Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various methods of treatment have been described for nonunions with infection, bone loss ...or both. One of them is the central bone grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating a tibiofibular synostosis. We present the results of uncontrolled, retrospective and continuous series of ten patients treated by a central bone grafting technique for infected tibial nonunion with bone loss. Mean follow-up period was 12 (10-15) years. Most injuries were a result of war injuries. Clinically and radiologically confirmed bony healing with total consolidation of the graft was achieved in all patients within a period of 10-12 months without further bone grafting. The newly-formed bone mass was able to fulfil the mechanical and functional demands of everyday life activities. Once again, the central bone grafting technique has shown to be a safe, reliable and effective method of treatment for infected tibial nonunion with bone defect.
Subtalarna artroereza vrijedna je metoda u liječenju simptomatskog fleksibilno spuštenog
stopala dječje dobi te vrijedna pomoćna metoda u liječenju simptomatskog fleksibilno
spuštenog stopala odrasle ...dobi, kod kojih intenzivna konzervativna terapija nije polučila rezultate
uklanjanja bola. U literaturi ima nedovoljno podataka o dugoročnom postoperativnom
praćenju bolesnika i dugotrajnom učinku artroereze na oboljela stopala u dječjoj i odrasloj
dobi te njenom utjecaju na ostatak muskuloskeletnog sustava.
Using ultrasound in evaluation of infant's hip development can reduce surgical procedures, hospitalization and late presentation of developmental dysplasia of the hip (DDH). The increasing incidence ...of DDH after ultrasound examination is observed and published by many authors. In a prospective study, radiograph of every single ultrasonographic positive hip in infants older than three months, was taken and analyzed in order to see whether it affects infants splintage rate in treating DDH. In a period of 30 months, clinical and simple static ultrasonographic examinations according to Graf were performed on 1430 consecutive infant hips in patients aged between 4 and 6 months. Sonographic positive hips were radiographed and acetabular index (AI) values on simple AP radiographs were analyzed. The sonographic DDH incidence was 51.75 per 1000 hips (51.75 per thousand). After X-ray examination of all 74 ultrasonographic positive hips, only 44 remained abnormal and required treatment indicating a true DDH incidence of 30.77 per 1000 hips (30.77 per thousand). The difference in incidence per ultrasonographic and X-ray positive hips is statistically significant p < 0.01 (t = 5,536). The rational approach in detection of DDH in a child more than 3 months old is to do radiographic assessment of every sonographic positive hip.
There are many angles measured on hip radiographs, but their prognostic value for hip development in patient with DDH is controversial. Our aim was to find out how the development of congenitally ...luxated hip could be predicted after reduction using Wiberg's CE angle and CE angle refined according to Ogata. 119 hips of 61 patients were retrospectively evaluated after reduction from 3 months of age until at least full osteomaturity. According to results of CE angles measurements good and poor hip development group were formed. Healthy hips of the patients with unilateral DDH were considered to be the control group. Negative linear trend of the curve connecting Wiberg's CE angle values measured within first postreductive years is a poor prognostic sign of hip development as are absolute negative values of refined CE angles. In cases where negative initial refined CE angles are combined with negative linear trend of Wiberg's CE angles prognosis is extremely poor. Both Wiberg's and Ogata's CE angle are of prognostic value regarding hip development and should be measured when evaluating AP radiographs of infant's hip.
To investigate the role of the cytolytic action mediated by perforin in the course of rheumatoid arthritis (RA), we studied the immunophenotypic characteristics of lymphocytes containing perforin in ...peripheral blood (systemic level), in synovial fluid (SF), and in the synovial membrane (local level) in patients during the acute or chronic phase of RA. Cells from patients with osteoarthritis were used as controls.
Flow cytometry was used for simultaneous detection of intracellular (perforin) and cell surface antigens. Mean fluorescence intensity (MFI) was a measure of the mean perforin content per cell. Immunocytochemical staining was used to visualize perforin in the cytoplasmic compartment of cells.
In acute RA highly significant changes in perforin expression were found in all compartments (peripheral blood, SF, and synovial membrane): (1) increase of percentage of total perforin positive cells; (2) increase of both subsets of cytolytic cells, T (CD8+P+) and NK (CD56+P+) cells; (3) increase in the frequency of perforin positive cells in CD8+ and CD56+ cell populations; and (4) the highest content of perforin/cell (MFI values) in all compartments, except in the synovial membrane.
Perforin positive cells may participate in the acute phase of RA by maintaining and perpetuating inflammation and contributing to tissue destruction.
Intra-articular calcaneal fracture as a skiing injury in children is extremely rare. We report on what we believe is a unique and previously unreported mechanism of a skiing injury, which caused ...intra-articular calcaneal fracture in a young competing skier, a member of the Croatian national ski team. This 14-year-old boy sustained a heel injury while training for giant slalom. There was no fall on the heel or obvious axial force that could have caused this type of calcaneal fracture. The skier had sophisticated equipment and used carving skies. We speculated that, when the skier tried to establish the lost balance during the fall, a violent contraction of triceps muscle occurred. Instead of an injury of a well-protected tuber or Achilles tendon, the strong pulling force of the Achilles tendon was transmitted more distally and anteriorly, generating axial compression force, which caused an intra-articular fracture of the calcaneus bone. Obviously, the existing ski boot did not sufficiently protect the calcaneus bone. We postulate that the calcaneal tuber and Achilles tendon were protected on the expense of the intra-articular calcaneal fracture. Our case warns of the possibility of a serious foot injury in young top skiers in spite of extensive improvement in the ski equipment. Sophisticated carving skis could be a contributing factor to an injury.
Cilj: Usporedbom kliničkih rezultata dviju skupina bolesnika koji su zbog artroze koljena
operativno liječeni ugradnjom totalne endoproteze koljena (TPK) istražiti utjecaj korištenja
minimalno ...invazivnog, subvastus pristupa sa standardnim, medijalnim parapatelarnim pristupom
na funkcionalni ishod operativnog zahvata. Metode: Tijekom 2012. godine proveli smo
prospektivnu, randomiziranu studiju na 60 bolesnika kojima je bila indicirana ugradnja TPK-a.
Bolesnici su slučajnim odabirom podijeljeni na eksperimentalnu skupinu od 30 bolesnika kod
kojih smo pri ugradnji TPK-a koristili minimalno invazivni subvastus pristup (SV skupina), dok
je kontrolnu skupinu činilo 30 bolesnika kod kojih smo pri ugradnji TPK-a koristili standardni,
medijalni parapatelarni pristup (STD skupina). Ispitivani su vrijeme trajanja operacije, perioperativni
gubitak krvi, Knee Society Score, Up and Go test, vizualno-analogna skala (VAS) bola te
je u frontalnoj i sagitalnoj ravnini mjereno pozicioniranje femoralne i tibijalne komponente
endoproteze. Uspoređivana je i učestalost ranih postoperativnih komplikacija zahvata. Mjerenja
su vršena dan pred zahvat, a potom 12. dana te 12 tjedana po zahvatu. Rezultati: Rani rezultati
usporedbe korištenja subvastus pristupa u odnosu na standardni medijalni parapatelarni
pristup pri ugradnji TPK-a pokazuju bolje rezultate u smislu ranijeg postizanja aktivne
ekstenzije te mogućnosti bolje fleksije koljena kod subvastus pristupa 12. dana te 12 tjedana
po zahvatu. Također je uočeno poboljšanje rezultata Knee Society Scorea i Up and Go testa u
SV skupini. U SV skupini bilo je potrebno učiniti statistički značajno manje lateralnih opuštanja
patele u odnosu na STD skupinu. Nismo našli statistički značajnu razliku između skupina u smislu
postoperativnog bola, trajanja operacije, gubitka krvi te pozicioniranja implantata, niti je
primijećena statistički značajna razlika učestalosti postoperativnih komplikacija (rabljena je razina
značajnosti od 5 %). Zaključak: Korištenje subvastus pristupa predstavlja dobru alternativu
standardnom pristupu pri usporedbi ranih rezultata operativnog liječenja artroze koljena
totalnom endoprotezom.
Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various
methods of treatment have been described for nonunions with infection, bone loss ...or both. One of them is the central bone
grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of
autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating
a tibiofibular synostosis. We present the results of uncontrolled, retrospective and continuous series of ten patients
treated by a central bone grafting technique for infected tibial nonunion with bone loss. Mean follow-up period was 12
(10–15) years. Most injuries were a result of war injuries. Clinically and radiologically confirmed bony healing with total
consolidation of the graft was achieved in all patients within a period of 10–12 months without further bone grafting.
The newly-formed bone mass was able to fulfil the mechanical and functional demands of everyday life activities. Once
again, the central bone grafting technique has shown to be a safe, reliable and effective method of treatment for infected
tibial nonunion with bone defect.
The human meniscus is important for normal knee function and
distributes loads, aids in joint lubrication, congruence, stability,
and proprioception. Repair of appropriate meniscal tears is possible
...and several methods exist to accomplish this. Clinical evidence
suggests that meniscal repairs can result in acceptable healing rates.
Herewith we presen the techniques of "outside-in" whic we use for
menisceal sutturing.
There are many angles measured on hip radiographs, but their prognostic value for hip development in patient with DDH is controversial. Our aim was to find out how the development of congenitally ...luxated hip could be predicted after reduction using Wiberg’s CE angle and CE angle refined according to Ogata. 119 hips of 61 patients were retrospectively evaluated after reduction from 3 months of age until at least full osteomaturity. According to results of CE angles measurements good and poor hip development group were formed. Healthy hips of the patients with unilateral DDH were considered to be the control group. Negative linear trend of the curve connecting Wiberg’s CE angle values measured within first postreductive years is a poor prognostic sign of hip development as are absolute negative values of refined CE angles. In cases where negative initial refined CE angles are combined with negative linear trend of Wiberg’s CE angles prognosis is extremely poor. Both Wiberg’s and Ogata’s CE angle are of prognostic value regarding hip development and should be measured when evaluating AP radiographs of infant’s hip.
