Posterior malleolar fractures of the tibia in fracture-dislocations of the ankle

Disertační práce se zabývá zlomeninami zadní hrany tibie u zlomenin hlezna. V diagnostice a léčbě zlomenin zadní hrany tibie u zlomenin hlezna celosvětově neexistuje na problematiku jednotný názor. Experimentální část studie se zaměřila na anatomii hlezenního kloubu, a to zejména na stavbu fibulární incisury distální tibie jako na jednu z klíčových oblastí pro stabilitu hlezna. Výsledkem bylo stanovení ideální vzdálenosti pro správné hodnocení postavení fibuly v incisuře tibie. V klinické části studie byl na základním souboru pacientů se zlomeninami hlezna se současně přítomným odlomením zadní hrany tibie hodnocen charakter zlomenin pomocí předoperačně prováděného RTG a CT vyšetření. Tím bylo možno stanovit základní morfologické typy zlomenin zadní hrany. Vzniklá klasifikace byla ověřována na rozšířeném souboru pacientů. V klinické praxi byla použita k volbě operačního přístupu a způsobu fixace. Správnost vzniklé klasifikace byla ověřena na rozšířeném souboru pacientů. Klinickou aplikací anatomické 3D CT klasifikace bylo dosaženo dobrého anatomického postavení přímou repozicí a stabilní osteosyntézou ze zvolených přístupů, a i dobrých funkčních výsledků. Zásadní význam pro přesnou identifikaci, posouzení všech lézí a pro předoperační plánování mělo provedení předoperačního CT vyšetření ve třech rovinách a...The dissertation deals with fractures of the posterior malleolus of the tibia in ankle fractures. There is no consensus on the issue in the diagnosis and treatment of tibial posterior malleolus fractures in ankle fractures worldwide. The experimental part of the study focused on the anatomy of the ankle joint, especially on the construction of the fibular incisure of the distal tibia as one of the key areas for ankle stability. The result was the determination of the ideal distance for the correct assessment of the position of the fibula in the incisure of the tibia. In the clinical part of the study, the pattern of the fractures was evaluated on a basic group of patients with ankle fractures with concurrent tibial posterior malleolus fracture using preoperative X-ray and CT examination. This made it possible to determine the basic morphological types of posterior malleolus fractures. The resulting classification was verified on an extended group of patients. In clinical practice, it was used to choose the surgical approach and method of fixation. The correctness of the resulting classification was verified on an extended group of patients. The clinical application of the anatomical 3D CT classification achieved a good anatomical position by direct reduction and stable osteosynthesis from the chosen...Department of Orthopaedics First Faculty of Medicine Charles University and Military University Hospital PragueKlinika ortopedie 1. LF UK a ÚVNFirst Faculty of Medicine1. lékařská fakult

Posterior malleolar fractures of the tibia in fracture-dislocations of the ankle

The dissertation deals with fractures of the posterior malleolus of the tibia in ankle fractures. There is no consensus on the issue in the diagnosis and treatment of tibial posterior malleolus fractures in ankle fractures worldwide. The experimental part of the study focused on the anatomy of the ankle joint, especially on the construction of the fibular incisure of the distal tibia as one of the key areas for ankle stability. The result was the determination of the ideal distance for the correct assessment of the position of the fibula in the incisure of the tibia. In the clinical part of the study, the pattern of the fractures was evaluated on a basic group of patients with ankle fractures with concurrent tibial posterior malleolus fracture using preoperative X-ray and CT examination. This made it possible to determine the basic morphological types of posterior malleolus fractures. The resulting classification was verified on an extended group of patients. In clinical practice, it was used to choose the surgical approach and method of fixation. The correctness of the resulting classification was verified on an extended group of patients. The clinical application of the anatomical 3D CT classification achieved a good anatomical position by direct reduction and stable osteosynthesis from the chosen..

Bosworth fracture complicated by unrecognized compartment syndrome: a case report and review of the literature

Introduction!#!Compartment syndrome (CS) is exceedingly rare in ankle fractures. However, the risk of CS development seems to be increased in the presence of a Bosworth fracture-dislocation (BF), a rare variant of locked dislocation of the fibula behind the tibia.!##!Materials and methods!#!Here, we report the case of a 39-year old man with delayed diagnosis of CS after having sustained a BF and failed attempts on closed reduction. The patient developed a flexion contracture of the hallux necessitating secondary fusion.!##!Results!#!At 3 years after the injury, the patient was capable of running, but had 10 degrees limitation of ankle dorsiflexion, persisting decreased sensation on the plantar surface and clawing of the lesser toes. A thorough review of the literature revealed nine cases of CS after 167 reported BF resulting in a calculated prevalence of 5.4%.!##!Conclusions!#!Given the extreme paucity of CS in malleolar fractures, CS in BF has a relatively high prevalence. Risk factors include severe dislocations, repeated attempts on closed reduction, and a long interval to definite surgery. A high index of suspicion is required because delayed diagnosis leads to lasting functional restrictions

A Comparison of the Reliability of Five Sleep Questionnaires for the Detection of Obstructive Sleep Apnea

The aim of this study was to compare the reliability of five sleep questionnaires in detecting the occurrence of obstructive sleep apnea (OSA). The study was conducted on a group of 201 patients. The patients completed five sleep questionnaires: the Epworth Sleepiness Scale (ESS), the STOP-Bang questionnaire, the STOP questionnaire, the Berlin questionnaire (BQ) and the Pittsburgh Sleep Quality Index (PSQI). Subsequently, the patients were examined using limited polygraphy, and the sensitivity and specificity of the questionnaires were evaluated. The STOP-Bang, Berlin and STOP questionnaires had the highest sensitivity for OSA detection (81.6%, 78.7%, and 74.2%, respectively), while the sensitivities of PSQI and ESS were low (50.8% and 34.5%). The ESS, STOP-Bang, STOP and Berlin questionnaires had the highest specificity (82.6%, 75%, 61.9%, and 61.9%). In our sample, we found the STOP-Bang and Berlin questionnaires to be the most suitable for OSA screening with the highest sensitivities (81.6%, 78.7%) and satisfactory specificities (75%, 61.9%). The STOP questionnaire was also relatively reliable, especially given its time-saving nature; though short, it preserved satisfactory sensitivity (74.2%) and specificity (61.9%). The ESS and PSQI were unsuitable for OSA screening