The Preparation and Biological Testing of Novel Wound Dressings with an Encapsulated Antibacterial and Antioxidant Substance.

Chronic wounds represent a significant socio-economic problem, and the improvement of their healing is therefore an essential issue. This paper describes the preparation and biological properties of a novel functionalized nanofiber wound dressing consisting of a polycaprolactone nanofiber carrier modified by a drug delivery system, based on the lipid particles formed by 1-tetradecanol and encapsulated gentamicin and tocopherol acetate. The cytotoxicity of extracts was tested using a metabolic activity assay, and the antibacterial properties of the extracts were tested in vitro on the bacterial strains Staphylococcus aureus and Pseudomonas aeruginosa. The effect of the wound dressing on chronic wound healing was subsequently tested using a mouse model. Fourteen days after surgery, the groups treated by the examined wound cover showed a lower granulation, reepithelization, and inflammation score compared to both the uninfected groups, a lower dermis organization compared to the control, a higher scar thickness compared to the other groups, and a higher thickness of hypodermis and bacteria score compared to both the uninfected groups. This work demonstrates the basic parameters of the safety (biocompatibility) and performance (effect on healing) of the dressing as a medical device and indicates the feasibility of the concept of its preparation in outpatient conditions using a suitable functionalization device.

Predictors of radiographic outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease.

PURPOSE: Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. METHODS: Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. RESULTS: Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. CONCLUSIONS: Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.

Systematic Literature Review and Expert Opinion for the Use of Viscosupplementation with Hyaluronic Acid in Different Localizations of Osteoarthritis.

Osteoarthritis (OA) is a significant cause of disability. Considering the increasing diffusion of the viscosupplementation (VS) with hyaluronic acid (HA), the International Symposium Intra Articular Treatment (ISIAT) appointed a Technical Expert Panel (TEP) to identify the criteria for successful VS with a specific HA in OA; this through a systematic literature review (SLR), performed following the PRISMA guidelines interrogating Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Grey Matters and American College of Rheumatology (ACR/EULAR) databases and the opinion of international experts. The research included only studies on adults and humans without limitations of language or time of publication. Researchers extracted both quantitative and qualitative data from each study. Mixed Methods Appraisal Tool (MMAT) was used to perform quality analysis for the level of evidence. The SLR retrieved 385 papers, 25 of which were suitable for the analysis. The TEP focused on the different formulations of the product Sinovial® [HA 0.8%, HA 1.6%, HA 2%, 800-1200 kDa, HA 3.2% (1400-2100 kDa/65-110 kDa)]. The choice was due to the vast amount of evidence available. The TEP weighed the evidence in two rounds of a Delphi survey; the results, and any disagreement, were discussed in a final session. Three domains were considered: 1) the patients' characteristics associated with the best results; 2) the contraindications and the conditions linked to increased risk of failure; 3) the clinical conditions in which VS is considered appropriate. The TEP concluded that VS with HA is safe and effective in the treatment of knee and hip OA of grades I to III and that it is possible to undertake VS in other situations (eg grade IV Kellgren-Lawrence - KL); a comprehensive examination of the patient should be performed before the procedure.

[Limb shortening in the management of leg length discrepancy]. / Zkrácení kosti jako operacní resení diference délek koncetin.

Limb shortening is an option to manage leg length discrepancy. Before skeletal maturity, small length discrepancy between 2 and 5 cm can be corrected by open or closed epiphyseodesis or stapling. All these procedures require exact timing of surgery. In skeletally matured patients is shortening of the femur considered safer than tibial shortening. Length discrepancy more than 10 cm should be corrected either by prolongation or one timed procedures concerning shortening osteotomy of longer limb followed with excised bone segment and its implantation in the contralateral limb. Presented review summarizes advantages and disadvantages of both operational concepts (shortening and lengthening) in leg length discrepancy management.

[Femoroacetabular impingement treatment options]. / Femoroacetabulární impingement a moznosti jeho resení.

Femoroacetabular impingement syndrome is a very common hip pathology that is responsible for hip pain in patients under 40 years of age. Anatomic changes in hip joint cause labral tears and cartilage dysfunction, both of these conditions cause severe hip pain and often lead to hip arthritis. This syndrome is very common in the population, but very often misdiagnosed and undertreated.The main treatment option is surgical treatment; conservative treatment alone is not successful. There are many surgical procedures that may be chosen according to the degree of hip pathology. In this article we present treatment options for femoroacetabular impingement syndrome and our results. Recently one of the main treatment options is hip arthroscopy we have very good experience and results with this method.

[Rehabilitation after total knee and hip arthroplasty]. / Rehabilitace po totální náhrade kycelního a kolenního kloubu.

The main purpose of total hip replacement is to relieve hip pain and recover the lost mobility of the joint. The postoperative functionality of the hip endoprosthesis is closely related to proper physiotherapy. A good range of motion, sufficient pain reduction and minimum disruption to the muscle tissues are conditions allowing the patients to perform individualized muscle strengthening exercises and to exercise the newly gained mobility, following practice sessions during the early postoperative period still in hospital. The authors describe the individual fazes of the physiotherapy and summarize the principles, which lead to a successful rehabilitation of the patient and his early recovery as well as return to normal life activities.

[Primary malignant bone tumors in children possibilities of limb-saving surgery using allografts]. / Primární maligní nádory kostí u detí moznosti záchovné chirurgie s vyuzitím alostepu.

Therapy of primary malignant bone tumors is always multimodal and requires close cooperation of oncologist, orthopedic surgeon, radiologist and others. In our article, we provide a brief overview of the most common malignant bone tumors in pediatric patients and summarize the commonly used therapeutic procedures. Despite advances in cancer treatment radical surgical resection of the tumor is still necessary. If possible, it should be complete removal of the affected structures, made in terms of the so-called limb-saving (limb-sparing) surgery that preserves the shape and function of the affected limb to the fullest extent possible. In addition the resection must be done at the same time with substitution of the removed bone. Bone grafts, both autografts and allografts, are used in majority of solutions. We also discuss the comparison of different approaches of limb-saving surgery compared to ablative procedures.

[Avascular necrosis of the femoral head]. / Avaskulární nekróza hlavice femuru.

Avascular necrosis of the femoral head in adults is not common, but not too rare diseases. In orthopedic practice, it is one of the diseases that are causing implantation of hip replacement at a relatively early age. In the early detection and initiation of therapy can delay the implantation of prosthesis for several years, which is certainly more convenient for the patient and beneficial. This article is intended to acquaint the reader with the basic diagnostic procedures and therapy.

A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study.

PURPOSE: The incidence of an anterior cruciate ligament (ACL) tear is highest in female patients; however, it is not apparent whether graft choice affects clinical results. The aim of this prospective randomised study was to evaluate clinical results of an ACL reconstruction using patellar tendon [bone-patellar tendon-bone (BTB)] or hamstring graft (HS) in female patients. METHODS: Inclusion criteria were traumatic instability, no signs of osteoarthritis, no previous instability and no contralateral knee instability. Inclusion criteria were met in 150 patients, mean age 26 (17-47) years. Patients were randomised into two groups of 75 patients according to graft type; all had the same rehabilitation protocol. Tegner Lysholm knee score and stability were evaluated pre-operatively and one and two years postoperatively. The difference between groups was statistically evaluated using unpaired t test. RESULTS: Of the 150 patients, all completed one year follow-up; three were lost to follow-up at two years. There was no significant difference in functional scores and knee stability between groups. The HS group had significantly less anterior knee pain in the first six months postoperatively. CONCLUSION: ACL reconstruction significantly improves clinical results and stability of the knee. Difference in Lysholm score and stability between groups was not significant. Neither group showed higher tendency to graft failure within two years. Graft choice for reconstruction in female patients should be surgeon specific and individualised, as both grafts studied achieved comparable results.

Femoroacetabular impingement syndrome--efficacy of surgical treatment with regards to age and basic diagnosis.

PURPOSE: The aim of this study was to assess the outcome of hip preserving surgery for femoroacetabular impingement relative to the condition resulting in FAI and to the patient's age at the time of the surgery. METHODS: With the conditions for exclusion duly met, enrolled in our study were a total of 100 hip joints (83 operated on with the aid of SHD, 17 with AMIS). The minimum follow-up period was 12 months, and the mean follow-up time was three years four months. WOMAC and NAHS questionnaires were used as rating instruments. To analyse the significance of the differences relative to the age at the time of surgery and to the basic diagnosis leading to FAI and subsequently to surgical operation we used non-parametric forms of analysis of variance (Friedman test and Kruskal-Wallis test), i.e., comparisons of the patients' pre-operative and postoperative states, estimation of the rate of improvement in the postoperative functional skills in relation to the age at the time of surgery and/or relative to the basic diagnosis necessitating surgical intervention, with respect to statistical significance at the level of p < 0.05. RESULTS: As testing of our cohort of patients and results analysis showed, the youngest group (<30 years) compared with the rest of the cohort shows greater postoperative improvement and consequently also a better surgical result. Proof was also obtained that the diagnosis leading to surgery for FAI has no effect on the patient's pre- or postoperative state or on the degree of improvement. CONCLUSIONS: The results of the study affirm the relevance of hip preserving surgery, especially in younger-aged groups.

Comparison of conservative against surgical treatment of anterior-superior iliac spine avulsion fractures in children and adolescents.

PURPOSE: Avulsion fracture of the anterior-superior iliac spine is an uncommon injury. It is mostly seen in adolescent sprinters, distance runners and soccer players. Most cases are unilateral. We present a cohort of patients and the strategy for their treatment. METHODS: During the period 2005-2012, we treated 23 (19 male, four female) patients with an average age of 15.1 years (4-17). Ten patients with minimally displaced fractures were treated conservatively, and 13 patients with greater fragment dislocation were treated surgically. All patients underwent the standardised rehabilitation protocol. We evaluated range of motion (ROM), X-ray six weeks and one year postoperatively, length of bed rest, return to activity and complication rates (infection, heterotopic ossification). RESULTS: All patients returned to sports at the preinjury level. Surgically treated patients showed faster recovery and better compliance with rehabilitation protocols. The time interval for X-ray union was comparable between groups, as was full recovery. There was no deep infection; however, there were five minor heterotopic ossifications, none of which required further treatment. CONCLUSION: We emphasise that the indication for surgical treatment is mainly determined by the grade of fragment displacement and the patient's sporting activity. Although long-term results were comparable between treatment methods, surgery carries the risk of higher complication rates and the need for osteosynthetic material extraction.

Mid-term results of revision total hip arthroplasty using the oval-shaped uncemented Trc-Cingr cup.

PURPOSE: The aim of the present study was to introduce a novel oblong revision cup type TC for use in revision total hip arthroplasty (THA), and to evaluate mid-term results in terms of bone tissue remodelling in the immediate area of the implant. METHODS: The results of 31 patients that underwent revision THA between 2004 and 2008 are presented. The mean follow-up interval was 7.1 years (range 5.3-9.3 years, minimum of five years following revision). Osteointegration of the implant and bone tissue remodelling around the implant and ribs were assessed by X-ray and computed tomography (CT). RESULTS: The average Harris hip score increased from 39.8 to 85.3. Excellent results were achieved in nine patients, good in 16, fair in three and poor in three. According to X-ray results, 25 hips had a well-fixed, bone-ingrown cup and five had a stable fibrous union in the middle and the distal third of the implant. Proximal migration of the cup was noted in one case. Pelvic CT was additionally performed in ten patients. In all cases, we detected bone remodelling in the space between the implant ribs. Kaplan-Maier survivorship of the acetabular components was 94.2 % at 7.1 years. CONCLUSIONS: Our results show that the novel oblong revision cup type TC is relatively simple to implant, and is associated with reliable primary fixation and documented osteointegration and bone remodelling in the immediate area.

Correlation of dynamic impact testing, histopathology and visual macroscopic assessment in human osteoarthritic cartilage.

OBJECTIVE: Improved staging of cartilage degeneration is required, particularly during the early stages. We correlated mechanical properties with histological and macroscopic findings. METHODS: One hundred and twenty cartilage samples were obtained during total knee arthroplasty. Two adjacent plugs were harvested--one for histological classification and one for macroscopic and biomechanical purposes. Dynamic impact testing was performed; normal stress, dissipated energy (∆E), tangent modulus and stiffness were evaluated. RESULTS: Samples were classified according to six categories of the ICRS histological scale. Mechanical characteristics revealing significant differences between the groups (p < 0.01) were specific damping and related absolute ∆E. A significant correlation was found between the macroscopic score and specific damping, as well as absolute and relative ∆E (p < 0.01). A strong relation was revealed between relative ∆E and cartilage thickness (p < 0.001; R (2) = 0.69). CONCLUSIONS: Only ∆E correlated with the condition of the cartilage--the value increased with decreasing quality-and is the most suitable characteristic. This change appears substantial in initial stages of cartilage deterioration.

Efficacy and tolerance of enzymatic hydrolysed collagen (EHC) vs. glucosamine sulphate (GS) in the treatment of knee osteoarthritis (KOA).

This was a 13-week, multicentre, randomised, parallel, double-blind study. One hundred men and women volunteers aged ≥ 40 years with knee osteoarthritis (KOA) were randomised to once daily enzymatic hydrolysed collagen (EHC) 10 g or glucosamine sulphate (GS) 1.5 g for 90 consecutive days. Follow-up took place after two weeks and after one, two and three months. Primary [visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC Index)] and secondary outcomes variables, assessed at weeks two, four, eight and 12, were KOA pain intensity measured by quadruple visual analogue scales in the target knee, the WOMAC total score index, patient's and investigator's global assessments of disease activity, joint assessment, use of rescue medication (ibuprofen 400 mg tablets) and assessment of Quality of Life index (SF-36 Questionnaire). Safety and tolerability were also evaluated. Clear improvement was observed in both joint pain and symptoms in patients with KOA treated with EHC (Colatech®) and significant differences were observed. Mean reductions from baseline for EHC 10 g daily and GS 1.5 g, respectively, were KOA pain intensity reduction in the target knee for Colatech® (p < 0.05): WOMAC index decrease ≤ 15 points at the last visit (day 90) for Colatech® in 16 patients (34.04%) (p < 0.05) and for glucosamine in six patients (13.04%); total score index for painful joints: Colatech® 1.6 (p < 0.05) and glucosamine 1.8; total score index for swollen joints: Colatech® 0.5 (p < 0.05) and glucosamine 0.7; patient's global assessment of efficacy as the sum of improvement good + ideal: 80.8% for Colatech® and 46.6% for glucosamine (p < 0.05). EHC (Colatech®) showed superior improvement over GS in the SF-36 Questionnaire in the Physical Health Index (42.0 for Colatech and 40.0 for glucosamine). The incidence of adverse events was similar in both groups. Both EHC and GS were well tolerated.

The anterior talo-fibular ligament reconstruction in surgical treatment of chronic lateral ankle instability.

Chronic lateral ankle instability causes significant problems in physical activity and accelerates development of osteoarthritic changes. The results of treatment for chronic ankle instability are often meets controversial. A surgical reconstruction of ATFL as described in this paper was performed during the period 1997-2005 on 47 patients (26 male, 21 female), with a mean age of 29.3 years. The average follow-up period was 46.2 months. All patients had clinical examination, X-ray and MRI. The mean values of the Good score improved from an average 3.32 prior to surgery to 1.19 one year after the operation. Paired t-tests showed improvements of great significance (p < 10(-28)). The Good score prior to surgery ranged from 2-4, whereas the scores one year after surgery were either 1 or 2, with a score of 1 being recorded in 38 cases (81%). In the postoperative follow-up, MRI showed a newly-formed ligament structure in all cases. The authors describe their own technique for a reconstruction of lateral ankle instability using remnants of the former ATFL. The scar tissue seems to be sufficient to form a new duplicated structure providing good stability. MRI proved to be a sensitive and specific method for identifying the extent of talo-fibular ligament injury.

Detecting postoperative change in children with cerebral palsy: net nondimensional versus body mass oxygen normalization.

The aim of the study is to investigate whether the net nondimensional oxygen utilization scheme is able to detect postoperative improvement in the energy cost of walking in children with cerebral palsy and to compare it with a body mass normalization scheme. We evaluated 10 children with spastic cerebral palsy before and 9 months after equinus deformity surgery. Participants walked at a given speed of 2 km/hr and 3 km/hr on a treadmill. Oxygen utilization was measured, and mass relative VO2 and net nondimensional VO2 were calculated. Coefficient of variation was used for the description of variability among subjects. Postoperatively, gait kinematics normalized and the mass relative VO2 and net nondimensional VO2 showed significant improvement. Net nondimensional VO2 is able to detect postoperative improvement with smaller variability among subjects than body mass related normalization in children with cerebral palsy.

The cultivation of human multipotent mesenchymal stromal cells in clinical grade medium for bone tissue engineering.

Clinical application of human multipotent mesenchymal stromal cells (hMSCs) requires their expansion to be safe and rapid. We aimed to develop an expansion protocol which would avoid xenogeneic proteins, including fetal calf serum (FCS), and which would shorten the cultivation time and avoid multiple passaging. First, we have compared research-grade alpha-MEM medium with clinical grade CellGro for Hematopoietic Cells' Medium. When FCS was used for supplementation and non-adherent cells were discarded, both media were comparable. Both media were comparable also when pooled human serum (hS) was used instead of FCS, but the numbers of hMSCs were lower when non-adherent cells were discarded. However, significantly more hMSCs were obtained both in alpha-MEM and in CellGro supplemented with hS when the non-adherent cells were left in the culture. Furthermore, addition of recombinant cytokines and other supplements (EGF, PDGF-BB, M-CSF, FGF-2, dexamethasone, insulin and ascorbic acid) to the CellGro co-culture system with hS led to 40-fold increase of hMSCs' yield after two weeks of cultivation compared to alpha-MEM with FCS. The hMSCs expanded in the described co-culture system retain their osteogenic, adipogenic and chondrogenic differentiation potential in vitro and produce bone-like mineralized tissue when propagated on 3D polylactide scaffolds in immunodeficient mice. Our protocol thus allows for very effective one-step, xenogeneic protein-free expansion of hMSCs, which can be easily transferred into good manufacturing practice (GMP) conditions for large-scale, clinical-grade production of hMSCs for purposes of tissue engineering.

Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy.

Palliative Schanz proximal femoral valgus osteotomy is considered a common option for treatment of irreducible hip dislocation in cerebral palsy. From 1992 to 2005, Schanz osteotomy was indicated on 55 occasions in 35 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9-18. Postoperatively, the main emphasis focussed on clinical presentation, improvement of hip range of motion, and pain relief. X-rays were carried out at three, six, and 12 months postoperatively with subsequent average follow up 98 +/- 4.5 months. In all patients, the range of hip abduction and flexion increased. In 54 (98.2%) cases painful symptoms significantly improved. One patient (1.8%) had a subsequent femoral head excision because of persistent hip pain. Transient hip pain persisted in four patients (7.3%). Schanz valgus osteotomy improves the hip range of motion, relieves pain, and facilitates care of the patient. Schanz femoral osteotomy is a less invasive method compared to proximal femoral excision and should preferably be used in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.

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.

Arthroscopic evaluation of ultrasonography and magnetic resonance imaging for diagnosis of rotator cuff tear.

BACKGROUND: Rotator cuff tear--diagnosis; comparison of MRI, ultrasonographic and arthroscopic findings. MATERIALS AND METHODS: Retrospective study--20 patients treated for shoulder pain due to rotator cuff tear, initially conservatively and after more than 6 months by arthroscopic shoulder surgery. Comparison of intraoperative findings with preoperative US and MRI images. RESULTS: Sensitivity of USG--1.0, specificity 0.9. Sensitivity of MRI--0.92, specificity 1.0. DISCUSSION: Clinical examination and physical tests are not fully reliable diagnostic tools in patients with shoulder pain, because symptoms of different conditions overlap. Using ultrasound to visualize the shoulder area has some advantages to other imaging techniques such as CT scan or MRI, and has a very good sensitivity and good specificity. Many authors agree that MRI is one of the most effective methods for the diagnosis of rotator cuff tear. CONCLUSIONS: Ultrasound and magnetic resonance imaging are both very sensitive techniques for diagnosis of rotator cuff abnormalities. Ultrasonography can be used as a primary method owing to its fast procedure and affordable cost.