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V Smetana

Publications and source records attributed to V Smetana.

10 recordsLinked to original sources
PubMed2001

[Transposition and hemitransposition of the anterior tibial muscle in the treatment of pes equinovarus].

PURPOSE OF THE STUDY: Authors present transposition and hemitransposition of anterior tibial muscle as one of the supporting surgeries in the treatment of neurogenous but also congenital club foot. MATERIAL: In the period of 30 years they indicated and performed transposition of anterior tibial muscle 79 times in 75 patients and hemitransposition of anterior tibial muscle in 27 patients. Most frequently they used this method in patients with childrens' cerebral palsy, least frequently in patients with congenital club foot. METHODS: The authors prefer hemitransposition of anterior tibial muscle (Biesalski-Mayer) at the younger age and transposition of the whole anterior tibial muscle in children above the age of 9 years and in cases where the foot is more rigid or where bone changes already have developed. From the medial approach they expose the distal origin of the tendon of anterior tibial muscle, separate one or both origins of the tendon in compliance with the nature of the transposition, transpose over a supporting section above the ankle and fix the tendon to base V or IV of the metatarsal. The evaluated group included patients who at the given period attended the control check, i.e. 14 patients after hemitransposition and 45 patients after complete transposition. The shortest interval after the surgery was 9 months. RESULTS: In the evaluated group the authors performed clinical examination and radiograph. They report excellent results in hemitransposition in 57.1% with achieved plantigrade position of the foot and the function of transposed muscle 4 according to the muscle test. In 42.9% of cases the result was good. Similar results they recorded in complete transposition, excellent result in 23 cases (48.9%), good result in 8 patients (38.2%), in 2 patients there occured valgus overcorrection (4.3%), in 8.5% of patients with progressive disease the position subsequently worsened. Radiograph examination showed in the younger age group until the age of 8 years an increased value of the talocalcanear angle. DISCUSSION: By the number of patients, indication and results the evaluated group is comparable with literary data. The authors present reasons for the localization of transposition to Vth or IVth metatarsal in contradiction to biomechanical studies. This operation is not usually indicated as a separate surgery, most often it is performed simultaneously with the operation on m. triceps surrae and operation after Steindler. CONCLUSION: The method of transposition of anterior tibial muscle is recommended by authors mainly in neurogenous club foot where a combined operation on muscles may result in the final remedy of the defect. The method of complete transposition of anterior tibial muscle may be used also in progressive neurogenous diseases with the purpose of postponing resection sub talo.

Adolescent↗
PubMed1995

On the mechanical function of tendon.

A mesoscopic approach is followed for mathematical modelling of the specific deformation properties of tendon. The approach starts from our general concept of modelling mechanical behaviour of heterogeneous media and assumes that the structure of tendon is optimized in such a way that it enables its adjacent muscle to work with a constant performance in the course of increasing loading (acting like a gearbox in a car). The model based on this assumption gives results that are in a very good accordance with observed properties of tendons. Clinical experience reveals that if this function of tendon is violated pathological changes appear in the respective muscle. RELEVANCE: Clarification and mathematical modelling of the mechanical function of tendon is of intellectual interest in its own right, but it is important also for cautioning surgeons against unnecessary violation of this function, and for tissue engineering aspects if tendon must be replaced.

Journal Article↗
PubMed1994

[Personal experience with the Grice operation in patients with cerebral palsy].

The authors give an account of Grice's operation, i.e. extraarticular, talocalcaneal arthrodesis as one of the basic operations in infantile cerebral palsy in children and adolescents which can be used in the spastic as well as paretic form of the disease. It is valuable as after reposition it stabilizes the position of tarsal bone sub talo. The 65 operations by Grice's method in infantile cerebral palsy with very favourable results (failure or partial failure in five operations, i.e. 9.2%) and the authors' experience with this operations also in other neurogenic disorders indicates that the operation is justified in children and adolescents. It may be performed also in adults. According to the authors' experience this operation does not lead during subsequent development to deformities of the sole and does not merely substitute the well known triple arthrodesis sub talo. Its application is much wider. It can be combined with other surgical procedures on soft parts as well as bones, in particular with Young's operation and with temporary fixation of tarsal bones with Kirschner wires after reposition.

Adolescent↗
PubMed1993

[Personal experience with treatment of congenital pes equinovarus].

The authors evaluated a group of 256 children operated in 1983-1992 at the Orthopaedic Clinic of the Faculty Hospital on account of congenital pes equinovarus. These children account for 25% of the total number of children treated because of this inborn defect by conservative treatment. The authors draw attention to the lack of uniformity of contemporary treatment of congenital pes equinovarus, and based on their own experience, they recommend an exact therapeutic plan. They emphasize the importance of early treatment by means of corrective plaster bandages, they describe the tactics of treatment by this method, as any deviation from this therapeutic pattern leads to incomplete elimination of the defect and to relapses. The authors present also a general review of possible surgical treatment and emphasize the tactics of postoperative treatment, incl. intensive rehabilitation and correction by footwear. They emphasize in particular the necessity of systematic and uninterrupted conservative treatment which is essential as preoperative preparation, as only by intensive care before and after surgery, incl. a correctly indicated and implemented operation, the desired goal, i.e. an anatomical position of the foot can be achieved.

Clubfoot↗
PubMed1993

[The Strayer surgical technic as the basic operation for treatment of pes equinus in cerebral palsy].

The authors describe the technique of Strayer's operation (gastrocnemius recession) in the spastic form of cerebral palsy and draw attention to its indications, possible combinations with other operations and technical errors associated with its implementation. They evaluate 644 operations made by Strayer's method. In 361 regularly followed-up patients they evaluate from the long-term aspect combined operations of the lower extremities (which form a functional unit), using as a basis their own locomotor and position standards. They emphasize the necessity of a correct strategy, i.e. selection and sequence of surgical procedures. They recommend Strayer's operation (gastrocnemius recession) as the basic operation in pes equinus spasticus and in genu flectum spasticum. In the conclusion they present their own modification of Strayer's operation elaborated by the first author.

Adolescent↗
PubMed1993

[Genu flectum in cerebral palsy, elongation of the flexors of the knee joint and our modification].

The authors evaluate the results of prolongation of the flexors of the knee joint in 175 patients with a flexed position of the knee joint associated with the spastic form of cerebral palsy. They draw attention to the interrelationship of the position of the lower extremities in the area of the sole, knee and hip joint and emphasize the necessity of correct assessment of primary contractures. They emphasize also the evaluation of correct concurrent function of flexors and extensors of the knee and their balanced functioning. The authors prefer a single surgical operation in combined affections of the lower extremities to the system of so-called minor steps. They emphasize the importance of postoperative rehabilitation and prosthetic support. In the authors' opinion surgery of the knee joint in manifestations of cerebral palsy on the lower extremities is the most controversial area associated with the highest percentage of failures and complications. Contrary to data in the literature, they refute the necessity of capsulotomy of the knee joint and recommend their own modification how to treat severe forms of genu flectum spasticum.

Adolescent↗
PubMed1993

[Importance of tenotomy of the adductors in the treatment of cerebral palsy manifestations in the lower extremities].

The authors evaluate 303 tenotomies of adductors performed in patients with cerebral palsy (CP) in 1970-1992. They emphasize the correct diagnosis of adduction contracture of the hip joint and correct treatment, incl. early surgery, not only because of the influence of adductors on standing and gait but also on the development of the hip joint in children. The authors draw attention to the increased incidence of subluxations and luxations of the hip joint in recent years in children with CP who were not operated or where the muscular balance and contractures of the hip joint were not modified. They emphasize the fact that in children where tenotomy of the adductors was performed in time before the age of 8 years, with a single exception luxation did not develop. In the authors' opinion tenotomy at the age of cca 11 years is an essential operation but in view of the development of skeletal changes it is late. The authors recommend to pay increased attention to the problem of adductors in CP as regards diagnosis and technical aspects of the operation.

Adolescent↗
PubMed1993

[Orthopedic surgery in children with cerebral palsy].

The authors present their experience with orthopaedic surgical treatment of children with cerebral palsy. The paper is based on a group of 630 patients where they performed 1882 operations of the lower extremities in 1970-1992. The authors evaluate the long-term results in regularly checked 361 patients (205 boys and 156 girls), mostly with the spastic form of cerebral palsy, with regard to different types of affections which markedly influence the prognosis of surgery (monoparesis, hemiparesis, diparesis, triparesis, quadruparesis). The authors emphasize the primary importance of rehabilitation and team work where the orthopaedist's work is guided by efforts to make further rehabilitation training possible and to facilitate it. They consider surgery an integral part of comprehensive treatment of cerebral palsy which must be followed immediately by further rehabilitation. The authors emphasize the part played be the orthopaedic surgeon to prevent the genesis and development of deformities of the locomotor apparatus.

Adolescent↗