The aim of this study is to describe the basic pathoanatomical characteristics of a stable Maisonneuve fracture and mid-term results of its nonoperative treatment. The study included 17 prospectively collected patients with a mean age of 59 years. The postinjury ankle CT had to meet the following criteria: nondisplaced or minimally displaced (up to 1 mm) fracture of medial malleolus, medial clear space less than 3 mm, nondisplaced or minimally displaced (up to 2 mm) fracture of posterior malleolus, anatomical position or minimal malposition of the distal fibula in the fibular notch (widening of the tibiofibular space up to 2 mm or external rotation of the distal fibula up to 10°). The average follow-up period was 34 months, the final follow-up included CT examination and functional evaluation based on AOFAS and FAOS scores. A medial malleolus fracture was recorded in 12

The terms Köhler´s teardrop, Köhler disease I and Köhler disease II are known to almost all orthopaedic surgeons and radiologists. However, little is known about this prominent personality of the German and world radiology, who described these structure or diseases. Alban Köhler (1874–1947) was one of the first German speaking pioneers in the emerging discipline – radiology, particularly radiology of bones and joints. He introduced new radiological techniques, such as “Teleröntgenographie”, and published a number of outstanding studies focused primarily on the musculoskeletal system, as well as on pulmonary tuberculosis and cardiac radiology. For a long time, Köhler had been actively involved in the study of radiation sickness and proposed measures that are valid to this day. The most famous Köhler´s publication “Lexikon der Grenzen des Normalen und der Anfänge des Pathologischen im Röntgenbilde” (The borderlands of the normal and early pathological in the skiagrams) was published for the first time in 1910. After Köhler´s death, the book was repeatedly published and gained recognition worldwide. Its 9th edition was initiated by Professor Emil Alfred Zimmer in 1953. Under a slightly modified title “Borderlands of normal and early pathological findings in skeletal radiology “, it is still published today, both in German and English.

The first successful internal fixation in the pre-aseptic period was performed by the Flemish surgeon Dominique Le Roy in 1796 in Antwerpen, using a gold wire in a patient with an open fracture of the lower leg. In the first half of nineteenth century, he was followed by a number of other surgeons, among them Achille Cléophase Flaubert, father of the famous novelist Gustave Flaubert, who treated both acute fractures and non-unions. Almost all operations resulted in suppuration, however, in many patients the fracture healed, while other cases ended in amputation or even death. Despite a series of failures, individual operations inspired the next generation of surgeons. Nevertheless, it took another 40 years before the foundations of modern internal fixation were laid by the Belgian surgeon Albin Lambotte.

Background Three-part pertrochanteric fractures with a large posterior fragment have been reported both in historical and recent 3D CT studies, however, without a detailed description. Methods From the collection of the Institute of Anatomy, the authors obtained 6 specimens of hip joints of individuals who had sustained a three-part pertrochanteric fracture with a large posterior fragment, and 7 patients with the same type of fracture were identified in a cohort of 56 patients with a trochanteric fracture documented by 3D CT reconstructions. The study focused on the anatomy of the posterior fragment, the courses of the fracture lines, the integrity of the medial cortex and the lateral trochanteric wall. Results Two types of the posterior fragment were identified, the quadrangular and the triangular ones. Separation of either of them markedly weakened the lateral trochanteric wall, more specifically, one quarter to two-thirds of its lateral surface. The triangular fragment was associated with shear instability on the medial aspect of the proximal femur and was markedly displaced in 5 of 7 cases. Exact identification of the shape and size of the posterior fragment was impossible with the use of postinjury radiographs alone. Conclusion In agreement with historical and recent CT studies, the findings of this study confirm the existence of a three-part type of pertrochanteric fracture with a large posterior fragment, and provides its detailed description, including its relevance to clinical practice.

In recent years, the interest in hip shelf arthroplasty (HSA) has been increasing and the number of studies documenting long-term results with minimal complications has been growing. The aim of this study is to present long-term results of HSA and analyze the factors that influence them. The group of 24 patients (38 hips) with a mean age of 30 years (range, 16 to 52 years), with acetabular dysplasia, was treated by HSA (Bosworth technique). The mean follow-up time for all hips was 26 years (range, 22 to 35 years). The endpoint of the follow-up was total hip arthroplasty. In all 38 hips, the positive effect of HSA lasted for at least 20 years. In 28 hips followed up on average for 24.5 years (range, 22 to 35 years), the positive effect still persisted at the latest follow-up. Three patients (3 hips), followed up for 26, 26 and 31 years, respectively, deteriorated in the last three years, but they rated their condition as good at the latest follow-up and did not require THA. Seven hips had to be converted to THA. The mean age of these patients at the time of HSA was 29 years (range, 16 to 41 years). The average interval between HSA and THA was 25 years (range, 22 to 31 years). In 3 converted hips, the subluxation was identified as a risk factor. No serious complication (infection, neurovascular injury) was recorded. Kaplan–Meier survival curve at 20-year follow-up was 100

Surgical approaches in bone surgery have undergone a long evolution over more than 130 years. While a number of publications have been devoted to the history of internal fixation, surgical approaches have remained neglected from this perspective. The development of approaches in musculoskeletal surgery is inextricably linked to four personalities. Theodor Kocher, in 1892, pointed out that descriptions of surgical approaches must be an essential part of surgical textbooks of operative techniques; James Edwin Thompson, in 1918, formulated the basic requirements for the surgical approaches to the skeleton of limbs; Arnold Kirkpatrick Henry published the first textbook of surgical approaches in 1927 and presented the concept of internervous planes in 1945; in the same year, Toufick Nicola created the first comprehensive atlas of surgical approaches to bones and joints of limbs, the pelvis and spine.

The beginnings of osteosynthesis (OS) in the Czech lands, dating back to the second half of the 19th century, are associated with the German surgeons W. Heine and C. Gussenbauer working in Prague. Development of the Czech musculoskeletal surgery began with the appointment of K. Maydl to the head of the Czech University Department of Surgery in Prague in 1891. In 1908, his pupil K. Kukula published the first "OS manifesto" in the Czech literature, including his own original method of fixation of diaphyseal fractures with a magnezium peg. Further development of OS of fractures came as late as in the 1920s. The first to publish his own results in a cohort of 37 patients was K. Šantrůček, followed by V. Novák. At the beginning of the 1930s, A. Jirásek presented an extensive review of the issues concerning OS of fractures based on his experience obtained from 476 operations. In 1939, J. Zahradníček published an extensive study focused on non-unions, including his own classification that was later modified by Weber and Čech. In 1941, E. Polák published the first Czech monograph dealing with nailing of femoral neck fractures. Immediately after World War II, development of intramedullary osteosynthesis took place, surprisingly first in peripheral departments. In the 1950s, osteosynthesis further progressed. Worth mentioning is the nail designed by A. Pavlík, who is known worldwide as the author of the harness used in management of DDH. Instrumental in introduction of AO principles into the clinical practice were O. Čech and F. Stryhal, who became familiar with the technique of stable OS during the 1960s. In 1972, they published an original Czech textbook of osteosynthesis, merely 9 years after the first AO textbook. In 1973, O. Čech together with B.G. Weber won worldwide recognition for their monograph Pseudarthrosen. During the 1970s, domestic production of implants was established in cooperation with S. Beznoska from Poldi Kladno. At the turn of the 1980s, operative treatment of fractures in our country reached the European level. Key words: osteosynthesis, history, operative treatment of fractures, Czech Republic.

The beginnings of osteosynthesis (OS) in the Czech lands, dating back to the second half of the 19th century, are associated with the German surgeons W. Heine and C. Gussenbauer working in Prague. Development of the Czech musculoskeletal surgery began with the appointment of K. Maydl to the head of the Czech University Department of Surgery in Prague in 1891. In 1908, his pupil K. Kukula published the first "OS manifesto" in the Czech literature, including his own original method of fixation of diaphyseal fractures with a magnezium peg. Further development of OS of fractures came as late as in the 1920s. The first to publish his own results in a cohort of 37 patients was K. & Scaron;antrucek, followed by V. Novak. At the beginning of the 1930s, A. Jirasek presented an extensive review of the issues concerning OS of fractures based on his experience obtained from 476 operations. In 1939, J. Zahradnicek published an extensive study focused on non-unions, including his own classification that was later modified by Weber and Cech. In 1941, E. Polak published the first Czech monograph dealing with nailing of femoral neck fractures. Immediately after World War II, development of intramedullary osteosynthesis took place, surprisingly first in peripheral departments. In the 1950s, osteosynthesis further progressed. Worth mentioning is the nail designed by A. Pavlik, who is known worldwide as the author of the harness used in management of DDH. Instrumental in introduction of AO principles intothe clinical practice were O. Cech and F. Stryhal, who became familiar with the technique of stable OS during the 1960s. In 1972, they published an original Czech textbook of osteosynthesis, merely 9 years after the first AO textbook. In 1973, O. Cech together with B.G. Weber won worldwide recognition for their monograph Pseudarthrosen. During the 1970s, domestic production of implants was established in cooperation with S. Beznoska from Poldi Kladno. At the turn of the 1980s, operative treatment of fractures in our country reached the European level. Key words: osteosynthesis, history, operative treatment of fractures, Czech Republic.

PURPOSE:Bosworth fracture-dislocations (BF) with entrapment of a fibular fragment behind the posterior rim of the distal tibia are rare but potentially serious injuries to the ankle. MATERIALS AND METHODS:We analyzed the radiographs of 23 consecutive patients with a mean age of 44 years who were treated for BF. All patients underwent routine radiological examination of the ankle and presence of a BF was confirmed intraoperatively in 22 cases and / or with CT in 15 cases. RESULTS:Tibiofibular overlap intersecting the joint line in the anteroposterior view of the ankle was found in 20 of 23 cases (87%) and persisted in 17 of 18 cases (94%) after unsuccessful closed reduction. Posterior subluxation of the talus in the lateral view was revealed in 21 of 23 cases (91%). Tibio-fibular dissociation, i.e., posterior displacement of the distal fibula relative to the distal tibia in the lateral view was found in 22 of 23 cases (96%). This sign remained positive in all 18 cases with unsuccessful closed reduction. Closed reduction of the talus beneath the distal tibia was associated with an average increase of anterior fibular angulation of 24.5 degrees in case of inadequate closed reduction. CONCLUSIONS:Bosworth fracture represents a rare but still highly variable ankle injury that may lead to misinterpretation of the initial radiographs. Reliable radiological signs are triangular tibiofibular overlap, posterior talar subluxation and tibiofibular dissociation that should prompt CT imaging which is essential for revealing the complex pathoanatomy and planning the surgical approach.

Introduction The posterior intermalleolar ligament (IML), although first described already 280 years ago, it is, however, still an unknown structure for many anatomists and orthopedic surgeons. Materials and methods A literature search of original publications and historical sources was performed without language restrictions. Results The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant structure reinforcing the posterior capsule of the ankle joint. Many French anatomists described and depicted this ligament in detail, which they called “faisceau accessoire”, or “faisceau tibial du ligament péronéo-astragalien postérieur”. In 1951, Georges Paturet introduced the term “faisceau intermalléolaire postérieur”. Sarrafian, in 1983, adopted Paturet́s description of the IML and called it the “posterior intermalleolar ligament”. This term has gradually become domesticated in the English literature, primarily thanks to Rosenberg et al., who, in 1995, published the first anatomical and MRI study of the IML. Conclusion The IML is a highly variable ligament reinforcing the posterior articular capsule of the ankle joint, passing between the posterior tibiofibular ligament and the posterior talofibular ligament. It can be visualized by MRI and is visible during posterior arthroscopy of the ankle. Its clinical importance lies in the fact that it may contribute to posterior impingement of the ankle joint.

The medial malleolus (MM) is an important stabilization structure of the ankle. However, the metrics of individual parts of the MM has been dealt with only by a few studies. The aim of the present study was to obtain metrical data of individual parts of the MM taking into account their clinical relevance. For the study we used adult male and female tibiae from the Pachner´s osteological collection. The study group comprised 298 tibiae. Each tibia was evaluated in terms of a detailed anatomy of the MM. The obtained data were further processed using a Microsoft Excel Office 2016 spreadsheet calculator. The MM anatomy was described in detail, including measurements of the following parameters: length and width of the MM, at the base, height of the anterior colliculus, height of the posterior colliculus, distance between the apexes of the anterior and the posterior colliculi and depth of the intercollicular groove. The anatomical structure of the MM was constant and no significant variations were found. An accurate description of the MM is important in terms of the anatomy of the deltoid ligament. This complex structure having multiple parts originates on the MM. It can be stated that the anterior, subtalar part (pars tibionavicularis, pars tibiospring and pars tibiocalcanealis) originates on the medial surface of the anterior colliculus. The posterior, tibiotalar part originates in the intercollicular grove and on the posterior colliculus. This topography is important for classification of injuries to the medial structures of the ankle.

INTRODUCTION:During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice. MATERIALS AND METHODS:A literature search of original publications and historical sources was performed. RESULTS:The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance. CONCLUSION:The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.

BACKGROUND:Recent pathoanatomic studies based on 3D CT reconstructions have questioned validity of AO/OTA classification because it does not reflect the reality and requires revision. These 3D CT studies, however, do not allow analysis of all details. Therefore, we have exploited the possibility to analyze the pathoanatomy of pertrochanteric fractures on postmortem specimens.MATERIAL AND METHODS:From the collection of the Institute of Anatomy, the authors obtained 16 specimens of hip joints of individuals who had sustained a pertrochanteric fracture and died within 30 days of the injury, with anteroposterior radiographs of the injured hip available in all of them. The number of major fragments and their shape, and the courses of the main fracture lines were studied.RESULTS:Three major fragments (a proximal head and neck fragment, a distal diaphyseal fragment and a posterior flat fragment), separated by three types of fracture lines (primary, secondary and tertiary lines) were identified. The primary line separated the proximal fragment (head and neck) from the distal diaphyseal fragment. The secondary fracture line separated the posterior flat fragment from the distal diaphyseal fragment. The tertiary fracture line split the posterior fragment into two parts. A key factor for fracture instability is the defect of the posterior cortex, which depends on the size and shape of the posterior fragment. Avulsion of the lesser trochanter and the adjacent cortex results in an unstable configuration of fracture lines on the medial side, while on the lateral side a large posterior fragment weakens the lateral trochanteric wall.CONCLUSION:In agreement with recent CT studies, the findings of this pathoanatomical study change, in a number of aspects, the traditional view of the pathoanatomy and classification of pertrochanteric fractures, and introduces the concept of three, instead of the traditional four, main fragments.

Division of the growing long bone into individual basic parts, that is, diaphysis, metaphysis, physes and epiphyses, has become generally accepted and used. However, the origin of these terms is almost unknown. Therefore, we have analyzed the literature in order to identify their sources. The terms epiphysis and apophysis have been used since the time of Hippokrates, although with different meanings. During the time of Galen, the term apophysis was used to describe all types of bone processes, and epiphyses denoted articular ends. The term diaphysis denoting the middle cylindrical part of the long bone was used for the first time by Heister in 1717. The first to use the term metaphysis was Theodor Kocher in his books on gunshot wounds and on bone inflammation of 1895. On the basis of Kocher's study, Lexer published a radiological study of the vascular supply to bones in which he defined metaphyseal blood vessels as a separate group supplying a particular part of the long bone. The epiphyseal growth plate had no particular name from the time of its first description in 1836. During the second half of 19th century, this structure acquired different names. The term "physis" was therefore introduced in 1964 by the American radiologist Rubin in order to label the growth structure between metaphysis and epiphysis clearly. One year later, the term physis also appeared in the radiological literature, and during the following decades it spread in the orthopedic literature.

Discussions about the optimal syndesmotic screw (SS) placement deal primarily with its biomechanical aspects. The aim of this article is to point out the anatomical aspects that have so far been mentioned only marginally. Optimal SS placement is dictated basically by three anatomical parameters that may be easily used intraoperatively without any angular measurements or 3D imaging: (1) the level of screw placement, (2) the insertion point at the lateral malleolar crest (LMC), and (3) the screw trajectory through the distal fibula and tibia. The proximal height is limited by concavity of the fibular notch (FN), while the distal height is limited by the extension of the superior recess of the ankle joint cavity. Therefore, the SS is optimally inserted through the concave surface of FN and above the superior synovial recess – between 2 and 3 cm above the ankle joint line. A more distal SS placement results in a higher rigidity of the tibiofibular mortise and lower bending force on the distal fibula. The LCM on the outer aspect of distal fibula is an ideal landmark for insertion of SS in the antero-posterior direction. In the interval of 20–25 mm proximal to the ankle joint line, the LMC may be used as an entry point. If the SS is inserted more proximally than 25 mm above the joint line, the ideal entry point lies 1 to 2 mm posterior to the LMC to ensure its trajectory through the distal fibula and fibular notch in a center-center direction. If the screw trajectory follows the direction of a reduction clamp that is placed close to the tip of the distal tibia and fibula along the axis of the ankle joint, a center-center trajectory in the distal tibia will be achieved without any angular measurements.

The Achilles tendon (AT) is the strongest tendon of the human body. The knowledge of AT anatomy is a basic prerequisite for the successful treatment of acute and chronic lesions. The structure of the AT results from a complicated fusion of three parts: the tendons of the medial and lateral gastrocnemius and the soleus muscles. From proximal to distal, the tendon fibers twist in a long spiral into a roughly 90° internal rotation. The tendon is narrowest approximately 5–7 cm above its calcaneal insertion and from there it expands again. The topography of the footprints of the individual AT components reflects the tendon origins. The anterior (deep) AT fibers insert into the middle third of the posterior aspect of the calcaneal tuberosity, the posterior (superficial) fibers pass over the calcaneal tuberosity and fuse with the plantar aponeurosis. A deep calcaneal bursa is interposed between the calcaneal tuberosity and the AT anterior surface. The AT has no synovial sheath but is covered along its entire length with a sliding connective tissue, the paratenon which is, however, absent on its anterior surface. The AT is supplied by the posterior tibial artery (PTA) and the peroneal artery (PA). Motor innervation of the triceps surae muscle is provided by fibers of the tibial nerve which also gives off sensitive fibers for the AT. Sensitive innervation is also provided via the sural nerve. The sural nerve crosses the AT approximately 11 cm proximal to the calcaneal tuberosity. The forces acting on the AT during exercise may be up to 12 times the body weight. Physiological stretching of AT collagen fibers ranges between 2

Introduction The Hueter-Volkmann law (HVL) of the response of growth plate to compression load is a basic concept in orthopaedics. However, little is known about the origin of HVL and its history. Materials and methods A literature search was performed in original publications and historical sources. Results An analysis of all Volkmann´s and Hueter´s texts has shown that none of their publications was based on experiments, but on the data in the literature and their own clinical observations. They did not deal at all with the effect of pressure on the growth plate and mentioned this structure only marginally. The authors coined the opinion that increased pressure retards and decreased pressure accelerates bone growth. Julius Wolff criticized the HVL and concentrated all his arguments in the book “The law of bone remodeling”. According to him, increased pressure leads to bone formation, decreased pressure to its resorption. The Wolff-Volkmann dispute was addressed in the German literature by a number of authors. Walther Müller in his monograph “The normal and pathological physiology of the bone” criticized Wolff for his concept of interstitial bone growth. In Müller´s view, HVL applies to the growing bone and Wolff confuses growth with hypertrophy of the mature bone. Conclusion The circumstances of the emergence of HVL are inaccurately and incompletely described in the current literature, as they are mostly taken from secondary sources. HVL, as it is presented today, is not the original formulation, but the result of a long historical evolution.

Introduction Bone growth is a fascinating process, primarily due to its complexity. Equally engaging is the history of its study, which, however, remains unknown to most anatomists and surgeons. Materials and methods A literature search was performed in original publications and historical sources. Results The early history of bone growth study may be divided into two periods. Firstly, the experimental one, between 1722 and 1847, which consisted in the study of bone growth by the drilling of benchmark holes into the diaphysis, and examination of growing bones in madder-fed animals. In the course of one century, four French scientists (Henri-Louis Duhamel du Monceau, Marie-Jean-Pierre Flourens, Gaspard Auguste Brullé and Frédéric Léopold Hugueny) and one British researcher (John Hunter) proved experimentally that the longitudinal growth of long bones occurred only at its epiphyseal ends and their final shape resulted from apposition and resorption processes taking place simultaneously both on the periosteal and intramedullary surfaces of the bone. In the second, the microscopic period (1836–1875), the physeal growth cartilage was discovered and described in detail, including its importance for the longitudinal growth of long bones. The first description of growth cartilage was published by a Swiss anatomist Miescher in 1836. Subsequently, this structure was studied by a number of English, German and French anatomists and surgeons. This whole period was concluded by Alfred Kölliker´s extensive study of bone resorption and its significance for typical bone shapes and Karl Langer´s study of the vascular supply of the growing and mature bone. Conclusion Research by French, English, German and Swiss scientists between 1727 and 1875 yielded fundamental insights into the growth of long bones, most of which are still valid today.