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Scapular fractures associated with acromioclavicular and sternoclavicular luxation
Strnad, Tomáš ; Tuček, Michal (advisor) ; Fulín, Petr (referee) ; Pilný, Jaroslav (referee)
Fractures of the scapula used to be among rare injuries, but in the last two decades their number has increased. Fractures of the scapula can be isolated, but in 67-92% they are combined with injuries to other structures of the shoulder girdle. The dissertation was divided into two parts: experimental and clinical. In the experimental part, the aim was to describe the occurrence and variants of sulcus coracoglenoidalis (CGN) and sulcus arteriae circumflexae scapulae (SCF). These two little-known structures play an important role in the occurrence of some types of scapula fractures and in their surgical treatment. Combined scapular injuries with AC and SC dislocation are rare. Therefore, in the clinical part, we decided to identify and describe in detail combined injuries of the scapula with AC and SC dislocation, including a detailed description of fractures of coracoid process. Anatomical studies were performed on 330 dry bone specimens of adult scapulas. Clinical studies were conducted on a set of 519 scapula fractures in adult patients occurring in the period 2002-2020. In the anatomical part of the dissertation, two anatomical structures were described for the first time: CGN and SCF. Our studies pointed to considerable variability in the occurrence and degree of formation of both of these...
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Development and evaluation of new cementless revision acetabular components for total hip arthroplasty / type TC /
Šťastný, Eduard ; Trč, Tomáš (advisor) ; Šponer, Pavel (referee) ; Pilný, Jaroslav (referee)
Development and evaluation of new cementless revision acetabular components for total hip arthroplasty / type TC / Objective: The aim of the clinical part of the study was to introduce a new revision oval cup type TC, and evaluate its reliability and utility in revision endoprosthesis. Due to the different structure of the implant, we aimed to objectively demonstrate the remodeling of bone tissue in its vicinity. In the experimental part of the work we verified the hypothesis that the use of locking screws has an effect on the bond strength of the implant with bone tissue, and therefore on the primary stability of the acetabular component. Method: We evaluated 31 patients that underwent revision hip surgery between 2004 and 2008. The mean follow-up was 7.1 years (range 5.3 to 9.3 years, minimum 5 years after surgery). Osteointegration of the implant and remodeling of bone tissue around the implant and its ribs were evaluated by digital radiography and computed tomography, and clinical results according to Harris. The experiment was based on the execution of pull-out tests after the implantation of TC cups in cadaveric bovine pelves. We evaluated the dependence of tensile forces in the axis of the implant on extraction of the metal cup from the bone bed. Four tests were conducted with the cup fixed...
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Posterior malleolar fractures of the tibia in fracture-dislocations of the ankle
Kostlivý, Karel ; Bartoníček, Jan (advisor) ; Pilný, Jaroslav (referee) ; Dráč, Pavel (referee)
The dissertation deals with fractures of the posterior malleolus of the tibia in ankle fractures. There is no consensus on the issue in the diagnosis and treatment of tibial posterior malleolus fractures in ankle fractures worldwide. The experimental part of the study focused on the anatomy of the ankle joint, especially on the construction of the fibular incisure of the distal tibia as one of the key areas for ankle stability. The result was the determination of the ideal distance for the correct assessment of the position of the fibula in the incisure of the tibia. In the clinical part of the study, the pattern of the fractures was evaluated on a basic group of patients with ankle fractures with concurrent tibial posterior malleolus fracture using preoperative X-ray and CT examination. This made it possible to determine the basic morphological types of posterior malleolus fractures. The resulting classification was verified on an extended group of patients. In clinical practice, it was used to choose the surgical approach and method of fixation. The correctness of the resulting classification was verified on an extended group of patients. The clinical application of the anatomical 3D CT classification achieved a good anatomical position by direct reduction and stable osteosynthesis from the chosen...
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Possibilities of influencing the healing and ligamentization of the graft during anatomical reconstruction of the anterior cruciate ligament - Results of the Prospective Randomised Study
Kasl, Jan ; Matějka, Jiří (advisor) ; Paša, Libor (referee) ; Pilný, Jaroslav (referee)
Aims Prospective, randomized, non-blinded study, on the effects of use of platelet-rich fibrin (PRF) in anterior cruciate ligament reconstruction surgery. Methods Initially, 40 patients between 2012 and 2014 were enrolled in the study and randomized for the treatment with (n=20, intervention group) or without (n=20) the use of PRF (controls). The average age was 29.1 years at inclusion, with 12 female and 28 male patients. Vivostat ® PRF was obtained from patient blood and applied onto the hamstring graft. Magnetic resonance imaging (MRI) documented healing was evaluated at 6 and 12 months. Clinical outcome parameters as well as standardized evaluation of knee laxity using the GenouRob device were collected at 12 months. Results Thirty-three patients completed the full follow-up (17 intervention, 16 control). In two cases, a graft tear was documented (occurred in the control group). However, there were no differences in the remodeling progress in MRI using the log-rank test (p=0.07). There was no difference in the return to pre-injury sport levels (p=0.232), Lysholm and IKDC scores (p=0.259 and p=0.364 respectively). Knee laxity measurements showed no differences between the intervention and control groups. Discussion Similar results we found in our study have recently been published by other world...
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Morphology of ankle fractures - its impact on the type of fracture and the outcomes of treatment
Marvan, Jiří ; Krbec, Martin (advisor) ; Čapek, Lukáš (referee) ; Pilný, Jaroslav (referee)
Ankle fractures can be serious and complex injuries with variable prognoses. In our department, ankle fractures are the third most common fracture behind fractures of the distal radius and the proximal femur. Ankle fractures present with considerable variability with regard to the extent of injury to bones and ligaments, with each injured structure requiring appropriate treatment. We analyzed a group of patients that were surgically treated, in the Orthopedics and Traumatology Clinic, 3rd Medical Faculty of Charles University, for ankle fractures, with a particular focus on the epidemiological, clinical, and morphological parameters of the fractures. Our objective was to supplement existing information regarding the morphology of ankle fractures. Furthermore, we wanted to experimentally verify certain aspects related to ankle fractures. Our first step was to focused on the structure of cortical and cancellous bone in the fibula by carrying out a biomechanical study of the distal fibula after treatment with various types of fixation. The structure of fibular cortical bone was analyzed, using superficial sections, from dry preparations of a human fibula. By rubbing Indian ink into polished sections of cortical bone, we were able to visualize both the direction and organization of the central vascular...
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Trochanteric fracture - clinical, anatomical and biomechanical aspects, therapy options, complications
Bartoška, Radek ; Báča, Václav (advisor) ; Čapek, Lukáš (referee) ; Pilný, Jaroslav (referee)
Hip fractures are mainly problems of the elderly population. The incidence in the Czech Republic is one of the highest in the world. They include a pertrochanteric fracture. One possibility of its therapy is intramedullary nailing. The advantages of the nailing is allowing a sliding effect of the proximal fragment which leads to better contact between fragments. Surgical procedure has its own risks and complications. We decided to evaluate a group of patients with pertrochanteric fractures treated in 2009-2011 with the PFN Medin. We analyzed the sliding effect and factors which can influence it and complications. The study cohort covers 304 patients. We found out that the sliding effect was in 195 cases (67.1%). The type of the fracture did not affect the sliding. There was no significant difference depending on the length or screw placement in the proximal fragment. We found following complications:3 medial displacement (0.9%), 6 varus collapses (1.9%), 4 necroses of the head of the femur (1.3%) , 13 cases of the femoral neck resorption (4.3%), 10 fractures around the nail (3.2%), 4 Z- effects (1.3%) and 3 "cut-out" phenomena (1.0%). We have created a model of stable and unstable fractures with the finite element method. The analyzes focused on the placement of the neck screw, showed that in stable...
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Benefits of the Acetabular Microfracture Technique in Arthroscopic Treatment of Chondral Defects in Femoroacetabular Impingement Syndrome: Two-year Results of a Multicenter Prospective Randomized Study
Rafi, Moheb ; Zeman, Petr (advisor) ; Paša, Libor (referee) ; Pilný, Jaroslav (referee)
1 ABSTRACT Benefits of the Acetabular Microfracture Technique in Arthroscopic Treatment of Chondral Defects in Femoroacetabular Impingement Syndrome - Two-year(s)? Results of a Multicenter Prospective Randomized Study. Purpose of the study Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoroacetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. Material and methods The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In group 1 (31 patients), microfractures for chondral defects was performed, while in group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in group 1 and 31.1 in...
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Fractures of the distal radius as serious geronto-traumatology problem and its possible solutions
Pacovský, Vladimír ; Topinková, Eva (advisor) ; Trč, Tomáš (referee) ; Pilný, Jaroslav (referee)
Fractures of the distal radius are the most common fractures treated at our clinics . It accounts for around 16 % of all fractures. Most often we meet them in two age groups - children and especially in postmenopausal women. In this group the fractures are frequently associated with osteoporosis. The most common cause of fracture is a fall on the outstretched extremity. Together with fractures of the proximal humerus, proximal femur and vertebral fractures they are the most common gerontotraumatologic fractures. The frequency of fractures of the distal radius gradually increasing. The reason is the increasing average age of the population and their active way of life. Our group consists of 5,359 patients treated for a fracture of the distal radius in 1998 and from 2001 to 2013 . During this time , the frequency of fractures increased by 19,7%. For women with distal radius fractures occur 3 times more frequently, the average age of treated was 59,1 years. About 80 % of distal radius fractures are treated conservatively. The surgical treatment of seniors decide not only the type and stability of the fracture, bone quality, but especially the overall condition of the patient and his claims to a final functional outcome. Long-term functional results after conservative treatment in the elderly are nearly the...
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Morphology of ankle fractures - its impact on the type of fracture and the outcomes of treatment
Marvan, Jiří ; Krbec, Martin (advisor) ; Čapek, Lukáš (referee) ; Pilný, Jaroslav (referee)
Ankle fractures can be serious and complex injuries with variable prognoses. In our department, ankle fractures are the third most common fracture behind fractures of the distal radius and the proximal femur. Ankle fractures present with considerable variability with regard to the extent of injury to bones and ligaments, with each injured structure requiring appropriate treatment. We analyzed a group of patients that were surgically treated, in the Orthopedics and Traumatology Clinic, 3rd Medical Faculty of Charles University, for ankle fractures, with a particular focus on the epidemiological, clinical, and morphological parameters of the fractures. Our objective was to supplement existing information regarding the morphology of ankle fractures. Furthermore, we wanted to experimentally verify certain aspects related to ankle fractures. Our first step was to focused on the structure of cortical and cancellous bone in the fibula by carrying out a biomechanical study of the distal fibula after treatment with various types of fixation. The structure of fibular cortical bone was analyzed, using superficial sections, from dry preparations of a human fibula. By rubbing Indian ink into polished sections of cortical bone, we were able to visualize both the direction and organization of the central vascular...
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Trochanteric fracture - clinical, anatomical and biomechanical aspects, therapy options, complications
Bartoška, Radek ; Báča, Václav (advisor) ; Čapek, Lukáš (referee) ; Pilný, Jaroslav (referee)
Hip fractures are mainly problems of the elderly population. The incidence in the Czech Republic is one of the highest in the world. They include a pertrochanteric fracture. One possibility of its therapy is intramedullary nailing. The advantages of the nailing is allowing a sliding effect of the proximal fragment which leads to better contact between fragments. Surgical procedure has its own risks and complications. We decided to evaluate a group of patients with pertrochanteric fractures treated in 2009-2011 with the PFN Medin. We analyzed the sliding effect and factors which can influence it and complications. The study cohort covers 304 patients. We found out that the sliding effect was in 195 cases (67.1%). The type of the fracture did not affect the sliding. There was no significant difference depending on the length or screw placement in the proximal fragment. We found following complications:3 medial displacement (0.9%), 6 varus collapses (1.9%), 4 necroses of the head of the femur (1.3%) , 13 cases of the femoral neck resorption (4.3%), 10 fractures around the nail (3.2%), 4 Z- effects (1.3%) and 3 "cut-out" phenomena (1.0%). We have created a model of stable and unstable fractures with the finite element method. The analyzes focused on the placement of the neck screw, showed that in stable...
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