[Management of diaphyseal forearm fractures using LCP angle- stable fixation devices and intramedullary nailing]. / Resení diafyzárních zlomenin predloktí pomocí uhlove stabilní dlahy LCP a nitrodrenového hrebování.

AIM OF THE STUDY: The aim of this study is to assess treatment outcomes of diaphyseal radial and ulnar fractures using angle- stable LCP device (Synthes, Svýcarsko), compared to ForeSight intramedullary nailing (Smith&Nephew, USA). MATERIAL AND METHODS: The prospective study included 80 patients with 115 forearm fractures, assigned to two equal groups, based on the fixation method. The group included 53 males and 27 females, the mean age was 36.6 years of age (range 18-77). the mean folow up period was 18 months (range 12-32 months). The patients were repetitevely x-rayed and their functional assessment was performed at the same time. Furthermore, treatment- related complications were also evaluated. RESULTS: Two cases of prolonged healing were recorded in the LCP device treatment group. Four cases of prolonged healing were recorded in the intramedullary nailing group, which healed within 18 months and did not require reoperation. The mean fracture healing time was 20.5 weeks (range 9-80 weeks) in the group with intramedullary nailing, and 19.0 weeks (range 12-46 weeks) in the LCP group. No significat differences in surgery time, healing time, postoperative pain scores or final 1-year functional outcomes were detected between the both treatment groups. Statistically significant prolonged healing was demonstrated in the intramedullary nailing group in cases, where fragment dislocation exceeded 3 mm, compared to a group of patients with anatomical repositioning and dislocation of less than 2 mm (p = 0.015; Anova). No cases of deep infections were recorded. Complications, recorded in the intramedullary nailing group, included the following: partial migration of securing nails in two subjects and incomplete synostosis in two subjects. Complications, recorded in the LCP device group, included: early re-fracturing in the original fracture location in a single subject (3 weeks after extraction). DISCUSSION: The results correspond with outcomes of other recent studies. Although open repositioning and internal fixation is considered a standard treatment method in forearm diaphyseal fractures, recently changing opinion on the use of nails in this indication is apparent. Considering ongoing improvements of these implants, the trend of nailing should be more widely accepted. CONCLUSION: Although their concept of fracture fixation is different, the both implants appear indicated for the management of forearm diaphyseal fractures.

[Treatment of intracapsular fractures of the femoral neck with a biaxial proximal femoral nail]. / Versorgung der Schenkelhalsfrakturen mit einem biaxialen proximalen Femurnagel.

BACKGROUND: Intracapsular fractures of the femoral neck are mostly treated using individual cancellous screws or a dynamic hip screw in combination with anti-rotational cancellous screws. The goal of this study was to evaluate the possibility of using proximal femoral nails for the surgical stabilisation of intracapsular fractures of the femoral neck. METHODS: A total of 58 patients (30 male, 28 female) were evaluated in a retrospective study after a minimum postoperative follow-up of 24 months. The average length of time after surgery was 33.1 months. According to the AO classification, the following numbers of type 31B intracapsular fractures of the femoral neck were included in the study: by number, 20 cases of type 31B1, 12 cases of type 31B2 and 26 cases of 31B3. The biaxial proximal femoral nail (Targon PF, B. Braun, Aesculap(R), Germany) was the tested implant and was inserted using standard surgical techniques. RESULTS: No complications in healing were noted in 48 patients (82.8% of the study group) 2 years following injury. The most frequent complication found was avascular necrosis of the head in seven patients (12.1%). Pseudoarthrosis formation was seen in two patients (3.4%), and other severe peroperative complications were observed in two other patients (3.4%). Reoperations were indicated in five patients, all of whom received a total hip endoprosthesis. We did not observe any refracture in the area of the implant. After 12 months 83% of the patients stated that they felt no or little pain. CONCLUSION: The results of our study have proven that the Targon PF biaxial proximal femoral nail may be used in treating intracapsular fractures of the femoral neck.

[Revision surgery in diaphyseal forearm fractures]. / Revizní operace diafyzárních zlomenin predloktí

PURPOSE OF THE STUDY: The aim of the study was to compare the results of revision surgery in diaphyseal fractures of the ulna and radius treated by intra-medullary interlocking nailing or plate osteosynthesis. MATERIAL AND METHODS: The group included 36 patients who, in the period from 2000 to 2005, were treated with the use of the intra-medullary ForeSight nail system (Smith & Nephew, USA) or a small, 3.5 mm auto-compression plate (different manufacturers). Pseudoarthrosis developed in 25 patients and recurrent fractures were found in 11 patients (six of these suffered fractures along the original fracture line after minimal trauma and five showed a recurrent fracture at the site of screw tunnels). The average age of the patients was 37.3 years. The average period between injury and revision surgery was 16 months (range, 4 to 32 months). The follow-up included examination for early and late complications and the evaluation of X-ray findings and functional outcomes. RESULTS: The average follow-up was 21 months (range, 12 to 36 months). For revision surgery, an intra-medullary nail was used in 28 and a plate in 8 patients. The average operative time was 85 min (range, 30 to 180 min). Radiographic union was achieved by 6 months in 30, by 12 months in three and by 18 months in three patients. The average fusion time in the 30 patients healing by 6 months (nailing, 23x, 7x plate osteosynthesis) was 16.05 weeks. The range of motion in the wrist, forearm and elbow was evaluated by the Anderson method. The outcomes were excellent, good and satisfactory in 11, 15 and 10 patients, respectively. Poor results or wrist or elbow stiffness were not recorded. Pain was recorded at rest and in activity, taking requirements for analgesic therapy into account. After revision surgery, 22 patients were free from pain, 10 reported occasional pain during activity and four experienced pain at rest. None of the patients required permanent analgesic therapy. CONCLUSIONS: The results of our study show the effectiveness of plate and nailing techniques in revision forearm surgery. The corrective procedure must be chosen with regard to the type of pseudoarthrosis, and individual therapy respecting the principles of stable osteosynthesis is necessary. A differentiated operative approach, infection control and stimulation of bony union also play important roles.

[Callus distraction lengthening of the tibia with the intramedullary kinetic nail (case report)]. / Prolongace bérce pomocí kalus-distrakce s vyuzitím kinetického intramedulárního hrebu (kazuistika).

In this report the first experience with callus distraction lengthening using the intramedullary kinetic nail is described. This was performed on a left tibia with a total shortening of 34 mm. The distraction phase lasted 36 days and the rate of distraction was 0.95 mm per day. The full weight-bearing of the treated lower extremity was allowed at 12 weeks after surgery. Complete consolidation of the callus was achieved at 112 days and the consolidation index was 3.21 days/mm. No serious complications were recorded during the post-operative period. At 12 months after surgery, the patient showed a full range of motion in the knee, his ankle range of motion was S 15-0-35, and he achieved an excellent functional outcome on evaluation by Paley's classification.

[Treatment of proximal humeral fractures by angular stabile, antegrade, interlocking intramedullar nail]. / Osetrení zlomenin proximálního humeru pomocí úhlove stabilního antegrádního zajisteného nitrodrenového hrebu--prospektivní studie.

INTRODUCTION: The objective of our study is evaluation of clinical and radiological results of dislocated proximal humeral fractures, treated by direct, angular stabile, antegrade and interlocking implants Targon PH (Aesculap, Tuttlingen, Germany). METHODS: We evaluated 102 patients (76 female and 26 male), average age was 67.3 years (26-87 years). The standard nail was used in 73 cases; the long one was used in 29 cases. We interpreted functional results (Constant's score and relative Constant's score), radiological results and postoperative complications. RESULTS: Constant's score achieved average 51.3 points--3 weeks after operation, 67.4 points--after 6 months and 75.8 points--after 1 year. Value of the relative Constant's score was 59.3%, 75.9% and 83.5%. We have found trend to the poorer functional outcomes in all complicated four-part fractures; especially in cases with disarticulation. The complete bone healing was reached in: 63.7% up to 3 months, 95.1% up to 6 months and 99% up to 1 year. We detected lecase of the pseudoarthrosis. We had 37 complications in our 102 patients group in the first year after operation. The migration of the proximal fixation screws was most frequent complication--12 patients. Eight times the humeral head aseptic necrosis appeared (5x partial, 3x complete), 3 times redislocation of tuberculum maius was found. We made reoperation 2 times by Phillos plate (1x for pseudoarthrosis, 1x for broken screws). CONCLUSIONS: Targon PH is intramedullary nail stabilisation of proximal humeral fractures by angular stabile, antegrade, interlocking system. We consider it for mini-invasive technique that provides high stability in osteoporotic bone and allows immediate postoperative shoulder mobilisation.

[Treatment of intracapsular femoral neck fractures with the use of a proximal femoral nail]. / Resení intrakapsulárních zlomenin krcku femuru pomocí proximálního femorálního hrebu.

PURPOSE OF THE STUDY: The management of intracapsular femoral neck fractures remains an unsolved issue of the present-day trauma surgery of the musculoskeletal system. These fractures are conventionally treated with the use of spongious screws or a dynamic hip screw combined with an antirotational spongious screw. The aim of this study was to evaluate the outcomes of surgical therapy using a different type of implant (proximal femoral nail) for intracapsular femoral neck fractures. MATERIAL: From January 2000 to March 2004, intracapsular fractures were treated with the use of a proximal femoral nail in 70 patients. In this retrospective study, 56 patients (28 men and 28 women) were evaluated at a minimum of 12 months after surgery. The average follow-up was 22.4 months. According to the AO classification, the fractures were categorized as 31- B1 in 20, 31-B2 in 12 and 31-B3 in 24 patients. METHODS: The implant used was a bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap, Germany) inserted by the standard surgical procedure. RESULTS: In 33.3 % of the patients the operative stabilization was performed early, within 6 hours of injury, in 51.8 % the operation was carried out within 24 hours, and 14.3 % of the patients underwent surgery later than 24 hours after injury. At one year after injury, fracture union without complications was recorded in 45 patients (80 %). Complications included avascular necrosis of the femoral head in seven patients (12.5 %), pseudoarthrosis in two patients (3.6 %) and other serious complications in two patients (3.6 %). Reoperations were indicated in five patients, and these underwent total hip replacement. No refracture occurred in the vicinity of the implant. No or little pain after the implantation procedure, as assessed at 12 months and later, was reported by 83 % of the patients. The patients in whom fracture union was achieved without complications were allowed to walk with full weight-bearing at 13.8, 16.4 and 20.4 weeks, when their injury was 31-B1, 31-B2 and 31-B3, respectively. CONCLUSIONS: Our results show that the bi-axial proximal femoral nail (Targon PF, B. Braun Aesculap, Germany) is useful for management of intracapsular femoral head fractures because of the following advantages: it eliminates the risk of lateral protrusion of the implant, it allows for even distribution of weight bearing and thus reduces the risk of pseudoarthrosis development, it has a low probability of the sliding screw getting jammed.