Reamed versus unreamed nail in the treatment of tibia shaft fractures.

PURPOSE: The aim of the prospective randomized study was to compare the results of the treatment of tibia shaft fractures (TSF) by reamed or unreamed intramedullar nail. METHODS: There were 103 patients with 104 TSF enrolled in the study within the period from December 2005 to June 2010. Seven patients were excluded from the study. Factors of injury severity, course of surgery and hospitalization, and incidence of early and delayed complications were recorded. X-ray was performed every 4 weeks until the fracture was healed. Functional results were evaluated at least 1 year after the surgery. Closed fractures were classified according to Tscherne classification and the open ones according to Gustilo classification. RESULTS: Forty-eight patients with 49 TSF were treated by unreamed tibial nail. There were 15 women and 33 men in this group. Injury severity score (ISS) ranged from 4 to 25 (ø 6.63). There were 45 closed fractures (0 16; I 22; II 7) and four open fractures (I 2; II 1; IIIA 1). In the reamed nail group there were 48 TSF. ISS ranged from 4 to 18 (ø 6.13). There were 35 closed (0 17; I 13; II 5) and 13 open (I 5; II 5; IIIA 3) fractures in this group. The time of operation was on average 15 min shorter in the unreamed nail group. X-ray healing was the same in both groups (18.12 versus 17.92 weeks). We had four patients in the unreamed nail group and six patients in the reamed nail group with delayed healing (28-44 weeks). We recorded no infection, loss of reduction or re-operation in both groups. Follow-up of functional results was 90 %. CONCLUSIONS: There was no statistically significant difference in clinical and functional results between the groups. We suggest that both methods are comparable.

[True/Flex intramedullary nailing for forearm shaft fractures. Long-term results]. / Nitrodrenová osteosyntéza diafyzárních zlomenin predloktí hrebem TrueFlex - dlouhodobé výsledky.

PURPOSE OF THE STUDY: Presentation of technical experience and the clinical and functional results of intramedullary fixation of forearm shaft fractures. MATERIAL AND METHODS: Between January 1994 and December 2009, a total of 96 patients with 144 radial and/or ulnar fractures (ulna, 33; radius,15; both, 48) were treated by nailing (True/Flex®). According to the AO classification there were 22-A, 22-B and 22-C type fractures in 39 (41%), 44 (46%) and 13 (13%).cases, respectively. Of these, 82 (85%) were closed (types: 0, 48; I, 33; II, 1) and 14 (15%) were open (types: I, 13; II, 1; III, 0) fractures. Seventy-eight patients (81%) were followed up and their functional outcomes were evaluated according to the criteria of Anderson et al. The average interval between the operation and final follow-up was 28 months (15 to 96 months) RESULTS: The average time to surgery was 2.2 days (0 to 25 days). Early complications were recorded in 4% of the patients (1x bursitis olecrani; 1x end cup replacement; 1x bending of nails) and late complications in 15% (5x non-union; 2x delay union; 4x bursitis olecrani; 1x ruptured tendon). Bone healing was achieved in 95% of the cases and took on average 16 weeks (7 to 34 weeks). No infection, refracture or synostosis occurred. Primary loss of reduction was recorded in four cases due to distraction in one, bent nails in two and a wrong size of the implant in one; secondary loss of reduction was found in three cases, with two cases of radius shortening and one 10°malrotation. No primary malrotation was recorded, but secondary loss of alignment was seen in the distal part of the radius and the proximal part of the ulna. Functional results according to the Anderson criteria were excellent and good in 87% of the cases. DISCUSSION: Intramedullary mailing provides good stability to mid- and distal-third shaft fractures of the ulna and mid- and proximalthird shaft fractures of the radius, particularly in AO type A and type B fractures. The technical aspects of the method are analysed in detail in this paper. CONCLUSIONS: True/Flex® intramedullary nailing, because of its minimally invasive approach and close reduction, allows us to minimise the risk of wound and neurovascular complications, especially in proximal shaft fractures of the radius.

[Post-traumatic hypoglossal nerve paresis due to occipital condyle fracture]. / Poúrazová paréza n. hypoglossus po zlomenine kondylu okcipitální kosti - kazuistika.

The authors describe the case of a patient, a 33-year-old man, who presented with paresis of the hypoglossal nerve following an occipital condyle fracture. The patient, as a driver, was involved in a car accident and from the beginning he complained of neck pain. The diagnosis was established by CT examination as late as 72 hours after injury on the basis of clinical presentation (difficulty in swallowing, chewing and speaking due to impaired mobility of the left half of the tongue, with the left half showing a marked hypotrophy and muscle weakness). A conservative treatment was used - application of a rigid cervical collar for 3 months, which resulted in gradual neurological improvement.

Ischemic affection of the spinal cord as a result of the blunt thoracic trauma--a case report.

Authors present the case of a patient who suffered the blunt thoracic trauma. In the clinical picture there dominated the paraplegia of both the lower extremities. Due to the weakened breathing on the right side the urgent thoracic drainage was performed. For circulation instability and amount of blood passing out of the drain an urgent thoracotomy was indicated even prior to the CT or MRI. During the operation bleeding from the Adamkiewicz's artery was spotted and sanated. After the postoperative stabilization the CT and MRI investigations proved the spinal cord ischemia as a cause of the local damage.

[Surgical management of proximal humeral fractures using the Hackethal (Zifko) method--a case review]. / Operacní lécba zlomenin proximálního humeru metodou podle Hackethala (Zifka)--case serie.

BACKGROUND: Fractures of the proximal humerus actually represent 5% of all fractures and 45% of all humeral fractures with the highest incidence in women over 60 years of age. The outcomes of the greatest concern at these patients (pain, function of the shoulder and activities of daily living) get worse with age, osteoporosis, grading of fracture type and of initial fracture displacement. According to the literature (Evidence Based Medicine--EBM level II-III) operative treatment of displaced fractures reduces pain and need for assistance in activities of daily living, but open reduction with internal fixation by conventional screws and plates was connected with implant loosening, infection and avascular necrosis, whereas closed reduction with different methods of miniinvasive percutaneous stabilisation is threatened by primary malreduction. AIM: Evaluation of clinical and functional outcomes and analysis of results of proximal humerus fractures treated by closed or percutaneous reduction and intramedullary fixation by means of bundle of Kirschner wires after Zifko. DESIGN: Retrospective descriptive study--case serie. MATERIAL AND METHODS: Within January 1, 2005 - December 31, 2005 there were 87 patients with 87 two- and three-fragments fractures of proximal humerus (according to Neers classification) operated at our institution, from which 76 by the method after ZiFko. 36 patients from these 76 came to final evaluation (follow-up rate 47%). AO fracture types were: A2-36%, A3-33%, B1-19%, C1-12%. RESULTS: The resulting Constant-Murley (CM) score reached in mean 89 points with 89% of excellent--good functional results. Complications were recorded in 30% of cases and were represented mainly by proximal migration of K-wires. Avascular necrosis of humeral head occured in two cases (5.5%). CONCLUSION: In spite of low follow-up rate we conclude, that the method of closed reduction and intramedullary fixation of two- and three-part fractures of proximal humerus after Zifko offers above-average final results with acceptable rate of complications, mostly not severe ones. The essential pre-condition of good result is proper reduction--closed of percutaneous one. On the contrary, suboptimal results correlate with primary and secondary malreductions. The incidence of latter increases in intraarticular fracture types with small fragment of head and thus with insuficient implant retention. To evaluate the merit of the method in relation to angle-stable extra-/or intramedullary implants, the prospective trials are needed.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

[Comparison of the effect of continuous and intermittent physical loading in type I diabetics]. / Srovnání úcinku kontinuální a intervalové záteze u diabetiku I. typu.

In order to evaluate the optimal mode of physical loads the authors examined 19 diabetics type I without secondary complications. On the second day of an educational-rehabilitation camp the authors subjected the patients to a continuous load-a 40-minute endurance run at a heart rate equal to 60% of the maximal oxygen requirement. On the fifth day an intermittent load with a maximal intensity--training of 4 x 10 minutes with 5-minute intervals was administered. At the onset, during the 20th and 40th minute of the load the titrable acidity, lactate and blood sugar level were assessed. The intermittent load led already after 20 minutes to marked acidosis (titrable acidity = 12) which did not increase after 40 minutes of the load. The authors recorded a statistically significant rise of the lactate level (4.57 mmol/l) which after 40 minutes of the load rose further to 12.3 mmol/l, as compared with values of titrable acidity during the 20th and 40th minute (0.44 and 1.14) and lactate during the 20th and 40th minute (4.57 and 3.86 mmol/l) during a continuous load. After evaluation by the test of linear correlation it appears with regard to the stability of the blood sugar level during a load that an intermittent load is more favourable. The drop of the blood sugar level in time during a continuous load was at the 1 level of significance, in intermittent loads at the 5% of significance. Both types of loads did not lead to hypoglycaemia or other complications and thus both can be used in diabetics type I.

[Does reconditioning improve compensation in diabetics?]. / Zlepsuje rekondice kompenzaci diabetu?

The authors evaluate the short-term and long-term effect of a ten-day educational camp on metabolic compensation, the physical and mental state and knowledge of the disease in 30 diabetics type I, mean age 29 years (range 17-45 years) with a duration of diabetes of 6.3 years (plus minus 5.6). After processing of individual parameters at the onset, after termination of reconditioning and after two subsequent months the authors revealed after evaluation by the paired t-test a statistically insignificant drop of the mean blood sugar level after reconditioning. After two months the mean blood sugar level rose again insignificantly and an insignificant decline of glycosylated haemoglobin occurred. After reconditioning a statistically significant decline of insulin consumption occurred (p < 0.01) but after two months the consumption returned to the original level. A significant increase was recorded in the knowledge of the disease (p < 0.05) and an increase in physical fitness (p < 0.01). The authors consider thus that the positive effect of reconditioning is mainly in training of a proper lifestyle, learning of self-monitoring and psychic improvement.

[New findings on the clinical significance of magnesium]. / Nekteré novejsí poznatky o klinickém významu magnézia.

Recent findings are concerned with the diagnosis, incidence, and therapy of hypomagnesaemia. The authors discuss the importance of Mg in stress, cardiac diseases, bone metabolism, neoplasms, blood clotting, in physical exertion and the Mg content of the diet.

[Dietary habits in a group of middle-aged women]. / Výzivové zvyklosti v souboru zen stredního veku.

The authors made a pilot nutrition survey in a group of 75 women working in the Skoda plant in Plzen. They analyzed the dietary intake during a three-day period. It was revealed that the intake of the investigated group is grossly at variance with principles of rational nutrition. The total energy intake (almost 10,000 kJ/day) comprised 44% fat, 42% carbohydrate and 14% protein. The P/S ratio was 0.36. The nutritional parameters did not correlate significantly with blood lipid levels or other investigated data. Only the total energy intake and total fat intake correlated positively with the BMI.