EXPERIENCIES WITH CHILD FOREARM FRACTURES IN GENERAL HOSPITAL PULA

To compare surgical and conservative treatment in proximal and distal forearm child fractures. The study compared 84 patients, aged 2-14 years, who were admitted to the hospital because of with forearm fracture. Criteria for the inclusion in the study were forearm fractures of 3/4 forearm bone. Children with proximal forearm fractures (N=45) were treated: conservative, manual reposition and immobilisation, primary operated within the first 24 hours n=16, secundary within the first 12 days n=11 after the fracture) and with distal forearm fractures (N= 39, conservative n=14, primary operated n=18 , secundary operated n=7). All patients with proximal and 31 patients with distal forearm fractures were treated with physiotherapy. We recorded immobilisation time, duration of physiotherapy and complete therapy. Functional improvement or deficite was assessed according «neutral-0-test«, degree of elbow, wrist movement and rotation of forearm. There were significant differences between primary and conservative treatment for proximal forearm fractures in duration of immobilisation (median 20 days, range18-24, vs median 49 days, range 30-58, respectively, p<0.05), all therapy (median 28 days, range 22-35, median 74 days range 63-81, respectively, p<0.05). The primary surgical group also had shorter physiotherapy. After primary surgical treatment we had lower functional deficit than in the conservative treatment (elbow index of movement median 1.04 , range 0.54-1.23 (median 3.42 range 2.98-3.64, p<0.05) and rotation index of forearm median 8.30 range 7.88-8.52 median (12.75 range 12.52-12.90). In distal forearm fractures there were significant differences between primary and secundary surgical treatment in immobilisation times (median 23 range 18-25 vs median 37 range 21-47, P<0.05), all therapy and physiotherapy (p<0.05). We had lower functional deficit after primary surgical treatment (wrist index movement median 2.87 range 2.01-3.28, 4.15 range 3.55-4.45, respectively p<0.005 and rotatio index median 1.84 range 1.56-2.00 median 2.95 range 2.56-3.24). Proximal forearm fractures caused bigger functional deficit than in a distal forearm. Primary surgery treatment can be recommended in proximal forearm fractures because after rehabilitation we had minimal functional deficit

TRANSPENDICULAR FIXATOR INFORCED WITH SHORT HOOKS IN THE TREATMENT OF INSTABILE SPINAL VERTEBRAL FRACTURES

Objectives. Clinical trial to compare HR-P with anterior fixation technique in neurological outcome and preoperative parameters in the emergency treatment of unstable burst thoracolumbar fracture. Patients and methods. Twenty nine patients with burst fracture underwent either anterior neurodecompression and fixation (n=13) or posterior reposition and fixation with HR-P (n=16) depending on the type of implants available at the time of operation. Neurologically injured patients were operated within the first 8 hours and neurologically intact patients within the first 2 days after fracture. Neurological improvement was assessed according to the Frankel scale and the Prolo economic/ function outcome scale. We recorded operation time, blood loss, hospital stay and cost, complication and donor site pain. Results. There were no significant differences between the groups in either neurological improvement (p=0.789), economic and functional outcome (p=0.294, p=0.163), operative time was shorter in the HR-P posterior approach group than in the anterior group (median 172 min, range 145-220, vs. Median 255 min, range 200-295, p<0.001). Blood loss, hospital cost and complication rate was significantly lower in the posterior fixation group (p<0.001). Conclusion. Both surgical techniques were equally effective in neurological improvement. HR-P can be recommended in emergency neurodecompression and fixation of unstable lumbar and thoracolumbar fractures because of the shorter operation time and smaller blood loss