Michal Mašek

Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients) of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A) were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B) in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17%) in group A and 1/34 (3%) in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Böhlers angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55%) in group A and in 30/34 (85%) in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the contraindications to surgery.

Compartment syndrome and regional anaesthesia: Critical review

Acute compartment syndrome (ACS) is a potential orthopaedic/traumatology emergency. Without prompt, precise diagnosis and immediate treatment with surgical decompressive fasciotomy it can lead to neurological dysfunction and disability. The role of regional anaesthesia (RA) in patients at risk for ACS/ and in those with developed ACS is controversial. The aim of this critical review was to answer the question, whether regional anaesthesia can delay the diagnosis. The authors use an evidence-based approach to discuss these high risk patients in considering RA as a method of choice for effective analgesia. To the date of data collection, there was no single case report identified where RA alone led to delay in ACS diagnosis and surgical treatment. In four clinical cases, epidural analgesia can be associated with delayed ACS diagnosis. Frequent clinical evaluation and breakthrough pain despite a functional RA in combination with intracompartment pressure measurement remains the keystone of recommended management for patients at risk of ACS.

The Pressure Ulcers Evidence in Patients with Spinal Cord Injury at Spinal Unit of Department of Traumatology at University Hospital Brno 2013– 2016

Aim: Aim of the study is to present an evidence of pres sure ulcers (PU), its localization, category and relation to the level of spinal cord injury in patients admitted at spinal unit (SU). Material and methods: In total 373 patients admitted at spinal unit from 2013 to 2016 was analysed. They fi rst hospitalisation was at one of spinal centres type 1a), which are defi ned by guidelines published by Ministry of Health CR (2002). All were examined us ing an international clas sifi cation ASIA. Localization of pres sure ulcers, category at the moment of admis sion, the time from the begin n ing of injury to admis sion at SU and the way of treatment was analysed. Results: We verify 49 (13.14%) patients with 76 pres sure ulcers in a basic set of 373 patients hospitalised at SU. The time from spinal cord injury (SCI) to the admis sion at SU has duration from 1 to 40 weeks. The disability AIS A was found in 87 (23.32%) patients and 24 (6.43%) of them had PU. AIS B was in 50 patients (13.40%) and 10 (2.68%) with PU; AIS C was in 106 (28.42%) patients and 10 (2.68%) with PU. The less disability AIS D was in 112 patients with 2 (0.54%) PU’s. It was not pos sible to examine ASIA score in 18 patients (4.83%) and 3 (0.54%) had PU. The most frequent localization of PU was sacrum in 37 (48.68%) and heels in 21 (27.63%) patients. The most frequent PU was second category – all together 47 (61.84%). In total 64 (84.21%) of PU’s was cured conservatively. Conclusion: In our set, there is the evidence that higher presence of PU was in patients with complete spinal cord injury AIS A, in tetraplegics patients and patients admitted from non-spinal departments. Poděkování patří prof. MU Dr. J. Bednaříkovi, CSc., FCMA, přednostovi Neurologické kliniky LF MU a FN Brno za neurologickou spolupráci v péči o spinální pa cienty. Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. L. Vašíčková, M. Mašek, J. Siegelová 1 Spinální jednotka, Klinika úrazové chirurgie LF MU a FN Brno 2 Katedra fyzioterapie a rehabilitace, LF MU, Brno 3 Ústav ochrany a podpory zdraví, LF MU, Brno  MUDr. Lia Vašíčková Spinální jednotka Kliniky úrazové chirurgie LF MU a FN Brno Jihlavská 20 625 00 Brno e-mail: liavasickova@tiscali.cz Přijato k recenzi: 15. 6. 2017 Přijato do tisku: 3. 7. 2017 Klíčová slova spinální jednotka – dekubitus – léze míšní – ASIA skóre

Impact of abdominal banding on splanchnic organ perfusion

Abdominal banding is still recommended by some surgeons to prevent eventeration after abdominal surgery. We assessed the impact of increased abdominal pressure (IAP) caused by abdominal banding on perfusion of splanchnic organs, ventilation and hemodynamics.

Intra-abdominal pressure (IAP) and hypoperfusion of splanchnic organs after major abdominal surgery.

In patients after major elective uncomplicated abdominal surgery clinically significant increase of intraabdominal pressure and markers of splanchic hypoperfusion are very rare.