Vojtech Havlas

Manipulation of pediatric supracondylar fractures of humerus in prone position under general anesthesia.

Background: Displaced pediatric supracondylar fractures are usually treated with manipulation and fixation with Kirschner wires. The procedure is commonly performed with the patient in supine position. Reducing and stabilizing the fracture with the patient in supine position are associated with various risks and technical difficulties. Methods: We describe a technique of manipulative reduction and fixation of pediatric supracondylar fractures by positioning the patient prone. Results: We have used this technique in 455 patients and prefer it to the commonly described method of fracture reduction and stabilization with the patient supine. Conclusions: Positioning the patient prone simplifies the reduction and provides adequate exposure to insert Kirschner wires safely from both medial and lateral aspects. Positioning the C-arm is easily achieved, and good radiographs are obtained without disturbing the reduced fracture. Level of Evidence: Level III.

Methods of Motion Assessment of Smart Orthosis of Upper Limb for Rehabilitation at the Clinic and at Home

The aim of this work is to describe proposed and tested methods for evaluation of short-term and long-term movement activity of a smart orthosis for the upper limbs during a rehabilitation process carried out at a clinic or at home. To quantify the description of motion we used methods of evaluation of the time domain data. To test the functionality of the methods, we compared the movement of the dominant and non-dominant limbs, assuming cyclical and acyclic movement, to obtain the expected values for a healthy population. In accordance with the goal, a group of cyclic and non-cyclic movements common to the home environment were proposed. The movements were divided according to the activities performed during sitting, standing and walking. It was: pen writing, typing on the keyboard/using the mouse, eating with a spoon and eating a croissant combing, lifting weights, reading a book, etc. Twenty healthy subjects participated in the study. Four gyro-accelerometers (Xsens Technologies B.V.) attached to the forearms and upper arms of both upper limbs were used to record the upper limb movements. The results show that the calculated values of dominant and non-dominant limb parameters differ significantly in acyclic movements. The smart orthosis which uses the proposed methods can be used to evaluate the physical activity, quantify the evaluation of the rehabilitation process, and thus, it finds use in clinical practice.

Design of Smart Orthosis of Upper Limb for Rehabilitation

Movement problems of the upper limb are a common consequence of many diseases and can drastically affect the daily life impairing normal activities. To regain motor function and muscle power is necessary to treat these diseases with an intense physical therapy. The smart orthosis is an effective and modern method used in the process of muscle rehabilitation. We propose a design of motorized orthosis subsystems for the upper limbs. The orthosis is a motor assist robotic system that, with the help of actuators, will allow the movement of selected parts of the upper limb. The main point is to offer a reliable low weighted exoskeleton with selected sensors to move and control the upper limbs covering 6 motions: shoulder adduction and abduction, shoulder flexion and extension and elbow flexion and extension. The device is a junction of a hard orthosis with a soft orthosis in order to perform passive physical therapist exercises in clinical practice. The actuation is made by Bowden cables connected in one end to the limb and another to a stepper motor located at a backpack carried by the patient decreasing the apparatus weight substantially. The project also includes a selection of sensors comprising accelerometers, strain gages, thermostats, oximeters, that can provide the necessary information to move the limbs quantifying the muscle activity and physical condition through time. Also, a cooling subsystem based on Peltier thermoelectric modules was implemented to control the muscle temperature in case of an inflammatory reaction. The design was certified by kinematic and structural strength simulation using SolidWorks software.

Management and Consequences of the Rotator Cuff Calcific Tendinopathy

Calcific tendinopathy of the rotator cuff represents a treatment challenge since there is no consensus on its treatment. Unfortunately, up to 38 % of the calcifications do not disappear with time. The persistence of the calcification is detrimental to the tendon biology and resistance. Thus, it is mandatory to follow up the calcification and to treat it in case it would not reabsorb spontaneously. Nonsteroidal anti-inflammatory drugs, rest, exercises, physiotherapy, and shock wave therapy are being used with varying results. Those who have not benefited from the conservative measures are indicated for nonsurgical invasive interventions or surgical treatment. Invasive interventions include steroid/anesthetic injection, barbotage (multiple needle punctures), aspiration, and ultrasound lavage. Surgical (arthroscopic) treatment should be reserved for chronic cases or for cuff ruptures due to the deposit.

Patellofemoral Disorders in the Skeletally Immature Patients

Osgood-Schlatter disease is a traction-induced inflammation of the patellar tendon and adjacent cartilage of the tibial tubercle growth plate. X-ray usually shows fragmentary ossification of the tibial tubercle. The treatment is conservative in most cases. Variations of surgical treatment include drilling or excision of the tibial tubercle, longitudinal incision in the patellar tendon, insertion of bone pegs, and/or a combination of any of these procedures. Sinding-Larsen-Johansson syndrome/disease is an overuse traction apophysitis of the distal pole of the patella. The most common clinical symptoms include pain over the inferior pole of patella precipitated by overstraining. Initial treatment consists of cryotherapy, stretching and strengthening exercises, and modification of activities. Surgical treatment is considered rarely in skeletally immature patients. Congenital dislocation of the patella is an uncommon condition that can have various clinical presentations. It is often associated with genetic syndromes of increased joint and connective tissue laxity. The most common clinical features are genu valgum, flexion contracture, and external rotation of the tibia with a hypoplastic patella. Treatment usually involves early surgical reconstruction, reducing the dislocation and realigning the quadriceps mechanism. Developmental dislocation of the patella usually manifests when the child begins to walk, because of knee instability. In this form the patella is located stably in the femoral groove when the knee is flexed but tends to drift laterally as the knee extends. Surgical treatment usually involves lateral retinacular release in combination with medial advancements and/or distal realignments, where indicated. Acute dislocation of the patella is usually related to anatomic features such as shallow femoral groove, valgus and rotational knee mal-alignment, or ligamentous laxity. Most acute patellar dislocations involve trauma and are reduced spontaneously. Indications for acute surgery in skeletally immature patients involve associated osteochondral fracture from the lateral femoral condyle or patellar surface. Recurrent dislocation of the patella usually occurs in patients with a history of acute dislocation and is usually based on underlying dysplasia. The first-line treatment in skeletally immature patients is conservative focusing on relieving symptoms by reduction of activities, use of NSAIDs, and a structured physiotherapy program. Surgical treatment is usually considered only after an unsuccessful prolonged rehabilitation program. Patella sleeve fracture is an uncommon injury unique to skeletally immature patients. X-ray or CT/MRI diagnosis and recognition of this pathology is very important, as part of the articular surface of the patella is usually displaced with the fragment. Open reduction and internal fixation of the fragment is required in most cases. Transverse fracture of the patella is relatively uncommon in children with open physis. The clinical presentation, diagnosis, and treatment do not differ from those in adults.