In this paper, the authors draw attention to biomechanics connected with the possibilities of treatment of complicated bone fractures. They present information about their own design, laboratory tests and numerical solutions (i.e. strength analyses and reliability assessments) of the various types of external fixators applied in traumatology and orthopaedics (i.e. intended for fractures of limbs and pelvis and its acetabulum). The new design of external fixators is based on the development of Ilizarov and other techniques and satisfies new demands of science.
Unstable pelvic fractures are usually associated with high impact energy trauma. As to surgical procedures the most frequently used methods are open reduction and inner fixation (ORIF), the other methods of stabilizing the unstable posterior pelvic ring are percutaneous iliosacral screw fixation under fluoroscopic control and CT-guided percutaneous fixation. The last mentioned procedure eliminates some of the problems associated with surgical treatment: prevents excessive blood loss during manipulation of the fracture hematom, lowers the possibility of infection, allows more accurate screw placement with direct measuring of the screw length and decreases the possibility of nerve injury. The CT-guided fixation is a delicate procedure and its result depends among others on the cooperation between operating room and CT room personnel. The radiologist and CT technologist have to know the operation technique and have to understand surgeon's requirements. In the available literature only a little was written and mentioned about the exact role of radiologist and CT technologist in the team. The aim of this article is to present the operation technique according to authors' own experience with two operated patients and to mention the surgeon's requirements on CT team.
At first, the doctors mentioned their own medical experience with treatment of complex pelvic injury in patients with polytrauma and give reasons for necessity of early stabilization of pelvic fractures by means of external fixation, especially with continuous hemorrhage into lesser pelvis region and the retroperitoneum. Afterwards, they used damage control surgery methods including selective embolization. However, this article is focused also on the design of external fixators applied in traumatology and orthopaedics (i.e. skills of engineers). These fixators can be used in the treatment of open and unstable (i.e. complicated) fractures of pelvis and its acetabulum. Two versions (i.e. old and new) are compared. Numerical modelling (i.e. Finite Element Method), together with CAD modelling, experiments, material engineering, and nanotechnology are presented as a support for developing of a new design of external fixators. Abstrakt Nejprve, lékaři zmiňují své vlastní lékařské zkušenosti s léčbou komplexního poranění pánve u pacientů s polytraumaty a udávají důvody pro neodkladnou včasnou stabilizaci pánevních zlomenin pomocí zevních fixátorů, obzvláště u plynulého krvácení do nižších oblastí pánve a retroperitonea. Potom využívají metod "damage control surgery" včetně selektivní embolizace. Nicméně, tento článek je také zaměřen na design nových externích fixátorů aplikovaných v traumatologii a ortopedii (tj. zkušenosti inženýrů). Tyto fixátory mohou být využívány v léčbě otevřených a nestabilních (tj. komplikovaných) zlomenin pánve a acetabula. Dvě verze fixátorů (tj. stará a nová) jsou porovnány. Počítačové modelování (tj. metoda konečných prvků), společně CAD sw, experimenty, materiálovým inženýrstvím a nanotechnologií jsou prezentovány jako podpora vývoje nových konstrukcí zevních fixátorů.
Background Traumatic thoracic aortic transection is one of the most severe complications of high-energy injuries, but patients rarely receive treatment, and it is fatal in the vast majority of cases. Due to the complexity of surgical revision for transection, endovascular repair with stent graft implantation is the preferred approach. Material/Methods We retrospectively analyzed the short-term and long-term treatment results for 31 patients (29 men, 2 women) treated at the Interventional Radiology Department, University Hospital Ostrava, for the isthmus part of a descending thoracic aorta injury between 2004 and 2020. Results The median patient age was 48 years (interquartile range [IQR]: 28–63 years). The most common causes of injury were traffic accidents and falls or jumps, with the trauma location at the Ishimaru zones 2 to 4 of the aortic isthmus. Aortic stent grafts were successfully implanted in all patients; 13% of patients had complications and 10% died due to the trauma severity. The median procedure duration was 30 min (IQR: 25–43 min) and the median hospital stay was 29 days (IQR: 28–63 days). Conclusions Aortic stent graft implantation appears to be a safe and effective method for dealing with thoracic aorta injury, with a low complication rate and high patient survival. The endovascular approach is the method of choice for treating this severe disease, and a multidisciplinary approach for emergency medical treatment with a comprehensive trauma protocol is essential.
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