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A Sosna

Publications and source records attributed to A Sosna.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Current views on diagnosis of osteoarticular tuberculosis].

This paper presents current methods used in the diagnosis of osteoarticular tuberculosis in the Czech Republic. It draws attention to difficulties and errors associated with the diagnosis of this disease. The aim of this study is to provide a comprehensive review of relevant diagnostic methods, from medical history to imaging techniques. A misdiagnosis and/or a late establishment of the diagnosis, which may result in inadequate primary therapy, prolong both the time needed for complete treatment and the duration of absenteeism. These may eventually have negative economic and social implications.

Diagnosis, Differential↗
PubMed2001

[Total hip joint replacement with the Walter type of prosthesis--long-term results].

PURPOSE OF THE STUDY: The authors deal with the issues of loosening of Walter cementless total hip replacement. The intention was to develop the curve of survival of components of the implant and analyze the causes of their failure. MATERIAL: On the group of 127 patients on between 1988 and 1991 with the average follow-up of 9.4 years the authors operated analyze results of this type of implant which was applied in the whole main spectre of orthopaedic indications. METHODS: Based on the results survival curves were drawn by the method after Kaplan-Meier and they were compared from different views. RESULTS: Loosening requiring revision was recorded in 33 cases, a marked decline of the curve was evident after the fifth year. Ten-year survival was recorded in 66% of cups. The comparison of the implant survival diagram in patients operated on by different surgeons revealed the substantial impact of the surgical technique on the implant survival. Loosening of the stem was recorded in 16 cases. More than 80% of stems have survived ten years. DISCUSSION: As potential causes of the failure of the cup the authors consider errors in the surgical technique, excessive pitch of cup thread and material composition of the used alloy from which the primary series of cups was manufactured. The error was also caused by the indication of a conical cup in cases of oval defects solved by the combination of the cup and a solid homogenous bone graft (21% of loosened cups). In stem loosening the cause again consists in incorrect surgical technical and material composition of the used alloy. A marked improvement of the survival curve may be achieved by the stem surface finish in the form of a combined plasmatic hydroxyapatite coating. CONCLUSION: Results obtained from the preceding model of the Walter cup led to the change of the design of both the cup and the stem. The original titanium alloy VT6 was replaced by Tl6A14V ELI (Extra Low Interstitial) according to a more strict ASTM F136 standard. Osteointegration of both components has been improved by porous titanic surface combined with hydroxyapatite.

Adult↗
PubMed2001

[Effect of ultrasonic shock waves on the bone-bone cement interface].

PURPOSE OF THE STUDY: Identification of the impact of ultrasound shock wave on the integration of bone cement in the bone and the examination of a potential application of this method in order to facilitate the extraction of cemented implants, mainly femoral component of total hip arthroplasty. MATERIAL: We used pig proximal femurs from which we made fragments involving approximately one third to one half of the profile of the bone and Palacos bone cement. METHOD: We made a groove in the cancellous bone, pressed bone cement with a wire loop in the cavity and let it harden. The samples were divided by random selection into two groups. Samples from A group were exposed to ultrasound shock waves and group B served as a control group. Then we measured the force needed for the extraction of the cement plug from the bone. RESULTS: Our measuring has shown an evident decrease of the force necessary for the extraction of the bone cement after the application of ultrasound shock wave. We did not find out any macroscopically evident damage of the bone cement or of the surrounding cortical bone. DISCUSSION: The results of our measuring are influenced by a different shape and size of the examined samples which also substantially differ from the situation when a stem of the endoprosthesis is implanted in the femoral canal and is surrounded by a cement mantle. As concerns risks associated with the application of the shock wave in this indication there is a risk of a fracture of the cortical bone around THR stem (the literature does not mention this complication) and a risk of the increase of pressure in the medullary cavity of the femur combined with a risk of fat embolism. In our view this increase of pressure is comparable with the effect of the implantation of femoral component. This method cannot be used for releasing cementless implants as the surrounding cortical bone gets damaged before the implant is released. CONCLUSION: Ultrasound shock wave is still used rarely in orthopaedics, however, the existing results are promising in many aspects. Of great importance is the fact that it is a non-invasive method. The field dealt with by this work covers only experiments in vitro but the results provide hope for a future clinical use.

Animals↗
PubMed2001

[Effect of shock waves on hip prosthesis implantation (preliminary report)].

Revision of total hip arthroplasty has increased dramatically and it began to be a big problem, because of the number of reoperation is growing directly with the number of primoimplantation. Extraction of bone cement from the canal of the femur is timely and technically very difficult and related with many complications. Therapy by ESWL was applicated in clinical praxis for the first time in the therapy of urolithiasis and then choledocholithiasis. Now it is used in orthopedy for the therapy of pseudoarthrosis, entesopathia and anthores. In our experiment we used models of pork femur to which we implanted the endoprothesis to bone cement. We expouned these samples to ESWL and controlled the ability of releasing of the endoprothesis. We replayed the experiment for four times after an abnormal number of shockwaves (more than 8,000 shocks), in two cases endoprothesis release spontaneously, in one case we needed a little power to release it and in the four cases the releasing was not achieved. These results show the probable influence of the shockwaves between the layers metal-cement and cement-bone spongiosa.

Animals↗
PubMed1996

Wrist arthrodesis in rheumatoid arthritis. A new technique using internal fixation.

Arthrodesis of the wrist is a standard operation which is indicated for severe rheumatoid arthritis in which destruction is too advanced for more conservative procedures, or after failure of previous surgery. We have developed an L-shaped plate designed for this purpose. It provides rigid internal fixation with the wrist in the neutral position and utilises bone grafts obtained from the distal ulna and the carpal bones. We have carried out 29 successful fusions between 1992 and 1995. In all 29 patients synovectomy and resection of the head of the ulna were performed; 11 also had reconstruction of ruptured extensor tendons. All the patients obtained bony union, pain relief and improved function.

Adult↗
PubMed1994

[A modified Desault bandage for fixation of the proximal humerus].

The authors present a variant of Desault's bandage for fixation of conservatively treated injuries of the proximal end of the humerus and for fixation of the upper extremity after surgery in this area. The bandage is made with elastic net bandage (called pruban), it is sufficiently strong and its application is easier and less time consuming.

Bandages↗
PubMed1993

[Results of reconstructive surgery in fractures of the proximal humerus].

In treatment of comminuted dislocation fractures of the proximal humerus the most serious therapeutic problem still remains the 6th group of Neer's classification, in particular fractures with four fragments and with a completely dislocated and devitalized head. The authors present in a retrospective study an overall comparison of results assembled in 30 patients (and 19 checked patients resp.) who were operated by the technique of anatomical reconstruction (13 and 8 patients resp.) or by the authors own technique of non-anatomical reconstruction (17 and 11 patients resp.), all operated on account of comminuted dislocation fractures of the proximal humerus at the orthopaedic clinics of the First and Third Medical Faculty, Charles University, Prague in 1976-1988. Analysis of the results of the checked patients made the authors draw the following conclusions: 1. Fractures of the proximal end of the humerus is a relative frequent injury, in particular in the elderly. About 20% of these injuries call for surgical treatment. 2. In all non-anatomical reconstructions the mobility is very restricted in particular exorotation, in anatomical reconstructions the restriction is much smaller. 3. In all patients operated by the technique of non-anatomical reconstruction within three years necrobiotic reconstruction of the fragment of the head occurred which is the greater, the larger the fragment of the head which was preserved. 4. The result of the reconstruction depends on the preservation of nurture of the fragment of the head and on selection of an adequate technique of osteosynthesis. 5. In anatomical reconstructions the most frequent complication was loosening of the osteosynthetic material, a varus position of the head and pseudoarthrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Our method of arthrodesis of the wrist].

The authors emphasize the importance of a stable pain-free carpus for the function of fingers. Reflections on their own type of osteosynthesis are based on anatomical and biomechanical findings. They emphasize the functional concept of the central pillar of the wrist where maximum flexion and extension takes place. In this very line formed by the distal portion of the radius, os lunatum, os capitatum and the base of the third metacarpal bone they apply the splint. The splint is as compared with classical AO splints low (only 2.8 mm), L-shaped and in its cross section slightly convex dorsally. It follows thus the natural arching of the carpal and metacarpal bone and does not increase the tension of soft structures and the overlying skin. By the localization of oval openings it makes slight self-compression possible and ensures adequate, three-point fixation of the metacarpal region. The oval opening in the short branch of the splint serves location of the centre of the transverse section of the second metacarpal bone and ensures correct placement of the screw. It makes plastic operation of extensors possible which in rheumatic synovialis and destruction of the carpal bone are frequently impaired. The authors present the results of 21 operations. Adequate healing of bone was achieved in all patients, on average after 3.5 months. In all the height of the carpal index (CHI) was increased and the hand grip improved. In nine patients they found rupture of the extensors and repaired it. In all instances they performed synovectomy and resection of the head of the ulna. Two patients have bilateral arthrodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Autofixation of the transposed tibial tuberosity in habitual patellar dislocation].

Habitual luxation of the patella is as a rule considered an indication for a stabilizing operation. As regards approaches to the surgical solution of this problem we can differentiate between operations of the proximal part of the extension apparatus, i.e. operations of the soft tissues and operations on the distal part of the extension apparatus, above all plastic operations and transposition of the insertion of the lig. patellae on the tuberositas tibiae. In the present paper the authors submit their own modification of transposition of the tuberositas tibiae, suitable in severe affections after closure of the epiphyseal space. The described technique makes it possible to anchor the transposed tuberosity by an autofixation mechanism without using osteosynthetic material. The basis of the method is removal of a small block of bone with the insertion of the lig. patellae, size 2 x 4 cm, and its insertion beneath the corticalis at a site selected in advance into an opening 2 x 2 cm with subsequent covering and stitching of the periosteum. The extent of medialization depends on testing during flexion and extension. To prevent the development of the syndrome of patellar hyperpression it is important to avoid excessive distalization of the insertion of the ligament. During the preoperative period it is recommended to apply a plaster splint for two weeks, followed by functional rehabilitation and gradual burdening; complete burdening should be attained by the third month after operation. The surgical technique was tested in a group of 16 patients at the First Orthopaedic Clinic and with regard to its simplicity and reliability the method can be recommended.

Humans↗
PubMed1991

[Non-cemented alloplasty of the hip joint].

The authors present a review of the contemporary problem of non-cemented alloplasty of the hip joint. They compare the advantages and disadvantages of cemented and non-cemented endoprostheses of the hip joint in relation to possible loosening and possible re-operation and with regard to the surgical technique. The negative action of bone cement is divided into two groups: 1. immediate effects which act on surrounding tissues and the patient's organism during operation. 2. late effects which involve abrasion and the phagocytic response to small cement fragments and the formation of osteoaggressive granulations. These late effects are demonstrated on histological material. The authors emphasize that non-cemented alloplasty has also some pitfalls which involve in particular higher demands on the accuracy of the surgical technique and, no doubt, more severe haemorrhage. The main advantages are according to the authors the elimination of negative effects of bone cement, in particular late effects. The authors tried to classify the contemporary spectrum of available non-cemented implants with regard to their design, materials and surface finish.

Bone Cements↗
PubMed1990

[Long-term results of Ludloff's repositioning method].

Authors have evaluated results of the surgical treatment of congenital dysplasia of the hip joint performed at I Orthopaedic Clinic in Prague in the years 1970-1985. In the course of this period open reduction according to Ludloff was performed in seventy children out of which eight times bilaterally. Fifty-six out of the total number of seventy children same for the follow-up check. The age of the children operated on ranged between five and 23 months; in six cases the operation was performed on both hip joints. The follow-up ranged from three to eighteen years with an average of eleven years. In all children the postoperative treatment consisted in the application of the Hanausek biomechanical apparatus. On the basis of clinical and roentgenological criteria the results were divided into fair and poor results. For fair result were considered the hips with a good range of motion (none of the motions was reduced more than by 50 percent of the normal range), patients did not feel any pain, the limb shortening did not exceed 1 cm and the Trendellenburg test was negative. From the roentegonological viewpoint for fair were considered the findings without persisting subluxation and dislocation with the spheric head (the asphercity on the Moose template did not exceed 2 mm) and without evident shape deformities of the proximal end of the femur (coxa vara, overgrowth of the greater trochanter). Only such hips which meeted both the clinical and roentgenological criteria were evaluated in general as fair, the other were assessed as poor. On the basis of these criteria the result of the treatment was evaluated as fair in 76 percent and poor in 24 percent of cases. The authors also observed the incidence of aseptic necrosis of the femoral head from the viewpoint of the types defined by Bucholz and Ogden. Necrosis of Type I was not found in the group, necrosis of Type II occurred 12 times, necrosis of Type III and Type IV three times each. No evident connection was found out between the incidence of the necrosis of head and the ligation of both branches of a. circumflexa femoris medialis. The main cause of the impossibility to perform reduction was the isthmus of the joint capsula in its inferomedial portion in the area of iliofemoral ligament. Of decisive importance for the development of the joint after open reduction was a perfect reduction of the head into acetabulum.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[Classification of deformities of the glenoid labrum in congenital hip dislocation].

The authors have developed their own classification of the deformities of labrum glenoidale in congenital hip dislocation. Open reposition was performed by the Ludloff procedure. The basic material for their work was the group of patients operated on at I. Orthopaedic Clinic of the Faculty of General Medicine of Charles University in Prague in the years 1970-1985. In the course of this period they operated on 78 hip joints in 70 children, out of which 8 operations were bilateral, the group comprised 17 boys and 53 girls, operation was performed on 30 right hip joints and 48 left ones. The age of children ranged from 5 to 23 months. The average age of children in time of operation was 9.3 months. On the basis of the cadaver material the authors have found out that glenoidale represents an extensive part of acetabulum. Labrum glenoidale is considerably more sizable in the dorsal parts of acetabulum so that the head seems to be completely enveloped by ligamentary limbus and the acetabulum seems to form at least half of the ball-shaped surface. In the dorsal and upper parts the acetabulum is from great part formed by a fibrous structure which is easily deformed. The pressure applied to the head dorsally can result in its dislocation just because the cartilaginous model of acetabulum is flat in its dorsal and proximal parts. This easily deformable structure is under certain conditions deformed by pressure of the head in such a way that in the first phase in the course of the onset of the dislocation it is always everted and in the second phase the evertion lither persists or the head shifts over the margin of the limbus and the limbus is then inverted by reposition force. The authors present in their work the classification of the limbus. Proceeding from operation findings they divide limbi into four groups according to differences in their shape: Type I: regularly annular (everted) limbus--it corresponds to a normal anatomic shape, it is not pronouncedly deformed and does not present an impediment to reduction. Type II: inverted gracilis limbus--it is exaggerated in comparison to the normal one, usually it is inverted in the acetabulum, it is never rigid but elastic. Together with the structure of capsule it can be an impediment to reduction. It can be relatively easily everted. Type III: inverted callous limbus--it is sizable, rigid, reducing by its position the capacity of the acetabulum. The reduction is usually difficult.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetabulum↗