Conservative versus surgical treatment of displaced midshaft clavicle fracture in adolescents.

INTRODUCTION: Midshaft clavicle fractures are common in childhood and their conservative treatment predominates. The indication for surgical treatment of adolescents with significantly displaced fractures remains controversial. The aim of this study was to compare the results of conservative or surgical treatment (intramedullary nailing) of these fractures. METHODS: Retrospective clinical study of patients aged 1117 years with significantly displaced clavicle fractures treated at the Department of Pediatric Surgery and Traumatology, University Hospital Hradec Králové in 20112020. RESULTS: In this period, 696 patients with a clavicle fracture (excluding neonatal fractures) were treated. Of these, only 90 (13%) adolescent patients had significantly displaced diaphyseal fractures. Conservative approach was adopted in 52 (58%) of them; the remaining patients underwent a surgical procedure, while an intramedullary inserted and fixed titanium nail (TEN) was used in 20 (22%) cases. Supportive fixation was necessary in 4 of the operated patients. The duration of supportive fixation (basic therapeutic procedure for conservative treatment) was significantly shorter in operated patients (18 vs. 29 days, p=0.0001). No statistically significant difference was found in terms of the time interval of complete healing and return to full activity (74 vs. 85 days, p=0.051). There was one complication in the healing of the surgical wound; all patients healed without sequelae. CONCLUSION: According to the study, intramedullary osteosynthesis using a fixed titanium nail reduced the need for supportive fixation and allowed to shorten its time. Overall cosmetic and functional results were comparable to the conservative procedure. Therefore, this method can be recommended, especially for active adolescents.

Foreign body ingestion in children.

INTRODUCTION: Evaluation of results of the group of paediatric patients treated for swallowed foreign bodies in the digestive tract. METHODS: Retrospective analysis of patients treated for foreign bodies in the digestive tract, managed at the University Hospital of Hradec Králové between 2011-2018. RESULTS: 365 patients (182 boys, 183 girls) with a foreign body in the digestive tract have been evaluated. The mean age was 2.4 years. Most of the children were treated as outpatients (280 children, 76.7%) and only 85 children (23.3%) were hospitalized. The most commonly swallowed frequent bodies included coins (26%) and batteries (14.5%); sharp objects occurred in 5.2%. Unusual foreign bodies were noticed, too. We can mention for example a pen or a plant nutrition product. In 302 cases (82.7%) the foreign bodies passed easily per vias naturales. Endoscopy was necessary in 63 cases (17.2%) - in 51 children the object had to be removed from the oesophagus and in 12 children the object had to be removed from the stomach. None of the swallowed bodies caused complications such as digestive tract perforation or bowel obstruction. No patient in the group was indicated for laparotomy to remove the foreign body. CONCLUSION: Foreign bodies entrapped in the oesophagus have to be removed endoscopically. In most cases, foreign bodies in the stomach require only observation in the outpatient setting because they leave the stomach easily, without complications, per vias naturales. If a battery remains at the same place of the digestive tract for more than 24 hours, endoscopic removal is indicated at our department. In addition, endoscopy is done in cases of swallowed multiple magnets or bodies that are too large and remain in stomach for several weeks or months. Surgical removal of foreign bodies should be reserved only for complicated cases.

[IKARUS Project--incidence of bone events in breast cancer: retrospective analysis of patients in oncological centres in the Czech Republic and Slovakia]. / Projekt IKARUS--zjistení incidence kostních príhod u karcinomu prsu: retrospektivní analýza nemocných dispenzarizovaných v onkologických centrech Ceské a Slovenské republiky.

BACKGROUND: Bone incidents today represent, in terms of frequency and the overall effect on the quality of life of patients with breast cancer, a serious health problem. In a number of clinical studies bisphosphonates have been shown to have a positive impact on reducing the risk of bone events and therefore to be effective in the prevention of bone events. The primary objective of this project was to identify the incidence of bone events in patients with metastatic breast cancer treated in the Czech and Slovak Republics. SUBJECTS: Retrospective, multi-centre, non-interventional, epidemiological and explorative studies to identify the incidence of bone events in the defined group of patients and a description of the practice of prevention and treatment of skeletal events in the years 2000-2005. Enrolled were patients with advanced metastatic breast cancer diagnosed in 2000. METHODS AND RESULTS: Analysis of overall survival and survival to disease progression, analysis of patterns of treatment of bone events and the practice of the use of bisphosphonates in the prevention of bone events in metastatic skeleton affection in the normal conditions of clinical practice, analysis of patient compliance in the treatment with bisphosphonates, analysis of the time interval between the occurrence of bone metastases and the occurrence of bone events and, last but not least, survival analysis of patients in relation to bone events. CONCLUSION: This work has shown that the practice of treatment with bisphosphonates since 2000 and assessed the survival of patients with metastatic breast cancer.