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Introduction: The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use in clinical medicine., Methods: Pubic symphysis morphology was investigated in 652 patients (348 women and 304 men), from which 449 CT scans and 203 MR scans were available. The average age of men was 48 years and women 39 years. Investigated parameters included dimensions of the interpubic disk, visibility and width of the reinforcing ligaments, and visibility, dimensions, and location of the symphysial cavity. The results were compared with MR scans of 20 healthy volunteers and 21 dissected anatomic specimens., Results: The craniocaudal, ventrodorsal, and mediolateral diameters of the pubic disk were 36 to 37.7, 14.8 to 15.2, and 2.2 to 4.2 mm in women and 42 to 42.3, 18.6 to 19, and 2.4 to 4.5 mm in men, respectively. Higher age correlated with shorter mediolateral diameter and larger craniocaudal and ventrodorsal diameters. The superior pubic ligament was visible in 93.1% of men (1.44 mm thick) and in 100% of women (1.7 mm); the inferior pubic ligament in 89.7% of men (1.74 mm) and 88% of women (1.95 mm), the anterior pubic ligament in 96.6% of men (1.5 mm) and 82% of women (1.34 mm); and the posterior pubic ligament in 65.5% of men (1.18 mm) and 63.7% of women (0.83 mm). A symphysial cavity was found in 24% of men and 22.9% of women, with craniocaudal, ventrodorsal, and mediolateral dimensions of 13, 10.7, and 3.2 mm in men and 9.5, 10.7, and 3 mm in women, respectively., Conclusion: The presented morphologic parameters provide an anatomic reference for diagnostics of pathologic conditions of the pubic symphysis. The following anatomic structures should be added to the official anatomic terminology: symphysial cavity (cavitas symphysialis), retropubic eminence (eminentia retropubica), anterior pubic ligament (ligamentum pubicum anterius), and posterior pubic ligament (ligamentum pubicum posterius)., Level of Evidence: II-III., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Objectives: We decided to compare the incidence and spectrum of pelvic fractures in 2020 affected by the anti-pandemic measures due to COVID-19 with previous years 2018 and 2019., Methods: This retrospective study included 391 patients treated at the author's clinic for pelvic fractures. From the medical records we recorded gender, age, mechanism of injury, trauma energy, fracture type based on the AO classification and severity of injury., Results: As expected, we observed no difference in the number of fractures caused by simple falls. However, we failed to prove a reduction in the number of high-energy injuries. In contrary, we observed an increase in the number of high-energy injuries in the period between lockdowns (p=0.0375). A surprising result was a dramatic increase in suicide attempts as a cause of pelvic fractures, with 6 (2.2 %) in 2018 and 2019 compared to 13 (10 %) in 2020 alone (p=0.0017)., Conclusion: We observed the increased number of suicidal attempts only on a limited number of specific patients with pelvic fractures; therefore, we cannot formulate any general conclusions regarding the incidence of suicide during the COVID-19 pandemic. Nevertheless, we consider this to be a warning signal highlighting the worsened population mental health due to COVID-19 pandemic (Tab. 2, Fig. 1, Ref. 34).

Introduction: Great variability in shape and size of the bony pelvis can be observed in the current population, but there is not enough data on how long the historical period must elapse to gain changes in pelvic shape and size. The aim of the study was to identify morphological changes in bony pelvis in males and females after a developmentally short period of approximately one thousand years., Material and Methods: Seventeen defined external dimensions of pelvic bone from 120 adult individuals (two craniocaudal, two ventrodorsal, six mediolateral, three acetabular dimensions, and four dimension of the auricular surface) were measured. The medieval sample of 60 pelvic bones (30 male and 30 female) was obtained from the Great Moravian site of Mikulčice-Valy (9th-10th century), while the modern collection of 60 pelvic bones (30 male and 30 female) dates from the late 19th and first half of the 20th centuries. Obtained results were evaluated using the independent t-test at a 5% level of significance., Results: A comparison of male and female pelvic dimensions within a single population yielded expected results: the mean male values were greater. In modern population, male pelvis mean values were greater in 15 of defined parameters, while in medieval population, male dimensions were larger in 16 variables. A comparison of modern and medieval female pelvic bones found 11 variables to be greater in medieval sample (one determining the craniocaudal dimension, five the mediolateral, all three the acetabular, and two determining the auricular surface dimensions), but only two were significant (two dimensions determining the mediolateral dimensions). In modern female samples, there were five variables greater (one determining the craniocaudal dimension, one the ventrodorsal, one the mediolateral, and two determining the auricular surface dimensions), but only two were significant as well (one determining the craniocaudal and one the ventrodorsal dimensions). A comparison of male pelvic bones found 13 variables to be greater in medieval pelvis (one determining the craniocaudal dimension, all six the mediolateral, one the ventrodorsal, all three the acetabular, and two determining the auricular surface dimensions), but only four were significant as well (all determining the mediolateral dimensions). In modern male sample, there were only four variables greater (one determining the craniocaudal dimension, one the ventrodorsal, and two determining the auricular surface dimensions), but only one was significant (determining the craniocaudal dimension)., Conclusion: Unexpectedly, our study did not find the early medieval population to have a smaller pelvis compared to the modern population. While pelvic bones of the former were somewhat lower, but wider, those of the latter population were a bit higher and narrower. The study allows a very careful statement that one millennium is a time period long enough for measurable morphological deviations of the pelvic bones shape and size to occur., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1-year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682-688, 2019. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Background: The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes., Methods: A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year., Results: Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p = 0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p = 0.021). Dual antiplatelet therapy was resumed more often (91.7%) in comparison to aspirin monotherapy (57.3%; p = 0.047), and vitamin K antagonist (56.3%; p = 0.042). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p = 0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%, 20 of them died due to cancer). Non-reinstitution of aspirin until discharge was associated with higher one-year mortality (17.6% vs. 34.8%; p = 0.018)., Conclusion: Preoperatively interrupted antithrombotics were re-administrated at discharge only in half of patients with AF, less likely in male patients and those undergoing elective surgery. The presence of AF was recognized as a predictor of one-year mortality, especially if aspirin therapy was not resumed until discharge., Trial Registration: ClinicalTrials.gov NCT01897220.

Introduction: Ankle fractures comprise a highly morphologically and etiologically diverse group of injuries, which includes various degrees of impairment of bone and ligamentous structures. The complete synostosis and incomplete bony bridging of tibiofibular syndesmosis are among the local late complications after surgically treated ankle fractures., Patients and Method: 269 patients were evaluated, including 203 patients with Weber type-B fractures, and 66 patients with Weber type-C fractures. All patients underwent ankle radiography at standard intervals (post-operatively, 6 and 12 weeks, 6 and 12 months). The final assessment one year after osteosynthesis was performed. The study analyzed age, sex, fracture morphology, the location and morphology of ossification, functional outcomes and subjective evaluations of patient status., Results: As risk factors there were found male sex, tibiotalar dislocation, syndesmotic screw fixation and Weber type-C fractures. The severity of subjective difficulties and objective status were not dependent on the size of distal tibiofibular synostosis., Discussion and Conclusion: Despite relatively extensive imaging findings of complete synostosis or incomplete bony bridging, they only limited functional outcomes to a minimal extent., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: Proximal femoral fractures are among the most commonly sustained fractures. The current treatment of stable proximal femoral fractures located in trochanteric region primarily involves the use of two systems: extramedullary dynamic hip screws and intramedullary hip nails. Given that these fractures are mainly found in the elderly population, the necessity of a repeat, due to failure of the first, may jeopardize the patient's life. Decisive factors contributing to the healing of a fracture (or the failure thereof) include fracture pattern, technical implementation of the operation (i.e., position of the implant), implant's properties and its changes in relation to the surrounding bone tissue during loading. Each screw insertion variant results in damage to various load-bearing bone structures, which can be expected to influence healing quality and stability of newly formed bone., Method: With the aid of a numerical model and finite element methods, the authors analyzed several different positions of IMHN/PFH-nails in the proximal femur, with the objective of determining positions with an increased risk of failure., Results and Conclusion: In model situations, it has been shown that in stable fractures results do not depend on absolutely precise positioning and small deflections in the nails and neck screws positions do not significantly increase the risk of failure for the entire fixation. Damage to load-bearing structures relative to various implant placements does not impact the resultant overall fixation stability. Therefore, it is not necessary to re-introduce implants in the ideal position, which can lead to reduced patient radiation doses during surgery.

Backround: The purpose of the study was to ascertain the incidence of bleeding and ischaemic complications in patients with cardiac disease after total hip arthroplasty (THA) and total knee arthroplasty (TKA)., Methods: In total, 477 patients (289 women, 188 men) with known history of cardiac disease or thromboembolic disease treated with surgery in 2010-2013, were enrolled in the study. Perioperative prevention of thromboembolic disease using low-molecular-weight heparins was applied in all the patients. The data that could have an impact on the development of monitored perioperative complications, were observed., Results: Complications occurred in 55 (11.6 %) patients: bleeding complications in 32, ischaemic in 19, and both in four patients. Complications were found in 13 (12.0 %) patients after THA and in 6 (9.5 %) patients after TKA. Bleeding complications were observed in 17 patients after THA and TKA, ischaemic in one, and both simultaneously in one patient.Bleeding complications occurred insignificantly more frequently after THA and TKA (p = 0.094); however, this difference was statistically significant after adjustment for risk factors (p = 0.003). On the contrary, ischaemic complications were significantly more frequent after other skeletal surgeries (p = 0.014). Nevertheless, this difference was not statistically significant after the adjustment (p = 0.880). The comparison of the risk of complications in patients after THA with that in patients after TKA showed no significant difference (p = 0.580)., Conclusion: The study showed a significantly higher incidence of bleeding complications in patients after THA and TKA compared to other surgeries of the musculoskeletal system in patients with a history of cardiac disease. Bleeding complications cannot be detected in advance (Tab. 1, Ref. 16).

The aim of this study was to present the midterm results of modified scarf osteotomy in the treatment of tailor's bunion. From 2004 to 2011, 23 modified scarf osteotomies (with the fifth metatarsal shortening) were performed in group of 18 patients for the treatment of tailor's bunion. The mean follow-up period was 58.8 (range: 24-89) months. Patients were evaluated retrospectively--clinically and radiographically, using the American Orthopaedic Foot & Ankle Society scoring system with weight-beared radiographs at the end of 2013. Five males and thirteen females (mean age: 46.5 years) were included in the study. Two males and three females were operated bilaterally. Average American Orthopaedic Foot & Ankle Society scores were 59.8 preoperatively and 92.3 at the final follow-up. Three patients had complications: delayed union, superficial wound infection and distal screw migration. The modified scarf osteotomy in the correction of tailor's bunion offers promising results in the midterm.

Using skeletal muscle homogenates for respirometry has many advantages, but the main challenge is avoiding the damage to outer mitochondrial membrane (OMM) and complex I. By optimising the amount of muscle and careful titration of substrates and inhibitors we developed a new protocol and compared it to isolated mitochondria. We found acceptable damage to OMM (~10-15% increment of oxygen flux after addition of cytochrome c) and to complex I (~70% of electron flux). Homogenate retained ~90% of phosphorylation capacity of isolated mitochondria. The use of fresh homogenate was crucial as mitochondrial function declined rapidly after 2-3h of cold storage., (Copyright © 2015 Elsevier B.V. and Mitochondria Research Society. All rights reserved.)

Background: Glutamine has been considered essential for rapidly dividing cells, but its effect on mitochondrial function is unknown., Materials and Methods: Human myoblasts were isolated from skeletal muscle biopsy samples (n = 9) and exposed for 20 days to 6 different glutamine concentrations (0, 100, 200, 300, 500, and 5000 µM). Cells were trypsinized and manually counted every 5 days. Seven days before the end of exposure, half of these cells were allowed to differentiate to myotubes. Afterward, energy metabolism in both myotubes and myoblasts was assessed by extracellular flux analysis (Seahorse Biosciences, Billerica, MA). The protocol for myoblasts was optimized in preliminary experiments. To account for different mitochondrial density or cell count, data were normalized to citrate synthase activity., Results: Fastest myoblast proliferation was observed at 300 µM glutamine, with a significant reduction at 0 and 100 µM. Glutamine did not influence basal oxygen consumption, anaerobic glycolysis or respiratory chain capacity. Glutamine significantly (P = .015) influenced the leak through the inner mitochondrial membrane. Efficiency of respiratory chain was highest at 200-300 µM glutamine (~90% of oxygen used for adenosine triphosphate synthesis). Increased glutamine concentration to 500 or 5000 µM caused mitochondrial uncoupling in myoblasts and myotubes, decreasing the efficiency of the respiratory chain to ~70%., Conclusion: Glutamine concentrations, consistent with moderate clinical hypoglutaminemia (300 µM), bring about an optimal condition of myoblast proliferation and for efficiency of aerobic phosphorylation in an in vitro model of human skeletal muscle. These data support the hypothesis of hypoglutaminemia as an adaptive phenomenon in conditions leading to bioenergetic failure (eg, critical illness)., (© 2013 American Society for Parenteral and Enteral Nutrition.)

Objectives: The study was aimed at the assessment of specific complications depending on the sliding hip screw position., Background: The finite element method in the biomechanical analysis of this implant may be used to predict the mechanical failure due to the screw position., Methods: 380 sliding screw osteosyntheses for stable pertrochanteric fractures of 365 patients were included in the study. We divided and analysed the osteosyntheses with five various screw positions and focused on the specific complications development. For the construction of the finite element model of the femur, the program ABAQUS 6.9 was used. Analyses were performed with evaluation of the bone response to the different screw locations (strain and stress) with maximum low-cycle high stress loading., Results: The specific complication rate was 10 %, with the re-operation rate of 4.2 %. If placing the screw in the middle third of the neck it reduced significantly strain patterns of the plate and screw. A screw position in the superior third of the neck significantly increased the strain of the plate and screw by more than 63 %., Conclusions: The conformity in the clinical and biomechanical analyses was observed. The finite element model can be considered as valid in predicting sliding screw failures (Tab. 4, Fig. 8, Ref. 30).

Purpose: The aim of this study was to determine the incidence of congenital malformations of the lumbosacral transitional vertebrae in the general population, and the differences in their gender and left/right distributions., Methods: The examined group comprised of all patients who underwent a pelvic X-ray during 2010 for any reason. The observed parameters included the following malformations: the presence of megatransversus at L5; sacralization of L5 or L6; a S1 lumbarization; the presence of six sacral vertebrae; or spina bifida at the level of L5, S1 or S2. In cases of megatransversus at L5, the lateral distribution was recorded. A total of 1,513 images were evaluated. Sex and lateral differences were evaluated using the Pearson's (χ (2)) test with a significance level of 5 %., Results and Conclusions: A total of 478 malformations were found in 417 patients, which constituted 27.6 % of the entire group. Malformations occurred in 250 women (25.4 % of all women) and 167 men (31.6 % of all men) and the female to male ratio in affected individuals was 1.5:1. The predominance of the occurrence of malformations observed in men was statistically significant (p = 0.009). The most frequently occurring malformations were the presence of six sacral vertebrae (179 patients) and megatransversus at L5 (150 patients). The study confirmed a high incidence of congenital malformations in the area of the lumbosacral transitional vertebrae and demonstrated a higher incidence in males. Unilaterally occurring megatransversus at L5 was significantly more common on the left side.

Purpose: The purpose of our work was to verify the hypothesis that muscle insertions and ligament attachments have an impact on the course of typical break lines in the area of the trochanteric massif, i.e., to provide a more detailed description of the origins and insertions of the musculo-ligamentous apparatus on the surface of the proximal femur, and to find a potential morphological correlate between muscle insertions and ligament attachments to the proximal femur and the course of the break line in a typical pertrochanteric fracture., Methods: A detailed dissection of areas of trochanter major et minor, linea et crista intertrochanterica was performed in 50 anatomical preparations of the proximal femur, and the insertions of the muscular-ligamentous structures were described. The set of 600 radiographs were used to obtain projections of typical break lines on the proximal femur, and corresponding areas of exposed bone surface were identified in the anatomical preparations based on the projections and on 15 real specimens of patients after the pertrochanteric fracture osteosynthesis., Results and Conclusion: Bone covered only with the periosteum, with no reinforcing elements of the origin or insertions of muscles or attachments of ligaments, represents the locus minoris resistentiae for beginning of fractures. Variability in the sizes and shapes of pertrochanteric fracture fragments also depends on variability of the locations and sizes of soft tissue attachment areas at specified sites on the proximal femur.

Introduction: The objective of this work is to present results obtained in a three-year study focussed on micturition, defecation and sexual disorders in women of active age., Methods: The monitored set consisted of 33 female patients treated in 2004-2009 for unstable pelvic fracture (B-type or C-type according to AO classification). Out of them 25 patients suffered B-type fracture and 8 patients suffered C-type fracture. Their age ranged between 17 and 55 years (the average age was 32 years). Anamnestic data were obtained based on UIQ, UDI and PISQ12 questionnaires. The non-parametric Mann-Whitney U-test was used for answers to individual questions representing nominal/ordinal variables. After finding a statistically significant difference in answers between both groups of patients, it was investigated by means of Pearson Chi2-test which answers are behind this statistically significant difference. If the number of answers to any question was less than 5, the exact Fisher test was used. In the event the rate equalled 0, Haldane correction was applied. All tests were considered statistically significant if the significance level was below 5%., Results: The occurrence of urologic problems was higher in the B-type fracture patients (84% vs. 50%), however, afflictions were more severe in the C-type fracture patients. Intestinal problems were more frequent in the C-type fracture patients (75% vs. 52%) and they were also more severe. Also sexual problems were more frequent in the C-type fracture patients (75% vs. 40%), although according to individual answers it was not possible to state that their sexual life was unequivocally worse., Conclusion: The analysis of comparison of micturition, sexual and defecation problems in patients one year after the unstable pelvic fracture showed in some respects higher problems in the patients who had suffered the C-type fracture. However, more important are the following observations, generally related to unstable pelvic fracture patients: 1. The occurrence of micturition, sexual and defecation problems was unexpectedly high; 2. Without active examination by a traumatologist during the after-treatment "minor" problems may escape his/her attention and may negatively affect life of each individual patient in the longer run; 3. A targeted method of detection of problems by means of questionnaires could lead to their disclosure; 4. A urologist, urogynaecologist, sexologist and proctologist have an indisputable place in the treatment of women who suffered a severe pelvic trauma.

The authors completed all available information of the national and foreign literature concerning problems of urogynecological injuries associated with a pelvic injury in women with regard to possible consequences to the quality of life. The authors also aimed their attention on potentional risks associated with pelvic injury in pregnant women. Urological and sexual disorders following pelvic injuries in women in the fertile age represent a separate chapter of traumatology. Increase in these injuries noticed in last years requires particular attention to diagnostics and treatment of these conditions: urinary incontinence, sexual disorders and pregnancy in women who suffered a pelvic injury. The problem of diagnostics and sequelae of injury of the pelvic floor still remains unresolved.

Purpose of the Study: To report on the early results and possible complications of iliosacral screw fixation in the management of unstable pelvic ring injuries., Material and Methods: One hundred and two unstable pelvic ring injuries were treated using iliosacral screw fixation for posterior pelvic ring disruptions. Closed manipulative reductions of the posterior lesion were attempted for all patients. Open reductions were used in the minority of patients with unsatisfactory closed reductions as assessed fluoroscopically at the time of surgery. Anterior fixations were by means of open reduction in 62 patients and by external fixation in 14 patients, and by screws in 7 patients. Twenty patients had no anterior fixation. Plain anteroposterior, inlet and outlet radiographs of the pelvis were obtained postoperatively at six weeks, three months, six months and one year. A pelvic computed tomography scan was performed postoperatively in those patients where residual displacement or screw misplacement was suspected. Complications were recorded., Results: One patient died 31 days after the trauma due to pneumonia and one died 9 months after the surgery after a fall from a height in a second suicidal attempt. There were two posterior pelvic infections and one anterior pelvic infection. Screw misplacement occurred in seven cases. In six cases a misplaced screw produced transient L5 neuroapraxia. There was no fixation failure requiring revision surgery. There was one case of injury to the superior gluteal artery., Discussion: Unstable pelvic ring disruptions are severe injuries, associated with a high rate of morbidity and mortality. Pelvic fractures can be treated by variety of methods. Treatment with traction and pelvic slings does not offer accurate reduction and confines the patient to prolong bed rest with all potential complications. Several authors documented lower morbidity and mortality rates and shorter hospital stay in patients treated by early operative stabilization of pelvic injuries. The timing of the surgery is still controversial. Some authors in large trauma centres believe that ideally the initial treatment should be the final treatment. The advantage of urgent fixation is the use of this usually minimally invasive technique in the initial stabilisation of a hemodynamically unstable patient.The disadvantage is performance of the surgery under increased stress and time limit, which may lead to the acceptance of sub-optimal reduction. Very good team work of the orthopaedic surgeon, anaesthetist and other involved specialists (general surgeon, urologist) is necessary., Conclusions: Iliosacral screw fixation is a useful method of stabilizing unstable pelvic ring injuries. It is a difficult technique, with a steep learning curve. The surgeon must understand the complex and variable sacral anatomy. High quality fluoroscopic imaging is a must. Especially in vertically unstable injuries the sacroiliac screws need to be augmented by sound anterior fixation. Low rates of infection, wound healing problems and minimal blood loss are advantages of this method.

The authors present the case of 36 years old woman, who suffered from unstable fracture of pelvis after she fell from the 5th floor. The spongiosa bleeding from both massae laterales sacri caused significant blood circuit destabilisation not only immediately after the injury but also in hours following the external fixation of pelvis. Due to persistent blood losses it was necessary to apply 38 RBC units, 48 FFP units, 1500 IU of antithrombin III, 1000 mg of fibrinogen and 6 platelet units within first 12 hospitalisation hours. With respect to ongoing bleeding and lack of accessible blood products it was decided to stop intensive hemotherapy and rationalize the treatment. The rationalization led to the hypotension (systolic blood pressure was 40-60 mm Hg), which along with gradual increase of body temperature caused unexpectable patient stabilisation. The systolic blood pressure was stabilized on 80 mm Hg and heart rate about 100/min. After 4 hours another 3 RBC units and 4 FFP units brought from the nearest reachable hospital were applied. The following blood pressure measurement was 120/80 and heart rate about 90/min. In the course of following 2 days it was possible to stop the catecholamine treatment. The authors are of opinion, that uncovered spongiosa caused by expresive dislocation of fragments may lead to massive bleeding that is difficult to stop by accessible means. The bleeding may be an essential risk for patients life and neither targeted intensive postoperative care can settle the matter.

Purpose of the Study: The aim of the study was to make a basic analysis of the patients treated for pelvic fractures in the year 2007 at 14 institutions in the Czech Republic and Slovakia., Material and Methods: The group investigated consisted of 474 patients treated in 2007. In a one-year prospective descriptive study, patients' data were recorded according to a unified protocol. They included age, gender, mechanism of injury, fracture type, associated injuries, method of treatment, post-operative complications, length of hospital stay, injury/surgery-to-standing time and number of deaths during primary hospitalization.The ?2 test of independence in a contingency table was used to compare categorical data. The level of significance for the test was set at 5%., Results: The group comprised 192 women and 282 men with an average age of 45.9 years (range, 15 to 95). In men, the frequency of pelvic fractures was significantly higher (p<0.001), because men significantly outnumbered women in the largest middle-age categories (30 to 59 years). Pelvic fractures were significantly higher only in women over 80 years of age. The most frequent cause of injury was a road traffic accident (237 patients, 50%). Significantly more men than women were injured in motorbike accidents (p=0.015), due to a fall from height (p=0.001) or by a falling object (p=0.040).Women more frequently suffered injury as a result of a suicidal attempt by jumping (p=0.051) or a simple fall (p<0.001). Type A2.2 fractures (115 patients, 24%; average age, 51.8 years) and type B2.1 (77 patients, 16%; average age, 43.5 years) were most frequent. In 248 patients (52%), a pelvic fracture was part of multiple trauma. These patients had an average ISS of 30 points. Conservative treatment was used in 287 patients (61%). In 71 patients, skeletal traction (30 patients, 6%), C-clamp (19 patients, 4%) or external fixation (22 patients, 5%) was temporarily applied during the primary treatment. Surgery was carried out in 187 patients (39%). The average operative time was 114 minutes (range, 45 to 315) Post-operative complications were recorded in 58 patients (30% of the surgically treated). The most frequent local com- plication was wound infection (11 patients, 6%). The average hospital stay was 27 days (range, 2 to 266); 181 patients (38%) required care at an anaesthesia and acute care department for an average of 14 days (range, 1 to 127). The injury/surgery-to-standing time was 30 days on average (range, 2 to 118 days). Twenty-six patients; nine women and 17 men (5%), died during primary hospitalization. Their average age was 62.5 years (74.1 years in women and 56.4 years in men)., Discussion: The higher number of injured men in the middle-age categories suggests a more risky behaviour of these men in driving motor cars and motorbikes and at work (falls from height, objects falling on them).Women significantly outnumbered men in simple falls (which can be explained by a higher occurrence of pubic ramus fractures due to osteoporosis in women at a higher age) and a difference at the margin of statistical significance was recorded in suicidal attempts (any explanation is beyond the scope of this study as well as beyond the field of trauma medicine). The higher number of type A2.2 and also type B2.1 fractures can too be explained by a higher occurrence of these fractures due to simple falls in elderly women with osteoporosis., Conclusions: The evaluation of the basic demographic and epidemiologic data of patients with pelvic fractures included in this multi- centre study revealed the following facts: pelvic fractures were significantly more frequent in men; the most frequent cause of pelvic fracture was a road traffic accident; the number of injured men was highest at age 40 to 50, in motorbike accidents, falls from height and in injuries by falling objects; women outnumbered men at the age category over 80 and in suicidal jumping from a height; the most frequent types of fractures were those affecting osteoporotic bone in elderly women (A2.2, B2.1); surgical treatment of pelvic fractures was associated with a relatively high number of complications; death during primary hospitalization was higher in elderly patients. Key words: pelvic fracture, demography, epidemiology, type of fracture, associated injuries.

PURPOSE OF THE STUDY To assess the effects of medical history, fracture type, method of treatment and complications on the risk of death in elderly patients treated for proximal femoral fracture. MATERIAL AND METHODS The group comprised of 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fracture at the Level I Traumacentre between January 2003 and June 2005. The follow-up ranged from 12 to 38 months. In a prospective consecutive manner the following was recorded: age, gender, serious internal diseases, pre-injury level of mobility, place of living before injury, fracture type (AO classification), time between injury and surgery, anaesthesia, surgical technique, complications and death. Statistical significance at the 95% level was ascertained using null-hypothesis tests for qualitative and quantitative variables by means of multivariate analysis. RESULTS The average age of the patients was 81 years (range, 70 to 99 years). The higher the age, the shorter the time of survival (p=0.015) as each additional year reduced survival by 4.6%. The women to men ratio was 4.2:1. The male gender had a significantly shorter time of survival (p=0.007). Two and more serious internal diseases in the patient's medical history, as compared with a single one, also made survival significantly shorter (p<0.001). When, before injury, a patient moved without walking support, survival was significantly longer than in a patient using a walking cane/crutch (p=0.022) or two canes/crutches or a walker (p<0.001), or in a bedridden patient (p=0.014). The fact that, before injury, a patient was living in a pensioner's home had no effect on a shortened time of survival (p=0.136). Similarly, the fracture type (31A or 31B and subgroups) was not significant for the length of survival (p=0.903). The interval between injury and surgery was not a risk factor for survival (p=0.269). No effect of the type of anaesthesia on survival was found (p=0.450). Neither the surgical technique nor the type of implant was significant for survival time. When general internal complications occurred, they affected the length of survival significantly (p<0.001). Also, pressure sores developing in the post-operative period significantly shortened the time of survival (p=0.037). Early complications did not result in shorter survival (p=0.867), but late deep infection in ive patients significantly shortened their lives (p=0.008). Failed osteosynthesis and consequent revision surgery shortened survival time only when it occurred during the primary treatment (p=0.003); after the primary hospitalization was terminated, it had no effect on the length of survival (p=0.398). DISCUSSION The study focused attention only to elderly patients with proximal femoral fracture treated surgically. The authors suggest that, by excluding patients treated conservatively, the group became more homogeneous and a more exact assessment of each factor's effect on death risk was possible. The investigated factors were recorded only during the first year following injury; however, death was recorded by the end of the study. Using the assessment of cumulative survival, this allowed for a more accurate statistical evaluation of the effect of each factor on the risk of death. CONCLUSIONS In patients over 70 years, a significantly shorter time of survival following the surgical treatment of proximal femoral fracture was found to be related to high age, male gender, multiple morbidity in the patient's medical history, poor patient's mobility before injury, general complications, development of pressure sores post-operatively, failed osteosynthesis requiring revision surgery and deep infection of the affected hip. No relation to significantly shorter survival was found for the following factors: living in a pensioner's home before injury, fracture type, time between injury and surgery, type of anaesthesia and operative technique. Key words: hip fracture, surgical treatment, mortality, risk factors.

Pelvic fractures are serious injuries. For the diagnosis and treatment of unstable pelvic ring fracture in a haemodynamically unstable patient, it is necessary to use standard procedures with the objective to stabilise both blood circulation and the pelvic ring. According to the state of the patient, the choice is between life-saving surgery, damage control surgery and procedures of early or delayed stabilisation of the pelvic ring. The survival of injured patients as well as their further health condition will depend on the method of treatment used in the first hours after injury.

The aim of the study is to present results showing whether a pelvic injury in polytrauma patients means a high risk of mortality. The retrospective study (January 2001 - December 2006) included 453 polytrauma patients (130 women, 323 men) with ISS exceeding 16 points, hospitalized at the authors' department (Traumacentre Level I). The age of patients ranged between 13-93 years, the mean age of the whole group was 41 years (43 years in women, 40 years in men). The highest percentage of the deceased was recorded in the subgroup with abdominal injury (35%) and in the subgroup with pelvic injury (31%), the lowest in the subgroup without abdominal injury (20%). A significant difference was recorded between the numbers of deceased patients with and without abdominal trauma (p < 0.001), and between the numbers of patients with and without pelvic injury (p = 0.046). The results of the study have demonstrated a significantly higher rate of mortality in polytrauma patients with ISS > 16 points, with a simultaneous pelvic injury as compared to the patients without pelvic injury.

Background: The authors examined the incidence of musculoskeletal injuries according to their type and location in the period of winter at a highland hospital, which also functions as a regional hospital for a few winter sport resorts., Methods and Results: . In the sample there were 1644 patients (696 women, 948 men) treated for primary musculoskeletal injuries from 1.1. to 31.3.2008. This was a retrospective study; the data were collected from medical reports. It included: age, sex, mechanism of injury, diagnosis and whether the patient had to be hospitalised or not. Age of the patients ranged from 1 to 95 years with an average of 29 years (31 for women and 28 for men). Younger age groups dominated among men. After 70 years of age there was a prevalence of women. Fractures were the most common cause of injury (653, 39.7%), followed by injuries to the joints' ligamentary apparatus by mechanism of distortion (379, 23.1%). Next in incidence were soft tissue injuries caused by contusion (325, 19.7%) and open wounds (241, 14.7%). The least common were luxated joints (43, 2.6%) and closed injury to muscles and tendons (3, 0.1%). The most frequent site of injury was the hand (404, 24.6%), while the least frequent place was the thigh (17, 1.0%)., Conclusions: In conclusion the study confirmed that other than the age, gender and the season, the geographic location also influences the spectrum of musculoskeletal injuries. The study also showed that the most common type of injuries was that of the upper extremity. The study did not confirm the expected prevalence of fractures among women. The prevalence of men was probably because of the prevalence of winter sport activities as a leading cause of injury (mostly skiing and snowboarding).

Objective: The goal of this work is to compare therapeutic results of two groups of patients with an infected fracture or chronic osteomyelitis of the lower leg and ankle joint treated by the method of radical debridement followed by free flap transfer or muscle transposition., Patients: In the period between 1 January 2002 and 30 September 2007 the authors used this method in the treatment of 52 patients (10 females and 42 males) with the average age of 44 years (ages ranged from 10 to 67). The observed group of patients was divided into retrospective and prospective subgroups., Methods: The difference between the retrospective and prospective parts of the study was how radical the debridement and necrectomy of the soft tissues was. A comparison of therapeutic results in both subgroups was made by evaluation of the amounts of postoperative complications, number of follow-up surgeries and the actual weight-bearing ability of the treated extremity., Results: The difference in the number of postsurgical complications (7 versus 2) was not significant (p=0.123), and neither was the difference in the number of follow-up surgeries (20 versus 17, p=0.706). The difference in the number of patients with fully weightbearing extremities (21 versus 22) was also not significant (p=0.670)., Conclusion: The authors feel that analysis of complications showed somewhat better results in the prospective part of the study, despite the lack of statistical proof. Therefore the authors regard the method of extensive debridement with the following coverage of the soft tissue defect by muscle flap as suitable for the treatment of infected fractures in the area of the lower leg and ankle joint and the treatment of osteomyelitis of the tibia.

Long-term or recurrent osteomyelitis results in the deterioration of soft tissue quality at the site of an infectious process. An insufficient perfusion of the scar tissue contributes to difficult treatment of osteomyelitis. A local transpositional or free muscle flap used to replace the vulnerable scar tissue will enhance perfusion of the affected bone and will help to control osteomyelitis. The authors present the case of a patient who had been treated by bone transport for a 14-cm-long segmental defect of the tibia after post-traumatic osteomyelitis. Recurrent osteomyelitis was found nine years after the primary surgery. The whole tibial cavity was opened leaving a 12-mm-wide trepanation opening, and debridement of all necrotic and inflammatory tissue including dystrophic skin was performed. The Orr technique was used for further treatment. There was no relapse and granulation tissue samples repeatedly gave negative culture results. Therefore, at the second stage, the soft tissue defect was covered with a free latissimus dorsi muscle flap. Anastomoses to the recipient vessels were technically difficult to carry out in the tissue greatly affected by previous chronic inflammation. Ten days after the surgery the patient was allowed to stand and walk, full weight-bearing was allowed at 2 months post-operatively when the flap was completely integrated. At 6-year follow-up the extremity was fully weight-bearing, with no recurrence of infection, and the patient was satisfied with the outcome. The authors regard this interdisciplinary management (extensive bone and soft tissue debridement, free muscle flap transfer) as a method indicated for the treatment of recurrent tibial osteomyelitis.

Finite element (FE) analysis has been widely used to study the behaviour of bone or implants in many clinical applications. One of the main factors in analyses is the realistic behaviour of the bone model, because the behaviour of the bone is strongly dependent on a realistic bone material property assignment. The objective of this study was to compare isotropic and orthotropic inhomogeneous material models used for FE analyses of the "global" proximal femur and "small" specimens of the bone (cancellous and cortical). Our hypothesis was that realistic material property assignment (orthotropy) is very important for the FE analyses of small bone specimens, whereas in global FE analyses of the proximal femur, this assignment can be omitted, if the inhomogeneous material model was used. The three-dimensional geometry of the "global" proximal femur was reconstructed using CT scans of a cadaveric femur. This model was implemented into an FE simulation tool and various bone material properties, dependant on bone density, were assigned to each element in the models. The "small" specimens of cortical and cancellous bone were created in the same way as the model of the proximal femur. The results obtained from FE analyses support our above described hypothesis.