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Biomedical subjects

J Pilný

Publications and source records attributed to J Pilný.

At least 19 recordsLinked to original sources
PubMed2007

[Defect of the femoral condyle in the knee after patellectomy. Long-term results of fresh massive osteochondral allografting].

The presence of a massive full-thickness osteochondral defect in the knee of young and active individuals is an unsolved problem in orthopedic surgery, especially in post-traumatic large bone defects. Fresh massive osteochondral allografts have been used for many years but mostly in oncology but not in post-traumatic cases. This case report describes a 20-year-old right leg-dominant woman, who, at age 19, sustained open Gustilo-Anderson type III comminuted fractures of the left patella and lateral femoral condyle in a motorbike accident. Initial treatment included immediate débridement and patellectomy with lavage. The large defect of the femoral condyle was reconstructed with a massive osteochondral allograft 1 year after the injury. The graft was obtained from our institutional tissue bank. The damaged bearing part of the condyle was resected to bleeding bone to create the nearly rectangular defect. The central condyle wall remained intact. The graft was trimmed to fit the defect and fixed with three cancellous 6.5-mm screws. The meniscus was not damaged. Partial weight bearing was permitted at 8 weeks and full weight bearing at 16 weeks after the surgery. At the last follow-up control 10 years after the surgery, no evidence of tibiofemoral arthrosis was present. The allograft-host interface was not visible. The radiodensity of the graft was nearly identical to the host bone. The Lysholm score and clinical findings were identical (100 points) to those 18 months after the surgery. The patient was extremely satisfied without complaints at 30 years of age.

Adult↗
PubMed2006

[Intra-articular calcaneal fractures].

PURPOSE OF THE STUDY: In this retrospective evaluation the authors present the group of patients with intraarticular calcaneal fractures that were treated from an extended lateral approach. MATERIAL: In the period from 2001 to 2003, 32 patients with intra-articular calcaneal fractures were treated by osteosynthesis, using a plate, from the extended lateral approach. All patients were men at an average age of 41.7 years (range, 20 to 63 years). The most frequent cause of injury was a fall from height. A combined injury was recorded in eight patients. The right calcaneus was broken in 11 and the left one in 21 patients. Patients with bilateral calcaneal fractures were not included in the evaluation. METHODS: Preoperative X-ray and CT examinations of the fractured calcaneus were carried out in all patients. The Sanders classification of calcaneal fractures was used for fracture evaluation. All patients were treated from the extended lateral approach by osteosynthesis with the use of a plate. Spongioplasty using an autologous graft from the iliac crest or an allogenous graft was carried out in 21 and 11 patients, respectively. The patients were operated on within an average of 7.3 days of admission (1 to 16 days), and were followed up for at least one year (average, 30 months) after surgery. Postoperative evaluation was based on radiographs and the results of the Kerr rating system obtained from questionnaires. RESULTS: The outcomes were excellent, 36 %; very good, 44 %; good, 17 %; and poor, 3 %. The Böhler angle postoperatively assessed on radiographs was on average + 28.5 degrees. All patients showed bone union, and no pseudoarthrosis was recorded. One patient had to be treated for a late purulent complication requiring metal removal. One patient underwent early wound revision due to postoperative hematoma. The metal was removed on average at 13 months postoperatively (range, 2.5 to 26 months). DISCUSSION: The treatment of intra-articular calcaneal fractures is determined by the type of injury, state of soft issues in the limb injured, patient's status and surgeon's experience. CONCLUSIONS: Our results as well as literature data show that exact reduction of the posterior subtalar joint with internal osteosynthesis can achieve good clinical outcomes in patients with intraarticular calcaneal fractures, particularly when the fractures are classified as Sanders II and III types.

Adult↗
PubMed2005

[Forefoot surgery under regional anesthesia].

PURPOSE OF THE STUDY: The aim of this study is to present the method of lower limb peripheral nerve block for forefoot surgery and, in comparison with other methods, to evaluate the results in terms of postoperative analgesia and postoperative complications. MATERIAL: Our group included 164 patients, 13 men and 151 women in the age range from 16 to 79 years, who underwent surgery for forefoot deformities during the years 1998-99. Of these, 77 (46 %) were operated on under general anesthesia, 54 (33 %) under infiltration anesthesia and 33 (21 %) under peripheral nerve block. METHODS: When peripheral nerve block was used, the anesthetic Marcain was administered about 1 hour before surgery at the following sites: along the deep branch of the peroneal nerve on the dorsal side of the foot, along the tibial nerve behind the inner ankle, and along the sural nerve in the outer ankle region. After surgery, the duration of requirement for analgesia in all three types of anesthesia was recorded. Complications associated with wound healing were also recorded. Subjective satisfaction of the patients was evaluated as a separate issue. RESULTS: No intraoperative complications were found in the patients operated on under peripheral nerve block. In three patients, regional anesthesia was not sufficient and had to be completed with topical anesthetics administered during the operation. The patients treated under regional anesthesia asked for analgesics after an average of 9.5 hours; those operated on under infiltration and general anesthesia required analgesics at an average of 2.5 hours (range, 2 to 4 hours) and within 30 min of waking up, respectively. Complications associated with wound healing were recorded in 5 %, 11 % and 6 % of the patients treated under general, infiltration and regional anesthesia, respectively. Of the 33 patients operated on under regional anesthesia, 28 would prefer this anesthesia for any other similar surgery and five would rather have general anesthesia. DISCUSSION: Regional anesthesia is associated with fewer complications of wound healing than topical anesthesia, which is apparently due to a lower degree of ischemia produced in the treated limb by peripheral nerve block. Healing after regional anesthesia is only a little worse than after general anesthesia, but with the absence of risks related to general anesthesia. Patients operated on under general anesthesia feel pain immediately after surgery, those receiving infiltration anesthesia ask for painkillers at an average of 2.5 hours and, with well-introduced regional anesthesia, patients are free from pain for 9.5 hour on the average. The duration of postoperative pain absence is also related to the anesthetic used. The use of 1 % Mesocain results in a fast onset of anesthesia but its effect is shorter, while 0.5 % Marcain has a slower onset but a longer effect. CONCLUSIONS: Regional anesthesia for forefoot surgery, if the anesthetic is well administered, is one of the options associated with minimal risks. It apparently reduces complications of wound healing, when compared with infiltration anesthesia. It can be used in situations where general anesthesia would put the patient at risk. It also has a pronounced analgesic effect that persists well after surgery and provides better postoperative comfort for the patient. Key words: lower limb, peripheral nerve block, forefoot surgery.

Adolescent↗
PubMed2005

[Heel pain].

Heel pain is quite frequent clinical symptom in our population. Successful therapy derives from the problem aetiology. The most frequent source of pain is the mechanical basis, both on dorsal and plantar side of calcaneum. Therapy includes a variety of procedures, from routine measures to surgical intervention.

Biomechanical Phenomena↗
PubMed2005

[Our experience with repair of the scapholunate ligament using the MITEK bone anchor].

PURPOSE OF THE STUDY: A complete rupture of the scapholunate (SL) interosseal ligament results in palmar flexion of the scaphoid and dorsiflexion of the lunate that leads to disintegration of the carpal circle and the development of scapholunate dissociation with dorsal intercalary segment instability. If the injury is not treated properly or early, the abnormal position of the scaphoid and lunate results in degenerative changes of the wrist shown by X-ray and referred to as scapholunate advanced collapse (SLAC). The aim of this study was to evaluate the results of our method used for reconstruction of the SL ligament by means of MITEK bone anchors in acute injury. MATERIAL AND METHODS: The group included 17 patients, 12 male and 5 female, aged 18 to 49 years, with complete SL ligament ruptures. The dominant hand was affected in 10 patients. After the diagnosis had been confirmed, we performed reconstructive surgery involving re-attachment of the SL ligament to the scaphoid by means of the MITEK Mini G2 anchor. The patients were examined by X-rays at 3, 6, 12 and 24 months after the operation to assess the SL angle, capitolunate (CL) angle, SL distance and signs of SLAC. Hand function and pain were evaluated on the basis of the Wrightington Hospital Wrist Scoring (WHWS) system. RESULTS: The average preoperative value of the SL angle was 79 degrees and was corrected to 38 degrees by surgery. By subsequent physical therapy for 12 months, an SL angle of 51 degrees was achieved and increased to 52 degrees during the following year. The CL angle, showing a preoperative average value of 34 degrees, was corrected by surgery to 6 degrees, further increased to 9 degrees by exercising and then remained unchanged. The average SL distance of 5.25 mm preoperatively was reduced to 2.75 mm by surgery with no further change. At 24 months of follow-up, the results of pain evaluation were excellent, good and satisfactory in 41 %, 47 % and 12 % of the patients, respectively, with no poor outcome indicating restriction of the patient's daily activities. Functioning of the hand was excellent in 47 %, good also in 47 % and satisfactory in 6 % of the patients. The range of motion was excellent, good and satisfactory in 24 %, 64 % and 12 % of the patients, respectively. No stiff wrist was recorded after reconstruction of the SL ligament by our method. The hand grip was evaluated as excellent in 47 %, good in 35 % and satisfactory in 18 % of the patients. DISCUSSION: The results show that by reconstruction of the SL ligament with the use of MITEK anchors, radiographic values of the SL and CL angles and SL distance can reach the normal levels within 24 months of the operation. As assessed by the WHWS system, excellent and good results were achieved in 88 % of the wrists treated. Similarly, at 24 months of followup, excellent or good functional outcomes were reported by 94 % of the patients, and excellent or good results in relation to the range of motion and hand grip were experienced by 88 % and 82 % of the patients, respectively. CONCLUSIONS: When treating complete SL ligament ruptures within 4 weeks of injury, stabilization with Kirschner's wires, re-attachment of the SL ligament and suture of the articular capsule are adequate procedures leading to the best results. The ligament reconstruction with MITEK anchors, as presented here, is a relatively simple method giving good results. For treatment of chronic instability it is necessary to use other surgical procedures that, however, will reduce wrist mobility to a greater extent.

Adolescent↗
PubMed2004

[Arthroscopy in the diagnosis and therapy of wrist disorders].

PURPOSE OF THE STUDY: Arthroscopy of the wrist is a method facilitating the establishment of diagnosis in patients with wrist complaints which may also serve for surgical management of some of the causes of wrist pathology. The author presents his first experience with carpal arthroscopy as a diagnostic method as well as a therapeutic technique performed in one or two stages. MATERIAL: A total of 34 patients, 12 women and 22 men, in the age range of 14 to 64 years, underwent carpal arthroscopy. This was performed to treat acute or chronic conditions in 16 and 18 patients, respectively. METHODS: Arthroscopy was carried out with the hand in vertical traction, using distraction forces of 50 to 70 N, from the approach between the third and fourth or/and the fourth and fifth extensor compartments, in order to inspect the mediocarpal joint by an arthroscope with a diameter of 2.4 mm. Neither a tourniquet nor a pump was employed. When a lesion was detected, it was treated by arthroscopy or an open procedure in one surgical procedure. When indicated, further surgical intervention followed. RESULTS: The arthroscopic inspection revealed triangular fibrocartilagenous complex (TFCC) lesions in 18 patients. Injury to the scaphoid-lunate (SL) ligament was found in 16 patients. One patient had a combined lesion of the triquetral-lunate and SL ligaments, two showed a SL lesion together with a distal radius fracture, three were diagnosed with pseudoarthrosis of the scaphoid bone and one with synovitis after rheumatoid arthritis. In two patients, adhesions in the radiocarpal joint following a fracture of the distal radius were found and shaved. A total of 22 patients were treated by arthroscopic surgery; 19 underwent open procedures in one stage and five were indicated for secondary surgery. DISCUSSION: Wrist arthroscopy has been reported in the literature as the only method that can reveal damage to SL ligaments not shown by X-ray or magnetic resonance imaging examination. During arthroscopy, several interventions can directly be carried out by this procedure, such as treatment of the TFCC, and thus relieve the patient's complaints. Arthroscopy is irreplaceable in the diagnosis of dynamic carpal instability or injury to TFCC in ulnar-carpal impingement. Our experience suggests that arthroscopically-guided osteosynthesis of the distal radius has great prospects. CONCLUSIONS: In our hospital acute arthroscopy is indicated when carpal connective tissue lesions, potentially leading to wrist instability, are suspected, when damage to carpal ligaments is found by X-ray examination or when an acute TFCC lesion is suspected. Arthroscopically-guided osteosynthesis of the distal radius appears to be a prospective method. In patients with chronic complaints, wrist arthroscopy is indicated in suspected TFCC lesions with ulnar-carpal impingement, in chronic carpal synovitis, and before sperious operations on the carpal bones in order to ascertain the state of cartilage and plan the appropriate surgery.

Adolescent↗
PubMed1980

Quantitative evaluation of the development of isoprenaline-induced heart lesions.

The development of heart lesions induced by isoprenaline (ISO) was quantitatively evaluated by 203Hg-Mercurascan (MSC) which was taken up and retained in the damaged cells. After the administration of ISO, the MSC uptake increased immediately at a constant rate, which was independent of the dose of ISO. A higher cardiotoxic effect of increased doses of ISO was caused by prolongation of the time during which the development of heart lesions proceeded. Later, when the damaged cells were subjected to cytolysis, MSC uptake decreased. The blockade of the effect of ISO by methypranol immediately stopped any further increase of MSC uptake. The accumulation of other labelled substances (Neohydrin, HgCl2, CaCl2) in the damaged myocardium was compared with the uptake of MSC. MSC and HgCl2 in particular are suitable for the observation of early changes; relatively less CaCl2 accumulated in the damaged hearts, but it can be used for the detection of more advanced lesions.

Animals↗