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Introduction: The authors have attempted to elucidate the differences between Chance, seat-belt, and flexion distraction fractures. Chance and seat-belt fractures have more common features, while flexion distraction fractures differ, in particular, due to the mechanism of injury. A difficult diagnosis is sometimes a common characteristic, while therapy is always the same., Patients and Methods: During the period from 1997 to 2005, the authors treated 23 seat-belt fractures, and only three "genuine" Chance fractures. All patients had normal neurological findings. The mechanisms of injury were a car crash in 20 cases, and a fall associated with flexion in 6 cases, such as a rolling fall while skiing. According to the localisation, Chance fractures were found at the L 1 level twice and at the L 2 level once. Seat-belt injury was found once each in the areas of T 7, L 4, L 5, -twice at L 2 and L 3, and 16 times at the T / L spine transition, respectively. All patients were operated on using instrumented posterolateral spondylodesis., Results: All fractures healed by spondylodesis as confirmed by X-ray images. All patients returned to their original job or school. 14 patients were evaluated 6 months after removal of the metallic implants. The mean subsequent kyphotisation was 1.4 degrees with the largest deviation of 4 degrees in a patient with a pure ligamentous variant of a seat-belt fracture., Conclusion: The objective of this work is to illustrate the various types of spinal distraction injuries of a seat-belt character and Chance fracture, when the vertebral body is not compressed. X-rays and often also CT scans show a "benign" character. Interpretation of the findings is very important for the development of further chronic instability of the spine and all consequences. If the diagnosis of a distraction injury is made the operative stabilisation is essential. That is why all our patients were tretaed by operation.

Purpose of the Study: To evaluate, in a retrospective study, injuries to the urogenital tract in patients with pelvic ring fractures. MATERIAL In the years 1998-2007, a total of 308 patients with pelvic ring fractures were treated. The study did not comprise patients with low-energy fractures, such as apophyseolysis in children, osteoporotic bone fractures or pathologic fractures. It also did not include patients with multiple injuries who died within 6 hours of admission to the hospital. The group consisted of 186 men and 122 women with an average age of 34 (range, 6 to 76) years., Results: The fractures sustained were classified as type A in 5 %, type B in 57 % and type C in 38 % of the patients. The average follow-up was 71 (range, 13 to 121) months. A primary injury to the urogenital tract was recorded in 50 (16 %) patients. Injury to the urethra was found in 23 (7.5%) and urinary bladder trauma in 18 (6%) patients, vaginal injury was in four women (1%), and penis injury in three (1%) and lacerated testicles in two men (1%). Injury to the urogenital tract was associated with a pelvic ring fracture type A in 5 %, type B in 34 % and type C in 61 % of the patients. Out of the 23 patients with urethral trauma, only six (26 %) were free from functional and subjective complaints; eight (35 %) continued to receive therapy for urethral stenosis seven (30 %) reported urinary incontinence, and seven men (30 %) had erection problems. In six patients (26%) the lasting sequelae were combined. The 18 patients with injury to the bladder reported no subjective complaints at a one-year follow-up. Two patients with penis root injury had erectile dysfunction. Two patients with the loss of both testicles were in the care of a psychiatrist. The patients' satisfaction was evaluated on a 0-to10-point scale. The average value for the whole group was 4.1 points. In the patients with erectile dysfunction, the value was 0.8, and in those with isolated injury to the urinary bladder it was 9.4 points., Discussion: The increasing number of injuries to the urogenital tract associated with permanent sequelae is caused by a growing number of pelvic ring fractures as well as, and this is more important, by decreasing mortality in patients with severe trauma to the pelvic ring The extent of urogenital injury is related to the degree of dislocation of the pelvic skeleton. Injury to the male urethra is the most frequent urogenital trauma because of the male anatomy. It occurs most often in unstable C type fractures when the pelvic ring is disrupted with bone displacement due to shear force at the site of urethra attachment. The consequences are related to the quality of treatment of urogenital tract injury as well as to how the skeletal injury is managed. The lasting effects of the primary injury to nerve structures are beyond repair by therapy., Conclusions: Injury to the urethra results in erectile dysfunction in 50 % of the injured patients it is often associated with urinary incontinence that has a strong effect on the patient's life quality. Isolated trauma to the urinary bladder has a good prognosis. The incidence of post-traumatic incontinence is not high, but reduces the patient's personal and social comfort. A prerequisite for a successful therapeutic outcome is a good cooperation of the orthopaedic surgeon and urologist. Key words: pelvic ring fractures, urogenital injury.

Purpose of the Study: To analyse retrospectively complications of the surgical treatment of displaced acetabular fractures., Material: In the years 1996 to 2006 a total of 251 patients with acetabular fractures were treated. The group comprised 162 men and 89 women; the average age was 35 years. The average follow-up was 71 months (range, 16 to 138). Based on the AO classification, type A fractures were found in 58%, type B in 23% and type C in 19% of the patients. Indications for surgical intervention were hip instability or hip incongruence., Results: The complications included intra-operative, and early and late post-operative problems. Of the intra-operative complications, 2% were vascular injuries, 5% were damage to the static nerve, 13% were due to incomplete reduction and 2% due to bone non-union. Early post-operative complications in five patients (2%) required revision surgery for early infection in two, haematoma in the wound in one and failed osteosynthesis in two patients. In one patient failed osteosynthesis was associated with hip dislocation. Late complications included aseptic necrosis in 7%, post-traumatic arthritis in 17%, para-articular ossification grades III and IV of the Brooker classification in 7% and late infection in 0.5% of the patients., Discussion: The outcome of surgical treatment depends on quality reconstruction of the articular surface and complications, and is related to the fracture type and method of treatment. Not every poor outcome means it is a complication, nor is it always related to the type of fracture. Some fracture types are bound to heal poorly. The complex anatomy of the joint involves rather frequent injury to nerve structures and imperfect reduction and fixation., Conclusions: The most frequent complication is the development of post-traumatic arthritis due to imperfect reduction. However, the current limit of achieving correct reduction and weight-bearing surface reconstruction remains an open issue. Aseptic necrosis in type A fractures was three-times as high as in type B and C fractures. Imperfect reconstruction of the acetabulum and failure to restore hip joint congruence were twice higher in type B than type A and C fractures.

Purpose of the Study: A group of 79 patients with ipsilateral fractures of the hip and femoral shaft treated with the use of a long proximal femoral nail (PFN-long) was retrospectively evaluated., Material: From January 1998 to February 2005, 79 patients were treated surgically. The group included 42 men and 37 women at an average age of 56.6 years. In 47 patients (37 men and 10 women; average age, 38 years; range, 18-72 years) the fractures were due to a high-energy trauma. In the remaining 32 patients (six men and 25 women; average age, 77.6 years), the cause of fracture was a low-energy trauma, most frequently an ordinary fall. The fractures were categorized according to the Dousa, Bartonícek and Krbec classification. Type IV fractures, i. e., subtrochanteric fractures involving the whole upper half of the femur, were most frequent., Methods: The Synthes PFN-long is based on the PFN and partly also UFN implants. The nail is matched to femoral shaft antecurvation, and femoral neck screws have a 10 degrees anteversion. The nail is cannulated, is 10 mm thick and is available in three lengths with a distal dynamic opening., Results: The results are based on the evaluation of 65 patients followed up for at least 12 months. At 12 months bone union was achieved in all patients; in 38 patients (58 %) it occurred by 6 months and in 59 patients (91 %) by 9 months. The outcomes were excellent in 42 (64 %), good in 18 (28 %) and satisfactory in 5 patients (8 %). Thirteen intra-operative complications (27 %) in nine patients were recorded, with the necessity of repeat surgery in four cases. Two problems were involved: incomplete reduction (nine fractures) and incorrect implant insertion (four fractures). Early complications included hematoma in the wound in five cases and one infected wound.A late complication was delayed union in two cases., Discussion: The management of ipsilateral fractures of the hip and femoral shaft is still associated with a high percentage of complications, mostly due to reduction being difficult. The PFN-long is an implant combining the advantages of the short PFN and UFN systems. Our results are in agreement with the literature data on similar fractures treated with second-generation reconstruction nails and have a lower percentage of complications, even though our group had different characteristics in terms of a higher average age and nearly equal numbers of men and women., Conclusions: The PFN-long is a high-quality implant that increases our options of treatment. Of all the reconstruction nails, it has most advantages. The availability of only three sizes (in three lengths with one thickness) is a certain disadvantage.

Purpose of the Study: A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study., Material: In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients., Methods: In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used., Results: The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients., Discussion: Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results., Conclusions: Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.