Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.
- MeSH
- bércové vředy chirurgie etiologie patologie terapie MeSH
- dospělí MeSH
- imunosupresiva škodlivé účinky MeSH
- komorbidita MeSH
- lidé MeSH
- neúspěšná terapie MeSH
- poranění dolní končetiny chirurgie komplikace patologie terapie MeSH
- tibie * chirurgie patologie zranění MeSH
- záchrana končetiny metody MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The aim of this study was to determine the effects of xylanase and flaxseed the performance of chickens, digesta viscosity, nutrient retention, fatty acid profile in muscle, tibia strength and interrelations of these factors in broiler chickens fed a wheat-based diet. Seven hundred and twenty one-day-old Ross 308 cockerels were assigned to four treatments according to the contents of flaxseed (0 and 80 g/kg) and xylanase (0 and 0.1 g/kg) in the diet. Xylanase significantly decreased the intake of feed (p < 0.001), decreased feed conversion (p < 0.001), and reduced mortality (p = 0.050). In addition, xylanase significantly increased the retention of all nutrients (p = 0.010 -<0.001) except crude fibre, the fat content in breast meat (p = 0.029) and liver (p = 0.019) and the concentration of polyunsaturated fatty acids (PUFAs) in meat (p = 0.002). Flaxseed supplementation did not influence performance but decreased the retention of dry matter (p = 0.016), crude protein (p = 0.012), organic matter (p = 0.016) and nitrogen-free extract (p = 0.008). Xylanase in combination with flaxseed increased the content of n-3 fatty acids in the breast meat (p = 0.006). The lowest n-6/n-3 ratio (p = 0.001) was detected in the flaxseed and flaxseed combined with xylanase groups. Significant interaction effects of flaxseed and xylanase on tibia strength (p = 0.030) and tibia ash content (p = 0.009) were detected. The administration of xylanase or flaxseed alone increased tibia strength. Compared with the control diet, the addition of flaxseed to the diet increased the digesta viscosity (p = 0.043) in the ileum, whereas the addition of xylanase decreased the level of this indicator. It can be concluded that xylanase is an enzyme suitable for increasing nutrient availability, and in the case of its addition to a flaxseed diet, it can reduce the antinutritional effect of flaxseed by reducing the viscosity of the digesta and increasing the content of health-promoting n-3 PUFAs.
- MeSH
- endo-1,4-beta-xylanasy * metabolismus MeSH
- fyziologie výživy zvířat MeSH
- kostní denzita účinky léků MeSH
- krmivo pro zvířata * analýza MeSH
- kur domácí * MeSH
- len * chemie MeSH
- polysacharidy * farmakologie MeSH
- potravní doplňky * analýza MeSH
- tibie účinky léků MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The aim of the present study was to examine the effects of attentional focus instructions on acute changes in the transverse relaxation time (T2) of the femorotibial cartilage and in cartilage volume during repeated drop-jump landings. Ten healthy females (Mage = 20.4 ± 0.8 years) performed a drop landing task from a 50 cm high box over the course of 3 days (50 repetitions each day) across three attentional focus conditions: external focus (EF: focus on landing as soft as possible), internal focus (IF: focus on bending your knees when you land), and control (CON: no-focus instruction), which was counterbalanced across focus conditions. T2 mapping and the volume of femorotibial cartilage were determined from magnetic resonance imaging scans at 1.5 T for the dominant knee before and after completing the drop landings in each attentional focus condition per day. Results indicated a smaller change in cartilage T2 relaxation time and volumetry in the central load-bearing lateral cartilage under the EF, compared to IF and CON. Moreover, the change in T2 and cartilage volume was greater for lateral tibial cartilage as compared to femoral cartilage and was independent of attentional focus instructions. No significant acute quantitative changes were observed in the medial compartment. The peak vertical ground reaction force was found to be the lowest under the EF, compared to IF and CON. These findings suggest that external focus of attention may reduce cartilage load, potentially aiding in the control or management of cartilage injuries during landing in female athletes.
- MeSH
- biomechanika MeSH
- kloubní chrupavka * fyziologie diagnostické zobrazování MeSH
- kolenní kloub fyziologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- mladý dospělý MeSH
- plyometrická cvičení MeSH
- pozornost * fyziologie MeSH
- tibie fyziologie diagnostické zobrazování MeSH
- zatížení muskuloskeletálního systému * fyziologie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This study aimed to summarize our experience with modified drilling epiphysiodesis and prediction methods for accurate timing of surgery and to compare the results with those of recent work by other authors. The Macnicol and Gupta modified drilling technique was used. Distal femoral and/or proximal tibial permanent epiphysiodesis was performed in 42 children (21 boys, 21 girls; median age at surgery=12.6 years, age range=9.4-15.4 years) between 2004 and 2016. Based on the groundwork of previous studies, we developed an auxological prediction method. The limb length discrepancy (LLD) was assessed by clinical examination and verified by an x-ray of the hips when standing with blocks under the shorter leg. The predicted shortening was 2.7 cm ± 1.1 cm. The final discrepancy after finishing skeletal growth was 0.5 ± 0.5 cm. In 26 patients (61.9%), equalization of both legs was achieved (0-0.5 cm). In 4 patients (9.5%), the remaining shortening was more than 1.0 cm. Shortening of an initially longer leg occurred in two patients (0.5 cm and 0.6 cm). Failure of growth plate arrest was observed in 1 patient. In another 3 patients, the efficacy of tibial epiphysiodesis was unsatisfactory. Minor complications occurred in 5 cases, but there was no evidence of angular deformity in the frontal and sagittal planes or proximal fibula overgrowth. Three patients (7.1%) returned to the operating room. Compared to published data, more patients achieved complete equalization of leg length. The results of this study verified the accuracy of the auxological prediction algorithm of LLD based on Shapiro's findings. The surgical outcome is comparable between Shapiro patterns 1 and 3. Auxological examination, assessment of bone age, and sexual maturation are crucial tools for accurate timing of surgery.
- MeSH
- antropometrie metody MeSH
- dítě MeSH
- epifýzy * chirurgie MeSH
- femur * chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- nestejná délka dolních končetin * chirurgie MeSH
- radiografie metody MeSH
- tibie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This study was aimed to compare the variability of inter-joint coordination in the lower-extremities during gait between active individuals with transtibial amputation (TTAs) and healthy individuals (HIs). Fifteen active male TTAs (age: 40.6 ± 16.24 years, height: 1.74 ± 0.09 m, and mass: 71.2 ± 8.87 kg) and HIs (age: 37.25 ± 13.11 years, height: 1.75 ± 0.06 m, and mass: 74 ± 8.75 kg) without gait disabilities voluntarily participated in the study. Participants walked along a level walkway covered with Vicon motion capture system, and their lower-extremity kinematics data were recorded during gait. The spatiotemporal gait parameters, lower-extremity joint range of motion (ROM), and their coordination and variability were calculated and averaged to report a single value for each parameter based on biomechanical symmetry assumption in the lower limbs of HIs. Additionally, these parameters were separately calculated and reported for the intact limb (IL) and the prosthesis limb (PL) in TTAs individuals. Finally, a comparison was made between the averaged values in HIs and those in the IL and PL of TTAs subjects. The results showed that the IL had a significantly lower stride length than that of the PL and averaged value in HIs, and the IL had a significantly lower knee ROM and greater stance-phase duration than that of HIs. Moreover, TTAs showed different coordination patterns in pelvis-to-hip, hip-to-knee, and hip-to-ankle couplings in some parts of the gait cycle. It concludes that the active TTAs with PLs walked with more flexion of the knee and hip, which may indicate a progressive walking strategy and the differences in coordination patterns suggest active TTA individuals used different neuromuscular control strategies to adapt to their amputation. Researchers can extend this work by investigating variations in these parameters across diverse patient populations, including different amputation etiologies and prosthetic designs. Moreover, Clinicians can use the findings to tailor rehabilitation programs for TTAs, emphasizing joint flexibility and coordination.
- MeSH
- amputace * MeSH
- amputovaní MeSH
- biomechanika MeSH
- chůze (způsob) * fyziologie MeSH
- chůze fyziologie MeSH
- dolní končetina MeSH
- dospělí MeSH
- hlezenní kloub patofyziologie MeSH
- kolenní kloub patofyziologie chirurgie MeSH
- kyčelní kloub chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- rozsah kloubních pohybů * MeSH
- tibie chirurgie patofyziologie MeSH
- umělé končetiny * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Total knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent. METHODS: A standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia. RESULTS: The equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 με in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 με, MBT only in less than 64% of the volume. CONCLUSION: The effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.
PURPOSE OF THE STUDY: Temporary hemiepiphyseodesis using figure-eight plates is currently one of the main surgical techniques to correct axial deformities of lower limbs in paediatric patients. Comprehensive analysis, correct indication and monitoring of treatment are the basic prerequisites for successful therapy. The aim of the study was to analyse parameters that could become an alternative to standard parameters used nowadays, namely the inserted screw angle (SA), and a new parameter - condylar ratio (CR). MATERIAL AND METHODS: The study included 47 patients treated at the Department of Paediatric Surgery, Orthopaedics and Traumatology at the University Hospital in Brno between 2014 and 2021 and diagnosed with idiopathic bilateral axis deviation of lower limbs, namely genu valgum. After having met the inclusion criteria, the patients underwent a clinical check-up, and long leg radiographs were also obtained. Anthropometric parameters (age, sex, BMI, intermalleolar distance (IMD)), duration of treatment as well as radiographic parameters - mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), SA and CR, and their derived parameters expressing the change per unit time and defined as a rate of correction (r-mLDFA, r-mMPTA, r-SA, r-CR) were recorded. The obtained values were subsequently statistically analysed, namely by comparing the pretreatment and posttreatment values and through correlation analysis. RESULTS: The mean age of the population was 11.4 years, BMI 26.9 and IMD 14.1. The mean duration of treatment in the study population was 13.9 months. A significant difference was established between the pretreatment and posttreatment values of all measured radiographic parameters (p<.05). A significant correlation was identified between r-mLDFA and r-SA (p=.002), while no significant correlation was found between r-mLDFA and r-CA or between r-CA and r-SA (p=.650; p=.884). DISCUSSION: Comprehensive evaluation of the treatment of axial deformities of lower limbs and its optimization are crucial for successful therapy. In addition to the standard mechanical or even anatomical parameters assessing the axis deviation of lower limbs, the authors seek to evaluate also other parameters that may provide a new insight into the deformity or offer additional benefits such as reduced radiation exposure. Such a parameter is for instance the angle of inserted screws in the eight-figure plate system, although there is a difference in opinion among the authors. In our study, we concluded that it is the change in the screw angle that significantly correlates with the mechanical axis of the femur, and thus, under certain circumstances, can become a monitoring parameter. Contrarily, the condylar ratio is a newly introduced quantity which in our study did not show any significant correlation with the mechanical axis of the femur, although a significant change before and after therapy was observed. CONCLUSIONS: A significant correlation was established between the rate of change in screw angle and r-mLDFA, which may, under certain circumstances, serve as a parameter for treatment evaluation, with the advantage of reduced radiation exposure since the assessment requires one scan of the knee joints under loading only. On the other hand, though, no significant correlation was established between the CR as the newly defined parameter and r-mLDFA, which is why it can only be considered as a complementary parameter rather than a decisive one. KEY WORDS: temporary hemiepiphysiodesis, growth plate, genua valga, screw angle, correlation.
- MeSH
- dítě MeSH
- femur chirurgie abnormality diagnostické zobrazování MeSH
- genua valga * chirurgie MeSH
- kostní destičky * MeSH
- kostní šrouby * MeSH
- lidé MeSH
- mladiství MeSH
- radiografie metody MeSH
- tibie chirurgie abnormality diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
INTRODUCTION: Complex ankle fractures frequently include the posterior malleolus (PM). Despite advances in diagnostic and treatment strategies, PM fracture involvement still predisposes to worse outcomes. While not incorporated into the most common PM fracture classifications, the presence of an intercalary fragment (ICF) complicates treatment. This study aims to describe the incidence, morphology, and location of ICFs in PM fractures. MATERIALS AND METHODS: A total of 135 patients with a mean age of 54.4 (SD ± 18.9) years and PM fractures were analyzed for the presence of an ICF. Patients with an ICF were compared to those without in terms of age, gender, and treatment received. Characteristics of the ICFs in terms of location and size were assessed. Furthermore, the presence of an ICF in relation to the PM fracture classification according to Haraguchi et al., Bartoníček/Rammelt et al., and Mason et al. was investigated. RESULTS: ICFs presented in 55 (41%) of the 135 patients. Patients with an ICF were younger, and the PM was more often operatively treated when compared to patients without an ICF. A posterolateral approach was used significantly more often in patients with an ICF. Almost all ICFs were found in the posterolateral (58%) and posterocentral (35%) regions. The majority of fragments were found in Bartoníček/Rammelt type 2 fractures, the most common fracture type. Bartoníček/Rammelt type 3 fractures had the highest relative frequency of ICFs. CONCLUSION: ICFs are frequently found in PM fractures; however, they are not incorporated into any of the common classifications. They are generally found in younger patients and associated with more complex PM fractures. As they can complicate reduction of the main fragment and may require direct exposure to restore joint congruency, ICFs should be considered in PM fracture classifications. Due to their location, the majority of ICFs are able to be accessed using a posterolateral approach.
- MeSH
- fraktury kotníku * diagnostické zobrazování chirurgie MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- tibie MeSH
- vnitřní fixace fraktury MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Introduction: Osteoid osteoma is a benign bone tumor with the classical characteristic of pain that subsides significantly with the use of nonsteroidal anti-inflammatory drugs. When conservative therapy fails, a surgical approach is then recommended. Radiofrequency ablation (RFA) has become more widely used compared to open resection due to fewer serious postoperative complications. But it is still important that the complications of RFA be recognized and addressed. Case report: We present a case of a 22-year-old man with acute pain on his left shin, accompanied by signs of localized inflammation. The clinical findings and radiology support the diagnosis of osteoid osteoma. A surgical intervention with percutaneous radiofrequency ablation was performed. However, post-operatively, the patient complains of prolonged fluid discharge from the surgical site. Following the biopsy and debridement surgery, both specimen culture and histopathology results revealed sterile inflammation with no specific process. Conclusion: RFA has become the most popular treatment of choice for osteoid osteoma, but it still comes with complications, most commonly involving subcutaneous bones such as the tibia. In conclusion, extra caution is needed when treating subcutaneously located bones with RFA.
- MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteom osteoidní * komplikace terapie MeSH
- radiofrekvenční ablace škodlivé účinky MeSH
- tibie diagnostické zobrazování patologie MeSH
- zánět diagnostické zobrazování etiologie terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Foot morphology is associated with altered loading of the ankle-foot complex in adolescent footballers, predisposing to pain and injury. However, usual singular plane clinical assessments do not accurately capture the 3D nature of foot morphology. A new approach is 3D laser scanning, with statistical shape model techniques creating individual-to-group comparison. However, no research exists on the adolescent, football-playing foot. Furthermore, a link between 3D foot morphology, and usual clinical and performance measures would be beneficial for practical implementation. METHODS: Four hundred forty-seven 3D foot scans from 224 elite male footballers (U12-U19) in bilateral stance were collected and further processed with statistical shape model techniques. Weighted shape parameters for individual principal components (Modes) were extracted for each foot. Centre of pressure displacement expressed as total travelled way in millimetres was calculated for bilateral and unilateral postural stability measures. Clinical assessments (Clarke's Angle, Resting Calcaneal Stance Position) were calculated on the 3D foot scans. Differences in weighted shape parameters, postural stability measures, and clinical assessments between age groups were determined by ANOVA. Correlations determined the relationship of Modes and clinical assessments to postural stability measures. Linear regression established if clinical assessments predicted the mode describing foot arch variation. RESULTS: Age groups significantly differed for Mode 1 (foot length), Mode 2 (foot arch), and Mode 5 (tibial rotation relative to the foot) (p < 0.05). Resting Calcaneal Stance Position (r = .663) and Clarke's Angle (r = -.445) were low-to-moderately correlated to Mode 2 (both p < 0.001), and linear regression found they were both significant predictors of Mode 2, though only moderately (R2 = .522). There were low correlations of foot morphology to the postural stability tests. CONCLUSION: This is the first study to describe the 3D foot morphology of male football-playing adolescents, and discover the differences between age groups. This will improve understanding and assessment of foot morphology in male adolescents because 2D techniques, as discovered in this study, do not strongly correlate to, nor predict, the 3D foot arch. Foot morphology was only lowly correlated to postural stability, thus a multifaceted program would be required for improvements.
- MeSH
- dolní končetina * MeSH
- hlezenní kloub MeSH
- lidé MeSH
- lineární modely MeSH
- mladiství MeSH
- patní kost * MeSH
- tibie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
