria Axilar/cirugía , Implantación de Prótesis Vascular , Femenino , Fijación Interna de Fracturas , Humanos , Fracturas del Hombro/cirugía
17.
Acta Chir Orthop Traumatol Cech ; 76(5): 404-9, 2009 Oct.
Artículo en Checo | MEDLINE | ID: mdl-19912705

RESUMEN

PURPOSE OF THE STUDY: The aim of the study was to make a basic analysis of the patients treated for pelvic fractures in the year 2007 at 14 institutions in the Czech Republic and Slovakia. MATERIAL AND METHODS: The group investigated consisted of 474 patients treated in 2007. In a one-year prospective descriptive study, patients' data were recorded according to a unified protocol. They included age, gender, mechanism of injury, fracture type, associated injuries, method of treatment, post-operative complications, length of hospital stay, injury/surgery-to-standing time and number of deaths during primary hospitalization.The ?2 test of independence in a contingency table was used to compare categorical data. The level of significance for the test was set at 5%. RESULTS: The group comprised 192 women and 282 men with an average age of 45.9 years (range, 15 to 95). In men, the frequency of pelvic fractures was significantly higher (p<0.001), because men significantly outnumbered women in the largest middle-age categories (30 to 59 years). Pelvic fractures were significantly higher only in women over 80 years of age. The most frequent cause of injury was a road traffic accident (237 patients, 50%). Significantly more men than women were injured in motorbike accidents (p=0.015), due to a fall from height (p=0.001) or by a falling object (p=0.040).Women more frequently suffered injury as a result of a suicidal attempt by jumping (p=0.051) or a simple fall (p<0.001). Type A2.2 fractures (115 patients, 24%; average age, 51.8 years) and type B2.1 (77 patients, 16%; average age, 43.5 years) were most frequent. In 248 patients (52%), a pelvic fracture was part of multiple trauma. These patients had an average ISS of 30 points. Conservative treatment was used in 287 patients (61%). In 71 patients, skeletal traction (30 patients, 6%), C-clamp (19 patients, 4%) or external fixation (22 patients, 5%) was temporarily applied during the primary treatment. Surgery was carried out in 187 patients (39%). The average operative time was 114 minutes (range, 45 to 315) Post-operative complications were recorded in 58 patients (30% of the surgically treated). The most frequent local com- plication was wound infection (11 patients, 6%). The average hospital stay was 27 days (range, 2 to 266); 181 patients (38%) required care at an anaesthesia and acute care department for an average of 14 days (range, 1 to 127). The injury/surgery-to-standing time was 30 days on average (range, 2 to 118 days). Twenty-six patients; nine women and 17 men (5%), died during primary hospitalization. Their average age was 62.5 years (74.1 years in women and 56.4 years in men). DISCUSSION: The higher number of injured men in the middle-age categories suggests a more risky behaviour of these men in driving motor cars and motorbikes and at work (falls from height, objects falling on them).Women significantly outnumbered men in simple falls (which can be explained by a higher occurrence of pubic ramus fractures due to osteoporosis in women at a higher age) and a difference at the margin of statistical significance was recorded in suicidal attempts (any explanation is beyond the scope of this study as well as beyond the field of trauma medicine). The higher number of type A2.2 and also type B2.1 fractures can too be explained by a higher occurrence of these fractures due to simple falls in elderly women with osteoporosis. CONCLUSIONS: The evaluation of the basic demographic and epidemiologic data of patients with pelvic fractures included in this multi- centre study revealed the following facts: pelvic fractures were significantly more frequent in men; the most frequent cause of pelvic fracture was a road traffic accident; the number of injured men was highest at age 40 to 50, in motorbike accidents, falls from height and in injuries by falling objects; women outnumbered men at the age category over 80 and in suicidal jumping from a height; the most frequent types of fractures were those affecting osteoporotic bone in elderly women (A2.2, B2.1); surgical treatment of pelvic fractures was associated with a relatively high number of complications; death during primary hospitalization was higher in elderly patients. Key words: pelvic fracture, demography, epidemiology, type of fracture, associated injuries.


Asunto(s)
Fracturas Óseas , Huesos Pélvicos/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/patología , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Adulto Joven
18.
Acta Chir Orthop Traumatol Cech ; 76(1): 41-6, 2009 Feb.
Artículo en Checo | MEDLINE | ID: mdl-19268048

RESUMEN

PURPOSE OF THE STUDY To assess the effects of medical history, fracture type, method of treatment and complications on the risk of death in elderly patients treated for proximal femoral fracture. MATERIAL AND METHODS The group comprised of 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fracture at the Level I Traumacentre between January 2003 and June 2005. The follow-up ranged from 12 to 38 months. In a prospective consecutive manner the following was recorded: age, gender, serious internal diseases, pre-injury level of mobility, place of living before injury, fracture type (AO classification), time between injury and surgery, anaesthesia, surgical technique, complications and death. Statistical significance at the 95% level was ascertained using null-hypothesis tests for qualitative and quantitative variables by means of multivariate analysis. RESULTS The average age of the patients was 81 years (range, 70 to 99 years). The higher the age, the shorter the time of survival (p=0.015) as each additional year reduced survival by 4.6%. The women to men ratio was 4.2:1. The male gender had a significantly shorter time of survival (p=0.007). Two and more serious internal diseases in the patient's medical history, as compared with a single one, also made survival significantly shorter (p<0.001). When, before injury, a patient moved without walking support, survival was significantly longer than in a patient using a walking cane/crutch (p=0.022) or two canes/crutches or a walker (p<0.001), or in a bedridden patient (p=0.014). The fact that, before injury, a patient was living in a pensioner's home had no effect on a shortened time of survival (p=0.136). Similarly, the fracture type (31A or 31B and subgroups) was not significant for the length of survival (p=0.903). The interval between injury and surgery was not a risk factor for survival (p=0.269). No effect of the type of anaesthesia on survival was found (p=0.450). Neither the surgical technique nor the type of implant was significant for survival time. When general internal complications occurred, they affected the length of survival significantly (p<0.001). Also, pressure sores developing in the post-operative period significantly shortened the time of survival (p=0.037). Early complications did not result in shorter survival (p=0.867), but late deep infection in ive patients significantly shortened their lives (p=0.008). Failed osteosynthesis and consequent revision surgery shortened survival time only when it occurred during the primary treatment (p=0.003); after the primary hospitalization was terminated, it had no effect on the length of survival (p=0.398). DISCUSSION The study focused attention only to elderly patients with proximal femoral fracture treated surgically. The authors suggest that, by excluding patients treated conservatively, the group became more homogeneous and a more exact assessment of each factor's effect on death risk was possible. The investigated factors were recorded only during the first year following injury; however, death was recorded by the end of the study. Using the assessment of cumulative survival, this allowed for a more accurate statistical evaluation of the effect of each factor on the risk of death. CONCLUSIONS In patients over 70 years, a significantly shorter time of survival following the surgical treatment of proximal femoral fracture was found to be related to high age, male gender, multiple morbidity in the patient's medical history, poor patient's mobility before injury, general complications, development of pressure sores post-operatively, failed osteosynthesis requiring revision surgery and deep infection of the affected hip. No relation to significantly shorter survival was found for the following factors: living in a pensioner's home before injury, fracture type, time between injury and surgery, type of anaesthesia and operative technique. Key words: hip fracture, surgical treatment, mortality, risk factors.


Asunto(s)
Fracturas de Cadera/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera , Femenino , Fracturas de Cadera/complicaciones , Fracturas de Cadera/mortalidad , Humanos , Masculino , Limitación de la Movilidad , Factores de Riesgo
19.
Rozhl Chir ; 86(1): 32-4, 2007 Jan.
Artículo en Checo | MEDLINE | ID: mdl-17416077

RESUMEN

A case review of laparoscopic management of the uterovaginal descent and rectal prolaps in one step in a young female following her complicated pelvic fracture.


Asunto(s)
Laparoscopía , Pelvis/lesiones , Prolapso Rectal/cirugía , Prolapso Uterino/cirugía , Adulto , Femenino , Humanos , Prolapso Rectal/etiología , Prolapso Uterino/etiología
20.
Rozhl Chir ; 86(11): 611-3, 2007 Nov.
Artículo en Checo | MEDLINE | ID: mdl-18214148

RESUMEN

The authors report on a rare complication of humeral luxations, thrombosis of the axillary artery. They present a literature overview to discuss possible causes and mechanisms of venous complications. Although humeral luxations are very frequently diagnosed in traumatological departments, vascular complications are rare. Therefore, thorough examination of every single patient is a must, taking the above possibility into consideration.


Asunto(s)
Arteria Axilar , Luxación del Hombro/complicaciones , Trombosis/etiología , Anciano , Femenino , Humanos , Luxación del Hombro/diagnóstico , Luxación del Hombro/terapia , Trombosis/diagnóstico
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