[Treatment of intra-articular proximal tibial evaluation of two- to seven-year follow-up]. / Výsledky lécby niktrokloubních zlomenin proximální tibie v UN Brno v letech 1997 az 1999: hodnocení po 5-7 letech od terapie.

PURPOSE OF THE STUDY: Intra-articular fractures of the proximal tibia always present a complicated therapeutic problem. In this retrospective study, the results of both conservative and surgical treatment of these fractures are evaluated. MATERIAL: In the period from 1997 to 1999, 114 patients with proximal tibial fractures were treated in the Traumatological Hospital in Brno-Traumacenter. Of these, 34 (30 %) were treated conservatively and 80 (70 %) by a surgical procedure. A total of 80 patients were included in follow-up (70 %). Of these, 61 had surgery, which involved arthroscopically-assisted intervention in 25 patients, arthrotomy in 27 patients and open reduction with external fixation in nine patients who had an open fracture (eight had type C3 fracture). Minimally invasive fixation with a cancellous screw and washer was used in 25, and a buttress plate in 27 patients. Spongioplasty was carried out in 11 patients. METHODS: Clinical and questionnaire-based evaluation was undertaken at 5 to 7 years after the injury and following therapy. The outcome was assessed on the basis of two classification systems, i.e., the IKDC (International Knee Documentation Committee) score and the Lansinger score designed particularly for the evaluation of proximal tibial fractures. The outcomes were evaluated in relation to fracture type, conservative or surgical treatment, method of osteosynthesis, and use of arthroscopic control and spongioplasty. RESULTS: In each of the evaluated patients, radiographs were obtained after injury and then at the completion of therapy. The fractures classified according to the AO system were as follows: type A1 fractures - 9 patients; types B1, B2, B3 - 46 patients; types C1, C2, C3 - 34 patients. The average IKDC and the Lansinger scores achieved at 5- to 7-year follow-up were 70 and 24 points, respectively. This can be regarded as a very good result. Within 5 years of injury, four patients underwent total knee arthroplasty; all of them were over 50 years and had a type C3 fracture. The type B3 and C3 treated by arthrotomy showed similar outcomes on both classification systems (IKDC/Lansinger: 69/67 and 24/24, respectively). The B3 fractures operated on under arthroscopic control had better outcomes (77/69) than those treated by arthrotomy (27/25), because this approach combines advantages of inner fracture fixation with a minimally invasive surgical technique. Better results were also achieved in fractures treated by minimally invasive fixation with cancellous screws. DISCUSSION: The outcomes of therapy in intra-articular fractures of the proximal tibia related to how serious the fracture was and how well it was reduced and stabilized. Both the approach to fracture reduction and the method of its stabilization (buttress plate, minimally invasive screws, external fixator) are selected according to fracture type and soft tissue state. Spongioplasty is indicated if subchondral bone is affected. Reduction and stabilization performed under arthroscopic control permit more precise reconstruction of the articular surface, but can be used only for certain fractures (type A1 and B1, B2 and B3). For reduction and stabilization of all fracture types, with the exception of AO type 41A-1 fracture, an Y-ray image intensifier system is necessary. The meniscus above the injured bone should be preserved in order to maintain good function of the joint. CONCLUSIONS: In intra-articular fractures of the proximal tibia, treatment outcomes depend on the type of fracture as well as correct reduction and use of appropriate fixation. When accurate alignment, joint stability and well reduced articular surfaces are achieved, outcomes are very good. At mid-term follow-up, reduction under arthroscopic control gives better results than stabilization performed by arthrotomy.

[Erectile dysfunction after traumatic pelvic injury]. / Erektilní dysfunkce po poranení pánve.

UNLABELLED: Erectile dysfunction is a serious consequence of pelvic injuries. The aim of the study was to review and assess erectile dysfunction rates in mono and polytraumatized males with the pelvic injury, and to highlight the impotence-type of the pelvic injury relation and to evaluate the therapeutic response of the patients. METHODS: In total, 231 mono- or polytraumatized males with the pelvic injury were mailed a private letter including the HEF-5 International Index of Erectile Function questionnaire. The AO classification was used to assess the relation of the pelvic injury type and the onset of the erectile dysfunctin. The c2 test was used to assess the statistical significance. The peroral treatment with the phosphodiesterase 5 (PDE5) inhibitors was the therapeutical method of first choice. The therapeutical effect was assessed using the IIEF 5 questionnaire. RESULTS: We concluded that the erectile dysfunction affects nearly a third (31.5%) of the males who suffered pelvic injuries. The fact, whether the patient suffered an isolated pelvic injury or a pelvic injury in a polytrauma, has no influence on the erectile dysfuntion onset (p = 0.218), however, the onset of impotence has a significant connection to the type of the pelvic injury. We confirmed a statistically significant increase in the erectile dysfuncion rates in patients with the pelvic ring injury type B and C (p = 0.023). The mean IIEF-5 score prior to the treatment initiation was 11.5. In 85% of the patients the peroral treatment of the erectile dysfunctin using the PDES inhibitors was successful and resulted in achievement of the pair sexual satisfaction. The score of the IIEF-5 questionnaire reached physiological values 23 (22-25) following the treatment. Based on the findings, the authors recommend, during their hospitalization, to inform the males who suffered the type B and C pelvic ring injury about a possibility of their sexual dysfunction, and to advise them to contact a sexual disorders specialist.

[Sport-related spiral fractures of the humeral diaphysis are not simple injuries]. / Sportovní spirální zlomeniny diafýzy humeru nejsou jednoduchým poranením.

OBJECTIVE: The objective of the submitted paper is to demonstrate the results of sports fractures of the diaphysis of the humerus and possible complications. METHOD: During a five-year period 18 men were followed up and treated during hospitalization with a spiral fracture of the diaphysis of the humerus. Their average age was 31.3 years. The mechanism of injury was in all rotational. In ten instances a fracture contracted during a "levered" fight was involved, in the remaining eight patients the cause of fracture was a fall from a bicycle or occurred during skiing. Five patients were not operated because the position of the fragments was favourable. In the remaining patients osteosynthesis was performed. An intramedullary nail was used in 7 and osteosynthesis by means of a splint in 6. The function of the shoulder joint and elbow was evaluated and compared with the sound side, as well as the muscular strength and subjective feeling of the patients. RESULTS: In all conservatively treated cases the fracture healed. The original function of the extremity was fully restored. In operated patients three times a pseudoarthrosis developed which was treated by surgical revision and four times injuries of the radial nerve. The subsequent rehabilitation was however quicker and in all instances complete function was achieved. CONCLUSIONS: The majority of spiral fractures of the humerus heals after conservative treatment. Early functional treatment is essential for preserving the function of the affected extremity. Surgical treatment should be indicated carefully and the radial nerve should be carefully protected.

[Does a pelvic compartment exist? Personal experience]. / Existuje pánevní kompartment? Nase zkusenosti.

The authors analyze a group of 7 patients transferred to their hospital for instable fractures of the pelvic circle and lumbar spine. The pelvic compartment was manifested 24-48 hours after injury. Early diagnostics are based on the use of new imaging techniques, spiral CT examination is preferred, and angiography in stabilized patients. Early surgical intervention is aimed at evacuation of haematomas, revision of vessels, release of the ureters and temporary nephrostomy.

[Cisapride (Prepulsid) in the prevention of postoperative gastrointestinal atony]. / Význam cisapridu (Prepulsidu) v prevenci pooperacní atonie trávicího ústrojí.

Administration of cisapride, 3 x 5 mg in a suspension one day before surgery and 30 mg 3 and 8 hours after abdominal surgery with subsequent administration of 2 x 30 mg in suppositories up to the time when oral ingestion is possible, hastens significantly the restoration of GIT motility as compared with placebo. It can be therefore recommended as effective medication in the prevention of complications caused by impaired motility of the digestive tract.