Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca最新文献

{"title":"Diagnostic Performance of Artificial Intelligence (AI) Chatbot Compared to Orthopedic Trauma Surgeons in Evaluating Indication for Surgery for Isolated Lateral Malleolar Fractures: a Retrospective Study.","authors":"Maria Oulianski, Rami Mosheiff, Dana Avraham, Omer Ben Yehuda, Yoram Weil, Mahmoud Jammal","doi":"10.55095/achot2026/027","DOIUrl":"10.55095/achot2026/027","url":null,"abstract":"<p><strong>Purpose of the study: </strong>The indication for surgery for isolated lateral malleolar fracture (AO/OTA 44B1) is debatable and in many cases, relies upon radiographic assessment of fracture stability. Artificial intelligence chatbots with visual analysis capabilities offer a potential attribute for radiographic assessment. This study compared the diagnostic performance of a commercially available AI chatbot with that of three fellowship-trained orthopedic trauma surgeons in evaluating equivocal isolated lateral malleolar fractures.</p><p><strong>Material and methods: </strong>A retrospective study. 50 patients with isolated lateral malleolar injury at the level of the syndesmosis (AO/OTA 44B1) were evaluated by three blinded fellowship-trained orthopedic trauma surgeons. Each rater measured standardized radiographic ankle parameters, medial clear space, tibiofibular clear space, and tibiofibular overlap, on anteroposterior and mortise views and determined a surgical versus nonoperative treatment recommendation. Subsequently, the same sets of radiographs were independently evaluated by an AI chatbot (Claude, Anthropic). The observers and AI decisions were compared to the actual outcome of the patients (operative vs. nonoperatives).</p><p><strong>Results: </strong>All raters recommended surgery at lower rates (34.0-46.0%) than the actual operative rate (56.0%). The difference in outcomes between the actual treatment and the observers varied and ranged between 67.3-86% with the AI within the same ranges. The AI's radiographic measurements differed systematically from all surgeons across five of six parameters. Inter-rater agreement between the AI and surgeons was slight, while inter-surgeon agreement was moderate (κ = 0.457-0.589). ROC analysis showed comparable AUC values (0.63-0.67) for all raters.</p><p><strong>Discussion: </strong>The AI chatbot demonstrated diagnostic accuracy comparable to orthopedic trauma surgeons in directing treatment for isolated lateral malleolar fractures, despite using a systematically different measurement strategy. All raters exhibited conservative bias as comparted with the actual outcome with modest discriminatory ability, reflecting the inherent difficulty of this clinical issue. These findings support a potential complementary role for AI in ankle fracture triage, while final clinical management decisions should remain in the hands of the orthopedic surgeon.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"133-139"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Osteoid Osteoma in S2: Percutaneous CT Guided Resection of a Double Nidus].","authors":"Jiří Skála-Rosenbaum, Jakub Ježek","doi":"10.55095/achot2026/031","DOIUrl":"https://doi.org/10.55095/achot2026/031","url":null,"abstract":"<p><p>The case report describes the option of percutaneous CT-guided ablation of osteoid osteoma with a double nidus to combine minimally invasive approach and CT(O-arm)-guided technique. Following X-ray, CT and MRI examinations, osteoid osteoma was diagnosed in the body of the second sacral vertebra (S2) in a 31-year-old female patient. CT reconstructions detected a double nidus with a defective, sclerotic rim. MRI demonstrated reaction in the surrounding tissue and edema in the nerve root. In consideration of the anatomic location of the osteoid osteoma and vicinity of the irritated S2 root percutaneous CT-guided intralesional resection of a double nidus was performed. There was immediate pain relief after the surgery, and the patient was discharged on the second postoperative day. The follow-up histological examination confirmed the diagnosis. During a five-year follow-up, the patient remained symptom-free and without recurrence of the disease. CT-guided minimally invasive resection of osteoid osteoma is an option in cases of benign tumor-like lesions located in the spine, as well as in cases of a double nidus. In comparison to radiofrequency ablation, percutaneous curettage enables obtaining valid histological specimens and does not bear the risk of thermal damage to neural tissue.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"194-197"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Avascular Necrosis of the Femoral Head after Hodgkin Lymphoma Treatment: Analysis of Risk Factors and Mid-Term Outcomes after Total Hip Replacement].","authors":"Martin Salášek, Jana Marková, Karolína Barešová, Richard Český, Heidi Móciková, Michal Zídka, Valér Džupa","doi":"10.55095/achot2026/015","DOIUrl":"10.55095/achot2026/015","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Treatment of classical Hodgkin lymphoma (cHL) can be eventually complicated by avascular necrosis of the femoral head (AVN FH). Stages 1 and 2 of AVN FH can be treated conservatively, but stages 3 and 4 are indicated for surgery. In adults, total hip replacement (THR) is the preferred method. The goal of our study was to analyze the risk factors for AVN FH and functional results after THR.</p><p><strong>Material and methods: </strong>This is a single-center retrospective observational longitudinal study. Patients with AVN FH after previous cHL treatment were included. Basic epidemiological data, time to AVN FH and THR, and complications of hemato-oncological treatment and THRs were recorded. Risk ratios, derived from 2×2 tables and from univariate Cox regression and Kaplan-Meier graphs, were analyzed. Categorical data were evaluated using the Fisher exact test and quantitative data using the Mann-Whitney-Wilcoxon test. Outcomes were measured using the modified Harris Hip Score (MHHS).</p><p><strong>Results: </strong>The mean incidence of AVN HF was 1.7 per year (95% CI 1.1-2.2). Patients with THRs tended to be older (p = 0.0424), the highest risk was ≥ 50 years. Mixed cellularity (MC) cHL had a higher risk of THR (log-rank test p = 0.0249) compared to nodular sclerosis (NS) cHL. Clinical stage IIB with massive mediastinal tumor was associated with the lowest risk of THR, p = 0.0348. The mean modified Harris Hip Score (MHHS) was higher in NS compared to MC subtype (85.1 (82.7-87.6) vs. only 75.4 (66.6-84.2), p = 0.0311). Periarticular calcification grade 1 was diagnosed in 84.6% of patients (95% CI 54.6-98.1). Revision surgery with cup and stem replantation was performed in one patient. No infections or cases of deep venous thrombosis were recorded.</p><p><strong>Conclusions: </strong>THR is a causal treatment of symptomatic AVN FH following cHL treatment. Age ≥ 50 years, MC subtype cHL, and AVN FH stages 3 and 4 were associated with a higher risk of THR. The mean MHHS was fully comparable with THRs for other indications. Higher calcification rates had no impact on the clinical outcome.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"162-169"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Bacteriophage Therapy in Orthopaedics and Trauma].","authors":"Radek Bartoška, Vladislav Barták, Jiří Gallo, David Musil","doi":"10.55095/achot2026/018","DOIUrl":"https://doi.org/10.55095/achot2026/018","url":null,"abstract":"<p><p>Bacteriophage therapy has re-emerged as a potential adjunctive strategy in the management of orthopedic and trauma-related infections, particularly fracture-related infection (FRI) and periprosthetic joint infection (PJI). These conditions are associated with biofilm formation, repeated surgery, prolonged antimicrobial therapy, impaired functional outcomes, and increasing rates of multidrug-resistant pathogens. The therapeutic rationale of bacteriophages is based on their high specificity for target bacteria, their ability to replicate at the site of infection, and their potential activity against biofilm. Experimental studies have demonstrated reduced bacterial burden, biofilm disruption, and improved efficacy of combined phage-antibiotic treatment. Progress made in local delivery systems and rapid diagnostic methods facilitates the development of personalized phage-based approaches. Nevertheless, current clinical evidence remains limited and largely derives from case reports and small series. Although preliminary results are encouraging, the role of bacteriophage therapy in routine orthopedic practice has not yet been established. At present, bacteriophage therapy should be regarded as an individualized adjunctive treatment option rather than an established standard of care for PJI and FRI.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"170-177"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Blood Loss in Open Spine Surgeries - Preoperative Estimate vs Reality].","authors":"Jiří Skála-Rosenbaum, Jakub Ježek, Petr Kafka","doi":"10.55095/achot2026/030","DOIUrl":"10.55095/achot2026/030","url":null,"abstract":"<p><p>Intraoperative blood loss represents a critical challenge in spinal surgery, with the potential to increase morbidity, mortality, and healthcare costs. Significant blood loss is associated with postoperative complications such as respiratory failure, infections, and hematomas. This paper evaluates current methods of estimating blood loss and highlights the discrepancy between intraoperative clinical estimates and the actual total blood loss, with a specific focus on the phenomenon of hidden blood loss (HBL). The concept of Total Blood Loss (TBL) is analyzed as the sum of Visible Blood Loss (VBL), consisting of blood in suction canisters, sponges, and drains, and HBL, which results from hemolysis and sequestration of blood into tissues. Mathematical formulas, specifically the Gross equation and Nadler's formula for patient blood volume, are discussed as tools for calculating TBL based on hematocrit changes. Visual estimation is consistently shown to be inaccurate, often leading to significant underestimation, especially in losses exceeding 1,000 ml. Research indicates that in major spinal procedures, approximately 21% of the total intraoperative blood loss is captured in surgical sponges. For practical intraoperative monitoring, a \"28% coefficient\" should be added to the volume in the suction canister to provide a realistic estimate of the blood trapped in textiles. Furthermore, HBL accounts for at least 30% of the total perioperative loss. In extensive posterior thoracolumbar fusions, the visible blood in the suction canister may represent about half of the actual TBL only. Younger patients are paradoxically more susceptible to higher HBL due to more dynamic transcapillary refill and greater vascular compliance.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"189-193"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Percutaneous Stabilization of the Thoracolumbar Spine: Indications, Limitations and Cohort Analysis].","authors":"Jakub Ježek, Jan Švec, Martin Kapounek, Jiří Skála-Rosenbaum","doi":"10.55095/achot2026/022","DOIUrl":"https://doi.org/10.55095/achot2026/022","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Percutaneous stabilization of the thoracolumbar spine represents a minimally invasive alternative to open posterior fixation. The aim of this study was to evaluate the indications, perioperative parameters, and limitations of this method in a single-center patient cohort.</p><p><strong>Material and methods: </strong>A retrospective analysis of 65 consecutive patients treated with percutaneous transpedicular stabilization of the thoracolumbar spine between 2021 and 2025 was performed. All procedures were carried out using an intraoperative CT-based navigation system (O-arm). Demographic data, primary diagnosis, extent of instrumentation, additional procedures, operative time, blood loss, length of hospital stay, and complications were evaluated.</p><p><strong>Results: </strong>The most common indication was trauma (75.4%), followed by metastatic disease (13.8%), and infection (10.8%). Placement of 8 screws was used most commonly (78.5%). The mean operative time was 104 minutes, and the mean blood loss was 141 ml. When patients who underwent decompression were excluded, the mean blood loss decreased to 112 ml (14 ml per screw). The mean length of hospital stay was 11.4 days and dropped to 6.7 days after excluding patients with concomitant factors. No pedicle screw malposition was observed. Revision surgery was required in 7 patients.</p><p><strong>Discussion: </strong>Percutaneous stabilization is associated with low blood loss and favourable postoperative outcomes. A more detailed analysis suggests that the percutaneous instrumentation itself is a low-blood-loss procedure, while overall perioperative parameters are significantly influenced by the scope of combined surgical procedures. Proper patient selection remains crucial.</p><p><strong>Conclusions: </strong>Percutaneous stabilization is an effective and less invasive method, particularly suitable for patients in whom deformity correction or posterior fusion is not required. The greatest benefit is observed in polymorbid, polytraumatized and oncological patients, where minimizing surgical burden is essential. Appropriate indication and awareness of the method's limitations are key to achieving optimal outcomes.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"156-161"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Three-Dimensional Surgical Correction of Scoliotic Curves Monitored Using the EOS Imaging].","authors":"Martin Repko, Michal Galko, Andrea Šprláková-Puková, Martin Prýmek, Dominik Parížek, Milan Filipovič","doi":"10.55095/achot2026/029","DOIUrl":"https://doi.org/10.55095/achot2026/029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;Structural scoliosis is a three-dimensional deformity that adversely affects the frontal, sagittal, and axial planes. Surgical correction of scoliotic deformities in children requires effective correction of all three planes, with restoration of a balanced position of the spine and the entire trunk. Using modern surgical instruments and targeted intraoperative maneuvers, we achieve this comprehensive 3D correction. The EOS Imaging System enables effective preoperative planning and postoperative verification of outcomes based on software processing of the acquired X-ray images. The aim of the study was to objectively assess the achieved surgical outcomes under the hypothetical assumption of effective surgical correction of spinal deformity in all three planes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;In the study, 20 patients with a primary diagnosis of adolescent idiopathic scoliosis were examined. All patients underwent a posterior spinal fusion within the planned extent of instrumentation. Stabilisation was achieved exclusively through transpedicular screw fixation, by applying derotation, rod reduction and translation correction maneuvers. The cohort was divided symmetrically into two groups: patients with primary thoracic structural curves who underwent selective correction in this region, and patients with primary double thoracolumbar structural curves who underwent surgery on both curves. All patients underwent preoperative evaluation using the EOS Imaging System, with subsequent follow-up examinations within a week after surgery and at 4, 12, and 24 months postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In both groups, a statistically significant correction of all three curves in the frontal plane and a statistically significant apical vertebral derotation were observed for both the main thoracic and lumbar curves. When comparing the two groups, statistically significant differences were found only in the preoperative lumbar Cobb angle (45.0° for selective instrumentation vs. 53.8° for instrumentation of both curves, p &lt; 0.05) and in its absolute change during the surgical procedure (29.9° vs. 42.1°, p &lt; 0.05). No statistically significant difference was found between the groups in the percentage of lumbar curve correction in the frontal plane (p = 0.147), in the derotation of lumbar apical vertebra (p = 0.147), or in the other evaluated parameters. No statistically significant differences were found in the sagittal parameters, either when comparing preoperative and postoperative conditions within individual groups (p &gt; 0.05) or when comparing the two groups with each other (p &gt; 0.05). Thus, no significant change occurred in the sagittal profile, and sagittal balance was maintained after surgery regardless of the chosen extent of instrumentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In both groups, a statistically significant correction of all three curves in the frontal plane and a statisticall","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"140-148"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Adjacent Segment Disease in Lumbar Spine and Lumbosacral Junction Stabilisation: Systematic Review].","authors":"Jan Zemánek, Jan Štulík, Zdeněk Klézl","doi":"10.55095/achot2026/014","DOIUrl":"10.55095/achot2026/014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;This paper aims to analyse available scientific sources related to adjacent segment disease after the surgical stabilisation of lumbar spine. To be specific, to the incidence, risk factors, gender and age of patients, correlation between the length of the instrumentation and ASD development, and the effects of suboptimal sagittal spine stability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;A systematic review was elaborated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline. A literature search in PubMed database was conducted in January 2025. The papers included in the systematic review were published between 2004 and 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search brought about 1,014 results, of which 59 studies were shortlisted based on their title and abstract. Those 59 articles were subsequently thoroughly examined and unsuitable papers were excluded. Yet another study meeting our criteria was identified through the analysis of cited references. A total of 17 papers that satisfied the predetermined criteria were selected. The number of patients included in the cohorts ranged from 117 to 3,799. The subjects were followed up for the period of at least 12 months up to 10 years postoperatively, the mean follow-up period reached 5.44 years. At the time of initial surgery, the age of the followed-up patients was 18 to 74 years, with a mean age of 56.67 years. The ASD incidence ranged from 0.74% to 30.3%. As concerns surgical therapy, 2.62%-27.4% of patients underwent surgery for adjacent segment disease. The most commonly referred to factor contributing to ASD development was the adjacent segment degeneration visible already preoperatively as well as iatrogenic damage to adjacent facets, high BMI, length of the fixation, sagittal balance, rheumatoid arthritis, or age. Osteoporosis, smoking, or diabetes mellitus, on the other hand, were not confirmed as risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Currently, there is a large body of studies on ASD published over several decades. This fact further reinforces its high clinical significance and long-term interest of academia in spine surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ASD is a common postoperative complication in instrumented lumbar and lumbosacral fusions. The most commonly cited risk factors were preoperative adjacent segment degeneration, followed by iatrogenic alterations on unfixed intervertebral joints, sagittal imbalance, and higher BMI of the patient. Some authors also refer to advanced age as a factor contributing to earlier development of adjacent segment degeneration. Different conclusions are stated with respect to the fixation length, with more frequent reference to higher incidence of ASD in longer-segment fixation. The outcomes of other studies, however, reveal that the frequency of ASD development is independent of the number of fixed segments. Moreover, in one case, prote","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"149-155"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Sternal Fracture as a Risk Factor for Blunt Cardiac Injury].","authors":"Barbora Vyhnánková, Valér Džupa, Zdeněk Šubrt","doi":"10.55095/achot2025/044","DOIUrl":"10.55095/achot2025/044","url":null,"abstract":"<p><p>Motor vehicle collisions are the leading cause of blunt chest trauma, including blunt cardiac injury (BCI) and sternal fracture (SF). Blunt cardiac injury occurs in about 20% of blunt chest trauma reaching to 76% in polytrauma patients. Reported SF rates range from 1.6% to 42%. This review evaluates the link between SF and BCI with focus on incidence, diagnosis and implications for patient management. A systematic search of the scientific literature in online databases over the past 15 years was conducted. The final set included 31 studies, predominantly retrospective, which were subsequently analyzed with emphasis on the definition of BCI, its occurrence and its association with SF. BCI refers to a heterogeneous group of cardiac injuries resulting from a common traumatic mechanism. The term is often used interchangeably with myocardial contusion, thereby limiting the comparability of study results. Clinically significant injury can range from mild arrhythmias to cardiogenic shock, while some cases of BCI may remain completely asymptomatic. SF is common and indicates a substantial force to the chest. Patients are often categorized into two groups: those with an isolated sternal fracture, which is usually a benign injury without cardiac involvement, and those with a combined sternal fracture, which is common in polytrauma patients. The association between SF and BCI remains controversial. Some studies regard SF as a general indicator of overall trauma severity, whereas others identify it as an independent risk factor for BCI. There are multiple approaches in diagnostics of BCI. Initial screening includes electrocardiography and monitoring of troponin I levels. If both are within normal limits, BCI is unlikely. Echocardiography is recommended for hemodynamically unstable patients or when initial test results are abnormal. Management includes continuous ECG monitoring, treatment of arrhythmias and analgesia. Current recommendations support screening for BCI following blunt chest trauma. Evidence is mixed on whether SF alone predicts the presence of BCI. Further prospective studies using a uniform definition of BCI are required to confirm the clinical significance of SF in the diagnosis and patient prognosis. Physicians should maintain a high index of suspicion for BCI in patients after high-energy chest trauma.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 3","pages":"178-188"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Newborn with Bilateral Lower Limb Amputation Due to Twin Anemia Polycythemia Sequence].","authors":"Pavel Sadovský, Lucie Papežová","doi":"10.55095/achot2026/007","DOIUrl":"10.55095/achot2026/007","url":null,"abstract":"<p><p>We present a case report of a newborn with bilateral lower limb ischemic gangrene caused by spontaneous Twin anemia polycythemia sequence (TAPS). Due to the extent of tissue damage, bilateral lower limb amputation was performed on the fourth day after birth-left knee disarticulation and right transfemoral amputation. The postoperative course was uneventful, and the wounds healed by primary intention. This case represents an exceptionally rare complication of TAPS, in which timely prenatal diagnosis could have enabled early intrauterine intervention.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"93 2","pages":"119-122"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}