Biomechanics and pathobiomechanics of locomotor apparatus

Elective subject on Departement of Anthropology and Human Genetics, Faculty of Sciences, Charles University Prague, and on Departement of Anatomy and Human Biomechanics, Faculty of Physical Education and Sport, Charles University Prague.

Lecturer: Prof. Ivo Mařík, MD, PhD.

The primary focus of biomechanics, at present, is the musculo-skeletal system of healthy population. The mechanical properties of the skeleton are investigated in healthy young people such as students, athletes. Little is known about skeletal biomechanical changes during periods of growth and aging. Also, few articles about biomechanics and pathobiomechanics in inborn skeletal defects have been published.

Great progress in orthopaedics and traumatology during last 25 years has been made as a result of knowledge about biomechanics of locomotor apparatus, conditions of bone tissue healing, choices of biomaterials, developement of implants for osteosynthesis of long bones and vertebral column and joint replacements. Methods of treatment in pathological situations are limited if disease, age or inborn defects have significantly impared mechanical properties of bone tissue. This is especially true of unexplored phenomena involving the growing period of individuals with inborn skeletal defects.

Inborn defects of locomotor apparatus appear to us like an experiment of nature and making it possible to study pathobiomechanics of skeleton directly. Inborn skeletal defects contain extensive groups of systemic defects, so called bone dysplasias and congenital limb defects. The affection of other systems including the central nervous system is common. The world epidemiological studies show that the defects of locomotor apparatus represent about two thirds of all inborn defects. Fundamentally, few of these defects are biomechanicaly important. It estimated that 200 to 300 children with consequential defects are born in the Czech Republic every year. It means that about 4 000 patients in the age till 25 years need a special comprehensive care. Antropometric examination methods together with X-ray investigation are still principal method of diagnostics, however they are also used to determine the appropriate surgical treatment and assess the expected results. Finding the pathobiomechanics out and the research with a view to treatment of biomechanically important inborn and acquired defects of locomotor system especially in the growing period together with complex interdisciplinal care helps to include these disabled people in our society as maximal full-valued individuals with a good social background. The economic effect of complex care is obvious.

The contents of the elective subject “Biomechanics and pathobiomechanics of locomotor apparatus is presented as a list of topics. The lessons shall give afford cognitions about musculo-skeletal system with abnormal development due to genetically given inborn defect or as a result of growing disorder provoked by some disease or an injury.

Congenital skeletal defects (systemic, limb and combined defects) have never been included as a subject into any medical field. The involved with bone dysplasias (osteochondrodysplasias) are currently on the border of interest of most orthopedists and paediatricians even in the Czech Republic. The treatment has been still symptomatic (orthopaedic-prosthetic fitting and orhopaedic-surgical treatment). The amazing development of molecular genetics makes it possible to perform prenatal diagnosis. Thanks to this, we expect new causal methods of therapy at some nosological units.

The elective subject: One semester, 28 lessons, concluding examination
Extent: 2 + 2 (two lessons of lectures, two lessons of practical in a week)

Note: Seminars (practical) are prerequisite for understanding problems and necessary for study of this subject. We prefer to accumulate the lectures into 3 blocks. We presume 3 half day long lectures, and 14 hours for practical. Practical and lectures will take place at accredit clinical workplace The Ambulant Centre for Defects of Locomotor Apparatus, Olsanska 7, Prague 3.

The head of teaching:

  • Assoc. Prof. Ivo Marik, MD, PhD
    Ambulant Centre for Defects of Locomotor Apparatus, Olsanska 7, Prague 3, 130 00, Czech Republic
    phone/fax: +420 222 582 214, e-mail: ambul_centrum@volny.cz, www.pojivo.cz

Co-workers:

  • RNDr. Daniela Zemková, PhD
    Paediatric Department, Charles University, FN Motol, Prague and Ambulant Centre for Defects of Locomotor Apparatus, Olsanska 7, Prague 3
  • Prof. Eng. Miroslav Petrtýl, DS.
    Czech Technical University in Prague, Faculty of Civil Engineering, Dept. of Mechanics, Lab. of Biomechanics and Biomaterial Engineering, Prague 6

The topics of lectures

  1. Functional adaptation of bones (skeletal remodelling) and its biomechanical and biorheological causes (viscoelastic features of bone tissue, deformational – rheological effects at function of osteoblasts and osteoclasts, remodelling of healthy bone tissue – acquired limb defects (dysostoses after injuries, inflammation and different disorders of growth, aseptic necroses). Pathogenesis of genetically given deformaties of long bones and vertebral bodies on the basis of inborn programmed genetic disorder, metabolic bone disorders, biomechanical laws (remodelling of physiologic and pathologic bone tissue, growth cartilage) and as a consequence of neural – extensive growth of spinal and peripheral nerves – macroneurotrophic growth /experimental studies of M. Roth / (Assoc. Prof. Ivo Marik, M.D. Ph.D.).
  2. Anthropometric evaluation of growth and proportionality, symmetry and asymmetry, congenital defects of growth, prediction of stature height, shortness or overgrowth of particular limb segments, axial deformities of legs, bone and calendar age – maturation. Orthopaedic antropology (RNDr. Dana Zemkova, PhD.).
  3. Clinical-anthropolgical-radiological diagnosis and classification of constitutional bone diseases (bone dysplasias), examples of pathological bone remodelling and possibilities of conservative treatment (controlled remodelling of long bones by means of high effective orthoses with adjusting prestress) and surgical treatment (biomechanical indications of corrective, segmental and lengthening operations, biological healing pre-requisites of bone regenerates during lengthening of long bones and multiple osteotomies) (Assoc. Prof. Ivo Marik, M.D. Ph.D.).
  4. Congenital limb defects – classification. Congenital disorders of growth, growth dynamic of shortened bones according to Shapiro (1982). Biomechanical and biological pre-reguisites for lengthening operations or epiphyseodesis in the area of knee joint. Orthotic treatment of congenital and other defects of limbs and feet (Assoc. Prof. Ivo Marik, M.D. Ph.D.).
  5. The biomechanics of the spine in physiological and pathological conditions (scoliosis, kyphosis, kyphoscoliosis idiopathic, systemic and congenital, 3 D deformities), diagnostics and treatment (complex conservative and surgical treatment), remodelling of the spine (Assoc. Prof. Ivo Marik, M.D. Ph.D.).
  6. The biomechanics of the foot in physiological and pathological conditions, orthotic treatment of congenital and acquired deformities of lower extremities including feet. reconstructive surgery of congenital and acquired defects of the foot with the aim to correct foot pathobiomechanics (Assoc. Prof. Ivo Marik, M.D. Ph.D.).
  7. Biomechanics in orthopaedics, biomechanics of prostheses of big joins, subchondral bone replacement, the first and the second phase of remodelling of corticalis from the macro-, meso- and microstructure point of view (Prof. Eng. Miroslav Petrtyl, DSc.)

Registered references

  • Mařík I. Systemic, limb and combined defects of the skeleton – part 1: diagnostic, therapeutical and biomechanical aspects. Monograph (in Czech). In: Pohybové ústrojí, 7, 2000, 2-3, p 81-215.
  • Mařík I. Systemic, limb and combined defects of the skeleton – part 2: representative case reports. Monograph (in Czech). In: Pohybové ústrojí, 8, 2001, 3-4, p.102-256.
  • Černý P, Pallová I, Mařík I. Grafická metoda určení rotace obratlů. Prospektivní studie. Pohybové ústrojí, 11, 2004, 3+4, p.163-170.
  • Čulík J, Mařík I, Zemková D. Nomogramy pro určování tibio-femorálního úhlu. Pohybové ústrojí, 9, 2002, No.3+4, p.81–89, 145-149.
  • Frost HM. Osteogenesis imperfecta. The set point proposal (a possible causative mechanism). Clin Orthop, 1987, 216, p.280-292.
  • Frost H.M. The Utah Paradigma of Skeletal Physiology. Vol. I. Bone and Bones and Associated Problems. ISMNI, Greece, 2004, 427 p.
  • Heřt J. Wolfův transformační zákon po 100 letech. Acta. Chir. orthop. Traum. čech., 57, 1990, No.6, p.465-76.
  • Marotti G. The structure of bone tissues and the cellular control of their deposition. Ital J Anat Embryol, 101, 1996, No 4, 25-79.
  • Maršík F, Mařík I, Klika V. Chemical kinetics of bone remodeling based on RANK – RANKL – OPG biology. Pohybové ústrojí, 11, 2004, No.3-4, Suplementum p.260-269.
  • Maršík F, Mařík I, Klika V. Chemické procesy kostní remodelace. Pohybové ústrojí, 12, 2005, No.1-2, p.51-61.
  • Marík I, Culík J, Cerny P, Zemková D, Zubina P, Hyánková E. New Limb Orthoses with High Bending Pre-Stressing. Orthopädie-Technik Quarterly, English edition III/2003, p.7-12.
  • Mařík I. Řízená remodelace u systémových vad skeletu v období růstu: metoda volby konzervativního léčení deformit dlouhých kostí. Iatrike Techne, No.2/2003, p.73 – 77.
  • Mařík I, Straus J, Sochr T. Biomechanické a kriminalistické aspekty podogramů dětí s kostními dysplaziemi a vrozenými končetinovými defekty. Pohybové ústrojí, 11, 2004, No.3+4, p.141-152.
  • Mařík I. Maříková A. Vrozené vady pohybového ústrojí, diagnóza a komplexní léčení. Postgraduální medicína, 8, 2006, No.1, p.28 – 37.
  • Mařík I, Maříková A, Hudáková O, Zemková D, Myslivec R, Hyánková E, Kozlowski K. Vrozené systémové vady pohybového ústrojí: pokroky v diagnostice. Rheumatologia, 23, 2009, No.2, p.33-41.
  • Nordin M, Frankel VH. Basic Biomechanics of the Musculoskeletal System. 2nd Ed, Lea and Febiger, Philadelphia, London, 1989, 323 s.
  • Petrtýl M. Biomechanické a biotermodynamické zákonitosti remodelace kostní tkáně. Pohybové ústrojí, 6, 1999, No.1, p.28-48.
  • Petrtýl M, Danešová J. Obecná teorie remodelace kostní tkáně. Pohybové ústrojí, 6, 1999, No. 3-4, p.244–263.
  • Petrtýl M, Danešová J, Mařík I, Lísal J, Wohlmuthová A, Jandeková D. Remodelace fibrózní tkáně a modelace lamelární kosti v interfragmentálním prostoru: Kauzální vztahy mezi jejich komponentami. Pohybové ústrojí, 12, 2005, No.1-2, p.77-91.