5th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?

PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.

[Administration of Anabolic Steroids in Combination with Vitamin D in the Early Stage of Treatment of Polytrauma Patients - a Dead End?] / Aplikace anabolických steroidu s vitaminem D v casné fázi lécby polytraumatizovaných pacientu ­ slepá ulicka?

PURPOSE OF THE STUDY Persistent catabolism is one of the main causes of delayed healing in polytrauma patients. The purpose of this study is to verify the effect of early administration of an anabolic steroid in combination with vitamin D on the process of bone healing in polytrauma patients. MATERIAL AND METHODS In this prospective study, the patients with a serious trauma were divided into two groups (a control group and a treatment group), with the treatment group being treated with nandrolone decanoate, an anabolic steroid in combination with vitamin D. In all the patients, bone metabolism markers and sex hormone levels (men only) were monitored through lab testing for the period of 70 days and the results of both the groups were subsequently compared. RESULTS The study included a total of 64 patients, 32 in the control group and 32 in the treatment group. The differences between the groups in gender (p = 0.387) as well as in the age of patients (p = 0.436) were statistically non-significant. There was a significant difference in the Injury Severity Score (48 in the treatment group as against 41 in the control group, p = 0.022). Even though this difference was statistically significant, it cannot be considered clinically significant since all the patients met the major trauma criteria. No positive effect of this treatment on bone metabolism parameters was established; on the very contrary, the only statistically significant changes were observed in the control group. To be specific, in levels of one of the bone formation markers, bone alkaline phosphatase on Day 7 after the injury (an increased level in the control group; p = 0.002) and in one of the bone resorption markers (bone acid phosphatase) on Day 70 after the injury (an increased level in the treatment group; p = 0.042). In the treatment group, 70 days after the injury a higher 25(OH)vitamin D level (p < 0.001) was reported and starting from Day 7 in men in the treatment group a significantly lower testosterone level and free testosterone level were observed. The level of androgenic hormones dramatically dropped in both the groups during the first days after the trauma, the dynamics of its normalization was faster in patients in the control group than in the treatment group. DISCUSSION The administration of nandrolone decanoate, an anabolic steroid, in combination with vitamin D did not produce the expected effect, i.e. an improvement in bone healing markers in polytrauma patients. One would expect that in polytrauma patients with a bone fracture or fractures during bone healing higher levels of all the markers of bone resorption as well as bone formation will persist. Similar increases in bone metabolism levels, however, were observed also in patients with injuries in other somatic regions. This indicates the importance of bone tissue involvement in the overall response of the organism to polytrauma. A faster normalization of the levels of testosterone, dihydrotestosterone and free testosterone in the control group compared to the treatment group corresponds with the supplemental effect of anabolic steroids and reduced production of these hormones as a feedback to hypothalamic-pituitary-adrenal axis. CONCLUSIONS In the follow-up period, the positive effect of anabolic steroid and vitamin D administration on bone metabolism in polytrauma patients was not confirmed. Key words: polytrauma, anabolic steroids, vitamin D, bone metabolism.

Artroskopicky asistovaná osteosyntéza nitrokloubních zlomenin lopatky ­ první zkusenosti a dvouleté klinické výsledky.

PURPOSE OF THE STUDY Fractures of the scapula are less frequent, with the incidence reported in literature of approximately 1% of all fractures and 3-5% fractures of shoulder. These fractures are predominantly treated non-operatively. Osteosynthesis is indicated in displaced intra-articular fractures and severely displaced extra-articular fractures of the scapular body, its lateral border in particular. Apart from open reposition and osteosynthesis, also minimally invasive osteosynthesis under fluoroscopic and arthroscopic control has recently been used to treat intra-articular fractures of the scapula. The arthroscopy facilitates debridement of the fracture line in the intra-articular region and control over the insertion of the osteosynthesis material in the subchondral bone of the glenoid and it also makes visible the accuracy of reduction of fractures of the glenoid articular surface. MATERIAL AND METHODS In 2013-2017, osteosyntheses of 9 intra-articular fractures of the scapula were performed with the use of both perioperative fluoroscopy and arthroscopy. The group included 7 men and 2 women, with the mean age of 37 years (range 24-52 years). 4.5 mm cannulated screws inserted in the subchondral bone either from the cranial or dorso-caudal part of the glenoid in dependence on the type of the fracture were used as osteosynthesis material. Postoperatively, the extremity was fixed by Desault type shoulder brace for 4 weeks. Rehabilitation using standard procedures for shoulder joint followed. The patients were followed up at regular intervals, namely on 10th day, at 4 weeks, 3, 6, 12 and 24 months postoperatively. The clinical outcomes and radiologic signs of healing were evaluated continuously and two years after the surgery the clinical outcomes were assessed using the Constant score. Arm elevation was assessed separately, as a dominant indicator of shoulder joint function. RESULTS No perioperative complications were reported, the operative times ranged from 45 to 120 minutes. Reduction was always performed in fractures with intra-articular displacement of less than 2 mm, which was measured both arthroscopically and on perioperative and postoperative radiographs. No complications of wound healing were observed. One patient experienced temporary paresthesia in the innervation zone of the sensitive branch of the radial nerve. The mean healing time of fractures was 121 days (range 107-146 days). The mean Constant score at two years after surgery was 83 points (range 78-87 points), the resulting restriction of elevation was 12° on average (range 0-23°). DISCUSSION There are not many papers covering a similar topic in world literature, most of them present the benefits of arthroscopy in some types of osteosyntheses of intra-articular fractures of the scapula. Most frequently mentioned are osteosyntheses of the anterior portion of the glenoid in case of a bony Bankart lesion. These papers highlight the benefits of minimal invasiveness of this procedure. CONCLUSIONS By visualising the fracture line, the arthroscopy facilitates a more accurate reduction of fragments and a minimally invasive osteosynthesis of some intra-articular fractures of the scapula when compared to closed reduction with fluoroscopic intraoperative control only. The use of arthroscopy in these interventions is conditional on perfect mastering of the surgical technique and also the use of special instruments both for arthroscopy and minimally invasive osteosynthesis. If these criteria are observed and the surgical technique mastered, the authors consider this method beneficial in treating the glenoid fractures. Key words: minimally invasive osteosynthesis, glenoid fractures.

[Comparison of Hospital Preparedness to Deal with Crisis Situations in Mass Casualty Incidents According to the UN Human Development Index]. / Porovnání pripravenosti nemocnic na resení krizového stavu pri hromadném nestestí v závislosti na indexu lidského rozvoje dané zeme.

PURPOSE OF THE STUDY This thesis presents the very current topic of general hospital preparedness to deal with crisis situations in mass casualty incidents. MATERIAL AND METHODS The key part of the work consists in a questionnaire survey of 26 foreign and domestic respondents, which provides a very good description of this issue in various countries of the world. The group is divided into health facilities in developed and developing countries of the world according to the UN Human Development Index. Another sub-group consists of hospitals in areas with a higher frequency of terrorist attacks and a separate group is formed by 5 hospitals in the Czech Republic. Based on the results of the questionnaire survey, the preparedness of hospitals for dealing with mass casualty incidents is compared in both the groups according to the advancement of the country and also in the subgroup of hospitals in the Czech Republic and in countries with frequent terrorist attacks. The maximum achievable score evaluating the hospital readiness is 20 points. The data obtained by the questionnaire survey is evaluated using statistical methods. RESULTS Higher preparedness of hospitals was found in developed countries, with a hospital preparedness score of 12.9 points compared with 5.9 points in developing countries' hospitals. Hospitals in the Czech Republic show a similar readiness for mass casualties as the other hospitals in developed countries, with the mean score of 12.2 points. Hospitals in countries with a higher number of terrorist attacks did not show a higher readiness to deal with crisis situations associated with mass casualties - the mean score of 9.4 points. DISCUSSION The following discussions and evaluations, together with personal experience and thorough knowledge of real-life solutions, became the basis for recommendations of triage procedures, organization of surgery and traumatology departments and material equipment of medical facilities in the Czech Republic. CONCLUSIONS By applying the results of the habilitation thesis it is possible to achieve an optimal solution and increase the reliability in the preparedness of hospitals in dealing with crisis situations, especially to eliminate the discrepancy between theory and practice. Key words: mass casualty incidents, triage, hospital preparedness, disaster management response.

Rationale and design of a prospective, randomised study of retrograde application of bone marrow aspirate concentrate (BMAC) through coronary sinus in patients with congestive heart failure of ischemic etiology (the RETRO study).

BACKGROUND: Heart failure (HF) is a major chronic illness and results in high morbidity and mortality. The most frequent cause of HF with reduced ejection fraction (HFREF) is coronary artery disease (CAD). Although revascularisation of ischemic myocardium lead to improvements in myocardial contractility and systolic function, it cannnot restore the viability of the already necrotic myocardium. METHODS/DESIGN: The aim of our prospective randomised study is to assess the efficacy of the retrograde application of non-selected bone marrow autologous cells concentrate (BMAC) in patients with HFREF of ischemic aetiology. The evaluated preparation is concentrated BMAC, obtained using Harvest SmartPReP2 (Harvest Technologies, Plymouth, MA, USA). The study population will be a total of 40 patients with established CAD, systolic dysfunction with LV EF of ≤40% and HF in the NYHA class 3. Patients have been on standard HF therapy for 3 months and in a stabilised state for at least 1 month, before enrolling in the clinical study. Patients will be randomised 1:1 to either retrograde BMAC administration via coronary sinus or standard HF therapy. The primary end-points (left ventricular end-systolic and end-diastolic diameters [LVESd/EDd] and volumes [LVESV/EDV] and left ventricular ejection fraction [LV EF]) will be assessed by magnetic resonance imaging. The follow-up period will be 12 month. DISCUSSION: The application of bone marrow stem cells into affected areas of the myocardium seems to be a promising treatment of ischemic cardiomyopathy. The Harvest BMAC contains the entire population of nuclear cells from bone marrow aspirates together with platelets. The presence of both platelets and additional granulocytes can have a positive effect on the neovascularisation potential of the resulting concentrate. Our assumption is that retrograde administration on non-selected BMAC via coronary sinus, due to the content of platelets and growth factors, might improve left ventricular function and parameters compared to standard HF therapy. Furthermore, it will be associated with improved exercise tolerance in the six-minute corridor walk test and an improvement in the life quality of patients without increasing the incidence of severe ventricular arrythmias. TRIAL REGISTRATION: (ClinicalTrials.gov; https://clinicaltrials.gov ; NCT03372954).

GENERAL HEALTH STATUS AMONG FIREFIGHTERS AND RESCUE OPERATIONS WORKERS.

Research objective - to study the state of health of staff of service of fire extinguishing and accident rescue services department for definition of the priority directions of rendering the treatment-and-prophylactic help and rehabilitation of employees. By means of an information and analytical method the retrospective analysis of reports about the registered diseases, their result and the reasons of temporary disability of staff of service of fire extinguishing and accident rescue services department of Department on emergency situations of Almaty in 2011-2016 has been carried out. Statistical processing of the received results of research is carried out by means of Student's t-criterion. The conducted research showed that the high level of primary incidence is characteristic of the staff of service of fire extinguishing and accident rescue services department, at the same time the most significant are diseases of respiratory organs, traumas, poisoning and some other consequences of influence of the external reasons, diseases of bone and muscular system and connecting tissue, blood circulatory system illness. Studying of the state of health of staff of service of fire extinguishing and rescue services allowed to establish the priority directions of rendering the treatment-and-prophylactic help and rehabilitation. Their contents are defined by need of concentration of efforts on prevention, treatment and rehabilitation of the most widespread diseases causing the maximum damage to health.

The rs1803274 polymorphism of the BCHE gene is associated with an increased risk of coronary in-stent restenosis.

BACKGROUND: We sought to identify gene polymorphisms that confer susceptibility to in-stent restenosis after coronary artery bare-metal stenting in a Central European population. METHODS: 160 controls without post-percutaneous coronary intervention in-stent restenosis were matched for age, sex, vessel diameter, and diabetes to 160 consecutive cases involving in-stent restenosis of the target lesion within 12 months. Using real time polymerase chain reaction and melting-curve analysis, we detected 13 single-nucleotide polymorphisms in 11 candidate genes - rs1803274 (BCHE gene), rs529038 (ROS1), rs1050450 (GPX1), rs1800849 (UCP3), rs17216473 (ALOX5AP), rs7412, rs429358 (ApoE), rs2228570 (VDR), rs7041, rs4588 (GC), rs1799986 (LRP1) and rs2228671 (LDLR). Multivariable logistic regression was used to test for associations. RESULTS: The rs1803274 polymorphism of BCHE was significantly associated with in-stent restenosis (OR 1.934; 95 % CI: 1.181-3.166; p = 0.009). No association was found with the other studied SNPs. CONCLUSIONS: The A allele of rs1803274 represents a risk factor for in-stent restenosis in Central European patients after percutaneous coronary intervention with bare-metal stent implantation.

[Multiple trauma - treatment of skeletal injuries with damage control orthopaedics]. / Polytrauma - osetrení skeletálních poranení metodou damage control orthopaedics.

New methods of treating seriously injured patients have been introduced in the field of trauma surgery since 1993. These consist mostly of differentiated and rapid procedures of treatment of the injured skeleton, with the aim of preventing the development of severe haemorrhagic shock and exsanguination of the patient. The precondition for introducing these techniques is the study of the organisms inflammatory response to trauma. Since 2000, this approach has been called damage control orthopaedics. The authors deal with the history of this method, the physiology of severe trauma, selection of patients eligible for this method and the appropriate timing of definitive treatment.

[Incidence of proximal femur fractures in relation to seasons of the year and weather]. / Distribuce zlomenin horního konce stehenní kosti v závislosti na rocní dobe a pocasí.

PURPOSE OF THE STUDY: The opinion that proximal femur fractures occur mainly in the winter season and are related to slippery surfaces prevails in both the lay and medical communities. The elucidation of this relationship would lead to a better understanding of the aetiology of these fractures and may help to prevent them in the elderly population. MATERIAL AND METHODS: In a retrospective study conducted at two departments, the occurrence of proximal femur fractures in patients 60+ years old in relation to weather conditions (air temperature and its humidity, atmospheric pressure, rain and mist) between January 1, 2001 and December 31, 2005 was investigated. Patients with high-energy or pathological fractures were excluded. The results were evaluated by Statistika software. RESULTS: A total of 1720 patients were studied, of whom 1313 were women and 407 were men. The numbers of fractures did not differ significantly among either the seasons or months of the year. No correlation was found between the number of fractures and each of the weather characteristics (air temperature and its humidity, atmospheric pressure, wind speed and visibility). DISCUSSION: It is widely believed that hip fractures are connected with winter months and temperatures below zero. This is supported by several facts related to winter characteristics, such as slippery icy pavements, clumsiness due to warm bulky clothes, bodies affected by cold and thus predisposed to a fall and poorer visibility on shorter winter days. The effect of seasonal variation on hip fracture incidence has been investigated in 10 studies of which only one has taken the influence of daily temperature into consideration. All studies were conduced in the countries north of 40° latitude, i.e., in climatic conditions similar to our country, with temperatures falling below zero and ice-glazed pavements in winter months. Of them, six have found no relation between proximal femur fractures and weather conditions, two have reported an increased incidence of these fractures in winter months and two in summer months. CONCLUSIONS: Our study did not show any significant relationship between the incidence of proximal femur fractures and weather characteristics. Seasons of the year had no effect on the number of hip fractures or the length of hospital stay due to their treatment.

[Right ventricular perforation by a rib fragment following blunt thoracic trauma]. / Perforace pravé komory srdecní ulomkem zebra po tupém urazu hrudníku.

Blunt chest trauma produces a variety of injuries. Penetrating cardiac injuries from rib fractures are extremely rare. We report the unusual case of a patient with multiple rib fractures and penetrating cardiac injury from dislocated segment of fractured VIII left rib. We did find eight patients reported in the literature having penetrating cardiac injuries from rib fractures. The clinical finding and the diagnosis of this injuries are discussed.

[Our first experiences with autologous transplantation of bone marrow stem cells to treat pseudarthrosis, delayed fracture healing and long bone defects fracture]. / Nase první zkusenosti s transplantatí autologních kmenových bunek kostní drene v lécbe pakloubu, opozdeného hojení zlomenin a defektních zlomenin dlouhých kostí.

Traumatology and orthopaedics have undergone substantial progress in the use of new, sophisticated techniques, implants and navigation methods. Nevertheless, these new methods continue to fail in some instances. Regenerative medicine using the growth potential of stem cells that posses the ability to regenerate damaged tissues represent one of the possible ways forward. There is a potential for more comprehensive utilization of bone marrow stem cells that had for many years been used in transplant medicine. Traumatology and orthopaedics could utilise stem cells in the treatment of bone defects, i.e. in the treatment of pseudarthrosis, delayed fracture healing, defect fractures and aseptic bone necroses. Bone formation and growth is a complex, predominantly anabolic, process with a range of feedbacks. Nevertheless, it is the bone marrow where the necessary progenitors of bone growth are located. These are mesenchymal stem cells (MSCs), haematopoietic stem cells (HSCs) as well as thrombocytes containing a range of necessary growth factors. A number of studies showed positive results for stem cells treatment of pseudarthrosis, with only a fraction, however, being statistically significant in human medicine. This method was used in 11 patients of the Traumatology Centre of the Faculty Hospital in Ostrava, Czech Republic in 2008. The researched patients were treated for pseudarthrosis of long bones, delayed multifragmentary fracture haling and defect fractures of long bones. Autologous concentrate of bone marrow stem cells was applied in one session into the area of bone defect in a patient lightly anaesthetised with propofol. The results from this small sample of patients are not yet available. However, we are sharing our first experiences with this treatment option.

[Pelvic fractures: role of imaging methods in the diagnosis of isolated pelvic fractures and multi-trauma]. / Diagnostika poranení pánve - role zobrazovacích metod u izolovaných traumat i polytraumat.

The authors evaluate the role of imaging methods used in the diagnostics of pelvic fractures with the aim to suggest the most effective way of their use. The exact diagnosis of an injury is achieved most quickly if, in hemodynamically stable patients, CT scan is the initial examination and, based on the findings, conservative, invasive (laparotomy) or miniinvasive (angiography with bleeding artery embolization) procedures are used. In hemodynamically unstable patients, the diagnostic procedure always begins with plain X-ray and FAST (ultrasound) examination of the pelvis. When large hemoperitoneum is diagnosed, laparotomy is indicated. When only a small amount of hemoperitoneum is detected, a primary, minimally invasive procedure (angiography with bleeding artery embolization) can be carried out by an experienced interventional radiologist. If this fails to result in stabilization of the circulation, laparotomy should follow. Key words: pelvic ring injury, diagnosis, plain radiography, FAST, MDCT, angiography, embolization.

[The role of plain radiography in pelvic trauma in the era of advanced computed tomography]. / Význam klasického rentgenového snímku pri poranení pánve v dobe moderní CT diagnostiky.

PURPOSE OF THE STUDY: The aim was to evaluate the diagnostic value of plain X-ray images in the diagnosis of pelvic ring injury in comparison with CT findings. MATERIAL AND METHODS: The group evaluated consisted of 30 patients, 11 women and 19 men, at an average age of 46 years (range, 20-81 years; women, 20-68 years, men, 20-81 years; average age, 49 and 44 years in women and men, respectively) in whom plain radiography and CT scans were done as part of the initial examination. A retrospective assessment of plain X-ray images was carried out by two independent specialists (radiologist and trauma surgeon). The authors together evaluated CT scans and carried out the final assessment of all medical records. Pelvic radiography was taken with a mobile X-ray unit; CT scans were done according to the standard trauma scanning protocol, using a CT scanner with either one row (CT) or 16 rows (multidetector/MDCT) of detectors. RESULTS: Based on the evaluation of X-ray and CT findings, a total of 133 fractures or displacements in the sacroiliac joint or pubic symphysis were detected. The radiologist identified 99 (74 %) injured structures and the trauma surgeon 111 (83 %) ones. This difference was not significant on the whole (p = 0.536), nor when individual structures were assessed. False negative findings were made by the radiologist on 10 occasions and by the trauma surgeon on seven occasions; the evaluation of image data sets by both observers was associated with only one false positive finding. The overall sensitivity of plain X-ray images, when compared to CT scans, was 83 %, but it was considerably lower on evaluation by one observer only (radiologist, 67 %; trauma surgeon, 78 %). DISCUSSION: The biggest difference between the findings of two independent specialists existed in the assessment of injuries to the posterior ring of the pelvis (SI joint, sacrum) on plain X-ray images. However, trauma in this region was identified without any doubt on CT scans. To diagnose the type of pelvic injury from CT scans without a possibility to evaluate standard anteroposterior (AP) radiographs or good-quality 2D or 3D reconstructions was found difficult in over one third of the patients. A validity comparison of standard AP radiography and high-quality 2D or 3D CT reconstructions showed that both had an equal value for the exact detection of pelvic injury type. For correct evaluation of the type of injury, scans from the MDCT were easier to read than those from the CT scanner. CONCLUSIONS: There is no doubt about the role of standard AP X-ray in the identification of pelvic injury type in polytraumatized, hemodynamically unstable patients. The validity of CT examination for identification of injury to the posterior ring of the pelvis in particular is so high that, in the primary diagnostic procedure, inlet and outlet radiography of the pelvis has lost its importance. The information on the stability and type of injury provided by 2D and 3D CT reconstructions is so exact that, at present, CT examination can reliably replace AP radiography, particularly if, for various reasons, good-quality X-ray images cannot be guaranteed.

[The T-plate in unstable pertrochanteric fractures of the femur]. / Pouzití T dlahy u nestabilní pertrochanterické zlomeniny femoru.

The author analyzed and evaluated the therapeutic results of unstable pertrochanteric fractures of the femur treated by the method of a T-shaped splint in 14 patients aged 35-65 years. In 78% during treatment redislocation into the varus position occurred. The mean loss of correction was 36 degrees, despite the fact that a rest regime with a lateral spike splint lasted on average for 32.4 days. In 57% a secondary operation with the necessity of respongioplasty was performed, in two cases final corrective revalgization osteotomy had to be performed. The use of a T-shaped splint in the above indication is controversial.

[Treatment of open fractures of the foot using external fixation]. / Lécení otevrených zlomenin nohy zevní fixací.

The authors give an account of their experience with the use of compression--distraction for the treatment of open dislocation fractures of the foot. The device was designed by the authors and the results are satisfactory when the apparatus is used in the mentioned indications.

[Treatment of fracture of the talar joint using the malleolar transtibial traction loop]. / Lécení zlomenin hlezenného kloubu maleolární transtibiální taznou klickou.

The authors submit their own experience with the treatment of malleolar fractures by means of a transtibial traction malleolar loop of their own modification which makes it possible by means of a minimal amount of osteosynthetic material to fix all three fragments of the malleolar fracture, incl. the tibiofibular syndesmosis. The authors applied this method in 20 patients with good results.

[Possibilities of treatment of fractures using external fixation in children]. / Moznosti lécení zlomenin zevní fixací u detí.

The authors submit their own experience with the use of a MCD device (modified compression-distraction apparatus) in the treatment of open fractures in children. The MCD apparatus is of their own design and manufacture and the results obtained in the treatment of fractures with this apparatus are satisfactory.