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The effect of enriched blood plasma on the treatment of chronic wounds
Šíma, Petr ; Džupa, Valér (advisor) ; Rob, Filip (referee) ; Burda, Rastislav (referee)
Population ageing is connected with increased incidence of chronic diseases. Some of the frequent conditions are chronic skin defects which are not life threatening, however, they significantly impair the quality of patient's life. The aim of this study is to present and test new materials and procedures leading to improvement and acceleration of treatment of lower leg ulcers. The first part of the study is focused on experimental laboratory testing of the impact of platelet rich plasma on cell growth in the in-vitro conditions. The experiment comprised of combination of new materials made from nanofibers generated from various types of organic polymers. Bio-compatibility and bio-degradability of cell carriers intended for treatment of chronic defects and mechanical properties of materials were monitored. The second part of the study is focused on the proof of better healing of chronic defects if the platelet rich plasma is used locally. The cohort included 25 patients with chronic defects who were treated using the autologous growth factors applied on nanocarriers. The control group included 15 patients treated by a standard moist wound therapy. The surface area and depth of the defect was measured and the results were subsequently statistically processed and evaluated. The third part of the...
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Operative treatment of the fractures of the proximal humerus with angular stable nails - prospective study
Kloub, Martin ; Džupa, Valér (advisor) ; Čižmář, Igor (referee) ; Pavelka, Tomáš (referee)
Dissertation work deals with the strategy of the operative treatment of the proximal humerus with angular stable nails. In experimental part were by the novel technique from cadavers prepared three part fractures and stabilized by the intramedulary nail Targon PH tested. In the clinical part were analysed long-term results of the treatment by this technique in own cohort of patients. Experimental part of the thesis showed excellent biomechanical features of the osteosynthesis and confirmed suitability of this technique for the treatment of humeral head fractures. Longterm results obtained in the clinical part then confirmed effectivness of the treatment by intramedullary nail Targon PH for all types of the fractures of the proximal humerus. In the group of the fractures of the surgical neck were found out majority of excellent or good results in all age groups with low rate of complications, in the group of the fractures of humeral head significant dependance of the clinical result and head necrosis development on the quality of the reduction of the fracture. Powered by TCPDF (www.tcpdf.org)
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Surgical treatment of calcaneal fractures. Optimalization of the position of a sustentacular screw
Pazour, Jan ; Džupa, Valér (advisor) ; Krtička, Milan (referee) ; Obruba, Petr (referee)
The present study focuses on the operative treatment of intraarticular calcaneal fractures. Oste- osynthesis of calcaneal fractures through an extensile lateral approach accompanies an incre- ased risk of wound healing complications. The less invasive surgical approaches reduce these risks but achieving a fracture reduction is harder. Another problem is a technically demanding placement of a sustentacular screw. The incorrect placement of a sustentacular screw is followed by an increased risk of the screw penetration into the talocalcaneal joint. A too-long screw can threaten the anatomical structures around sustentaculum tali. Finally, the malposition of the screw can negatively influence the stability of the osteosynthesis. The purpose of the study was to compare the results of the treatment of calcaneal fractures using a plate osteo- synthesis through an extensile lateral approach and the less invasive intramedullary fixation with C-nail using a sinus tarsi approach from the perspective of the incidence of wound healing complications, stability of the osteosynthesis and the functional results. Furthermore, the impact of various positions of the sustentacular screw on the stability of osteosynthesis was also ana- lyzed. The thesis consists of two sections - clinical and experimental. In the...
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Biomechanical Study of Force Transmission in the Area of Periprosthetic Fracture of the Distal Femur in Individual Types of Osteosynthesis with Application in Practice
Malotín, Tomáš ; Matějka, Jiří (advisor) ; Džupa, Valér (referee) ; Rozkydal, Zbyněk (referee)
Periprosthetic distal femoral fractures (PDFF) constitute an unpleasant complication in patients with a total knee replacement (TKR). The incidence reported in literature is 0,3-2,5 %. The number of periprosthetic knee fractures has been increasing due to the ageing of population, a growing number of implants, a longer life expectancy of patients, a more intensive physical activity of patients, and osteoporosis. Most of these fractures are treated surgically, non-surgical treatment is reserved solely for patients unable to undergo a surgery for general health conditions. Our retrospective study evaluated the group of patients with PDFF who were treated at our department in the period 2007-2020 and 4035 primary TKR were performed. The total number of patients with PDFF was 88. The mean age of patients with PDFF was 77 years (56- 94 years) and at the time of fracture the mean age was 71 years in men and 78 years in women. The average time from the TKR to periprosthetic fracture was 8.2 years (0-20 years). The fractures were assessed using the Su classification modified by Krbec. A primary TKR was performed in 75 cases for gonarthrosis, in 7 cases for rheumatoid arthritis and in 6 cases for secondary,post-traumatic gonarthrosis. The average incidence of periprosthetic distal femoral fractures was 6...
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Biological characteristics of orthopaedic implant surfaces
Ballay, Rastislav ; Landor, Ivan (advisor) ; Džupa, Valér (referee) ; Gallo, Jiří (referee)
Total hip and knee arthroplasty surgeries form an integral part of orthopaedic practice. With an increase of the primary arthroplasty surgeries performed, comes also an increase in the number of complications. The most common complications of these otherwise very successful procedures is periprosthetic joint infections which are also one of the most difficult to treat. In the first part of the study, we evaluated the primary bacterial resistance of the 14 most commonly used materials in the construction of joint prostheses. More specifically, we concentrated on how their surface treatment resists colonisation by specific bacterial species (Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Enterococcus faecalis and Escherichia coli). The studied materials included metal alloys that are commonly used in the weight bearing parts of implants - CoCrNo, FeNiCr and Ti6A14V - but also polymeric and ceramic materials used in the bearing materials, represented by ultra-high- molecular-weight polyethylene (UHMWPE) and aluminium oxide (Al2O3). Our aim was to assess the relationship between material surface roughness and the sensitivity to colonisation by specific bacterial strains and to evaluate their affinity to different materials. Previous studies have proven that the roughness of...
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Treatment of humeral diaphyseal fractures using Hackethals retrograde elastic nailing - a clinical and experimental verification of this method in contemporary traumatology
Obruba, Petr ; Džupa, Valér (advisor) ; Horák, Zdeněk (referee) ; Paša, Libor (referee)
Hackethal's bundle nailing of diaphyseal humeral fractures was historically reliable and cheap method, used for stabilization of simple humeral shaft fractures. After arrival of solid nails, this technique was successively abandoned, initially in Germany, followed by countries of Central Europe. Several cliniques are at present still using this technique successfully. Goal of this work was to establish, whether the declared stability of this technique is comparable to those of more evolved methods, whether this technique does not cause higher amount of complications, and to describe how the stability of nails bundle depends on number and diameter of used implants. The cost efficiency of different modern osteosynthetic methods used for stabilization of humeral shaft fractures was also analyzed. For verification of determined hypotheses, two clinical and one experimental studies were developed. First clinical study was focused on success rate of osteosynthesis and it's complications. In studied population of 50 patients, 4 of them (8%) developed a non-union, which was in all cases caused by wrong indication or technical error during implantation. Superficial infection was observed once, no deep infection had developed. Nine patients (18%) have healed in rotational or axial malalingement that had no...
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Minimally invasive stabilization of posterior pelvic ring injuries with a transiliac internal fixator and two iliosacral screws: comparison of outcome and biomechanics
Salášek, Martin ; Pavelka, Tomáš (advisor) ; Džupa, Valér (referee) ; Plánka, Ladislav (referee)
Introduction: Vertically unstable sacral transforaminal fractures can be stabilized both with a transiliac internal fixator (TIFI) or iliosacral screws (IS). Goals: 1. comparison of radiological and clinical results between dorsal pelvic segment stabilization with TIFI, IS respectively, 2. evaluation and comparison of biomechanical parameters of TIFI and IS construct. Material and methods of clinical study: Prospective study, both TIFI and IS group had 32 patients, the most of injuries were assessed as type C1.3, only patients with a high-energy mechanism of injury were included. Radiological results were evaluated according Matta, clinical results according Majeed score, Pelvic Outcome Score. Categorical data were evaluated by two-sided Fishers exact test or Pearson's χ2 test, continuous data by Student's t-test, a test result with p <0.05 was considered as statistically significant. Methods of biomechanical study: Using CT images, finite element model of the pelvis was developed. Pohlemann type II fracture was simulated and fixed either with TIFI or two IS. The sacral base was loaded vertically (250-500 N), displacement magnitudes on medial and lateral fracture surface and the maximum bone stress were calculated. The intact pelvis was used as a reference. Stiffness was determined by linear...
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Proximal femoral fracture. Results of treatment. Secondary prevention of new proximal femoral fracture after fracture of contralateral proximal femur.
Vaculík, Jan ; Džupa, Valér (advisor) ; Tuček, Milan (referee) ; Edelmann, Karel (referee)
In terms of loss of independence, mortality and their economic impact, proximal femoral fractures are the most serious of all low energy fractures. They heighten the risk of further low energy fractures including contralateral proximal femoral fracture. Fracture of the contralateral proximal femur is associated with higher mortality than fracture of the first proximal femur. Approximately half of proximal femoral fracture patients have already suffered a low energy fracture. In most cases, even these patients are not treated for osteoporosis and no course of action is undertaken to prevent further fractures. Patients suffering low energy fractures are often not aware of the causes of the fracture and do not know that by preventative measures it is possible to reduce risk of further fractures. Patients with low energy fractures frequently suffer from chronic diseases and a significant number of these patients suffer from cognitive impairment. In most cases, treatment by general practitioners to prevent fractures is not provided although there is considerable evidence showing the effectiveness of preventative measures. With a view to unifying approaches to prevention, guidelines for fracture prevention after proximal femoral fracture have been established, endorsed by professional organizations. Aim: The goal...
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Evaluation and setting of standards of conventional ratio of flexors and extensors of knee of young athletes
Ižovská, Jana ; Zahálka, František (advisor) ; Džupa, Valér (referee)
Title: Evaluation and determination of standard ratio of extensors and flexors of the knee in sporting youth. Objectives: The aim of the thesis is to establish the standards of the force ratio H: Q for the youth football categories U16, U17, U18, U19, U21 and adult players of the Czech Republic and based on the prescription type of study to establish a percentage critical disbalance of dynamic knee stabilizers which may be the most common cause of injuries to dynamic or static knee joint stabilizers in soccer players. Methods: The monitored group of players consisted of football players playing in elite Czech football clubs, both in youth and senior categories, who meet the predetermined selection criteria. The isokinetic strength parameters were monitored using a Cybex Humac Norm isokinetic dynamometer (Cybex NORM ®, Humac, CA, USA). We investigated maximum strength moment (PT) of extensors and knee flexors of dominant and non-dominant limb at concentric contraction at angular velocities of 60, 180 and 300ř.s-1 . Then we watched the players wounded. If the injury occurred, then we looked back at its strength characteristics and the strength ratio between the extensors and flexors of the knees and whether it was possible to predict the injury and determine the critical level that indicates the...
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