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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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