Organ transplantation is one of the most important medical achievements of the 20
century. Kidney transplantation is the most efficient method of renal replacement therapy. The first successful ...kidney transplantation in human was performed in 1954 in Boston, USA. In former Yugoslavia, the first kidney transplantation was performed on April 16, 1970 in Ljubljana, Slovenia, and second one on January 30, 1971 in Rijeka, Croatia. In both cases, the mother donated kidney to the son. In the article, we describe the prerequisite conditions for this operation, the characteristics of first patients, and the impact of transplantation program on the development of the hospitals and medical schools.
Purpose: Video materials have been used as teaching tools for many years. With the development of modern technology, new video devices have appeared that have greatly improved the quality and ...capabilities of video materials. This study was conducted with the purpose of investigating and comparing the current traditional and modern ways of recording ski elements. In the traditional way of recording, the cameraman stands on the ski slope and uses a camera to record a demonstration of the ski element of the skier moving toward him. On the other hand, the modern way of recording was made with the Gopro 360 max, which allows you to record video while skiing.Methods: The sample of respondents who evaluated the quality of the traditional and the Gopro 360 max videos for three skiing elements consisted of 149 students (105 male and 44 female) from the Faculty of Kinesiology Osijek. Prior to the video quality assessment test, the performance of the ski elements was explained to the students using traditional and modern video footage. When solving the ski knowledge test, students had the opportunity to watch and use traditional and/or modern videos.Results: The average score that students achieved on the ski knowledge test was 8.9 ± 2.48 points (74.16 ± 0.21%). When evaluating the quality and contribution of the videos, students rated the usefulness of the traditional method of video recording with an average score of 3.01 ± 1.25, while the modern method of video recording received an average usefulness score of 3.79 ± 1.07. The difference between the traditional and modern video recording was statistically significant at the p < 0.01 level.Conclusion: The obtained results indicate that the way the Gopro360 max records and presents the skiing elements contributes significantly to the quality of the presentation and the acquisition of specific skiing knowledge compared to the traditional recording method.
Abstract Background Femoral neck fractures in children are very rare and account for about 1% of all paediatric fractures. The aim of this retrospective study was to analyse the clinical and ...radiographic outcome in paediatric femoral neck fracture and to review the role of early decompression of the hip in the final outcome. Patients and methods The study was performed at the Department of Paediatric Orthopaedics and Traumatology, University Children's Hospital in Belgrade, Serbia from January 1996 to January 2010. The study included 28 patients, 12 female and 16 male, aged 4–14 years. Patients who were aged over 14 years or who had pathological femoral neck fractures or metabolic disturbances were excluded from the study. The type of neck fracture was determined according to the Delbet and Colonna classification. The patients were treated using different surgical procedures: closed reduction and cast immobilisation, closed reduction and percutaneous fixation with Kirschner wires (K-wires), closed reduction and fixation with cannulated screws and open reduction with Wagner plate stabilisation. The final outcome was evaluated using the clinical outcome (based on the Howorth–Ferguson scale), radiographic outcome and occurrence of complications. Results The median age of patients included in the study was 10.75 years and the average follow up was 9 years. According to the Delbet classification, there was one patient with type I, eight patients with type II, 16 patients with type III and three patients with type IV femoral neck fracture. Based on the Colonna classification, there were 23 displaced and five non-displaced femoral neck fractures. Decompression of the hip was performed in 21 patients. Avascular necrosis (AVN) developed as the main complication in 11 patients. The final outcome was excellent in 14 patients, good in four patients and poor in 14 patients. Conclusion Our study unequivocally confirms the positive effect of urgent treatment on the incidence of AVN as well as on the outcome. We have established a 12-hour interval after injury as an optimal time limit for commencing treatment. Unambiguously positive effects of hip decompression on the incidence of AVN were also noted. We found similar efficiency for open and needle hip decompression.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background The purpose of this retrospective study was to evaluate the complications associated with leg lengthening in children treated with the Ilizarov external fixator (IEF) and compare ...them between two groups of patients: one group was treated using an IEF alone and the other group was treated using an IEF in association with intramedullary alignment (IA). Patients and methods The study was performed at the University Children's Hospital in Belgrade, Serbia during a fourteen-year period (from 2000 to 2014). Complications occurred in 73 paediatric patients who underwent the leg lengthening procedure. Complications were classified according to the Caton classification and compared between two groups. Group I comprised 39 patients who underwent the limb lengthening procedure using IEF alone. Group II consisted of 34 patients who were treated with the combination of IEF and IA using two Kirschner wires (K-wires) or Titanium Elastic Nails (TEN). The duration of hospital treatment was also compared between the two groups and the impact of the type of IA on the occurrence of complications was assessed. Results There was a high rate of complications in patients treated using an IEF compared with those treated using the combination of IEF and IA, but there was no statistically significant difference between the two groups. There was a statistically significant difference in the duration of initial hospitalisation between the two groups, particularly when comparing TEN usage in IA. A comparison of the group of patients treated using an IEF in association with K-wires and patients treated using IEF and TEN showed there was no statistically significant difference in complication rate and duration of initial hospitalisation. Conclusion IA has multiple advantages as a method of treatment of leg length inequality. The major effect of applying IA in association with a circular IEF is significantly reduced complication rate and duration of initial hospitalisation, particularly when using TEN as a method of IA. This method of treatment also decreases hospital costs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Chronic shoulder dislocations are extremely rare. The goal of this retrospective study was to describe the epidemiology of chronic shoulder dislocation in our environment and to evaluate the ...outcome of treatment. Bio-demographic data and injury details were retrieved from case files. Definitive method of reduction and stabilisation and duration of follow-up care were also noted. Nine cases of subcoracoid anterior chronic shoulder dislocation were seen during the 6-year period of the study. Seven (78%) of these patients were male and two (22%) were female. The mean age was 42 (±17.5) years. The common mechanisms of injury were road traffic crash in four patients (44%), domestic falls in four patients (44%) and dislocation while getting out of bed in one patient (12%). None of the patients had neurovascular deficit at presentation. Five patients were managed operatively and four were managed non-operatively. Mean follow-up was 8 months (range 6–12 months). Clinical evaluation by Rowe shoulder score revealed that operated cases had significantly higher mean rank scores than non-operated cases using the Mann-Whitney U test. Two operated cases were graded fair and three poor. All cases managed non-operatively had poor outcome grades. Meticulous attempt at soft tissue repair and early supervised physiotherapy can contribute to a favourable outcome.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Road traffic injuries are a major cause of death in the emergency room. The goal of this study was to highlight the demographic pattern of road traffic-related deaths in the accident and ...emergency room of a regional trauma centre. This was a 5-year retrospective study in which road traffic-related cases of emergency room mortality between June 2009 and June 2014 were reviewed. A total of 33 road traffic crash-related deaths occurred during this period with a male-to-female ratio of 2.3:1. Most of these patients were pedestrians with severe injuries involving two or more Abbreviated Injury Scale (AIS) coded regions. The mean time between injury and presentation in the first trauma facility was 112.1 (±55.4) min, and between presentation in the emergency room and death was 410 (±645) min. Mangled lower extremity, bilateral long bone lower limb fractures, pelvic injuries, blunt injuries to the chest and abdomen, and cranial fossae fractures were the common injury pattern. Median ISS and NISS in these patients were 22 (interquartile range IQR = 11) and 25 (IQR = 17), respectively. Severe injuries, delayed presentation, multiple referrals and delayed resuscitative measures contribute to road traffic crash-related mortality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background Elastic stable intramedullary nailing (ESIN) osteosynthesis has been used in our department for the treatment of long-bone fractures in children and adolescents for more than 17 ...years. During this period we have shown that ESIN has several advantages compared with other methods of treatment. However, as with every other method, ESIN has its drawbacks and complications. These occur primarily if indication criteria are not respected or ESIN technique is inadequate. This paper presents the rate of complications that occurred with this method in our patients, and the means of prevention and treatment of these complications. Patients and methods A total of 270 patients treated with ESIN osteosynthesis for fractures of long bones of the extremities completed treatment. The study was conducted at the Department of Child Surgery and Orthopaedics of the Clinical Hospital Centre in Rijeka. All the Nancy Nails used in the study were of the same quality, from one manufacturer and were applied using the standard ESIN technique. In 228 patients (84%), ESIN was the primary treatment, whereas in the remaining 42 patients (16%), ESIN was applied after an attempt at manual reposition and immobilisation of bone fragments. All patients had control radiography at least three times and postoperative monitoring was conducted for at least two years. Results A total of 35 of the 270 observed patients developed complications; some patients had several complications. There were 53 early intraoperational complications and 29 late postoperative complications. All complications resolved with appropriate therapy. The treatment was satisfactory in all patients except those with an elongation of the extremity (leg) of more than 1 cm. Conclusion Postoperative complications related to the ESIN method of osteosynthesis in the patients in this study were detected by radiological control examinations and long-term clinical monitoring. All the complications of ESIN were relatively easy to treat with current medical methods. The frequency of particular complications is significantly reduced if indication criteria for ESIN are respected and correct ESIN technique is used.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background Surgical site infections (SSI) are nosocomial infections that cause considerable problems in orthopaedic surgery. Antibiotic prophylaxis can be used to reduce the risk for SSI. ...There is no universal antibiotic that can be recommended for prophylaxis in terms of coverage of all possible pathogens because of antibiotic resistance, and there are no universal recommendations for different types of patients in terms of injury type, selected operation and risk factors for development of SSI. The aim of this study was to analyse the effectiveness of antibiotic prophylaxis in surgical treatment (ORIF) of closed lower limb fractures in young, healthy patients. Patients and methods Patient details were collected from the patient histories. Inclusion criteria for participants were age 20–30 years, not suffering from any type of chronic disease or state that may affect postoperative infection and ISS ≤ 9. Antibiotic prophylaxis use and outcome (SSI) were compared between two groups of patients. Data were analysed using descriptive statistics, Fisher's exact test and t -test for proportions. Results A total of 347 patients with closed lower limb fractures treated with ORIF met the inclusion criteria. There were 290 male and 57 female patients, with an average age of 24.47 years. Prophylactic antibiotics were given to 242 patients (69.74%); 2 g ceftriaxone was administered to 88.02% of the patients who received antibiotic prophylaxis. Ten patients developed postoperative infection (eight out of 242 with antibiotic prophylaxis and two out of 105 without antibiotic prophylaxis). The difference between the two groups was not statistically significant (Fisher's exact test, P = 0.749). Conclusion Antibiotic prophylaxis was ineffective in preventing SSI in patients with no risk factors for SSI who were undergoing ORIF for closed lower limb fractures.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Zdravstvena njega, današnja medicinsko-tehnička dostignuća i priznati standardi liječenja omogućavaju sveobuhvatnu kvalitetu, sigurnost i sljedivost zdravstvenih postupaka poštujući načela u funkciji ...zaštite zdravlja. Kontinuiranom edukacijom unaprjeđuje se kvaliteta zdravstvene njege i povećava se učinkovitost u radu s bolesnicima te se time održava i povećava njihova sigurnost. zdravstveni problemi bolesnika stvaraju potrebu za adekvatnim i pravodobnim zbrinjavanjem, zdravstvenom njegom i liječenjem. prilikom pružanja kvalitetne zdravstvene njege pažnja je orijentirana prema bolesniku i njegovim potrebama, kako bi se održala i povećala njihova sigurnost, zadovoljstvo, osamostaljenje i ozdravljenje ili mirna smrt. Stoga zdravstveni postupci moraju biti sistematizirani, planirani te utemeljeni na znanju i iskustvu. zdravstvena njega bolesnika, koji predstavljaju rizičnu skupinu za razvoj kroničnih rana ili su već zadobili neki oblik kronične rane, očituje se preventivnim mjerama koje se provode edukacijom bolesnika, motiviranjem, praćenjem, ranim prepoznavanjem rizika i uzroka te njihovim smanjenjem ili uklanjanjem na način da se provedu potrebni propisani postupci liječenja koje određuje zdravstveno stanje bolesnika. osim preventivnih mjera, zdravstvena njega bolesnika koji imaju kroničnu ranu usmjerena je na zbrinjavanje oštećenog tkiva u provedbi adekvatne i pravodobne dijagnostike, uz pravodobnu i pravilnu procjenu rane i općeg stanja bolesnika. zato je potrebno poznavanje patofiziološkog procesa te primjena lokalne ili sistemske terapije. Cilj liječenja je spriječiti daljnju progresiju raspada rane, poboljšanje općeg stanja bolesnika, te smanjenje mogućnosti razvoja infekcije i drugih komplikacija osnovne bolesti. U cjelokupnom zbrinjavanju pacijenata kroz proces zdravstvene njege medicinska sestra/tehničar provode sistematizirane intervencije koje su usmjerene prema održavanju i optimaliziranju zdravstvenog stanja, sprječavanju nastanka komplikacija postojećih bolesti, ciljanoj skrbi o rani, smanjenju boli, povećanju pokretljivosti i zadovoljstva s ciljem postizanja zadovoljavajućih funkcionalnih i estetskih rezultata. U današnje vrijeme znanje i iskustvo uz kontinuiranu edukaciju omogućuju kako bi se u korak s liječenjem postigla, održala i povećala kvaliteta zdravstvene njege.
Distalni tibiofibularni zglob odgovoran je za širinu i stabilnost takozvane zglobne viljuške gležnja koju sačinjavaju distalna tibija i distalna fibula. Prema nekim autorima tijekom uganuća gležnja u ...95 % slučajeva dolazi i do ozljede ligamenta distalnog tibiofibularnog zgloba. Upravo je prepoznavanje ovih ozljeda od velike važnosti, jer se pacijenti s tim ozljedama liječe dvostruko dulje od pacijenata s ozljedama ligamentarnih struktura lateralne strane gležnja, a do povratka sportskim aktivnostima protekne i do 6 mjeseci. Standardni klinički testovi i klasične rendgenske snimke nisu često dostatni za postavljanje dijagnoze, pa je pri sumnji na ozljede sindezmoze potrebno učiniti i magnetsku rezonanciju. Način liječenja akutnih izoliranih ozljeda sindezmoze ovisi o stupnju nestabilnosti gležnja. Danas još uvijek postoje nedoumice i nesuglasja u postavljanju dijagnoze i liječenja takvih ozljeda. U ovom radu pokušali smo na sistematičan način prikazati anatomske karakteristike distalnog tibiofibularnog zgloba, ali i najnovije stavove u dijagnostici i liječenju ozljede sindezmoze.
Distal tibiofibular joint is responsible for the distal crucial anatomic structure responsible for the ankle joint stability. According to some authors syndesmosis injury occurs in 95% of the lateral ankle sprain during sport activity. Syndesmotic injuries often require twice as long to return to sport as compared to isolated lateral ligament sprains and can lead to prolonged pain and disability. Clinical tests and plain radiography have limited diagnostic capacity and often MRI imaging is necessary. The treatment of the acute isolated syndesmotic injury depends on the ankle stability. Today still, there is some doubt and disagreement regarding diagnostic criteria, classification, and treatment of syndesmotic injury.
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