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The authors analyze the results of their long-term follow-up of basic epidemiological characteristics in fractures of proximal humerus (1,464 patients), distal radius (2,514 patients), proximal femur (3,340 patients) and fracture-dislocation of the ankle (1 195 patients). In fractures of the proximal femur, the average age was 78 years; 71.6 years in men and 80.3 years in women; male-female ratio was 27:73. In fractures of the proximal humerus, the average age was 67 years; 58.8 years in men and 71.2 years in women; male-female ratio was 30:70. In fractures of the distal radius, the average age was 59 years; 45.8 years in men and 64.7 years in women; male-female ratio was 29:71. In fracture-dislocation of the ankle the average age was 49 years; 43.4 years in men and 54.7 years in women; male-female ratio was 50:50. Until 5th decade men had higher representation in all groups of fractures, starting from 6th decade the ratio changed. Introduction of new implants (locking plate, new generation of nails) for fractures of the distal radius and proximal humerus increased significantly the percentage of patients operated on.

In the period from 2000 to 2005, with support of several grants, a unique multi-media center for teaching endoscopic techniques was established at the Department of Anatomy, 3rd Faculty of Medicine, Charles University in Prague. This conditions have been provided for the repeated use of cadavers preserved by a special embalming method of Professor Thiel of the Institute for Anatomy, University of Graz, for simulation of surgical procedures. One room of the Department has been converted into a small operating theatre and an audio-visual network with wireless Internet connection covers the whole dissection unit of the Department. A graphic studio for production of teaching materials has also been set up. The course in dissection for the first- and second-year medical students also includes demo arthroscopy. In addition to the courses for students, postgraduate courses for young surgeons are organized. These provide an opportunity to learn about techniques and instruments employed in a broad range of arthroscopic procedures, using appropriate cadaver materials.

Hemiarthroplasty has still its place in the therapeutic algorithm of the treatment of dislocated intracapsular femoral neck fractures. As compared to internal fixation it is accompanied by less complications and allows an immediate postoperative weight bearing. In contrast to total hip arthroplasty, this operation is not so demanding for the patient. However in the long-term perspective it is often associated with erosion of acetabulum. Therefore it is indicated mainly for biologically older patients with less physical activity without osteoarthritis of the hip. In these patients we usually prefer a cemented monoblock hemiarthroplasty. In case of biologically younger patients where it is impossible to use total hip arthroplasty due to general or local condition, modular hemiarthroplasty is indicated with a removable head allowing in case of acetabular erosion an easy conversion to total hip arthroplasty. Hemiarthroplasty must be correctly indicated and technically properly performed. First of all it is necessary to respect the relation between the centre of the prosthetic head and the apex of the greater trochanter, i.e. the head centre should be 1-2 mm below the level of apex of the greater trochanter. Further, it requires a correct anteversion and suture of the articular capsule as a prevention of postoperative dislocation.

Purpose of the Study: The aim of the study is to present a basic statistical overview of fracture-dislocations of the ankle in adults in a one-year group of patients., Material: The analyzed group of patients comprised 232 patients (121 men, 111 women) treated for fracture-dislocations of the ankle at the authors' department between 1 January and 31 December 1999. In all patients the physes were closed. The type of fractures was classified after B. G. Weber., Results: Type A fractures accounted for 23%, Type B fractures for 65% and Type C fractures for 12% of all cases. The average age of the injured was 49 years (range, 16-89), with men prevailing until 5th decade and women predominating from 6th decade. In 65% of Type A fractures there occurred only the fracture of lateral malleolus, in 31% the fracture involved also medial malleolus and in 4% it affected also the posterior margin of the distal tibia. In 49% of Weber B type of fractures the medial malleolus was fractured, in 20% the deltoid ligament was ruptured and in 31% there occurred no injury on the medial aspect. Avulsion of the posterior margin of the distal tibia occurred in 46%. In 71% of Type C fractures the fracture was located in the lower half of fibula, Maisonneuve type occurred in 29%. Medial malleolus was fractured in 57%, the deltoid ligament was ruptured in 36%, in 7% there was no medial injury. The posterior margin of the distal tibia was avulsed also in 46%. Fracture of the posterior margin of the distal tibia occurred in Type A in 4%, in Type B in 46% and in Type C also in 46%. In Types B and C the size of the avulsed posterior part of the distal tibia covered 1/4 of its articular surface in 75% of cases, 1/3 in 17% and 1/2 in 8% of cases., Discussion: We have found an adequate group of patients for comparison only in the Lindsjö work who evaluated a group of adult patients treated at his department between the beginning of February 1972 and end of June 1975. Other groups of patients which we studied and which included some of the parameters that we have examined are not comparable from the viewpoint of the basic selection of patients as the selection was made in a different way, namely according to the manner of treatment, i.e. conservatively or surgically, or according to the preference of one of the types of the fractures or the period of follow-up. Also, the so called epidemiological studies concentrated only on one or two factors (men/women ratio, the cause of injury, the period of the year). In addition, some works also include fractures in growing individuals., Conclusion: Fracture-dislocations affect equally men and women. Men prevail until the age of fifty, women afterwards. The average age of patients was 49 years. Most frequent is Weber B Type, least frequent Weber C.

Purpose of the Work: To analyze duration of surgery in individual types of internal fixation of fractures of the trochanteric massif and identify factors which have an impact on it., Material: Analysis covered a group of 137 patients treated with Ender nailing (EN), 314 patients by means of Dynamic Hip Screw (DHS), 74 patients by means of Gamma nail, 37 patients by means of Proximal Femoral Nail (PFN) and 13 patients by means of 130 degrees angled blade plate. The groups of patients included basicervical femoral neck fractures (29 cases), peritrochanteric and subtrochanteric fractures. Peritrochanteric fractures were evaluated according to Kyle classification, types I and II as stable (174 cases), type III unstable (159 cases) similarly as type IV (peri/subtrochanteric fractures or comminuted fractures of the whole trochanteric massif--35 cases). High subtrochanteric fractures (55 cases) were evaluated after Seinsheimer. From the viewpoint of AO/ASIF classification they were 31A1, 31A2, 31A3 fractures. EN was indicated mainly in Kyle I through IV fractures, DHS for basicervical fractures and Kyle I through III fractures, Gamma nail for Kyle I through IV fractures and high subtrochanteric fractures, PFN mainly for high subtrochanteric fractures and Kyle III fractures, 130 degrees angled blade plate was indicated only for stable peritrochanteric Kyle I fractures., Results: The average duration of surgery, i.e. starting from the skin incision until the suture of the wound, was in DHS 47 min., in EN 52 min., in 130 degrees angled blade plate 54 min., in PFN 58 min. and in Gamma nail 70 min. The shortest time intervals were achieved in stable peritrochanteric fractures of Kyle I and II (EN, DHS, Gamma), the longest ones in high subtrochanteric fractures (Gamma, PFN). The impact of the learning curve was analyzed in DHS. In 1995 the average duration was 70 min. (35 patients/year), in 2000 already only 39 min. (123 patients/year)., Discussion: If we wish to make a serious evaluation of the duration of surgery of any method we must not forget that apart from it there is a whole number of other factors by which it is influenced. In case of proximal femur it is the type of fracture, the number and experience of surgeons, mastering the learning curve, annual frequency of surgeries at the respective Department as well as variation within the surgical technique (e.g. in DHS the number of distal locking and the number of locking screws, etc.) A significant role in this study was also played by the development of internal fixation at the Department of the authors. For instance, considerably shorter duration of surgery as well as minimum of complications in PFN were achieved thanks to mastering of the learning curve on the Gamma nail which we had started to use 3 years before. An objective evaluation requires also a sufficient number of cases in order to eliminate errors caused by low numbers and other variable factors., Conclusion: Surgery duration data which we present are comparable with the values included in the world literature. It applies not only to the duration of surgery in individual implants but also in individual types of proximal femur fractures. At present at our Department the average duration of surgery ranges in dependence on the applied implant, type of fracture and skills of the surgeon between 30 and 60 minutes. Relatively shortest duration can be achieved in DHS, in Gamma nail and PFN the duration is slightly longer. However, the duration of surgery is only a supporting factor. Of much greater importance for the patient is the quality of the surgery. Thus favouring any method only on the basis of the duration of surgery is absolutely irrelevant.

Purpose of the Study: Authors report on five-year results in patients after THR operated on between 1994 and 1995 in which a cementless CLS Spotorno cup was used., Material: In the given period 59 patients were operated on (35 women and 24 men). The average age at the time of implantation was 54.6 years. The most frequent causes of the indication for THR was primary osteoarthritis of the hip in 27 patients and postdysplastic osteoarthritis in 16 patients. Applied were 46-62 mm cups for 28 mm and 32 mm diameters of the head. The femoral component used was a cementless Poldi--42 times, cemented MS-30--16 times and cementles CLS--once. The surgical approach was first anterolateral, later Bauer transgluteal approach which allows a better visualization of the location during the reaming of acetabulum and cup positioning. The reaming of acetabulum and implantation of the cup were performed in a standard way. Prior to incision Kefzol (cefazolin) was administered intravenously in the dosage of 2 g. In patients with a preceding operation on the hip joint the administration of Kefzol was extended to 24 to 72 hours (3 x 1 g each 8 hours intravenously). Standard antithrombotic prevention by miniheparinization was applied in all patients until they were able to walk with the help of crutches (7 to 10 days). In case of an increased risk of thromboembolic complications heparin with a low molecule weight (Fraxiparine) was applied over the same period., Methods: In the period between autumn 1999 and spring 2000 clinical examination of the patients operated on was performed together with a radiograph of the hip joint involved. Clinical findings were evaluated after Harris hip score. Radiograph findings were compared to the postoperative and the control ones made one year after the operation. Evaluated were the position of components and signs of their loosening, if any., Results: After the average follow-up of 59 months 57 patients were checked. Excellent results according to Harris were achieved in 40 patients, good results in 13 patients and satisfactory results in 4 patients. No poor result was recorded. Radiographs proved a full integration of CLS Spotorno cups without any signs of loosening in all checked patients., Discussion: Not very numerous works in both foreign and domestic literature list according to the experience of individual authors the following advantages of CLS Spotorno cup: a small bone loss during reaming of acetabulum, excellent primary stability, excellent secondary stability and its easy reimplantation as compared to all types of cementless cups. Only in one female patient after a peroperative fissure of proximal femur the control examination showed a lower value of Harris score than was the average value of the whole group. Similarly, the Harris score was lower in female patients who postoperatively experienced complications of neurological and internal nature (1 temporary paresis of n. ischiadicus, 1 phlebothrombosis of veins of the limb operated on). Control radiograph examination proved a full bone integration without signs of loosening in both components of the implant in all 57 checked patients., Conclusion: After five years the authors have a good experience with CLS Spotorno cup and recently they have started to indicate it more often in postdysplastic coxarthrosis in younger patients and in revision surgery for aseptic loosening of a cup. In young patients they recommend its matching with CLS Spotorno cementless femoral component and in middle-aged patients its matching with MS-30 (Morscher-Spotorno) cemented femoral component the centralizer of which allows an ideal anchoring of the stem in the cement mantle.