Information publication of Department of Orthopaedic Surgery ...

Ortopinfo
Information publication of Department of Orthopaedic Surgery, University of Debrecen

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Ortopinfo
An electronic publication of Department of Orthopaedic Surgery, University of
Debrecen
The web page of the publication: www.ortopedia.dote.hu/ortopinfo
Made by SkylCom Kft.
The realization of the project was supported by TÁMOP-4.2.3-08/1-2009-0006
grant of University of Debrecen.
Date of publication: 31. July, 2011

Contents
Chapter one: Department of Orthopaedic Surgery ..............................................................4
Patient Care ..................................................................................................................................5
Staff .................................................................................................................................................9
Research ........................................................................................................................................ 11
Chapter two: The Laboratory of Biomechanics .................................................................... 14
History ...........................................................................................................................................15
Research ....................................................................................................................................... 19
Device- and implant development ..................................................................................20
Biomechanical material- and structure tests ............................................................... 22
Application of 3D technologies ........................................................................................ 23
Base research, development of surgical techniques ....................................................24
Complex project .................................................................................................................. 25
Biomechanical Material Testing Laboratory .......................................................................27
Operation ....................................................................................................................................29
Staff ........................................................................................................................................30
Equipment ............................................................................................................................30
Services ...................................................................................................................................31
Contact .......................................................................................................................................... 33
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Chapter one
Dep. of Orthopaedics

Patient care
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Department of Orthopaedic Surgery manages the following activities:
» Hospital services
» Full locomotor surgery
» Surgical treatment of rheumatic diseases
» Surgical treatment of accident conditions
» Total endoprotetics
» Out-patient services
Admission
» General orthopaedic special consultation
» Childhood screening tests
» Supplying of therapeutical equipments
To use the orthopaedic services you need a referral, except urgent cases. Referral can be obtained
from the family doctor.
Out-patient services
General orthopaedic special consultation:
Consultation hours: Monday, Wednesday, Thursday and Friday: 8:30-15:30
Tuesday: 9:00-17:00.
Registration needed.
Referral needed.
Child hip screening:
Consultation hours: workdays 13:30-15:30
Registration not needed.
Referral needed.

Traumathology special consultation:
Consultation hours: Tuesday: 8:00-9:00
Registration needed.
Referral needed.
Thursday: 8:00-10:00
The patients can register by phone: +36 52 255 912 or by e-mail: ortopinfo@dote.hu
Patient care for fee
Patients from abroad need to pay the following fees for our services.
1. Out-patient services
Treatment
HUF
Fee
EUR* RON*
First examination 12 000 45 194
Control examination 8 000 30 129
Consilium 12 000 45 194
Hip ultrasound examination 12 000 45 194
Bandaging 4 600 17 73
Individual physical training 3 450 13 56
Massage (30 minutes) 3 450 13 56
Taking of blood 1 200 4,5 20
Teaching of the use therapeutical equipments 3 450 13 56
Relaxation infusion (daily) 7 000 26 112
Intraarticularis injection 3 450 13 56
Ultrasound therapy treatment 3 450 13 56
* The actual fee is calculated based on the daily Forint/Euro/RON exchange rate
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2. Hospital serices
The fees bellow are only for informing. The actual fee can be calculated only after orthopaedic
and anesteologic examinations.
Beavatkozás, kezelés megnevezése
HUF
Treatment
EUR RON
Implant (min.)
HUF EUR RON
Implantation of total endoprtosthesis
805 000 2 900 12 600 430 000 1 560 6 800
Implantation of revision total
endoprtosthesis
1 150 000 4 200 18 000 500 000 1 820 7 800
Cemented total hip replacement 920 000 3 350 14 400 140 000 510 2 200
Uncemented total hip replacement
1 035 000 3 760 16 200 250 000 910 3 900
Revision total hip replacement 1 265 000 4 600 19 770 430 000 1 560 6 800
Lumbar spine operation 1 150 000 4 200 18 000 500 000 1 820 7 800
Scoliosis operation 1 495 000 5 450 23 360 800 000 2 910 12 500
Orthopaedic small operation 172 500 630 2 700
Orthopaedic smaller medium operation
287 500 1 050 4 500
Orthopaedic bigger medium operation
550 000 2 000 8 600
Orthopaedic large operation 805 000 2 900 12 600
Arthroscopy 172 500 630 2 700
Conservative treatment of locomotor
diseases (daily)
7 500 30 120
Other treatments Based on personal calculations

Staff
Our Department has a 81-person staff including 21 doctors.
Dr. Zoltán Csernátony
head of department
associate professor
Prof. Dr. Kálmán Szepesi
professor emeritus
Dr. Levente Gáspár
associate professor
Dr. István Soltész
specialist
Dr. Gabriella Szücs
adjunct professor
Prof. Dr. János Rigó
professor emeritus
Dr. Zoltán Jónás
head surgeon
Dr. János Szabó
assistant lecturer
Dr. Tünde Simon
assistant lecturer
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Dr. Zoltán Karácsonyi
assistant lecturer
Dr. László Kiss
assistant lecturer
Dr. Henrik Rybaltovszki
specialist
Dr. Gyula Győrfi
doctor
Dr. Csenge Szeverényi
assistant lecturer
Dr. Tamás Bazsó
assistant lecturer
Dr. Zsolt Hunya
specialist

Research
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The research activity of the Department is in the following areas:
» Base research and development of surgical techniques
» Implant- and medical equipment development
The most important publications of the Department are the followings:
Csernátony Z, Gáspár L, Mórocz I. Térdízületi synovialis chondromatosis. Magyar Traumat
Ortop 1991;34:53-6.
Gáspár L, Farkas Cs, Csernátony Z. Menisectomia után kialakuló radiológiai elváltozások
és ezek összefüggése a térdfunkció romlásával. Magyar Traumat Ortop 1999;42:5-12.
Póti L, Csernátony Z, Soltész I, Kiss Á. A csípőízületre frontális síkban ható erők
biomechanikai analízise avascularis necrosis esetén. Magyar Traumat Ortop 1999;42:34-41.
Csernátony Z, Szepesi K, Gáspár L, Dezső Zs, Jónás Z. „The Rotational Preconstraint”.
A kinetic model of a possible new mechanism in the ethiopathogenesis of scoliosis. Medical
Csernátony Z, Szepesi K, Gáspár L, Kiss L. Contradictions of Derotation in Scoliosis Surgery
Using the CD Principle. Medical Hypotheses 2002;58(6):498-502.
Csernátony Z, Gáspár L, Jónás Z, Szepesi K. Modified Unit Rod technique in Scoliosis
Surgery. Acta Orthop Scand 2002 Aug; 73(4):481-2.
Manó S, Novák L, Csernátony Z. A 3D nyomtatás technológiájának alkalmazása a
cranioplasticában. Biomechanica Hungarica 2008 július; I.1:15-20.

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Molnár Sz, Manó S, Kiss L, Csernátony Z. Ex vivo and in vitro determination of the axial
rotational axis of the human thoracic spine. Spine. 31(26):E984-E991, December 15, 2006.
Molnár Sz, Manó S, Kiss L, Csernátony Z. Ex vivo and in vitro determination of the axial
rotational axis of the human thoracic spine. Spine. 31(26):E984-E991, December 15, 2006.
Csernátony Z, Dezső Zs, Gáspár L. Csípőprotézisek rotációs stabilitása a femur proximalis
metaphysisében. Biomechanikai modellkísérlet. Magyar Traumat Ortop 2007;50.2:107-16.
51. Csernátony Z, Kiss L, Manó S. A new technique of wedge osteotomy to diminish undesirable
fractures. Eur J Orthop Surg Traumatol 2008; 18:485-488.
Csernátony Z, Molnár S, Hunya Z, Manó S, Kiss L. Biomechanical examination of the thoracic
spine-the axial rotation moment and vertical loading capacity of the transverse process. J Orthop Res.
2011 Jun 6 (megjelenés alatt)
Csernátony Z, Hunya Zs, Sikula J, Kollár J. A thoracalis gerinc processus transversusainak geomet-
riai vizsgálata. Biomechanica Hungarica 2008 július; I.1:57-62.
Csernátony Z, Manó S, Pálinkás J. CAB: Egy új típusú implantátum a háti gerincszakasz görbü-
letének korrekciójára. First Hungarian Conference on Biomechanics. 2004. 77-84.
Kiss L, Manó S, Molnár Sz, Csernátony Z. Sikertelen felső ugróízületi protézisműtét salvage tech-
nikája: az Ankle Ball Spacer - biomechanikai előtanulmány.
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Chapter two
Biomechanics Lab

History
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The history of the Laboratory of Biomechanics started in 1993, when Zoltán Csernátony orthopaedic
surgeon looked for research partners for finish his biomechanical experiments
by some tests on human femurs. After visit more institutes the Miklós Ybl Technical College
seemed to show some cooperation in the execution of the tests. The result of the successful
cooperation was that to give an official frame to similar further projects the Department of
Orthopaedic Surgery, University of Debrecen and the Miklós Ybl Technical College in 1993
founded the Biomechanical Research Laboratory.
Development phases of the CAB hook
The new building of the Laboratory in 2000
Initially a small 30 m² room was the home to the experiments.
The College appointed Róbert Horváth
(head of department) as the Deputy Head of the Laboratory.
The most important result of the period till
2000 was the development of a new principle based,
patented spine implant system that was successfully
applied in the Department of Orthopaedics, more
than 30 cases with an excellent result.
In 2000, the Laboratory has a significant development,
when moved to a new, its own, 100 m2 building,
and the same year a mechanical engineer, Sándor
Manó joined to the Laboratory as a permanent staff.
The professional development of the laboratory had
a serious impulse due to these changes, which have
significantly contributed by the successful grant projects.
The maximum value of an approximately $ 350 000
investment was an Instron 8874-type servohydraulic
biaxial biomechanical material testing equipment. In
Hungary this was the first time when a similar knowledge
device was used. This machine has the opportunity
to pull and push, as well as screwing for both
static and dynamic tests.
In 2005, thanks to a GVOP tender based on the services
of the Instron 8874 machine, we founded a new
unit named Biomechanical Material Testing Laboratory,
whose standard measurement activities was ac-

credited by the National Accreditation Board in 2006. In the same year thanks to another
tender, obtaining a ZPrint 310 3D printer, we adopted
the application of Rapid Prototyping technology in
the medicine in Hungary. We apply this method successfully
for the production of custom implants (cranioplasty,
plastic surgery), surgical planning (orthopaedic,
neurosurgery), and during the development of
medical devices.
Since 2000 the number of our device development projects
has dynamically grown. As a participant of the major
project University Knowledge Center we developed a
special operating table for spinal surgery, a knee moving
device, as well as a modular-based revision total hip
prosthesis system.
In the programme József Öveges from 2006, involving
students we planned a so called heel vibration rehabilitation
device and successfully realized a clinical trial
using the prototype.
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In the context of external professional cooperation also
The extended Lab in 2005
there are several finished and running projects. One of
the most advanced of these is a patient and horse monitoring system connected to the hippotherapy.
The Laboratory of Biomechanics in the case of enough capacity perform services as well, in
particular in the field of material testing and 3D printing, and will be happy to accept external
(research) partner’s willingness to cooperate.
Last but not least in the laboratory, the scientific journal titled Biomechanica Hungarica was
founded and is edited by the staff of the laboratory.
The year 2011 brought an important change for the life of the laboratory, when we will move
from the territory of the Faculty of Engineering to the area of the Medical Center. With this
step the common operation with the Faculty of Engineering ends, at the same time, the dialy
communication between the Laboratory and the Department of Orthopaedic Surgery will
highly simplified, since the distance will dramatically decrease. Although the principle will
continue to prevail, that the biomechanical – particularly the cadaver — research activity be
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separated in space from the clinical healing activity.
This year the Laboratory of Biomechanics of the Department of Orthopaedic Surgery is 18
years old. With the moving to a new location,
with its well-established professional
acknowledgement, and results we feel that
it represents a strong professional potential,
and we hope it will continue to be a useful
background unit of the more effective locomotor
surgery.
The building of the Laboratory at the Faculty of Engineering
Manó S. A Debreceni Egyetem Biomechanikai Laboratóriuma. Biomechanica Hungarica 2011;IV(1):7-14.

Research
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The Sanat-R prosthesis
As a part of the Department of Orthopaedic Surgery, the main activity of our Laboratory is
the locomotor base- and applied research. Our diversified activities can be arranged into four
main categories.
1. orthopaedic and medical device- and implant development
2. biomechanical and other material and structure testing
3. application of medical 3D technologies
4. biomechanical and locomotor surgery related base research and surgical technique
development.
In this section we present some example projects from the categories above.
Device- and implant development
Regional University Knowledge Center
The Regional University Knowledge Center grant is a grand, complex project
based on the scientific capacity of University of Debrecen. The Department
of Orthopaedic Surgery and our Laboratory worked on a sub-project
within this main project.
The most important goal of our sub-project was the development of a new
biologically fixed total hip revision endoprosthesis system.
Our further aims are to develop and construct a new moving device prototype
that helps the rehabilitation of the patients after implanting a knee or
a hip prosthesis, additionally the development of a special operating table
for spine surgery based on a new concept.
Development of a heel vibrating device
During this project - involving 4 TDK student - we designed and built the prototype of a
rehabilitation device that helps the rehabilitation and the work of the physiotherapist after
certain (mainly total endoprtosthesis) knee operations
The device executes individual programmed moving therapy controlled by a PDA.
We performed the first clinical trials and the processing of the collected data is currently in
progress.

Development of a self positioning operation lamp
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During the project we developed an operating lamp based on an automatic wireless positioning
system and built the first working prototype. During
the application of the system the surgeon can adjust the
perfect direction and the focus of the light using a special
wireless pointing device by a single button-pushing.
The sterilized pointing device is held by the surgeon and
used to mark the focus point and the direction of the light.
After pointing to the appropriate place the surgeon pushes
a button and the positioning system automatically adjusts
the light-source realizing the desired focus and direction.
The advantages of this new system in contradiction to a
conventional operation lamp are the followings:
The prototype of the operating lamp
» eliminate sterilization problems
» the adjusting process is controlled directly by the surgeon
» perfect focus and light direction can be adjusted for the operating surgeon
» eliminate personal communication problems
» easy handling
» fast moving and switching between positions
» built in camera
Other implant- and device development projects
» the CAB hook: spinal implant system
» modular revision acetabular component
» wheelchair with spine-extending function
» special saw for bone surgery
» spine self-exposer
» surgical aiming device
» spiral implant for femur head stabilization
» reverse airbag for the protection of the hip in car
seats
Wheelchair with spine-extending function
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Biomechanical material and structural tests
Comparison of the stability of fixation techniques for pelvis ring injury
The goal of this project was to compare the reached stability in the pelvis ring in the case of
Denis I and II fractures applying the following three techniques:
» Direct plate fixation
» Narrow and wide DC-plate fixation
» KFI-H plate fixation
The main direction of the method was to apply final element
analysis, but there were several cadaver tests in our
Laboratory as well.
The main result of the project was that the difference in
the stability of the techniques not as significant as the
difference between the invasivity.
Bodzay T, Asbóth L, Szita J, Váradi K. Medencegyűrű-sérülések műtéti rögzítésének végeselemes modellezé-
se. Biomech Hung 2008;I(1):37-46.
Compression test of a nanocomposite material
New approach of nanocomposite based bone substitution
In this OTKA project we would like to develop a new,
nanocomposite based material for bone substitution.
Cooperating with the Department of Inorganic and Analytical
Chemistry, University of Debrecen, we produced
several materials that were tested at the Laboratory of
Biomechanics.
Currently we are starting the animal experiments.

Other biomechanical material/structure testing research projects
» Biomechanical comparison of three cemented stem removal techniques in revision
hip surgery
» Examining the application of Reverse Kapandji operation in the treatment of proximal
radioulnar synostosis
» Comparison of the stability of different pelvis osteotomies
Application of 3D technologies
In our Laboratory there are three dimensional printer,
scanner, furthermore mechanical and visual designing
software to solve certain medical- surgical tasks.
Our Laboratory is the first place in Hungary, where the
3D printing as a rapid prototyping technology is applied
for surgical purposes. By this technology (even from CT
scans) it is possible to produce real objects based on
computer three dimensional models. The method can
be successfully applied in a wide area of the medicine,
particularly in the following specialities:
» neurosurgery, cranioplasty
» producing of individual implants, spacers (orthopaedics, plastic surgery)
» operation planning
» demonstration, education
» designing of implants and medical devices
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Tóth K, Sisák K, Wellinger K, Manó S, Horváth G, Szendroi M, Csernátony Z. Biomechanical
comparison of three cemented stem removal techniques in revision hip surgery. Archives of Orthopaedic
and Trauma Surgery (közlésre elfogadva)
Rybaltovszki H, Fekete K, Manó S. Is there any reality to the reverse Kapandji operation In the
treatment of proximal radioulnar synostosis? Biomechanica Hungarica 2010 dec; III.2:43-51
3D nyomtatóval készült modellek
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The method make applying molding process possible as well. In the case of cranioplasty,
or other bone substitution operation first we produce
the positive mould with the 3D printer based
on CT scans, then we mold it with silicone and get
the negative mould, that forms the spacer or the
substitution in the operating room. We successfully
applied the method several times at the Department
of Orthopaedic Surgery, furthermore at the Department
of Neurosurgery in Debrecen and Szeged.
Csernátony Z, Novák L, Bognár L, Ruszthi P, Manó S. Számítógépes tervezésű cranioplastica. Első hazai
eredmények a térbeli nyomtatás orvosi alkalmazásával. Magyar Traumat Ortop 2007;50.3:238-43.
Manó S, Novák L, Csernátony Z. A 3D nyomtatás technológiájának alkalmazása a cranioplasticában.
Biomechanica Hungarica 2008 július; I.1:15-20.
Base research and surgical techniques
» Development of nanocomposite based material for bone substitution (see earlier)
» Elaboration of the Spine Knows Better (SKB) correction technique
» Roof Step Cut technique: a new method for acetabular correction

Complex project: the influence of the lubrication properties of human materials for
the stability of spinal implants
n this complex project we examine the stability of the spinal implants related to the ambient
material and the tightening torque of the fixing screws.
As the first step we determined the relative lubricating
properties of some human materials that are exist
during a spinal operation. For the measurements
a special machine was built to measure the relative
lubricity. In this way we compared the lubricity of
the human materials like blood and fat to some wellknown
lubricants.
After constructing the device for the measurements we
executed the comparative measurements with the following
result.
Based on these results we chosen the industry equivalent lubricant material for the spinal implant
tests, so we used motor oil as this has the most similar lubricity to the human materials.
Ortopinfo
Tiba Zs, Husi G, Manó S, Kiss L, Jónás Z, et al. An easy to use device for lubricity examination. Biomechanica
Hungarica 2009;II(2):27-30.
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During the mechanical tests described in the standard ASTM F-1798 we compared the dry
vs the lubricant based, furthermore the weakly vs the strongly tightened
implants based on the force required to move the components
relatively.
The model for torque measurement
The last sub-project is a measurement sequence where we ask spinal
surgeons to tighten the screws of spinal implants using a plastic
model. With this experiment we would like to see how much is the
really applied torque to these implants and compare the manufacturer’s
suggestions and the results of the previous sub-projects.

Meterial Testing Lab
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Laboratory of Biomechanics has participated in material testing from the first time, particularly
in tests of human bones. The year 2003 brought a significant change, when we set an
Instron 8874 type biomechanical material testing machine going. Using this machine we got
the possibility for the introduction of standard material tests beside
our biomechanical studies, which raised the possibility of accreditation
by establishing the required quality management system.
Thanks to a grant we started to realize the accreditation process of
the testing activity of the laboratory in 2005, so the Biomechanical
Material Testing Laboratory was founded in the same year for the
purpose to sharply separate the accredited material testing activity
with its quality management system from any other activity of the
laboratory.
The main activity of the Material Testing Laboratory is the research:
various biomechanical nature experiments, measurements and
tests. In addition, in conjunction with the accredited activity we carry
out external orders as well.
The detailed list of our standard testing procedures:
Material Test Standard
Metals tensile test MSZ EN 10002-1:2001
MSZ EN ISO 527-1:1999
MSZ EN ISO 527-2:1993
tensile test
MSZ EN ISO 527-3:1996
Plastics
MSZ EN ISO 527-4:1999
MSZ EN ISO 527-5:1999
bending test MSZ EN ISO 178:2000
compression test MSZ EN ISO 604:2003
determination of density MSZ EN ISO 1183-1:2004
tensile test MSZ EN 12814-2:2000
Welded joints of plastics T-peel test MSZ EN 12814-4:2001
tensile test MSZ EN 12814-7:2003
Plastics and rubbers Shore hardness (A,D) MSZ ISO 868:1991
External fixator static and cyclic tests ASTM F 1541 – 02
Spine implant static and cyclic tests ASTM F 1798 - 97

Operation
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Staff
The following persons form the staff of the Laboratory of Biomechanics and the Laboratory
of the Biomechanical Material Testing Laboratory:
Equipment
Dr. Zoltán Csernátony
head of laboratory
Sándor Manó
assistant research fellow
quality manager
Katalin Deutsch
laboratory assistant
Calibrated devices of the Material Testing Laboratory
» Instron 8874 biomechanical material testing machine
Capacity: 25 kN; 100 Nm
Test types: static/cyclic; axial/torsion
» Advanced Video Extensometer (connected to Insron 8874)
FOV: 200 mm
Accuracy: ±2.5 μm
» Instron S1 Durometer
With Shore A and D heads

» Mitutoyo measuring devices
Mitutoyo 227-201 digital micrometer
Mitutoyo 145-185 inner micrometer
Mitutoyo 551-231-10 digital caliper
» Torque meters
Torqueleader Quickset
WERA 7112B DS
Workshop equipment
» E2N turning machine
» ZX45Z milling machnine
» Metabo sawing machine
» Circular saws
» Tabletop drilling machine
» Hand tools
3D technologies
» ZPrinter 310 3D printer
» Cobra Fastscan 3D scanner
» 3D szoftware: 3DS Max 2012, Magics, Mimics, Catia V5
Services
We offer several services for industrial or institutional partners in the following fields.
Material and construction tests
» Accredited tests based on standards in page 56.
» Non-standardized biomechanical and other tests including cadaver experiments.
3D printing
» Geometry prototypes of any mechanical part or even implant: We can manufacture
even the most complex 3d objects with maximum size of 200x200x250 mm by our
Zprint 310 three dimensional printer.
» Individual implants and spacers: We can produce silicon molding forms based on 3D
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Instron 8874
ZPrinter 310
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objects printed by our 3d printer. This form can be used for making individual bone
substitution implants/spacers for cranioplasty or different orthopaedic operations.
» 3D models for surgical planning based on CT scans: The model of the bone holding in
your hand offers the best possibilities to plan a difficult operation. You can plan any
movement and the whole process, what’s more the model can be formed, drilled as
you would do it during the operation. We used this method several times in the case
of hip, spine, ankle and foot problems.
3D scanning, 3D reconstruction
» We have a Cobra Fastscan handheld 3D laser scanner. Using this technology we can
digitalize objects in a wide size range anywhere.
» We undertake the reconstruction of bones and certain soft tissues based on CT scans,
that can be put at your disposal in any popular editable 3D file format.
Cadaver experiments
» We undertake the full arrangement of cadaver experiments executed in our Laboratory
including the taking of the ethical approval.

Contact
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Department of Orthopaedic Surgery
Address: 4032 Debrecen, Nagyerdei krt. 98.
Postal address: 4012 Debrecen, Pf. 16.
E-mail addresses
The building of the Department is the second one to the right approaching
from the main entrance.
Direct phone numbers Extension
Secretariat: 06 52 255 815 55815
Fax: 06 52 255 815
Reception: 06 52 255 604 55626
Patient registration: 06 52 255 912 56185
Dr. Zoltán Csernátony head of department: csz@med.unideb.hu
Judit Varga secretary: vargaj@med.unideb.hu
General information, registration: ortopinfo@med.unideb.hu
Laboratory of Biomechanics
Address: 4032 Debrecen, Nagyerdei krt. 98.
Postal address: 4032 Debrecen, Nagyerdei krt. 98.
Location: Basement of the Theoretic Block beyond the restaurant.
Phone numbers:
Room of the Laboratory: 06 52 415 155/77707
Head of laboratory: 06 52 255 815
E-mail addresses
Dr. Zoltán Csernátony head of laboratory: csz@med.unideb.hu
Sándor Manó: manos@med.unideb.hu