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PURPOSE OF THE STUDY Extended lateral approach to calcaneus fractures is associated with a high risk of infection. Such risk can be reduced by using mini-invasive approaches. The sinus tarsiapproach provides a good overview of the posterior joint facet of the calcaneus and can also be done as a mini-invasive procedure. The authors present their first experience with osteosynthesis of joint depression calcaneal fractures using the anterolateral locking plate inserted through the sinus tarsiapproach. MATERIAL AND METHODS During the period from 1 February 2020 to 31 January 2022, 18 patients were treated by the anterolateral locking plate in the authors‘ department (3 women, 15 men). Eleven fractures were classified according to Sanders as IInd grade, five as IIIrd grade and two fractures were classified as tongue-type (as described by Essex-Lopresti). The fractures were treated by open reduction through the sinus tarsiapproach and osteosynthesis by the anterolateral locking plate combined with headless screws. The following factors were examined: time from injury, duration of surgery, quality of reduction (post-op control with multiplanar CT scans), wound and technical complications, loss of reduction after treatment, substance abuse and comorbidities. The follow-up was 12–36 months (median 17). At one year after surgery, the functional outcomes were evaluated using the AOFAS Hindfoot score. RESULTS The most common negative predispositions for successful healing were smoking (9 cases), alcohol abuse, drug abuse, mild mental retardation, personality disorder, insulin-dependent diabetes and epilepsy (1 case each), hypothyreodism and bronchial asthma (2 cases each). The time from injury to surgery and duration of surgery surgery were measured. The quality of reduction was excellent in 12 patients (dislocation less than 1 mm), good in 6 patients (dislocation less than 2 mm), dislocation more than 2 mm was not present in the group. In one case, a revision surgery was performed because of screw malposition into the subtalar joint, delayed wound healing was observed in two cases. There was no case of deep surgical site infection or loss of reduction. The mean AOFAS score after one year was 85 points. The most common complaints were scar pain or discomfort. DISCUSSION The current studies on osteosynthesis of calcaneal fractures favor the sinus tarsiapproach for its lower risk of wound-related complications compared to the extended lateral approach. The sinus tarsiapproach requires the use of different osteosynthetic material than the conventional calcaneal plate. If a conventional locking plate is to be used, the surgical approach has to be modified. In 2021, Wang et al. published an intermediate step leading to the reduction of early complications and the use of conventional locking calcaneal plate inserted through the sinus tarsiapproach, with an additional incision. The sinus tarsiapproach is used also when intramedullary nailing is performed, which is preferred by biomechanical studies evaluating the rigidity of osteosynthesis. However, when comparing nails and locking plates, the differences are insignificant. The use of anterolateral locking plates was presented by Xie et al., with results similar to those of our own group of patients. CONCLUSIONS The results of the followed-up group of patients confirm low complication rate of the sinus tarsiapproach as reported by current literature. At the same time, it provides good options for reduction even in complicated fractures. For successful osteosynthesis, the anterolateral locking plate with headless screws may be used. The incidence of post-operative complications is low even in high-risk patients. Adhesions of peroneal tendons can be treated with material removal and tissue release. They could be prevented by good physiotherapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: The aim of the study was to identify factors contributing to the development of non-union after fixation of diaphyseal humeral fractures using Hackethal's intramedullary nailing technique. Methods: In the time period from 2001 to 2010 156 patients with diaphyseal humeral fractures were treated surgically using Hackethal's technique. Six of them (3.8%) developed non-union. This group included three women and two men aged 63-69 years and one woman aged 37 years. The following parameters of the patients were recorded: age, gender, comorbidities, substance abuse, mechanism of injury, fracture type and location according to the AO/ASIF classification, and the operative technique. Results: A non-union developed in six patients treated with Hackethal´s method (3.8%). Five of six non-unions (83%) were observed in patients in their sixties. In the subgroup of sexagenarians, non-union developed in 20.8% of surgically treated patients, as compared to 3.8 % in entire group. In the union group, fractures have been caused by high energy trauma in 52% of patients. In patients who developed non-union, high energy trauma caused 67% of fractures. With correct surgical technique the development of a non-union was observed in 0.7% of patients, with incorrect technique in 35.7% (p

Introduction: Volkmann's ischaemic contracture (VIC) is a disabling condition resulting from tissue necrosis due to impaired vascular supply to the limb. Over the years VIC has become rare in developed countries with many different aetiologies described. It was alarming to have high incidence of established VIC in our practice in Nepal. A detailed analysis was conducted to accurately describe this issue., Methods: We collected 47 cases of VIC over six years and noted the age, sex, district of origin and cause of VIC, duration of injury to presentation, and the grade of VIC. Then we compared these characteristics of VIC of each Nepal province and created a map to show the problematic regions., Results: Out of 47 patients, 46 could have been prevented by an early treatment. The most common cause was a tight cast in 25 patients (53.19%), followed by unintentionally self-caused VIC by applying tight bandages in 21 patients (44.68%). Most cases came from province 6 (29.78%). Our group included three mild (6.4%), 35 moderate (74.5%) and nine severe (19.1%) cases of VIC. Only 14 cases (29.78%) had a timely fasciotomy in the past., Conclusion: VIC is an irreversible complication of the compartment syndrome which is an easily preventable condition in the setting of developing countries. Our focus should, therefore, aim at preventing such disastrous conditions as 97.87% of cases we encountered could have been avoided by proper primary care. In the case of Nepal most cases came from province 6 and province 3.

The paper introduces the concept of the rational design of a deployable humeral intramedullary nail plug based on a honeycomb structure used for the surgical treatment of humeral shaft fractures. The concept serves for to restore the axial alignment of bone fragments and to maintain stability via bone-nail friction and locking screws. The design nail plug was gained by optimisation process the Latin Hypercube Sampling Design algorithm and Multi-Objective Genetic Algorithm. It was shown that we can use statistical shape function combined by 3 D printing for designing of a new rationally designed implants.

Fractures of the surgical neck of the scapula combined with a fracture of the coracoid base constitute a specific and rare type of a fracture pattern. When displaced, they present a severe, completely unstable type of surgical neck fracture, requiring a precise CT diagnosis, open reduction and stable internal fixation of the fracture via the Judet approach. The aim of this study is to describe our four cases and discuss three others reported to date.

Elastic bundle nailing is a method for simple humeral mid-shaft fracture osteosynthesis. The aim of our subsequent numerical simulations was to find out torsional and bending stiffness of an elastic bundle nailed humerus. Parametrical 3D numerical model was developed. The diameter of nails was the varying parameter of 1.8, 2.5, 3 and 4 mm. From our results can be seen that the bending stiffness in bundle nailing technique does not depend on nail diameter. On the contrary the torsional stiffness does highly depend on nail diameter. The dependency of the maximal stress on a nail diameter during bending and torsion of the humerus is non-linear. It can be seen that the higher diameter is used the higher stress occurs. Achieved results allow us for the recommendation of optimal nail diameter for this method, which lies between 2 and 3 mm.

Objective: The aim of the study was to identify factors contributing to the development of non-union after fixation of diaphyseal humeral fractures using Hackethal's intramedullary nailing technique., Methods: In the time period from 2001 to 2010 156 patients with diaphyseal humeral fractures were treated surgically using Hackethal's technique. Six of them (3.8%) developed non-union. This group included three women and two men aged 63-69 years and one woman aged 37 years. The following parameters of the patients were recorded: age, gender, comorbidities, substance abuse, mechanism of injury, fracture type and location according to the AO/ASIF classification, and the operative technique., Results: A non-union developed in six patients treated with Hackethal´s method (3.8%). Five of six non-unions (83%) were observed in patients in their sixties. In the subgroup of sexagenarians, non-union developed in 20.8% of surgically treated patients, as compared to 3.8 % in entire group. In the union group, fractures have been caused by high energy trauma in 52% of patients. In patients who developed non-union, high energy trauma caused 67% of fractures. With correct surgical technique the development of a non-union was observed in 0.7% of patients, with incorrect technique in 35.7% (p<0.001)., Conclusion: Treatment of diaphyseal humeral fractures with Hackethal's intramedullary elastic bundle nailing resulted in an overall high union rate. Factors contributing to the development of non-union were extension of this method to AO type B3 and C fractures and technical imperfection during implantation. Level of Evidence III, Prospective, Case-Control Study., Competing Interests: All the authors declare that there is no potential conflict of interest referring to this article.

Introduction: Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and only brief mentions can be found in the literature., Methods: The group comprised 12 patients (mean age, 39 years), who sustained 13 fractures of the glenoid fossa. In all the fractures, all parts of the glenoid fossa were separated from the scapular neck or body. In total 5 patients (6 fractures) were treated non-operatively and 7 patients were operated on. The method of treatment was based on displacement of the fragments, the patient´s general and local conditions. Indication for operative treatment was displacement of articular fragments of more than 3mm. This criterion was met by 10 patients (11 fractures). Owing to the general or local condition, operation was contraindicated in 2 patients with 3 fractures; one patient refused the operation. One patient with a bilateral fracture was lost to follow-up., Results: According to the site of separation of articular fragments, the fractures were divided into three groups - the separation line passed through the anatomical neck; through the coracoid process or surgical neck of the scapula; or through the scapular body. In 6 of the 7 operated patients, a good or very good result was achieved. In 2 patients with minimal fragment dislocation treated non-operatively, the fractures healed in an anatomical position and full range of motion was achieved. In 2 patients with severe fragment displacement treated non-operatively, the healing resulted in glenoid fossa incongruence and painful and limited range of motion., Conclusion: Fractures of the entire glenoid fossa are the most severe injuries to scapula. Their diagnosis requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment from the Judet approach.Key words: scapular fractures glenoid fractures classification, operative treatment Judet approach.

Purpose of the Study: The aim was to determine indication criteria for use of arthroscopy in the treatment of post-traumatic changes in the elbow joint, to present the surgical technique and to evaluate the results of a prospective study involving early follow-up of functional and radiographic outcomes of this treatment., Material and Methods: Between February 2010 and February 2013, arthroscopic surgery was carried out on 14 elbows in 14 patients at the Clinic of traumatology of Masaryk hospital in Ústí nad Labem. The group comprised seven men and seven women, with an average age of 40 years (range, 20 to 67 years). The indications for elbow arthroscopy included conditions after intraarticular fractures in fie, elbow dislocation in one, severe elbow contusion in four and complex injury to the elbow joint in four patients. Arthroscopic surgery was performed at an average of 11 months after the primary injury. The prospective follow-up lasted for an average of 12 months (range, 6 to 25). The outcomes of surgery were evaluated on the basis of radiograms and multiplanar reconstructions of CT images, elbow function was assessed using two rating systems, i.e., the Mayo Elbow Performance Score (MEPS) and Hospital for Special Surgery (HSS) score., Results: The average active range of motion (ROM) at the elbow joint was 118°/33° (145°-90°/60°-5°) before surgery and improved to 131°/5° (150°-90°/15°-0°), i.e., by 13°/28° (150°-90°/60°-0°) intra-operatively. The average fial value of elbow ROM after functional stabilization was 126°/16° (145°-90°/70°-0°), which means improvement by 8°/17° (45°-0°/50°-0°) or a total of 25°. On post-operative radiograms, the fidings were stable in 11 (79%) patients; elbows in three patients (21%) showed progression of degenerative changes (osteophyte formation and periarticular ossifiation). The fial functional scores, as assessed using the MEPS and HSS score systems, were 88.93 (55-100) and 88.29 (50-100) points (average/ range), respectively., Discussion: The study showed, in agreement with other authors' reports, that the degree of improvement in active range of motion and functional performance of the elbow is directly related to the severity of post-traumatic conditions. A certain residual ROM restriction usually remains. The outcome was poorer in patients with complex injuries of the elbow or in those with displaced intra-articular fractures of the joint and was also related to the severity of joint injury. Patients who were treated after a longer injury-to-surgery period and who suffered a more serious joint injury had more advanced arthritis, higher degree of joint contracture, worse pre-operative functional scores and less improvement in post-operative ROM of the elbow joint., Conclusions: From the results of early functional assessments and radiographic fidings it can be concluded that the elbow joint arthroscopy is a safe and reliable technique to treat post-traumatic conditions caused by intrinsic factors in mild and moderate elbow stiffness. However, this method cannot be recommended in severe stiffness of the elbow or in stiffness due to extrinsic causes. Although the improvement in ROM achieved during the surgical procedure cannot be maintained in its full extent, this technique relieves persisting pain and signifiantly improves ROM of the elbow joint.

Purpose of the Study: The aim of this prospective study was to evaluate the clinical and radiographic results in a group of patients with calcaneal fractures treated by means of minimally invasive, arthroscopically-assited osteosynthesis., Material and Methods: A total of 175 calcaneal fractures in 154 patients were treated surgically at the Trauma Centre of Masaryk Hospital between January 2006 and August 2010. Twenty-six patients were enrolled in this prospective study. They had a total of 30 calcaneal fractures, of which 28 were managed by minimally invasive, arthroscopically-assisted osteosynthesis. The patient's records included demographic data, relevant medical history, fracture type by Sander's classification, associated injuries, time to surgery, length of surgery, post-operative quality of reduction, Böhler's angle before and after surgery, healing complications, hospitalisation time, follow-up period, bone union, functional outcome in Rowe score and hardware removal. The patients underwent minimally invasive osteosynthesis under arthroscopic and radiographic guidance. For this procedure, patients with Sanders type IIa and IIb fractures were predominantly indicated. The group also included patients older than 60 years, smokers, patients addicted to alcohol, a diabetic patient, a dialysed patient and a patient with chronic lower-limb lymphoedema., Results: The patient group included 21 men with 25 fractures (83.5%) and five women with five fractures (16.5%). Nine men (42.9%) were heavy smokers; three men (14.3%) and one woman (20 %) were addicted to alcohol. All fractures were closed and, according to the Sanders system, were classified as follows: 16 fractures as type IIa (57.1%); eight fractures as IIb (28.6%); two fractures as IIIab (7.1%) and one IIIac and IIIbc (3.6% respectively). Six patients (23.1%) sustained bilateral fractures of the lower-limb. In the post-operative period, no disturbance of soft tissue healing and no superficial or deep wound infection were observed. The outcome of fracture reduction assessed by CT examination was excellent in 24 fractures (85.6%), satisfactory in one (3.6%) and poor in one fracture (3.6%). The mean Böhler's angle was +7.2 degrees pre-operatively and +35.4 degrees post-operatively. In all patients bone union was achieved within 3 months; hardware was removed in 19 fractures (67.9%). Functional outcomes according to the Rowe score were very good in 18 (69.2%), good in four (15.4%) and satisfactory in four (15.4%) patients. There were no poor results. The mean Rowe score for the whole patient group was 86 points., Discussion: The demographic data are in agreement with the recent literature data. However, most studies have not included smokers and people addicted to alcohol, therefore, no comparison can be made. The comparison with studies on ORIF-treated fractures is also difficult, because our study included a higher number of less severe fracture types. The surgical technique is demanding and was, at the beginning, associated with intra-operative errors. The post-operative values of Böhler's angle are comparable to the results of ORIF techniques, but this does not mean that this technique could substitute the use of ORIF in complex fractures. The absence of any soft- or bone-tissue healing problems is a very good result, considering the number of risk factors in our patient group. The good functional outcomes according to the Rowe score can be attributed to a higher proportion of less complex fractures in the group., Conclusions: In our group of patients with predominantly less severe types of calcaneal fractures, the quality of post-operative fracture reduction, as a result of minimally invasive, arthroscopically-assisted osteosynthesis, appeared to be comparable with open techniques. The observed complete bone healing and absence of soft-tissue problems could present a surgical option to treatment nihilism in patients contraindicated for ORIF techniques.

Purpose of the Study: The aim of the study was to assess the clinical outcomes and permanent sequelae of pelvic fractures at one year after injury and to identify factors that influenced these results., Material and Methods: The group evaluated consisted of 151 patients older than 15 years treated for pelvic fractures in 2007 at seven hospitals in the Czech Republic and Slovakia. This one-year descriptive prospective study included all basic epidemiological data concerning the patients and the evaluation of their clinical results using the Majeed score. The obtained data were statistically analysed by the 2% test of independence and contingency tables at a 5% level of significance. For data obtained at a low frequency, only descriptive statistical methods were used., Results: From the original group of 237 patients (101 women and 136 men), 16 died (7 women and 9 men) and 70 were lost for follow-up (28 women and 42 men), leaving 151 patients (64%) for evaluation. This final group comprised 66 women (44%) and 85 men (56%) with the age range of 16 to 82 and an average age of 42.7 years (women, 45.3 years; men, 40.7 years). Age distribution, causes of injury, types of pelvic fracture, associated injuries and methods of treatment in this group were similar to those in the original group. The clinical outcomes evaluated using the pelvic Majeed score were excellent and good in 85%, fair in 12% and poor in 3% of the patients. The prediction of clinical outcome was more accurate when based on the extent of dislocation of the dorsal segment after fracture healing than on the type of pelvic fracture The permanent sequelae were recorded in 22 patients (15%) and a total of 43 specific complaints were identified; some patients had multiple sequelae involving neurological, urological and sexual problems. Neurological deficit was related to the type of pelvic injury and its highest occurrence was associated with type C pelvic fractures. Permanent neurological deficits were found in 15 patients (10% of patients in the final group), of whom 10 were diagnosed early after injury as having neurological lesions (7% of the final group) and in five the diagnosis was made after surgery (8 %of surgically treated patients). Fifteen permanent urological disorders were recorded in 13 patients and they also were most frequent in type C fractures. However, they were more strongly associated with primary urethral injury and primary or post-operative neu-rogenic lesions. Sexual sequelae were also found in association with type C fractures; almost all patients with these problems had injury to the lower urinary tract or neurogenic lesions. Permanent gastrointestinal sequelae were in three patients; all of them sustained unstable pelvic fractures and were diagnosed with post-operative neurogenic lesions., Discussion: Based on the evaluation of basic patient data, the patient group described here can be regarded as a representative sample of the originally treated patients. Therefore, in the authors' view, the results presented here can be taken as valid. In agreement with other authors, the study recorded poorer clinical outcomes in the patients with more serious types of pelvic injury, and dramatically worse results in relation to the extent of dislocation of the dorsal segment after the pelvic fracture had healed. The authors confirmed that permanent neurological and urological sequelae occur more frequently in patients with a more serious pelvic injury. Urological and sexual problems were more often associated with the presence of neurologi- cal deficit than with the type of pelvic fracture and injury to the lower urinary tract., Conclusions: The evaluation of patient data at one year after pelvic injury in this prospective longitudinal study justify the authors to draw the following conclusions: clinical outcomes were worse in unstable pelvic fractures; worse clinical results were related to the extent of residual dislocation of the dorsal pelvic segment; permanent neurological sequelae were most frequent and were perceived by the patients with strong negative feelings particularly when they manifested clinically after surgery; permanent urological, sexual and gastrointestinal problems were more closely associated with neurological deficits than with the severity of primary injury to the pelvic skeleton, lower urinary tract, sexual organs or digestive system.

Purpose of the Study: We aimed to determine the incidence of pressure sores and their effect on survival in patients older than 70 years who underwent surgery for hip fracture, and to identify the factors which were associated with an increased risk of pressure sores., Material and Methods: The group comprised 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fractures in the Trauma center between January 2003 and June 2005. Follow-up ranged from 12 to 18 months. In a prospective study we assessed relevant medical history, demographic and clinical data, pre-, intra-, and post-operative factors and the presence, location and depth of pressure sores. Statistical significance at a 5 % level of probability was determined by testing null hypotheses for qualitative and quantitative variables, using multivariate analysis adjusted for selected baseline characteristics., Result: The average age of the patient group was 81 years (range, 70-99). Pressure ulcers developed in 92 patients (34.2 %); their presence in the post-operative period significantly reduced patient survival (p=0.037). In terms of location, pressure ulcers in the calcaneal region had a more significant effect on patient mortality (p=0.011) than those in the sacral region (p=0.130). Age was not significantly associated with pressure ulcer development (p=0.547), in contrast to male gender (p=0.007). A lower mobility score before injury was a significant risk factor (p=0.007). Co-morbidities adjusted for age and gender had a significant effect (p=0.003). The factors that did not significantly increase the risk of pressure ulcers were as follows: the patient's living environment before injury (p=0.113), AO type of fracture (p=0.653), type of anaesthesia (p=0.702), surgical procedure used (p=0.946), morbidity before injury (p=0.267) and time to surgery (p=0.180). The presence of acute complications was of boundary significance (p=0.083). DISCUSSION The study included only the patients with proximal femoral fractures who underwent surgery. It was the authors' view that, by excluding conservatively treated patients, a more homogenous group was achieved. There is only sparse information in the literature concerning the effect of pressure ulcers on reduced patient survival, and the significance of pressure ulcer location has not been evaluated at all. Similarly, the effect of pre-morbidity on pressure ulcer development has not been reported in any of the studies available. In contrast to other studies, the authors did not find age to be a risk factor for increased ulcer development. They believe that the quality and quantity of the input data (prospective data collection, large sample size, long follow-up) guarantee the validity of the results obtained in this study. The incidence of pressure sores is in agreement with the results of relevant studies involving large numbers of patients and prolonged follow-up., Conclusions: In patients older than 70 years undergoing surgery for hip fracture, the development of pressure ulcers had a significant effect on reduced survival, with the highest significance for ulcers in the calcaneal region. Factors significantly increasing the risk of ulcer development were male gender, morbidity before injury and pre-existing chronic complications. The presence of acute complications was of boundary significance. The study did not show any significant effect of age, pre-morbidities, time to surgery, patient's living environment before injury, fracture type, type of anaesthesia or surgical procedure used on the incidence of pressure ulcers.

Purpose of the Study: To evaluate the mid-term results in a group of patients with displaced comminuted (three- and four-fragment) fractures of the proximal humerus treated by angle-stable plate osteosynthesis and compare them with the results in the patients in whom the method of percutaneous Kirschner-wire (K-wire) fixation was used., Material and Methods: The group treated with angle-stable implants (ASI group) consisted of 55 patients, 13 men and 42 women. A Targon Ph nail was used in 32 and a Philos plate in 23 patients. These patients were compared with a group of nine patients, one man and eight women, treated by percutaneous K-wire fixation (K-wire group). At a follow-up of 12 months at least, final Constant (CS) and DASH scores were assessed. The CS was related to the values for the unaffected limb, and an individual relative CS was calculated and expressed in percent. The mean follow-up was 30 (range, 13-55) months in the ASI group and 58 (range, 39-76) months in the K-wire group. The following seven characteristics were evaluated : fracture type, surgical technique, dominance of the affected limb, patient age, injury-surgery interval, and individual relative CS and DASH scores. The results were statistically analysed with a 5% level of statistical significance set for all tests., Results: The average age in the ASI group was 62.1 years, with 64.7 (range, 29-95) years for women and 35.5 (range, 26-76) years for men. In the K-wire group the average age was 66.1 (range, 53-84) years. The functional outcomes in four-fragment fractures were significantly worse than in three-fragment fractures (mean relative CS and DASH scores of 56 and 21 versus 72 and 32). The K-wire group showed a significantly worse functional outcomes than the ASI group in both the mean relative CS score (p<0.001) and the mean DASH score (p=0.003). No significant relationship was found in any other pair of variables. The patient's age had no effect on functional outcome, as assessed by CS (p=0.412) and DASH (p=0.076) and the injury-surgery interval had no influence, either (CS, p=0.220; DASH, p=0.118). There was no relation between the patient's age and choice of the surgical method (p=0.467), between the patient's age and a fracture type (p=0.356) and between the patient's age and injury to either a dominant or a non-dominant limb (p=0.659). Dominance or non-dominance of the affected limb had no effect on CS or DASH scores (p=0.662 and p=0.302, respectively) or on a type of fracture (p=0.183)., Discussion: Several surgical techniques used for the treatment of proximal humerus fractures suggest the absence of consensus in therapy. Novel angle-stable implants show better biochemical properties and meet criteria required in minimally invasive techniques. Some authors prefer intramedullary nailing for three-fragment fractures and the use of an angle-stable plate for four-fragment fractures. These indication criteria were also confirmed by the results of our study., Conclusions: The analysis of functional outcomes showed that the therapeutic effect of K-wire transfixation was significantly worse than the effect of the angle-stable plate technique, and therefore the authors stopped using this method. At present intramedullary nailing is indicated in two- and three-fragment fractures and in some less displaced four-fragment fractures. An angle-stable plate is used in severely displaced four-fragment fractures. If the head is broken or dislocated, older patients are primarily indicated for hemiarthroplasty and younger ones for humeral head reconstruction.

Although proximal humeral fractures are common diagnosis in emergency, cases of axillary artery injuries are rare. Authors present a patient, who underwent high energy trauma during a traffic accident like a pedestrian. Comminuted proximal humeral fracture was complicated with an occlusion of the third part of the axillary artery. There was necessary an urgent surgery, ostesynthesis with locking plate and reconstruction of the axillary artery by interposition of expanded polytetrafluoroethylene (ePTFE) graft. Postoperative course was uncomplicated, patient had no symptoms of ischaemia of extremity or claudication and started physiotherapy. In review of the literature authors present possible reasons of arterial injuries, possibilities of treatments to minimize risk of amputation. Axillary artery injury from proximal humeral fracture is rare, but every surgeon must be aware of this entity in order to avoid fatal complications.

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.

The authors report on a rare complication of humeral luxations, thrombosis of the axillary artery. They present a literature overview to discuss possible causes and mechanisms of venous complications. Although humeral luxations are very frequently diagnosed in traumatological departments, vascular complications are rare. Therefore, thorough examination of every single patient is a must, taking the above possibility into consideration.

A case review of laparoscopic management of the uterovaginal descent and rectal prolaps in one step in a young female following her complicated pelvic fracture.

Purpose of the Study: Heart contusion is a severe injury for the diagnosis of which there still doesn't exist a uniform procedure. The aim of the work was to compare individual methods and provide opinion on the justification of their use., Material: In the period of 1998-2000 at the authors' departments 103 patient were hospitalised with a severe contusion of the chest. These patients were admitted at the department within 24 hours after the injury., Methods: The diagnosis was based on the examination of the ratio of CKMB/CK serum levels, cTnl serum level, ECG examination and echocardiography., Results: Heart contusion was diagnosed in 18 patients of the group of 103. The most precise diagnostic method proved to be the determination of the serum level of troponin I (success rate 86%) and echocardiographic examination (succes rate 67%)., Conclusions: Examination of cTnl serum level and echocardiography are the best methods for the determination of the diagnosis of heart contusion. Simultaneous application of these two methods is the most reliable diagnostic procedure. Examination of CK and CKMB serum levels produces often falsely positive results and it is not a contribution to the determination of the diagnosis of heat contusion.