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Objective: To evaluate our experience with hybrid endovascular and open surgical treatment of thoracoabdominal aneurysms., Material and Methods: Between 1996 and 2008 8 patients with thoracoabdominal aneurysm (6 Crawford type IV and 2 type V) from the total of 257 aortic aneurysms with elective endovascular repair were treated using hybrid procedure. A retrograde revascularisation of visceral and renal arteries through the open access and endovascular exclusion of aneurysms using a stent-graft were done., Results: A primar technical success of the hybrid procedure was in all cases. There was no severe ischaemia of visceral organs, kidneys (no need of haemodialysis) or spinal cord (paraplegia). One patient died on an acute pancreatitis 14 postperative day. Further follow up (in range 16-52 months) showed henceforth a successful exclusion of all the aneurysms without evidence of endoleak and patency of all bypasses with a good function of revascularised organs., Conclusion: Owing to minimal haemodynamic load and technical simplicity with a short time of organ ischaemia hybrid procedure represents an acceptable possibility of type IV and V thoracoabdominal aneurysms repair.

Introduction: The incidence of vascular replacement infection is reported between 0.5-6.0%. The infection of aortal valve replacement is usually managed by its removal and axilofemoral reconstruction. Replacement removal and reconstruction in situ is another alternative. The aim of our work is to give the comparison of the results obtained with the extra-anatomic reconstruction and alternative techniques., Materials and Methods: Between January 1987 and August 2008 1324 abdominal aortal replacements were performed in our department. In 14 patients (1.05%) the infection of the replacement occurred; one of the patients was operated on in another hospital. In eight patients axilobifemoral/axilopoplietal by-pass was applied (Group A). In two patients the whole replacement was removed together with in situ reconstruction (ISR) using a new bifurcation replacement. In two patients a partial resection of the replacement and the resected part substitution or femoro-femoral cross-over by-pass was performed. Three patients were treated with a total or partial replacement removal without the following reconstruction., Results: In Group A no haemorrhage from the aortal stub occurred. The mean value of surgical management due to the replacement infection was 3.5 (1-6). For Group B the number was 5 (1-16). In Group B there were three reinfections, in Group A none. In both Group A and B one patient died; one thigh amputation was necessary in Group A, two in Group B., Conclusions: The partial or total removal of the replacement followed with in situ reconstruction is considered a safe and good method solving the infection of the aortal replacement in some patients. The results are comparable to those obtained with extra-anatomic reconstruction that remains the method of choice in patients with virulent infections.

A primary survey study involving a set of 113 lower limbs of 66 patients was focused on the prevalence of additional front great saphenous vein (AFGSV) and the measurement of the distance between its start in the great saphenous vein (GSV) and the saphenofemoral junction (SFJ), the measurement of the distance between the passage of AFGSV through the saphenous fascia and its start in GSV, and compared the width of AFGSV anechogenous lumen with the calibre of GSV. The prevalence of AFGSV in the observed set was 42.5%. Reflux was proved in 6 AFGSVs (12.5%). The width of the AFGSV anechogenous lumen was on an average 0.29 cm (M 0.26 cm, SD +/- 0.15 cm), and the width of GSV anechogenous lumen measured on lower limbs with simultaneous occurrence of AFGSV was 0.38 cm (M 0.38 cm, SD +/- 0.11 cm) on an average. Comparison of the anechogenous lumen width of the two veins showed a statistically significant difference (p < 0,001). AFGSV in the observed set of lower limbs started in VS at an average distance of 0.8 cm from the saphenofemoral junction (M 0.8 cm, SD +/- 0.46 cm). The minimum start point distance was 0.1 cm, the maximum was 1.84 cm. In 3 cases (6.3%), AFGSV started directly in the common femoral vein (v. femoralis communis), which was the place where also the saphenous vein begins. The distance between the passage of AFGSV through saphenous fascia to upper subcutaneous layers and the start of the vein in GSV was on an average 13.2 cm (M 14.5 cm, SD +/- 6.5 cm). The maximum distance between the passage of AFGSV through saphenous fascia and the start of the vein in GSV was 4 cm, the maximum distance being 30 cm.

Unlabelled: The aim of the prospective study was to find out the following: 1. What is the prevalence of deep vein reflux of the leg in patients with superficial vein reflux detected by ultrasonography? 2. What are the possible causes of deep vein insufficiency of the leg retrospectively detectable on the basis of targeted medical history? 3. Is the incidence of identified deep vein insufficiency of the leg gender specific? The sample consisted of 100 legs with superficial vein reflux detected on ultrasonography (C1 - C4 / CEAP) of 79 randomized patients (59 women aged 45 +/- 12 years and 20 men aged 52 +/- 15 years). We collected the medical history of all patients and examined them for any vascular diseases of the leg. Superficial and deep venous system of the leg was examined by routine duplex ultrasonography with 7.5 a 10 MHz linear probe in B-mode, colour flow mapping and pulse Doppler using Valsalva manoeuvre and manual compression of thigh. During the examination, patients lay both prone and on their back., Results: Prevalence of deep vein reflux in patients with superficial vein reflux detected by ultrasonography was 43 %. Prevalence of deep vein reflux in patients only with primary venous insufficiency (i.e. personal medical history without phlebothrombosis of the leg, trauma, surgery or plaster fixation) was 35.4% in our sample. The possible causes of deep vein reflux in our patients are the following: overweight and obesity (58.6%), primary valvular insufficiency (35.4%), secondary valvular insufficiency--post-thrombotic, post-traumatic (34.9%) and various combinations of these factors. Deep vein insufficiency increased with the BMI. Deep vein reflux was significantly more frequent in men (80%) as compared with women (54.2%).

Background: The aim of the study was to assess the safety, feasibility and efficacy of mechanical distal protection during primary angioplasty using FilterWire EZ (FW)., Method and Results: Thirty-one patients with acute myocardial infarction (AMI) were treated by primary angioplasty with distal protection using FW. The results were compared with a matched control group consisting of 33 patients with AMI treated by primary angioplasty alone. Successful FW positioning was obtained in 30 patients (97%). In these patients a lower rate of distal embolisation (3 vs. 18%, p=0.04) was found and a more effective reperfusion was assessed by ST elevation's resolution >50% immediately after the procedure (83 vs. 61%, p=0.05). A higher number of patients with corrected TIMI frame count <27 in FW group supported more effective reperfusion to but this difference did not reached statistical significance (87 vs. 73%, p=0.09). There were no differences between groups regarding average peak CK and CK-MB. However, there is a trend to lower release in FW group (32.1+/-24.5 vs. 35.3+/-31.0, p=0.33; 4.2+/-3 vs. 4.4+3.7, p=0.44)., Conclusions: The presented study confirmed that distal embolisation during primary angioplasty is a frequent phenomenon. In this setting, adjunctive use of the FW is feasible and save, and it may improve myocardial reperfusion by reducing the embolic events.

A case of 40-year-old patient with compression of coronary artery and myocardial ischaemia is presented. Compression resulted from the herniation of abdominal organs into the thoracic cavity, which developed many years after the car accident trauma.

Introduction: One-day surgical methods lower the procedures costs as well the need for urgent beds in surgical clinics. The varix operation seem to be the optimal diagnosis suitable for the one-day surgical procedure., Aim: The aim of this work is to assess a feasibility of the one-day surgery for the low extremities varix operations., Methodology: During the period starting in January until December 2003, 98 extremities were operated for varices. The surgical procedure was the same for the hospitalized as well as for the patients assigned to the one-day surgery programme. Each patient was examined with the duplex ultrasound prior to the surgery, after the surgery a compressive bandage was indicated., Results: We operated 98 extremities in 96 patients suffering from varices during the period from January 2003 to December 2003. The trial group consisted of 67 females and 29 males aged 21-79 years of age (the average of 45.3 years). According to the CEAP classification, 57 extremities (58.2%) were assigned to the C2 category, 30 extremities (30.6%) to the C3 category, 6 extremities (6%) to the C4 category, 4 extremities (4%) to the C5 category and one extremity (1%) to the C6 category. 14 extremities in the group were operated due to the disease relapse. 62 patients (i.e. 65%) were released for the home-care on the day of the operation, 27 patients (28%) were released the following day. One patient was hospitalized for two days, three patients for three days, one patient for four days and two patients for five days. 91 out of the total 98 extremities (i.e. 93%) underwent the one-day surgery., Conclusion: Although some patients require hospitalization, the varix surgery is safe and suitable for the one-day surgery. A thorough preoperative examination as well each patient's cooperation are both very important.

Authors have done a retrospective analysis of 94 lower extremities in 88 patients examined from 1996 to 2002 for recurrence of varices in lower extremities. The goal was to find out the most frequent causes of recurrence of varices in lower extremities in patients with history of varices surgery referred to venous guidance clinic because of another onset of varices in lower extreminites or clinical signs of chronic venous insufficiency. Reflux was proved in 78 lower extremities from the total number of 94 (83%) in our sample. Isolated reflux was discovered in 59 extremities in saphenofemoral junction (39 extremities), in saphenopopliteal junction (14 extreminies), and in perforators (6 extremities). Combined reflux detected simultaneously in two or three places (SFJ, SPJ, perforators) was found in 19 extremities. In 11 cases the reflux was proved in two places and in 8 cases even in 3 places simultaneously. The main cause of recurrence of varices in lower extremities in our sample was reflux especially in saphenofemoral junction and saphenopopliteal junction. Reflux in perforators was usually accompanied with saphenofemoral and/or saphenopopliteal junctions incompetence. Isolated reflux in perforators was found very rarely (6.4%). The cause of varices recurrence was not disclosed in 17% of cases.

The aim of the clinical study was to monitor and analyse possible causes of chronic venous insufficiency (CVI) in a randomised sample of patients with diagnosed CVI. There were 100 patients in the investigated sample, 82 women of an average age of 40.4 years and 18 men of an average age of 42.7 years. Monitoring of risk factors of development and advancement of CVI in our sample of patients showed following results: 1. frequent overweight and obesity (BMI > 25 kg/m2) in women (47.6%) and men (83%) with relatively frequent cases when a patient put on weight more than 5 kg within the last 5 years before development of CVI signs (24.4% of women and 22% of men); 2. a predominance of multiparas (68.3%) over women who have not given a birth or gave birth to 1 child (31.7%), we have found a big percentage of multiparas among both women younger than 40 (40%) and especially older women (> or = 40 years) where the percentage was 75.4%); 3. a positive family history in the majority of our patients with CVI (71%), in 88.7% in a first grade relative; 4. the major part of people in the sample were standing when working (59%), the number of people with sedentary work was high too (32%); 5. smoking admitted only minor part of the CVI patients (27%); 6. significant history of hormonal treatment in the female patients (37.8%), especially among women younger than 40 (48%); 7. other risk factors (accidents and surgeries of lower extremities, recurrent thrombophlebitis) appeared either in a very small percentage of the patients (lower limbs surgeries) or in significantly smaller percentage compared to risks in points 1 to 4 (accidents of lower extremities 20%), recurrent thrombophlebitis 22%).

The authors discuss the surgical treatment of primary varices. The analysis is based on pathophysiological principles in the development of venous insufficiency. The attention is paid to reflux in key positions, presumably sapheno-femoral and sapheno-popliteal junctions, respectively. Dilated perforators with a reflux are considered to ensue from these refluxes. These principles enable to draw conclusions on an adequate therapeutic procedure, a limited stripping of saphena veins. A total stripping is indicated only exceptionally, when the whole stem is affected.

Aims: The authors describe the occurrence of complications in laparoscopic approach to treat inguinal hernias in patients operated on at 2nd Surgical Clinic in Olomouc from May 1991 to the end of the year 2002., Methods: The occurrence of preoperation and postoperation complications and relapses in inguinal hernias treated with laparoscopy in the period of May 1991 to the end of 2002. The TAPP method was used for operation on 98% of inguinal hernias, the IPOM method for 0.9% of inguinal hernias, TEP method in 0.4% and a simple suture in operation on 0.7% of inguinal hernias., Results: Five hundred and thirty four (56% of all surgically treated inguinal hernias) were treated with laparoscopy in adult patients in the period of May 1991 to the end of 2002. Eight preoperation and postoperation complications (1.4%) were encountered. These included two cases of hematoma in the wound after port (0.3%), one hematoma of scrotum (0.2%), two artificial perforations of intestine (0.3%), one case of neuralgia of n. genitofemoralis, one artificial perforation of urinary bladder (0.2%), and one postoperation hydrocele (0.2%). There were 14 relapses (2.6%) in the 534 inguinal hernias operated on with laparoscopy., Conclusion: Based on our experience in the solution of inguinal hernias with laparoscopy the method of transabdominally-preperitoneally localized grid (TAPP). In this method we have used three-point fixation--by a screw to pected ossis pubis and the upper margins of the grip with two transparietal stitches fixed permanently in subcutaneous tissue.

Aims: The authors present their initial experience with surgical grid CHS 100 P with strengthened middle strip for the intestinal hernioplasty by the method without tension according to Lichtenstein., Methods: In the inguinal hernioplasty by anterior transinguinal way in adult patients the authors use prolene grid and a surgical grid CHS 100 P with strengthened middle strip having been developed in collaboration with the Research Knitting Institute in Brno., Results: From November 2001 to May 2003 56 adult patients were operated on inguinal hernia by the tensionless plasty according to Lichtenstein using a surgical grid CHS 100 P. No preoperation of postoperation complication or relapse were encountered. The patients were subject to load in the first postoperation day., Conclusion: Based on our first experience with flexible surgical grid with strengthened middle band CHS 100 P used for tensionless inguinal hernioplasty in adult patients according to Lichtenstein it may be concluded that the grid is well tolerated by the patients. Flexibility of the grid makes it possible to fully load inguinal area during the first postoperation day.

Aim of the Study: The authors present their first experience with the application of esophageal manometry during the operation on achalasia of esophagus. The completeness of performed myotomy is evaluated on the basis of decreased pressure in the region of lower esophageal sphincter (LES)., Methods: Stationary pull-through four-channel manometry was performed twice during the operation: before the application of capnoperitoneum to localize LES with evaluation of its length and tonus and after the myotomy was performed after capnoperitoneum was abolished to verify sufficient extent of myotomy. The subsequent endoscopic control was used to exclude damage of esophagus mucous membrane., Results: In the period of one year during 2002/2003 the authors operated on four patients with achalasia, when manometry was used for peroperative localization of LES and evaluation of the extent of myotomy. The peroperation manometry demonstrated decreased tonus of LES (the mean 42.06 mmHg before myotomia and the mean 20.03 mmHg after myotomia) and in one case the finding resulted in necessary extension of myotomia., Conclusions: Based on our preliminary experience with peroperation manometry in operations on achalasia of esophagus it may be stated that it is a useful method for objectivization of the completeness of myotomy, which does not significantly prolong the period of operation. It contrast, it makes it possible to respond to lasting hypertonic area in LES subjected to myotomy, which may be the cause of lasting complaints of patients after the operation.

The authors paid attention to revealing as precisely as possible anatomical and haemodynamic conditions in venous vascular bed in the course of ultrasonographic examination of 309 lower extremities with clinical manifestations of chronic venous insufficiency (CVI). A combined reflux in the superficial and deep venous system (53.7%) or isolated reflux in superficial veins (25.9%) proved to be the most frequent pathogenic bases of CVI. Pathophysiology of varices was mostly based on the venous reflux and the primary idiopathic CVI was mostly present (98.1%). The post-thrombotic partial obstruction of the deep venous system (post-thrombotic venous changes on the walls) was demonstrated exceptionally (1.9%). A high coincidence of reflux in the deep and superficial venous system points out to s.c. secondary reflux in the deep veins originating on the basis of primary reflux in the large or small saphena. An attempt was made to clarify, whether the development and frequency of incompetent perforators is directly connected with the presence and seriousness of reflux in the large and small saphena. The presence and severity of large saphena insufficiency does not univocally indicate the presence of dilated or insufficient perforators on the medical side of the crus, where these anastomoses are present most frequently. The large saphena is a long vein typically suffering from segmental insufficiency, i.e. reflux affecting a certain portion, whereas other parts of the vein may be fully competent. Anatomical venous variability and abnormalities on lower extremities were demonstrated in every fifth extremity (62 extremities, 20.1%). Most of them concerned large saphena (39 extremities, 62.8%), small saphena being second (15 extremities, 25.2%). Other anatomical deviations occurred sporadically as solitary findings. In the large saphena, duplication was present most frequently (54.8%). Insufficient variable superficial veins and anatomical venous anomalies were mostly not the only pathogenic basis of CVI, but were predominantly associated with insufficiently in the area of deep veins and perforators (84%). In our cohort there were altogether 55 extremities (17.8%) after the operation on superficial venous system, where relapses of varices were found. The causes of post-operation relapse of varices may be divided into three groups: 1. insufficiency of the large saphena, 2. insufficiency of the small saphena and 3. insufficiency of the deep veins. A combined simultaneous insufficiency in several venous systems was found most frequently (27 extremities, 49.1%). Even though the reflux in the deep veins was demonstrated in 50.9% of these extremities, a combination with the reflux in superficial veins and perforators (49.1%) was present with the exception of one case of isolated insufficiency. The insufficiency of the large and small saphena was clearly the leading single causes (15 extremities, 27.3%) of varix relapses. The patients should never be operated on the venous system of lower extremities without previous detailed ultrasonographic examination. It is the only way to increase probability of the operation success and to decrease the risk of relapses of CVI manifestations.

Objective: Comparison of two surgical procedures in discontinuation of the venae perforantes., Method: The authors evaluated perspectively a group of 78 patients subjected to 82 operations with severing of the venae perforantes on the lower extremities. They defined the indications for both surgical procedures., Results: The open procedure (Cockett's segmental operation) was indicated in 10 extremities, ESDP in 72. The endoscopic operation lasted on average 59 minutes, the open one 50 minutes. The hospitalization period in the endoscopic variant was shorter (6.1 days vs. 8.5 days after the open operation). preoperative complications such as haemorrhage from the severed perforator occurred in ESDP. In Cockett's operation there were no preoperative complications, but there were two cases of healing per secundam during the postoperative period. Healing of crural ulcers within 12 weeks was recorded in both types of operations. The open procedure is indicated where there are major nodes on the leg and there are no extensive trophic changes, in particular in patients in stages C3 and C4. ESDP is indicated in patients in advanced stages of CVI, i.e. C5 and C6 according to CEAP., Conclusions: Every method has its indications whereby a higher incidence of complications may be foreseen after the open operation as compared with the endoscopic one.

Objective: To evaluate the importance of anastomozing veins in the development of chronic venous insufficiency (CVI)., Method: Perspective analysis of a group of 82 extremities where the perforators were severed by the endoscopic or open method., Results: Surgery of the perforators was associated with a decline of the total number of perforators detectable on DUS, with a marked reduction of extremities with insufficient perforators and improved total CEAP score. In 98% extremities at the same time surgery of the epifascial venous system was performed., Conclusions: The role of perforators in the development of CVI is not unequivocal and its assessment is more difficult due to concurrent operations of the epifascial system. Dissection of the perforators is indicated in cca one tenth of patients with CVI.

Objective: Manometric findings in achalasia are pathognomic already in early clinical stages of the disease. The authors evaluate the importance of manometry in the diagnosis and therapy, in particular in early stages of the disease., Method: During manometry we obtain data on the function of the lower oesophageal sphincter and the body of the oesophagus. Impaired relaxation of the sphincter is evaluated, as well as increased tonus of the sphincter and tertiary contraction of the body of the oesophagus. In patients with achalasia we implement laparoscopically extramucous myotomy., Results: In 1997 we started a prospective manometric study of dysphagic complaints. We examined 304 patients on account of different diseases of the oesophagus incl. 16(5.2%) where we proved or confirmed achalasia in stage I, II or III according to the radiological classification. These patients were indicated for laparoscopic myotomy. In one instance we had to convert the operation to an open one. In two instances we added partial fundoplasty according to Thal on account of perforation of the oesophageal mucosa. Four patients were subjected after a 5-12-month interval to remyotomy. Twice because of the development of a fibrous stricture at the site of myotomy and twice for an obviously inadequate original myotomy. The history of dysphagia in patients with primary operations was on average 37.3 months., Conclusions: Manometric examination of patients with functional dysphagia makes it possible to detect achalasia in early stages and to indicate in time surgical treatment. In case of a relapse or persistence of complaints manometry makes it possible to express objectively the cause which is most frequently an atonic oesophagus with inadequate evacuating capacity, stricture at the site of myotomy or inadequate myotomy.

In a prospective study the authors examined by coloured duplex sonography 76 patients (93 extremities) with chronic venous insufficiency (CVI), before a planned operation of the veins of the lower extremities. Attention was focused on the site of the reflux ( superficial, deep venous system, perforators) and the importance of perforators and congenital venous anomalies in CVI. In the investigated group of patients with CVI a combined reflux was present in several venous systems concurrently, confirmed in 69 extremities (74.2%). In 25 extremities the authors found insufficiency of the saphenofemoral junction along with femoropopliteal reflux. This high grade of reflux coincidence in these two neighbouring anatomical areas indicates so-called secondary reflux. Dilated perforators were found in 65 extremities (70%). These insufficient perforators were most frequently on the median side of the leg, regardless whether in the proximal or distal half. Obviously there is direct correlation between the grade of CVI according to the international clinical classification and the number of incompetent perforators. The ratio of inborn venous anomalies in the development of CVI in the authors group of patients was not statistically significant.

The authors describe a mini-invasive procedure in surgery of varicosities of the lower extremities. The objective is to reduce surgical trauma and improve the resulting cosmetic effect after extirpation of the great saphenous vein. The method was used in 9 patients of 35 operated between September and December 1998. The initial experience with endoscopic dissection of the proximal portion of the saphenous vein is favourable. The tissue traumatization is smaller, haematoma of the thigh is less common.

Objective: The authors evaluate the changing clinical picture of gastroduodenal ulceration in recent years., Method: They analysed their own clinical material from January 1994 till April 1998 when at the Second Surgical Clinic in Olomouc 188 patients were hospitalised on account of gastroduodenal ulceration., Results: The group of patients comprised a high proportion of patients above 60 years of age (102, i.e. 55%) and twice as many cases of duodenal ulcers as compared with gastric ones. In 4% ulcers were present at both sites. In 92% (173 patients) acute admissions were involved and only in 8% (15 patients a planned admission for elective treatment was involved. As to complications haemorrhage was most frequent (84%), perforations in 13% and pylorostenosis in 3%. Of the acute admissions 56 patients were operated, i.e. 32%, the rest were treated by conservative methods. The surgical lethality was 12%, the lethality of the conservatively treated patients 5%., Conclusion: Gastroduodenal ulceration is at present characterised by a predominance of conservative treatment, a decline of elective operations, a high percentage of complications in particular in advanced age, more frequent affection of the duodenum and late indication for surgery, when conservative treatment is not very successful.

The authors describe their own experience assembled with treatment of chronic venous insufficiency. During the period from VII/95 to III/98 they operated 257 patients with diseases of the venous system. In 22 patients (8%) they operated 24 times by miniinvasive procedures. Eight times retroperitoneoscopic lumbar sympathectomy and sixteen times endoscopic subfascial dissection of the perforators was performed. The remaining patients (92%) were treated by classical operations of the superficial venous system.

During the period between August 1995 and February 1996 at the Second Surgical Clinic of the Faculty Hospital in Olomouc 12 retroperitonescopic lumbar sympathectomies were performed on account of different indications. The authors present an elaborate technique of access into the retroperitoneum and their own technique of lumboscopic sympathectomy. The success of the method was evaluated clinically and by histological evidence of sympathetic ganglia in the collected material. Retroperitoneoscopic lumbar sympathectomy is considered a gentle and safe method which can be used also in other patients where the risk of open surgery would be excessive.

In 1948-1990 the authors operated 112 patients with paraoesophageal and mixed hiatus hernias. 100 patients operated in 1988 were followed up on a long-term basis. Gastroesophageal reflux was recorded before operation in 52%, haemorrhage in 18%, an ulcer in the neck in 7% an incarceration and obstruction in 9%. Before the onset of the seventies hiatorrhaphy and gastropexy were performed. During check-up examinations in these patients relapses were recorded in 47%, reflux in 43%, subjective complaints in 26%. This made the authors change the surgical procedure and in subsequent years they performed hiatorrhaphy, fundoplication, fundophrenopexy and anterior gastropexy. The incidence of relapses of hernia during check-up examinations declined to 21%, of gastroesophageal reflux to 9% and subjective complaints to 10%. The follow-up period varied between 1 and 19 years. The surgical lethality was 2%.

At the Second Surgical Clinic of the Faculty Hospital with Policlinic in Olomouc 72 patients with fractures of the proximal end of the femur were treated. Sixty-four patients were operated and eight were treated primarily by conservative methods or death occurred before the planned operation. A total of 14 patients were discharged to domestic treatment, 32 patients were referred to other institutions, mostly sanatoria for the chronically sick. In the whole group a total of 61 various complications were recorded, 26 patients died during hospitalization at the surgical department, another four patients in other institutions. In addition to these somatic complications the authors investigated also psychosocial aspects. From the investigation ensues that in addition to adequate supervision and care few people have adequate social contacts, despite the fact that they do not live alone. In these patients we are more frequently faced with pessimism, fear or actual loss of interest in the future. In the care of these patients an important part is played by personal contact, a true emotional relationship and interest in the patient's problems. Our aim should be not only healing of the fracture but also mental wellbeing, optimism and mental balance, because patients then tolerate better certain restrictions and complaints.