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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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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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Radiological, Histochemical and Histological Changes M. Erector Spinae by Patients with a Fracture of Thoracolumbal Spine Treated With Open or Miniivasive Stabilisation
Matějka, Tomáš ; Matějka, Jiří (advisor) ; Džupa, Valér (referee) ; Chaloupka, Richard (referee)
Today, miniinvasive operations are part of modern medicine and in recent years have partially replaced open methods. The aim of this study was to compare radiological, histochemical and histological changes of the erector spinae muscle in patients with thoracolumbar spine fractures treated with open (OPEN) and miniinvasive (MISS) stabilization. The purpose was not to evaluate one method as better or worse, it was only a comparison and finding out the advantages and disadvantages of individual operations. During the study, we compared both the above-mentioned differences in the quality of the erector spinae muscle and laboratory changes in blood levels of muscle enzymes, we compared the duration of operations, the accuracy of insertion of transpediculars screws, blood loss, kyphotization of spine segments and exposure of radiation. It has been hypothesized that muscle damage in all factors will be lower in MISS than in OPEN. A total of 38 patients with type A and B fractures according to the Vaccar classification, 19 underwent MISS surgery and 19 at the OPEN method were included in the prospective randomized study. The average age of the whole group was 46.4 years (18 - 68), the average age for MISS procedures was 42.6 (18 - 66), for OPEN was 48.7 (19 - 68). Only monotrauma of the TL spine was...
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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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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) ; Zahradník, David (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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Effectiveness of Sonographic Examinations in Prevention and Treatment of Developmental Hip Dysplasia
Zídka, Michal ; Džupa, Valér (advisor) ; Kokavec, Milan (referee) ; Šponer, Pavel (referee)
Purpose: The aim of the study is to demonstrate the success of early detection and the efficacy of early hip dysplasia treatment within neonatal hip screening in the Czech Republic. Measures are proposed to optimize follow-up and maintain long-term sustainability of the newborn care. Materials and Methods: 316 children with various degrees of hip involvement were detected by "triple sieve" orthopedic screening system. Diagnosis and treatment were monitored by clinical and sonographic examinations (according to Graf). The risk factors, their influence on the treatment course, the effectiveness of outpatient treatment using abduction devices, timing and duration of treatment and participation in follow-up were evaluated. Furthermore, data analysis on national hip arthroplasty register was performed in patients treated for sequels of hip dysplasia. These data were correlated (in order to assess their efficacy) with methods of dysplasia detection at the time these patients were born. Results: Conservative treatment was successful in 98.7 % of 316 treated children. Only 31 % of children had a positive clinical finding. Positive family history showed no significance either for detection or treatment course. The breech position correlated significantly with the incidence of hip dysplasia - OR = 2.80 (99%...
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