8 research outputs found
Periprosthetic Infections after Total Hip and Knee Arthroplasty ā A Review
Periprosthetic joint infections (PJI) in orthopedic surgery are considered to be very serious and dangerous complications
of total joint arthroplasty. PJI becomes a long-lasting medical problem and a heavy burden on patient and his
family. Patients with such a complication are a signifi cant fi nancial burden for the health care system. Recognizing this
issue, investing in scientifi c research and simultaneously developing technologies in medicine are efforts taken to increase
successfulness in preventing and treating PJI. Each year the number of total joint arthroplasties increases which entails
a rise in the number of complications among which infections are the leading ones. Sometimes, in the worst case scenarios,
infections can endanger patientsā lives. New procedural algorithms and new diagnostic possibilities help us make
accurate and early diagnoses of postoperative PJI with a great degree of certainty. These diagnostic methods include
laboratory tests, imaging, histopathology and microbiological analyses. Treatment options depend on many factors which
include the onset of symptoms, patientsā general physical condition and type of pathogen. The approach to treating PJI is
complex and it requires a multidisciplinary approach in order to ensure the most successful treatment possible. For adequate
and successful treatment we need to take into account antibiotic therapy, one-stage or two-stage revision, Girdlestone
operation, athrodesis and amputation. In this review we will try to sum up all relevant fi ndings and suggest further
steps in management of PJI
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 0Ā°, 10Ā° and 20Ā° 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 0Ā°, 10Ā° and 20Ā° 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 0Ā°. 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
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 canĀ“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 ā125 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 ā125 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
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 0Ā°, 10Ā° and 20Ā° 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 0Ā°, 10Ā° and 20Ā° 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 0Ā°. 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
Osteochondritis Dissecans of the Medial and Lateral Femoral Condyles affecting Adult Knee
We report the first case of osteochondritis dissecans (OCD) affecting a large area of lateral and medial femoral condyles with adult-onset in the same knee of the 22-year old professional athlete with respect to result of applied therapeutic procedure. After a clinical examination, radiograph and magnetic resonance imaging showed a huge bicondylar OCD. Through arthrotomy, the osteochondral fragment was fixed with biodegradable pins combined with two threaded 4 mm cobalt-chrome cancellous screws. By using this surgical fixation procedure, osteochondral fragments healed completely, which is evidenced artroscopically one year after a new trauma episode which resulted in the lateral meniscus reinjury. According to our knowledge this is the first reported case of bicondylar OCD affecting adult knee. In the rare case of such a large osteochondral defect, when fixation with biodegradable pins could be insufficient, a combination with cancellous screws can bring good results, even in professional athletes