Recommendations on osteoporosis management addressed to Czech GPs after surgical fracture management had little effect on treatment. As the anti-osteoporotic preparations can only be prescribed by specialists, the availability of necessary examinations and treatment is limited by the motivation of GPs. Consequently, the implementation of Fracture Liaison Services to help close the care gap may be limited in the absence of participation by Czech GPs.

ÚVODV současné době se nejen ve světě, ale i u nás stala minimally invasive surgery (dále MIS) technika mocným a účinným marketingovým nástrojem, který zvyšuje jednak prestiž operatérů, nemocnic, ale i výrobců implantátů. Pro laickou veřejnost je totiž díky jednostranně pozi-tivní publicitě ve veřejných médiích prezentována jako měřítko úrovně operatéra i pracoviště a tímto se stává coby vrchol pokroku i lákadlem pro pacienty.Současná vlna zájmu o miniinvazivní operování je spojena s vývojem speciálních instrumentárií pro miniinvazivní techniky. Vzniká tak i výrazný komerční tlak, který je dále posilován velkým zájmem médií o tyto tech-288/ ACTA CHIRURGIAE ORTHOPAEDICAE

PURPOSE OF THE STUDYOur main objective was to evaluate the mortality and complications of patients following surgical treatment of hip fractures and to identify the associated risk factors for postoperative mortality. MATERIAL AND METHODSWe retrospectively reviewed all patients over the age of 50 who underwent surgical treatment for femoral neck and peritrochanteric fractures at our institution in 2003 and 2013. Mortality was compared between subgroups classified by age, gender, fracture type, method of treatment. Correlation between mortality and postoperative complications, time to surgery, and blood transfusion need were evaluated. Chi-square was used for categorical variables and two-tailed student's t-test for continuous variables. Survival curves were compared by the log-rank test. Mortality rates were adjusted for patient age and compared to the mortality rates of Prague's population in the given years. RESULTSAltogether 425 patients were surgically treated for proximal femoral fracture in 2013, while 229 patients were treated in 2003. The overall 1-year mortality decreased by 10% over the study period (38% in 2003 and 28% in 2013), despite the higher average age in 2013. Survival was better in all subgroups broken down by diagnosis and method of treatment, statistically relevant in the subgroup of femoral neck fractures, notwithstanding the method of treatment and in the subgroup treated with total hip arthroplasty.The strongest prognostic factor for survival was the advanced age. The mortality rate rises significantly over the age of 75. The largest age group was between 85-89 years, with 1-year mortality rate of 32%. The annual mortality of the general population in Prague aged 85-89 years was 13% and has improved only by 1% in the decade.The reoperative rate was 4% and did not affect mortality. There was no significant relationship between mortality and complications or delay of surgery for up to 4 days. DISCUSSIONThe factors that might have contributed to better survival are the introduction of guidelines for hip fracture care to our unit, better prophylaxis of venous thromboembolism, improvement of surgical skills due to the growing volume of these cases, and a higher rate of discharges to aftercare units. CONCLUSIONSMortality has significantly decreased between 2003 and 2013 (p < 0.001). We didn't find a correlation between mortality and delay of surgery up to 4 days. That means that a complicated operation such as hip arthroplasty could be postponed and operated in more comfortable conditions (in superaseptic OR) by orthopedic surgeons.Although we haven't identified any modifiable risk factor, we believe that the reasons for better survival are multifactorial as discussed.

PURPOSE OF THE STUDY MIPO (Minimally Invasive Plate Osteosynthesis) technique is currently a commonly used method to treat fractures of the distal third of tibia diaphysis. At the same time, it is just like other methods accompanied by a relatively high complication rate. The purpose of this study was to determine whether the use of this technique at our department is effective and whether the complication rate does not differ considerably from values reported by literature. MATERIAL AND METHODSIn the period 2014-2016, minimally invasive plate osteosynthesis was performed in a total of 42 patients, who had suffered a fracture of the distal third of tibia diaphysis. They sustained a low-energy trauma. The mean age of patients was 50 years (range 27-86 years) and the mean follow-up period was 11.8 months (range 1.5-38 months). All the patients were treated with a minimally invasive technique with the use of subcutaneous LCP. In 41 patients (98%) it was inserted via anteromedial approach. In one patient only (2%), the LCP was inserted via anterolateral approach due to the unfavourable local finding on the medial side of the distal lower limb. RESULTSOf the total number of operated patients, 35 patients (83%) underwent surgery within 24 hours of injury, including two patients in whom an external fixator was used. The mean operative time was 61 minutes (range of 30-150 minutes). The primary healing occurred in 93% of patients with radiological signs of healing within 5.6 months on average (range of 1.5-16 months). Time to full weight bearing was 4.2 months on average (range of 1.5-16 months). Delayed healing was observed in four patients. In three patients, a non-union developed, necessitating revision surgery. Infectious complications were reported in seven patients, in three of whom deep wound infection developed. In one case, the chronic infection resulted in a lower limb amputation. In five patients mal-union occurred. DISCUSSIONThe outcomes achieved by the authors in treating fractures of the distal third of tibia diaphysis with a minimally invasive technique do not considerably differ from the outcomes reported by other authors in literature. In terms of the outcomes and the complication rate, the MIPO method is comparable to the treatment of these fractures with the use of nails. Limiting for fracture healing is the vascular supply. Therefore, in treating these injuries it is necessary to proceed with minimum invasiveness and carefulness and to seek to limit any additional trauma to soft tissues, thus also to vascular supply. In case of syndesmosis failure, the concurrent treatment of distal fibula fractures is clearly indicated. In case of intact syndesmosis, fibular osteosynthesis and the sequence of procedures are to be decided by the surgeon. At present, rigid osteosynthesis is being abandoned for potential slower healing up to development of non-unions. CONCLUSIONSThe treatment of fractures of the distal third of tibia diaphysis remains an unsolved issue despite the development of stateof-the art materials...