Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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The term "complex pelvic fractures" is reserved for pelvic ring fractures associated with soft tissue injuries in the pelvic region and with haemodynamic instability of the patient. These fractures represent only 10% of all pelvic fractures; however, the morality rate exceeds 33%. This study describes the algorithm of the urgent treatment of serious pelvic ring injuries. ⋯ Complex pelvic ring fractures require the aggressive approach. The basic reanimation procedures include application of the pelvic clip. This is the only way how to control extensive haemorrhage associated with the pelvic ring fractures and how to improve patient's haemodynamic conditions. The final surgical treatment of the pelvis fractures should be completed early after the injury. This is within the competence of specialized centres.
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Hemiarthroplasty has still its place in the therapeutic algorithm of the treatment of dislocated intracapsular femoral neck fractures. As compared to internal fixation it is accompanied by less complications and allows an immediate postoperative weight bearing. In contrast to total hip arthroplasty, this operation is not so demanding for the patient. ⋯ Hemiarthroplasty must be correctly indicated and technically properly performed. First of all it is necessary to respect the relation between the centre of the prosthetic head and the apex of the greater trochanter, i.e. the head centre should be 1-2 mm below the level of apex of the greater trochanter. Further, it requires a correct anteversion and suture of the articular capsule as a prevention of postoperative dislocation.