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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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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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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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Establishing optimal indications for distal radius fractures, based on fracture type, and comparison of the outcomes of clinical evaluation with mathematical modeling
Vlček, Martin ; Landor, Ivan (advisor) ; Džupa, Valér (referee) ; Koudela, Karel (referee)
Distal radius fractures are the most common types of break to the arm bones. Conservative treatment in unstable fracture types cannot guarantee healing of the bones in a correct anatomical position. Locking plate osteosynthesis is at present regarded as the method of choice in surgical treatment of all types of distal radius fractures. An issue to be solved concerns the role for intramedullary implants in these indications. The aim of our study was to find the optimal indication for each of the osteosynthesis method currently used in distal radius fractures. We evaluated the one-year results of treatment for distal radius fractures. The group evaluated comprised 49 conservatively treated fractures, 78 fractures treated by angle-stable locking plates with either rigiddirection or multidirectional screws and 35 fractures in which Targon DR intramedullary nails or X-screws were used. Some radiographic parameters were better in the patients treated by intramedullary osteosynthesis, while some of the functional outcomes were better in the fractures treated by plate osteosynthesis although this method was indicated in patients with significantly more complicated fractures. A mathematical model was used to simulate distal radius fractures, type C1 and type C2. The stability of both locking plate and intramedullary...
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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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The Impact of the Mechanical Dependence of the Components of Total Elbow Replacement on Implant Survivorship
Güttler, Kristián ; Landor, Ivan (advisor) ; Koudela, Karel (referee) ; Džupa, Valér (referee)
Drawing on long-term clinical experience, the dissertation provides an overview of the options for the reconstructive surgery of irreversibly damaged elbow joints and the individual structural directions in the development of total elbow replacements. The clinical study focuses on the comparison of the unconstrained Souter-Strathclyde elbow implant, which has been used at our workplace since 1987, and the semiconstrained Coonrad-Morrey implant, which we started to use in the nineties. The disadvantages of the Souter-Strathclyde implant consist of a relatively complex surgery technique and narrower indication which does not permit larger primary instability of the operated elbow and large bone defects. Due to these reasons in recent years the Coonrad-Morrey total elbow replacement has been the preferred option at our workplace. The main problem as regards the long-term survival of this implant is especially the wear of the polyethylene bushings of the fl oppy hinge. This can be solved through an early replacement of this hinge before substantial abrasive wear develops ultimately leading to the loosening of the whole implant. We have elaborated a methodology that maps the condition of the polyethylene bushings and at the same time examines the integration of the humeral and ulnar component in the...
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Utilization of local carriers of antibiotics for treatment of infection of locomotive apparatus
Melicherčík, Pavel ; Jahoda, David (advisor) ; Koudela, Karel (referee) ; Džupa, Valér (referee)
Infections of locomotive apparatus presents serious problem in orthopeadic and traumatology for a typical course with recidivisms and often evolution to bacterial resistance. Eradication of bacterial causers of infections of locomotive apparatus not have to be always reliable. One of possibility how to increase therapeutic potential is utilization a local aplication of antibiotics. Aim of dessertation thesis is verify influence of released glycopeptide antibiotic vancomycin from bone grafts in experiment in vitro after previous comparasion of properties in 34 chosen carriers from point of view both material constitution and elution characterization for different antibiotics on the strength of sources from accessible literature. The most widespread used local carrier of antibiotics is bone cement intended firstly to solve infections of alloplasties by two-stroke reimplantation. There is necessary subsequent its extraction compared to newer, biodegradable carriers. The best properties from a view of criteria suitable local carrier of antibiotics in orthopeadic and traumatology have carriers composed from several sort of materials, so-called composites. On the strength of results performed experiment we verified that bone grafts could be a good local carrier of vancomycin. Highest average...
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Epidemiology Study of patients after the THA
Herůfek, Radim ; Džupa, Valér (advisor)
Total hip arthroplasty is one of the best methods of treatment postwar medicine. Patients with severely degenerated joints are plagued by persistent pain that will not allow them normal daily activities , do not allow them quality sleep and also cause great mental anguish. Joint replacement implant leads relieving pain , restore function . Originally disabled patient returns to normal life and employment , which is often physically demanding. Therefore, total replacement of the significant effect of treatment , social and economic . The significant development of total joint arthroplasty for the last 40 years has resulted in various types and designs of acetabular holes femoral stems and heads , which in turn causes a lack of clarity on the menu, which , moreover, is still expanding. For implantation compensation is very important accurate indication of a specific type prosthesis , and therefore it is necessary to conduct epidemiological studies of patients who help refine the indications thus facilitating the selection of individual components. The following work is an overview of epidemiological data of patients with implantation of hip replacement patients operated on Orthopaedics and Traumatology FNKV clinic in 2006.
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Demographic and Epidemiology Study of Patients with Pelvic Injury
Derevjaník, Peter ; Džupa, Valér (advisor)
Severe pelvic injury is usually caused by high injury and is often associated with injuries to other organ systems [l, 5, 18, 24, 26, 28, 31]. The exposed surface of cancellous bone of the pelvis and injured surrounding vascular structures can be a source of excessive bleeding causing hemorrhagic shock with fatal consequences for the patient [3,4,6, 14, 15, 17, 23]. For mastering This initial condition is serious fracture treatment of pelvic challenging for patient and nursing staff and can have debilitating effects [7, 8, 10, 11, 13, 16, 20, 25, 26]. Pelvic injury occurs primarily in younger people and middle-aged, so has significant social accent [2, 11, 24, 18, 21, 26]. In the present work, we present an overview of basic demographic and epidemiological data on patients treated for a fractured pelvis in our the Traumacentre.
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Review of patients with musculosceletal injury treated during winter months in a highland hospital
Rousek, Miloslav ; Džupa, Valér (advisor)
Backround. The authors examined the incidence of musculoskeletal injuries according to their type and location in the period of winter at a highland hospital, which also functions as a regional hospital for a few winter sport resorts. Methods and results. In the sample there were 1644 patients (696 women, 948 men) treated for primary musculoskeletal injuries from 1.1. to 31.3. 2008. This was a retrospective study, the data was collected from medical reports. It included: age, sex, mechanism of injury, diagnosis and whether the patient had to be hospitalised or not. Age of the patients ranged from 1 to 95 years with an average of 29 years (31 for women and 28 for men). Younger age groups dominated among men. After 70 years of age there was a prevalence of women. Fractures were the most common cause of injury (653, 39.7%), followed by injuries to the joints' ligamentary apparatus by mechanism of distortion (379, 23.1%). Next in incidince were soft tissue injuries caused by contusion (325, 19.7%) and open wounds (241, 14.7%). The least common were luxated joints (43, 2.6%) and closed injury to muscles and tendons (3, 0.1%). The most frequent site of injury was the hand (404, 24.6%), while the least frequent sire was the thigh (17, 1.0%). Conclusions. In conclusion the study confirmed that other than the age,...
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