COMPUTER REPRESENTATION OF OSTEOSYNTHESIS STABILITY IN LOCKING PLATES USED FOR THE TREATMENT OF OSTEOPOROTIC PROXIMAL HUMERUS FRACTURES

Background: Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age. Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method. Subjects and methods: This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0°, 10° and 20° in four types of static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf ). Results: When examining the Philos plate in axial load on the bone with fracture gap angle from 0°, 10° and 20° no significant differences between the results for the displacements were observed. Therefore, results for other loads are related to total displacements of the bone only at the angle of 0°. Given that the results of the total bone displacement and maximum bone displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and 79.96% for flexion of maximum displacement in the fracture gap in Artrex plate. Conclusions: Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to be more stable than with Arthrex plate

THE RESULTS OF INTERNAL FIXATION OF PROXIMAL HUMERAL OSTEOPOROTIC FRACTURES WITH PHILOS LOCKING PLATE

Background: In the last fifty years since plate and screw osteosynthesis has been implemented in fracture treatment, osteosporotic bone fractures were observed as a special problem. Due to special histologic, anatomic, physical and biomehanic properties of osteoporotic changed bone the laws of biomechanics suggest that stable osteosynthesis for osteoporotic bone is necessary to increase the contact surface of metallic implants and bone and the stability of the screw-plate-bone compound. There are numerous surgical techniques and methods for treatment of osteoporotic proximal humeral fractures. Every surgical procedure has to establish anatomical reduction and stable fixation that will enable early mobilisation. Subjects and methods: The aim of this study was to present results of internal fixation of proximal humeral osteoporotic fractures with PHILOS locking plate. Between 2007 and 2012, a total of 67 patients older than 65 years with closed proximal humerus fractures underwent surgical treatment with PHILOS plate system (Synthes, Switzerland). 42 patients were operated with deltopectoral approach and 25 with deltoid split approach. After a mean follow up period of 14.68 (6-28) months functional and radiologic results were assessed. Results: We noted 9 postoperative complications related to surgical technique (1 intraarticular screw placement, 1 displacement in major tuberculum fragment, 1 displacement in major tuberculum fragment along with oblique placement of the plate, 2 cases of inadequate reduction, 1 case of humeral head avascular necrosis, varus humeral head fixation in 3 cases). None of the patients developed superficial or deep surgical infection. There was no nonunions. In the final evaluation, the Constant shoulder score was 91.75 (72-100). Conclusions: In this study PHILOS locking plate showed good applicability, respecting bone biologic properties because of negligible interference with blood supply of the humeral head. There was no requirement to shape the plate enabling stabilization at constant angles as clear benefit of this plate. All that enables early mobilisation, and no implant insufficiency resulting in satisfactory treatment results and high Constant shoulder scores

USE OF NEW MATERIALS IN THE TREATMENT OF CHRONIC POST-TRAUMATIC WOUNDS

Poslijeoperacijske infekcije uz prisustvo osteosintetskog materijala u tijelu velik su problem za bolesnika i operatera. dosadašnji stav je da se osteosintetski materijal mora odstraniti i tek tada se može očekivati sanacija infekcije. Međutim, uklanjanje osteosintetskog materijala kod nesraslog prijeloma znatno komplicira sanaciju infekcije i prijeloma. indicira se postavljanje vanjskog fiksatora i tek u slučaju saniranja mekotkivnog statusa, može se pristupiti reosteosintezi. pojava terapije negativnim tlakom unijela je nove mogućnosti liječenja ovog tipa infekcija bez potrebe odstranjenja osteosintetskog materijala iz tijela. Svojim direktnim i indirektnim djelovanje terapija negativnim tlakom stvara povoljne uvjete za cijeljenje. Uporaba novih materijala, transformirajućeg pudera (Altrazeal®) i topičkog hemoglobina u spreju (Granulox®), koji lokalno u rani djeluju protektivno i suportivno, osiguravajući i poboljšavajući fiziološke uvjete zarastanja, daje dodatne mogućnosti za adekvatno i sigurno cijeljenje.Postoperative infection and the presence of osteosynthetic material in human body pose a major problem for patients and operators. Previously, it was considered that osteosynthetic material must be removed, and only then the expected full infection recovery could occur. However, removal of osteosynthetic material in unhealed fractures complicates bone fracture healing, as well as infection recovery. Nowadays, it is indicated to place an external bone fixator and in case of soft tissue recovery access to reosteosynthesis. The negative pressure wound therapy has brought new opportunities for treatment of this type of infections without the need of osteosynthetic material removal. Direct and indirect effects of negative pressure wound therapy create optimal healing conditions. Local use of new materials, transforming powder (Altrazeal R) and topical hemoglobin spray (GranuloxR), provide and improve physiological conditions for appropriate and safe healing

USE OF NEW MATERIALS IN THE TREATMENT OF CHRONIC POST-TRAUMATIC WOUNDS

Poslijeoperacijske infekcije uz prisustvo osteosintetskog materijala u tijelu velik su problem za bolesnika i operatera. dosadašnji stav je da se osteosintetski materijal mora odstraniti i tek tada se može očekivati sanacija infekcije. Međutim, uklanjanje osteosintetskog materijala kod nesraslog prijeloma znatno komplicira sanaciju infekcije i prijeloma. indicira se postavljanje vanjskog fiksatora i tek u slučaju saniranja mekotkivnog statusa, može se pristupiti reosteosintezi. pojava terapije negativnim tlakom unijela je nove mogućnosti liječenja ovog tipa infekcija bez potrebe odstranjenja osteosintetskog materijala iz tijela. Svojim direktnim i indirektnim djelovanje terapija negativnim tlakom stvara povoljne uvjete za cijeljenje. Uporaba novih materijala, transformirajućeg pudera (Altrazeal®) i topičkog hemoglobina u spreju (Granulox®), koji lokalno u rani djeluju protektivno i suportivno, osiguravajući i poboljšavajući fiziološke uvjete zarastanja, daje dodatne mogućnosti za adekvatno i sigurno cijeljenje.Postoperative infection and the presence of osteosynthetic material in human body pose a major problem for patients and operators. Previously, it was considered that osteosynthetic material must be removed, and only then the expected full infection recovery could occur. However, removal of osteosynthetic material in unhealed fractures complicates bone fracture healing, as well as infection recovery. Nowadays, it is indicated to place an external bone fixator and in case of soft tissue recovery access to reosteosynthesis. The negative pressure wound therapy has brought new opportunities for treatment of this type of infections without the need of osteosynthetic material removal. Direct and indirect effects of negative pressure wound therapy create optimal healing conditions. Local use of new materials, transforming powder (Altrazeal R) and topical hemoglobin spray (GranuloxR), provide and improve physiological conditions for appropriate and safe healing

Computer representation of osteosynthesis stability in locking plates used for the treatment of osteoporotic proximal humerus fractures

Background: Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age. Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method. Subjects and methods: This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0°, 10° and 20° in four types of static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf ). Results: When examining the Philos plate in axial load on the bone with fracture gap angle from 0°, 10° and 20° no significant differences between the results for the displacements were observed. Therefore, results for other loads are related to total displacements of the bone only at the angle of 0°. Given that the results of the total bone displacement and maximum bone displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and 79.96% for flexion of maximum displacement in the fracture gap in Artrex plate. Conclusions: Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to be more stable than with Arthrex plate

Treatment of Hardware Infection after Osteosynthesis of Lower Leg using Negative Pressure Wound Therapy and Transforming Powder Dressing

Fractures of the distal part of the lower leg are more common in everyday practice and traumatology. In young and active patients these injuries are mainly caused by high energy trauma. They are treated with external fi xator in fi rst step, and in second step, after sanation of the soft tissue, with open reduction and internal fi xation (ORIF). It is very safe and effective method of treatment. Treatment of the infections that occur in the early postoperative period after open reduction and internal fi xation represents a great problem and challenge for surgeons. It is widely accepted that the presence of deep infection can´t be cured in the presence of hardware. However, removal of hardware in the presence of unhealed fractures signifi cantly complicates sanation of infection and fracture itself. We have decided to present a 35-years-old patient with a hardware infection with present chronic wound with hardware exposed eight months after the fi rst operation and six months after second operation. The wound measured one centimeter in diameter with cell detritus and bad granulations tissue inside the wound. Hardwre was exposed in the depth of the wound.The secretion was minimal. Negative Pressure Wound Therapy (NPWT) was applicated after debridemet and lavage performed in ambulatory conditions. The starting therapy was continuously –125 mm Hg of vacuum. After fi ve days of NPWT the defect was partially fi lled with granulation tissue. For another fi ve days we continue with NPWT with the same values of –125 mm Hg pressure but in the intermitent mode. After that period we used transforming powder dressing for covering and protection of the wound with was fi lled with granulation tissue. Five days later, wound was completely healed with epithelisation. After four months of patient follow-up, we found the wound is completely repaired. The patient denies pain and has continued orderly fl ow of fracture healing, with no signs of infection

Results of percutaneous repair of Achilles tendon rupture at Traumatology department of University hospital "Sisters of charity"

Uvod: Ahilova tetiva, najsnažnija tetiva u ljudskom tijelu podložna je ozljedama te u modernim vremenima, kad popularnost rekreativnog bavljenja sportom intenzivno raste, ruptura Ahilove tetive postaje jedan od učestalijih medicinskih problema današnjeg društva. Glavni cilj ovog istraživanja je utvrditi rezultate liječenja rupture Ahilove tetive perkutanom metodom na Klinici za traumatologiju KBC-a „Sestre milosrdnice“ u usporedbi s otvorenom metodom te s rezultatima svjetskih i regionalnih zdravstvenih ustanova. Ispitanici i metode: Provedeno je retrospektivno istraživanje koje je uključivalo ukupno 316 ispitanika koji su podvrgnuti operacijskom liječenju rupture Ahilove tetive u razdoblju od 2013. do 2021. Pretraživanjem arhive iz povijesti bolesti su dobiveni podatci o vrsti operativnog zahvata, mehanizmu ozljede, dobi i spolu ispitanika, vremenu hospitalizacije i o mogućim komplikacijama operacijskog liječenja (infekcije, rerupture, ozljeda suralnog živca). Svi su podatci uneseni u tablicu programa Excel gdje se izvela jednostavna statistička obrada, a za složeniju statističku obradu je korišten program MedCalc za procjenu uspjeha perkutane metode. Istraživanje je u potpunosti provedeno na Klinici za traumatologiju KBC-a „Sestre milosrdnice“. Rezultati: Kao glavne mjere ishoda uzete su komplikacije operativnog liječenja te broj dana hospitalizacije. Utvrđeno je kako nije pronađena statistički značajna razlika u prednostima jedne nad drugom metodom po pitanju ozljede suralnog živca (p=1). Postoji statistički značajna prednost perkutane metode gledajući broj infekcija (χ2=0,8; P=0,005). Medijan dana hospitalizacije za 4 dana je veći kod otvorenog pristupa nego kod perkutanog (Z=14,2;P<0,001). Zbog malenog apsolutnog broja ispitanika s rerupturama kao i premalog omjera ispitanika s rerupturom u odnosu na veličinu promatrane populacije se ne može ustanoviti statistički značajna prednost perkutane metode. Zaključak: Rezultati perkutane metode za liječenje rupture Ahilove tetive na Klinike za traumatologiju KBC-a „Sestre milosrdnice“ su jednaki ili bolji u usporedbi s rezultatima regionalnih i svjetskih zdravstvenih ustanova, a perkutana metoda se preporučuje kao metoda izbora u liječenju zbog manjeg broja komplikacija.Introduction: The Achilles tendon, the strongest tendon in the human body, is prone to injury and in modern times, when the popularity of recreational sports is growing rapidly, Achilles tendon rupture is becoming one of the most common medical problems in modern society. The main goal of this study is to determine the results of treatment of Achilles tendon rupture by percutaneous method at the Traumatology department of University hospital "Sisters of charity" in comparison with the open method and the results of global and regional health institutions. Subjects and Methods: A retrospective study was conducted involving a total of 316 subjects who underwent surgical treatment for Achilles tendon rupture between 2013 and 2021. Data obtained from medical history of these patients included type of surgical procedure, mechanism of injury, age and sex of the subjects, time of hospitalization and possible complications of surgical treatment (infections, reruptures, sural nerve injuries). All data was put into an Excel spreadsheet where simple statistical processing was performed, and for more complex statistical processing, MedCalc was used to assess the success of the percutaneous method. The research was conducted entirely at the Traumatology department of University hospital "Sisters of charity". Results: Complications of surgical treatment and the number of days of hospitalization were taken as the main outcome measures. It was found that no statistically significant difference was found in one surgical procedure over the other in terms of sural nerve injury (p=1). There is a statistically significant advantage of the percutaneous method when looking the number of infections (χ2 = 0.8; P = 0.005). The median of days spent in hospital was 4 days higher in the open approach than in the percutaneous approach (Z = 14.2; P <0.001). Due to the small absolute number of subjects with reruptures as well as the insufficient ratio of subjects with reruptures in relation to the size of the observed population, a statistically significant advantage of the percutaneous method cannot be established. Conclusion: The results of the percutaneous method for the treatment of Achilles tendon rupture at the Traumatology department of University hospital "Sisters of charity" are equal or better compared to the results of regional and global health institutions, and the percutaneous method is recommended as the method of choice due to fewer complications

Results of percutaneous repair of Achilles tendon rupture at Traumatology department of University hospital "Sisters of charity"

Uvod: Ahilova tetiva, najsnažnija tetiva u ljudskom tijelu podložna je ozljedama te u modernim vremenima, kad popularnost rekreativnog bavljenja sportom intenzivno raste, ruptura Ahilove tetive postaje jedan od učestalijih medicinskih problema današnjeg društva. Glavni cilj ovog istraživanja je utvrditi rezultate liječenja rupture Ahilove tetive perkutanom metodom na Klinici za traumatologiju KBC-a „Sestre milosrdnice“ u usporedbi s otvorenom metodom te s rezultatima svjetskih i regionalnih zdravstvenih ustanova. Ispitanici i metode: Provedeno je retrospektivno istraživanje koje je uključivalo ukupno 316 ispitanika koji su podvrgnuti operacijskom liječenju rupture Ahilove tetive u razdoblju od 2013. do 2021. Pretraživanjem arhive iz povijesti bolesti su dobiveni podatci o vrsti operativnog zahvata, mehanizmu ozljede, dobi i spolu ispitanika, vremenu hospitalizacije i o mogućim komplikacijama operacijskog liječenja (infekcije, rerupture, ozljeda suralnog živca). Svi su podatci uneseni u tablicu programa Excel gdje se izvela jednostavna statistička obrada, a za složeniju statističku obradu je korišten program MedCalc za procjenu uspjeha perkutane metode. Istraživanje je u potpunosti provedeno na Klinici za traumatologiju KBC-a „Sestre milosrdnice“. Rezultati: Kao glavne mjere ishoda uzete su komplikacije operativnog liječenja te broj dana hospitalizacije. Utvrđeno je kako nije pronađena statistički značajna razlika u prednostima jedne nad drugom metodom po pitanju ozljede suralnog živca (p=1). Postoji statistički značajna prednost perkutane metode gledajući broj infekcija (χ2=0,8; P=0,005). Medijan dana hospitalizacije za 4 dana je veći kod otvorenog pristupa nego kod perkutanog (Z=14,2;P<0,001). Zbog malenog apsolutnog broja ispitanika s rerupturama kao i premalog omjera ispitanika s rerupturom u odnosu na veličinu promatrane populacije se ne može ustanoviti statistički značajna prednost perkutane metode. Zaključak: Rezultati perkutane metode za liječenje rupture Ahilove tetive na Klinike za traumatologiju KBC-a „Sestre milosrdnice“ su jednaki ili bolji u usporedbi s rezultatima regionalnih i svjetskih zdravstvenih ustanova, a perkutana metoda se preporučuje kao metoda izbora u liječenju zbog manjeg broja komplikacija.Introduction: The Achilles tendon, the strongest tendon in the human body, is prone to injury and in modern times, when the popularity of recreational sports is growing rapidly, Achilles tendon rupture is becoming one of the most common medical problems in modern society. The main goal of this study is to determine the results of treatment of Achilles tendon rupture by percutaneous method at the Traumatology department of University hospital "Sisters of charity" in comparison with the open method and the results of global and regional health institutions. Subjects and Methods: A retrospective study was conducted involving a total of 316 subjects who underwent surgical treatment for Achilles tendon rupture between 2013 and 2021. Data obtained from medical history of these patients included type of surgical procedure, mechanism of injury, age and sex of the subjects, time of hospitalization and possible complications of surgical treatment (infections, reruptures, sural nerve injuries). All data was put into an Excel spreadsheet where simple statistical processing was performed, and for more complex statistical processing, MedCalc was used to assess the success of the percutaneous method. The research was conducted entirely at the Traumatology department of University hospital "Sisters of charity". Results: Complications of surgical treatment and the number of days of hospitalization were taken as the main outcome measures. It was found that no statistically significant difference was found in one surgical procedure over the other in terms of sural nerve injury (p=1). There is a statistically significant advantage of the percutaneous method when looking the number of infections (χ2 = 0.8; P = 0.005). The median of days spent in hospital was 4 days higher in the open approach than in the percutaneous approach (Z = 14.2; P <0.001). Due to the small absolute number of subjects with reruptures as well as the insufficient ratio of subjects with reruptures in relation to the size of the observed population, a statistically significant advantage of the percutaneous method cannot be established. Conclusion: The results of the percutaneous method for the treatment of Achilles tendon rupture at the Traumatology department of University hospital "Sisters of charity" are equal or better compared to the results of regional and global health institutions, and the percutaneous method is recommended as the method of choice due to fewer complications

Results of percutaneous repair of Achilles tendon rupture at Traumatology department of University hospital "Sisters of charity"

Uvod: Ahilova tetiva, najsnažnija tetiva u ljudskom tijelu podložna je ozljedama te u modernim vremenima, kad popularnost rekreativnog bavljenja sportom intenzivno raste, ruptura Ahilove tetive postaje jedan od učestalijih medicinskih problema današnjeg društva. Glavni cilj ovog istraživanja je utvrditi rezultate liječenja rupture Ahilove tetive perkutanom metodom na Klinici za traumatologiju KBC-a „Sestre milosrdnice“ u usporedbi s otvorenom metodom te s rezultatima svjetskih i regionalnih zdravstvenih ustanova. Ispitanici i metode: Provedeno je retrospektivno istraživanje koje je uključivalo ukupno 316 ispitanika koji su podvrgnuti operacijskom liječenju rupture Ahilove tetive u razdoblju od 2013. do 2021. Pretraživanjem arhive iz povijesti bolesti su dobiveni podatci o vrsti operativnog zahvata, mehanizmu ozljede, dobi i spolu ispitanika, vremenu hospitalizacije i o mogućim komplikacijama operacijskog liječenja (infekcije, rerupture, ozljeda suralnog živca). Svi su podatci uneseni u tablicu programa Excel gdje se izvela jednostavna statistička obrada, a za složeniju statističku obradu je korišten program MedCalc za procjenu uspjeha perkutane metode. Istraživanje je u potpunosti provedeno na Klinici za traumatologiju KBC-a „Sestre milosrdnice“. Rezultati: Kao glavne mjere ishoda uzete su komplikacije operativnog liječenja te broj dana hospitalizacije. Utvrđeno je kako nije pronađena statistički značajna razlika u prednostima jedne nad drugom metodom po pitanju ozljede suralnog živca (p=1). Postoji statistički značajna prednost perkutane metode gledajući broj infekcija (χ2=0,8; P=0,005). Medijan dana hospitalizacije za 4 dana je veći kod otvorenog pristupa nego kod perkutanog (Z=14,2;P<0,001). Zbog malenog apsolutnog broja ispitanika s rerupturama kao i premalog omjera ispitanika s rerupturom u odnosu na veličinu promatrane populacije se ne može ustanoviti statistički značajna prednost perkutane metode. Zaključak: Rezultati perkutane metode za liječenje rupture Ahilove tetive na Klinike za traumatologiju KBC-a „Sestre milosrdnice“ su jednaki ili bolji u usporedbi s rezultatima regionalnih i svjetskih zdravstvenih ustanova, a perkutana metoda se preporučuje kao metoda izbora u liječenju zbog manjeg broja komplikacija.Introduction: The Achilles tendon, the strongest tendon in the human body, is prone to injury and in modern times, when the popularity of recreational sports is growing rapidly, Achilles tendon rupture is becoming one of the most common medical problems in modern society. The main goal of this study is to determine the results of treatment of Achilles tendon rupture by percutaneous method at the Traumatology department of University hospital "Sisters of charity" in comparison with the open method and the results of global and regional health institutions. Subjects and Methods: A retrospective study was conducted involving a total of 316 subjects who underwent surgical treatment for Achilles tendon rupture between 2013 and 2021. Data obtained from medical history of these patients included type of surgical procedure, mechanism of injury, age and sex of the subjects, time of hospitalization and possible complications of surgical treatment (infections, reruptures, sural nerve injuries). All data was put into an Excel spreadsheet where simple statistical processing was performed, and for more complex statistical processing, MedCalc was used to assess the success of the percutaneous method. The research was conducted entirely at the Traumatology department of University hospital "Sisters of charity". Results: Complications of surgical treatment and the number of days of hospitalization were taken as the main outcome measures. It was found that no statistically significant difference was found in one surgical procedure over the other in terms of sural nerve injury (p=1). There is a statistically significant advantage of the percutaneous method when looking the number of infections (χ2 = 0.8; P = 0.005). The median of days spent in hospital was 4 days higher in the open approach than in the percutaneous approach (Z = 14.2; P <0.001). Due to the small absolute number of subjects with reruptures as well as the insufficient ratio of subjects with reruptures in relation to the size of the observed population, a statistically significant advantage of the percutaneous method cannot be established. Conclusion: The results of the percutaneous method for the treatment of Achilles tendon rupture at the Traumatology department of University hospital "Sisters of charity" are equal or better compared to the results of regional and global health institutions, and the percutaneous method is recommended as the method of choice due to fewer complications