The purpose of this thesis was to study the outcome of Single Event Multilevel Surgery (SEMLS) on the gait pattern known as crouch gait in children with spastic diplegic cerebral palsy. The term “crouch gait” in the literature has been defined by many authors to mean a flexed knee coupled with many different combinations of posture at the ankle. Consequently it was necessary to provide a robust definition of crouch gait before the outcome study could proceed. Crouch gait was defined in the context of a classification of sagittal gait patterns in spastic diplegia. In the cross-sectional study on the classification of sagittal gait patterns, 187 children with spastic diplegia were categorised according to visual recognition of their gait pattern and sagittal plane kinematic data. Six gait patterns in spastic diplegia were identified, one of which was crouch gait. A pattern of increasing age, severity and biomechanical incompetency in maintaining an extended posture was seen across the gait patterns and crouch gait appeared to be the “end” gait pattern. A longitudinal study documented how the identified gait patterns evolved over time. Thirty-four children were followed for more than one year and the results indicated that the stability of the gait pattern was variable. The reliability of the classification was found to be acceptable. (For complete abstract open document)

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L'os humain adulte est le résultat d'un processus de maturation multi échelle complexe et multifactoriel. Concernant la croissance de l'os de l'enfant, les données quantitatives issues de la littérature sont peu nombreuses et souvent discutables. Une caractérisation multimodale de ce matériau (acoustique, mécanique, histologique, biochimique et par l'imagerie) permet de traduire quantitativement les différences observées en pratique clinique avec l'os adulte. Cette étude propose de déterminer les paramètres biomécaniques de l'os cortical au cours de la croissance par une approche multimodale. Différents types d’échantillons ont été utilisés, os long (fibula), os plats (côtes issus de la cage thoracique des patients scoliotiques) en provenance de service de chirurgie orthopédique. Des résultats originaux ont été obtenus, avec des lois reliant les données à différentes échelles. Les résultats ont permis d’infirmer des hypothèses concernant la déminéralisation osseuse dans le cadre des études sur la scoliose idiopathique chez l’enfant, et l’obtention de nouvelles données concernant l’os cortical au cours de la croissance. / Human bone is the result of a multiscale maturation process determined by several factors. Concerning the bone growth, few quantitative data are available in literature and their validity is questionable. A multimodal method (acoustical, mechanical, histological, biochemical and using imagery) characterizing the bone matrix leads to quantify the differences between adult and children based on clinical observations. The goal of this study is to quantify the biomechanical properties of cortical bone during growth by using a multimodal method. Several kinds of samples have been characterized, on one hand from long bone (fibula) and on the other hand from flat bone (extracted from the scoliotic rib hump). Original results have been found with law linking multiscale data. These results weak the hypothesis of bone demineralization in idiopathic adolescent scoliosis and provide new data concerning cortical bone during growth process.

Bone drilling is an essential part of many orthopaedic surgical procedures, including those for internal fixation and for attaching prosthetics. Drilling into bone is a fundamental skill that can be both very simple, such as drilling through long bones, or very difficult, such as drilling through the vertebral pedicles where incorrectly drilled holes can result in nerve damage, vascular damage or fractured pedicles. Also large forces experienced during bone drilling may promote crack formation and can result in drill overrun, causing considerable damage to surrounding tissues. Therefore, it is important to understand the effect of bone material quality on the bone drilling forces to select favourable drilling conditions, and improve orthopaedic procedures.

The Diploma paper explores the quality-related issues of nursing care provided at the Orthopedics Department of the České Budějovice Hospital. The survey used quality indicators to review the quality of nursing care delivered at the different units of the Orthopedics Dept. The nursing care was audited to find out whether the operating theatres were kept properly sanitized. Another audit was carried out to examine the level of expertise found in the nursing staff taking care of patients with epidural catheter. The audit followed the already established standard of "Nursing care provided to patients with epidural catheter". The nurses were tested to reveal their competence in caring for the orthopedic patients. A recommendation issued by the Czech Nursing Association was utilized to arrive at the optimal numbers of nurses at the standard nursing units. The outpatients and inpatients were polled to disclose their degree of satisfaction. The nurses were given a questionnaire to measure the extent to which they were happy about their working conditions. The survey has accomplished all its objectives and all the hypotheses have been confirmed as true. The Orthopedics Dept. of the České Budějovice Hospital provides a quality nursing care. Monitoring the quality of nursing care is important mainly for achieving better standards. The nursing staff can be made aware of them through the evaluation of treatment and nursing care effectivity.

O presente estudo visa comparar biomecanicamente, por meio do ensaio de flexão em quatro pontos, a resistência de segmentos de rádios de cães autoclavados e desvitalizados em nitrogênio líquido. Foram utilizados 20 cadáveres de cães de mais de dois anos de idade e massa corporal superior a 20 kg, portanto 40 rádios, que foram divididos em quatro grupos: grupo autoclave (GA), grupo controle autoclave (GCA), grupo nitrogênio (GN) e grupo controle nitrogênio (GCN). Os corpos de prova dos grupos GCA e GCN pertenciam ao lado contralateral dos grupos GA e GN, respectivamente. Os ossos foram autoclavados a 121ºC, por 20 min a 2 atm. A desvitalização em nitrogênio foi realizada por meio da imersão em nitrogênio líquido, por 20 min, seguida de descongelamento à temperatura ambiente, sendo finalizada por imersão em solução de NaCL a 0,9%, por mais 15 min. A avaliação da resistência biomecânica foi realizada pelo ensaio de flexão em quatro pontos. Foi utilizado o programa de computador PMI para calcular o momento de inércia após o ensaio biomecânico destrutivo. Foram comparadas as variáveis força máxima, rigidez, altura máxima à secção transversa do corpo de prova, deslocamento do baricentro em relação ao eixo x, flecha, tensão-tração, tensão compressão e tensão máxima. Não foram encontradas diferenças estatisticamente significantes entre os grupos GN e GCN. Foram encontradas diferenças estatisticamente significantes entre os grupos GA e GCA somente na comparação da variável força máxima. A análise das variáveis tensão-tração, tensão-compressão e tensão máxima evidenciou diferenças estatisticamente significantes entre os grupos GA e GN, sendo os valores maiores para o grupo GA. Também foi realizada comparação entre os deltas (GN menos GCN e GA menos GCA) em que não foram observadas diferenças estatísticas. / The present study aim to, biomechanically compare through the four points bending test, the strenght of autoclaved and devitalized in liquid nitrogen radius segments. 20 corpses of dogs (>2 years of age and >20 kg of weight) were used. 40 radius were collected and divided into 4 groups, Autoclave Group (GA), Control Autoclave Group (GCA), Nitrogen Group (NG) and Control Nitrogen Group (GCN). Bone segments from groups GCA and GCN were contralateral to GA and NG. The segments were autoclaved at 121ºC and 2 atm for 20 minutes. Nitrogen devitalization of the bone segments was obtained by 20 minutes immersion, followed by thawing at room temperature and 15 minutes immersion in 0,9% NaCL solution. The biomechanical strenght evaluation was performed in the four points bending test; afterwards, PMI computer program calculated the moment of inertia after the destructive biomechanical assay. Variables compared were maximum strength, stiffness, maximum high trough the transverse section of the bone segment, centers of mass dislocation in relation to x axe, arrow, stress-tension, stress-compression and maximum stress. No statistically significant differences between the GN and GCN groups were found. Statistically significant differences were found between groups GA and GCA only in the comparison of the maximum force variable. The analysis of variable stress-tension, stress-compression and maximum stress showed statistically significant differences between the GA and GN groups, with higher values for the GA group. Comparison of the deltas (GN least GCN and GA least GCA) that no statistical differences were observed was also performed.

Submitted by (edna.saturno@ufrpe.br) on 2016-10-19T16:12:08Z No. of bitstreams: 1 Maira Santos Severo.pdf: 777167 bytes, checksum: ba733560f6b6bb2311da79b0576b6970 (MD5) / Made available in DSpace on 2016-10-19T16:12:08Z (GMT). No. of bitstreams: 1 Maira Santos Severo.pdf: 777167 bytes, checksum: ba733560f6b6bb2311da79b0576b6970 (MD5) Previous issue date: 2008-02-22 / Humeral and femoral fractures are frequent in the clinical routine of dogs and cats, and various methods of stabilization of the same, with their advantages and disadvantages are proposed in the literature. This study aimed to evaluate a new technique for stabilization of femoral and humeral fractures through use of intramedullary pin and paracortical fixing with polymethylmethacrylate. We used 12 animals affected by fractures of humerus or femur, six cats and six dogs, weighing ranging between 2.3 and 15.0 kg (median of 7.3 kg), aged between four months and eight years, the various races, where three of them had fracture of the humerus and the others had femoral fracture, all diagnosed by clinical and radiographic examination (in two projections). All patients were submitted to the stabilization of fractures with the use of intramedullary pin and paracortical fixing with polymethylmethacrylate. The bone healing was evaluated through monitoring radiographic 30, 60 and 90 days after the procedure, and by the measurement of serum marker of bone activity, alkalinephosphatase (AP), on day zero (day of the surgery) and after seven, 15 , 30, 60 and 90 days of surgery. It was observed immediately after the deployment of the technique (trans-operative period), that the method effectively neutralized the forces of rotation, bending, shear and axial displacement, providing degrees of alignment and affixing adequate, but over time the stability not required remained, generating in some animals, delayed bone union, interfering directly in functional recovery of the member. Moreover were observed phenomena of the wound dehiscence, loss of integrity of the implants and osteomyelitis. The reference values for the AP was below found in the literature and compared with the graduate of healing there was no significant difference. The animal species was decisive in association with the functional evolution of the State and bone union, as in cats, showed better results. This approach to stabilization of humeral and femoral fractures in dogs and cats is applicable only to transverse fracturesor slightly oblique and can be considered inefficient, compared to the number of imperfections, observed during the research. / Fraturas femorais e umerais são freqüentes na rotina clínica de cães e gatos; e vários métodos de estabilização das mesmas, com suas vantagens e desvantagens são propostos pela literatura. A presente pesquisa objetivou avaliar uma nova técnica de estabilização das fraturas femorais e umerais mediante uso de pino intramedular e fixação paracortical com polimetilmetacrilato. Foram utilizados 12 animais acometidos por fraturas de fêmur ou úmero, sendo seis gatos e seis cães, com peso variando entre 2.3 e 15.0 kg (mediana de 7.3 kg), idades entre quatro meses e oito anos, de raças variadas, onde três deles apresentaram fratura de úmero e os demais apresentaram fratura femoral, todas diagnosticadas através de exames clínico e radiográfico. Todos os pacientes foram submetidos à estabilização das fraturas mediante a utilização de pino intramedular e fixação paracortical com polimetilmetacrilato. A cicatrização óssea foi avaliada através do acompanhamento radiográfico 30, 60 e 90 dias após o procedimento cirúrgico, e mediante a aferição sérica do marcador de atividade óssea, fosfatase alcalina(FA), no dia zero (dia da cirurgia) e após sete, 15, 30, 60 e 90 dias após a cirurgia. Observou-se imediatamente após a implantação da técnica (período trans-operatório), que o método neutralizou eficientemente as forças de rotação, flexão, deslocamento axial e cisalhamento; proporcionando graus de alinhamento e aposição adequados, mas ao longo do tempo a estabilidade requerida não permaneceu, gerando em alguns animais, retardo na união óssea, interferindo diretamente na recuperação funcional do membro. Além disso foram observados fenômenos de deiscência de ferida, perda da integridade dos implantes e osteomielite. Os valores de referência para a FA estiveram abaixo dos encontrados na literatura e quando comparados com o grau de cicatrização não houve diferença significativa. A espécie animal foi determinante na associação com a evolução funcional do membro e da união óssea, visto que, nos felinos, apresentou melhores resultados. Esta técnica de estabilização de fraturas umerais e femorais emcães e gatos é aplicável apenas a fraturas transversas ou levemente oblíquas e pode ser considerada pouco eficiente, frente ao número de vicissitudes, observadas durante a pesquisa.

Orientador: Maria Clara Filippini Ierardi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica / Made available in DSpace on 2018-08-16T17:12:39Z (GMT). No. of bitstreams: 1 Larosa_MariaAparecida_D.pdf: 10660809 bytes, checksum: a977970425db7202c5a36a0e2a30a789 (MD5) Previous issue date: 2010 / Resumo: No presente trabalho, o aço inoxidável austenítico ASTM F 138, empregado na fabricação de implantes ortopédicos temporários e permanentes, foi submetido a tratamento de superfície por laser, com o intuito de analisar as modificações microestruturais resultantes deste tratamento e seus efeitos na resistência à corrosão e ao desgaste microabrasivo. A caracterização microestrutural foi feita por microscopia óptica, microscopia eletrônica de varredura, microdureza Vickers e difração de raios-X. Para analisar o comportamento em corrosão do aço, antes e após o tratamento, foram realizados três tipos diferentes de ensaios eletroquímicos usando solução de Ringer como eletrólito. O comportamento em desgaste foi avaliado a partir de ensaios por microabrasão do tipo esfera-sobre-placa, utilizando como abrasivos uma suspensão de partículas de carboneto de silício (SiC) em água destilada e uma suspensão de SiC em solução de Ringer. Após o tratamento por laser, o aço apresentou uma microestrutura refinada constituída por dendritas de austenita, com um aumento de aproximadamente 23% na dureza e com melhoria frente à corrosão e ao desgaste. / Abstract: In this work, ASTM F 138 austenitic stainless steel, used in temporary and permanent orthopaedic implants manufacture, was subjected to laser surface treatment. The purpose is analyze the microstructural changes resulting from this treatment and their effects on the microabrasive wear and corrosion resistance. The microstructural characterization was performed by optical microscopy, scanning electron microscopy, Vickers microhardness and X-ray diffraction. In order to analyze the corrosion behavior, three different types of electrochemical tests were carried out before and after treatment, using Ringer's solution as electrolyte. The wear behavior was evaluated using ball-cratering microabrasive wear tests, using slurry of silicon carbide particles (SiC) in distilled water and slurry of SiC in Ringer's solution. After laser treatment, the steel presented a refined microstructure consisted of austenite dendrites, with a 23% hardness increase and improved corrosion and wear resistance. / Doutorado / Materiais e Processos de Fabricação / Doutor em Engenharia Mecânica

The thesis analyses the company Beznoska s.r.o. on the domestic and foreign markets. It describes the activities and strategy of the company, which is engaged in the production of orthopaedic implants and implants in the field of orthopaedics. The second part of the thesis focuses on the analysis of the domestic market, i.e. the Czech Republic. It analyses particularly Ukraine from the foreign markets. Subsequently, by using comparison and analysis among the selected countries, it is searching for potential market for company expansion.

Text in Afrikaans / In this quantitative study emphasis is placed on the role of the nurse as a member of the rehabilitation team. Furthermore, the role of the nurse in patient education as well as the importance of effective patient education during the rehabilitation process after hip replacement surgery is emphasised. Various factors that impacted on the rehabilitation process are highlighted. A structured interview schedule was used to interview a group of 20 respondents. All of the respondents participated voluntarily. Orem's Selfcare Theory was used as a theoretical basis for the study. The researcher determined which information respondents regarded as important to attain functional independence during the rehabilitation process. The data gathered would serve as recommendation for a planned information brochure that could in future be given to patients at their first visit to the surgeon before surgery. The brochure could then be used as a basis for patient education in the course of the rehabilitation process. / Advanced Nursing Sciences / M.A. (Verpleegkunde)