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Variant anatomy, which is an integral part of anatomical science, is related to abnormalities in the human body structure. Our understanding of variant anatomy is based on thousand years of anatomical experience. These abnormalities generally do not interfere with the function of the human body and do not typically manifest as pathological nosological units. However, under certain conditions, these abnormalities can worsen existing pathological states or even evoke new ones. Understanding variant anatomy is a basic skill not only of mere anatomists, but also of clinicians who work in fields involving both diagnostic techniques and therapeutic interventions. To gain and retain a good knowledge of the most frequent and clinically relevant anatomical variations, a simple, clear, and exactly defined nomenclature of variant structures is needed. A list of items comprising variant anatomy, which have been incorporated into the internationally accepted nomenclatures Terminologia Anatomica (1998) and Terminologia Neuroanatomica (2017), is described and analyzed. Examples of the most common anatomical variations related to terminology are mentioned, and variant anatomy as a whole and its role in understanding current anatomy are discussed.

INTRODUCTION The purpose of the study was to evaluate the injury-treatment time interval in a group of patients with limb bone fractures over the period of one year; and to compare this interval in the most frequent fractures of the upper and lower limb. MATERIAL AND METHODS The followed-up group of the prospective one-year monocentric study included 3,148 patients treated consecutively for 3,909 fractures. For the purpose of sub-analysis of the injury-treatment time interval in limb bone fractures, excluded from the group were the patients with multiple fractures (520 pts), patients with spinal fractures (356 pts) and pelvic fractures (210 pts). The statistical significance of the achieved results was tested with the use of contingency tables (chi-square test of independence). The significance level for the quantified tests was set at 5%. RESULTS The sub-analysis covered 1,727 patients whose medical records mentioned the exact time of injury and first examination. Within the first 6 hours after the injury, 536 (56.0%) patients with an upper limb bone fracture and 429 (55.7%) patients with a lower limb bone fracture were treated. Within 24 hours after the injury, 683 (71.4%) patients with an upper limb bone fracture and 572 (74.3%) patients with a lower limb bone fracture were treated. Within the first 24 hours after the injury, 104 (76.4%) patients with a proximal humerus fracture, 240 (84.5%) patients with a distal radius fracture and only 174 (55.5%) patients with metacarpal and phalanx fractures were treated. In the first hours after the injury, most frequently treated were the patients who sustained a distal radius fracture, and the longest injurytreatment time interval was seen in patients with hand bone fractures. The difference in the 24hour injury-treatment interval was significant when comparing distal radius fractures and proximal humerus fractures (p = 0.047) and when comparing distal radius fractures and hand bone fractures (p < 0.001). Within 24 hours after the injury, 166 (83.3%) patients with a proximal humerus fracture, 128 (79.1%) patients with an ankle fracture and 142 (63.4%) patients with metatarsal and phalanx fractures were treated. The shortest injury-treatment interval was reported in patients with a proximal femoral fracture and an ankle fracture, and relatively the lowest number of treated patients in the first hours after the injury was reported among patients with metatarsal and toe fractures. When evaluating the 24hour injury-treatment time interval, this difference was significant only when comparing proximal femoral fractures and metatarsal and phalanx fractures (p < 0.001), while when comparing proximal femoral fractures and ankle fractures the difference was not significant (p = 0.283). DISCUSSION There are not many studies of other authors focused on monitoring the injury-treatment time interval in the most frequent limb bone fractures. They also confirm that the treatment is sought out most quickly by patients with fractures that make walking or self-care impossible. CONCLUSIONS The results of the study confirmed that the fastest treatment was requested in patients with fractures which made the selfcare (distal radius) or walking (proximal femur, ankle) impossible; less painful fractures (metacarpal, phalanx fractures) and fractures that do not compromise walking (metatarsal fractures) were treated in the first 24 hours after the injury significantly less frequently. The patients with ankle fractures sought out treatment the most quickly compared to the patients with other fractures; it concerned largely occupational or sports injuries sustained by young men who were brought for treatment immediately after the injury, directly from their workplace or sports ground. The treatment of osteoporotic fractures (proximal humerus, distal radius, proximal femur) was spread over the first 6 hours due to the lack of independence of elderly patients after sustaining a fall at home; in majority of them transport to treatment was arranged for by relatives or neighbours only with a certain delay, once they became aware of their injury. Key words: fracture epidemiology, limb bone fractures, trauma-treatment time interval.

At first sight, the issue of morphological terminology may seem to be a "closed and unchanging chapter", as many of the structures within the human body have been known for decades or even centuries. However, the exact opposite is true. The initial knowledge of the microscopic structure of the human body has been continuously broadening thanks to the development of new specialized staining techniques, discovery of the electron microscope, or later application of histochemical and immunohistochemical methods into routine tissue examination. Contrary to popular belief, histology has a status of constantly developing scientific discipline, with continuous influx of new knowledge, resulting in an unavoidable necessity to revise the histological nomenclature at regular intervals. The team of experts of the Federative International Programme on Anatomical Terminology, a working group of the International Federation of Associations of Anatomists, published in 2008 the First Edition of Terminologia Histologica. Terminologia Histologica (TH) is the best and most extensive of all the histological nomenclatures ever issued. However, here we suggest that several terms of important histological structures are still missing while several other terms are disputable. First, we present some clinically important terms of cells and tissue structures for inclusion in the next TH and, in a second part, we refer to some new terms in the current edition of the TH which are not yet mentioned in current histology textbooks (e.g., fusocellular connective tissue, bundle bone as the third type of bone tissue, spongy layer of vagina or arteria vaginata from the splenic white pulp). With this article we hope to start a wide scientific discussion which will lead to an inambiguous definition and demonstration of typical examples of all terms in the TH, with the result that the new edition of the Terminologia Histologica will become an internationally accepted communication tool for all practitioners and teachers of histology alike., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Objectives: The aim of this study was to assess fractures of extremities, spine and pelvis in patients with respect to mechanism, time of the incident and demography of patients in order to propose preventive measures., Methods: A mono-centric (Level I Trauma Centre, predominantly urban population) prospective study was carried-out during the one-year period from 1 January to 31 December 2012. Patients with bone fractures of extremities, spine and pelvis were studied. Demography, mechanism and time of the injury were analysed., Results: The study group consisted of 3,148 patients, 53% being women and treated for 3,909 fractures. The mean age of patients was 53 years. The most traumatised patients were of the 3rd and 4th decade, a further increase in the incidence of fractures was seen in the 7th and 9th decade. Multiple fractures were significantly higher in men (p = 0.002). A car crash or fall from a height was more common cause of spinal fracture or pelvic fracture than fracture to the upper or lower limbs (p < 0.001). Most of the fractures occurred during the day between 9 a.m. and 6 p.m., on Saturdays and during the winter season. The bones most often broken were the radius (739 patients, 18.5%) and femur (436 patients, 11.1%)., Conclusions: Our study highlights the need for injury prevention focused on sex, age and types of activities performed. Among younger individuals, such programmes should primarily be targeted toward men who, as observed in our sample, have a higher fracture frequency compared to women. Conversely, injury prevention programmes for individuals ≥ 60 years should primarily be targeted toward women, who have the highest fracture prevalence in this population.

Introduction: The aim of the study was to provide accurate data regarding the incidence of large vessel injury as part of pelvic trauma in patients treated during a 12-year period., Methods: In total, 715 patients admitted and treated for pelvic fractures from 2001-2012 were analyzed. Data on large vessel injuries (aorta, inferior vena cava, common iliac artery and vein) reported in perioperative or autopsy findings were obtained from the patient database. The statistical significance of achieved results was tested using contingency tables (chi-square test of independence or Fisher factorial test). The significance level for the calculated tests was chosen to be 5%., Results: Sixty six (9%) patients died in the first hours after admission, 43 (6%) of them prior to surgery. Seventy (10%) underwent urgent surgeries, 47 (7%) of whom survived and 23 (3%) died. A large vessel injury in the pelvic region was detected in 13 (2%) patients. In the surviving surgical patients, a serious injury of pelvic venous plexus, as the only source of bleeding, was found only once (2%), while in patients who deceased post-surgically and pre-surgically, serious vascular injury in the pelvic region was diagnosed in 5 and 7 patients in both subgroups (22% and 41%, resp.). This difference was significantly higher in comparison with surviving patients (p=0.0002 and p=0.0109, resp.)., Conclusion: The incidence of large vessel injury with severe bleeding associated with pelvic trauma was low in our study; however, the risk of death in patients with this injury was significantly higher. The results of our study support the hypothesis that in most patients a large artery or vein injury in combination with massive bleeding from the venous plexus due to a dislocated pelvic fracture results in death even before arrival of emergency services. This hypothesis could be verified in a study including also autopsy findings in persons who died even before hospital admission., Key Words: unstable pelvic injury vascular injury risk of death.

PURPOSE OF THE STUDY Perilunate dislocations and perilunate fractures are serious wrist injuries which are often overlooked at primary treatment. Their inadequate therapy results in severe wrist damage and patient disability. An early diagnosis and correct therapy can prevent such conditions. MATERIAL AND METHODS A group of 25 patients with 26 wrist injuries is presented. It included nine patients with isolated perilunate dislocations (34%), 11 patients with trans-scaphoid perilunate dislocations (44%),two with trans-radial trans-scaphoid perilunate dislocations (7%) and next two patients with trans-radial perilunate dislocations (7%). One patients had, in addition to perilunate dislocation, injury to the capitohamat joint with damage to both portions of the interosseous ligament (4%). One patient (4%) sustained a trans-scaphoid perilunate dislocation with injury to the scapholunate ligament, in which the proximal pole of the scaphoid was separated and interfered with dislocation reduction. RESULTS The correct diagnosis was made on early examination in 16 patients (62%), within a week of injury in four patients (15%), within a months of injury in two patients (8%) and even later in four patients (15%). The results of treatment evaluation based on the Wrightington Hospital Wrist Scoring System were excellent in 19%, good in 54%, satisfactory in 19% and poor in 8% of the patients. The poor result in one patient was due to necrosis of the lunate bone;the diagnosis of a perilunate dislocation was made within a month of injury. The poor results in the other patient were associated with complex regional pain syndrome. DISCUSSION Perilunate injuries of the wrist are quite frequent and although the treatment procedure is commonly known, its principles are not always obeyed. A good outcome is related to an early diagnosis and correct reconstruction of the injured structures. In our group, the diagnosis was made at the first examination in only 62% of patients and later than a week after injury in 23%. The patient in whom necrosis of the lunate bone developed had the diagnosis made at 1 post-injury month. Early reduction of bone structures and reconstruction of ligaments also contribute to good results. CONCLUSIONS Good outcomes in perilunate injuries depend on an early and correct diagnosis, an appropriate therapeutic procedure and an orthopaedic surgeon who has experience with management of such injuries. A deep knowledge of wrist kinetics is necessary for this therapy as not all injuries happen according to textbook descriptions. Key words: perilunate dislocation, carpal instability, damage to carpal ligaments.

Purulent inflammation of the pubic symphysis is a rare condition involving the symphysis and parasymphyseal parts of the pubic bones. It is usually found in immuno-compromised patients and its most frequent cause is Staphylococcus aureus. Conservative treatment is based on long-term administration of antibiotics and has been efficient, as reported, in about 50% of the patients. The authors treated five patients with a late diagnosis of purulent infection of the pubic symphysis in whom the antibiotic therapy had to be completed by surgical intervention. Three patients undergoing surgery with removal of the infected necrotic tissue healed fast and well. One patient required repeated surgery because of recurrent purulency; eventually, the infection cleared up. One patient was treated only conservatively because she refused surgical treatment. Consequently, pubic diastasis developed and she suffered from persistent pelvic pain. One year after treatment her condition became complicated by pelvic fracture following a fall. The patient refused surgery again. However, the development of non-union and progression of complaints made her agree to a surgical treatment; fixation of the non-union had a satisfactory outcome. In the literature, infection in the symphysis region is referred to by several different names. One - in the authors' opinion incorrect use - is "arthritis" (septic arthritis of the pubic symphysis; pubic symphysis septic arthritis; infectious osteoarthritis of the pubis). Another term is "osteomyelitis" (acute pubic osteomyelitis; pubic osteomyelitis; osteomyelitis of the pubis; osteomyelitis pubis; osteomyelitis of the pubic symphysis; osteomyelitis of the symphysis pubis). None of the names shows clearly whether it is primary an infection of the symphysis or of the parasymphyseal bone. A combination of the term "osteitis" with "infectious" (infectious osteitis pubis) is an attempt to distinguish purulent symphysitis pubis from osteitis pubis. The authors completed both the Czech and English title of this paper with the Latin designation symphysis pubis purulenta. A possibility of using a new name, such as "pubosymphysitis", in analogy to "spondylodiscitis" can also be discussed. However, the use of simple terms "infection of symphysis" or "infection of pubic symphysis" seems to be most practicable. Based on the experience with the treatment of five patients with infection of the pubic symphysis, the authors suggest that the late phase with abscess formation or purulent discharge should be managed by surgery. This treatment has good clinical outcomes although it may be complicated by slow healing of soft tissues around the symphysis and instability of the anterior pelvic segment with its sequelae. Key words: infection of the symphysis, infection of the pubic symphysis, septic arthritis of the pubic symphysis, pubic osteomyelitis.

Unlabelled: PURPOSE OF THE STUDY This radiographic study was focused on measuring the dimensions of pelvic bones at sites of minimally invasive screw insertion with the aim to assess the risk of damage to vascular and nervous structures. MATERIAL AND METHODS The group consisted of 77 patients (39 women and 38 men) aged between 19 and 85 years (average, 65; women, 65; men, 64) who underwent CT examination of the pelvis because of reasons other than injury. On the left side, a total of 14 dimensions of the superior pubic ramus, supraacetabular region, retroacetabular region, quadrilateral surface of the acetabulum and lateral foraminal sides of the S1 and S2 vertebral bodies were measured. The results were evaluated using descriptive statistics. RESULTS The inner antero-posterior dimension of the isthmic area of the superior pubic ramus was 8 mm or less in four women (10.3%) and 9 or 10 mm in further 14 women (35.9%). The inner cranio-caudal dimension of the superior pubic ramus was 8 mm or less in 14 women (35.9%) and 9 or 10 mm in further 16 women (41.0%). These dimensions obtained in men were as follows: 8 mm and less in three men (7.9%) (7 mm in one, 8 mm in two), and 9 or 10 mm in nine men. Sizes of the other pelvic bones were large enough to allow for safe insertion of single screws. DISCUSSION Single screws most frequently used in minimally invasive treatment of pelvic fractures are cannulated screws 7.3 mm or 6.5 mm in diameter; less frequently used are 4.5-mm cancellous screws (e.g. in treatment of avulsion injuries) or long 3.5-mm cortical "creeping" screws to be inserted in the superior pubic ramus. The use of "creeping" screws reported by several authors indicates problems associated with placement of standard screws (diameter, 7.3 mm and 6.5 mm) through the isthmus into the superior ramus. In slim high pelvises of some patients with gracile skeletons or in low pelvises of small women, the screws can protrude over the cortical margin. However, the risk of injury to nervous or vascular structures is low when the intraosseous screw is exactly inserted and it is so even in case its thread cuts into cortical bone. Neither the femoral artery nor the femoral nerve is situated too close to the superior pubic ramus. The "corona mortis" may potentially be jeopardised because of its contact with both the superior and posterior cortical bones of the superior ramus, but it usually follows a course more lateral to the isthmus of the ramus. CONCLUSIONS The results of the study showed that the size of the superior pubic ramus in its isthmic area may cause difficulties during insertion of cannulated screws with standard diameters (7.3 mm and 6.5 mm) in the majority of women and in some men. The risk of damage to vascular and nervous structures during screw insertion is associated only with the superior and posterior walls of the superior pubic ramus and with the area of the S2 foramen in case the correct procedure of intraosseous screw insertion is not strictly followed., Key Words: retrograde pubic screw, iliosacral screw, supraacetabular screw, retrograde posterior column screw.

Purpose: The aim of this study was to evaluate a sample of patients who sustained hip fractures during the years 1997-2011 and identify risk factors for a subsequent contralateral hip fracture; one-year mortality rates were compared in both groups., Methods: A total of 5,102 patients with hip fractures were prospectively studied to identify patients who had also suffered a subsequent, contralateral, hip fracture (SCHF). Those patients who had sustained a second fracture within 18 months of the initial fracture were then studied. All data were statistically processed., Results: Within 18 months of the first fracture, a SCHF occurred in 105 patients (2.1 %). These patients were an average of three years older than those in the single fracture group. Risk factors for the development of a SCHF included: female gender, residing in a residential care facility, and limited mobility prior to injury. Trochanteric fractures did not represent a statistically significant risk factor for SCHF. More than three-quarters of patients with subsequent injuries suffered the same type of fractures on the opposite side. Patients with subsequent fractures had lower one-year mortality rates than patients with only one fracture., Conclusion: Patients at greatest risk for a SCHF were women with limited mobility who resided in nursing homes for the elderly. The lower mortality rate associated with second fractures shows that the prognosis for such patients is good. Since the at-risk group is so well defined, prophylactic measures for these patients should be utilized in order to minimize the risk of additional fractures.

Purpose of the Study: The study was designed to investigate whether anatomical variations of the anterior and posterior divisions of the internal iliac artery and their branches are associated with different risks of bleeding resulting from injury to the posterior pelvic segment., Material and Methods: The study was carried out on 19 cadavers. The dissected area included the internal iliac artery from the common iliac artery bifurcation to the origins of the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery. Using an electronic slide rule, distances between the bifurcation and the origin of each branch from either the anterior or the posterior division were measured. The diameter of each vessel was also determined. Findings of the study were compared with variations described in the literature. The degree of risk for bleeding related to different anatomical variations of the internal iliac artery and its branches was evaluated based on the proximity to the bone., Results: There are six anatomical variations of internal iliac artery branches. Four of them were found: type A1 was recorded in 10 specimens, type A2 in six, type B1 in two and type C in one specimen. Types B2 and D were not seen., Discussion: The type B2 and C anatomical variations were considered to carry higher risks of bleeding due to injury to the posterior pelvic segment. These variations are characterized by vessels larger in diameter and a longer course of the posterior division along the posterior part of the greater sciatic notch (area often involved in unstable pelvic ring fractures). On the other hand, the type C variation showed a longer internal iliac artery separated from the bone with a thick layer of soft tissue, which suggested lower risk than was attributed to the dominant type A1 variation. It was not possible to evaluate type B2 variation because it is very rare and was not found in study material. In type A2 and B1 variations, the branches were separated from bony structures similarly to the dominant type A1 variation., Conclusions: The cadaver study designed to assess the risk of bleeding associated with different morphological variations of the branching pattern of the internal iliac artery did not identify any anatomical arrangement that might carry a higher risk of injury to the vessels by free bone fragments of the posterior segment in unstable pelvic fractures. It can be concluded that less common branching patterns of the internal iliac artery are not associated with higher risk of bleeding than the dominant type A1 variation.

PURPOSE OF THE STUDY The aim of the study was to assess treatment outcomes in patients undergoing K-wire transfixation of unstable ankle fractures and compare the results with those of patients in whom it was possible to perform primary one-stage osteosynthesis. MATERIAL AND METHODS Between 2009 and 2012, a total of 358 patients (191 women and 167 men) had surgery for unstable ankle fracture. At 1-year follow-up, their subjective feelings, objective findings and ankle radiographs were evaluated. The fractures were categorised according to the Weber classification. A patient group treated by one-stage osteosynthesis, a group with definitive transfixation and a group of patients in whom temporary transfixation was converted to definitive osteosynthesis were assessed and compared. RESULTS The group treated by one-stage osteosynthesis included 278 patients with an average age of 47 years; the group of 20 patients with definitive transfixation had an average age of 67 years, and the group of 60 patients who had temporary transfixation with subsequent conversion to internal osteosynthesis were 55 years on average. In the group with one-stage osteosynthesis, 223 (80%) ankle fractures on post-injury radiographs were associated with minor joint dislocations and 55 (20%) with major dislocations. On the other hand, the radiographs of the patients treated by temporary transfixation and delayed open reduction with internal fixation showed major dislocations in 38 (63%) and minor dislocations in the rest of the patients (37%); the difference between the two groups was statistically significant (p<0.001). Posterior malleolar fractures were most frequent in the group with temporary transfixation (60%) and least frequent in the group with primary osteosynthesis (44%); also this difference was statistically significant (p=0.032). At one-year follow-up, in the group with one-stage osteosynthesis, 220 patients (79%) had no radiographic signs of posttraumatic ankle osteoarthritis while, in the group with temporary transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p < 0.001 and p = 0.003, respectively). DISCUSSION In this study the morphological and clinical aspects of surgically treated ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered than to the method itself. Key words: unstable ankle fracture, soft tissue condition, indications for transfixation, treatment outcome.

Destot was a leading pioneer in radiology, a pupil of Ollier, an anatomist, and researcher who followed in the experimental medicine tradition of Claude Bérnard. This work is an extensive, in depth, look at the life and work of Étienne Destot. On February 5, 1896, he began performing X-ray examinations, less than two months after Roentgen's discovery! His pioneering work described a space bordered by the hamate, capitate, triquetrum, and lunate; this space is now known as Destot's space. Tanton stated that Destot was the first to reveal the mechanism of fractures of the posterior margin of the distal tibia and to emphasize their clinical relevance; in honor of this contribution, Tanton named such a fracture the “fracture of Destot.” Moreover, Destot is credited with being the first physician to use the term “pilon” in the orthopedic literature. He first described fractures of the scaphoid in 1905. He also described superficial hematomas, Destot's sign, located above the inguinal ligament or in the scrotum or thigh. Such hematomas are indicative of pelvic fractures. Destot is credited with inventing or improving many pieces of medical equipment (e.g., Lambotte's screw plates, anastomotic boutons for the digestive tube, monopolar endocavital radiological tubes). He was also active in developing technical aspects of equipment (e.g., radioscopic examination of the heart, a prototype of the mobile radiological laboratory). Étienne Destot is best known as a radiologist; however, his influence extends well beyond this field. He was an anatomist and surgeon, the founder of radiology in Lyon, prosector, physician, electrician, researcher, and artist.

Introduction: Pelvic ring injuries rank among the most serious skeletal injuries. According to published data, pelvic fractures constitute 3-8% of all fractures. There has been a threefold increase in the number of these fractures over the last 10 years. A significant factor determining the choice of the therapeutic procedure, timing and sequence of individual steps, and also the prognosis of the patient with a fractured pelvis, are associated injuries defined as injuries to the organs and anatomical structures found in the pelvic region. Published data describes the incidence of injury to neurogenic structures as ranging between 9 and 21%, to the urogenital tract between 5 and 11%, to the gastrointestinal tract in 3-17% and to the gynecologic organs up to 1%. The pathway of the pudendal nerve may be affected in types B and C fractures where the root fibers emerge from the foramina sacralia and plexus sacralis is formed, on the one hand, and in types A, B and C fractures during the nerve's course alongside the inferior pubic ramus., Materials and Methods: In order to determine the frequency of potential injury to the pudendal nerve, a set of 225 pelvic fractures treated between 2007 and 2009 was assessed; 38 fixed hemipelves were also used to study the length of the course of the pudendal nerve alongside the inferior pubic ramus, on the one hand, and the distances from the symphysis pubica at the crossing of the branches of the n. pudendus-n. dorsalis penis and the branches for the muscles of the diaphragma urogenitale on the other hand., Conclusion: The work elucidated the selected distances and discuss their possible clinical relevance for evaluation of the seriousness of pelvic fractures from the perspective of late sequelae in the region innervated by the pudendal nerve., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: The authors describe their first experience with virtually navigated pelvic and spine screws based on perioperative CT navigation., Material and Methods: From 22 October 2012 (launching the device) to 9 January 2013, a total of 15 CT-navigated pelvic and spine operations were performed in 14 patients. Nerve root compression, scoliosis, vertebral fracture and spondylodiscitis were the indications for spine procedures; B-type and C-type fractures according to the AO classification were the indications in pelvic surgical procedures. The preparation and the course of the procedures were in accordance with current standards and recommendations in all the cases. Perioperative navigation and subsequent examination of the screw trajectory were performed via O-arm imaging system (Medtronic Navigation, Louisville, Colorado) instead of the standard C-arm fluoroscopy., Results: A total of 73 screws were inserted (60 transpedicular screws into cervical, thoracic and lumbar vertebrae, 9 iliosacral screws into the first sacral vertebra and 4 pubic screws). Only one of the pubic screws (1.4% of all screws) was found malpositioned at the subsequent perioperative examination and was extracted immediately and replaced. Further complications were not observed and none of the procedures had to be converted into a standard fluoroscopy guided operation., Conclusion: A short but intensive experience with perioperative CT navigation allows us to state: 1. CT navigation shortens the operating time and minimalizes the risk of screw malposition in multiple screw spine procedures; 2. CT navigation improves the introduction of iliosacral and pubic screws in pelvic fixations; 3. there is virtually no radiation load to the staff using the CT navigation; 4. mastering this technique will allow a wider use of miniinvasive screw insertion in the pelvis and other regions where minimal dislocation will enable miniinvasive internal fixation.

Purpose of the Study: The aim of the study was to assess differences in the number and severity of associated injuries between patients with pelvic injury and those with acetabular fracture., Material and Methods: The patients treated in the period from January 1, 2008, to December 31, 2010, were enrolled. The group comprised 249 patients (130 women and 119 men) with pelvic injuries and 58 patients (14 women and 44 men) with acetabular fractures. In the patients with pelvic injury, the average age was 52 years, 61 in women and 43 in men, in the range of 17 to 91 years. In the patients with acetabular fracture, the average age was 54 years, 59 in women and 53 in men, in the range of 21 to 96 years. The relevant data including age, sex, cause of injury, associated injuries and the overall severity of injury were obtained from the patient database. The results were statistically analysed using Pearson's .2 test at a 5% level of significance., Results: Acetabular fractures were recorded in more men than women and this difference was significantly higher (p = 0.002) than in the patients with pelvic injury in whom similar numbers of men and women were affected. A fall from height was significantly more frequent as a cause of pelvic injury than that of acetabular fracture (p = 0.034). The patients with pelvic injury also had significantly more associated injuries (p = 0.016) and the number of these patients with an Injury Severity Score (ISS) higher than 16 was significantly higher compared with the number of patients with acetabular fractures (p < 0.001)., Discussion: Little published information is available on comparison of the severity of injuries in patients with pelvic injuries and those with acetabular fractures because these conditions are in fact two nosological units. In pelvic injuries, as conditions usually accompanied by multiple trauma, associated injuries, risk factors for death, requirements for primary life-saving measures, complications and treatment outcomes have been studied. Less attention has been paid to these issues in patients with acetabular fractures; the authors focused on determining the quality of intra-articular fracture treatment in relation to a subsequent risk of avascular necrosis of the femoral head or early arthritis., Conclusions: The study comparing the patients with pelvic injury with those having acetabular fracture showed a significantly higher proportion of men in the group with acetabular fractures. A fall from height significantly more often caused a pelvic injury than an acetabular fracture. In traffic accidents, drivers usually suffered acetabular fractures while pedestrians and cyclists had pelvic injuries. However, a significantly higher number of associated injuries and multiple trauma with an ISS > 16 recorded in the patients with pelvic injury in comparison with those with acetabular fractures was the most important difference between these two groups.

Purpose of the Study: To present the results of a three-year study on micturition, defecation, gynecological and sexual disorders in middle-aged women who sustained pelvic fractures., Material and Methods: A group of 33 female patients who were treated for unstable pelvic fractures (AO types B or C) in the 2004-2009 period were evaluated (treated group) and compared with 31 women who had given vaginal birth at least once and went to see a urologist because of urinary problems in the period from 2009 to 2010 (control group). The questionnaires used in the study included ICIQ, UIQ, UDI and PISQ12 instruments. Urodynamic tests included flow cystometry, urethral pressure profile at rest and under stress and uroflowmetry. For a comparison of continuous variables of normal distribution, the t-test for independent samples was used. In the questionnaire study when responses were classified as nominal-ordinal variables, the Mann-Whitney U-test was used. Differences between the two patient groups in qualitative variables were tested by Pearson s 2 test. When the expected number of answers in contingency table was lower than 5, Fisher s exact test was used; when the number of answers was 0, Haldane s correction was employed. The results in all tests were considered significant when the level of significance was lower than 5%, i.e. p-value < 0.05., Results: The age of patients in the treated group ranged from 17 to 55 years (average, 32 years), the age in the control group was between 30 and 78 years (average, 58 years). The difference was significant (p<0.001). The control group patients had significantly more serious urination disorders than the treated group patients. Some micturition problems were reported by 25 patients (75%) of the treated group and by all patients of the control group (p<0.001). Intestinal disorders were more frequent in the treated group, in which 19 (61%) patients reported problems as against seven (21%) in the control group. Gynaecological problems involving feelings of genital prolapse had 13 (39%) control patients (p = 0.041). Sexual disorders were markedly worse in the treated group, with 16 (52%) of the patients having problems in comparison with only seven (21%) in the control group., Discussion: A comparison of patient groups composed using the method described here is disputable. The first difficulty lay with a low compliance of the treated patients, of whom only 33 underwent examination out of 52 originally enrolled. The other problem was the necessity of having an exactly defined control group of patients willing to undergo urological and gynaecological examination including urodynamic testing. The groups composed by our method were comparable only in the micturition disorder characteristic. A significantly higher age of the control group affected the comparison of defecation, gynaecological and sexual problems., Conclusions: The results of this study showed a high occurrence of micturition, defecation and sexual disorders in middle-aged women after pelvic injury. However, the problems are usually not serious enough to make the patients seek help of a specialist. The authors recommend that these problems should be looked for by disorder-directed inquiry in the final period of pelvic fracture treatment and help of a specialist in urology, gynaecology, sexuology or proctology should be offered to the patients in whom disorders have been identified. Key words: urinary incontinence, voiding dysfunction, stool incontinence, obstipation, unstable pelvic fracture.

Purpose of the Study: The study presents the evaluation and comparison of two groups of patients surgically treated for ankle fractures at our department in 2007 and in 2010, respectively. Our analysis included patients' age, the mechanism of injury, fracture morphology and the method of osteosynthesis. The aim of the comparison was to ascertain recent trends in the development of the selected characteristics., Material and Methods: The 2007 group comprised 62 patients, 31 men and 32 women, the 2010 group had 123 patients, 55 men and 68 women. The ankle fractures were classified according to the Weber and Lauge-Hansen systems. The selected characteristics were analysed in each group and the results were compared to obtain information on changes during the interval of 4 years. The data were evaluated using the methods of descriptive statistics; categorical data were analysed by the chi-square test with the level of significance set at 5%., Results: The average age was 44 years in men and 59 in women in the 2007 group and 40 years in men and 56 in women in the 2010 group; in the whole patient group, the average age decreased from 52 years in 2007 to 47 years in 2010. Based on the Weber classification, the incidence of fractures in 2007 and 2010 was as follows; type A, 5% in both years; type B, 68% and 72%; type C, 27% and 23%. There was no significant difference between the groups in the incidence of either type B or type C fractures (p = 0.823 and p = 0.659, respectively). The majority of fractures were caused by low-energy mechanisms. High-energy injuries due to falls from a height or traffic accidents did not exceed 6 %. In men, who sustained sports-related injury more often, fractures were found in 23% and 16% in 2007 and 2010, respectively; this difference approached statistical significance (p = 0.050). Most of the fibular fractures were managed by plate osteosynthesis, often in combination with lag screws. Medial malleolar fractures were usually fixed with two cancellous screws, or with a screw and a K-wire. The number of surgical inspections of the medial structures of an injured ankle with no medial malleolar fracture decreased from 68% in 2007 to 37% in 2010. Osteosynthesis of a fractured posterior margin of the distal tibia was carried out in 7% of the patients in 2007 and in 23% in 2010., Discussion: The morphological and epidemiological characteristics described were selected to obtain a comprehensive notion of the patients studied. Only the patients who had surgery were included. An increase in the number of ankle fractures managed surgically during a four-year period of our study was due to a growing number of patients and the fact that surgery was indicated more frequently because stricter criteria for assessment of post-reduction findings or secondary displacement were adopted. In surgical treatment, the recent trend preferring primary osteosynthesis to transfixation or external fixation has been evident because it allows for early rehabilitation and return to normal activities., Conclusions: The number of ankle fractures treated by primary osteosynthesis grew between 2007 and 2010. There was also an increase in the number of fractured posterior margins of the distal tibia managed by osteosynthesis. The results of the Weber and Lauge-Hansen classifications were in agreement with the relevant literature data. In the majority of cases the ankle fracture occurred as a single trauma.

Purpose of the Study: The aim of the study was to record the frequency of L5 transverse process fractures associated with pelvic injuries and to find out whether in unstable pelvic fractures the frequency is significantly higher., Material and Methods: The group evaluated comprised 106 patients (38 women and 68 men; average age, 43.4 years; range, 16 to 95 years) treated for pelvic ring fractures at two trauma centres in the period from January 1 to December 31, 2007. Their radiographs and CT scans were retrospectively reviewed in order to identify fractures of the L5 transverse processes and to obtain exact descriptions of injuries to the dorsal pelvic structures. The results were statistically analysed using the Chi-square test with a 5 % level of significance., Results: The evaluation of radiographs and CT scans identified L5 process fractures in 21 patients; none of these had type A pelvic fracture. An L5 transverse process fracture was found in 10 (15 %) of 69 patients with type B pelvic fracture and in 11 (73 %) of 15 patients with type C pelvic fracture, i.e., only in the patients with unstable injury to the pelvis classified as type C or type B. The occurrence of L 5 transverse process fractures was significantly higher in completely unstable, type C pelvic trauma than in partially unstable, type B pelvic injury (p < 0.001)., Discussion: Our results showed that evaluation of the radiographs was not sufficient for the identification of L5 transverse process fractures and trauma to the dorsal pelvic structures. The reason was either poor quality or incorrect positioning. This gives support to the recommendations of many authors that CT scans should be the standard method for identification of all pelvic injuries. The study also confirmed that L5 transverse process fractures are associated with unstable pelvic injuries. Their significantly high occurrence is in agreement with other relevant studies which, however, have reported the results without statistical evaluation., Conclusions: The study shows a significantly higher occurrence of L5 transverse process fractures in patients with unstable pelvic ring injuries. The finding of such a fracture should focus attention to looking for trauma to the dorsal pelvic structures.