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Syndesmotic lesion in fracture-dislocations of the ankle - Maisonneuve fracture
Fojtík, Petr ; Naňka, Ondřej (advisor) ; Hromádka, Rastislav (referee) ; Skála-Rosenbaum, Jiří (referee)
A Maisonneuve fracture (MF) is a fracture dislocation of the ankle caused by external rotational force. In the traditional concept it includes a subcapital fracture of the fibula, an injury to the tibiofibular syndesmosis and to the interosseous membrane, and it is considered as an unstable injury. The experimental (anatomical) goal of the dissertation work was a detailed study of the incisura fibularis tibiae (IFT), its maximum depth and its localization relative to the articular surface of the ankle. The second experimental goal was a detailed description of the lateral surface of the distal fibula, where there is a prominent but still nameless edge that gives the distal fibula its typical triangular shape on a transverse section (workingly we called it lateral malleolar crest, LMC). Both of these structures are extremely important in the diagnosis and treatment of ankle fractures. The clinical part of the work included an overview of all the literature devoted to MF and further analysis of our group of patients with MF with a focus on the posterior malleolus (PM) fracture. Anatomical studies were performed on 352 dry bone specimens of adult tibiae and fibulae. The clinical study was conducted on a group of 100 patients with MF in adult patients treated at The Department of Orthopedics, 1st...
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Epidemiology study of the proximal femur fracture in 2007
Rajtmajer, Jan ; Skála-Rosenbaum, Jiří (advisor)
With the increasing average age of the population continues to grow and increase its susceptibility to various diseases, including fractures. Hand in hand with this trend of increasing the number of patients over 65 years. At the same time improves the quality of medical and care and what it was 10 years ago hardly feasible with todayseems granted. The population older than 65 years are now very hip fractures common reason for visits to orthopedic trauma or the surgery ambulance. In these patients, it is a risk of disease associated with up to 30% mortality. Usually play a major role associated diseases, such as pneumonia, pulmonary embolism or sepsis, decubitus. In this work I have focused on comparing the incidence of newcases in 1997 and 2007. The assumption is that the population will be older than 64 years in 2007 compared 1997, a significant increase in patients with fractures of theproximal femur. but in age group 50 to 64 years, the same number of fractures.
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The hip fracture register, optimalization of hip hemiarthroplasty position
Skála - Rosenbaum, Jiří ; Bartoníček, Jan (advisor) ; Chomiak, Jiří (referee) ; Janeček, Miloš (referee)
The study examines the monocentric epidemiological data of patients with hip fractures from 1997-2007. Adult patients treated for hip fracture between the years 1997-2007 were included in the study. Retrospective statistical assessment of continually gathered data focused on epidemiology and demographics. The second part of the study was concerned on risk factors on protrusion of hemiarthroplasty into the acetabulum. The goal was to specify exact indication, proper operative technique and selection of the implant. The study involved 3 683 patients (2 678 women, 1 005 men). Patients older than 70 years accounted for 82 % of all cases. There was an increase in the number of hip fractures resulting in a significant increase in pertrochanteric fractures (AO-31A1+2) (p<0.001). The ratio of trochanteric to neck hip fractures increased from 0.99 to 1.53. Continual monitoring of patients with hip fracture offers data which allows comparisons between regions and countries. The importace of a continual increase in the number of hip fractures has its importance in macroeconomical planning in traumatology. Hemiarthroplasty was conversed to total hip arthroplasty in 12 patients in our department. The indication, time period to conversion and hemiarthroplasty position were retrospectively assessed. The direction of...
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Single-Bundle versus Double-Bundle Technique of the Anatomical Anterior Cruciate Ligament Reconstruction
Zeman, Petr ; Koudela, Karel (advisor) ; Skála-Rosenbaum, Jiří (referee) ; Kalina, Radim (referee)
Purpose of the study: The aim of the study is to present a comparison of two years result of double-bundle versus single-bundle anatomical reconstruction of the anterior cruciate ligament using hamstring tendons and their fixation with bioabsorbable interference screws. Material and methods: A total of 110 patients with an isolated anterior cruciate ligament rupture and the healthy contralateral knee who met the indication criteria for double- bundle anterior cruciate ligament reconstruction were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At two years after surgery, 82 patients (DB group, n=43; SB group, n=39), comprising 66 men and 16 women, were evaluated; the average age was 29 years and the injury-to- surgery interval was 81 days. Pre-operative and post-operative subjective criteria involved the subjective IKDC and Lysholm score were evaluated. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20ř flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. Results: No statistically significant difference was found in pre-operative values between the two...
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Intra-articular Calcaneal Fractures - Osteosynthesis with Calcaneal Locking Compression Plate - Contribution to Fill Defect in Body of Calcaneus
Zeman, Jaroslav ; Koudela, Karel (advisor) ; Plánka, Ladislav (referee) ; Skála-Rosenbaum, Jiří (referee)
Calcaneal fractures are common injuries that prevent patients from getting on with their normal life for a long time. They are usually caused by axial forces leading to impaction of the talus into the calcaneus. Falls and jumps from heights are the most common causes. These fractures also occur bilaterally. We used open reduction and internal fixation with a calcaneal LCP for the treatment of 98 patients with 114 calcaneal fractures in our department from August 2005 till December 2011. Bilateral fractures of the calcaneus occurred in 16 patients - 2 women and 14 men. On the day of injury plain radiographs of the calcaneus in lateral and axial projection were taken. Computed tomography was performed in all operated patients in sagittal, transversal and coronal planes. On the basis of CT findings the fractures were classified as Sanders types I - IV. Patients with type II and III fractures were indicated for surgical ORIF treatment. The results were evaluated using the Rowe score. The aim of the experimental work was to assess the biomechanical strength of the calcaneus without fracture and to compare it with the strength of the calcaneus after the osteosynthesis with an angular stable plate alone or in combination with filling of the calcaneal defect with injectable self-hardening hydroxyapatite...
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Scapular fractures: Clinical anatomy, radiodiagnostics, classification-it's importance for operative treatment
Tuček, Michal ; Bartoníček, Jan (advisor) ; Paša, Libor (referee) ; Skála-Rosenbaum, Jiří (referee)
Fractures of the scapula are not very frequent and account for less than 0.5 per cent of all fractures. In most cases they are caused by high-energy trauma and are associated with other injuries. Until recently, fractures of the scapula were rather neglected and treated mostly conservatively. Lately, hover the situation has changed. The number of patients with a scapula fracture is increasing, the interest in this issue is growing and discussion focuses more and more on operative treatment of these fractures. The dissertation thesis provides a comprehensive overview of diagnostics, classification and treatment of scapula fractures. In the anatomical section we have described weak areas in the construction of the scapula that predispose incidence of fracture lines. We have studied topographic relations of individual structures on the posterior aspect of the scapula from the viewpoint of the Judet approach and its modifications in individual types of fractures of the scapular body and neck. In the radiological section we have compared efficiency of individual imaging methods with the aim to evaluate the possibilities of individual radiographic methods, 3D CT reconstructions in particular, from the viewpoint of an exact determination of the type of the fracture, number of fragments and their...
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Polymethylmethacrylate augmented direct anterior screw fixation in type II odontoid fractures in low bone density C2 vertebrae - a biomechanical cadaveric study
Řehoušek, Petr ; Skála-Rosenbaum, Jiří (advisor) ; Klézl, Zdeněk (referee) ; Repko, Martin (referee)
Odontoid peg fractures are the most common injuries of the cervical spine in the elderly. Anterior screw stabilisation in type II odontoid peg fractures improves survival and function in these patients but may be complicated by failure of fixation. The purpose of our study was to determine whether cement augmentation of a standard anterior screw provides biomechanically superior fixation of type II odontoid fractures in comparison to a non-cemented standard screw. In the second part of the study the aim was focused the role of bone cement amount and its quality to the stiffness of odontoid and vertebrae body junction. Twenty human cadaveric C2 vertebrae from elderly donors (mean age 83 years) were obtained. Anderson and D'Alonzo type II odontoid fracture was created by transverse osteotomy and fluoroscopy guided anterior screw fixation was performed. The specimens were divided into two matched groups. The cemented group (n=10) had radiopaque high viscosity polymethylmethacrylate cement injected via Jamshidi needle into the base of the odontoid peg. The other group was not augmented. A V-shaped punch was used for loading the odontoid in an antero-posterior direction until failure. The failure state was defined as screw cut-out or 5% force decrease. Mean failure load and bending stiffness were...
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Biomechanical and clinical evaluation of different reconstruction techniques of the anterior cruciate ligament
Kautzner, Jakub ; Havlas, Vojtěch (advisor) ; Podškubka, Aleš (referee) ; Skála-Rosenbaum, Jiří (referee)
Aim: This disertation study was divided into two main topics, clinical trial and biomechanical experiment. The aim of clinical part was to evaluate and compare clinical outcomes after ACL reconstruction using two main types of autografts in woman patients. Eperimental part of the study was designed to investigate the effect of graft interaction with the fixation material on biomechanical properties of the graft. Methods: In clinical part of the study 150 female patients after ACL reconstruction after 2 years postoperatively. Clinical results based on Tegner-Lysholm score, knee laxity and anterior knee pain were recorded for both groups and then compared. Experimental part of the study was designed to evaluate the biomechanical properties of hamstring grafts using load-to failure impaction testing using laser vibrometer. The effect of graft's structure damage on the biomechanical properties of the graft was tested. Results: Tegner-Lysholm score improved in both observed groups, there was no significant difference in results between both groups at 2 years postoperatively. The experimantal part of the study supported the hypothesis that the biomechanical properties will be significantly affected by the interaction with the fixation device Conclusion: Clinical results show no difference between the two...
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Intra-articular Calcaneal Fractures - Osteosynthesis with Calcaneal Locking Compression Plate - Contribution to Fill Defect in Body of Calcaneus
Zeman, Jaroslav ; Koudela, Karel (advisor) ; Plánka, Ladislav (referee) ; Skála-Rosenbaum, Jiří (referee)
Calcaneal fractures are common injuries that prevent patients from getting on with their normal life for a long time. They are usually caused by axial forces leading to impaction of the talus into the calcaneus. Falls and jumps from heights are the most common causes. These fractures also occur bilaterally. We used open reduction and internal fixation with a calcaneal LCP for the treatment of 98 patients with 114 calcaneal fractures in our department from August 2005 till December 2011. Bilateral fractures of the calcaneus occurred in 16 patients - 2 women and 14 men. On the day of injury plain radiographs of the calcaneus in lateral and axial projection were taken. Computed tomography was performed in all operated patients in sagittal, transversal and coronal planes. On the basis of CT findings the fractures were classified as Sanders types I - IV. Patients with type II and III fractures were indicated for surgical ORIF treatment. The results were evaluated using the Rowe score. The aim of the experimental work was to assess the biomechanical strength of the calcaneus without fracture and to compare it with the strength of the calcaneus after the osteosynthesis with an angular stable plate alone or in combination with filling of the calcaneal defect with injectable self-hardening hydroxyapatite...
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Single-Bundle versus Double-Bundle Technique of the Anatomical Anterior Cruciate Ligament Reconstruction
Zeman, Petr ; Koudela, Karel (advisor) ; Skála-Rosenbaum, Jiří (referee) ; Kalina, Radim (referee)
Purpose of the study: The aim of the study is to present a comparison of two years result of double-bundle versus single-bundle anatomical reconstruction of the anterior cruciate ligament using hamstring tendons and their fixation with bioabsorbable interference screws. Material and methods: A total of 110 patients with an isolated anterior cruciate ligament rupture and the healthy contralateral knee who met the indication criteria for double- bundle anterior cruciate ligament reconstruction were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At two years after surgery, 82 patients (DB group, n=43; SB group, n=39), comprising 66 men and 16 women, were evaluated; the average age was 29 years and the injury-to- surgery interval was 81 days. Pre-operative and post-operative subjective criteria involved the subjective IKDC and Lysholm score were evaluated. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20ř flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. Results: No statistically significant difference was found in pre-operative values between the two...
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