Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies.

PURPOSE: Pelvic ring fractures requiring surgical stabilization are severe injuries. Surgical site infections occurring after stabilization of the pelvis are serious complications, requiring complex and multidisciplinary treatment. METHODS: This is a retrospective observational study from a level I trauma centre. One hundred and ninety-two patients who underwent stabilization of closed pelvic ring injuries without signs of pathological fracture were selected for inclusion into the study. After excluding seven patients for having incomplete data, the final study group consisted of 185 patients (117 men and 68 women). Basic epidemiologic data and potential risk factors were recorded and analyzed by Cox regression, Kaplan-Meier curves, and risk ratios in 2 × 2 tables. Categorical variables were compared by Fisher exact tests and chi squared tests. Parametric variables were analyzed with Kruskal-Wallis tests with post hoc Wilcoxon tests. RESULTS: Surgical site infections occurred in 13% of the study group (24 from 185). Eighteen infections occurred in men (15.4%) and six in women (8.8%). There were two significant risk factors in women: age over 50 years (p = 0.0232) and concomitant urogenital trauma (p = 0.0104). The common risk ratio for both these factors was 212.59 (8.78-5148.68), p = 0.0010. No significant risk factors were identified in men despite younger men having a higher incidence of infection (p = 0.1428). CONCLUSION: Overall rate of infectious complications was higher than in the literature, but this might be caused by inclusion of all patients regardless of surgical strategy. Higher age in women and lower age in men were associated with higher infection rates. Concomitant urogenital trauma was a significant risk factor in women.

CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures.

PURPOSE: Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures. MATERIALS AND METHODS: The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon's experience as possible risk factors for limb malrotation after trochanteric fracture surgeries. RESULTS: The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error. CONCLUSION: Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.

Suicide attempts as a cause of pelvic injuries during the COVID-19 pandemic.

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

Paediatric pelvic injuries: a retrospective epidemiological study from four level 1 trauma centers.

AIM OF THE STUDY: Epidemiologic evaluation of pelvic ring injuries in children. METHODS: Retrospective analysis over a period of 13 years, excluding pathological fractures. AO/OTA type, epidemiological data, type of treatment, and complications were recorded. Data were assessed using Fisher's exact test and Wilcoxon test. RESULTS: 243 boys, 115 girls, mean age (SD) 14.1 ± 3.0 years, AO/OTA types: 281 A, 52 B, 25 C. Multiple trauma: 62, combined trauma: 59, mono-trauma: 237. 281 patients were treated non-operatively, 97 surgically. ETIOLOGY: traffic accidents 88, falls from a great height 37, crushing injuries four, and sports injuries 192, simple falls 30, others seven. High-energy mechanisms prevailed in types B and C. Low-energy mechanism in type A (p < 0.0001). Similar differences were found between type A (p = 0.0009) and in case type C requiring surgery and cases treated non-operatively (p < 0.0001). Twenty-six patients (7.3%) had complications (pelvic asymmetry 5, neurological deficits 5, non-union 1, ectopic calcification 4, others 7). Higher complication rates were associated with types B and C (p = 0.0015), with surgically treated cases (p < 0.0001) and multiple trauma (p = 0.0305). DISCUSSION: Results of this trial were comparable with other studies. CONCLUSION: Sports injuries accounted for most type A injuries, while types B and C tended to be associated with high-energy trauma. Complications were associated with the severity of pelvic trauma, more common in surgically treated group of patients; this is primarily linked to the surgical cases being more serious as well as the associated injuries.

A case of marked bilateral asymmetry in the sacral alae of the Neandertal specimen Regourdou 1 (Périgord, France).

OBJECTIVES: A marked asymmetry was previously reported in the sacral alae and S1-L5 facets orientation of the Neandertal individual Regourdou 1. Here, we provide a detailed description and quantification of the morphology and degree of asymmetry of this sacrum. MATERIAL AND METHODS: Regourdou 1 was compared to a modern human sample composed of 24 females and 17 males, and to other Neandertal individuals. Both traditional and geometric morphometric analyses were used in order to quantify the degree of sacral asymmetry of Regourdou 1. RESULTS: The asymmetry of both sacral alae and facets orientation substantially exceeds directional and absolute asymmetry of the healthy modern sample. Regourdou 1 shows a considerably shorter right ala, which is absolutely and relatively outside of the modern and Neandertal variations. CONCLUSION: Regourdou 1 shows marked sacral asymmetry that probably originated in early ontogenetic development. An asymmetric sacrum reflects asymmetric load dissipation and could relate to other morphological abnormalities observed in the skeleton, especially the mild scoliosis of the spine and the asymmetry of the femoral diaphyses. Further investigation is necessary to elucidate the relationship between those morphologies as well as a potential impact on the life of the individual.

Where and what arteries are most likely injured with pelvic fractures?: The Influence of Localization, Shape, and Fracture Dislocation on the Arterial Injury During Pelvic Fractures.

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

Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment.

PURPOSE OF THE STUDY: Outpatient treatment of hip dysplasia in newborns has excellent results. A combination of general screening with early treatment with a functional abduction device works well. Treatment with the Frejka pillow and the Pavlik harness is frequently used in our region. The aim of the study is to compare efficiency and treatment duration, related to the brace used, and to prove that the choice of an abduction device implies parental compliance with the treatment protocol. MATERIALS AND METHODS: Data of 286 treated children were analyzed. The diagnosis was made in the first weeks of life by clinical and sonographic examinations during general screening. The choice of treatment device was expert dependent and was involved by many variables. The experience, type of clinical finding and sonographic pathology according to Graf, availability of a treating facility, and the potential cooperation of individual parents were major parameters. The Frejka pillow was used to treat 145 children and the Pavlik harness was used in 137 children. The treatment duration and percentage of infants lost from follow-up in relation to the device used was documented. RESULTS: The success rate of outpatient treatment was 98.6%. In six patients, the type of device had to be changed during the treatment period. Physiological sonographic findings were achieved in all hips by the end of the treatment. The Frejka pillow was used as the preferred device in milder stable dysplastic hips, while unstable and decentered hips were treated more frequently with the Pavlik harness. Treatment lasted, on average, 95 days and 119 days in the Frejka and in the Pavlik group, respectively; there was no statistical significance in treatment duration of comparable sonographic pathologies. We observed statistically greater parental non-compliance with the treatment protocol in the Pavlik harness group (p = 0.0279; OR 2.7; 95% CI 1.07; 8.5). CONCLUSIONS: Neither of the abduction devices was inferior with regard to treatment efficiency. We found that parental cooperation was an important factor during screening and treatment. The treatment decision and the choice of the brace must be made with full consent of the parents, keeping in mind that comfort during the nursing care may have a significant influence on compliance with the treatment protocol.

A 1-year prospective monocentric study of limb, spinal and pelvic fractures: Can monitoring fracture epidemiology impact injury prevention programmes?

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.

The importance of intramedullary hip nail positioning during implantation for stable pertrochanteric fractures: biomechanical analysis.

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

Mitochondrial function in skeletal muscle of patients with protracted critical illness and ICU-acquired weakness.

BACKGROUND: Mitochondrial damage occurs in the acute phase of critical illness, followed by activation of mitochondrial biogenesis in survivors. It has been hypothesized that bioenergetics failure of skeletal muscle may contribute to the development of ICU-acquired weakness. The aim of the present study was to determine whether mitochondrial dysfunction persists until protracted phase of critical illness. METHODS: In this single-centre controlled-cohort ex vivo proof-of-concept pilot study, we obtained vastus lateralis biopsies from ventilated patients with ICU-acquired weakness (n = 8) and from age and sex-matched metabolically healthy controls (n = 8). Mitochondrial functional indices were measured in cytosolic context by high-resolution respirometry in tissue homogenates, activities of respiratory complexes by spectrophotometry and individual functional capacities were correlated with concentrations of electron transport chain key subunits from respiratory complexes II, III, IV and V measured by western blot. RESULTS: The ability of aerobic ATP synthesis (OXPHOS) was reduced to ~54% in ICU patients (p<0.01), in correlation with the depletion of complexes III (~38% of control, p = 0.02) and IV (~26% of controls, p<0.01) and without signs of mitochondrial uncoupling. When mitochondrial functional indices were adjusted to citrate synthase activity, OXPHOS and the activity of complexes I and IV were not different, whilst the activities of complexes II and III were increased in ICU patients 3-fold (p<0.01) respectively 2-fold (p<0.01). CONCLUSIONS: Compared to healthy controls, in ICU patients we have demonstrated a ~50% reduction of the ability of skeletal muscle to synthetize ATP in mitochondria. We found a depletion of complex III and IV concentrations and relative increases in functional capacities of complex II and glycerol-3-phosphate dehydrogenase/complex III.

Subsequent contralateral hip fractures: can at-risk patients be identified? An observational study of 5,102 patients.

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.

The modified scarf osteotomy in the treatment of tailor's bunion: midterm follow-up.

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

Combined traumatic atlantooccipital and atlantoaxial articulation instability: a case report with survival.

Traumatic atlantooccipital dislocation is a rare injury in survivors with 15 % share in deaths due to spinal injury. The authors present a case of a patient with concurrent atlantooccipital and atlantoaxial instability of the upper cervical spine, which he suffered after a fall from height. Atlantooccipital dislocation in surviving patients is a rare injury, for which in some cases coincident bone injury is reported to upper cervical spine, such as occipital fracture or contingent odontoid (C2 dens) fracture. In our case, it is combined with atlantoaxial instability and this combined type of injury has not yet been described in the literature. We performed realignment of the dislocation and posterior occipitocervical (C0-C3) fusion. After the surgery, the patient manifested neurological improvement almost to a normal neurological outcome with persistent residual finding after subarachnoid hemorrhage.

Anatomist and the pioneer of radiology Étienne Destot--95th anniversary of his death.

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.

Developmental malformations in the area of the lumbosacral transitional vertebrae and sacrum: differences in gender and left/right distribution.

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

The correlation between muscles insertions and topography of break lines in pertrochanteric fractures: a comprehensive anatomical approach of complex proximal femur injuries.

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

Mid-term functional and radiological outcomes after total hip replacement performed for complications of acetabular fractures.

OBJECTIVE: Acetabular fractures can lead to serious complications such as avascular necrosis of the femoral head (AVN), osteoarthritis, non-union. Total hip replacement (THR) is a treatment option for these complications. The purpose of this study was to assess the functional and radiological outcomes of THR at least 5 years after the primary implantation. METHODS: This retrospective study analysed clinical data from 77 patients (59 males, 18 females) who were treated from 2001 to 2022. Data was collected on the incidence of AVN of the femoral head, complications, interval from fracture to THR, reimplantation. The modified Harris Hip Score (MHHS) was used to evaluate outcome. RESULTS: The mean age at the time of fracture was 48 years. Avascular necrosis developed in 56 patients (73%), with 3 cases of non-union. Osteoarthritis without AVN developed in 20 patients (26%), non-union without AVN in one patient (1%). The mean time from fracture to THR was 24 months for AVN with non-union, 23 months for AVN alone, 22 months for AVN with arthritis, 49 months for hip osteoarthritis without AVN. The time interval was significantly shorter for cases of AVN than for cases of osteoarthritis without AVN (p = 0.0074). Type C1 acetabular fracture was found to be a risk factor for femoral head AVN (p = 0.0053). Common complications of acetabular fractures included post-traumatic sciatic nerve paresis (17%), deep venous thrombosis (4%), infections (4%). Hip dislocation was the most common complication of THR (17%). There were no cases of thrombosis following THR. According to Kaplan-Meier analysis, the proportion of patients without revision surgery within 10-year period was 87.4% (95% CI 86.7-88.1). The results of the MHHS after THR: 59.3% of patients had excellent results, 7.4% good, 9.3% satisfactory results, and 24.0% had poor results. The mean MHHS was 84 points (95% CI 78.5-89.5). Paraarticular ossifications were observed in 69.4% of patients in the radiological evaluation. CONCLUSION: Total hip replacement is an effective treatment for serious complications of acetabular fracture treatment. Its results are comparable to THR peformed for other indications, although it is associated with a higher number of paraarticular ossifications. Type C1 acetabular fracture was found to be a significant risk factor for early femoral head AVN.

[Present concept for management of severely injured patients in Trauma Centre Faculty Hospital Královské Vinohrady]. / Aktuální koncepce osetrení závazných poranení v Traumatologickém centru Fakultní nemocnice Královské Vinohrady.

BACKGROUND: The implementation of standardized protocols for management of polytrauma, multiple injuries and complicated monotrauma has led to improvement in trauma care with decrease in posttraumatic morbidity and mortality. The introduction of algorithm "Definitive Surgical Trauma Care" (DSTC) with concept of "damage control" surgery assumed the principal role in care of polytrauma patients. It can be accomplished only in the trauma- centre with implementation of care system for severely injured patients. Analysis of severely injured patients treated in Trauma Centre Faculty Hospital Královské Vinohrady was performed in a retrospective study. METHODS AND RESULTS: 515 injured patients admitted to emergency unit of the Department of anaesthesiology and resuscitation in years 2009-2010 were evaluated. There were 385 men and 130 women. Average age of patients was 45 years. Primary trauma admissions were 482 (83%) victims. There were 248 (48%) polytrauma patients, 158 (31%) with craniocerebral injuries, 76 (15%) with associated injuries and 33 (6 %) injured with monotrauma. ISS > 16 were in 309 injured patients, average rate ISS was 26.5. Trauma care in emergency unit was provided with the team of specialists (general surgeon for visceral traumatology, orthopaedic surgeon for extremities trauma, specialist for intensive care, anaesthesiology and diagnostic radiology). 412 surgical or radio intervention procedures were performed. There were 313 (76%) urgent surgeries and 99 delayed (24%). The most frequent urgent surgery was for fractures of extremities, (36%) and neurotraumas (29%). Acute operations for thoracic and abdominal trauma were performed in 24% of patients. Delayed surgeries were mostly operations of extremities fractures (66%) and maxillofacial injuries (15%). Mortality was 18% (95 patients); being highest in group of patients with Injury Severity Score (ISS) > 40 (65%). CONCLUSIONS: The implementation of trauma care system in severely injured patients brings increased numbers of primary trauma admissions to trauma centres. Polytraumas and craniocerebral injuries were the most frequently admitted patients to emergency unit. Implementation of standardized protocols with interdisciplinary cooperation in trauma management represents improvements of trauma care. Early indication and performance of urgent operations with control of bleeding and prevention of subsequent contamination belongs to principal steps in the management of severely injured patients. Definitive management with reoperation in polytrauma patients can be indicated after the stabilisation. ISS > 40 was connected with high mortality rate (65%).

Leg Ulcer Therapy by Local Injection of Autologous Growth Factors: Results of a Pilot Study.

INTRODUCTION: Population ageing has led to an increase in the prevalence of many chronic diseases that occur in elderly patients including chronic wounds of various aetiologies, especially leg ulcers. The treatment of these wounds is lengthy and associated with health, economic and social problems. The aim of our study was to compare the outcomes of local injections of autologous growth factors with standard dressings for leg ulcer treatment. METHODS: The study included 25 patients with leg ulcers treated with autologous growth factors, and 15 patients treated with standard wet dressings only. The area and depth of ulcers were measured on days 0, 5, 28, 84 and 168, and statistically processed using the chi-square test, the Fischer exact test, the Wilcoxon two-sample test, the non-parametric paired Wilcoxon test and the Friedman analysis of variance (ANOVA) test at a significance level of 5%. RESULTS: Area and depth did not significantly differ between the two groups before initiation of the treatment (p = 0.472 and p = 0.242, respectively). During the study period, the average leg ulcer area decreased in both the study and control groups by 72% and 40%, respectively. The paired Wilcoxon test showed that this decrease was significant in the study group (p < 0.001), but not in the control group (p = 0.075). CONCLUSION: Leg ulcers heal better when treated with autologous growth factor injections than when treated with standard dressings alone. A further study with a larger number of patients is needed to confirm the presented results. However, this method seems to be a promising way to treat ulcers of the lower extremities.

A Morphologic Analysis of the Pubic Symphysis Using CT and MRI.

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