Mehanička svojstva ortopedskih gipseva

Gipsani zavoji često se koriste za imobilizaciju ortopedskih ozljeda. Prilikom njihovog namakanja u vodi dolazi do egzotermne reakcije, a oslobođena toplina može dovesti do nastanka opekotina na koži. Nakon omatanja zavoja i namakanja vodom nastaje slojeviti kompozit kojemu je matrica medicinski gips, a ojačalo pamučna mrežasta gaza. U ovom radu ispitan je utjecaj temperature sadrenja i debljine na mehanička svojstva gipsanih zavoja od triju različitih proizvođača. Zavoji od 10 i 15 slojeva su načinjeni pri različitim temperaturama sadrenja. Trotočkastim ispitivanjem određena su mehanička svojstva pri savojnom opterećenju. Praćena je promjena temperature sadrenja tijekom očvršćivanja gipsanog zavoja

RESULTS OF TREATMENT OF DISPLACED SUPRACONDYLAR FRACTURES IN CHILDREN

Prijelomi humerusa u suprakondilarnom području najučestaliji su prijelomi lakta u dječjoj dobi. To su većinom nestabilani prijelomi, teški za repoziciju i retenciju ulomaka, a postupak njihova liječenja nije posve usuglašen. U radu se analiziraju kasni rezultati liječenja 48-ero djece s prijelomima humerusa u suprakondilarnom dijelu s pomakom ulomaka. Repozicijom zatvorenim načinom, fiksacijom s dvije ukriženo postavljene Kirschnerove žice i nadlaktičnom imobilizacijom liječeno je 40-ero, a osmero je djece liječeno samo nadlaktičnom imobilizacijom. Otvorena repozicija ulomaka bila je učinjena u troje djece. Za procjenu uspješnosti liječenja mjerene su kutne deformacije i usporedne razlike gibljivosti zdravog i liječenog lakta. Prema Flynnovu kriteriju 93,7% liječene djece ima vrlo dobre i odlične rezultate liječenja. Najučestalija je komplikacija varus angulacija (16,7%). Kasni rezultati liječenja u naše djece i rezultati autora sa sličnim serijama djece potvrđuju stav da je zatvorena repozicija i perkutana stabilizacija Kirschnerovim žicama metoda izbora u liječenju suprakondilarnih prijeloma humerusa s pomakom ulomaka.Supracondylar fractures of humerus are the most common fractures in children. The management of severely displaced, unstable fractures of the humerus in children continues to be controversial. We undertook a retrospective study of 48 children with displaced supracondylar fractures (8 were treated with plaster and 40 with cross percutaneous Kirschner wire pinning). Only three children were treated with open reduction and percutaneous cross-pin fixation. Clinical outcome was evaluated by loss of elbow motion and change of carrying angle. According to Flynn s criteria, results were good or excellent in 93.7% patients. The cubitus varus is the most frequent long-term complication (16.7%). Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing displaced supracondylar fractures

Prijelomi nadlaktične kosti u djece – okolnosti i uzroci nastanka [Fracture of the humerus in children – causes and mechanisms of injury]

Due to hyperactivity, children are often exposed to injuries of the upper arm and fractures of the humerus can leave permanent damage even after the surgical treatment. The high incidence of fractures justifi es questioning the possible prevention of this injury. Preventive actions are possible only with the knowledge of the causes and circumstances of the fracture. Aim is to analyze the circumstances of the injury, critical places and activities engaged in at the time of the humeral fracture by age groups. The paper analyzed 102 children that were treated at the University Hospital Centre in Zagreb due to fractures of the humerus in the period from 2010 to 2014. In this study, we analyzed 45 girls (44%) and 57 boys (56%). The average age of children was 8.3 years. Fractures of the distal third of the humerus accounted for 4/5 of all analyzed fractures. The right hand was affected more frequently. Nearly 80% of fractures were unstable, which generally require surgical treatment. The injury occurred most often among the 5-9 year-olds. Most injuries took place at the recreational facilities (47%), followed by injuries at home (31%), on streets or roads (15%) and at school or kindergarten (7%). Mechanism of the injury was mainly a fall onto the arm (94%) and the rest of the injuries were due to a direct blow. Almost half of the children got injured in sports or recreational activities. Due to close physical contact and engagement in games, children in preschool and early school age are by far the most susceptible to injuries. To reduce the incidence of such injuries, preventive actions should be taken during daily activities under the supervision of parents towards the most vulnerable age group (5-9 years), along with increasing the supervision in preschools and schools. Of all the activities, the most dangerous to cause fractures of the humerus occur in sports grounds and recreational facilities of preschool children and children in the lower grades of elementary school

FRACTURE OF THE HUMERUS IN CHILDREN – CAUSES AND MECHANISMS OF INJURY

Zbog hiperaktivnosti djeca su često izložena ozljedama nadlaktice, a prijelomi nadlaktične kosti i nakon operativnog liječenja mogu ostaviti trajne posljedice. Visoka pojavnost prijeloma opravdava propitivanje o mogućoj prevenciji nastanka. Preventivna postupanja moguća su jedino uz poznavanje uzroka i okolnosti nastanka prijeloma. Cilj je ovog rada analizirati okolnosti nastanka, kritična mjesta i aktivnosti djece pri prijelomu nadlaktične kosti prema dobnim skupinama. U radu je analizirano 102-je djece liječene u KBC-u Zagreb zbog prijeloma nadlaktične kosti, u periodu od 2010. do 2014. U studiji je analizirano 45 djevojčica (44%) i 57 dječaka (56%). Prosječna dob djece iznosila je 8,3 godine. Prijelomi ­distalne trećine nadlaktične kosti čine 4/5 svih analiziranih prijeloma. Nešto je češće bila zahvaćena desna ruka. Gotovo 80% prijeloma bilo je nestabilno i oni su redovito nalagali operacijsko liječenje. Najviše ozlijeđenih bilo je u dobi od 5 do 9 godina. Najčešće su se ozljede događale na rekreacijskome mjestu (47%), zatim kod kuće (31%), na ulici ili cesti (15%) te u školi ili vrtiću (7%). Način nastanka ozljede uglavnom je pad na ruku (94%), a ostatak ozljeda posljedica je izravnog udarca. Gotovo polovina djece ozlijedila se u sportskim ili rekreacijskim aktivnostima. Daleko najčešće stradaju djeca u predškolskoj i ranoj školskoj dobi u igri i kontaktu s drugom djecom slične dobi. Kako bi se smanjila učestalost ovakvih ozljeda, preventivne aktivnosti treba usmjeriti prema najugroženijoj dobnoj skupini (5 – 9 godina) kod dnevnih aktivnosti pod nadzorom roditelja, ali i povećati nadzor u predškolskim i školskim ustanovama. Od svih aktivnosti najopasniji za nastanak prijeloma nadlaktične kosti jesu sportska igrališta i mjesta rekreativnih aktivnosti predškolske djece i djece u nižim razredima osnovne škole.Due to hyperactivity, children are often exposed to injuries of the upper arm and fractures of the humerus can leave permanent damage even after the surgical treatment. The high incidence of fractures justifies questioning the possible prevention of this injury. Preventive actions are possible only with the knowledge of the causes and circumstances of the fracture. Aim is to analyze the circumstances of the injury, critical places and activities engaged in at the time of the ­humeral fracture by age groups. The paper analyzed 102 children that were treated at the University Hospital Centre in Zagreb due to fractures of the humerus in the period from 2010 to 2014. In this study, we analyzed 45 girls (44%) and 57 boys (56%). The average age of children was 8.3 years. Fractures of the distal third of the humerus accounted for 4/5 of all analyzed ­fractures. The right hand was affected more frequently. Nearly 80% of fractures were unstable, which generally require ­surgical treatment. The injury occurred most often among the 5-9 year-olds. Most injuries took place at the recreational facilities (47%), followed by injuries at home (31%), on streets or roads (15%) and at school or kindergarten (7%). Mechanism of the injury was mainly a fall onto the arm (94%) and the rest of the injuries were due to a direct blow. Almost half of the children got injured in sports or recreational activities. Due to close physical contact and engagement in games, children in preschool and early school age are by far the most susceptible to injuries. To reduce the incidence of such injuries, preventive actions should be taken during daily activities under the supervision of parents towards the most vulnerable age group (5-9 years), along with increasing the supervision in preschools and schools. Of all the activities, the most ­dangerous to cause fractures of the humerus occur in sports grounds and recreational facilities of preschool children and children in the lower grades of elementary school

Prijelomi kostiju šake u djece – okolnosti i uzroci nastanka [Hand fractures in children - causes and mechanisms of injury]

Hand is extremely exposed to various loads and traumas of everyday tasks and activities, resulting in fist fractures being fairly common injuries. The most common mechanism of injury is a direct blow. This retrospective study analyzed the data on 274 children admitted for hand fractures at Clinical Hospital Center Zagreb in the period from 2006 to 2014. The study included 76 girls (28%) and 198 boys (72%). The average patient age was 11.9 years and most were between 10 and 13 years of age. Phalangeal fractures accounted for 80%, metacarpal fractures for 17%, and carpal fractures for 3% of all injuries. Most commonly injuries occurred during recreation (4 1%), at home (37%), at school (18%) and in the street (4%). Direct blow was the major cause of injury (76%), and 24% were caused by fall. Injuries during sport activities are the most common cause of the hand fractures in pediatric population and direct blow is the main mechanism of injury. The peak incidence is at the age of 10-13 years in boys and girls, so prevention should be aimed at this age group. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities

TESTICULAR CAPILLARY HEMANGIOMA, REPORT A TWELVE YEAR PATIENT

Kapilarni hemangiom testisa iznimno je rijedak tumor. Prikazujemo slučaj testikularnog hemangioma u namjeri da skrenemo pozornost na rijetke benigne neoplazme i poštednu kirurgiju testisa zahvaćenog tumorom. Bolesnik je dvanaestogodišnji dječak, koji se prezentirao vodenom kilom i palpabilnim tumorom lijevog testisa. Ultrazvuk skrotuma i testisa pokazuje varikokelu II. stupnja, manji izljev u lijevom skrotumu te hipoehogenu zonu lijevog testisa veličine 5 mm u promjeru. Razina tumorskih markera u serumu (alfa-fetoproteina i beta-korionskoga gonadotropina) bila je u granicama referentnih vrijednosti. Intraoperativno je načinjena biopsija, a brza histološka analiza (na smrznutom preparatu) pokazuje kapilarni hemangiom. Potom je tumor potpuno odstranjen, a testis sačuvan. Klinički, ultrazvučnim nalazom i nalazom magnetske rezonancije hemangiomi se ne razlikuju od malignih solidnih tumora testisa. Intraoperacijska brza patohistološka dijagnoza određuje opsežnost kirurškog zahvata. Enukleacija hemangioma u zdravo tkivo testisa siguran je i opravdan kirurški zahvat.Capillary hemangiomas of the testis are extremly rare tumors. We reported a case of intratesticular hemangioma, unusually localisation of this vascular benign neoplasm. The patient was 12 year old boy, with hydrocele and a palpabile testicular mass. Scrotal sonography revealed varicocele and hydrocele in the left scrotal sac. There was a solid hypoechogenic zone 5 mm in diameter in the left testis. Tumor markers like serum level of b human chorionic gonadotropin and a fetoprotein were normal. The patient underwent surgery, and intraoperativ frozen section showed a capillary hemangioma. The lesion was completly removed, but testis was preserved. Accordingly tu the literature, tumors of vascular origin are extremly rare. Capillary hemangiomas of the testis are similarity to malignant testicular solid tumors during physical examination, ultrasound examination and MR imaging. Before operation, it’s hardly differentiate tumors of testis, but intraoperativ frozen section cuold be helpfull to differentiate a hemangioma from other testicular mass. Hemangioma is benign, but lesion must be complete removed to avoid recurence. In cases capillarx hemangimas, tumor enucleation with preservation tissue of the testis is possible if intraoperative frozen section examination can be performed

TREATMENT OF EMPYEMA THORACIS IN CHILDREN

Empijem prsišta nakupljanje je infektivne tekućine u pleuralnom prostoru, a najčešće nastane kao komplikacija bakterijske pneumonije u djece. Bolest ima ubrzan tijek i često već nakon nekoliko dana unatoč antibiotskom liječenju ulazi u stadij kada je nužno kirurško liječenje. Nema općeprihvaćenog stajališta kada i koju od kirurških metoda treba primijeniti. Te razlike u liječenju empijema prsišta osobito su izražene u djece. Unatoč razlikama u procjeni faze bolesti i optimalne metode liječenja krajnji su ishodi uglavnom dobri. U radu se analiziraju literaturna zapažanja o učinkovitosti različitih metoda te se opisuju postupci liječenja djece s empijemom prsišta. Opisan je postupak torakoskopske i otvorene operacije prsišta u djece. Iznesena su vlastita zapažanja i iskustva u liječenju empijema prsišta.Empyema, an accumulation of infected fluid in the thoracic cavity, is commonly secondary to bacterial pneumonia in children. Despite the high prevalence and availability of many medical treatment options, there is no general consensus on the optimal management approach, which would lead to full and rapid recovery. Especially, there are the big differences in treatment options for the child with empyema. Regardless of the differences in the procedures, the ultimate outcomes are good. This article reviews the current literature and discusses the important considerations in managing these patients. This paper describes thoracoscopic and open thoracic surgery procedures in children. The authors present their own observations based on years of experience in the treatment of thoracic empyema

EXOTHERMIC REACTIONS OF PLASTER IMMOBILIZATION – ANALYSIS OF THREE KINDS OF PLASTER BANDAGES

Egzotermna reakcija sadre iznimno je važno svojstvo koje treba poznavati s obzirom na komplikacije što mogu nastati zbog povišenja temperature u tijeku sadrenja. Razvoj komplikacija izravno utječe na tijek, duljinu i kvalitetu liječenja. U ovom radu bilježe se temperature površine sadrenih pripravaka veličine 10 × 10 cm, brzovežućim sadrenim zavojem širine 10 cm, triju različitih proizvođača: Safix plus (Hartmann, Njemačka), Cellona (Lohmann & Rauscher, Austrija) i Gipsan (Ivo Lola Ribar d. o. o., Hrvatska). Priređene su tri debljine sadrenih pločica (10, 15 i 30 slojeva). Sadrenje je načinjeno u vodi temperature 22 i 34 °C. Unatoč sličnom obrascu ponašanja svih triju sadrenih zavoja izmjerene su razlike. Sve tri vrste sadrenih zavoja koji se rabe u Hrvatskoj u standardnim uvjetima sadrenja imaju nisku razinu egzotermne reakcije, a prosječne su površne temperature niske te nema potencijalne opasnosti od opeklinskih ozljeda. Ako se sadrenje obavljalo u vodi temperature 34 °C, najviše srednje temperature zabilježene su na pločicama (u 15 slojeva) sadrenog zavoja Gipsan (46,2 °C), zatim Cellone (41,3 °C) i Safixa plus (38,9 °C). Pri istoj temperaturi vode sadrenja najviša srednja temperatura izmjerena je na površini pločice (30 slojeva) sadrenog zavoja Gipsan (48,4 °C), zatim Cellone (45,4 °C), a najniža kod pločica sadrenog zavoja Safix plus (41,7 °C). Kada se rabe u debljini od 15 do 30 slojeva, a sadre se vodom temperature 34 °C, sadrene pločice svih proizvođača razvijaju srednje temperature više od 40 °C, u trajanju od 8 do 12 minuta. Od ispitivanih sadrenih zavoja Gipsan (Ivo Lola Ribar d. o. o., Hrvatska) razvijao je najviše temperature, a neke pločice bile su ugrijane na 50 °C. Razine egzotermnih reakcija ispitivanih sadrenih zavoja međusobno se razlikuju prema svim ispitivanim uvjetima, posebice pri sadrenju vodom temperature 34 °C.Exothermic reaction of plaster is a very important characteristic to understand, especially when it comes to complications which can occur during local temperature change during molding plaster of Paris. And these complications directly influence the speed and quality of treatment. In this paper we measured temperatures of plaster bandage tiles 10×10 cm, from three different manufacturers in Croatian hospitals: Safix plus (Hartmann, Germany), Cellona (Lohmann &Rauscher, Austria) and Gipsan ( Ivo Lola Ribar, Croatia). We made three different plaster tiles 10×10 cm, from 10, 15 and 30 layers of plaster bandages. We immersed plaster tiles in two different water temperatures, one group in water 22 °C, and another in 34 °C. Although all plaster bandages have similar chemical characteristics, we have measured some differences. All three kinds of plaster bandages used in Croatia have low exothermic reaction when plaster molding is done in standard conditions, average local temperature is low and there is no danger of local burns. We immersed a plaster tile with 15 layers in water on 34° C, and highest average temperature was measured at Gipsan (46.2 °C), then Cellona (41.3 °C) and Safix plus (38.9 °C). On the same water immersion temperature, on plaster tile with 30 layers average temperatures were Gipsan (48.4°C), Cellona (45.4 °C), and lowest in Safix plus (41.3 °C). Plaster tiles form all manufacturers, when used 15-30 layers thick, and water immersion temperature is 34°C, develop average temperature over 40°C, in duration from 8-12 minutes. Between three different plaster bandages analyzed, Gipsan (Ivo Lola Ribar, Croatia) developed highest temperature, and some plaster tiles were measured over 50 °C

Fizikalna svojstva sadrenih zavoja [Physical properties of plaster bandages]

The physical properties of plaster bandages are a very important factor in achieving the basic functions of immobilization (maintaining bone fragments in the best possible position), which directly affects the speed and quality of fracture healing. This paper compares the differences between the physical properties of plaster bandages (mass, specific weight, drying rate, elasticity and strength) and records the differences in plaster modeling of fast bonding 10 cm wide plaster bandages, from three different manufacturers: Safix plus (Hartmann, Germany), Cellona (Lohman Rauscher, Austria) and Gipsan (Ivo Lola Ribar ltd., Croatia). Plaster tiles from ten layers of plaster, dimension 10 x 10 cm were made. The total number of tiles from each manufacturer was 48. The water temperature of 22 °C was used for the first 24 tiles and 34 'C was used for the remainder. The average specific weight of the original packaging was: Cellona (0.52 g/cm3), Gipsan (0.50 g/cm3), Safix plus (0.38 g/cm3). Three days after plaster tile modeling an average specific weight of the tiles was: Gipsan (1.15 g/cm3), Safix plus (1.00 g/cm3), Cellona (1.10 g/cm3). The average humidity of 50% for Safix plus and Cellona plaster tiles was recorded 18 hours after modeling, while for the Gipsan plaster tiles, this humidity value was seen after 48 hours. On the third day after plaster modeling the average humidity of the plaster tiles was 30% for Gipsan, 24% for Safix and 16% for Cellona. Cellona plaster tiles made with 34 °C water achieved the highest elasticity (11.75±3.18 MPa), and Gipsan plaster tiles made with 22 °C had the lowest (7.21±0.9 MPa). Cellona plaster tiles made with 34 °C water showed maximum material strength (4390±838 MPa), and Gipsan plaster tiles made with 22 °C water showed the lowest material strength (771±367 MPa). The rigidity and strength of Cellona and Gipsan plaster are higher in tiles made in warmer water, and for Safix plus are higher in tiles made in cooler water. All three types of plaster differentiate in physical properties. The differences in mass and specific weight before and after plaster modeling are minimal. There are greater differences in drying rate, elasticity and strength between the three different plaster materials