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Clinical outcomes of first metatarsophalangeal joint prosthesis PH-Flex Medin and its effect on the biomechanics of the forefoot in the propulsion phase of the gait cycle
Popelka, Stanislav ; Hromádka, Rastislav (advisor) ; Krbec, Martin (referee) ; Holinka, Martin (referee)
The dissertation evaluates the results of a first metatarsophalangeal (MTP) joint replacement. The PH-Flex MTP joint replacement was developed at the 1st Department of Orthopaedics, the first faculty of medicine in conjunction with the Medin s.r.o. company. The clinical trials ran between 2007 and 2011. Between 2011 and 2016, the implant was used in clinical practice, where the indication criteria of its use were gradually adjusted. This work summarises publications originating in our department, evaluating the 5-year period during which the implant was used and the results of its use. In the first part of the dissertation, we present the retrospective study evaluating a group of 31 patients after the implantation of 35 MTP joint replacements was published in 2017. Bilateral surgery was performed on 4 patients. A minimum follow-up of 6 months was required for inclusion in the study. In 30 cases, the indication was 1st MTP joint arthritis of grades 3 and 4 according to the Coughlin classification. A conversion from hemiarthroplasty to total arthroplasty was performed in 4 patients, and in 1 case, the surgery was performed as a revision from a failed silastic 1st MTP joint replacement. The evaluation was performed not only radiographically but also according to the American Orthopaedic Foot and Ankle...
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Maisonneuve fracture - anatomy, diagnostics, operative approaches and technics of osteosynthesis
Kašper, Štěpán ; Tuček, Michal (advisor) ; Kachlík, David (referee) ; Hromádka, Rastislav (referee)
Although Maisonneuve fracture (MF) is a well-known type of ankle fracture-dislocation, there are a number of misconceptions that can lead to wrong choice of treatment. The concept of Maisonneuve fracture is also not understood by all authors in the same way and the recent CT studies confirmed that this is much more complex and variable injury. The dissertation was divided into two main parts: anatomical (experimental) and clinical. In the experimental part, the aim was to describe the appearance and shape and demonstrate the clinical significance of the crista malleoli lateralis (CML), which is located on the lateral side of the distal fibula and which previous anatomical and clinical studies neglected. Knowledge of this structure is essential to correct placement of syndesmal screws. The aim of the clinical part was the precise description of the pathoanatomy and associated injuries within the "classic" and less frequent forms of Maisonneuve fracture based on CT examination and intraoperative findings. Anatomical studies were performed on 352 dry bone specimens of adult fibula. Clinical studies were conducted on a set of 54 adult patients with "classic" MF occuring in the period 2012-2018 and 11 adult patients with "double" MF occuring in the period 2012-2020. In the anatomical part of the...
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Syndesmotic lesion in fracture-dislocations of the ankle - Maisonneuve fracture
Fojtík, Petr ; Naňka, Ondřej (advisor) ; Hromádka, Rastislav (referee) ; Skála-Rosenbaum, Jiří (referee)
A Maisonneuve fracture (MF) is a fracture dislocation of the ankle caused by external rotational force. In the traditional concept it includes a subcapital fracture of the fibula, an injury to the tibiofibular syndesmosis and to the interosseous membrane, and it is considered as an unstable injury. The experimental (anatomical) goal of the dissertation work was a detailed study of the incisura fibularis tibiae (IFT), its maximum depth and its localization relative to the articular surface of the ankle. The second experimental goal was a detailed description of the lateral surface of the distal fibula, where there is a prominent but still nameless edge that gives the distal fibula its typical triangular shape on a transverse section (workingly we called it lateral malleolar crest, LMC). Both of these structures are extremely important in the diagnosis and treatment of ankle fractures. The clinical part of the work included an overview of all the literature devoted to MF and further analysis of our group of patients with MF with a focus on the posterior malleolus (PM) fracture. Anatomical studies were performed on 352 dry bone specimens of adult tibiae and fibulae. The clinical study was conducted on a group of 100 patients with MF in adult patients treated at The Department of Orthopedics, 1st...
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Preoperative planning of the reconstructive surgery of the forefoot
Klouda, Jan ; Hromádka, Rastislav (advisor) ; Naňka, Ondřej (referee) ; Teyssler, Petr (referee)
Univerzita Karlova v Praze 1. lékařská fakulta Postgraduální doktorský program v biomedicíně Studijní obor: Experimentální chirurgie Disertační práce MUDr. Jan Klouda: Preoperative planning of the reconstructive surgery of the forefoot Abstract The presented thesis describes a study aimed at the change of articular surface position in the region of first metatarsophalangeal joint after operative reconstruction due to hallux valgus deformity, done by performing Lapidus arthrodesis. The study evaluates a cohort of patients, who underwent surgery in Department of Orthopaedics, First Faculty of Medicine, Charles University in Prague at Motol University Hospital from 2010 to 2015. The results and clinical implications of the aforementioned retrospective study were published in 2018. The observers evaluated several defined angles on preoperative and postoperative radiographs of the forefoot. The angles were thoroughly selected with regard to the exact representation of first metatarsophalangeal joint articular surface position in relation to the axes of first metatarsal and the whole forefoot. The executed measurements allowed us to assess the overall effectivity of the performed surgery in deformity correction, as well as to describe possible pitfalls and disadvantages resulting from the change of structural...
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Three-Dimensional Anatomy of the Proximal Humerus and Rotator cuff attachment : Study of Clinical Anatomy for Optimization of Shoulder Arthroplasty Implantation
Hromádka, Rastislav ; Pokorný, David (advisor) ; Gallo, Jiří (referee) ; Zach, Petr (referee)
The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...
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Three-Dimensional Anatomy of the Proximal Humerus and Rotator cuff attachment : Study of Clinical Anatomy for Optimization of Shoulder Arthroplasty Implantation
Hromádka, Rastislav ; Pokorný, David (advisor) ; Gallo, Jiří (referee) ; Zach, Petr (referee)
The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...
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