[Staged management of open tibial fractures with soft tissue defect]. / Etapovitý menezment otvorených zlomenín proximálnej tíbie s defektom mäkkých castí

Open tibial fractures with extensive soft tissue injury and accompanying bone defect are still a challenge for surgeons. Soft tissue injury is often underestimated in clinical practice. In our case report, we present the options for clinical usage of heterologous bone grafting combined with autologous bone stem cells as a therapeutic alternative to calotaxis and free bone flaps.

[C-sign and talocalcaneal coalition]. / C-príznak a talokalkaneárna koalícia.

Talocalcaneal coalition is an abnormal bridge between talus and calcaneus, causing pain and restriction of subtalar movement; its incidence is less than 1 %. The signs and symptoms usually become manifest in the second decade of life with ossification of the lesion. They involve flat foot, peroneal muscle spasm, tarsal tunnel syndrome, or valgus tilt of the heel. The sings need not be noticeable and may appear only as tiredness and vague pain in the hind foot after exercise or an easily twisted ankle. The authors describe the case of talocalcaneal coalition in a 20-year-old man, incidentally diagnosed at ankle fracture. The presence of C-sign led to CT examination and the exact diagnosis. Radiological demonstration of this abnormality may be difficult because plain X-ray images in both projections may show normal findings. Literature data report, in addition to C-sign, further secondary signs of talocalcaneal coalition present on lateral radiographs of the ankle joint. Although these signs do not directly point to talocalcaneal coalition, they reveal abnormal anatomy or movement of the joint and may initiate more thorough examination by CT or MRI and the establishment of an exact diagnosis. Therefore, to know the secondary signs and pay attention to them is very useful.

[Pulmonary alveolar hemorrhage--a rare complication of isolated thoracic injury]. / Pl'úcna alveolárna hemorágia--zriedkavá komplikácia izolovaného poranenia hrudníka.

Occurrence of Diffuse Alveolar Hemorrhage Syndrome (DAH) after blunt thoracic trauma is rare. It is more common to occure in a immuno deficient patient or in drug dependent people. We present a case of DAH, which occured in young man after blunt thoracic injury. Clinically it was presented by hemoptysis. No respiratory insufficiency was recorded and DAH was treated without need of mechanical pulmonal ventilation.

[Inveterated simultaneous dislocation of the proximal and distal radioulnar joints without an associated fracture]. / Inveterovaná súcasná luxácia proximálneho a distálneho radioulnárneho klbu bez pridruzenej zlomeniny.

The authors present an unusual case of the inveterated simultaneous dislocation of the proximal and distal radioulnar joints without an associated fracture in a 55-years-old man. Both dislocations persisted 4 months after injury and primary unsuccessful open reduction of the radial head. The left forearm was fixed in rigid full supination of 90 degrees and no rotational movements of the forearm were possible. Darrach's procedure and radial head resection resulted in 135 degrees of the forearm rotation (from 0 degrees to 90 degrees of supination, from 0 degrees to 45 degrees of pronation) without restriction of the flexion and extension of the elbow and wrist. No significant instability of the elbow and wrist, no valgus deformity of the elbow and no reduction of all daily activities of the patient were present at 6 years follow-up.

[Bilateral stress fracture of the mid-tibial shaft in a professional dancer]. / Obojstranná únavová zlomenina strednej diafýzy tíbie u profesionálneho tanecníka.

Stress fractures of the anterior cortex of the mid-tibial shaft in dancers are rare, with a 1.4 % incidence in injured eli- te dancers. Treatment can be difficult and long-lasting and can seriously influence the dancer's career. The authors pre- sent the case of a 26-year-old professional dancer of a folk dance ensemble who suffered rare simultaneous bilateral mid-tibial shaft stress fractures. A conservative method of treatment with avoiding exercise and dancing activities resulted in the resolution of symptoms and healing of the fractures after 6 months. The patient finished his dancing career because of the necessity of a prolonged therapy interfering with his dancing activities. Current options of the treatment are also presented.

Late laceration of the superficial femoral artery by an intertrochanteric fracture fragment.

Injury to the femoral vessels is a rare complication after intertrochanteric fractures, and usually involves the profunda femoris artery. We report the case of a 79-year-old male with an intertrochanteric fracture, treated by closed antegrade intramedullary nailing, which was complicated by late injury to the superficial femoral artery 5 weeks after surgery. The injury was caused by a spike of bone from the anteriorly displaced lesser trochanter fragment. Direct suture of the injured artery was possible without subsequent complications.

[Bilateral pathological sub-trochanteric fracture in a long-term biphosphonate user]. / Bilaterálna patologická subtrochanterická zlomenina pri dlhodobom uzívaní bifosfonátu.

The number of papers reporting the occurrence of specific pathological fractures in long-term biphosphonate users has recently increased. They refer to the forms of stress fracture probably resulting from an extreme decrease in bone turnover, which may involve sub-trochanteric or isolated transverse fractures, or short transverse fractures with a unicortical beak in an area of cortical hypertrophy. At the time of prodromal signs and symptoms, cortical bone at the site of impeding fracture appears rougher on radiographs. Gradually, an incomplete fracture develops, with a subsequent complete fracture often sustained without any mechanism of injury noted. The occurrence of such fractures is reported in the range of 2 to 8 years from the start of biphosphonate use. The fractures are often bilateral and, at the time the first occurs, it is often possible to diagnose contralateral pathological changes similar to those before the first fracture. The paper presents the case of a female patient who sustained a bilateral pathological sub-trochanteric fracture; the first fracture occurred after 5 and the other after 9 years of Rizendronat use. She was followed up for unilateral incomplete sub-trochanteric fracture from the fourth year of its use. In that period, magnetic resonance imaging showed a pathological finding in the contralateral extremity. She had already had prodromal signs manifested as lasting hip pain before the first fracture. Both fractures were surgically treated. Thirty-three months later she had to undergo repeat surgery for pseudoarthrosis at the site of the first fracture. The pseudoarthrosis healed without complications. However, in the second fracture non-union was still present at 7 months after surgery. The patient took Rizendronat during the whole treatment period and thereafter. In the discussion, certain aspects of long-term biphosphonate use are addressed, as well as some preventive, diagnostic and therapeutic procedures related to this rare complication.

[Traumatic atlantoaxial rotatory fixation in a child]. / Traumatická atlantoaxiálna rotacná fixácia u diet'at'a.

Traumatic atlantoaxial rotary fixation is defined as low-energy mechanism injury resulting in fixed subluxation of the atlantoxial complex expressing oneself as a slight head flexion, lateral tilt of the head to one side, head rotation to the other side and painful limitation of motion that makes it impossible to turn head to the contralateral side voluntary. As a result of the rarity of the injury it is often neglected, treated improperly, treated for the duration, or it has permanent consequences. We present a case report of a 10 year old patient treated in our department with acute traumatic atlantoaxial rotary fixation. The diagnosis was made on the basis of synthesis of anamnestic data, clinical picture and static CT examination. The patient was successfully treated conservatively. In the discussion we present a brief look at the etiopathogenesis, diagnosis and treatment of the injury. Its pathogenesis is still not fully understood. The most reliable diagnostic methods are dynamic X-ray and dynamic CT examinations. In our discussion, more is dedicated to clinical diagnostics, and static X-ray and CT examinations as a way likely to lead together with anamnestic data on the accident at the correct diagnosis even in the absence of acute dynamic CT or X-ray examinations. The treatment of acute traumatic atlantoaxial rotary fixation is usually indicated for conservative treatment, with excellent results. Neglected cases generally require surgical intervention. Treatment of neglected atlantoaxial rotary fixation is usually difficult and permanently distorting anatomical growing organism.

[Intra-operative myelography in treatment of fractures of thoracolumbar spine]. / Peroperacná perimyelografia pri liecbe zlomenín torakolumbálnej chrbtice.

PURPOSE OF THE STUDY: The aim of this retrospective study was to evaluate the results of intra-operative myelography as the method used to assess the reduction of bone fragments from the posterior margin of the vertebral body. MATERIAL AND METHODS: Forty patients with 42 comminuted fractures of the thoracolumbar spine were included in the study. The pre-operative spinal stenosis caused by bone fragments from the posterior margin of the vertebral body, as detected by CT scanning, ranged from 25 % to 85 %. Neurological deficit was due to injury in 19 patients and in one it developed post-operatively after the patient stood and walked. After ligamentotaxis and internal fixation, intra-operative myelography was used to show decompression of the spinal canal. A spinal block or severe constriction of contrast flow was an indication for hemilaminectomy (laminectomy) and direct decompression of the spinal canal. In the patients with neurological deficit and severe spinal stenosis persisting after ligamentotaxis and detectable by skiascopy, hemilaminectomy (laminectomy) and direct spinal decompression followed by intra-operative myelography were carried out. RESULTS: Intra-operative myelography was used 46 -times (20-times in 20 patients free from neurological deficit and 26-times in 20 patients with neurological deficit). In 38 cases (82.6 %) dural sac compression was not present (patients with neurological deficit, 13-times after ligamentotaxis, eight-times after ligamentotaxis and hemilaminectomy with direct decompression, twi- ce at repeat surgeryúúú patients without neurological deficit, 15-times). On two occasions (4.4 %) the contrast agent injected into the dural sac did not make the interior body part visible, on three occasions (6.5 %) contrast medium was injected extradurally, and dural sac compression following ligamentotaxis requiring hemilaminectomy (laminectomy) and direct decompression occurred in three cases (6.5 %). In the patients without neurological deficit, dural sac compression was not recorded. No serious complications associated with contrast medium injection in the dural sac were present, and there was no deterioration of neurological symptoms due to a dural tap. In three cases (6.5 %) a false negative finding was recorded, showing free flow of contrast medium with no areas of constriction or obstruction and signs of post-operative nerve irritation ( radicular syndrome associated with L3 fracture with a fragment placed laterally in two patients and hyperalgesia of the thigh after T12 fracture in one patient). Repeat surgery and additional decompression (hemilaminectomy and foraminotomy, laminectomy) resulted in immediate resolution of neurological symptoms. DISCUSSION: The success rate, complications and disadvantages of intra-operative myelography have not been reported. At present, ionic water-soluble contrast agents used for intrathecal administration are associated with only a low number of serious complications. Neurological deficit due to dural tap is rare. Extradural administration is not effective. A disadvantage reported here involves a failure to visualize the area because of a low amount of contrast agent administered to avoid spinal cord injury. A possibility of false negative findings arising from only one lateral view of the contrast agent flowing round fragments is the major disadvantage. In contrast to the previous reports, we relate the false negative findings to neurological findings. CONCLUSIONS: Intra-operative myelography is still a currently used method. Its advantages include a simple procedure without removal of posterior column structures, and the possibility of objective recording and continuous observation of the dural sac. The free flow of contrast medium makes obstruction of the spinal canal impossible. The consequences of a false negative finding can be successfully treated at the second stage.

[Simultaneous double interphalangeal dislocation on a single finger]. / Súcasná dvojitá interfalangeálna luxácia na jednom prste ruky.

The authors report a rare case of the simultaneous double interphalangeal dislocation in the little finger of the left hand. A 35-year-old man, playing football as a goalkeeper, was injured when another player trod on his little finger. The dislocation was reduced by traction without anesthesia and the finger was immobilized on a splint. Although the patient removed the splint only a week later and failed to come for a check-up, at 1 year, his little finger showed no deformity and regained a full range of painless, active motion.

[Dislocation of the humerus--diagnosis and the Arlt method of reduction]. / Luxácia humeru--diagnostika a repozícia podl'a Arlta.

Authors present 248 shoulder dislocations included recurrent dislocations in a 3-year period. All of dislocations were of anterior type except 3 posterior dislocations and 1 inferior or luxatio erecta. They describe and recommend method of reduction without local or general anesthesia according to Arlt, which was used in 234 cases with effectivity of 96.6%. Posterior dislocation can have a very subtle signs and is generally initially missed in more than 50% cases. Two X-ray views in posterior dislocation are necessary to confirm diagnosis. Authors used in addition to anteroposterior transthoracic view with no posterior dislocation missed.

[Hip dislocation with ipsilateral femoral shaft fracture.]. / Luxácia koxy s ipsilaterálnou zlomeninou diafýzy femuru.

Dislocation of the hip with fracture of the ipsilateral shaft of femur occurs very rarely. Authors report three cases of this combined injury. The most frequent problems concerning this injury such as difficult reduction of the hip dislocation, delayed diagnosis and treatment of the hip dislocation, avascular necrosis of the head of the femur, sciatic nerve palsy, simultaneous fracture of the acetabulum and the head of the femur are discussed. Early closed reduction of the hip joint is difficult because the long lever of the femoral shaft and classical methods of reduction cannot be used. Diagnosis, methods of the reduction and following treatment are outlined. Key words: hip dislocation, femoral shaft fracture.

[Traumatic hip dislocation in childhood.]. / Traumatická luxácia koxy v detskom veku.

Traumatic dislocation of the hip is injury with increasing incidence which is caused mainly by car crashes. This injury is rare in children with incidence in 5 % of traumatic hip dislocations. Authors present two cases of hip dislocation in children. The first is posterior hip dislocation and the second is a very rare anterior dislocation. The reduction of dislocation in a general anesthesia within 6 hours is emphasized to achieve good final outcome and prevent complications. Key words: traumatic hip dislocation, children.

[Isolated dorsal radiocarpal dislocation.]. / Izolovaná dorzálna radiokarpálna luxácia.

The authors report a case of isolated dorsal radiocarpal dislocation without intraarticular fracture of the radius. This injury is very rare and only several case reports we can found in literature. Dislocation of the distal radioulnar joint was also present without ulnar styloid fracture.The mechanism of this injury is described exactly according to data of the patient. Closed reduction and plaster cast fixation brought subjectively satisfactory result and objectively only light restriction of movement and grip strength of the injured extremity without signs of instability. Key words: radiocarpal dislocation, treatment.

[Percutaneous transfixation in fractures of distal radius and evaluation of results.]. / Perkutánna osteosyntéza zlomenin distálneho radia a hodnotenie výsledkov.

Authors evaluate results of fractures of distal radius in a group of patients who were treated with the method of percutaneous osteosynthesis by means of K-wires.Two systems were used in the evaluation. Using the Green and O'Brien evaluation system modified by Cooney excellent and good results were achieved in 54,2 % patients. On the basis of Gartland and Werley evaluation system specified by Sarmiento excellent and good results were achieved in 75 % patients. Authors point out the difference in the results caused by a greater strictness of the first evaluation system mentioned. Key words: fractures of distal radius, transfixation.

[Swivel luxácia Chopartovho klbu.]. / Swivel Chopart Dislocation.

The authors report a special type of Chopart dislocation named as swivel dislocation or tarsal rotation. This injury is characterized by dislocation of the talonavicular joint but the calcaneocuboid joint remains intact.The foot creates a typical rotational movement but it does not evert or invert. The axis of rotation is interosseous talo-calcaneal ligament, which remains intact. In the reported case the medial swivel dislocation is present in combination with fracture-dislocation of the ankle joint with diaphyseal fracture of fibula and segmental fracture of tibia in the same extremity in multiple injury patient. The typical characteristic and method of treatment of this rare injury are presented. Key words: Chopart dislocation, multiple injuries, therapy, consequence.