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.

[Isolated intraperitoneal rupture of the urinary bladder following a blunt abdominal trauma--a case review]. / Izolovaná intraperitoneální ruptura mocového mechýre po tupém poranení bricha--kazuistika.

Isolated urinary bladder rupture is a uncommon injury. Authors are presenting the case of isolated intraperitoneal bladder rupture caused by blunt trauma of abdomen. This report describes assessment of this type of trauma and compares it with references. Due to early obtaining of exact diagnosis and following operative treatment no complications were in this case.

[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.

[Operation treatment of the humeral shaft fractures]. / Operacní lécba zlomenin diafýzy humeru.

INTRODUCTION: Nowadays the humeral shaft fractures represent about 4% of all fractures. Most of them can be treated conservatively. In this type of treatment the cooperation of the patient is necessary, treatment is long lasting and needs the extremity to be immobilized. That's why still more fractures are indicated for the operation treatment, which enables an early rehabilitation and selfcare of the patient. AIM: The aim of our work was to assess the functional and clinical results in patients after the operation of the humeral shaft fractures treated by closed reposition and intramedullary fixation or by open reposition and plate osteosynthesis (ORIF). DESIGN: Retrospective descriptive study--case serie MATERIAL AND METHODS: In our department within the years 2001-2006 we operated on 101 patients with humeral shaft fractures. 65 patients came to be checked, the follow up rate--65%. Fractures were classified according AO: A--50%, B--29%, C--21%. The ORIF was used in 18 patients, closed reduction and locked intramedullary nail in 21 patients, and closed reduction and K-wires bundle (Hackethal) in 26 patients. RESULTS: The resulting conditions we evaluated by Constant-Murley and Liverpool elbow scoring system. The mean value reached 86/8.9. In 82% of patients we have reached good to excellent results. Complications were noted in 34 CONCLUSION: In spite of limited number of patients in our study the results of ours generally are not in contradiction to the current literature data. The best results were achieved by ORIF. On the contrary, the worst outcomes with greatest number of complications were in Hackethal group.